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Torrungruang K, Vathesatogkit P, Mahanonda R, Thienpramuk L. Periodontitis and hypertension are linked through systemic inflammation: A 5-year longitudinal study. J Clin Periodontol 2024; 51:536-546. [PMID: 38196116 DOI: 10.1111/jcpe.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIM To investigate the associations between periodontitis and hypertension and potential mediation via systemic inflammation through a 5-year longitudinal study. MATERIALS AND METHODS The severity and extent of periodontitis were determined using probing depth (PD). Oral hygiene was assessed using plaque scores. The associations between periodontal variables and 5-year blood pressure changes or incident hypertension were analysed using linear or Poisson regression, adjusting for potential confounders. Mediation analysis of two systemic inflammatory biomarkers, namely white blood cell count (WBC) and C-reactive protein (CRP) levels, was performed. RESULTS The study population included 901 hypertension-free participants, aged 50-73 years. Greater mean PD, higher percentage of sites with PD ≥ 6 mm and poor oral hygiene were associated with elevated systolic blood pressure and increased hypertension risk (relative risks = 1.17 [95% confidence interval [CI]: 1.02-1.34], 1.13 [95% CI: 1.02-1.26] and 1.08 [95% CI: 1.03-1.13], respectively). Periodontitis and poor oral hygiene were associated with higher WBC and CRP levels (p < .05), which, in turn, were associated with increased hypertension risk (p < .05). WBC and CRP jointly mediated 14.1%-26.9% of the associations between periodontal variables and incident hypertension. CONCLUSIONS Periodontitis and poor oral hygiene were associated with increased hypertension risk, and systemic inflammation was, in part, a mediator of these associations.
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Affiliation(s)
- Kitti Torrungruang
- Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Prin Vathesatogkit
- Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rangsini Mahanonda
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Lalitsara Thienpramuk
- Dental Clinic Department, Medical and Health Division, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
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Bárcena García M, Cobo Plana JM, Rodríguez Cagiao G, Arcos González PI. Epidemiological methods used in the periodontal health research in military personnel: a systematic review. BMJ Mil Health 2024; 170:72-77. [PMID: 34921095 PMCID: PMC10850676 DOI: 10.1136/bmjmilitary-2021-001977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Periodontal disease is a prevalent pathology in military personnel worldwide. The objective is to analyse the methodological features of periodontal health research performed in military personnel in their home countries. METHODS A PRISMA systematic review of literature was carried out in PubMed, EMBASE and Web of Science databases on military periodontal health studies. Study design type, language, publication date, year, country, size and sample selection, age, sex, military, diagnostic procedure, examiners, periodontal, gingival and oral hygiene index were extracted. RESULTS Eighty-eight out of 5355 studies found were selected, published between 1921 and 2020, with samples ranging from 52 to 16 869 individuals, generally not randomised, and consisting mainly of men with a mean age of 25 years. Predominant studies were cross-sectional descriptive studies, carried out in the Army, on American military personnel, and in the English language. Most of the studies used the WHO periodontal probe handled by two or more examiners. The Löe and Silness gingival index and the Silness and Löe plaque index were the most used indexes to assess gingival condition and oral hygiene, respectively. Community Periodontal Index of Treatment Needs was the most widely used periodontal index. CONCLUSIONS Research on periodontal health carried out in military populations from the 1920s to the present has been performed from an almost exclusively descriptive approach. Issues such as the characteristics and representativeness of the samples, the epidemiological design and the different gingival-periodontal indexes used may limit the comparability of the study results.
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Affiliation(s)
- Millán Bárcena García
- Department of Dentistry, Military Army Base 'Conde de Gazola', Ministry of Defense, Ferral del Bernesga, León, Spain
| | - J M Cobo Plana
- Department of Surgery and Medical and Surgical Specialties, University of Oviedo, Faculty of Medicine and Health Sciences, Oviedo, Asturias, Spain
| | - G Rodríguez Cagiao
- Department of Dentistry, Military School of Health, Central Defense Academy, Ministry of Defense, Madrid, Spain
| | - P I Arcos González
- Department of Medicine, University of Oviedo, Faculty of Medicine and Health Sciences, Oviedo, Asturias, Spain
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de Carvalho-Buonocore HLCC, Moreira ARO, Costa MSV, Thomaz EBAF, Souza SDFC. Accuracy of clinical and radiographic recording protocols for diagnosing periodontitis. Oral Dis 2023; 29:2854-2864. [PMID: 35785457 DOI: 10.1111/odi.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the accuracy of periodontal examination at 6-sites full-mouth protocol with clinical and radiographic partial-mouth recording protocols (PRPs) to diagnose periodontitis considering new 2018 case definition. METHODS Periodontitis was diagnosed by full-mouth assessment of clinical attachment level (CAL) at 6-sites (n = 8529) according to 2018 case definition (standard reference). Three clinical and radiographic PRPs were considered: (i) 4 interproximal sites of all teeth (4-sites, full-mouth); (ii) 6-sites on Community Periodontal Index of Treatment Needs (CPITN) teeth (6-sites, CPITN teeth); (iii) 4-sites on CPITN teeth (4-sites, CPITN teeth); (iv) radiographic examination on interproximal sites of all teeth (rM-D, full-mouth); and (v) radiographic examination on interproximal sites of CPITN teeth (rM-D, CPITN teeth) using Image J®. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), accuracy, and Κappa (k) were estimated (α = 0.05). RESULTS The 4-sites, full-mouth protocol showed 100% sensitivity and NPV, 79.87% PPV, low specificity (38.32%), 69.30% accuracy, and poor agreement (k = 0.468). 6-sites and 4-sites CPITN teeth protocols showed 100% PPV and specificity, sensitivity and NPV of >60%, accuracy of >80%, and good agreement (k > 0.65). All clinical PRPs outperformed radiographic protocols. CONCLUSION Clinical PRPs using index teeth are highly accurate in diagnosing periodontitis considering 2018 case definition.
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Ribeiro YJS, Ferreira LG, Nelson-Filho P, Arnez MFM, Paula-Silva FWG. Influence of digital media in the oral health education of mother-child pairs: study protocol of a parallel double-blind randomized clinical trial. Trials 2022; 23:639. [PMID: 35945570 PMCID: PMC9361624 DOI: 10.1186/s13063-022-06602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dental caries is the most common non transmissible chronic disease in childhood and the control of dental biofilm in children is one of the greatest challenges in oral disease prevention. Digital media applications can help patients in improving their oral hygiene performance and reducing the number of appointments due to pain and discomfort reasons. This study aims to investigate the use of an smartphone application (WhatsApp) to deliver oral health education to mother-child pairs, with the ultimate goal of controlling dental biofilm and caries through digital activities focused on oral hygiene. Methods This study was designed as a randomized, double-blind, parallel clinical trial involving 100 pairs of mothers and children (6–12 years old). The mothers and children will be randomly allocated to the control group (n = 50 pairs), who will receive a single visit conventional oral health education, or to the experimental group (n = 50 pairs), who will receive both a single visit conventional oral health education and educational videos through WhatsApp Messenger, twice a week. Before randomization of the groups and after the intervention, pairs will be evaluated regarding to plaque index (VPI), gingival bleeding index (GBI), and number of decayed, missing and filled permanent or primary teeth (DMF-T) modified by the inclusion of active non-cavitated carious lesions (Nyvad criteria). Socioeconomic data, dental history, and oral health literacy will obtained using questionnaires (Oral Health Literacy Assessment Task for Paediatric Dentistry; BOHLAT-P). Chi-square, Student’s t-test, paired Student’s t-test, Mann-Whitney, and Friedman tests will be used with a 5% significance level. Discussion This intervention proposal is designed to motivate behavioral change in mother-child pairs. We hypothesize that adding digital media to traditional oral health programs will provoke improvements in oral hygiene behavior and health outcomes. To our knowledge, this is the first study evaluating the effect of educational videos communicated by digital media (WhatsApp) on the oral health of mother-child pairs evaluated by long-term dental examinations. In addition, we will assess the maternal level of comprehension of the provided information via a literacy assessment tool. The clinical trial is registered at the Brazilian Registry of Clinical Trials (No. RBR-7s8bw6m). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06602-4.
