Critical appraisal of systematic reviews of intervention studies in periodontology using AMSTAR 2 and ROBIS tools.

Background: Systematic reviews of intervention studies are used to support treatment recommendations. The aim of this study was to assess the methodological quality and risk of bias of systematic reviews of intervention studies in in the field of periodontology using AMSTAR 2 and ROBIS. Material and Methods: Systematic reviews of randomized and non-randomized clinical trials, published between 2019 and 2020, were searched at MedLine, Embase, Web of Science, Scopus, Cochrane Library, LILACS with no language restrictions between October 2019 to October 2020. Additionally, grey literature and hand search was performed. Paired independent reviewers screened studies, extracted data and assessed the methodological quality and risk of bias through the AMSTAR 2 and ROBIS tools. Results: One hundred twenty-seven reviews were included. According to AMSTAR 2, the methodological quality was mainly critically low (64.6%) and low (24.4%), followed by moderate (0.8%) and high (10.2%). According to ROBIS, 90.6% were at high risk of bias, followed by 7.1% low, and 2.4% unclear risk of bias. The risk of bias decreased with the increased in the impact factor of the journal. Conclusions: Current systematic reviews of intervention studies in periodontics were classified as low or critically low methodological quality and high risk of bias. Both tools led to similar conclusions. Better adherence to established reporting guidelines and stricter research practices when conducting systematic reviews are needed. Key words:Bias, evidence-based dentistry, methods, periodontics, systematic review.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310). MATERIALS AND METHODS: A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach). RESULTS: This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (ORadj from 1.27 to 1.90; PRajd = 1.19; RRadj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence). CONCLUSIONS: MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components. CLINICAL RELEVANCE: Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Self-perceived and self-reported breath odour and the wearing of face masks during the COVID-19 pandemic.

OBJECTIVES: To assess the self-perception of breath odour (SPBO) and oral hygiene habits (OHHs) while the wearing of face masks during the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional study included 4647 individuals who answered a structured questionnaire containing demographic, medical and dental variables and self-perceived breath odour. Variables associated with changes in self-perceived breath odour, self-perceived halitosis and changes in OHHs were assessed through multivariate logistic regression. RESULTS: Changes in self-perceived breath odour were reported by 1572 individuals and were associated with smoking, systemic conditions, dry mouth, tongue coating, the period of face mask use and its interaction with prior thinking of having bad breath. Likewise, 645 individuals started to consider having bad breath. This was associated with the interaction between prior family/friends saying they have bad breath and period of face mask use. Changes in OHHs were strongly associated with changes in SPBO and starting to consider having bad breath. CONCLUSION: Changes in one's SPBO was associated with the wearing of face masks and was significant for changes in OHHs. Findings may be important to guide comprehensive preventive and therapeutic strategies in relation to oral health care.

Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT).

The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Self-reported halitosis in a sample of Brazilians: Prevalence, associated risk predictors and accuracy estimates with clinical diagnosis.

AIMS: To evaluate the prevalence of self-reported halitosis and its predictors, and to determine the accuracy estimates of self-reported measures with clinical evaluation of halitosis. MATERIALS AND METHODS: This cross-sectional study comprised 5,420 individuals (teaching staff, administrative personnel and ongoing students from Federal University of Minas Gerais), who answered a structured questionnaire containing sociodemographic, medical and dental data, and self-reported halitosis measures. A subsample (n = 159) underwent halitosis assessment through the organoleptic method. Predictors for self-reported halitosis were determined through univariate and multivariate analyses. Accuracy estimates of self-reported measures were evaluated in this subsample. RESULTS: Prevalence of self-reported halitosis varied from approximately 4%-35%, depending on the self-reported measure. Self-reported halitosis was mainly associated with socio-economic variables (age, gender, educational level), parameters of oral health (gingival bleeding, gingival infections, tongue coating, general oral health evaluation) and impacts on daily activities (family/social environment and intimate relations). Specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score ≥2) and strong (organoleptic score ≥4) halitosis. Combinations of self-reported measures retrieved useful accuracy estimates for strong halitosis. CONCLUSION: Prevalence rates of self-reported halitosis may be considered moderate. Accuracy diagnostic estimates were determined to be useful, with good prediction for non-diseased individuals.

Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT)

Abstract The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Halitose autorrelatada: prevalência, fatores associados e acurácia diagnóstica / Self-reported halitosis: prevalence, associated factors and diagnostic accuracy

A halitose autorrelatada tem sido utilizada como uma ferramenta diagnóstica importante em estudos epidemiológicos por ser de fácil avaliação e refletir a percepção do indivíduo segundo sua condição. Entretanto, a prevalência e os fatores associados variam na literatura. O objetivo deste trabalho foi avaliar a prevalência de halitose autorrelatada e seus preditores associados, bem como determinar as estimativas de acurácia de medidas autorrelatadas com avaliação clínica da halitose. Foi realizado um estudo transversal com uma amostra de 5420 indivíduos que responderam, via e-mail, um conjunto de perguntas incluindo questões abertas e fechadas sobre dados socioeconômicos e demográficos, história médica e odontológica, hábitos de higiene bucal, parâmetros de saúde bucal e medidas de auto relato para halitose, sendo: medida 1 - "Coloque a palma da mão na frente da boca e sopre. Depois desse teste, você diria que tem mau hálito?"; medida 2 - "Você já foi diagnosticado pelo seu dentista com mau hálito?"; medida 3 - "Algum membro da sua família ou amigo já lhe disse que você tem mau hálito?". Posteriormente, foi realizado um exame clínico em uma subamostra de 159 indivíduos para determinação clínica da halitose através do método organoléptico. Os preditores de halitose autorrelatada foram determinados por meio de análises univariadas e multivariadas. Estimativas de acurácia diagnóstica do autorrelato foram avaliadas na subamostra. A prevalência da halitose autorrelatada para a medida 1 foi de 14,6% (n = 792), para a medida 2 de 4,1% (n = 221) e para medida 3 de 33,2% (n = 1799). A halitose autorrelatada esteve associada principalmente a variáveis socioeconômicas (idade, sexo, escolaridade), parâmetros de saúde bucal (sangramento gengival, infecções gengivais, saburra lingual, avaliação geral da saúde bucal) e impactos nas atividades cotidianas (ambiente familiar ou social e relação íntima). Os valores de especificidade para medidas de halitose autorrelatadas foram determinados como sendo altos para halitose clínica (escore organoléptico 2) e forte (escore organoléptico 4). No geral, combinações de medidas de autorrelato melhoraram o AROC dos modelos preditivos multivariados. Pode-se concluir que as taxas de prevalência de halitose autorreferida podem variar de acordo com a medida de autorrelato, mas no geral podem ser consideradas moderadas. Estimativas de acurácia diagnóstica foram determinadas como úteis e com boa predição para indivíduos não doentes.

Self-reported halitosis has been used as an important diagnostic tool in epidemiological studies that can be easily applied, demands less time and resources to be performed, and can reflect the individual's perception of their condition. However, its prevalence and associated factors vary in the literature. The aim of this study was to evaluate the prevalence of self-reported halitosis and its associated factors, as well as to determine accuracy estimates with clinical evaluation of halitosis. A cross sectional study was conducted in a sample of 5420 individuals who answered, via e mail, a set of closed questions that addressed socioeconomic and demographic data, medical and dental history, oral hygiene habits, parameters of oral health and self reported measures of halitosis, being: measure 1 - "Put the palm of the hand in front of the mouth and blow. After that test, would you say you have bad breath? "; measure 2 - "Have you ever been diagnosed with bad breath by your dentist "; measure 3 - "Has any member of your family or friend ever told you that you have bad breath?". Subsequently, a clinical examination was performed in a subsample of 159 individuals for the clinical diagnostic of halitosis through the organoleptic method. Predictors associated with self-reported halitosis were determined by means of univariate and multivariate analyzes. Accuracy estimates of self-report were evaluated in the subsample. Prevalence of self-reported halitosis for measure 1 was of 14.6% (n = 792), for measure 2 of 4.1% (n = 221) and for measure 3 of 33.2% (n = 1799). Self-reported halitosis was mainly associated with socioeconomic variables (age, gender, educational level), parameters of oral health, (gingival bleeding, gingival infections, tongue coating general evaluation of oral health) and impacts on daily activities (family or social environment and intimate relations). The specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score ≥2) and strong (organoleptic score ≥4) halitosis. Overall, combinations of self-reported measures improved the AROC of multivariate predictive models. It can be concluded that prevalence rates of self-reported halitosis may vary according to the self-reported measure, but can be considerate moderate. Estimates of diagnostic accuracy were determined to be useful and with good prediction for non-diseased individuals.