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La Rosa GRM, Di Stefano A, Gangi D, Emma R, Fala V, Amaliya A, Yilmaz HG, Lo Giudice R, Pacino SA, Pedullà E, Górska R, Kowalski J, Polosa R. Dental plaque quantitation by light induced fluorescence technology in exclusive Electronic Nicotine Delivery Systems (ENDS) users. J Dent 2024; 147:105223. [PMID: 38987079 DOI: 10.1016/j.jdent.2024.105223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES In comparison to conventional combustible cigarettes, Electronic Nicotine Delivery Systems (ENDS) including both e-cigarettes (ECs) and heated tobacco products (HTPs) significantly reduce exposure to toxic chemical emissions. However, their impact on dental plaque remains unclear. This study measures dental plaque in ENDS (ECs and HTPs) users using quantitative light-induced fluorescence (QLF) technology, comparing them with current, former, and never smokers. METHODS This cross-sectional study compared dental plaque measurements using QLF technology (Q-ray cam™ Pro) among current smokers (≥10 cigarettes/day), former smokers (quit ≥6 months), never smokers, and exclusive ENDS users (quit ≥6 months). Dental plaque measurements were expressed as ΔR30 (total area of mature dental plaque) and ΔR120 (greater plaque thickness/maturation-calculus). The Simple Oral Hygiene (SOH) score was calculated by the QLF proprietary software. Statistical analyses including ANCOVA was performed by R version (4.2.3) with p < 0.05. RESULTS A total 30 smokers, 24 former smokers, 29 never smokers, and 53 ENDS users were included. Current smokers had significantly higher ΔR30 and ΔR120 values compared to other groups (p < 0.001). ENDS users showed plaque levels similar to never and former smokers (p > 0.05) but significantly lower than current smokers (p < 0.01). Although ENDS users showed a lower SOH score than smokers, this difference was not statistically significant. Daily toothbrushing and mouthwash usage were significant covariates. CONCLUSION ENDS users exhibited reduced accumulation of dental plaque and calculus compared with current smokers. CLINICAL SIGNIFICANCE Exclusive ENDS use could less impact dental plaque accumulation compared to cigarette smoking. Further research is needed to confirm these findings and fully understand ENDS impact on dental plaque formation.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of Clinical and Experimental Medicine, University of Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy.
| | | | | | - Rosalia Emma
- Department of Clinical and Experimental Medicine, University of Catania, Italy; Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
| | - Valeriu Fala
- Faladental, Chișinău, Republic of Moldova; "Nicolae Testemiţanu" State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
| | - Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Hasan Guney Yilmaz
- Near East University, Faculty of Dentistry. Department of Periodontology. Nicosia, Mersin10, Turkey
| | - Roberto Lo Giudice
- Department of Human Pathology of Adults and Developmental Age, University of Messina, Italy
| | - Sebastiano Antonio Pacino
- Addendo srl, Dental Clinic, Catania, Italy; ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Italy; Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
| | - Renata Górska
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kowalski
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Italy; Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
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Chen X, Niu W, Hu G, Chen C. Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis. PLoS One 2024; 19:e0302592. [PMID: 38717998 PMCID: PMC11078434 DOI: 10.1371/journal.pone.0302592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the economics of three different gargles in the treatment of chronic periodontitis. METHODS A total of 108 patients with periodontitis received one of the following three gargles: xipayi, compound chlorhexidine, or Kangfuxin gargle. The basic information of the patients, the costs of the gargles, the periodontal indexes before and after treatment, and the scores of the 3-level version of the EuroQol Five Dimensions Questionnaire were collected. The cost-effectiveness and cost-utility of the various gargles were determined. RESULTS The cost-effectiveness ratios (CER) of the three groups after treatment were 1828.75, 1573.34, and 1876.92 RMB, respectively. The utility values before treatment were 0.92, 0.90, and 0.91, respectively, and the utility values after treatment were 0.98, 0.98, and 0.97, respectively. The cost-utility ratios (CURs) were 213.43, 195.61, and 301.53 RMB, respectively. CONCLUSIONS For each increase in effective rate and quality-adjusted life years, the treatment cost of periodontitis patients was lower than the gross domestic product per capita of Jiangsu Province, indicating that the treatment cost is completely worth it. The CER and CUR results were the same, and the compound chlorhexidine group was the lowest, demonstrating that when the same therapeutic effect was achieved, it cost the least.
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Affiliation(s)
- Xin Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Wenzhi Niu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Guangyu Hu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Changfeng Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
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Moin M, Haider MM, Rizvi KF, Imtiaz R, Maqsood A, Altamash S, Ahmed N, Heboyan A. Enhancing Oral Hygiene in Children With Hearing Impairment: The Impact of Skit Video Interventions -A Randomized Controlled Trial. Glob Pediatr Health 2024; 11:2333794X241240302. [PMID: 38529336 PMCID: PMC10962031 DOI: 10.1177/2333794x241240302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024] Open
Abstract
Aim. This study aimed to assess the effectiveness of 3 interventions-skit video, pictorial, and sign language-in improving the oral hygiene of children with hearing impairment. Materials and Methods. Sixty children randomly divided into 3 groups: Skit video, Pictorial, and Sign language. The mean gingival and Oral Hygiene Index scores were recorded before and after interventions. A 1-way ANOVA was used for statistically significant difference between pre and post intervention scores. Results. A significant difference in mean oral hygiene and gingival index scores before and after interventions was found in Group A (P < .005). A statistically significant difference was also found between group A and B in inter group comparison of OHI and GI scores post intervention (P < .004). Conclusion. Skit video and pictorial intervention effectively improves oral health resulting in reduced mean oral hygiene and gingival scores.
