{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:27:15Z","timestamp":1786980435666,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Oral Invest"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Although bowel symptoms are often predominant, inflammatory bowel disease (IBD) patients can have several oral manifestations. The aim of this study was to investigate the prevalence of dental caries and periodontal disease in patients with Crohn\u2019s disease (CD) and ulcerative colitis (UC) compared to an age and gender-matched control group of patients without IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>The DMFT (Decayed, Missing, Filled Teeth) scores and the DPSI (Dutch Periodontal Screening Index) of 229 IBD patients were retrieved from the electronic health record patient database axiUm at the Academic Centre for Dentistry Amsterdam (ACTA) and were compared to the DMFT scores and DPSI from age and gender-matched non-IBD patients from the same database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The total DMFT index was significantly higher in the IBD group compared to the control group. When CD and UC were analyzed separately, a statistically significant increased DMFT index was observed in CD patients but not in UC patients. The DPSI did not differ significantly between the IBD and non-IBD groups for each of the sextants. However, in every sextant, IBD patients were more frequently edentulous compared to the control patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CD patients have significantly more dental health problems compared to a control group. Periodontal disease did not differ significantly between IBD and non-IBD groups as determined by the DPSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>It is important that IBD patients and physicians are instructed about the correlation between their disease and oral health problems. Strict oral hygiene and preventive dental care such as more frequent checkups should be emphasized by dental clinicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-021-03835-6","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T22:02:48Z","timestamp":1614031368000},"page":"5273-5280","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Dental and periodontal disease in patients with inflammatory bowel disease"],"prefix":"10.1007","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0819-0238","authenticated-orcid":false,"given":"Christopher X. W.","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk S.","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilgin","family":"Kalender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanne K. H.","family":"De Boer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tymour","family":"Forouzanfar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan G. A. M.","family":"de Visscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"3835_CR1","first-page":"294","volume":"27","author":"WE Ek","year":"2014","unstructured":"Ek WE, Amato MD, Halfvarson J (2014) The history of genetics in inflammatory bowel disease. Ann Gastroenterol 27:294\u2013303","journal-title":"Ann Gastroenterol"},{"key":"3835_CR2","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1016\/S0140-6736(07)60750-8","volume":"369","author":"DC Baumgart","year":"2007","unstructured":"Baumgart DC, Carding SR (2007) Inflammatory bowel disease: cause and immunobiology. Lancet 369:1627\u20131640","journal-title":"Lancet"},{"key":"3835_CR3","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.tripleo.2009.07.035","volume":"108","author":"M Fatahzadeh","year":"2009","unstructured":"Fatahzadeh M (2009) Inflammatory bowel disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:e1\u2013e10","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"3835_CR4","doi-asserted-by":"publisher","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","volume":"390","author":"SC Ng","year":"2017","unstructured":"Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG (2017) Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390:2769\u20132778. https:\/\/doi.org\/10.1016\/S0140-6736(17)32448-0","journal-title":"Lancet"},{"key":"3835_CR5","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1038\/sj.bdj.2016.954","volume":"221","author":"CXW Tan","year":"2016","unstructured":"Tan CXW, Brand HS, De Boer NKH, Forouzanfar T (2016) Gastrointestinal diseases and their oro-dental manifestations: part 1: Crohn\u2019s disease. Br Dent J 221:794\u2013799. https:\/\/doi.org\/10.1038\/sj.bdj.2016.954","journal-title":"Br