ASSESSMENT OF RISK FOR PERIODONTAL-DISEASE .1. RISK INDICATORS FOR ATTACHMENT LOSS

SPECIFIC RISK INDICATORS ASSOCIATED With either susceptibility or resi stance to severe forms of periodontal disease were evaluated in a cros s-section of 1,426 subjects, 25 to 74 years of age, mostly metropolita n dwellers, residing in Erie County, New York, and surrounding areas. The study sample exhibited a wide range of periodontal disease experie nce defined by different levels of attachment loss. Therefore, it was possible to accurately assess associations between the extent of perio dontal disease and patient characteristics including age, smoking, sys temic diseases, exposure to occupational hazards, and subgingival micr obial flora. Age was the factor most strongly associated with attachme nt loss, with odds ratios for subjects 35 to 44 years old ranging from 1.72 (95% CI: 1.18 to 2.49) to 9.01 (5.86 to 13.89) for subjects 65 t o 74 years old. Diabetes mellitus was the only systemic disease positi vely associated with attachment loss with an odds ratio of 2.32 (95% C I: 1.17-4.60). Smoking had relative risks ranging from 2.05 (95% CI: 1 .47-2.87) for light smokers increasing to 4.75 (95% CI: 3.28-6.91) for heavy smokers. The presence of two bacteria, Porphyromonas gingivalis and Bacteroides forsythus, in the subgingival flora represented risks of 1.59 (95% CI: 1.11-2.25) and 2.45 (95% CI: 1.87-3.24), respectivel y. Our results show that age, smoking, diabetes mellitus, and the pres ence of subgingival P. gingivalis and B. forsythus are risk indicators for attachment loss. These associations remain valid after controllin g for gender, socioeconomic status, income, education, and oral hygien e status expressed in terms of supragingival plaque accumulation and s ubgingival calculus. Longitudinal, intervention, and etiology-focused studies will establish whether these indicators are true risk factors.