A 5-year study of attachment loss in community-dwelling older adults: incidence density

This is the second of three papers that present trends in attachment loss and tooth loss over a 5-yr period in a population of community-dwelling elderly black and whites. The first paper in this series showed that in addition to subject attrition during the 5 yr of the study, teeth also were lost. This loss of subjects and teeth resulted in trends that were not always consistent over time, because people were lost from the study and teeth with more active and advanced periodontal disease were more likely to be lost. In these instances, the incidence density (time-to-event) analytic strategy is useful. Incidence density is the average rate of occurrence for a fixed follow-up period. In 1988, the University of North Carolina School of Dentistry initiated the Piedmont 65+ Dental Study, which was designed to elicit 800 dentate respondents in the 5-county area who were examined again at 18, 36 and 60 months. Our findings indicated that for every 1000 sites followed for 1 yr in this population, 20.6 sites will experience attachment loss of 3+mm. Incidence densities varied greatly by subgroup, indicating that certain characteristics predispose sites for attachment loss. A multivariate logistic regression model indicated that people who are smokers, Porphyromonas gingivalis positive, have 5 or more missing teeth, are not high school graduates, and have not had a dental visit in the last 5 yr are at higher risk of attachment loss. Posterior teeth and mesiobuccal sites are at higher risk. We conclude that incidence density analyses are useful for longitudinal periodontal data and we illustrate the use of incidence density rates to plan clinical trials.