Dent J"},{"key":"3835_CR6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1038\/sj.bdj.2017.37","volume":"222","author":"CXW Tan","year":"2017","unstructured":"Tan CXW, Brand HS, de Boer NKH, Forouzanfar T (2017) Gastrointestinal diseases and their oro-dental manifestations: part 2: ulcerative colitis. Br Dent J 222:53\u201357. https:\/\/doi.org\/10.1038\/sj.bdj.2017.37","journal-title":"Br Dent J"},{"key":"3835_CR7","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1093\/ibd\/izy017","volume":"24","author":"SAG De Vries","year":"2018","unstructured":"De Vries SAG, Tan CXW, Bouma G et al (2018) Salivary function and oral health problems in Crohn\u2019s disease patients. Inflamm Bowel Dis 24:1361\u20131367. https:\/\/doi.org\/10.1093\/ibd\/izy017","journal-title":"Inflamm Bowel Dis"},{"key":"3835_CR8","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1111\/j.1600-051X.2006.00942.x","volume":"33","author":"B Gr\u00f6ssner-Schreiber","year":"2006","unstructured":"Gr\u00f6ssner-Schreiber B, Fetter T, Hedderich J et al (2006) Prevalence of dental caries and periodontal disease in patients with inflammatory bowel disease: a case-control study. J Clin Periodontol 33:478\u2013484. https:\/\/doi.org\/10.1111\/j.1600-051X.2006.00942.x","journal-title":"J Clin Periodontol"},{"key":"3835_CR9","doi-asserted-by":"publisher","first-page":"497","DOI":"10.12968\/hmed.2014.75.9.497","volume":"75","author":"S Jurge","year":"2014","unstructured":"Jurge S, Hegarty AM, Hodgson T (2014) Orofacial manifestations of gastrointestinal disorders. Br J Hosp Med (Lond) 75:497\u2013501. https:\/\/doi.org\/10.12968\/hmed.2014.75.9.497","journal-title":"Br J Hosp Med (Lond)"},{"key":"3835_CR10","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1080\/00016480310015326","volume":"124","author":"PJ Bradley","year":"2004","unstructured":"Bradley PJ, Ferlito A, Devaney KO, Rinaldo A (2004) Crohn\u2019s disease manifesting in the head and neck. Acta Otolaryngol 124:237\u2013241","journal-title":"Acta Otolaryngol"},{"key":"3835_CR11","first-page":"193","volume":"71","author":"BW Sigusch","year":"2004","unstructured":"Sigusch BW (2004) Periodontitis as manifestation of Crohn\u2019s disease in primary dentition: a case report. J Dent Child 71:193\u2013196","journal-title":"J Dent Child"},{"key":"3835_CR12","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.tripleo.2007.09.032","volume":"105","author":"L Abraham-Inpijn","year":"2008","unstructured":"Abraham-Inpijn L, Russell G, Abraham DA, B\u00e4ckman N, Baum E, Bull\u00f3n-Fern\u00e1ndez P, Declerck D, Fricain JC, Georgelin M, Karlsson KO, Lamey PJ, Link-Tsatsouli I, Rigo O (2008) A patient-administered Medical Risk Related History questionnaire (EMRRH) for use in 10 European countries (multicenter trial). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:597\u2013605. https:\/\/doi.org\/10.1016\/j.tripleo.2007.09.032","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"3835_CR13","doi-asserted-by":"publisher","unstructured":"Gilli M, Maringer D, Schumann E (2013) Oral health surveys basic methods. World Heal Organ. https:\/\/doi.org\/10.1016\/b978-0-12-375662-6.00011-0","DOI":"10.1016\/b978-0-12-375662-6.00011-0"},{"key":"3835_CR14","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1111\/j.1600-051X.2009.01495.x","volume":"36","author":"U Van Der Velden","year":"2009","unstructured":"Van Der Velden U (2009) The Dutch periodontal screening index validation and its application in the Netherlands. J Clin Periodontol 36:1018\u20131024. https:\/\/doi.org\/10.1111\/j.1600-051X.2009.01495.x","journal-title":"J Clin Periodontol"},{"key":"3835_CR15","doi-asserted-by":"publisher","first-page":"e0134001","DOI":"10.1371\/journal.pone.0134001","volume":"10","author":"A Johannsen","year":"2015","unstructured":"Johannsen A, Fored MC, H\u00e5kansson J, Ekbom A, Gustafsson A (2015) Consumption of dental treatment in patients with inflammatory bowel disease, a register study. PLoS One 10:e0134001. https:\/\/doi.org\/10.1371\/journal.pone.0134001","journal-title":"PLoS One"},{"key":"3835_CR16","doi-asserted-by":"publisher","first-page":"e91059","DOI":"10.1371\/journal.pone.0091059","volume":"9","author":"S Szymanska","year":"2014","unstructured":"Szymanska S, L\u00f6rdal M, Rathnayake N, Gustafsson A, Johannsen A (2014) Dental caries, prevalence and risk factors in patients with Crohn\u2019s disease. PLoS One 9:e91059. https:\/\/doi.org\/10.1371\/journal.pone.0091059","journal-title":"PLoS