Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort

BMC Oral Health

Heiko Becher^1,10  Ti-Sun Kim^1,12  Astrid Steinbrecher⁸  Marc Schmitter²  Stefanie Samietz⁶  Tobias Pischon⁸  Nicole Pischon³  Christa Meisinger^1,11  Jakob Linseisen^1,11  Jan Kühnisch⁴  Karin Halina Greiser⁵  Julia Fricke⁷  Nihad El-Sayed^1,12  Katja Diercke¹  Daniel Hagenfeld⁹  Heiko Zimmermann^1,13 

[1] Department of Orthodontics, University of Heidelberg, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany;Department of Prosthodontics, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany;Department of Periodontology and Synoptic Dentistry, Charité - University Medicine Berlin, Berlin, Germany;Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University of Munich, Goethestraße 70, 80336 München, Germany;Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld, 581, 69120 Heidelberg, Germany;Poliklinik für zahnärztliche Prothetik und Medizinische Werkstoffkunde Zentrum für Zahn, Mund- und Kieferheilkunde Universitätsmedizin Greifswald, Greifswald, Germany;Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany;Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch, Robert-Rössle-Strasse 10, 13125 Berlin, Germany;Policlinic of Periodontology, University-Hospital of Münster, Münster, Germany;Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany;Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany;Department of Conservative Dentistry, Section of Periodontology, University of Heidelberg, lm Neuenheimer Feld 400, 69120 Heidelberg, Germany;Institute of Public Health, University of Heidelberg, lm Neuenheimer Feld 324, 69120 Heidelberg, Germany

关键词: German National Cohort;    Bleeding on probing;    Laboratory parameters;    BMI;    Dental examination;    Periodontitis;   

Others  :  1118171
DOI  :  10.1186/1472-6831-15-7

 received in 2014-07-23, accepted in 2015-01-03,  发布年份 2015

【 摘 要 】

Background

To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated.

Methods

From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis.

Results

Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis.

