Sona Rivas-Tumanyan

Periodontal Disease, Hypertension, and Blood Pressure Among Older Adults in Puerto Rico

BACKGROUND Current scientific evidence addressing the relationship between periodontitis and hypertension is limited to studies producing inconsistent results. METHODS All participants of an ongoing representative cohort of Puerto Rican elderly who were ≥70 years old and residing in the San Juan metropolitan area were invited to this cross-sectional study. Periodontal probing depth (PD) and attachment loss (AL) were summarized using the Centers for Disease Control and Prevention and the American Academy of Periodontology definition for severe periodontitis (≥2 teeth with AL ≥6 mm and ≥1 tooth with PD ≥5 mm). Three repeated blood pressure (BP) measurements taken were averaged using a standardized auscultatory method. Information on hypertension history, use of antihypertensive medications, and potential confounders (age, sex, smoking, heavy and binge drinking, diabetes, use of preventive dental services, flossing, body mass index, consumption of fruits, vegetables, whole wheat bread, and high-fiber cereal) was collected during in-person interviews. High BP was defined as average systolic BP ≥140 mm Hg or diastolic ≥90 mm Hg. Multivariate logistic regression models were used to study the relationship between severe periodontitis, hypertension history, and high BP. RESULTS The study population comprised 182 adults. In multivariate analysis, there was no association between severe periodontitis and hypertension history (odds ratio [OR] = 0.99; 95% confidence interval [CI]: 0.40 to 2.48). Severe periodontitis was associated with high BP, with OR of 2.93 (95% CI: 1.25 to 6.84), after adjusting for age, sex, smoking, and binge drinking. This association was stronger when restricted to those with hypertension or taking antihypertensive medications: OR = 4.20 (95% CI: 1.28 to 13.80). CONCLUSION The results of this study suggest that periodontitis may contribute to poor BP control among older adults.

Success and complications of implant-retained prostheses provided by the Post-Doctoral Prosthodontics Program, University of Puerto Rico: A cross-sectional study

STATEMENT OF PROBLEM The success rate of implant-retained prostheses in a postdoctoral prosthodontics program was unknown and could not be related to any set of potential clinical issues or patient characteristics. PURPOSE The purpose of this study was to determine the success rate of implant-retained prostheses placed by prosthodontic residents between 1997 and 2012 and to evaluate the associations between patient classifications and specific restoration characteristics as related to prosthesis success or failure. MATERIAL AND METHODS A total of 272 prostheses in 119 patients were clinically evaluated. Success was defined as the absence of prosthetic complications or any implant-related complication that affected prosthesis survival. Logistic regression was used to evaluate associations between prosthesis success/failure and a wide array of study variables, adjusting for patient age, sex, and prosthesis longevity. RESULTS The overall success rate was 71%, with a mean prosthesis age of 4.5 years (range: 4 months to 16.8 years). Implant single crowns were the most successful prosthesis type (81% success). The most common complications observed were porcelain fractures in fixed dental prostheses (15%) and lack of stability (31%) and retention (29%) in removable dental prostheses. Having a removable prosthesis (versus natural dentition) in the opposing occlusion significantly decreased the odds of success (OR=0.26, 95% CI: 0.11-0.64). Definitively cemented fixed prostheses were more successful than those cemented with an interim cement (OR=4.56, 95% CI: 1.37-15.22). CONCLUSIONS The overall success rate of the implant-retained prostheses placed in the program was low compared with previously published studies. This study revealed the need for an efficient, comprehensive recall system for patients receiving implant-retained prostheses, either fixed or removable.

Association between Type, Amount, and Pattern of Carbohydrate Consumption with Dental Caries in 12-Year-Olds in Puerto Rico

Objective: To identify the types, food sources, and pattern of carbohydrates that significantly contribute to dental caries in Puerto Rican children. Methods: As part of an island-wide cross-sectional oral health study in 1,587 twelve-year-olds, diet intake was assessed in a representative subset (n = 801) with a 24-hour dietary recall. Carbohydrate intake was quantified using a computer-based diet analysis program. Caries was assessed using the National Institute of Dental and Craniofacial Research diagnostic criteria. Odds ratios were used to associate carbohydrate intake quartiles with caries, after controlling for important confounders. Results: A total of 723 subjects had complete data. Most were females (54%) and attended public schools (77%). The caries prevalence was 33%. The highest quartile intake for the following sugars significantly increased the odds of caries compared to the lowest quartile: total carbohydrates (OR = 1.93, 95% CI = 1.08-3.46), total sugars (OR = 1.88, 95% CI = 1.01-351), sucrose (OR = 2.05, 95% CI = 1.13-3.70), fructose (OR = 1.95, 95% CI = 1.05-3.62), and inositol (OR = 2.52, 95% CI = 1.38-4.63). The main food sources of these sugars were juices, including natural juices with no added sugars, and sweetened beverages. The odds of caries also increased significantly in children whose 10% of total energy intake was from total sugars (OR = 3.76, 95% CI = 1.03-13.7). Conclusion: After adjusting for important caries risk factors, total carbohydrates, total sugars, ≥10% kilocaloric energy from total sugars, and sucrose, fructose, and inositol intake significantly increased caries risk. Our findings can help raise awareness about the potential caries risk from the main sources of these sugars, natural fruit juices and sweetened beverages, which are consumed in great quantities in many societies.

A Semi-Quantitative Food Frequency Questionnaire Validated in Hispanic Infants and Toddlers Aged 0 to 24 Months

BACKGROUND There are limited validated food frequency questionnaires (FFQs) for infants and toddlers, most of which were evaluated in Europe or Oceania, and the ones available for use in the United States have important limitations. OBJECTIVE Our aim was to assess the validity of an FFQ developed for infants and toddlers. DESIGN A semi-quantitative FFQ was developed that included 52 food items, their sources, and portion sizes. The FFQ inquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ, followed by a 24-hour recall on two occasions with 1 week between data collection. PARTICIPANTS/SETTING A total of 296 caregivers of infants and toddlers aged 0 to 24 months enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children, Puerto Rico. MAIN OUTCOME MEASURES Intake of nutrients and food groups were averaged for the two FFQs and the two 24-hour food recalls, and adjusted for energy intake. STATISTICAL ANALYSES PERFORMED Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24-hour recalls. RESULTS A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs and 24-hour recalls and between the means of FFQs and 24-hour food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-hour recalls ranged from 0.26 (folate) to 0.77 (energy), with a mean correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-hour recalls ranged from 0.28 (sweets) to 0.80 (breast milk), with a mean correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (n=186), results were similar. CONCLUSIONS This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods, and food groups in this sample of infants and toddlers.