{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:09:51Z","timestamp":1787584191879,"version":"build-2736575974"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005634","name":"Suomen Hammasl\u00e4\u00e4k\u00e4riseura Apollonia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005634","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004212","name":"P\u00e4ivikki ja Sakari Sohlbergin S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004212","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents\u2019 poor oral health.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this cross-sectional observational study dentists examined 209 residents\u2019 oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents\u2019 poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Participants were grouped according to their ADS scores: low (n\u2009=\u200939), moderate (n\u2009=\u200996) and high ODB (n\u2009=\u200974). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents\u2019 oral health when considering a resident\u2019s need for consultation with an oral health professional.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12903-021-01984-4","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T11:02:33Z","timestamp":1638874953000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study"],"prefix":"10.1186","volume":"21","author":[{"given":"Lina","family":"Julkunen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaija","family":"Hiltunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannu","family":"Kautiainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riitta K. T.","family":"Saarela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaisu H.","family":"Pitk\u00e4l\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4ivi","family":"M\u00e4ntyl\u00e4","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"1984_CR1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/jgs.16154","volume":"68","author":"PP Coll","year":"2020","unstructured":"Coll PP, Lindsay A, Meng J, Gopalakrishna A, Raghavendra S, Bysani P, et al. The prevention of infections in older adults: oral health. J Am Geriatr Soc. 2020;68:411\u20136.","journal-title":"J Am Geriatr Soc"},{"key":"1984_CR2","doi-asserted-by":"crossref","first-page":"411","DOI":"10.2105\/AJPH.2011.300362","volume":"102","author":"SO Griffin","year":"2012","unstructured":"Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102:411\u20138.","journal-title":"Am J Public Health"},{"key":"1984_CR3","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1177\/154405910808700418","volume":"87","author":"S Awano","year":"2008","unstructured":"Awano S, Ansai T, Takata Y, Soh I, Akifusa S, Hamasaki T, et al. Oral health and mortality risk from pneumonia in the elderly. J Dent Res. 2008;87:334\u20139.","journal-title":"J Dent Res"},{"key":"1984_CR4","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1902\/jop.2008.070442","volume":"79","author":"MJ Novak","year":"2008","unstructured":"Novak MJ, Potter RM, Blodgett J, Ebersole JL. Periodontal disease in Hispanic Americans with type 2 diabetes. J Periodontol. 2008;79:629\u201336.","journal-title":"J Periodontol"},{"key":"1984_CR5","doi-asserted-by":"crossref","first-page":"725","DOI":"10.3233\/JAD-141170","volume":"43","author":"DK Shoemark","year":"2015","unstructured":"Shoemark DK, Allen SJ. The microbiome and disease: reviewing the links between the oral microbiome, aging, and Alzheimer\u2019s disease. J Alzheimers Dis. 2015;43:725\u201338.","journal-title":"J Alzheimers Dis"},{"key":"1984_CR6","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/ger.12363","volume":"35","author":"T Kato","year":"2018","unstructured":"Kato T, Abrahamsson I, Wide U, Hakeberg M. Periodontal disease among older people and its impact on oral health-related quality of life. Gerodontology. 2018;35:382\u201390.","journal-title":"Gerodontology"},{"key":"1984_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics3030032","author":"P Newton","year":"2018","unstructured":"Newton P, Curl C, Prasad R, Pass P, Bowden J. A qualitative exploratory study of informal carers\u2019 experiences of identifying and managing oral pain and discomfort in community-dwelling older people living with dementia. Geriatrics (Basel). 