Oral Health Indicators Research Articles

Association between clinical and subjective oral health status among schoolgoing children in South Bengaluru

Introduction: A number of self-report measures have been developed that assess the subjective health status such as dental neglect; dental anxiety and oral health related quality of life. Aim: To access the association between clinical and subjective oral health status among school going children in south Bangalore. Methods: 300 completed questionnaires designed to measure oral health indicators were collected from both children (6-10 yrs) and parents. Caries was assessed using dmft index. Result: Out of 300 children examined 55.3% - girls 44.7% - boys. Children with infrequent brushing had more caries. 28% of parents monitored their children while 42% brushed on their own. More than half of the parents and children thought it was necessary to visit dentist frequently and oral health would affect general health. Conclusion: In our study dental self-report items showed high level concordance between child and parents and was found to be clinically valid.

Oral health for healthy longevity in an ageing society: maintaining momentum and moving forward

The ageing of populations worldwide is rapidly accelerating. However, the global burden of oral disease remains a critical and often underestimated problem. As ageing progresses globally, oral health maintenance becomes a matter not only of public health, but also of human rights. Therefore, in low- and middle-income countries, policymakers are seeking to realize universal health coverage even as they struggle with severe resource limitations. To achieve and maintain global oral health, we propose an ongoing global monitoring cycle consisting of the following four steps: needs assessment, implementation of appropriate health care systems and provisions, reducing the global burden of oral disease, and working to achieve a healthy ageing society. Rather than a unidirectional information flow from high income to low- and middle-income countries, the proposed system would establish a multidirectional information-sharing cycle that would benefit all countries. To make this possible, however, we must develop a standardized set of core oral health indicators that all countries use, as well as a global repository for gathering, compiling, and sharing the data. This system would allow each country to move forward at its own pace and in locally-appropriate ways, making it more effective and efficient in the long run than the current pattern of setting unrealistic goals that all countries are expected to achieve by a certain point in time.

Poor oral health affects survival in head and neck cancer

IntroductionPoor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. Materials and methodsCases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). ResultsRoutine dental visits during the preceding 10years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4–0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer—(e.g., >10 visits: HR=0.4, 95% CI=0.2–0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. ConclusionWe found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.

Transition to agriculture in South-Eastern Arabia: Insights from oral conditions.

In Southeast (SE) Arabia, agriculture is supposed to expand around 3000 BC, but its tempo and its actual role in populations' subsistence is still debated by archaeologists. Here, we compare dental health conditions of 11 skeletal samples from coastal and inland sites, dated from the Late Neolithic (ca. 4500-3100 BC) to the Early Bronze Age (EBA), conventionally divided into Hafit (ca. 3100-2700 BC) and Umm an-Nar period (ca. 2700-2000 BC). The goal is to assess long-term trends in subsistence patterns and regional variability during the local transition to agriculture. Seven indicators of oral health and childhood stress were analyzed, including dental wear, calculus, caries, alveolar resorption, periapical lesions, ante-mortem tooth loss (AMTL), and linear enamel hypoplasia (LEH). Neolithic coastal populations are globally characterized by high dental wear, high calculus frequency, high LEH frequency, and frequent periodontal disease, whereas they exhibit low abscesses and AMTL frequencies and a total absence of carious lesions. Samples from the Hafit period present high dental wear, low rates of calculus and LEH, frequent periodontal disease, combined with low abscess and AMTL frequencies and absence of caries. By contrast, samples from the Umm an-Nar period exhibit much lower dental wear, calculus and LEH rates, whereas caries, periapical lesions and AMTL frequencies increase significantly. Marked differences were observed between coastal and inland Umm an-Nar groups, the latter presenting significantly higher frequencies of caries, periapical lesions, alveolar resorption and AMTL. Oral conditions from the Neolithic coastal populations denote a diet mainly composed of unprocessed and abrasive food, with high protein and low carbohydrate intakes, and frequent stress episodes. Although Hafit populations display some changes in oral pathologies, which indicate modifications in their lifestyle and a diversification of the diet, no markers of high carbohydrate intakes were observed in our samples. The impact of agriculture on oral health appears clearly only from the Umm an-Nar period, and is more intense inland than on the coast, where marine resources are still a main component of the diet.

