Publications by authors named "José João Mendes"

56 Publications

Global Prevalence and Drivers of Dental Students' COVID-19 Vaccine Hesitancy.

Vaccines (Basel) 2021 May 29;9(6). Epub 2021 May 29.

Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem 51000, Palestine.

Background: Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students' acceptance levels.

Methods: A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE.

Results: A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17-40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; < 0.01).

Conclusions: The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.
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http://dx.doi.org/10.3390/vaccines9060566DOI Listing
May 2021

Periodontal Health, Nutrition and Anthropometry in Professional Footballers: A Preliminary Study.

Nutrients 2021 May 25;13(6). Epub 2021 May 25.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, 2829-511 Almada, Portugal.

Poor oral health in elite sport is a pressing issue, however little is known about the periodontal status of professional footballers. The aim of this study was to examine the prevalence of periodontitis in a group of professional footballers and its association with nutritional parameters and self-report non-traumatic injuries. Additionally, we assessed its association with anthropometric, dietary inflammatory load and self-reported muscular and/or articular injuries. Twenty-two professional footballers were evaluated at the beginning of the 2020-2021 season via full-mouth periodontal inspection, anthropometric measurements and the application of the dietary inflammatory index through a food intake measurement of 24 h dietary recall on two different days. Self-reporting non-traumatic muscular and articular injuries for the past 6 months were recorded from each athlete. Then we compared clinical measurements according to the periodontal status and we correlated age, periodontal and nutritional parameters. Overall, the prevalence of periodontitis was 40.9% and peri-implantitis was also observed. No significant differences were found regarding age or nutritional parameters according to the periodontal status. More non-traumatic muscular events in the past 6 months were found in the periodontitis group (55.6% vs. 38.4%), although the difference was non-significant. Both clinical attachment loss, periodontal pocket depth and the periodontal epithelial surface area revealed a significant moderate correlation with the percentage of fat mass, muscle mass, muscle mass index and total adipose folds. This group of professional footballers showed an alarming prevalence of periodontitis. Further studies shall examine whether periodontitis and periodontal treatment impact the performance of this group of athletes.
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http://dx.doi.org/10.3390/nu13061792DOI Listing
May 2021

Causal Association between Periodontitis and Parkinson's Disease: A Bidirectional Mendelian Randomization Study.

Genes (Basel) 2021 May 19;12(5). Epub 2021 May 19.

Evidence-Based Hub, CRU, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829-511 Almada, Portugal.

The latest evidence revealed a possible association between periodontitis and Parkinson's disease (PD). We explored the causal relationship of this bidirectional association through two-sample Mendelian randomization (MR) in European ancestry populations. To this end, we used openly accessible data of genome-wide association studies (GWAS) on periodontitis and PD. As instrumental variables for periodontitis, seventeen single-nucleotide polymorphisms (SNPs) from a GWAS of periodontitis (1817 periodontitis cases vs. 2215 controls) and eight non-overlapping SNPs of periodontitis from an additional GWAS for validation purposes. Instrumental variables to explore for the reverse causation included forty-five SNPs from a GWAS of PD (20,184 cases and 397,324 controls). Multiple approaches of MR were carried-out. There was no evidence of genetic liability of periodontitis being associated with a higher risk of PD (B = -0.0003, Standard Error [SE] 0.0003, = 0.26). The eight independent SNPs (B = -0.0000, SE 0.0001, = 0.99) validated this outcome. We also found no association of genetically primed PD towards periodontitis (B = -0.0001, SE 0.0001, = 0.19). These MR study findings do not support a bidirectional causal genetic liability between periodontitis and PD. Further GWAS studies are needed to confirm the consistency of these results.
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http://dx.doi.org/10.3390/genes12050772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159074PMC
May 2021

Tooth Loss and Blood Pressure in Parkinson's Disease Patients: An Exploratory Study on NHANES Data.

Int J Environ Res Public Health 2021 May 10;18(9). Epub 2021 May 10.

Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz-Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal.

To evaluate tooth loss severity in PD patients and the impact of missing teeth on blood pressure (BP) and glycated hemoglobin (Hba1c) levels. All adults reporting specific PD medication regimens with complete dental examinations were included from the NHANES 2001 to 2018 databases. Sociodemographic, systolic BP (SBP), diastolic BP (DBP) and Hba1c data were compared according to tooth loss severity, and linear regression analyses on the impact of tooth loss on SBP, DBP and Hba1c levels were conducted. The 214 included participants presented 9.7 missing teeth, 23.8% severe tooth loss and 18.2% total edentulousness. Severe tooth loss cases were significantly older ( < 0.001), had higher smoking prevalence ( = 0.008), chronic medical conditions ( = 0.012) and higher Hba1c ( = 0.001), SBP ( = 0.015) and DBP ( < 0.001) levels. Crude and adjusted linear models revealed a relationship between SBP, DBP and missing teeth; however, age confounded these links (SBP: B = 0.10, SE = 0.16, < 0.05; DBP: B = 0.16, SE = 0.10, < 0.05). Tooth loss presented no significant relationship with Hba1c levels. Severe tooth loss is prevalent among PD patients. Blood pressure levels showed a positive linear relationship with the number of missing teeth, although age was a confounding factor. Furthermore, tooth loss and Hba1c levels revealed no significant linear relationship.
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http://dx.doi.org/10.3390/ijerph18095032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126086PMC
May 2021

Network Protein Interaction in the Link between Stroke and Periodontitis Interplay: A Pilot Bioinformatic Analysis.

Genes (Basel) 2021 May 20;12(5). Epub 2021 May 20.

Evidence-Based Hub, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829-511 Caparica, Portugal.

