The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics.

BACKGROUND: The association between orthodontic treatment and temporomandibular disorders (TMD) has been contentious in the literature. OBJECTIVES: To analyse the associations between orthodontic treatment and TMD diagnosis and diseases characteristics. METHODS: This case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Differences in orthodontic treatment between TMDs and controls, as well as across different TMD diagnoses within the TMD group were analysed. Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. RESULTS: Of the 291 participants, 119 (40.9%) underwent orthodontic treatment and 172 (59.1%) had no orthodontics experience. Orthodontic treatment included: mandibular orthodontic treatment (102 subjects) and maxillary orthodontic treatment (113 subjects) of those 47 used a headgear. Following multivariate analysis among TMDs, orthodontic treatment was associated with a good level of oral hygiene versus poor (Odds ratio [OR]: 5.17 [1.04-25.59]), lower number of tender muscles [OR = 0.84 (0.74-0.96)] and lower (better) Pittsburgh Sleep Quality Index (PSQI) scores (OR = 0.86 [0.76-0.97]). None of the studied parameters maintained a statistically significant association with orthodontic treatment in the multivariate analysis among the entire study population. CONCLUSIONS: Utilising a holistic approach, this study supports the main hypothesis that orthodontic treatment is not associated with TMD diagnosis and disease characteristics.

Integrated therapy of intraductal irrigations and sialoendoscopies of salivary glands to improve mouth dryness.

OBJECTIVE: To assess the combination of salivary gland intraductal irrigations (IG) followed by sialoendoscopy irrigations (SI) of the parotid gland on the improvement of salivary gland secretory dysfunction (SGSD). METHODS: We retrospectively analyzed the records of SGSD patients who underwent major salivary gland IG followed by SI during 2014-2020. Records included demographics, systemic background, signs, and symptoms. Improvement was assessed by comparing the mean unstimulated and stimulated whole salivary flow rate (UWSF, SWSF) from the baseline point (before IG procedure) to the last point (after SI) using repeated measures. The between-subjects effects of various factors and covariants were analyzed using repeated measures ANCOVA. RESULTS: One hundred patients were included with an age range of 15-83 years (mean age of 60.1 ± 13.1 years). Improvement was detected on UWSF measurements (p = 0.031, F = 3.83), but not on SWSF measurements (p = 0.165, F = 1.85). The between-subjects effects on UWSF measurements were statistically significant for sex (p = 0.003, F = 9.526) and salivary gland manipulators use (p < 0.001, F = 15.107) and for the interaction between sex and salivary gland manipulators use (p- = 0.002, F = 9.709). Results of long-term follow-up for 10.87 ± 11.79 months after the SI procedure demonstrated sustained improvement in UWSF measurements (p = 0.011, F = 4.91). CONCLUSIONS: The combination of IG followed by SI increases UWSF salivary secretion in SGSD patients for a relatively extended duration.

Periodontal Disease and Its Association with Metabolic Syndrome-A Comprehensive Review.

Periodontal disease is a complex and progressive chronic inflammatory condition that leads to the loss of alveolar bone and teeth. It has been associated with various systemic diseases, including diabetes mellitus and obesity, among others. Some of these conditions are part of the metabolic syndrome cluster, a group of interconnected systemic diseases that significantly raise the risk of cardiovascular diseases, diabetes mellitus, and stroke. The metabolic syndrome cluster encompasses central obesity, dyslipidemia, insulin resistance, and hypertension. In this review, our objective is to investigate the correlation between periodontal disease and the components and outcomes of the metabolic syndrome cluster. By doing so, we aim to gain insights into the fundamental mechanisms that link each systemic condition with the metabolic syndrome. This deeper understanding of the interplay between these conditions and periodontal disease can pave the way for more effective treatments that take into account the broader impact of managing periodontal disease on the comprehensive treatment of systemic diseases, and vice versa.

SOS teeth with advanced caries and sociodemographic indicators, health-related habits and dental attendance patterns: data from the Dental, Oral, Medical Epidemiological (DOME) nationwide records-based study.

