UNASSIGNED: Recent studies suggest that lipid-lowering agents (LLA) may reduce chronic periodontitis, but it is unknown whether this benefit extends to people with type 2 diabetes (T2D).
UNASSIGNED: We assessed the association between LLA use and periodontitis in Hispanic adults with T2D.
UNASSIGNED: This was a cross-sectional observational study.
UNASSIGNED: We assessed the association of LLA use and periodontal parameters in 253 Puerto Ricans 40-65 years with T2D who participated in the Lipid-Lowering agents use in Periodontitis and Diabetes Study study. Participants were classified as (a) none- or <1 year, (b) 1-4 years, or (c) >4 years. The primary outcome consists of a tertile percent of sites with probing pocket depth (PPD) ⩾ 4 mm and the secondary outcome includes tertiles of percent sites with clinical attachment loss (CAL) ⩾ 4 mm. Multinomial logistic regression models adjusted for age, gender, smoking status, education, waist circumference, glycosylated hemoglobin A1C (HbA1c), bleeding on probing, examiner, and anti-inflammatory agents were used to estimate the association.
UNASSIGNED: LLA (92.5%, statins) was used by 52% of participants. LLA use 1-4 years was associated with lower odds of PPD ⩾ 4 mm (OR: 0.22, p = 0.005; high versus low tertile) or lower odds of CAL ⩾ 4 mm (OR: 0.33, p = 0.02, middle versus low tertile), compared to those with LLA minimal or no use. This association was lost for participants who used LLA for >4 years. LLA users for >4 years with periodontal disease had elevated HbA1c (OR: 1.36, p = 0.05).
UNASSIGNED: The use of LLA for 1-4 years was associated with lower values of periodontal parameters versus minimal LLA use. This association was not present among people using LLA > 4 years users, but these participants had poorer glycemic control compared to other participants. In this cross-sectional study, the finding that LLA use 1- 4 years is associated with lower values of periodontal parameters of severity in T2D individuals may help clarify some of the controversies regarding the benefit of these medications in this population.
Lipid-lowering agents and lower values of periodontal parameters in individuals with type 2 diabetes • Lipid-lowering agents (LLA), such as statins, are reported to reduce chronic periodontitis, making individuals with diabetes ideal candidates for this treatment due to their high prevalence of oral disease.• The association between LLA use and periodontitis was assessed among Hispanic adults with type 2 diabetes (T2D).• Short-term LLA use (but not long-term use) was associated with lower values of periodontal parameters in individuals with T2D.• For long-term LLA use, high glycemic level was associated with high values of periodontitis.• Thus, under the study design limitations, the finding may provide clinical implications and may help clarify some of the controversies regarding the benefits of LLA use in humans.• Furthermore, the higher glycemic levels for periodontal patients with long-term LLA use points to the need to monitor these patients carefully.

We read the study conducted by Joseph and colleagues with great interest, which investigated the loco-regional control, disease-specific survival (DSS), overall survival (OS), and treatment-related complications in 163 oral cancer (OC) patients treated with radiotherapy (RT) or chemo-RT (CRT) for close resection margins (CRMs).The study results offer valuable insights into the role of RT/CRT in OC patients with CRMs, but two concerns must be addressed to interpret the outcomes rigorously.

BACKGROUND: Edentulism is the partial or total loss of teeth, it is irreversible and disabling due to its sequelae in the masticatory, phonetic and aesthetic function that affect the quality of life.
OBJECTIVE: To establish the impact of edentulism and sociodemographic factors on the quality of life of the Salvadoran population.
METHODS: Secondary cross-sectional analysis of data in 3322 users of the Public Health System of El Salvador, aged 15 to > 60 years. The variables under study were sociodemographic, edentulismo and quality of life. Edentulism was determined by clinical examination using the Oral Impact on Daily Performance scale. The statistical analysis was performed using χ2, OR, multiple regression analysis and set the significance threshold at p < 0.05.
RESULTS: Partial edentulism in the upper jaw was present in 68.24% people, partial edentulism in the lower jaw was present in 72.42% people and complete edentulism was observed in 2.02% people. There were significant sex differences and a relationship between sex and quality of life (p < 0.004); the self-perception of severe/very severe impacts was greater in women. People without education or with primary or secondary education only were the most affected (p < 0.05). Tooth loss increases with age, affecting quality of life in a severe/very severe manner. Complete edentulism had greater impacts on quality of life in terms of eating (25.64%), speaking (21.15%), and socializing/enjoying contact with people (10.90%). A severe/very severe impact on quality of life of teeth lost was reported mainly by those over 60 years of age, with an average of 11 missing posterior teeth, 6 missing anterior teeth and 13 missing teeth per patient. Those missing up to 6 anterior teeth were times more likely to perceive severe/very severe impacts on quality of life than those without any missing teeth (OR:5.788). Edentulism affected the quality of life of those examined, especially the loss of upper anterior teeth.