The clinical interaction between stroke and periodontitis has been consistently studied and confirmed. Hence, exploring potentially new protein interactions in this association using bioinformatic strategies presents potential interest. In this exploratory study, we conducted a protein-protein network interaction (PPI) search with documented encoded proteins for both stroke and periodontitis. Genes of interest were collected via GWAS database. The STRING database was used to predict the PPI networks, first in a sensitivity purpose (confidence cut-off of 0.7), and then with a highest confidence cut-off (0.9). Genes over-representation was inspected in the final network. As a result, we foresee a prospective protein network of interaction between stroke and periodontitis. Inflammation, pro-coagulant/pro-thrombotic state and, ultimately, atheroma plaque rupture is the main biological mechanism derived from the network. These pilot results may pave the way to future molecular and therapeutic studies to further comprehend the mechanisms between these two conditions.
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http://dx.doi.org/10.3390/genes12050787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160956PMC
May 2021

Economic burden of periodontitis in the United States and Europe - an updated estimation.

J Periodontol 2021 May 30. Epub 2021 May 30.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz - Cooperativa de Ensino Superior, Almada, Portugal.

Background: The aim of this study is to estimate the direct and indirect economic burdens of periodontal disease in the US and in Europe.

Methods: We used the most recent data available for the US and for Europe (32 European countries) to estimate the cost of periodontal disease. Global health, dental and periodontal expenditures were estimated. We tried to estimate the direct and the indirect costs of periodontitis. Indirect costs, those related to productivity losses, are a consequence of periodontal disease proper, plus edentulism and caries because of periodontal disease.

Results: In 2018, the aggregate cost in the US was estimated at $3.49B and €2.52B in Europe. Indirect costs because of periodontal disease amounted to $150.57B (95% confidence interval [CI]: 103.32-189.87) in the US countries and €156.12B (95% CI: 123.72-221.86) in Europe. The majority of the projected indirect costs were because of edentulism related to periodontal disease and periodontal disease. Indirect costs were the majority of the estimated economic impact with an average of 0.73% (95% CI: 0.50%-0.93%) of annual gross domestic product in the US and 0.99% (95% CI: 0.78%-1.40%) in Europe.

Conclusions: Periodontal disease caused an estimated loss of $154.06B in the US and €158.64B in Europe, in 2018. These results show that the economic burden of periodontal disease is significant and its indirect costs are impactful.
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http://dx.doi.org/10.1002/JPER.21-0111DOI Listing
May 2021

Inflammatory factors, genetic variants, and predisposition for preterm birth.

Clin Genet 2021 May 19. Epub 2021 May 19.

Centro de Investigação Interdisciplinar Egas Moniz, Campus Universitário Quinta da Granja, Caparica, Portugal.

Preterm birth is a major clinical and public health challenge, with a prevalence of 11% worldwide. It is the leading cause of death in children younger than 5 years old and represents 70% of neonatal deaths and 75% of neonatal morbidity. Despite the clinical and public health significance, this condition's etiology is still unclear, and most of the cases are spontaneous. There are several known preterm birth risk factors, including inflammatory diseases and the genetic background, although the underlying molecular mechanisms are far from understood. The present review highlights the research advances on the association between inflammatory-related genes and the increased risk for preterm delivery. The most associated genetic variants are the TNFα rs1800629, the IL1α rs17561, and the IL1RN rs2234663. Moreover, many of the genes discussed in this review are also implicated in pathologies involving inflammatory or autoimmune systems, such as periodontal disease, bowel inflammatory disease, and autoimmune rheumatic diseases. This review presents evidence suggesting a common genetic background to preterm birth, autoimmune and inflammatory diseases susceptibility.
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http://dx.doi.org/10.1111/cge.14001DOI Listing
May 2021

Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review.

J Clin Periodontol 2021 May 17. Epub 2021 May 17.

Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal.

Aim: To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long-term periodontal maintenance (PM).

Material And Methods: PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow-up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta-analyses of number of tooth loss per patient per year were conducted.

Results: Thirty-six papers regarding thirty-three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta-analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long-term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta-regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient-related factors (age and smoking) and tooth-related factors (i.e. tooth type and location) were associated with tooth loss during PM.

Conclusion: The majority of patients undergoing long-term PM have not lost teeth. On average, long-term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results.
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http://dx.doi.org/10.1111/jcpe.13488DOI Listing
May 2021

Autogenous Mineralized Dentin versus Xenograft granules in Ridge Preservation for Delayed Implantation in Postextraction Sites: A Randomized controlled clinical trial with an 18 months follow-up.

Clin Oral Implants Res 2021 May 12. Epub 2021 May 12.

Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Portugal.

Objectives: To test primary stability of delayed implants placed in post-extraction ridges preserved with autogenous mineralized dentin matrix (MDM) versus xenograft granules. Clinical, histological and pain experience outcomes were further assessed.

Material And Methods: From March 2018 to July 2020, patients requiring ridge preservation in preparation for delayed implant placement in post-extraction sites were included. Participants were randomly allocated to either the test (MDM) or control group (xenograft granules) prior to ridge preservation. Visual analogue scale and analgesic consumption were measured every day for a week. Six months after preservation trephine cores were harvested for histomorphometry prior to implant placement. Implants were then placed and implant stability was measured immediately as well as two months after placement. Marginal bone loss, and presence of mucositis/peri-implantitis were registered up to 18 months after prosthetic loading.

Results: Fifty-two patients (66 implants) completed the study. MDM and xenograft groups presented similar primary (77.1 ± 6.9 vs. 77.0 vs. 5.9) and secondary (81.8 ± 5.1 vs. 80.1 ± 3.8) implant stabilities. The percentage of newly formed bone in MDM (47.3%) was significantly higher than xenograft (34.9%) (p<0.001), and the proportion of residual graft was significantly lower (12.2% in MDM and 22.1% in xenograft) (p<0.001). No significant differences were found as far as clinical, radiographic and patient-related outcomes.

