Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Association Between Metabolic Syndrome and Oral Diseases Among US Adults(Harvard University School of Dental Medicine, 2025) Alhassan, Hameedaldeen; Natto, ZuhairThe objective was to assess the association between oral diseases and metabolic syndrome (MetS), examining both the individual and combined effects of MetS five components. Also, to validate the NHANES diagnostic criteria and Overjet artificial intelligent (AI) platform with the gold standard for periodontal disease diagnosis. First, a systematic review and meta-analysis were conducted by searching PubMed, Embase, and Web of Science for studies published between 1990 and 2023 that examined the association between Dental caries and MetS in adults. Two independent authors selected and analyzed articles, assessed risk of bias, and evaluated the overall evidence certainty. Meta-analyses were performed to estimate pooled odds ratios (ORs), or mean differences (MDs), and corresponding 95% confidence intervals (CIs) for decayed teeth (DT) and DMFT (Decayed, Missing, and Filled Teeth). Second, data from NHANES 2011-2018 were used to assess the association between MetS and oral diseases (dental caries and periodontal disease). The sample included adults over 29 years who completed laboratory and clinical assessments for MetS and oral diseases. Logistic regression models (OR and 95% CI) were used to assess associations between MetS and both untreated caries and periodontal disease. Negative binomial regression (mean ratio [MR] and 95% CI) was conducted to examine the association between MetS and DMFT score. Third, clinical and radiographic records of patients aged over 29 years were utilized to validate the NHANES diagnostic criteria (based on clinical measures alone) and the Overjet AI software (using full-mouth radiographs) for detecting periodontal disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the accuracy of both clinical measures and the Overjet AI software, using a gold standard defined as a combination of clinical and radiographic analysis conducted by a periodontist. The meta-analysis (nine studies with 59,075 participants) revealed that there was a positive statistically insignificant association between DT and MetS (OR: 1.17, 95% CI: 0.87–1.58; MD: 0.22, 95% CI: -0.08–0.52). However, a significant positive association was found between MetS and DMFT (OR: 1.28, 95% CI: 1.08–1.51). Results from NHANES showed that participants with MetS were more likely to have untreated caries and high DMFT mean score by 34% and 10%, respectively. While there was no association between MetS and periodontal disease. Low HDL was the most significant MetS component associated with dental caries, while insulin resistance was the strongest component linked to periodontal disease. Having all five MetS components was associated with a 17% higher likelihood of a high DMFT score. Results from the validity study showed that detecting periodontal disease using clinical measures achieved 96% sensitivity and 99% specificity. While Overjet AI software achieved 100% sensitivity and 89% specificity. In conclusion, the study revealed a positive association between MetS and dental caries, while there was no association between MetS and periodontal disease. Future prospective cohort studies could provide a better understanding of these associations. The validity study demonstrated that both clinical measures and Overjet AI software achieved high accuracy in detecting periodontal disease.6 0Item Restricted Is Fatigue Associated with Oral Health Outcomes Among American Adults?(King's College London, 2024-08) Alotaibi, Abdulmajeed; Sabbah, WaelBackground: Fatigue is a frequent problem in the American adult population, affecting every aspect of health, from mental to physical wellbeing. Although the negative effects of fatigue on general health are well documented, little research has been identified that investigated its effect on oral health. Among the adverse consequences of fatigue, bad oral habits like neglecting oral hygiene and regular dental check-ups can lead directly to negative outcomes with individual’s teeth, such as tooth loss, tooth decay and periodontal disease. Fatigue is described as the subjective sense of not being able to accomplish a task efficiently owing to decreased effectiveness. Objective: This study examines the correlation between fatigue and oral health among US population. Method: Data were gathered from the 2015-2018 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of adults aged 18 and above. The Patient Health Questionnaire-9 (PHQ-9) was used to assess and examine fatigue using a thoroughly validated assessment based on the Prime-MD diagnostic instrument. In NHANES, it is referred to as the Depression Screener Questionnaire (DPQ). The tooth count was established by clinical exams performed by qualified dentists. Logistic regression models were used to determine the relationship between tooth count and fatigue and adjusted for demographic characteristics, socioeconomic status, dental visits, multimorbidity and smoking status. Results: Of the 11,848 participants (mean age: 47.25 years), 52.94% experienced fatigue. The incidence of tooth loss was greater among individuals who reported being 3 fatigued. However, after accounting for demographic characteristics, socioeconomic status, mean poverty income ratio, and multimorbidity, the link between tooth loss and fatigue maintained its statistical significance (Odds Ratio ‘OR’ = 1.21, 95% Confidence Interval ‘CI’: 1.01-1.43). Model 3 found Participants who hadn't seen a dentist in over a year have more chance to experience fatigue (OR = 1.21, 95% CI: 1.04-1.39, p = 0.014). Conclusion: to conclude, having fewer teeth is linked to fatigue among American adults. To manage fatigue and its broader health effects, a multifaceted approach is needed, including regular dental care, reducing socioeconomic disparities, and assessing both physical and mental health. This integrated strategy can improve overall well-being and address the complex link between fatigue and oral health.16 0Item Restricted Is root caries more likely to occur among older adults with multimorbidity?(KING'S COLLEGE LONDON, 2024) Alyamani, Saif; Sabbah, WaelBackground: Root caries, a prevalent dental condition in the older population, substantially impacts oral health and overall quality of life. It leads to tooth surface loss, pain, and increased risk of periodontal disease, affecting nutrition, psychological well-being, and social interactions. Effective prevention and management are crucial. Multimorbidity, is prevalent in older populations and can influence various health outcomes. The aim of this study is to examine the relationship between multimorbidity and root caries in older American adults. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, this cross-sectional study focused on adults aged 60 years and older. The presence of root caries or root restoration was assessed through clinical dental examinations. Multimorbidity was identified by the existence of nine chronic diseases, namely, diabetes, asthma, cancer, heart attack, stroke, angina, chronic pulmonary disease, kidney diseases, and arthritis. Logistic regression models were used in this study to evaluate the association between multimorbidity and root caries, adjusting for sociodemographic factors, health behaviours, and dental care access. Results: Among the 2486 participants (mean age: 69.3 years), 23% had root caries, while 43% had multimorbidity (two or more conditions). Root caries prevalence was higher in individuals with multimorbidity. However, after adjusting for confounders, multimorbidity’s association with root caries did not show statistically significant results (OR = 1.02, 95% CI: 0.88-1.18). Significant associations were found between root caries and smoking (OR = 4.67 for current smokers vs. never smokers) and income to-poverty ratio, with lower ratios linked to higher root caries prevalence. Conclusion: While multimorbidity alone did not show a significant impact on root caries prevalence, lifestyle factors, particularly smoking and socioeconomic status, played critical roles. Addressing these modifiable risk factors and improving access to dental care are essential for enhancing oral health outcomes in older adults. Additional studies are required to investigate the intricate interactions of factors influencing oral health in this demographic.24 0