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To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine.This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults' Oral Health. Subjectively reported smoking status (daily smokersSelf-reported daily smokers had 1.82 (95% CI: 1.32-2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 μg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%.Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden.

Aim To examine how physical ability and comorbidity associate with oral health. Methods and results The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physical ability was determined by measuring limitations in daily activities (activities of daily living [ADL] and instrumental activities of daily life [IADL]) and the number of comorbidities with Functional Comorbidity Index (FCI). Poisson's multivariate regression model was used to estimate prevalence rate ratio (PRR) and their 95% confidence intervals (CI). The physical ability or number of comorbidities did not associate consistently with oral diseases, but ADL, IADL and FCI associated all with self-perceived oral discomfort (PRR: 1.74, CI: 1.01-3.03; PRR: 1.20, CI: 1.06-1.35; PRR: 1.20, CI: 1.05-1.36, respectively). Furthermore, IADL associated also with poor self-perceived oral health (PRR: 1.27, CI: 1.03-1.57). Conclusion Older people with impaired physical ability and comorbidities are more likely to have oral discomfort and have poorer self-perceived oral health.

Objective To study whether diets based on the Nordic food culture and dietary recommendations are related to periodontal disease development. Methods The data were based on the Health 2000 and 2011 Surveys (BRIF8901). The participants were aged 30-49 in 2000, periodontally healthy, without diabetes or rheumatoid arthritis. Analyses were made in the total study population (n = 240) and among nonsmokers (n = 193) in 2011. Periodontal condition was determined in a clinical examination, and the number of teeth with deepened (≥4 mm) periodontal pockets in 2011 was used as an outcome. The diet was measured using a validated food frequency questionnaire and the quality of the diet using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS) in 2000. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models. Results Low scores (indicating poor diet) in both the BSDS and the RFDS were associated with the development of deepened periodontal pockets. Among nonsmokers, the associations between low dietary scores and the number of teeth with deepened periodontal pockets were stronger than among the whole study population. Conclusions Among middle-aged adults, poor-quality diet appears to be associated with the development of periodontal disease.

Objective: The aim was to evaluate the association of behavioural and socioeconomic factors with the occurrence of periodontal disease and dental caries, paying special attention to the simultaneous occurrence of these diseases. Materials and methods: The study population consisted of 5255 dentate persons aged >= 30 years from a nationally representative survey. Caries and probing pocket depth were recorded by tooth and calculated in relation to the number of existing teeth. The groups were: non-affected (A), the two most affected quintiles for periodontal disease with little or no dental caries (B), the two most affected quintiles for dental caries with little or no periodontal disease (C) and the two most affected quintiles for both periodontal disease and dental caries (D). Presence of dental plaque was determined, and behavioural and socioeconomic factors were established. Results: Dental plaque, smoking, lack of regular dental check-ups, older age and a basic level of education were strongly associated with the simultaneous occurrence of periodontal disease and dental caries. Conclusions: There are many behavioural and socioeconomic factors that associate with the occurrence of both periodontal disease and dental caries. These factors also increase the risk of individuals having these diseases simultaneously.

Aim To investigate whether obesity, central obesity, and weight gain are associated with periodontal pocketing. Materials and methods A never smoking sub-population (n = 725) of the Northern Finland Birth Cohort 1966 was categorized based on body mass index (participants with normal weight, overweight, and obesity) and waist circumference (participants without central obesity, and with central obesity) at ages 31 and 46. The categories were combined to define whether the participants stayed in the respective BMI and WC categories or passed on to a higher category during follow-up. A periodontal examination was done at age 46. Results WC was more consistently associated with periodontal pocketing than BMI. The RRs for the number of sites with PPD ≥ 4 mm and bleeding PPD ≥ 4 mm in participants with central obesity both at age 31 and at age 46 were 1.7 (95% CI 1.4-2.0) and 2.1 (95% CI 1.6-2.6). The respective values for participants who had no central obesity at age 31 but had central obesity at age 46 were 1.6 (95% CI 1.4-1.8) and 1.9 (95% CI 1.6-2.3). Conclusion Of all the studied measures, central obesity appeared to be most strongly associated with the inflammatory condition of the periodontium. This article is protected by copyright. All rights reserved.

AIM To investigate whether the metabolic syndrome (MetS) is associated with deepened periodontal pockets and alveolar bone loss. MATERIALS AND METHODS This study was based on a subpopulation of the Northern Finland Birth Cohort 1966 survey (n = 1964). The criteria of the AHA/NHLBI were used to determine MetS. The analyses were based on the metabolic data at ages 31 and 46, and probing pocket depth and alveolar bone level data at age 46. Relative risks (RR, 95% CI) were estimated using Poisson regression models. RESULTS Relative risks for PD ≥ 4 mm and BL ≥ 5 mm were higher in individuals with an exposure to MetS ≥ 15 years (RR 1.8, 95% CI 1.6-2.1 and RR 1.5, 95% CI 1.3-1.9, respectively) than in those whose exposure was

Aim To study whether dental caries, periodontal disease, and stomatitis, and the related inflammatory burden associate with diagnosed Alzheimer's disease (AD) and dementia among older people. Methods The study population included 170 individuals aged ≥75 years. The primary outcome was diagnosed AD and the secondary outcome was any types of diagnosed dementia. Information about participants' oral diseases and the related inflammatory burden was based on the clinical oral examination. Relative risks (RRs) and confidence intervals (CIs) were estimated using regression models. Results Dental caries, the presence of ≥3 carious teeth (RR: 3.47, 95% CI: 1.09-11.1) and the number of carious teeth (RR: 1.24, CI: 1.11-1.39), and inflammatory burden (RR: 1.44, CI: 1.04-2.01) were associated with a higher likelihood of having AD. Also, periodontal disease and stomatitis were associated, although nonstatistically, with AD and dementia. The risk estimates for any type of dementia were in most cases lower than for AD. Conclusion Oral diseases and the related inflammatory burden were in most cases associated more strongly with diagnosed AD than dementia in general. Of the oral diseases studied, the strongest association was between dental caries and AD.

