Abstract
Objective
To compare the accuracy of periodontal examination at 6‐sites full‐mouth protocol with clinical and radiographic partial‐mouth recording protocols (PRPs) to diagnose periodontitis ...considering new 2018 case definition.
Methods
Periodontitis was diagnosed by full‐mouth assessment of clinical attachment level (CAL) at 6‐sites (
n
= 8529) according to 2018 case definition (standard reference). Three clinical and radiographic PRPs were considered: (i) 4 interproximal sites of all teeth (4‐sites, full‐mouth); (ii) 6‐sites on Community Periodontal Index of Treatment Needs (CPITN) teeth (6‐sites, CPITN teeth); (iii) 4‐sites on CPITN teeth (4‐sites, CPITN teeth); (iv) radiographic examination on interproximal sites of all teeth (rM‐D, full‐mouth); and (v) radiographic examination on interproximal sites of CPITN teeth (rM‐D, CPITN teeth) using Image J®. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), accuracy, and Κappa (
k
) were estimated (
α
= 0.05).
Results
The 4‐sites, full‐mouth protocol showed 100% sensitivity and NPV, 79.87% PPV, low specificity (38.32%), 69.30% accuracy, and poor agreement (
k
= 0.468). 6‐sites and 4‐sites CPITN teeth protocols showed 100% PPV and specificity, sensitivity and NPV of >60%, accuracy of >80%, and good agreement (
k
> 0.65). All clinical PRPs outperformed radiographic protocols.
Conclusion
Clinical PRPs using index teeth are highly accurate in diagnosing periodontitis considering 2018 case definition.
Aim
To investigate the confluence of caries and periodontitis indicators from adolescence to elderhood among Americans.
Materials and Methods
This cross‐sectional study explored the grouping among a ...set of caries and periodontitis indicators (the proportion of sites with bleeding on probing, moderate probing pocket depth PPD, 4–5 mm, severe PPD ≥6 mm, moderate clinical attachment level CAL, 3–4 mm, severe CAL ≥5 mm, number of teeth with furcation involvement, number of decayed teeth, number of teeth with pulp involvement, and the number of missing teeth) in 14,421 Americans from the NHANES III study. Exploratory factorial analysis was used to determine the constructs between those indicators (factorial loading ≥0.3). These analyses were stratified by age and confirmed with a confirmatory factorial analysis. We also performed a sensitivity analysis using the NHANES 2011–2014.
Results
Two constructs were extracted. The first, Chronic Oral Diseases Burden, grouped caries indicators with moderate PPD and moderate CAL for the youngest subjects (13–39 years old), while for the subjects over 50 years, the Chronic Oral Disease Burden grouped caries indicators with severe CAL and PPD and furcation involvement. The second construct, Periodontal Destruction, grouped only periodontitis indicators.
Conclusions
Caries and periodontitis indicators grouped consistently across the different age ranges in lapse times of 25 years.
Aim
To investigate the association among iron overload, periodontal status, and periodontitis progression rate in sickle cell anaemia (SCA).
Materials and Methods
This case series evaluated 123 ...patients. Clinical attachment level (CAL) and probing depth (PD) were evaluated at six sites per tooth. Alveolar bone loss was estimated using periapical radiography. Study outcomes were periodontal status (measured as number of sites with CAL of ≥3 mm, CAL of ≥5 mm, PD of ≥4 mm, and PD of ≥6 mm) and periodontitis progression rate (determined as ratio of alveolar bone loss to age). Serum transferrin saturation and ferritin levels were obtained from medical records. Poisson regression was performed to estimate associations. Covariables included in the adjusted models (comorbidities, skin colour, socioeconomic class, and vaso‐occlusive crisis) were defined by DAGs.
Results
Serum transferrin saturation level revealed a significant positive association with the number of sites with CAL of ≥3 mm, CAL of ≥5 mm, PD of ≥4 mm, and PD of ≥6 mm. Patients with serum transferrin saturation level of >45% were 1.93 times more likely to have rapid periodontitis progression.
Conclusion
High serum transferrin saturation level is associated with a greater extent of periodontitis and rapid periodontitis progression in SCA.
