Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study

J Periodontol. 2022 Mar;93(3):354-363. doi: 10.1002/JPER.21-0415. Epub 2021 Nov 1.


Background: Very few studies have investigated the effect of patient and site factors on periodontal progression and long-term tooth loss in populations with minimal dental care. The aim of this retrospective study was to assess tooth loss and radiographic bone loss over at least 5 years in patients attending a national-health service primary care practice in Sicily and undergoing no regular care.

Methods: Records of two hundred consecutive patients with at least 5 years follow-up were screened and demographic, clinical and radiographic data were retrieved. Analyses of associations between patient and site factors and tooth loss were performed.

Results: After excluding not suitable patients, a total of 159 patient records with clinical and radiographic data with average 8.6 years follow-up were included. One hundred of these patients had no professional mechanical plaque removal (PMPR) carried out throughout the study follow-up. Nearly 65% of patients lost at least 1 tooth during the follow-up period, with a total of 400 extracted teeth (for periodontal and non-periodontal reasons). The annual tooth loss rate was slightly higher for "no PMPR" (untreated) patients (0.30 teeth/patient/year) compared with patients who had PMPR (0.27 teeth/patient/year). On a patient-level, only reduced frequency of daily tooth brushing was associated with tooth loss at logistic regression, whereas staging, grading and diagnosis of caries were associated with rates of tooth loss/year. At multilevel analysis including patient- and tooth-factors, age, diagnosis of caries and endodontic disease and percentage of bone loss at baseline were associated with tooth loss.

Conclusion: This study confirms the importance of tooth brushing, initial bone loss, caries and endodontic disease in predicting tooth survival in a primary care setting.

Keywords: bone loss; initial periodontal disease diagnosis; periodontal disease progression; tooth loss.

MeSH terms

  • Dental Caries* / diagnostic imaging
  • Dental Caries* / therapy
  • Humans
  • Retrospective Studies
  • Tooth Extraction
  • Tooth Loss* / diagnostic imaging
  • Toothbrushing