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Design and aim This randomised controlled clinical trial assessed the efficacy of using dental floss in addition to toothbrushing in reducing gingival and plaque indices. Intervention The participants received oral hygiene instruction and supervised personal and professional plaque removal every week for two months. The research team instructed the participants to perform toothbrushing twice daily - groups 'toothbrushing and flossing' (TB + DF) and 'toothbrushing alone' - and use dental floss once daily - group TB + DF. Gingival index (GI) and plaque idex (PI) were evaluated at baseline and after one and two months. Case selection The authors invited the participants via the Federal University of Santa Maria screening service, social media and public posters. The participants were 18 years and older, without interproximal clinical attachment loss, with papillae completely filling the interproximal space and with at least 24 teeth remaining. The participants were included if they had a gingival index score of two at more than 15% of the interproximal sites. The authors excluded dental students, patients with xerostomia or diabetes, pregnant women, smokers, patients with orthodontic appliances and restraints, patients requiring antimicrobial prophylaxis, patients having used antibiotics/anti-inflammatory agents within the last three months and those with psychomotor disorders. Experimental groups and data analysis The authors used a block randomisation sequence with block sizes of ten. Randomisation confidentiality was maintained using serially sealed, numbered, opaque envelopes. At baseline, all the participants received oral prophylaxis and their GI, probing depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP) were assessed. A clinical staff member disclosed the experimental group assignments, distributed scheduled oral hygiene materials and conducted assigned study interventions. Each participant received a soft toothbrush (Colgate Twister Compact Head, New York, NY, USA) and fluoride dentifrice (Colgate Triple Action, 90 g, New York, NY, USA). Patients were instructed to brush their teeth twice daily. Subjects from the TB + DF group also received dental floss and were asked to use it once daily (Colgate, Tarpaulin, New York, NY, USA). The research team supervised the oral hygiene practices at day zero and recalled the patients to provide them with personalised oral hygiene instruction and dental plaque removal. Individual patients were considered as units of analysis. PI, GI, CAL, PD, gingival bleeding (GI = 2), BOP and percentage sites with different GI scores were presented as means, standard deviations and standard errors. The authors used multiple imputations to replace missing data and mixed linear models to analyse and compare the experimental groups. Results In total, 75 participants were randomised. Both groups showed a significant reduction in gingival inflammation (GI = 2) in the first month, albeit no change was seen in the second month. Adding flossing to toothbrushing significantly reduced the GI = 2 by the end of the first month (37.7 to 15.9%), maintaining optimised overall oral health through day 60 (15.1%) compared with toothbrushing alone. No significant differences were noted between the two groups from the first to the second month. Interproximal dental plaque was reduced for both groups from baseline to day 30 with no marked change from then to day 60. Plaque reduction was similar in both groups. Conclusions Toothbrushing reduces interdental plaque build-up and halts its progression while improving gingival health in adults with no interdental attachment loss. Dental flossing as an adjuvant to toothbrushing also enhances these benefits. [ABSTRACT FROM AUTHOR]

Aim This study evaluates the available clinical evidence with regards to the effectiveness of mechanical oral hygiene devices in patients who are in periodontal maintenance. Data sources A structured online search was conducted in PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. All the databases were explored from initiation to October 2019. Reference lists of all the included studies were hand-searched as well. Study selection Randomised clinical trials or controlled clinical trials were included in this systematic review if the participants were adult patients (≥18 years) in the maintenance phase of treatment with no systemic disorder. The scope of included studies was to assess the effects of manual toothbrushes (MTBs) and powered toothbrushes (PTBs) or interdental brushes (IDBs) on dental plaque removal and other parameters of periodontitis and gingivitis. These parameters were as follows: plaque index score (PI), bleeding on probing, clinical attachment level (CAL), gingival index (GI), probing pocket depth (PPD), gingival index (GI) and gingival recession (REC). Data extraction and synthesis The Cochrane Handbook for Systematic Reviews of Interventions (2011) and the recommendations for strengthening the reporting of systematic reviews and meta-analyses (PRISMA) were both applied to extract data (with regards to population, intervention, comparison and outcomes) in