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Affiliation(s)
- Maria Moin
- Bahria University Dental College, Karachi, Pakistan
| | | | | | - Rabia Imtiaz
- Bahria University Dental College, Karachi, Pakistan
| | | | - Sara Altamash
- Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Naseer Ahmed
- Altamash Institute of Dental Medicine, Karachi, Pakistan
| | - Artak Heboyan
- Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
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Conte G, Amaliya A, Gupta S, Emma R, Gospodaru S, Bordeniuc G, Fala V, Pacino SA, Urso S, Zucchelli G, Polosa R. Repeatability of dental plaque quantitation by light induced fluorescence technology in current, former, and never smokers. BMC Oral Health 2023; 23:480. [PMID: 37443061 PMCID: PMC10347782 DOI: 10.1186/s12903-023-03154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The effects of smoking on the accumulation of dental plaque have not been studied in depth. We compared dental plaque quantitation obtained with a novel light induced fluorescence technology among current, former, and never smokers and verified measurements' repeatability. METHODS Dental plaque quantitation was objectively assessed by quantitative light induced fluorescence (QLF) technology on three separate study visits in current, former, and never smokers: baseline (day 0), day 7, day 30. Increase in the fluorescence intensity of at least 30% (ΔR30) and 120% (ΔR120) together with the simple oral hygiene (SOH) scoring were considered for analysis. RESULTS The QLF parameters were highly repeatable in each study group (p < 0.0001, by regression analyses). All QLF parameters showed a significant difference between never smokers and current smokers (p = 0.041 for ΔR30; p = 0.027 for ΔR120; p = 0.04 for SOH). No significant differences were observed between never and former smokers and between current and former smokers except for ΔR120 (p = 0.033). CONCLUSION Dental plaque measurements by QLF technology were highly reproducible and showed greater plaque formation among current smokers compared to non-smokers. Objective and reproducible quantitation of dental plaque can be a valuable clinical and regulatory science endpoint to investigate the effect of smoking cessation medications, combustion-free tobacco products, and consumer care products on oral health. CLINICAL RELEVANCE There is a need to objectively evaluate the relationship between smoking and plaque build-up as well as maturation. Current smokers demonstrated greater and more mature plaque buildup when compared to never and former smokers. Differences in plaque build-up and maturation between current, former and non-smokers may be utilized as an effective tool for patient motivation, identifying therapeutic end-points, translational research as well as prognostication. TRIAL REGISTRATION The study is a pilot study parts of a larger project with registration ID: NCT04649645. As preliminary study, the pilot study referred into this paper started before the larger study registered in ClinicalTrials.gov.
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Affiliation(s)
- Gianluca Conte
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Addendo Srl, Dental Clinic, Catania, Italy
| | - Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Shipra Gupta
- Unit of Periodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rosalia Emma
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Gheorghe Bordeniuc
- Fala Dental, Chișinău, Republic of Moldova
- "Nicolae Testemiţanu" State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
| | - Valeriu Fala
- Fala Dental, Chișinău, Republic of Moldova
- "Nicolae Testemiţanu" State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
| | - Sebastiano Antonio Pacino
- Addendo Srl, Dental Clinic, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Salvatore Urso
- Department of Biological, Geological and Environmental Sciences, University of Catania, Catania, Italy
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Riccardo Polosa
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy.
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy.
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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Sim KY, Jang YS, Jang YS, Nerobkova N, Park EC. Association between Smoking and Periodontal Disease in South Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4423. [PMID: 36901429 PMCID: PMC10002277 DOI: 10.3390/ijerph20054423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Smoking poses a threat to global public health. This study analyzed data from the 2016-2018 National Health and Nutrition Examination Survey to investigate smoking's impact on periodontal health and identify potential risk factors associated with poor periodontal health in Korean adults. The final study population was 9178 patients, with 4161 men and 5017 women. The dependent variable was the Community Periodontal Index (CPI), to investigate periodontal disease risks. Smoking was the independent variable and was divided into three groups. The chi-squared test and multivariable logistic regression analyses were used in this study. Current smokers had a higher risk of periodontal disease than non-smokers (males OR: 1.78, 95% CIs = 1.43-2.23, females OR: 1.44, 95% CIs = 1.04-1.99). Age, educational level, and dental checkups affected periodontal disease. Men with a higher number of pack years had a higher risk of periodontal disease than non-smokers (OR: 1.84, 95% CIs = 1.38-2.47). Men who quit smoking for less than five years had a higher risk of periodontal disease than non-smokers but lower than current smokers (current OR: 1.78, 95% CIs = 1.43-2.23, ex OR: 1.42, 95% CIs = 1.04-1.96). Those who had quit smoking for less than five years had a higher risk of periodontal disease than non-smokers but lower than current smokers (males OR: 1.42, 95% CIs = 1.04-1.96, females OR: 1.11, 95% CIs = 1.71-1.74). It is necessary to motivate smokers by educating them on the importance of early smoking cessation.
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Affiliation(s)
- Ka-Yun Sim
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
| | - Yun Seo Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
| | - Ye Seul Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
| | - Nataliya Nerobkova
- Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Sager P, Kocher T, Pitchika V, Samietz S, Völzke H, Walter C, Holtfreter B. Powered tooth brushes are beneficial for long-term oral health: Results from the Study of Health in Pomerania (SHIP-TREND). J Clin Periodontol 2023; 50:548-558. [PMID: 36606369 DOI: 10.1111/jcpe.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/05/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
AIM To determine the long-term effects of the use of powered tooth brush (PTB) in comparison to manual tooth brush (MTB) on periodontitis severity, coronal caries experience, and the number of missing teeth using in a population-based cohort study. MATERIALS AND METHODS Using 7-year follow-up data of 2214 participants of the Study of Health in Pomerania (SHIP-TREND), comprehensively adjusted linear models using generalized least squares and ordinal regression models estimated the effects of PTB usage on dental outcomes in complete case and imputed data. RESULTS At follow-up, PTB users had lower medians for mean probing depth (PD; 2.21 mm) and mean clinical attachment levels (1.73 mm) than MTB users (2.30 and 1.96 mm, respectively). Adjusted models revealed the beneficial effects of PTB usage on follow-up levels of plaque, bleeding on probing, mean PD, percentage of sites with PDs ≥4 mm, mean clinical attachment levels (all, interdental, and non-interdental sites, respectively), and the number of missing teeth. For the number of missing teeth, the effects were more pronounced in participants aged ≥50 years. No significant effects of PTB usage on the number of decayed or filled surfaces (all and interdental sites) were found. CONCLUSIONS A recommendation of PTB usage in dental practice could contribute to the long-term promotion of oral health.
