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Rahim A, Hassan S, Ullah N, Noor N, Rafique R, Khattak FA, Afaq S. Association and comparison of periodontal and oral hygiene status with serum HbA1c levels: a cross-sectional study. BMC Oral Health 2023; 23:442. [PMID: 37394484 DOI: 10.1186/s12903-023-03042-7] [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: 02/16/2023] [Accepted: 05/13/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Diabetes Mellitus and periodontitis are chronic diseases with known reciprocal association. Studies have shown that uncontrolled diabetes increases the risk of development and progression of periodontal disease. This study aimed to explore the association and severity of periodontal clinical parameters and oral hygiene with HbA1c levels in non-diabetics and T2DM patients. MATERIALS AND METHODS In this cross-sectional study, the periodontal status of 144 participants, categorized into non-diabetics, controlled T2DM, and uncontrolled T2DM and were assessed via the Community Periodontal Index (CPI), Loss of Attachment Index (LOA index), and the number of missing teeth, while oral hygiene was measured by utilizing the Oral Hygiene Index Simplified (OHI-S). SPSS was used for data analysis. Chi-square test was used to find out the association of different independent variables with HbA1c groups, while ANOVA and post-hoc tests were run for inter-group and intra-group comparison respectively. RESULTS Out of 144 participants, the missing dentition was prevalent in uncontrolled T2DM with mean 2.64 ± 1.97 (95% CI 2.07-3.21; p = 0.01) followed by controlled T2DM 1.70 ± 1.79 (95% CI 1.18-2.23; p = 0.01) and non-diabetics 1.35 ± 1.63 (95% CI 0.88-1.82; p = 0.01) respectively. Furthermore, non-diabetics had a higher proportion of CPI score 0 (Healthy) [30 (20.8%); p = 0.001] as compared to uncontrolled T2DM [6 (4.2%); p = 0.001], while CPI score 3 was more prevalent in uncontrolled T2DM in comparison to non-diabetics. Loss of attachment (codes-2,3 and 4) was also frequently observed in uncontrolled T2DM compared to non-diabetics (p = 0.001). Similarly, based on Oral Hygiene Index- Simplified (OHI-S), the result showed that poor oral hygiene was most commonly observed in uncontrolled T2DM 29 (20.1%) followed by controlled T2DM patients 22 (15.3%) and non-diabetic [14 (9.7%); p = 0.03]. CONCLUSION This study showed that periodontal status and oral hygiene status were deteriorated in uncontrolled T2DM patients compared to non-diabetic participants and controlled T2DM.
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Affiliation(s)
- Abid Rahim
- Sardar Begum Dental College, Gandhara University, Peshawar, Pakistan
- Dental Surgery Department, Qazi Hussain Ahmed Medical Complex (MTI), Nowshera, Pakistan
| | - Sabreen Hassan
- Department of Oral Pathology, Saidu College of Dentistry, Swat, Pakistan
| | - Naeem Ullah
- Department of Community Medicine, Saidu Medical College, Swat, Pakistan
| | - Nawal Noor
- Sardar Begum Dental College, Gandhara University, Peshawar, Pakistan
| | | | - Farhad Ali Khattak
- Research & Development Cell, Khyber College of Dentistry, Peshawar, Pakistan.
| | - Saima Afaq
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
- School of Public Health Faculty of Medicine, Imperial College London, London, UK.
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Kuntjoro M, Hendrijantini N, Prasetyo EP, Legowo D, Sitalaksmi RM, Agustono B, Ari MDA, Hong G. Human umbilical cord mesenchymal stem cells accelerate and increase implant osseointegration in diabetic rats. J Appl Oral Sci 2023; 31:e20220375. [PMID: 36995883 PMCID: PMC10065760 DOI: 10.1590/1678-7757-2022-0375] [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: 10/06/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE This study was conducted to assess the effect of hUCMSCs injection on the osseointegration of dental implant in diabetic rats via Runt-related Transcription Factor 2 (Runx2), Osterix (Osx), osteoblasts, and Bone Implant Contact (BIC). METHODOLOGY The research design was a true experimental design using Rattus norvegicus Wistar strain. Rattus norvegicus were injected with streptozotocin to induce experimental diabetes mellitus. The right femur was drilled and loaded with titanium implant. Approximately 1 mm from proximal and distal implant site were injected with hUCMSCs. The control group was given only gelatin solvent injection. After 2 and 4 weeks of observation, the rats were sacrificed for further examination around implant site using immunohistochemistry staining (RUNX2 and Osterix expression), hematoxylin eosin staining, and bone implant contact area. Data analysis was done using ANOVA test. RESULTS Data indicated a significant difference in Runx2 expression (p<0.001), osteoblasts (p<0.009), BIC value (p<0.000), and Osterix expression (p<0.002). In vivo injection of hUCMSCs successfully increased Runx2, osteoblasts, and BIC value significantly, while decreased Osterix expression, indicating an acceleration of the bone maturation process. CONCLUSION The results proved hUCMSCs to accelerate and enhance implant osseointegration in diabetic rat models.
