{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T09:33:27Z","timestamp":1776159207657,"version":"3.50.1"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Inflammation-modulating elements are recognized periodontitis (PD) risk factors, nevertheless, the association between dietary inflammatory index (DII) and PD has never been appraised. We aimed to assess the association between DII and PD and the mediation effect of DII in the association of PD with systemic inflammation. Using the National Health and Nutrition Examination Survey 2009\u20132010, 2011\u20132012 and 2013\u20132014, participants who received periodontal exam and provided dietary recall data were included. The inflammatory potential of diet was calculated via DII. PD was defined according to the 2012 case definition. White blood cells (WBC), segmented neutrophils and C-reactive protein (CRP) were used as proxies for systemic inflammation. The periodontal measures were regressed across DII values using adjusted multivariate linear regression and adjusted mediation analysis. Overall, 10,178 participants were included. DII was significantly correlated with mean periodontal probing depth (PPD), mean clinical attachment loss (CAL), thresholds of PPD and CAL, WBC, segmented neutrophils and DII (p &lt; 0.01). A linear regression logistic adjusted for multiple confounding variables confirmed the association between DII and mean PPD (B = 0.02, Standard Error [SE]: 0.02, p &lt; 0.001) and CAL (B = \u22120.02, SE: 0.01, p &lt; 0.001). The association of mean PPD and mean CAL with both WBC and segmented neutrophils were mediated by DII (from 2.1 to 3.5%, p &lt; 0.001). In the 2009\u20132010 subset, the association of mean CAL with serum CRP was mediated by DII (52.0%, p &lt; 0.01). Inflammatory diet and PD may be associated. Also, the inflammatory diet significantly mediated the association of leukocyte counts and systemic inflammation with PD.<\/jats:p>","DOI":"10.3390\/nu13041194","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T11:48:29Z","timestamp":1617623309000},"page":"1194","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Association between Dietary Inflammatory Index and Periodontitis: A Cross-Sectional and Mediation Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2503-260X","authenticated-orcid":false,"given":"Vanessa","family":"Machado","sequence":"first","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"},{"name":"Evidence-Based Hub, Clinical Research Unit, Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1019-8263","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Botelho","sequence":"additional","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"},{"name":"Evidence-Based Hub, Clinical Research Unit, Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal"}]},{"given":"Jo\u00e3o","family":"Viana","sequence":"additional","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-1986","authenticated-orcid":false,"given":"Paula","family":"Pereira","sequence":"additional","affiliation":[{"name":"Grupo de Estudos em Nutri\u00e7\u00e3o Aplicada (GENA), CiiEM, Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"}]},{"given":"Lu\u00edsa Bandeira","family":"Lopes","sequence":"additional","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8482-5936","authenticated-orcid":false,"given":"Lu\u00eds","family":"Proen\u00e7a","sequence":"additional","affiliation":[{"name":"Evidence-Based Hub, Clinical Research Unit, Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal"},{"name":"Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"}]},{"given":"Ana Sintra","family":"Delgado","sequence":"additional","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0167-4077","authenticated-orcid":false,"given":"Jos\u00e9 Jo\u00e3o","family":"Mendes","sequence":"additional","affiliation":[{"name":"Clinical Research Unit (CRU), Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Egas Moniz\u2013Cooperativa de Ensino Superior, 2829-511 Almada, Portugal"},{"name":"Evidence-Based Hub, Clinical Research Unit, Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1017\/S0007114510003053","article-title":"Redox-Modulatory Vitamins and Minerals That Prospectively Predict Mortality in Older British People: The National Diet and Nutrition Survey of People Aged 65 Years and Over","volume":"105","author":"Bates","year":"2011","journal-title":"Br. J. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1017\/S0007114507725163","article-title":"Nutritional Status and Subsequent All-Cause Mortality in Men and Women Aged 75 Years or over Living in the Community","volume":"98","author":"Jia","year":"2007","journal-title":"Br. J. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/aje\/kwj007","article-title":"Serum Antioxidants, Inflammation, and Total Mortality in Older Women","volume":"163","author":"Walston","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Calvo, N., and Mart\u00ednez-Gonz\u00e0lez, M.\u00c1. (2017). Vitamin C Intake Is Inversely Associated with Cardiovascular Mortality in a Cohort of Spanish Graduates: The SUN Project. Nutrients, 9.","DOI":"10.3390\/nu9090954"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4124","DOI":"10.3390\/nu7064124","article-title":"Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the PREDIMED Study","volume":"7","author":"Ramallal","year":"2015","journal-title":"Nutrients"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart Disease and Stroke Statistics\u20142018 Update: A Report from the American Heart Association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1038\/s41523-020-00179-4","article-title":"Long-Term Anti-Inflammatory Diet in Relation to Improved Breast Cancer Prognosis: A Prospective Cohort Study","volume":"6","author":"Wang","year":"2020","journal-title":"NPJ Breast Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/ajcn\/nqaa019","article-title":"Anti-Inflammatory Diet In Rheumatoid Arthritis (ADIRA)\u2014a Randomized, Controlled Crossover Trial Indicating Dieffects on Disease Activity","volume":"111","author":"Vadell","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/jcpe.13094","article-title":"The Influence of an Anti-Inflammatory Diet on Gingivitis. A Randomized Controlled Trial","volume":"46","author":"Woelber","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/j.ctim.2019.102281","article-title":"Anti-Inflammatory Diet: Necessity of Scientific Spotlight and Challenges","volume":"50","author":"Watanabe","year":"2020","journal-title":"Complement. Ther. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1161\/CIRCULATIONAHA.115.018010","article-title":"Examining Dietary Patterns in Relation to Chronic Disease: Matching Measures and Methods to Questions of Interest","volume":"132","author":"Subar","year":"2015","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1017\/S1368980013002115","article-title":"Designing and Developing a Literature-Derived, Population-Based Dietary Inflammatory Index","volume":"17","author":"Shivappa","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.3945\/jn.109.114025","article-title":"A New Dietary Inflammatory Index Predicts Interval Changes in Serum High-Sensitivity","volume":"139","author":"Cavicchia","year":"2009","journal-title":"J. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1038\/sj.ebd.6401182","article-title":"Impact of Smoking on Tooth Loss in Adults","volume":"17","author":"Carson","year":"2016","journal-title":"Evid. Based Dent."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e011367","DOI":"10.1161\/JAHA.118.011367","article-title":"Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial","volume":"7","author":"Shah","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","first-page":"1","article-title":"Association between Dietary Inflammatory Index and Inflammatory Markers in the HELENA Study","volume":"61","author":"Shivappa","year":"2017","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1002\/oby.21833","article-title":"Inflammatory Potential of Diet, Weight Gain, and Incidence of Overweight\/Obesity: The SUN Cohort","volume":"25","author":"Ramallal","year":"2017","journal-title":"Obesity"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.numecd.2015.09.002","article-title":"Prospective Association between the Dietary Inflammatory Index and Metabolic Syndrome: Findings from the SU.VI.MAX Study","volume":"25","author":"Neufcourt","year":"2015","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.clnu.2017.06.001","article-title":"Diet-Borne Systemic Inflammation Is Associated with Prevalent Tooth Loss","volume":"37","author":"Kotsakis","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/jcpe.12732","article-title":"Impact of the Global Burden of Periodontal Diseases on Health, Nutrition and Wellbeing of Mankind: A Call for Global Action","volume":"44","author":"Tonetti","year":"2017","journal-title":"J. Clin. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1177\/0022034514552491","article-title":"Global Burden of Severe Periodontitis in 1990\u20132010: A Systematic Review and Meta-Regression","volume":"93","author":"Kassebaum","year":"2014","journal-title":"J. Dent. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/jcpe.13118","article-title":"Predictors for Tooth Loss in Periodontitis Patients: Systematic Review and Meta-Analysis","volume":"46","author":"Helal","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/nri3785","article-title":"Periodontitis: From Microbial Immune Subversion to Systemic Inflammation","volume":"15","author":"Hajishengallis","year":"2015","journal-title":"Nat. Rev. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/nrrheum.2009.28","article-title":"Periodontitis in Systemic Rheumatic Diseases","volume":"5","author":"Chapple","year":"2009","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/jcpe.12517","article-title":"Are Periodontal Diseases Really Silent? A Systematic Review of Their Effect on Quality of Life","volume":"43","author":"Buset","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00784-019-03188-1","article-title":"The Impact of Nonsurgical Periodontal Treatment on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis","volume":"24","author":"Botelho","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.nutres.2014.06.001","article-title":"A High-Fiber, Low-Fat Diet Improves Periodontal Disease Markers in High-Risk Subjects: A Pilot Study","volume":"34","author":"Kondo","year":"2014","journal-title":"Nutr. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/aje\/kww187","article-title":"Diet-Induced Overweight and Obesity and Periodontitis Risk: An Application of the Parametric g-Formula in the 1982 Pelotas Birth Cohort","volume":"185","author":"Nascimento","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"66","DOI":"10.12968\/denu.2016.43.1.66","article-title":"Nutrition and Periodontal Disease","volume":"43","author":"Raindi","year":"2016","journal-title":"Dent. Update"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/JPER.19-0463","article-title":"Dietary Flavonoid Intake and Risk of Periodontitis","volume":"91","author":"Alhassani","year":"2020","journal-title":"J. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lachat, C., Hawwash, D., Ock\u00e9, M.C., Berg, C., Forsum, E., H\u00f6rnell, A., Larsson, C., Sonestedt, E., Wirf\u00e4lt, E., and \u00c5kesson, A. (2016). Strengthening the Reporting of Observational Studies in Epidemiology\u2014Nutritional Epidemiology (STROBE-Nut): An Extension of the STROBE Statement. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002036"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1177\/0022034510377793","article-title":"Accuracy of NHANES Periodontal Examination Protocols","volume":"89","author":"Eke","year":"2010","journal-title":"J. Dent. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1902\/jop.2012.110664","article-title":"Update of the Case Definitions for Population-Based Surveillance of Periodontitis","volume":"83","author":"Eke","year":"2012","journal-title":"J. Periodontol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1600-0757.2011.00418.x","article-title":"Nutrition, Dietary Guidelines and Optimal Periodontal Health","volume":"58","author":"Kaye","year":"2012","journal-title":"Periodontology 2000"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Laiola, M., De Filippis, F., Vitaglione, P., and Ercolini, D. (2020). A Mediterranean Diet Intervention Reduces the Levels of Salivary Periodontopathogenic Bacteria in Overweight and Obese Subjects. Appl. Environ. Microbiol., 86.","DOI":"10.1128\/AEM.00777-20"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.archoralbio.2017.01.023","article-title":"The Relationship between Insulin Resistance and Periodontitis Is Not Affected by Mediterranean Diet in a Spanish Population","volume":"77","author":"Bullon","year":"2017","journal-title":"Arch. Oral Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1038\/ejcn.2011.45","article-title":"Probiotics Affect the Clinical Inflammatory Parameters of Experimental Gingivitis in Humans","volume":"65","author":"Slawik","year":"2011","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_38","first-page":"387","article-title":"Probiotics and Periodontal Health","volume":"4","author":"Gupta","year":"2011","journal-title":"J. Med. Life"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/0972-124X.82260","article-title":"Probiotics in Periodontal Health and Disease","volume":"15","author":"Chatterjee","year":"2011","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-018-24207-3","article-title":"Impact of a Vegan Diet on