this systematic review. A network meta-analysis (NMA) was performed to compare (either directly or indirectly) the studies that shared (at least) a common treatment. Treatments were then ranked using frequentist weighted least squares method. This was done based on the standardised mean difference of end plaque scores for each oral hygiene device. Finally, the authors provided a clinical significance assessment of study results using distribution-based methods. Results In the 16 included trials, 17 comparisons were selected to be assessed. In comparisons between PTBs and MTBs, 80% of them found no difference with respect to improving clinical parameters (four out of five). When adjunctive effect of an oral irrigator (OI) in addition to regular hygiene was evaluated, 66% (two out of three) of comparisons showed a positive significant effect on the GI, bleeding index scores and PPD in favour of using an OI. In 50% of comparisons (two out of four) concerning PI reduction, IDBs showed significantly better results than dental floss. This finding was endorsed by the authors' clinical significance assessment. Indirect results of the NMA ranked the cylindrical and conical IDBs as the best oral hygiene devices (compared to MTBs) in removing interdental plaque. Conclusions Considering the dearth of evidence that met the inclusion criteria for each oral hygiene device and the low certainty of the resultant findings, no definite conclusion could be drawn to recommend any device as the best option to use in periodontal maintenance patients. Yet, according to indirect evidence, it was found that IDBs, as adjuvants to tooth brushing, could significantly improve PI reduction compared with merely using MTBs. [ABSTRACT FROM AUTHOR]

Aim: This study evaluates the long-term risk of immune-mediated systemic conditions in individuals with periodontitis compared to those without. Data sources: A structured online search was conducted in Medline, Cochrane library, and EMBASE using MeSH terms. All the databases were explored from initiation to June 2022. Reference lists of the eligible studies were hand searched as well. Study selection: Peer-reviewed longitudinal retrospective/prospective cohorts and randomized controlled trials comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy individuals were deemed eligible. Only studies with a minimum follow-up of one year were included. Data extraction and synthesis: The authors checked demographics, data source, exclusion/inclusion criteria, total follow-up duration, disease outcome, and limitations to determine the eligible studies. After assessing the risk of bias for the included studies using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, the authors used the following measures to quantify the disease outcome: relative risk (RR), odds ratio (OR), and hazard ratio (HR). Systemic conditions were categorized as immune-mediated via disrupted metabolic networks (diabetes, kidney disease, liver disease, metabolic syndrome) or chronic inflammation (inflammatory bowel disease, osteoporosis, RA, psoriasis, Sjogren's syndrome), hence recognized as metabolic or autoimmune/inflammatory diseases, respectively. A random effect meta-analysis was used to synthesize the risk of developing each disease. The authors performed subgroup analysis for periodontitis diagnosis type (self-report/clinically diagnosed) and severity. They also conducted a sensitivity analysis to assess the effect of removing studies that did not adjust for smoking status. Results: From 3354 studies, 166 full texts were screened. Finally, 30 studies were deemed eligible for the systematic review, of which 27 made it to the meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in individuals with periodontitis compared to those without periodontitis (diabetes—relative risk [RR]: 1.22, 95% CI: 1.13–1.33; RA—RR: 1.27, 95% CI: 1.07–1.52; osteoporosis—RR: 1.40, 95% CI: 1.12–1.75). The risk of diabetes showed a gradient increase by periodontitis severity (moderate—RR = 1.20, 95% CI = 1.11–1.31; severe—RR = 1.34, 95% CI = 1.10–1.63). Conclusions: People with moderate-to-severe periodontitis have the highest risk of developing diabetes. In contrast, the effect of periodontal severity on the risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is needed to assess the periodontitis-multimorbidity association further. [ABSTRACT FROM AUTHOR]

Data sources The national electronic health records of the Hamad Medical Corporation (HMC) in the State of Qatar. Data extraction and synthesis This case-control study included 568 patients from the HMC electronic database for data eliciting from 27 February 2020 to 31 July 2020. Patients with coronavirus disease 2019 (COVID-19) complications were considered as cases. Controls were defined as COVID-19 patients without major complications (discharged). Multivariate logistic regression was performed to assess the association between the exposures (periodontitis, demographics and medical conditions) and outcomes (COVID-19 complications). The association was adjusted for possible confounding factors. Additionally, sensitivity analyses were performed to account for stronger risk factors of the