In the majority of cases, periodontitis precedes the manifestation of RA, but due to the quality of the existing studies, causality cannot be supported at this time.63
OTHER
Background characteristics, such as behavioral changes, socioeconomic status, and education level are frequently important when evaluating the associations between specific risk predictors and periodontal disease.
Risk Markers
BLEEDING ON PROBING
BOP has been thoroughly investigated in a number of longitudinal studies of periodontitis patients enrolled in maintenance programs. The high negative predictive value of this index makes it valuable in identifying the absence of clinical inflammation with high accuracy.64 However, the presence of BOP does not necessarily indicate disease progression. Consequently, BOP presents with high specificity but low sensitivity. As demonstrated by Lang et al65 in 1986 over a period of four consecutive maintenance appointments, a specific site may present with BOP in every maintenance visit, but there is still a 70% chance that this site will not lose attachment.
PROBING DEPTH
Another retrospective study evaluating patients in periodontal maintenance (for more than 11 years on average) showed that PDs of 5 mm and above following active periodontal therapy indicate increased risk for tooth loss. More specifically, the ORs of teeth with a deepest PD of 5, 6, or 7 mm to be extracted during the periodontal maintenance phase were 7.7, 11, and 64.2.66
FURCATION INVOLVEMENT
Several longitudinal studies in patients undergoing supportive periodontal treatment have demonstrated the association between furcation involvement and tooth loss. See chapter 5 for further considerations.
CRESTAL LAMINA DURA
A 3-year study by Rams et al67 concluded that the presence of radiographic crestal lamina dura is positively associated with clinically stable periodontal status in interproximal sites. On the other hand, the absence of crestal lamina dura cannot be used as a predictor for periodontal disease recurrence due to its low positive predictive value.67 Greenstein et al68 performed a cross-sectional study to investigate the potential relationship between the crestal lamina dura and clinical signs of inflammation, PD, BOP, and attachment loss. No association could be established based on the study findings.68
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