Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review

An IoT-based aptasensor biochip for the diagnosis of periodontal disease

Severe periodontitis affects nearly 1 billion individuals worldwide, highlighting the need for early diagnosis. Here, an integrated system consisting of a microfluidic chip and a portable point-of-care (POC) diagnostic device is developed using a polymethyl methacrylate (PMMA) chip fabrication and a three-dimensional printing technique, which is automatically controlled by a custom-designed smartphone application to routinely assess the presence of a specific periodontitis biomarker, odontogenic ameloblast-associated protein (ODAM). A sandwich-type fluorescence aptasensor is developed on a microfluidic chip, utilizing aptamer pair (MB@OD64 and OD35@FAM) selectively binding to target ODAM. Then this microfluidic chip is integrated into an automated Internet of Things (IoT)-based POC device, where fluorescence intensity, as a signal, from the secondary aptamer binding to ODAM in a sandwich-type binding reaction on the microfluidic chip is measured by a complementary metal oxide semiconductor (CMOS) camera with a 488 nm light-emitting diode (LED) excitation source. Obtained signals are processed by a microprocessor and visualized on a wirelessly connected smartphone application. This integrated biosensor system allows the rapid and accurate detection of ODAM within 30 min with a remarkable limit of detection (LOD) of 0.011 nM under buffer conditions. Clinical application is demonstrated by successfully distinguishing between low-risk and high-risk individuals with 100 % specificity. A strong potential in the translation of this fluorescence-based microfluidic aptasensor integrated with an IoT-based POC system is expected to be employed for non-invasive, on-site, rapid, and accurate ODAM detection, facilitating periodontitis diagnosis.

Impact of tobacco habits on poor oral health status among bone-factory workers in a low literacy city in India: A cross-sectional study

Oral health is a vital indicator of well-being that is influenced by various habits and lifestyles of individuals. Oral diseases are the bottleneck in the effective control of non-communicable diseases (NCDs) due to chronic in nature and reciprocal relationship as sharing the common risk factors and habits such as sugar, tobacco, and alcohol consumption that increase the risk of developing various inevitable diseases. However, there is a lack of literature highlighting the relationship between risk factors for oral diseases and general health among individuals. This cross-sectional study was carried out among 500 study participants aged 20 to 64 years who gave written informed consent and were recruited by Multistage Stratified Cluster Sampling technique among workers in five bone factories, working for at least one year since January 2001 to March 2022 in Sambhal city, Uttar Pradesh. WHO-Basic Oral Health Survey-1997 was used to record the data regarding sociodemographic and oral health status variables. We used the modified WHO-STEPWISE pre-structured questionnaire to record tobacco consumption habits and oral health-seeking behavior. We scheduled a clinical intra-oral examination to record the Decayed Missing Filled Teeth (DMFT) index and the interview on the premises of five bone factories. Among the 500 bone-factory workers, the total number of males was 342 (68.40%) and 158 (31.60%) were females. The mean age (Standard Deviation) was 33.18 (10), and the mean DMFT score of factory workers was 2.84 (3.12). Production workers had the highest mean DMFT score of 4.60 (3.25). More than half of the factory workers (53.2%) were tobacco users. Tobacco users were 3.52 times more likely to have a severe DMFT index. Most common pre-cancerous lesions were oral submucous fibrosis and leukoplakia. Compared to non-tobacco users, mild tobacco users have 6.80 folds higher odds of oral lesions. Tobacco consumption is not only harmful for oral health but also leads to several non-communicable and systemic diseases. NCDs and dental caries are chronic and preventable conditions with a bidirectional relationship implicated by modifiable major risk factors such as tobacco consumption. Decreasing the consumption of tobacco use may improve oral health and reduce the risk of the development of NCDs. Also, regular dental visits should be scheduled to monitor the oral health status of factory workers. Additionally, tailored intervention for tobacco cessation should be implicated to maintain the general and oral health of industrial workers.

Preparation and optimization of an eggshell membrane-based biomaterial for GTR applications

OBJECTIVES

Guided Tissue Regeneration (GTR) is a popular clinical procedure for periodontal tissue regeneration. However, its key component, the barrier membrane, is largely collagen-based and is still quite expensive, posing a financial burden to the patients as well as healthcare systems and negatively impacting the patient's decision-making. Thus, our aim is to prepare a novel biomimetic GTR membrane utilizing a natural biomaterial, soluble eggshell membrane protein (SEP), which is economical as it comes from an abundant industrial waste from food and poultry industries, unlike collagen. Additive polymer, poly (lactic-co-glycolic acid) (PLGA), and a bioceramic, nano-hydroxyapatite (HAp), were added to improve its mechanical and biological properties.

METHODS

For this barrier membrane preparation, we initially screened the significant factors affecting its mechanical properties using Taguchi orthogonal array design and further optimized the significant factors using response surface methodology. Furthermore, this membrane was characterized using SEM, EDAX, and ATR-FTIR, and tested for proliferation activity of human periodontal ligament fibroblasts (HPLFs).

RESULTS

Optimization using response surface methodology predicted that the maximal tensile strength of 3.1 MPa and modulus of 39.9 MPa could be obtained at membrane composition of 8.9 wt% PLGA, 7.2 wt% of SEP, and 2 wt% HAp. Optimized PLGA/SEP/HAp membrane specimens that were electrospun on a static collector showed higher proliferation activity of HPLFs compared to tissue culture polystyrene and a commercial collagen membrane.

SIGNIFICANCE

From the results observed, we can conclude that SEP-based nanofibrous GTR membrane could be a promising, environment-friendly, and cost-effective alternative for commercial collagen-based GTR membrane products.

Prevalence of dental visits in older Japanese adults receiving public assistance

OBJECTIVES

Exemption from paying dental care costs among recipients of public assistance contributes to universal health care coverage. Although this system might reduce the financial barriers to dental care among patients, there are still several other barriers for public assistance recipients. Therefore, this study examined whether receiving public assistance was associated with a higher prevalence of dental visits for any reason, treatment and prevention.

METHODS

Data were obtained from 16 366 respondents from the 2019 wave of a nationwide cohort study on older adults in Japan. Poisson regression analyses with robust error variance were used to examine the associations between receiving public assistance and dental visits, adjusting for number of teeth, dental pain, periodontal conditions, age, sex, number of family members, education, equivalent household income, working status, instrumental activities of daily living, medical conditions, depressive symptoms, instrumental support and geographical variations.

RESULTS

More than half of the non-recipients of public assistance visited a dentist for some reason in the past 6 months. Meanwhile, only 37% of the recipients visited a dentist. In addition, almost half of the non-recipients had treatment visits, while only 34% of the recipients visited. Furthermore, 46% of the non-recipients had dental visits for prevention, while 32% of the recipients had preventive visits. In the fully adjusted models, compared to non-recipients, public assistance recipients were 24% (Prevalence Ratio [PR]: 0.76, 95% Confidence Intervals [CI]: 0.64, 0.90), 23% (PR: 0.77, 95% CI: 0.65, 0.92) and 21% (PR: 0.79, 95% CI: 0.65, 0.95) less likely to have dental visits for any reason, treatment, and prevention, respectively.

CONCLUSIONS

Although recipients were exempted from dental treatment fees, receiving public assistance was associated with a lower prevalence of dental visits for any reason, treatment and prevention. Future studies should identify the barriers to accessing dental care among public assistance recipients to improve dental visits.

