Clinical Oral Investigations

, Volume 22, Issue 3, pp 1411–1422 | Cite as

Dental anxiety and oral health-related quality of life in aggressive periodontitis patients

  • Liran Levin
  • Avraham Zini
  • Jonathan Levine
  • Maor Weiss
  • Ron A. Lev
  • Avihai Hai
  • Daniella Chebath-Taub
  • Galit Almoznino
Original Article
  • 273 Downloads

Abstract

Objectives

To measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with aggressive periodontitis (AgP) compared to controls and analyze their association with various demographic and clinical parameters.

Methods

Sixty consecutive patients with AgP were compared to 80 age- and sex-matched controls with no known history of periodontal disease. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah’s Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss.

Results

AgP patients exhibited statistically significant higher scores in the DAS total as well as sub-scores, except from DAS 1st question. Compared to the control group, AgP patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores.

Among both AgP and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain.

Conclusions

AgP patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases.

Statement of Clinical Relevance

Aggressive periodontitis (AgP) patients exhibited higher dental anxiety levels and worse oral health-related quality of life (OHRQoL) compared to controls. Professionals should design strategies that will cope with the dental anxiety associated with the treatment and prevent decreases in OHRQoL.

Keywords

Periodontal disease Aggressive periodontitis Dental anxiety Dental fear Quality of life 

Abbreviations

AgP

Aggressive periodontitis

BOP

Bleeding on probing

CP

Chronic periodontitis

DAS

Dental Anxiety Scale

DMFT

Decay, Missing and Filled Teeth

G-AgP

Generalized aggressive periodontitis

LR

Logistic regression (LR)

NRS

Numerical rating scale

OHIP-14

Oral Health Impact Profile 14

OHRQoL

Oral health-related quality of life

PI

Plaque index

PD

Probing depth

WHO

World Health Organization

Notes

Author Contributions

Each of the contributors provided substantive intellectual contribution to one or more of the activities related to this manuscript as follows:

Liran Levin: made substantial contributions to the study’s conception and design, interpretation of data, revised and approved the manuscript.

Avraham Zini: analysis and interpretation of data and approved the manuscript.

Jonathan Levine: data collection of the aggressive periodontitis group and approved the manuscript.

Maor Weiss: data collection of the aggressive periodontitis group and approved the manuscript.

Ron Lev: revised and approved the manuscript.

Avihay Hai: data collection of the control group and approved the manuscript.

Daniella Chebath-Taub: data collection of the control group and approved the manuscript.

