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Abstract: Periodontal disease is quite common in many developing countries, but no nationally representative data on periodontal disease is available in Myanmar until 2016. A nationwide cross-sectional survey with a stratified two-stage sampling method was conducted among 4668 participants aged 12-74 years. Periodontal assessments and self-administered questionnaire surveys were conducted to assess the periodontal status and risk factors in the Myanmar population using data from the first national oral health survey in 2016-2017. Descriptive statistics and logistic regression analysis were performed to assess the prevalence of periodontitis and its association with potential risk factors. The prevalence of gingivitis was 38.2%, 41.5%, 44.4%, and 43.7% in 12, 15-18, 35-44, and 60-74 year-olds, respectively. The prevalence of periodontitis in the latter three age groups was 2.3%, 16.3%, and 35.2%, respectively. After adjusting for other risk factors, younger participants aged 15-18 years (odds ratio [OR]: 0.1, 95% confidence interval [95% CI]: 0.0-0.2) and aged 35-44 years (OR: 0.4, 95% CI: 0.3-0.5) were less likely to have periodontitis. Moreover, participants educated upto junior high school level (OR: 1.6, 95% CI: 1.1-2.7), primary school and below level (OR: 1.9, 95% CI: 1.2-3.2), everyday smokers (OR: 1.6, 95% CI: 1.3-2.0), and everyday tobacco chewers (OR: 1.5, 95% CI: 1.2-1.8) were associated with increased risk of periodontitis. Periodontal complications were prevalent in Myanmar older adults. Prevention efforts should focus on tobacco control and oral hygiene., (Copyright © 2024 Copyright: © 2024 WHO South-East Asia Journal of Public Health.)

This nationwide cross-sectional survey investigated the association between periodontal disease and self-reported systemic health in periodontal patients who regularly visited private dental clinics in Japan. Data from 999 patients of 444 dental clinics were analyzed; the patients were aged 40 years or older, regularly visited dentists, and had diagnosed periodontal disease (defined as two or more teeth with a clinical attachment level ≥6 mm). Medical history was collected with a self-reported questionnaire. Number of teeth with a probing pocket depth (PPD) ≥5 mm was used to define periodontal status, and the highest quartile was used as the dependent variable. A Poisson regression model showed that histories of diabetes and hypertension were associated with a larger number of teeth with a PPD ≥5 mm (diabetes: prevalence rate ratio [PRR] 1.36, 95% confidence interval [CI] 1.00-1.85; hypertension: PRR 1.27, 95% CI 1.02-1.58) after adjusting for potential periodontal risk factors. These findings suggest that diabetes and hypertension are associated with worse periodontal disease. Dentists should confirm the diabetes and hypertension status of patients who receive maintenance care, because these conditions could affect periodontal management of patients.

Objectives: The aim of this study was to investigate the possible correlation between vitamin D receptor (VDR) gene polymorphism and susceptibility to chronic kidney disease (CKD) and periodontal disease., Material and Methods: This study analysed 345 participants, who were all 79 years of age. Kidney function levels were determined based on the estimated glomerular filtration rate (eGFR; non-reduced function: ≥60 and reduced function: <60 ml min -1  1.73 m -2 ). VDR TaqI genotyping was also studied. We calculated the periodontal inflamed surface area (PISA). After classifying participants into quartile groups according to eGFR or PISA values, the subjects were then split into two groups (highest quartile versus the other three groups combined). Multiple logistic regression analysis was performed to evaluate the odds ratios between the eGFR and VDR TaqI genotype with the different PISA groups. The eGFR was set as the dependent variable while the VDR TaqI genotype, HbA1C, gender, smoking habits and body mass index were defined as independent variables., Results: A significant association was observed between the VDR TaqI genotype and eGFR in the PISA high group (odds ratio = 3.97, p = .027)., Conclusion: Study results suggest that VDR TaqI genotype might be associated with CKD during inflammatory conditions caused by periodontal disease., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aims: An association between periodontal disease and liver enzymes has been reported previously. This study examined the relationship between clinical periodontal parameters and changes in liver enzymes levels in 265 non-institutionalized Japanese elderly aged 72 years over 8 years., Materials and Methods: The number of sites with probing pocket depth (PPD) ≥ 6 mm and clinical attachment level (CAL) ≥ 6 mm were measured. Changes in liver enzymes (alanine transaminase [ALT] and aspartate transaminase [AST]) was grouped based on any elevation of concentrations. The relationship was determined by logistic regression with adjustment for confounders. Interaction test and stratified analysis were then performed according to smoking status and alcohol drinking habits, separately., Results: Elevation in ALT, but not AST, was significantly associated with PPD (odds ratio [OR] = 1.10) and CAL (OR = 1.03). A significant interaction of periodontal parameters on ALT was observed with smoking status, but not with alcohol drinking habit. The stratified analysis suggested that ALT was found to be significantly correlated with PPD (OR = 1.20) and CAL (OR = 1.04) to those who were smoker., Conclusion: The elevation in ALT levels might be associated with clinical periodontal parameters among non-institutionalized Japanese elderly, and this association was modified by smoking status., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to examine the association between periodontal disease and renal function in elderly women with different genotypes., Material and Methods: A total of 332 postmenopausal never-smoking women were analysed. Poor renal function was defined as serum cystatin C > 0.91 mg/l. Periodontal disease markers such as periodontal inflamed surface area (PISA) were evaluated. Selected variables, including PISA quartile, body mass index (BMI), HbA1C and age in Arg allele carriers and non-carriers based on the beta-3 adrenergic receptor, or between Ala allele carriers and non-carriers based on peroxisome proliferator-activated receptor gamma, were analysed using multiple logistic regression analysis., Results: The odds ratios of serum cystatin C level and PISA (fourth quartile) were significantly positive for both Arg (2.52; p = 0.035) and Ala allele non-carriers (2.36; p = 0.021). A significant association was also found between serum cystatin C level and BMI for both Arg (1.18; p = 0.001) and Ala allele non-carriers (1.12; p = 0.003)., Conclusion: The results of this study suggest that periodontal inflammation might be associated with renal function. Furthermore, in both the Arg and Ala allele non-carriers, the associations between BMI and PISA for renal function became stronger., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to evaluate the reciprocal effects of chronic kidney disease (CKD) and periodontal disease., Material and Methods: A total of 332 postmenopausal never smoking women were enrolled, and their serum high-sensitivity C-reactive protein, serum osteocalcin and serum cystatin C levels were measured. Poor renal function was defined as serum cystatin C > 0.91 mg/l. Periodontal disease markers, including clinical attachment level and the periodontal inflamed surface area (PISA), were also evaluated. Logistic regression analysis was conducted to evaluate the relationships between renal function and periodontal disease markers, serum osteocalcin level and hsCRP level. The prevalence-rate ratios (PRRs) on multiple Poisson regression analyses were determined to evaluate the relationships between periodontal disease markers and serum osteocalcin, serum cystatin C and serum hsCRP levels., Results: On logistic regression analysis, PISA was significantly associated with serum cystatin C level. The odds ratio for serum cystatin C level was 2.44 (p = 0.011). The PRR between serum cystatin C level and periodontal disease markers such as number of sites with clinical attachment level ≥6 mm was significantly positive (3.12, p < 0.001). Similar tendencies were shown for serum osteocalcin level., Conclusion: This study suggests that CKD and periodontal disease can have reciprocal effects., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: Potentially significant associations between metabolic syndrome (MetS) and periodontal disease have been reported in recent studies; however, there is a dearth of literature regarding the relationship of MetS with serum antibody levels to periodontal pathogens. The aim of this cross-sectional study was to investigate the association between MetS and serum antibody to the periodontal pathogen Porphyromonas gingivalis (P. gingivalis) in 216 Japanese individuals aged 79 years., Materials and Methods: Serum antibody levels to P. gingivalis were measured by enzyme-linked immunosorbent assay. An elevated serum antibody response was defined as the upper quartile and was considered as the outcome variable. A multivariable logistic regression model was used to evaluate the association of MetS defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria with an elevated antibody status. Adjustments for gender, income, education, smoking status, dental-care utilisation patterns and brushing frequency were considered., Results: The prevalence of MetS was 22.2% (n = 48). Study participants with MetS were 2.9 times more likely to have an elevated serum antibody to P. gingivalis (adjusted odds ratio = 2.91, 95% confidence interval = 1.24-6.85) after simultaneous adjustment for other covariates., Conclusion: Our findings suggest an independent relationship between MetS and serum antibody levels to P. gingivalis in the Japanese elderly. Additional longitudinal epidemiologic studies with larger, more diversified samples and more complete information are needed to substantiate our findings., (© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.)

