Haworth Simon, Shungin Dmitry, Kwak So Young, Kim Hae-Young, West Nicola X, Thomas Steven J, Franks Paul W, Timpson Nicholas J, Shin Min-Jeong, Johansson Ingegerd
Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Bristol Dental School, University of Bristol, Bristol, UK.
Community Dent Oral Epidemiol. 2018 Dec;46(6):555-562. doi: 10.1111/cdoe.12391. Epub 2018 Jun 29.
Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.
An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.
In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).
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. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.
在大规模人群研究中，缺失牙计数或新发牙缺失测量作为一种衡量牙齿状况的简单方法正受到关注。我们探讨这些指标的意义以及缺失牙可能如何影响其他牙齿状况测量指标。
在两个形成对比的成年人群中开展了一项观察性研究。共有62522名成年参与者，他们来自基因-生活方式相互作用与牙齿终点研究（GLIDE）瑞典分支以及韩国国家健康与营养检查调查（KNHANES），具备临床评估的龋齿和牙周指数。GLIDE中有28244名参与者可获得牙齿缺失的纵向测量数据，中位随访时间为10.6年。
在纵向分析中，牙齿缺失风险与基线牙齿状况（既往牙齿缺失、牙周状况和龋齿状况）以及社会人口统计学变量（年龄、吸烟状况和最高教育水平）相关。横断面数据分析表明，龋齿暴露指数并非独立于牙周状况。关联的强度和方向在不同组之间有所不同，即使对于专门旨在避免测量牙齿缺失的指标也是如此。在GLIDE中，牙周健康受损的个体（任何一个牙象限的社区牙周指数[CPI]为3或更高）具有更高的标准化龋补牙面数（DFS；DFS数量除以牙齿表面总数）（发病风险比[IRR]为1.05[95%CI：1.04，1.07]），但在KNHANES中，其标准化DFS低于牙周健康状况较好的个体（所有牙象限的CPI<3）（IRR：0.95[0.92，0.98]）。
新发牙缺失是一种衡量牙齿疾病的复杂指标，有多个决定因素。龋齿和牙周疾病作为牙齿缺失驱动因素的相对重要性在不同年龄组之间有所不同。在研究人群中，龋齿暴露指标与牙周状况相关，并且这些关联可能因人群而异。在大规模人群研究中进行有效推断可能需要考虑这些指标的研究特异性特征。