Knowledge and attitudes on oral health of women during pregnancy and their children: an online survey

BACKGROUND

Life-long healthy behaviors are established during pregnancy and the first years of life. In this cross-sectional survey, new mothers with a high level of schooling living in Northern Italy (Lombardy Region) were interviewed to assess their knowledge and attitudes towards their and child oral health.

METHODS

A questionnaire (27 items) was developed to assess socio-demographic factors, knowledge, and attitudes towards maternal and child oral health. The questionnaire was disseminated in perinatal courses, private gynecological clinics, and via social media. Mothers aged ≥18 years, with at least a child aged 0-36 months, with a high school diploma or higher, were included in the survey.

RESULTS

A total of 1340 women completed the questionnaire, 1297 of whom had a child aged 0-36 months, 792 lived in Lombardy, and 600 had a high level of education and were finally included. About half of the sample (44.67%) was aged between 31 and 35 years, 76.50% were employed, and the majority had only one child (81.50%). During pregnancy, 28.33% of the sample reported problems with teeth and gums, while only 36.00% visited a dentist. More than 40% of the sample said they were not aware of a possible link between oral health and pregnancy, and 73.17% had not received any advice about their oral health or the future health of their baby's mouth. Less than 20% of women were aware of the increased caries risk associated with prolonged or night-time breastfeeding. Better knowledge/attitude was associated with the age of the child (p < 0.05), the number of children (p < 0.05) and whether the mother had received advice during pregnancy (p < 0.05).

CONCLUSIONS

The results of this survey show a lack of dental care during pregnancy, a lack of information about oral health from health professionals during and after pregnancy, and consequently gaps in the knowledge needed to care for the oral health of the woman and her child. There is a need for training in oral health for pregnant women and new mothers, but also a need for behavioural change among health professionals who care for pregnant women.

Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care

Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.

Persistent enrichment of multidrug resistant Klebsiella in oral and nasal communities during long-term starvation

The human oral and nasal cavities can act as reservoirs for opportunistic pathogens capable of causing acute infection. These microbes asymptomatically colonize the human oral and nasal cavities which facilitates transmission within human populations via the environment, and they routinely possess a clinically-significant antibiotic-resistance genes. Among these opportunistic pathogens, the Klebsiella genus stands out as a notable example, with its members frequently linked to nosocomial infections and multidrug resistance. As with many colonizing opportunistic pathogens, how Klebsiella transitions from an asymptomatic colonizer to a pathogen remains unclear. Here, we explored a possible explanation by investigating the ability of oral and nasal Klebsiella to outcompete their native microbial community members under in vitro starvation conditions, which could be analogous to external hospital environments. When Klebsiella was present within a healthy human oral or nasal sample, the bacterial community composition shifted dramatically under starvation conditions and typically became dominated by Klebsiella. Furthermore, introducing K. pneumoniae exogenously into a native microbial community lacking K. pneumoniae, even at low inoculum, led to repeated dominance under starvation. K.pneumoniae strains isolated from healthy individuals' oral and nasal cavities also exhibited resistance to multiple classes of antibiotics and were genetically similar to clinical and gut isolates. In addition, we found that in the absence of Klebsiella, other understudied opportunistic pathogens, such as Peptostreptococcus, dominate under starvation conditions. Our findings establish an environmental circumstance that allows for the outgrowth of Klebsiella and other opportunistic pathogens. The ability to outcompete other commensal bacteria and to persist under harsh environmental conditions may contribute to the colonization-to-infection transition of these opportunistic pathogens.

Age-group-specific association of oral health and systemic health on cognitive function: a cross-sectional study of Korean elders

BACKGROUND

Although the importance of oral and systemic healthcare for elderly people is increasing owing to the rapid ageing of the population in South Korea, studies on the relationship between oral health, systemic health, and cognitive function, as well as on the prediction of cognitive function by oral and systemic health depending upon age groups are lacking.

METHODS

We included 5,975 out of 6,488 participants from the 8th wave of the Korean Longitudinal Study of Aging (KLoSA) panel data, divided the participants into three age groups, and performed a hierarchical multiple linear regression analysis to explain cognitive function with four types of predictors: oral health status, sociodemographic factors, objective health status, and subjective health status.

RESULTS

Oral health status was positively correlated with systemic health status and cognitive function. Of all ages over 54, cognitive function was significantly predicted by oral health variables, such as the number of functional teeth, masticatory ability, and Geriatric Oral Health Assessment Index (GOHAI); sociodemographic variables, such as age, sex, education level, and residence; and systemic health variables, such as diagnosis of diabetes mellitus, cancer or malignant tumours, cerebrovascular disease and rheumatoid arthritis, depressive symptom, and self-rated health status. Oral health variables explained cognitive function differently by age group; GOHAI appeared important predictor in the group aged < 75 years, whereas the number of functional teeth did in the group aged ≥ 75 years. Educational level, masticatory ability, depressive symptoms, and self-rated health status were pivotal factors age-independently.

CONCLUSIONS

The general and age-group-specific association between oral health, systemic health, and cognitive function were confirmed, suggesting that age-group-specific oral healthcare should be emphasized for the effective management of systemic and cognitive health in the elderly group.

Periodontitis is associated with multimorbidity in a large dental school population

AIM

To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients.

MATERIALS AND METHODS

A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used.

RESULTS

Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%).

CONCLUSIONS

This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.

Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis

CONTEXT

Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors.

OBJECTIVE

This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security.

DATA SOURCES

The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status.

DATA EXTRACTION

Data extraction was performed by two reviewers.

DATA ANALYSIS

Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security.

CONCLUSION

Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021268582.

Evidence-Informed Oral Health Policy Making: Opportunities and Challenges

Despite a clear need for improvement in oral health systems, progress in oral health systems transformation has been slow. Substantial gaps persist in leveraging evidence and stakeholder values for collective problem solving. To truly enable evidence-informed oral health policy making, substantial "know-how" and "know-do" gaps still need to be overcome. However, there is a unique opportunity for the oral health community to learn and evolve from previous successes and failures in evidence-informed health policy making. As stated by the Global Commission on Evidence to Address Societal Challenges, COVID-19 has created a once-in-a-generation focus on evidence, which has fast-tracked collaboration among decision makers, researchers, and evidence intermediaries. In addition, this has led to a growing recognition of the need to formalize and strengthen evidence-support systems. This article provides an overview of recent advancements in evidence-informed health policy making, including normative goals and a health systems taxonomy, the role of evidence-support and evidence-implementation systems to improve context-specific decision-making processes, the evolution of learning health systems, and the important role of citizen deliberations. The article also highlights opportunities for evidence-informed policy making to drive change in oral health systems. All in all, strengthening capacities for evidence-informed health policy making is critical to enable and enact improvements in oral health systems.

Impact of oral/dental disease burden on postoperative infective complications: a prospective cohort study

OBJECTIVES

This prospective cohort study aimed to assess the association between dental disease burden and postoperative infective complications (POICs) in patients undergoing major surgical procedures under general anaesthesia.

METHODS

Pre-surgical dental assessment was undertaken on patients planned for major surgery. Demographic and surgical variables including putative risk factors for POICs and POIC status were documented. The univariable association between POIC status and each factor was examined. Those variables associated at P value ≤ 0.2 were candidates for inclusion in multiple logistic regression models. Backward stepwise variable selection was used to identify the independent predictors for POIC in the best fitting logistic regression model. The area under the receiver operating curve (AUC) was used to quantify the model's global classification performance.

