Community

dentistry and Batch : 21

oral Group : 1

epidemiology. Fayez Aldossari

43510008
Faisal almoammer
43410202
Faris alfaris
43410123
Ghassan sobh
 About the
journal
introductio
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Outline E-learning Aim of the

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Discussion
  Community Dentistry and Oral Epidemiology is a
bimonthly peer-reviewed medical journal covering dental
about public health and the application of epidemiology to
dentistry. It was established in 1973 and is published by
Communtiy
John Wiley & Sons. The editor-in-chief is W. Murray
dentistry and Thomson (University of Otago).
oral
epidemiology
journal  According to the Journal Citation Reports, the journal
has a 2019 impact factor of 2.278, ranking it 24th out of
91 journals in the category "Dentistry, Oral Surgery &
Medicine"[1] and 78th out of 181 in the category
"Public, Environmental & Occupational Health".
 about  Editor-in-Chief :
Communtiy  W. Murray Thomson
dentistry and  History : from 1973 to Present
oral
 Publisher : John Wiley & Sons
epidemiology
journal  ISSN:0301-5661
  Editorial Board :
 Professor Sarah Baker. Sheffield, UK
about
Communtiy  Professor Luisa Borrell. New York, USA
dentistry and
oral
 Professor Lisa Jamieson. Adelaide, Australia
epidemiology
journal
 Professor Roger Keller Celeste. Porto Alegre, Brazil

 Associate Professor Belinda Nicolau. Montreal, Canada

 Associate Professor Georgios Tsakos. London, UK

 about  Abstracting and indexing :
Communtiy  Directory of Open Access Journals (DOAJ)
dentistry and  Emerging Sources Citation Index (ESCI)
oral  PubMed Central
epidemiology  SCImago Journal Rank (SJR)
journal
 Scopus.
 Tooth loss is a complex measure of oral
disease: Determinants and methodological
considerations
  Associations between oral health and health status are of
interest to the public, clinicians and the research community.

 Epidemiological studies investigating these relationships

Introduction : require measures of oral disease, which ideally would be
comprehensive, specific and validated.

 Several studies have reported that having fewer teeth at

baseline or losing teeth during study follow-up increases the
risk of a range of adverse health outcomes.
  Observational studies report dental caries and periodontal
disease are the most common indications for the extraction of
permanent teeth.
Introduction :
 To clarify the meaning of tooth loss in the epidemiologic
context, it would be helpful to use longitudinal data
  A few studies report on tooth survival over time or trends
in repeated cross-sectional samples , but most rely on
self-reported tooth loss with limitations in validity or are
performed in selected patient groups with limitations in
Introduction : generalizability into the general population.

 In summary, tooth loss is entering routine use as an

epidemiological measure of dental health, but the
properties of this measure are not well understood .
  Methods and results
 This study was conducted in 2 independent populations, in Sweden and
the Republic of Korea . Included participants from the Gene-Lifestyle
Methods and Interactions and Dental Endpoints (GLIDE).
results  The participants were recruited from the population-based
V€asterbotten Intervention Program (VIP)30 by linkage to the dental
register using a 12-digit personal identity number.
 Those with a dental record available within a 5-year window from a
VIP visit were included. Participants aged ≥18 years were included
with no exclusions for maximum age.
 For longitudinal analysis, participants needed to have multiple outcome
data available. Information on demographic characteristics and
smoking behaviour was from the VIP records.
  The KNHANES is a national cross-sectional survey which includes a
new sample of approximately 10 000 individuals each year.
 KNHANES aims to achieve a sample which is representative of the
Methods and noninstitutionalized civilian population of Korea, using a stratified,
results multistage probability cluster study design.
 The KNHANES study and protocol is described in full elsewhere.
Participants were eligible if they were aged 18 years or older at the time
of screening and had exposure, outcome and covariate data available,
with no exclusions for maximum age.
  The Community Periodontal Index (CPI) is a level measure of
periodontal health which is used to screen for periodontal
Methods and treatment need and scored separately for 6 regions (sextants) of
results the mouth.

 Higher scores indicate worse periodontal health. Participants

with a CPI score of 3 or 4 in one or more sextants were
classified as having impaired periodontal health.
  In GLIDE some participants had full mouth pocket charting data rather than
CPI scores. These participants were classified as having impaired
periodontal health if 4 teeth in the mouth had pocketing of at least 4 mm, or
if any tooth in the mouth had pocketing of at least 5 mm.