Background: It has been hypothesized that β-3 adrenergic receptor and peroxisome proliferator-activated receptor gamma (PPARγ) might have gene-environmental and gene-gene interactions in periodontal disease. The purpose of this study is to elucidate the interaction between β-3 adrenergic receptor and PPARγ gene polymorphism with periodontal disease., Methods: Three hundred thirty-two postmenopausal females were enrolled, and their serum high-sensitivity C-reactive protein (hsCRP) and hemoglobin A1c (HbA1c) were examined. β-3 adrenergic receptor and PPARγ genotypes were then determined. An oral examination was performed. The number of remaining teeth was counted, and the probing depth (PD) and clinical attachment level (CAL) were measured. Prevalence-rate ratios (PRRs) were calculated by multiple Poisson regression analyses to evaluate the relationship among periodontal disease markers, such as the number of sites with CAL 4 to 5 or ≥6 mm or PD 4 to 5 or ≥6 mm, and β-3 adrenergic receptor polymorphisms, PPARγ polymorphisms, and the interaction term adjusted by age, hsCRP, and HbA1c, after converting the number of remaining teeth (n) to an offset variable., Results: In the participants with body mass index (BMI) ≥25, PRRs of β-3 adrenergic receptor genotype (Trp/Arg and Arg/Arg) for periodontal disease markers were 0.13 to 0.70 (P <0.0001 to 0.74), those of PPARγ genotype (Pro/Pro) were 0.66 to 3.14 (P = 0.01 to 0.68), and those of the interaction term for the two genotypes were 1.69 to 12.61 (P <0.0001 to 0.33). However, in the participants with BMI <25, a constant tendency was not observed., Conclusion: The results confirmed a positive relationship between the interaction term for β-3 adrenergic receptor genotype and PPARγ genotype and various periodontal markers in obese elderly females.

Background: There has been little evaluation in longitudinal epidemiologic studies of the effect of metabolic syndrome (MetS) on periodontal status. The specific aim of this longitudinal study is to investigate whether MetS in the Japanese population could be a risk factor for periodontal disease., Methods: A total of 125 older adults from Japan for whom data were available for the years 2003 to 2006 were selected for the current study. Full-mouth periodontal status, measured as clinical attachment level (CAL), was recorded at baseline and in follow-up examinations. Development of periodontal disease was considered to be ≥2 teeth demonstrating a longitudinal loss of proximal attachment of ≥3 mm at the follow-up dental examination. A multivariable Poisson regression model with robust error variance was used to evaluate the association of MetS defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria with development of periodontal disease. Adjustments for sex, income, education, smoking status, number of teeth at baseline, mean CAL at baseline, pattern of visits to a dentist, and brushing frequency were considered., Results: The prevalence of MetS was 21.6% (27/125). Study participants with MetS were approximately 2.6 times more likely to develop periodontal disease (adjusted relative risk 2.58, 95% confidence interval 1.17 to 5.67) after simultaneous adjustment for other covariates., Conclusions: These findings support the hypothesis that MetS may be a risk factor for periodontal disease in older Japanese individuals. Additional studies with larger, more diverse populations and more complete information are needed to substantiate the findings.