RESULTS

Among the 285 patients, 49 patients (17.2%) had POICs. The independent predictors for POIC were expected length of hospital stay (4-6 days; odds ratio [OR] = 4.80, 95% confidence internal [CI]: 1.30-17.70, P = 0.018, 7-9 days; OR = 5.42, 95% CI: 1.51-19.41, P = 0.009, ≥ 10 days; OR = 28.80, 95% CI: 4.12-201.18, P < 0.001), four or more decayed teeth (OR = 6.03, 95% CI: 2.28-15.94, P < 0.001) and visible tongue plaque (OR = 3.21, 95% CI: 1.54-6.70, P = 0.002). The AUC was 0.78 (95% CI: 0.71-0.85) indicating good discrimination. A simple screening tool for POIC was developed.

CONCLUSIONS/CLINICAL RELEVANCE

In addition to systemic/surgical factors, this study identified clinically detected decayed teeth and visible tongue plaque as independent predictors for POICs. Preoperative dental assessment/care might be beneficial to assess risk for POICs and improve postoperative outcomes.

Redefining the non-communicable disease framework to a 6 × 6 approach: incorporating oral diseases and sugars

The WHO Global Oral Health Status Report, published in 2022, highlighted the alarming state of oral health worldwide and called for urgent action by integrating oral health into non-communicable diseases (NCDs) and universal health coverage initiatives. 3·5 billion people have oral diseases, surpassing all other NCDs combined. The detrimental role of sugars as a risk factor for oral diseases and other NCDs has also been well documented. Despite the evidence, oral diseases and sugars are not part of the current NCD framing, which focuses on five diseases and five risk factors (ie, 5 × 5). Oral diseases and sugars remain sidelined, disproportionately affecting poor and disadvantaged populations. In this Viewpoint, we advocate for the integration of oral diseases and sugars into the current approach towards the prevention and control of NCDs. An expanded 6 × 6 framework would recognise growing evidence and would reiterate the need to strengthen action, resource allocation, and policy development for NCDs. We present the evidence and rationale for, and benefits of, an expanded NCD framework and detail recommendations to guide efforts towards improved priority, investment, and equitable health outcomes for NCDs, including oral health.

Evaluation of a Digital Decision Support System to Integrate Type 2 Diabetes Mellitus and Periodontitis Care: Case-Vignette Study in Simulated Environments

BACKGROUND

As highlighted by the recent World Health Organization Oral Health Resolution, there is an urgent need to better integrate primary and oral health care. Despite evidence and guidelines substantiating the relevance of integrating type 2 diabetes mellitus (T2DM) and periodontitis care, the fragmentation of primary and oral health care persists.

OBJECTIVE

This paper reports on the evaluation of a prototype digital decision support system (DSS) that was developed to enhance the integration of T2DM and periodontitis care.

METHODS

The effects of the prototype DSS were assessed in web-based simulated environments, using 2 different sets of case vignettes in combination with evaluation surveys among 202 general dental practitioners (GDPs) and 206 general practitioners (GPs). Each participant evaluated 3 vignettes, one of which, chosen at random, was assisted by the DSS. Logistic regression analyses were conducted at the participant and case levels.

RESULTS

Under DSS assistance, GPs had 8.3 (95% CI 4.32-16.03) times higher odds of recommending a GDP visit. There was no significant impact of DSS assistance on GP advice about common risk factors for T2DM and periodontal disease. GDPs had 4.3 (95% CI 2.08-9.04) times higher odds of recommending a GP visit, 1.6 (95% CI 1.03-2.33) times higher odds of giving advice on disease correlations, and 3.2 (95% CI 1.63-6.35) times higher odds of asking patients about their glycated hemoglobin value.

CONCLUSIONS

The findings of this study provide a proof of concept for a digital DSS to integrate T2DM and periodontal care. Future updating and testing is warranted to continuously enhance the functionalities of the DSS in terms of interoperability with various types of data sources and diagnostic devices; incorporation of other (oral) health dimensions; application in various settings, including via telemedicine; and further customization of end-user interfaces.

Demystifying the connection between periodontal disease and chronic kidney disease - An umbrella review

Chronic kidney disease (CKD) and poor oral health are inter-related and their significant impact on each other is well established in the literature. Many systematic reviews and meta-analyses have demonstrated a strong relationship between CKD and periodontitis, where periodontal treatment has shown potential in improving CKD outcomes. However, the quality of the studies and heterogeneity of the results show variation. The aim of this umbrella review was to review the quality of the current systematic reviews on the relationship between CKD and oral health with an emphasis on periodontal disease and to generate clinically relevant guidelines to maintain periodontal health in patients with CKD. This umbrella review was conducted and reported in alignment with the Joanna Briggs Institute and the PRISMA 2020 guidelines. The review protocol was established prior to commencing the review and registered on JBI and PROSPERO (CRD42022335209). Search strings were established for PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Dentistry & Oral Science Source up to April 2022. All systematic reviews and meta-analyses that considered the relationship between CKD and periodontitis or periodontal treatment were included. Of 371 studies identified through the systematic search, 18 systematic reviews met the inclusion criteria. Ten studies assessed the relationship between oral health status and CKD with a focus on periodontitis and CKD, five reviewed the impact of periodontal treatment on CKD outcomes, two included both relationship and effectiveness of periodontal treatment and one qualitatively reviewed oral health-related quality of life in patients with kidney failure. Findings indicate there is a bidirectional relationship between CKD and periodontal disease. In view of the heterogeneity of the existing literature on CKD and periodontal disease, specific recommendations for the management of periodontitis among patients with CKD are proposed for medical professionals, dental professionals, and aged care workers based on the evidence collated in this review.

Oral-health-related quality of life in adolescents: umbrella review

BACKGROUND

To evaluate oral conditions, demographic and socioeconomic characteristics of oral health-related quality of life (OHRQoL) in adolescents.

METHODS

Umbrella review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes (PRISMA) checklist. The search strategy used a combination of words, applied in the electronic databases PubMed, WebScience, Embase, Lilacs, Scopus and Cochrane. Included publications until January 2022, without restrictions. Data collection took place with systematized practices and the eligibility criteria were studies focusing on OHRQoL; teenagers; adolescentes; present the term "systematic review" and/or "meta-analysis" in the title or abstract. The quality assessment followed the Assessment of Multiple Systematic Reviews (AMSTAR 2) and the adherence of the article to the PRISMA was verified.

RESULTS

Three hundred sixty-two articles were identified, and 22 were included, published between 2009 and 2022. 21 Systematic reviews focused on the English language. Most studies showed heterogeneity in the methodological structuring process: 10 articles were considered of low and 10 critically low quality. Clinical conditions associated with worsening in quality of life were dental caries, malocclusion, dental trauma, toothache, edentulism, need for orthodontic treatment, irregular brushing, and periodontal disease. Socioeconomic factors related to housing, parental education, access to health care, absence of siblings and nuclear family influence OHRQoL. Completion of orthodontic treatment, health promotion programs, dental care and safe housing all have a positive impact.

CONCLUSION

Worse oral health status, older age, female sex and worse socioeconomic status were significantly associated with worse OHRQoL.

TRIAL REGISTRATION

PROSPERO CRD4202129352.

Exploring the relationship between oral health and multiple health conditions: An outcome-wide approach

PURPOSE

A growing body of evidence suggests that oral health is associated with a wide range of health outcomes; however, opinions tend to vary because of inconsistent findings. This study aimed to simultaneously examine the association between oral health status and multiple health and well-being indicators using outcome-wide epidemiology.

