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Tooth Loss in Individuals Under Periodontal Maintenance Therapy: Prospective Study

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Tooth Loss in Individuals Under Periodontal Maintenance Therapy: Prospective Study Periodontics Periodontics Tooth loss in individuals under periodontal maintenance therapy: prospective study Telma Campos Medeiros Lorentz(a) Abstract: This prospective study aimed to evaluate the incidence, the (a) Luís Otávio Miranda Cota underlying reasons, and the influence of predictors of risk for the oc- José Roberto Cortelli(b) Andréia Maria Duarte Vargas(c) currence of tooth loss (TL) in a program of Periodontal Maintenance Fernando Oliveira Costa(a) Therapy (PMT). The sample was composed of 150 complier individuals diagnosed with chronic moderate-severe periodontitis who had finished active periodontal treatment and were incorporated in a program of (a) PhD, Division of Periodontics, School of Dentistry, Federal University of Minas PMT. Social, demographic, behavioral and biological variables were col- Gerais, Belo Horizonte, Brazil. lected at quarterly recalls, over a 12-month period. The effect of predic- (b) PhD, Department of Dentistry, Periodontics tors of risk of and confounding for the dependent variable TL was tested Research Division, University of Taubaté, São Paulo, Brazil. by univariate and multivariate analysis, as well as the underlying reasons (c) PhD, Division of Preventive Dentistry, School and the types of teeth lost. During the monitoring period, there was a of Dentistry, Federal University of Minas considerable improvement in periodontal clinical parameters, with a sta- Gerais, Belo Horizonte, Brazil. bility of periodontal status in the majority of individuals. Twenty-eight subjects (18.66%) had TL, totaling 47 lost teeth (1.4%). The underlying reasons for TL were: periodontal disease (n = 34, 72.3%), caries (n = 3, 6.4%), prosthetic reasons (n = 9, 19.2%), and endodontic reasons (n = 1, 2.1%). Additionally, subjects with 10% of sites with probing depth be- tween 4 and 6 mm were 5 times more likely to present TL (OR = 5.13, 95% CI 2.04-12.09). In this study, the incidence of TL was small and limited to few individuals. Additionally, gender and severity of periodon- titis were significantly associated with TL during the monitoring period. Descriptors: Epidemiology; Periodontitis; Risk factors; Tooth loss. Introduction Tooth loss (TL) is one of the most visible results of the development of periodontal disease, and causes physiological and psychological impacts Corresponding author: on patient’s life. Longitudinal studies have demonstrated the effective- Fernando de Oliveira Costa ness of periodontal therapy in arresting the progression of periodontal Faculdade de Odontologia, UFMG 1,2 Departamento CPD disease, maintaining gingival health and preventing TL. Av. Antonio Carlos, 6627 - Pampulha The dental mortality has already been reported in longitudinal stud- Belo Horizonte - MG - Brazil CEP: 31270-901 ies through the combination of lost teeth during active therapy and Peri- E-mail: [email protected] odontal Maintenance Therapy (PMT).3-6 The vast majority of studies reported TL only during the maintenance period.3,5,7-11 However, recent studies recommended the description of TL prevalence during the active therapy and its incidence during PMT as a mean of assessing the overall Received for publication on Oct 06, 2009 Accepted for publication on Mar 09, 2010 effectiveness of periodontal therapies.12,13 Moreover, most of the stud- ies on TL in programs of PMT have retrospective designs,3,4,6-8,14 and as Braz Oral Res. 2010 Apr-Jun;24(2):231-7 231 Tooth loss in individuals under periodontal maintenance therapy: prospective study a consequence, data may reflect the traditional bias (2009).2 related to the design methodology. As described elsewhere, one feature of the pres- The periodontitis has been singled out as one of ent study that is of particular interest is the exclu- the main causes of dental mortality after 45 years sion of third molars from periodontal examination, of age,15 and has been associated to serious negative except when they occupied the position of second impacts on quality of life of periodontally suscep- molars and were in complete eruption and in func- tible individuals. Thus, periodontal maintenance tion. programs must make efforts to stabilize periodontal tissues and minimize, as a priority goal, the occur- Reasons underlying tooth loss rence of additional TL over time. The reasons underlying TL were categorized In addition, the identification of variables of risk into: (1) periodontal [teeth with severe clinical at- for TL in programs of PMT can help clinicians and tachment loss (CAL) and deep probing depth (PD), periodontists to establish the frequency of visits, and furcation involvement, severe mobility, and ad- to improve the adherence to maintenance programs vanced bone loss that not responded satisfactorily with greater compliance of individuals. Accordingly, to active therapy or any of the procedures during the objective of this prospective cohort study was to PMT)], (2) cariogenic (crown or root advanced de- describe the incidence of