Excessive weight in pregnant women increases the chance of diagnosing periodontitis combined with tooth loss.

BACKGROUND: Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy. METHODS: A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level. RESULTS: The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: ORadjusted:1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: ORadjusted:1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance. CONCLUSIONS: There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss.

Systematic review to evaluate accuracy studies of the diagnostic criteria for periodontitis in pregnant women.

The diversity of criteria used in the diagnosis of periodontitis in pregnant women makes it difficult to define and compare the disease. Using a systematic review, this study evaluated the accuracy of criteria for diagnosing periodontitis in pregnant women. Searches were carried out in the databases: Medline/PubMed, Embase, Scopus, Web of Science, SciELO, Lilacs, ProQuest, and CINAHL. Validation studies of the criteria used for diagnosing periodontitis met the inclusion criteria. The study steps were performed by three independent reviewers. A qualitative synthesis of the included articles was carried out and the quality methodological analysis using the QUADAS-2 instrument. The assessment of the quality of the evidence was obtained through the GRADE tool. A total of 592 records were identified, of which only 6 made up this systematic review. The included studies analyzed different criteria for diagnosing periodontitis, evaluating 3,005 pregnant women. The criteria selected as a test presented results equivalent to the performance of those recognized as the gold standard. The self-reported criteria were of lower diagnostic accuracy. A major limitation of this review was the small number of primary studies that evaluated clinical diagnosis of periodontitis in pregnant women, which was highly heterogeneous, making it impossible to carry out accuracy meta-analysis and additional analyzes. There is a lack of consensus on the criteria for the diagnosis of periodontitis, with great variability in the accuracy and prevalence of the disease in pregnant women.

The effect of antireaction medications on the association between periodontitis and leprosy reactions: An important methodological issue in periodontal medicine.

BACKGROUND: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs. METHODS: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI). RESULTS: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: ORadjusted = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and lifestyle factors were associated with the presence of LRs. CONCLUSIONS: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis.

The impact of obesity on the outcome of periodontal disease treatment: Systematic review and meta-analysis.

Background: Obesity and periodontitis are two commonly occurring disorders that affect a considerable amount of the world's population. Several studies have mentioned that there may be a link between the two. The purpose of this systematic review was to determine whether there was a difference in response to nonsurgical periodontal therapies (NSPTs) between obese and nonobese individuals. Materials and Methods: An online search was assembled with a combination of Medical Subject Headings terms and free-text words of the literature published up to December 2020, to identify interventional studies limited to an adult human population. Titles, abstracts, and finally full texts were scrutinized for possible inclusion by two independent investigators. Reduction in periodontal pocket depth was the primary parameter used to assess the outcome of NSPT. Results: The primary search yielded 639 significant titles and abstracts. After filtering, data extraction, and quality assessment, 34 full-text studies were selected. All studies matching inclusion criteria, suggest a positive association between obesity and periodontal disease. Conclusion: Although a possible correlation exists between periodontitis and obesity, as with other oral-systemic disease implications, some controversy exists. While some studies have reported a distinct correlation between periodontitis and obesity, other papers have suggested only moderate or no association between the two conditions at all. These results advise of a difference between response to NSPT amid obese and nonobese individuals. However, with few quality studies and variable reported findings, there is limited evidence of any significant difference in clinical practice. However, it can be a positive warning that obesity is a risk factor toward the outcome of periodontal disease treatment.

Depression and associated factors among Brazilian adults: the 2019 national healthcare population-based study.

BACKGROUND: Mental disorders represent a major public health challenge worldwide, affecting 80% of people living in low- and middle-income countries. Depression, a mental disorder, is a chronic disease of long duration that causes changes in the brain, resulting from a combination of genetic, physiologic, environmental, and behavioral factors. The aim of this study was to investigate possible factors associated with depression in Brazilian adults. METHODS: A population-based, cross-sectional study was carried out using the public domain database of the 2019 National Health Survey, conducted in Brazil. Depression was considered the dependent variable, and through hierarchical analysis, predictor variables were investigated such as, at the distal level-socioeconomic variables, at the intermediate level-variables related to lifestyle behavior, health condition, and history, and at the proximal level-demographic variables. Logistic regression analysis was used to obtain the adjusted Odds Ratio and the respective 95% confidence interval to identify possible factors associated with depression. RESULTS: The study included 88,531 participant records with 10.27% diagnosed with depression. The adjusted association measurements, after selecting the independent variables in the hierarchical analysis, showed the following factors associated with depression with differing magnitudes: age, brown and white race/skin color, female sex, poor, very poor, or regular self-reported health condition, diagnosis of cardiovascular disease, work-related musculoskeletal disorder, history of smoking habit, and macroeconomic region. CONCLUSIONS: An effective strategy for preventing and managing depression in Brazilian adults must include the control of health status and lifestyle behavior factors, with actions and programs to reduce people's exposure to these factors, understanding that socioeconomic-demographic differences of each population can potentially reduce the disease burden.