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Affiliation(s)
- Yuri Jivago Silva Ribeiro
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Luanna Gonçalves Ferreira
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Maya Fernanda Manfrin Arnez
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco Wanderley Garcia Paula-Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil.
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Alshihayb TS, Sharma P, Dietrich T, Heaton B. Exploring periodontitis misclassification mechanisms under partial-mouth protocols. J Clin Periodontol 2022; 49:448-457. [PMID: 35246856 DOI: 10.1111/jcpe.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/25/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
AIM To investigate the sources of periodontitis misclassification under partial-mouth protocols (PMPs) and to explore possible approaches to enhancing protocol validity. MATERIALS AND METHODS Using data from 10,680 adults with 244,999 teeth from the National Health and Nutrition Examination Survey, we compared tooth-, site-, and quadrant-specific periodontal parameters and case identification under full-mouth protocols and PMPs. Separately, we utilized population measures of tooth-specific periodontal severity to generate PMPs with tooth selection based on the population ranking of clinical severity and assessed the sensitivity of case identification. RESULTS Symmetry of clinical severity was generally confirmed, with the exception of lingual inter-proximal sites, which yielded greater sensitivity in identifying periodontitis compared to buccal sites due to more severe pocketing and attachment loss on average. Misclassification of severe periodontitis occurred more frequently under commonly implemented PMPs compared to ranking-based selection of teeth, which yielded sensitivity estimates of 70.1%-79.4% with the selection of 8 teeth and reached 90% with the selection of only 14 teeth. CONCLUSIONS Clinical symmetry and sources of periodontitis misclassification were confirmed. The proposed selection of teeth based on population rankings of clinical severity yielded optimal sensitivity estimates for the detection of severe periodontitis and may present a favourable alternative to current options.
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Affiliation(s)
- Talal S Alshihayb
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Praveen Sharma
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Periodontal Research Group, University of Birmingham, Birmingham, UK
| | - Thomas Dietrich
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.,Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
| | - Brenda Heaton
- Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Accuracy of Estimating Periodontitis and Its Risk Association Using Partial-Mouth Recordings for Surveillance Studies: A Systematic Review and Meta-Analysis. Int J Dent 2022; 2022:7961199. [PMID: 35342426 PMCID: PMC8947864 DOI: 10.1155/2022/7961199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Our aim is to conduct an up-to-date systematic review and meta-analysis pertaining to the accuracy of using the partial-mouth recording protocol (PRP) in surveillance studies to estimate the periodontitis prevalence, extent, severity, and its risk associations. Methods Medline and Embase databases were searched for studies which assessed the periodontitis prevalence, severity, extent, or its risk associations using PRPs versus full-mouth recording protocols (FRPs); searches were conducted up until May 26, 2021. The risk of bias and the applicability of the studies were assessed using the QUADAS-2 tool. Both qualitative data synthesis and quantitative data synthesis were performed, and comparisons were done for the accuracy and precision of PRPs for different periodontitis outcomes. The study's protocol was registered through the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202160032). Results A total of 14 studies were included. The studies had a considerable degree of heterogeneity, along with a moderate risk of bias and applicability concerns. Several factors influenced the accuracy or precision of using PRPs, including the age, distribution of periodontitis in the studied population, PRP selection, total PRP sites, the threshold for minimum sites with CAL, and the severity of periodontitis case definitions. Overall, the PRP with the highest accuracy and precision mainly included (1) a full-mouth protocol at the following partial sites: mesiobuccal-midbuccal-distolingual (MB-B-DL), mesiobuccal-distolingual (MB-DL), mesiobuccal-midbuccal-distobuccal (MB-B-DB), mesiobuccal-distobuccal (MB-DB), and 84 sites using the random site selection method (RSSM) and (2) random-half-mouth (RHM) protocols. Conclusions The PRPs with the highest overall accuracy and precision in estimating the periodontitis prevalence, extent, severity, and risk associations included the full-mouth assessment at the following partial sites: MB-B-DL, MB-DL, MB-B-DB, MB-DB, and 84 sites using RSSM and RHM protocols.
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Luo LS, Luan HH, Jiang JF, Wu L, Li C, Leng WD, Zeng XT. The spatial and temporal trends of severe periodontitis burden in Asia, 1990-2019: A population-based epidemiological study. J Periodontol 2022; 93:1615-1625. [PMID: 35289931 DOI: 10.1002/jper.21-0625] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/05/2022] [Accepted: 03/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the long-term and spatial patterns of incidence, prevalence and disability-adjusted life year (DALY) of severe periodontitis in Asia from 1990 to 2019, and to estimate the associations between disease burden and socioeconomic development using the Socio-Demographic Index (SDI). METHODS Data were obtained from the global burden of disease study 2019. The average annual percent change (AAPC) was calculated to reflect temporal trends, spatial autocorrelation analysis was conducted to estimate the spatial characteristics, and spatial panel models were used to investigate the association between SDI and severe periodontitis burden. RESULTS For Asia as a whole, the crude rates increased by 1.10% per year for incidence, 1.42% per year for prevalence and 1.41% per year for DALY from 1990 to 2019. The age-standardized incidence, prevalence and DALY rates increased by 0.18%, 0.22% and 0.23% per year, respectively. Spatially, the hot spots of age-standardized incidence, prevalence and DALY rates were located in Southern Asia, besides, these rates all showed increasing trends in most countries, and the increases were clustered in Southeastern Asia. Furthermore, SDI showed a negative association with incidence (coef = -14.44; 95%CI: -24.63, -4.25) and prevalence (coef = -40.09; -51.81, -28.36), and a positive association with DALY rates (coef = 0.31; 0.23, 0.38). CONCLUSIONS Severe periodontitis poses a serious public health challenge in Asian countries with increasing temporal trends and substantial spatial inequalities. Effective geographically targeted public health interventions and strategies are needed to address the growing burden associated with severe periodontitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Hang-Hang Luan
- Department of Forensic Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun-Feng Jiang
- Department of Sociology, School of Sociology, Central China Normal University, Wuhan, Hubei Province, China
| | - Lan Wu
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Cheng Li
- Department of Stomatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Wei-Dong Leng
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Detecting and monitoring dental plaque levels with digital 2D and 3D imaging techniques. PLoS One 2022; 17:e0263722. [PMID: 35167618 PMCID: PMC8846510 DOI: 10.1371/journal.pone.0263722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Detecting and monitoring dental plaque is an important issue in research and clinical practice. In this context, new digital imaging methods that permit permanent documentation of the clinical findings could be promising tools. The aim of the study was therefore to investigate whether disclosed plaque can be reliably visualised on 2D and 3D images captured with digital intraoral imaging devices. Clinical examination was the reference method. Twenty subjects (27.5±1.2 years) were included and plaque was measured at three different stages: habitual plaque (T1), after 72 h without oral hygiene (T2) and after a subsequent habitual brushing exercise (T3). At each time point, plaque was disclosed followed by the clinical examination and capturing the 2D and 3D images (intraoral-camera CS 1500 and intraoral-scanner CS 3600; Carestream Dental, Germany). Plaque amounts were recorded on oral and vestibular surfaces of the Ramfjord-teeth (16, 21, 24, 36, 41, 44) using the Rustogi-modified-Navy-Plaque-Index (RMNPI) and expressed as percentage of plaque-containing RMNPI areas of all RMNPI areas. At T1, percentages (mean±SD) obtained from the clinical examination, 2D and 3D images were 62.2±10.6, 65.1±10.0 and 64.4±10.6 resp. increasing to 76.9±8.0, 77.9±8.6 and 77.5±9.4 resp. at T2. After toothbrushing (T3), values decreased to 56.3±11.1, 58.2±12.1 and 61.2±10.8 resp. All methods were able to show statistically significant changes in plaque amounts at the different time points with in part statistically significant but minor differences between them. The Bland-Altmann analysis revealed a good agreement between values from both 2D and 3D images with the clinical examination. The agreement of the scores obtained with the both image-based methods for the single RMNPI areas with the clinical examination was mainly classified as substantial to almost perfect. Amounts of plaque can be reliably detected and monitored on 2D images from an intraoral camera and on 3D images from an intraoral scanner.