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., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to elucidate whether the association between beta-3 adrenergic receptor polymorphism and periodontal disease is modified by body weight., Material and Methods: We enrolled 332 postmenopausal women and determined their HbA1C levels (%) and beta-3 adrenergic receptor (rs4994) genotypes. Periodontal parameters including clinical attachment level (CAL) were measured. After selecting subjects for each body mass index (BMI) level, the prevalence rate ratio (PRR) by multiple Poisson regression analysis was calculated to evaluate the relationship between periodontal disease and beta-3 adrenergic receptor polymorphism. The number of sites with CAL≥6 mm was used as a dependent variable, and beta-3 adrenergic receptor genotype [categorized as Arg non-carriers (reference) or Arg carriers], age (y) and HbA1C (%) were adopted as independent variables. We converted the number of probing sites (n) to an offset variable., Results: The PRR of the beta-3 adrenergic receptor genotype for the number of sites of CAL≥6 mm showed a positive association in subjects with BMI≥25.0 and increased markedly with BMI. The PRR in subjects with BMI≥30 was 3.10 (p < 0.0001)., Conclusion: This study indicates a positive association between periodontal disease and the beta-3 adrenergic receptor genotype in obese individuals., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To investigate the longitudinal relationship between the intake of dietary antioxidants and periodontal disease in community-dwelling older Japanese., Design: A retrospective cohort study, with a follow-up of 2 years (2003-2005). Intakes of dietary antioxidants (vitamin C, vitamin E, α-carotene and β-carotene) were assessed with a validated FFQ. Participants were classified by tertile of antioxidant intake. Full-mouth periodontal status, measured as the clinical attachment level, was recorded at baseline and follow-up examinations. Periodontal disease progression was considered as loss of attachment of 3 mm or greater over the study period at the interproximal site for each tooth. Finally, the number of teeth with periodontal disease progression per person was calculated and was used as the outcome. Poisson regression analysis was conducted, with dietary antioxidants as the main exposure, to estimate their influence on the number of teeth with periodontal disease progression., Setting: Niigata City (Japan)., Subjects: Dentate individuals aged 75 years in 2003, for whom data were available, were included in the analyses (n 264)., Results: A higher intake of dietary antioxidants was inversely associated with the number of teeth with periodontal disease progression, controlling for other variables. The multivariate-adjusted incidence rate ratios in the first, second and third tertiles were 1·00, 0·76 (95 % CI 0·60, 0·97) and 0·72 (95 % CI 0·56, 0·93) for vitamin C; 1·00, 0·79 (95 % CI 0·62, 0·99) and 0·55 (95 % CI 0·42, 0·72), for vitamin E; and 1·00, 1·02 (95 % CI 0·81, 1·29) and 0·73 (95 % CI 0·56, 0·95) for β-carotene., Conclusions: The study results suggest that higher intake of antioxidants may mitigate periodontal disease in community-dwelling older Japanese.

Background: Early detection of decreased kidney function can help prevent the progression of kidney disease to kidney failure and cardiovascular events. Potentially significant associations between kidney function and periodontal disease have been reported in cross-sectional studies. However, no longitudinal study has been performed and no study has been performed in Japan. The aim of this longitudinal study was to investigate the effect of periodontal disease on kidney function in community-dwelling Japanese elderly., Study Design: Retrospective cohort., Setting & Participants: Members of this cohort were drawn from a longitudinal interdisciplinary study of aging. Included for this analysis were 317 participants (166 men, 151 women) aged 75 years in 2003., Predictor: The periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue, was calculated for each participant. Participants were classified in quartile groups according to PISA, then divided into 2 groups (highest quartile vs the other 3 groups combined)., Outcomes: The primary outcome for the analysis was decreased kidney function, defined as a decrease in estimated glomerular filtration rate at follow-up., Measurements: Multivariable logistic regression analyses were performed to predict decreased kidney function on the basis of periodontal status, risk factors for kidney disease, and other potentially relevant covariates., Results: During the 2-year follow-up (2003-2005), 45 participants (14.2%) developed decreased kidney function. The highest PISA quartile was associated significantly with a greater cumulative incidence of decreased kidney function (OR, 2.24; 95% CI, 1.05-4.79) than the referent group (the other 3 quartiles) after adjusting for covariates., Limitations: Extension of interpreting the findings to other age groups is limited., Conclusion: These results suggest that periodontal disease may be a risk factor for decreased kidney function in Japanese elderly., (Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Low concentrations of serum anti-oxidants, including ascorbic acid and α-tocopherol, are associated with higher risks of many inflammatory diseases that interrelate with oral health. The present study examined the longitudinal relationship of serum ascorbic acid and α-tocopherol to periodontal disease in 224 Japanese individuals, aged 71 yrs, for whom data were available for the years 1999-2007. Participants were classified by tertiles of serum ascorbic acid and of α-tocopherol. Full-mouth periodontal status, measured as clinical attachment level (CAL), was recorded at baseline and annual follow-up examinations. The number of teeth with a loss of CAL ≥ 3 mm at any site over the study period was calculated as 'periodontal disease events'. Poisson regression analysis was conducted to assess predictors of periodontal disease events, with serum ascorbic acid and α-tocopherol as the primary predictors of interest. The multivariate adjusted relative risks (95% confidence intervals) in the highest, middle, and lowest tertiles were 1.00 (reference), 1.12 (1.01-1.26), and 1.30 (1.16-1.47) for ascorbic acid and 1.00 (reference), 1.09 (0.98-1.21), and 1.15 (1.04-1.28) for α-tocopherol, respectively. Our findings support the hypothesis that low serum levels of ascorbic acid and α-tocopherol may be a risk factor for periodontal disease in Japanese elderly.

Background and Objective: We hypothesized that renal function is associated with the relationship between periodontal disease and bone metabolism. The present study evaluated the relationship of bone formation and resorption markers to periodontal disease, taking renal function into consideration, in elderly Japanese subjects., Material and Methods: We selected 148 subjects aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). We measured two bone formation markers (serum bone-specific alkaline phosphatase and serum osteocalcin) and two bone resorption markers (urinary deoxypyridinoline and urinary cross-linked N-telopeptide of type I collagen). Creatinine clearance per 24 h, as a measure of renal function, was also determined. The correlations between mean CAL or percentage of sites with ≥6mm CAL (6+mm CAL) and bone turnover markers, and between bone turnover markers and creatinine clearance levels, were performed by multiple linear regression analysis., Results: There were significant negative relationships between mean CAL or 6+mm CAL and serum osteocalcin levels adjusted for gender, smoking habits and oral care habits (β=-0.25, p=0.014 and β=-0.35, p=0.001, respectively). In addition, there was a negative relationship between serum osteocalcin and creatinine clearance levels adjusted for gender and smoking habits (β=-0.45, p<0.0001)., Conclusion: Results from the present study suggest that serum osteocalcin was significantly associated with renal function and periodontal disease. The low systemic bone metabolism, which might be caused by low renal function, is associated with periodontal disease., (© 2011 John Wiley & Sons A/S.)

