Wenche Sylling Borgnakke

Aim: Our goal was to develop and externally validate oral health self‐report measures for predicting periodontitis in a representative U.S. adult population (30–79 years old) and to evaluate a predictive scoring tool for periodontitis constructed from the best performing model parameter estimates. Methods: The predictive models for periodontitis using demographic characteristics and self‐reported oral health measures were developed and tested with the National Health and Nutrition Examination Survey (NHANES) 2009–2012 data (development 2009–2010, validation 2011–2012). The best performing model was externally validated against clinical periodontitis cases defined by measurements from a full‐mouth periodontal examination at six sites around all teeth excluding third molars. A predictive scoring tool derived from the transformed sum of the model coefficient estimates was also externally validated. Model performances were evaluated by their sensitivity, specificity, predictive accuracy, and area under the receiver‐operating characteristic curve (AUROC). Results: Our best model used self‐reported oral health, smoking, and demographics. Predictive Risk Scores (PRS) of ≥65 captured about 98% of the true periodontitis cases. Three forms of the model (1—individual risk factor variables, 2—continuous PRS, and 3—PRS categories) were applied to the development and validation data sets. Overall, all three forms had high sensitivity (>84%) in both the development and validation data sets and had similar AUROC (around 80%). Specificity was low to moderate. When externally validated, the model incorporating PRS as a continuous measure had high sensitivity (84.0%) and low specificity (57.5%), with AUROC of 79.5% and predictive accuracy of 71.6%. Similarly, when PRS as a categorical variable was externally validated, the model had a high sensitivity (82.8%) and low specificity (59.9%), with an AUROC of 79.3% and predictive accuracy of 72.0%. Conclusion: Overall, modeling of four self‐report oral health measures, combined with smoking and demographic characteristics, performs well in predicting clinical periodontitis in a nationally representative sample of the adult dentate US adult population. Compared with clinical periodontal examination, this approach is promising as a viable, non‐clinical, and much less resource‐intensive alternative method for estimating the burden of periodontitis.

This study explored the associations between tooth loss and all‐cause mortality among 8710 community‐dwelling US adults aged ≥ 30 years who participated in the National Health and Nutrition Examination Surveys (NHANES) III in 1988–1994 and subsequently were linked to the 2006 National Center for Health Statistics (NCHS) public‐use mortality records. At baseline, 22.3% had all 28 non‐third molar teeth, 36.4% were missing 1–5 teeth, 28.0% 6–27 teeth, and 13.3 % all 28 teeth. During 12–18 (mean = 14.2) years, 2,385 participants died with 22.4% of the deceased being edentulous versus 12.7% having 28 teeth. Age‐adjusted mortality rate was 29.3 (±0.6)/1000 person‐years among the former versus 9.9 (±1.3) among the latter. Age‐adjusted mortality was associated with edentulism, with edentate being 2.6 times (HR = 2.58; 95% CI: 1.81–3.69) more likely to have died than fully dentate, though attenuated upon further adjustment to 45% greater risk (HR = 1.45; 95% CI: 1.02–2.05). In contrast, this association between mortality and missing some, but not all teeth, was non‐significant upon adjustment for all covariates. In conclusion, edentulism—but not missing 30 years was statistically significantly associated with all‐cause mortality over an average of 14.2 years later.

The study aims were (1) to explore whether “periodontal treatment” consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long‐term periodontal maintenance treatment, is cost‐effective in terms of preventing periodontitis‐attributable tooth extraction and replacement by implant‐supported crowns (“extraction/replacement”); (2) to assess the effect of cigarette smoking on this cost‐effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow‐up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost‐effectiveness. Cigarette smoking adversely impacted this cost‐effectiveness, with current heavy smokers experiencing no cost‐effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost‐effectiveness for Grade B periodontitis. Assessed by mean annual costs of “extraction/replacement,” periodontal treatment was cost‐effective, which decreased in a dose–response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost‐effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Aim: To systematically identify, synthesize and critically summarize the available scientific evidence from randomized controlled trials (RCTs) regarding whether short (≤6 mm) perform as well as long (≥10 mm) implants regarding implant survival, marginal bone loss, and biologic and prosthetic complications in different clinical scenarios.Materials and Methods: Cochrane Collaboration's risk of bias tool and the GRADE approach were applied. Results were synthesized using random‐effects meta‐analyses assessed by trial sequential analyses.Results: Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included. Moderate/high certainty/quality evidence demonstrated similar 5‐year survival rates for ≤6‐mm and ≥10‐mm implants in non‐augmented bone and full‐mouth rehabilitation in either jaw, and for 6‐mm implants in the maxilla instead of sinus lift. Nevertheless, the evidence for 5‐year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4‐mm and 5‐mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants. Marginal bone level and short‐ and long‐term biologic or prosthetic complications were similar.Conclusions: Based on moderate/high certainty/quality evidence from 5‐year RCTs, implants ≤6 mm may be viable alternatives to ≥10‐mm implants in either jaw in native bone and full‐arch rehabilitation, and 6‐mm implants may be used as an alternative to sinus lift. Trial registration: PROSPERO ID: CRD42021254365.