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Accuracy and precision of using partial-mouth recordings to study the prevalence, extent and risk associations of untreated periodontitis. Saudi Dent J 2021; 34:142-149. [PMID: 35241904 PMCID: PMC8864468 DOI: 10.1016/j.sdentj.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
To study the accuracy and precision of estimating the prevalence, extent and associated risks of untreated periodontitis using partial-mouth recording protocols (PRPs) Methods: A purposive sample of 431 individuals who had never been treated for periodontal disease was recruited from screening clinics at the King Saud bin Abdul-Aziz University for Health Sciences. Data were collected using questionnaires and clinical examinations. The prevalence, extent and risk associations of periodontitis were evaluated. Three PRPs were compared to full-mouth recordings (FRPs) in terms of the sensitivity, specificity, predictive values, and absolute bias. Results: The prevalence of periodontitis was estimated with the highest accuracy and precision by examinations of the full mouth at the mesiobuccal and distolingual sites (FM)MB-DL, followed by random half-mouth (RHM) recordings. The extent of periodontitis was estimated with high precision using all the PRPs, and the absolute bias ranged from −0.6 to −2.3. The absolute bias indicated by OR for risk associations was small for the three PRPs and ranged from −0.8 to 0.8. Conclusion: (FM)MB-DL and RHM were the PRPs with moderate to high levels of accuracy and precision for estimating the prevalence and risk associations of periodontitis. The extent of periodontitis was estimated with high precision using all three PRPs. The results of this study showed that the magnitude and direction of bias were associated with the severity of periodontitis, the selected PRPs and the magnitude of the risk associations.
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Zhan J, Zhang Y, Wang X, Tai B, Hu D, Lin H, Wang B, Si Y, Wang C, Zheng S, Liu X, Rong W, Wang W, Feng X, Chen X. Related factors of periodontal health among Chinese middle school students, findings from a national cross-sectional survey. BMC Oral Health 2021; 21:517. [PMID: 34641832 PMCID: PMC8507307 DOI: 10.1186/s12903-021-01889-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the related risk factors of periodontal health status among Chinese middle school students. Methods This study is a part of the Fourth National Oral Health Epidemiological Survey, which is by far the largest oral epidemiological survey in China, including all provinces, municipalities and autonomous regions in mainland China. A multi-stage stratified sampling method was used to select middle school students aged 12–15 from the sampled middle school for investigation. The survey consisted of two parts: oral examination and questionnaire survey. The oral examination included gingival bleeding and calculus. The questionnaire included sociodemographic information, oral health knowledge, attitudes and behaviors. Logistic regression and generalized linear mixed model were used to investigate the risk factors of gingival bleeding and calculus.
Results A total of 118,514 middle-school students has been examined. Less gingival bleeding (OR = 0.746, CI 0.718–0.774) and calculus (OR = 0.550, CI 0.529–0.527) were found in 12-year-old group compared to 15-year-old group. The periodontal health status of males was worse than that of females (gingival bleeding OR = 1.102, CI 1.074–1.132, calculus OR = 1.258, CI 1.223–1.295). Besides age and gender, region, living place, ethnic groups, family structure, parent’s education level, oral health knowledge and behavior were also related to gingival bleeding and calculus. Conclusions Gingival bleeding and calculus occurred most of 12–15 years old adolescents in China. Several related factors, such as gender, age, ethnicity, father’s education level, oral health knowledge and behavior, were found in multi-factorial models. The impact of province should arouse people’s attention.
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Affiliation(s)
- Jingyu Zhan
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Yu Zhang
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, People's Republic of China
| | - Baojun Tai
- School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Deyu Hu
- West China Hospital of Stomatology, Sichuan University, Chengdu, People's Republic of China
| | - Huancai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat- Sen University, Guangzhou, People's Republic of China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, People's Republic of China
| | - Yan Si
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuguo Zheng
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Xuenan Liu
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Wensheng Rong
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Weijian Wang
- Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Xiping Feng
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China.
| | - Xi Chen
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, People's Republic of China.
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Botelho J, Leira Y, Viana J, Machado V, Lyra P, Aldrey JM, Pías-Peleteiro JM, Blanco J, Sobrino T, Mendes JJ. The Role of Inflammatory Diet and Vitamin D on the Link between Periodontitis and Cognitive Function: A Mediation Analysis in Older Adults. Nutrients 2021; 13:nu13030924. [PMID: 33809193 PMCID: PMC8001166 DOI: 10.3390/nu13030924] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from periodontitis are at a higher risk of developing cognitive dysfunction. However, the mediation effect of an inflammatory diet and serum vitamin D levels in this link is unclear. In total, 2062 participants aged 60 years or older with complete periodontal diagnosis and cognitive tests from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-2014 were enrolled. The Consortium to Establish a Registry for Alzheimer's disease (CERAD) word learning subtest (WLT) and CERAD delayed recall test (DRT), the animal fluency test (AFT) and the digit symbol substitution test (DSST) was used. Dietary inflammatory index (DII) was computed via nutrition datasets. Mediation analysis tested the effects of DII and vitamin D levels in the association of mean probing depth (PD) and attachment loss (AL) in all four cognitive tests. Periodontitis patients obtained worse cognitive test scores than periodontally healthy individuals. DII was negatively associated with CERAD-WLT, CERAD-DRT, AFT and DSST, and was estimated to mediate between 9.2% and 36.4% of the total association between periodontitis with cognitive dysfunction (p < 0.05). Vitamin D showed a weak association between CERAD-DRT, AFT and DSST and was estimated to between 8.1% and 73.2% of the association between periodontitis and cognitive dysfunction (p < 0.05). The association between periodontitis and impaired cognitive function seems to be mediated both by a proinflammatory dietary load and vitamin D deficiency. Future studies should further explore these mediators in the periodontitis-cognitive decline link.
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Affiliation(s)
- João Botelho
- Periodontology Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal;
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
- Correspondence: ; Tel.: +351-212-946-800
| | - Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute and NIHR UCLH Biomedical Research Centre, University College London, London WC1E 6DE, UK;
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
- Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - João Viana
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - Vanessa Machado
- Periodontology Department, Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal;
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - Patrícia Lyra
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
| | - José Manuel Aldrey
- Dementia Unit, Department of Neurology, Clinical University Hospital, 15706 Santiago de Compostela, Spain; (J.M.A.); (J.M.P.-P.)
| | - Juan Manuel Pías-Peleteiro
- Dementia Unit, Department of Neurology, Clinical University Hospital, 15706 Santiago de Compostela, Spain; (J.M.A.); (J.M.P.-P.)
| | - Juan Blanco
- Periodontology Unit, Faculty of Medicine and Odontology, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain;
- Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain;
| | - José João Mendes
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal; (J.V.); (P.L.); (J.J.M.)
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12
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Tiensripojamarn N, Lertpimonchai A, Tavedhikul K, Udomsak A, Vathesatogkit P, Sritara P, Charatkulangkun O. Periodontitis is associated with cardiovascular diseases: A 13-year study. J Clin Periodontol 2021; 48:348-356. [PMID: 33386631 DOI: 10.1111/jcpe.13418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively evaluate the association between periodontitis and the incidence of cardiovascular diseases (CVDs) in Thai adults. MATERIALS AND METHODS Medical data from the questionnaires and physical examinations of 1850 participants aged 47-73 years from EGAT study were gathered. Random half-mouth periodontal examination of each participant was performed by calibrated periodontists, and periodontal status was defined. The incidence of new CVD events, including coronary heart disease (CHD) and stroke, was verified by cardiologists. The Cox proportional hazard regression model was used to estimate hazard ratios (HRs). RESULTS The prevalence of no/mild, moderate and severe periodontitis in the study participants was 11.7%, 52.7% and 35.6%, respectively. During the 13-year follow-up, CVD events occurred in 110 (5.9%) participants, with 82 (4.4%) from CHD and 28 (1.5%) from stroke. After adjusting for cardiovascular risk factors, a significant association between severe periodontitis and the incidence of CHD was found compared with the no/mild periodontitis group with an HR of 4.53 (95% confidence intervals: 1.08-19.02). However, no significant association was seen when considering total CVD events and stroke outcome. CONCLUSIONS This study demonstrates that severe periodontitis is associated with an increased incidence of CHD, independent of established cardiovascular risk factors.