Conclusions

Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

【 授权许可】

   
2015 Zimmermann et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Schaudinn C, Gorur A, Keller D, Sedghizadeh PP, Costerton JW: Periodontitis: an archetypical biofilm diseas. J Am Dent Assoc 2009, 140:978-986.
• [2]Socransky SS, Haffajee AD: The bacterial etiology of destructive periodontal disease: current concepts. J Periodontol 1992, 63:322-331.
• [3]Page RC, Kornman KS: The pathogenesis of human periodontitis: an introduction. Periodontol 1997, 14:9-11.
• [4]Calsina G, Ramón J-M, Echeverría J-J: Effects of smoking on periodontal tissues. J Clin Periodontol 2002, 29:771-776.
• [5]Johnson GK, Slach NA: Impact of tobacco use on periodontal status. J Dent Educ 2001, 65:313-321.
• [6]Salvi GE, Carollo-Bittel B, Lang NP: Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks. J Clin Periodontol 2008, 35:398-409.
• [7]Emrich LJ, Shlossman M, Genco RJ: Periodontal-Disease in Non-Insulin-Dependent Diabetes-Mellitus. J Periodontol 1991, 62:123-131.
• [8]Hodge PJ, Robertson D, Paterson K, Smith GL, Creanor S, Sherriff A: Periodontitis in non-smoking type 1 diabetic adults: a cross-sectional study. J Clin Periodontol 2012, 39:20-29.
• [9]Schaefer AS, Richter GM, Groessner-Schreiber B, Noack B, Nothnagel M, El Mokhtari NE, et al.: Identification of a shared genetic susceptibility locus for coronary heart disease and periodontitis. PLoS Genet 2009, 5:e1000378.
• [10]Schaefer AS, Richter GM, Nothnagel M, Laine ML, Ruhling A, Schafer C, et al.: A 3′ UTR transition within DEFB1 is associated with chronic and aggressive periodontitis. Genes Immun 2010, 11:45-54.
• [11]Schaefer AS, Richter GM, Nothnagel M, Manke T, Dommisch H, Jacobs G, et al.: A genome-wide association study identifies GLT6D1 as a susceptibility locus for periodontitis. Hum Mol Genet 2010, 19:553-562.
• [12]Cobb CM, Williams KB, Gerkovitch MM: Is the prevalence of periodontitis in the USA in decline? Periodontol 2009, 50:13-24.
• [13]Locker D, Slade GD, Murray H: Epidemiology of periodontal disease among older adults: a review. Periodontol 1998, 16:16-33.
• [14]Genco RJ: Current view of risk factors for periodontal diseases. J Periodontol 1996, 67:1041-1049.
• [15]Timmerman MF, der Weijden GAV: Risk factors for periodontitis. Int J Dent Hyg 2006, 4:2-7.
• [16]Heitz-Mayfield LJ: Disease progression: identification of high-risk groups and individuals for periodontitis. J Clin Periodontol 2005, 32:196-209.
• [17]Pistorius A, Krahwinkel T, Willershausen B, Boekstegen C: Relationship between stress factors and periodontal disease. Eur J Med Res 2002, 7:393-398.
• [18]Gorelick PB: Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy. Stroke 2002, 33:862-875.
• [19]Grau AJ, Becher H, Ziegler CM, Lichy C, Buggle F, Kaiser C, et al.: Periodontal disease as a risk factor for ischemic stroke. Stroke 2004, 35:496-501.
• [20]Kim H-D, Sim S-J, Moon J-Y, Hong Y-C, Han D-H: Association between periodontitis and hemorrhagic stroke among Koreans: a case–control study. J Periodontol 2010, 81:658-665.
• [21]Bahekar AA, Singh S, Saha S, Molnar J, Arora R: The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J 2007, 154:830-837.
• [22]Persson GR, Persson RE: Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol 2008, 35:362-379.
• [23]Andriankaja OM, Genco RJ, Dorn J, Dmochowski J, Hovey K, Falkner KL, et al.: Periodontal disease and risk of myocardial infarction: the role of gender and smoking. Eur J Epidemiol 2007, 22:699-705.
• [24]Cueto A, Mesa F, Bravo M, Ocaña-Riola R: Periodontitis as risk factor for acute myocardial infarction. A case control study of Spanish adults. J Periodontal Res 2005, 40:36-42.
• [25]Georgiou T, Marshall R, Bartold MP: Prevalence of systemic diseases in Brisbane general and periodontal practice patients. Aust Dent J 2004, 49:177-184.
• [26]Niedzielska I, Janic T, Cierpka S, Swietochowska E: The effect of chronic periodontitis on the development of atherosclerosis: review of the literature. Med Sci Monit 2008, 14:RA103-RA106.
• [27]Bourgeois D, Bouchard P, Mattout C: Epidemiology of periodontal status in dentate adults in France, 2002–2003. J Periodontal Res 2007, 42:219-227.
• [28]Gera I: Periodontal treatment needs in Central and Eastern Europe. Fogorv Sz 2004, 97:179-189.
• [29]Holtfreter B, Kocher T, Hoffmann T, Desvarieux M, Micheelis W: Prevalence of periodontal disease and treatment demands based on a German dental survey (DMS IV). J Clin Periodontol 2010, 37:211-219.
• [30]Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C: The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005, 83:661-669.
