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Assessments of greenhouse gas (GHG) emissions in managed areas are facing various challenges. A non-flow-through, non-steady-state (NFT-NSS) chamber coupled to a frame permanently inserted into the landfilled substrates is a standard method for quantifying GHG emissions in managed areas, such as pulp and paper mill sludge (PPMS) landfill sites. Frequent measurements are needed to minimize uncertainties on GHG emission factors at the landfill site scale. However, maintaining a frame inserted into the substrates for a long time period is often impossible due to landfilling management operations. Therefore, GHG measurements using NFT-NSS chambers placed directly on substrates' surface could be an interesting option. Our objectives were to determine the relationships between CO 2 , CH 4 , and N 2 O fluxes measured with (F + ) and without (F-) a frame inserted in the substrates' surface and to develop correction factors for fluxes measured without a frame. Measurements were made at different PPMS landfill sites in the province of Québec, Canada. Stronger GHG flux relationships were observed at the provincial (across sites) than the specific site scale: the variance in GHG fluxes from F- chambers explained up to 80 % of variance in fluxes from F + chambers. The measured CO 2 , CH 4 , and N 2 O fluxes in F- chambers were on average 53, 78, and 63 % lower, respectively, than those estimated by the models at provincial scale. The correction factors developed with this approach could greatly extend the number of sites where in situ GHG measurements can be done and would help refining GHG inventories at the provincial and national levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry., Methods: The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols., Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols., Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 American Dental Hygienists' Association and the Canadian Dental Hygienists Association.)

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols. Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery., (Copyright © 2024 The American Dental Hygienists’ Association.)

Introduction: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis., Objective: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care., Methods: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today., Conclusion: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided., (© 2023. The Author(s).)

Abstract: In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Recycling is a commonly acknowledged strategy to reduce the environmental impacts linked to primary resource exploitation. Large regional variations can be observed in recycling processes' parameters, like efficiency, energy mix and treatment of rejects. Life-cycle assessment (LCA) is widely used to evaluate the environmental impacts of recycling processes, but existing studies are neither harmonized nor sufficient to provide a comprehensive geographical and technological coverage of recycling processes. The purpose of this research is to develop an efficient and iterative approach for the parametrized generation of semi-automated regionalized life-cycle inventories that take into account technological and geographical variabilities in the recycling sector. The regionalization framework is then applied to create a parametrized paper recycling regionalization tool. This tool is used in the results section to compare the national climate change impacts of recycling three paper grades. Results show a significant global warming impact variability between countries for recycled graphic paper (0.36 to 2.25 kg CO 2 -Eq/kg wastepaper recycled), newsprint (0.27 to 1.84 kg CO 2 -Eq/kg wastepaper recycled) and corrugated cardboard (0.28 to 1.68 kg CO 2 -Eq/kg wastepaper recycled) productions. A regionalized LCA of the international recycling of the mixed wastepaper exported from Quebec's (Canada) sorting centers is also performed with the tool and compared to the non-regionalized mixed wastepaper recycling process available in the ecoinvent database. Only nine midpoint ReCiPe impact categories remain environmentally advantageous compared to virgin paper production when applying the regionalization methodology, compared to sixteen when using the ecoinvent process, illustrating how regionalization can substantially influence LCA results., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Treat-to-target (T2T) recommendations for the use of systemic therapies (including biologics) in patients with moderate-to-severe plaque psoriasis have been published by a few groups of experts worldwide. However, there remains considerable variability in the choice of target severity measure and timing of milestones. To develop consensus recommendations for implementing T2T strategies for the management of moderate-to-severe plaque psoriasis using biologics. An expert group of Canadian dermatologists (the Committee) convened to develop a T2T consensus statement. They held a virtual meeting during which a preliminary set of criteria was created. These criteria were then reviewed, modified, and recirculated until unanimous agreement was achieved. The Committee agreed that defining treatment target is multidimensional and should reflect objective severity measures, as well as clinician and patient-reported outcomes. The Committee unanimously proposes a criterion-based system for determining the achievement of treatment target. The proposed T2T approach presented here provides a clinical framework for defining treatment success, measuring progress toward treatment success, recognizing when treatment modifications are warranted, and recommending treatment optimization strategies., (© 2022 Wiley Periodicals LLC.)