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Affiliation(s)
- Pauline Sager
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Stefanie Samietz
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Clemens Walter
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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Modifiable risk factors for the development and progression of periodontal tissue diseases. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.5-2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In this review, an analysis of modifiable risk factors for the development and progression of periodontal tissue diseases was carried out. The review highlights the data on the relationship of periodontal infection, tobacco smoking, diabetes mellitus, cardiovascular disease, drug-induced periodontal tissue damage, stress, and obesity with the risk of developing and progression of periodontal tissue diseases. A rather detailed analysis of the mechanisms of pathogenic influence of the microflora of the oral cavity, including in the subgingival plaque, was carried out. The mechanisms of the pathological effect of smoking on the state of periodontal tissues are described. Data on the effect of periodontal treatment on glycemic control in patients with diabetes mellitus are presented. The article emphasizes the importance of the presence of periodontal diseases as a risk factor for cardiovascular and cerebrovascular diseases, describes the mechanisms of the mutual influence of cardiovascular pathology and the inflammatory process in the periodontium. In addition, the article presents the possibilities of the iatrogenic effect of systemic drugs on the state of periodontal tissues. The data on the influence of stress loads on the development of dental diseases are presented. The review article describes in detail the mechanisms of influence of overweight and obesity on the risks of development and progression of periodontal tissue diseases. Based on the results of the scientific research publications presented in the article, it can be stated that not only the dentist, but also doctors of other specialties need to work to change the modifiable risk factors for the development and progression of periodontal diseases.
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Karobari MI, Siddharthan S, Adil AH, Khan MM, Venugopal A, Rokaya D, Heboyan A, Marya CM, Marya A. Modifiable and Non-modifiable Risk Factors Affecting Oral and Periodontal Health and Quality of Life in South Asia. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2209270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives:
The study aimed to review the prevalence of periodontal disease and associated factors among developing South Asian countries. The review was also aimed at providing an insight into how such factors play a role in affecting the Quality of life of patients with compromised oral health.
Background:
It has been observed that Oral health directly correlates with the Quality of life of an individual, so it is imperative to understand this, particularly in the developing parts of the world.
Methods:
A MeSH keyword search was carried out with the keywords: Periodontal diseases, Oral Health, Public Health, Asia, QoL, Quality of Life, Southeast Asia, Tobacco, and Risk Factors, and based on the findings, this detailed review was compiled.
Results:
The South Asian population forms 24.89% of the world population, while periodontal disease is an inflammatory condition that affects 11% of the globe. Several studies previously conducted across developing countries have shown that various factors like the socioeconomic status of an individual, smoking habit, consumption of alcohol, hypertension, history of diabetes, obesity, and stress are indirectly related to the onset of periodontal disease. Characteristics associated with specific populations like ethnicity, behavioral characteristics, and environmental factors may affect causing periodontitis.
Conclusion:
Dental practitioners in this region should consider risk factors that can be altered significantly to uplift the periodontal health status of an individual, which is not being considered in many developing countries.
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Walther C, Spinler K, Borof K, Kofahl C, Heydecke G, Seedorf U, Beikler T, Terschüren C, Hajek A, Aarabi G. Evidence from the Hamburg City Health Study - association between education and periodontitis. BMC Public Health 2022; 22:1662. [PMID: 36056348 PMCID: PMC9438138 DOI: 10.1186/s12889-022-14096-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Large-scale population-based studies regarding the role of education in periodontitis are lacking. Thus, the aim of the current study was to analyze the potential association between education and periodontitis with state of the art measured clinical phenotypes within a large population-based sample from northern Germany. MATERIAL & METHODS The Hamburg City Health Study (HCHS) is a population-based cohort study registered at ClinicalTrial.gov (NCT03934957). Oral health was assessed via plaque-index, probing depth, gingival recession and gingival bleeding. Periodontitis was classified according to Eke & Page. Education level was determined using the International Standard Classification of Education (ISCED-97) further categorized in "low, medium or high" education. Analyses for descriptive models were stratified by periodontitis severity. Ordinal logistic regression models were stepwise constructed to test for hypotheses. RESULTS Within the first cohort of 10,000 participants, we identified 1,453 with none/mild, 3,580 with moderate, and 1,176 with severe periodontitis. Ordinal regression analyses adjusted for co-variables (age, sex, smoking, diabetes, hypertension and migration) showed that the education level (low vs. high) was significantly associated with periodontitis (OR: 1.33, 95% CI: 1.18;1.47). CONCLUSION In conclusion, the current study revealed a significant association between the education level and periodontitis after adjustments for a set of confounders. Further research is needed to develop strategies to overcome education related deficits in oral and periodontal health.
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Affiliation(s)
- Carolin Walther
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kristin Spinler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Borof
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Udo Seedorf
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Beikler
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Terschüren
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Andre Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Design of a nanofibrous guided tissue regeneration carrier as a potential drug delivery system for tetracycline hydrochloride in the management of periodontitis. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Khajavi A, Radvar M, Moeintaghavi A. Socioeconomic determinants of periodontitis. Periodontol 2000 2022; 90:13-44. [PMID: 35950737 DOI: 10.1111/prd.12448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Amin Khajavi
- Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Radvar
- Department of Periodontology, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Moeintaghavi
- Department of Periodontology, Mashhad University of Medical Sciences, Mashhad, Iran
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Diamanti I, Polychronopoulou A, Papaioannou W, Theodoridis C, Margaritis V, Mamai-Homata E, Kalfas S. Socio-behavioral factors, oral hygiene level and periodontitis prevalence in a 35-44-year-old Greek adult population: A cross-sectional survey. J Clin Exp Dent 2021; 13:e1021-e1029. [PMID: 34667498 PMCID: PMC8501865 DOI: 10.4317/jced.58507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background Sub-optimal oral hygiene is considered as a primary risk factor for periodontitis occurrence. Various socio-behavioral determinants may contribute either independently or by influencing adversely the oral hygiene (OH) level. The aim of the present study was to examine the periodontal status of 35-44-year-old Greek adults and determine the contribution of risk indicators, including the socio-behavioral aspects and the population’s oral hygiene level, on disease prevalence.
Material and Methods In 1218 participants, Community Periodontal Index (CPI), Loss of Attachment (LoA) and simplified Oral Hygiene Index (OHI-S) were calculated. Multivariable regression models examined the effect of socio-behavioral factors with/without the inclusion of OHI-S level on pocket depth (PD)≥4mm and LoA≥4mm presence.
