Clinical and other risk indicators for early periodontitis in adults

Abstract

Background: Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis.

Methods: A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated.

Results: Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites.

Conclusions: In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces.

Figure 1

Clinical characteristics of subjects by ethnic and racial group A) shows deeper mean PD and periodontal AL in African-American and Hispanic subjects. B) African-American and Hispanic subjects had higher percent of sites BOP, sites with PD >3 mm and AL > 2 mm, and higher proportions of current smokers. *P >0.001; †P >0.02.

Figure 2

Subject mean periodontal attachment levels plotted against, mean gingival index (A) and mean percent bleeding on probing (B). Mean attachment levels ranged from 0.8 mm to 2 mm. There were significant positive associations (Table 3) between mean attachment levels and both these measures of gingival inflammation.

Figure 3

Percents of sites by tooth type with PD >3 mm. A) Illustrates interproximal sites. B) Illustrates buccal and lingual sites, using a smaller scale than for interproximal sites. At interproximal sites, posterior teeth were more often affected than anterior teeth, with lower second molars showing more sites with loss than other teeth. There were fewer sites with periodontal pockets >3 mm loss at buccal and lingual sites compared with interproximal sites, although the distributionacross tooth types of buccal/lingual PD was similar to that of interproximal sites. *Tooth sites are ordered 1 = central incisor, to 7=second molar:

Figure 4

Teeth with periodontal attachment loss grouped by number of sites with AL > 2 mm (1–2, 3–6, 7–15 or >16 sites) to reflect subjects disease severity. Teeth are ordered 1=central incisor; to 7 = second molar. A) Mandibular lower molars were most frequently affected at all levels of subjects’ disease severity. B) There were generally fewer sites with loss at buccal and lingual sites compared by tooth type with interproximal sites. The distribution of maxillary buccal/lingual sites with attachment loss was similar to that of interproximal sites. The distribution of mandibular buccal/lingual sites with attachment loss showed a different pattern with the lower first bicuspid (tooth 4), as well as incisors and canines, exhibiting increased frequencies of periodontal attachment loss.