Galit Almoznino: principal investigator, made substantial contributions to the study’s conception and design, acquisition of data, and analysis and interpretation of data; drafted the submitted the article and provided final approval of the version to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4(1):1–6.  https://doi.org/10.1902/annals.1999.4.1.1 CrossRefPubMedGoogle Scholar
  2. 2.
    Albandar JM (2014) Aggressive periodontitis: case definition and diagnostic criteria. Periodontol 2000 65(1):13–26.  https://doi.org/10.1111/prd.12014 CrossRefPubMedGoogle Scholar
  3. 3.
    Susin C, Haas AN, Albandar JM (2014) Epidemiology and demographics of aggressive periodontitis. Periodontol 2000 65(1):27–45.  https://doi.org/10.1111/prd.12019 CrossRefPubMedGoogle Scholar
  4. 4.
    Levin L (2011) Aggressive periodontitis: the silent tooth killer. Alpha Omegan 104(3–4):74–78PubMedGoogle Scholar
  5. 5.
    Laine ML, Crielaard W, Loos BG (2012) Genetic susceptibility to periodontitis. Periodontol 58(1):37–68.  https://doi.org/10.1111/j.1600-0757.2011.00415.x CrossRefGoogle Scholar
  6. 6.
    Levin L, Baev V, Lev R, Stabholz A, Ashkenazi M (2006) Aggressive periodontitis among young Israeli army personnel. J Periodontol 77(8):1392–1396.  https://doi.org/10.1902/jop.2006.050323 CrossRefPubMedGoogle Scholar
  7. 7.
    Levin L, Einy S, Zigdon H, Aizenbud D, Machtei EE (2012) Guidelines for periodontal care and follow-up during orthodontic treatment in adolescents and young adults. J Appl Oral Sci 20(4):399–403CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Silness J, Loe H (1964) Periodontal disease in pregnancy. Ii. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135CrossRefPubMedGoogle Scholar
  9. 9.
    Shibly O, Rifai S, Zambon JJ (1995) Supragingival dental plaque in the etiology of oral diseases. Periodontol 8:42–59CrossRefGoogle Scholar
  10. 10.
    Christersson LA, Zambon JJ, Genco RJ (1991) Dental bacterial plaques. Nature and role in periodontal disease. J Clin Periodontol 18(6):441–446CrossRefPubMedGoogle Scholar
  11. 11.
    Moulton R, Ewen S, Thieman W (1952) Emotional factors in periodontal disease. Oral Surg Oral Med Oral Pathol 5(8):833–860CrossRefPubMedGoogle Scholar
  12. 12.
    Gupta OP (1966) Psychosomatic factors in periodontal disease. Dent Clin N Am:11–19Google Scholar
  13. 13.
    Clarke NG, Hirsch RS (1995) Personal risk factors for generalized periodontitis. J Clin Periodontol 22(2):136–145CrossRefPubMedGoogle Scholar
  14. 14.
    Johannsen A, Asberg M, Soder PO, Soder B (2005) Anxiety, gingival inflammation and periodontal disease in non-smokers and smokers—an epidemiological study. J Clin Periodontol 32(5):488–491.  https://doi.org/10.1111/j.1600-051X.2005.00704.x CrossRefPubMedGoogle Scholar
  15. 15.
    Corah NL (1969) Development of a dental anxiety scale. J Dent Res 48(4):596CrossRefPubMedGoogle Scholar
  16. 16.
    Corah NL (1988) Dental anxiety. Assessment, reduction and increasing patient satisfaction. Dent Clin N Am 32(4):779–790PubMedGoogle Scholar
  17. 17.
    Levin L, Eli I, Ashkenazi M (2006) Dental anxiety among young Israeli male adults as related to treatment received during childhood. J Public Health Dent 66(2):147–151CrossRefPubMedGoogle Scholar
  18. 18.
    Almoznino G, Zini A, Aframian DJ, Kaufman E, Lvovsky A, Hadad A, Levin L (2014) Demographic profile, plaque index and DMFT scores of young individuals with dental anxiety and exaggerated gag reflex. Oral Health Prev Dent.  https://doi.org/10.3290/j.ohpd.a32345
  19. 19.
    Maggirias J, Locker D (2002) Five-year incidence of dental anxiety in an adult population. Community Dent Health 19(3):173–179PubMedGoogle Scholar
  20. 20.