2018. https:\/\/doi.org\/10.3390\/geriatrics3030032.","journal-title":"Geriatrics (Basel)"},{"issue":"Suppl","key":"1984_CR8","doi-asserted-by":"crossref","first-page":"26S","DOI":"10.14219\/jada.archive.2007.0360","volume":"138","author":"TK Boehm","year":"2007","unstructured":"Boehm TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc. 2007;138(Suppl):26S-33S.","journal-title":"J Am Dent Assoc"},{"issue":"2","key":"1984_CR9","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1741-2358.2004.00012.x","volume":"21","author":"P Peltola","year":"2004","unstructured":"Peltola P, Vehkalahti MM, Wuolijoki-Saaristo K. Oral health and treatment needs of the long-term hospitalised elderly. Gerodontology. 2004;21(2):93\u20139.","journal-title":"Gerodontology"},{"key":"1984_CR10","first-page":"c3","volume":"78","author":"DC Matthews","year":"2012","unstructured":"Matthews DC, Clovis JB, Brillant MG, Filiaggi MJ, McNally ME, Kotzer RD, et al. Oral health status of long-term care residents-a vulnerable population. J Can Dent Assoc. 2012;78:c3.","journal-title":"J Can Dent Assoc"},{"key":"1984_CR11","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12955-015-0300-y","volume":"13","author":"J Porter","year":"2015","unstructured":"Porter J, Ntouva A, Read A, Murdoch M, Ola D, Tsakos G. The impact of oral health on the quality of life of nursing home residents. Health Qual Life Outcomes. 2015;13:102.","journal-title":"Health Qual Life Outcomes"},{"key":"1984_CR12","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1007\/s00784-015-1652-8","volume":"20","author":"L De Visschere","year":"2016","unstructured":"De Visschere L, Janssens B, De Reu G, Guyck J, Vanobbergen J. An oral health survey of vulnerable older people in Belgium. Clin Oral Investig. 2016;20:1903\u201312.","journal-title":"Clin Oral Investig"},{"key":"1984_CR13","first-page":"143","volume":"34","author":"B Janssens","year":"2017","unstructured":"Janssens B, Vanobbergen J, Petrovic M, Jacquet W, Schols JMGA, De Visschere L. The oral health condition and treatment needs assessment of nursing home residents in Flanders (Belgium). Community Dent Health. 2017;34:143\u201351.","journal-title":"Community Dent Health"},{"key":"1984_CR14","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/ger.12356","volume":"35","author":"MN Yoon","year":"2018","unstructured":"Yoon MN, Ickert C, Slaughter SE, Lengyel C, Carrier N, Keller H. Oral health status of long-term care residents in Canada: results of a national cross-sectional study. Gerodontology. 2018;35:359\u201364.","journal-title":"Gerodontology"},{"key":"1984_CR15","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1754-4505.1999.tb01370.x","volume":"19","author":"CY Lin","year":"1999","unstructured":"Lin CY, Jones DB, Godwin K, Godwin RK, Knebl JA, Niessen L. Oral health assessment by nursing staff of Alzheimer\u2019s patients in a long-term-care facility. Spec Care Dent. 1999;19:64\u201371.","journal-title":"Spec Care Dent"},{"key":"1984_CR16","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.3390\/nu11102261","volume":"11","author":"KS Salminen","year":"2019","unstructured":"Salminen KS, Suominen MH, Kautiainen H, Roitto HM, Pitk\u00e4l\u00e4 KH. Energy intake and severity of dementia are both associated with HRQOL among older long-term care residents. Nutrients. 2019;11:2261.","journal-title":"Nutrients"},{"key":"1984_CR17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373\u201383.","journal-title":"J Chronic Dis"},{"key":"1984_CR18","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","volume":"12","author":"MF Folstein","year":"1975","unstructured":"Folstein MF, Folstein SE, McHugh PR. \u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u201398.","journal-title":"J Psychiatr Res"},{"key":"1984_CR19","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1192\/bjp.140.6.566","volume":"140","author":"CP Hughes","year":"1982","unstructured":"Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566\u201372.","journal-title":"Br J Psychiatry"},{"key":"1984_CR20","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0749-0690(02)00059-9","volume":"18","author":"Y Guigoz","year":"2002","unstructured":"Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002;18:737\u201357.","journal-title":"Clin Geriatr Med"},{"key":"1984_CR21","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.oooo.2012.05.009","volume":"114","author":"SM Osailan","year":"2012","unstructured":"Osailan SM, Pramanik R, Shirlaw P, Proctor GB, Challacombe SJ. Clinical assessment of oral dryness: development of a scoring system related to salivary flow and mucosal wetness. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:597\u2013603.","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"1984_CR22","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1902\/jop.1967.38.6_part2.610","volume":"38","author":"H Loe","year":"1967","unstructured":"Loe H. The gingival index, the plaque index, and the retention index systems. J Periodontol. 1967;38:610\u20136.","journal-title":"J Periodontol"},{"key":"1984_CR23","first-page":"378","volume-title":"Carranza\u2019s clinical periodontology","author":"JH Do","year":"2019","unstructured":"Do JH, Takei HH, Carranza FA. Periodontal examination and diagnosis. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, editors. Carranza\u2019s clinical periodontology. St. Louis: Elsevier Inc.; 2019. p. 378\u201396."},{"key":"1984_CR24","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1161\/01.CIR.0000118497.44961.1E","volume":"109","author":"SJ Janket","year":"2004","unstructured":"Janket SJ, Qvarnstrom M, Meurman JH, Baird AE, Nuutinen P, Jones JA. Asymptotic dental score and prevalent coronary heart disease. Circulation. 2004;109:1095\u2013100.","journal-title":"Circulation"},{"issue":"8","key":"1984_CR25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1472-6831-8-16","volume":"15","author":"O Lindy","year":"2008","unstructured":"Lindy O, Suomalainen K, M\u00e4kel\u00e4 M, Lindy S. Statin use is associated with fewer periodontal lesions: a retrospective study. BMC Oral Health. 2008;15(8):16.","journal-title":"BMC Oral Health"},{"key":"1984_CR26","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1016\/j.jamda.2021.05.027","volume":"22","author":"RKT Saarela","year":"2021","unstructured":"Saarela RKT, Hiltunen K, Kautiainen H, Roitto HM, M\u00e4ntyl\u00e4 P, Pitk\u00e4l\u00e4 KH. Oral health and frailty among older long-term care residents in Finland. J Am Med Dir Assoc. 2021;22:2394\u20135.","journal-title":"J Am Med Dir Assoc"},{"key":"1984_CR27","doi-asserted-by":"crossref","first-page":"4132","DOI":"10.3390\/ijerph16214132","volume":"16","author":"FMF Wong","year":"2019","unstructured":"Wong FMF, Ng YTY, Leung WK. Oral health and its associated factors among older institutionalized residents-a systematic review. Int J Environ Res Public Health. 2019;16:4132.","journal-title":"Int J Environ Res Public Health"},{"key":"1984_CR28","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1741-2358.2009.00281.x","volume":"27","author":"C Gluhak","year":"2010","unstructured":"Gluhak C, Arnetzl GV, Kirmeier R, Jakse N, Arnetzl G. Oral status among seniors in nine nursing homes in Styria, Austria. Gerodontology. 2010;27:47\u201352.","journal-title":"Gerodontology"},{"issue":"7","key":"1984_CR29","doi-asserted-by":"crossref","first-page":"20S","DOI":"10.1177\/0022034514537828","volume":"93","author":"NJ Kassebaum","year":"2014","unstructured":"Kassebaum NJ, Bernab\u00e9 E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss. A systematic review and meta-analysis. J Dent Res. 2014;93(7):20S-28S.","journal-title":"J Dent Res"},{"key":"1984_CR30","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1080\/00016357.2018.1425900","volume":"76","author":"T Aro","year":"2018","unstructured":"Aro T, Laitala M, Syrj\u00e4l\u00e4 AM, Laitala ML, Virtanen JI. Perceptions of older people\u2019s oral health care among nurses working in geriatric home care. Acta Odontol Scand. 2018;76:427\u201332.","journal-title":"Acta Odontol Scand"},{"key":"1984_CR31","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/idh.12227","volume":"14","author":"T Pihlajam\u00e4ki","year":"2016","unstructured":"Pihlajam\u00e4ki T, Syrj\u00e4l\u00e4 AM, Laitala ML, Pesonen P, Virtanen JI. Oral health care-related beliefs among Finnish geriatric home care nurses. Int J Dent Hyg. 2016;14:289\u201394.","journal-title":"Int J Dent Hyg"},{"key":"1984_CR32","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.job.2013.09.001","volume":"56","author":"G Hajishengallis","year":"2014","unstructured":"Hajishengallis G. Aging and its impact on innate immunity and inflammation: implications for periodontitis. J Oral Biosci. 2014;56:30\u20137.","journal-title":"J Oral Biosci"},{"key":"1984_CR33","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1046\/j.1532-5415.2001.49187.x","volume":"49","author":"K Avlund","year":"2001","unstructured":"Avlund K, Holm-Pedersen P, Schroll M. Functional ability and oral health among older people: a longitudinal study from age 75 to 80. J Am Geriatr Soc. 2001;49:954\u201362.","journal-title":"J Am Geriatr Soc"},{"key":"1984_CR34","first-page":"370","volume":"13","author":"G Nordenram","year":"2001","unstructured":"Nordenram G, Ljunggren G, Cederholm T. Nutritional status and chewing capacity in nursing home residents. Aging (Milano). 