AIM To investigate the association of hyperglycaemia and changes in glycaemic control with periodontal status in non-diabetic individuals. MATERIALS AND METHODS A sub-population (n = 647) of the Northern Finland Birth Cohort 1966 was studied. We categorized long-term glucose balance based on fasting plasma glucose (FPG) at ages 31 and 46: FPG

We assessed dental and periodontal health in adults aged ≥30 years living in southern and northern Finland as part of the Health 2000/2011 Surveys (BRIF8901).Clinical findings in 2000 (n = 2967) and 2011 (n = 1496) included the presence of teeth and number of teeth with caries, fillings, fractures or periodontal pockets.Edentulousness decreased in all age groups. The prevalence of those with no caries increased from 67% to 69% in men and from 80% to 85% in women, and of those with no periodontal pocketing from 26% to 30% in men and from 39% to 42% in women. In 2011, the mean number of decayed teeth was 0.8 in men and 0.3 in women, and the corresponding mean numbers of teeth with deepened periodontal pockets 5.6 and 3.7. The gender difference had levelled concerning edentulousness, number of teeth and DMF teeth, but still existed in the occurrence of caries and periodontal pocketing.The findings were in line with other population-based reports in the 2000s. However, periodontal health in Finland seems not to be as good as in many European countries and in the USA.

Aim To explore the association between toothbrushing behaviour and change in periodontal pocketing among adults. Methods We pooled data from 1,025 adults, aged 30–89 years, who participated in two national surveys in Finland (Health 2000 and Health 2011, BRIF8901) and reported their toothbrushing frequency. A cumulative measure of regular toothbrushing was created by counting the number of times participants reported brushing twice or more daily across the two surveys (ranging from 0 to 2). The association between toothbrushing behaviour and the number of teeth with periodontal pocket depth (PPD) ≥4 mm over 11 years was assessed in linear regression models adjusting for confounders. Results There was a clear dose–response relationship between toothbrushing frequency (either at baseline or follow-up) and change in number of teeth with PPD ≥ 4 mm. There was also evidence of a cumulative effect of regular toothbrushing on change in number of teeth with PPD ≥ 4 mm. Participants who reported brushing twice or more a day in both surveys developed 1.99 (95% CI: 1.02–2.95) fewer teeth with PPD ≥ 4 mm than those who did not report this behaviour in any survey. Conclusion This 11-year prospective study showed that toothbrushing behaviour was associated with smaller increments in the number of teeth with periodontal pocketing., final draft, peerReviewed

Objectives The objective of this study was to determine whether drugs with sedative properties are related to oral health behaviour—such as frequency of toothbrushing, using toothpaste and dental visits—and oral hygiene, measured by the number of teeth with dental plaque, among community-dwelling older people. Methods The study population consisted of 159 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study (Geriatric Multidisciplinary Strategy for the Good Care of Older People study). The data were collected by interviews and clinical examinations during 2004-2005. Sedative properties of drugs were assessed using the sedative load (SL) model. Logistic and Poisson regression models were used to estimate odds ratios/relative risks (OR/RR) and 95% confidence intervals (CI). Results After adjusting for confounding factors, SL associated with infrequent toothbrushing (OR 1.72, CI: 0.61-4.89), toothpaste use less than twice a day (OR 3.34, CI: 1.39-8.12), non-regular dental visits (OR 2.28 CI: 0.91-5.30) and the number of teeth with dental plaque (RR 1.20 CI: 1.04-1.39) compared to participants without a SL. Conclusions The results of this study suggest that use of drugs with sedative properties indicates poor oral health behaviour among older people.

Background During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011. Methods The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen’s model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation. Results No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector. Conclusions Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care., published version, peerReviewed

Background This study investigates whether alcohol use predicts the periodontal pocket development over an 11-year follow-up period. Methods The study participants' periodontal condition was examined both in the Health 2000 and 2011 Surveys (BRIF8901). Participants were aged 30 to 65 years, dentate, periodontally healthy, and did not have diabetes or rheumatoid arthritis in 2000. Periodontal outcome measures in 2011 were the number of teeth with deepened (≥4 mm) periodontal pockets and the presence of deepened periodontal pockets. The exposure in 2000 was alcohol use (amount [g/week], frequency [any alcohol or different beverages]). Incidence rate ratios (IRRs) with 95% confidence intervals (CI) were estimated using negative binomial regression model and Poisson regression model with a robust variance estimator. Results Overall, the amount of alcohol use or use over the risk limit in 2000 was inconsistently associated with the development of periodontal pockets (IRRs varied from 0.6 to 1.0). The frequency of alcohol use (any alcohol or different beverages) had an inconsistent association with the presence of periodontal pockets (IRRs varied from 0.5 to 1.2) while there was an inverse association with the number of teeth with periodontal pockets. Among smokers, there were no clear associations between any of the exposures and either of the outcomes. The same was found among non-smokers except an inverse association was found between frequency of alcohol use and the number of teeth with periodontal pockets. Conclusion Alcohol use was not consistently associated with the periodontal pocket development over a period of 11 years.

Objective: The objective of this study is to study the association of alcoholic beverages and serum gamma-glutamyltransferase (GGT) level with periodontal condition.Material and methods: Th...

The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y (n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health–related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health–related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health.Knowledge Transfer Statement: The findings of this study can help clinicians and oral health policy makers to reorient oral health services toward those who are unemployed as a risk group for poor oral health. The research highlights the role of employment in the longitudinal changes of clinically determined oral health, taking into consideration other socioeconomic factors. The study concluded that unemployment seemed to have a role in social inequalities of oral health.