determined complications. The results were reported using the odds ratio (OR) and 95% confidence intervals (CIs). Laboratory data (blood parameters concerning the course of COVID-19) were also compared between the case and control groups. Results The patients were divided into 40 cases and 528 controls. Among the patients with periodontitis, 12.8% (33/258) went through COVID-19 complications, whereas 2.2% (7/310) of those without periodontitis experienced complications. The adjusted OR of patients with periodontitis was 3.67 (95% CI 1.46-9.27) for all COVID-19 complications, 8.81 (95% CI 1.00-77.7) for death, 3.54 (95% CI 1.39-9.05) for intensive care unit admission and 4.57 (95% CI 1.19-17.4) for the need of assisted ventilation. After conducting subgroup analyses for age, diabetes and smoking, periodontitis was still significantly associated with all the outcomes. Laboratory biomarkers (haemoglobin A1c, white blood cells and C-reactive protein) had higher levels in COVID-19 patients with periodontitis than those without periodontal disease. Conclusions This study concluded that periodontitis was significantly associated with higher risks of COVID-19 complications and higher blood marker levels. These results, however, are not of high quality and further research in this regard is required. [ABSTRACT FROM AUTHOR]

Data sources The national electronic health records of the Hamad Medical Corporation (HMC) in the State of Qatar. Data extraction and synthesis This case-control study included 568 patients from the HMC electronic database for data eliciting from 27 February 2020 to 31 July 2020. Patients with coronavirus disease 2019 (COVID-19) complications were considered as cases. Controls were defined as COVID-19 patients without major complications (discharged). Multivariate logistic regression was performed to assess the association between the exposures (periodontitis, demographics and medical conditions) and outcomes (COVID-19 complications). The association was adjusted for possible confounding factors. Additionally, sensitivity analyses were performed to account for stronger risk factors of the determined complications. The results were reported using the odds ratio (OR) and 95% confidence intervals (CIs). Laboratory data (blood parameters concerning the course of COVID-19) were also compared between the case and control groups. Results The patients were divided into 40 cases and 528 controls. Among the patients with periodontitis, 12.8% (33/258) went through COVID-19 complications, whereas 2.2% (7/310) of those without periodontitis experienced complications. The adjusted OR of patients with periodontitis was 3.67 (95% CI 1.46-9.27) for all COVID-19 complications, 8.81 (95% CI 1.00-77.7) for death, 3.54 (95% CI 1.39-9.05) for intensive care unit admission and 4.57 (95% CI 1.19-17.4) for the need of assisted ventilation. After conducting subgroup analyses for age, diabetes and smoking, periodontitis was still significantly associated with all the outcomes. Laboratory biomarkers (haemoglobin A1c, white blood cells and C-reactive protein) had higher levels in COVID-19 patients with periodontitis than those without periodontal disease. Conclusions This study concluded that periodontitis was significantly associated with higher risks of COVID-19 complications and higher blood marker levels. These results, however, are not of high quality and further research in this regard is required. [ABSTRACT FROM AUTHOR]

Aim: This systematic review sought to assess the validity of age estimation methods based on bone or dental maturity indices and their reproducibility through a meta-analysis of validation and reproducibility studies. Data sources: A systematic online search was conducted in PubMed and Google Scholar. Study selection: Cross-sectional studies were included. The authors excluded articles without information on validity and reproducibility outcomes, articles not written in English or Italian, and those where it was impossible to obtain pooled reproducibility estimates of Cohen's kappa or the intraclass correlation coefficient (ICC) due to a lack of information on the variability measure. Data extraction and synthesis: The authors tried to follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. They also considered the PICOS/PECOS strategy to assess the research questions in their included studies; nevertheless, no particular guideline was reported to be consistently followed in their study. Results: Twenty-three (23) studies were selected for data extraction and critical appraisal. The pooled male mean error of the age prediction was 0.08 years (95% CI: −0.12; 0.29), and the pooled female mean error was 0.09 years (95% CI: −0.12; 0.30). Studies using Nolla's method had a mean error closest to zero with a slight overestimation: mean male age prediction error of 0.02 (95% CI: −0.37; 0.41) and mean female age prediction error of 0.03 (95% CI: −0.34; 0.41). Haavikko's method had a mean error of −1.12 (95% CI: −2.29; 0.06) and −1.33 (95% CI: −2.54; −0.13) for males and females, respectively. Cameriere's method also underestimated the chronological age and was the only method with a higher absolute mean error for males