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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 70-77. doi: 10.19723/j.issn.1671-167X.2023.01.010

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Multivariable analysis of tooth loss in subjects with severe periodontitis over 4-year natural progression

Jing WEN1,Xiang-ying OUYANG1,*(),Xi-yan PEI2,Shan-yong QIU1,Jian-ru LIU1,Wen-yi LIU1,Cai-fang CAO1   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
  • Received:2020-10-09 Online:2023-02-18 Published:2023-01-31
  • Contact: Xiang-ying OUYANG E-mail:kqouyangxy@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82071118);the National Natural Science Foundation of China(81991500);the National Natural Science Foundation of China(81991502);the National Natural Science Foundation of China(81870772)

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Abstract:

Objective: To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss. Methods: A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed. Results: In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss. Conclusion: In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.

Key words: Periodontitis, Natural progression, Tooth loss, Number of teeth

CLC Number: 

  • R781.4

Figure 1

Tooth types of tooth loss over 4-year natural progression"

Table 1

Baseline characteristics of the sample according to the various number of teeth lost (TL=0, TL=1-2, and TL≥3)"

Characteristics TL=0(n=174) TL=1-2(n=34) TL≥3(n=9) P
Age/years☆ 33.13±7.50 36.41±5.05 35.67±6.00 0.033
Gender, n(%)☆ 0.007
    Female 87 (50.0) 20 (58.8) 0 (0.0)
    Male 87 (50.0) 14 (41.2) 9 (100.0)
Smoking dosage# 7.28±15.12 8.10±12.78 12.79±9.03 0.029
Smoking years 5.82±8.73 5.18±7.95 13.44±7.49 0.014
Number of baseline missing molars☆ 0.27±0.70 1.53±1.89 1.78±1.05 ＜0.001
Number of teeth with WPDL* 0.28±0.67 1.15±1.64 2.89±3.41 ＜0.001
Number of teeth with PD≥7 mm/%* 1.00±5.30 5.00±13.8 15.00±20.40 0.002
Number of teeth with PD≥5 mm/%* 16.00±20.70 28.00±32.3 44.00±34.40 0.022
Mean CAL/mm# 2.16±0.96 2.49±1.15 4.25±2.01 0.003
CALmax/mm# 2.90±1.61 3.08±2.11 6.13±3.27 0.015
Number of teeth with CAL≥5 mm/%* 18.70±24.49 29.62±32.31 64.44±34.88 ＜0.001
Number of teeth with CAL≥3 mm/% 66.54±32.75 74.29±26.65 89.00±19.74 0.090
Mean PD/mm# 2.73±0.46 3.00±0.66 3.42±0.67 0.002
PDmax/mm# 5.18±1.21 5.63±1.41 6.44±1.67 0.004
Number of teeth with IBD☆ 0.50±0.98 1.26±1.99 2.00±1.73 0.003
Number of teeth with BL＞65%* 0.06±0.48 0.21±0.48 3.56±4.85 ＜0.001
Number of teeth with BL＞50%* 0.75±2.01 2.06±3.22 9.78±7.38 ＜0.001
Number of teeth with caries/residual roots☆ 0.56±1.03 1.68±1.77 2.00±2.29 ＜0.001
Number of teeth with periapical lesions* 0.28±0.63 1.24±1.37 2.33±2.00 ＜0.001

Table 2

Univariate analysis for higher rate of TL (TL=0, TL=1-2, TL≥3)"