The longitudinal relationship between dietary n-6 to n-3 PUFAs ratio and periodontal disease in 235 Japanese subjects for whom data were available for the years 2003-2006 was investigated. PUFAs intake was assessed at baseline with a brief-type self-administered diet history questionnaire. Full-mouth periodontal status, measured as the clinical attachment level (CAL), was recorded at baseline and once a year for 3 years. The number of teeth with a change in the loss of CAL ≥3 mm at any site over a year was calculated as 'periodontal disease events'. Poisson regression analysis was conducted, with dietary n-6 to n-3 PUFAs ratio as the main predictor, to estimate its influence on periodontal disease events. A high dietary n-6 to n-3 PUFAs ratio was significantly associated with greater number of periodontal disease events. The findings suggest the dietary n-6 to n-3 PUFAs ratio is associated with periodontal disease among older Japanese., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to evaluate the relationship between bone fragility of the mandibular inferior cortex and tooth loss in older adults by accounting for periodontal disease and bone metabolism markers., Research Design: A total of 177 subjects aged 77 years participated in this study. We counted the number of remaining teeth. The mandibular cortex condition was examined using the mandibular inferior cortex classification (MICC) on dental panoramic radiographs. The mandibular inferior cortex was detected on both sides of the mandible, distally from the mental foramen (C1, normal; C2, mild/moderate erosion; C3, severe erosion). Multiple linear regression analysis was performed to assess the relationship between the mandibular cortex condition with the MICC and the number of remaining teeth after controlling for confounding factors such as gender, the percentage of sites with > or = 4 mm clinical attachment levels, and serum osteocalcin levels., Results: The mean +/- SD number of remaining teeth of MICC C1, C2 and C3 were 20.7 +/- 7.5, 14.6 +/- 8.1 and 4.0 +/- 0.0 for males, and MICC C1, C2, and C3 were 21.7 +/- 7.6, 17.2 +/- 8.0, and 16.2 +/- 10.4 for females. The MICC was significantly associated with the number of remaining teeth using multiple linear regression analysis (beta = -0.21, p = 0.031)., Conclusion: This study suggests that there is a relationship between bone fragility of the mandibular inferior cortex and tooth loss related to periodontal disease.

Objective: Fish oil has anti-inflammatory actions that may benefit periodontal health. We investigated the longitudinal relation between dietary ω-3 fatty acids (FAs), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) to periodontal disease in community-dwelling elderly., Methods: Fifty-five participants aged 74 y were randomly selected from a longitudinal interdisciplinary study of aging. Dietary intake data were obtained by a 3-d weighed food intake. The dietary intakes of energy, DHA, and EPA were calculated based on the Standard Food Composition Tables in Japan. Dental examinations were carried out at baseline and once a year for 5 y. The number of teeth with periodontal progression over 5 y per person was calculated as "periodontal disease events." Negative binomial regression analysis was conducted, which included DHA, EPA, and other covariates as independent variables to estimate the influence on periodontal disease events. Longitudinal data were analyzed for participants for whom data were available for 5 y (n=36)., Results: Low DHA intake was significantly associated with more periodontal disease events. The mean number of periodontal disease events for participants who consumed the lowest tertile of DHA was approximately 1.5 times larger (lowest tertile, incidence rate ratio 1.49, 95% confidence interval 1.01-2.21) than the reference group (highest tertile of DHA consumption), after simultaneously adjusting for possible confounders., Conclusion: The findings suggest there may be an inverse, independent relation of dietary DHA intake to the progression of periodontal disease in older people., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The association between phenytoin-induced gingival hyperplasia (PIGH) and five major periodontopathic bacteria was investigated by real-time PCR in 12 subjects (30.6 +/- 7.95 years of age) with severe motor and intellectual disabilities. The subjects had not received antibiotics or periodontal therapy within three months. A healthy gingival site or a site with the lowest gingival hyperplasia score (minimum site), and a site with the maximum score of gingival hyperplasia (maximum site) on each subject were selected for investigation. The clinical parameters were measured after microbial sampling. The following results were obtained: 1. The detection rates of both Treponema denticola and Porphyromonas gingivalis were 75% (9/12) at the maximum sites, and that of Tannerella forsythia was 33.3% (4/12). The detection rate of Prevotella intermedia was 58.3% (7/12), but no significant correlation was observed between this bacterium and the other types of bacteria in quantitative analysis. 2. The detection rate of P. gingivalis with type II fimA was 25% (1/4) at the minimum sites, and 83.3% (5/6) at the maximum sites. 3. The samples were divided into three groups; namely, those with no detection of P. gingivalis at either the minimum sites or the maximum sites, no detection at the minimum sites but detection at the maximum sites, and detection at both sites. In conclusion, 1) the detection rates of T. denticola and P. gingivalis were the highest at the maximum sites. In particular, the detection rate of P. gingivalis with type II fimA was high in the present study, and 2) the subgingival microflora was diverse because of the diverse severity of gingival inflammation associated with PIGH.

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.