    Almoznino G, Zini A, Sharav Y, Yanko R, Lvovsky A, Aframian DJ (2016) Overlap between dental anxiety, gagging and blood-injection-injury related fears—a spectrum of one multidimensional phenomenon. Physiol Behav 165:231–238.  https://doi.org/10.1016/j.physbeh.2016.07.021. S0031-9384(16)30586-8 [pii] CrossRefPubMedGoogle Scholar
  21. 21.
    van Houtem CM, Aartman IH, Boomsma DI, Ligthart L, Visscher CM, de Jongh A (2013) Is dental phobia a blood-injection-injury phobia? Depress Anxiety.  https://doi.org/10.1002/da.22168
  22. 22.
    Kilic C, Ak S, Ak HB (2014) Anxiety sensitivity: another reason to separate dental fears from blood-injury fears? J Anxiety Disord 28(2):280–282.  https://doi.org/10.1016/j.janxdis.2014.01.001 CrossRefPubMedGoogle Scholar
  23. 23.
    Schierz O, John MT, Reissmann DR, Mehrstedt M, Szentpetery A (2008) Comparison of perceived oral health in patients with temporomandibular disorders and dental anxiety using oral health-related quality of life profiles. Qual Life Res 17(6):857–866.  https://doi.org/10.1007/s11136-008-9360-3 CrossRefPubMedGoogle Scholar
  24. 24.
    Lin CS (2013) Pain catastrophizing in dental patients: implications for treatment management. J Am Dent Assoc 144(11):1244–1251CrossRefPubMedGoogle Scholar
  25. 25.
    Boman UW, Lundgren J, Berggren U, Carlsson SG (2010) Psychosocial and dental factors in the maintenance of severe dental fear. Swed Dent J 34(3):121–127PubMedGoogle Scholar
  26. 26.
    Berggren U, Meynert G (1984) Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc 109(2):247–251CrossRefPubMedGoogle Scholar
  27. 27.
    Kurer JR, Watts TL, Weinman J, Gower DB (1995) Psychological mood of regular dental attenders in relation to oral hygiene behaviour and gingival health. J Clin Periodontol 22(1):52–55CrossRefPubMedGoogle Scholar
  28. 28.
    Monteiro da Silva AM, Newman HN, Oakley DA, O'Leary R (1998) Psychosocial factors, dental plaque levels and smoking in periodontitis patients. J Clin Periodontol 25(6):517–523CrossRefPubMedGoogle Scholar
  29. 29.
    Fardal O, Johannessen AC, Linden GJ (2001) Pre-treatment conceptions of periodontal disease and treatment in periodontal referrals. J Clin Periodontol 28(8):790–795CrossRefPubMedGoogle Scholar
  30. 30.
    Liu Y, Huang X, Yan Y, Lin H, Zhang J, Xuan D (2015) Dental fear and its possible relationship with periodontal status in Chinese adults: a preliminary study. BMC Oral Health 15:18.  https://doi.org/10.1186/1472-6831-15-18 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fardal O, Hansen BF (2007) Interviewing self-reported highly anxious patients during periodontal treatment. J Periodontol 78(6):1037–1042.  https://doi.org/10.1902/jop.2007.060407 CrossRefPubMedGoogle Scholar
  32. 32.
    Guzeldemir E, Toygar HU, Cilasun U (2008) Pain perception and anxiety during scaling in periodontally healthy subjects. J Periodontol 79(12):2247–2255.  https://doi.org/10.1902/jop.2008.080152 CrossRefPubMedGoogle Scholar
  33. 33.
    Delgado-Angulo EK, Sabbah W, Suominen AL, Vehkalahti MM, Knuuttila M, Partonen T, Nordblad A, Sheiham A, Watt RG, Tsakos G (2015) The association of depression and anxiety with dental caries and periodontal disease among Finnish adults. Community Dent Oral Epidemiol.  https://doi.org/10.1111/cdoe.12179
  34. 34.
    Khambaty T, Stewart JC (2013) Associations of depressive and anxiety disorders with periodontal disease prevalence in young adults: analysis of 1999-2004 National Health and Nutrition Examination Survey (NHANES) data. Ann Behav Med 45(3):393–397.  https://doi.org/10.1007/s12160-013-9471-0 CrossRefPubMedGoogle Scholar
  35. 35.
    Kressin NR, Reisine S, Spiro A 3rd, Jones JA (2001) Is negative affectivity associated with oral quality of life? Community Dent Oral Epidemiol 29(6):412–423CrossRefPubMedGoogle Scholar
