Association between periodontitis and depression severity - A cross-sectional study of the older population in Hamburg.

The aim of the current study is to investigate the association between periodontitis (exposure variable) and depression severity (outcome variable) in an older German population. We evaluated data from 6,209 participants (median age 62 years) of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Depression severity were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Multiple linear regression models were adjusted for age, sex, diabetes, education, smoking, and antidepressant medication. Linear regression analyses revealed a significant association between log-transformed depression severity and periodontitis when including the interaction term for periodontitis * age, even after adjusting for age, sex, diabetes, education, smoking and antidepressant medication. We identified a significant association between severe periodontitis and elevated depression severity, which interacts with age. Additionally, we performed a linear regression model for biomarker analyses, which revealed significant associations between depression severity and severe periodontitis with log-transformed inflammatory biomarkers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). In order to identify new therapeutic strategies for patients with depression and periodontal disease, future prospective studies are needed to assess the physiological and psychosocial mechanisms behind this relationship and the causal directionality.

Religious affiliation and oral health-related quality of life: a cross-sectional study based on a nationally representative survey in Germany.

BACKGROUND: Studies have shown an association between a person's religiosity, and physical as well as psychological, health status. However, results differ between certain religious affiliations. While good oral health is important for our overall health and wellbeing, research on religious affiliation and oral health status, specifically oral health-related quality of life (OHRQoL), is lacking. Thus, our aim was to investigate the association between religious affiliation and OHRQoL. METHODS: A nationally representative online survey (n = 3,075 individuals) was conducted in August/September 2021. The mean age was 44.5 years (SD: 14.8 years, 18 to 70 years) and 51.1% of the individuals were female. OHRQoL was measured using the Oral Health Impact Profile (OHIP-G5). Religious affiliation served as key explanatory variable. Several covariates were included in regression analyses. RESULTS: Regressions revealed that compared to individuals with no religious affiliation, individuals belonging to Christianity had poorer OHRQoL (ß = 0.31, p < 0.01), individuals belonging to Islam had poorer OHRQoL (ß = 2.62, p < 0.01) and individuals belonging to another religious affiliation also had poorer OHRQoL (ß = 1.89, p < 0.01). CONCLUSION: Our study demonstrated an association between religious affiliation and OHRQoL. Individuals with specific religious affiliations should be addressed to avoid low OHRQoL.

Association between an Anti-Inflammatory Dietary Score and Periodontitis-Evidence from the Population-Based Hamburg City Health Study.

While the effects of dietary patterns on cardiovascular risk and diabetes have been well studied, the evidence is scarce as to which diet has the greatest anti-inflammatory potential and how dietary patterns are associated with periodontitis. In the Hamburg City Health Study (HCHS), we developed an anti-inflammatory dietary score using a data-driven approach based on the relationship of relevant selected food groups with inflammatory biomarkers (hsCRP and IL-6). The aim of this cross-sectional study was to evaluate the association between the anti-inflammatory dietary score and the incidence of periodontitis in Hamburg, Germany. A total of n = 5642 participants fit the required inclusion criteria and were selected for analysis. Periodontal disease was assessed using probing depth, gingival recession, and bleeding on probing. Dietary intake was measured using a food frequency questionnaire (FFQ). A self-developed anti-inflammatory dietary score served as the key explanatory variable. Higher scores reflected lower inflammatory processes (measured through the biomarkers hsCRP and IL-6). Several covariates were included in the regression analysis. Regressions revealed that a higher anti-inflammatory dietary score was significantly associated with lower odds to be affected by periodontal disease in an unadjusted model (OR 0.86, 95% CI 0.82-0.89, p < 0.001) and in an adjusted model (age, sex, smoking, diabetes, hypertension, and physical activity) (OR 0.93, 95% CI 0.89-0.98, p = 0.003). Our study demonstrated a significant inverse association between an anti-inflammatory dietary score and periodontitis. Individuals with higher intake of proinflammatory nutrition should be specifically addressed to avoid periodontitis.

An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach.

BACKGROUND: Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. OBJECTIVE: This study aims to describe the development process of the MuMi app. METHODS: For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. RESULTS: On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. CONCLUSIONS: The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.

Oral health, anxiety symptoms and depressive symptoms: findings from the survey of health, ageing and retirement in Europe.

BACKGROUND: There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge. METHODS: Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis. RESULTS: Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (ß = 0.11, P < 0.001) and higher depressive symptoms (ß = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (ß = 0.02, P < 0.001) and higher depressive symptoms (ß = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (ß = -0.35, P < 0.001) and lower depressive symptoms (ß = -0.36, P < 0.001). CONCLUSION: Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required.

Inflammatory Response in Oral Biofilm during Pregnancy: A Systematic Review.

Understanding the inflammatory response in oral biofilm during pregnancy and its association with oral and maternal health is essential for identifying biomarker patterns that may serve as markers of pregnancy-related complications. We aimed to conduct a systematic review of the available literature to assess: (1) inflammatory responses in oral biofilm during pregnancy, (2) the association between inflammatory responses in oral biofilm during pregnancy and maternal, oral or systemic conditions, (3) changes in the response of inflammatory biomarkers found in the oral biofilm during different pregnancy stages, and (4) the value of other risk factors such as nutrition and lifestyle. PubMed, Web of Science and Cochrane Library were systematically searched from inception until April 2022. From 5441 records, 39 studies were included for qualitative assessment. The oral biofilm in pregnant women was associated with increased inflammatory biomarkers when compared to non-pregnant women. Levels of inflammatory biomarkers in the oral biofilm were found to be highest in pregnant women with systemic conditions. Increased inflammatory biomarkers in the oral biofilm were also associated with worse oral health outcomes. Given the importance of nutrition and lifestyle for pregnancy and oral health outcomes and the fact that these factors were largely excluded in the included studies, future research should consider a holistic view of the mother during pregnancy to capture physiological, hormonal, immunologic, and metabolic changes in the context of inflammatory responses.