Introduction: Dental implants are widely employed as dependable replacements for lost teeth. However, it is crucial to establish, solely through prospective cohort studies, whether a history of periodontitis indeed constitutes a significant risk factor for implant failure.Methods: A systematic literature search was conducted in October 2022 in several electronic databases with subsequent manual updates. Only original prospective cohort studies evaluating the implant (loss) rate ≥1 year after implant loading were included. Logarithmic risk ratio and weighted mean differences were calculated. Study results were summarized using random effects meta‐analyses evaluated by trial sequential analyses. The Newcastle‐Ottawa scale evaluated study bias and the GRADE approach assessed the certainty/quality of the evidence.Results: A total of 14 publications reporting on 12 prospective cohort studies were included. Low evidence certainty/quality evidence due to the absence of randomized clinical trials revealed significantly greater odds of failure in patients with a history of periodontitis at follow‐ups both after ≤5 years (RR = 1.62; 95% CI: 1.71–2.37; p = 0.013) and >5 years (RR = 2.26; 95% CI: 1.12–4.53; p = 0.023). The incidence of peri‐implantitis (RR = 4.09; 95% CI: 1.93–8.58; p < 0.001) and the weighted mean (WM) of marginal bone loss (WM difference = 0.75 mm; 95% CI: 0.18–1.31; p < 0.05) were statistically significantly greater in the periodontally compromised group, whereas there was no significant difference between the two groups for peri‐implant probing depth.Conclusion: A history of periodontitis can be considered a significant risk factor for incident implant failure, peri‐implantitis, and greater marginal bone loss.

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment (“deep cleaning”) can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation – especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth – has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with – or at risk for – hyperglycemia.

Background: Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people. Methods: A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O’Malley’s scoping review framework. Results: The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. Conclusion: There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.

Background: Unsupervised clustering is a method used to identify heterogeneity among groups and homogeneity within a group of patients. Without a prespecified outcome entry, the resulting model deciphers patterns that may not be disclosed using traditional methods. This is the first time such clustering analysis is applied in identifying unique subgroups at high risk for periodontitis in National Health and Nutrition Examination Surveys (NHANES 2009 to 2014 data sets using >500 variables.Methods: Questionnaire, examination, and laboratory data (33 tables) for >1,000 variables were merged from 14,072 respondents who underwent clinical periodontal examination. Participants with ≥6 teeth and available data for all selected categories were included (N = 1,222). Data wrangling produced 519 variables. k‐means/modes clustering (k = 2:14) was deployed. The optimal k‐value was determined through the elbow method, formula = ∑ (x_i²) – ((∑ x_i)2 /n). The 5‐cluster model showing the highest variability (63.08%) was selected. The 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (AAP) and 2018 European Federation of Periodontology/AAP periodontitis case definitions were applied.Results: Cluster 1 (n = 249) showed the highest prevalence of severe periodontitis (43%); 39% self‐reported “fair” general health; 55% had household income <$35,000/year; and 48% were current smokers. Cluster 2 (n = 154) had one participant with periodontitis. Cluster 3 (n = 242) represented the greatest prevalence of moderate periodontitis (53%). In Cluster 4 (n = 35) only one participant had no periodontitis. Cluster 5 (n = 542) was the systemically healthiest with 77% having no/mild periodontitis.Conclusion: Clustering of NHANES demographic, systemic health, and socioeconomic data effectively identifies characteristics that are statistically significantly related to periodontitis status and hence detects subpopulations at high risk for periodontitis without costly clinical examinations.

Aim: We retrospectively explored effects of smoking on tooth loss due to periodontitis (TLP) in long‐term compliant patients.Materials and Methods: Chart data were collected from 258 patients undergoing post‐non‐surgical periodontal treatment (mean 2.24 visits/year) for 10–47.5 (mean 24.2) years. Patients were categorized as: (1) never smokers, (2) former smokers, (3) current light smokers (<10 cigarettes/day) and (4) current heavy smokers (≥10 cigarettes/day).Results: Of 6,590 teeth present at baseline (mean 25.6 teeth/patient), 264 teeth were lost due to periodontitis, corresponding to 0.03, 0.05, 0.08 and 0.11 TLP annually among never smokers, former smokers, current light smokers and current heavy smokers, respectively. A tooth from a current heavy smoker had 4.4‐fold, 2.7‐fold and 2.6‐fold greater risk of TLP than a tooth from a never smoker, a current light smoker and a former smoker, respectively. Both heavy and light former smokers needed washout periods of approximately 15 years to reach the TLP risk level of never smokers. The TLP risk decreased by 6%/year of smoking cessation.Conclusions: It took almost 15 years of smoking cessation for the risk of TLP among former smokers to reach the level of never smokers. Hence, the 2018 periodontitis grading system should consider the impact of the “washout” period on former smokers.