PMID- 10052770
OWN - NLM
STAT- MEDLINE
DCOM- 19990413
LR  - 20041117
IS  - 0022-3492 (Print)
IS  - 0022-3492 (Linking)
VI  - 70
IP  - 1
DP  - 1999 Jan
TI  - Prognosis versus actual outcome. IV. The effectiveness of clinical parameters and 
      IL-1 genotype in accurately predicting prognoses and tooth survival.
PG  - 49-56
AB  - BACKGROUND: Recently, a genetic marker (IL-1 genotype) that identifies 
      individuals at higher risk for developing severe periodontal disease was 
      discovered. A subgroup of the population reported on earlier was evaluated to 
      determine if knowledge of the patient's IL-1 genotype would improve accuracy in 
      assignment of prognoses and prediction of tooth loss. METHODS: This subgroup 
      consisted of 42 patients (1,044 teeth) in maintenance care for 14 years; 16 
      tested IL-1 genotype-positive (IL-1GP). Nine were smokers, and 30 had a history 
      of smoking, with an average of 29.44 pack years. A multiple Cox regression model 
      and Kaplan-Meier survival plots were fit to the subset of patients to evaluate 
      tooth loss. RESULTS: Both IL-1GP and heavy smoking were significantly related to 
      tooth loss. A positive IL-1 genotype increased the risk of tooth loss by 2.7 
      times, and heavy smoking by 2.9 times. The combined effect of IL-1GP and heavy 
      smoking increased the risk of tooth loss by 7.7 times. The value of clinical 
      parameters traditionally used to assign prognosis was found to be dependent on 
      IL-genotype and smoking status. In the model that included IL-1 genotype and 
      heavy smoking, none of the clinical parameters added significantly to the model 
      for tooth loss while mobility, probing depth, crown-to-root ratio, and percent 
      bone loss added significantly to the model, which included IL-1 genotype in 
      non-smokers. IL-1GP patients and patients who smoked heavily demonstrated a much 
      worse tooth survival rate when compared to IL-1 genotype-negative patients and 
      non-smokers, respectively. CONCLUSIONS: Knowledge of the patient's IL-1 genotype 
      and smoking status will improve the clinician's ability to accurately assign 
      prognosis and predict tooth survival. Clinical implications are as follows. 
      Investigators were unable to judge which patients would be IL-GP or negative 
      based on their clinical presentation or family history of tooth loss due to 
      periodontal disease. Since periodontal diseases are multifactorial, knowledge of 
      the patient's genotype is more important in predicting future risk than 
      explaining past disease. Knowledge of IL-1 genotype status would be important in 
      developing a treatment plan and predicting tooth survival for a new patient who 
      smokes and presents with periodontal disease, especially if restorative care is 
      needed. Knowledge of a maintenance patient's IL-1 status would help target 
      therapy for non-responding areas; one would be less likely to take a "wait and 
      see approach" with IL-1GP patients. IL-1 positive non-smokers can be successfully 
      treated and maintained over long periods of time.
FAU - McGuire, M K
AU  - McGuire MK
AD  - Department of Periodontics, University of Texas, Dental Branch Houston, USA. 
      mkmperio@hal-pc.org
FAU - Nunn, M E
AU  - Nunn ME
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Periodontol
JT  - Journal of periodontology
JID - 8000345
RN  - 0 (Genetic Markers)
RN  - 0 (Interleukin-1)
SB  - IM
MH  - Adult
MH  - Age Distribution
MH  - Cohort Studies
MH  - Female
MH  - Genetic Markers
MH  - Genetic Predisposition to Disease
MH  - Genotype
MH  - Humans
MH  - Interleukin-1/*genetics
MH  - Male
MH  - Middle Aged
MH  - Periodontal Index
MH  - Periodontitis/complications/*genetics
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Reproducibility of Results
MH  - Smoking/adverse effects
MH  - Survival Analysis
MH  - Tooth Loss/*diagnosis/etiology/*genetics
EDAT- 1999/03/03 00:00
MHDA- 1999/03/03 00:01
CRDT- 1999/03/03 00:00
PHST- 1999/03/03 00:00 [pubmed]
PHST- 1999/03/03 00:01 [medline]
PHST- 1999/03/03 00:00 [entrez]
AID - 10.1902/jop.1999.70.1.49 [doi]
PST - ppublish
SO  - J Periodontol. 1999 Jan;70(1):49-56. doi: 10.1902/jop.1999.70.1.49.