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Affiliation(s)
- Mefina Kuntjoro
- Universitas Airlangga, Faculty of Dental Medicine, Department of Prosthodontic, Surabaya, Indonesia
| | - Nike Hendrijantini
- Universitas Airlangga, Faculty of Dental Medicine, Department of Prosthodontic, Surabaya, Indonesia
| | - Eric Priyo Prasetyo
- Universitas Airlangga, Faculty of Dental Medicine, Department of Conservative Dentistry, Surabaya, Indonesia
| | - Djoko Legowo
- Universitas Airlangga, Faculty of Veterinary Medicine, Surabaya, Indonesia
| | - Ratri Maya Sitalaksmi
- Universitas Airlangga, Faculty of Dental Medicine, Department of Prosthodontic, Surabaya, Indonesia
| | - Bambang Agustono
- Universitas Airlangga, Faculty of Dental Medicine, Department of Prosthodontic, Surabaya, Indonesia
| | | | - Guang Hong
- Tohoku University, Graduate Scholl of Dentistry, Liaison Center for Innovative Dentistry, Aoba-Ku, Sendai, Japan
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Kurinami N, Ashida K, Sugiyama S, Morito Y, Hasuzawa N, Yoshida A, Morita A, Hieshima K, Miyamoto F, Kajiwara K, Jinnouchi K, Jinnouchi T, Jinnouchi H, Nomura M. Reduced Number of Remaining or Healthy Teeth in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Study Assessed by Dentists or Dental Hygienists in Japan. Intern Med 2023; 62:987-993. [PMID: 37005297 PMCID: PMC10125810 DOI: 10.2169/internalmedicine.9773-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective This study assessed the relationships between oral health (number of remaining and healthy teeth and periodontal disease) and type 2 diabetes mellitus (T2DM) to contribute to improved patient care. Patients We conducted a cross-sectional cohort study of consecutive patients being regularly treated for chronic diseases (T2DM, hypertension, and dyslipidemia). A dentist or dental hygienist accurately evaluated the oral environment. Patients with fewer than 20 teeth were classified as having reduced remaining teeth (RRT). Results A total of 267 patients were enrolled, including 153 patients (57%) with T2DM and 114 without (43%). Patients with T2DM had 3 fewer remaining teeth on average than those without DM [median: 22 (interquartile range (IQR): 11-27) vs. median: 25 (IQR: 17.3-28), p=0.02]. In addition, patients with T2DM had 4 fewer healthy teeth on average than those without DM [median: 8 (IQR: 2.8-15) vs. median: 12 (IQR: 6-16), p=0.02]. The frequency of RRT was higher in the T2DM group (n=63; 41%) than in the non-DM group (n=31; 27%, p=0.02). Multivariable logistic regression for the presence of RRT in the T2DM group found that age [odds ratio (OR), 1.08; 95% confidence interval (CI), 1.03-1.13; p<0.01] and regular dental consultations (OR, 0.28; 95% CI, 0.10-0.76; p=0.01) were independently and significantly associated. Conclusion The number of remaining or healthy teeth was significantly lower in patients with T2DM than in those without T2DM in current Japanese clinical practice. Regular dental consultation is recommended to preserve remaining teeth in patients with T2DM.