One"},{"key":"3835_CR17","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1111\/j.1600-051X.2008.01231.x","volume":"35","author":"F Brito","year":"2008","unstructured":"Brito F, de Barros FC, Zaltman C et al (2008) Prevalence of periodontitis and DMFT index in patients with Crohn\u2019s disease and ulcerative colitis. J Clin Periodontol 35:555\u2013560. https:\/\/doi.org\/10.1111\/j.1600-051X.2008.01231.x","journal-title":"J Clin Periodontol"},{"key":"3835_CR18","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1097\/MIB.0000000000000452","volume":"21","author":"V Koutsochristou","year":"2015","unstructured":"Koutsochristou V, Zellos A, Dimakou K, Panayotou I, Siahanidou S, Roma-Giannikou E, Tsami A (2015) Dental caries and periodontal disease in children and adolescents with inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 21:1839\u20131846. https:\/\/doi.org\/10.1097\/MIB.0000000000000452","journal-title":"Inflamm Bowel Dis"},{"key":"3835_CR19","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/idj.12542","volume":"70","author":"L Zhang","year":"2020","unstructured":"Zhang L, Gao X, Zhou J, Chen S, Zhang J, Zhang Y, Chen B, Yang J (2020) Increased risks of dental caries and periodontal disease in Chinese patients with inflammatory bowel disease. Int Dent J 70:227\u2013236. https:\/\/doi.org\/10.1111\/idj.12542","journal-title":"Int Dent J"},{"key":"3835_CR20","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/0030-4220(93)90063-A","volume":"76","author":"B Sundh","year":"1993","unstructured":"Sundh B, Johansson I, Emilson C-G, Nordgren S, Birkhed D (1993) Salivary antimicrobial proteins in patients with Crohn\u2019s disease. Oral Surg Oral Med Oral Pathol 76:564\u2013569","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"3835_CR21","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1159\/000073343","volume":"21","author":"T Sch\u00fctz","year":"2003","unstructured":"Sch\u00fctz T, Drude C, Paulisch E, Lange KP, Lochs H (2003) Sugar intake, taste changes and dental health in Crohn\u2019s disease. Dig Dis 21:252\u2013257. https:\/\/doi.org\/10.1159\/000073343","journal-title":"Dig Dis"},{"key":"3835_CR22","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/0030-4220(84)90284-6","volume":"57","author":"TP Rooney","year":"1984","unstructured":"Rooney TP (1984) Dental caries prevalence in patients with Crohn\u2019s disease. Oral Surg Oral Med Oral Pathol 57:623\u2013624","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"3835_CR23","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1177\/2050640620957138","volume":"8","author":"A Goldinova","year":"2020","unstructured":"Goldinova A, Tan CXW, Bouma G, Duijvestein M, Brand HS, Boer NK (2020) Oral health and salivary function in ulcerative colitis patients. United European Gastroenterol J 8:1067\u20131075. https:\/\/doi.org\/10.1177\/2050640620957138","journal-title":"United European Gastroenterol J"},{"key":"3835_CR24","doi-asserted-by":"publisher","first-page":"298","DOI":"10.14219\/jada.archive.1989.0211","volume":"119","author":"ID Mandel","year":"1989","unstructured":"Mandel ID (1989) The role of saliva in maintaining oral homeostasis. J Am Dent Assoc 119:298\u2013304. https:\/\/doi.org\/10.14219\/jada.archive.1989.0211","journal-title":"J Am Dent Assoc"},{"key":"3835_CR25","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1038\/ajg.2011.44","volume":"106","author":"JK Hou","year":"2011","unstructured":"Hou JK, Abraham B, El-Serag H (2011) Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 106:563\u2013573. https:\/\/doi.org\/10.1038\/ajg.2011.44","journal-title":"Am J Gastroenterol"},{"key":"3835_CR26","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1111\/jre.12422","volume":"52","author":"K Agossa","year":"2017","unstructured":"Agossa K, Dendooven A, Dubuquoy L, Gower-Rousseau C, Delcourt-Debruyne E, Capron M (2017) Periodontal manifestations of inflammatory bowel disease: emerging epidemiologic and biologic evidence. J Periodontal Res 52:313\u2013324. https:\/\/doi.org\/10.1111\/jre.12422","journal-title":"J Periodontal Res"},{"key":"3835_CR27","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1111\/jcpe.12698","volume":"44","author":"SN Papageorgiou","year":"2017","unstructured":"Papageorgiou SN, Hagner M, Nogueira AVB, Franke A, J\u00e4ger A, Deschner J (2017) Inflammatory bowel disease and oral health: systematic review and a meta-analysis. J Clin Periodontol 44:382\u2013393. https:\/\/doi.org\/10.1111\/jcpe.12698","journal-title":"J Clin