than females (males: −0.22 [95% CI: −0.44; 0.00]; females: −0.17 [95% CI: −0.34; −0.01]). Overall, Demirjian's and Willems's methods tended to overestimate chronological age in both males (Demirjian: 0.59 [95% CI: 0.28; 0.91]; Willems: 0.07 [95% CI: −0.17; 0.31]) and females (Demirjian: 0.64 [95% CI 0.38; 0.90]; Willems: 0.09 [95% CI: −0.13; 0.31]). The prediction intervals (PI) overlapped zero for all methods, rendering the difference between estimated and chronological ages not statistically significant for males and females. Cameriere's method showed the smallest PI for both biological genders, while the Haavikko and other methods had the widest intervals. No heterogeneity was observed in inter-examiner (heterogeneity: Q = 5.78, p = 0.888) and intra-examiner (heterogeneity: Q = 9.11, p = 0.611) agreement, so a fixed-effects model was used. For inter-examiner agreement, the ICC ranged from 0.89 to 0.99, and the meta-analytic pooled ICC was 0.98 (95% CI 0.97; 1.00), which was near-perfect reliability. Concerning intra-examiner agreement, the ICCs ranged from 0.90 to 1.00, and the meta-analytic pooled ICC was 0.99 (95% CI 0.98; 1.00), which was also close to perfect reliability. Conclusions: This study recommended the Nolla and Cameriere methods as preferred approaches while mentioning that the Cameriere method was validated on a smaller sample size than Nolla's, thus requiring further testing on additional populations to better assess the mean error estimates by sex. However, the evidence in this paper is of very low quality and offers no certainty. [ABSTRACT FROM AUTHOR]

Aim This systematic review sought to assess and scrutinise the validity and practicality of published and preprint reports of prediction models for the diagnosis of coronavirus disease 2019 (COVID-19) in patients with suspected infection, for prognosis of patients with COVID-19, and for identifying individuals in the general population at increased risk of infection with COVID-19 or being hospitalised with the illness. Data sources A systematic, online search was conducted in PubMed and Embase. In order to do so, the authors used Ovid as the host platform for these two databases and also investigated bioRxiv, medRxiv and arXiv as repositories for the preprints of studies. A public living systematic review list of COVID-19-related studies was used as the baseline searching platform (Institute of Social and Preventive Medicine's repository for living evidence on COVID-19). Study selection Studies which developed or validated a multivariable prediction model related to COVID-19 patients' data (individual level data) were included. The authors did not put any restrictions on the models included in their study regarding the model setting, prediction horizon or outcomes. Data extraction and synthesis Checklists of critical appraisal and data extraction for systematic reviews of prediction modelling studies (CHARMS) and prediction model risk of bias assessment tool (PROBAST) were used to guide developing of a standardised data extraction form. Each model's predictive performance was extracted by using any summaries of discrimination and calibration. All these steps were done according to the aspects of the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) and preferred reporting items for systematic reviews and meta-analyses (PRISMA). Results One hundred and forty-five prediction models (107 studies) were selected for data extraction and critical appraisal. The most common predictors of diagnosis and prognosis of COVID-19 were age, body temperature, lymphocyte count and lung imaging characteristics. Influenza-like symptoms and neutrophil count were regularly predictive in diagnostic models, while comorbidities, sex, C-reactive protein and creatinine were common prognostic items. C-indices (a measure of discrimination for models) ranged from 0.73 to 0.81 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.68 to 0.99 in the prognostic models. All the included studies were reported to have high risks of bias. Conclusions Overall, this study did not recommend applying any of the predictive models in clinical practice yet. High risk of bias, reporting problems and (probably) optimistic reported performances are all among the reasons for the previous conclusion. Prompt actions regarding accurate data sharing and international collaborations are required to achieve more rigorous prediction models for COVID-19. [ABSTRACT FROM AUTHOR]