Variables TL=0
(n=174)		 TL=1-2
(n=34)		 TL≥3
(n=9)		 P OR 95%CI
Age/years 33.13±7.50 36.41±5.05 35.67±6.00 0.013 1.069 1.014-1.127
Gender, n(%) 0.491 1.264 0.649-2.462
    Female 87 (50.0) 20 (58.9) 0 (0.0)
    Male 87 (50.0) 14 (41.1) 9 (100.0)
Smoking index, n(%) 0.055 2.081 0.985-4.402
    Slight 143 (82.2) 25 (73.5) 5 (55.6)
    Moderate/Severe 31 (17.8) 9 (26.5) 4 (44.4)
Number of teeth with BL＞50% 0.75±2.01 2.06±3.22 9.78±7.38 ＜0.001 1.344 1.208-1.496
Number of baseline missing molars 0.27±0.70 1.53±1.89 1.78±1.05 ＜0.001 1.986 1.540-2.560
Number of teeth with WPDL, n(%)
    0 140 (80.5) 16 (47.0) 3 (33.3)
    1-2 30 (17.2) 14 (41.2) 1 (11.1) 0.002 25.585 1.590-7.622
    ≥3 4 (12.3) 4 (11.8) 5 (55.6) ＜0.001 3.483 7.776-84.268
Number of teeth with periapical lesions, n(%)
    0 133 (76.4) 9 (26.5) 3 (33.3)
    1-2 33 (19.0) 22 (64.7) 1 (11.1) ＜0.001 7.265 3.290-16.039
    ≥3 3 (4.6) 3 (8.8) 5 (55.6) ＜0.001 59.086 15.165-230.212
Number of teeth with caries/residual roots, n(%)
    0 120 (69.0) 10 (29.4) 3 (33.3)
    ≥1 54 (31.0) 24 (70.6) 6 (66.7) ＜0.001 5.023 2.440-10.350
Number of teeth with IBD, n(%)
    0 123 (70.7) 20 (58.9) 3 (33.3)
    ≥1 51 (29.3) 14 (41.1) 6 (66.7) 0.023 2.188 1.112-4.306

Table 3

Orderly multivariate Logistic regression analysis for higher rate of TL (TL=0, TL=1-2, TL≥3)"

Variables TL=0
(n=174)		 TL=1-2
(n=34)		 TL≥3
(n=9)		 B SE Wald P OR 95%CI
Age/years 33.13±7.50 36.41±5.05 35.67±6.00 0.012 0.035 0.113 0.737 1.012 0.922-1.059
Gender, n(%) 0.110 0.540 0.042 0.839 1.116 0.311-2.581
    Female 87 (50.0) 20 (58.9) 0 (0.0)
    Male 87 (50.0) 14 (41.1) 9 (100.0)
Smoking index, n(%) 0.536 0.639 0.705 0.401 1.709 0.489-5.977
    Slight 143 (82.2) 25 (73.5) 5 (55.6)
    Moderate/Severe 31 (17.8) 9 (26.5) 4 (44.4)
Number of teeth with BL＞50% 0.75±2.01 2.06±3.22 9.78±7.38 0.438 0.245 3.199 0.044 1.550 1.043-2.507
Number of baseline missing molars 0.27±0.70 1.53±1.89 1.78±1.05 0.573 0.161 12.600 0.000 1.774 1.293-2.433
Number of teeth with WPDL, n(%)
    0 140 (80.5) 16 (47.0) 3 (33.3)
    1-2 30 (17.2) 14 (41.2) 1 (11.1) 0.347 0.518 0.449 0.503 1.415 0.513-3.904
    ≥3 4 (12.3) 4 (11.8) 5 (55.6) 2.573 0.824 9.750 0.002 13.105 2.606-65.891
Number of teeth with periapical lesions, n(%)
    0 133 (76.4) 9 (26.5) 3 (33.3)
    1-2 33 (19.0) 22 (64.7) 1 (11.1) 1.480 0.475 9.714 0.002 4.393 1.732-11.145
    ≥3 3 (4.6) 3 (8.8) 5 (55.6) 2.254 0.801 7.909 0.005 9.526 1.980-45.787
Number of teeth with caries/residual roots, n(%)
    0 120 (69.0) 10 (29.4) 3 (33.3)
    ≥1 54 (31.0) 24 (70.6) 6 (66.7) 1.108 0.484 5.253 0.022 3.028 1.175-7.815
Number of teeth with IBD, n(%)
    0 123 (70.7) 20 (58.9) 3 (33.3)
    ≥1 51 (29.3) 14 (41.1) 6 (66.7) 0.140 0.484 0.083 0.773 1.150 0.337-2.248
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