A motivational interview intervention delivered at home to improve the oral health literacy and reduce the morbidity of Chilean disadvantaged families: a study protocol for a community trial

IntroductionOral health education/promotion interventions have been identified as cost-efficient tools to improve the oral health of the population. These interventions are regularly made in contexts where the target population is...

An evaluation of selected oral health indicators and cariogenic bacteria titer in patients with Helicobacter pylori.

Studies based on polymerase chain reaction (PCR) techniques indicate that Helicobacter pylori can be constantly or temporarily present in the oral cavity in virulent or non-virulent form. Streptococcus mutans exerts a strong inhibitory effect on H. pylori. The aim of the present study was to investigate the prevalence and virulence of H. pylori in the oral cavity and the correlation of these factors with oral health and cariogenic bacteria titer. The study involved 108 adults who were positive in urease tests for H. pylori presence in the gastric mucosa. Group I consisted of 50 patients with positive saliva tests using PCR for the presence of H. pylori DNA, while group II comprised 58 patients with negative tests. The research material consisted of saliva and dental plaque. To determine the density of S. mutans and Lactobacillus, commercially available S. mutans and LB sets were used. H. pylori DNA was found in the oral cavities of 46% of the patients who had tested positive in urease tests for the presence of these bacteria in the stomach. Among those who tested positive for the presence of H. pylori in the oral cavity, virulent strains were identified in 16% of the patients. Approximal plaque index (API) and bleeding on probing (BOP) were found to be significantly higher in patients with confirmed H. pylori in the oral cavity. This group also had a smaller number of S. mutans colonies. H. pylori is found more often in patients with poor oral hygiene. Oral sanitation and hygiene instructions should be considered relevant as a complement to eradication therapy.

Impact of delayed gratification on oral health and caries status in the primary dentition

ObjectiveThe ability to delay gratification (ATDG) is naturally linked to key regulatory psychological traits involved in self-discipline/regulation. The aim of this study was to ascertain the normalized impact of ATDG as an early predictor of oral health, on the primary dentition. Methods404 subjects [202 children (4–6 years old) and 202 mothers] were enrolled in a case-control study. Systematic data collection included: i) extraoral diagnostic parameters; ii) intraoral health status; iii) behavioral aspects; iv) baseline socio-demographic data. The ICC, the paired Student’s t-test and kappa statistic were used to evaluate intra-observer reliability. Distributions were explored with the chi-squared test [Odds ratio;95%CI;p<0.05]. Conditional logistic regression was used to evaluate associations between all clinical diagnostic data and ATDG. ResultsOverweight/obese children and those diagnosed with ADHD are more prone to lack ATDG (p<0.001). Higher deft values were observed in children who lacked ATDG, who were also strongly associated with higher sugar consumption and more impulsive personalities (p<0.001;OR:.107/0.031;95%CI:036–0.316/0.008–0.115). By contrast, children with responsible personality traits were associated with this skill (p<0.028;OR:3.33;95%CI:1.1–9.7) and obtained the lowest deft (p<0.306;OR:0.539;95%CI:0.165–0.176) and gingival index values (p<0.001;OR:10.44;95%CI:2.6–40.9), which are clear indicators of better current and future oral health. ConclusionsThese data provide insights into a novel predictor for identifying individuals at a higher risk of dental caries in early childhood. Clinical significanceThe present study offers a new hypothesis for identifying individuals with poor oral health status. Early tools to detect the most vulnerable population sectors are critically important to reduce the global burden of caries and other oral diseases.

