Synergistic effect of maternal obesity and periodontitis on preterm birth in women with pre-eclampsia: a prospective study.

AIM: The aim of this study was to investigate if pregnant women with both obesity and periodontitis are more likely to experience preterm birth (PTB) in women with pre-eclampsia (PE) than pregnant women with only obesity or only periodontitis. MATERIALS AND METHODS: The study examined a total of 328 pregnant women at 21-24 weeks of gestation. Overweight and obesity was defined based on criteria proposed by the WHO Expert Consultation. Periodontal conditions were assessed by measuring periodontal clinical attachment loss. PTB was defined as delivery at <37 weeks, and PE was defined as blood pressure higher than 140/90 mmHg on two separate occasions with at least 1+ proteinuria on a random urine screen after the 20th week of pregnancy. RESULTS: After adjusting for other important cofactors, pregnant women with periodontitis were 5.56 times [95% confidence interval (CI) = 1.22-25.39] more likely to have PTB with PE than women without periodontitis. The association was much stronger (odds ratio = 15.94, 95% CI = 3.31-76.71) in women with both obesity and periodontitis. CONCLUSIONS: Our results of this study indicate that pregnant women with both pre-pregnancy obesity and periodontitis are significantly more likely to have PTB with PE than pregnant women with only periodontitis.

Oily Fish Intake and Cognitive Performance in Community-Dwelling Older Adults: The Atahualpa Project.

Due to their high content of omega-3 polyunsaturated fatty acids, oily fish consumption is likely associated with a better cognitive performance. However, information on this association is controversial, with some studies showing a positive effect while others showing no association. We aimed to assess the effects of oily fish consumption on cognitive performance in a population of frequent fish consumers living in rural coastal Ecuador. Atahualpa residents aged ≥60 years were identified during a door-to-door survey and evaluated by the use of the Montreal Cognitive Assessment (MoCA). Oily fish servings per week were calculated in all participants. We estimated whether fish intake correlated with MoCA scores in generalized multivariate linear models adjusted for demographics, cardiovascular risk factors, edentulism and symptoms of depression. Out of 330 eligible persons, 307 (93%) were enrolled. Mean MoCA scores were 19 ± 4.8 points, and mean oily fish consumption was 8.6 ± 5.3 servings per week. In multivariate analyses, MoCA scores were related to fish servings (ß 0.097, 95% CI 0.005-0.188, p = 0.038). Locally weighted scatterplot smoothing showed an inflection point in the total MoCA score curve at four fish servings per week. However, predictive margins of the MoCA score were similar across groups below and above this point, suggesting a direct linear relationship between oily fish intake and cognitive performance. Simple preventive measures, such as modifying dietary habits might be of value to reduce the rate of cognitive decline in community-dwelling older adults living in underserved populations.

Association between estimated fluoride intake and dental caries prevalence among 5-year-old children in Korea.

BACKGROUND: The purposes of this study were to estimate the fluoride intake from food and drink in 5-year-old Korean children, and to measure the association between estimated fluoride intake and dental caries prevalence. METHODS: The study involved a secondary analysis of raw data from the 4(th) Korea National Health and Nutrition Examination Survey (KNHANES; 2007-2009). The study subjects were 167 boys and 147 girls aged 5 years who had undergone both physical and nutritional examination as part of the survey. The KNHANES comprised a health questionnaire, a physical examination, and a nutritional examination. The nutritional examination of KNHANES consisted of 3 parts: a dietary life survey, a food-frequency questionnaire, and a food intake investigation. The food intake investigation used the 24-h recall method, with information being provided by the children's parents. On the basis of this information, we evaluated the fluoride content in a total of 310 food items using the hexamethyldisiloxane (HMDS)-facilitated diffusion method, modified using Taves' microdiffusion method. As part of the KNHANES survey, oral examinations were conducted at a mobile examination centre by trained dentists using dental mirrors under a fluorescent light. These examinations were performed using methods proposed by the World Health Organization. RESULTS: The dietary fluoride intake of 5-year-old Korean children was estimated to be 0.35 mg/day, or 0.016 mg/kg/day. The "decayed or filled surfaces" (dfs) indices of primary teeth were higher in children who had a lower dietary intake of fluoride. There was a significant inverse association between dietary fluoride intake and the prevalence of dental caries. CONCLUSION: The inverse association between dietary fluoride intake levels and prevalence of dental caries implies that the introduction of community caries prevention programmes may be beneficial. Such programmes would include water fluoridation and a fluoride supplementation programme.

Association between periodontitis and preeclampsia in never-smokers: a prospective study.