BACKGROUND: "SOS teeth" are teeth that need to be treated first, and represent dental teeth with deep caries seen clinically and radiographically which may require root canal treatment or extraction. The aims of the present research were to study the associations of SOS teeth with: socio-demographic parameters, dental attendance patterns, health-related habits among young to middle-aged adults. METHODS: This cross-sectional records-based research analyzed data from the Dental, Oral, Medical Epidemiological (DOME) repository that captures comprehensive socio-demographic, medical, and dental databases of a nationwide sample of 132,529 records of dental attendees to military dental clinics for 1 year aged 18 to 50 years. RESULTS: SOS teeth had a significant positive association in the multivariate analysis with male sex [OR 1.137, 95% Confidence Interval (CI): 1.079-1.199], rural versus urban Jewish locality [OR 1.748 (1.082-2.825)], and consumption of sweetened beverages [OR 1.415 (1.337-1.496)]. SOS teeth retained significant negative associations (protective parameter) with academic [OR 0.647 (0.592-0.708)] and technicians (OR 0.616 (0.556-0.682)] compared to high school education, high [OR 0.437 (0.401-0.476)], and medium (OR 0.648 (0.598-0.702)] versus low socio-economic status, urban non-Jewish versus urban Jewish locality [OR 0.746 (0.693-0.802)], Asia (OR 0.658 (0.452-0.959)], North America (OR 0.539 (0.442-0.658)] and Israel [OR 0.735 (0.686-0.788)] versus western Europe birth countries. CONCLUSIONS: Health authorities should be familiar with this profile of the patient who is vulnerable to SOS teeth and formulate policies and allow the appropriate implementation of strategies in those in high-risk populations.

Expression of stem cell markers in stroma of odontogenic cysts and tumors.

BACKGROUND: The stroma of odontogenic cysts/tumors may confer them differential biological behavior. We aimed to investigate the immunoexpression of stem cell markers (Nanog, SOX2, Oct4, and CD34) in the stroma of odontogenic cysts and tumors. CD34 was investigated exclusively as a marker for stromal fibroblast/fibrocyte cells (CD34 + SFCs). CD34 + SFCs were also investigated ultrastructurally. METHODS: Ten cases each of primary odontogenic keratocyst (OKC), recurrent OKC, dentigerous cyst, ameloblastoma, unicystic ameloblastoma, odontogenic myxoma, and 7 syndromic OKC were included. Results were represented as the mean score (%) of positive cells/field for each marker for each study group. For CD34 + SFCs, results are presented as the mean number of cells/field for each type of lesion. Kruskal-Wallis and Spearman's correlation statistical tests were used; significance was set at P < .05. RESULTS: All markers except Oct4 were expressed by stromal cells in all lesions. Expression of SOX2 was significantly higher in tumors than in cysts (P < .05). CD34 + SFCs were more frequent in cysts than in tumors. Ultrastructurally, CD34 + SFCs were identified for the first time in odontogenic lesions and showed characteristic bipolar/dendritic morphology. CONCLUSION: Among examined stromal stem cell markers, only SOX2 distinguished tumors from cysts. CD34 + SFCs may also contribute to the biological behavior of odontogenic lesions.

Improvement of dry mouth following intraductal irrigation of salivary glands.

OBJECTIVES: To assess the effect of major salivary gland intraductal irrigations (IGs) to relieve mouth dryness. METHODS: We retrospectively analyzed the records of patients with mouth dryness who underwent major salivary gland IG during 2013-2015. Records included demographics, medical background, dry mouth etiologies and symptomatology, and results of sialometry and sialo-cone-beam computerized tomography. Subjective improvement following the IG procedure (yes/no) and sustained subjective improvement (mouth dryness relief for ≥1 month) were recorded. Objective improvement was assessed by comparing the mean unstimulated (USF) and stimulated (SSF) whole salivary flow (WSF) rate before and after the IG. RESULTS: Seventy-four patients were included [mean age: 59.08 ± 12.46 years]. Improvement was detected in the USF (p = .027), but not in the SSF (p = .878). Fifty-five (84.6%) noted subjective improvement, while 10 (15.4%) did not. Subjective improvement was positively associated with the USF following IG (p = .037), with salivary gland swelling episodes (p = .033), and with difficulties in swallowing dry foods (p = .014). Of those with subjective improvement, 45 (81.8%) reported sustained improvement, which was positively associated with lack of a gritty eye sensation (p = .042) and abnormal sialo-CBCT findings (p = .001). CONCLUSIONS: Major salivary gland IG is a simple and safe procedure that may relieve dry mouth for a relatively extended duration. Further studies are needed to confirm these preliminary findings and assess their underlying mechanisms.