Dietary habits, oral impact on daily performance and type 2 diabetes: a matched case-control study from Sudan

BackgroundIt is evident that social and behavioural factors influence on individuals’ general health and quality of life. Nevertheless, information about the influence of dietary habits on oral health-related quality of life is limited; especially among patients with type 2 diabetes (T2D). The aim of this study was to examine the influence of dietary habits and clinical oral health indicators on oral health-related quality of life in individuals with and without T2D.MethodsA total of 149 T2D cases and 298 controls were recruited for this age and gender matched case-control study. Questionnaire-guided interviews were conducted to collect data about socio-demographic characteristics, consumption of food items per week (milk, meat, eggs, vegetables, fruits, sweets and bread) and oral impact on daily performance (OIDP). Plaque index, bleeding on probing, probing depth, tooth mobility, decayed, missing and filled teeth index (DMFT) and root caries were recorded.ResultsDifficulty with eating and sleeping were more frequently reported by T2D cases (23.5% and 16.1%, respectively) than by the controls (10.7% and 5.0%, respectively) (P < 0.01). After adjusting for diabetic status, plaque index, bleeding on probing, probing depth, tooth mobility, root caries, and missing teeth, those with high consumption of milk and sweets, were more likely than those with low consumption to report any oral impact (OIDP > 0). The corresponding ORs were 1.23 (1.01–4.89) and 2.10 (1.08–4.09), respectively. Participants with low consumption of meat and vegetables were more likely than their counterparts with high consumption to report any oral impact. The corresponding ORs were 0.46 (0.25–0.83) and 0.38 (0.17–0.87), respectively. There was a significant interaction between diabetic status and meat consumption as well as between diabetic status and bread consumption.ConclusionsOral impacts were more frequently reported in T2D cases than controls. Independent of diabetic- and oral clinical status, dietary habits discriminated between individuals with and without oral impacts. The influence of meat and bread consumption on OIDP varied significantly according to T2D status.

A Pilot Study to Evaluate the Oral Microbiome and Dental Health in Primary Open-Angle Glaucoma.

To evaluate possible associations between primary open-angle glaucoma (POAG), dental health, and the oral microbiome. Case-control study was conducted at SUNY Downstate. Adult subjects (40 to 87 y) were recruited as POAG cases (n=119) and controls without glaucoma (n=78) based on visual field and optic nerve criteria. Overall 74.6% were African Americans (AA). Information on medical history and oral health was collected and ophthalmologic examinations were performed. Mouthwash specimens (28 AA cases and 17 controls) were analyzed for bacterial DNA amounts. Analyses were limited to AAs as the predominant racial group. Outcome measures included number of natural teeth, self-reported periodontal health parameters, and amounts and prevalence of oral bacterial species. Logistic regression was used to evaluate associated factors and potential interactions. Cases and controls had similar age (mean: 62.2 and 60.9 y, respectively, P>0.48), and frequency of hypertension, diabetes, but cases had a higher proportion of men (P<0.04). On average (±SD), cases had fewer natural teeth than controls [18.0 (±11.1) vs. 20.7 (±9.4)]. Having more natural teeth was inversely associated with POAG, in multivariable analyses, at older ages [eg, odds ratio (95% confidence interval) at age 55: 1.0 (0.95-1.06), P=0.98 vs. at age 85: 0.87 (0.79-0.96), P=0.007]. Amounts of Streptococci were higher in cases than controls (P<0.03) in samples from the subset of subjects analyzed. The number of teeth (an oral health indicator) and alterations in the amounts of oral bacteria may be associated with glaucoma pathology. Further investigation of the association between dental health and glaucoma is warranted.

Tobacco Use, Oral Health, and Risk of Parkinson's Disease.