METHODS

Data were obtained from the Japan Gerontological Evaluation Study. Oral health status was categorized as: ≥20 teeth, 10-19 teeth with dental prosthesis, 0-9 teeth with prosthesis, 10-19 teeth without prosthesis, and 0-9 teeth without prosthesis. We examined the associations between oral health status in 2013 and 35 health and well-being outcomes in 2019, including physical/cognitive health, psychological distress, subjective health, social well-being, prosocial/altruistic behaviors, and health behaviors, using two databases (n=32,827 and 15,905).

RESULTS

Compared to individuals with ≥20 teeth, those with <20 teeth had a 10-33% higher risk of mortality and a 7-10% higher risk of functional disability six years later. Additionally, individuals with fewer than 20 teeth tended to go out less frequently and eat fewer vegetables and fruits. Furthermore, individuals with 0-9 teeth without a prosthesis were more likely to have severe functional disability (risk ratio (RR):1.17, 95% confidence interval (CI):1.05-1.31), engage in fewer intellectual activities (standardized difference: 0.17, 95% CI: 0.10-0.24), and feel more hopeless (RR: 1.21, 95% CI: 1.04-1.41).

CONCLUSIONS

The prevention of tooth loss and prosthodontic treatment may be associated with reduced mortality and functional disability, as well as maintenance of intellectual ability, frequency of going out, and improvements in dietary lifestyle.

Is tooth loss associated with multiple chronic conditions?

OBJECTIVES

To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age.

MATERIALS AND METHODS

Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders.

RESULTS

The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors.

CONCLUSION

Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.

Children's dental panoramic radiographs dataset for caries segmentation and dental disease detection

When dentists see pediatric patients with more complex tooth development than adults during tooth replacement, they need to manually determine the patient's disease with the help of preoperative dental panoramic radiographs. To the best of our knowledge, there is no international public dataset for children's teeth and only a few datasets for adults' teeth, which limits the development of deep learning algorithms for segmenting teeth and automatically analyzing diseases. Therefore, we collected dental panoramic radiographs and cases from 106 pediatric patients aged 2 to 13 years old, and with the help of the efficient and intelligent interactive segmentation annotation software EISeg (Efficient Interactive Segmentation) and the image annotation software LabelMe. We propose the world's first dataset of children's dental panoramic radiographs for caries segmentation and dental disease detection by segmenting and detecting annotations. In addition, another 93 dental panoramic radiographs of pediatric patients, together with our three internationally published adult dental datasets with a total of 2,692 images, were collected and made into a segmentation dataset suitable for deep learning.

Dental Caries a Risk Factor for Intracerebral Hemorrhage

INTRODUCTION

Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and exhibits inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for ICH. The purpose of this study was to test the association between dental caries and incident ICH.

METHODS

The presence of dental caries and periodontal disease was assessed in subjects from the Dental Atherosclerosis Risk in Communities (DARIC) study without prior stroke or ICH. This cohort was followed for incident ICH over a period of 10 years. Cox regression was used to compute crude and adjusted hazards ratio from the dental assessment.

RESULTS

Among 6,315 subjects, dental surface caries and/or root caries were recorded in 1,338 (27%) subjects. Of those, 7 (0.5%) had incident ICH over a period of 10 years following the visit 4 assessment. Of the remaining 4,977 subjects, 10 (0.2%) had incident ICH. Those with dental caries versus those without dental caries were slightly younger (mean age 62.0 ± 5.7 vs. 62.4 ± 5.6, p = 0.012), had a greater proportion of males (51 vs. 44%, p < 0.001), African Americans (44 vs. 10%, p < 0.001), and were hypertensive (42 vs. 31%, p < 0.001). The association between caries and ICH was significant (crude HR 2.69, 95% CI 1.02-7.06) and strengthened after adjustment for age, gender, race, education level, hypertension, and periodontal disease (adjusted HR 3.88, 95% CI 1.34-11.24).

CONCLUSION

Dental caries is a potential risk for incident ICH after caries detection. Future studies are needed to determine if treatment of dental caries can reduce the risk of ICH.

Quality assessment of systematic reviews with meta-analysis in undergraduate nursing education

BACKGROUND

Little attention has been given to the methodological quality of meta-analyses in nursing education. This warrants further improvements in meta-analyses in nursing education.

OBJECTIVE

This study aimed to assess the methodological quality of meta-analysis in the field of undergraduate nursing education.

DESIGN

This was a methodological study to review the methodological quality of systematic reviews (SRs) with meta-analysis.

METHODS

Exhaustive literature searches were performed using five comprehensive databases. Between 1994 and 2022, 11,827 studies were identified, and 41 full-text articles met the inclusion criteria. Two researchers extracted data using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2. The Chi-square test was conducted to make comparisons before and after 2017, the year AMSTAR-2 was released.

RESULTS

A comprehensive literature retrieval strategy, inclusion and exclusion criteria, literature selection, and data extraction were observed in nursing education more than in other disciplines. Improvements to be made include pre-specifying the protocol, providing a list of excluded studies with their exclusion reasons, reporting the source of funding for the included studies, assessing and discussing the potential impact of risk of bias, as well as investigating and discussing publication bias and its impact.

CONCLUSIONS

The number of SRs with meta-analyses in nursing education is increasing. This warrants efforts to improve the quality of research. In addition, guidelines for reporting SRs in the field of nursing education should be constantly updated.

Association of Dental Infections with Intracranial Atherosclerotic Stenosis

INTRODUCTION

Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study.

METHODS

Full-mouth clinical periodontal measurements (7 indices) collected at 6 sites per tooth from 6,155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven PD stages (Periodontal Profile Class [PPC]-I to -VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic-resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS.

RESULTS

Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC-V) had significantly higher odds of having ≥50% ICAS. This association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%.

CONCLUSION

We report significant associations between mild-moderate tooth loss, severe tooth loss, and severe PD with <50% ICAS as well as an association between extensive gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.

Oral and systemic health: is there a "new" link with COVID-19?

OBJECTIVES

The objective of the present narrative review was to evaluate the evidence of a possible association between periodontitis and COVID-19, and its biological plausibility, using as models the potential associations with cardiovascular diseases, diabetes, and some respiratory diseases.

METHODS

A recent systematic review was used as main reference to explore the associations of periodontitis with different respiratory diseases, including COVID-19, following two focussed questions: a PECOS question, aimed to explore epidemiological evidence, and a PICOS question, designed to explore the evidence derived from intervention studies. In addition to that evidence, other relevant scientific documents, including consensus papers, were carefully selected and appraised.

FINDINGS

Convincing evidence was found to support the association of periodontitis and cardiovascular diseases, diabetes, and some respiratory diseases. The biological plausibility behind those associations is based on four factors: (1) bacteraemia of oral bacteria and periodontal pathogens, (2) increased systemic inflammation, (3) common genetic factors, and (4) common environmental risk factors. Limited initial evidence is available to support an association between periodontitis and COVID-19 complications. Among the proposed factors to explain the suggested association, a combination of the previously mentioned factors, plus additional factors related with SARS-CoV-2 characteristics and pathogenicity, has been suggested.

CONCLUSIONS

Initial evidence suggests that periodontitis may be associated with a more severe COVID-19 and with a higher risk of death due to COVID-19.

CLINICAL RELEVANCE

Due to the possible association between periodontitis and an increased severity for COVID-19, additional efforts should be made to improve oral and periodontal health, including the promotion of oral healthy habits, such as oral hygiene.