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Affiliation(s)
- Noboru Kurinami
- Kurinami Clinic, Japan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Japan
- Diabetes Care Center, Jinnouchi Hospital, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Seigo Sugiyama
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Division of Cardiovascular Medicine, Diabetes Care Center, Jinnouchi Hospital, Japan
| | | | - Nao Hasuzawa
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | | | | | | | | | | | | | | | - Hideaki Jinnouchi
- Diabetes Care Center, Jinnouchi Hospital, Japan
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Japan
| | - Masatoshi Nomura
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Japan
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Ahmadinia AR, Rahebi D, Mohammadi M, Ghelichi-Ghojogh M, Jafari A, Esmaielzadeh F, Rajabi A. Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis. BMC Endocr Disord 2022; 22:100. [PMID: 35418054 PMCID: PMC9006550 DOI: 10.1186/s12902-022-01012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have assessed the relationship between type 2 diabetes (T2D) and tooth loss; however, results have been inconsistent. Therefore, the present systematic review and meta-analysis of observational studies was designed to examine the association between T2D and tooth loss. METHODS This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We searched all the relevant studies in international databases of Scopus, PubMed, ProQuest, Web of Science, Cochrane Library, and Google scholar search engine until February 2022. The heterogeneity of the studies was calculated using the I2 index. Measure of effect and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model. RESULTS In the present study, 22 eligible studies were included. Meta-analysis of unadjusted and adjusted results showed that T2D significantly increased the risk of tooth loss, and Odds Ratio (OR) unadjusted was 1.87 (95% CI: 1.62-2.13, p < 0.001), and OR adjusted was 1.20 (95% CI: 1.10-1.30, p < 0.001), respectively. Subgroup analysis based on study design for adjusted OR indicated that in the cohort study (OR: 1.29, 95% CI: 1.07-1.51), in the cross-sectional study (OR: 1.15, 95% CI: 1.06-1.23), and in the case-control study (OR: 5.10, 95% CI: 1.01-9.18) there was a significant association between T2D and tooth loss. Other subgroups analyses showed consistent results and no publication bias existed. CONCLUSIONS The findings suggest that T2D is associated with increased risk of tooth loss. This conclusion may provide useful evidence for correlated clinical researches.
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Affiliation(s)
- Amir Reza Ahmadinia
- Dental Research Center, School of Dentistry Golestan University of Medical Sciences, Gorgan, Iran
| | - Donya Rahebi
- Dental Research Center, School of Dentistry Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Mohammadi
- Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mousa Ghelichi-Ghojogh
- Department of Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Firooz Esmaielzadeh
- School of Nursing and Allied Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Abdolhalim Rajabi
- Dental Research Center, School of Dentistry Golestan University of Medical Sciences, Gorgan, Iran
- Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
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Factors Associated with Tooth Loss in General Population of Bialystok, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042369. [PMID: 35206557 PMCID: PMC8872086 DOI: 10.3390/ijerph19042369] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 01/23/2023]
Abstract
Background: The aim of this study was to assess risk factors for tooth loss in the population of the city of Bialystok, in north-eastern Poland, taking into account the entire population and different age groups. The study included 1138 subjects divided into three subgroups: 20–44 years, 45–64 years, and 65–79 years. Participants were classified according to the number of teeth lost (0–8 vs. 9–28). Socio-economic variables, smoking history, and dental habits were collected through a questionnaire. Medical examinations provided data on the body mass index and the fasting blood glucose level. Data were statistically analysed using Mann-Whitney U, Student’s t, chi2 tests, and binary logistic regression, p < 0.05. Results: For the general population, being female (OR 1.38, 1.07–1.79, p = 0.015), having secondary education (OR 4.18, Cl 2.97–5.87, p < 0.000), higher body mass index (OR 1.13, Cl 1.10–1.17, p < 0.000), higher fasting blood glucose level (OR 1.03 1.03–1.04, p < 0.000), being former smoker (OR 1.72, Cl 1.29–2.31, p < 0.000), ever smoker (OR 1.69, Cl 1.29–2.20, p < 0.000), current smoker (OR 1.62, Cl 1.15–2.29, p < 0.006), longer smoking period (OR 1.11, Cl 1.09–1.14, p < 0.000), last visit to the dentist over a year ago (OR 1.92, Cl 0.44–2.58, p < 0.000) and tooth brushing less than two times a day (OR 1.6, Cl 1.14–2.23, p < 0.006) were associated with losing more than 8 teeth. In the subgroup aged 20–44 years, only smoking duration was a risk factor for tooth loss (p = 0.02). For the middle-aged and oldest groups, education level (respectively p < 0.001, and p = 0.001), body mass index (respectively, p < 0.001, and p = 0.037), smoking status ever/former/current (respectively p < 0.001 and p = 0.002), smoking status never/ever (respectively p < 0.001 and p = 0.009), smoking duration (p < 0.001) were related to tooth loss. Additionally, in the elderly group, fasting blood glucose level (p = 0.044) and frequency of dental visits (p = 0.007) were related to tooth loss. We concluded that in the evaluated population, tooth loss was associated with socio-demographic, medical, and behavioural factors.
