Site-level progression of periodontal disease during a follow-up period

Abstract

Periodontal disease is assessed and its progression is determined via observations on a site-by-site basis. Periodontal data are complex and structured in multiple levels; thus, applying a summary statistical approach (i.e., the mean) for site-level evaluations results in loss of information. Previous studies have shown the availability of mixed effects modeling. However, clinically beneficial information on the progression of periodontal disease during the follow-up period is not available.We conducted a multicenter prospective cohort study. Using mixed effects modeling, we analyzed 18,834 sites distributed on 3,139 teeth in 124 patients, and data were collected 5 times over a 24-month follow-up period. The change in the clinical attachment level (CAL) was used as the outcome variable. The CAL at baseline was an important determinant of the CAL changes, which varied widely according to the tooth surface. The salivary levels of periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, were affected by CAL progression. “Linear”- and “burst”-type patterns of CAL progression occurred simultaneously within the same patient. More than half of the teeth that presented burst-type progression sites also presented linear-type progression sites, and most of the progressions were of the linear type. Maxillary premolars and anterior teeth tended to show burst-type progression. The parameters identified in this study may guide practitioners in determining the type and extent of treatment needed at the site and patient levels. In addition, these results show that prior hypotheses concerning "burst" and "linear" theories are not valid.

Relationship between herpesviruses and periodontal disease progression

“…Also, our findings that there were increased amount of total bacteria and increased percentage of red complex bacteria (Pg, Td, or Tf) in disease and DP sites unrelated to EBV contrast with the suggestion that EBV is a cofactor in periodontal disease (Contreras & Slots, 2001;Contreras, Umeda, et al, 1999;Contreras, Zadeh, Nowzari, & Slots, 1999;Kato, Imai, Ochiai, & Ogata, 2015;Slots, 2007 when treatment is not provided (Kocher, Konig, Dzierzon, Sawaf, & Plagmann, 2000;Nomura et al, 2017;Ramseier et al, 2017). Further, our findings suggest that the standard of care is effective for most sites (i.e.…”

“…Further, more needs to be done to identify the risk factors involved in disease progression, and how best to prevent disease progression. As practitioners target more precise therapies, it is important to realize that Pg, Td, and Tf are strongly associated with disease progression as documented by our findings and many others (Farias et al, 2012;Nomura et al, 2017;Teles et al, 2008); thus, these periodontal pathogens should be targeted for elimination, if progression of periodontitis is to be halted.…”

“…Thus, these findings suggest that practitioners can potentially expect that at least 25% of their patients over the age of 40 years who have periodontitis to experience disease progression despite the delivery of the standard of care. This provides a perspective compared to the natural history of periodontal disease when treatment is not provided (Kocher, Konig, Dzierzon, Sawaf, & Plagmann, ; Nomura et al, ; Ramseier et al, ). Further, our findings suggest that the standard of care is effective for most sites (i.e.…”

Tooth-Level Analysis of Dental Caries in Primary Dentition in Myanmar Children

“…When tooth-level analysis is carried out, each tooth is not statistically independent, as each tooth is nested in a subject’s and tooth’s constructed hierarchy structure. The mixed-effect model was used to calculate the sensitivity for dental caries at the tooth level [ 39 , 40 ]. Sex and age were used for the subject-level parameter, and with or without dental caries by tooth was used for the tooth-levels parameter.…”

The combined use of salivary biomarkers and clinical parameters to predict the outcome of scaling and root planing: A cohort study

“…actinomycetemcomitans in saliva were significantly related to the progression of periodontitis during periodontal maintenance (Morozumi et al, 2016;Nomura et al, 2012Nomura et al, , 2017). In the current study, P. gingivalis, P. intermedia, A. actinomycetemcomitans and T. forsythia in saliva at baseline were analysed; we found that the detection of A. actinomycetemcomitans increased the probability of further attachment loss in the multivariate model, while, surprisingly, a lower T. forsythia load was associated with a higher probability of further attachment loss in both univariate and multivariate models.…”