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Tooth loss is a complex measure of oral disease : Determinants and methodological considerations

Haworth, Simon; Shungin, Dmitry LU ; Kwak, So Young; Kim, Hae Young; West, Nicola X.; Thomas, Steven J.; Franks, Paul W. LU ; Timpson, Nicholas J.; Shin, Min Jeong and Johansson, Ingegerd (2018) In Community Dentistry and Oral Epidemiology 46(6). p.555-562
Abstract

Objectives: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status. Methods: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with... (More)

Objectives: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status. Methods: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years. Results: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants). Conclusions: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
caries, epidemiology, periodontal diseases, tooth loss
in
Community Dentistry and Oral Epidemiology
volume
46
issue
6
pages
8 pages
publisher
Munksgaard International Publishers
external identifiers
  • scopus:85056452429
ISSN
0301-5661
DOI
10.1111/cdoe.12391
language
English
LU publication?
yes
id
8cc1d4a2-7f0a-42b6-a56d-b310c06a7074
date added to LUP
2018-11-26 13:54:50
date last changed
2019-01-06 14:17:22
@article{8cc1d4a2-7f0a-42b6-a56d-b310c06a7074,
  abstract     = {<p>Objectives: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status. Methods: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years. Results: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI &lt;3 in all sextants). Conclusions: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.</p>},
  author       = {Haworth, Simon and Shungin, Dmitry and Kwak, So Young and Kim, Hae Young and West, Nicola X. and Thomas, Steven J. and Franks, Paul W. and Timpson, Nicholas J. and Shin, Min Jeong and Johansson, Ingegerd},
  issn         = {0301-5661},
  keyword      = {caries,epidemiology,periodontal diseases,tooth loss},
  language     = {eng},
  number       = {6},
  pages        = {555--562},
  publisher    = {Munksgaard International Publishers},
  series       = {Community Dentistry and Oral Epidemiology},
  title        = {Tooth loss is a complex measure of oral disease : Determinants and methodological considerations},
  url          = {http://dx.doi.org/10.1111/cdoe.12391},
  volume       = {46},
  year         = {2018},
}