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Aim: To assess the extent of remission and progression of periodontal diseases among adults in a Northeast German Region., Materials and Methods: The Study of Health in Pomerania (SHIP) is a population-based cohort study with baseline examinations conducted in 1997-2001 and 5-year-follow-up in 2002-2006. The study comprised 2558 subjects aged 20-81 years. Periodontal status was assessed by probing depth (PD) and attachment level (AL), measured at four surfaces per tooth, half-mouth. An event was defined as AL progression or remission of ≥3 mm on ≥2 sites., Results: Average change in mean AL (mean PD) was 0.10 mm (-0.05 mm) during follow-up, equalling 0.02 mm/year (-0.01 mm/year). Adjusted for gender and follow-up time, change in mean AL was significantly higher in 20-29- and 60-69-year-old patients compared with 50-59-year-old patients (p < 0.05). 6.5 (7.5) events of progression (remission) in AL per 100 person-years were observed. In multivariate models, risk factors for progression comprised current smoking, middle or low education, being single or divorced and diabetes (p < 0.05). Enhanced progressive attachment loss seen in 20-29- and 60-81-year-old patients was explained through unfavourable risk factors distributions., Conclusions: Periodontal progression was moderate. Periodontal prophylaxis and motivation to reduce risk factors should especially be addressed to patients having unfavourable risk factor distributions., (© 2012 John Wiley & Sons A/S.)

Platelet factor 4 (PF4) and heparin (H) form PF4/H complexes, the target of the immune reaction in heparin-induced thrombocytopenia (HIT). HIT seems to be a secondary immune response as anti-PF4/H-IgG antibodies occur as early as day 4 of heparin treatment. This study investigated whether prevalent infections such as periodontitis may induce the PF4/H immune response as: (1) natural anti-PF4/H Abs are present in the normal population; (2) PF4 bound to bacteria exposes the same antigen(s) as PF4/H complexes; and (3) sepsis induces PF4/H Abs in mice. We found PF4 bound to periodontal pathogens (Aggregatibacter actinomycetemcomitans; Porphyromonas gingivalis) enabling subsequent binding of human anti-PF4/H Abs. The association of natural PF4/H Abs and periodontitis was assessed in a case-control study, enrolling individuals with natural anti-PF4/H Abs (n = 40 matched pairs), and in the cross-sectional population-based Study of Health in Pomerania (SHIP; n = 3500). Both studies showed a robust association between periodontitis and presence of anti-PF4/H Abs independent of inflammation markers (case-control study: lowest vs highest tertile, odds ratio, 7.12 [95% confidence interval, 1.73-46.13; P = .005]; SHIP study, p(trend) ≤ 0.001). Thus, preimmunization to PF4/bacteria complexes by prevalent infections, for example, periodontitis, likely explains the presence of natural anti-PF4/heparin Abs and the early occurrence of anti-PF4/H-IgG in HIT.