Role of Dentistry in Humanitarian Projects: Knowledge and Perspective of Future Professionals on the World of Volunteering in Spain

Non-governmental organizations (NGOs) in dentistry seek to promote the improvement on oral health in the most disadvantaged regions. The objective of this study is to identify the level of knowledge, expectations, and motivations that dental school students have about volunteering in dentistry, as well as to evaluate possible differences in these variables depending on their level of dental training. During the month of September 2022, a voluntary and anonymous online survey was carried out among all the students at the Dentistry School of Oviedo University. There were 5 questions to judge knowledge about global oral health course. 12 additional questions were included to assess the willingness to volunteer in international setting, the volunteer profile, as well as the most effective means to improve oral health in host communities. None of the students from our center had participated as a volunteer in dental NGOs, but up to 64.4% of them had considered their collaboration. The level of knowledge about global oral health obtained was low, with the percentage of correct answers ranging between 14.4% (in the question about the ideal patient/dentist ratio) and 57.8% (in the question about the fluoride concentration in drinking water). Majority of dental students (98.9%) were not aware that basic package of oral care was created by WHO. Significantly, the students of the clinical courses showed a greater motivation to volunteer.

Influence of periodontitis on levels of autoantibodies in rheumatoid arthritis patients: A systematic review

BACKGROUND AND OBJECTIVE

Periodontitis (PD) is a dysbiotic disease of tooth-supporting structures that has been associated with various systemic diseases including rheumatoid arthritis (RA). To date, evidence demonstrated increased prevalence of RA among PD patients and postulated PD to have a role in the development of autoantibodies in RA patients. Therefore, a systematic review was conducted to assess the available evidence to ascertain the effect of PD on levels of autoantibodies in the serum, saliva and gingival crevicular fluid (GCF) of RA patients.

MATERIAL AND METHODS

The systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Relevant literature was searched from PubMed, Web of Science, Scopus and Ebscohost databases from inception until 31 August 2020. The risk of bias in each study was determined based on the Newcastle-Ottawa Scale tool. Results from random-effect meta-analyses were presented as summary estimates of odds ratios (ORs) for seropositivity and standardised mean difference (SMD) of autoantibody levels with 95% confidence intervals. Sensitivity tests and meta-regression were performed to assess the robustness of the results and potential cause of heterogeneity.

RESULTS

The electronic and manual searches gathered 932 articles. Following screening and full-text assessment, a total of 29 studies were included in the analysis. Twenty-eight published observational studies were included in the quantitative analysis in the form of random-effect meta-analysis which revealed that PD was associated with anti-citrullinated proteins autoantibodies (ACPAs) and Rheumatoid Factor (RF) seropositive RA patients (OR for ACPA seropositivity: 1.82; 95% CI: 1.13-2.93) (OR for RF seropositivity: 1.53; 95% CI: 1.05-2.24). Also, RA patients with PD had increased serum levels of ACPA and RF. However, high heterogeneity among studies' results, partially ascribed to the unstandardised case definition of PD and laboratory testing of autoantibodies. Apart from ACPA and RF in serum, studies which reported on other RA-related autoantibodies, as well as autoantibody levels in saliva and GCF were scarce.

CONCLUSION

RA patients with PD tend to have greater ACPA and RF levels in their serum when compared with the RA patients without PD supporting the plausible role of PD in the development of systemic autoimmunity in RA patients.

Why Are Family Doctors Still Not Addressing Oral Health?

Oral health dramatically affects overall health and vice versa. Oral health is a key health indicator for Healthy People 2030. Yet family physicians are not addressing this important health issue at the same level they address other essential health problems. Studies show that family medicine training and clinical activities are lacking in the area of oral health. The reasons are multi-factorial including insufficient reimbursement, lack of accreditation emphasis, and poor medical-dental communication. There is hope. Robust oral health curricula for family doctors exist and efforts are being made to create primary care oral health education champions. The tide is turning on accountable care organizations adding oral health services, access, and outcomes to their systems. Like behavioral health, oral health can be fully integrated into the care family physicians offer.

Causal Effect of Tooth Loss on Cardiovascular Diseases

Many studies suggest associations between oral health and cardiovascular diseases, but there is a lack of causal evidence. Exploiting exogenous variation in tooth loss in US adults due to differential childhood exposure to fluoridated water, this study investigated the causal effect of tooth loss on cardiovascular diseases. A total of 722,519 participants in the Behavioral Risk Factor Surveillance System (BRFSS) waves 2006, 2008, or 2010 (birth years 1940-1978) were included in the analytical sample. To identify the effect of tooth loss on having a history of coronary heart disease (CHD) or stroke, instrumental variable analysis exploited childhood exposure to drinking water fluoride as an instrument. The weighted prevalence of CHD and stroke histories was 5.1% and 2.1%, respectively. First-stage regression indicated that childhood exposure to drinking water fluoride was a strong instrument for the number of lost teeth in adulthood (coefficient -0.61; 95% confidence interval [CI] -0.80, -0.41; F = 37.47). The probability of CHD was significantly higher by 1.04 percentage points (95% CI 0.57, 1.50) per lost tooth. The effect of tooth loss on stroke was significant only for people aged ≥60 y (coefficient 0.93 percentage points; 95% CI 0.14, 1.71). These findings are supportive of a causal effect of tooth loss on cardiovascular diseases among US adults, particularly in older age.

Effectiveness of periodontal treatment to improve glycemic control: an umbrella review

AIM

The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis.

MATERIALS AND METHODS

A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I² index. The publication bias was evaluated using a funnel plot and Egger's linear regression method.

RESULTS

Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone.

CONCLUSIONS

The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.

Use of the dental formula from the National Database of Health Insurance Claims and Specific Health Checkups of Japan

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is a database including health insurance claim and specific health checkup data. Observational studies using real-world big data attract attention because they have certain strengths, including external validity and a large sample size. This review focused on research using the dental formula of the NDB because the number of teeth is an important indicator of oral health. The number of teeth present calculated using the dental formula of periodontitis patients was similar to that from the Survey of Dental Diseases. In addition, the graphs of the presence rates of tooth types by 5-year age groups from the NDB were smoother and had less overlap than those from the Survey of Dental Diseases, and they could detect slight changes in the presence rate that reflected sugar consumption before and after World War II. Using the NDB, a low number of teeth was associated with high medical care expenditures, high risk of aspiration pneumonia, and high risk of Alzheimer’s disease. Although there are some restrictions on the use of the NDB, we hope that dental research using the NDB will be further promoted in the future.

Propionate Attenuates Growth of Oral Streptococci through Enhancing Methionine Biosynthesis

Oral streptococci are considered as an opportunistic pathogen associated with initiation and progression of various oral diseases. However, since the currently-available treatments often accompany adverse effects, alternative strategy is demanded to control streptococci. In the current study, we investigated whether short-chain fatty acids (SCFAs), including sodium acetate (NaA), sodium propionate (NaP), and sodium butyrate (NaB), can inhibit the growth of oral streptococci. Among the tested SCFAs, NaP most potently inhibited the growth of laboratory and clinically isolated strains of Streptococcus gordonii under anaerobic culture conditions. However, the growth inhibitory effect of NaP on six different species of other oral streptococci was different depending on their culture conditions. Metabolic changes such as alteration of methionine biosynthesis can affect bacterial growth. Indeed, NaP enhanced intracellular methionine levels of oral streptococci as well as the mRNA expression level of methionine biosynthesis-related genes. Collectively, these results suggest that NaP has an inhibitory effect on the growth of oral streptococci, which might be due to alteration of methionine biosynthesis. Thus, NaP can be used an effective bacteriostatic agent for the prevention of oral infectious diseases caused by oral streptococci.