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients\' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

Introduction: Gallstones are one of the most common digestive diseases globally, with an estimated affected population of 15% in the United States. Our aim is to assess the current association between oral health and gallstones, exploring potential mediation factors. Methods: Self-reported gallstones were determined based on medical condition questionnaires. Dental status was assessed by dental professionals and oral health questionnaire. Mediation analysis was conducted for body mass index, blood glucose, triglycerides, and cholesterol, and the percentage of mediation effects was calculated. Results: We included 444 patients with gallstones and 3565 non-gallstone participants from National Health and Nutrition Examination Survey. After fully adjusting for all covariates, the prevalence of gallstones is higher when the number of missing teeth is at T3 compared to T1 (odds ratio [OR]: 1.93, confidence interval [CI]: 1.14 - 3.26, p = 0.02, p-trend = 0.01), and there was an inverted L-shaped association between missing teeth and gallstones, with an inflection point of 17. Bone loss around mouth was also associated with gallstones (OR: 1.78, 95% CI: 1.27 - 2.48, p = 0.002), but not root caries and gum disease. Mediation analysis identified blood glucose as a crucial mediator, with a mediation effect ratio of 4.91%. Conclusions: Appropriate lifestyle interventions for patients with missing teeth may help delay the onset of gallstones, such as healthy dietary habits, trace elements supplementing, and managing weight and blood sugar levels. Further exploration of the relationship between oral health and overall health contributes to disease prevention and comprehensive medical management.

This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR.

The masticatory organ is at the center of dental practice. Tooth loss, regarded as an organ failure, is a core dispute in our profession, as it more often than not does not happen spon-taneously but is influenced by the dentist\'s treatment plan. Despite the prosthetic possibili-ties of tooth replacement, efforts should be made to preserve as many teeth as possible. Decisions between tooth preservation and extraction are complex and have far-reaching consequences. This article discusses this problem using a clinical case study of a 43-year-old female patient with pronounced localized periodontitis. After a comprehensive diagnosis and treatment planning, a daring regenerative therapy was carried out to try to preserve the tooth. The case shows that even seemingly hopeless teeth can be successfully treated syn-chronously using modern therapeutic approaches. Initial literature data supports the possi-bility of preserving severely compromised teeth in the long term in compliant patients. An integrative treatment approach based on individual patient factors and modern regenerative techniques may well be a viable alternative to tooth extraction and prosthetic restoration, albeit not inexpensive and uncomplicated. This communication emphasizes the need for precise diagnostics, a comprehensive treatment plan, and honest communication with pa-tients about the prospects of success and possible risks, and highlights the strengths of con-sistent tooth preservation.
Das Kauorgan steht im Mittelpunkt der zahnärztlichen Praxis. Zahnverlust wird als Organver-sagen betrachtet und stellt ein bedeutendes Problem dar. Trotz prothetischer Möglichkeiten sollte der Erhalt möglichst vieler Zähne angestrebt werden. Entscheidungen zwischen Zahn-erhalt und Extraktion sind komplex und haben weitreichende Folgen. Dieser Artikel behan-delt das Thema anhand eines klinischen Falls einer 43-jährigen Patientin mit ausgeprägter lokalisierter Parodontitis. Nach umfassender Diagnose und Behandlungsplanung wurde eine regenerative Therapie durchgeführt, um den Zahn zu erhalten. Der Fall zeigt, dass auch scheinbar hoffnungslose Zähne mit modernen Therapiemethoden bei zu guter Mundhygiene motivierbaren Patienten erfolgreich behandelt werden können. Erste Literaturdaten unter-stützen die Möglichkeit, stark beeinträchtigte Zähne langfristig zu erhalten. Ein integrativer Behandlungsansatz, basierend auf individuellen Patientenfaktoren und modernen Regenera-tionstechniken, kann eine Alternative zur Extraktion und prothetischen Versorgung sein, ob-wohl er kostspielig und kompliziert ist. Dieser Artikel betont die Notwendigkeit präziser Di-agnostik, umfassender Behandlungspläne und ehrlicher Kommunikation mit den Patienten über Erfolgsaussichten und Risiken sowie die Stärken des konsequenten Zahnerhalts.

