06/17/2022
Mean Annual Attachment, Bone Level, and Tooth Loss: A Systematic Review
"Characterizing participants at baseline by diagnosis, i.e., periodontitis and non-periodontitis is challenging. First, gingivitis and periodontitis are increasingly viewed as part of a continuum,1 and therefore an arbitrary threshold for diagnosis might lack validity. This is highlighted by the high prevalence values of at least mild forms of periodontitis which typically affect almost half of most populations.6-8 Similar difficulties exist with case definitions for other chronic conditions such as hypertension, diabetes, etc. For these conditions, case definitions are based on natural history/treatment studies, where subjects beyond a certain threshold have different health/treatment outcomes. As an analogy for periodontitis, a starting point might be to look across cohorts to determine whether there are subjects with a certain baseline periodontal status, who go on to lose more attachment and teeth and then define them as periodontally “healthy” or “severe.”
In addition to periodontal data, a consensus is required for a standardized data set of potential modifiers of attachment level change including certain oral microbiomes, genetic factors, lifestyle, general health, and socioeconomic measures.62
Finally, tooth loss, as a measure of periodontitis progression requires further research. Prevention of tooth loss is arguably the chief objective of prevention and treatment of periodontitis and is implicit in definitions of oral health.73 Although this parameter would potentially seem to be ideal in terms of being an objective measure and a true endpoint for assessing the impact of periodontal diseases,74 the many contributors to tooth loss/retention (e.g., patient preference, caries, dental professional treatment planning) complicate the interpretation of the data currently beyond very general observations. "
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