Assessing the Impact of Periodontal Therapy on Tooth Loss: A Register-Based Longitudinal Study in Denmark

While regular periodontal care is advocated to reduce tooth loss considerably among periodontitis patients, evidence from observational studies is often limited to small single-center studies. This study aims to quantify the effect of periodontal care on tooth extractions among 40-year-old new periodontitis patients over 20 years.

A nationwide register-based cohort study was conducted, encompassing 40-year-old individuals with incident periodontitis in 2001, tracked through Danish registers until the end of 2021. Receiving any periodontal care was determined annually, and the number of tooth extractions served as the annually varying outcome. G-estimation of structural nested mean models adjusted for time-varying confounding and loss to follow-up was employed to estimate the average treatment effect of periodontal therapy on subsequent tooth extractions.

The study included 1251 40-year-olds with incident periodontitis in 2001. The average follow-up from 2002 onwards was 19.1 years and amounted to 23,878 person-years. On average, participants received periodontal care in 12.1 years (SD 6.3) and lost an average of 2.3 teeth (SD 3.5). G-estimation showed that receiving periodontal therapy in a given year compared to not receiving any periodontal therapy reduced the number of teeth extracted in the following year by 0.04 (95% CI: 0.02; 0.06). Receiving periodontal therapy for 5 years in a row compared to not receiving any periodontal therapy was associated with an average of 0.08 (95% CI: 0.04; 0.13) fewer extracted teeth, while on average 0.62 teeth were lost in a 5-year period (0.12 per year).

Periodontal therapy resulted in a modest reduction in tooth extractions among 40-year-olds with incident periodontitis over 20 years. The effectiveness of periodontal therapy against tooth loss seems to be considerably smaller than indicated by earlier clinical studies.