Objective: We hypothesise that a difference in nutrition influences dental caries and periodontal disease. There are few previous studies especially longitudinal ones which have evaluated this hypothesis. This study investigated the relationship between nutritional intake, including milk and milk products (MMP), and dental disease, controlling for several confounding factors., Material and Methods: A group of 600 subjects aged 70, randomly selected for this study, included approximately the same number of male and female subjects. The number of teeth on which root caries had occurred or where there was a periodontal event over a 6-year period was measured. To determine quantitative food intake at baseline, a semi-quantitative food frequency questionnaire was used during face-to-face interviews by dieticians. The stepwise method of multiple linear regression analysis was used to identify independent predictors of the number of root caries or periodontal disease events during the 6 years. Intake of the six food groups includes (i) fish, shellfish, meat, beans and eggs; (ii) MMP; (iii) dark green and yellow vegetables (DYV); (iv) other vegetables and fruits; (v) cereals, nuts and seeds, sugar and sweeteners, confectioneries (CNSC) and (vi) fats and oils. The alcohol, gender and anthropometric evaluation including measurements of weight and height for the calculation of body mass index, educational level, the number of family members and the number of remaining teeth were used as independent variables., Results: According to stepwise multiple regression analysis, two variables (quantity of MMP, and gender) were negatively associated with the number of root caries events during the 6 years. The standardised coefficients were -0.14 (p = 0.035) and -0.17 (p = 0.007) respectively. In addition, DYV were negatively, and three other variables (CNSC; alcohol; and the number of remaining teeth at baseline) were positively associated with the number of periodontal disease events during the 6 years. The standardised coefficients were -0.16 (p = 0.001), 0.11 (p = 0.042), 0.10 (p = 0.041) and 0.58 (p < 0.001) respectively., Conclusion: Our results suggest that the intake of MMP in this elderly population correlated with root caries events. In addition, intake of vegetables negatively correlated, and intake of 'CNSC' positively correlated with periodontal disease events.

Objective: The purpose of this study was to evaluate the relation of bone turnover markers such as bone formation and resorption to periodontal disease and jaw bone morphology in elderly Japanese subjects., Subjects and Methods: We selected 148 subjects for participation in this study. All subjects were aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). Biochemical parameters of bone turnover measured included urinary deoxypyridinoline, serum osteocalcin (S-OC), and serum bone-specific alkaline phosphatase. In addition, to evaluate the jawbone, we used the mandibular inferior cortex classification (MIC)., Results: Serum osteocalcin had significantly higher (males: P = 0.038, females: P = 0.041) tendency for MIC Class (ANOVA). Multiple linear regression results showed that the number of remaining teeth and S-OC were negatively associated with the percentage of sites with > or =6 mm CAL (R(2) = 0.322, P < 0.001). Coefficients and betas were -0.71, -0.46 (P < 0.001) and -1.11, -0.28 (P = 0.002), respectively., Conclusion: In conclusion, this study suggests that there is a significant relation of bone turnover markers to periodontal disease and jaw bone morphology in elderly Japanese subjects.

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.

Many of the protective immune responses of old people are impaired and this leads to an increased risk of oral bacterial infections. Little is known about the interaction between the systemic immune response on one hand and oral infections and oral diseases on the other. Here, we conducted an epidemiological study of the independent elderly to determine the relationships between activated natural killer (NK) cells and oral bacterial infections: oral diseases such as dental caries and periodontal disease. One hundred independent elderly people aged 77 years old (53 males, 47 females) were examined. Blood samples were drawn, and activated NK cells were evaluated using CD16, CD56, and CD69 monoclonal antibodies with flow cytometry. Bacterial counts for oral streptococci, lactobacillus, and opportunistic pathogens were performed using culture techniques. Oral disease examinations were performed by dentists. A larger percentage of CD69(+)NK cells (CD16(+)CD56(+)) showed significant correlations to the isolation numbers of total streptococci (r=0.409, P<0.01), the species numbers of opportunistic pathogens (r=-0.318, P<0.01), the numbers of decayed teeth (r=-0.223, P<0.05), and the amount of bridge work (r=0.219, P<0.05). A higher proportion of CD69(+)NK cells is associated with the incidence of dental caries and the number of opportunistic pathogens and total streptococci in the oral cavity of the elderly. This suggests that the proportionate number of CD69(+)NK cells may be a useful indicator for oral infection in elderly subjects.

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.

Background: Chronic renal failure involves a slow, progressive loss of renal function over months or years. It is possible that periodontal disease and chronic kidney disease might share common risk factors. This study investigated whether a link exists between periodontal disease and chronic renal function in community-dwelling elderly subjects., Methods: A total of 145 study subjects, all 77 years of age, participated in this study. A periodontal examination was carried out by trained dentists. Urine was collected over 24 hours, and blood was taken on the morning of the dental exam. The volume of creatinine per 24 hours (Cre&#95;U) and volume of urine per 24 hours were used as urinary markers of kidney function; serum creatinine levels (Cre&#95;S) were used as a blood marker of kidney function. Creatinine clearance per 24 hours was calculated as Cre&#95;U/Cre&#95;S. In addition, biochemical parameters of bone turnover were measured: urinary deoxypyridinoline (U-DPD) as a bone resorption marker and serum osteocalcin (S-OC) as a bone formation marker. Multiple regression analysis was used to evaluate the relationship between the percentage of periodontal sites with > or =6-mm clinical attachment level (% > or =6-mm CAL) and renal function, as well as the relationship between % > or =6-mm CAL and bone metabolism. The % > or =6-mm CAL was used as the dependent variable. The number of remaining teeth, smoking habit, gender, use of interdental brushes or dental floss, volume of urine per 24 hours, and creatinine clearance per 24 hours were independent variables in the first test. In addition, the number of remaining teeth, smoking habits, gender, use of interdental brushes or dental floss, U-DPD, and S-OC were independent variables in the second test., Results: Multiple regression analysis showed that creatinine clearance per 24 hours and S-OC were significantly associated with % > or =6-mm CAL per person. The standardized coefficients were 0.26 (P = 0.015) and -0.27 (P = 0.006), respectively., Conclusions: The % > or =6-mm CAL was significantly associated with renal function and bone metabolism markers. This study suggests that the increased incidence of chronic renal failure that occurs with age might increase the probability of severe periodontal disease in community-dwelling elderly subjects.

