Periodontal disease

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2
Periodontal disease

• Oral bacterial inflammation
• Irreversible attachment loss
• Bone destruction
• Tooth loss
• Smoking, socioeconomic background, diabetes,
  genetic, attitude toward health, supragingival
  plaque control

3

• Women are generally in better health than men,
  and they have a lower mortality rate
• Women were in better periodontal health, but they
  had fewer teeth than their male counterparts.

4
Hypothesis I

• Teeth are very seldom lost teeth are extracted
  by dentists.
• Scheutz F, Poulsen S. A tooth per child? Lancet
  19983521387.
• Whether the frequency of dental appointments
  could be a reason for the gender-related
  difference.
• Women take better care of their health and
  therefore visit the dentist more frequently then
  man.

5
Hypothesis II

• For each child born, one tooth is lost.
• Christensen K, Gaist D, Jeune B, Vaupel JW.
• A tooth per child? Lancet 1998352204.
• Parity is associated with tooth loss and dental
  disease in US women.
• Russell SL, Yaffee R, Ickovics J. Exploring
  pathways between parity and dental health in US
  women

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Hypothesis III

• Women are at high risk of osteoporosis than men,
  especially in older age.
• It is assumed that there are associations between
  osteoporosis, periodontal disease, alveolar bone
  loss, and tooth loss.

7
(SHIP)
8
Hypothesis I

• Female participants reported a higher frequency
  of dental appointments than their male
  counterparts.
• The frequency of dental visits during the
  previous 12 months was negatively correlated with
  the number of teeth In the age groups of the 20-
  to 60-year-old participants, regardless of sexes.

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Hypothesis I

• In participants older than 60 years, there was a
  positive correlation (P lt 0.0001). The more
  frequent dental appointments that participants in
  this age group had, the more teeth they had.
• hypothesis I is to be rejected.

10
Hypothesis II
nulliparous
One or more children
1. With every child born, the number of teeth was
reduced by nearly one tooth 2. The relationship
was greater in the lowest income class and was
much attenuated in the group of the highest
social level. 3. Hypothesis II is to be accepted.
11
Hypothesis III
Mengt50 y/o
Women HT(-)
Women HT()

• Bone density was not assessed.
• Estimated bone turnover by excretion of urinary
  deoxypyridinoline collagen
• Only those women who do not use estrogens after
  menopause have fewer teeth than men women using
  estrogen even have more teeth than men.
• Hypothesis III is to be accepted.

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• The results of this analysis support the
  assumption that giving birth to children is
  associated with an increased risk of tooth loss.
• However, this association was detected only in
  participants with a low socioeconomic status of
  the husband or low education level.

13

• Pregnancy-associated gingivitis seems to have
  some impact on long-term dental health, even
  though this gingivitis is considered a temporary
  disturbance
• Pregnancy is characterized by high bone turnover
  with resorption and a significant decrease in
  bone mineral density

14

• Individuals with osteoporosis may be at an
  increased risk of the manifestations of oral
  osteoporosis although such a risk is not
  definitively proved.
• There is the possibility that the lack of
  estrogen influences the activities of bone cells
  and immune cells that the progression of alveolar
  bone loss will be enhanced.
• Alveolar bone loss is a strong and independent
  predictor of incident tooth loss in
  post-menopausal women. Conversely, the number of
  teeth is no predictor of bone density.

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• Bone remodeling processes and decreasing bone
  mineral density affect tooth retention during
  pregnancy and later, after menopause. The
  association between the number of children born
  (and also of pregnancies) and collagen turnover
  confirms such findings.
• These effects may explain the paradox of having
  fewer teeth with better periodontal health.