AIM: The aim of this prospective study was to investigate the relationship between periodontitis and preeclampsia in never-smokers. MATERIALS AND METHODS: Pregnant women were recruited at 21 to 24 weeks of gestation from March 2009 to June 2013. Information on demographics, health behaviours, obstetric history, and systemic diseases that can influence periodontal status and preeclampsia was collected. Full-mouth periodontal probing was performed by two trained examiners. The inter-examiner Kappa value was 0.822 for clinical attachment loss (CAL). Periodontitis was defined as clinical periodontal attachment loss (CAL) of 4.0 mm or greater on 2 or more sites not on the same tooth. Information on the occurrence of preeclampsia was collected by five obstetricians. RESULTS: We studied a total of 283 subjects, comprised of 67 subjects with periodontitis and 216 subjects without periodontitis. Of these, 13 (4.6%) women were diagnosed with preeclampsia. After adjusting for all confounders, the adjusted odds ratio of periodontitis for preeclampsia was 5.56 (95% confidence interval of 1.49-20.71). CONCLUSIONS: There was a significant relationship between periodontitis and the occurrence of preeclampsia among never-smokers.

The relationship between periodontitis and metabolic syndrome among a Korean nationally representative sample of adults.

AIMS: The aim of this study was to examine whether metabolic syndrome (MS) is associated with periodontitis in a representative sample of Korean adults, who were involved in the Fourth Korea National Health and Nutrition Examination Survey (KNHANES). MATERIALS AND METHODS: A total of 7178 subjects over the age of 19 years who participated in KNHANES were examined. MS was defined as the definition proposed by the National Cholesterol Education Program Adult Treatment Panel III and the abdominal obesity cut-off line based on Korean Society for the Study of Obesity. The periodontal status was assessed by the Community Periodontal Index. Multivariate logistic regression analysis was carried out adjusting for the sociodemographics, oral health behaviours and status, and health behaviour. All analyses considered a complex sampling design, and multivariate analysis was also performed in the subgroups (age, gender, current smoking status). RESULTS: Multivariate logistic regression analysis revealed significant associations between MS and periodontitis. After adjusting for all covariates, the adjusted odds ratio (OR) of periodontitis (community periodontal index ≥ 3) was 1.55 (1.32-1.83) for MS. In subgroup analysis, periodontitis is associated with MS in subjects over age 40 and the adjusted ORs were higher in females and in the smoker group than in males and in non-smokers. CONCLUSIONS: MS is associated with periodontitis.

Level of professional ethics awareness and medical ethics competency of dental hygienists and dental hygiene students: the need to add ethics items to the Korean Dental Hygienist Licensing Examination

PURPOSE: This study aimed to evaluate the level of professional ethics awareness and medical ethics competency in order to assess the potential need for ethics items to be included on the Korean Dental Hygienist Licensing Examination. METHODS: In total, 358 clinical dental hygienists and dental hygiene students completed a structured questionnaire to evaluate their level of ethical awareness and medical ethics competency. The sub-factors of medical ethics were classified into relationships with patients, medical and social relations, and individual specialized fields. RESULTS: Only 32.1% of participants indicated that they had taken a course on professional ethics in the university curriculum, but 95.2% of respondents considered professional ethics to be important. The overall score for medical ethics competency was average (3.37 out of 5). The score for relationships with patients was 3.75 points, followed by medical and social relations (3.19 points) and individual specialized fields (3.16 points). The level of professional ethics awareness was higher among participants who had taken a course on professional ethics than among those who had not done so or who did not remember whether they had done so. CONCLUSION: Dental hygienists were aware of the importance of professional ethics, but their medical ethics competency was moderate. Therefore, medical ethics should be treated as a required subject in the university curriculum, and medical ethics competency evaluations should be strengthened by adding ethics items to the Korean Dental Hygienist Licensing Examination.

Educational effect of 3D applications as a teaching aid for anatomical practice for dental hygiene students.

The purpose of this study is to find out effective methodology of anatomical curriculum by comparing the education effects and satisfaction using different teaching tools, plastic model and three-dimensional (3D) application. A survey was conducted on the satisfaction level, understanding, and the usefulness of the tools used in the lectures of the two dental hygiene students groups who used the 3D application and the plastic model respectively. The interest in anatomical structure of the 3D App group was 4.20, which was significantly higher than that of the plastic model group 3.60, and the usefulness of the content of anatomy education was 4.31 in the 3D App group, significantly higher than the plastic model group (P<0.05). It was found that the interest in anatomical structure of students increased by 0.347 when using 3D applications compared to the case without the use (P=0.012) and understanding in anatomical structure and class concentration increased by 0.191, respectively, but these results were marginally significant. We expect that this study serves as a reference for the development and supplementation of anatomy teaching and learning method.

Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists.

PURPOSE: This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. METHODS: A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects' responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. RESULTS: Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. CONCLUSION: Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience.

Association between obesity and periodontitis in pregnant females.

