National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA.
Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, Unit of Periodontology, University Medicine Greifswald, Greifswald, Germany.
J Clin Periodontol. 2018 Jun;45 Suppl 20:S130-S148. doi: 10.1111/jcpe.12944.
We used epidemiologic data of clinical periodontal status from two population-based samples in two countries, United States and Germany, to examine 1) the impact of age on the relative contribution of recession and pocketing on the distribution of clinical attachment loss, and 2) whether it is feasible to define age-dependent thresholds for severe periodontitis.
The analytical sample was based on persons aged ≥30 and included 10,713 individuals in the United States, participants in NHANES 2009 to 2014, and 3,071 individuals in Pomerania, Germany, participants in the SHIP-Trend 2008 to 2012. NHANES used a full-mouth examination protocol to collect data on recession (R), pocket depth (PD) and clinical attachment loss (CAL) for six sites/tooth on a maximum of 28 teeth; SHIP-Trend used a half-mouth examination at four sites/tooth. In both samples, percentile distributions of mean CAL/person were generated for each 5-year age interval. Age-dependent thresholds defining the upper quintile of mean CAL were calculated for both samples. The topographic intraoral distribution of CAL and the relative contribution of R and PD on CAL was assessed.
Mean CAL increased linearly with age in both samples and was higher in SHIP-Trend than NHANES across the age spectrum. In contrast, mean PD was constant across age groups in both populations. R contributed increasingly to CAL with age, especially after 45 to 49 years. Upper quintile mean CAL thresholds in NHANES were < 3 mm for ages up to 39 years, and under 3.58 mm in all other age groups. Corresponding values in SHIP-Trend were also < 3 mm in ages up to 39 years but increased linearly with age up to 7.21 mm for ages ≥75 years.
Despite substantial differences in the overall severity of attachment loss between the two samples, common patterns of CAL and of the relative contribution of R and PD to CAL with increasing age were identified. Although periodontitis severity may vary in different populations, empirical evidence-driven definitions of CAL thresholds signifying disproportionate severity of periodontitis by age are feasible.
我们利用来自美国和德国两个国家的两个基于人群的临床牙周状况流行病学数据，检验了 1）年龄对龈退缩和牙周袋对临床附着丧失分布的相对贡献的影响，以及 2）是否可以定义与年龄相关的重度牙周炎的阈值。
分析样本基于年龄≥30 岁的人群，包括美国 2009 年至 2014 年 NHANES 参与者 10713 人和德国 Pomerania 地区 2008 年至 2012 年 SHIP-Trend 参与者 3071 人。NHANES 使用全口检查方案收集了 6 个位点/牙齿的龈退缩（R）、牙周袋深度（PD）和临床附着丧失（CAL）的数据，最多可检查 28 个牙齿；SHIP-Trend 使用 4 个位点/牙齿进行半口检查。在两个样本中，为每个 5 年年龄间隔生成了个体平均 CAL 的百分位分布。为两个样本计算了定义平均 CAL 上 5 分位数的年龄依赖性阈值。评估了 CAL 的口腔内分布和 R 和 PD 对 CAL 的相对贡献。
在两个样本中，CAL 均随年龄呈线性增加，在整个年龄范围内，SHIP-Trend 中的 CAL 均高于 NHANES。相比之下，在两个人群中，PD 均值在各年龄组中均保持不变。R 对 CAL 的贡献随年龄增长而增加，尤其是在 45 至 49 岁之后。在 NHANES 中，年龄在 39 岁以下的上 5 分位 CAL 阈值<3mm，所有其他年龄组<3.58mm。在 SHIP-Trend 中，39 岁以下的年龄<3mm，但年龄在 75 岁以上时线性增加至 7.21mm。
尽管两个样本的附着丧失总体严重程度存在显著差异，但确定了 CAL 以及 R 和 PD 对 CAL 随年龄增长的相对贡献的共同模式。尽管不同人群中的牙周炎严重程度可能有所不同，但基于经验证据驱动的 CAL 阈值定义，表明按年龄划分的牙周炎严重程度不成比例是可行的。