Results 11.8% of the participants had healthy periodontium, whereas 37.3% and 5.6% presented with shallow and deep pocketing, respectively. 60.4%, 28.8%, and 10.8.% of the adults demonstrated LoA≤3mm, 4-5mm, and ≥6mm, accordingly. Fair and poor oral hygiene significantly increased the likelihood for PD≥4mm (OR=4.8-20.3) and LoA≥4mm (OR=3.3-6.0) presence. ‘Emergency-oriented dental visiting pattern’ significantly elevated the chance for PD≥4mm presence (OR=1.7). ‘Lower education level’ ‘urban location’, and ‘using an interdental brush’ were significantly independently linked to LoA≥4mm occurrence (OR=1.7-2.1, 1.5, and 2.0, respectively). Lower educated individuals demonstrated inferior oral hygiene status, which in turn elevated significantly the chances of PD≥4mm presence. Smoking more than 10 cigarettes/day, emergency-oriented dental attendance pattern and not flossing were linked to worse oral hygiene levels, which consequently increased significantly the likelihood of LoA≥4mm occurrence.
Conclusions Fair and poor oral hygiene contribute strongly to periodontitis occurrence. Various socio-behavioral factors may influence adversely oral hygiene maintenance, leading to periodontitis manifestations. Key words:Community periodontal index, periodontal attachment loss, oral hygiene, adults 35-44, cross-sectional survey, socio-behavioral indicators.
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Affiliation(s)
- Iliana Diamanti
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - William Papaioannou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Theodoridis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eleni Mamai-Homata
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Kalfas
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073459. [PMID: 33810461 PMCID: PMC8037399 DOI: 10.3390/ijerph18073459] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This cross-sectional study evaluated the utility of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classifications of epidemiological studies in terms of periodontitis severity, prevalence and associated risk factors and the 2012 American Academy of Periodontology/Centers for Disease Control and Prevention (AAP/CDC) case definitions. METHODS We included 488 participants aged 35-74 years. Measurements were recorded at six sites per tooth by two qualified examiners. The evaluated parameters included pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP). Periodontitis prevalence and severity were reported using the 2018 EFP/AAP classification and the AAP/CDC case definitions. The data were stratified by recognized risk factors (age, diabetes and smoking status). RESULTS The 2018 EFP/AAP classification indicated that all patients suffered from periodontitis. When CAL served as the main criterion, the frequency of patients with severe (Stages III-IV) periodontitis was 54%. When the AAP/CDC case definitions were applied, the prevalence of periodontitis was 61.9% and that of severe periodontitis 16.8%. Age was the most significant risk factor, regardless of the chosen case definition. CONCLUSION It is essential to employ a globalized standard case definition when monitoring periodontitis and associated risk factors.
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Yamamoto T, Tanaka M, Kuribayashi N, Okuguchi F, Isotani H, Iwamoto M, Sugimoto H, Nakagawa O, Minabe M, Fuchida S, Mochida Y, Yokoyama H. Low education is associated with poor periodontal status in patients with type 2 diabetes mellitus: A cross-sectional study. Clin Exp Dent Res 2020; 7:419-428. [PMID: 33258300 PMCID: PMC8404492 DOI: 10.1002/cre2.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 01/14/2023] Open
Abstract
Objectives Cardiovascular disease remains the most common cause of death in patients with type 2 diabetes mellitus. Because periodontitis is a risk factor of cardiovascular disease, identification of risk factors of periodontitis is valuable to control periodontitis effectively. The purpose of this study was to examine the association of education and household income with periodontal status in patients with type 2 diabetes mellitus. Methods Participants were 2,436 patients (59.8% male, aged 29–93 years) with type 2 diabetes mellitus from 27 medical clinics. Participants' medical records and information about education, household income, general health status, and health behaviors were collected. Periodontal status was assessed in a nearby dental office. Multiple linear regression analyses and ordered logistic regression analyses were conducted to examine the association of periodontal parameters with education and household income after adjusting for age, sex, general health status, and health behaviors. Results Multiple linear regression analysis showed that mean probing pocket depth was not significantly associated with education and household income. Ordered logistic regression analyses showed statistically significant odds ratios (ORs) of junior high school (reference: university) for the tertiles of the percentage of sites with bleeding on probing (OR: 1.42; 95% confidence interval [CI]: 1.11–1.81), percentage of mobile teeth (OR: 1.58; 95% CI: 1.24–2.03), and number of teeth present (OR: 0.51; 95% CI: 0.39–0.65), and statistically significant odds ratios of high school (reference: university) for the tertiles of the percentage of mobile teeth (OR: 1.27; 95% CI: 1.06–1.51) and number of teeth present (OR: 0.74; 95% CI: 0.62–0.88), but not household income. Conclusions These results suggest that low education is one of the important predictors of poor periodontal status in patients with type 2 diabetes mellitus. It is important to provide targeted interventions including periodontal education in junior high school.
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Affiliation(s)
- Tatsuo Yamamoto
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Michio Tanaka
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | | | | | | | | | | | | | - Masato Minabe
- Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Shinya Fuchida
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Yuki Mochida
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
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Veynachter T, Orti V, Moulis E, Rousseau H, Thilly N, Anagnostou F, Jeanne S, Bisson C. Prevalence and Associated Factors of Self-Reported Gingival Bleeding: A Multicenter Study in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228563. [PMID: 33218143 PMCID: PMC7698919 DOI: 10.3390/ijerph17228563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 12/11/2022]
Abstract
Gingival bleeding (GB) is a common sign of gingival inflammation which indicates the presence of periodontal diseases. This cross-sectional multicenter survey aimed to assess the prevalence of self-reported gingival bleeding (SRGB) in French adults and identify the main associated factors. A questionnaire-based interview was randomly proposed to 794 individuals in four French cities (Nancy, Montpellier, Paris, and Rennes). Subjects were recruited in preventive medicine centers (50%), railway stations, and malls (50%). The questionnaire comprised 25 items: SRGB characteristics, socioeconomic variables, oral hygiene habits, use of drugs, and anxiety level. The overall prevalence of SRGB was 63.2% [59.8%; 66.6%], with 58.7% bleeding after toothbrushing and 4.5% spontaneous bleeding. Males reported significantly lower SRGB prevalence than females (p = 0.04). The distribution of SRGB frequency was inversely proportional to age (p < 0.0001). No association between drug use and SRGB was found. The people interviewed in the preventive medicine centers reported the highest frequency of SRGB (p < 0.0001). In the multivariate logistic model, SRGB was significantly related to occupation, smoking status, brushing frequency, and anxiety level. In conclusion, SRGB was prevalent in more than half of the sample and was mainly associated with age, toothbrushing frequency, and anxiety level. Thus, providing information to patients about the importance of this oral manifestation may play an important role in preventing periodontal diseases.