AIM: To investigate the relationship between frequency of interdental cleaning and 11-year change in teeth with periodontal pocketing in Finnish adults.METHODS: Data from 1667 dentate adults, aged 30 to 82 years, who participated in the Health 2000 survey and were re-examined in 2004 and/or 2011 were analysed. Participants reported their frequency of interdental cleaning (either dental floss or interdental brush) at baseline. Teeth with periodontal pocketing (PD) ≥4 mm were counted in every survey and treated as a repeated outcome. The association between the frequency of interdental cleaning and the number of teeth with PD ≥4 mm was evaluated in linear mixed effects models, controlling for demographic factors, socioeconomic position, diabetes, smoking status, toothbrushing frequency, dental attendance and number of teeth.RESULTS: Twelve per cent of adults reported daily interdental cleaning. Significant inverse linear trends in the number of teeth with PD ≥4 mm were found in every survey according to the frequency of interdental cleaning. However, this association was completely attenuated after adjustment for the full set of confounders. Contrarily, toothbrushing frequency was negatively associated with the baseline number of teeth with PD ≥4 mm and its rate of change over time.CONCLUSION: Interdental cleaning was not associated with 11-year change in periodontal pocketing after accounting for other established risk factors for periodontal disease.

This study investigated whether alcohol use influences periodontal pocket development during a 4-yr follow-up period. The study included those participants who took part in both the Health 2000 Survey and the Follow-up Study on Finnish Adults' Oral Health. The participants at baseline were aged ≥30 yr, periodontally healthy, and did not have diabetes or rheumatoid arthritis. The development of periodontal pockets at follow-up was measured as the number of teeth with periodontal pockets and the presence of periodontal pockets. Alcohol use at baseline was measured as g/wk, frequency, and use over the risk limit. Incidence rate ratios with 95% CI were estimated using negative binomial regression models and Poisson regression models with a robust variance estimator. No consistent association was found between any of the alcohol variables and periodontal pocket development in the total population or among non-smokers. Among smokers, a positive association was found with the frequency of alcohol use. In general, risk estimates were slightly higher for women than for men. In summary, light-to-moderate alcohol use appears not to be consistently associated with the development of periodontal pockets. The adverse effects on the periodontium seem, to some extent, to be dependent on gender and smoking.

Objective To investigate whether alcohol use is associated with deepened periodontal pockets and whether this association is dependent on age, gender or socioeconomic position (SEP). Material and methods This cross-sectional study, based on the Health 2000 Survey, consisted of dentate, non-smoking Finnish adults aged 30-65 years (n = 3059). The outcome was the number of teeth with deepened (≥4 mm) periodontal pockets. The exposure was self-reported alcohol use assessed as amount, frequency, and use over the risk limit. Zero-inflated negative binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CI). Results In this study, alcohol use did not consistently associate with the number of teeth with deepened periodontal pockets. An association with the number of teeth with deepened periodontal pockets was found among men, older participants, and those participants belonging to basic or intermediate educational groups. An association with poor periodontal health was observed among men or older participants who belonged to the basic or intermediate educational group, whereas such associations were not observed among those participants belonging to the higher educational group. Conclusions The association between alcohol use and periodontal health appears to be confounded by individual characteristics such as age, gender, and especially one's SEP.

Background & aims Chronic liver disease is a major health concern worldwide and the identification of novel modifiable risk factors may benefit subjects at risk. Few studies have analyzed periodontitis as a risk factor for liver complications. We studied whether periodontitis is associated with incident severe liver disease. Methods The study comprised 6165 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Survey (BRIF8901) during 2000-2001, a nationally representative cohort. Follow-up was until 2013 for liver-related admissions, liver cancer and mortality from National Hospital Discharge, Finnish Cancer Registry and Causes of Death Register, Statistics Finland. Mild to moderate periodontitis was defined as ≥1 tooth with periodontal pocket ≥4 mm deep, and advanced periodontitis as ≥5 teeth with such pockets. Multiple confounders were considered. Results A total of 79 subjects experienced a severe liver event during follow-up. When adjusted for age, sex and number of teeth, hazards ratios by Cox regression regarding incident severe liver disease were, for mild to moderate periodontitis, 2.12 (95% CI 0.98-4.58), and, for advanced periodontitis, 3.69 (95% CI 1.79-7.60). These risk estimates remained stable after additionally adjusting for alcohol use, smoking, metabolic risk, serum gamma-glutamyltransferase, dental-care habits, lifestyle and socioeconomic status. Periodontal disease-associated liver risk was accentuated among subjects with non-alcoholic fatty liver disease or heavy alcohol use at baseline. Conclusions Periodontitis was associated with incident liver disease in the general population independently of various confounders. As a preventable disease, periodontal disease might present a modifiable risk factor for chronic liver disease.

Aim To study whether periodontal condition is associated with the development of type 2 diabetes mellitus (T2DM). Materials and methods A population-based follow-up study was conducted among persons born in 1935 and living in the city of Oulu, Finland (n = 395). The baseline examinations were done during 1990-1992, and the follow-up examinations were done during 2007-2008. The data were gathered by questionnaires, laboratory tests and clinical measurements. Poisson regression models were used in the data analyses. Results The adjusted rate ratios (RR) with 95% confidence intervals (95% CI) for the incident T2DM among subjects with 4-5 mm deep periodontal pockets (n = 98), among subjects with 6 mm deep or deeper periodontal pockets (n = 91), and among edentulous subjects (n = 118) were 1.32 (95% CI: 0.69-2.53), 1.56 (95% CI: 0.84-2.92) and 1.00 (95% CI: 0.53-1.89), respectively, compared to dentate subjects without deepened (4 mm deep or deeper) periodontal pockets (n = 88). The adjusted RR per site (the number of sites with deepened periodontal pockets as a continuous variable) was 1.02 (95% CI: 1.00-1.04). Conclusions Poor periodontal condition may be a predictor of the development of T2DM. However, the causality between periodontal condition and the development of T2DM remains uncertain.