Where periodontitis meets metabolic syndrome-The role of common health-related risk factors.

OBJECTIVES: To analyse and compare associations between metabolic syndrome (MetS) and its components in periodontitis compared to control patients. METHODS: This 7-year cross-sectional study retrospectively analysed medical records of 504 individuals aged 18-90 who attended the student dental clinic between 2008 and 2014. Demographics, smoking habits, blood pressure, waist circumference, as well as presence of: periodontitis, MetS, diabetes, hypertension, hyperlipidaemia, stroke, heart disease, cancer and psychiatric disorders were recorded. RESULTS: The study population composed of 231 (45.8%) males and 273 (54.2%) females, with an average age of 55.79 ± 16.91 years. A patient profile associated with periodontitis was identified and included male sex, older age, smoking, higher smoking pack-years, abdominal obesity, higher systolic and diastolic blood pressures, the presence of MetS or its components, hypertension, hyperlipidaemia, diabetes or diseases associated with its consequences such as ischaemic heart disease and stroke. Following multivariate logistic regression analysis, age and smoking retained a significant association with periodontitis, whereas the systemic disorders did not. CONCLUSIONS: The association between periodontitis and MetS may be explained by shared common profile and risk factors. An appropriate risk factors management approach should be adopted by both dental and general health clinicians and health authorities, to control common high-risk behaviours.

Oral health-related quality of life in patients with disorders of nutrition.

BACKGROUND: Researchers demonstrated a correlation between nutrition and health-related quality of life (HRQoL). Little is known about the correlation between disorders of nutrition (DON) and Oral HRQoL (OHRQoL). OBJECTIVES: (a) To measure OHRQoL in DON patients compared to patients attending nutritional counselling for other reasons (eg, systemic diseases or general dietary counselling) (NCOR) and to healthy controls attending routine dental screenings. (b) To analyse associations between OHRQoL and demographics, health-related behaviours and nutritional practices. We hypothesised that OHRQoL is impaired in DON patients and correlates with poor health-related behaviours and nutritional practices METHODS: Demographic, smoking, alcohol and physical activity habits, verbal pain scale, oral health impact profile-14 (OHIP-14) and nutritional practice data were collected from 63 DON, 35 NCOR and 100 controls. RESULTS: Compared to controls, DON patients exhibited poorer OHIP-14 global scores and had more functional limitation, physical disability, psychological disability, social disability and handicap. OHIP-14 global score was positively associated with maternal origin, oral symptoms, eggs and eggplant consumption, avoiding seasoning, hot drinks and fibrous food and negatively associated with physical activity and fresh vegetable consumption. In the conceptual hierarchical multiple regression model, verbal pain scale, eggplant consumption and physical activity were mediators in the relationship between DON and OHIP-14. DON, physical activity and eggplant consumption also directly associated with OHRQoL. CONCLUSIONS: Oral HRQoL was impaired in DON patients and correlated with poor health-related behaviours and nutritional practices. Routine workup of DON patients should include OHRQoL assessment.

Dental anxiety and oral health-related quality of life in aggressive periodontitis patients.

OBJECTIVES: To measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with aggressive periodontitis (AgP) compared to controls and analyze their association with various demographic and clinical parameters. METHODS: Sixty consecutive patients with AgP were compared to 80 age- and sex-matched controls with no known history of periodontal disease. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah's Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss. RESULTS: AgP patients exhibited statistically significant higher scores in the DAS total as well as sub-scores, except from DAS 1st question. Compared to the control group, AgP patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both AgP and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain. CONCLUSIONS: AgP patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases. STATEMENT OF CLINICAL RELEVANCE: Aggressive periodontitis (AgP) patients exhibited higher dental anxiety levels and worse oral health-related quality of life (OHRQoL) compared to controls. Professionals should design strategies that will cope with the dental anxiety associated with the treatment and prevent decreases in OHRQoL.

