Toshinobu Hirotomi

Longitudinal study on the relationship between serum albumin and periodontal disease

AIM The purpose of this study was to evaluate the relationship between periodontal disease and the general health status in community-dwelling elderly using the serum albumin concentration as a criterion index of the severity of underlying disease and nutrition. MATERIAL AND METHODS Six hundred subjects aged 70 years underwent a baseline examination. Dental examinations were carried out at baseline and once a year for 4 years. Periodontal conditions were estimated for subjects with at least one remaining tooth. Clinical attachment levels at six sites of all teeth present were measured. A change in loss of attachment of 3 mm or greater in 1 year at each site was defined as periodontal disease progression. Data were analysed in subjects for whom data were available for 4 years. RESULTS Serum albumin concentration at baseline ranged from 3.4 to 5.0 g/dl with a mean of 4.3+/-0.2. When the analysis was stratified by smoking status, we found that serum albumin concentration had a significant effect on periodontal disease progression among non-smokers (standardized regression coefficient=-0.16; p=0.017), using multiple regression analysis. CONCLUSIONS The findings of the present study suggest that serum albumin concentration is a significant risk predictor of periodontal disease progression among elderly non-smokers.

Association between serum calcium and periodontal disease progression in non‐institutionalized elderly

OBJECTIVE To assess the effect of baseline serum calcium on the progression of periodontal disease in non-institutionalized elderly. BACKGROUND Although a few studies have found some evidence of the role played by dietary calcium in periodontal disease process, there is a paucity of information pertinent to longitudinal assessment of serum calcium-periodontal relationships. MATERIAL AND METHODS Clinical attachment levels of 266 Japanese subjects aged 70 years were recorded at baseline and annually for six consecutive years. Progression of periodontal disease (PPD) was defined as the number of teeth that showed additional attachment loss of > or =3 mm during the 6 years. The number of PPD was calculated for each subject and categorised into four levels, namely, PPD(0), PPD(1), PPD(2) and PPD(3) where the number of teeth with additional attachment loss ranged from 0, 1-10, 11-20 and >20 respectively. The levels of serum calcium, albumin, random blood sugar, immunoglobulin (IgG, IgA and IgM), gender, smoking habits, education, gingival bleeding and the number of teeth present were obtained at baseline. RESULTS Serum calcium, IgA, smoking, gingival bleeding and teeth present were associated with PPD at p < or = 0.10 and were included in a multinomial logistic regression analysis. Serum calcium was the only variable that was significantly associated with PPD with relative risks of 100 at PPD(1) and PPD(2), respectively, and 1000 at PPD(3). CONCLUSION Serum calcium may be considered a risk factor for periodontal disease progression in non-institutionalized elderly.

Tooth‐related risk factors for periodontal disease in community‐dwelling elderly people

OBJECTIVE While most previous epidemiological studies have focused on subject-level risk factors for periodontal destruction, tooth-related factors have not been fully explored. The purpose of this study was to evaluate both tooth-related and subject-related factors affecting periodontal disease progression using a two-level multilevel model. MATERIAL AND METHODS A longitudinal survey over a period of 10 years was carried out on 286 community-dwelling elderly subjects aged 70 years at baseline. Clinical attachment level (CAL) was measured at six sites per tooth on all teeth present and periodontal disease progression was defined as CAL> or =3 mm. RESULTS Periodontal disease progression was found in 79% of the subjects and most frequently in maxillary molars. Multilevel logistic regressions revealed that subjects wearing removable dentures were significantly at risk for periodontal disease progression. Abutment teeth for removable/fixed dentures were also significantly more likely to suffer periodontal breakdown. Furthermore, the following tooth-related variables were found to be possible risk factors for periodontal disease progression: maxillary and multirooted teeth. CONCLUSION Multirooted teeth and abutments for a fixed denture were possible risk factors for periodontal disease progression.