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Weijdijk LPM, Ziukaite L, Van der Weijden GA(F, Bakker EWP, Slot DE. The risk of tooth loss in patients with diabetes: A systematic review and meta-analysis. Int J Dent Hyg 2022; 20:145-166. [PMID: 33973353 PMCID: PMC9291053 DOI: 10.1111/idh.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/09/2021] [Accepted: 05/05/2021] [Indexed: 01/02/2023]
Abstract
AIM The aim of this systematic review was to comprehensively and critically summarize and synthesize the risk of losing teeth among with diabetes mellitus (DM) compared to those without DM, as established in observational studies. MATERIALS AND METHODS MEDLINE-PubMed and Cochrane databases were searched through a period from their inception through October 2020 to identify eligible studies. Papers that primarily evaluate the number of teeth in DM patients compared to non-DM individuals were included. A descriptive analysis of the selected studies was conducted, and when feasible, a meta-analysis was performed. The quality of the studies was assessed. RESULTS A total of 1087 references were generated, and screening of the papers resulted in 10 eligible publications. A descriptive analysis demonstrated that six of these studies indicate a significantly higher risk of tooth loss in DM patients. This was confirmed by the meta-analysis risk ratio of 1.63 95% CI (1.33; 2.00, p < 0.00001). Subgroup analysis illustrates that this is irrespective of the risk-of-bias assessment. The higher risk of tooth loss in DM patients was also higher when only DM type II patients or studies with a cross-sectional design were considered. Patients with a poor DM control status presented a significantly increased risk of tooth loss. When the data were separated by the world continent where the study was performed, Asia and South America had numerically higher risks and a 95% CI that did not overlap with Europe and North America. CONCLUSION There is moderate certainty for a small but significantly higher risk of tooth loss in DM patients as compared to those without DM.
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Affiliation(s)
- Lotte P. M. Weijdijk
- Department of Oral and Maxillofacial SurgeryAmsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Clinic for DentistryDental Care Utrecht (DCU)UtrechtThe Netherlands
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Laura Ziukaite
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - G. A. (Fridus) Van der Weijden
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eric W. P. Bakker
- Division Clinical Methods and Public Health Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dagmar Else Slot
- Department of PeriodontologyAcademic Center for Dentistry Amsterdam (ACTA)ACTA is a joint venture between the Faculty of Dentistry of the University of Amsterdam and the Faculty of Dentistry of the Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Jacob L, Shin JI, Oh H, López-Sánchez GF, Smith L, Haro JM, Koyanagi A. Association between diabetes and edentulism and their joint effects on health status in 40 low and middle-income countries. BMJ Open Diabetes Res Care 2021; 9:9/1/e002514. [PMID: 34620622 PMCID: PMC8499266 DOI: 10.1136/bmjdrc-2021-002514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/26/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Previous studies on the diabetes-edentulism relationship have yielded conflicting results. Therefore, the goal of this study was to investigate the association between diabetes and edentulism, and their joint effects on health status in adults from 40 low and middle-income countries (LMICs). RESEARCH DESIGN AND METHODS Data from the World Health Survey were used for this cross-sectional study (2002-2004). Forty countries (18 low-income and 22 middle-income countries) were included. Edentulism and diabetes were assessed using yes-no questions based on self-report. Health status was assessed in seven different domains (self-care, pain/discomfort, cognition, interpersonal activities, sleep/energy, affect, and perceived stress). The association between diabetes (exposure) and edentulism (outcome) was analyzed using multivariable logistic regression models, while their joint effects on health status were assessed using multivariable linear regression models. RESULTS There were 175 814 adults aged ≥18 years included in this study (mean (SD) age 38.4 (16.0) years; 49.3% men). Overall, the prevalence of edentulism was 6.0% and diabetes was 2.9%. There was a positive and significant association between diabetes and edentulism in the overall sample (OR=1.40, 95% CI 1.18 to 1.66), in low-income countries (OR=1.78, 95% CI 1.21 to 2.62) and in middle-income countries (OR=1.24, 95% CI 1.04 to 1.47). In addition, people with comorbid diabetes and edentulism had worse health status in the domains of cognition, sleep/energy, and perceived stress, compared with those with diabetes only. CONCLUSIONS Diabetes was positively associated with edentulism in this sample of more than 175 000 individuals living in LMICs. Providing oral care to individuals with diabetes may potentially lead to a reduction in their risk of edentulism.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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Suzuki S, Sugihara N, Kamijo H, Morita M, Kawato T, Tsuneishi M, Kobayashi K, Hasuike Y, Sato T. Self-Reported Diabetes Mellitus and Tooth Extraction Due to Periodontal Disease and Dental Caries in the Japanese Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179024. [PMID: 34501613 PMCID: PMC8430558 DOI: 10.3390/ijerph18179024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
Diabetes mellitus is closely related to oral health. We aimed to determine the relationship between diabetes mellitus and tooth extraction due to periodontal disease and dental caries. Japan’s second nationwide survey data collected from 4 June to 10 June 2018 was used to identify reasons for tooth extraction among patients aged > 40 years. General dentists collected information on patients who underwent tooth extraction procedures, and the presence of diabetes mellitus was determined through interviews. Multivariable logistic regression was performed to investigate the relationship between diabetes mellitus and the reasons for tooth extraction, including periodontal disease and dental caries. In total, 2345 dentists responded to the survey (response rate 44.8%). We analyzed data on 4625 extracted teeth from 3750 patients (1815 males and 1935 females). Among patients with self-reported diabetes mellitus, 55.4% had extractions due to periodontal disease compared to 46.7% of such extractions among those without self-reported diabetes mellitus. Self-reported diabetes mellitus was significantly associated with tooth extraction due to periodontal disease. No significant differences were observed in dental caries according to self-reported diabetes mellitus status. This study provides further evidence of a significant association between diabetes mellitus and tooth extraction due to periodontal disease.
