1
|
Champaiboon C, Ongphichetmetha N, Lertpimonchai A. Bioactive glass and arginine dentifrices reduce root sensitivity during daily activities following non-surgical periodontal therapy: A randomized controlled trial. J Periodontol 2024; 95:135-145. [PMID: 37475476 DOI: 10.1002/jper.23-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Evidence on the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on reducing root sensitivity (RS) following non-surgical periodontal therapy (NSPT) is limited. The aim of this study was to compare the efficacy of these dentifrices in reducing RS during daily activities in patients undergoing NSPT. METHODS Using a double-blind randomized controlled trial, CSPS, arginine, or control dentifrices were randomly assigned to 45 RS individuals following NSPT. The participants used the dentifrices 2×/day for 8 weeks. A self-reported visual analog scale (VAS) was assessed during daily activities. RESULTS Self-reported VAS scores were similar among the three groups at each time point. The with-in group analysis revealed that the arginine dentifrice reduced RS from Week 1-8 compared with baseline in response to cold. Similarly, the CSPS dentifrice reduced RS at Week 4 and 8. The CSPS and arginine dentifrices exhibited RS relief resulting from toothbrushing starting at Week 4 and 2, respectively. In response to air, RS relief was observed from Week 4 in the arginine group. The number of patients with VAS > 2 in response to cold declined at Week 2 and 4 in the CSPS and arginine groups, respectively. In response to toothbrushing, only 10% in the test groups still had RS at Week 8. In response to air, the number of RS patients only in the arginine group decreased at Week 4. CONCLUSION The CSPS and arginine dentifrices provided comparable RS relief during daily activities within 2-4 weeks and remained effective up to 8 weeks.
Collapse
Affiliation(s)
- Chantrakorn Champaiboon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Periodontal Disease and Dental Implants, Chulalongkorn University, Bangkok, Thailand
| | | | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Periodontal Disease and Dental Implants, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
2
|
Khunthananithi P, Lertpimonchai A, Sritara C, Srithanyarat SS, Thienpramuk L, Mongkornkarn S. Decreased bone mineral density is associated with an increased number of teeth with periodontitis progression: a 5-year retrospective cohort study. Clin Oral Investig 2023; 28:51. [PMID: 38153562 PMCID: PMC10754725 DOI: 10.1007/s00784-023-05463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Longitudinal studies on the systemic bone loss-periodontitis relationship are limited with disparate results. The aim of this study was to investigate the association between bone mineral density (BMD) and periodontitis progression, controlling for other covariables in a Thai population. MATERIALS AND METHODS In 2,418 participants, BMD values of the lumbar spine, femoral neck, and total hip were measured with dual-energy X-ray absorptiometry at baseline. Each participant's BMD status was classified as normal, osteopenia, or osteoporosis. Full mouth periodontal examinations on 6 sites/tooth were performed at baseline and 5-year follow-up visits. Periodontitis progression was defined as a tooth presenting an additional proximal CAL loss of ≥ 3 mm or an additional lost tooth with a baseline CAL ≥ 5 mm. The risk effects of BMD status on the number of teeth with periodontitis progression were analyzed using multivariate Poisson regression. RESULTS Baseline BMD status of osteoporosis was associated with an increased number of teeth with periodontitis progression in the subgroups of postmenopausal women, non-smokers, and participants with periodontitis stage III/IV with adjusted risk ratios of 1.31 (95% CI = 1.09-1.58), 1.19 (95% CI = 1.04-1.36), and 1.13 (95% CI = 1.00-1.28), respectively. CONCLUSION Baseline BMD in the osteoporosis range increased the risk of having a greater number of teeth with periodontitis progression in specific participant subgroups. CLINICAL RELEVANCE Decreased BMD is a potential factor affecting periodontitis progression risk in some individuals. Multidisciplinary approaches in educating and maintaining patients' bone-oral health may help improve their quality of life.