Aim: To examine whether a healthy diet based on nutrient recommendations is associated with periodontal condition in smokers. Material and Methods: Daily smokers from the cross‐sectional Health 2000 Survey (BRIF 8901) in Finland were analysed in two age groups (30–49 and 50–79 years, n = 704 and 267) and according to the level of oral hygiene. Periodontal condition was measured as the number of sextants with gingival bleeding and teeth with ≥4 mm deepened periodontal pockets. Information on nutrition was collected by a validated food frequency questionnaire and measured using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS). Results: In the total study population, no association between the scores and periodontal condition was observed. Among 30‐ to 49‐year‐old participants with good oral hygiene, diet scores associated inversely with the number of teeth with deepened periodontal pockets (p = .078 (BSDS) and p = .027 (RFDS)). Conclusions: In a representative sample of Finnish adults who smoke, a healthy diet was not associated with periodontal condition. Among a younger age group with good oral hygiene, a healthy diet associated with better periodontal condition. Age and oral hygiene appeared to modify the association between diet and periodontal condition.

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objective To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations. Methods Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators. Results Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated. Conclusion Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.

Apart from the effects of vitamin D on bone metabolism, it is also known for its immunomodulatory properties. However, so far, it is not clear whether serum 25-hydroxyvitamin D [25(OH)D] exerts any beneficial effect on the periodontium. The aim of the present study is to investigate whether the serum level of 25(OH)D is related to periodontal condition, measured by means of pocketing and gingival bleeding.This cross-sectional study is based on a non-smoking subpopulation without diabetes of the Finnish Health 2000 Survey (N = 1,262). Periodontal condition was measured as the number of teeth with deep (≥4 mm) periodontal pockets and the number of bleeding sextants per individual. Serum 25(OH)D level was determined by means of a standard laboratory measurement. Prevalence rate ratios and 95% confidence intervals were estimated using Poisson regression models.There were practically no associations between serum 25(OH)D level and teeth with deep (≥4 mm) periodontal pockets or bleeding sextants. A somewhat lower proportion of teeth with deep periodontal pockets was found in higher serum 25(OH)D quintiles among individuals with a good oral hygiene level.Serum 25(OH)D did not seem to be related to periodontal condition, measured as periodontal pocketing and gingival bleeding in this low-risk, low-25(OH)D status population.

Objective The aim was to study whether the anticholinergic burden of drugs is related to xerostomia and salivary secretion among community-dwelling elderly people. Background Anticholinergic drugs have been shown to be a risk factor for dry mouth, but little is known about the effects of cumulative exposure to anticholinergic drugs measured by anticholinergic burden on salivary secretion or xerostomia. Methods The study population consisted of 152 community-dwelling, dentate, non-smoking, older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS). A Poisson regression model with robust error variance was used to estimate relative risks (RR) with 95% confidence intervals (CI 95%). Results Participants with a high-anticholinergic burden (ADS ≥ 3) were more likely to have xerostomia (RR: 3.17; CI: 1.44-6.96), low-unstimulated salivary flow (

Background Body mass index (BMI) has been found to associate with different parameters of chronic periodontal disease in previous studies. It is reasonable to expect that central adiposity measures, such as waist circumference and waist-to-height ratio, which indirectly takes into account visceral fat, are more accurate measures of obesity-related oral health risks than BMI. The aim of this study was to examine whether central obesity is associated with periodontal pocketing, an indication of infectious chronic periodontal disease. Methods The study was based on a subpopulation from the national Health 2000 Survey in Finland. It included dentate, non-diabetic, never-smoking subjects aged 30–49 (n = 1287). The outcome variable was the number of teeth with deepened periodontal pockets (4 mm or more) and the number of teeth with deep periodontal pockets (6 mm or more). Central obesity was measured by means of waist circumference (WC) and waist-to-height ratio (WHtR). Poisson regression models were used to estimate prevalence rate ratios (PRR) and their 95% confidence intervals. Results Our main finding was that both WC and WHtR were associated with the number of teeth with deeper (4 mm or more) periodontal pockets; the PRR for the fifth quintile in WC was 1.5, CI: 1.2–1.9 and in WHtR 1.4, CI: 1.1–1.7, when compared to the lowest quintile. Corresponding figures for deep (6 mm or more) periodontal pockets were 2.3, CI: 0.9–6.1 for WC and 1.9, CI: 0.8–4.4 for WHtR. There were no essential differences in the strengths of the associations between WC and WHtR and the number of teeth with deepened periodontal pockets. Conclusion Both central adipose measures—WC and WHtR—seem to be associated with periodontal pocketing in non-diabetic, never-smoking subjects aged 30–49 years old., published version, peerReviewed

Aim The aim of this cross-sectional study was to investigate whether periodontal condition is associated with hypertension and systolic blood pressure. Materials and methods The study population consisted of dentate, non-diabetic, non-smoking individuals aged 30-49 years (n = 1296) in the national Health 2000 Survey in Finland. The number of teeth with deepened (≥4 mm) and deep (≥6 mm) periodontal pockets and the number of sextants with gingival bleeding were used as explanatory variables. Hypertension and systolic blood pressure were used as outcome variables. Results There was no consistent association between the number of teeth with deepened (≥4 mm) (OR 0.98, 95% CI 0.95-1.01) or deep (≥6 mm) (OR 1.01, 95% CI 0.90-1.12) periodontal pockets and hypertension after adjusting for confounding factors. Nor was there any essential association between the number of bleeding sextants and hypertension. Conclusions Periodontal pocketing and gingival bleeding did not appear to be related to hypertension in non-diabetic, non-smoking individuals aged 30-49 years. Further studies using experimental study designs would be required to determine the role of infectious periodontal diseases in the development or progression of hypertension.