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Affiliation(s)
- Seitaro Suzuki
- Department of Epidemiology and Public Health, Tokyo Dental College, Kanda-Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan;
- Correspondence: ; Tel.: +81-3-6380-9272; Fax: +81-3-6380-9606
| | - Naoki Sugihara
- Department of Epidemiology and Public Health, Tokyo Dental College, Kanda-Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan;
| | - Hideyuki Kamijo
- Department of Social Security for Dentistry, Tokyo Dental College, Kanda-Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan;
- 8020 Promotion Foundation, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan; (M.T.); (K.K.); (Y.H.); (T.S.)
| | - Manabu Morita
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho, Kita-ku, Okayama 700-8530, Japan;
| | - Takayuki Kawato
- Department of Oral Health Sciences, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan;
| | - Midori Tsuneishi
- 8020 Promotion Foundation, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan; (M.T.); (K.K.); (Y.H.); (T.S.)
- Japan Dental Association Research Institute, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan
| | - Keita Kobayashi
- 8020 Promotion Foundation, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan; (M.T.); (K.K.); (Y.H.); (T.S.)
| | - Yoshihiro Hasuike
- 8020 Promotion Foundation, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan; (M.T.); (K.K.); (Y.H.); (T.S.)
- Japan Dental Association, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan
| | - Tamotsu Sato
- 8020 Promotion Foundation, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan; (M.T.); (K.K.); (Y.H.); (T.S.)
- Japan Dental Association, 4-1-20 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan
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Parolini F, Biancalana E, Rossi C, Raggi F, Mengozzi A, Solini A. Clinical and epigenetic determinants of edentulism in type 2 diabetic subjects referring to a tertiary center. J Diabetes Complications 2021; 35:107910. [PMID: 33757716 DOI: 10.1016/j.jdiacomp.2021.107910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/12/2021] [Accepted: 03/09/2021] [Indexed: 12/21/2022]
Abstract
AIMS Edentulism, extreme consequence of severe periodontitis, carries a high cardiovascular and all-cause death risk. The prevailing phenotype of edentulous patients with type 2 diabetes (T2D) has never been defined, neither it is known whether an epigenetic signature of such condition exists. METHODS We collected clinical and biochemical data and administered a questionnaire on oral health in 248 consecutive T2D individuals. Vital status was checked after 17 ± 7 months. miRNAs involved in periodontal inflammation were measured. RESULTS Forty-seven patients (19%) were edentulous (ED), a higher prevalence than in the Italian general population (10.9% from ISTAT data). ED were older, with low level of instruction and higher fasting glucose vs not edentulous (noED). Participants displayed a scarce awareness of the association periodontitis-T2D. ED showed a specific epigenetic signature (lower miR214-5p and higher miR126-5p urinary levels). At the follow-up, metabolic profile similarly improved in ED and noED; death occurrence was similar. CONCLUSIONS In this cohort of T2D, age is the only variable associated with edentulism; such condition displays an epigenetic signature, independent of the clinical phenotype; awareness of the clinical relevance and implications of periodontitis and edentulism are scarce. However, edentulism does not mark an increased rate of micro-macrovascular complications or mortality.
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Affiliation(s)
- Federico Parolini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Edoardo Biancalana
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Rossi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | - Francesco Raggi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy
| | | | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy.