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Affiliation(s)
- Thomas Veynachter
- Faculty of Dentistry, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France;
- Department of Periodontology, University Hospital, 54000 Nancy, France
- SIMPA, Stress Immunity Pathogens Unit, Brabois Santé Campus, EA 7300, F-54000 Nancy, France
- Correspondence:
| | - Valérie Orti
- Department of Dentistry, University of Montpellier, 34193 Montpellier, France; (V.O.); (E.M.)
| | - Estelle Moulis
- Department of Dentistry, University of Montpellier, 34193 Montpellier, France; (V.O.); (E.M.)
| | - Hélène Rousseau
- Platform Support for Clinical Research, University Hospital, 54505 Vandoeuvre-Lès-Nancy, France; (H.R.); (N.T.)
| | - Nathalie Thilly
- Platform Support for Clinical Research, University Hospital, 54505 Vandoeuvre-Lès-Nancy, France; (H.R.); (N.T.)
| | - Fani Anagnostou
- Department of Dentistry, Garancière, University of Paris Diderot, 75006 Paris, France;
| | - Sylvie Jeanne
- Department of Periodontology, University of Rennes, 35043 Rennes, France;
| | - Catherine Bisson
- Faculty of Dentistry, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France;
- Department of Periodontology, University Hospital, 54000 Nancy, France
- SIMPA, Stress Immunity Pathogens Unit, Brabois Santé Campus, EA 7300, F-54000 Nancy, France
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Wellappuli N, Ekanayake L. Role of oral health‐related behaviors in education inequalities in chronic periodontitis among Sri Lankan men. ACTA ACUST UNITED AC 2019; 10:e12416. [DOI: 10.1111/jicd.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/05/2018] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nimali Wellappuli
- Office of the Provincial Director of Health ServicesColombo Sri Lanka
| | - Lilani Ekanayake
- Department of Community Dental Health Faculty of Dental Sciences University of Peradeniya Peradeniya Sri Lanka
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Al-Alimi A, Halboub E, Al-Sharabi AK, Taiyeb-Ali T, Jaafar N, Al-Hebshi NN. Independent determinants of periodontitis in Yemeni adults: A case-control study. Int J Dent Hyg 2018; 16:503-511. [DOI: 10.1111/idh.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/26/2022]
Affiliation(s)
- A Al-Alimi
- Faculty of Dentistry; Department of Oral Biology & Biomedical Sciences (Periodontology); University Malaya; Kuala Lumpur Malaysia
- Faculty of Dentistry; Department of Periodontology, Oral Pathology, Oral Medicine and Radiology; University of Sana'a; Sana'a Yemen
| | - E Halboub
- Faculty of Dentistry; Department of Maxillofacial Surgery and Diagnostic Sciences; Jazan University; Jazan Saudi Arabia
| | - AK Al-Sharabi
- Faculty of Dentistry; Department of Periodontology, Oral Pathology, Oral Medicine and Radiology; University of Sana'a; Sana'a Yemen
| | - T Taiyeb-Ali
- Faculty of Dentistry; Department of Oral Biology & Biomedical Sciences (Periodontology); University Malaya; Kuala Lumpur Malaysia
| | - N Jaafar
- Faculty of Dentistry; Department of Community Oral Health & Clinical Prevention; University Malaya; Kuala Lumpur Malaysia
| | - NN Al-Hebshi
- Maurice H. Kornberg School of Dentistry; Temple University; Philadelphia PA USA
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Muniz FWMG, Costa RDSA, Cavagni J, Milanesi FC, Hilgert JB, Gomes SC, Oppermann RV, Rösing CK. Body fat rather than body mass index is associated with gingivitis - A southern Brazilian cross-sectional study. J Periodontol 2018; 89:388-396. [PMID: 29603230 DOI: 10.1002/jper.17-0292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND This cross-sectional study aimed to evaluate the association between body mass index (BMI) and body fat with gingivitis in 613 adults of Porto Alegre, Brazil. METHODS Individuals with at least four teeth were included in this study. They were identified through a multi-stage probability sampling, considering the city distribution of sex and age. Structured interviews were conducted by trained researchers in order to collect sociodemographic characteristics, behavioral habits, and systemic impaired conditions. Visible plaque and modified gingival index were assessed by a trained and calibrated examiner. Additionally, weight, height, and body fat percentage were measured. Body fat percentage was determined by bioelectrical-impedance analysis using a portable electrical micro-current monitor. The median sites with marginal bleeding was 20%, and used as a cutoff point for gingivitis. Crude and adjusted prevalence ratio by mean Poisson regression with robust variance were calculated. Two multivariable models were performed in order to associate both independent and dependent variables. RESULTS In the multivariable analysis that included BMI, no significant association with gingivitis was detected. On the other hand, the multivariable model that included body fat showed that very high body fat category (PR 1.22; 95% CI: 1.01 to 1.49) was significantly associated with higher marginal gingival bleeding. CONCLUSION Very high body fat category rather than BMI was significantly associated with higher positive marginal gingival bleeding in adults.
