Trends over 30 years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio‐economic factors – based on epidemiological surveys in Sweden 1983–2013

Abstract

ObjectiveEpidemiological studies of the prevalence of periodontitis over an extended time using the same methodology to investigate and classify periodontitis are sparse in the literature. Smoking and socio‐economic factors have been proven to increase the risk for periodontal disease. The objective of this study was to investigate 30‐year time trends, using the same methodology to classify the prevalence and severity in alveolar bone loss (ABL) and to investigate the influence of tobacco and socio‐economic factors.MethodsFour cross‐sectional epidemiological studies in an adult population were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 787–1133 individuals aged 35–85 who answered a questionnaire about tobacco use and socio‐economic factors were radiographically and clinically examined. A number of teeth, ABL and calculus visible on radiographs were registered. The severity of ABL as detected on radiographs was classified into no bone loss, moderate or severe.ResultsThe prevalence of moderate ABL decreased from 45% in 1983 to 16% in 2008, but increased to 33% in 2013 (P < 0.05). The prevalence of severe ABL remained the same from 1983 (7%) to 2013 (6%). Calculus visible on radiographs increased from 22% in 2008 to 32% in 2013 (P < 0.05). Socio‐economic factors had limited impact on the severity of ABL.ConclusionModerate ABL and calculus visible on radiographs significantly increased between 2008 and 2013. Smoking was the strongest factor associated with ABL overall.

Attitudes to dental care, Sweden 2003‐2013, and clinical correlates of oral health‐related quality of life in 2013

“…The sample was then grouped into five age intervals: 30‐41, 42‐58, 59‐71, 72‐77 and 78‐85 years, resulting in mean ages as close to 35 (35.2), 50 (50.2), 65 (65.2), 75 (74.7) and 85 (80.5) as possible (Table ). For further details, see Edman et al …”

“…The severity of ABL was based on bone levels at interproximal sites visible on radiographs in the premolar and molar regions, and categorized into “no bone loss,” “moderate bone loss” and “severe bone loss.” The categorization of ABL was performed by two of the authors, and manifest caries was confirmed on bite‐wing radiographs by the authors. Details regarding the different parameters have been reported in greater detail elsewhere . Temporomandibular disorders (TMD) were determined by three anamnestic questions, based on validated self‐reported pain questions: “Have you constantly or often (once a week or more) problems with ache in the jaws or face?”; “Are you tired or exhausted (once a week or more) in the jaws when, for example, chewing?”; “Have you often (once a week or more) problems with opening wide or locking of the jaw?” The response alternatives were “yes” or “no.” The three TMD‐questions were dichotomized into (0) “no TMD problems” and (1) “TMD problems” (response to at least one of the three questions).…”

“…Poor health‐related behaviours have been found to be more common among less educated individuals and individuals with low income . Low socio‐economic position, in terms of the individual's own socio‐economic position, or parental education or income, and occupational background, have been associated with dental caries lesions, while smoking and negative life events have been found to be associated with periodontal disease in several studies …”

Evaluation of different oral care systems: Results for Germany and selected highly developed countries. An update of a former study

“…Particularly the approximal cleaning, the snacking and the smoking habits of German adults need to be improved, whereby the high smoking rates combined with low approximal self-care might be responsible for the comparatively poor periodontal status of the adult German population [18,23,47].…”

Porphyromonas gingivalis infection in gestational diabetes mellitus and survival in tobacco smokers.

“…Clinical studies have demonstrated that smokers have the more severe periodontal disease [162][163][164]. A recent country wide epidemiological study conducted in Sweden suggested a strong association between smoking and moderate and severe alveolar bone loss overall [165]. In a cohort study carried out in New Zealand, it has been found that the extent and prevalence of alveolar bone loss was greater in smokers compared to never smokers and former smokers [166].…”