The amino acid residues 361-386 of Streptococcus mutans PAc includes an important region associated with the interaction between S. mutans and salivary components. We investigated the relationships between levels of the anti-PAc (361-386) peptide antibody (PPA) in saliva and periodontal status in 281 elderly subjects (mean age 77 years; 118 females, 163 males) by assessing dental calculus (CA), attachment loss (AL), pocket depth (PD), bleeding on probing (BOP) and various blood parameters. Enzyme-linked immunosorbent assay results revealed that subjects with a PPA level of greater than 0.1 (PPA detected group) showed a lower average value for number of sites with more than 6 mm of AL/6 points x 100/tooth (rAL6) than those with a PPA level of less than 0.1 (PPA not detected group). Furthermore, average values for rAL6 were significantly lower in the PPA detected group, and BOP, AL and rAL6 correlated positively and significantly with the percentage of eosinophils present in leukocytes in female subjects in both groups. PPA level had a negative correlation with percentages of basophils and eosinophils. The results indicate that systemic increases in numbers of eosinophils and basophils are associated with the development of periodontal diseases, while PPA level may be a useful indicator of periodontal status.

Background: A Japanese population residing in the same area may be suitable for evaluation of the association among IgG subclass levels, smoking status, and periodontal disease due to similar racial and environmental factors, as these factors can interact to influence serum IgG subclass levels. The present cross-sectional investigation attempted to examine the influence of serum IgG subclass levels and smoking status on periodontal condition in a population of elderly Japanese subjects., Methods: Elderly individuals (N = 451, age, 71 years) residing in Niigata City, Japan participated in the present study. Clinical evaluations, which consisted of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and calculus, and serological determinations including serum IgG subclass levels and anti-Porphyromonas gingivalis fimbriae IgG subclass titers were conducted. All participants were asked to complete questionnaires regarding smoking status and were then divided into one of three groups: never smoker, former smoker, or current smoker., Results: Distributions of the number of teeth did not differ significantly across the groups. The proportion of sites with CAL > or =4 mm (%CAL4) in current smokers was significantly higher in comparison with never smokers. Multiple linear regression analysis revealed that %CAL4 was influenced by number of teeth, serum IgG2 levels, gender, and smoking status (R(2) = 0.253, P < 0.001). The effect of IgG2 was greater than that of smoking status. Distribution of IgG2 was not significantly different across the three groups., Conclusion: These data indicate that serum IgG2 levels influences periodontal conditions in an elderly Japanese population independent of smoking status.

Background: FcgammaRIIIb genotypes and smoking are risk factors for periodontal disease. However, the interaction of FcgammaRIIIb- NA1-NA2 polymorphism with smoking remains unclear. The purpose of this study was to determine if FcgammaRIIIb-NA1-NA2 polymorphism and smoking are associated with periodontal disease progression among elderly people., Methods: Among 70-year-old subjects, 164 with neither diabetes mellitus nor blood sugar > or =140 mg/dl, who had more than 20 teeth and who could participate in both the baseline and the follow-up examinations were included in the study. The NA1 group comprised subjects with FcgammaRIIIb-NA1NA1 genotype (N = 53), while the NA2 group included subjects with FcgammaRIIIb-NA1NA2 or NA2NA2 genotype (N = 111). We examined the progression of periodontitis by measuring attachment loss during 3 years., Results: The frequency of subjects who showed > or =4 mm additional attachment loss at one or more sites was 55.6% for smokers and 37.2% for non-smokers. The odds ratio (OR) was 2.13 (confidence interval [CI]: 0.92 to 4.76). We found a better association between periodontal progression and smoking in the NA2 group. The OR for smokers was 3.03 (CI:1.12 to 8.33, P = 0.028). Additionally, the mean number of sites with > or =4 mm additional attachment loss per person between smokers and non-smokers in the NA2 group or between smokers and non-smokers in the NA1 group was 2.90 3.42 and 0.74 1.53 or 0.57 0.79 and 0.68 1.03, respectively (P <0.001; analysis of variance [ANOVA])., Conclusion: Our results may suggest an association between smoking and periodontal disease progression in elderly people with FcgammaRIIIb-NA2 polymorphism.

Objective: Bone loss is a common feature of periodontitis and osteoporosis. Both diseases may share common etiologic agents which may either affect or modulate the process of both diseases. The purpose of this study was to evaluate the relationship between systemic bone mineral density (BMD) and periodontal disease among older people., Materials and Methods: Among all 4,542 inhabitants aged 70 years according to a registry of residents in Niigata city in Japan, 600 people were selected randomly. One hundred and eighty-four subjects who did not have diabetes mellitus, whose blood sugar was <140 mg/dl, who had more than 20 teeth, who were non-smokers, and who did not take medication for osteoporosis, were included in the study. Four dentists performed clinical evaluations on probing attachment level (PAL). We also utilized the data on BMD of the heel, which we measured using an ultrasound bone densitometer. Follow-up clinical surveys were done by measuring PAL after 3 years. Finally, 179 subjects who could participate in both the baseline and the follow-up examinations were included in the analysis. After dividing the subjects into an osteopenia group (OG) and non-osteopenia group (NOG), we evaluated the relationship between BMD and the number of progressive sites which had > or =3 mm additional attachment loss during 3 years after controlling the known confounding factors., Results: The mean number of progressive sites for the OG and the NOG, respectively, were 4.65+/-5.51 and 3.26+/-3.01 in females and 6.88+/-9.41 and 3.41+/-2.79 in males. Two-way analysis of variance was performed to discriminate among effects of gender, BMD, and gender-BMD interaction. A significant effect of BMD (OG or NOG, p=0.043) with a significant interaction (p=0.038) was observed. Furthermore, BMD was associated with the number of progressive sites which had > or =3 mm additional attachment loss during the 3 years (p=0.001) by multiple linear regression analysis., Conclusions: This study suggested that there was a significant relationship between periodontal disease and general BMD.