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Number of Remaining Teeth and Its Association with Educational Level in Chilean Adults: Data from the National Health Survey 2016-2017. Int J Dent 2020; 2020:8848190. [PMID: 32934655 PMCID: PMC7479467 DOI: 10.1155/2020/8848190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/09/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Several population studies have addressed oral health inequalities. Edentulism, functional dentition, and number of remaining teeth have been associated with different socioeconomic level measurements. The aim of this study was to evaluate the association between educational level and tooth loss in the Chilean population aged 15 years and above, based on the 2016-2017 National Health Survey (ENS 2016-2017). Material and Methods. The sample for this cross-sectional study comprised 5473 subjects. The main independent variable was educational level (LEL: low, MEL: medium, and HEL: high). To measure tooth loss, we considered the variables number of remaining teeth, edentulism, and functional dentition. We used logistic regressions to assess the condition of dentition according to the subject's EL. As to the number of teeth variable, linear regressions were conducted. The analyses were carried out considering the complex sampling design in SPSS 24.0. Results When comparing LEL subjects with HEL subjects, the adjusted difference in number of remaining teeth was 3.11 for the maxilla and 1.72 for the mandible. An individual with LEL had a 7.51 [3.50-16.10] and 6.06 [2.68-13.68] times higher risk of upper edentulism and lower edentulism than a HEL individual, respectively. Regarding functional dentition, the adjusted OR in HEL subjects was 13.33 [8.02-22.15] and in MEL subjects was 2.81 [2.03-3.87], compared to LEL results. Conclusions LEL was associated with a significant tooth loss in the Chilean population. Subjects with LEL obtained a lower mean of number of remaining teeth and higher prevalence of edentulism and nonfunctional dentition.
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11
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Suzuki S, Noda T, Nishioka Y, Imamura T, Kamijo H, Sugihara N. Evaluation of tooth loss among patients with diabetes mellitus using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Int Dent J 2020; 70:308-315. [PMID: 32103503 DOI: 10.1111/idj.12561] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/01/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although diabetes mellitus is reported to be related to tooth loss, there is limited population-based evidence for this relationship. We investigated the actual situation of tooth loss by performing a population-based survey using information obtained from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) in Japan. METHODS Medical, dental and pharmacy claims data generated between 1 April 2015 and 31 March 2016 were obtained and analysed. Patients with medical and pharmacy claims of diabetes mellitus were allocated to the diabetes mellitus group. Patients with medical claims of acute upper respiratory inflammation, but without claims of diabetes mellitus, were allocated to the control group. The number of claims involving tooth loss, treatment of periodontal disease and visits to medical and dental institutions were obtained from the NDB. Descriptive statistics were used to compare the nature of tooth loss between patients with diabetes mellitus and the control groups. RESULTS There were 5,248,405 patients in the control group and 1,570,082 patients in the diabetes mellitus group. Patients in the diabetes mellitus group showed a higher level of tooth loss than patients in the control group, among both sexes. Patients with diabetes mellitus tended to lose their posterior teeth at an earlier age than patients in the control group. Moreover, patients in the diabetes mellitus group showed greater tooth loss, regardless of whether or not periodontal disease was treated. CONCLUSION Patients with diabetes mellitus show a higher level of tooth loss than those without diabetes mellitus, based on the results of a population-based survey.
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Affiliation(s)
- Seitaro Suzuki
- Department of Epidemiology and Public Health, Tokyo Dental College, Tokyo, Japan
| | - Tatsuya Noda
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Yuichi Nishioka
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Japan.,Department of Diabetes and Endocrine Medicine, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Heath, Health Management and Policy, Nara Medical University, Kashihara, Japan
| | - Hideyuki Kamijo
- Department of Social Security for Dentistry, Tokyo Dental College, Tokyo, Japan
| | - Naoki Sugihara
- Department of Epidemiology and Public Health, Tokyo Dental College, Tokyo, Japan
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12
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Wang X, Wang H, Zhang T, Cai L, Kong C, He J. Current Knowledge Regarding the Interaction Between Oral Bone Metabolic Disorders and Diabetes Mellitus. Front Endocrinol (Lausanne) 2020; 11:536. [PMID: 32903738 PMCID: PMC7438828 DOI: 10.3389/fendo.2020.00536] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 07/01/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus, a major chronic disease affecting human health, has been increasing in prevalence in recent years. Diabetes mellitus can cause bone metabolic disorders in patients, leading to osteoporosis, a higher risk of traumatic fracture, and other bone diseases. Bone metabolic disorders in the oral cavity principally manifest as periodontitis, loss of alveolar bone, and failure of implant osseointegration. In recent years, numerous studies have shown that there is a complex interaction between bone metabolic disorders and diabetes mellitus. This paper reviews the adverse effects of diabetes on oral bone metabolism disorders such as alveolar osteoporosis and bone loss in patients with periodontitis, discusses the potential mechanisms of diabetic bone loss, and suggests potential ways to prevent and treat oral bone loss in patients with diabetes mellitus.