Periodontitis in individuals with few remaining teeth and a high gingival bleeding index increases the probability of dyslipidemia.

BACKGROUND: Dyslipidemia, a silent multifactorial condition, is characterized by changes in blood lipid levels, affecting all socioeconomic strata, increasing the risk for atherosclerotic diseases. This study investigated whether there is an association between dyslipidemia and the combined exposure of periodontitis plus the number of remaining teeth, gingival bleeding, or caries. METHODS: A two-center cross-sectional study was conducted involving 1270 individuals, with a minimum age of 18 years. Socioeconomic and demographic data, health conditions, lifestyle parameters, and anthropometric, biochemical, and oral clinical examinations were performed. The exposures considered were the presence of periodontitis, dental caries, number of remaining teeth, and gingival bleeding. The outcome was dyslipidemia as defined by the Brazilian Guidelines on Dyslipidemia and Prevention of Atherosclerosis. The combined associations between periodontitis plus other oral health conditions and dyslipidemia were estimated using confounder-adjusted prevalence ratios (PRsingle , PRmultiple , for single and multiple covariable adjustments) with 95% confidence intervals (95% CIs), in a Poisson regression model with robust variance. RESULTS: The occurrence of dyslipidemia was 70.1% and periodontitis was 84.1%. A positive association between periodontitis and dyslipidemia existed: PRsingle  = 1.13; 95% CI: 1.01-1.26. Combined exposure of periodontitis plus <11 remaining teeth (PRmultiple  = 1.23; 95% CI: 1.05-1.43), as well as combined exposure of periodontitis plus ≥10% gingival bleeding and <11 remaining teeth (PRmultiple  = 1.22; 95% CI: 1.03-1.44), represented greater probabilities of 23% and 22% of individuals having a diagnosis of dyslipidemia. CONCLUSION: Periodontitis combined with fewer than 11 teeth doubled the likelihood of being diagnosed with dyslipidemia.

Improving oral health of adolescent girls in Kenya through education - An observational study.

OBJECTIVES: Dental caries and periodontal diseases are significant health concerns in developing nations. This study assessed the impact of a comprehensive oral health education program on adolescent girls in rural Kenya. METHODS: Eighty-seven girls aged 13-18 years attending school in rural Nanyuki, Kenya, were enrolled in the study. The comprehensive program included personalized oral hygiene training, education and health advocacy coaching. Dental caries, gingival inflammation and dental plaque biofilm were assessed at baseline, 1- and 2.5-year post-implementation. RESULTS: The intervention was highly effective in arresting pre-existing carious lesions and preventing the formation of new ones in this population. The data revealed that there was a significant remineralization of incipient caries lesion, as shown by decreases in modified ICCMS™ scores from baseline to 1-year post-implementation. From baseline to the 2.5-year post-implementation assessment, only six new carious lesions developed. Dental plaque biofilm was reduced by 83.6%, and gingival inflammation was reduced by 81.6%. CONCLUSION: A comprehensive oral health program, which included behavioural awareness and educational approaches, resulted in significant positive oral health outcomes in caries, dental plaque biofilm and gingival inflammation.

Gingival fenestration defect treated with gingivectomy and gingivoplasty: A case report with an 8-year follow-up.

INTRODUCTION: Gingival fenestration (GF) is scarcely reported in the literature. We present a unique case of GF defect combined with gingivitis and altered passive eruption (APE). CASE PRESENTATION: An 18-year-old female patient with gingivitis, APE, and GF in the mandibular left central incisor presented for periodontal treatment. The gingival lesion was successfully treated with basic periodontal therapy gingivectomy, and gingivoplasty and resulted in an excellent aesthetic long-term outcome. This case report shows its 8-year clinical follow-up. CONCLUSION: There are no earlier reports dealing with the use of gingivoplasty for the treatment of GF, as it is not the usual therapeutic intervention for these defects. Gingivoplasty proved to be effective in treating GF. Why is this case new information? Available literature on gingival fenestration defects does not describe gingivectomy and gingivoplasty as a treatment of choice. Gingivectomy and gingivoplasty proved to be effective in treating gingival fenestration defects. What are the keys to successful management of this case? Proper diagnosis. What are the primary limitations to success in this case? Gingival fenestration has been defined when the overlying gingiva is denuded, exposing the root to the oral cavity. However, in this case report, only the crown was exposed because the patient had altered passive eruption.

