Who is at risk? Periodontal disease risk analysis made accessible for the general dental practitioner

Abstract

The use of odds ratio (OR) in risk analysis is considered a useful means of cross-comparing risk factors by which a disease is influenced. This article outlines the interpretation of reported ORs with respect to periodontal disease, highlighting those factors that are most deserving of consideration. The claim that periodontal disease is implicated in some serious systemic diseases is investigated with respect to the evidence. Data retrieval was carried out, focusing primarily on ORs for factors shown to be positively correlated with the incidence of periodontal disease. Using the available data, a risk evaluation scoring system was proposed (the Cronin/Stassen BEDS CHASM scale). The results of the evaluation support the view that hygiene therapy, smoking cessation and control of the glycaemic state offer the largest and most easily achieved reduction in risk with respect to attachment loss. The literature on systemic diseases indicates that the mechanisms with which periodontitis may interact seem biologically plausible, compellingly so in the cases of coronary heart disease and diabetes mellitus. However, statistical evidence to confirm these suggested interactions is equivocal, with the data retrieved in some instances being less than decisive. Further investigation is recommended. Glossary: AL: attachment loss, BL: bone loss, BMI: body mass index, CI: confidence interval, CHD: coronary heart disease, CVD: cardiovascular disease, IE: infective endocarditis, OR: odds ratio, SES: socioeconomic status, HAART: highly active anti-retroviral therapy. © 2008 Macmillan Publishers Limited. All rights reserved.