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Alcohol intake impacts severe periodontitis
HARM / ETIOLOGY
A R T I C L E A N A LY S I S & E VA L U AT I O N Alcohol intake impacts severe periodontitis SUMMARY Subjects Subsample of Hisayama, Japan, residents 40 to 79 years of age in July to September 1998 (982, 22% of total population) examined. Twenty-one were excluded because of 10 or fewer teeth or missing data, leaving 961 participants, 378 male and 583 female in the analysis.
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Relationship between drinking and periodontitis: the Hisayama Study. Shimazaki Y, Saito T, et al. J Periodontol 2005;76(9):1534-41.
Exposure Reported alcohol intake in g/d.
LEVEL OF EVIDENCE
Main Outcome Measure
3b
Multiple outcomes: Pocket depth (PD): None (no teeth with PD Q 4 mm), low (0.1%<19.9% teeth with PD Q 4 mm), mid (20%<34.9% teeth with PD Q 4 mm), and high (Q35% teeth with PD Q 4 mm). Clinical attachment loss (CAL): None (no teeth with CAL Q 5 mm), low (0.1%<9.9% teeth with CAL Q 5 mm), mid (10%<21.9% teeth with CAL Q 5 mm), and high (Q22% teeth with CAL Q 5 mm).
Main Results Compared with nondrinkers, participants drinking 15 to 29.9 g/d alcohol had higher odds of being in the high periodontitis group (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1-6.6) using PD as the outcome. A similar result was found among those consuming at least 30 g/d alcohol. There was no association with CAL.
PURPOSE/QUESTION To quantify the association between alcohol intake and periodontitis
SOURCE OF FUNDING Ministry of Education, Science, Sports and Culture of Japan
TYPE OF STUDY/DESIGN Cross-sectional analysis of a cohort
Conclusions The effect of drinking is limited to those persons with deep periodontal pockets in more than a third of their teeth.
COMMENTARY AND ANALYSIS The data are very carefully collected but some additional analyses could have strengthened the paper. To their credit, the authors adjusted for potential confounders such as age, sex, smoking (including quantity smoked), number of teeth, plaque index, and glucose tolerance. Conducting for glucose tolerance was particularly appropriate because it quantifies glycemic control, which is related to periodontitis. Why did they not adjust for body mass index (BMI)? It has been shown to be related with periodontitis and may be associated with alcohol intake. The authors should have chosen any one outcome measure and stuck to it. It is difficult to interpret a significant finding with one measure but not with another, and it raises the issue of multiple testing. In conducting stratified analyses (as was done in this study) the study’s power was substantially reduced. If a linear trend was suspected (as was reported in the results) the authors could have done ordinal logistic regression for the categorical outcomes. Alternatively, they could have used each individual measurement using multilevel models, which would have accounted for correlation at the level of the tooth and individual. This method would have been particularly strong because it makes no assumptions about the cutpoints used to make the categories. How were the cutpoints selected? Note that they are different for PD and CAL. Were they made by quantiles (which would be unbiased) or by checking which cutpoints gave ‘‘significant’’ results, which would be biased.
J Evid Base Dent Pract 2006;6:244-5 1532-3382/$35.00 Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2006.06.015
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
Overall the study is still useful because it confirms the association between alcohol intake and periodontitis in another population.
REVIEWER Anwar T. Merchant, DMD, ScD Assistant Professor
Volume 6, Number 3
McMaster University Clinical Epidemiology and Biostatistics Population Health Research Institute 237 Barton Street East Hamilton, ON L8L 2X2 Canada [email protected]
Shimazaki et al
245
A R T I C L E A N A LY S I S & E VA L U AT I O N Alcohol intake impacts severe periodontitis SUMMARY Subjects Subsample of Hisayama, Japan, residents 40 to 79 years of age in July to September 1998 (982, 22% of total population) examined. Twenty-one were excluded because of 10 or fewer teeth or missing data, leaving 961 participants, 378 male and 583 female in the analysis.
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Relationship between drinking and periodontitis: the Hisayama Study. Shimazaki Y, Saito T, et al. J Periodontol 2005;76(9):1534-41.
Exposure Reported alcohol intake in g/d.
LEVEL OF EVIDENCE
Main Outcome Measure
3b
Multiple outcomes: Pocket depth (PD): None (no teeth with PD Q 4 mm), low (0.1%<19.9% teeth with PD Q 4 mm), mid (20%<34.9% teeth with PD Q 4 mm), and high (Q35% teeth with PD Q 4 mm). Clinical attachment loss (CAL): None (no teeth with CAL Q 5 mm), low (0.1%<9.9% teeth with CAL Q 5 mm), mid (10%<21.9% teeth with CAL Q 5 mm), and high (Q22% teeth with CAL Q 5 mm).
Main Results Compared with nondrinkers, participants drinking 15 to 29.9 g/d alcohol had higher odds of being in the high periodontitis group (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1-6.6) using PD as the outcome. A similar result was found among those consuming at least 30 g/d alcohol. There was no association with CAL.
PURPOSE/QUESTION To quantify the association between alcohol intake and periodontitis
SOURCE OF FUNDING Ministry of Education, Science, Sports and Culture of Japan
TYPE OF STUDY/DESIGN Cross-sectional analysis of a cohort
Conclusions The effect of drinking is limited to those persons with deep periodontal pockets in more than a third of their teeth.
COMMENTARY AND ANALYSIS The data are very carefully collected but some additional analyses could have strengthened the paper. To their credit, the authors adjusted for potential confounders such as age, sex, smoking (including quantity smoked), number of teeth, plaque index, and glucose tolerance. Conducting for glucose tolerance was particularly appropriate because it quantifies glycemic control, which is related to periodontitis. Why did they not adjust for body mass index (BMI)? It has been shown to be related with periodontitis and may be associated with alcohol intake. The authors should have chosen any one outcome measure and stuck to it. It is difficult to interpret a significant finding with one measure but not with another, and it raises the issue of multiple testing. In conducting stratified analyses (as was done in this study) the study’s power was substantially reduced. If a linear trend was suspected (as was reported in the results) the authors could have done ordinal logistic regression for the categorical outcomes. Alternatively, they could have used each individual measurement using multilevel models, which would have accounted for correlation at the level of the tooth and individual. This method would have been particularly strong because it makes no assumptions about the cutpoints used to make the categories. How were the cutpoints selected? Note that they are different for PD and CAL. Were they made by quantiles (which would be unbiased) or by checking which cutpoints gave ‘‘significant’’ results, which would be biased.
J Evid Base Dent Pract 2006;6:244-5 1532-3382/$35.00 Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2006.06.015
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
Overall the study is still useful because it confirms the association between alcohol intake and periodontitis in another population.
REVIEWER Anwar T. Merchant, DMD, ScD Assistant Professor
Volume 6, Number 3
McMaster University Clinical Epidemiology and Biostatistics Population Health Research Institute 237 Barton Street East Hamilton, ON L8L 2X2 Canada [email protected]
Shimazaki et al
245