Background: The oral cavity is a reservoir for colonization and infection of systemic organs by pathogenic bacteria. It is understood that aging, tooth eruption, hormonal changes, active disease, oral hygiene, and other factors have an influence on biofilm formation and bacterial accumulation in the oral cavity., Objective: To understand the influence of systemic health care on microfloral changes, we conducted epidemiological studies of nursing home residents in an attempt to elucidate the relationship between underlying systemic diseases and the isolation frequency of oral opportunistic pathogens., Methods: The prevalence of bacteria and fungi causing pneumonia in association with oral biofilm bacteria were determined using detection culture plates. The influences of gender, age, denture-wearing status, number of teeth, and bedridden status in the patients residing in nursing homes were then analyzed., Results: The isolation frequency rates of Candida albicans, Pseudomonadaceae, Staphylococcus spp., and some strains of Enterobacteriaceae in plaque samples, as well as C. albicans and Xanthomonas maltophilia in samples from the pharynx, were significantly higher in those requiring systemic care (mean age 83.9 years) than in those who did not require such care (mean 71.0 years). In particular, the frequencies of Pseudomonas spp., C. albicans, and Serratia marcescens in plaque were significantly higher in those who were bedridden. Furthermore, the isolation of Pseudomonas spp. and Klebsiella pneumoniae, and/or C. albicans in plaque was significantly associated with heart disease., Conclusion: The coexistence of Pseudomonas spp. and C. albicans in elderly with 10-19 teeth is a potential indicator of high risk for pneumonia and heart disease. Therefore, attention to oral hygiene and professional care for removing the indicators may diminish the occurrence of systemic disease in the elderly requiring systemic care., (Copyright 2003 S. Karger AG, Basel)

Objectives: A strategy for the control of periodontal disease progression is required to prevent tooth loss in older people. However, detailed epidemiological data on periodontal conditions in elderly people is limited. The purpose of the present study is to describe the natural history of periodontal disease and to evaluate the intraoral factors relating to the disease progression in systemically healthy elderly people., Methods: In the cross-sectional study, 599 and 162 subjects aged 70 and 80 years, respectively, were examined. Of those subjects aged 70 years, 436 (73%) participated in the 2-year longitudinal study. Pocket depth (PD) and attachment level (AL) were measured for all functioning teeth at six sites per tooth. In the cross-sectional study, AL of 4 mm or greater and 7 mm or greater were defined as moderate and severe disease, respectively. In the longitudinal study, a change in AL of 3 mm or greater at each site was defined as periodontal disease progression., Results: In the cross-sectional study, 97.1% of the subjects had at least one site of AL of 4 mm or greater (4+ mm). The prevalence of AL of 7 mm or greater (7+ mm) was 47.9%, with 2.8 affected teeth per person in those with AL 7+ mm. These findings reveal that periodontal disease is extremely widespread in the elderly population. However, very few had many teeth with severe periodontal conditions. In the longitudinal study, 75.1% experienced attachment loss of 3 mm or greater (3+ mm) during the 2-year study period. Of those subjects who experienced attachment loss, a mean of 4.7 teeth exhibited attachment loss. Multivariate logistic regression showed that both the highest AL in each tooth at baseline and abutment teeth for removable partial dentures were significantly related to periodontal disease progression as well as tooth loss incidence., Conclusions: These results suggest that teeth with poor periodontal conditions as well as abutment teeth for removable partial dentures were significant intraoral factors relating to periodontal disease progression as well as tooth loss.

The aim of this study was to identify the risk factors for periodontal disease progression by individual characteristics at baseline among elderly people over a 2-year period. Subjects were selected from 4542 people aged 70 years residing in Niigata who were in good general health and who did not require special care for their daily activities. Gender, smoking and alcohol drinking habits were obtained using a questionnaire, while serum levels of disease markers were investigated and attachment levels were clinically recorded. For the assessment of periodontal disease progression, additional attachment loss was used if one or more sites had a 3-mm or more increase in probing attachment level over a 2-year period. In all, 394 subjects (208 males and 186 females) were surveyed. Approximately 75% of subjects exhibited additional attachment loss over a 2-year period. Significant associations were found between additional attachment loss and smoking, and attachment level of 6 mm or more at baseline, with odds ratios of 3.75 and 2.29, respectively. Smoking habit and baseline attachment level of 6 mm or more may be considered risk factors for further attachment loss among healthy elderly people.

There is a paucity of information pertaining to oral disease patterns including periodontal disease in Cambodia, which is just emerging from a 20-year ruin. A house-to-house survey was conducted to assess the periodontal status of 1948 subjects aged 15-74 years in a rural commune in Cambodia using Community Periodontal Index (CPI) and measuring Attachment Loss (LA). The periodontal status of Cambodians increased with age as indicated by both CPI and LA. Calculus was the most common finding among Cambodians pointing to overall poor oral hygiene levels. Notwithstanding the poor oral hygiene, however, the severe periodontitis as denoted by > or = 6mm periodontal pockets was rare even in the elderly while edentulousness was not frequently observed until 65 years. Preventive programmes targeting periodontal disease in Cambodia should focus on oral health education and simple oral hygiene instructions while the ubiquitous calculus could be dealt with oral prophylaxis.

Periodontal conditions were assessed by CPITN and loss of attachment in 601 elderly people randomly selected in Kitakyushu, Japan. The percentage of edentulous persons was 21 per cent, 38 per cent and 65 per cent in the 65-74 year, 75-84 year and 85 years and older groups, respectively. In dentate persons, over 60 per cent had pocket probing depths of 4mm or more; in the majority loss of attachment did not exceed 5mm. The mean numbers of sextants with pocket probing depths of 4-5mm (CPITN 3) and probing depths of 6mm and more (CPITN 4) were similar in each age group. The mean numbers of sextants with both pockets and loss of attachment showed no clear difference among groups. Only the mean number of excluded (no, or only one tooth) sextants increased with increasing age from 1.9 to 3.1. It could therefore be suggested that in the population examined the progress of periodontal destruction with increasing age might not be shown by an increase in pocket probing depth, loss of attachment or gingival recession, but only by an increase in tooth loss. The results for the remaining teeth show that a) severe loss of periodontal attachment (6mm or more) was not frequently encountered, b) recession (attachment loss without pocketing) was present at only very low levels, c) the main periodontal problem seemed to be pocketing, which could be treated. It is therefore tempting to suggest that some of the teeth already lost, could have been saved if proper self- and professional care had been applied.

The general acceptance and use of the CPITN system worldwide has provided, in a very short time, a vast amount of data on periodontal diseases. This data has been entered into the WHO Global Oral Data Bank, from which, after analysis, much valuable information has been derived. Overall the CPITN system is seen as having more than fulfilled the initial hopes invested in it. It has provided a simple yet effective method for measuring and monitoring the magnitude, prevalence and severity of periodontal diseases throughout the world, as well as helping in our understanding of the disease process.