Collapse
Affiliation(s)
- Phanthapha Khunthananithi
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Chanika Sritara
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supreda Suphanantachat Srithanyarat
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Lalitsara Thienpramuk
- Medical and Health Department, Health Division, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | - Sanutm Mongkornkarn
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand.
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
3
|
Teza H, Pattanateepapon A, Lertpimonchai A, Vathesatogkit P, J McKay G, Attia J, Thakkinstian A. Development of Risk Prediction Models for Severe Periodontitis in a Thai Population: Statistical and Machine Learning Approaches. JMIR Form Res 2023; 7:e48351. [PMID: 38096008 PMCID: PMC10755655 DOI: 10.2196/48351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Severe periodontitis affects 26% of Thai adults and 11.2% of adults globally and is characterized by the loss of alveolar bone height. Full-mouth examination by periodontal probing is the gold standard for diagnosis but is time- and resource-intensive. A screening model to identify those at high risk of severe periodontitis would offer a targeted approach and aid in reducing the workload for dentists. While statistical modelling by a logistic regression is commonly applied, optimal performance depends on feature selections and engineering. Machine learning has been recently gaining favor given its potential discriminatory power and ability to deal with multiway interactions without the requirements of linear assumptions. OBJECTIVE We aim to compare the performance of screening models developed using statistical and machine learning approaches for the risk prediction of severe periodontitis. METHODS This study used data from the prospective Electricity Generating Authority of Thailand cohort. Dental examinations were performed for the 2008 and 2013 surveys. Oral examinations (ie, number of teeth and oral hygiene index and plaque scores), periodontal pocket depth, and gingival recession were performed by dentists. The outcome of interest was severe periodontitis diagnosed by the Centre for Disease Control-American Academy of Periodontology, defined as 2 or more interproximal sites with a clinical attachment level ≥6 mm (on different teeth) and 1 or more interproximal sites with a periodontal pocket depth ≥5 mm. Risk prediction models were developed using mixed-effects logistic regression (MELR), recurrent neural network, mixed-effects support vector machine, and mixed-effects decision tree models. A total of 21 features were considered as predictive features, including 4 demographic characteristics, 2 physical examinations, 4 underlying diseases, 1 medication, 2 risk behaviors, 2 oral features, and 6 laboratory features. RESULTS A total of 3883 observations from 2086 participants were split into development (n=3112, 80.1%) and validation (n=771, 19.9%) sets with prevalences of periodontitis of 34.4% (n=1070) and 34.1% (n=263), respectively. The final MELR model contained 6 features (gender, education, smoking, diabetes mellitus, number of teeth, and plaque score) with an area under the curve (AUC) of 0.983 (95% CI 0.977-0.989) and positive likelihood ratio (LR+) of 11.9 (95% CI 8.8-16.3). Machine learning yielded lower performance than the MELR model, with AUC (95% CI) and LR+ (95% CI) values of 0.712 (0.669-0.754) and 2.1 (1.8-2.6), respectively, for the recurrent neural network model; 0.698 (0.681-0.734) and 2.1 (1.7-2.6), respectively, for the mixed-effects support vector machine model; and 0.662 (0.621-0.702) and 2.4 (1.9-3.0), respectively, for the mixed-effects decision tree model. CONCLUSIONS The MELR model might be more useful than machine learning for large-scale screening to identify those at high risk of severe periodontitis for periodontal evaluation. External validation using data from other centers is required to evaluate the generalizability of the model.
