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PreprintCC BY-NC-NDmedRxiv

Estimating Lifetime Periodontal Burden Under Informative Tooth Loss

  • K. M. McCormick1
  • N. Amarasena
  • G. Guzzo
  1. 1Adelaide University
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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.

Objective.To develop and evaluate a framework for estimating periodontitis experience from cross-sectional data by incorporating informative tooth loss under etiological uncertainty.

Methods.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.

Results.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).

Conclusions.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.

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Cite

BibTeXRIS
BibTeX
@misc{mccormick2026estimating,
  title = {{Estimating Lifetime Periodontal Burden Under Informative Tooth Loss}},
  author = {K. M. McCormick and N. Amarasena and G. Guzzo},
  howpublished = {medRxiv},
  year = {2026},
  month = may,
  doi = {10.64898/2026.05.27.26354300},
  url = {https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2},
  note = {CC BY-NC-ND},
}
RIS
TY  - UNPB
TI  - Estimating Lifetime Periodontal Burden Under Informative Tooth Loss
AU  - K. M. McCormick
AU  - N. Amarasena
AU  - G. Guzzo
PY  - 2026
DA  - 2026/05/27
PB  - medRxiv
DO  - 10.64898/2026.05.27.26354300
UR  - https://www.medrxiv.org/content/10.64898/2026.05.27.26354300v2
AB  - 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.  Objective.To develop and evaluate a framework for estimating periodontitis experience from cross-sectional data by incorporating informative tooth loss under etiological uncertainty.  Methods.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.  Results.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).  Conclusions.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.
ER  -