Few studies have investigated the associations between use of Swedish moist snuff (snus), associated poor oral health, and risk of Parkinson's disease (PD). We followed 20,175 participants who were free of PD in 1973-1974 in Uppsala, Sweden, until the end of 2012. We used Cox proportional hazards regression models to estimate hazard ratios and corresponding 95% confidence intervals for the associations between tobacco use, oral health indicators, and PD risk. We found that tobacco use was associated with a lower risk of PD in males. Compared with males who never used any tobacco daily, pure ever tobacco smokers, pure ever snus users, and combined users had adjusted hazard ratios of 0.68 (95% confidence interval (CI): 0.49, 0.93; n=83), 0.51 (95% CI: 0.27, 0.95; n=11), and 0.21 (95% CI: 0.07, 0.67; n=3), respectively. No association was observed for number of teeth, dental plaque, or detectable oral mucosal lesions and PD risk, although there was a suggestive association with Candida-related oral mucosal lesions in males (hazard ratio=1.56, 95% CI: 0.92, 2.65; P=0.098). Use of snus is associated with a lower risk of PD in males, while poor oral health seems not to be associated with PD occurrence.

Oral Health Indicators for Risk of Malnutrition in Elders.

Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders. Cross-sectional study. Five community centers run by non-government organizations (NGOs). 195 community dwelling elders (65 or above). An interviewer-administered questionnaire was completed to collect information on elders' socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders' nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA). The mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL. Elders' tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition.

The New Definition of Oral Health and Relationship between Oral Health and Quality of Life.

FDI World Dental Federation, which has 200 dental association members in some 130 countries, is the official representative body and voice of more than 1 million clinicians worldwide. It set itself the task of creating a new definition for oral health as a baseline to develop tools to measure oral health and related indicators. The definition allows FDI to position oral health within the global health agenda in areas such as quality of life and wellbeing and the challenge of an ageing population worldwide. Furthermore, it provides an impetus for FDI activities in favour of worldwide periodontal health.

School-Based Oral Hygiene Education Program Has Long-Term Positive Effects on Oral Health Indicators

Long-term effectiveness of school-based children oral hygiene program on oral health after 10-year follow-up. Lai H, Fann JC-Y, Yen AM-F, Chen L-S, Lai M-H, Chiu SY-H. Community Dent Oral Epidemiol 2016;44(3):209-15. Information not available TYPE OF STUDY/DESIGN: Prospective cohort design.

Severity of illness and extra pyramidal symptoms as predictors for oral diseases among patients with schizophrenia

Objective: The study explores the association between severity of illness (positive, negative, depressive and cognitive symptoms) and extra pyramidal symptoms (EPS) with dental caries, periodontal disease and prosthetic needs among patients with schizophrenia.Material and methods: A total of 71 schizophrenic patients diagnosed based on ICD-10 criteria participated in the study. Clinical Global Impression – Schizophrenia (CGI–SCH) scale was used to evaluate positive, negative, depressive, cognitive symptoms and overall severity of schizophrenia. Simpson–Angus Scale (SAS) was used for assessment of EPS. Dental examinations were conducted as per WHO (1997) criterion.Results: Mean DMFT and CPI scores with periodontal pockets were 5.57 ± 2.12 and 2.37 ± 0.74; significant differences being noted among those with and without EPS (p < 0.001). Positive and EPS associated with dental caries with odds ratio of 5.26 (1.05, 26.2) and 8.52 (2.31, 31.4) (p < 0.001). Depressive and EPS were associated with periodontal disease with odds ratio of 4.19 (1.53, 32.5) and 5.27 (1.29, 21.5), respectively (p < 0.001). Cognitive and EPS were associated with dental prosthetic needs with odds ratio of 4.33 (1.47, 31.2) (p < 0.001) and 7.78 (1.43, 42.2), respectively (p < 0.001).Conclusions: Patients with schizophrenia had high dental caries, periodontal disease and unmet dental prosthetic needs. Severity of the schizophrenic and EPS was associated with poor oral health. Efforts need to be focused on strengthening the evidence of its association with oral health indicators through further studies including cohort investigations.