Objective: This study assessed the features of the 100 most-cited papers on oral health-related quality of life (OHRQoL)., Methods: The 100 most-cited OHRQoL papers were collected from Web of Science, adopting a combined keyword search strategy. Google Scholar and Scopus databases were searched to compare citations. The following data were extracted from papers: title of the paper, number of citations, authorship, country, year of publication, title of the journal, study design, sample size, topic and OHRQoL instruments used. Graphical bibliometric networks were created using VOSviewer software., Results: The number of citations of the top 100 most-cited OHRQoL papers ranged from 73 to 949. Fifty-six papers received at least 100 citations and two received more than 400 citations. Most papers were from Canada (23%) and had been published in Community Dentistry and Oral Epidemiology (37%). David Locker was the most-cited author (25 papers; 3,521 citations). The cross-sectional study design was the most common (68%). The impact of oral health conditions on OHRQoL (43%) was the most frequent topic, and the Oral Health Impact Profile (OHIP) was the most commonly used OHRQoL instrument (48%)., Conclusions: This bibliometric analysis highlighted the characteristics of the 100 most-cited OHRQoL papers, demonstrating that this field is far from saturated. This list of the most-cited articles can provide a reference point to guide oral health research, education and services., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Prostate cancer is the most common malignancy and the third most common cause of death in Canadian men. In light of evolving diagnostic pathways for prostate cancer and the increased use of MRI, which now includes its use in men prior to biopsy, the Canadian Association of Radiologists established a Prostate MRI Working Group to produce a white paper to provide recommendations on establishing and maintaining a Prostate MRI Programme in the context of the Canadian healthcare system. The recommendations, which are based on available scientific evidence and/or expert consensus, are intended to maintain quality in image acquisition, interpretation, reporting and targeted biopsy to ensure optimal patient care. The paper covers technique, reporting, quality assurance and targeted biopsy considerations and includes appendices detailing suggested reporting templates, quality assessment tools and sample image acquisition protocols relevant to the Canadian healthcare context.

Aim: The aim of this position paper is to investigate the current state of the evidence for proposed associations between periodontitis and rheumatoid arthritis, Alzheimer's disease, obesity, inflammatory cancers, and renal disease using a narrative review approach. This is the last of a series of 5 position papers from the Canadian Dental Hygienists Association (CDHA) on the relationship between periodontitis and systemic conditions., Methods: Individual literature searches were conducted for each of the 5 proposed linkages and limited to human studies, with a preference for systematic reviews (SRs) and prospective studies, in the English language, published between 2015 and 2021, focused on associations between 1) periodontitis and rheumatoid arthritis; 2) periodontitis and Alzheimer's disease/cognitive impairment; 3) periodontitis and obesity; 4) periodontitis and inflammatory cancers; and 5) periodontitis and chronic kidney disease. Databases searched were PubMed, MEDLINE/OVID, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Web of Science., Results: A total of 39 papers were selected for discussion, including 6 SRs for rheumatoid arthritis; 7 SRs for Alzheimer's disease/cognitive impairment; 11 SRs, 1 meta-review of SRs, and 1 population-based cohort study for obesity; 9 SRs for inflammatory cancers; and 4 SRs for kidney disease., Conclusions: The evidence for the 5 proposed associations varied in strength, with obesity being most strongly associated with periodontal disease. More robust studies are recommended to clarify the exact nature of these associations., Competing Interests: The author has declared no conflicts of interest., (Copyright © 2022 CDHA | ACHD.)

