Periodontal conditions in a 65-year-old population and prevalence of periodontitis according to three different bone level thresholds

Abstract

Aims The aims of this cross-sectional study were to describe the prevalence and severity of periodontal disease in a 65-year-old population in Oslo, Norway, and to investigate to what extent the radiographic bone level threshold for periodontitis case definition influences the prevalence. Materials and methods A random sample of 454 subjects underwent a clinical and radiographic examination and answered a questionnaire regarding general health, medications, and smoking habits. Clinical periodontal parameters (periodontal pocket depths, bleeding on probing, mobility, and furcation involvement) and radiographic bone loss were used to identify periodontitis cases and to assess periodontal stage and grade. Results Of the 454 participants, 52.6% were defined as “periodontitis cases”. Of the total study population “unstable cases of recurrent periodontitis” were present in 38.1%, 16.5% of the participants were assigned to stage II, 32.8% to stage III, and 3.3% to stage IV. When lowering the radiographic bone loss cutoff from > 3 mm to > 2 mm or > 1 mm the prevalence of periodontitis increased to 91.9% and 99.6%. Conclusions Periodontitis was common among 65 year-olds living in Oslo, and in the majority of those with periodontitis, the disease was recurrent and unstable. This study also shows that the choice of bone loss cutoff for defining a periodontitis case affects the prevalence estimates to a large extent. In addition, this study addresses weaknesses in the use of the consensus report of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions for epidemiologic studies in its current form.

Periodontitis in a 65-year-old population: risk indicators and impact on oral health-related quality of life

“…Seven participants were excluded from the analyses due to < 2 remaining teeth (n = 3) or missing questionnaire (n = 4), resulting in a study sample of 453 individuals. The recruitment process has been described in detail in a previous publication [ 14 ]. One of the participants that was excluded due to missing questionnaire had severe periodontitis, therefore the prevalence of periodontitis (52.5%) and severe periodontitis (36.0%) in the present paper differ slightly from the previous publication (52.6% and 36.1% respectively) [ 14 ].…”

“…In addition, the number of patients per dentist in Norway is lower compared to most countries in the world and a large proportion of Norwegian dental practitioners have reported that they have an insufficient number of patients [ 13 ]. Despite this public financial support and readily accessible dental health services, a recent study on the same sample population as the present showed a periodontitis prevalence of 52.6% [ 14 ]. This is within the range of other recent studies from Norway (33–81%) [ 4 , 5 , 15 , 16 ].…”

“…In order to detect and document oral conditions with a prevalence of at least 10%, and the possibility for longitudinal follow-up after 5 years, the final sample size estimate was 450 individuals. The recruitment procedure has been described in detail in previous publications [ 14 , 29 ]. The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK 2018/1383), and performed in compliance with the tenets of the Declaration of Helsinki.…”

“…BW were obtained using an intraoral imaging unit (MINIRAY, SOREDEX, PaloDEx Group Oy, Tuusula, Finland) with a rectangular collimator (length 30.5 cm). The periodontal status was assessed based on the consensus report from 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions (2018 EFP/AAP classification) [ 25 , 26 ], and the examination protocol and reproducibility of the examiners have been described in detail in a previous publication [ 14 ]. Briefly, for % radiographic bone loss the ICC (95% CI) was 0.79 (0.66–0.86) for inter-examiner agreement and 0.88 (0.86–0.90) for intra-examiner agreement, and for staging periodontitis the weighted Cohen’s kappa (95% CI) was 0.72 (0.66–0.78) for inter-examiner agreement and 0.90 (0.82–0.98) for inter-examiner agreement.…”

“…Participants with < 2 remaining teeth were excluded from the analyses. The above-mentioned methods have been described in a previous publication [ 14 ]. The results from the descriptive analyses are presented as percentage distributions, mean and standard deviation (SD) or median and inter quartile range (IQR).…”