TL in a program of PMT struction); (3) prosthetic (teeth incompatible with and investigate the underlying reasons and risk vari- appropriate restorative procedures) (4) endodontic ables associated with TL. (non treatable endodontic pathological processes); The hypothesis under testing is that programs of and (5) root fracture (longitudinal and/or horizontal PTM can promote periodontal stability, and there- fractures leading to a non satisfactory crown-root fore minimize the incidence of TL. ratio obtained through surgical procedures). During the PMT, the decision of tooth extraction was based Methods on clinical and radiographic individual dental con- This study was approved by the Research Eth- ditions. ics Committee of the Federal University of Minas Gerais – Brazil, under the paragraph opinion ETIC Statistical analysis 060/2005. Statistical analysis included a characterization of the sample and descriptive analysis of variables Cohort study of interest, a univariate analysis, and a multivariate The sample for this prospective cohort study was logistic regression. Independent variables of inter- composed of 150 compliers individuals who were in- est (demographic, behavioral, biological, and social) cluded in a program of PMT, and monitored during were tested to determine which of them could be 12 months in consecutive 4 quarterly recalls, named associated to the additional TL over the 12-month PMT1 (baseline), PMT2, PMT3 and PMT4. These interval of PMT. The parametric and non-paramet- individuals presented the following criteria: diagno- ric tests (Chi-squared, Friedman, Kruskal-Wallis, sis of chronic moderate-advanced periodontitis be- Fisher’s exact, t-Student, and Mann-Whitney) were fore the active periodontal treatment, and comple- used, where appropriate. tion of active periodontal therapy in a period of less A logistic regression analysis was performed to than 4 months before the entry in the maintenance investigate the association between the dependent program. All steps of the methodology adopted in variable TL (occurrence of at least 1 tooth loss from the present study, as well as sample characteristics, PMT1 to PMT4) and the following independent pre- periodontal clinical examination, determination of dictors of risk: gender, age, marital status, diabetes, clinical periodontal status, periodontal monitor- smoking (smokers/former smokers, those reporting ing, and intra-examiner reliability on each quarterly to have smoked more than 100 cigarettes through- recall were previously described by Lorentz et al. out their lives, and non-smokers), alcohol use (yes/ 232 Braz Oral Res. 2010 Apr-Jun;24(2):231-7 Lorentz TCM, Cota LOM, Cortelli JR, Vargas AMD, Costa FO no), family income [(less/equal, and greater than 2 als presented 3,393, 3,376, 3,362, and 3,346 teeth, Brazilian minimum salaries), bleeding on probing respectively. In PMT1, there were reported 807 (BOP) in more than 30% of sites, PD ≥ 4 mm in lost teeth. Hence, it is observed that TL in PMT2, more than 30% of sites, PD between 4 and 6 mm PMT3 and PMT4 was respectively, 17, 14, and 16 up to 10% of sites, and CAL ≥ 3 mm in more than teeth. Thus, in PMT4 it was registered a total of 854 30% of sites. lost teeth (mean of 5.69, 95% CI 5.04-6.34). Confounding variables were determined if their The incidence rate of TL, when considering in- removal from the model caused changes greater dividuals and teeth as the sample units (from PMT1 than 15% in the β coefficient. All variables included to PMT4), was respectively 18.66% (n = 28 subjects in the final multivariate model were determined to who had lost at least 1 tooth) and 1.38% (n = 47 be independent through the assessment of their col- teeth lost), with an average of 0.31 lost teeth per linearity. Odds ratio (OR) estimates and their confi- subject. dence intervals (CI) were calculated and reported. Table 1 shows the frequency of TL in relation All tests were performed using statistical soft- to age in the sample unit individuals. It is observed ware (SPSS Inc., version 14.0, Chicago, IL, USA). that most of the subjects with TL (67.9%) were over Results were considered significant if a p-value low- 40 years of age. er than 5% was attained (p < 0.05). The Table 2 shows the average of present teeth by age groups from PMT1 to PMT4. There is a sig- Results nificant decrease in the number of present teeth in In the present study, individuals presented a the higher age groups in relation to the lower age mean age of 44.9 ± 9.5 years (range 18-74 years). groups (p = 0.001). Sixteen subjects (10.7%) were diabetic, and 61 subjects (40.7%) were smokers/former smokers. It Table 1 - Frequency of tooth loss in relation to age consid- is important to highlight that most of the sample ering individuals as the sample unit (n = 150; from PMT1 had a low socioeconomic status. Periodontal sta- to PMT4). tus of the sample was also described by Lorentz Tooth loss et al. (2009).2 During the interval from PMT1 to Age group Yes No PMT4, an increase in the number of sites with PD Total n % n % and CAL ≤ 3 mm, and a consequent reduction in Up to 30 years 2 7.1 14 11.5 16 the number of sites with PD of ≥ 4 mm, could be observed.
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