Annie M. Vivares-Builes

Influence of the Socio-Economic Context on Self-Reported Gingival Bleeding in Individuals of Ethnic Minority Groups: A Multilevel Analysis

Introduction: To evaluate the influence of the socio-economic context on self-reported gingival bleeding (SRGB) in individuals of ethnic minority groups (IEG). Methods: Data from the 2007 National Public Health Survey in Colombia were collected. A multiple-stage stratified sampling was used. Data from 34.843 subjects were collected through interviews. The influence of socio-economic factors on SRGB in IEG was investigated with logistic and multilevel regression analyses. Results: Out of 34.843 subjects studied, a total of 6.440 individuals were members of ethnic minority groups. SRGB was observed in approximately 5% of IEG. There was a significant difference between IEG and subjects of the rest of the sample (28.403 subjects) regarding SRGB, elementary and high school education, Gross Domestic Product (GDP), Human Development Index (HDI) and Unmet Basic Needs Index (UBNI) disfavouring IEG (P<0.05). The logistic model showed that SRGB was associated with IEG (P<0.001). This association persisted after controlling for confounders. A total of 33 Colombian states (level 2) and 6.440 members (level 1) of ethnic minority groups were included in the multilevel analisys; this model showed that the variance on SRGB was statistically significant at level 1 and 2. However, the variation at IEG level (35%) was smaller than the variation between states (65%) in the multilevel multivariate model. Conclusions: SRGB was higher in IEG. Also, GDP, HDI and UBNI were unfavourable factors in the members of ethnic minority groups. Considering these detriment factors and the higher variation between states, this study suggests that socio-economic context affects significantly SRGB in IEG.

Gaps in Knowledge About the Association Between Maternal Periodontitis and Adverse Obstetric Outcomes: An Umbrella Review

Objectives Scientific literature has established that the periodontal condition during pregnancy could be associated with obstetric/neonatal morbidity, and these effects have an important relationship with problems during childhood and cardiovascular disease in adulthood. This umbrella review aimed to summarize the results about the association between maternal periodontitis and obstetric complications (low birth weight, preterm delivery, and preeclampsia) and identify the gaps in the scientific literature. Methods An umbrella review of systematic reviews with or without meta‐analysis was performed. Quality evaluation and descriptive analysis of the characteristics of the included studies were conducted. Results Nineteen systematic reviews/meta‐analyses were considered. In total, the systematic reviews included 99 observational studies. Most of the reviews established an association between maternal periodontitis and a higher risk of low birth weight, preterm delivery, and preeclampsia. The magnitude and statistical significance of this relationship are influenced by the context in which the studies have been conducted. Gaps were identified in the definition/evaluation of periodontal disease, criteria of gestational age for study purposes, and potential confounders, among others. Conclusions Although scientific literature has established an association among the analyzed pathologies, conceptual and methodological gaps were identified, and they should be considered as integral components when this association is investigated.

La Invisibilidad de Estudios en Salud Oral en Mujeres en Situación de Prostitución: Una Revisión Sistemática Exploratoria

El objetivo fue describir los estudios existentes a nivel mundial relacionados con salud oral en mujeres en situacion de prostitucion. Para ello se realizo una revision exploratoria (Scoping Review) sobre el tema en cuestion en estudios publicados en forma de articulos cientificos originales en revistas de revision por pares, sin restriccion en el periodo de busqueda e indexados en 4 bases de datos internacionales (PubMed, EMBASE, LILACS y SCOPUS). Descripcion de las principales caracteristicas de los estudios. Como resultados principales, luego de hacer el proceso de seleccion se encontraron 10 estudios con diferentes enfoques metodologicos (cuantitativos, cualitativos o mixtos y estudios de intervencion). Seis de los estudios fueron realizados en paises asiaticos (Japon y Singapur). Las tematicas abordadas fueron: manifestaciones orales del VIH, uso del condon, practicas y actitudes frente al sexo oral. Solamente se encontro un estudio especifico en salud oral realizado en Senegal el cual analiza la situacion periodontal en trabajadoras sexuales con y sin VIH. Los estudios en salud oral para la poblacion en situacion de prostitucion son escasos. Siendo un grupo sensible y vulnerable socialmente, se requiere fomentar la investigacion en estas mujeres para identificar las posibles situaciones de desigualdad social que impactan en las condiciones de salud oral en este colectivo.

An Umbrella Review Exploring the Effect of Periodontal Treatment in Pregnant Women on the Frequency of Adverse Obstetric Outcomes

Objective In the recent years, efforts have been made to reduce epidemiologic indicators of periodontal disease in pregnant women. This umbrella review aims to analyze the systematic reviews/meta‐analyses investigating the effect of periodontal therapy in pregnant women on the frequency of obstetric complications (low birth weight, preterm delivery, and preeclampsia) and to identify the gaps in the scientific literature. Methods A systematic review of systematic reviews with and without meta‐analysis of intervention studies was conducted. Quality evaluation and qualitative analysis of the reviews were performed. Results A total of 223 articles were obtained, and 18 of them were included in the analysis, 13 articles included meta‐analysis, where 11 were of high quality and 7 of medium quality according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guide. These systematic reviews/meta‐analyses included a total of 19 studies (17 randomized clinical trials). Descriptive systematic reviews showed that periodontal therapy has positive effects on reducing the frequency of adverse pregnancy outcomes. In systematic reviews with meta‐analysis, overall effect estimators were not significant, although a reduction in the incidence of obstetric complications was observed. Subgroup analysis resulted in significant effects, depending on sociodemographic conditions. Conclusions Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of adverse pregnancy outcomes in pregnant women receiving periodontal therapy. Possible explanations are related to factors such as the type of studies analyzed, indicator of obstetric complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.