Collapse
Affiliation(s)
- Htun Teza
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anuchate Pattanateepapon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Prin Vathesatogkit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gareth J McKay
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - John Attia
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
4
|
Lertpimonchai A, Tuntrakul S, Rattanasiri S, Sutthiboonyapan P, Vathesatogkit P, Udomsak A, Tavedhikul K. Validity of Simple Self-Reported Periodontal Status Questions. Int Dent J 2022; 73:121-127. [PMID: 36460520 PMCID: PMC9875259 DOI: 10.1016/j.identj.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/03/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this research was to evaluate the validity of the questions developed by Thai periodontists on self-reported periodontal status and symptoms in identifying severe periodontitis amongst adults in Thailand. METHODS Registered Electricity Generating Authority of Thailand (EGAT) employees completed medical examinations and full-mouth periodontal examinations. They also were interviewed using a self-reported questionnaire that was developed by Thai periodontists. The questions pertained to their periodontal status and symptoms comprising swollen gums, bad breath, loose teeth, bleeding on brushing, painful gums, and pus or abscesses. The participants were categorised as having nonsevere and severe periodontitis according to the Centers for Disease Control and Prevention in partnership with the American Academy of Periodontology (CDC/AAP) case definitions. Self-reported periodontal status and symptom results were compared with actual periodontal status. The area under the receiver operating characteristic curve (AUROCC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. RESULTS A total of 1393 EGAT employees participated in this study. The questions on self-reported periodontal status and all symptoms poorly identified patients with severe periodontitis, with an AUROCC of 0.52 to 0.60. The sensitivity was 5.0% to 40.2%; however, the specificity was good, at 73.2% to 99.1%. The validity of the self-reported questions was comparable amongst the sex, education, and income subgroups. CONCLUSIONS This study demonstrated that self-reported periodontal status and symptoms were inadequate in identifying patients with severe periodontal disease.
Collapse
Affiliation(s)
- Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Supang Tuntrakul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimchanok Sutthiboonyapan
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Prin Vathesatogkit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Artit Udomsak
- Medical and Health Division, Electric Generation Authority of Thailand, Nonthaburi, Thailand
| | - Kanoknadda Tavedhikul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand,Corresponding author. Kanoknadda Tavedhikul, Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok 10330, Thailand.
| |
Collapse
|
5
|
Pakdeesettakul S, Charatkulangkun O, Lertpimonchai A, Wang HL, Sutthiboonyapan P. Simple flowcharts for periodontal diagnosis based on the 2018 new periodontal classification increased accuracy and clinician confidence in making a periodontal diagnosis: a randomized crossover trial. Clin Oral Investig 2022; 26:7021-7031. [PMID: 35945292 DOI: 10.1007/s00784-022-04662-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the simple flowcharts for practical periodontal diagnosis based on the 2018 new periodontal classification. MATERIALS AND METHODS In this randomized two-period crossover trial, 152 participants assigned a periodontal diagnosis for 25 case scenarios using the flowcharts (test group) and using the consensus reports (control group). Self-confidence questionnaires were completed at the end of each period. Questionnaires about the perception of the flowcharts were completed at the end of the study. The accuracy of the diagnosis, the time used, and participants' confidence in assigning a diagnosis between using the flowcharts and using the consensus reports were compared. RESULTS The mixed model analysis indicated that using the flowcharts was associated with a significant increase in the accuracy of the periodontal diagnosis, compared with using the consensus reports (P = 0.008). After the subgroup analysis, a significant increase in the accuracy of the full diagnosis and the accuracy of periodontal health, gingivitis, and periodontitis identification was seen in only the dental students. The time used for making the diagnosis using flowcharts and using consensus reports was similar. The self-confidence scores significantly increased when using flowcharts for diagnosis. CONCLUSIONS The simple flowcharts are user-friendly tools that can aid clinicians in accurately assigning a periodontal diagnosis and improve clinicians' confidence in assigning a periodontal diagnosis using the new periodontal classification. CLINICAL RELEVANCE The flowcharts can be used for periodontal screening and assigning periodontal diagnosis using the new classification in routine practice.