Periodontitis severity relationship with metabolic syndrome: A systematic review with meta-analysis.

The objective of this study was to investigate the association between periodontitis severity and metabolic syndrome (MetS) through systematic review, registered in PROSPERO: CRD42021232120. Selected articles were independently chosen by three reviewers from six databases, including using article reference lists, up until March 2022. Eligible studies were observational, without language limitation, and in subjects aged at least 18 years. The methodological quality of selected studies was assessed using the Newcastle-Ottawa Scale. Random effects models calculated summary measurements (odds ratio-OR, 95% confidence interval, 95%CI). The I2 test evaluated the statistical heterogeneity of the data. Sensitivity, subgroup, and meta-regression analyses were performed. For the reliability of evidence, the Grading of Recommendations, Assessment, Development, and Evaluations tool was used. A total of 2133 records were identified, and 14 studies were included comprising 24,567 participants. The summary odds ratio showed a positive association between individuals with moderate (ORadjusted  = 1.26; 95%CI = 2.10-5.37; I2  = 45.85%), and severe periodontitis (ORadjusted  = 1.50; 95%CI:1.28-1.71; I2  = 56.46%), and MetS. Subgroup and meta-regression analyses showed that study effect size was influenced by year of publication, study design, and MetS diagnostic criteria, contributing to inter-study variability. The findings showed that moderate and severe levels of periodontitis are associated with MetS, suggesting a possible dose-response effect.

Obesity in young women is positively associated with periodontitis.

OBJECTIVE: This cross-sectional study was performed to investigate the association between excess body weight and periodontitis in adults, stratified by sex and age, and using different criteria for obesity. MATERIAL AND METHODS: Enrolled in the study were 345 individuals with a minimum age of 18 years who had attended the Public Health Service in the city of Salvador, Bahia, Brazil. All individuals underwent a complete periodontal examination and anthropometric measurements and answered a questionnaire regarding their socioeconomic, demographic, health, and lifestyle conditions. Excess body weight (exposure factor) was defined using body mass index (BMI) and waist circumference (WC). Prevalence ratios (PRs) and 95% confidence intervals (95%CI) were obtained by Poisson regression analysis with robust variance. RESULTS: Periodontitis was found in 74.2% of study participants, with the disease being more prevalent among those individuals with increased WC. The occurrence of overweight was 44.4% and that of obesity ranged from 29.9 to 70.8%, dependent upon the specific definition of obesity that was used. There was a positive association between obesity (WC > 88 cm) and periodontitis only among women, after adjustment for age, smoking habit, education level, diabetes, and family income (PRadjusted: 1.20; 95%CI: [1.01-1.44]). The magnitude of this positive association was higher among women aged 18 to 49 years when the outcome was severe periodontitis, and the exposure was obesity defined by WC. CONCLUSIONS: The findings draw attention to the high frequency of the diseases investigated: overweight, obesity and periodontitis. Moreover, obesity was positively associated with periodontitis in women and younger individuals, demonstrating that among those with obesity, there is a higher probability of having periodontitis. The smaller number study of men in the may have influenced the non-statistically significant association found in that group. CLINICAL RELEVANCE: Obese females and younger people are more likely to also have periodontitis. Periodontal evaluation and clinical management of individuals with obesity is recommended.

Pilot test of an emerging leaders program for dental school faculty.

PURPOSE/OBJECTIVES: The School of Dentistry at The University of Texas Health Science Center at San Antonio (UTHSA-SoD) implemented an SoD Emerging Leaders Program (SoDELP) in 2020-2021. This case report describes the leadership training needs of junior faculty that stimulated SoDELP development, the inter-institutional collaboration that facilitated program implementation, SoDELP curriculum content, and outcomes of formative assessment for two pilot cohorts of the SoDELP. METHODS: The 32-h curriculum was comprised of readings, reflection exercises, seminars by the Center for Professional Excellence at the University of Texas at San Antonio, case discussion, analysis of leadership dilemmas, and self-assessments. For a capstone project, participants created a case depicting a challenging leadership situation they experienced as a team leader or member. The SoDELP commenced in a face-to-face format but was completed online due to COVID 19. Formative evaluation included participants' pre- and post-training perceptions elicited by the Leadership Attitudes, Confidence and Concerns Inventory (LACCI) and qualitative appraisal of program components obtained by surveys and focus groups. RESULTS: All 18 participants completed SoDELP and provided positive evaluations of program content, organization, teaching quality, and value. Analysis of pre- and post-assessments indicated that participants' confidence in performing an array of leadership tasks was significantly enhanced, and participants' concerns about assuming leadership roles, such as not being ready for the job, impact on friendships, or concerns about ethical challenges, were significantly reduced. The LACCI displayed promising reliability in assessing participants' confidence, attitudes and concerns, demonstrating the potential to serve as a measurement tool to appraise outcomes of leadership training in the health professions. CONCLUSION: Outcomes suggest that SoDELP enhances faculty members' sense of readiness for leadership roles, and the LACCI may be a useful assessment tool for leadership training.

