The COVID‑19 pandemic disrupted human relationships through public health distancing mandates and migration shifts. These changes had the potential to be especially disruptive in public housing, which are government‑funded developments for housing low‑income, frequently mobile, populations. In light of these social upheavals, our goal is to leverage this natural experiment to understand the persistence of relationships, measured as ties in social networks, within disadvantaged public housing communities. We develop a predictive model of relationship maintenance, what we call ego-alter tie-retention, using data from an egocentric longitudinal survey of 187 adults residing in two Boston public‑housing developments. Baseline data were collected between March 2019 and 2020. Our outcome variable is tie-retention (yes vs. no) of each reported tie at approximately 1 year post baseline. Predictors include the degree to which different types of tie overlap (multiplexity), tie‑strength measures (frequency of contact, shared meals, closeness, years known, relationship type, residence), individual ego and alter attributes (age, education, employment, caregiver status), and homophily of relationships (based on gender, Hispanic ethnicity, housing category, caregiver status, sugar‑sweetened beverage/food consumption, self‑rated health, education, smoking). Multilevel hierarchical logistic regression with penalized quasi‑likelihood estimation was used, and model fit was compared via Akaike information criterion. The best fitting model includes multiplexity, longer relationship duration, shared (i.e., homophilous) educational background, and ego-level smoking (AIC = 519.2). These findings have implications for the design of social network-based interventions in public housing contexts. Leveraging durable, homophilous social ties may achieve greater intervention longevity and reach in similar low‑income urban settings.

Background. American Indian/Alaska Native (AI/AN), Black (B), and Hispanic/Latino (H/L) people are underrepresented in dentistry, yet disproportionately constitute the safety-net dental workforce. We examined the relationship between serving as safety-net providers (SNPs) and self-reported income. Methods. Using data from a 2012 national survey of AI/AN, B, and H/L dentists, we examined the relationship between being an SNP and income using linear regression, stratified by potential modifying factors. Results. In 2011, AI/AN, B, and H/L SNPs earned 82% of non-SNP income, even after considering traditional predictors of practice choice and income (race and educational debt), as well as practice trends (practice ownership and busyness). Discussion. Serving as a SNP may explain observed income differences between AI/AN, B, and H/L dentists and their non-SNP counterparts. Given that these dentists are more likely to practice in safety nets, practice choice may contribute to the observed racial income gap in dentistry.

BACKGROUND:Self-reported data can extend the reach of oral health research, but "Don't know" responses may threaten validity. We explored characteristics of participants who responded "Don't know" to a periodontal health question across three distinct cohorts. METHODS:We used data from three questionnaire-based observational studies, namely, the Pregnancy Study Online (PRESTO) (N = 10,996), the Black Women's Health Study (BWHS) (N = 479), and the National Health and Nutrition Examination Survey (NHANES) (N = 15,502), to evaluate responses to questionnaire items related to periodontal health (e.g., "Has a dentist or dental hygienist ever told you that you have periodontitis or gum disease?"). We compared sociodemographic and behavioral factors across each response category ("Yes," "No," "Don't know"). We used Monte Carlo simulation to create multiple datasets of 100,000 participants under different scenarios to calculate the percent change in observed effect estimates in analyses using the full cohort compared to analytic cohorts excluding "Don't know" respondents. RESULTS:"Don't know" prevalences ranged from 1.6% to 4.1%. We observed differences between "Don't know" responders and those who answered "Yes" or "No" across all three cohorts. "Don't know" responders were more likely to have lower educational attainment, lower income, and reduced engagement with oral healthcare services. We observed substantial bias in complete-case effect estimates in some simulated scenarios. Bias was larger when the underlying population prevalence of "Don't know" responses was higher. CONCLUSIONS:"Don't know" responders had distinct patterns of sociodemographic characteristics and oral healthcare engagement. The degree of bias in complete-case analysis was dependent on simulated factors. PLAIN LANGUAGE SUMMARY:Research about oral health often asks people to answer questions about their teeth and gums. Sometimes people respond that they "Don't know" the answer to these questions, which can make data challenging for researchers to analyze. In this study, we used three different data sources to look at whether there were particular characteristics that were more common among people who said they "Don't know" in response to a question about their gum health. "Don't know" responses were not very common in any of the three groups, ranging from 1.6% in a representative survey of people in the United States to 4.1% in a group of women in the United States and Canada trying to become pregnant. In all three groups, people who said "Don't know" had a lower household income, less education, and were less likely to have seen a dentist recently. We also used simulated datasets to evaluate when excluding people who responded "Don't know" would be expected to cause the most bias in analyses. The expected bias increased with the number of "Don't know" responses in the data.