 Indices for number of teeth, number of tooth surfaces, decayed missing and
Methods and filled surfaces (DMFS), decayed missing and filled teeth (DMFT), decayed
results and filled surfaces (DFS) and standardized DFS (standardized DFS) were
derived from surface-level electronic dental charting excluding third molar
teeth.

 The demographic variables used in the analyses were age, sex and highest
educational level. Smoking behaviour was also included using self-reported
questionnaire data. Longitudinal analysis was performed using a Weibull
survival model using the function in the statistical package data.
Methods and
results
  The GLIDE and KNHANES populations included in cross-
sectional analysis had comparable sample sizes, mean age and
proportion with university-level education (Table 1).

Methods and  Both populations had greater representation from female than
male participants. The KNHANES population contained a
results greater proportion of active smokers but had lower levels of
oral disease (DMFS, proportion with CPI ≥3 and missing teeth)
than the GLIDE population.

 In longitudinal analysis in GLIDE around one-third of

participants experienced tooth loss during follow-up, with
median time at risk of approximately 12 years.
Methods and
results
 Dental status as a predictor of tooth loss

 Participants with CPI 3 or higher had greater hazard for tooth loss than

Methods and participants with CPI <3 and this effect was larger in younger participants than
older participants (Table 2).
results
 Each additional decayed or filled tooth surface at study baseline was associated
with increasing hazard for tooth loss in individuals aged under 45 years but
was modelled to have minimal effect on hazard in individuals aged 55 years or
older.

 Hazard for tooth loss was higher in individuals who had previously lost teeth
than individuals who had not previously lost any teeth despite adjustment for
periodontal status and baseline DFS, with the largest effect in individuals
under 45 years who had already lost 7 or more teeth.
Methods and
results
 Age and sociodemographic predictors of tooth loss

Methods and
Each 1-year increase in baseline age was associated with
results increasing hazard for tooth loss (Table 3). Participants aged 55
years and older had a greater increment in hazard for each 1-year
increase in base line age than younger participants.

Current smokers had greater hazard for tooth loss than

nonsmokers. Higher educational attainment was associated with
decreased hazard for tooth loss.
Methods and
results
 We examined the associations between periodontal status and WHO caries
indices in GLIDE and KNHANES to evaluate whether these relationships are
stable or population-specific.

Methods and
results  Multiple caries indices were associated with periodontal status (Table 4). In
GLIDE, participants with CPI 3 or higher had greater incidence risk for caries
traits than participants with better periodontal health.

Younger participants (aged under 45 years) with CPI 3 or higher had higher
incidence risk for DMFS than participants with better periodontal health while
older participants (≥55 years) with CPI 3 or higher had reduced incidence risk
than participants with better periodontal health.
 Counts of missing teeth or incident tooth loss are gaining traction as a
low‐cost and simple way to measure dental status at scale. We
evaluated incident tooth loss and number of teeth in relation to
Discussion : potential causes and confounders and identified that tooth loss is a
complex measure of oral health.

The main strengths of the study are the large sample size with
clinically assessed data, representative populations and inclusion of
longitudinal data. The study has limitations which should be
considered. While there is value in considering 2 very different
populations.
  Finally, teeth missing due to dental disease could not be distinguished from
other causes, and CPI scores were used as a common basis for comparison
Discussion : across the 2 populations but these scores have limitations and do not provide
a clinical diagnosis of periodontal disease.

We evaluated dental status as a predictor of tooth loss in a longitudinal

analysis as well as the association between clinically assessed measures
of dental status and tooth loss in 2 culturally distinct cohorts of middle
aged and older men and women.

Impaired periodontal health and caries experience increase with age and
that tooth loss was associated with age, smoking and educational level.
  The number of missing teeth was associated with subsequent tooth loss.
Previous tooth loss may capture complex causes of tooth loss which act
independently of dental disease.

Discussion :
 For example, previous tooth loss may indicate that a participant or the dentist
prefer extraction over other treatment options for a particular clinical
scenario, and therefore predicts extraction as the preferred treatment choice
in the future.

 Retrospectively diagnosing previous dental disease which leads to tooth loss

will be a challenge in population‐level studies but one deserving of the same
status as diagnosing periodontal disease and caries present at the time of
examination.
  We also suggest that the existence of age‐ and population‐specific properties
of dental indices is an important factor to consider when drawing conclusions
from epidemiological studies.
Discussion :
 In conclusion, 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.
 Stay home , stay safe .
Take home
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Take care of your beloved ones and
keep a distance for now so we can
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E-learning
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 No question .
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