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Notes: Objectives: The purpose of this study was to determine the validity of a self-reported periodontal disease measure for use in the Health Professionals Follow-up Study. Methods: Participating dentists responded to the question “Have you had periodontal disease with bone loss?” Radiographs obtained from 140 participants were evaluated for bone loss at 32 posterior sites and used as the standard. A site was positive if it had bone loss 〉2 mm and/or complete loss of crestal lamina dura. To avoid falsely classifying participants as positive, three blinded examiners independently evaluated each participant's radiographs. An a priori decision rule was used to classify a participant positive if all examiners independently assessed the same two or more sites positive. Results: The validity of the self-reported measure was good among dentists, with positive and negative predictive values of 0.76 and 0.74, respectively. Among nondentists, the self-reported measure showed discriminatory power by confirming associations with known risk factors such as age and smoking. Conclusion: Dentists have a good perception of their periodontal status, and there is reasonable consensus among dentists regarding the threshold for defining periodontal disease. Self-reported measures might have potential for use in studies of other populations with substantial cost reduction, and deserve further evaluation.

Notes: Objectives: To assess the validity of self-reported oral disease and health care measures in two populations. Methods: Telephone interviews were conducted among a subsample of participants in the VA Dental Longitudinal Study (VADLS) asking them about periodontal disease status and treatment. Radiographic alveolar bone loss evaluated at all the interproximal sites was used as the standard. A separate study was carried out among first-time patients at the Harvard School of Dental Medicine (HSDM) student clinic. Self-reported measures were obtained by a self-administered questionnaire and compared with clinical and radiograph examinations. The measures used were based on published work that demonstrated good validity of self-reported periodontal measures among health professionals. Results: Among 145 VADLS participants, self-reports of periodontal disease showed a good specificity (59.8%-90.7%), but low sensitivity (17.7%-64.7%). Among 58 HSDM patients, the self-reported numbers of remaining teeth, fillings, root canal therapy, and prosthesis were strongly correlated with clinical records (r=0.74-1.0); self-report was less accurate for measures of periodontal disease (r=0.56) and decayed teeth (k=0.47). Conclusions: Self-reports provide reasonably valid estimates for numbers of remaining teeth, fillings, root canal therapy, and fixed and removable prostheses. However, they appear to be less useful for the assessment of dental caries and periodontal disease in the two populations we have studied. There remains a need and potential to further develop self-report oral health measures that are valid for use in large population studies. Such self-report measures would yield great cost and time savings.

Notes: Objectives: This study evaluates the feasibility of obtaining preexisting dental radiographs by mail, the validity of assessing alveolar bone loss from posterior radiographs compared to full mouth, and the validity of alveolar bone loss assessed from radiographs taken at different times. Methods: This investigation uses data obtained for a study evaluating associations between oral conditions, blood biomarkers, and coronary heart disease within two large cohorts: the Nurses' Health Study and the Health Professionals Follow-up Study. If consenting participants had dental radiographs, we requested these radiographs from their dentists. Some dentists returned multiple sets of radiographs, which enabled us to conduct this study. A calibrated periodontist read all radiographs with good intraexaminer reliability (r=0.91). We compared posterior radiographs to full mouth (n=121 sets), as well as radiographs taken at different times (mean difference of 5 years) (n=102 pairs). Results: Of the 812 participants, 81 percent consented and 66 percent provided radiographs. Posterior radiographs underestimated periodontitis (≥1 site with ≥5 mm alveolar bone loss) prevalence by 6 percent (53.7% vs 57.0%) compared to full mouth, with sensitivity of 0.94 (95% confidence interval [CI]/0.86, 0.98) and specificity of 1. Spearman correlation coefficients comparing mean alveolar bone loss were 0.70 for anterior versus posterior teeth (mean difference/0.48), 0.92 for posterior teeth versus full mouth (mean difference/0.25), and 0.78 for pairs of radiographs taken at different times (mean difference=0.01). The kappa statistic was 0.70 comparing radiographs taken within 5 years and 0.29 when the period extended beyond 5 years. Conclusion: Preexisting radiographs are feasible for use in epidemiologic studies and provide valid assessments of periodontal disease. [J Public Health Dent 2004;64(4):223–30]

Notes: Objective: The objective of this study was to determine the validity of self-reported periodontal measures among nondentist health professionals. Valid self-reported measures could provide a time- and cost-efficient alternative for large epidemiologic studies. Methods: A subsample of 212 male nondenfists sampled on the basis of their reported periodontal severity from the Health Professional Follow-up Study (HPFS) provided dental radiographs and completed questionnaires assessing self-reported oral health. Alveolar bone loss was evaluated from the radiographs at 32 posterior sites and used as the standard measure of cumulative periodontal disease. Results: The self-reported ordinal periodontal measure had a linear relationship with mean radiographic bone loss (r=.61). The positive and negative predictive values of the dichotomized self-reported periodontal measures were 83 percent and 69 percent. Self-reported history of periodontal surgery was also a good surrogate for bone loss (predjctjve value positive 78 percent and negative 71 percent). Conclusions: Self-reports can provide discrimination and ranking information of cumulative periodontal disease among health professionals and can be used to provide valid results in etiologic studies in health professionals' populations.