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Affiliation(s)
| | - Attawood Lertpimonchai
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Kanoknadda Tavedhikul
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | | | | | - Orawan Charatkulangkun
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
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13
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Optimal Examination Sites for Periodontal Disease Evaluation: Applying the Item Response Theory Graded Response Model. J Clin Med 2020; 9:jcm9113754. [PMID: 33233427 PMCID: PMC7700480 DOI: 10.3390/jcm9113754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Periodontal examination data have a complex structure. For epidemiological studies, mass screenings, and public health use, a simple index that represents the periodontal condition is necessary. Periodontal indices for partial examination of selected teeth have been developed. However, the selected teeth vary between indices, and a justification for the selection of examination teeth has not been presented. We applied a graded response model based on the item response theory to select optimal examination teeth and sites that represent periodontal conditions. Data were obtained from 254 patients who participated in a multicenter follow-up study. Baseline data were obtained from initial follow-up. Optimal examination sites were selected using item information calculated by graded response modeling. Twelve sites—maxillary 2nd premolar (palatal-medial), 1st premolar (palatal-distal), canine (palatal-medial), lateral incisor (palatal-central), central incisor (palatal-distal) and mandibular 1st premolar (lingual, medial)—were selected. Mean values for clinical attachment level, probing pocket depth, and bleeding on probing by full mouth examinations were used for objective variables. Measuring the clinical parameters of these sites can predict the results of full mouth examination. For calculating the periodontal index by partial oral examination, a justification for the selection of examination sites is essential. This study presents an evidence-based partial examination methodology and its modeling.
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14
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Alshihayb TS, Kaye EA, Zhao Y, Leone CW, Heaton B. The impact of periodontitis exposure misclassification bias from partial-mouth measurements on association with diabetes and cardiovascular disease. J Clin Periodontol 2020; 47:1457-1465. [PMID: 32990981 DOI: 10.1111/jcpe.13376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
AIM To quantify exposure misclassification bias arising from use of partial-mouth protocols in studies of periodontitis-systemic disease associations. MATERIALS AND METHODS Using data from 10,134 adults participating in the National Health and Nutrition Examination Survey, we classified periodontal status based on full-mouth clinical examinations and three commonly used partial-mouth protocols. Associations between periodontitis and self-reported diabetes and cardiovascular disease were evaluated under each protocol using adjusted logistic regression. Percent relative bias was calculated to evaluate magnitude and direction of bias. RESULTS Misclassification primarily resulted in underestimation of associations, the extent of which depended on both the outcome under study and exposure severity. Bias due to misclassification of severe periodontitis was negligible for cardiovascular disease (0%-4.1%) compared to diabetes (177.7%-234.1%). In contrast, bias in moderate periodontitis associations was comparable across each outcome-diabetes (28.4%-39.5%) and cardiovascular disease (8.9%-46.7%). Results did not meaningfully change based on the partial-mouth protocol implemented. Stratified analyses showed increased bias among those with ≤15 teeth. Use of mean attachment loss as a continuous exposure resulted in minimal-to-no bias. CONCLUSIONS Exposure misclassification bias due to use of partial-mouth protocols can yield inaccurate conclusions about periodontitis-systemic disease associations, the extent of which may depend on periodontitis classification and the association under study.
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Affiliation(s)
- Talal S Alshihayb
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Elizabeth A Kaye
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Yihong Zhao
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA.,Rutgers University, Piscataway, NJ, USA
| | - Cataldo W Leone
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Brenda Heaton
- Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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15
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Sadiq N, Probst JC, Merchant AT, Martin AB, Shrestha D, Khan MM. The role of dental insurance in mitigating mortality among working-age U.S. adults with periodontitis. J Clin Periodontol 2020; 47:1294-1303. [PMID: 32939782 DOI: 10.1111/jcpe.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 07/28/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess the relationship of dental insurance with all-cause mortality and mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM), and cerebrovascular diseases (CBD) among those with periodontitis. MATERIALS AND METHODS NHANES III and its associated mortality data set were used in this study. The outcome variables were "all-cause mortality" and "combined mortality" due to CVD, DM, and CBD. The independent variable was dental insurance stratified over periodontitis status. Unweighted frequencies with weighted column percentages were used for descriptive statistics, and chi-square test was applied for significance. Cox proportional hazard models were used for stratified multivariable analyses. All analyses were performed in SAS v9.4 accounting for survey data complexities. Significance level was kept at 5%. RESULTS The mortality was 14.58% for all-cause mortality and 4.06% for combined mortality among those with periodontitis in this study. Dental insurance significantly reduced the hazard of all-cause mortality among those with periodontitis (HR: 0.75; 95% CI: 0.61 - 0.93), adjusted for covariates. However, no association of dental insurance with combined mortality was observed among periodontitis group. CONCLUSIONS Dental insurance reduces hazard of all-cause mortality among those with periodontitis. Dental insurance ensures access to dentists and improves oral and dental health. Longitudinal study is needed to establish causality.
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Affiliation(s)
- Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.,Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Janice C Probst
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Amy B Martin
- College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Deepika Shrestha
- Data Management and Analysis Division, Center for Policy, Planning and Evaluation, DC Department of Health, Washington, DC, USA
| | - M Mahmud Khan
- Department of Health Policy & Management, University of Georgia, Athens, GA, USA
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16
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Steinmeier S, Wiedemeier D, Hämmerle CHF, Mühlemann S. Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry. BMC Oral Health 2020; 20:266. [PMID: 32977794 PMCID: PMC7517740 DOI: 10.1186/s12903-020-01255-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoral scans (IOS) provide three-dimensional images with approximate true colors representing a possible tool in teledentistry for remote examination. The aim of the present cross-sectional validation study was, therefore, to evaluate the levels of agreement between remote diagnoses derived from IOS and diagnoses based on clinical examinations for assessing dental and periodontal conditions. METHODS The test sample comprised 10 patients representing different clinical conditions. Following the acquisition of IOS (Trios, 3Shape), a full-mouth dental and periodontal examination was done and periapical radiographs were taken. Ten dentists were asked to perform dental and periodontal scorings for each of the ten patients on a tablet computer presenting the IOS. Scores included diagnosis of gingivitis/periodontitis, and evaluated presence as well as amount of plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, stain, and non-carious cervical lesion, as well as presence of decayed, filled, and crowned teeth and implants. In a second round of assessments, the periapical radiographs were provided and the dentists were able to change the scores. The time for the remote assessment was recorded. The agreement between remote and clinical scorings (reference) was then analyzed descriptively. RESULTS The mean time for the tele assessment was 3.17 min and the additional consultation of the radiographs accounted for another 1.48 min. The sensitivity and specificity values were 0.61 and 0.39 for gingivitis and 0.67 and 0.33 for periodontitis, with no relevant changes when radiographs were provided for the diagnosis of periodontitis (0.72 and 0.28). The agreement for dichotomized dental and periodontal indices ranged between 78 and 95%. With the provision of radiographs, the remote examiners were able to detect existing filled teeth, crowned teeth, and implants, whereas the detection of decayed teeth (70%) was not improved. CONCLUSIONS The remote examination using IOS was effective in detecting dental findings, whereas periodontal conditions could not be assessed with the same accuracy. Still, remote assessment of IOS would allow a time-efficient screening and triage of patients. Improvement of the image quality of IOS may further allow to increase the accuracy of remote assessments in dentistry. According to the Swiss Regulation this investigation is not a clinical trial and therefore no registration in a WHO-registry is needed.
