Incidence of attachment loss in community dwelling older adults
The purpose of this study was to present the incidence of attachment loss over 18 months in a representative sample by using a multivariate prediction model to distinguish who will and will not experience disease progression. Five dentists examined a population of 811 older adults (population was part of Piedmong 65 + Study).The gingival recession and probing depth measured on two sites per tooth were used. Microbiological assays included BANA and immunofluorescent assays for A. actinomycetemcomitans, P. intermedia, and P. gingivalis (samples were taken from lower R0 second molars for BANA assays and from MB aspects of the four first molar teeth for the immunofluorescent assay). Six hundred and eleven participants out of 818 were reexamined after 18 months (263 blacks and 229 whites). A change in attachment loss of 3 mm or more over the 18 months was set as a conservative estimate of actual change taking place. Blacks were significantly more likely to experience attachment loss irrespective of the sites involved. Fifty percent of the samples had at least one losing site. One-third of the blacks and one-fourth of the whites had two losing sites; 24% of the blacks and 16% of the whites had three or more losing sites. The extent of loss was 6.17% sites for blacks and 3.10% for whites.
When broken down by age, this difference in extent by race was significant for all groups except the youngest age group. When compared by gender there were no differences, but males tended to show more extensive loss of attachment in both races. Higher scores were seen in individuals having less than 12 years of education (for both, blacks and whites).The multivariate etiologic models for blacks implicate the presence of P. gingivalis and P. intermedia in concentrations greater than 27%. In addition, poor oral hygiene, non-compliance with regular dental visits and those with memory deficits were at higher risk of attachment loss. The etiologic model for whites indicates that people who had P. gingivalis in concentrations greater than 27% were at higher risk for attachment loss. People who smoked cigarettes regularly were at higher risk, but the only significant risk predictor for both races was having a serious case of periodontitis at baseline. In conclusion, the only significant risk predictor was having serious periodontal disease at baseline. [c.c.]
Brown, L.F., J.D. Beck, and G.R. Rozier, J Periodont, 65:316, 1994