PURPOSE:Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents. METHODS:Respondents self-reported demographics, oral health status and associated risk behaviours (n = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (n = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power. RESULTS:Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status. CONCLUSIONS:Oral health homophily is predicted by relationship strength and 'excellent/very good/good' oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.

BACKGROUND: Fertility success among mixed-sex couples depends on frequency and timing of sexual intercourse, yet little research has evaluated the association between preconception sexual function time-to-pregnancy. OBJECTIVE: To evaluate the effects of female sexual dysfunction, distress related to sexual functioning, and painful intercourse on time pregnancy. STUDY DESIGN: We followed 2500 participants from Pregnancy Study Online, a prospective cohort study of self-identified females attempting pregnancy without the use of fertility treatments. Participants enrolled between 2021 and 2024. Thirty days after enrollment, participants completed a supplemental questionnaire that contained questions about sexual health, including a modified version of the 6-item Female Sexual Function Index (score range 2-30, score <19 defined as sexual dysfunction) and the Female Sexual Distress Scale (score range 0-48, score >= 20 defined as clinically relevant distress), which assess experiences in the previous 4 weeks. Participants completed the supplemental questionnaire no later than 6 months after initiating conception attempts. We estimated time-to-pregnancy based on self-reported pregnancy status on follow-up questionnaires completed every 8 weeks for up to 12 months. We used proportional probabilities regression to calculate fecundability ratios and 95% confidence intervals relating exposure measures time-to-pregnancy, adjusting for a range of prespecified confounders. an exploratory analysis, we evaluated individual domains of sexual function (ie, interest, arousal, orgasm, lubrication, and satisfaction) in relation time-to-pregnancy. RESULTS: The study population was primarily non-Hispanic White, high income, with college or graduate education. Exposure prevalence was 20.1% for female sexual dysfunction, 8.8% for distress, and 29.6% for any pain with intercourse. We observed no association between female sexual dysfunction and time-to-pregnancy (adjusted fecundability ratio 1.00, 95% confidence interval 0.890, 1.13) when female sexual dysfunction was defined using a clinically validated cut point, but observed that those in the first, second, and third quartile of scores had delayed conception compared to those in the fourth (highest function) (adjusted fecundability ratios 0.90, 95% confidence interval 0.76, 1.06; 0.88, 95% confidence interval 0.75, 1.04; and 0.90, 95% confidence interval 0.77, 1.04, respectively). We found 18% reduced fecundability among those with sexual distress as defined by a clinically validated cut point compared to those without (adjusted fecundability ratio 0.82, 95% confidence interval 0.69, 0.98). Participants reporting painful intercourse most or all the time had a longer time-to-pregnancy than those reporting no pain (adjusted fecundability ratio 0.81, 95% confidence interval 0.62, 1.06). In exploratory analyses, lower function in orgasm and lubrication domains, but not interest, desire, and arousal, were associated with longer time-to-pregnancy. CONCLUSION: Preconception sexual dysfunction, specifically distress and frequent painful intercourse, was associated with delayed conception. Preconception clinical assessment of sexual function, including discussion of individual domains of sexual function, may elucidate important modifiable issues.

