Research Corner - Tooth loss during supportive periodontal care: A prospective study
Mr Alex Pollard, Honorary Editor, has kindly written a precis of a recently published article.
Tooth loss during supportive periodontal care: A prospective study.
It is helpful to understand how well our patients do once they move into supportive periodontal care, the importance of this phase is often overlooked but it is as essential for long term stability as any other part of periodontal therapy. Hasan and colleagues set out to answer a straightforward but important question. How often are teeth lost during supportive periodontal care, and what are the risk factors for tooth loss?
The study used a prospective design. Adult patients who had already completed active periodontal therapy were enrolled at the start of supportive periodontal care in a United Kingdom specialist practice. They were followed for five years. At each maintenance visit the clinicians recorded probing depths, bleeding on probing, clinical attachment levels, mobility and changes in periodontal status. Any extractions were documented, together with whether the cause was periodontal or non-periodontal. Because data were collected in real time rather than reconstructed from historical notes, the findings represent the day-to-day reality of maintenance rather than a retrospective estimate.
The primary outcome was the number of teeth lost during the five-year period. The researchers also examined whether tooth loss was associated with patient level variables such as stage and grade of periodontitis, smoking, age and the periodontal risk assessment score. At the tooth level, the study evaluated well recognised risk indicators including deep pockets, clinical attachment loss, furcation involvement, intrabony defects, mobility and previous endodontic treatment. This structure resembles how clinicians typically assess risk during supportive periodontal care.
The results were positive overall, with an annual tooth loss rate of only 0.08 teeth per patient, and fewer than half of these losses attributed to periodontal causes. Patients with more severe baseline disease, however, showed much higher odds of losing teeth during maintenance. Those with Stage IV periodontitis had an odds ratio of 4.09 (95CI 1.42, 1.175) compared with individuals with Stage III periodontitis. Patients with Grade C periodontitis had an odds ratio of 4.13 (95CI 1.75, 9.71) compared with those with Grade B disease. A high periodontal risk assessment category almost doubled the risk, with an odds ratio of 1.93 (95CI 1.03, 3.58). These figures support what many clinicians recognise clinically. Patients with the most advanced baseline disease often remain vulnerable, even when they attend regularly.
Disease progression was also reported as a secondary outcome. Once again, patient level risk played a key role. Individuals in the high periodontal risk assessment category had more than seven times the odds of progression (OR 7.13: 95CI 1.85, 27.53), and those with Grade C periodontitis had nearly three times the odds compared with those with Grade B disease (OR 2.86: 1.33, 6.14). These findings reinforce the idea that susceptibility is not erased by good maintenance. Instead, it requires tailored recall intervals, clear communication and close monitoring.
The limitations of the study are worth acknowledging. The cohort was drawn from a private specialist practice with a single experienced operator, and this may limit generalisability to broader populations including routine general practice or NHS settings. Approximately one quarter of patients were lost to follow up, largely due to disruption during the COVID pandemic. The group was predominantly White and medically healthy, with very low rates of diabetes, which means the findings may not fully reflect outcomes for more medically complex or diverse populations.
Despite these limitations the study provides meaningful prospective evidence about the long-term stability of patients in supportive periodontal care. It demonstrates that well maintained patients can expect remarkably low levels of periodontal tooth loss and that most risk is carried by those with the most severe baseline disease. For patients who fear that tooth loss is unavoidable once they have been diagnosed with periodontitis, this evidence offers a far more reassuring message.
For me, this paper underscores the value of supportive periodontal care delivered with structure, consistency and attention to individual risk. It reminds us of the importance of the maintenance phase, which forms the cornerstone of long-term periodontal stability. When patients engage with SPT, and clinicians tailor it thoughtfully, the outcomes can be extremely encouraging.