Conclusions: Implants placed in sites preserved with MDM had similar primary stability in comparison to xenograft granules. MDM showed a significantly higher quantity of newly formed bone and lower amount of residual graft in histomorphometry results and equal clinical and patient-related outcomes.
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http://dx.doi.org/10.1111/clr.13765DOI Listing
May 2021

Online Problem-Based Learning in Clinical Dental Education: Students' Self-Perception and Motivation.

Healthcare (Basel) 2021 Apr 5;9(4). Epub 2021 Apr 5.

Evidence-Based Hub, CiiEM, Egas Moniz-Cooperativa de Ensino Superior CRL, Campus Universitário, Quinta da Granja, 2829-511 Caparica, Portugal.

The physical closure of higher education institutions due to coronavirus disease 2019 (COVID-19) shed a brighter light on the need to analyze, explore, and implement strategies that allow the development of clinical skills in a distance learning situation. This cross-sectional study aims to assess dental students' self-perception, motivation, organization, acquired clinical skills, and knowledge using the online problem-based learning method, through the application of a 41-item questionnaire to 118 senior students. Answers were subjected to descriptive and inferential statistics analysis. Further, a principal component analysis was performed, in order to examine the factor structure of the questionnaire. Results show that online problem-based learning can be considered a relevant learning tool when utilized within the specific context of clinical dental education, displaying benefits over the traditional learning strategy. Overall, dental students prefer a hybrid system over the conventional one, in a distance learning context, and assume self-responsibility for their own learning, while knowledge thoroughness is perceived as inferior. This online active learning method is successful in improving information and clinical ability (visual/spatial and auditory) advancement in the scope of dental education, with similar results to presential settings. Further studies are required to assess clinical skill development through active learning methods, in a distance learning context.
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http://dx.doi.org/10.3390/healthcare9040420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066721PMC
April 2021

Association between Dietary Inflammatory Index and Periodontitis: A Cross-Sectional and Mediation Analysis.

Nutrients 2021 Apr 5;13(4). Epub 2021 Apr 5.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, 2829-511 Almada, Portugal.

Inflammation-modulating elements are recognized periodontitis (PD) risk factors, nevertheless, the association between dietary inflammatory index (DII) and PD has never been appraised. We aimed to assess the association between DII and PD and the mediation effect of DII in the association of PD with systemic inflammation. Using the National Health and Nutrition Examination Survey 2009-2010, 2011-2012 and 2013-2014, participants who received periodontal exam and provided dietary recall data were included. The inflammatory potential of diet was calculated via DII. PD was defined according to the 2012 case definition. White blood cells (WBC), segmented neutrophils and C-reactive protein (CRP) were used as proxies for systemic inflammation. The periodontal measures were regressed across DII values using adjusted multivariate linear regression and adjusted mediation analysis. Overall, 10,178 participants were included. DII was significantly correlated with mean periodontal probing depth (PPD), mean clinical attachment loss (CAL), thresholds of PPD and CAL, WBC, segmented neutrophils and DII ( < 0.01). A linear regression logistic adjusted for multiple confounding variables confirmed the association between DII and mean PPD (B = 0.02, Standard Error [SE]: 0.02, < 0.001) and CAL (B = -0.02, SE: 0.01, < 0.001). The association of mean PPD and mean CAL with both WBC and segmented neutrophils were mediated by DII (from 2.1 to 3.5%, < 0.001). In the 2009-2010 subset, the association of mean CAL with serum CRP was mediated by DII (52.0%, < 0.01). Inflammatory diet and PD may be associated. Also, the inflammatory diet significantly mediated the association of leukocyte counts and systemic inflammation with PD.
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http://dx.doi.org/10.3390/nu13041194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066166PMC
April 2021

The Role of Inflammatory Diet and Vitamin D on the Link between Periodontitis and Cognitive Function: A Mediation Analysis in Older Adults.

Nutrients 2021 Mar 12;13(3). Epub 2021 Mar 12.

Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal.

Patients suffering from periodontitis are at a higher risk of developing cognitive dysfunction. However, the mediation effect of an inflammatory diet and serum vitamin D levels in this link is unclear. In total, 2062 participants aged 60 years or older with complete periodontal diagnosis and cognitive tests from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 and 2013-2014 were enrolled. The Consortium to Establish a Registry for Alzheimer's disease (CERAD) word learning subtest (WLT) and CERAD delayed recall test (DRT), the animal fluency test (AFT) and the digit symbol substitution test (DSST) was used. Dietary inflammatory index (DII) was computed via nutrition datasets. Mediation analysis tested the effects of DII and vitamin D levels in the association of mean probing depth (PD) and attachment loss (AL) in all four cognitive tests. Periodontitis patients obtained worse cognitive test scores than periodontally healthy individuals. DII was negatively associated with CERAD-WLT, CERAD-DRT, AFT and DSST, and was estimated to mediate between 9.2% and 36.4% of the total association between periodontitis with cognitive dysfunction ( < 0.05). Vitamin D showed a weak association between CERAD-DRT, AFT and DSST and was estimated to between 8.1% and 73.2% of the association between periodontitis and cognitive dysfunction ( < 0.05). The association between periodontitis and impaired cognitive function seems to be mediated both by a proinflammatory dietary load and vitamin D deficiency. Future studies should further explore these mediators in the periodontitis-cognitive decline link.
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http://dx.doi.org/10.3390/nu13030924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001166PMC
March 2021

Diagnosis of SARS-Cov-2 Infection by RT-PCR Using Specimens Other Than Naso- and Oropharyngeal Swabs: A Systematic Review and Meta-Analysis.

Diagnostics (Basel) 2021 Feb 21;11(2). Epub 2021 Feb 21.

Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior CRL, Campus Universitário, Quinta da Granja, 2829-511 Caparica, Portugal.

