A retrospective analysis of the role of age and sex in outcomes of non-surgical periodontal therapy at a single academic dental center


This study aimed to resolve conflicting literature reports on the role of age and gender in NSPT outcomes. A study of 75 US adult patients (age ≥ 30 years) showed that 6 months after NSPT, twice as many men of all ages had “active” probing sites showing progression of periodontitis (passed ≥ 2 demonstrated CAL of ≥ 2.5 mm at the probing site) compared with women of all ages (29% and 15%, respectively).The same study also showed that twice as many older patients (aged 60-69) had “active” probing sites compared with patients aged 50-59 (56% vs. 27%, hazard ratio 2.8), Independent of baseline periodontal determinants16. Another study of 98 UK patients with periodontitis (mean age 53 years) who underwent NSPT, periodontal surgical treatment (where indicated) and periodontal maintenance for 5-10 years showed that tooth loss after adjustment for confounders (ultimate outcome of periodontitis) was significantly associated with age (OR 1.11; 95% CI 1.06, 1.16; phosphorus < 0.001), whereas males had a trend toward greater odds of tooth loss (OR 2.00; 95% CI 0.95, 4.18; phosphorus= 0.068)number 17. In contrast, a retrospective study of 117 Italian patients with slowly progressive (formerly “chronic”) and rapidly progressive (formerly “aggressive”) periodontitis phenotypes showed that patients who received at least 3 NSPT treatments There were no significant differences in treatment outcomes between older and older subjects (mean age 35 and 59 years, respectively)18. Similarly, a study of 172 Swiss patients undergoing periodontal maintenance for 3–27 years showed no significant difference in the progression of periodontal destruction (OR 1.2; 95% CI 0.6, 2.6; phosphorus= 0.571) and tooth loss (OR 1.1; 95% CI 0.7, 1.9; phosphorus= 0.593) between men and women19. A systematic review of other studies with a meta-analysis showed that among patients receiving NSPT, periodontal surgical treatment (when indicated), and periodontal maintenance for ≥ 3 years, the odds of tooth loss were significantly associated with older age (OR 1.05 ; 95% CI 1.03, 1.08; phosphorus< 0.05), but not male gender (OR 0.95; 95% CI 0.86, 1.05; phosphorus≥0.05)20.

This study showed that, at baseline (before NSPT), severe periodontitis (evidenced by CAL ≥ 5 mm) was significantly associated with middle age and older age (35–64 years and ≥ 65 years, respectively). Severe periodontitis (as evidenced by PD ≥ 6 mm) was significantly associated with middle age (35-64 years). Overall, these results are consistent with the 2009-14 NHANES-based study, which showed that severe periodontitis (defined as the presence of ≥ 2 interproximal sites and CAL ≥ 6 mm) was more common in middle-aged individuals (30-64 years of age). years) compared with older adults (≥ 65 years) (14.5% and 9.0%, respectively)11. Results at reassessment were similar to those at baseline, showing similar mechanisms underlying age-related differences in severe periodontitis at baseline and reassessment. Since the onset and progression of periodontitis is the result of an imbalance between periodontal pathogens and the host immune system, it is necessary to understand whether changes in the periodontal microbiota and/or immune response in older adults compared with younger adults may contribute to periodontitis. Increased prevalence of gingivitis and clinically significant impact on the outcome of periodontal treatment.A recent cross-sectional study of untreated older individuals (age ≥65 years) showed that plaque scores and bleeding on probing (surrogate markers of oral hygiene status and gingival inflammation, respectively) decreased with age. Increasetwenty one.A large-scale study shows no significant difference in the composition of the subgingival microbiota between young and older patients with periodontitistwenty twowhile other studies show a higher prevalence among older adults Porphyromonas gingivalisand middle pine23,24. These results may suggest that increased periodontal destruction may be due to systemic host factors rather than oral microbiota differences. Older adults frequently exhibit age-related impairment of adaptive immune system responses (senescence) and persistent low-grade inflammation caused by various cellular and humoral mechanisms (inflammatory senescence) (the “age-related susceptibility” hypothesis)25,26,27,28,29,30.Indirectly, this is consistent with earlier literature that the increased susceptibility to periodontitis in older patients is more important for the rate of destruction than the duration of periodontal tissue exposure to dental biofilm31. Another recent study showed that older adults who maintained a healthy lifestyle had significantly lower incidence/progression of tooth-specific periodontal disease compared with older adults who did not maintain a healthy lifestyle (OR 0.61; 95% CI 0.39, 0.95)14.

