Epidemiology of Periodontal Health: diagnosis, trends, and systemic relationships

As a prevalent oral disease, periodontitis leads to the loss of tooth-supporting tissue and eventually tooth loss. It is associated with a variety of systemic conditions and is considered a public health problem worldwide. The thesis aimed to understand the periodontal health problem at a population level based on epidemiological principles and methods. We systematically reviewed the definitions of periodontal health used in the literature. There is significant heterogeneity in measuring methods, periodontal parameters, and cut-off values. Tooth loss related to periodontitis (TLPD) is viewed as a critical parameter to stage periodontitis severity. We proposed a surrogate indicator (periodontal status of adjacent teeth) to determine the TLPD when the reasons for extracted teeth are lacking. In the descriptive study, socioeconomic inequalities in oral hygiene and periodontal status were present in the Netherlands over two decades. The analytical studies were performed to understand the determinants and systemic links of periodontal health problems in the population. Apart from professional periodontal care and optimal oral hygiene measures, maintaining periodontal health can be achieved through non-pharmacological strategies (e.g., dietary and lifestyle adjustments). Consuming a pro-inflammatory diet indicated by the energy-adjusted dietary inflammatory index (E-DII) score is related to periodontal disease. Relatively stronger associations were seen in older adults and males. Periodontal inflammation was associated with poor cognitive performance in the elderly. Systemic inflammation (as measured by WBC count) was an explanatory mediator of this association. In the prospective cohort study, concomitant presence of cognitive impairment and periodontitis seemed to increase the risks of all-cause and cardiometabolic mortality among older adults.