the Human Salivary Microbiota","volume":"8","author":"Hansen","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1902\/jop.2009.090270","article-title":"Preventive Effects of a Cocoa-Enriched Diet on Gingival Oxidative Stress in Experimental Periodontitis","volume":"80","author":"Tomofuji","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1902\/jop.2009.080376","article-title":"The Impact of the Stone Age Diet on Gingival Conditions in the Absence of Oral Hygiene","volume":"80","author":"Baumgartner","year":"2009","journal-title":"J. Periodontol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Woelber, J.P., Bremer, K., Vach, K., K\u00f6nig, D., Hellwig, E., Ratka-Kr\u00fcger, P., Al-Ahmad, A., and Tennert, C. (2017). An Oral Health Optimized Diet Can Reduce Gingival and Periodontal Inflammation in Humans\u2014A Randomized Controlled Pilot Study. BMC Oral Health, 17.","DOI":"10.1186\/s12903-016-0257-1"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.jacc.2006.03.052","article-title":"The Effects of Diet on Inflammation Emphasis on the Metabolic Syndrome","volume":"48","author":"Giugliano","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"754","DOI":"10.3389\/fimmu.2018.00754","article-title":"Role of C-Reactive Protein at Sites of Inflammation and Infection","volume":"9","author":"Sproston","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1038\/nrrheum.2011.37","article-title":"C-Reactive Protein in Rheumatology: Biology and Genetics","volume":"7","author":"Rhodes","year":"2011","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1902\/jop.2003.74.7.1007","article-title":"Relationship of Destructive Periodontal Disease to the Acute-Phase Response","volume":"74","author":"Craig","year":"2003","journal-title":"J. Periodontol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3402\/jom.v6.26102","article-title":"Dynamic Interactions of Neutrophils and Biofilms","volume":"6","author":"Hirschfeld","year":"2014","journal-title":"J. Oral Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/prd.12313","article-title":"New Developments in Neutrophil Biology and Periodontitis","volume":"82","author":"Hajishengallis","year":"2020","journal-title":"Periodontology 2000"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.cell.2014.03.011","article-title":"Role of the Microbiota in Immunity and Inflammation","volume":"157","author":"Belkaid","year":"2014","journal-title":"Cell"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/prd.12005","article-title":"Periodontal Disease Immunology: \u201cDouble Indemnity\u201d in Protecting the Host","volume":"62","author":"Ebersole","year":"2013","journal-title":"Periodontology 2000"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/jcpe.13189","article-title":"Periodontitis and Cardiovascular Diseases: Consensus Report","volume":"47","author":"Sanz","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S2213-8587(18)30038-X","article-title":"Systemic Effects of Periodontitis Treatment in Patients with Type 2 Diabetes: A 12 Month, Single-Centre, Investigator-Masked, Randomised Trial","volume":"6","author":"Gkranias","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s00394-016-1158-4","article-title":"Association between Diet-Related Inflammation, All-Cause, All-Cancer, and Cardiovascular Disease Mortality, with Special Focus on Prediabetics: Findings from NHANES III","volume":"56","author":"Deng","year":"2017","journal-title":"Eur. J. Nutr."},{"key":"ref_55","first-page":"145","article-title":"Partial Recording Protocols Performance on the Assessment of Periodontitis Severity and Extent: Bias Magnitudes, Sensibility, and Specificity","volume":"59","author":"Machado","year":"2018","journal-title":"Rev. Port. Estomatol. Med. Dent. E Cir. Maxilofac."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"7093","DOI":"10.1038\/s41598-020-63700-6","article-title":"The 2018 Periodontitis Case Definition Improves Accuracy Performance of Full-Mouth Partial Diagnostic Protocols","volume":"10","author":"Botelho","year":"2020","journal-title":"Sci. Rep."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/4\/1194\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:58:21Z","timestamp":1760363901000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/4\/1194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,5]]},"references-count":56,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["nu13041194"],"URL":"https:\/\/doi.org\/10.3390\/nu13041194","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,5]]}}}