The rapid and accurate testing of SARS-CoV-2 infection is still crucial to mitigate, and eventually halt, the spread of this disease. Currently, nasopharyngeal swab (NPS) and oropharyngeal swab (OPS) are the recommended standard sampling techniques, yet, these have some limitations such as the complexity of collection. Hence, several other types of specimens that are easier to obtain are being tested as alternatives to nasal/throat swabs in nucleic acid assays for SARS-CoV-2 detection. This study aims to critically appraise and compare the clinical performance of RT-PCR tests using oral saliva, deep-throat saliva/posterior oropharyngeal saliva (DTS/POS), sputum, urine, feces, and tears/conjunctival swab (CS) against standard specimens (NPS, OPS, or a combination of both). In this systematic review and meta-analysis, five databases (PubMed, Scopus, Web of Science, ClinicalTrial.gov and NIPH Clinical Trial) were searched up to the 30th of December, 2020. Case-control and cohort studies on the detection of SARS-CoV-2 were included. The methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2). We identified 1560 entries, 33 of which (1.1%) met all required criteria and were included for the quantitative data analysis. Saliva presented the higher accuracy, 92.1% (95% CI: 70.0-98.3), with an estimated sensitivity of 83.9% (95% CI: 77.4-88.8) and specificity of 96.4% (95% CI: 89.5-98.8). DTS/POS samples had an overall accuracy of 79.7% (95% CI: 43.3-95.3), with an estimated sensitivity of 90.1% (95% CI: 83.3-96.9) and specificity of 63.1% (95% CI: 36.8-89.3). The remaining index specimens could not be adequately assessed given the lack of studies available. Our meta-analysis shows that saliva samples from the oral region provide a high sensitivity and specificity; therefore, these appear to be the best candidates for alternative specimens to NPS/OPS in SARS-CoV-2 detection, with suitable protocols for swab-free sample collection to be determined and validated in the future. The distinction between oral and extra-oral salivary samples will be crucial, since DTS/POS samples may induce a higher rate of false positives. Urine, feces, tears/CS and sputum seem unreliable for diagnosis. Saliva testing may increase testing capacity, ultimately promoting the implementation of truly deployable COVID-19 tests, which could either work at the point-of-care (e.g. hospitals, clinics) or at outbreak control spots (e.g., schools, airports, and nursing homes).
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http://dx.doi.org/10.3390/diagnostics11020363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926389PMC
February 2021

Regenerative Endodontic Procedures: An Umbrella Review.

Int J Environ Res Public Health 2021 01 17;18(2). Epub 2021 Jan 17.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, 2829-511 Almada, Portugal.

The Regenerative Endodontic Procedure (REP) is a biologically based method in which a damaged pulp-dentin complex is replaced by a new vital tissue. This umbrella review aimed to critically assess the available systematic reviews (SRs) on REP. An electronic database search was conducted (PubMed-Medline, CENTRAL, Scielo, Web of Science, and LILACS) until December 2020. Studies were included if they were an SR on REP. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality in each specific section of REP protocols and outcomes. From 403 entries, 29 SRs were included. Regarding the methodological quality, ten studies were of critically low, three of low, fourteen of moderate, and two were rated as high quality. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of REP.
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http://dx.doi.org/10.3390/ijerph18020754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830213PMC
January 2021

Early Tooth Loss after Periodontal Diagnosis: Development and Validation of a Clinical Decision Model.

Int J Environ Res Public Health 2021 02 2;18(3). Epub 2021 Feb 2.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829-511 Almada, Portugal.

The aim of this study was to develop and validate a predictive early tooth loss multivariable model for periodontitis patients before periodontal treatment. A total of 544 patients seeking periodontal care at the university dental hospital were enrolled in the study. Teeth extracted after periodontal diagnosis and due to periodontal reasons were recorded. Clinical and sociodemographic variables were analyzed, considering the risk of short-term tooth loss. This study followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines for development and validation, with two cohorts considered as follows: 455 patients in the development phase and 99 in the validation phase. As a result, it was possible to compute a predictive model based on tooth type and clinical attachment loss. The model explained 25.3% of the total variability and correctly ranked 98.9% of the cases. The final reduced model area under the curve (AUC) was 0.809 (95% confidence interval (95% CI): 0.629-0.989) for the validation sample and 0.920 (95% CI: 0.891-0.950) for the development cohort. The established model presented adequate prediction potential of early tooth loss due to periodontitis. This model may have clinical and epidemiologic relevance towards the prediction of tooth loss burden.
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http://dx.doi.org/10.3390/ijerph18031363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908103PMC
February 2021

Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey.

Sci Rep 2021 Jan 12;11(1):630. Epub 2021 Jan 12.

Evidence-Based Hub Egas Moniz, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz - Cooperativa de Ensino Superior, CRL, Almada, Portugal.

To explore the association between bacterial vaginosis (BV) and periodontitis (PD) and to determine whether PD and BV might be linked with systemic serum alterations. We used the National Health and Nutrition Examination Survey 2001-2004, with women aged 18-49 years old and diagnosed with or without BV according to Nugent's method. PD was defined according to the 2012 case definition. We compared serum counts according to the presence of PD and the presence of BV. Multivariable regression was used to explore and identify relevant variables towards the presence of BV. 961 women fulfilled the inclusion criteria. In women with BV, PD was associated with higher inflammation, characterized by increased white blood cells (p = 0.006) and lymphocyte (p = 0.009) counts. Predictive models presented a statistically significant association between PD and BV [Odds Ratio (OD) = 1.69, 95% Confidence Interval (CI): 1.09-2.61 for periodontitis; OD = 2.37, 95% CI: 1.30-4.29 for severe PD]. Fully adjusted models for age, smoking, body mass index, diabetes mellitus and number of systemic conditions reinforced this association [OD = 1.71, 95% CI: 1.06-2.76 for PD; OD = 2.21, 95% CI: 1.15-4.25 for severe PD]. An association between BV and PD is conceivable. PD was associated with higher systemic markers of inflammation in women with BV. Our data is novel and could serve as a foundation to guide future studies in the confirmation of this association and the underlying mechanisms.
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http://dx.doi.org/10.1038/s41598-020-79496-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803979PMC
January 2021

Blood Pressure and Tooth Loss: A Large Cross-Sectional Study with Age Mediation Analysis.

