Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study.

AIM: Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. MATERIALS AND METHODS: Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. RESULTS: Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. CONCLUSIONS: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil.

INTRODUCTION: There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition. METHODS: Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries. RESULTS: The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries. CONCLUSION: Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

Investigating the causal effect of cognition on the self-reported loss of functional dentition using marginal structural models: The Panel on Health and Ageing of Singaporean Elderly study.

AIM: To assess the effect of cognition on the loss of functional dentition. MATERIALS AND METHODS: We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study (n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009-2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time-varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted. RESULTS: The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88-3.69) among those with cognitive impairment after taking well-known confounders into account. CONCLUSIONS: After accounting for the time-varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain.

Chronic oral diseases burden: The confluence of caries and periodontitis throughout life.

AIM: To investigate the confluence of caries and periodontitis indicators from adolescence to elderhood among Americans. MATERIALS AND METHODS: This cross-sectional study explored the grouping among a set of caries and periodontitis indicators (the proportion of sites with bleeding on probing, moderate probing pocket depth [PPD, 4-5 mm], severe PPD [≥6 mm], moderate clinical attachment level [CAL, 3-4 mm], severe CAL [≥5 mm], number of teeth with furcation involvement, number of decayed teeth, number of teeth with pulp involvement, and the number of missing teeth) in 14,421 Americans from the NHANES III study. Exploratory factorial analysis was used to determine the constructs between those indicators (factorial loading ≥0.3). These analyses were stratified by age and confirmed with a confirmatory factorial analysis. We also performed a sensitivity analysis using the NHANES 2011-2014. RESULTS: Two constructs were extracted. The first, Chronic Oral Diseases Burden, grouped caries indicators with moderate PPD and moderate CAL for the youngest subjects (13-39 years old), while for the subjects over 50 years, the Chronic Oral Disease Burden grouped caries indicators with severe CAL and PPD and furcation involvement. The second construct, Periodontal Destruction, grouped only periodontitis indicators. CONCLUSIONS: Caries and periodontitis indicators grouped consistently across the different age ranges in lapse times of 25 years.

Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis.

AIM: To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS: This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS: The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (ß = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (ß = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS: This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.

Australians support for policy initiatives addressing unhealthy diet: a population-based study.

To inform public health policy implementation in Australia, our study investigated the level of public support for six policy initiatives addressing unhealthy diet. The policy initiatives included taxing soft drinks and energy drinks, taxing less healthy food and beverage purchases, zoning to restrict the supply of junk foods near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugar-sweetened beverages from vending machines in schools, and public places. Data from a cross-sectional population-based study for 4040 Australians aged 15+ years, were analysed. A high overall support across all policy initiatives was observed. Nearly three-quarter of public support was observed for policy initiatives targeting children (zoning to restrict the supply of junk food near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugars-sweetened beverages from vending machines in schools), and half of Australians supported policy initiatives of taxing soft drinks and energy drinks and taxing less healthy food and beverage purchases. Australian women and those with tertiary level of education were more likely to support public health initiatives targeting children and all policy initiatives respectively. Interestingly, young adults expressed low level of support for all policy initiatives. The study demonstrated considerable public support for policy initiatives focussed on protecting children from unhealthy diet in Australia. Framing, designing and implementing policies targeting children is potentially a good starting point for policymakers to create a health promoting food environment.

The relationship between periodontal status and hyperglycemia after kidney transplantation.

OBJECTIVES: Several factors have been associated with hyperglycemia after kidney transplantation (KTx), including systemic inflammation. This study aimed to investigate the relationship between periodontal status and hyperglycemia in KTx patients. MATERIALS AND METHODS: Forty-four KTx patients were included in this cross-sectional study. Periodontitis severity was categorized into stage I to IV. Fasting blood glucose (FBG) was measured, and hyperglycemia was analyzed at different FBG cutoff points (100 mg/dL, 110 mg/dL, 120 mg/dL, 126 mg/dL, 140 mg/dL). Age, history of smoking, prior type 2 diabetes (T2D), and prior cardiovascular disease (CVD) were considered cofounders. Multivariable logistic regression modelling was performed with periodontitis as the exposure and hyperglycemia as the outcome. Pathway analysis was performed with FBG as a continuous outcome. RESULTS: Periodontitis had increased odds of hyperglycemia from 120 mg/dL FBG cutoff, even after adjustment. In addition, periodontitis severity was positively associated with FBG level (ß = 0.323, SE = 0.127, P = 0.011). CONCLUSION: The findings suggest that periodontitis may be related to increase of hyperglycemia and FBG levels in KTx patients. CLINICAL RELEVANCE: Periodontitis severity and cardiovascular disease were positively associated with FBG levels in KTx patients. Clinicians and patients should be aware of the potential benefit of periodontal care for better glycemic control management.

The association between halitosis and oral-health-related quality of life: A systematic review and meta-analysis.