Successful Treatment of Extremely Severe Obstructive Sleep Apnea with a Dental Appliance.

BACKGROUND: A dental appliance for obstructive sleep apnea (OSA) is recommended for patients who cannot adjust to continuous positive airway pressure (CPAP) treatments. OBJECTIVES: To describe patients with extremely severe OSA who were successfully treated with a dental appliance and to compare their characteristics with the relevant literature to identify clinical features associated with a good outcome. METHODS: The clinical, management, and outcome data of three patients with an apnea-hypopnea index (AHI) of > 80 who showed clinical improvement following treatment with a dental appliance were collected retrospectively from sleep laboratory reports in Israel over a period of 3 years. RESULTS: The patients included one man and two women, aged 33, 56, and 61 years, respectively. The diagnosis of OSA was based on clinical examination and polysomnography. AHI values at presentation were 83, 81, and 84, respectively. Treatment with a dental appliance (Herbst® or MDSA®) was proposed due to patient noncompliance with CPAP. Follow-up polysomnography with the dental appliance revealed a reduction in the AHI to 1.7, 10.7, and 11, respectively. All patients had supine OSA and a retrognathic mandible, both of which have been found to be associated with a good prognosis for treatment with a dental appliance. CONCLUSIONS: Dental appliances may be considered an appropriate second-choice option to treat severe OSA in patients who are noncompliant with CPAP. This study helps physicians identify patients with extremely severe OSA who are suitable for dental appliance treatment. Well-designed large-scale studies are needed to reach definitive conclusions.

Demographic profile, plaque index and DMFT scores of young individuals with dental anxiety and exaggerated gag reflex.

PURPOSE: To characterise demographic and clinical parameters among individuals with dental anxiety and exaggerated gag reflex compared to a control group and to analyse the associations between the various parameters. MATERIALS AND METHODS: Sixty-eight patients with dental anxiety and 54 patients with exaggerated gag reflex were compared to a control group of 200 individuals undergoing dental treatment. The collected data included demographic parameters, health status, smoking habits, Decayed, Missing and Filled Teeth (DMFT) and plaque index (PI) scores. RESULTS: PI was significantly higher among patients with exaggerated gag reflex (1.91 ± 0.95) and dental anxiety patients (1.82 ± 0.89) compared to the control group (1.27 ± 0.74; P < 0.001). DMFT was significantly higher among patients with dental anxiety (13.64 ± 7.57) compared to patients with exaggerated gag reflex (10.52 ± 5.42; P = 0.033), and between both groups compared to the control group (4.09 ± 4.034; P < 0.001). Multivariate logistic regression analysis revealed that PI, DMFT and age were positively associated with exaggerated gag reflex and that DMFT and educational level were positively associated with dental anxiety compared to the control group. DMFT was the only significant parameter positively associated with dental anxiety compared to exaggerated gag reflex. CONCLUSION: DMFT and PI scores were higher among patients with dental anxiety and exaggerated gag reflex. Clinicians should consider additional oral hygiene measures and education, maintenance meetings and recall visits in those patients, as well as using supplementary aids, such as fluoride mouthwash and fluoride varnish applications, to maintain oral hygiene without triggering the exaggerated gag reflex.

Oral Health Related Quality of Life in Young Individuals with Dental Anxiety and Exaggerated Gag Reflex.

