Attachment Loss Trends Over 3 Years in Community‐Dwelling Older Adults

M ost of our knowledge regarding the natural history of periodontitis in adults has come from clinical studies of dental patients. However, it is known that dental patients usually are not representative of what actually happens in the population. For this type of information, epidemiologie studies are required. The purpose of this paper is to present the trends in attachment loss over a 3‐year period in a population of communitydwelling elderly blacks and whites. Specifically, this paper presents attachment loss trends both at the person and site level to address the following issues: 1) whether attachment loss during one period in time makes a person at higher risk for attachment loss at a subsequent period; 2) whether sites with deeper periodontal pockets at baseline are more likely to experience future attachment loss; and 3) whether teeth that experience attachment loss during one time period are more likely to be lost at the next time period. In 1988, the University of North Carolina School of Dentistry initiated the Piedmont 65+ Dental Study, which is a subsample of the parent study, the Piedmont 65+ Study of the Elderly under the direction of investigators from Duke University. The dental study subsample was designed to elicit 800 dentate respondents in the 5‐county area who were examined again at 18 and 36 months. Our findings indicated that, for the two 18‐month periods investigated, attachment loss during the first period was related positively to the incidence of attachment loss at a subsequent period at the person level, but not at the site level. This is consistent with an episodic, random hit model of disease which places overall risk at the patient level with variation at the site level due to site characteristics. Our data also indicated that baseline probing depth was positively associated with the proportion of sites that demonstrated break down over the next 3 years. However, the vast majority of sites that experienced attachment loss had probing depths of 3 mm or less. Finally, teeth with more attachment loss at baseline had a higher probability of being lost during the next 3 years and teeth that experienced attachment loss during the initial 18 months were more likely to be lost during the next 18 months than teeth without additional attachment loss. In summary, this population‐based study of older adults who experienced a substantial incidence of attachment loss over a 3‐year period supports the findings from a number of clinical studies that indicate that attachment loss and pocket depth are related to probability of future breakdown in individual sites. J Periodontol 1994; 65:737–743 .