The Sex and Gender Intersection in Chronic Periodontitis

Periodontitis, a complex polymicrobial inflammatory disease, is a public health burden affecting more than 100 million people and being partially responsible for tooth loss. Interestingly, periodontitis has a documented higher prevalence in men as compared to women signifying a possible sex/gender entanglement in the disease pathogenesis. Although relevant evidence has treated sex/gender in a simplistic dichotomous manner, periodontitis may represent a complex inflammatory disease model, in which sex biology may interfere with gender social and behavioral constructs affecting disease clinical phenotype. Even when it became clear that experimental oral health research needed to incorporate gender (and/or sex) framework in the hypothesis, researchers overwhelmingly ignored it unless the research question was directly related to reproductive system or sex-specific cancer. With the recognition of gender medicine as an independent field of research, this study challenged the current notion regarding sex/gender roles in periodontal disease. We aimed to develop the methodological and analytical framework with the recognition of sex/gender as important determinants of disease pathogenesis that require special attention. First, we aim to present relevant sex biologic evidence to understand the plausibility of the epidemiologic data. In periodontitis pathogenesis, sex dimorphism has been implicated in the disease etiology possibly affecting the bacterial component and the host immune response both in the innate and adaptive levels. With the clear distinction between sex and gender, gender oral health disparities have been explained by socioeconomic factors, cultural attitudes as well as access to preventive and regular care. Economic inequality and hardship for women have resulted in limited access to oral care. As a result, gender emerged as a complex socioeconomic and behavioral factor influencing oral health outcomes. Taken together, as disease phenotypic presentation is a multifactorial product of biology, behavior and the environment, sex dimorphism in immunity as well as gender socio-behavioral construct might play a role in the above model. Therefore, this paper will provide the conceptual framework and principles intergrading sex and gender within periodontal research in a complex biologic and socio-behavioral dimension

Non-surgical and Supportive Periodontal Therapy: Predictors of Compliance

Aim To identify predictors of compliance during non-surgical and supportive periodontal therapy (SPT). Materials and Methods In this retrospective study, demographic, dental, medical data of 427 new patients in a private practice were collected. Data were analysed in statistical models with non-surgical therapy and SPT compliance used as dependent variables. Results Of the 427 patients, 17.3% never agreed to initial therapy, 10.7% never completed therapy and 20.8% completed treatment, but never entered SPT. Of the 218 SPT patients, 56% became non-attenders after a period of 20 months, 33% were erratic attenders and 10.5% were regular attenders until the end of the observation period (5.5–6.5 years). Patients became erratic attenders after a mean period of regular attendance of 18.1 ± 16.2 months, whereas 49.6% of the patients, who abandoned SPT, were regular attenders until the time they stopped. In a univariate correlation model, periodontal disease severity emerged as a significant predictor of the completion of non-surgical periodontal therapy (p = 0.01). In a multivariate linear regression model, smoking was negatively associated with SPT compliance (p = 0.047). Conclusions A low compliance of the population was observed. Smoking and periodontal disease severity represented significant, but modest modifiers of a patient compliance with SPT and initial therapy respectively

Under-representation of women on dental journal editorial boards.

Each journal's editorial and advisory board plays a critical role in resolving gender bias in the peer-review and publication process. Thus, this study aimed to quantify women's participation in editorial and advisory boards of major dental journals. Gender data on editorial and advisory boards were extracted from major dental journals, which were then categorized by journal specialty focus. The gender of the editor-in-chief and associate editor-in-chief was noted to assess the effect of journal leadership on women's participation in journal boards. For comparison purposes, data were also obtained regarding the percentage of women faculty for each dental specialty.Overall, in the major 69 dental journals, 14.8% of editorial board members were women. An one-way ANOVA analysis revealed statistically significant gender differences between journal specialty categories (p = 0.003) with some dental specialties' journals demonstrating a relatively high participation of women as editorial board members. There was a significant positive correlation for various dental specialties between women's representation in editorial and advisory boards and women in similar dental academic specialties (p = 0.02, r2 = 0.55). Furthermore, there was a positive correlation between the presence of women in journal editorial leadership and the percentage of women serving as advisory board members (p = 0.03). Our results confirmed that the under-representation of women on dental journal editorial boards was significantly different between dental science specialties. When there were more women in journal editorial leadership positions, there was a higher participation of women as editorial and advisory board members. Journals should increase the numbers of women on editorial boards in order to secure diversity, improve publication quality and recognize women's contribution to dental science