PURPOSE: To measure the oral health-related quality of life (OHRQoL) among young individuals presenting with dental anxiety and exaggerated gag reflex and to compare it to the OHRQoL among young individuals attending restorative dental treatment. MATERIALS AND METHODS: Patients with dental anxiety and/or exaggerated gag reflex who were referred to the Department of Oral Medicine were included. Clinical examinations included DMFT index (Decayed, Missing and Filled Teeth) according to the WHO criteria and oral hygiene was assessed with the plaque index (PI). The survey included the validated Hebrew version of the Oral Health Impact Profile (OHIP-14). RESULTS: Overall, 322 patients completed the study. The dental anxiety group consisted of 68 patients, the exaggerated gag reflex group of 54 patients and the control group of 200 patients. Control group patients presented with lower PI and DMFT values. Patients with dental anxiety and/or exaggerated gag exhibited worse OHIP-14 scores overall as well as on each separate subscale. PI and DMFT were found to be in strong relation to the OHIP-14. Multivariable logistic regression analysis of factors influencing the OHIP-14 scores revealed a significant influence of the DMFT score. CONCLUSIONS: Patients with dental anxiety and exaggerated gag reflex were shown to suffer considerably from impaired oral health-related quality of life. This impairment may be attributed to a higher prevalence of caries and avoidance of dental treatment. Those populations should be identified and monitored carefully as well as encouraged to seek the appropriate behavioural treatment in order to improve their dental heath and oral health related quality of life.

Quantitive Assessment of Gustatory Function and Its Association with Demographics, and Systemic Morbidity.

This study aimed to analyze the associations of gustatory dysfunction as measured by validated taste strips with demographics and co-morbidities. This cross-sectional study retrospectively analyzed records of patients who attended the Orofacial Chemosensory Center of Hadassah Medical Center between 2017 and 2020. Taste strips were used as a validated method to determine taste dysfunction. A total of 272 subjects were included, 137 (50.4%) women and 135 (49.6%) men, with a mean age of 53.5 ± 19.3 years and age range of 18-98 years. The total taste score among the study population was 8.53 ± 4.03 (scale range 0-16). Age had a significant negative correlation with the total taste score (p = 0.001), and men exhibited worse total (p < 0.001), salty (p = 0.003), and bitter (p < 0.001) scores. Major trauma was associated with worse total (p < 0.001) and specialized taste assessments (sweet (p = 0.001), sour (p = 0.002), salty (p = 0.016), and bitter (p < 0.001)). Chemotherapy was associated with reduced total (p < 0.001), salty (p = 0.003), and bitter (p = 0.001) taste scores. Zinc deficiency exhibited worse salty (p = 0.027) and total (p = 0.038) taste scores. Patients with burning mouth syndrome (BMS) showed higher salty scores (p = 0.017). Patients who experienced exposure to toxic chemicals exhibited worse salty scores (p = 0.024). We conclude that gustatory dysfunction is associated with older age, male sex, and co-morbidities of major trauma, current chemotherapy, zinc deficiency, BMS, and exposure to toxins. The study highlights the importance of systemic evaluation and quantitive gustatory dysfunction assessment as part of the diagnostic process of patients with subjective complaints of taste disorders.

Statistical Methods and Machine Learning Algorithms for Investigating Metabolic Syndrome in Temporomandibular Disorders: A Nationwide Study.

The objective of this study was to analyze the associations between temporomandibular disorders (TMDs) and metabolic syndrome (MetS) components, consequences, and related conditions. This research analyzed data from the Dental, Oral, Medical Epidemiological (DOME) records-based study which integrated comprehensive socio-demographic, medical, and dental databases from a nationwide sample of dental attendees aged 18-50 years at military dental clinics for 1 year. Statistical and machine learning models were performed with TMDs as the dependent variable. The independent variables included age, sex, smoking, each of the MetS components, and consequences and related conditions, including hypertension, hyperlipidemia, diabetes, impaired glucose tolerance (IGT), obesity, cardiac disease, obstructive sleep apnea (OSA), nonalcoholic fatty liver disease (NAFLD), transient ischemic attack (TIA), stroke, deep venous thrombosis (DVT), and anemia. The study included 132,529 subjects, of which 1899 (1.43%) had been diagnosed with TMDs. The following parameters retained a statistically significant positive association with TMDs in the multivariable binary logistic regression analysis: female sex [OR = 2.65 (2.41-2.93)], anemia [OR = 1.69 (1.48-1.93)], and age [OR = 1.07 (1.06-1.08)]. Features importance generated by the XGBoost machine learning algorithm ranked the significance of the features with TMDs (the target variable) as follows: sex was ranked first followed by age (second), anemia (third), hypertension (fourth), and smoking (fifth). Metabolic morbidity and anemia should be included in the systemic evaluation of TMD patients.