The Relationship Between Serum Lipids and Periodontitis in Elderly Non-Smokers

BACKGROUND There are common risk factors for periodontal disease and cardiovascular disease in elderly patients. Some studies reported that a low total cholesterol (TC) serum level is associated with a higher level of death in the elderly. The purpose of this study was to investigate the relationship between serum lipids and periodontal disease in non-smoking elderly patients. METHODS Two hundred thirty-four non-smokers (63 males and 171 females) participated in this study. Multiple regression analysis was performed to evaluate the relationship between serum lipids and periodontitis and between serum lipids and inflammatory factors. The percentage of sites with probing depth (PD) > or =4 mm, clinical attachment level (CAL) > or =4 mm, and bleeding on probing (BOP) were used as dependent variables. TC, high-density lipoprotein cholesterol (HDL-C), gender, and the number of teeth present were included in the model as independent variables in the first analysis. TC, HDL-C, and low-density lipoprotein cholesterol (LDL-C) were used as dependent variables. Albumin, inorganic phosphorus, calcium, and C-reactive protein were used as independent variables in the second analysis. RESULTS According to the results of the multiple linear regression analysis, TC was associated with the percentage of sites with PD > or =4 mm (P <0.01; beta = -0.19), CAL > or =4 mm (P <0.01; beta = -0.20), and BOP (P = 0.03; beta = -0.16). HDL-C and LDL-C have a significant association with inflammatory markers and inorganic phosphorus and calcium, respectively. CONCLUSION Higher TC is associated with a lower prevalence of periodontitis in non-smoking elderly patients.

Number of teeth and 5-year mortality in an elderly population

OBJECTIVES Several epidemiological studies have shown the association between tooth loss and mortality. However, the impact of number of teeth on mortality has not yet been fully addressed in an elderly population with many teeth. Thus, the purpose of this cohort study was to assess the possible role of number of teeth as a predictor of mortality in the elderly. METHODS The subjects included in this study were generated from a cohort study started in 1998. Oral examinations and the completion of a questionnaire were carried out. A total of 600 subjects aged 70 years were enrolled at baseline. All the subjects were in good general health and did not require any special care for their daily activities. The 5-year mortality data were collected after the baseline survey. After excluding those with incomplete data, 569 subjects were analyzed. The Kaplan-Meier method was used to analyze survival curves and a Cox regression model to clarify the impact of the number of remaining teeth on the 5-year mortality. RESULTS During the follow-up period, 25 (4.4%) subjects died. Subjects with 20 teeth or more had a significantly lower mortality rate (2.5%) than those with 19 teeth or fewer (6.1%, log-rank test, P = 0.036). Even after adjusting for confounders including gender, BMI, serum albumin level, current smoking status, education, number of family members living together and a history of chronic diseases, the risk of all-cause mortality was significantly associated with the number of remaining teeth (P = 0.047) with a hazard ratio of 0.96, indicating that there was a 4% point increase in the 5-year survival rate per additional tooth retained at the age of 70. CONCLUSION The findings of this study suggest that retaining more teeth might be a useful indicator for longevity of older people.

Tooth-related risk factors for tooth loss in community-dwelling elderly people.

OBJECTIVE To appropriately explore risk factors for tooth loss operating at the tooth-level, subject-related factors and a hierarchical data structure have to be considered. The purpose of this study was to evaluate tooth-related and subject-related risk factors affecting tooth loss. METHODS A 10-year longitudinal survey was carried out on 286 elderly subjects. At baseline, the prosthodontic status and abutment function of the 5574 teeth were recorded. Tooth loss was defined as the main outcome variable, and a multilevel logistic regression model considering subject and tooth levels was applied. RESULTS Tooth loss was found in 75% of subjects and most frequently in molars. A multivariable, multilevel logistic regression revealed that the following tooth-related variables were significantly related to tooth loss over 10 years: maxillary teeth, multirooted teeth, single crowns, abutment teeth for a fixed/removable partial denture (FPD/RPD), and periodontally involved teeth. Among them, single crowns, abutment teeth for an FPD, and teeth with severe periodontal disease at baseline had the highest odds of 5.1, 6.0, and 7.1, respectively. CONCLUSIONS The findings of this study suggest that tooth loss is the result of complex interactions of tooth-related factors. Several tooth-related variables including multirooted teeth, abutments, and single crowns were found to be possible risk factors for tooth loss. Thus, these findings confirm and underline the potential benefit of minimizing prosthetic treatment of molars.