Engaging patients to develop a customized digital health companion for periodontitis: Study protocol

Periodontitis is a chronic inflammatory disease resulting in the destruction of tooth-supporting tissues. It affects billions of people around the globe and substantiates an enormous economic burden to society. Digital tools such as mobile Health (mHealth) applications have the potential to increase patient engagement, knowledge about the disease, and adherence to treatment recommendations. Digital health companions represent a new kind of digital tool aiming to support patients throughout their course of periodontal care. This paper presents the study protocol of the Paro-ComPas project which aims to co-develop and evaluate a digital patient companion application (“app”) to empower patients along their journey with periodontitis. As a first step, a qualitative study design encompassing semi-structured interviews with patients and experts as well as focus group discussions (FGD) will be used. Patients in different stages of periodontal care will be recruited from dental practices across Germany and are invited to share their experiences and opinions about their care and potential areas for support. Experts from relevant areas (e.g., mHealth, behavior change psychology, oral health, and dental hygiene) will be interviewed to map a holistic view on the current delivery of care and best practices of mHealth development. After setting up a minimal viable product (MVP) based on a requirements analysis, FGDs with patients will take place to incorporate user feedback and finalize the development of the prototypic app. The prototypic app will then be evaluated in a randomized, multi-center clinical trial in comparison with the current standard of care. Finally, a comprehensive implementation roadmap will be developed together with all relevant stakeholders. This comprehensive approach will allow us to map the patient journey and develop a digital health companion tailored to the needs of patients with periodontitis using an already existing indication independent medical companion toolbox. Novel insights into patients’ knowledge and perception of periodontal disease as well as barriers in adherence to periodontal care pathways will be provided. This knowledge will be converted in a systematically tailored companion app to serve the needs and preferences of people to better address periodontitis. The results from the clinical trial will provide unique insights into the extent to which the patient companion app contributes to adherence to periodontal care. Although mHealth applications have become popular in recent years, only few apps focusing on promotion of oral health have been released so far. Our study presents a novel and comprehensive approach to both co-developing and evaluating a proof of concept for a digital health companion for patients with periodontitis.

Nutrition and Health in Human Evolution–Past to Present

Anyone who wants to understand the biological nature of humans and their special characteristics must look far back into evolutionary history. Today’s way of life is drastically different from that of our ancestors. For almost 99% of human history, gathering and hunting have been the basis of nutrition. It was not until about 12,000 years ago that humans began domesticating plants and animals. Bioarchaeologically and biochemically, this can be traced back to our earliest roots. Modern living conditions and the quality of human life are better today than ever before. However, neither physically nor psychosocially have we made this adjustment and we are paying a high health price for it. The studies presented allow us to reconstruct food supply, lifestyles, and dietary habits: from the earliest primates, through hunter-gatherers of the Paleolithic, farming communities since the beginning of the Anthropocene, to the Industrial Age and the present. The comprehensive data pool allows extraction of all findings of medical relevance. Our recent lifestyle and diet are essentially determined by our culture rather than by our millions of years of ancestry. Culture is permanently in a dominant position compared to natural evolution. Thereby culture does not form a contrast to nature but represents its result. There is no doubt that we are biologically adapted to culture, but it is questionable how much culture humans can cope with.

Burden of Oral Diseases and Access to Oral Care in an Ageing Society

Objective

The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society.

Methods

We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature.

Results

The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs.

Conclusions

To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

The Global Need for Easy and Valid Assessment Tools for Orofacial Pain

The World Health Organization recently adopted a historic resolution (WHA74.5) on the urgent need for global oral health improvement. This resolution is particularly relevant in the perspective of the high prevalence of untreated oral diseases. However, one important aspect has been mentioned only in passing, namely that poor oral health often leads to orofacial pain, which is the most common reason for emergency dental visits worldwide. Therefore, an evidence-based decision-making process on oral health should include data related to orofacial pain complaints. To that end, the availability of reliable and valid assessment tools of orofacial pain and related treatment outcomes is essential. INfORM (International Network for Orofacial Pain and Related Disorders Methodology) of the International Association for Dental Research has been one of the driving forces behind the development and implementation of comprehensive sets of tools for such assessments. However, as a prerequisite for the desired global implementation, reliable and valid tools that are also brief, easy to translate, and culturally adaptable need to be further developed and tested. Some of the groundwork to facilitate this process has already been carried out. In addition, a working group within INfORM has developed a short clinical assessment tool for orofacial pain diagnostics that is near completion and will soon be ready for dissemination. Ultimately, reliable and valid orofacial pain assessment is a necessary step toward the development and implementation of appropriate "best buy" interventions that address this major driver of need for oral health care worldwide.

Association between Periodontal Treatment and Healthcare Costs in Patients with Coronary Heart Disease: A Cohort Study Based on German Claims Data

There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed.

Causal Inference: Onward and Upward!

When announcing the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021, the Royal Swedish Academy emphasized how conclusions about cause and effect can be drawn from natural experiments. But what can dental research learn from this? The economist’s toolbox provides a number of methods for causal inference from observational data such as instrumental variables, regression discontinuity designs, or difference-in-differences analyses. Although the relevance of improving causal inference in dental research has repeatedly been highlighted in recent years, dental research still seems to reveal major room for improvement in the application of such methods. First, there seems to be an absence of causal literature on key essential research questions for oral health. Second, the diversity and diffusion of causal inferential methods in the dental literature seem very limited so far. Third, while dental research has widely been promoting the use of directed acyclic graphs (DAGs) to help conceptualize causal thinking, comparably little attention seems to have been paid to choosing and applying appropriate data-analytic approaches for causal inference. Fourth, similar to other fields of medicine, confusion seems to persist within the dental research community as to the use of causal language. If dental research is to secure a robust evidence base for promoting effective oral health interventions, we argue that dental research needs to move beyond its current methodological echo chamber and embrace a radically different approach to causal inference. We call for editors, reviewers, and authors to embrace a much more critically reflective approach to causal inference.

Association between Participation in the Short Version of a Workplace Oral Health Promotion Program and Medical and Dental Care Expenditures in Japanese Workers: A Longitudinal Study

Studies suggest that intensive oral health promotion programs in the workplace reduce dental and medical care expenditures. The purpose of this longitudinal study was to evaluate the short version of an oral health promotion program in the workplace from the viewpoint of dental and medical care expenditures. Data for annual expenditures and number of days of dental, periodontal, and medical treatment in fiscal year 2018 and participation in the short version of a workplace oral health promotion program of 2545 workers (20–68 years old) in a company in fiscal year 2017 and prior were obtained. Zero-inflated negative binomial regression models or negative binomial regression models were used to evaluate the association between participation in the program and expenditures or number of days of treatment after adjusting for sex and age. Program participants were more likely than non-participants to visit dentists for dental and periodontal treatment. Those who participated twice or more spent less on dental, periodontal, and medical treatment and had fewer visits to dentists than non-participants. These results suggest that the short version of an oral health promotion program in the workplace decreases expenditures for dental, periodontal, and medical treatment.