Prevalence of Fissured Tongue in a South Indian Population - A Cross-Sectional Study

Background: Tongue is an indicator of oral and general health. Fissured tongue is a common normal variant which does not require any treatment. Clinically, fissures are of varying depth up from 2 mm to 6 mm usually on the dorsal aspect at times extending onto the margins. Objectives: The objectives of the study are: 1. To determine the prevalence of fissured tongue, 2. To assess the most prevalent pattern of fissured tongue in patients visiting a dental school, 3. To assess the possible association between the occurrence of fissured tongue with age, sex, habits, symptoms and medical illness. Methods: A cross sectional study was conducted among 500 patients, who visited the OPD of a dental school in South India. Fissured tongue was diagnosed clinically based on the presence of grooves on the dorsal and lateral aspects of the tongue and also the pattern of fissure. The subjects were interviewed for their habit history, symptoms related to tongue lesions and medical history. Statistical analysis: Chi square test was done to assess the relation between fissured tongue with age, sex, habits, symptoms and medical illness. Results: Out of the 500 patients screened, fissured tongue was present in 65 cases. 44 were males and 21 were females. Overall tongue fissures were present in 13%. The fissures were found to be least in the 10-20 year age group, 2 (3.07%) and it was most prevalent in the 21-40 age group, 25 (38.46%), followed by 41- 60, 22 (33.84%) and 61-80, 16 (24.61%) years of age. The most prevalent pattern of fissure was found to be central longitudinal fissuring, 32 (49.23%), followed by transverse fissures arising from a central fissure 10 (15.38%), then type I, 9 (13.84%) type V, 9 (13.84%), type VI, 4 (6.15%) and type III, 1 (1.53%). The least prevalent pattern was type III, double fissures. In our study 100% of our patients were asymptomatic. In our study 20% and 13.8% of fissured tongue was found in patients with diabetes mellitus and hypertension. There was no significant association of fissured tongue with systemic conditions. Prevalence of fissured tongue in patients with tobacco chewing, tobacco smoking and alcohol intake were 4.6%, 1.5%, and 1.5% respectively. Conclusion: The prevalence was seen more in the elderly age group and in the males. Central longitudinal fissuring was the most prevalent pattern seen. The fissured tongue was asymptomatic in all our patients. The occurrence of fissured tongue showed no association with any systemic conditions and habits.

Patterns of Partial Edentulism and its Relation to Khat Chewing in Jazan Population - A Survey Study.

Partial edentulism is a prime indicator of overall oral health in a given country. Khat chewing habit in the south region of Saudi Arabia is widely practiced by a majority of the population. To determine the frequency of Kennedy's classes in each arch among different age groups, gender and to find out the relationship between khat chewing and the pattern of partial edentulism. The data was collected from 780 subjects reporting to the College of Dentistry, Jazan University, who required removable partial dentures. Clinical intra-oral and radiographic examinations were done. The study subjects were divided into five age groups, 20-29, 30-39, 40-49, 50-59 and ≥ 60 years respectively. Khat chewing hours/day and type of Kennedy's classes were recorded. The data were entered into a Statistical Package for Social Sciences program and analysed accordingly using Fisher-Exact test. Class III was the highest in all middle age groups followed by Class I. Class III was the highest in males, while in females, Class I was the highest in both arches. Class IV was the lowest in all age groups, both arches, and genders. Among khat chewers Class III was the highest followed by class I in both arches. Class IV was the highest in >12 hours duration in maxilla but in the mandible, Class I and II were the highest in 1-6 hours duration. The obtained p-values were statistically significant (p<0.001) in all tested variables and age groups. Kennedy's Class III was the highest followed by Class I, while Kennedy's Class IV was the lowest in all age groups and both arches regardless of khat chewing durations. In males Class III, was the highest, while in females Class I was the highest in both arches.