Collapse
Affiliation(s)
- Suphakan Pakdeesettakul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Orawan Charatkulangkun
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Pathumwan, 10330, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Pathumwan, 10330, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - Pimchanok Sutthiboonyapan
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henry Dunant Rd., Wangmai, Pathumwan, 10330, Bangkok, Thailand. .,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand. .,Center of Excellence in Genomics and Precision Dentistry, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
6
|
Charupinijkul A, Arunyanak S, Rattanasiri S, Vathesatogkit P, Thienpramuk L, Lertpimonchai A. The effect of obesity on periodontitis progression: the 10-year retrospective cohort study. Clin Oral Investig 2021; 26:535-542. [PMID: 34180000 DOI: 10.1007/s00784-021-04031-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/09/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Due to inconsistent findings in limited previous cohort studies, the aim of this study was to estimate the obesity effect on periodontitis progression in Thai adults. MATERIALS AND METHODS This 10-year retrospective cohort study comprised 2216 employees of the Electric Generation Authority of Thailand (EGAT). Their demographic, medical, and periodontal status was collected. Subjects with periodontitis progression were defined as having ≥ 2 teeth with progression. Additional proximal clinical attachment loss ≥ 3 mm or tooth loss with severe periodontitis at baseline were used to identify disease progression at the tooth level. Central obesity was classified using the waist-hip ratio. Multi-level Poisson regression was used to determine the effect of obesity on periodontitis progression by adjusting for age, sex, education, income, smoking, alcohol drinking, exercise, diabetes mellitus, and hypertension. RESULTS The cumulative incidence of periodontitis progression during the 10-year period was 59.6 cases per 100 persons (95% CI: 57.5, 61.6). The univariate analysis indicated that obese subjects had 15% higher risk of progression than that of healthy subjects. However, when confounders were analyzed simultaneously, the effect of obesity was not significant with a risk ratio of 0.98 (95% CI: 0.88, 1.08). CONCLUSIONS Despite the higher incidence of disease progression in the obese, obesity is not an independent risk factor for periodontitis progression. CLINICAL RELEVANCE Obesity and periodontitis progression share many common risk factors. Using the obesity as a preliminary screening for periodontitis progression may be an alternative prevention protocol.
Collapse
Affiliation(s)
- Apinun Charupinijkul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sirikarn Arunyanak
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prin Vathesatogkit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lalitsara Thienpramuk
- Medical and Health Division, Electric Generation Authority of Thailand, Nonthaburi, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. .,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
7
|
Ongphichetmetha N, Lertpimonchai A, Champaiboon C. Bioactive glass and arginine dentifrices immediately relieved dentine hypersensitivity following non-surgical periodontal therapy: A randomized controlled trial. J Periodontol 2021; 93:246-255. [PMID: 34061357 DOI: 10.1002/jper.21-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is no report concerning calcium sodium phosphosilicate (CSPS) and arginine dentifrices in reducing dentine hypersensitivity (DH) in patients undergoing non-surgical periodontal therapy. The aim of the study was to compare the efficacy of a dentifrice containing bioactive glass, 5% CSPS, and 8% arginine dentifrice in relieving DH in patients undergoing non-surgical therapy. METHODS Using a double-blind randomized controlled trial, 45 volunteers with DH following non-surgical therapy were immediately applied with one of three dentifrices containing: 5% CSPS, 8% arginine, or control on DH teeth. The participants then continued to brush twice daily for 8 weeks. DH was assessed using the Schiff cold air sensitivity scale and tactile tests at baseline, immediately after application, and up to 8 weeks. RESULTS The Schiff analysis revealed that the CSPS dentifrice significantly reduced DH immediately and declined through week 8. The arginine group demonstrated reduced DH through week 2. In contrast, DH reduction in the control began later at week 1. The visual analog scale analysis demonstrated that only CSPS had a significantly reduced percentage DH at the immediate, 2, 4, and 8 weeks compared with the baseline. The percentage of patients with DH (Schiff score ≥2) in the CSPS and arginine groups reduced to ≈ 50% after the in-office application. The number of DH patients treated with CSPS then decreased to 9% at the 2-week evaluation. CONCLUSION The CSPS and arginine dentifrices were beneficial in reducing periodontitis patient's discomfort, immediately and in the first 2 weeks following non-surgical periodontal therapy.