2001;13:370\u20137.","journal-title":"Aging (Milano)"},{"key":"1984_CR35","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jamda.2018.10.025","volume":"20","author":"EK Lindroos","year":"2019","unstructured":"Lindroos EK, Saarela RKT, Suominen MH, Muurinen S, Soini H, Kautiainen H, et al. Burden of oral symptoms and its associations with nutrition, well-being, and survival among nursing home residents. J Am Med Dir Assoc. 2019;20:537\u201343.","journal-title":"J Am Med Dir Assoc"},{"key":"1984_CR36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s40520-020-01503-5","volume":"33","author":"AL Klotz","year":"2021","unstructured":"Klotz AL, Zajac M, Ehret J, Kilian S, Rammelsberg P, Zenth\u00f6fer A. Which factors influence the oral health of nursing-home residents with cognitive and motor impairments? Aging Clin Exp Res. 2021;33:85\u201393.","journal-title":"Aging Clin Exp Res"},{"key":"1984_CR37","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/ger.12442","volume":"37","author":"KH Lee","year":"2020","unstructured":"Lee KH, Jung ES, Choi YY. Association of oral health and activities of daily living with cognitive impairment. Gerodontology. 2020;37:38\u201345.","journal-title":"Gerodontology"},{"key":"1984_CR38","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s10654-020-00648-x","volume":"35","author":"R Nadim","year":"2020","unstructured":"Nadim R, Tang J, Dilmohamed A, Yuan S, Wu C, Bakre AT, et al. Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis. Eur J Epidemiol. 2020;35:821\u201333.","journal-title":"Eur J Epidemiol"},{"key":"1984_CR39","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/ger.12391","volume":"36","author":"X Chen","year":"2019","unstructured":"Chen X, D\u2019Souza V, Yu L. The oral health status of residents with different cognitive and dental-related functions in three North Carolina assisted living facilities. Gerodontology. 2019;36:142\u20138.","journal-title":"Gerodontology"},{"key":"1984_CR40","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1111\/jcpe.13016","volume":"45","author":"A Tiisanoja","year":"2018","unstructured":"Tiisanoja A, Syrj\u00e4l\u00e4 AM, Tertsonen M, Komulainen K, Pesonen P, Knuuttila M, et al. Oral diseases and inflammatory burden and Alzheimer\u2019s disease among subjects aged 75 years or older. J Clin Periodontol. 2018;45:1287\u201398.","journal-title":"J Clin Periodontol"},{"key":"1984_CR41","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1136\/bmj.298.6676.779","volume":"298","author":"KJ Mattila","year":"1989","unstructured":"Mattila KJ, Nieminen MS, Valtonen VV, Rasi VP, Kes\u00e4niemi YA, Syrj\u00e4l\u00e4 SL, et al. Association between dental health and acute myocardial infarction. BMJ. 1989;298:779\u201381.","journal-title":"BMJ"},{"issue":"20","key":"1984_CR42","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12877-019-1349-y","volume":"3","author":"B Everaars","year":"2020","unstructured":"Everaars B, Weening-Verbree LF, Jerkovi\u0107-\u0106osi\u0107 K, Schoonmade L, Bleijenberg N, de Wit NJ, et al. Measurement properties of oral health assessments for non-dental healthcare professionals in older people: a systematic review. BMC Geriatr. 2020;3(20):4.","journal-title":"BMC Geriatr"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01984-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-021-01984-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01984-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T23:03:38Z","timestamp":1638918218000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcoralhealth.biomedcentral.com\/articles\/10.1186\/s12903-021-01984-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1984"],"URL":"https:\/\/doi.org\/10.1186\/s12903-021-01984-4","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"7 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 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":"The participation was voluntary. Each participant or his\/her closest proxy gave written informed consent. The City of Helsinki and the Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the study protocol. This study adheres to the guidelines of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"624"}}