1. Osteoporosis and periodontitis
The aim of this study was to determine any relationship between bone mineral density (BMD), tooth loss and periodontal status with age, number of years since onset of menopause and educational level, since these factors can lead to greater tooth loss. The cross-sectional study included 112 women aged 45-80 years. BMD was determined for lumbar spine region and proximal femur while dental and periodontal status were evaluated clinically and on panoramic radiographs. For the analysis of tooth loss frequency, participants were divided into four age groups. Significant inverse correlation was found between number of lost teeth and BMD at hip region but not at the lumbar spine. Several indicators of periodontal condition were significantly correlated with BMD, but not with postmenopausal period length. Importantly, participants missing one or more incisors or canines had significantly lower mean value of BMD compared to those in whom these teeth remained. Although osteoporosis is not the main cause of periodontitis, it may be a factor that leads to enhanced pocket depth and greater risk of tooth loss in ageing women.

Savic Pavicin I et al. The relationship between periodontal disease, tooth loss and decreased skeletal bone mineral density in ageing women. Gerodontol 2017; Aug 15.

Q Which of the following statements may be correctly based on the results of this study?
A Osteoporosis is the main cause of periodontitis
B Significant inverse correlation was found between number of lost teeth and BMD at hip region but not at the lumbar spine
C Participants missing one or more incisors or canines had significantly higher mean value of BMD
D Osteoporosis may be a factor that leads to enhanced loss of attachment

  1. Does insulin resistance affect obesity and periodontitis?
One hundred and ten obese and 102 lean individuals, were evaluated for periodontal disease and divided into three groups according to insulin resistance (IR): lean without IR (LWIR), obese without IR (OWIR), and obese with IR (OIR). Anthropometric, metabolic, inflammatory and periodontal parameters were evaluated. Periodontitis was more prevalent in obese (80.9%) than lean subjects (41.2%), with the former showing a six-fold increased risk. Obese subjects in general displayed higher diastolic blood pressure and lower HDL cholesterol than lean subjects. OIR had higher systolic blood pressure, glucose, insulin, triglycerides and number of teeth with pocket depth (PD) >= 4 mm than OWIR, while other periodontal variables remained unaltered. Analysis showed that probing depth, bleeding on probing and insulin resistance were independent predictors of number of teeth with PD >= 4 mm. The data support an association between obesity and periodontitis, and point to a central role of IR. Periodontitis tends to be more extensive in obese patients with IR.

Martinez-Herrera M et al. Involvement of insulin resistance in normoglycaemic obese patients with periodontitis: A cross-sectional study. J Clin Periodontol 2017; Jul 11.

Q Individuals:
A With obesity displayed lower diastolic blood pressure
B Who were lean had a five-fold increased risk of periodontitis
C With obesity had a six-fold increased risk of periodontitis
D Whether obese or lean all had pocket depths greater than 6mm

  1. Forty years on
Remarkably, this study assessed long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over 40 years using data originated from a periodontitis study in Sri Lanka in 1970. In 2010, 75 subjects (15.6%) of the original cohort were re-examined. PTL over 40 years varied between 0 and 28 teeth (4 had no PTL, 12 were edentulous). Attachment loss was a statistically significant covariate for PTL and smoking and calculus were associated with disease initiation. Calculus, plaque and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81mm at the age of 30 indicated subjects were likely to have a dentition of at least 20 teeth at 60 years of age. The results highlight the importance of treating early periodontitis along with smoking cessation, in those under 30 years of age. They further show that calculus removal, plaque control and the control of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Ramseier CA et al. Natural history of periodontitis: Disease progression and tooth loss over 40 years.  J Clin Periodontol 2017 Jul 22.

Q Attachment loss:
A Is a statistically significant factor in periodontitis-related tooth loss
B Is best left untreated for forty years or more
C Of <1.81mm at the age of 30 is likely to predict edentulousness by age 60 years
D Seems not to be influenced by calculus, plaque and gingivitis over four decades

  1. All at threes and twos
Evidence that asymptomatic third molars (M3s) negatively affect their adjacent second molars (A-M2s) was evaluated using the association between visible M3s (V-M3s) of various clinical status with the periodontal pathologic features of their A-M2s. Subjects with at least one quadrant having intact M3s and M2s, either with V-M3s and symptom free or without adjacent V-M3s, were enrolled (n=572). Periodontal parameters, including plaque index, bleeding on probing, probing pocket depth (PPD), and at least one site with a PPD of 5 mm or more, obtained from M2s were analysed according to the presence or absence of V-M3s or the status of the M3s. Irrespective of their status, the presence of V-M3s was shown to be a risk factor for the development of periodontal pathologic features in their A-M2s. Although the prophylactic removal of asymptomatic V-M3s remains controversial, medical decisions should be made as early as possible, because, ideally, extraction should be performed before symptom onset.

Qu HL et al. Effect of asymptomatic visible third molars on periodontal health of adjacent second molars: a cross-sectional study. J Oral & Maxillofacial Surg 2017 Apr 14.

Q The presence of visible third molars:
A Has no periodontal influence on their adjacent second molars
B Usually provides a protective periodontal influence on second molars
C Is a risk factor for the development of periodontal pathologic features in their adjacent second molars
D Invariably means pockets of 5mm or more on their distal aspect