Int J Environ Res Public Health 2021 01 2;18(1). Epub 2021 Jan 2.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal.

We aimed to investigate the association between blood pressure (BP) and tooth loss and the mediation effect of age. A cross-sectional study from a reference dental hospital was conducted from September 2017 to July 2020. Single measures of BP were taken via an automated sphygmomanometer device. Tooth loss was assessed through oral examination and confirmed radiographically. Severe tooth loss was defined as 10 or more teeth lost. Additional study covariates were collected via sociodemographic and medical questionnaires. A total of 10,576 patients were included. Hypertension was more prevalent in severe tooth loss patients than nonsevere tooth lost (56.1% vs. 39.3%, < 0.001). The frequency of likely undiagnosed hypertension was 43.4%. The adjusted logistic model for sex, smoking habits and body mass index confirmed the association between continuous measures of high BP and continuous measures of tooth loss (odds ratio (OR) = 1.05, 95% CI: 1.03-1.06, < 0.001). Age mediated 80.0% and 87.5% of the association between periodontitis with both systolic BP ( < 0.001) and diastolic BP ( < 0.001), respectively. Therefore, hypertension and tooth loss are associated, with a consistent mediation effect of age. Frequency of undiagnosed hypertension was elevated. Age, gender, active smoking, and BMI were independently associated with raised BP.
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http://dx.doi.org/10.3390/ijerph18010285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795250PMC
January 2021

Varying the Polishing Protocol Influences the Color Stability and Surface Roughness of Bulk-Fill Resin-Based Composites.

J Funct Biomater 2020 Dec 22;12(1). Epub 2020 Dec 22.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal.

Surface properties of composites such as roughness and color impact periodontal health and aesthetic outcomes. Novel bulk-fill composites with improved functionality are being introduced and, in light of the existing variety of finishing/polishing procedures, research of their surface properties is warranted. Sixty discs were prepared from bulk-fill composites (Filtek™ Bulk Fill Posterior Restorative and Fill-Up™) and incremental-fill Filtek™ Z250. They were further divided according to different polishing procedures ( = 5): three multi-step polishing procedures or finishing with a bur (control). Surface roughness (Ra) was measured using an atomic force microscope (The AFM Workshop TT-AFM). A spectrophotometer (Spectroshade Micro Optic) was used to determine color stability, after exposure to a coffee solution. Data were analyzed using two-way MANOVA (significance level of 5%). Resin composite type, polishing procedure, and their interaction had a statistically significant effect on surface roughness ( < 0.001) and color change ( < 0.001). Fill-Up™ exhibited the highest surface roughness and greatest color change. Differences in color change were statistically significant ( < 0.001). Filtek™ Bulk Fill registered the lowest surface roughness and color change, after the three-step polishing procedure. Both parameters were significantly correlated (ρ = 0.754, < 0.001) and found to be material dependent and polishing-procedure dependent. Higher surface roughness relates to greater color changes.
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http://dx.doi.org/10.3390/jfb12010001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838793PMC
December 2020

An immersive educational tool for dental implant placement: A study on user acceptance.

Int J Med Inform 2021 02 27;146:104342. Epub 2020 Nov 27.

INESC-ID Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Portugal. Electronic address:

Background: Tools for training and education of dental students can improve their ability to perform technical procedures such as dental implant placement. Shortage of training can negatively affect dental implantologists' performance during intraoperative procedures, resulting in lack of surgical precision and, consequently, inadequate implant placement, which may lead to unsuccessful implant supported restorations or other complications.

Objective: We designed and developed IMMPLANT a virtual reality educational tool to assist implant placement learning, which allows users to freely manipulate 3D dental models (e.g., a simulated patient's mandible and implant) with their dominant hand while operating a touchscreen device to assist 3D manipulation.

Methods: The proposed virtual reality tool combines an immersive head-mounted display, a small hand tracking device and a smartphone that are all connected to a laptop. The operator's dominant hand is tracked to quickly and coarsely manipulate either the 3D dental model or the virtual implant, while the non-dominant hand holds a smartphone converted into a controller to assist button activation and a greater input precision for 3D implant positioning and inclination. We evaluated IMMPLANT's usability and acceptance during training sessions with 16 dental professionals.

Results: The conducted user acceptance study revealed that IMMPLANT constitutes a versatile, portable, and complementary tool to assist implant placement learning, as it promotes immersive visualization and spatial manipulation of 3D dental anatomy.

Conclusions: IMMPLANT is a promising virtual reality tool to assist student learning and 3D dental visualization for implant placement education. IMMPLANT may also be easily incorporated into training programs for dental students.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104342DOI Listing
February 2021

Network Protein Interaction in Parkinson's Disease and Periodontitis Interplay: A Preliminary Bioinformatic Analysis.

Genes (Basel) 2020 11 23;11(11). Epub 2020 Nov 23.

Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal.

Recent studies supported a clinical association between Parkinson's disease (PD) and periodontitis. Hence, investigating possible interactions between proteins associated to these two conditions is of interest. In this study, we conducted a protein-protein network interaction analysis with recognized genes encoding proteins with variants strongly associated with PD and periodontitis. Genes of interest were collected via the Genome-Wide Association Studies (GWAS) database. Then, we conducted a protein interaction analysis, using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, with a highest confidence cutoff of 0.9 and sensitivity analysis with confidence cutoff of 0.7. Our protein network casts a comprehensive analysis of potential protein-protein interactions between PD and periodontitis. This analysis may underpin valuable information for new candidate molecular mechanisms between PD and periodontitis and may serve new potential targets for research purposes. These results should be carefully interpreted, giving the limitations of this approach.
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http://dx.doi.org/10.3390/genes11111385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700320PMC
November 2020

Validation of the Third Molar Maturation Index (I) to assess the legal adult age in the Portuguese population.

