Social factors and periodontitis in an older population

Regression with race-modifiers: towards equity and interpretability

The pervasive effects of structural racism and racial discrimination are well-established and offer strong evidence that the effects of many important variables on health and life outcomes vary by race. Alarmingly, standard practices for statistical regression analysis introduce racial biases into the estimation and presentation of these race-modified effects. We advocate abundance-based constraints (ABCs) to eliminate these racial biases. ABCs offer a remarkable invariance property: estimates and inference for main effects are nearly unchanged by the inclusion of race-modifiers. Thus, quantitative researchers can estimate race-specific effects "for free"-without sacrificing parameter interpretability, equitability, or statistical efficiency. The benefits extend to prominent statistical learning techniques, especially regularization and selection. We leverage these tools to estimate the joint effects of environmental, social, and other factors on 4th end-of-grade readings scores for students in North Carolina ( n = 27, 638) and identify race-modified effects for racial (residential) isolation, PM 2.5 exposure, and mother's age at birth.

Regression with race-modifiers: towards equity and interpretability

The pervasive effects of structural racism and racial discrimination are well-established and offer strong evidence that the effects of many important variables on health and life outcomes vary by race. Alarmingly, standard practices for statistical regression analysis introduce racial biases into the estimation and presentation of these race-modified effects. We introduce abundance-based constraints (ABCs) to eliminate these racial biases. ABCs offer a remarkable invariance property: estimates and inference for main effects are nearly unchanged by the inclusion of race-modifiers. Thus, quantitative researchers can estimate race-specific effects "for free"-without sacrificing parameter interpretability, equitability, or statistical efficiency. The benefits extend to prominent statistical learning techniques, especially regularization and selection. We leverage these tools to estimate the joint effects of environmental, social, and other factors on 4th end-of-grade readings scores for students in North Carolina (n = 27, 638) and identify race-modified effects for racial (residential) isolation, PM2.5 exposure, and mother's age at birth.

Polymorphism of salivary proteins and risk of periodontal diseases: A systematic review and meta-analysis of clinical studies

OBJECTIVES

The present systematic review and meta-analysis aimed to assess the association between salivary protein polymorphisms and the risk of periodontal diseases (PD).

DATA

The review incorporated cross-sectional, case-control, retrospective/prospective cohort, and randomized controlled trials assessing the influence of salivary protein polymorphisms on the risk of PD development were included in this review.

SOURCES

A thorough literature search was conducted across electronic databases, namely PubMed, Scopus, Embase, and Web of Science, without any restrictions on publication language and year.

STUDY SELECTION

A total of 168 studies were identified, of which 19 were eligible for inclusion. The risk of bias (RoB) assessment of the included studies was conducted at the methodological level.

RESULTS

A total of 16 studies were included. Polymorphism in the gene encoding TNF-α was found to be protective against gingivitis, while those encoding IL-1α and IL-1β were associated with developing gingivitis. Of the 42 proteins investigated, various gene polymorphisms were identified as protective or risk factors for periodontitis. Protective genes include CFH, DNMT1, OPRM1, and TLR9. Conversely, certain salivary protein genes (e.g., CRP, ERN1, FAM5C, IDH2, LTA, TET2, MPA, NLRP3, TLR4) were associated with periodontitis risk. Notably, IL6, MMP9, and MUC7 genes showed no association with PD, while MMP13 was linked to early implant loss. Overall, the meta-analysis found a statistically significant association between salivary proteins' polymorphisms and risk of PD.

CONCLUSIONS

Salivary protein polymorphisms significantly influence PD, revealing protective and risk-associated genotypes. Despite limitations, findings suggest therapeutic targets, emphasizing the complex genetics-periodontal health interplay.

CLINICAL SIGNIFICANCE

This study unveils salivary protein polymorphisms as pivotal factors in PD. Protective genes including CFH and TLR9, and risk-associated genes including CRP and TLR4, indicate a genetic basis for PD susceptibility.

Epidemiological and sociodemographic transitions of severe periodontitis incidence, prevalence, and disability-adjusted life years for 21 world regions and globally from 1990 to 2019: An age-period-cohort analysis

BACKGROUND

Severe periodontitis is one of the most prevalent diseases and a global public health problem due to its high incidence and prevalence. However, there are few studies on the burden of periodontitis in different regions of the world.

METHODS

We extracted data on the incidence, prevalence, and disability-adjusted life years (DALYs) from the Global Burden of Disease study as severe periodontitis burden measures. We also explored the global burden of severe periodontitis according to 21 world regions and Socio-Demographic Index (SDI) quintiles. The joinpoint model was used to analyze temporal trends of major regions from 1990 to 2019, and the age-period-cohort model was used to estimate age, period, and cohort trends in severe periodontitis.

RESULTS

Globally, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and disability-adjusted life years (DALYs) rate increased from 1990 to 2019 (percentage change: 5.77%, 7.78%, and 8.01%, respectively), with average annual percent changes of 0.2%, 0.3%, and 0.3%, respectively. The region with the highest DALY rate was western sub-Saharan Africa with a value of 142.5 (95% uncertainty interval: 56.3, 303.7) per 100,000 in 2019. For the ASIR, ASPR, and DALY, the age effect of severe periodontitis showed an increase followed by a decrease, the period effect showed an upward trend, the cohort effect showed an overall decreasing trend, and the cohort relative risk for incidence for some SDI quintiles showed a slight increase in recent years.

CONCLUSIONS

Oral health varies significantly across regions, and it is essential to address inequalities in oral health between countries. Effective measures to prevent severe periodontitis risk factors should also be taken in regions with low SDI.

Threshold-effect of income on periodontitis and interactions with race/ethnicity and education

OBJECTIVES

The aims of this study were to explore the shape of the relationship of income and education with periodontal health, and to assess the interactions between them and race/ethnicity.

METHOD

Individual level data from the Brazilian National Oral Health Survey in 2010 (Pesquisa Nacional de Saúde Bucal-SB Brasil 2010) were obtained for 9,779 subjects. Relations between per capita income and education with periodontal health were smoothed using Locally Weighted Scatter-plot Smoother (Lowess) technique. Multivariable logistic regression was used to assess independent effects of income, education, race/ethnicity adjusted for age, sex and time since last dental appointment.

RESULTS

Prevalence of adults with moderate to severe and severe periodontitis was 17.6 and 6.5%, respectively. The relationship between periodontal health and income was curvilinear, showing a threshold of no relationship for income levels higher than US$ 600/month. In multivariable analysis, after controlling for covariates, only income was significantly associated with periodontal health. There was no significant interaction of income with race or education, neither between race and education.

CONCLUSION

The relation between periodontal health and income was curvilinear and indicated the presence of a threshold, supporting income transfer programs. Beyond the threshold, only education presented a negative linear relationship with moderate to severe periodontitis.