BACKGROUND: The purpose of this study is to investigate whether overweight and obesity before pregnancy are associated with periodontitis during pregnancy. METHODS: This study examined a total of 315 pregnant females at 21 to 24 weeks of gestation. Overweight and obesity were defined based on criteria proposed by the World Health Organization Expert Consultation. Periodontal conditions were assessed by measuring clinical periodontal attachment loss (AL). To investigate whether obese pregnant females have increased risk according to the extent of periodontitis, the data were divided into two groups: 1) generalized periodontitis and 2) localized periodontitis. A comparison among underweight, normal-weight, and overweight/obese groups for explanatory variables was analyzed using the χ(2) test for categorical variables and an analysis of variance for continuous variables. Multivariate logistic regression analysis was performed with adjustments for age, health and oral health behaviors, and obstetric information. RESULTS: Age, age at first delivery, periodontitis, and periodontal conditions (two or more interproximal sites with AL ≥4 mm not on the same tooth) were significantly associated with body mass index (BMI) (P <0.05). The adjusted odds ratio of periodontitis was 4.57 (95% confidence interval = 2.30 to 9.07) for overweight and obese females (BMI ≥23 kg/m(2)), after adjusting for all of the covariates. CONCLUSION: There is a strong association between prepregnancy overweight/obesity and periodontitis in pregnant females.

A retrospective cohort study on the association between periapical abscess, advanced periodontal disease, and the national oral health screening program among Korean adults.

The National Oral Health Screening Program (NOHSP) is a general population-based program in Korea. The objective of this study was to assess the association between participation in the NOHSP and dental visit for periapical abscess (PA) and advanced periodontal disease (APD) among Korean adults. Data were obtained for subjects from the National Health Insurance database. The authors conducted a retrospective cohort study of 9358 randomly selected subjects who were between 40 and 64 years old in 2002. The outcomes of dental visit for PA or APD from the years 2003 to 2007 were compared between the screening and nonscreening groups. The nonscreening group had 19% higher risk of PA and 15% higher risk of APD. This study suggests that the NOHSP may decrease the risk of dental visit because of PA and APD by preventing the progress of lesion to the advanced stage among Korean adults.

Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea.

BACKGROUND: The aim of this study is to confirm the association among oral health behaviors, periodontitis, and preeclampsia in Korean women. METHODS: This study is designed as a case-control study. Sixteen women with preeclampsia and 48 without preeclampsia post-delivery were included in this study from November 2007 to January 2010. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may influence the periodontal condition and preeclampsia. Full-mouth periodontal probing was conducted by one trained examiner (KHB). Localized periodontitis was defined as periodontal clinical attachment loss (AL) ≥ 3.5 mm on two or three sites not on the same tooth. In addition, generalized periodontitis was defined as clinical AL ≥ 3.5 mm on ≥ 4 sites not on the same tooth. Gingival crevicular fluid was collected using a sterilized paper point for quantitative analysis of Treponema denticola, Porphyromonas gingivalis, Prevotella intermedia (Pi), and Tannerella forsythia (previously T. forsythensis). RESULTS: After adjusting for confounders, the adjusted odds ratio (OR) was 4.79 (95% confidence interval [CI]: 1.02 to 29.72) for localized periodontitis and 6.60 (95% CI: 1.25 to 41.61) for generalized periodontitis. In addition, the proportion of floss or interdental brush users in women with preeclampsia was lower than that in women without (adjusted OR: 0.21; 95% CI: 0.02 to 0.93). Pi was significantly more prevalent in women with preeclampsia (P = 0.028). CONCLUSION: These results indicate that preeclampsia could be associated with the maternal periodontal condition and interdental cleaning.

Health behaviors, periodontal conditions, and periodontal pathogens in spontaneous preterm birth: a case-control study in Korea.

BACKGROUND: This study aims to determine whether periodontal conditions or dental health behaviors are risk factors for preterm birth (PTB), and whether periodontal pathogens are risk indicators for PTB among Korean mothers. METHODS: This study was designed as a hospital-based case-control study. Examiner masking was ensured for the validity of the examinations. The mothers included those who gave birth between November 2007 and July 2009 at the obstetrics clinic of a general hospital in Seoul, Korea. Information on demographic and health conditions, periodontal conditions, and microbacterial data was collected. RESULTS: A total of 172 women met the inclusion criteria, 59 mothers who delivered a preterm neonate were assigned to the case group while the other 113 were assigned to the control group. There were no significant differences in demographic information, oral health conditions, and obstetric characteristics. Among health-related behaviors, only scaling within 12 months before pregnancy showed a significant difference (P = 0.031). Even in the adjusted logistic model, only the difference in the experience of scaling before pregnancy was significant between the PTB cases and the controls (P = 0.039). Periodontal disease did not exhibit a significant relationship with PTB even after adjustment for potential confounding factors. Among the microbacterial factors, only Porphyromonas gingivalis showed a slight difference (P = 0.060). CONCLUSION: There was a significant difference in scaling experience within 12 months before pregnancy and P. gingivalis showed a marginal difference between the PTB and the control groups but clinical periodontal conditions showed no association with PTB.