Biomarkers of non-communicable chronic disease: an update on contemporary methods

Chronic diseases constitute a major global burden with significant impact on health systems, economies, and quality of life. Chronic diseases include a broad range of diseases that can be communicable or non-communicable. Chronic diseases are often associated with modifications of normal physiological levels of various analytes that are routinely measured in serum and other body fluids, as well as pathological findings, such as chronic inflammation, oxidative stress, and mitochondrial dysfunction. Identification of at-risk populations, early diagnosis, and prediction of prognosis play a major role in preventing or reducing the burden of chronic diseases. Biomarkers are tools that are used by health professionals to aid in the identification and management of chronic diseases. Biomarkers can be diagnostic, predictive, or prognostic. Several individual or grouped biomarkers have been used successfully in the diagnosis and prediction of certain chronic diseases, however, it is generally accepted that a more sophisticated approach to link and interpret various biomarkers involved in chronic disease is necessary to improve our current procedures. In order to ensure a comprehensive and unbiased coverage of the literature, first a primary frame of the manuscript (title, headings and subheadings) was drafted by the authors working on this paper. Second, based on the components drafted in the preliminary skeleton a comprehensive search of the literature was performed using the PubMed and Google Scholar search engines. Multiple keywords related to the topic were used. Out of screened papers, only 190 papers, which are the most relevant, and recent articles were selected to cover the topic in relation to etiological mechanisms of different chronic diseases, the most recently used biomarkers of chronic diseases and finally the advances in the applications of multivariate biomarkers of chronic diseases as statistical and clinically applied tool for the early diagnosis of chronic diseases was discussed. Recently, multivariate biomarkers analysis approach has been employed with promising prospect. A brief discussion of the multivariate approach for the early diagnosis of the most common chronic diseases was highlighted in this review. The use of diagnostic algorithms might show the way for novel criteria and enhanced diagnostic effectiveness inpatients with one or numerous non-communicable chronic diseases. The search for new relevant biomarkers for the better diagnosis of patients with non-communicable chronic diseases according to the risk of progression, sickness, and fatality is ongoing. It is important to determine whether the newly identified biomarkers are purely associations or real biomarkers of underlying pathophysiological processes. Use of multivariate analysis could be of great importance in this regard.

Determination of salivary concentrations of leptin and adiponectin, ability to reduce ferric ions and total antioxidant capacity of saliva in patients with severe early childhood caries

INTRODUCTION

One of the most common oral diseases affecting children is early childhood caries (ECC). The link between oxidative stress and ECC has been proven in numerous clinical studies. Technical and biological variability were so high in most of the studies that none of the markers have yet been proven suitable for routine clinical use. This study aimed to evaluate the antioxidant status and the levels of leptin and adiponectin in saliva of children with severe early childhood caries (S-ECC).

METHODS

Morning unstimulated saliva samples were collected from children (n = 40, 0-6 years old) for the evaluation of oxidative stress which were measured by total antioxidant capacity (TAC), and by the ferric reducing antioxidant power (FRAP) assays, as well as to assess the salivary levels of leptin and adiponectin. FRAP, TAC, leptin and adiponectin concentrations were evaluated in S-ECC group (n = 31) and caries free group CF (n = 9). All results were analyzed based on age and sex.

RESULTS

Overall median salivary leptin and adiponectin levels were 5.59 pg/mL and 24.86 ng/mL, respectively. Significantly lower leptin levels were observed in saliva of caries free children (4.66 pg/mL) than in the S-ECC group (6.64 pg/mL, p < 0.01). No significant difference was observed for adiponectin levels (S-ECC and CF, 25.31 and 23.2 ng/mL, respectively, p = 0.961). TAC and FRAP values of saliva had similar values in children with S-ECC and caries free children. TAC and FRAP values also remained stable with the age of the children, without significant differences with respect to sex.

CONCLUSION

The increased concentrations of leptin in saliva of children with S-ECC suggests that leptin may play a role in inflammatory and immune responses in the development of early childhood caries.

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival

INTRODUCTION

Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications.

AIM

This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control.

DISCUSSION

Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients.

CONCLUSION

In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

OBJECTIVES

To identify the association between periodontal diseases (gingivitis and periodontitis) and chronic diseases including cardiovascular disease, cardiometabolic disease, autoimmune disease and mental ill health.

DESIGN

Retrospective cohort.

SETTING

IQVIA Medical Research Data-UK between 1 January 1995 and 1 January 2019.

PARTICIPANTS

64 379 adult patients with a general practitioner recorded diagnosis of periodontal disease (exposed patients) were matched to 251 161 unexposed patients by age, sex, deprivation and registration date.

MAIN OUTCOME MEASURES

Logistic regression models accounting for covariates of clinical importance were undertaken to estimate the adjusted OR (aOR) of having chronic diseases at baseline in the exposed compared with the unexposed group. Incidence rates for each outcome of interest were then provided followed by the calculation of adjusted HRs using cox regression modelling to describe the risk of outcome development in each group.

RESULTS

The average age at cohort entry was 45 years and the median follow-up was 3.4 years. At study entry, the exposed cohort had an increased likelihood of having a diagnosis of cardiovascular disease (aOR 1.43; 95% CI 1.38 to 1.48), cardiometabolic disease (aOR 1.16; 95% CI 1.13 to 1.19), autoimmune disease (aOR 1.33; 95% CI 1.28 to 1.37) and mental ill health (aOR 1.79; 95% CI 1.75 to 1.83) compared with the unexposed group. During the follow-up of individuals without pre-existing outcomes of interest, the exposed group had an increased risk of developing cardiovascular disease (HR 1.18; 95% CI 1.13 to 1.23), cardiometabolic disease (HR 1.07; 95% CI 1.03 to 1.10), autoimmune disease (HR 1.33; 95% CI 1.26 to 1.40) and mental ill health (HR 1.37; 95% CI 1.33 to 1.42) compared with the unexposed group.

CONCLUSIONS

In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health. Periodontal diseases are very common; therefore, an increased risk of other chronic diseases represent a substantial public health burden.

Oral Condition and Incident Coronary Heart Disease: A Clustering Analysis

Poor oral health has been linked to coronary heart disease (CHD). Clustering clinical oral conditions routinely recorded in adults may identify their CHD risk profile. Participants from the Paris Prospective Study 3 received, between 2008 and 2012, a baseline routine full-mouth clinical examination and an extensive physical examination and were thereafter followed up every 2 y until September 2020. Three axes defined oral health conditions: 1) healthy, missing, filled, and decayed teeth; 2) masticatory capacity denoted by functional masticatory units; and 3) gingival inflammation and dental plaque. Hierarchical cluster analysis was performed with multivariate Cox proportional hazards regression models and adjusted for age, sex, smoking, body mass index, education, deprivation (EPICES score; Evaluation of Deprivation and Inequalities in Health Examination Centres), hypertension, type 2 diabetes, LDL and HDL serum cholesterol (low- and high-density lipoprotein), triglycerides, lipid-lowering medications, NT-proBNP and IL-6 serum level. A sample of 5,294 participants (age, 50 to 75 y; 37.10% women) were included in the study. Cluster analysis identified 3,688 (69.66%) participants with optimal oral health and preserved masticatory capacity (cluster 1), 1,356 (25.61%) with moderate oral health and moderately impaired masticatory capacity (cluster 2), and 250 (4.72%) with poor oral health and severely impaired masticatory capacity (cluster 3). After a median follow-up of 8.32 y (interquartile range, 8.00 to 10.05), 128 nonfatal incident CHD events occurred. As compared with cluster 1, the risk of CHD progressively increased from cluster 2 (hazard ratio, 1.45; 95% CI, 0.98 to 2.15) to cluster 3 (hazard ratio, 2.47; 95% CI, 1.34 to 4.57; P < 0.05 for trend). To conclude, middle-aged individuals with poor oral health and severely impaired masticatory capacity have more than twice the risk of incident CHD than those with optimal oral health and preserved masticatory capacity (ClinicalTrials.gov NCT00741728).