Tooth Loss Strongly Associates With Malnutrition in Chronic Kidney Disease

Background In chronic kidney disease (CKD), inadequate nutritional intake, inflammation, and increased oxidative stress have been the major contributing factors in malnutrition pathogenesis. However, there is still a paucity of evidence assessing the magnitude of the effect of tooth loss on malnutrition in CKD populations. The authors hypothesize that among patients with CKD, tooth loss may affect nutritional status, using the National Health and Nutrition Examination Survey 1988 to 1994 (NHANES III). Methods Glomerular filtration rate (GFR) was estimated based on cystatin C levels using the relevant equation. Urinary albumin-to-creatinine ratio (albuminuria) was calculated in milligrams per gram with a cutoff point of 30 mg/g. CKD was defined based on estimated GFR \u3c60 mL/minute/1.73m2 and albuminuria ≥30 mg/g. The cutoff point for serum albumin was set at 3.7 g/dL. Tooth loss categories were based on the number of missing and replaced teeth. Results A total of 2,749 patients was included and stratified based on their oral health status. There was a statistically significant correlation between tooth loss and the proportion of patients with low protein and caloric intake (P = 0.02 and 0.01, respectively). Serum albumin reached a frequency peak in the fully edentulous group without dentures (group 4, 19.2%). In the same group, individuals had lower protein (30.1%) and caloric intake (30.2%) (P = 0.01 and 0.02, respectively). Furthermore, logistic regression analysis confirmed the significant role of tooth loss on serum albumin and protein and energy intake in this population even after adjusting for confounding variables. Conclusion Tooth loss independently predicts low energy and protein intake, as well as serum albumin levels, biomarkers of malnutrition in CKD

The association of women on editorial leadership and advisory board membership.

<p>The scatterplot and line fit shows a linear trend (r² = 0.44) and a significant correlation between women on journal editorial leadership and women as editorial and advisory board members. (p = 0.03).</p

Women’s representation on Dental Journal Editorial Boards.

<p>Journal Categories in an ascending order based on statistical mean (mean and standard deviation, as represented by solid circle and bards, respectively). Periodontology journals showed the lowest proportion of women on editorial boards followed by oral and maxillofacial surgery. Public health journals showed the highest representation of women in editorial boards. Perio: periodontology journals, Oral Sx: oral and maxillofacial surgery journals, Prostho: prosthodontic journals, Endo: endodontic journals, Ortho: orthodontic journals, Oral Mx: oral medicine, oral pathology, oral radiology journals, Pedo: pediatric dentistry journals.</p

The association of women on editorial/advisory board and in the corresponding academic specialty.

<p>The scatterplot and fit line shows a linear trend (r² = 0.55) and confirms a positive and significant correlation between women on editorial and advisory boards and women faculty per academic specialty (p = 0.01).</p

Implant Failure Predictors in the Posterior Maxilla: A Retrospective Study of 273 Consecutive Implants

Background: The goal of this study was to retrospectively analyze a cohort of 136 patients who underwent dental implant placement in the posterior maxilla at the University of Connecticut Health Center to assess and identify predictors for implant failure in the posterior maxilla. Methods: Data were retrieved from patient charts to identify subjects older than 21 years of age who received dental implant(s) in the posterior maxilla. Patients without a postoperative baseline radiograph were excluded. A recall radiograph was taken 3 to 6 months after implant placement. If there was no recall radiograph, the subject was contacted for a recall visit that included a clinical evaluation and radiographs to determine the implant status. Based on a univariate screening, variables considered potential implant failure predictors included gender, diabetes, smoking, implant length, implant diameter, membrane use, sinus-elevation technique, and surgical complications. These parameters were further assessed, and a multivariable logistic regression was performed with implant failure as a dependant variable. All tests of significance were evaluated at the 0.05 error level. Results: Two hundred seventy-three implants were placed in the posterior maxilla. Fourteen implants failed (early and late failures combined), resulting in a 94.9% overall survival rate. The survival rates for the sinus-elevation group and native bone group were 92.2% and 96.7%, respectively (P = 0.090). Based on the multivariable analysis, sinus floor-elevation procedures were not associated with increased risk for implant failure (P = 0.702). In contrast, smoking and surgical complications had a statistically significant effect on implant failure; the odds ratios for implant failure were 6.4 (P = 0.025) and 8.2 (P = 0.004), respectively. Conclusion: Sinus-elevation procedures with simultaneous or staged implant placement do not increase the risk for implant failure, whereas smoking and surgical complications markedly increase the risk for implant failure