Collapse
Affiliation(s)
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implants, Chulalongkorn University, Bangkok, Thailand
| | - Chantrakorn Champaiboon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implants, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
8
|
Suwanprasit W, Lertpimonchai A, Thienpramuk L, Vathesatogkit P, Sritara P, Tamsailom S. Metabolic syndrome and severe periodontitis were associated in Thai adults: A cross-sectional study. J Periodontol 2021; 92:1420-1429. [PMID: 33590483 DOI: 10.1002/jper.20-0651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies support the relationship between metabolic syndrome (MetS) and periodontitis. However, age is the major confounding factor for both conditions. Therefore, this cross-sectional study was performed to investigate the relationship between MetS and severe periodontitis in different Thai adult age groups. METHODS Data on the medical history, medical examination, and full mouth oral examination of 5,690 Electricity Generating Authority of Thailand employees aged 25 to 77 years were collected. The prevalence ratio (PR) between risk variables, MetS, and periodontitis was determined using Poisson regression analysis. Moreover, the subgroup analysis and effect modification by age on severe periodontitis were performed. RESULTS Overall, MetS was significantly associated with severe periodontitis compared with non-severe periodontitis (adjusted PR, 1.11; 95% confidence interval [CI], 1.01 to 1.13). The association was modified by age, with negative effect modification observed on the multiplicative and additive scales. The subgroup analysis revealed a significant relationship between MetS and severe periodontitis only in participants aged <45 years with an adjusted PR of 1.69 (95% CI, 1.29 to 2.21). All MetS components, except hypertension, were associated with severe periodontitis in this group. CONCLUSIONS There is a significant relationship between MetS and severe periodontitis in adults aged <45 years. Therefore, attempts to control the risk of MetS and periodontitis should be emphasized for early adults to reduce the incidence of these conditions and related complications when they become elderly.
Collapse
Affiliation(s)
- Winita Suwanprasit
- Department of Periodontology, Center of Excellent in Periodontal Disease and Dental Implant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Center of Excellent in Periodontal Disease and Dental Implant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Lalitsara Thienpramuk
- Health Division, Medical and Health Department, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | - Prin Vathesatogkit
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyamitr Sritara
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Tamsailom
- Department of Periodontology, Center of Excellent in Periodontal Disease and Dental Implant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
9
|
Tiensripojamarn N, Lertpimonchai A, Tavedhikul K, Udomsak A, Vathesatogkit P, Sritara P, Charatkulangkun O. Periodontitis is associated with cardiovascular diseases: A 13-year study. J Clin Periodontol 2021; 48:348-356. [PMID: 33386631 DOI: 10.1111/jcpe.13418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively evaluate the association between periodontitis and the incidence of cardiovascular diseases (CVDs) in Thai adults. MATERIALS AND METHODS Medical data from the questionnaires and physical examinations of 1850 participants aged 47-73 years from EGAT study were gathered. Random half-mouth periodontal examination of each participant was performed by calibrated periodontists, and periodontal status was defined. The incidence of new CVD events, including coronary heart disease (CHD) and stroke, was verified by cardiologists. The Cox proportional hazard regression model was used to estimate hazard ratios (HRs). RESULTS The prevalence of no/mild, moderate and severe periodontitis in the study participants was 11.7%, 52.7% and 35.6%, respectively. During the 13-year follow-up, CVD events occurred in 110 (5.9%) participants, with 82 (4.4%) from CHD and 28 (1.5%) from stroke. After adjusting for cardiovascular risk factors, a significant association between severe periodontitis and the incidence of CHD was found compared with the no/mild periodontitis group with an HR of 4.53 (95% confidence intervals: 1.08-19.02). However, no significant association was seen when considering total CVD events and stroke outcome. CONCLUSIONS This study demonstrates that severe periodontitis is associated with an increased incidence of CHD, independent of established cardiovascular risk factors.