Attributes and behaviors tend to cluster (homophily) among connected individuals (social networks). Accordingly, the design of effective interventions to address chronic disease risk behaviors at the individual level has proven challenging. To effectively move behavior-change interventions upstream, beyond the individual, an understanding of behavior clustering within a social context is required. This ego-centric/participant reported social network study aimed to identify individual-level (gender, behavior) and relational (closeness) factors that predict homophily on the consumption frequency of both sugar-sweetened beverages (SSB) and sugar-sweetened foods (SSF) among residents of public housing developments in Boston, MA. Egos/participants (n = 272) named alters/social contacts (n = 889) with whom they discuss important matters, share meals, and interact within their housing development. Egos reported sociodemographics, relationship attributes and health behaviors, including SSB and SSF consumption for themselves and alters. Data were collected between March 2019–2020. Multilevel regression models evaluated homophily on SSB and SSF. The best fitting model predicting homophily on SSB included daily contact (OR 1.99, 95

The knowledge and beliefs can affect the behavior of parents about preventive oral care of their children. Aim: This study aimed to perform the semantic equivalence of an instrument that assesses beliefs, knowledge, behaviors and barriers to oral care of mothers/caregivers about early childhood caries in their children aged 0 to 5 years between the original English version and the Brazilian Portuguese language version. Methods: Conceptual and item equivalence were initially performed. Following, semantic equivalence was evaluated according to the following steps: (1) translations of the instrument into Brazilian Portuguese, performed by two independent translators (both native in Brazilian Portuguese and fluent in English); (2) unification of the two translations by an expert committee; (3) two back-translations performed by two independent translators (both native in English and fluent in Brazilian Portuguese); (4) unification of the two back-translations by an expert committee; (5) unified back-translated version sent to the authors of the original instrument for evaluation; (6) committee review; (7) pre-test in a group of 20 Brazilian mothers/caregivers of children aged 0 to 5 years; (8) review and final version of the instrument in Brazilian Portuguese. Results: All items adequately reflected the Brazilian culture. Small divergences were found during translations and back-translations, and the expert committee chose the versions that would best fit into Brazilian culture. Pre-test also brought important insights to the process. All changes made were presented and approved by the original authors. Conclusion: The semantic equivalence allowed the development of a Brazilian Portuguese version of the instrument semantically equivalent to the original version.

BACKGROUND:The Periodontal Disease Self Report (PDSR) measure was originally created and psychometrically validated using a nationwide sample via online data collection. No clinical parameters were included in the prior validation of the PDSR. Thus, this study evaluated potential evidence for the clinical validity of the measure by examining associations between the PDSR scores and various clinical parameters obtained from a new sample of participants in which full-mouth periodontal examinations were conducted. METHODS:Adults from a community sample (n = 114) provided demographic information, responded to the PDSR measure and received a full-mouth clinical periodontal examination. Individual self-report items, subscale scores and total scores obtained from the PDSR were evaluated against clinical parameters of periodontitis. Regression models and receiver operating characteristic statistics were also utilised to test the ability of the PDSR to predict clinical outcomes. RESULTS:PDSR total scores were positively correlated with mean probing depth (r = 0.50, p < 0.01) and mean clinical attachment loss (r = 0.52, p < 0.01). After accounting for common risk factors in periodontal disease, the PDSR predicted mean probing depth (β = 0.45, 95% CI: 0.02-0.04; ΔR2 = 0.19). The area under the curve for the PDSR scores distinguishing between CDC/AAP no/mild periodontitis and moderate/severe periodontitis categories was 0.71 (95% CI: 0.62-0.81). CONCLUSIONS:Clinical data support the use of the PDSR measure as a screening tool for periodontal disease. Additionally, the PDSR may offer added utility compared to other measures due to less reliance on information obtained via clinical encounters.