A comparative study of the utility of oral health indicators in adults

A comparative study of the utility of oral health indicators in adults

Association of adverse oral health outcomes with socioeconomic inequalities and dental needs in Brazilian adolescents.

This study aimed to explore the relations between adverse oral outcomes and socioeconomic, demographic, and self-rated oral health variables and to describe their distribution. Principal component analysis was conducted on data from adolescents in the Brazilian National Oral Health Survey (N = 5,445). Higher loadings were found for crowding (0.6), maxillary and mandibular irregularities (0.5), and count of communitary periodontal index (CPI) sextants with bleeding and dental calculus (0.5). The mean rates for periodontal and occlusal disorders were at least two times higher in adolescents from lower income families and those reporting the need for dental prostheses, as well as those dissatisfied with their dental and overall oral health. Increased mean rates of occlusal disorders were associated with schooling delay and history of toothache in the previous six months. The mean scores suggested accumulation of at least one of the negative oral health indicators in the lower income strata, among adolescents with schooling delay, and in those reporting dental needs. The results suggest priorities for planning and monitoring as a function of oral health requirements.

Oral health conditions and activities of daily living in an elderly population in Brazil

Abstract Objective: To analyze the relationship between the oral health status and functional capacity in performing basic activities of daily living of a population of elderly persons. Method: A cross-sectional population-based study with 441 individuals aged 60 years or over both genders was performed in the municipality of Macaíba, Rio Grande do Norte. From intraoral epidemiological examination, the degree of caries attacks (CPO-D index), periodontal condition (CPI and PIP indexes), the use and need for dental prosthesis and the presence of oral lesions were evaluated. Independence in Activities of Daily Living was used to evaluate functional capacity. Socioeconomic and demographic characteristics were surveyed using a structured questionnaire. Results: Oral health variables were subjected to factor analysis, which resulted in four indicators. There was no association between these indicators and the functional capacity of the elderly. Gender, age, presence of caregiver, dominant area of residence, time of last visit to the dentist, type of care sought during such visit and self-perception regarding prosthesis replacement were significantly associated with oral health indicators. Conclusion: Given the non-identification of the effect of functional capacity on the oral health of the elderly, the time of measurement of the events investigated should be considered. It is suggested that dependency among the elderly occurs at different times from when the consequences of oral problems are observed, considering the cumulative effects of a previous history of invasive dental care.

Poor oral health is associated with an increased risk of esophageal squamous cell carcinoma - a population-based case-control study in China.

To further examine the association between oral hygiene and esophageal squamous cell carcinoma (ESCC) risk and the effect modification of other exposures, we conducted a population-based case-control study between 2010 and 2012 in Taixing, China, a high-risk area for ESCC. Cases were primarily recruited from endoscopy units at local hospitals, supplemented by linkage to the local Cancer Registry. Control subjects were frequency matched to cases by sex and age (5-year groups) and were randomly selected from the Taixing Population Registry. For the current analysis, data from 616 histopathologically confirmed cases and 770 controls with complete information on oral hygiene were analyzed. Unconditional logistic regression models, including oral hygiene indicators and potential behavioral confounders, were used to derive odds ratios (ORs) and 95% confidence intervals (CIs). Tooth loss was only marginally significantly associated with ESCC risk (yes vs. no, OR = 1.29, 95% CI 0.94-1.74). However, the excess risk increased with increasing numbers of lost teeth (more than 6 teeth lost vs. none, OR = 1.48, 95% CI 1.04-2.11). Tooth brushing once or less per day, compared with tooth brushing twice or more per day, was associated with a 1.81-fold increased risk of ESCC. In the stratification analyses, the increased risks associated with these indicators of oral health were more pronounced in older subjects (age ≥ 70 years), women, non-smokers, and non-drinkers. Further studies are warranted to verify these findings and to explore the underlying mechanisms, e.g., changed oral microbiota, associated with poor oral hygiene.