Sci Rep 2020 10 28;10(1):18466. Epub 2020 Oct 28.

Department of Forensic Medicine, University of Sechenov, Moscow, Russia.

Age estimation is a major step in forensic and legal procedures. Its relevance has been increasing due to growing society issues, such as identification of missing people, crimes against minors or lack of valid identification papers from locals or foreigners. Evaluation of the cut-off value of the Third Molar Maturation Index (I) = 0.08 for discriminating minors from adults in the Portuguese population. The left lower third molars were analysed by applying a specific cut-off value of 0.08 determined by Cameriere et al. in 2008. A sample of 778 digital panoramic radiographs of a representative Portuguese sample (442 females and 336 males), in the age range of 12-24 years (mean age 17.7 ± 2.98 years in females and 18.1 ± 3.0 years in males), was retrospectively evaluated. I decreased as the real age gradually increased in both sexes. The 0.08 cut-off score was valuable in discriminating adults from minors. According to the pooled results, the accuracy, by means of area under the curve, was 92.8% (95% confidence interval (CI) 91.0-94.6%). The proportion of correctly classified subjects (sensitivity) was 90.7% (95% CI 88.7-92.8%) and the specificity was 94.9% (95% CI 93.3-96.4%). The results show that I is a valuable method to differentiate minors from adults in the Portuguese population.
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http://dx.doi.org/10.1038/s41598-020-75324-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595217PMC
October 2020

Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis.

Exp Hematol 2021 01 15;93:1-13. Epub 2020 Oct 15.

Periodontology Unit, University College London Eastman Dental Institute, London, UK.

Periodontitis is a chronic inflammatory disease with local and systemic implications. Evidence suggests consistent hematologic changes associated with periodontitis. Our aim was to critically appraise the available evidence on hemogram, leukogram, and thrombogram alterations in otherwise healthy patients suffering from periodontitis when compared with controls. For this systematic review (SR), we searched MEDLINE, Web of Science, EMBASE, and the Cochrane Library (CENTRAL) for studies published up to June 2020. Both observational and interventional studies with baseline standard hematologic levels were included. Outcomes of interest were baseline hemogram, leukogram, and thrombogram values and the impact of periodontitis treatment on these outcomes. Upon risk of bias assessment, data extraction and both qualitative and quantitative (standardized mean differences) analyses were performed. Random-effects meta-analyses were performed to provide pooled estimates. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed (PROSPERO Reg. No. CRD42020164531). A total of 45 studies, eight intervention and 37 case-control studies, were identified after the final search of 3,012 titles. Following quality assessment, 43 articles were deemed to have low risk of bias, and two articles moderate risk. Meta-analyses confirmed that periodontitis was associated with both white and red cell lineages. Severe chronic periodontitis was associated with greater white blood cell counts (mean difference [MD] = 0.53, 95% confidence interval [CI]: 0.26-0.79) when compared with controls. Periodontitis was associated with a larger number of neutrophils (MD = 7.16%, 95% CI: 5.96-8.37) and lower mean platelet volume (MD = 0.30 fL, 95% CI: 0.49 to -0.10) compared with healthy participants. Nonsurgical periodontal treatment was associated with a decrease in white blood cell (WBC) levels (MD = 0.28 10/L, 95% CI: -0.47 to -0.08) in patients with chronic periodontitis. Periodontitis is associated with hematologic changes (Strength of Recommendation Taxonomy [SORT] A recommendation). Higher WBC levels, higher neutrophil levels, higher erythrocyte sedimentation rate, and lower mean platelet volumes are the most common blood count findings. The association between periodontitis and WBC could be causal in nature. Further assessment to determine whether periodontitis causes changes in circulating blood cells and to identify the molecular mechanisms underlying these associations is warranted.
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http://dx.doi.org/10.1016/j.exphem.2020.10.001DOI Listing
January 2021

Periodontal status, perceived stress, diabetes mellitus and oral hygiene care on quality of life: a structural equation modelling analysis.

BMC Oral Health 2020 08 20;20(1):229. Epub 2020 Aug 20.

Clinical Research Unit (CRU), CiiEM, IUEM, Almada, Portugal.

Background: To determine if periodontal risk assessment (PRA), the number of missing teeth, diabetes mellitus (DM), perceived stress and interproximal cleaning are associated with oral health-related quality of life (OHRQoL), using Andersen's behavioral modelling (ABM).

Material And Methods: Data derived from 472 adults derived from a representative population of the Study of Periodontal Health in Almada-Seixal (SoPHiAS) was used. Socioeconomic status, perceived stress scale (PSS-10), oral health behaviors and oral health impact profile (OHIP-14) were collected through questionnaire. Periodontal conditions were assessed with a full-mouth periodontal examination. PRA was computed through behavioral and clinical information. Variables were grouped into Predisposing Factors, Enabling, Need, Oral Health Behaviors and Perceived Health Outcome latent variables. Confirmatory factor analysis, structural ABM and model fitness were conducted.

