{
  "abstract": "Background.Clinical attachment loss (CAL) is widely used in population oral health research as an indicator of periodontal tissue destruction but can only be measured on teeth present at examination. Retained-dentition summaries may therefore underrepresent cumulative periodontal destruction when tooth loss is partly periodontal in origin.\n\nObjective.To develop and evaluate a framework for estimating periodontitis experience from cross-sectional data by incorporating informative tooth loss under etiological uncertainty.\n\nMethods.Data came from 10,324 dentate adults aged [≥]30 years in NHANES 2009-2014 who completed periodontal and glycated hemoglobin (HbA1c) assessments. Expected Periodontitis Experience (EPE) combined observed CAL among retained teeth with the expected periodontal contribution of missing teeth. Published extraction-cause studies informed age-specific weights for missing teeth. EPE was compared with mean CAL and extent CAL [≥]4 mm using survey-weighted age patterns and late-life curvature within glycemic groups. HbA1c was used as a theoretically related but distinct external measure.\n\nResults.Periodontal observability declined with age, particularly among adults with diabetes. Conventional observed-site measures showed weaker or declining fitted increases after age 70, whereas EPE retained a more consistently increasing age pattern. Late-life curvature was 0.06, 0.04, and -0.05 across glycemic groups for EPE, compared with -0.47, -0.91, and -2.70 for extent CAL [≥]4 mm. EPE also showed the strongest rank correlation with HbA1c ({rho} = 0.291 versus 0.238-0.255).\n\nConclusions.Treating tooth loss as probabilistically informative may provide a more coherent representation of cumulative periodontal destruction in cross-sectional periodontal epidemiology, particularly at older ages.",
  "abstract_shown": true,
  "affiliations": [
    "Adelaide University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "K. M. McCormick"
    },
    {
      "name": "N. Amarasena"
    },
    {
      "name": "G. Guzzo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c6gk9gy95gxnt.bib",
  "cited_by": 2,
  "doi": "10.64898/2026.05.27.26354300",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2.full",
  "id": "c6gk9gy95gxnt",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "dentistry and oral medicine"
    ],
    [
      "openalex",
      "3506|Oral microbiology and periodontitis research"
    ]
  ],
  "openalex": "W7162870574",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-05-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c6gk9gy95gxnt.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:50Z",
      "native_id": "10.64898/2026.05.27.26354300",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:dentistry and oral medicine",
      "subfield": "general"
    }
  ],
  "title": "Estimating Lifetime Periodontal Burden Under Informative Tooth Loss",
  "title_text": "Estimating Lifetime Periodontal Burden Under Informative Tooth Loss",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:50Z",
  "url": "https://research.draconitic.com/paper/c6gk9gy95gxnt",
  "venue": "medRxiv",
  "versions": []
}