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Affiliation(s)
- Sabrina Steinmeier
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Daniel Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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17
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Machado V, Proença L, Morgado M, Mendes JJ, Botelho J. Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination. J Clin Med 2020; 9:jcm9072313. [PMID: 32708230 PMCID: PMC7408796 DOI: 10.3390/jcm9072313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.
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Affiliation(s)
- Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal;
- Clinical Research Unit (CRU), CiiEM, IUEM, 2829-511 Almada, Portugal; (M.M.); (J.J.M.)
- Correspondence:
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), CiiEM, IUEM, 2829-511 Almada, Portugal;
| | - Mariana Morgado
- Clinical Research Unit (CRU), CiiEM, IUEM, 2829-511 Almada, Portugal; (M.M.); (J.J.M.)
| | - José João Mendes
- Clinical Research Unit (CRU), CiiEM, IUEM, 2829-511 Almada, Portugal; (M.M.); (J.J.M.)
| | - João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal;
- Clinical Research Unit (CRU), CiiEM, IUEM, 2829-511 Almada, Portugal; (M.M.); (J.J.M.)
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18
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Botelho J, Machado V, Proença L, Mendes JJ. The 2018 periodontitis case definition improves accuracy performance of full-mouth partial diagnostic protocols. Sci Rep 2020; 10:7093. [PMID: 32341429 PMCID: PMC7184582 DOI: 10.1038/s41598-020-63700-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
We aimed to compare the accuracy performance of the new 2018 periodontitis case definition by the European Federation of Periodontology (EFP)/ American Association of Periodontology (AAP) with Centers for Disease Control (CDC)/AAP 2012 in full-mouth partial recording protocols (PRP). Retrospective data from NHANES 2011-2012 and 2013-2014 were analyzed. For each case definition, full-mouth diagnostic was defined as the reference standard. Patients were diagnosed for the presence of periodontitis and staging for each PRP. Sensitivity, specificity, accuracy and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass ROC/AUC analyses. Our performance analysis shows that the new 2018 classification outperforms the 2012 classification regarding the diagnosis and staging of periodontitis on full-mouth PRPs. This recent case definition has strengthened the utility of PRPs and its improvements certainly explain the observed findings. Also, our findings contribute to the reliability of PRPs and its use in future worldwide epidemiological surveys.
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Affiliation(s)
- João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal.
- Clinical Research Unit (CRU), CiiEM, IUEM, Almada, Portugal.
| | - Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, IUEM, Almada, Portugal
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), CiiEM, IUEM, Almada, Portugal
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19
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Zhang L, Gao X, Zhou J, Chen S, Zhang J, Zhang Y, Chen B, Yang J. Increased risks of dental caries and periodontal disease in Chinese patients with inflammatory bowel disease. Int Dent J 2020; 70:227-236. [PMID: 31998967 DOI: 10.1111/idj.12542] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/26/2019] [Accepted: 11/02/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) may be associated with oral diseases, but few relevant studies have been reported in China. This study aimed to compare the prevalence, severity and extent of dental caries and periodontal disease in Chinese IBD patients and healthy controls. MATERIALS AND METHODS In this cross-sectional study, questionnaires and oral examinations were completed for 389 IBD patients [265 with Crohn's disease (CD) and 124 with ulcerative colitis (UC)] and 265 healthy controls based on the established criteria of the World Health Organization. Tobit regression, multiple linear regression and logistic regression were performed to analyse the data. RESULTS After adjusting for confounders, the decayed, missing and filled surfaces indices were significantly increased in the CD and UC patients compared with those in the controls (P < 0.001). Patients with CD [odds ratio (OR) = 4.27, 95% confidence interval (95% CI): 2.63-6.95, P < 0.001] and UC (OR = 2.21, 95% CI: 1.24-3.94, P = 0.007) had significantly higher risks of dental caries than controls. Significantly higher percentages of sites with probing pocket depth ≥ 5 mm and clinical attachment loss ≥ 4 mm were observed in CD and UC patients compared with controls (P < 0.001). A fully adjusted model revealed that CD and UC were risk indicators for periodontitis (OR = 4.46, 95% CI: 2.50-7.95, P < 0.001; OR = 4.66, 95% CI: 2.49-8.71, P < 0.001, respectively). No significant differences in dental caries and periodontal disease were observed between the CD and UC patients. CONCLUSIONS Chinese IBD patients have a higher prevalence, severity and extent of dental caries and/or periodontal disease than controls, and require oral health education and multidisciplinary treatment.
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Affiliation(s)
- Limin Zhang
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiang Gao
- Department of Gastroenterology, The Center for Inflammatory Bowel Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiamin Zhou
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shan Chen
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinxin Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yingfan Zhang
- Department of Gastroenterology, the Center for Inflammatory Bowel Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baili Chen
- Department of Gastroenterology, the Center for Inflammatory Bowel Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junying Yang
- Department of Stomatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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20
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Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol 2019; 89 Suppl 1:S46-S73. [PMID: 29926936 DOI: 10.1002/jper.17-0576] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
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Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Cléverson O Silva
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
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21
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Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014. J Am Dent Assoc 2019; 149:576-588.e6. [PMID: 29957185 DOI: 10.1016/j.adaj.2018.04.023] [Citation(s) in RCA: 294] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND This report presents weighted average estimates of the prevalence of periodontitis in the adult US population during the 6 years 2009-2014 and highlights key findings of a national periodontitis surveillance project. METHODS Estimates were derived for dentate adults 30 years or older from the civilian noninstitutionalized population whose periodontitis status was assessed by means of a full-mouth periodontal examination at 6 sites per tooth on all non-third molar teeth. Results are reported according to a standard format by applying the Centers for Disease Control and Prevention/American Academy of Periodontology periodontitis case definitions for surveillance, as well as various thresholds of clinical attachment loss and periodontal probing depth. RESULTS An estimated 42% of dentate US adults 30 years or older had periodontitis, with 7.8% having severe periodontitis. Overall, 3.3% of all periodontally probed sites (9.1% of all teeth) had periodontal probing depth of 4 millimeters or greater, and 19.0% of sites (37.1% of teeth) had clinical attachment loss of 3 mm or greater. Severe periodontitis was most prevalent among adults 65 years or older, Mexican Americans, non-Hispanic blacks, and smokers. CONCLUSIONS This nationally representative study shows that periodontitis is a highly prevalent oral disease among US adults. PRACTICAL IMPLICATIONS Dental practitioners should be aware of the high prevalence of periodontitis in US adults and may provide preventive care and counselling for periodontitis. General dentists who encounter patients with periodontitis may refer these patients to see a periodontist for specialty care.
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Torrungruang K, Katudat D, Mahanonda R, Sritara P, Udomsak A. Periodontitis is associated with elevated serum levels of cardiac biomarkers—Soluble ST2 and C‐reactive protein. J Clin Periodontol 2019; 46:809-818. [DOI: 10.1111/jcpe.13149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/30/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kitti Torrungruang
- Department of Microbiology, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | | | - Rangsini Mahanonda
- Department of Periodontology, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | - Piyamitr Sritara
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Artit Udomsak
- Medical and Health Department Electricity Generating Authority of Thailand Nonthaburi Thailand
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23
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Romano F, Perotto S, Castiglione A, Aimetti M. Prevalence of periodontitis: misclassification, under-recognition or over-diagnosis using partial and full-mouth periodontal examination protocols. Acta Odontol Scand 2019; 77:189-196. [PMID: 30623706 DOI: 10.1080/00016357.2018.1535136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to assess the bias in estimating the prevalence of periodontitis due to partial-mouth periodontal examination protocols (PMPE) and to relate the severity and extent of periodontal damage to periodontitis misclassification when applying case definitions by Centres of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIALS AND METHODS A full-mouth periodontal examination (FMPE) was performed in 721 adults living in North Italy to identify moderate and severe periodontitis. These results were compared with those obtained with two PMPE protocols analyzing two interproximal sites on all teeth (fMB-DL) or four interproximal sites in two random diagonal quadrants (pMDB-MDL). RESULTS Both PMPE systems estimated the prevalence of moderate periodontitis with limited bias (-2.79% for pMDB-MDL and -3.49% for fMB-DL), whereas produced larger relative biases for severe periodontitis (-28.74% versus - 14.55%). The percentage of under-recognition of existing periodontal disease was 8.9% under fMB-DL and 15.5% under pMDB-MDL. The diagnosis of moderate and severe periodontal disease was correctly assigned to individuals with on average 8% and 30% of pathological sites, respectively. CONCLUSION These findings suggest that PMPE systems provide high level of bias when using CDC/AAP case definitions.