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Affiliation(s)
| | | | - Juliano Cavagni
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Carpes Milanesi
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sabrina Carvalho Gomes
- Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rui Vicente Oppermann
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Cho YD, Kim PJ, Kim HG, Seol YJ, Lee YM, Ku Y, Rhyu IC, Ryoo HM. Transcriptomics and methylomics in chronic periodontitis with tobacco use: a pilot study. Clin Epigenetics 2017; 9:81. [PMID: 28811843 PMCID: PMC5553745 DOI: 10.1186/s13148-017-0381-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/03/2017] [Indexed: 12/17/2022] Open
Abstract
Background Accumulating evidence suggests that tobacco smoking affects the susceptibility to and severity of chronic periodontitis. Epigenetics may explain the role of smoking in the development and progress of periodontal disease. In this study, we performed transcriptomic and methylomic analyses of non-periodontitis and periodontitis-affected gingival tissues according to smoking status. Methods Human gingival tissues were obtained from 20 patients, including non-smokers with and without periodontitis (n = 5 per group) and smokers with and without periodontitis (n = 5 per group). Total RNA and genomic DNA were isolated, and their quality was validated according to strict standards. The Illumina NextSeq500 sequencing system was used to generate transcriptome and methylome datasets. Results Comprehensive analysis, including between-group correlation, differential gene expression, DNA methylation, gene set enrichment, and protein-protein interaction, indicated that smoking may change the transcription and methylation states of extracellular matrix (ECM) organization-related genes, which exacerbated the periodontal condition. Conclusions Our results suggest that smoking-related changes in DNA methylation patterns and subsequent alterations in the expression of genes coding for ECM components may be causally related to the increased susceptibility to periodontitis in smokers as they could influence ECM organization, which in turn may have an effect on disease characteristics. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0381-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Young-Dan Cho
- Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 03080 South Korea.,Department of Molecular Genetics, School of Dentistry, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
| | - Pil-Jong Kim
- Department of Dental Services Management and Informatics, School of Dentistry, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
| | - Hong-Gee Kim
- Department of Dental Services Management and Informatics, School of Dentistry, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
| | - Yang-Jo Seol
- Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 03080 South Korea
| | - Yong-Moo Lee
- Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 03080 South Korea
| | - Young Ku
- Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 03080 South Korea
| | - In-Chul Rhyu
- Department of Periodontology, School of Dentistry, Seoul National University, 101 Daehak-no, Jongno-gu, Seoul, 03080 South Korea
| | - Hyun-Mo Ryoo
- Department of Molecular Genetics, School of Dentistry, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
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Almerich-Silla JM, Almiñana-Pastor PJ, Boronat-Catalá M, Bellot-Arcís C, Montiel-Company JM. Socioeconomic factors and severity of periodontal disease in adults (35-44 years). A cross sectional study. J Clin Exp Dent 2017; 9:e988-e994. [PMID: 28936289 PMCID: PMC5601116 DOI: 10.4317/jced.54033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/21/2017] [Indexed: 12/04/2022] Open
Abstract
Background Periodontal disease or periodontitis is an inflammatory disease with a hight prevalence. According to the last oral health survey of the Spanish population, between 24% and 37% of Spaniards aged over 35 years have periodontitis and 6% to 10% of the adult population have deep periodontal pockets. The aim of this study was to determine the association between risk factors and the presence of periodontal pockets in the adult population. Material and Methods A cross sectional or prevalence study of a representative sample of the adult population of the Valencia region was designed. The sample was recruited at 35 health centres, The study was conducted in November and December 2006 under standardized conditions as regards light sources, equipment and instruments and the position of the three previously calibrated dentist examiners. Results The sample examined consisted of 733 individuals (220 men and 513 women). Measured by the CPI, 13% were healthy and 5.5% presented bleeding. The prevalence of calculus was 59.3%, that of 3.5-5.5 mm pockets was 15.8% and that of pockets deeper than 5.5 mm was 4.6%. Almost half the sextants were healthy (2.89), 0.61 presented bleeding and 1.74 presented calculus. The mean number of sextants affected by 3.5-5.5 mm pockets was 0.46 and 0.07 presented deep pockets (>5.5 mm).
An adjusted multiple logistic regression model with the presence of periodontal pockets as the dependent variable showed that the significant independent variables were low social class (OR=1.81), smoking (OR=1.68), primary education (OR=1.57), male gender (OR=1.56) and age (OR=1.08). The other study variables were not significant in this model. Conclusions Socioeconomic factors such as primary education and low social class, as well as gender, age and smoking, were found to be associated to a significant degree with greater prevalence of periodontal disease in the adult population. Key words:Periodontal disease, adults, socioeconomic factors, periodontal pockets, cross sectional study.
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Affiliation(s)
- José-Manuel Almerich-Silla
- Tenured lecturer, Preventive Dentistry Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia (Spain)
| | - Pedro J Almiñana-Pastor
- Grado en Odontología [equivalent to BDS],, Specialist Master of Periodontics, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia (Spain)
| | - Montserrat Boronat-Catalá
- Grado en Odontología [equivalent to BDS],, Specialist Master of Periodontics, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia (Spain)
| | - Carlos Bellot-Arcís
- PhD, Associate lecturer, Orthodontics Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia (Spain)
| | - José-María Montiel-Company
- Post-doctoral contract lecturer, Preventive Dentistry Teaching Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia (Spain)
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Aoyama N, Suzuki JI, Sato H, Yoshida A, Shiheido Y, Izumi Y. Japanese workers with long leisure time have deteriorated periodontal condition: A cross-sectional study. J Oral Biosci 2017. [DOI: 10.1016/j.job.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chung JH, Hwang HJ, Kim SH, Kim TH. Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition Examination Survey. J Periodontol 2016; 87:864-71. [PMID: 26912338 DOI: 10.1902/jop.2016.150682] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study is to examine whether oral hygiene and self-care, particularly in periodontal health, are associated with chronic obstructive pulmonary disease (COPD) in the Korean population. METHODS Data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were used to assess the community periodontal index (CPI) of 5,878 participants (normal lung function: n = 5,181; obstructive spirometric pattern: n = 697) aged ≥40 years, who underwent spirometry. RESULTS Participants with COPD brushed their teeth less frequently and used the following less frequently: 1) dental floss and/or interdental brush; 2) mouthwash; and 3) electric toothbrush (P <0.001). Prevalence of periodontitis in patients with COPD (58.1%) was significantly higher than in those without COPD (34.0%, P <0.001). Number of teeth was significantly lower in patients with COPD compared with controls. Decayed-missing-filled tooth index was significantly lower in patients with COPD. This study shows risk of COPD by periodontal severity. Periodontitis (CPI 3 and 4) was associated in males with COPD after adjustment for: 1) age; 2) income; 3) education; 4) smoking; 5) alcohol consumption; 6) exercise; 7) body mass index; 8) toothbrushing frequency; 9) diabetes mellitus; and 10) number of teeth (CPI 3: relative risk [RR] = 1.38, 95% confidence interval [CI] = 1.12 to 2.05; CPI 4: RR = 1.23, 95% CI = 1.06 to 1.56). CONCLUSION Findings of this cross-sectional study suggest that COPD in males may be associated with severe periodontitis and indicates the importance of promoting dental care in patients with COPD.
