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.

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.

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.

"Dental Cluster" Versus "Metabolic Cluster": Analyzing the Associations of Planned and Delivered Dental Procedures with Metabolic Syndrome, Utilizing Data from the Dental, Oral, Medical Epidemiological (DOME) Cross-Sectional Record-Based Nationwide Study.

There are conflicting results existing regarding the association between dental status and metabolic syndrome (MetS). The present research 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 MetS components, consequences, and related conditions. The SDU score of each dental procedure represents the time and complexity of the executed procedure. This cross-sectional study analyzed data from the Dental, Oral, Medical Epidemiological (DOME) repository, which includes comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of 132,529 military personnel. Univariate analyses revealed that SDU-P had statistically significant positive associations with all systemic morbidities related to MetS, while the SDU-D exhibited positive associations with some of the systemic morbidities and with lower ORs. SDU-P and SDU-D were associated with worse scores of auxiliary examinations used in the assessment of MetS components. SDU-P retained significant positive associations in the multivariate analysis with impaired glucose tolerance (IGT) (OR = 7.40 (1.91-28.57)), deep vein thrombosis (DVT) (OR = 5.61 (1.53-20.83)), obstructive sleep apnea (OSA) (OR = 5.05 (2.40-10.63)), and fatty liver (OR = 1.82 (1.17-2.84)). In contrast, obesity was the only systemic parameter retaining a significant association with SDU-D following multivariate analysis (OR = 1.47 (1.23-1.76)). It can be concluded that SDU-P, but not SDU-D, is a better predictor of systemic morbidities related to MetS. In other words, MetS is associated with a higher dental treatment needs burden, rather than with dental treatments performed de facto. Dental and general health authorities should collaborate and share information and focus on reducing common health-related risk factors, such as smoking and sugar consumption, in particular among high-risk populations, such as immigrants and those with lower SES and rural locality.

Cognitive Performance and Its Associations with Dental Caries: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-Based Nationwide Study.

Relatively few studies have analyzed the association between cognitive performance and dental status. This study aimed to analyze the association between cognitive performance and dental caries. Included were data from the dental, oral, medical epidemiological (DOME) study; cross-sectional records-based research, which integrated large socio-demographic, medical, and dental databases of a nationally representative sample of young to middle-aged military personnel (N = 131,927, mean age: 21.8 ± 5.9 years, age range: 18-50). The cognitive function of draftees is routinely measured at age 17 years using a battery of psychometric tests termed general intelligence score (GIS). The mean number of decayed teeth exhibited a gradient trend from the lowest (3.14 ± 3.58) to the highest GIS category (1.45 ± 2.19) (odds ratio (OR) lowest versus highest = 5.36 (5.06-5.68), p < 0.001). A similar trend was noted for the other dental parameters. The associations between GIS and decayed teeth persisted even after adjusting for socio-demographic parameters and health-related habits. The adjustments attenuated the OR but did not eliminate it (OR lowest versus highest = 3.75 (3.38-4.16)). The study demonstrates an association between cognitive performance and caries, independent of the socio-demographic and health-related habits that were analyzed. Better allocation of resources is recommended, focusing on populations with impaired cognitive performance in need of dental care.

Hypertension and Its Associations with Dental Status: Data from the Dental, Oral, Medical Epidemiological (DOME) Nationwide Records-Based Study.

Conflicting results have been published regarding the associations between dental status and hypertension. This study aims to explore whether or not hypertension is associated with dental status among young to middle-aged adults. To that end, data from the Dental, Oral, Medical Epidemiological (DOME) study were analyzed. The DOME is a cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18-50 years who attended the military dental clinics for one year. The prevalence of hypertension in the study population was 2.5% (3363/132,529). Following multivariate analysis, the associations between hypertension and dental parameters were lost and hypertension retained a positive association with obesity (Odds ratio (OR) = 4.2 (3.7-4.9)), diabetes mellitus (OR = 4.0 (2.9-5.7)), birth country of Western Europe vs. Israeli birth country (OR = 1.9 (1.6-2.2)), male sex (OR = 1.9 (1.6-2.2)), cardiovascular disease (OR = 1.9 (1.6-2.3)), presence of fatty liver (OR = 1.8 (1.5-2.3)), the birth country Asia vs. Israeli birth country (OR = 1.6 (1.1-2.3)), smoking (OR = 1.2 (1.05-1.4)), and older age (OR = 1.05 (1.04-1.06)). Further analysis among an age-, smoking- and sex matched sub-population (N = 13,452) also revealed that the dental parameters lost their statistically significant association with hypertension following multivariate analysis, and hypertension retained a positive association with diabetes (OR = 4.08 (2.6-6.1)), obesity (OR = 2.7 (2.4-3.2)), birth country of Western Europe vs. Israel (OR = 1.9 (1.6-2.3)), cardiovascular disease (OR = 1.8 (1.5-2.2)), fatty liver (OR = 1.7 (1.3-2.3)), high school education vs. academic (OR = 1.5 (1.3-1.8)), and low socio-economic status (SES) vs. high (OR = 1.4 (1.03-1.8)). We analyzed the associations between C-reactive protein (CRP) and dental parameters and combined the statistically significant variables to create a dental inflammation score (DIS). This crated a final model with the appropriate weights written as follows: DIS = (periodontal disease × 14) + (the number of teeth that required crowns × 11) + (missing teeth × 75). The mean DIS was 10.106 ± 25.184, and it exhibited a weak positive association with hypertension in the univariate analysis (OR = 1.011 (1.010-1.012)). Receiver operating characteristic (ROC) analysis of the DIS against hypertension produced a failed area under the curve (AUC) result (0.57 (0.56-0.58)). Moreover, the DIS also lost its statistical significance association with hypertension following multivariate analysis. We conclude that hypertension had no statistically significant nor clinically significant association with dental status. The study established a profile of the "patient vulnerable to hypertension", which retained well-known risk factors for hypertension such as older age, male sex, smoking, diabetes, obesity, and fatty liver but not dental parameters.