Data sources This review article scrutinised 16 clinical studies (clinical trials and observational studies) concerning coronavirus disease of 2019 (COVID-19). Additionally, 18 guidelines about the COVID-19 were reviewed and the key points were represented in this study. Study selection The review included human trials, in-vitro studies, review articles, and credible news reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 complications, treatment guidelines, management strategies, and epidemiological features. There were no exclusion criteria reported in this review and the included information was in English and Chinese languages. Data extraction and synthesis A descriptive review of the literature was conducted, taking a comprehensive approach. The paper consisted of three main parts: introduction, presentation, and management. The introduction part presented basic information about the SARS-CoV-2, its evolution and transmission, and the course of disease. The presentation section introduced the signs and symptoms, diagnosis, high risk groups, and complications of COVID-19. Eventually, some evidence was presented about the prevention, medical management, and measuring responses to the treatments in the management section. Results Based on the results of this study, non-pharmaceutical interventions, including strict social isolation and distancing measures, might reduce the spread of the SARS-CoV-2 by nearly 99.3 percent (reproduction number mitigating from 406 to 2.5 in 30 days). In the supportive management section, monitoring vital signs and neonatal feeding were stated as the most important factors to consider. For symptomatic neonates, medical management and intervention were mentioned as essential. It was claimed that for adults with mild infection, the best option would be home quarantine with further medical monitoring or hospitalisation if required. The following sequence was also suggested as early supportive therapy and monitoring: intravenous fluid administration, oxygen therapy, and application of corticosteroids. Management of critical patients with critical COVID-19 included admission to intensive care unit, use of continuous positive airway pressure and bi-level positive airway pressure in certain circumstances, endotracheal intubation, invasive mechanical ventilation, extracorporeal membrane oxygenation, and fluid resuscitation and vasopressors. Additionally, this study suggested oseltamivir, iopinavir, remdesivir, chloroquine, baricitinib, ruxolitinib, and fedratinib as possible drugs to help manage COVID-19. A soaring c-reactive protein level and decreased albumin content in the blood were reported to be associated with a deteriorating status in COVID-19 patients. To keep the number of exposures to a minimum, two separate viral clearance tests taken at least 24 hours apart, were stated as necessary laboratory results before the discharge of patients with COVID-19. Conclusions The study warns about possible exponential spread of COVID-19 and proposes to adhering to tighter restrictions of social distancing. Besides the clinical guidelines presented within the study, it also encourages further up-to-date and evidence-based management guidelines for patients with COVID-19. [ABSTRACT FROM AUTHOR]

Data sources This review included 13 clinical studies (observational or clinical trial) which reported results of studies of the 2019 novel coronavirus (2019-nCoV). The other 62 referenced papers were of different types (eg, reviews, WHO protocols, letter to editor etc). Study selection The study selected trials, reviews, and in-vitro research assessing the critical aspects of saliva as an easily accessible and early-stage diagnostic source, and also an entry route for 2019-nCoV. Most of the clinical studies were descriptive case series of patients who had contracted 2019-nCoV in China. These were mainly studies designed to compare saliva samples with throat swabs, with regard to the presence of 2019-nCoV RNA. Another aspect of the included studies was the susceptibility of oral tissues to 2019-nCoV due to the expression of angiotensin-converting enzyme II (ACE2) as a receptor for the 2019-nCoV. Some review studies and clinical infection control protocols were also included to discuss the transmission patterns of 2019-nCoV from the oral cavity. Studies were not restricted to English language and they were not all full-text papers. Data extraction and synthesis A narrative synthesis of the results was conducted using distinct headings and subheadings, defined by the authors based on relevancy to the consensus about the importance of saliva with reference to 2019-nCoV. Results There was an inherent heterogeneity among the included clinical studies concerning their designs, sampling techniques, and the results about the diagnostic value of saliva. The percentage of coronavirus disease of 2019 (COVID-19) patients with positive 2019-nCoV RNA varied from 12.9% to 91.67% among these studies. Regarding the possibility of direct virus invasion into the oral tissues, the results suggested that ACE2+ cells in salivary glands could possibly be the target cells of 2019-nCoV and theoretically could generate infectious saliva in a sustained way. Furin was suggested as another protein which makes the tongue more vulnerable to 2019-nCoV, especially in conditions inducing its upregulation (for example, squamous cell carcinoma). According to the comparisons between 2019-nCoV and SARS-CoV, saliva could be considered of diagnostic value via the early detection of viral RNA for both of the viruses. Whilst the viral peak was shown to be at onset of symptoms for 2019-nCoV, it can linger up to the tenth day after the appearance of symptoms for SARS-CoV. Finally, this paper warns about airborne transmission, particularly for close contacts. Conclusions Saliva can be proposed as an easily accessible diagnostic source although further clinical studies are required. Given the presence of viral RNA in saliva in the early stages of COVID-19, the recommendations to wear masks to prevent the rapid transmission of infectious droplets into the air, and keep a safe distance from other people are clearly based in evidence. [ABSTRACT FROM AUTHOR]