  36. 36.
    Sanders C, Egger M, Donovan J, Tallon D, Frankel S (1998) Reporting on quality of life in randomised controlled trials: bibliographic study. BMJ 317(7167):1191–1194CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Scott DL, Garrood T (2000) Quality of life measures: use and abuse. Baillieres Best Pract Res Clin Rheumatol 14(4):663–687.  https://doi.org/10.1053/berh.2000.0106 CrossRefPubMedGoogle Scholar
  38. 38.
    Chavers LS, Gilbert GH, Shelton BJ (2002) Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence. J Public Health Dent 62(3):140–147CrossRefPubMedGoogle Scholar
  39. 39.
    Slade GD (1997) Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 25(4):284–290CrossRefPubMedGoogle Scholar
  40. 40.
    Slade GD, Spencer AJ (1994) Development and evaluation of the oral health impact profile. Community Dent Health 11(1):3–11PubMedGoogle Scholar
  41. 41.
    Kushnir D, Zusman SP, Robinson PG (2004) Validation of a Hebrew version of the oral health impact profile 14. J Public Health Dent 64(2):71–75CrossRefPubMedGoogle Scholar
  42. 42.
    Kressin NR, Spiro A 3rd, Atchison KA, Kazis L, Jones JA (2002) Is depressive symptomatology associated with worse oral functioning and well-being among older adults? J Public Health Dent 62(1):5–12CrossRefPubMedGoogle Scholar
  43. 43.
    Ferreira MC, Dias-Pereira AC, Branco-de-Almeida LS, Martins CC, Paiva SM (2017) Impact of periodontal disease on quality of life: a systematic review. J Periodontal Res.  https://doi.org/10.1111/jre.12436
  44. 44.
    Eltas A, Uslu MO (2013) Evaluation of oral health-related quality-of-life in patients with generalized aggressive periodontitis. Acta Odontol Scand 71(3–4):547–552.  https://doi.org/10.3109/00016357.2012.696698 CrossRefPubMedGoogle Scholar
  45. 45.
    Araujo AC, Gusmao ES, Batista JE, Cimoes R (2010) Impact of periodontal disease on quality of life. Quintessence Int 41(6):e111–e118PubMedGoogle Scholar
  46. 46.
    Abramson JH (2004) WINPEPI (PEPI-for-windows): computer programs for epidemiologists. Epidemiol Perspect Innov 1(1):6.  https://doi.org/10.1186/1742-5573-1-6 CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Almoznino G, Aframian DJ, Sharav Y, Sheftel Y, Mirzabaev A, Zini A (2015) Lifestyle and dental attendance as predictors of oral health-related quality of life. Oral Dis 21(5):659–666.  https://doi.org/10.1111/odi.12331 CrossRefPubMedGoogle Scholar
  48. 48.
    American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of periodontal diseases and conditions (2015). J Periodontol 86 (7):835–838.  https://doi.org/10.1902/jop.2015.157001
  49. 49.
    Saito A, Kikuchi M, Ueshima F, Matsumoto S, Hayakawa H, Masuda H, Makiishi T (2009) Assessment of oral self-care in patients with periodontitis: a pilot study in a dental school clinic in Japan. BMC Oral Health 9:27.  https://doi.org/10.1186/1472-6831-9-27 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Meusel DR, Ramacciato JC, Motta RH, Brito Júnior RB, Flório FM (2015) Impact of the severity of chronic periodontal disease on quality of life. J Oral Sci 57(2):87–94.  https://doi.org/10.2334/josnusd.57.87 CrossRefPubMedGoogle Scholar
  51. 51.
    Loe H, Silness J (1963) Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 21:533–551CrossRefPubMedGoogle Scholar
  52. 52.
    Kingman A, Susin C, Albandar JM (2008) Effect of partial recording protocols on severity estimates of periodontal disease. J Clin Periodontol 35(8):659–667.  https://doi.org/10.1111/j.1600-051X.2008.01243.x CrossRefPubMedGoogle Scholar
  53. 53.
    Beltran-Aguilar ED, Eke PI, Thornton-Evans G, Petersen PE (2012) Recording and surveillance systems for periodontal diseases. Periodontol 60(1):40–53.  https://doi.org/10.1111/j.1600-0757.2012.00446.x CrossRefGoogle Scholar