COVID-19 vaccination experience among United States dental professionals and students: Safety, confidence, concerns, and side effects.

OBJECTIVES: The purpose of this study was to evaluate the COVID-19 vaccination experience among United States-based dental professionals and students: to understand their beliefs, concerns, safety and confidence levels, and side effects experienced after vaccination; striving to boost vaccination acceptability to curtail the pandemic. METHODS: An observational survey study approved by The University of Texas Health San Antonio Institutional Review Board was distributed to members of the School of Dentistry community using Qualtrics XM software. The survey was completed anonymously. Data were analyzed using R statistical computing software, χ2 test and Fisher's Exact test. RESULTS: Over 80% of all participants felt moderately to very safe working after the COVID-19 vaccine was made available, and more than 75% were moderately to very confident that the vaccine can protect them during the pandemic. At least 35% were moderately to very concerned about immediate and long-term side effects of the vaccine; despite the concerns, 94% received the vaccine. Side effects were more common after the second dose of the vaccine. Most common side effects were injection site pain, and general side effects of fatigue/tiredness, headache, muscle/body ache, and chills/fever. 74% reported no effect of the vaccine on daily activities, and the severity of side effects no worse than mild (about 60%). CONCLUSIONS: Majority of the participants felt safe and confident that the vaccine would protect them against COVID-19 infection. Sharing these findings and reliable information that the vaccine is safe and effective is paramount to fostering the vaccine uptake and curtailing the pandemic. PRACTICAL IMPLICATIONS: Findings of this study demonstrated the confidence of the UT Health San Antonio, School of Dentistry community that the benefits of the vaccines greatly outweigh the risks; boosting the vaccination acceptance while creating a COVID-19 free environment both for the academic dental setting and the community it serves.

Mothers' high glycemic levels and the association between periodontitis and low birth weight.

BACKGROUND: Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW). METHODS: A total of 732 women took part in this case-control study; 172 were mothers of children with LBW <2,500 g, and 560 were mothers of children with BW ≥2,500 g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within 7 days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the ORadjusted was 1.55; 95% CI: 1.04 to 2.31; using the Gomes-Filho et al. criteria the ORadjusted was 1.91; 95% CI, 1.06 to 3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW. CONCLUSION: Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude.

Periodontitis is a factor associated with dyslipidemia.

OBJECTIVE: To investigate the association between the severity of periodontitis (exposure) and dyslipidemia (outcome). METHODS: This was a cross-sectional study of users of public health services. Periodontitis was defined using the Center for Disease Prevention and Control and the American Academy of Periodontology criteria. Lipid evaluation used data on systemic biomarkers. Dyslipidemia diagnosis was based on the Guidelines of total cardiovascular risk of the World Health Organization. Weight, height, waist circumference, and blood pressure were measured, and socioeconomic-demographic, lifestyle behavior factors, general and oral health conditions of the participants were collected. Hierarchical and logistic regression analyzes were used to determine the association between the exposures and the outcome. Odds Ratios, unadjusted and adjusted, and 95% confidence intervals were estimated. RESULTS: Of 1,011 individuals examined, 75.17% had dyslipidemia, and 84.17% had periodontitis, 0.2% with mild, 48.56% moderate, and 35.41% severe disease. The association between periodontitis and dyslipidemia was maintained through hierarchical analysis and in the multiple regression modeling, showing that the occurrences of dyslipidemia in the group with periodontitis, and its moderate and severe levels, were, respectively, 14%, 30%, and 16% higher compared with those without periodontitis. CONCLUSIONS: The results showed a positive association between moderate and severe periodontitis and dyslipidemia.

Multifaceted impact of COVID-19 on dental practice: American dental care professionals prepared and ready during unprecedented challenges.

BACKGROUND: The purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances. METHODS: The authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ2 test, and Wilcoxon rank sum test. RESULTS: Nearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%). CONCLUSIONS: Dental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances. PRACTICAL IMPLICATIONS: The pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges.

Adjuvant therapy with 1% alendronate gel for experimental periodontitis treatment in rats.