AIM: To investigate whether halitosis is associated with impaired oral-health-related quality of life (OHRQoL). MATERIALS AND METHODS: This is a systematic review of the literature. Electronic searches were performed in PubMed via Medline, Web of Science, Scopus, and EMBASE up to and including June 2021. Observational studies that assessed halitosis in association with OHRQoL were included. The pooled standardized mean difference (SMD) was estimated by meta-analysis. RESULTS: Thirteen studies were included in the review; however, the meta-analysis included only 10 studies, all cross-sectional, comprising 2692 individuals. The overall meta-analysis showed an association between halitosis and impaired OHRQoL (SMD 0.51; 95% confidence interval 0.27-0.75). Subgroup analyses, however, indicated that this association remained only among adults. Neither the OHRQoL instrument nor the halitosis assessment method, or the cultural background, influenced the pooled estimates. Meta-regression analyses revealed that the OHRQoL instrument, the halitosis assessment method, and the sample composition did not explain the between-study heterogeneity. Methodological quality appeared to explain 20% of the overall heterogeneity, as studies with high risk of bias overestimated the magnitude of the association. CONCLUSION: Our findings suggest that halitosis is associated with impaired OHRQoL.

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs.

BACKGROUND: The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group. METHODS: A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis. RESULTS: From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers' perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers' perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN. CONCLUSIONS: An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community's health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities.

Challenges in identifying indigenous peoples in population oral health surveys: a commentary.

There are currently 370 million persons identifying as indigenous across 90 countries globally. Indigenous peoples generally face substantial exclusion/marginalization and poorer health status compared with non-indigenous majority populations; this includes poorer oral health status and reduced access to dental services. Population-level oral health surveys provide data to set priorities, inform policies, and monitor progress in dental disease experience/dental service utilisation over time. Rigorously and comprehensively measuring the oral health burden of indigenous populations is an ethical issue, though, given that survey instruments and sampling procedures are usually not sufficiently inclusive. This results in substantial underestimation or even biased estimation of dental disease rates and severity among indigenous peoples, making it difficult for policy makers to prioritise resources in this area. The methodological challenges identified include: (1) suboptimal identification of indigenous populations; (2) numerator-denominator bias and; (3) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world in an oral health context. These include acknowledgment of the need to engage indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets, and mitigating and/or carefully assessing biases inherent in population oral health methodologies for indigenous peoples.

Oral diseases: a global public health challenge.

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

Ending the neglect of global oral health: time for radical action.

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

Income at birth and tooth loss due to dental caries in adulthood: The 1982 Pelotas birth cohort.

OBJECTIVE: To estimate the effect of income at birth on adulthood tooth loss due to dental caries in 539 adults from the 1982 Pelotas birth cohort. METHODS: Family income was collected at birth. Tooth loss was clinically assessed when individuals were aged 31. Dental visit and oral hygiene at age 25 were considered mediators. Confounders included maternal skin color, and individual's skin color, sex, and income in adulthood. Marginal structural modeling was used to estimate the controlled direct effect of income at birth on tooth loss due to dental caries that was neither mediated by the use of dental service nor oral hygiene. RESULTS: Forty-three percent of the individuals of low income at birth lost one/two teeth, and 23% lost three or more; among those non-poor, the prevalence was 30% and 14%, respectively. Poor individuals at birth had a 70% higher risk for missing teeth in adulthood than those non-poor. The risk of losing one/two (risk ratio 1.68) and three or more teeth (risk ratio 3.84) was also higher among those of low income at birth. CONCLUSIONS: Economic disadvantage at birth had an effect on tooth loss due to dental caries at age 31 not mediated by individual risk factors.

Is there an association between depression and periodontitis? A birth cohort study.

AIM: To investigate the association between depression and periodontitis among adults enrolled in the 1982 Pelotas Birth Cohort, Brazil. MATERIALS AND METHODS: Major depressive episode (MDE) and severity of depressive symptoms obtained in 2012 were considered the exposure of this study. In 2013, periodontitis, the outcome of interest, was clinically assessed and two different case definitions were used: the CDC/AAP and a combination of clinical attachment loss (CAL) and bleeding on probing (BOP) simultaneously. Serum levels of C-reactive protein and frequency of dental flossing were defined as mediators while confounders comprised a set of variables collected throughout the life-course of the participants. The parametric g-formula was used to test the direct, indirect and total effects of depression on periodontitis. RESULTS: 539 participants were clinically examined. Individuals with depressive symptoms presented higher risk of periodontitis (risk ratio [RR] 1.19). The presence of depressive symptoms was also associated with moderate/severe periodontitis (total effect RR 1.18). None of the associations was mediated by flossing or C-reactive protein levels. Finally, neither the presence of depressive symptoms nor the presence of major depression was associated with the combination of CAL+BOP. CONCLUSIONS: A positive association between depressive symptoms and periodontitis and moderate/severe periodontitis was found. MDE was not associated with periodontitis.

Prediction models for the incidence and progression of periodontitis: A systematic review.