This study also showed that the prevalence of severe periodontitis (evidenced by CAL ≥ 5 mm) in men was significantly higher at baseline (before NSPT) and at reassessment (higher likelihood of CAL ≥ 5 mm or PD ≥ 6 mm). high category). Similarly, studies based on the 2009-14 NHANES showed that men of all ages had significantly more severe periodontitis (defined as the presence of ≥ 2 interproximal sites and ≥ 6 mm CAL) compared with women of all ages. High (11.5% vs. 4.3%, respectively)11. A retrospective study of 858 Swedish subjects aged ≥60 years showed that periodontitis (defined as interproximal CAL ≥5 mm in ≥30% of probing sites) was more common in men (OR 1.8; CI 1.3, 2.4)32. Several mechanisms have been proposed to explain sex-related differences in the prevalence and/or severity of periodontitis. For example, similar to older adults, poorer oral hygiene in men may play an important role in this difference.A large-scale study based on the 2017-18 NHANES that included 4,741 adult participants (mean age 53.7 years) showed that compared with women, men reported poorer home oral hygiene care (significant flossing frequency). lower) and receive professional dental care less frequently33both behavioral factors are significantly related to periodontitis11.In addition, sex-specific innate immune responses against microbial pathogens have also been reported, possibly due to differential expression of Toll-like receptors, different34.Gender differences between periodontitis and type 2 diabetes35metabolic syndrome36myocardial infarction37ischemic heart disease32and mortality32was also reported.

Contrary to observations at baseline, in which males were more likely to be in the ≥5 mm CAL category than other CAL categories, the magnitude of change (Δ) in CAL and PD between baseline and reassessment was similar between males and females. However, logistic regression showed that men had significantly higher odds of being in the CAL ≥ 5 mm and PD ≥ 6 mm categories at reassessment compared with women. The mechanisms underlying the differences in the prevalence and/or severity of periodontitis between men and women at reassessment may be similar to those at baseline. Because these differences may be primarily related to differences in oral hygiene conditions, baseline and reassessment plaque scores will be important clinical determinants to include in our future studies.

The mean change between baseline and reassessment in CAL and PD was less than 1 mm across all strata, according to the demographic characteristics analyzed. Although the magnitude of the mean change was small, age, race, and smoking were statistically significantly associated with the magnitude of the mean change in linear regression analyses. Elderly (≥65 years) patients had smaller mean changes in PD than younger (18-34 years) patients; non-smokers had smaller mean changes in CAL than smokers; African Americans had greater mean changes in CAL and PD than Caucasians; The average change in CAL was greater in Asians than in Caucasians.Statistical versus clinical significance is an important issue when determining the significance of periodontal treatment results, and methods for assessing periodontal status and considerations for determining clinical significance have been extensively described38,39.Statistical analyzes may be affected by a variety of factors, including statistical rarity, the magnitude of the observed effect, characteristics of the study population, and inconsistencies with treatment response39. Although the results of this study showed statistical significance and showed good evidence of a real effect, their significance may be limited because the magnitude of the changes was relatively small. This small magnitude may be affected by various factors, including our study limitations.

Although not the focus of this study, a significant association was found between severe periodontitis (PD ≥ 6 mm) and African Americans (but not other races) at baseline.Large-scale epidemiological study reports higher prevalence of severe periodontal destruction in African Americans11,40,41. Similar to baseline, at reassessment, there was a significantly higher proportion of African Americans in the severe periodontitis category. Furthermore, linear regression analysis showed that African American race was associated with slight but statistically significant differences in CAL and PD values ​​at reassessment compared with baseline. Similar to gender, differences in plaque scores by race or socioeconomic status at baseline and reassessment may provide further insight into race-related NSPT responses.

Strengths of the study include the large number of participants (n= 2866) who had been treated at this academic center for many years (13 years) completed full-mouth periodontal charts at baseline and reassessment, using periodontitis definitions and cutoffs consistent with current periodontal disease classifications. Limitations include a single-center database, a retrospective study design and its associated genetic limitations (e.g., lack of investigator control over the data collected), missing data on potential confounders (e.g., gum bleeding and plaque scores, and socioeconomic status) ), reported self-reported status of systemic disease, and short-term assessment time points after NSPT. Furthermore, characteristics of the study population indicated that participants had a higher mean rate of tooth loss at baseline and thus represent a patient group with more severe periodontal destruction. The high rate of tooth loss at baseline also suggests that patients referred to academic centers may represent a population with severe periodontitis, and the interpretation of the study results should be considered in this context. NSPT providers at this academic center include dental students, postdoctoral trainees, and periodontal specialists, so differences in provider expertise and experience levels may affect NSPT validity and study results. Because this was a retrospective study without calibrating for provider experience or stratifying the analysis according to provider experience level, it is not possible to comment on the NSPT results based on provider experience level. Providers in academic dental centers often have varying levels of experience; therefore, our observations likely reflect what can be achieved in the academic center setting. Finally, because only recently treated patients were included in the study, some patients may have had multiple episodes of NSPT due to poor response to treatment, which may have affected the reported results. To partially address these limitations, a multicenter study including dental repositories from other US dental schools should be conducted, which is currently underway. To further address these limitations, a prospective randomized controlled study should be conducted that includes non-surgical and surgical treatment modalities and provides accurately recorded data at each treatment phase.



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