{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T13:28:21Z","timestamp":1794058101385,"version":"4.8.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical &amp; Exp Dental Res"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Scarce scientific evidence is available on the association of cumulative coping challenges and periodontitis. The present retrospective cross\u2010sectional exploratory study explored a new method to depict the association between periodontal disease (extent\/severity\/rate of progression) and cumulative coping challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A population sample was identified with an array of periodontal disease levels and coping challenges within an academic setting. In January 2026, a total of 39 student\u2010led patient presentations were recorded using an ordinal scale based on the 2017 American Academy of Periodontology\/European Federation of Periodontology framework of staging\/grading and a cumulative coping challenges score, including biologic, sociologic, behavioral, demographic, and oral disability\u2010related factors. Spearman's correlation analysis was used to correlate periodontal disease level and cumulative coping challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A distinct and significant association was found between level of periodontal disease and cumulative coping challenges (Spearman's\n                      <jats:italic>\u03c1\u2009<\/jats:italic>\n                      =\u20090.77, 95% CI,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Clusters of patients depicted that those with mild forms of periodontal disease (Stages I\u2013II) had few coping challenges and another group with severe forms of periodontal disease (Stages III\u2013IV) harbored higher cumulative coping challenges. No person appeared with high disease and low cumulative coping challenges, and only one person appeared with low disease and high coping challenges.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This retrospective cross\u2010sectional exploratory study quantified risk factors from a series of cumulative coping challenges resulting in a single metric to be correlated with disease level based on the current staging\/grading system for periodontal diseases. Periodontitis was observed among individuals with minimal disease and few coping challenges, and another group with severe stages and extensive coping challenges. Despite the theoretical limitation of the proposed scale, the present model has a practical use in an educational setting as an exploratory composite index.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cre2.70457","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:49:57Z","timestamp":1789847397000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Periodontal Disease and Cumulative Coping Challenges: A Retrospective Cross\u2010Sectional Exploratory Educational Study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-6591","authenticated-orcid":false,"given":"David C.","family":"Johnsen","sequence":"first","affiliation":[{"name":"Department of Pediatric Dentistry University of Iowa College of Dentistry Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A. G.","family":"Erickson","sequence":"additional","affiliation":[{"name":"Pre\u2010doctoral student University of Iowa College of Dentistry Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6323-8700","authenticated-orcid":false,"given":"Derek","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Computational Biology University of Iowa College of Dentistry Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8486-6810","authenticated-orcid":false,"given":"Carlos","family":"Garaicoa\u2010Pazmino","sequence":"additional","affiliation":[{"name":"Department of Periodontics University of Iowa, College of Dentistry Iowa City Iowa USA"},{"name":"School of Dentistry Universidad de Especialidades Esp\u00edritu Santo Samborondon Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2011.117001"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jper.70064"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.12309"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cre2.615"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12323"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2018.04.023"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.7.711"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/0097840X.1986.9936764"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2013.09.001"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-051x.2002.290311.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cre2.70135"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","unstructured":"Johnsen D. C. C.Garaicoa\u2010Pazmino A.Jain et al.2026. Dental School Caries and Periodontitis Risk Analysis Skillsets Carryover to Practice: A 10\u2010Year Survey. (In press).","DOI":"10.1186\/s12909-026-09804-5"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jdd.13762"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12234"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.06.010"},{"issue":"1","key":"e_1_2_12_17_1","first-page":"7","article-title":"Periodontal Risk Assessment (PRA) for Patients in Supportive Periodontal Therapy (SPT)","volume":"1","author":"Lang N. 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