• [31]Micheelis W: Oral health in Germany: an oral epidemiological outline. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011, 54:1022-1026.
• [32]Demmer RT, Papapanou PN: Epidemiologic patterns of chronic and aggressive periodontitis. Periodontol 2010, 53:28-44.
• [33]Gatke D, Holtfreter B, Biffar R, Kocher T: Five-year change of periodontal diseases in the Study of Health in Pomerania (SHIP). J Clin Periodontol 2012, 39:357-367.
• [34]Struch F, Dau M, Schwahn C, Biffar R, Kocher T, Meisel P: Interleukin-1 gene polymorphism, diabetes, and periodontitis: results from the Study of Health in Pomerania (SHIP). J Periodontol 2008, 79:501-507.
• [35]Demmer RT, Desvarieux M, Holtfreter B, Jacobs DR Jr, Wallaschofski H, Nauck M, et al.: Periodontal status and A1C change: longitudinal results from the study of health in Pomerania (SHIP). Diabetes Care 2010, 33:1037-1043.
• [36]Holtfreter B, Schwahn C, Biffar R, Kocher T: Epidemiology of periodontal diseases in the Study of Health in Pomerania. J Clin Periodontol 2009, 36:114-123.
• [37]Wichmann HE, Kaaks R, Hoffmann W, Jockel KH, Greiser KH, Linseisen J: The German national cohort. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012, 55:781-787.
• [38]German National Cohort (GNC) Consortium: The German national cohort: aims, study design and organization. Eur J Epidemiol 2014, 29:371-382.
• [39]Cutress TW, Ainamo J, Sardo-Infirri J: The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987, 37:222-233.
• [40]Lang NP, Adler R, Joss A, Nyman S: Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol 1990, 17:714-721.
• [41]Lang NP, Joss A, Orsanic T, Gusberti FA, Siegrist BE: Bleeding on probing. A predictor for the progression of periodontal disease? J Clin Periodontol 1986, 13:590-596.
• [42]Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al.: The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 2007, 35:170-178.
• [43]Li DY, Guo JJ, Zhao JJ, Ge SY, Wang ZH, Ye J: Analysis of pathogenic relations between dental caries and periodontitis. Shanghai kou qiang yi xue = Shanghai journal of stomatology 2002, 11:289-290.
• [44]Al Omari MA, Al Habashneh R, Taanni DQ: Dental caries experience in patients with aggressive periodontitis compared to those with chronic periodontitis. Quintessence Int 2008, 39:847-851.
• [45]Kinane DF, Jenkins WM, Adonogianaki E, Murray GD: Cross-sectional assessment of caries and periodontitis risk within the same subject. Community Dent Oral Epidemiol 1991, 19:78-81.
• [46]Pitiphat W, Merchant AT, Rimm EB, Joshipura KJ: Alcohol consumption increases periodontitis risk. J Dent Res 2003, 82:509-513.
• [47]Dietrich T, Bernimoulin JP, Glynn RJ: The effect of cigarette smoking on gingival bleeding. J Periodontol 2004, 75:16-22.
• [48]Benguigui C, Bongard V, Ruidavets JB, Sixou M, Chamontin B, Ferrieres J, et al.: Evaluation of oral health related to body mass index. Oral Dis 2012, 18:748-755.
• [49]Loos BG: Systemic markers of inflammation in periodontitis. J Periodontol 2005, 76:2106-2115.
• [50]Kalburgi V, Sravya L, Warad S, Vijayalaxmi K, Sejal P, Hazeil D: Role of systemic markers in periodontal diseases: a possible inflammatory burden and risk factor for cardiovascular diseases? Ann Med Health Sci Res 2014, 4:388-392.
• [51]Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, et al.: IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest 2004, 113:1271-1276.
• [52]Lainson PA, Brady PP, Fraleigh CM: Anemia, a systemic cause of periodontal disease? J Periodontol 1968, 39:35-38.
• [53]Anand PS, Sagar DK, Ashok S, Kamath KP: Association of aggressive periodontitis with reduced erythrocyte counts and reduced hemoglobin levels. J Periodontal Res 2014, 49:719-728.
• [54]Hayashida H, Kawasaki K, Yoshimura A, Kitamura M, Furugen R, Nakazato M, et al.: Relationship between periodontal status and HbA1c in nondiabetics. J Public Health Dent 2009, 69:204-206.
• [55]Holtfreter B, Demmer RT, Bernhardt O, Papapanou PN, Schwahn C, Kocher T, et al.: A comparison of periodontal status in the two regional, population-based studies of SHIP and INVEST. J Clin Periodontol 2012, 39:1115-1124.
• [56]Albandar JM: Underestimation of periodontitis in NHANES surveys. J Periodontol 2011, 82:337-341.
• [57]Tran DT, Gay I, Du XL, Fu Y, Bebermeyer RD, Neumann AS, et al.: Assessing periodontitis in populations: a systematic review of the validity of partial-mouth examination protocols. J Clin Periodontol 2013, 40:1064-1071.
• [58]Thomson WM, Williams SM: Partial- or full-mouth approaches to assessing the prevalence of and risk factors for periodontal disease in young adults. J Periodontol 2002, 73:1010-1014.
• [59]Armitage GC: Development of a classification system for periodontal diseases and conditions. Northwest Dent 2000, 79:31-35.