Periodontal status and the efficacy of the first-line treatment of major depressive disorder

Objectives

The efficacy of treatment of major depressive disorder (MDD) is not satisfactory. Systemic inflammation may play an important role in MDD pathogenesis and treatment outcomes. Periodontal disease is the systemic inflammatory condition. Its prevalence may be as high as 45%. We aimed to assess the association of periodontal status with the outcome of 3‐month first‐line treatment of MDD with selective serotonin reuptake inhibitors.

Material and Methods

We performed the prospective cohort study during 2018/2019 at Psychiatric Hospital “Sveti Ivan,” Croatia, on a consecutive sample of 43 patients. The outcome was the MDD symptoms severity measured using the Hamilton Depression Rating Scale‐17. The periodontal status was indicated by the clinical attachment loss (CAL).

Results

Baseline periodontal status had a nonlinear significant and clinically relevant association with the MDD treatment outcome (R² change of the quadratic term = 0.12; p = 0.027). In patients with good baseline periodontal status the severity of MDD symptoms was significantly improved. When the value of CAL was ≥4.44 mm, indicating the worse periodontal status, further increase in baseline CAL was associated with the worsening of MDD treatment outcomes independently of the baseline depression severity and 14 sociodemographic and clinical predictors of treatment outcome.

Conclusions

Periodontal healthcare is accessible, and should be utilize in an integrative, multidisciplinary approach not only for the sake of psychiatric patients' quality of life and prevention of periodontal disease, but for the sake of the outcomes of psychiatric treatment as well.

OralDisk: A Chair-Side Compatible Molecular Platform Using Whole Saliva for Monitoring Oral Health at the Dental Practice

Periodontitis and dental caries are two major bacterially induced, non-communicable diseases that cause the deterioration of oral health, with implications in patients' general health. Early, precise diagnosis and personalized monitoring are essential for the efficient prevention and management of these diseases. Here, we present a disk-shaped microfluidic platform (OralDisk) compatible with chair-side use that enables analysis of non-invasively collected whole saliva samples and molecular-based detection of ten bacteria: seven periodontitis-associated (Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola) and three caries-associated (oral Lactobacilli, Streptococcus mutans, Streptococcus sobrinus). Each OralDisk test required 400 µL of homogenized whole saliva. The automated workflow included bacterial DNA extraction, purification and hydrolysis probe real-time PCR detection of the target pathogens. All reagents were pre-stored within the disk and sample-to-answer processing took < 3 h using a compact, customized processing device. A technical feasibility study (25 OralDisks) was conducted using samples from healthy, periodontitis and caries patients. The comparison of the OralDisk with a lab-based reference method revealed a ~90% agreement amongst targets detected as positive and negative. This shows the OralDisk's potential and suitability for inclusion in larger prospective implementation studies in dental care settings.

COVID-19 and oral diseases: Assessing manifestations of a new pathogen in oral infections

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a recently identified virus responsible for life-threatening coronavirus disease 19 (COVID-19). The SARS-CoV-2 infected subjects can be asymptomatic or symptomatic; the later may present a wide spectrum of clinical manifestations. However, the impact of SARS-CoV-2 on oral diseases remain poorly studied. Detection of SARS-CoV-2 in saliva indicates existence of virus in the oral cavity. Recent studies demonstrating the expression of ACE-2, a SARS-CoV-2 entry receptor, in oral tissues further strengthens this observation. Cytokine storm in severe COVID-19 patients and copious secretion of pro-inflammatory cytokines (IL-6, IL-1β and TNF-α) in multiple symptomatic oral pathologies including periodontitis and periapical periodontitis suggests that inflammatory microenvironment is a hallmark of both COVID-19 and oral diseases. Hyperinflammation may provide conducive microenvironment for the growth of local oral pathogens or opportunistic microbes and exert detrimental impact on the oral tissue integrity. Multiple case reports have indicated uncharacterized oral lesions, symptomatic irreversible pulpitis, higher plaque index, necrotizing/desquamative gingivitis in COVID-19 patients suggesting that SARS-CoV-2 may worsen the manifestations of oral infections. However, the underlying factors and pathways remain elusive. Here we summarize current literature and suggest mechanisms for viral pathogenesis of oral dental pathology derived from oral microbiome and oral mucosa-dental tissue interactions. Longitudinal studies will reveal how the virus impairs disease progression and resolution post-therapy. Some relationships we suggest provide the basis for novel monitoring and treatment of oral viral disease in the era of SARS-CoV-2 pandemic, promoting evidence-based dentistry guidelines to diagnose virus-infected patients to improve oral health.

Community pharmacists' knowledge, attitudes and practices towards oral healthcare and its management: A systematic review

BACKGROUND

Community pharmacists play a significant part in providing oral healthcare advice as there are significant connections between oral healthcare and body system healthcare.

OBJECTIVE

To systematically review the literature regarding the knowledge, attitudes and practice of community pharmacists in managing oral healthcare problems.

METHODS

A systematic review was conducted through Scopus, PubMed and Google Scholar databases. Studies regarding knowledge, attitudes and practice of management of dental care by community pharmacists between 1990 and 2019 were included.

RESULTS

Forest plot was performed to access knowledge, attitudes and practice of community pharmacist on oral healthcare. The results showed there were 44% of community pharmacists have a lack of knowledge on oral healthcare to provide an appropriate recommendation to patients with dental problems. Eighty-eight per cent of community pharmacists were willing to improve their knowledge of oral healthcare. There were 86% of them recognised that their role was significant in oral health. However, there were 59% of community pharmacists who had poor attitude in providing oral health information.

CONCLUSIONS

Community pharmacists were lacking knowledge on oral health mainly because of paucity in providing appropriate training courses. This has led to poor practices towards oral healthcare as they were unable to provide suitable products recommendations to the patients. This has led the community pharmacists into lack of attitudes in providing oral health information. However, most of the community pharmacists were conscious of their role in the oral healthcare system and were willing to improve their knowledge of oral healthcare.

Pharmacy participation in dental and oral health care: a scoping review protocol

OBJECTIVE

The aim of the review is to identify and describe the characteristics and associated outcomes of dental and oral health advice and support provided by members of the pharmacy profession. Research exploring the role, attitudes, and knowledge of pharmacists, pharmacy students, and support staff relating to dental and oral health care, as well as stakeholder perceptions, will also be examined.

INTRODUCTION

With the increasing prevalence of dental and oral health disorders and resource constraints within health care systems, other avenues for oral health promotion and care provision are warranted. Pharmacists, as primary care professionals working across various practice settings, could play a significant role in promoting good oral health. Yet, there is limited insight about the role, attitudes, and knowledge of members of the pharmacy profession towards dental and oral health care, as well as what stakeholders, such as consumers and other health care professionals, think about their role in this context.

INCLUSION CRITERIA

Any full-text publication that describes outcomes related to pharmacist, pharmacy assistant, or student involvement, knowledge, or attitudes towards dental or oral health care in any setting, and stakeholder perspectives of this role, will be included. Reviews, protocols, and commentaries will be excluded, as will studies specifically focused on smoking cessation or that do not describe the related health promotion activity.

METHODS

Articles published in English will be sought from health and educational databases with no date restrictions, with additional references identified via snowballing using citations and reference lists. Data searching and screening processes will follow JBI methodology, involving two independent reviewers, and data extraction presented in a narrative form.