Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

Abstract

Objective

To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes.

Material and methods

In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10–16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual.

Results

144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 − 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 − 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups.

Conclusions

Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Keywords:

• Adolescent
• dental plaque
• gingival diseases
• oral health
• juvenile idiopathic arthritis

Acknowledgements

This study is part of the multicenter NorJIA Study (The Norwegian JIA Study – Temporo-mandibular Involvement, Oral Health, Uveitis, Bone Health and Quality of Life in Children with Juvenile Idiopathic Arthritis (JIA)). NorJIA is a collaboration among universities (University of Bergen, Norwegian University of Science and Technology, The Arctic University of Norway), university hospitals (Haukeland University Hospital, St. Olav’s Hospital, University Hospital of North Norway) and oral health centers (Oral Health Centre of Expertise in Western Norway-Vestland, Center for Oral health Services and Research, Trondheim, Public Dental Health Service Competence Centre of Northern Norway) in Bergen, Trondheim and Tromsø. Represented by Karen Rosendahl MD PhD (PI), Marit Slåttelid Skeie DDS PhD, Marite Rygg MD PhD, Ellen Nordal MD PhD, Anne N. Åstrøm DDS PhD, Karin Tylleskär MD, Annika Rosén DDS PhD, Elisabeth Grut Gil DDS, Johannes Maria Fischer DDS, Xieqi Shi DDS PhD, Oskar Angenete MD, Lena Cetrelli DDS, Gunnar Lyngstad DDS, Marie Sager DDS, Astrid J Feuerheim PhD, Anette Lundestad MD, Thomas Augdal MD, Paula Frid DDS, Veronika Rypdal MD, Josefine Halbig DDS, Athanasia Bletsa DDS PhD, Marit Midtbø DDS PhD, Larissa von Wangenheim Marti DDS and Mats Säll DDS. We are indebted to radiographers Marianne Lothe Vollan and Erik Haro, and the study nurses Tone Kvinnsland Amdal, Susanne Irene Tobiesen Eidset, Line Rapp Simonsen, Marte Grimsmo Teige, Brita Lena Hansen, and Lisbeth Aune. Finally, we are thankful to all the children and their caregivers who participated in the study.

Ethics approval and consent to participate

The study was approved by the Regional Committees for Medical and Health Research Ethics (2012/542/REC), Rogaland, Vestland (West). Written informed consents were obtained from the caregivers and the adolescents as appropriate. The study was registered at ClinicalTrials.gov (No: NCT03904459). All procedures were performed in accordance with relevant guidelines.

Author contributions

EGG: Contributed to the design and data collection of this sub-study, performed statistical analysis, and wrote the manuscript in consultation with MSS, ANÅ and SAL. MSS: Conceived and designed this sub-study. ANÅ: Conceived the idea of performing multilevel analysis. SAL: Performed statistical analysis. MR: Aided in interpretation and writing of the manuscript and to the design and data collection of the NorJIA study. JF, JH, PF, KT, KR: Contributed to data collection and provided valuable comments. AR, AB, KL, XS, LC: Provided valuable comments. All authors have read and approved the manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Notes

1 The Norwegian JIA Study – Temporo-mandibular Involvement, Oral Health, Uveitis, Bone Health and Quality of Life in Children with Juvenile Idiopathic Arthritis (JIA).

Additional information

Funding

The current study is supported by universities (University of Bergen, Norwegian University of Science and Technology, The Arctic University of Norway), university hospitals (Haukeland University Hospital, St. Olav’s Hospital, University Hospital of North Norway) and oral health centres (Oral Health Centre of Expertise in Western Norway-Vestland, Centre for Oral health Services and Research, Trondheim, Public Dental Health Service Competence Centre of Northern Norway) in Bergen, Trondheim and Tromsø, and “Norsk Revmatikerforbund” (Norway) as part of the data collection. First author’s PhD program are financed by University of Bergen. The reported funding’s did not play a role in in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.