PURPOSE: The aim of this study was to evaluate the effects of locally delivered 1% alendronate (ALN) gel used as an adjunct to non-invasive periodontal therapy. METHODS: Ligature-induced periodontitis was performed in 96 rats. The ligature was tied in the cervical area of the mandibular left first molar. The animals were randomly divided into 4 groups: 1) NT, no treatment; 2) SRP, scaling and root planning; 3) SRP/PLA, SRP followed by filling the periodontal pocket with placebo gel (PLA); and 4) SRP/ALN, SRP followed by filling the periodontal pockets with 1% ALN gel. Histomorphometric (percentage of bone in the furcation region [PBF]) and immunohistochemical (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tartrate-resistant acid phosphatase) analyses were performed. Data were statistically analyzed, with the threshold of statistical significance set at P≤0.05. RESULTS: The SRP, SRP/PLA, and SRP/ALN groups presented a higher PBF than the NT group (P≤0.01) at 7, 15, and 30 days. The SRP/ALN group presented a higher PBF than the SRP/PLA group in all experimental periods, as well as a higher PBF than the SRP group at 15 and 30 days. No differences were observed in the immunohistochemical analyses (P>0.05 for all). CONCLUSIONS: Locally delivered 1% ALN gel used as an adjunct to SRP enhanced bone regeneration in the furcation region in a rat model of experimental periodontitis.

Periodontitis and its higher levels of severity are associated with the triglyceride/high density lipoprotein cholesterol ratio.

BACKGROUND: Periodontitis and the Triglyceride/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio have both been associated with cardiovascular disease, metabolic syndrome, and obesity. Additionally, the ratio is a possible substitute for predicting insulin resistance. This study investigated the association between periodontitis, its severity levels (exposures), and the TG/HDL-C ratio (outcome). METHODS: A cross-sectional study of public health service users in Brazil considered socioeconomic-demographic characteristics, lifestyle behavior, and general and oral health conditions. Anthropometric measurements and blood pressure were also measured. Systemic biomarker data were obtained, as well as assessment of periodontal diagnosis and its severity. The TG/HDL-C ratio was calculated using the serum triglyceride level over HDL cholesterol and the cut-off point, TG/HDL-C ≥2.3 serving as the cutoff indicting dyslipidemia. Logistic and linear regressions were used to statistically analyze the data. RESULTS: A total of 1011 participants were included, with 84.17% having periodontitis and 49.85% having a TG/HDL-C ratio ≥2.3. For individuals with periodontitis, the odds of TG/HDL-C ratio ≥2.3 were 1.47 times greater than in those without periodontitis (ORAdjusted  = 1.47, 95% CI: 1.02-2.14). Similar results were found for those with moderate and severe periodontitis, with a slight increase in the measurement magnitude with disease severity. CONCLUSION: A positive relationship between periodontitis and the TG/HDL-C ratio ≥2.3 was found, suggesting a possible association with periodontal disease severity.

An accuracy study of the clinical diagnosis of periodontitis in pregnant women.

BACKGROUND: There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females. METHODS: An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined. RESULTS: The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease. CONCLUSIONS: A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.

Moderate and severe periodontitis are positively associated with metabolic syndrome.

OBJECTIVE: This study investigated the association between periodontitis severity (exposure) and metabolic syndrome (MetS - outcome), using two criteria for diagnosis of the outcome, since this relationship remains unexplored. MATERIALS AND METHODS: A case-control study was conducted with 870 individuals: 408 with first MetS diagnosis (cases) and 462 without MetS (controls). Participants' general information was obtained using a questionnaire and laboratory data was collected from medical records. Periodontitis severity criteria followed the Center for Disease Control and Prevention: none, mild, moderate, and severe. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by logistic regression analysis. RESULTS: Findings showed a positive association between moderate and severe periodontitis and MetS: ORadjusted = 1.64 (95% CI: 1.01 to 2.68) and ORadjusted = 1.94 (95% CI: 1.19 to 3.16), respectively, after adjustment for age, sex, schooling level, smoking habit, and cardiovascular disease. The adjusted measurements showed that among individuals with moderate or severe periodontitis, the probability of having MetS was around two times greater than among those without periodontitis, and that the chance was greater among participants with severe periodontitis than those with moderate periodontitis. CONCLUSION: An association between the severity of periodontal status and MetS was found, suggesting a possible relationship between the two diseases. CLINICAL RELEVANCE: MetS influences the etiology of cardiovascular diseases, one of the leading causes of mortality worldwide. The findings suggest that the greater the severity of periodontitis, the greater is the association magnitude with MetS. The health professional needs to recognize that the importance of periodontal disease may play in MetS.