Longitudinal relationship between root caries and serum albumin.

Serum albumin levels are a practical marker of general health status in the elderly and have been used to determine the severity of an underlying disease and the risk for death. This longitudinal study evaluated the relationship between serum albumin levels and root caries. A total of 266 persons with at least 1 tooth at baseline underwent a baseline examination and then annual investigations for 6 years. Multiple linear regression analysis was used to assess the relationship between changes in serum albumin levels and the number of root caries lesions over 6 years, after adjustment for confounding factors. Change in the number of root caries lesions was significantly associated with change in serum albumin concentrations. The standardized coefficient was −0.148 (p = 0.024). We can confirm that serum albumin concentration correlates with root caries events. From these data, we conclude that persons with hypoalbuminemia are at high risk for root caries.

Salivary spinability and periodontal disease progression in an elderly population

OBJECTIVE To explore the relationship between the spinability of stimulated whole saliva and periodontal disease progression over 12 months in an elderly population. METHODS Three hundred and thirty-two subjects aged 76 years at baseline were studied. Attachment loss was calculated on a site-by-site basis, and periodontal disease progression was defined as an attachment loss of >or=3mm. Stimulated whole saliva was collected and salivary spinability (SS) was measured. A multiple linear regression analysis was performed to assess the relationship between periodontal disease progression and SS after controlling for other covariates. The independent variables were selected from those which had significant relationships with disease progression in the bivariate analyses. RESULTS Mean SS was 1.94+/-0.42 mm in males and 1.88+/-0.32 mm in females; this difference was not significant. Simple linear regression analysis showed a significant positive relationship between periodontal disease progression and SS (P=0.026), whereas there was no significant relationship between periodontal disease progression and salivary flow rate. Multiple regression analysis revealed a significant positive relationship between periodontal disease progression and SS (P=0.024) after controlling for the number of remaining teeth and baseline periodontal conditions. The model explained 15.5% of the variance in the percentage of sites where the disease had progressed. CONCLUSIONS These findings suggest that elderly subjects with viscous saliva are prone to periodontal disease progression.

Comparison of periodontal conditions among three elderly populations in Japan and Germany.

AIM There is a growing interest in comparing periodontal conditions between countries. This study compared periodontal disease conditions in three elderly populations- one from Japan and two from Germany. MATERIALS AND METHODS We compared periodontal data of 70-year-old subjects from the Niigata Study with 65-74-year-old subjects from the Study of Health in Pomerania (SHIP) and from West Germany (DMS III). A total of 489, 399 and 549 dentate subjects were analysed, respectively. Recording protocols were standardized. Linear or logistic models were used to compare Niigata Study with SHIP. RESULTS Elderly German subjects in SHIP and DMS III had significantly more severe periodontal conditions and fewer remaining teeth compared to those in Niigata Study, though differences were less pronounced for DMS III. German subjects showed a significantly different pattern of various periodontal risk factors compared to Japanese subjects. Even after adjustment for putative periodontal risk factors, SHIP subjects still presented significantly higher adjusted values for most periodontal parameters compared to Niigata Study subjects (p < 0.05). CONCLUSIONS Periodontitis was more prevalent in SHIP compared with Niigata Study, even after comprehensive risk factor adjustment. Only to a very small extent, differences between studies could be explained by the risk factors explored.

The relationship between objective evaluation by DAI and self-perceived dental aethetics in a population of university freshmen

month; eventually it had root fracture probably as a result of masticatory stress. The root-fractured tooth was immobilized with composite resin and orthodontic wire. The patient had a stable bite 6 years and 5 months after the fracture. A radiograph of the upper left-central incisor showed that the fractured site healed with interposition of bone and connective tissue. Also, the coronal fragment continued to erupt in concert with the growth of the alveolar process and helped to maintain the alveolar ridge of the same height and width as the adjacent teeth. These results indicated that ‘‘orthodontic traction of the inverted and impacted upper central incisor with a marked dilacerated root’’ was useful for maintaining the height and width of the alveolar ridge and would provide favorable conditions for replacing the retracted incisor with an implant or a bridge.