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Affiliation(s)
- Jae Ho Chung
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Hee-Jin Hwang
- Department of Family Medicine, Catholic Kwandong University College of Medicine
| | - Sun-Hyun Kim
- Department of Family Medicine, Catholic Kwandong University College of Medicine
| | - Tae Ho Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
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Bergamaschi CC, Santamaria MP, Berto LA, Cogo-Müller K, Motta RHL, Salum EA, Nociti Júnior FH, Goodson JM, Groppo FC. Full mouth periodontal debridement with or without adjunctive metronidazole gel in smoking patients with chronic periodontitis: A pilot study. J Periodontal Res 2015; 51:50-9. [PMID: 25900347 DOI: 10.1111/jre.12278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The evidence of effectiveness of metronidazole (Mtz) as an adjunct therapy to periodontal procedure in the treatment of patients with chronic periodontitis is not conclusive. The aim of this study was to compare the effect of Mtz (delivered locally as a gel or systemically as a tablet) as an adjunctive therapy with full mouth periodontal debridement (1 h of ultrasonic calculus/plaque removal) in smokers with chronic periodontitis. MATERIAL AND METHODS This pilot study involved 30 smokers with at least six teeth with a clinical attachment loss of ≥ 5 mm and probing pocket depth (PPD) of ≥ 5 mm. They were randomly assigned into one of three groups (n = 10): (i) 3 g daily of placebo gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; (ii) 3 g daily of a 15% Mtz benzoate gel applied topically (using a dental tray with the gel overnight) + periodontal debridement; and (iii) a daily single dose of 750 mg Mtz (Flagyl(®)) + periodontal debridement. Clinical parameters (visible plaque index, gingival bleeding index [GBI], relative attachment level and PPD) and quantitative analysis (by real-time polymerase chain reaction) of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia were assessed at baseline and at 1, 3 and 6 mo after periodontal debridement. RESULTS There was no statistically significant difference in the average GBI and visible plaque index values at baseline between the groups (p ≥ 0.05). There was no significant difference between groups in all parameters evaluated (p ≥ 0.05). Significant reductions in GBI at 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in both PPD and relative attachment level at 1, 3 and 6 mo were observed in all groups (p < 0.05). Significant reductions in bacterial levels at 7 and 30 d were observed in all groups (p < 0.05). CONCLUSION Adjunctive use of Mtz (gel or tablet) to periodontal debridement had similar clinical and microbiological improvement compared to treatment with placebo + periodontal debridement in smokers with chronic periodontitis up to 6 mo post-treatment. Further studies are necessary to confirm the clinical relevance of these findings.
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Affiliation(s)
- C C Bergamaschi
- Department of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - M P Santamaria
- Division of Periodontics, College of Dentistry, State University of São Paulo, São José dos Campos, Brazil
| | - L A Berto
- Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - K Cogo-Müller
- Department of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | - R H L Motta
- Department of Pharmacology, Anesthesiology and Therapeutics, São Leopoldo Mandic Dental School, Campinas, Brazil
| | - E A Salum
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - F H Nociti Júnior
- Department of Prosthodontics and Periodontology, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
| | - J M Goodson
- Department of Clinical Research, The Forsyth Institute, Boston, MA, USA
| | - F C Groppo
- Department of Pharmacology, Anesthesiology and Therapeutics, Dental School of Piracicaba, State University of Campinas, Piracicaba, Brazil
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Albertsen A. Tough luck and tough choices: applying luck egalitarianism to oral health. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:342-62. [PMID: 25870307 DOI: 10.1093/jmp/jhv001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Luck egalitarianism is often taken to task for its alleged harsh implications. For example, it may seem to imply a policy of nonassistance toward uninsured reckless drivers who suffer injuries. Luck egalitarians respond to such objections partly by pointing to a number of factors pertaining to the cases being debated, which suggests that their stance is less inattentive to the plight of the victims than it might seem at first. However, the strategy leaves some cases in which the attribution of individual responsibility is appropriate (and so, it seems, is asking people to pick up the tab for their choices). One such case is oral health or significant aspects of this. It is appropriate, the paper argues, to hold people responsible for a number of factors that affect their oral health. A luck egalitarian approach inspired by John Roemer can assess whether people have acted responsibly by comparing their choices to those of their peers. A luck egalitarian approach to oral health would recommend prioritizing scarce resources in a responsibility-weighted queuing system and include copayment and general taxation among its measures of financing.
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Nociti FH, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000 2015; 67:187-210. [PMID: 25494601 DOI: 10.1111/prd.12063] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2014] [Indexed: 02/05/2023]
Abstract
This literature review provides an overview of the current scenario regarding the impact of smoking on the progression and treatment of periodontitis; clinical, microbiological and immunological data from studies from our and other groups are presented. In general, preclinical and clinical data are unanimous in demonstrating that smokers present increased susceptibility, greater severity and faster progression of periodontal disease compared with nonsmokers. The evidence further demonstrates that smokers lose more teeth and have a less favorable response to therapy than do nonsmokers. Although it is well established that smoking significantly impacts on the onset, progression and outcome of periodontal disease, the mechanisms involved remain unclear. More importantly, some of the reported deleterious effects of smoking on periodontal tissues have been reported to be reversible upon participation in smoking-cessation programs. Therefore, clinicians should strongly advise smokers to enroll in cessation strategies, even temporarily, in order to improve the overall outcome.
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Zimmermann H, Zimmermann N, Hagenfeld D, Veile A, Kim TS, Becher H. Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis. Community Dent Oral Epidemiol 2014; 43:116-27. [PMID: 25255820 DOI: 10.1111/cdoe.12126] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing. METHODS Systematic literature search was conducted in nine online resources (PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association. RESULTS Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant (P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95%CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity (I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95%CI: 1.21-1.71, P < 0.0001). CONCLUSIONS There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects.
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Affiliation(s)
- Heiko Zimmermann
- Unit of Epidemiology and Biostatistics, Institute of Public Health, University of Heidelberg, Germany
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Woodman AJ. Using risk assessment in periodontics. Prim Dent J 2014; 3:51-6. [PMID: 25198640 DOI: 10.1308/205016814812736709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Risk assessment has become a regular feature in both dental practice and society as a whole, and principles used to assess risk in society are similar to those used in a clinical setting. Although the concept of risk assessment as a prognostic indicator for periodontal disease incidence and activity is well established in the management of periodontitis, the use of risk assessment to manage the practical treatment of periodontitis and its sequelae appears to have less foundation. A simple system of initial risk assessment - building on the use of the Basic Periodontal Examination (BPE), clinical, medical and social factors - is described, linked to protocols for delivering care suited to general dental practice and stressing the role of long-term supportive care. The risks of not treating the patient are considered, together with the possible causes of failure, and the problems of successful treatment are illustrated by the practical management of post-treatment recession.