Periodontol"},{"key":"3835_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-020-1053-5","volume":"20","author":"YY She","year":"2020","unstructured":"She YY, Kong XB, Ge YP, Liu ZY, Chen JY, Jiang JW, Jiang HB, Fang SL (2020) Periodontitis and inflammatory bowel disease: a meta-analysis. BMC Oral Health 20:1\u201311. https:\/\/doi.org\/10.1186\/s12903-020-1053-5","journal-title":"BMC Oral Health"},{"key":"3835_CR29","doi-asserted-by":"publisher","first-page":"2768","DOI":"10.1097\/01.MIB.0000438356.84263.3b","volume":"19","author":"SR Vavricka","year":"2013","unstructured":"Vavricka SR, Manser CN, Hediger S, V\u00f6gelin M, Scharl M, Biedermann L, Rogler S, Seibold F, Sanderink R, Attin T, Schoepfer A, Fried M, Rogler G, Frei P (2013) Periodontitis and gingivitis in inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 19:2768\u20132777. https:\/\/doi.org\/10.1097\/01.MIB.0000438356.84263.3b","journal-title":"Inflamm Bowel Dis"},{"key":"3835_CR30","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.amepre.2018.02.014","volume":"54","author":"FRM Leite","year":"2018","unstructured":"Leite FRM, Nascimento GG, Scheutz F, L\u00f3pez R (2018) Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med 54:831\u2013841","journal-title":"Am J Prev Med"},{"key":"3835_CR31","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.jdent.2017.07.013","volume":"67","author":"M de Ara\u00fajo Nobre","year":"2017","unstructured":"de Ara\u00fajo Nobre M, Mal\u00f3 P (2017) Prevalence of periodontitis, dental caries, and peri-implant pathology and their relation with systemic status and smoking habits: results of an open-cohort study with 22009 patients in a private rehabilitation center. J Dent 67:36\u201342. https:\/\/doi.org\/10.1016\/j.jdent.2017.07.013","journal-title":"J Dent"},{"key":"3835_CR32","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/j.1600-0765.2011.01431.x","volume":"47","author":"RA Habashneh","year":"2012","unstructured":"Habashneh RA, Khader YS, Alhumouz MK et al (2012) The association between inflammatory bowel disease and periodontitis among Jordanians: a case-control study. J Periodontal Res 47:293\u2013298. https:\/\/doi.org\/10.1111\/j.1600-0765.2011.01431.x","journal-title":"J Periodontal Res"},{"key":"3835_CR33","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1902\/jop.1994.65.3.260","volume":"65","author":"SG Grossi","year":"1994","unstructured":"Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, Norderyd OM, Genco RJ (1994) Assessment of risk for periodontal disease. I. Risk Indicators for Attachment Loss. J Periodontol 65:260\u2013267. https:\/\/doi.org\/10.1902\/jop.1994.65.3.260","journal-title":"J Periodontol"},{"key":"3835_CR34","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1111\/j.1600-051X.2004.00563.x","volume":"31","author":"P Axelsson","year":"2004","unstructured":"Axelsson P, Nystr\u00f6m B, Lindhe J (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol 31:749\u2013757. https:\/\/doi.org\/10.1111\/j.1600-051X.2004.00563.x","journal-title":"J Clin Periodontol"}],"container-title":["Clinical Oral Investigations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-021-03835-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00784-021-03835-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00784-021-03835-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T01:07:10Z","timestamp":1629162430000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00784-021-03835-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":34,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["3835"],"URL":"https:\/\/doi.org\/10.1007\/s00784-021-03835-6","relation":{},"ISSN":["1432-6981","1436-3771"],"issn-type":[{"value":"1432-6981","type":"print"},{"value":"1436-3771","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,23]]},"assertion":[{"value":"23 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with the guidelines of the Ethics Review Committee of the VU University Medical Center. The Ethics Review Committee of the VU University Amsterdam confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"For this study, formal consent was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"N.K.H. de Boer served as a speaker for AbbVie and MSD and as a consultant and\/or principal investigator for TEVA Pharma VB and Takeda. He received (unrestricted) research funding from MLDS, TEVA Pharma VB, and Takeda, all outside the submitted work. All other authors have nothing to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}