LIFESTYLE RISK ASSESSMENT SCORE FOR PERIODONTAL DISEASE (LRASPD)

Abstract

Background: Periodontitis is a chronic inflammatory disease that destroys tooth-supporting tissues (gums, ligaments, and bone). It is a multifactorial disease that is impacted by behavioral, genetic, environmental, and immunological factors. However, the main etiology is poor oral hygiene, which causes the accumulation of dental plaque. There are limited studies on the association between a combination of lifestyle factors and periodontal disease, nor is there a comprehensive risk assessment score that can be used clinically. The aim of the study is to investigate the association of socio-demographic variables and lifestyle factors with periodontitis, and to create a Lifestyle Risk Assessment Score for Periodontal Disease (LRASPD) to be used as a screener in the dental clinic. In addition, the association of LRASPD with periodontitis was examined. A secondary analysis was performed to assess if diabetes status alters the association of LRASPD with periodontitis. Methods: A cross-sectional study using secondary data from the National Health and Nutrition Examination Survey (NHANES) from the 2009-2010, 2011-2012, and 2013-2014 cycles was conducted. Adults aged 30 years and above with complete data on 2

periodontitis, lifestyle, and demographic factors were selected. Bivariate and multiple logistic regression were used to analyze the data. Also, LRASPD was created by converting coefficients from the logistic regression to a score based on the following demographic (age, gender, race/ethnicity, education level, and poverty income ratio) and lifestyle (smoking, alcohol consumption) variables. Results: The final logistic regression with only significant variables showed that current and past smokers had 2.41 and 1.31 higher odds of moderate/severe periodontitis than non-smokers; while heavy and moderate drinkers had 1.60 and 1.04 higher odds, respectively, than no/light drinkers. Individuals aged 45-64 had 3.48 times higher odds, and those aged 65 and older have 4.08 times higher odds compared to those aged 30-44. Males had 2.21 times more moderate/severe periodontitis than females. Other races had 1.74 higher odds, non-Hispanic Blacks 1.40, and Hispanics 1.34 higher odds than non-Hispanic White individuals. Those with less than a high school education had 1.45 times higher odds compared to those with higher education. Individuals below the poverty level had 1.26 times higher odds compared to those at or above the poverty level. Individuals with a high-risk score of the LRASPD had 15.13 increased odds of having moderate/severe periodontitis compared to those with no/low-risk scores. After adjusting for diabetes, individuals with a high-risk score of the LRASPD had 14.78 increased odds of having moderate/severe periodontitis compared to individuals with a no/low-risk score. Individuals with diabetes had 1.23 increased odds of having moderate/severe periodontitis. 3

Conclusion: Individuals with a high-risk score of LRASPD, followed by individuals with moderate-risk, had higher odds of having moderate/severe periodontitis compared to individuals with a low-risk score, which indicates a potential dose-dependent relationship. Also, diabetes has lower odds of having moderate or severe periodontitis compared to the LRASPD groups, which suggests that LRASPD plays a more significant role than diabetes. The LRASPD may serve to evaluate lifestyle risks of periodontal disease in dental clinic settings. Also, it can help to understand the combined impact of lifestyle factors on the development and progression of periodontal disease.