Background Consumption of dietary sugar (e.g. sugar-sweetened beverages and high sugar foods) is a predominant contributor to chronic health conditions, particularly in communities of low socio-economic position. Our objective was to explore social contextual influences on dietary sugar consumption among public housing residents in Boston, MA. Methods This study employed the use of photovoice, a qualitative technique involving participant photography and narratives. Due to the COVID-19 pandemic, we conducted photovoice methods using Zoom. Adult residents of two public housing developments were invited to participate in pairs of online group sessions. The first session provided training on photovoice methodology and a discussion of example photographs and written narratives. Over the ensuing two weeks, participants took or identified stock photos as visual examples of personally-experienced barriers and facilitators of avoiding sugary foods and beverages. During the second session, study staff facilitated development of verbal narratives via group discussion. A total of 18 sessions were audio recorded, transcribed, and double-coded for themes. Results Participants ( n = 49) were predominantly women and identified as either Hispanic (61.2%) or non-Hispanic Black (30.6%). Approximately half of participants (51.1%) reported consuming sugar-sweetened beverages at least once per day. Qualitative analysis revealed participant-identified influences on dietary sugar consumption across multiple domains of influence, including individual preferences, beliefs, or circumstance, the social environment, the physical environment, and the macro environment. Conclusions The multiple social contextual influences on dietary sugar consumption identified in this study, particularly centrality of the home, cultural influences, individual-level sabotaging factors, may be useful for development of culturally tailored health promotion messaging and intervention through multiple channels.

BACKGROUND:The target trial framework was developed as a strategy to design and analyze observational epidemiologic studies with the aim of reducing bias due to analytic decisions. It involves designing a hypothetical randomized trial to answer a question of interest and systematically considering how to use observational data to emulate each trial component. AIMS:The primary aim of this paper is to provide a detailed example of the application of the target trial framework to a research question in oral epidemiology. MATERIALS AND METHODS:We describe the development of a hypothetical target trial and emulation protocol to evaluate the effect of preconception periodontitis treatment on time-to-pregnancy. We leverage data from Pregnancy Study Online (PRESTO), a preconception cohort, to ground our example in existing observational data. We discuss the decision-making process for each trial component, as well as limitations encountered. RESULTS:Our target trial application revealed data limitations that precluded us from carrying out the proposed emulation. Implications for data quality are discussed and we provide recommendations for researchers interested in conducting trial emulations in the field of oral epidemiology. DISCUSSION:The target trial framework has the potential to improve the validity of observational research in oral health, when properly applied. CONCLUSION:We encourage the broad adoption of the target trial framework to the field of observational oral health research and demonstrate its value as a tool to identify directions for future research.

OBJECTIVE:Research into the influence and role of social networks on oral health outcomes has been limited. This study aims to demonstrate via explanatory modeling the influence of social networks on oral health outcomes among women in who live in public housing in Boston, Massachusetts.METHODS:Individual- and network-level data were obtained from a cross-sectional survey of adult female residents of 2 public housing developments in Boston, Massachusetts. Participants responded to close-ended questions about sociodemographic characteristics, oral and general health status, and health-related behaviors for themselves as well as their named social contacts. Based on this information, network-level variables were calculated for each participant, including the proportion of the social network with certain characteristics or attributes. To assess the salience of network measures in explaining the variability in self-reported oral health status, overall health status, use of dental services within the last year, and current dental treatment needs, logistic regression models with individual-level covariates were compared with corresponding models that additionally included network-level variables with McFadden R2 for comparison purposes.RESULTS:Model comparisons for each outcome of interest demonstrated that adding network-level covariates significantly improved model fit. Additionally, network-level covariates displayed strong independent associations with the outcomes of interest. The network proportion needing dental treatment was positively associated with participants' odds of reporting current dental treatment needs (odds ratio, 4.71; 95% CI, 1.47 to 15.05). An individual's odds of reporting no dental visit within the past year decreased with increasing exposure to social contacts with reported dental visits within the past year (odds ratio, 0.26; 95% CI, 0.07 to 0.89).CONCLUSION:The salience of specific network attributes depended on the outcome under study. Interventions aimed at reducing the poor oral health burden in this and similar population groups may benefit from integrating information on social networks, including tailoring intervention delivery and/or messaging to account for the potential influence of social networks.KNOWLEDGE TRANSFER STATEMENT:This work may be beneficial to those developing policy solutions and interventions aimed at reducing the burden of poor oral health outcomes in socioeconomically disadvantaged populations, such as women who reside in public housing developments. The potential for leveraging social networks to seed messaging about oral health, for example, may enhance efforts to reduce oral health disparities.

