Periodontitis is a common problem with severe periodontitis being ranked as  the 6^th most prevalent condition in the 2010 Global Burden of Disease study (Marcenes et al  2013).  The aim of this study by Thomson  et al was to describe changes in the occurrence of periodontal attachment loss (AL) , and to evaluate risk factors for unfavourable AL progression, through ages 26, 32 and 38.

The data was gathered from the Dunedin Multidisciplinary Health and Development Study (DMHDS) . This is a longitudinal cohort of children born in Dunedin, between 1st April 1972 and 31st March 1973 (n=1037). Children were assessed within a month of their third birthdays and again at ages 5,7,9,11,13,15,18,21,26,32 and 38.   Periodontal examinations were conducted at ages 26, 32 and 38, with half-mouth examinations at age 26, but full-mouth examinations at ages 32 and 38.

• 831  individuals had periodontal examinations at all three ages;
• the prevalence and extent of AL increased as the cohort aged.
• Between 26 and 32, one in nine participants had 1+ sites showing new or progressing AL; that proportion almost doubled between ages 32 and 38.
• Four periodontitis trajectory groups were identified, comprising 55.2%, 31.5%, 10.7% and 2.5% of the cohort; these were termed the “Very low”, “Low”, “Moderately increasing” and “Markedly increasing” trajectory groups respectively.
• Those who had smoked tobacco at all ages from 15 through 38 were at higher risk of being in the “Moderately increasing” or “Markedly increasing” trajectory groups. There was a similar risk gradient for those who were in the highest 20% of cannabis usage.

The authors concluded

Periodontitis commences relatively early in adulthood, and its progression accelerates with age, particularly among smokers.

Comment

The author highlight in their discussion that there was a disproportional loss of lower socio-economic participants, which my lead to underestimates of disease levels. The association of the accelerating progression with age  in smokers ( or cannabis users) reinforces the need to reduce an eliminate smoking. It also highlights the need for clinicians to be vigilant for signs of periodontal disease in early adulthood.

Links

Thomson WM, Shearer DM, Broadbent JM, Foster Page LA, Poulton R. The natural history of periodontal attachment loss during the third and fourth decades of life. J Clin Periodontol. 2013 Jul;40(7):672-80. doi: 10.1111/jcpe.12108. Epub 2013 May 9. PubMed PMID: 23656174.

Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJ. Global Burden of Oral Conditions in 1990-2010: A Systematic Analysis. J Dent Res. 2013 May 29. [Epub ahead of print] PubMed PMID: 23720570.