Aim
To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life.
Materials and methods
This population‐based study analysed ...2032 youngers (18–19 years old) of the RPS cohort. BMD of lumbar spine (BMD‐LS) and of the whole body (BMD‐WB) were assessed by dual x‐ray emission densitometry. Low BMD‐LS (Z‐score ≤ −2) and low BMD‐WB (Z‐score ≤ −1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes).
Results
The prevalence of severe periodontitis was 10.97%. Low BMD‐LS (odds ratio OR = 2.08, confidence interval CI = 1.12–3.85, p = .01) and low BMD‐WB (OR = 1.34, CI = 1.001–1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD‐LS and BMD‐WB were also associated with a greater extent of periodontitis (p < .05).
Conclusions
Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.
Aim
To investigate the association between increased serum markers of iron (ferritin and transferrin saturation) and the severity and extent of periodontitis in post‐menopausal (PM) women.
Materials ...and Methods
Data from 982 PM women participating in NHANES III were analysed. Exposures were high ferritin (≥300 μg/ml) and transferrin saturation (≥45%). The primary outcome was moderate/severe periodontitis defined according to Centers for Disease Control and Prevention and the American Academy of Periodontology. The extent of periodontitis was also assessed as outcome: proportion of sites affected by clinical attachment loss ≥4 mm and probing depth ≥4 mm. Crude and adjusted prevalence ratio (PR) and mean ratio (MR) were estimated using Poisson regression.
Results
The prevalence of moderate/severe periodontitis was 27.56%. High ferritin was associated with moderate/severe periodontitis in the crude (PR 1.55, p = .018) and in the final adjusted model (PR 1.53, p = .008). High ferritin and transferrin saturation levels were associated with a higher proportion of sites with clinical attachment loss ≥4 mm (p < .05).
Conclusions
The increasing serum iron markers seem to contribute to periodontitis severity and extent in PM women.
Objective
Mechanisms underlying the oral outcomes in sickle cell anemia (HbSS) have been less explored. This study aimed to investigate the association of morbimortality indicators and hydroxyurea ...use with adaptive pulp and jaw bone trabecular changes in HbSS.
Methods
This cross‐sectional study included 123 individuals with HbSS. The exposures were the morbimortality indicators of HbSS (number of vaso‐occlusive crises, organ damage, hemoglobin level, and leukocyte count) and the use of hydroxyurea for HbSS treatment. The outcomes were adaptive pulp and jaw bone trabecular changes confirmed by radiographic examination. Associations were estimated by Poisson regression in crude and adjusted analyses for sex, skin color, socioeconomic class, and age.
Results
The vaso‐occlusive crises (mean ratio (MR) = 3.5, p = 0.045), lower hemoglobin (MR = 2.4, p = 0.037), and higher leukocyte count (MR = 2.17, p = 0.036) were risk factors, while the use of hydroxyurea was inversely associated with adaptive pulp changes (MR = 0.23, p = 0.024). The vaso‐occlusive crises were associated with jaw bone trabecular changes (MR = 1.33, p = 0.02).
Conclusion
Adaptive pulp changes may be a potential clinical marker of chronic vasculopathy in HbSS. The use of hydroxyurea may reduce the frequency of adaptive pulp changes.
Objective
To investigate pathways from micronutrient intake and serum levels to Chronic Oral Diseases Burden.
Methods
We analyzed cross‐sectional data from NHANES III (n = 7936) and NHANES 2011–2014 ...(n = 4929). The exposure was the intake and serum levels of vitamin D, calcium, and phosphorus. Considering the high correlation of those micronutrients in the diet, they were analyzed as a latent variable dubbed Micronutrient intake. The outcome was the Chronic Oral Diseases Burden, a latent variable formed by probing pocket depth, clinical attachment loss, furcation involvement, caries, and missing teeth. Pathways triggered by gender, age, socioeconomic status, obesity, smoking, and alcohol were also estimated using structural equation modeling.