  54. 54.
    Weinberg MA, Hassan H (2012) Bleeding on probing: what does it mean? Gen Dent 60(4):271–276 quiz page 277–278PubMedGoogle Scholar
  55. 55.
    Breivik EK, Bjornsson GA, Skovlund E (2000) A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 16(1):22–28CrossRefPubMedGoogle Scholar
  56. 56.
    dos Santos Calderon P, Peixoto RF, Gomes VM, da Mota Correa AS, de Alencar EN, Rossetti LM, Conti PC (2012) Concordance among different pain scales in patients with dental pain. J Orofac Pain 26(2):126–131PubMedGoogle Scholar
  57. 57.
    Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2(2):175–184CrossRefPubMedGoogle Scholar
  58. 58.
    Wide Boman U, Carlsson V, Westin M, Hakeberg M (2013) Psychological treatment of dental anxiety among adults: a systematic review. Eur J Oral Sci 121(3 Pt 2):225–234.  https://doi.org/10.1111/eos.12032 CrossRefPubMedGoogle Scholar
  59. 59.
    Corah NL, Gale EN, Illig SJ (1978) Assessment of a dental anxiety scale. J Am Dent Assoc 97(5):816–819CrossRefPubMedGoogle Scholar
  60. 60.
    Schuurs AH, Duivenvoorden HJ, Thoden van Velzen SK, Verhage F, Makkes PC, Eijman MA (1985) Dimensionality of dental anxiety measurements. Community Dent Oral Epidemiol 13(3):152–155CrossRefPubMedGoogle Scholar
  61. 61.
    Kim S, Lee YJ, Lee S, Moon HS, Chung MK (2013) Assessment of pain and anxiety following surgical placement of dental implants. Int J Oral Maxillofac Implants 28(2):531–535.  10.11607/jomi.2713 CrossRefPubMedGoogle Scholar
  62. 62.
    Kirova DG, Atanasov DT, Lalabonova CK, Janevska S (2010) Dental anxiety in adults in Bulgaria. Folia Med (Plovdiv) 52(2):49–56Google Scholar
  63. 63.
    Eli I, Uziel N, Baht R, Kleinhauz M (1997) Antecedents of dental anxiety: learned responses versus personality traits. Community Dent Oral Epidemiol 25(3):233–237CrossRefPubMedGoogle Scholar
  64. 64.
    Eli I, Bar-Tal Y, Fuss Z, Silberg A (1997) Effect of intended treatment on anxiety and on reaction to electric pulp stimulation in dental patients. J Endod 23(11):694–697.  https://doi.org/10.1016/S0099-2399(97)80404-9 CrossRefPubMedGoogle Scholar
  65. 65.
    Kleinhauz M, Eli I, Baht R, Shamay D (1992) Correlates of success and failure in behavior therapy for dental fear. J Dent Res 71(11):1832–1835CrossRefPubMedGoogle Scholar
  66. 66.
    Berggren U, Pierce CJ, Eli I (2000) Characteristics of adult dentally fearful individuals. A cross-cultural study. Eur J Oral Sci 108(4):268–274CrossRefPubMedGoogle Scholar
  67. 67.
    Kaufman E, Rand RS, Gordon M, Cohen HS (1992) Dental anxiety and oral health in young Israeli male adults. Community Dent Health 9(2):125–132PubMedGoogle Scholar
  68. 68.
    Humphris GM, Morrison T, Lindsay SJ (1995) The modified dental anxiety scale: validation and United Kingdom norms. Community Dent Health 12(3):143–150PubMedGoogle Scholar
  69. 69.
    Ng SK, Leung WK (2006) Oral health-related quality of life and periodontal status. Community Dent Oral Epidemiol 34(2):114–122.  https://doi.org/10.1111/j.1600-0528.2006.00267.x CrossRefPubMedGoogle Scholar
  70. 70.
    Lawrence HP, Thomson WM, Broadbent JM, Poulton R (2008) Oral health-related quality of life in a birth cohort of 32-year olds. Community Dent Oral Epidemiol 36(4):305–316.  https://doi.org/10.1111/j.1600-0528.2007.00395.x CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Baer PN (1971) The case for periodontosis as a clinical entity. J Periodontol 42(8):516–520.  https://doi.org/10.1902/jop.1971.42.8.516 CrossRefPubMedGoogle Scholar
  72. 72.