Does Oral Health-Related Quality of Life Differ by Income Group? Findings from a Nationally Representative Survey.

OBJECTIVES: Clarify the association between income group and oral health-related quality of life. METHODS: Data were used from a nationally representative online survey with n = 3075 individuals. It was conducted in late Summer 2021. The established Oral Health Impact Profile (OHIP-G5) was used to measure oral health-related quality of life. The income group (household net income) was used as key independent variable. It was adjusted for several covariates. Full-information maximum likelihood was used to address missing values. RESULTS: Individuals in the lowest income decile had a lower oral health-related quality of life (Cohen's d = -0.34) compared to individuals in the second to ninth income deciles. Individuals in the highest income decile had a higher oral health-related quality of life (Cohen's d = 0.20) compared to individuals in the second to ninth income deciles. Consequently, there was a medium difference (Cohen's d = 0.53) between individuals in the lowest income decile and individuals in the highest income decile. Additionally, multiple linear regressions showed significant differences between individuals in the lowest income decile and individuals in the second to ninth income deciles (ß = 0.72, p < 0.01). In contrast, only marginal significant differences were identified between individuals in the second to ninth income deciles and individuals in the highest income decile (ß = -0.28, p < 0.10). CONCLUSIONS: The current study particularly stressed the association between low income and low oral health-related quality of life in the general adult population. Increasing oral health-related quality of life in individuals with low income is a major issue which should be targeted.

Empowerment in cancer patients: Does peer support make a difference? A systematic review.

OBJECTIVE: Empowerment is critical for cancer patients to make informed choices, to manage medication, and to navigate through the oncological care system. Cancer peer support provides patients with information, emotional relief and may promote empowerment. This paper provides a systematic review of the literature examining the impact of cancer peer support interventions on psychological empowerment. METHODS: PubMed, Web of Science, CINAHL, Cochrane Library, PsycINFO and PSYNDEX databases were systematically searched from inception until December 2020. We included quantitative studies, published in English or German, which examined peer-led cancer support interventions and their impact on the three components of psychological empowerment (intrapersonal, interactional and behavioural) among participating cancer patients. RESULTS: Database searches and screening of relevant reference lists identified 2336 potentially relevant articles. A total of 29 studies were included in the review. Active coping, self-efficacy and knowledge were the most prominent dimensions of empowerment in these studies. The majority of studies revealed that peer support led to a small to medium, significant increase in psychological empowerment, and was associated with further patient-reported benefits. CONCLUSIONS: The existing evidence suggests a weak to moderate, positive association between cancer peer support and the three components of psychological empowerment among cancer patients. Peer support groups should be seen as an important element in cancer care and clinical practice and, thus, be more systematically involved in cancer care.

Association between Dietary Pattern and Periodontitis-A Cross-Sectional Study.

The aim of the study was to investigate the relationship between specific known dietary patterns and the prevalence of periodontal disease in a northern population-based cohort study. We evaluated data from 6209 participants of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Dietary intake was assessed with the food frequency questionnaire (FFQ2). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Ordinal logistic regression models were used to determine the association. Ordinal regression analyses revealed a significant association between higher adherence to the DASH diet/Mediterranean diet and lower odds to be affected by periodontal diseases in an unadjusted model (OR: 0.92; 95% CI: 0.87, 0.97; p < 0.001/OR: 0.93; 95% CI: 0.91, 0.96; p < 0.001) and an adjusted model (age, sex, diabetes) (OR: 0.94; 95% CI: 0.89, 1.00; p < 0.0365/OR: 0.97; 95% CI: 0.94, 1.00; p < 0.0359). The current cross-sectional study identified a significant association between higher adherence to the DASH and Mediterranean diets and lower odds to be affected by periodontal diseases (irrespective of disease severity). Future randomized controlled trials are needed to evaluate to which extent macro- and micronutrition can affect periodontitis initiation/progression.

[Oral health literacy of persons with migration background-first results of the MuMi study]. / Mundgesundheitskompetenz von Menschen mit Migrationshintergrund ­ Erste Auswertungen der MuMi-Studie.

BACKGROUND: First investigations indicate a migration background of residents in Germany as a discrete risk factor for poor oral health. A lower level of oral health literacy among people with a migration background is considered a reason worthy of being investigated. AIM: This article presents results on oral health literacy and oral health gained from the MuMi study (promoting oral health and oral health literacy of people with a migration background). METHODS: The oral health and oral health literacy as well as the sociodemographics of patients with and without migration background were examined in 40 dental surgeries in Hamburg, Germany. Associations between migrant status, oral health, and oral health literacy were analyzed with logistic regressions. Potential confounders were gradually integrated into the multivariate analyses. RESULTS: Patients with and without a migration background differed significantly in oral health literacy and clinical parameters of oral health (approximal plaque index and degree of caries restoration). The logistic regression analysis revealed highly significant associations between migration background, oral health literacy, and oral hygiene, while also accounting for education and socioeconomic status. DISCUSSION: Migration background constitutes a discrete risk factor for lower oral health and oral health literacy for these relevant population groups. This fact needs stronger reflection in further research and political decision-making in order to promote equality of oral health opportunities.