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Affiliation(s)
- Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School University of Turin, Turin, Italy
| | - Stefano Perotto
- Postgraduate Program in Periodontology, University of Turin, Turin, Italy
| | - Anna Castiglione
- Città della Salute e della Scienza and CPO Piedmont, Unit of Clinical Epidemiology, Turin, Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School University of Turin, Turin, Italy
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24
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Wahlin Å, Papias A, Jansson H, Norderyd O. Secular trends over 40 years of periodontal health and disease in individuals aged 20-80 years in Jönköping, Sweden: Repeated cross-sectional studies. J Clin Periodontol 2018; 45:1016-1024. [PMID: 29971805 DOI: 10.1111/jcpe.12978] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/13/2018] [Accepted: 07/01/2018] [Indexed: 12/19/2022]
Abstract
AIM To assess trends over 40 years regarding prevalence and severity of periodontitis in a Swedish adult population. MATERIALS AND METHODS Cross-sectional examinations using the same clinical protocol have been repeated every 10 years (1973-2013) in a Swedish city with focus on periodontal disease in adults. Periodontal recordings included all teeth, excluding 3rd molars. Periodontal disease experience was classified (no/minor, moderate and severe). RESULTS The no/minor group increased from 43% in 1983 to 60% in 2013. There was a non-significant trend for a decrease of the severe group. Over the 40-year period, the number of teeth increased significantly and at the examination 2013, the severe group accounted for this increase. More than 60% of the study population in 2013 had no periodontal pockets (PD) ≥6 mm. The number of PD ≥4 mm and ≥6 mm were unaltered between 2003 and 2013 in all age groups, except for the 20-year old individuals. This group showed a statistically significant increase of ≥4 mm PD. CONCLUSIONS The periodontal health has improved in the population over the 40 years. The number of teeth increased significantly in the population, and in 2013, this increase occurred entirely in the severe group. Finally, there was a trend toward diminished prevalence of severe periodontitis.
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Affiliation(s)
- Åsa Wahlin
- The Institute for Postgraduate Dental Education, Jönköping, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Apostolos Papias
- The Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Henrik Jansson
- The Institute for Postgraduate Dental Education, Jönköping, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden.,Department of Biomedicine and Natural Sciences, School of Health Sciences, Centre for Oral Health, Jönköping University, Jönköping, Sweden
| | - Ola Norderyd
- The Institute for Postgraduate Dental Education, Jönköping, Sweden.,Faculty of Odontology, Malmö University, Malmö, Sweden.,Department of Biomedicine and Natural Sciences, School of Health Sciences, Centre for Oral Health, Jönköping University, Jönköping, Sweden
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25
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Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol 2018; 45 Suppl 20:S44-S67. [DOI: 10.1111/jcpe.12939] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | | | - Dimitris N. Tatakis
- Division of Periodontology; College of Dentistry; The Ohio State University; Columbus OH USA
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26
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Im SI, Heo J, Kim BJ, Cho KI, Kim HS, Heo JH, Hwang JY. Impact of periodontitis as representative of chronic inflammation on long-term clinical outcomes in patients with atrial fibrillation. Open Heart 2018; 5:e000708. [PMID: 29713482 PMCID: PMC5922561 DOI: 10.1136/openhrt-2017-000708] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 02/12/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives Relationship between atrial fibrillation (AF) and inflammation was shown in previous studies. However, there was limited data about the association between the periodontitis and AF in the long-term follow-up. The aim of this study was to evaluate the impact of periodontitis on long-term clinical outcomes in patients with AF. Methods The Kosin University echocardiography, ECG and periodontitis database were reviewed from 2013 to 2015 to identify patients with AF. Those patients were divided into two groups according to the presence of periodontitis and clinical events including any arrhythmic attack, thromboembolic and bleeding and death were collected during a median of 18 months. Results Among 227 patients with AF, 47 (20.7%) patients had periodontitis. Major adverse cardiac events (MACE) were significantly higher in patients with periodontitis compared with those without periodontitis (p<0.001). Arrhythmias including AF, atrial tachycardia, atrial premature beat, ventricular tachycardia and ventricular premature beat also occurred in 44 (93.6%) patients, which was higher significantly higher incidence in patients with periodontitis than in those without periodontitis (p<0.001). In univariate analysis, age, CHA2DS2-VASc, left atrial volume index (LAVi) and periodontitis were significantly associated with arrhythmic events and MACE including bleeding events, thromboembolic events, arrhythmic events and mortality. In multivariate analysis, LAVi (p=0.005) and periodontitis (p<0.001) were independent risk factors for arrhythmic events and periodontitis (p<0.001) for MACE at the long-term follow-up. Conclusions The periodontitis as representative of chronic inflammation was an independent predictor of arrhythmic events and MACE in patients with AF.
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Affiliation(s)
- Sung Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jinho Heo
- Department of Dentistry/Oral & Maxillofacial Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Bong Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Hyun Su Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
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27
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Dutra ER, Chisini LA, Cademartori MG, Oliveira LJCD, Demarco FF, Correa MB. Accuracy of partial protocol to assess prevalence and factors associated with dental caries in schoolchildren between 8-12 years of age. CAD SAUDE PUBLICA 2018; 34:e00077217. [DOI: 10.1590/0102-311x00077217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract: The aim of this study was to test accuracy and reliability of a partial protocol (PP) of oral examination involving the permanent first molars. This cross-sectional study was carried out in two stages. First, a cross-sectional study was performed in a representative sample of 1,211 children using DMFT-index in a full-mouth protocol (FM). A PP was simulated from FM data using only data from the permanent first molars. A second part was performed with 202 children examined by a gold standard examiner (FM) and three dentists using the PP to assess its reliability. Accuracy of PP was assessed by sensitivity/specificity/predictive positive and negative values. Inter-examiner reliability in comparison with gold standard examiner was assessed using weighted kappa. The prevalence of dental caries observed using DMFT index was 32.4% and was 30.2% for PP . The PP presented high sensitivity (93.1%; 95%CI: 91.5-94.5), showing similar magnitude of association’s measures for all associated factors investigated. When compared with the gold standard FM examination, all examiners obtained high parameters of sensitivity and specificity (around 90%). Predictive negative values were higher than predictive positive values for the examiners. This study showed that this partial protocol involving the permanent first molars is accurate and reliable as a screening tool to assess dental caries prevalence and associated factors in schoolchildren.
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28
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Torrungruang K, Ongphiphadhanakul B, Jitpakdeebordin S, Sarujikumjornwatana S. Mediation analysis of systemic inflammation on the association between periodontitis and glycaemic status. J Clin Periodontol 2018; 45:548-556. [PMID: 29500831 DOI: 10.1111/jcpe.12884] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 01/04/2023]
Abstract
AIM This cross-sectional study investigated the associations between periodontitis, systemic inflammation and glycaemic status. MATERIALS AND METHODS The participants were divided into three groups: normoglycaemia, impaired fasting glucose (IFG) and diabetes. Multinomial logistic regression was used to examine the associations between periodontitis severity and glycaemic status, adjusting for potential confounders. Mediation analysis of four systemic inflammatory biomarkers, C-reactive protein (CRP), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), was performed. RESULTS This study comprised 2,036 participants, aged 39-66 years. Severe periodontitis was associated with IFG and diabetes with odds ratios of 1.6 (95% confidence interval [CI]: 1.1-2.4, p = .023) and 2.4 (95% CI: 1.3-4.5, p = .006), respectively. The CRP, WBC and PLR were associated with both periodontitis severity and glycaemic status (p < .05). In contrast, the NLR was associated with periodontitis severity (p < .05) but not glycaemic status (p > .05). The CRP, WBC and PLR mediated 8%, 13% and 6%, respectively, of the association between severe periodontitis and diabetes. Similar proportions mediated were observed for the periodontitis-IFG association. CONCLUSIONS Our findings support the role of systemic inflammation as mediators of the associations between periodontitis and IFG or diabetes.