Collapse
Affiliation(s)
| | - Attawood Lertpimonchai
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Kanoknadda Tavedhikul
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | | | | | - Orawan Charatkulangkun
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
10
|
Champaiboon C, Lertpimonchai A, Lertpimonchai K. Bioactive glass versus Arginine dentifrices on the reduction of dentin permeability and acid tolerance. Clin Exp Dent Res 2020; 7:620-627. [PMID: 33283468 PMCID: PMC8404494 DOI: 10.1002/cre2.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives To compare the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on dentin permeability and acid tolerance. Material and Methods Sixty dentin discs were randomly assigned into 3 groups, then brushed for 1 min with CSPS, arginine, or fluoride (control) dentifrices. To test acid tolerance, each disc was soaked in 6% citric acid for 1 min. Dentin permeability was measured before, following brushing, and acid challenge. Ten discs per group were similarly treated and evaluated for tubule occlusion following a single dentifrice application, while other five discs per group were employed in an acid tolerance assay. Results The percentage reduction in dentin permeability was 39.26%, 32.27%, and 21.71% in the arginine, CSPS, and control groups, respectively. The differences in dentin permeability reduction between the arginine and CSPS groups following brushing and acid challenge were not significant (p = 0.398 and p = 0.211, respectively). The arginine dentifrice demonstrated a significant reduction in permeability compared with the control (p = 0.011). In addition, the occlusion exhibited by the arginine and CSPS dentifrices was more resistant to acid challenge compared with that of the control (p < 0.001). From SEM analysis, dentinal tubule occlusion was observed after a single application in all groups. Some open dentinal tubules were detected in the test groups, while almost all of the orifices were open in the fluoride group following acid challenge. Conclusions There is no significant difference between arginine and CSPS dentifrices in reducing dentin permeability following a single application and acid challenge. Following acid challenge, the reduced permeability generated by arginine and CSPS was more stable compared with the fluoride dentifrice.
Collapse
Affiliation(s)
- Chantrakorn Champaiboon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kullanun Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
11
|
Chansawang K, Lertpimonchai A, Siripaiboonpong N, Thienpramuk L, Vathesatogkit P, Limpijankit T, Charatkulangkun O. The severity and extent of periodontitis is associated with cardio-ankle vascular index, a novel arterial stiffness parameter. Clin Oral Investig 2020; 25:3487-3495. [PMID: 33180188 DOI: 10.1007/s00784-020-03670-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/29/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the association between the severity and extent of periodontitis and arterial stiffness using the cardio-ankle vascular index (CAVI). MATERIALS AND METHODS A cross-sectional study of 2888 Electricity Generation Authority of Thailand (EGAT) employees aged 44-78 years was conducted. The severity of periodontitis was evaluated based on mean clinical attachment level (CAL). The percentage of sites with CAL ≥ 5 mm was used to divide the extent of periodontitis into healthy (0%), localized (> 0-< 30%), and generalized (≥ 30%). The CAVI value, a novel blood pressure-independent arterial stiffness parameter, was analyzed as both continuous and categorical data (low: < 9 or high: ≥ 9). Regression analysis was used to estimate the level of association. RESULTS The participants demonstrated a mean CAL, % sites with CAL ≥ 5 mm, and a CAVI value of 3.2 ± 1.2 mm, 16.0 ± 20.8%, and 8.24 ± 1.12, respectively. Higher mean CAVI was observed with greater mean CAL and % sites with CAL ≥ 5 mm. The mean CAVI of the healthy, localized, and generalized periodontitis groups were 8.01 ± 1.11, 8.22 ± 1.12, and 8.51 ± 1.04, respectively (p < 0.01). Linear and logistic regression analysis demonstrated a significant relationship between CAVI and all periodontal variables with β = 0.004-0.17 and OR = 1.01-1.58, respectively. CONCLUSIONS There is a significant dose-dependent association between the severity and extent of periodontitis and arterial stiffness measured by CAVI in Thai adults. CLINICAL RELEVANCE Preventing arterial stiffness, an early sign of cardiovascular events, by controlling the emerging risk factors, such as periodontitis, might have a high impact on health promotion.