Patient profiles and success rates under different sedation techniques in a tertiary care center.

OBJECTIVES: Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates. METHOD AND MATERIALS: This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded. RESULTS: In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (re-visiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P < .001). The success rate at the first session may be predictive of the success in subsequent sessions. CONCLUSION: A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities.

Olfactory and gustatory disorders associated with SARS-CoV-2 infection in children and adults: a topic review.

This paper is aimed at comprehensively reviewing olfactory and gustatory disorders caused by SARS-CoV-2 in children and adults. An electronic and manual search was done on three databases: MEDLINE, Embase, and Web of Science. Inclusion criteria included publications written in English, involving humans in the age range of 0 to 99 years that were captured by a controlled vocabulary of thesaurus terms. Olfactory and gustatory disorders rates in COVID-19 ranged from 22% to 71.9% in adults and 16.6% to 25.8% in children. Olfactory and gustatory disorders might appear as the first symptom, and in adults might even be the only symptom (4.8% to 10%). Anosmia is the most common olfactory disorder and hypogeusia is the most common gustatory disorder. In 33% to 89% of cases, olfactory and gustatory disorders resolve spontaneously within a few weeks, coinciding with the resolution of other COVID-19 symptoms, both in adults and children. However, in some patients, olfactory and gustatory disorders persist beyond the resolution of other symptoms. Notably, children generally experience a swifter and more favorable recovery compared to adults. The precise pathogenesis underlying olfactory and gustatory disorders in the context of COVID-19 remains unclear and is likely multifactorial. Presently, no established treatment protocol exists for olfactory and gustatory disorders and current treatments reviewed lack robust evidence and are not readily available for clinical use. Olfactory training represents the only therapy currently recommended by international authorities. Pediatric practitioners and general dental practitioners should be aware of olfactory and gustatory disorders in both pediatric and adult populations, including their biologic mechanisms, treatment options, and recovery rates.

Obstructive Sleep Apnea, Metabolic Dysfunction, and Periodontitis-Machine Learning and Statistical Analyses of the Dental, Oral, Medical Epidemiological (DOME) Big Data Study.

This study aimed to analyze the associations of obstructive sleep apnea (OSA) with dental parameters while controlling for socio-demographics, health-related habits, and each of the diseases comprising metabolic syndrome (MetS), its consequences, and related conditions. We analyzed data from the dental, oral, and medical epidemiological (DOME) cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel for one year. Analysis included statistical and machine learning models. The study included 132,529 subjects; of these, 318 (0.2%) were diagnosed with OSA. The following parameters maintained a statistically significant positive association with OSA in the multivariate binary logistic regression analysis (descending order from highest to lowest OR): obesity (OR = 3.104 (2.178-4.422)), male sex (OR = 2.41 (1.25-4.63)), periodontal disease (OR = 2.01 (1.38-2.91)), smoking (OR = 1.45 (1.05-1.99)), and age (OR = 1.143 (1.119-1.168)). Features importance generated by the XGBoost machine learning algorithm were age, obesity, and male sex (located on places 1-3), which are well-known risk factors of OSA, as well as periodontal disease (fourth place) and delivered dental fillings (fifth place). The Area Under Curve (AUC) of the model was 0.868 and the accuracy was 0.92. Altogether, the findings supported the main hypothesis of the study, which was that OSA is linked to dental morbidity, in particular to periodontitis. The findings highlight the need for dental evaluation as part of the workup of OSA patients and emphasizes the need for dental and general medical authorities to collaborate by exchanging knowledge about dental and systemic morbidities and their associations. The study also highlights the necessity for a comprehensive holistic risk management strategy that takes systemic and dental diseases into account.

Periodontitis and Metabolic Syndrome: Statistical and Machine Learning Analytics of a Nationwide Study.