Background and objectives Vitamin D has been studied primarily for its involvement in calcium and phosphate absorption and bone metabolism. The active form of vitamin D-1,25(OH)2 D-has also been investigated for its immune modulatory properties. We explored associations between serum levels of 25(OH)D and 1,25(OH)2 D and periodontal health. Subjects and methods This case-control study included 55 subjects with chronic periodontitis (cases) and 30 periodontally healthy subjects (controls). Their serum levels of 25(OH)D, 1,25(OH)2 D, ultrasensitive C-reactive protein and high-density lipoprotein cholesterol were determined. Associations between vitamin D and periodontal health status were studied using logistic regression analysis. Results A statistically significant association was found between serum 1,25(OH)2 D level and periodontal health status; in that subjects with a low 1,25(OH)2 D were more likely to belong to the periodontitis group (OR = 0.97, 95% CI = 0.95-1.00). There was practically no association between 25(OH)D level and periodontal health status. Conclusion In this case-control study low serum 1,25(OH)2 D level appeared to be associated with periodontitis, which was in line with the previously reported associations between serum 1,25(OH)2 D levels and other inflammatory diseases. Whether this association is causal in nature, remains to be confirmed in future studies.

Periodontitis is a chronic inflammatory disease with a multifactorial etiology. We investigated whether human major histocompatibility complex (MHC) polymorphisms (6p21.3) are associated with periodontal parameters. Parogene 1 population samples ( n = 169) were analyzed with 13,245 single nucleotide polymorphisms (SNPs) of the MHC region. Eighteen selected SNPs ( P ≤ 0.001) were replicated in Parogene 2 population samples ( n = 339) and the Health 2000 Survey ( n = 1,420). All subjects had a detailed clinical and radiographic oral health examination. Serum lymphotoxin-α (LTA) concentrations were measured in the Parogene populations, and the protein was detected in inflamed periodontal tissue. In the Parogene 1 population, 10 SNPs were associated with periodontal parameters. The strongest associations emerged from the parameters bleeding on probing (BOP) and a probing pocket depth (PPD) of ≥6 mm with the genes BAT1 , NFKBIL1 , and LTA . Six SNPs, rs11796, rs3130059, rs2239527, rs2071591, rs909253, and rs1041981 ( r 2 , ≥0.92), constituted a risk haplotype. In the Parogene 1 population, the haplotype had the strongest association with the parameter BOP, a PPD of ≥6 mm, and severe periodontitis with odds ratios (95% confidence intervals) of 2.63 (2.21 to 3.20), 2.90 (2.37 to 3.52), and 3.10 (1.63 to 5.98), respectively. These results were replicated in the other two populations. High serum LTA concentrations in the Parogene population were associated with the periodontitis risk alleles of the LTA SNPs (rs909253 and rs1041981) of the haplotype. In addition, the protein was expressed in inflamed gingival connective tissue. We identified a novel BAT1-NFKBIL1-LTA haplotype as a significant contributor to the risk of periodontitis. The genetic polymorphisms in the MHC class III region may be functionally important in periodontitis susceptibility.

Aim To investigate whether the systemic response against a local inflammatory process in periodontium is dependent on the individual's serum lipid composition. Material and methods This study was based on a subpopulation of the Health 2000 Survey that included 878 subjects who were aged between 45 and 64 years, dentate, non-diabetic and non-rheumatic. The inflammatory condition of periodontium was measured by means of the number of teeth with deepened (4 mm or deeper) periodontal pockets. Systemic inflammation was assessed by means of the serum levels of interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α). The association between an inflammatory condition in the periodontium and the systemic inflammatory response was analyzed using linear regression models. Results The number of teeth with deepened periodontal pockets was associated with elevated serum IL-6 levels among subjects with an unfavourable lipid composition (low-density lipoprotein cholesterol ≥ 3.7 mmol/l or high-density lipoprotein cholesterol < 1.3 mmol/l). There was no association between serum TNF-α levels and the number of teeth with deepened periodontal pockets in these data. Conclusion The systemic response against the inflammatory condition of periodontium varied between individuals. The variation appeared to be dependent on the serum lipid composition or related factors. This article is protected by copyright. All rights reserved.

Aim The goal of this study was to explore whether insulin resistance and beta cell function are related to periodontal pocket formation, indicative of infectious periodontal disease in non-smoking adults without manifest diabetes. Material and Methods We analysed data from a Health 2000 Survey consisting of dentate subjects without any indication of diabetes, aged between 30 and 64, who had never smoked and who had participated in the Follow-up Study on Finnish Adults' Oral Health about 4 years later (n = 157). The Homeostasis Model Assessment Indices were used to measure insulin resistance (HOMA-IR) and β-cell function (HOMA-B). The development of periodontal disease was measured by means of the incidence of deepened periodontal pockets (4 mm deep or deeper) during the follow-up period. Incidence rate ratios (IRR) were estimated using Poisson regression models. Results Both HOMA-IR and HOMA-B indices were associated with periodontal pocket formation during the 4-year follow-up. Conclusion The results of this follow-up study suggest that impaired glucose metabolism measured as insulin resistance and altered beta cell function predict the breakdown of periodontal tissues. Further studies about their role in the pathogenesis of periodontal diseases are needed.