Aim This study evaluates the effectiveness of preprocedural mouth rinsing when performing non-surgical periodontal prophylaxis to reduce bacterial aerosol contamination. Data sources The authors used the population, intervention, control and outcomes (PICO) question format to perform a systematic online search in Scopus, PubMed, Cochrane Library and Web of Science. All the databases were explored with no time limit until April 2020. Study selection Randomised clinical trials were included in this systematic review. No inclusion or exclusion criteria are mentioned in this study and it is limited to bacterial contamination studies. Data extraction and synthesis The authors extracted the following information from the included studies: authors; article publication year; study design; sampling size and allocation of test and control groups; intervention details; type and description of periodontal prophylaxis procedures; and primary outcomes. They focused on statistically significant findings and the reduction of bacterial aerosol contamination between groups was measured by colony forming units (CFU) using means and percentages. The primary outcome was that bacterial count expressed as CFU on blood agar plates. If permissible, they calculated the mean CFU reduction in the included studies and reported them. The authors also assessed the studies' risk of bias using the revised Cochrane risk of bias tool for randomised trials. Results In total, 30 randomised controlled trials were included, 21 of which assessed the preprocedural rinsing and the remaining nine focused on other interventions. The bacterial incubation protocol differed among studies. The data collection sites differed among the studies in terms of the number of samples obtained, position, direction and distance from the subjects' mouths. There were no marked differences in the CFU reduction regarding the periodontal prophylaxis devices used and the location of aerosol sampling collection from these studies. Nearly half of the studies (52.4%, 11/21) collected the sample at or near the operator and dental assistant. Chlorhexidine (CHX) rinse was mostly tested (80.9%, 17/21) with various concentrations and volumes. Among studies comparing CHX with other agents (71.4%, 15/21), CHX was more effective for the better part of studies, with more than half of the studies (7/15) reporting over a 70% reduction in CFU when using CHX preprocedural mouth rinse. Conclusions Evidence corroborates the effectiveness of preprocedural mouth rinses, especially CHX, in reducing the bacterial contamination of aerosols in periodontal, non-surgical prophylaxis compared with mouth rinsing with water, or with no rinsing. Nevertheless, the low-quality of evidence and the high heterogeneity among the included studies warn that one should be cautious in generalising the findings of this study to other settings and contaminating agents, like viruses. The findings of this study emphasise the need for more studies on the efficacy and effectiveness of preprocedural rinses in reducing the viral load in aerosols (and droplets) during periodontal prophylaxis procedures. [ABSTRACT FROM AUTHOR]

Data sources The Longitudinal Health Insurance Database 2010 (LHID2010). Data extraction and synthesis This retrospective cohort study elicited data from the LHID2010 database with a sample of 98,800 patients from 2001 to 2012. To assess the correlation between the exposure (periodontal treatment versus individuals without periodontal disease) and the outcome (pneumonia), Cox proportional-hazards regression analysis was adopted. Propensity score matching was conducted according to age, gender, monthly income, urbanisation and comorbidities to further adjust the comparison group (individuals without periodontal disease) for potential baseline predictor variables. Results Patients who received periodontal treatment had a significantly lower cumulative incidence of pneumonia compared to the individuals in the comparison group throughout the 12-year follow-up period (log-rank test, p <0.001). Further sign-mapping of the data regarding the type of periodontal treatment indicated that scaling (compared to no periodontal treatment) is associated with a significant reduction in the risk of pneumonia (adjusted HR: 0.70; 95%CI: 0.66-0.75). Additionally, intensive periodontal treatment (for example, flap surgery) could lower the pneumonia risk by about 66% compared to no periodontal treatment (adjusted HR: 0.34; 95%CI: 0.19-0.62). Conclusions Conducting periodontal treatment is associated with a reduced risk of pneumonia. When looked at from a healthcare delivery perspective, this nationwide study can present further evidence that providing patients with thorough oral and dental examinations, and following periodontal treatment if necessary, might reduce the incidence of subsequent pneumonia events. [ABSTRACT FROM AUTHOR]