Results: ABM applied to OHIP-14 showed acceptable model fit (χ = 2.75, CFI = 0.92, TLI = 0.90, RMSEA = 0.05, CI 90% [0.04-0.07]). The average of OHRQoL was 9.5 ± 11.3. Patient with periodontitis and with a high number of missing teeth experienced worse OHRQoL. Uncontrolled DM participants had more periodontal treatment necessity and poorer OHRQoL. Characteristic like aging and lower levels of education were directly associated with better OHRQoL, but in indirect path the OHRQoL was diminishes. Good oral hygiene and preventative measures were associated to lower periodontal treatment necessity. Lower periodontal treatment necessity was associated to higher OHRQoL. Age, tooth loss and interproximal cleaning were the most associated items to Predisposing, Need and Oral Health Behaviors, respectively.

Conclusion: ABM confirmed age, number of missing teeth, DM, interproximal cleaning and perceived stress as associated factors for OHRQoL. Uncontrolled DM was associated to higher Need and poorer OHRQoL. Good oral hygiene habits promote a healthy periodontium and, consequently, increases OHRQoL.
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http://dx.doi.org/10.1186/s12903-020-01219-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441730PMC
August 2020

Parkinson's Disease, Periodontitis and Patient-Related Outcomes: A Cross-Sectional Study.

Medicina (Kaunas) 2020 Jul 30;56(8). Epub 2020 Jul 30.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Caparica, Portugal.

People with Parkinson's disease (PD) may be at risk of having bad periodontal status. A consistent periodontal examination is critical to investigate how it impacts on PD quality of life. We aimed to assess the periodontal status of people with PD, and its association with quality of life and self-perceived xerostomia. To this end, from February to March 2020, we consecutively enrolled 28 PD individuals, and motor and non-motor symptoms of PD were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). We performed full-mouth periodontal examination and gathered information on self-perceived quality of life in PD, oral health impact profile (OHIP-14) and xerostomia. The prevalence of periodontitis was 75.0% and most cases were identified as severe (46.4%). Upper extremity rigidity, hand posture and kinetic tremors were significantly correlated with worse periodontal status. PDQ-8 showed to be correlated with self-perceived oral health-related quality of life and xerostomia levels. This group of people with PD had a high prevalence of periodontitis. Deteriorated levels of the upper extremities in advanced stages of PD were associated with worse periodontal status and hygiene habits. Quality of life in PD appears to be associated with self-perceived OHRQoL and xerostomia.
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http://dx.doi.org/10.3390/medicina56080383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466334PMC
July 2020

Relationship between Blood and Standard Biochemistry Levels with Periodontitis in Parkinson's Disease Patients: Data from the NHANES 2011-2012.

J Pers Med 2020 Jul 25;10(3). Epub 2020 Jul 25.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal.

People with Parkinson's Disease (PD) are associated with the presence of periodontitis. We aimed to compare blood and standard biochemical surrogates of PD patients diagnosed with periodontitis with PD individuals without periodontitis. This retrospective cohort study used a sample from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 that underwent periodontal diagnosis ( = 3669). PD participants were identified through specific PD reported medications. Periodontitis was defined according to the 2012 case definition, using periodontal examination data provided. Then, we compared blood levels and standard chemical laboratory profiles of PD patients according to the presence of periodontitis. Multivariable regression was used to explore this dataset and identify relevant variables towards the presence of periodontitis. According to the medication report, 37 participants were eligible, 29 were secure and 8 were unsecure PD medications regimens. Overall, PD cases with periodontitis presented increased levels of White Blood Cells (WBC) ( = 0.002), Basophils ( = 0.045) and Segmented neutrophils ( = 0.009), and also, lower levels of Total Bilirubin ( = 0.018). In the PD secure medication group, a significant difference was found for WBC ( = 0.002) and Segmented neutrophils ( = 0.002) for the periodontitis group. Further, WBC might be a discriminating factor towards periodontitis in the global sample. In the secure PD medication, we found gender, segmented neutrophils and Vitamin D2 to be potential discriminative variables towards periodontitis. Thus, periodontitis showed association with leukocyte levels alterations in PD patients, and therefore with potential systemic changes and predictive value. Furthermore, Vitamin D2 and gender showed to be associated with periodontitis in with secure medication for PD. Future studies should assess in more detail the potential systemic repercussion of the presence of periodontitis in PD patients.
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http://dx.doi.org/10.3390/jpm10030069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565163PMC
July 2020

Validity of the association between periodontitis and female infertility conditions: a concise review.

Reproduction 2020 09;160(3):R41-R54

Clinical Research Unit (CRU), CiiEM, Egas Moniz, CRL, Monte de Caparica, Portugal.

Hormones and inflammatory mechanisms are implicated with female reproductive function, including follicle maturation, ovulation, embryo implantation, and pregnancy. Periodontitis is a chronic inflammatory disease due to a polymicrobial disruption of the homeostasis and may be considered as a potential risk factor that affect female fertility. The role of periodontitis is becoming meaningful, with significant associations with polycystic ovary syndrome, endometriosis and bacterial vaginosis. Further, periodontitis is linked with known risk factors towards female infertility, such as age, obesity, and chronic kidney disease. This review aims to summarize the available evidence on the association between periodontitis and female infertility-associated conditions, and to discuss warranting steps in future research.
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http://dx.doi.org/10.1530/REP-20-0176DOI Listing
September 2020

Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination.

J Clin Med 2020 Jul 21;9(7). Epub 2020 Jul 21.

Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal.

In this study, we explore the diagnostic accuracy of a Radiographic-based Periodontal Bone Loss (R-PBL) method as a screening tool for periodontitis, in the form of radiographic bone loss, under the 2018 case definition in comparison to the 2012 case definition. The analysis was based on 456 patients (253 females and 203 males), screened for periodontal status in the Study of Periodontal Health in Almada-Seixal (SoPHiAS) project and subjected to a panoramic dental X-ray. Patients were diagnosed for the presence of periodontitis following the 2018 and 2012 case definition. R-PBL classification was defined by alveolar bone loss and diagnosed as no periodontitis (≥80% remaining alveolar bone), mild to moderate periodontitis (66% to 79%), or severe periodontitis (<66%). We appraise the X-ray quality to look for the influence on the performance of R-PBL. Sensitivity, specificity, accuracy, and precision, through several indicators, were determined. Performance measurement was assessed through binary and multiclass Receiver operating characteristic/are under the curve (ROC/AUC) analyses. Our results show that the tested R-PBL method under the 2018 case definition is a reliable tool in periodontitis cases screening. This method does not replace clinical periodontal evaluation, but rather, it screens patients towards a definitive periodontitis diagnosis. These results will contribute to support the development of automated prediction systems towards periodontitis surveillance.
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http://dx.doi.org/10.3390/jcm9072313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408796PMC
July 2020

Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis.