The aim of the present study was to investigate associations between serum concentrations of vitamin D metabolites, 25-hydroxyvitamin D [25(OH)D], and its active form, 1,25-dihydroxyvitamin D [1,25(OH)D], and the severity of chronic periodontitis.Presence of dental plaque, probing pocket depth (PD), and attachment level in 80 type 1 diabetes mellitus subjects were recorded. The serum levels of 25(OH)D, 1,25(OH)D, ultrasensitive C-reactive protein, IL-6, TNF-α, high-density lipoprotein cholesterol, and glycosylated hemoglobin (percentage) were determined. Multivariate regression models were used to explore the associations between serum 25(OH)D (nanomoles per liter) and 1,25(OH)D (picomoles per liter) levels and periodontal health status.Antiinfective periodontal therapies were delivered and the clinical examination and laboratory analyses were repeated 8 weeks after the therapies.A statistically significant association was found between the serum level of 1,25(OH)D (odds ratio 1.06, 95% confidence interval 1.02-1.11) and periodontal health at the baseline; subjects with a high level were more likely to belong to the group of no or mild periodontitis. The serum level of 1,25(OH)D showed a statistically significant increase after antiinfective periodontal therapy in both no or mild (P = .001) and moderate or severe periodontitis (P.001) subjects. The association between serum 25(OH)D level and periodontal health was negligible.This study has shown a significant positive association between the serum 1,25(OH)D level and periodontal health status. To what extent this association is causal in nature remains to be confirmed.

The aim was to study the determinants of preventive oral health care need among community-dwelling old people. The study population consisted of 165 participants, a subpopulation in the Geriatric Multidisciplinary Strategy for Good Care of Elderly People (GeMS) study. Fifty-five percent of the edentate participants with full dentures and 82% of the dentate had a need for preventive oral health care. In the total study population, the need for preventive care was associated with co-morbidity (measured by means of the Modified Functional Co-morbidity Index) odds ratios (OR) 1.2 (confidence intervals [CI] 1.0-1.5), being pre-frail or frail, OR 2.5 (CI 1.2-5.1), presence of natural teeth, OR 4.8 (CI 2.2-10.4), and among dentate participants, the use of a removable partial denture, OR 12.8 (CI 1.4-114.4). Primary care clinicians should be aware of the high need for preventive care and the importance of nonoral conditions as determinants of preventive oral health care need.

Aim To examine whether a Nordic diet measured by the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS) is associated with periodontal condition. Material and Methods The study population consisted of non-smoking, non-diabetic and non-rheumatoid individuals in the Health 2000 Survey in Finland. Analyses were made in two age groups (30–49 years (n = 1210) and 50–79 years (n = 977)) and subsequently in two oral hygiene groups (good oral hygiene and poor oral hygiene). The number of sextants with gingival bleeding and the number of teeth with deepened periodontal pockets were used as outcome variables. Dietary data were collected by a validated food frequency questionnaire. Results Both the BSDS and the RFDS were weakly, although statistically significantly associated with less gingival bleeding in the younger age group (p = 0.019, p

Aim To examine whether the intake of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) is associated with periodontal condition. Material and Methods The study population consisted of non-smoking, non-diabetic and non-rheumatoid individuals in the Health 2000 Survey in Finland. Analyses were made in two age groups: 30–49 years (n = 1212) and 50–79 years (n = 980). Clinically determined sextants with gingival bleeding and teeth with periodontal pockets were used as outcome variables. Dietary data were collected by a validated food frequency questionnaire. Energy-adjusted intakes of arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), omega-3 and omega-6 PUFAs, as well as ratios of EPA/AA and of DHA/AA, and omega-3/omega-6 PUFAs were used as exposures. Prevalence rate ratios were estimated using Poisson regression models. Results In this population, there were no statistically significant associations between the examined omega-3 or omega-6 fatty acids or their ratios and the periodontal outcome variables. Conclusions This cross-sectional study provided evidence that individual omega-3 or omega-6 fatty acids, their subclasses or ratios are not associated with periodontal health among a non-diabetic, non-rheumatoid and non-smoking population.

Objective: The aim was to investigate how sedative load and the total number of drugs used are related to hyposalivation and xerostomia among 75‐year‐old or older dentate, non‐smoking, community‐dwelling people. Materials and Methods: The study population consisted of 152 older people from the Oral Health GeMS study. The data were collected by interviews and clinical examinations during 2004–2005. Sedative load, which measures the cumulative effect of taking multiple drugs with sedative properties, was calculated using the Sedative Load Model. Results: The results showed that participants with a sedative load of either 1–2 or ≥3 had an increased likelihood of having low stimulated salivary flow (

doi: 10.1111/j.1741-2358.2012.00679.x Salivary flow rate and risk of malnutrition – a study among dentate, community-dwelling older people Objective: To analyse the relation between unstimulated and stimulated salivary secretion and the risk of malnutrition among home-dwelling elderly people. Background: Saliva has an important role in eating. Despite this, there are only a few studies on the role of salivary secretion in the development of malnutrition among elderly people. Materials and methods: The study population consisted of 157 subjects aged 75 or older. This was a part of GeMS study carried out in Kuopio, in eastern Finland. The data used in this study were collected by means of interviews and geriatric and oral clinical examinations. The risk of malnutrition was measured using the Mini Nutritional Assessment Short-Form. Logistic regression models were used to estimate odds ratios (OR) and their 95% Confidence Intervals (CI). Results: Subjects with a low unstimulated salivary flow rate (

doi: 10.1111/j.1741-2358.2010.00427.x Associations of instrumental activities of daily living and handgrip strength with oral self-care among home-dwelling elderly 75+ Objective: To study the associations of instrumental activities of daily living (IADL) and the handgrip strength with oral self-care among dentate home-dwelling elderly people in Finland. Materials and methods: The study analysed data for 168 dentate participants (mean age 80.6 years) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study. Each participant received a clinical oral examination and structured interview in 2004–2005. Functional status was assessed using the IADL scale and handgrip strength was measured using handheld dynamometry. Results: Study participants with high IADL (scores 7–8) had odds ratios (ORs) for brushing their teeth at least twice a day of 2.7 [95% confidence intervals (CI) 1.1–6.8], for using toothpaste at least twice a day of 2.0 (CI 0.8–5.2) and for having good oral hygiene of 2.8 (CI 1.0–8.3) when compared with participants with low IADL (scores ≤6). Participants in the upper tertiles of the handgrip strength had ORs for brushing the teeth at least twice a day of 0.9 (CI 0.4–1.9), for using the toothpaste at least twice a day of 0.9 (CI 0.4–1.8) and for good oral hygiene of 1.1 (CI 0.5–2.4) in comparison with the study subjects in the lowest tertile of handgrip strength. Conclusion: The results of this study suggest that the functional status, measured by means of the IADL scale, but not handgrip strength, is an important determinant of oral self-care among the home-dwelling elderly.