Results
In both NHANES cycles, micronutrient intake (p‐value < 0.05) and vitamin D serum (p‐value < 0.05) were associated with a lower Chronic Oral Diseases Burden. Micronutrient intake reduced the Chronic Oral Diseases Burden via vitamin D serum (p‐value < 0.05). Obesity increased the Chronic Oral Diseases Burden by reducing vitamin D serum (p‐value < 0.05).
Conclusion
Higher micronutrient intake and higher vitamin D serum levels seem to reduce Chronic Oral Diseases Burden. Healthy diet policies may jointly tackle caries, periodontitis, obesity, and other non‐communicable diseases.
Aim
To investigate pathways between unhealthy and healthy dietary patterns and periodontitis in adolescents (18–19 years of age).
Materials and Methods
This population‐based study (n = 2515) modelled ...direct and mediated pathways (via biofilm and obesity) from patterns of healthy diet (fruits, fibre, vegetables, and dairy) and unhealthy diet (sugars, snacks, and salty/fast foods) with initial periodontitis (bleeding on probing BoP, probing depth PD ≥ 4 mm, clinical attachment loss CAL ≥ 4 mm), moderate periodontitis (BoP, PD ≥ 5 mm, and CAL ≥ 5 mm), and European Federation of Periodontology and the American Academy of Periodontology (EFP‐AAP) periodontitis definitions, adjusting for sex, socio‐economic status, smoking, and alcohol, through structural equation modelling (α = 5%).
Results
Higher values of healthy diet were associated with lower values of initial periodontitis (standardized coefficient SC = −0.160; p < .001), moderate periodontitis (SC = −0.202; p < .001), and EFP‐AAP periodontitis (p < .05). A higher value of unhealthy diet was associated with higher values of initial periodontitis (SC = 0.134; p = .005) and moderate periodontitis (SC = 0.180; p < .001). Biofilm mediated the association between higher values of unhealthy diet and all periodontal outcomes (p < .05).
Conclusions
Our findings suggest that both healthy and unhealthy dietary patterns may contribute to reduced or increased extent and severity of periodontitis by local and systemic mechanisms, preceding the effect of other established causes such as smoking and obesity, in younger population.
The retention of glass fiber post (GFP) is considered a key factor for the long-term success of restorations of endodontically treated teeth. This study aimed to compare the compressive strength of a ...ceramic crown supported by a GFP using different luting agents.
Forty single-rooted premolars were randomly divided into four groups (n = 10 each): control group (teeth without a GFP), Ketac Cem group (glass ionomer), RelyX ARC group (conventional dual-curing resin), and RelyX U200 group (self-adhesive dual-curing resin). After luting of the posts and placement of all-ceramic crowns made using feldspathic porcelain (Noritake EX-3), they were exposed to thermocycling for 1000 cycles and compressive strength tests. Statistical analysis included Kruskal–Wallis test with Dunn’s multi-comparison test.
The Ketac Cem group and RelyX U200 group showed significantly greater fracture resistance to compressive loading than the control group.
This study indicates a possible role of the luting agent used with the GFP in influencing the compressive strength of the restored teeth. In this study, the self-adhesive dual-curing resin and glass ionomer both offered resistance to fractures.
Background
This study was conducted to investigate the biological factors underlying the association between pulp necrosis (PN) in subjects with permanent teeth with intact crowns and sickle cell ...anemia (SCA).
Methods
This cohort study included 140 subjects: 125 without PN and 15 with PN. A theoretical model was built to explore the following biological factors involved in the association between PN and SCA, namely (a) increased number of sickle cell crises in the previous year (No. SCCs/year), (b) low percentage of blood oxygen saturation (SpO2) in the body, and (c) comorbidities (CoMs). The theoretical model for testing associations was analyzed by structural equation modeling.
Results
PN was associated with CoMs (SFL = 1.115; p = .032) but not with No. SCCs/year (SFL = .127; p = .596) or body SpO2 (SFL = −.102; p = .485). The prevalence rates of osteoarticular lesions (p = .009) and death
(p<.001) were significantly higher in subjects with PN than in those without.
Conclusions
Comorbidities, primarily osteoarticular lesions, are associated with PN in permanent teeth with intact crowns of patients with SCA. PN can be considered an indicator of the lethality of SCA.