In Japan CPITN has been widely applied in dentistry over the past 10 years. CPITN has been introduced for screening purposes into basic dental epidemiology, dental public health and dental clinical practice. From many surveys the periodontal needs of young, mature and elderly populations have been documented. For the purpose of promoting improved periodontal awareness and care, CPITN has been implemented in dental public health and community based activities in schools, in industry, and in health centres. This has involved periodontal screenings and appropriate health guidance. The Japanese Health Laws are being modified to include a need for periodic oral examinations which will incorporate a CPITN screening. National goals for periodontal health at different age levels, based on CPITN, have been proposed and included in the national '8020' goal for oral health.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.

The periodontal conditions of 2424 pregnant and 1565 non-pregnant women were assessed according to the community periodontal index of treatment needs (CPITN). The aim of this survey was to obtain information which is necessary for the planning of preventive programs of periodontal disease for pregnant women. 95% of the pregnant women and 96% of the non-pregnant women had some signs of periodontal disease. The % of pregnant women having 4 or 5 mm pockets was significantly higher than that of non-pregnant women, increased with the month of pregnancy, reached a maximum of 31% in the 8-month group, but decreased to the control level in the 9-month group. These changes were interpreted to suggest that the increase of pocket depth during pregnancy was caused by gingival enlargement rather than by periodontal destruction. The results show that pregnant women had a healthier periodontal condition when compared with non-pregnant women, i.e., the number of sextants with healthy periodontal tissues was higher, the % of people having deep pockets (6 mm or deeper) was lower, and the need for prophylaxis was lower in pregnant than in non-pregnant women. These findings suggest that a special program of periodontal disease prevention for pregnant women is not necessary.

A CPITN survey was conducted on 1958 institutionalised elderly people aged 59 years and older at 29 of the 30 public and private institutions in the city of Kitakyushu, Japan. About 60 per cent of the sample was edentulous, and the prevalence of periodontal conditions was high. The percentages of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets were 3, 4, 32, 52, and 9 per cent respectively. Half the sextants in the dentate subjects were scored as excluded (less than two teeth), indicating that many teeth were missing. Only very few sextants were healthy. These findings indicate the importance of preventive programmes for periodontal diseases in the younger generations, because (a) dental care for the elderly population becomes more difficult with increasing age and (b) periodontal care, if it is available at all, is provided too late for most people.

The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15-19 years and 35-44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5-15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other diseases.

Results of more than 100 CPITN surveys from over 60 countries for the age group 15-19 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the mean number of sextants affected per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. The most frequently observed condition in adolescents was score 2 (calculus with or without bleeding). Calculus seems to be much more prevalent in non-industrialized than in industrialized countries. Although some shallow pocketing of 4 or 5 mm was present in two-thirds of all populations observed, it affected mostly only a minority of the sample and then only in one or two sextants. However, a few surveys showed a relatively high prevalence of pocketing. As the surveys were carried out in adolescents, such high figures indicate serious problems ahead.

In 1987, a survey was carried out to determine the prevalence and treatment needs of periodontal diseases in 2,684 (997 males and 1,687 females) employees of 57 supermarkets in Japan. The aim of this survey was to obtain fundamental data for planning preventive programs for periodontal diseases in the Japanese population. Most of the subjects showed some signs of periodontal disease. The percentages of persons having pathologic pockets 4 mm or deeper increased with age, and reached about 50% in the 45- to 64-year-olds. The percentage of persons affected was similar between the males and females, but the percentage of persons having pathologic pockets tended to be higher in the males than in the females. These findings indicate that the prevalence of periodontal diseases is extremely high among the Japanese population, and that primary prevention of periodontal disease during school days is required in order to maintain the adults' periodontal health.

A CPITN survey was conducted involving 12,832 Japanese subjects from 7 to 64 years of age. Subjects under 18 were schoolchildren, and 18-year-old and older subjects represented various social backgrounds, having been randomly selected from both urban and rural Japan. Fifty percent of the 7-yr-old children had signs of periodontal disease, and this percentage increased with increasing age. In those under 14, this increase in periodontal disease was mainly due to an increase in the proportion of children developing dental calculus. Subjects with 6 mm or deeper pockets were observed starting from the 20-29-yr-old age group. In subjects over this age, the prevalence of periodontal disease was higher in men than in women. The percentages of subjects having pathologic pockets had increased remarkably in the 30-44-yr-olds. In the 45-64-yr-old group, almost all subjects had some sign of periodontal disease, and the percentage of those with 4 or 5 mm pockets and 6 mm or deeper pockets were 37% and 21%, respectively.

Background and Objective Epidemiologic data examining the longitudinal relationship between periodontitis and cognitive status are very limited, especially in Asian populations. The present study examined the longitudinal relationship of periodontitis with cognitive decline in 85 Japanese community-dwelling individuals (average age: 79.3 years) for whom data were available from comprehensive health examinations conducted in 2010 and 2013. Material and Methods Based on a baseline full-mouth periodontal examination, severe periodontitis was defined using a Centers for Disease Control and Prevention/American Academy of Periodontology definition. Cognitive decline during the 3-year study period was defined using the results of the Mini-Mental State Examination ( MMSE). Information on age, gender, education, depression, body mass index, smoking status, alcohol use, exercise, hypertension, diabetes, history of cardiovascular disease and stroke, and baseline MMSE scores were obtained and tested as potential confounders in the statistical models. Results Among 85 study participants, 21 (24.7%) were defined as having severe periodontitis. Multivariable Poisson regression analyses revealed that severe periodontitis was significantly associated with an increased risk of cognitive decline [adjusted relative risk = 2.2; 95% confidence interval (95% CI): 1.1-4.5]. Furthermore, multivariable linear regression analyses revealed that participants with severe periodontitis had a 1.8-point greater decrease (95% CI: −3.3 to −0.2) in MMSE score than those without severe periodontitis. Conclusion Within the limitations related to its small sample size, the findings of the present study suggest that severe periodontitis is significantly associated with future decline in cognitive function among community-dwelling older Japanese subjects. [ABSTRACT FROM AUTHOR]