Aim High-density lipoprotein (HDL) cholesterol is known for its anti-inflammatory and antioxidant activities in protection against cardiovascular diseases. We investigated whether a protective association also exists between serum HDL and periodontal inflammation in type 1 diabetic subjects (T1DM). Methods Plaque and periodontal inflammation (bleeding and PD ≥ 4 mm) were examined in 80 subjects with T1DM. The serum levels of glycosylated haemoglobin (HbA1c, %) and HDL (mmol/l) were determined. Adjusted associations between inflammation and serum HDL were analysed using linear regression analysis. To study the linearity of the association, the subjects were categorized into HDL tertiles (I-III). Results A statistically significant negative association was observed between serum HDL level and the extent of bleeding and PD ≥ 4 mm. Subjects in HDL tertiles II and III (high HDL) presented significantly fewer inflamed sites when compared with the subjects in tertile I (low HDL), whereas no significant difference in the number of inflamed sites was observed between tertiles II and III. Conclusions Based on the finding of a negative association between serum HDL and periodontal inflammation, HDL may be considered a marker of susceptibility to periodontal inflammation. A longitudinal study is needed to verify possible causal relationship between serum HDL and inflammation.

Komulainen K, Ylostalo P, Syrjala A-M, Ruoppi P, Knuuttila M, Sulkava R, Hartikainen S. Preference for dentist’s home visits among older people. Community Dent Oral Epidemiol 2012; 40: 89–95. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate factors associated with older people’s preference for a dentist’s home visit. Methods: This is a report on 321 home-dwelling participants (mean age 81.6) in the population-based Geriatric Multidisciplinary Strategy for Good Care of the Elderly (GeMS) study, conducted in 2004–2005 in the city of Kuopio in eastern Finland. The information about sociodemographic and general health-related factors and the use of social and health services was collected by two study nurses using a structured interview. Each study subject was given a clinical oral examination and an interview about oral health and the use of dental health care services by one of two dentists. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Of the study subjects, 25.9% preferred a dentist’s home visit. The preference for choosing a dentist’s home visit was associated with a low score (≤24) in the Mini-Mental State Examination, OR 6.1 (CI: 2.9–13.6), and a low score (

AIM The aim of this cross-sectional study was to investigate whether serum total cholesterol/high-density lipoprotein cholesterol (TC/HDL) ratio and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL/HDL) ratio are associated with periodontal infection. MATERIALS AND METHODS This study was based on a subpopulation of the Health 2000 Survey, which included dentate, non-diabetic subjects who had never smoked and who were aged between 30 and 49 years (n=1297). The numbers of teeth with deepened (4 mm deep or deeper) and with deep (6 mm deep or deeper) periodontal pockets were used as outcome variables, as well as the presence of gingival bleeding. RESULTS We found no consistent associations between TC/HDL or LDL/HDL ratios and the number of teeth with deepened periodontal pockets or the presence of gingival bleeding among normal weight subjects. Nor were there any consistent associations between TC/HDL or LDL/HDL ratios and the number of teeth with deepened periodontal pockets or the presence of gingival bleeding among subjects whose body mass index was 25 or more. CONCLUSIONS This study does not provide evidence that unfavourable lipid composition can be considered as an important risk for periodontal infection in a general adult population.

Passoja A, Knuuttila M, Hiltunen L, Karttunen R, Niemela O, Raunio T, Vainio O, Hedberg P, Tervonen T. Serum IL-6 may modulate periodontal inflammation in type 1 diabetic subjects. J Clin Periodontol 2011; 38: 687–693. doi: 10.1111/j.1600-051X.2011.01731.x. Abstract Aims: To evaluate the associations between serum inflammatory biomarkers and periodontal inflammation in subjects with type 1 diabetes mellitus (T1DM). Our hypothesis was that local host responses may be modulated by the serum inflammatory mediators. Material and methods: Plaque, bleeding on probing and probing pocket depth (PD) were examined in 80 T1DM subjects at the baseline and in 58 subjects 8 weeks after periodontal therapy. The levels of glycosylated haemoglobin, serum interleukin (IL)-6, ultrasensitive C-reactive protein and the lipid profile were measured at the baseline and after therapy. Stratification of the sample separately by smoking and body mass index (BMI) was performed. Adjusted associations between the levels of systemic biomarkers and periodontal parameters were studied using multiple regression models. Results: The level of serum IL-6 was associated with the extent of bleeding and PD4 mm at the baseline in non-smokers and in subjects with BMI26 kg/m2. These associations were also evident after periodontal therapy. Subjects with a high after-therapy IL-6 level presented poorer periodontal healing than those with a low level. Conclusions: The observed associations may be considered to be suggestive of a modulatory effect of IL-6 on host responses in T1DM subjects.