The Dental, Oral, Medical Epidemiological (DOME) Study: Protocol and Study Methods.

OBJECTIVES: To develop and present the methods utilized for the Dental, Oral, Medical Epidemiological (DOME) study. METHODS: The DOME is an electronic record-based cross-sectional study, that was conducted to measure the dental, periodontal, and oral morbidities and their associations with systemic morbidities, among a nationally representative sample of young to middle-aged adults military personnel from the IDF (Israel Defense Forces). To that end, we developed a strict protocol including standardized terminology, data collection, and handling. RESULTS: Data for the DOME study was derived simultaneously from three electronic records of the IDF: (1) a central demographic database, (2) the dental patient record (DPR), and (3) the medical computerized patient record (CPR). The established DOME repository includes socio-demographic, dental and medical records of 132,354 young to middle-age military personnel from the IDF, who attended the dental clinics during the year 2015. Records of general military personnel (N > 50,000), with no recorded dental visits during the study period, served as a control group regarding all other parameters except dental. The DOME study continues and is currently collecting longitudinal data from the year 2010 until 2020. The IDF employs a standardized uniform administrative and clinical work-up and treatment protocols as well as uniform computerized codes. We describe the standardized definitions for all the parameters that were included: socio-demographics, health-related habits, medical and dental attendance patterns, and general and dental health status. Multicollinearity analysis results of the sociodemographic and medical study parameters are presented. CONCLUSION: Standardized work-up and definitions are essential to establish the centralized DOME data repository to study the extent of dental and systemic morbidities and their associations.

SOS Teeth: First Priority Teeth with Advanced Caries and Its Associations with Metabolic Syndrome among a National Representative Sample of Young and Middle-Aged Adults.

"SOS teeth" are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. These are teeth with severe morbidity, that may require pulp capping, root canal treatment, or extraction, and therefore should be treated first. The study aims to explore whether or not a metabolic syndrome (MetS) is associated with SOS teeth. To that end, we performed across-sectional records-based study of a nationally representative sample of 132,529 military personnel aged 18-50 years, who attended the military dental clinics for one year. The mean number of SOS had no statistically significant association with: smoking (p = 0.858), alcohol consumption (p = 0.878), hypertension (p = 0.429), diabetes mellitus (p = 0.866), impaired glucose tolerance (p = 0.909), hyperlipidemia (p = 0.246), ischemic heart disease (p = 0.694), S/P myocardial infarction (p = 0.957), obstructive sleep apnea (p = 0.395), fatty liver (p = 0.074), S/P stroke (p = 0.589), and S/P transient ischemic attack (p = 0.095) and with parental history of: diabetes (p = 0.396)], cardiovascular disease (p = 0.360), stroke (p = 0.368), and sudden death (p = 0.063) as well as with any of the medical auxiliary examinations (p > 0.05). Cariogenic diet was positively associated with SOS teeth (p < 0.001). We conclude that SOS teeth had no statistically significant association with MetS components or with conditions that are consequences or associated with MetS. The only statistically significant parameter was a cariogenic diet, a well-known risk factor for caries and MetS.

SOS Teeth: Age and Sex Differences in the Prevalence of First Priority Teeth among a National Representative Sample of Young and Middle-Aged Adults.

BACKGROUND: "SOS teeth" are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. OBJECTIVES: To assess the prevalence and distribution of SOS teeth with regard to age and sex difference among young to middle-aged adults. METHODS: This is a cross-sectional records-based study of a nationally representative sample, consisting of young to middle-aged military personnel, who attended the military dental clinics of the Israel Defense Forces (IDF) for one year. SOS teeth definition corresponds to code number 6 of the "Caries Assessment Spectrum and Treatment (CAST)" as an instrument to assess dental caries. Data pertaining to age and sex were drawn from the central demographic database and that of SOS teeth were obtained from the Dental Patient Record (DPR). RESULTS: The study included 132,529 dental records. The prevalence of patients with SOS teeth was 9.18 % (12,146/132,323). The number of teeth that were found to be SOS teeth was 18,300, i.e., 1.5 SOS teeth per "diseased" patient (18,300/12,146). The mean number of SOS teeth per the whole study population was 0.14 ± 0.52 and the range was 0-20. The mean number of SOS teeth per patient had a statistically significant negative correlation with age (p < 0.001; Odds Ratio (OR) = 0.997; 95% confidence interval: 0.997-0.998) and with male sex compared to females (p < 0.001; OR = 1.029 confidence interval: 1.023-1.036). CONCLUSION: Assessment of first priority SOS teeth may be part of the dentist's work-up. It provides dentists and health authorities with useful information regarding urgent dental care needs to plan dental services.