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Affiliation(s)
- Kitti Torrungruang
- Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Boonsong Ongphiphadhanakul
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Somchai Sarujikumjornwatana
- Health Division, Medical and Health Department, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
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29
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Kim OS, Shin MH, Kweon SS, Lee YH, Kim OJ, Kim YJ, Chung HJ. The severity of periodontitis and metabolic syndrome in Korean population: The Dong-gu study. J Periodontal Res 2017; 53:362-368. [DOI: 10.1111/jre.12521] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
Affiliation(s)
- O. S. Kim
- Department of Periodontology; School of Dentistry; Dental Science Research Institute; Chonnam National University; Gwangju Korea
| | - M. H. Shin
- Department of Preventive Medicine; Chonnam National University Medical School; Gwangju Korea
| | - S. S. Kweon
- Department of Preventive Medicine; Chonnam National University Medical School; Gwangju Korea
- Jeonnam Regional Cancer Center; Chonnam National University Hwasun Hospital; Hwasun Korea
| | - Y. H. Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science; Wonkwang University School of Medicine; Iksan Korea
| | - O. J. Kim
- Department of Oral Pathology; School of Dentistry; Dental Science Research Institute; Chonnam National University; Gwangju Korea
| | - Y. J. Kim
- Department of Periodontology; School of Dentistry; Dental Science Research Institute; Chonnam National University; Gwangju Korea
| | - H. J. Chung
- Department of Periodontology; School of Dentistry; Dental Science Research Institute; Chonnam National University; Gwangju Korea
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30
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Ediani Machado M, Tomazoni F, Ruffo Ortiz F, Ardenghi TM, Zanatta FB. Impact of Partial-Mouth Periodontal Examination Protocols on the Association Between Gingival Bleeding and Oral Health–Related Quality of Life in Adolescents. J Periodontol 2017; 88:693-701. [DOI: 10.1902/jop.2017.160622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Michely Ediani Machado
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Fernanda Tomazoni
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Fernanda Ruffo Ortiz
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Fabricio Batistin Zanatta
- Department of Stomatology, Faculty of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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31
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Machado ME, Tomazoni F, Casarin M, Ardenghi TM, Zanatta FB. Partial-mouth periodontal examination protocols for the determination of the prevalence and extent of gingival bleeding in adolescents. Community Dent Oral Epidemiol 2017; 45:427-433. [DOI: 10.1111/cdoe.12306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Michely Ediani Machado
- Department of Stomatology; School of Dentistry; Federal University of Santa Maria; Santa Maria Rio Grande do Sul Brazil
| | - Fernanda Tomazoni
- Department of Stomatology; School of Dentistry; Federal University of Santa Maria; Santa Maria Rio Grande do Sul Brazil
| | - Maísa Casarin
- Department of Stomatology; School of Dentistry; Federal University of Santa Maria; Santa Maria Rio Grande do Sul Brazil
| | - Thiago M. Ardenghi
- Department of Stomatology; School of Dentistry; Federal University of Santa Maria; Santa Maria Rio Grande do Sul Brazil
| | - Fabricio Batistin Zanatta
- Department of Stomatology; School of Dentistry; Federal University of Santa Maria; Santa Maria Rio Grande do Sul Brazil
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Preisser JS, Marks SJ, Sanders AE, Akinkugbe AA, Beck JD. A new way to estimate disease prevalence from random partial-mouth samples. J Clin Periodontol 2016; 44:283-289. [PMID: 27883200 DOI: 10.1111/jcpe.12656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Abstract
AIM Standard partial-mouth estimators of chronic periodontitis (CP) that define an individual's disease status solely in terms of selected sites underestimate prevalence. This study proposes an improved prevalence estimator based on randomly sampled sites and evaluates its accuracy in a well-characterized population cohort. METHODS Importantly, this method does not require determination of disease status at the individual level. Instead, it uses a statistical distributional approach to derive a prevalence formula from randomly selected periodontal sites. The approach applies the conditional linear family of distributions for correlated binary data (i.e. the presence or absence of disease at sites within a mouth) with two simple working assumptions: (i) the probability of having disease is the same across all sites; and (ii) the correlation of disease status is the same for all pairs of sites within the mouth. RESULTS Using oral examination data from 6793 participants in the Arteriolosclerosis Risk in Communities study, the new formula yields CP prevalence estimates that are much closer than standard partial mouth estimates to full mouth estimates. CONCLUSIONS Resampling of the cohort shows that the proposed estimators give good precision and accuracy for as few as six tooth sites sampled per individual.
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Affiliation(s)
- John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah J Marks
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Anne E Sanders
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aderonke A Akinkugbe
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - James D Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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33
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Yoshihara A, Iwasaki M, Miyazaki H, Nakamura K. Bidirectional relationship between renal function and periodontal disease in older Japanese women. J Clin Periodontol 2016; 43:720-6. [DOI: 10.1111/jcpe.12576] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Akihiro Yoshihara
- Department of Oral Health and Welfare; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - Masanori Iwasaki
- Department of Community Oral Health Development; Kyushu Dental University; Fukuoka Japan
| | - Hideo Miyazaki
- Department of Oral Health Science; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - Kazutoshi Nakamura
- Department of Community Preventive Medicine; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
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Tran DT, Gay IC, Du XL, Fu Y, Bebermeyer RD, Neumann AS, Streckfus CF, Chan W, Walji MF. Partial-mouth periodontal examination protocol for estimating periodontitis extent and severity in a US population. Clin Exp Dent Res 2016; 2:73-79. [PMID: 29744152 PMCID: PMC5839260 DOI: 10.1002/cre2.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
We have previously demonstrated that half-mouth four-site periodontal examination protocol performed well in estimating periodontitis prevalence. This study aimed to assess biases associated with this same protocol in estimating periodontitis extent and severity in a United States population. Periodontitis extent as determined by percentage of sites with clinical attachment loss (CAL) ≥3, and ≥5 mm and severity as determined by mean CAL were calculated for full-mouth examination and half-mouth four-site protocol based on 3734 adults sampled from the National Health and Nutrition Examination Survey 2009-2010. Probing depth was excluded because of low data reliability. The comparison between full-mouth and half-mouth assessments was based on bias, relative bias, Wilcoxon signed-rank test, and intra-class correlation coefficient (ICC). For full-mouth examination, periodontitis extent was 21.2% for CAL ≥3 mm and 6.9% for CAL ≥5 mm; periodontitis severity (mean CAL) was 1.73 mm. Half-mouth four-site protocol provided bias -1.2% and relative bias -5.7% for extent (CAL ≥3 mm). Corresponding numbers were -0.3% and 4.3% for extent (CAL ≥5 mm), -0.05 mm and -2.9% for severity. Although the difference between full-mouth and half-mouth assessments was statistically significant, ICCs between them were ≥0.96 for extent (CAL ≥3, 5 mm), and severity (mean CAL). Half-mouth four-site protocol performed well in estimating periodontitis extent and severity based on CAL. Therefore, this protocol should be considered for periodontitis surveillance.
