title: Risk indicators for periodontal disease in a remote Canadian community--a dental practice-based study.
abstract: OBJECTIVE
  The purpose of this cross-sectional study was to identify risk markers and risk indicators for periodontal attachment loss in a remote Canadian community. Of special interest was the association between smoking and periodontal disease experience.
  
  
  METHODS
  Data were collected from a convenience sample of 187 adult patients attending a dental office in a rural community located in Northern Ontario. Information was obtained via a questionnaire and a periodontal examination. The questionnaire included the use of dental services, self-care behaviors, general health status, smoking, and personal characteristics. Periodontal health was assessed using the mean periodontal attachment loss (MPAL), measured at two sites on all remaining teeth and the proportions of sites examined with loss of 2 mm or more and 5 mm or more. Plaque scores and measures of the number of missing teeth also were obtained. The relationships between mean periodontal attachment loss, the proportion of sites with 5 mm or more of loss and independent variables such as age, sex, current smoking status, mean tooth plaque scores, flossing frequency, and regularity of preventive dental visits were examined in bivariate and multivariate analyses.
  
  
  RESULTS
  The data revealed a mean periodontal attachment loss of 3.9 mm (SD=1.5). The mean proportion of sites examined with loss of 2 mm or more was 0.89 and the mean proportion with loss of 5 mm or more was 0.35. In linear regression analysis, plaque scores, the number of missing teeth, age, current smoking status, regularity of dental visits, and flossing frequency had statistically significant independent effects and explained 60.0 percent of the variance in mean periodontal attachment loss. Just over 30 percent of subjects had severe periodontal disease, defined as 50 percent or more of sites examined with loss of 5 mm or more. In logistic regression analysis, missing teeth, dental visiting, smoking status, age, and flossing frequency had significant independent effects. The strongest association observed was with smoking, which had an odds ratio of 6.3. The logistic regression model correctly predicted 64.3 percent of cases with severe disease.
  
  
  CONCLUSIONS
  The data indicate that the periodontal health of these patients is poor. Risk indicators or markers of poor periodontal health in the population studied included missing teeth, plaque scores, age, current smoking status, regularity of dental visits, and flossing frequency. This supports previous findings that behavioral factors play an important role in periodontal disease.
authors.affiliation: Department of Periodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada.
authors.forename: Mandy
authors.initials: M
authors.lastname: Sbaraglia
authors.forename: Robert S
authors.initials: RS
authors.lastname: Turnbull
authors.forename: David
authors.initials: D
authors.lastname: Locker
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D003742:Dental Devices, Home Care; D003774:Dental Plaque Index; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D009910:Oral Hygiene; D017622:Periodontal Attachment Loss / Q000209:etiology*; D010512:Periodontal Index; D018570:Risk Assessment; D012423:Rural Health; D012907:Smoking / Q000009:adverse effects; D016388:Tooth Loss / Q000145:classification