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Risk factors of periodontal disease: review of the literature. Int J Dent 2014; 2014:182513. [PMID: 24963294 PMCID: PMC4055151 DOI: 10.1155/2014/182513] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/07/2014] [Indexed: 01/15/2023] Open
Abstract
Objectives. This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. Data. Original articles that reported on the risk factors for periodontal disease were included. Sources. MEDLINE (1980 to Jan 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: "periodontal disease," "periodontitis," "risk factors," and "causal." This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Conclusions. It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors.
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A Clinicoradiographic and Pathological Study of Pericoronal Follicles Associated to Mandibular Third Molars. J Craniofac Surg 2014; 25:e283-7. [DOI: 10.1097/scs.0000000000000712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim DW, Park JC, Rim TT, Jung UW, Kim CS, Donos N, Cha IH, Choi SH. Socioeconomic disparities of periodontitis in Koreans based on the KNHANES IV. Oral Dis 2013; 20:551-9. [PMID: 24033864 DOI: 10.1111/odi.12168] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 06/26/2013] [Accepted: 07/12/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to identify the socioeconomic factors associated with the prevalence of periodontitis in Koreans. METHODS Cross-sectional data from 12 763 subjects, 15 years old and above, who underwent periodontal examinations were obtained from the Korean National Health and Nutrition Examination Survey IV (2007-209). Multivariate linear and logistic regression analyses were applied to estimate the association between socioeconomic indicators and prevalence of periodontitis. RESULTS A significant association was found between increasing age and periodontitis. Participants with higher income were less likely to have periodontitis (aOR = 0.9 and 95% CI = 0.78-0.98, and aOR = 0.7 and 95% CI = 0.60-0.80 in the middle and highest quintiles of monthly household income, respectively). In addition, participants living in rural areas were less likely to have periodontitis (aOR = 0.9 and 95% CI = 0.81-0.99), and current smokers were more likely to have periodontitis (aOR = 1.7 and 95% CI = 1.49-1.89). The analysis of comorbidities revealed that individuals with diabetes mellitus (DM) were significantly more likely to have periodontitis (aOR = 1.4 and 95% CI = 1.18-1.68). CONCLUSIONS In a rapidly increasing Korean population, the lower socioeconomic groups as well as individuals with DM were significantly more likely to present with periodontitis.
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Affiliation(s)
- D W Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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Buchwald S, Kocher T, Biffar R, Harb A, Holtfreter B, Meisel P. Tooth loss and periodontitis by socio-economic status and inflammation in a longitudinal population-based study. J Clin Periodontol 2013; 40:203-11. [DOI: 10.1111/jcpe.12056] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Sabine Buchwald
- Unit of Periodontology; Centre of Oral Health; University of Greifswald; Greifswald Germany
| | - Thomas Kocher
- Unit of Periodontology; Centre of Oral Health; University of Greifswald; Greifswald Germany
| | - Reiner Biffar
- Unit of Prosthodontics; Gerodontology and Biomaterials; Centre of Oral Health; University of Greifswald; Greifswald Germany
| | - Ali Harb
- Institute of Community Medicine; University of Greifswald; Greifswald Germany
| | - Birte Holtfreter
- Unit of Periodontology; Centre of Oral Health; University of Greifswald; Greifswald Germany
| | - Peter Meisel
- Unit of Periodontology; Centre of Oral Health; University of Greifswald; Greifswald Germany
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Zini A, Sgan-Cohen HD, Marcenes W. Is religiosity related to periodontal health among the adult Jewish population in Jerusalem? J Periodontal Res 2011; 47:418-25. [DOI: 10.1111/j.1600-0765.2011.01447.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Boillot A, El Halabi B, Batty GD, Rangé H, Czernichow S, Bouchard P. Education as a predictor of chronic periodontitis: a systematic review with meta-analysis population-based studies. PLoS One 2011; 6:e21508. [PMID: 21814546 PMCID: PMC3140980 DOI: 10.1371/journal.pone.0021508] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 06/02/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The impact of socioeconomic inequalities on health is well-documented. Despite the links of periodontal disease with cardiovascular diseases, adverse pregnancy outcomes and diabetes, no meta-analysis of socioeconomic variations in periodontal disease exists. This meta-analytic review was conducted to determine the extent to which education attainment influences risk of periodontitis in adults aged 35+ years in the general population. METHODS The authors searched studies published until November 2010 using EMBASE and MEDLINE databases. References listed were then scrutinised, our own files were checked, and, finally, we contacted experts in the field. The authors included only general population-based studies conducted in adults aged 35 years and more. All articles were blind reviewed by two investigators. In the case of disagreement, a third investigator arbitrated. Using PRISMA statement, two reviewers independently extracted papers of interest. RESULTS Relative to the higher education group, people with low education attainment experience a greater risk of periodontitis (OR: 1.86 [1.66-2.10]; p<0.00001). The association was partially attenuated after adjustment for covariates (OR: 1.55 [1.30-1.86]; p<0.00001). Sensitivity analyses showed that methods used to assess periodontitis, definition of cases, study country and categorization of education are largely responsible for the heterogeneity between studies. No significant bias of publication was shown using both the Egger (p = 0.16) and rank correlation tests (p = 0.35). CONCLUSIONS In the studies reviewed, low educational attainment was associated with an increased risk of periodontitis. Although this evidence should be cautiously interpreted due to methodological problems in selected studies, efforts to eliminate educational inequalities in periodontitis should focus on early life interventions.
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Affiliation(s)
- Adrien Boillot
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - Bechara El Halabi
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - George David Batty
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Hélène Rangé
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
| | - Sébastien Czernichow
- Department of Nutrition, Ambroise Paré Hospital, University Versailles St-Quentin, Boulogne-Billancourt, France
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis Diderot University, U.F.R. of Odontology, Paris, France
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Socio-economic position, smoking, and plaque: a pathway to severe chronic periodontitis. Br Dent J 2011. [DOI: 10.1038/sj.bdj.2011.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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