Collapse
Affiliation(s)
- Kansurang Chansawang
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Nisachon Siripaiboonpong
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | | | | | - Orawan Charatkulangkun
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Pathumwan, Bangkok, 10330, Thailand.
- Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, 10330, Thailand.
| |
Collapse
|
12
|
Niramitchainon C, Mongkornkarn S, Sritara C, Lertpimonchai A, Udomsak A. Trabecular bone score, a new bone quality index, is associated with severe periodontitis. J Periodontol 2020; 91:1264-1273. [PMID: 32100286 DOI: 10.1002/jper.19-0580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The association between systemic bone loss and periodontitis remains unresolved; and the trabecular bone score (TBS) is a new index for assessing decreased bone quality. Therefore, this cross-sectional study investigated the association between TBS and severe periodontitis. METHODS Eight hundred and five Thai participants, aged 30 to 82 years, underwent bone quality assessment. Their mean TBS was calculated from dual-energy X-ray absorptiometry images at the L1 to L4 lumbar spine using TBS software. Each participant was classified as normal, partially degraded, or degraded TBS. Full-mouth periodontal examinations determined plaque score, probing depth, clinical attachment level (CAL), and the number of remaining teeth. The participants were classified as non-severe or severe periodontitis. Differences in periodontal parameters between the TBS groups were analyzed using one-way ANOVA. The association between TBS and severe periodontitis was assessed with multivariate binary logistic regression. For severe periodontitis, the additive interaction between TBS and oral hygiene status was also analyzed. RESULTS The mean CAL was 0.9-mm higher in the degraded TBS group compared with the normal TBS group. Degraded TBS was associated with severe periodontitis with an adjusted odds ratio (OR) of 2.10 (95% confidence interval [CI] = 1.03 to 4.26). The combination of degraded TBS and plaque score ≥80% increased the adjusted OR to 5.71 (95% CI = 1.15 to 28.43). CONCLUSIONS Degraded TBS is associated with severe periodontitis and has a synergistic effect with poor oral hygiene, suggesting monitoring decreased bone quality and good oral hygiene for promoting the periodontal-systemic health of these individuals.
Collapse
Affiliation(s)
- Chutinun Niramitchainon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sanutm Mongkornkarn
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chanika Sritara
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Medical and Health Department, Health Division, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| |
Collapse
|
13
|
Lertpimonchai A, Rattanasiri S, Tamsailom S, Champaiboon C, Ingsathit A, Kitiyakara C, Limpianunchai A, Attia J, Sritara P, Thakkinstian A. Periodontitis as the risk factor of chronic kidney disease: Mediation analysis. J Clin Periodontol 2019; 46:631-639. [PMID: 30993705 PMCID: PMC6593715 DOI: 10.1111/jcpe.13114] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 04/11/2019] [Indexed: 01/29/2023]
Abstract
AIM To determine sequences and magnitude of causality among periodontitis, diabetes and chronic kidney disease (CKD) by mediation analysis. METHODS Ten-year-data were retrieved from the Electric Generation Authority of Thailand (EGAT) study. A cohort of 2,635 subjects was identified with no CKD at baseline. The interested outcome was CKD incidence defined as glomerular filtration rate <60 ml/min/1.73 m2 . The percentage of proximal sites with clinical attachment loss ≥5 mm was used to represent periodontitis. Mediation analysis with 1,000-replication bootstrapping was applied to two causal diagrams, diagram A (Periodontitis → Diabetes → CKD) and diagram B (Diabetes → Periodontitis → CKD). RESULTS The cumulative incidence of CKD was 10.3 cases per 100 persons during 10-year period. In diagram A, each increasing percentage of proximal sites with severe periodontitis increased the adjusted odds ratio of CKD 1.010 (95% CI: 1.005, 1.015) and 1.007 (95% CI: 1.004, 1.013), by direct and indirect effect through diabetes, respectively. In diagram B, diabetes increased the odds of CKD twofold, with 6.5% of this effect mediated via periodontitis. CONCLUSIONS Periodontitis had significant direct effect, and indirect effect through diabetes, on the incidence of CKD. Awareness about systemic morbidities from periodontitis should be emphasized.