Nutrients 2020 Jul 22;12(8). Epub 2020 Jul 22.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Almada, Portugal.

To explore the vitamin D levels of periodontitis patients in comparison with periodontally healthy ones, and to assess the influence of vitamin D supplementation as an adjunctive during nonsurgical periodontal treatment (NSPT). Five databases (Pubmed, Embase, Scholar, Web of Sciences, and Cochrane Library) were searched until May 2020. Mean difference (MD) meta-analysis with corresponding 95% confidence interval (95% CI) and sensitivity tests via meta-regression were used. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Sixteen articles were included, fourteen case-control and two intervention studies, all reporting 25-hydroxyvitamin D (25(OH)D) levels. Compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in chronic periodontitis patients (pooled MD = -6.80, 95% CI: -10.59 to -3.02). Subgroup analysis revealed differences among 25(OH)D measurements, with liquid chromatography-mass spectrometry being the most homogeneous method (pooled MD = -2.05, 95% CI: -3.40 to -0.71). Salivary levels of 25(OH)D showed no differences between groups. Due to the low number of studies, conclusions on aggressive periodontitis and in the effect of vitamin D supplementation after NSPT were not possible to ascribe. Compared with healthy controls, 25(OH)D serum levels are significantly lower in chronic periodontitis patients, with an overall SORT A recommendation. Future studies are needed to clarify the effect of vitamin D supplementation and the biological mechanisms linking vitamin D to the periodontium.
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http://dx.doi.org/10.3390/nu12082177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468917PMC
July 2020

Comparisons of Periodontal Status between Females Referenced for Fertility Treatment and Fertile Counterparts: A Pilot Case-Control Study.

Int J Environ Res Public Health 2020 07 22;17(15). Epub 2020 Jul 22.

Clinical Research Unit (CRU), CiiEM, IUEM, 2829-511 Almada, Portugal.

Studies investigating the periodontal status of women seeking fertility treatment have never been conducted. The purpose of this pilot study was to compare the periodontal status among females referenced to a Fertility Clinic (FC) when compared to matched females from a representative regional epidemiological sample. Our secondary aims were to investigate if periodontal clinical measures differ between these two groups of females and how they impact on oral health-related quality of life (OHRQoL). We enrolled 18 women from an FC and 18 age, race and body mass index matched controls from the epidemiological survey Study of Periodontal Health in Almada-Seixal (SoPHiAS). In each subject, we performed a circumferential periodontal inspection to infer the periodontal status and applied a questionnaire measuring OHRQoL. FC females presented higher levels of periodontal disease, with higher periodontal epithelial surface area, periodontal probing depth and clinical attachment loss. However, periodontal diseases did not impact OHRQoL in this particular group of women seeking fertility care, suggesting unawareness about periodontal diseases. Within the limitations of this study, females referenced for fertility treatment presented worse periodontal measures than females from a representative control sample. These preliminary results may support future prospective studies to further explore the periodontal status and possible consequences in women seeking fertility care.
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http://dx.doi.org/10.3390/ijerph17155281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432159PMC
July 2020

Perceived xerostomia, stress and periodontal status impact on elderly oral health-related quality of life: findings from a cross-sectional survey.

BMC Oral Health 2020 07 10;20(1):199. Epub 2020 Jul 10.

Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Quinta da Granja, Almada, 2829 - 511, Portugal.

Background: To investigate if self-perceived xerostomia and stress are significant variables on the Oral-Health Related Quality of Life (OHRQoL) of elderly patients, considering the periodontal status, oral hygiene habits and sociodemographic characteristics simultaneously.

Methods: The study cohort included 592 participants (320 females/272 Males), aged 65 years or older, representing the elder inhabitants of the Study of Periodontal Health in Almada-Seixal (SoPHiAS). Patients answered a socio-demographic and oral hygiene habits questionnaire. The Oral Health Impact Profile-14 (OHIP-14), Summated Xerostomia Inventory-5 (SXI-5) and Perceived Stress Scale-10 (PSS-10) were used. Full-mouth circumferential periodontal inspection was carried out. Multivariable regression analyses were used considering the level of periodontitis, clinical characteristics, the number of teeth, SXI, PSS-10, age, gender and oral hygiene habits.

Results: Self-perceived xerostomia and stress showed a positive significant correlation with OHRQoL and each of its domains. Multiple linear regression analysis demonstrated the significant impact of SXI-5 (B = 1.20, p <  0.001) and PSS-10 (B = 0.35, p <  0.001) on the OHRQoL. SXI-5 (Odds Ratio (OR) = 1.28, p <  0.001) and PSS-10 (OR = 1.03, p = 0.022) were associated with a more frequently affected OHRQoL. The number of missing teeth, being male, mean probing depth and mean clinical attachment loss were also significant towards a frequently affected OHRQoL. Conversely, age was negatively associated with a lower OHRQoL.

Conclusion: Self-perceived xerostomia and stress are significant variables towards OHRQoL in elderly patients. Future studies should consider these self-perceived xerostomia and stress when investigating the impact of periodontitis and missing teeth on quality of life of older adults.
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http://dx.doi.org/10.1186/s12903-020-01183-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350690PMC
July 2020