6.4 Methodological considerations
6.4.5 Statistical analyses
In the cross-sectional studies I−II, the outcome was a count variable and the excess zeros caused over-dispersion. Some tests were carried out to check for the appropriate model fit. Using the Vuong test, the fit of the zero-inflated negative binomial regression model was compared with an ordinary negative binomial regression model, and the likelihood ratio tested the fit of the zero-inflated negative binomial regression model versus the zero-inflated Poisson regression model. These tests showed that the most appropriate model was the zero-inflated negative binomial regression model. In the longitudinal studies III−IV, the negative binomial regression model was used for the count outcome variable due to the skewed data. To obtain easily interpretable risk estimates, the Poisson regression model with a robust variance estimator was used for the dichotomous outcome variable in studies III−IV (Zou, 2004).
7 CONCLUSION AND CLINICAL IMPLICATIONS
Although harmful alcohol use is a known risk for many diseases, the effects of alcohol use on the periodontium are still unclear. The present study suggests that light-to-moderate alcohol use cannot be considered a risk factor for the development of periodontal disease, since the present study showed that alcohol use was not associated with the presence of deepened (≥4 mm) periodontal pockets or the development of deepened periodontal pockets, which is a crucial step in the development of periodontitis.
Alcohol use was associated with periodontal condition among certain subgroups, indicating that the harmful effects of alcohol use on the periodontium are dependent on individual factors such as age, gender, and especially SEP.
The findings in this dissertation provide additional evidence that the short-term and long-term effects of light-to-moderate alcohol use are not associated with poor periodontal condition. The evidence on the long-term effects of alcohol use on the periodontium, obtained from the follow-up studies (4-year and 11-year follow-up studies), are valuable when studying the risk factors of periodontitis. The results also highlight the socioeconomic inequality in alcohol-related periodontal disease outcomes. These findings can be useful for dentists and policy-makers in providing alcohol-related health advice and employing the common risk factor approach in an effective way. The findings could contribute toward the Global Goals for Oral Health 2020 for reduction of periodontal diseases. It also indirectly contributes to the United Nations’ 2030 Agenda for Sustainable Development by reducing the global burden of non-communicable diseases caused by periodontal disease.
8 FUTURE DIRECTIONS FOR RESEARCH
More longitudinal studies are warranted to investigate the association of alcohol use with the development of periodontal disease in other populations. This study did not address whether alcohol use is associated with the progression of periodontal disease, and thus investigating the progression of periodontitis in relation to alcohol intake would be useful. Investigating the effects of different alcoholic beverages on the periodontium is important, since the effects of the intake of various alcoholic beverages are not thoroughly understood. Since binge drinking is more prevalent among Finns, future studies should investigate whether binge drinking has harmful effects on the periodontium. More studies examining the role of genetics in the association of alcohol use with periodontal disease are required.
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