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Affiliation(s)
- Xiaofeng Wang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Pediatrics, Pediatric Research Institute, The University of Louisville School of Medicine, Louisville, KY, United States
| | - Huiyu Wang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tianfu Zhang
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lu Cai
- Department of Pediatrics, Pediatric Research Institute, The University of Louisville School of Medicine, Louisville, KY, United States
- Departments of Radiation Oncology, Pharmacology, and Toxicology, University of Louisville, Louisville, KY, United States
| | - Chenfei Kong
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Chenfei Kong
| | - Jinting He
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
- Jinting He
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Northridge ME, Chakraborty B, Salehabadi SM, Metcalf SS, Kunzel C, Greenblatt AP, Borrell LN, Cheng B, Marshall SE, Lamster IB. Does Medicaid Coverage Modify the Relationship between Glycemic Status and Teeth Present in Older Adults? J Health Care Poor Underserved 2019; 29:1509-1528. [PMID: 30449760 DOI: 10.1353/hpu.2018.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Understanding the relationships among diabetes, teeth present, and dental insurance is essential to improving primary and oral health care. Participants were older adults who attended senior centers in northern Manhattan (New York, N.Y.). Sociodemographic, health, and health care information were obtained via intake interviews, number of teeth present via clinical dental examinations, and glycemic status via measurement of glycosylated hemoglobin (HbA1c). Complete data on dental insurance coverage status for 785 participants were available for analysis (1,015 after multiple imputation). For participants with no dental insurance and any private/other dental insurance, number of teeth present is less for participants with diabetes than for participants without diabetes; however, for participants with Medicaid coverage only, the relationship is reversed. Potential explanations include the limited range of dental services covered under the Medicaid program, inadequate diabetes screening and monitoring of Medicaid recipients, and the poor oral and general health of Medicaid recipients.
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Yoo JJ, Kim DW, Kim MY, Kim YT, Yoon JH. The effect of diabetes on tooth loss caused by periodontal disease: A nationwide population-based cohort study in South Korea. J Periodontol 2019; 90:576-583. [PMID: 30548930 DOI: 10.1002/jper.18-0480] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/11/2018] [Accepted: 12/06/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Our purpose was to compare the risk of tooth loss caused by periodontal disease between diabetic and nondiabetic individuals and to estimate the relative risk of tooth loss according to the severity and control of diabetes. METHODS We selected 10,215 individuals who were diagnosed as diabetics in the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in 2003 and the same number of individuals who had never been diagnosed with diabetes during the period covered by the NHIS-NSC (2002-2013) with propensity score matching. Diabetic individuals were divided into two groups according to the treatment modality. We counted the number of teeth lost in each group to determine the difference in the risk of tooth loss among groups and used the Cox proportional hazards model to calculate hazard ratios (HRs) of tooth loss caused by periodontitis. RESULTS Diabetic individuals had a higher risk of tooth loss than nondiabetic individuals (HR = 1.298, 95% confidence interval [CI]: 1.233 ≤ HR ≤ 1.366; P < 0.01). The severer the degree of diabetes, the higher the risk of tooth loss. As the number of dental visits increased, the risk of tooth loss declined (HR = 0.998, 95% CI: 0.996 ≤ HR ≤ 0.999; P < 0.01). CONCLUSIONS Within the limits of this retrospective cohort study, the risk of tooth loss among diabetic individuals was higher than that among nondiabetic individuals. The risk of tooth loss declined with increasing numbers of dental visits and increased with the severity of diabetes.
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Affiliation(s)
- Jin-Joo Yoo
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Dong-Wook Kim
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Man-Yong Kim
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Young-Taek Kim
- Department of Periodontology, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Joon-Ho Yoon
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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Saito M, Shimazaki Y, Nonoyama T, Tadokoro Y. Associations of number of teeth with medical costs and hospitalization duration in an older Japanese population. Geriatr Gerontol Int 2019; 19:335-341. [PMID: 30761710 DOI: 10.1111/ggi.13622] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 12/23/2022]
Abstract
AIM Many studies have reported close relationships between oral and systemic health. We explored the association of the number of remaining teeth with medical costs and hospitalization duration in people aged 75 and 80 years. METHODS Oral health examinations were carried out at dental clinics in 2014. Medical cost and hospitalization duration data for fiscal year 2015 were obtained from the Mie Prefecture health insurer. We analyzed the data of 4700 individuals who met our inclusion criteria: 2745 75-year-olds and 1955 80-year-olds. The effects of remaining tooth numbers on medical costs and hospitalization days were analyzed using a generalized linear model with log link adjustment for confounders. RESULTS Total medical costs for all diseases were significantly higher in those with 20-27, 10-19 and 1-9 teeth, and in edentulous older individuals, compared with those with 28 teeth. Outpatient medical costs for diabetes were significantly higher in those with 20-27 and 1-9 teeth. Inpatient medical costs for digestive cancers were significantly higher in those with 10-19 and 1-9 teeth, and in edentulous older individuals. Hospitalization for digestive cancer was significantly longer in those with 20-27, 10-19 and 1-9 teeth, and in edentulous older individuals, than in those with 28 teeth. The number of teeth as a continuous variable was significantly inversely associated with medical costs for cerebrovascular disease and digestive cancer, and hospitalization days for digestive cancer. CONCLUSION Small numbers of teeth were associated with higher medical costs and longer hospital stays for older Japanese. Geriatr Gerontol Int 2019; 19: 335-341.