OBJECTIVE: The aim of this analysis was to compare a clinical periodontal prognostic system and a developed and externally validated artificial intelligence (AI)-based model for the prediction of tooth loss in periodontitis patients under supportive periodontal care (SPC) for 10 years.
METHODS: Clinical and radiographic parameters were analysed to assign tooth prognosis with a tooth prognostic system (TPS) by two calibrated examiners from different clinical centres (London and Pittsburgh). The prediction model was developed on the London dataset. A logistic regression model (LR) and a neural network model (NN) were developed to analyse the data. These models were externally validated on the Pittsburgh dataset. The primary outcome was 10-year tooth loss in teeth assigned with \'unfavourable\' prognosis.
RESULTS: A total of 1626 teeth in 69 patients were included in the London cohort (development cohort), while 2792 teeth in 116 patients were included in the Pittsburgh cohort (external validated dataset). While the TPS in the validation cohort exhibited high specificity (99.96%), moderate positive predictive value (PPV = 50.0%) and very low sensitivity (0.85%), the AI-based model showed moderate specificity (NN = 52.26%, LR = 67.59%), high sensitivity (NN = 98.29%, LR = 91.45%), and high PPV (NN = 89.1%, LR = 88.6%).
CONCLUSIONS: AI-based models showed comparable results with the clinical prediction model, with a better performance in specific prognostic risk categories, confirming AI prediction model as a promising tool for the prediction of tooth loss.

BACKGROUND: While studies have suggested an association between periodontal disease and an increased risk of cardiovascular disease, the strength of this association and its specific links to various types of cardiovascular disease have not been thoroughly investigated. This study aimed to examine how gingivitis and tooth loss affect cardiovascular diseases, probing their individual impacts.
METHODS: A retrospective cohort study was conducted, encompassing 3,779,490 individuals with no history of cardiovascular disease, utilizing data from the National Health Examination and the Korean National Health Insurance database from 2006 to 2019. Cox proportional hazards models were applied to estimate the association between tooth loss, gingivitis, and cardiovascular disease.
RESULTS: Following a median follow-up of 10.38 years, 17,942 new cardiovascular disease cases were identified, comprising 10,224 cases of angina pectoris, 6,182 cases of acute myocardial infarction, and 9,536 cases of stroke. It was observed that the risk of stroke was significantly higher in the tooth loss group compared to the control group (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.04-1.15). In the group with gingivitis and tooth loss, the risk of stroke and cardiovascular disease was significantly higher than in the control group (aHR: 1.12, 95% CI: 1.04-1.20; aHR: 1.08, 95% CI: 1.03-1.14). The gingivitis group exhibited a higher risk associated with stroke (aHR: 1.05, 95% CI: 1.01-1.10) among individuals aged 50 and above. However, statistically significant associations between periodontal disease and angina pectoris were not observed, nor between periodontal disease and acute myocardial infarction except among those aged above 50. Furthermore, the association between periodontal disease and cardiovascular disease was found to be stronger among individuals over the age of 50, males, those with obesity, and smokers compared to the control group.
CONCLUSIONS: Our results emphasize the association of tooth loss and gingivitis with cardiovascular disease, specifically stroke, underlining the critical need for preventive oral healthcare. Tailored interventions are necessary to reduce the heightened risk of cardiovascular disease events, especially stroke, among older, obese individuals and smokers.

OBJECTIVE: To explore whether: (i) people with severe mental illness (SMI) experience worse oral health than the general population, and (ii) the risk factors for poor oral health in people with SMI.
METHODS: Cross-sectional data were extracted from the National Health and Nutrition Examination Survey (1999-2016), including on self-rated oral health, oral pain, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. Ordinal logistic regression and zero-inflated negative binomial models were used to explore predictors of oral health outcomes.
RESULTS: There were 53,348 cases included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.60, 95% CI: 1.34-1.92). In people with SMI, risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.
CONCLUSIONS: People with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Performing regular physical exercise and flossing may lower the risk of poor oral health, while smoking and diabetes may increase the risk. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes in people with SMI.