Collapse
Affiliation(s)
- Attawood Lertpimonchai
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphot Tamsailom
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chantrakorn Champaiboon
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Atiporn Ingsathit
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anusorn Limpianunchai
- Medical and Health Division, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Piyamitr Sritara
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
14
|
Mongkornkarn S, Suthasinekul R, Sritara C, Lertpimonchai A, Tamsailom S, Udomsak A. Significant association between skeletal bone mineral density and moderate to severe periodontitis in fair oral hygiene individuals. ACTA ACUST UNITED AC 2019; 10:e12441. [PMID: 31338983 DOI: 10.1111/jicd.12441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022]
Abstract
AIM This cross-sectional study aimed to investigate the association between skeletal bone mineral density (BMD) and periodontitis in Thai adults and elders. METHODS This study comprised 3282 participants aged 30-82 years. BMD was assessed at 3 skeletal sites using dual-energy X-ray absorptiometry. Each participant's BMD status was classified as normal, osteopenia or osteoporosis. Periodontal assessments were the number of remaining teeth, plaque score, probing depth and clinical attachment level (CAL). The participants were classified into no/mild or moderate/severe periodontitis groups. The mean periodontal variables between BMD categories were compared. The association between the BMD status and moderate/severe periodontitis was analyzed using binary logistic regression. RESULTS Among the BMD categories, the greatest mean CAL and the lowest mean number of remaining teeth were found in the osteoporosis group. The mean CAL difference between the osteoporosis and normal BMD groups was 0.3 mm. In 337 participants with a plaque score of less than 40%, there was a significant association between osteoporosis and moderate/severe periodontitis. CONCLUSION Skeletal BMD in the osteoporosis range was associated with moderate/severe periodontitis in individuals with fair oral hygiene, suggesting the benefit of special attention to the skeletal bone health of these individuals.
Collapse
Affiliation(s)
- Sanutm Mongkornkarn
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Rapatchata Suthasinekul
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chanika Sritara
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Attawood Lertpimonchai
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Suphot Tamsailom
- Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Medical and Health Department, Health Division, Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| |
Collapse
|
15
|
Lertpimonchai A, Rattanasiri S, Arj-Ong Vallibhakara S, Attia J, Thakkinstian A. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J 2017. [PMID: 28646499 PMCID: PMC5724709 DOI: 10.1111/idj.12317] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: Dental plaque accumulation and inadequate personal oral hygiene (OH) are known major risk factors of periodontitis. Nevertheless, the magnitude of their effects has not yet been the subject of a meta-analysis. Material and methods: The Medline and Scopus databases were searched up to May 2016. Observational studies were eligible if they assessed associations between OH and periodontitis in adult subjects. A multivariate random-effects meta-analysis was used to pool the effects of fair/poor OH versus good OH on periodontitis across studies. The associations between oral care habits and periodontitis were also assessed. Results: A total of 50 studies were eligible; 15 were used for pooling the effect of fair OH versus good OH and poor OH versus good OH on periodontitis, with pooled odds ratios (ORs) of 2.04 [95% confidence interval (CI): 1.65–2.53] and 5.01 (95% CI: 3.40–7.39), respectively. Eleven studies examined oral care habits measured according to toothbrushing regularity and dental visit frequency; pooled ORs of 0.66 (95% CI: 0.47–0.94) and 0.68 (95% CI: 0.47–0.98) were obtained, respectively. Conclusions: Fair to poor OH increases the risk of periodontitis by two- to five-fold. This risk can be reduced by regular toothbrushing and dental visits.
Collapse
Affiliation(s)
- Attawood Lertpimonchai
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Periodontology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sakda Arj-Ong Vallibhakara
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - John Attia
- School of Medicine and Public Health, Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|