AIM We investigated in a nationally representative sample, how periodontitis modifies the association between the carriage of periodontal pathogens and serology. MATERIALS AND METHODS The population comprised 1586 dentate subjects who participated in an interview, clinical and radiological oral health examination, and saliva collection. Serum immunoglobulin A (IgA)- and IgG-class antibody levels against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and their salivary occurrence were determined in the whole population. The quantity of the pathogens was measured in a subpopulation. RESULTS In the univariate analyses, the corresponding antibody levels were higher in the pathogen carriers compared with the non-carriers, and clearly higher in the carriers with periodontal pockets compared with the carriers without. In the multi-variate analyses, however, all antibody levels associated strongly with age (p

Aim To investigate the role of periodontal infection in obesity in an adult population. Material and methods This study was based on a subpopulation of the Health 2000 Survey that included dentate, non-diabetic subjects, aged 30-49 years (n=2784). Obesity was measured using the body mass index (BMI), body fat percentage (BF%) and waist circumference (WC). The extent of periodontal infection was measured using the number of teeth with deepened (4 mm deep or deeper) periodontal pockets and was categorized into four categories (0, 1-3, 4-6, 7 or more). Results The number of teeth with deepened periodontal pockets was found to be associated with BMI in an exposure-response manner among the total study population. The association was found among men and women, and also among never-smokers. The number of teeth with deepened periodontal pockets was also associated with BF% and WC among never-smokers. Conclusion Periodontal infection measured by means of the number of teeth with deepened periodontal pockets appears to be associated with obesity. However, no inferences about causality can be made and further studies are needed to clarify the possible role of periodontal infection in obesity.

Oral Diseases (2011) 17, 387–392 Objective: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home-dwelling elderly people aged 75 years or older. Subjects and Methods: This study was based on a subpopulation of 157 (111 women, 46 men) home-dwelling, dentate, non-smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination. Results: Persons with very low (

Timonen P, Suominen-Taipale L, Jula A, Niskanen M, Knuuttila M, Ylostalo P: Insulin sensitivity and periodontal infection in a non-diabetic, non-smoking adult population. J Clin Periodontol 2011; 38: 17–24. doi: 10.1111/j.1600-051X.2010.01642.x Abstract Aim: The aim of this study was to examine whether there is an association of insulin sensitivity with periodontal infection in a non-diabetic, non-smoking adult population. Materials and Methods: A subpopulation of the Health 2000 Survey (effective n=2050) consisted of dentate subjects without any indication of diabetes, aged between 30 and 64, and who had never smoked. The outcome variable was periodontal infection measured by means of the number of teeth with deepened periodontal pockets. Insulin sensitivity was measured using the homeostasis model assessment index for insulin resistance. Poisson regression models were used to estimate the relative risks and 95% confidence intervals. Results: We found that insulin sensitivity was associated with periodontal infection in the age group 30–49, but not in persons aged 50–64. Controlling for body weight made the association between insulin sensitivity and periodontal infection disappear. Conclusion: The lack of knowledge of the underlying causal model prevents making definite conclusions about the role of reduced insulin sensitivity in the pathogenesis of periodontal infection.

Bernabe E, Suominen AL, Nordblad A, Vehkalahti MM, Hausen H, Knuuttila M, Kivimaki M, Watt RG, Sheiham A, Tsakos G. Education level and oral health in Finnish adults: evidence from different lifecourse models. J Clin Periodontol 2011; 38: 25–32. doi: 10.1111/j.1600-051X.2010.01647.x. Abstract Aim: To assess the relationship between education level and several oral health outcomes in Finnish adults, using three conceptual lifecourse models. Materials and Methods: This study analysed data from 7112 subjects, aged 30 years or over, who participated in the nationally representative Finnish Health 2000 Survey. Parental and own education levels were the childhood and adulthood socioeconomic measures, respectively. Oral health was indicated by edentulousness, perceived oral health and levels of dental caries and periodontal disease. Three conceptual lifecourse models, namely critical period, accumulation and social trajectories, were separately tested in regression models. Results: In line with the critical period model, parental and own education levels were independently associated with oral health after mutual adjustment. There was also a graded linear relationship between the number of periods of socioeconomic disadvantage and oral health, corresponding to the accumulation model. Gradual declines in oral health were evident between social trajectories from persistently high to upwardly mobile, downwardly mobile and persistently low groups. Conclusion: There was similar support for the lifecourse models of critical period, accumulation and social trajectories. They collectively contribute to a better understanding of oral health inequalities.

Saxlin T, Ylostalo P, Suominen-Taipale L, Aromaa A, Knuuttila M. Overweight and obesity weakly predict the development of periodontal infection. J Clin Periodontol 2010; doi: 10.1111/j.1600-051X.2010.01633.x. Abstract Aim: The aim of this study was to investigate the association between body weight and periodontal infection in a longitudinal setting. Material and methods: This study was based on a subpopulation of the Health 2000 Survey that included dentate, non-diabetic subjects aged 30–59 years, who had never smoked and who had participated in the Follow-Up Study on Finnish Adults' Oral Health approximately 4 years later (n=396). The number of new teeth with deepened (4 mm deep or deeper) periodontal pockets in the follow-up examination was used as the outcome variable. Body weight was measured using body mass index, categorized into three categories

Mattila PT, Niskanen MC, Vehkalahti MM, Nordblad A, Knuuttila MLE. Prevalence and simultaneous occurrence of periodontitis and dental caries. J Clin Periodontol 2010; 37: 962–967. doi: 10.1111/j.1600-051X.2010.01620.x. Abstract Aim: The aim of the study was to evaluate the prevalence and simultaneous occurrence of periodontal disease and dental caries in Finnish adults. Material and Methods: The study was performed as part of the nationally representative Health 2000 Survey. The study population was 5255 subjects aged 30 years and older. Probing pocket depth (PPD) and untreated dentinal caries were recorded by tooth. Teeth with PPD 4 mm and deeper indicated periodontal disease, and teeth with PPD 6 mm and deeper indicated a severe periodontal disease. Results: Sixty-four percent of persons had periodontal disease, 21% had a severe periodontal disease, and 29% had dental caries. Persons having periodontal disease had significantly more often dental caries (33%) compared with those without periodontal disease (23%). This was even more evident in persons having severe periodontal disease (44%). Accordingly, persons having dental caries had significantly more often severe periodontal disease (31%) compared with those without dental caries (16%). The mean number of teeth with dental caries or periodontal disease per person was greater when the mean number of teeth with the other disease was also greater. Conclusions: These data indicate that especially severe periodontal disease and dental caries tend to accumulate in the same subjects.