Summary Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-described intervention for noncompressible torso hemorrhage. Several Canadian centres have included REBOA in their hemorrhagic shock protocols. However, REBOA has known complications and equipoise regarding its use persists. The Canadian Collaborative on Urgent Care Surgery (CANUCS) comprises surgeons who provide acute trauma care and leadership in Canada, with experience in REBOA implementation, use, education and research. Our goal is to provide evidence- and experience-based recommendations regarding institutional implementation of a REBOA program, including multidisciplinary educational programs, attention to device and care pathway logistics, and a robust quality assurance program. This will allow Canadian trauma centres to maximize patient benefits and minimize risks of this potentially life-saving technology., Competing Interests: Competing interests: Andrew Kirkpatrick has consulted for Zoll, Innovative Trauma Care, CSL Behring and SAM Medical Corporations, and is the principal investigator of a prospective randomized controlled trial that is partially supported by the Acelity Corporation (https://clinicaltrials.gov/ct2/show/NCT03163095). No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Introduction: Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on-site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on-site drug testing technologies., Methods: Paper spray mass spectrometry was used to provide on-site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2-day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components., Results: During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4-anilino-N-phenethyl-piperidine (4-ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co-measured with fentanyl, and in seven cases it was detected alone., Discussion and Conclusions: The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on-site drug checking methods and harm reduction services., (© 2021 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Over 64 billion paper-plastic laminate (PPL) coffee cups are consumed between the United States and Canada annually, the majority accumulating in landfills due to a hydrophobic plastic inner-lining. Recycling can mitigate environmental damage and provide economic value from repurposed products. We found that standard repulping methods were insufficient to separate fiber from plastic due to the low intensity of treatment. To increase process intensity, we mechanically refined shredded PPL coffee cups and Kraft eucalyptus sheets (control) at 2%, 3%, and 4% consistencies with three passes to determine the energy required to separate fibers from plastic and the effects on fiber quality. 2% and 3% consistency PPL cups measured under 40 kWh/tonne of input material for one refiner pass and ∼ 80 kWh/tonne for 4% consistency PPL cups. Recovered fiber fraction totaled 87.7%, 85.3%, and 80.5% of input mass of Kraft eucalyptus and 72.3%, 72.6%, and 79.6% of input mass of PPL cups at 2%, 3%, and 4% consistency, respectively. Fines content of PPL cups jumped from 8% pre-refining to ∼ 30% post-refining while Kraft eucalyptus fibers were unaffected, suggesting that breaking the plastic-fiber bonds results in fines generation. Mean fiber length of PPL cups slightly decreased with consistency and tensile strength improved. Freeness decreased with consistency only in PPL cup samples. These results demonstrate a low energy requirement to effectively separate fiber and plastics in PPL cups as well as minimal impact on fiber quality using existing refining technology, and provides an estimate of the financial costs of local recycling efforts., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: We evaluated reporting completeness and transparency in randomized controlled trials (RCTs) conducted using administrative data based on 2021 CONSORT Extension for Trials Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria., Study Design and Setting: MEDLINE and the Cochrane Methodology Register were searched (2011 and 2018). Eligible RCTs used administrative databases for identifying eligible participants or collecting outcomes. We evaluated reporting based on CONSORT-ROUTINE, which modified eight items from CONSORT 2010 and added five new items., Results: Of 33 included trials (76% used administrative databases for outcomes, 3% for identifying participants, 21% both), most were conducted in the United States (55%), Canada (18%), or the United Kingdom (12%). Of eight items modified in the extension; six were adequately reported in a majority (>50%) of trials. For the CONSORT-ROUTINE modification portion of those items, three items were reported adequately in >50% of trials, two in <50%, two only applied to some trials, and one only had wording modifications and was not evaluated. For five new items, four that address use of routine data in trials were reported inadequately in most trials., Conclusion: How administrative data are used in trials is often sub-optimally reported. CONSORT-ROUTINE uptake may improve reporting., Competing Interests: Declaration of Competing Interests All authors have completed the ICJME uniform disclosure form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, (Copyright © 2021. Published by Elsevier Inc.)

This paper investigates the role of admission forms in the regulation of asylum confinement in the second half of the nineteenth century. Taking the Toronto Lunatic Asylum as a case study it traces the evolution of the forms' content and structure during the first decades of this institution. Admission forms provide important material for understanding the medico-legal assessment of lunacy in a certain jurisdiction. First, they show how the description of insanity depended on a plurality of actors. Second, doctors were not necessarily required to indicate symptoms of derangement. Third, patients' relatives played a fundamental role in providing clinical information. From an historiographical perspective, this paper invites scholars to consider the function of standardized documents in shaping the written identity of patients.

Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: This quali-quantitative study analysed the 100 most-cited papers in core dental public health (DPH) journals focusing on understanding international knowledge production., Methods: The DPH journals were selected from titles and scopes at Web of Science Core Collection database up to March 2020. Further comparisons were performed at Scopus and Google Scholar databases. Some bibliometric parameters were extracted as follows: title, number of citations, citation density (number of citations per year), first author's country, year of publication, study design and subject. VOSviewer software was used to create graphical bibliometric maps., Results: Papers were ranked by the total number of citations, which ranged from 104 to 1,019, and six papers were cited more than 400 times. Papers were published from 1974 to 2013, mainly in Community Dentistry and Oral Epidemiology. Most frequent study designs were cross-sectional (30%) and nonsystematic review (25%). Most papers were from Europe (54%) and North America (31%). First authors were predominantly from the United Kingdom (17%), United States of America (17%) and Canada (14%). VOSviewer map of co-authorship demonstrated the existence of clusters in the research collaboration. Although epidemiology was the most frequent subject (84%), health services research presented eight times higher citation density., Conclusions: Top 100 most-cited papers in core DPH journals were predominantly observational studies from Anglo-Saxon countries. Top 100 most-cited papers in core DPH journals tend to be cross-sectional studies carried out in the United States with highest citation in health services research. Locker D, Petersen PE and Sheiham A are a landmark for DPH field., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Patient reported outcome measures (PROMs) provide valuable insight on patients' well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to (a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; (b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and (c) gather feedback on user experience., Methods: Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95 % Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes., Results: 196 patients participated in this project. Scores on the forms had high ICC agreement > 0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83 % of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10 % of respondents suggested improvements to improve the user interface., Conclusions: E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.

Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed., Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control., Methods: The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality., Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM., Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2021 CDHA | ACHD.)