Notes: Abstract –  Objectives:  Many studies have reported associations between oral health and cardiovascular diseases; poor nutritional status due to impaired dentition status has been suggested as a mediator. Our objective is to evaluate the associations between tooth loss and the self-reported consumption of fruits and vegetables and selected CVD-related nutrients.Methods:  A total of 83,104 US women who completed a food frequency questionnaire (FFQ) in 1990 and 1994 and reported number of natural teeth in 1992, were included in a cross-sectional analysis relating dietary intake to number of natural teeth. A longitudinal analysis was also conducted to evaluate whether tooth loss in 1990–1992 was associated with change in diet between 1990 and 1994.Results:  After adjusting for age, total calorie intake, smoking and physical activity, edentulous women appeared to have dietary intake associated with increased risk for CVD, including significantly higher intake of saturated fat, trans fat, cholesterol and vitamin B12, and lower intake of polyunsaturated fat, fiber, carotene, vitamin C, vitamin E, vitamin B6, folate, potassium, vegetables, fruits, and fruits excluding juices compared with women with 25–32 teeth. In the longitudinal analyses, women who lost more teeth were more likely to change their diet in ways that would potentially increase risk for development of CVD. They also tended to avoid hard foods, such as raw carrot, fresh apple or pear.Conclusions:  Women with fewer teeth have unhealthier diets such as decreased intake of fruits and vegetables, which could increase CVD risk. Diet may partially explain associations between oral health and cardiovascular disease.

Notes: Objectives: The objectives of this study were: (1) to compare the mercury levels in general dentists with the mercury levels in other health professionals using toenail clippings as a biomarker, (2) to identify risk factors associated with high mercury levels, and (3) to compare practice characteristics of dentists with high and low mercury levels. Methods: A sample of 579 men was randomly selected from the 33,737 men participating in the Health Professionals Follow-up Study who had provided toenail samples in 1987. A questionnaire was sent to these male subjects in 1991 to obtain information on fish consumption, tooth-brushing frequency, number of teeth, number of amalgam restorations, general practice or specialty status, number of amalgam restorations placed and removed per week, mercury storage and handling procedures, and mercury spillage incidents. A measure of long-term mercury exposure was obtained from toenail samples using neutron activation analysis for the 410 respondents (71% response rate). The 90th percentile mercury level in toenails (0.88 ppm) was selected as the threshold for elevated toenail mercury level. Results: No relationship was found between the number of dental amalgams and toenail mercury levels among general dentists, dental specialists, and nondental health professionals. General dentists were found to have more than twice the level of mercury in toenails than nondental health professionals (mean level=0.94 vs 0.45) and 60 percent higher than dental specialists (mean=0.59). The combined use of disposable capsules and water storage of scrap amalgam appeared to reduce the risk of elevated mercury levels. Regardless of professional status, consumption of tuna and saltwater fish were the primary exposure factors that were positively associated with toenail mercury levels. Conclusions: As shown by the associations with dental profession and fish consumption, the mercury content of toenails is a stable biomarker of cumulative long-term mercury exposure. The lack of association between nail mercury levels and number of amalgam restorations suggests that avoidance of mercury amalgam restorative materials cannot be justified by the presence of mercury released from dental amalgams.

Notes: Objectives: This paper evaluates the relation of tooth loss to incidence of coronary heart disease in two large cohort studies. Methods: Participants included 41,407 men and 58,974 women free of any cardiovascular diseases at baseline. We recorded 1,654 incident coronary heart disease events (562 fatal events) among men during 12 years of follow-up and 544 events (158 fatal events) among women during 6 years of follow-up. Results: After controlling for important cardiovascular risk factors, compared to men with 25–32 teeth at baseline, men with 0–10 teeth had a significantly higher risk of coronary heart disease (relative risk [RR]/1.36; 95 percent confidence interval [CI]/1.11, 1.67). The relative risk increased to 1.79 (95% CI/1.34, 2.40) when limited to fatal events. Women with 0–10 teeth were also at increased risk of coronary heart disease compared to women with 25–32 teeth (RR/1.64; 95% CI/1.31, 2.05). The association was similar for fatal events (RR/1.65; 95% CI=1.11, 2.46). The association between number of teeth and incidence of coronary heart disease was similar between men with and without a history of periodontal disease, and there was no significant association between tooth loss during follow-up and coronary heart disease. Conclusions: This study showed a significant association between number of teeth at baseline and risk of coronary heart disease and the mechanisms to explain this association should be further clarified. [J Public Health Dent 2004;64(4):209–15]