AIMS: To comprehensively review, identify and critically assess the performance of models predicting the incidence and progression of periodontitis. METHODS: Electronic searches of the MEDLINE via PubMed, EMBASE, DOSS, Web of Science, Scopus and ProQuest databases, and hand searching of reference lists and citations were conducted. No date or language restrictions were used. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist was followed when extracting data and appraising the selected studies. RESULTS: Of the 2,560 records, five studies with 12 prediction models and three risk assessment studies were included. The prediction models showed great heterogeneity precluding meta-analysis. Eight criteria were identified for periodontitis incidence and progression. Four models from one study examined the incidence, while others assessed progression. Age, smoking and diabetes status were common predictors used in modelling. Only two studies reported external validation. Predictive performance of the models (discrimination and calibration) was unable to be fully assessed or compared quantitatively. Nevertheless, most models had "good" ability to discriminate between people at risk for periodontitis. CONCLUSIONS: Existing predictive modelling approaches were identified. However, no studies followed the recommended methodology, and almost all models were characterized by a generally poor level of reporting.

Effect of life-course family income trajectories on periodontitis: Birth cohort study.

AIMS: To quantify the impact of life course income trajectories on periodontitis in adulthood. MATERIALS AND METHODS: Data from the 1982 Pelotas Birth Cohort Study, Brazil, were used. Information on family income was collected at birth and ages 15, 19, 23 and 30 years. Group-based trajectory modelling was used to identify income trajectories. Periodontal measures were assessed through clinical examination at age 31. Log-Poisson regression models were used to estimate prevalence ratios (PRs) of any and moderate/severe periodontitis, as outcomes. RESULTS: Prevalence of any periodontitis and moderate/severe periodontitis was 37.3% and 14.3% (n = 539). Income trajectories were associated with prevalence of moderate/severe periodontitis. Adjusted PR in participants in low and variable income trajectory was 2.1 times higher than in participants in stable high-income trajectory. The unadjusted association between income trajectories and prevalence of any periodontitis was explained by the inclusion of behavioural and clinical variables in the model. CONCLUSIONS: Low and variable life course income increased the prevalence of moderate/severe periodontitis at age 31 years. The findings may inform programmes in identifying and targeting potentially at-risk groups during the life course to prevent periodontitis.

Diet-Induced Overweight and Obesity and Periodontitis Risk: An Application of the Parametric G-Formula in the 1982 Pelotas Birth Cohort.

We aimed to estimate hypothetical effects of habits (smoking, alcohol consumption, and fat and carbohydrates consumption) combined with diet-induced overweight/obesity on the risk of periodontitis. The risk of any periodontitis, moderate/severe periodontitis, and the combination of bleeding on probing (BOP) and clinical attachment loss (CAL) was estimated using the parametric g-formula in adults aged 31 years from the 1982 Pelotas Birth Cohort in Brazil. Individuals in this cohort have been followed since birth. Hypothetical conditions were set independently for each risk factor and in combination for the entire population. A total of 539 participants had oral examinations in 2013. The cumulative 31-year risk under no intervention was 33.3% for any periodontitis, 14.3%, for moderate/severe periodontitis, and 14.7%, for BOP and CAL. According to our statistical approach, diet-induced overweight/obesity increased the risk of all outcomes: 11% (overweight) and 22% (obesity) higher risk of periodontitis; 12% (overweight) and 27% (obesity) higher risk of moderate/severe periodontitis; 21% (overweight) and 57% (obesity) higher risk of CAL and BOP. When overweight/obesity was combined with other unhealthy habits, the risk was even greater. Our findings suggest that the combination of diet-induced obesity with other risk factors may increase the risk of periodontitis. Further research in the field is required to corroborate our study.

Prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders: a systematic review and meta-analysis.

OBJECTIVE: This study aims to estimate the prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders (TMD). MATERIAL AND METHODS: Search strategies were developed for each of the following databases: PubMed, LILACS, Scopus, Web of Science, Proquest, LIVIVO, and Google Scholar and OpenGrey was used to assess the grey literature. It was included in this review only observational studies using either research diagnostic criteria (RDC)/TMD or DC/TMD indexes were selected. The Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute was used to assess the risk of bias of the included studies. A proportion random effects meta-analysis was conducted within the eight included studies. RESULTS: Eight studies met the eligibility criteria and were selected. All of the included studies used the RDC/TMD and report associated otologic signs and symptoms. The studies were clustered into groups based on prevalence for each individual sign or symptom. The most prevalent otologic symptom associated with TMD was ear fullness (74.8 % standard deviation (SD), 43.02 to 96.25 %; n = 50), followed by otalgia (55.1 % SD, 31.78 to 77.30; n = 386), tinnitus (52.1 % SD, 38.43 to 65.74; n = 1293), vertigo (40.8 % SD, 11.29 to 74.72; n = 374), and hearing loss (38.9 % SD, 2.83 to 85.46; n = 744). CONCLUSION: The prevalence of otologic signs and symptoms in adult patients with TMD is high. The most prevalent otologic symptom in patient adults with TMD is ear fullness. CLINICAL RELEVANCE: This study intends to provide understanding over the prevalence of otologic signs and symptoms in TMD cases in adults.