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Affiliation(s)
- Duong T. Tran
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Isabel C. Gay
- School of Dental MedicineEast Carolina UniversityGreenvilleNC27834USA
| | - Xianglin L. Du
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Yunxin Fu
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Richard D. Bebermeyer
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Ana S. Neumann
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Charles F. Streckfus
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Wenyaw Chan
- School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
| | - Muhammad F. Walji
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexas77030USA
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35
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Oral Candida Carriage and Morphotype Differentiation in Chronic Periodontitis Patients with and without Diabetes in the Indian Sub-Continent. Dent J (Basel) 2015; 3:123-131. [PMID: 29567932 PMCID: PMC5851191 DOI: 10.3390/dj3040123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the oral Candida carriage and morphotype differentiation of Candida species in chronic periodontitis patients, with and without diabetes mellitus. This cross sectional study included 30 subjects in the age range of 40–60 years, who were divided into two groups: 15 chronic periodontitis only (CP) patients, and 15 chronic periodontitis patients with diabetes (CPD). Clinical measurements included plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and fasting blood sugar level (FBS). The unstimulated whole saliva samples were collected for fungal analysis. Candida carriage was analyzed by measuring colony forming units (CFU) following the culture of samples. Qualitative morphotype differentiation of Candida species from yeast to hyphal form was analyzed using Periodic acid-Schiff (PAS) staining. There was no statistically significant difference between CP and CPD groups for the periodontal parameters. However, a significantly higher Candida species CFU count was found in CPD (0.33 ± 0.23) as compared to CP (0.05 ± 0.04) group. This pilot study suggests that the occurrence of Candida species is higher in the saliva of chronic periodontitis patients with diabetes as compared to patients with chronic periodontitis alone.
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36
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Eke PI, Dye BA, Wei L, Slade GD, Thornton-Evans GO, Borgnakke WS, Taylor GW, Page RC, Beck JD, Genco RJ. Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012. J Periodontol 2015; 86:611-22. [PMID: 25688694 PMCID: PMC4460825 DOI: 10.1902/jop.2015.140520] [Citation(s) in RCA: 925] [Impact Index Per Article: 102.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009 to 2010 and 2011 to 2012 cycles of the National Health and Nutrition Examination Survey (NHANES). METHODS Estimates were derived for dentate adults, aged ≥30 years, from the US civilian non-institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (AL) and periodontal probing depth (PD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of non-Hispanic Asians were sampled in 2011 to 2012 to provide reliable estimates of their periodontitis prevalence. RESULTS In 2009 to 2012, 46% of US adults, representing 64.7 million people, had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PD ≥4 mm, and 19.3% of sites (37.4% teeth) had AL ≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and non-Hispanic blacks (59.1%), followed by non-Hispanic Asian Americans (50.0%), and lowest in non-Hispanic whites (40.8%). Prevalence varied two-fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education. CONCLUSIONS This study confirms a high prevalence of periodontitis in US adults aged ≥30 years, with almost fifty-percent affected. The prevalence was greater in non-Hispanic Asians than non-Hispanic whites, although lower than other minorities. The distribution provides valuable information for population-based action to prevent or manage periodontitis in US adults.
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Affiliation(s)
- Paul I. Eke
- Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Bruce A. Dye
- Division of Health and Nutrition Examination Surveys, CDC, Hyattsville, MD
| | | | - Gary D. Slade
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Wenche S. Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - George W. Taylor
- Department of Preventive and Restorative Dental Sciences, University of California School of Dentistry, San Francisco, CA
| | - Roy C. Page
- Department of Periodontics, University of Washington School of Dentistry, Seattle, WA
| | - James D. Beck
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - Robert J. Genco
- Department of Oral Biology, State University of New York School of Dental Medicine, Buffalo, NY
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Chu Y, Ouyang X. Accuracy of Partial-Mouth Examination Protocols for Extent and Severity Estimates of Periodontitis: A Study in a Chinese Population With Chronic Periodontitis. J Periodontol 2015; 86:406-17. [DOI: 10.1902/jop.2014.140422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zimmermann H, Hagenfeld D, Diercke K, El-Sayed N, Fricke J, Greiser KH, Kühnisch J, Linseisen J, Meisinger C, Pischon N, Pischon T, Samietz S, Schmitter M, Steinbrecher A, Kim TS, Becher H. Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort. BMC Oral Health 2015; 15:7. [PMID: 25604448 PMCID: PMC4324664 DOI: 10.1186/1472-6831-15-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/03/2015] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. Methods From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis. Results Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. Conclusions Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.
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Affiliation(s)
- Heiko Zimmermann
- Institute of Public Health, University of Heidelberg, lm Neuenheimer Feld 324, 69120 Heidelberg, Germany.
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Yoshihara A, Sugita N, Iwasaki M, Miyazaki H, Nakamura K. The interaction between beta-3 adrenergic receptor polymorphism and obesity to periodontal disease in community-dwelling elderly Japanese. J Clin Periodontol 2015; 41:460-6. [PMID: 24460850 DOI: 10.1111/jcpe.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The purpose of this study was to elucidate whether the association between beta-3 adrenergic receptor polymorphism and periodontal disease is modified by body weight. MATERIAL AND METHODS We enrolled 332 postmenopausal women and determined their HbA1C levels (%) and beta-3 adrenergic receptor (rs4994) genotypes. Periodontal parameters including clinical attachment level (CAL) were measured. After selecting subjects for each body mass index (BMI) level, the prevalence rate ratio (PRR) by multiple Poisson regression analysis was calculated to evaluate the relationship between periodontal disease and beta-3 adrenergic receptor polymorphism. The number of sites with CAL≥6 mm was used as a dependent variable, and beta-3 adrenergic receptor genotype [categorized as Arg non-carriers (reference) or Arg carriers], age (y) and HbA1C (%) were adopted as independent variables. We converted the number of probing sites (n) to an offset variable. RESULTS The PRR of the beta-3 adrenergic receptor genotype for the number of sites of CAL≥6 mm showed a positive association in subjects with BMI≥25.0 and increased markedly with BMI. The PRR in subjects with BMI≥30 was 3.10 (p < 0.0001). CONCLUSION This study indicates a positive association between periodontal disease and the beta-3 adrenergic receptor genotype in obese individuals.
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Affiliation(s)
- Akihiro Yoshihara
- Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Zimmermann H, Zimmermann N, Hagenfeld D, Veile A, Kim TS, Becher H. Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis. Community Dent Oral Epidemiol 2014; 43:116-27. [PMID: 25255820 DOI: 10.1111/cdoe.12126] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing. METHODS Systematic literature search was conducted in nine online resources (PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association. RESULTS Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant (P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95%CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity (I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95%CI: 1.21-1.71, P < 0.0001). CONCLUSIONS There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects.
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Affiliation(s)
- Heiko Zimmermann
- Unit of Epidemiology and Biostatistics, Institute of Public Health, University of Heidelberg, Germany
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Tran DT, Gay I, Du XL, Fu Y, Bebermeyer RD, Neumann AS, Streckfus C, Chan W, Walji MF. Assessment of partial-mouth periodontal examination protocols for periodontitis surveillance. J Clin Periodontol 2014; 41:846-52. [PMID: 25041094 DOI: 10.1111/jcpe.12285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate bias associated with nine identified partial-mouth periodontal examination (PMPE) protocols in estimating periodontitis prevalence using the periodontitis case definition given by the Centers of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). MATERIAL AND METHODS Prevalence from full-mouth examination was determined in a sample of 3667 adults ≥30 years old from the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Prevalence, absolute bias, relative bias, sensitivity and inflation factor were derived for these protocols according to the CDC/AAP definition and half-reduced CDC/AAP definition as ≤50% of sites were measured. RESULTS Bias in moderate and severe periodontitis prevalence ranged between 11.1-52.5% and 27.1-76.3% for full-mouth mesiobuccal-distolingual protocol and half-mouth mesiobuccal protocol respectively; according to the CDC/AAP definition. With half-reduced CDC/AAP definition, half-mouth four sites protocol provided small absolute bias (3.2%) and relative bias (9.3%) for the estimates of moderate periodontitis prevalence; corresponding biases for severe periodontitis were -1.2% and -10.2%. CONCLUSION Periodontitis prevalence can be estimated with limited bias when a half-mouth four sites protocol and a half-reduced CDC/AAP case definition are used in combination.
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Affiliation(s)
- Duong T Tran
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, USA
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