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Affiliation(s)
- Mizuki Saito
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Toshiya Nonoyama
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Number of remaining teeth and its association with socioeconomic status in South Korean adults: Data from the Korean National Health and Nutrition Examination Survey 2012-2013. PLoS One 2018; 13:e0196594. [PMID: 29746489 PMCID: PMC5945020 DOI: 10.1371/journal.pone.0196594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/16/2018] [Indexed: 02/08/2023] Open
Abstract
Background Socioeconomic status (SES) is associated with systemic disease and influences oral and general health. Several studies have found inequalities associated with oral health and SES. We examined the relationship between tooth loss and SES in Korean adults using data from the 2012–2013 Korean National Health and Nutrition Examination Survey. Methods: A total of 7,005 participants were included in this study. Subjects were divided into two groups depending on their total number of natural teeth: <20 and ≥20. Next, participants were divided into quartiles depending on household income and educational level. Multivariate logistic regression was used to obtain odds ratios (OR) for remaining teeth according to income and education levels. Results As income and education levels increased, subjects were more likely to have ≥20 remaining teeth (p-value and p-value for trend <0.001), brush their teeth more than three times per day, use extra oral products, and have regular oral-health checkups (all p<0.001). The odds of having ≥20 remaining teeth increased with increases in income and education, after adjusting for all covariates (OR = 1.493 for income Q3, OR = 1.571 for income Q4; OR = 1.763 for 10–12 years education, OR = 2.189 for ≥13years education). Conclusion Subjects with higher SES had more remaining teeth than subjects with lower SES. Preserving remaining teeth should be encouraged in subjects with low SES by promoting good oral-health behavior and encouraging more oral-health checkups.
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Taboza ZA, Costa KL, Silveira VR, Furlaneto FA, Montenegro R, Russell S, Dasanayake A, Rego RO. Periodontitis, edentulism and glycemic control in patients with type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 2018; 6:e000453. [PMID: 29607049 PMCID: PMC5873546 DOI: 10.1136/bmjdrc-2017-000453] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To compare the glycemic control in non-smoking patients with type 2 diabetes according to their periodontal and dental status. RESEARCH DESIGN AND METHODS This cross-sectional study investigated patients previously diagnosed with type 2 diabetes and under antidiabetic medication. Clinical data and fasting blood glucose (FBG) levels were collected from medical and dental records. Patients were divided into three groups according to dental and periodontal diagnosis: no or mild periodontitis (NO/MILD, n=96), moderate or severe periodontitis (MOD/SEV, n=74) and edentulous (n=141). FBG levels were compared between groups. Logistic regression was also applied to estimate the OR of presenting hyperglycemia. RESULTS Edentulous patients had significantly higher FBG levels of 155.7±70.9 (mean±SD mg/dL) than those in the MOD/SEV (136.6±33.8) and the NO/MILD (123.1±36.7) groups. Differences between the latter two groups were also significant. Edentulous patients had adjusted ORs of 4.53, 4.27 and 3.95 of having FBG≥126, ≥150 and ≥180 mg/dL, respectively, in comparison with NO/MILD group. The MOD/SEV group also presented significant odds of having FBG≥126 mg/dL (OR=2.66) and ≥150 mg/dL (OR=2.45) than the NO/MILD group. CONCLUSIONS Patients in the MOD/SEV group had worse glycemic control than the ones in the NO/MILD group. However, edentulous patients presented higher glycemic levels than both dentate groups, and also presented with higher odds of having hyperglycemia.
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Affiliation(s)
- Zuila Albuquerque Taboza
- Department of Clinical Dentistry, Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | - Katia Linhares Costa
- Department of Clinical Dentistry, Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | - Virginia Régia Silveira
- Division of Periodontics, Department of Dentistry, School of Dentistry at Sobral, Federal University of Ceara, Sobral, Ceará, Brazil
| | - Flavia Aparecida Furlaneto
- Department of Surgery and Bucco-Maxillofacial Traumatology and Periodontology, School of Dentistry at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Renan Montenegro
- Department of Community Health, Faculty of Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | - Stefanie Russell
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York City, New York, USA
| | - Ananda Dasanayake
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York City, New York, USA
| | - Rodrigo O Rego
- Division of Periodontics, Department of Dentistry, School of Dentistry at Sobral, Federal University of Ceara, Sobral, Ceará, Brazil
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York City, New York, USA
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