    Monteiro Mde F, Casati MZ, Taiete T, Vale HF, Nociti FH Jr, Sallum EA, Silverio KG, Casarin RC (2015) Periodontal clinical and microbiological characteristics in healthy versus generalized aggressive periodontitis families. J Clin Periodontol 42(10):914–921.  https://doi.org/10.1111/jcpe.12459 CrossRefPubMedGoogle Scholar
  73. 73.
    Cakmak O, Tasdemir Z, Aral CA, Dundar S, Koca HB (2016) Gingival crevicular fluid and saliva stress hormone levels in patients with chronic and aggressive periodontitis. J Clin Periodontol 43(12):1024–1031.  https://doi.org/10.1111/jcpe.12614 CrossRefPubMedGoogle Scholar
  74. 74.
    Iqbal PS, Khan SN, Haris M, Narayanan M, Laju S, Kumar SS (2015) Assessment of systemic inflammatory markers in patients with aggressive periodontitis. J Int Oral Health 7(Suppl 2):48–51PubMedPubMedCentralGoogle Scholar
  75. 75.
    Susin C, Albandar JM (2005) Aggressive periodontitis in an urban population in southern Brazil. J Periodontol 76(3):468–475.  https://doi.org/10.1902/jop.2005.76.3.468 CrossRefPubMedGoogle Scholar
  76. 76.
    Borges Tde F, Regalo SC, Taba M Jr, Siessere S, Mestriner W Jr, Semprini M (2013) Changes in masticatory performance and quality of life in individuals with chronic periodontitis. J Periodontol 84(3):325–331.  https://doi.org/10.1902/jop.2012.120069 CrossRefPubMedGoogle Scholar
  77. 77.
    Ehrenthal JC, Graetz C, Plaumann A, Dorfer CE, Herzog W (2016) Number of teeth predict depressive symptoms in a longitudinal study on patients with periodontal disease. J Psychosom Res 89:16–19.  https://doi.org/10.1016/j.jpsychores.2016.08.002 CrossRefPubMedGoogle Scholar
  78. 78.
    Graetz C, Ehrenthal JC, Senf D, Semar K, Herzog W, Dorfer CE (2013) Influence of psychological attachment patterns on periodontal disease - a pilot study with 310 compliant patients. J Clin Periodontol 40(12):1087–1094.  https://doi.org/10.1111/jcpe.12159 CrossRefPubMedGoogle Scholar
  79. 79.
    McGrath C, Bedi R (1999) The value and use of 'quality of life’ measures in the primary dental care setting. Prim Dent Care 6(2):53–57PubMedGoogle Scholar
  80. 80.
    Cunha-Cruz J, Hujoel PP, Kressin NR (2007) Oral health-related quality of life of periodontal patients. J Periodontal Res 42(2):169–176.  https://doi.org/10.1111/j.1600-0765.2006.00930.x CrossRefPubMedGoogle Scholar
  81. 81.
    Dahl KE, Wang NJ, Skau I, Ohrn K (2011) Oral health-related quality of life and associated factors in Norwegian adults. Acta Odontol Scand 69(4):208–214.  https://doi.org/10.3109/00016357.2010.549502 CrossRefPubMedGoogle Scholar
  82. 82.
    Yang SE, Park YG, Han K, Kim SY (2016) Association between dental pain and tooth loss with health-related quality of life: the Korea national health and nutrition examination survey: a population-based cohort study. Medicine (Baltimore) 95(35):e4707.  https://doi.org/10.1097/MD.0000000000004707 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Liran Levin
    • 1
  • Avraham Zini
    • 2
  • Jonathan Levine
    • 3
  • Maor Weiss
    • 3
  • Ron A. Lev
    • 4
  • Avihai Hai
    • 4
  • Daniella Chebath-Taub
    • 4
  • Galit Almoznino
    • 2
    • 5
    • 6
  1. 1.Department of Periodontology, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Department of Community DentistryHebrew University-Hadassah School of Dental MedicineJerusalemIsrael
  3. 3.Department of Prosthodontics, Oral and Maxillofacial CenterIsrael Defense Forces, Medical CorpsTel-HashomerIsrael
  4. 4.Department of Periodontology, Oral and Maxillofacial CenterMedical Corps, Israel Defense ForcesTel-HashomerIsrael
  5. 5.Department of Oral Medicine, Oral and Maxillofacial centerMedical Corps, Israel Defense ForcesTel-HashomerIsrael
  6. 6.Department of Oral Medicine, Sedation and Maxillofacial imagingHebrew University-Hadassah School of Dental MedicineJerusalemIsrael

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