This study aimed to analyze the associations between periodontitis and metabolic syndrome (MetS) components and related conditions while controlling for sociodemographics, health behaviors, and caries levels among young and middle-aged adults. We analyzed data from the Dental, Oral, and Medical Epidemiological (DOME) record-based cross-sectional study that combines comprehensive sociodemographic, medical, and dental databases of a nationally representative sample of military personnel. The research consisted of 57,496 records of patients, and the prevalence of periodontitis was 9.79% (5630/57,496). The following parameters retained a significant positive association with subsequent periodontitis multivariate analysis (from the highest to the lowest OR (odds ratio)): brushing teeth (OR = 2.985 (2.739-3.257)), obstructive sleep apnea (OSA) (OR = 2.188 (1.545-3.105)), cariogenic diet consumption (OR = 1.652 (1.536-1.776)), non-alcoholic fatty liver disease (NAFLD) (OR = 1.483 (1.171-1.879)), smoking (OR = 1.176 (1.047-1.322)), and age (OR = 1.040 (1.035-1.046)). The following parameters retained a significant negative association (protective effect) with periodontitis in the multivariate analysis (from the highest to the lowest OR): the mean number of decayed teeth (OR = 0.980 (0.970-0.991)); North America as the birth country compared to native Israelis (OR = 0.775 (0.608-0.988)); urban non-Jewish (OR = 0.442 (0.280-0.698)); and urban Jewish (OR = 0.395 (0.251-0.620)) compared to the rural locality of residence. Feature importance analysis using the eXtreme Gradient Boosting (XGBoost) machine learning algorithm with periodontitis as the target variable ranked obesity, OSA, and NAFLD as the most important systemic conditions in the model. We identified a profile of the "patient vulnerable to periodontitis" characterized by older age, rural residency, smoking, brushing teeth, cariogenic diet, comorbidities of obesity, OSA and NAFLD, and fewer untreated decayed teeth. North American-born individuals had a lower prevalence of periodontitis than native Israelis. This study emphasizes the holistic view of the MetS cluster and explores less-investigated MetS-related conditions in the context of periodontitis. A comprehensive assessment of disease risk factors is crucial to target high-risk populations for periodontitis and MetS.

The Triangle of Nonalcoholic Fatty Liver Disease, Metabolic Dysfunction, and Periodontitis: Analysis of the Dental, Oral, Medical and Epidemiological (DOME) Records-Based Nationwide Research.

This study aimed to analyze the associations of nonalcoholic fatty liver disease (NAFLD) with dental parameters, while controlling for socio-demographics, health-related habits, and each of the metabolic syndrome (MetS) components, consequences, and related conditions among a nationally representative sample of young and middle-aged adults. To that end, we analyzed data from the dental, oral, medical epidemiological (DOME) cross-sectional records-based study that combined comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18-50 who attended military dental clinics for one year. The prevalence of NAFLD in the study population was 0.7% (938/132,529). The following parameters maintained a statistically positive association with NAFLD in the multivariate analysis (from highest to lowest OR): male sex (OR = 3.91 (2.29-6.66)), hyperlipidemia (OR = 3.69 (2.75-4.95)), diabetes Type 2 (OR = 3.14 (2.21-4.46)), hypertension (OR = 1.67 (1.30-2.14)), periodontitis (OR = 1.42 (1.06-1.89)), body mass index (BMI) (OR = 1.15 (1.13-1.18)), and age (OR = 1.08 (1.06-1.09)). The multivariate analysis established a profile of the "patient vulnerable to NAFLD", including older age, male sex, and other MetS components, including diabetes type 2, hypertension, hyperlipidemia, BMI, and periodontitis. This profile aligns with the current new definition of metabolic dysfunction-associated fatty liver disease (MAFLD). We also analyzed the associations of the sum of the standard dental unit (SDU) scores of planned (SDU-P) and delivered (SDU-D) dental procedures per patient with NAFLD using receiver operating characteristic (ROC) analysis. The SDU-P (planned) score exhibited excellent discrimination for NAFLD (area under the curve (AUC) = 0.718 (0.703-0.734)). Overall, the results confirmed the hypothesis of this research, i.e., that NAFLD is associated with dental morbidity, particularly with periodontitis.