BACKGROUND:Self-reported measures of periodontitis developed for use in population surveillance are increasingly used in causal research. Numerous studies evaluate the validity of these measures against clinical parameters of periodontitis, yet few include validation parameters outside of multivariable models. Individual item validity is necessary to adequately inform use of these measures in causal research. METHODS:We used data from the National Health and Nutrition Examination Survey 2011-2014 in which dentate participants completed full-mouth periodontal examinations (N = 6966). We evaluated six self-report questionnaire items related to periodontal disease status against periodontitis case definitions developed by the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP). We estimated the sensitivity and specificity of individual items using severe and moderate-to-severe periodontitis classifications. We additionally combined items to evaluate the validity of joint measures. RESULTS:Sensitivity was highest when measures were evaluated against severe periodontitis. Self-rated oral health of fair/poor demonstrated the highest sensitivity for severe (0.60) and moderate-to-severe periodontitis (0.48). Specificity was highest when evaluated against moderate-to-severe periodontitis, with self-reported history of tooth mobility as the most specific measure (0.87 for severe disease; 0.92 for moderate-to-severe) followed by a history of bone loss (0.88 for severe; 0.91 for moderate-to-severe). Combining questions generally improved specificity at the expense of sensitivity. CONCLUSIONS:Our findings related to item-specific validity and the associated clinical profiles facilitate needed considerations for the use of self-reported measures of periodontitis in causal research. Additionally, item-specific validity can be used to inform assessments of misclassification bias within such investigations.

Observational research provides valuable opportunities to advance oral health science but is limited by vulnerabilities to systematic bias, including unmeasured confounding, errors in variable measurement, or bias in the creation of study populations and/or analytic samples. The potential influence of systematic biases on observed results is often only briefly mentioned among the discussion of limitations of a given study, despite existing methods that support detailed assessments of their potential effects. Quantitative bias analysis is a set of methodological techniques that, when applied to observational data, can provide important context to aid in the interpretation and integration of observational research findings into the broader body of oral health research. Specifically, these methods were developed to provide quantitative estimates of the potential magnitude and direction of the influence of systematic biases on observed results. We aim to encourage and facilitate the broad adoption of quantitative bias analyses into observational oral health research. To this end, we provide an overview of quantitative bias analysis techniques, including a step-by-step implementation guide. We also provide a detailed appendix that guides readers through an applied example using real data obtained from a prospective observational cohort study of preconception periodontitis in relation to time to pregnancy. Quantitative bias analysis methods are available to all investigators. When appropriately applied to observational studies, findings from such studies can have a greater impact in the broader research context.

OBJECTIVES:Periodontal disease is multifactorial in its aetiology, which encompasses biopsychosocial contributors, including psychological stress. Gastrointestinal distress and dysbiosis have been associated with several chronic inflammatory diseases yet have rarely been investigated with respect to oral inflammation. Given the implications of gastrointestinal distress on extraintestinal inflammation, this study aimed to evaluate the potential role of such distress as a mediator between psychological stress and periodontal disease. METHODS:Utilizing a cross-sectional, nationwide sample of 828 adults in the USA generated via Amazon Mechanical Turk, we evaluated data collected from a series of validated self-report psychosocial questionnaires on stress, gut-specific anxiety around current gastrointestinal distress and periodontal disease, including periodontal disease subscales targeted at physiological and functional factors. Structural equation modelling was used to determine total, direct and indirect effects, while controlling for covariates. RESULTS:Psychological stress was associated with gastrointestinal distress (ß = .34) and self-reported periodontal disease (ß = .43). Gastrointestinal distress also was associated with self-reported periodontal disease (ß = .10). Gastrointestinal distress likewise mediated the relation between psychological stress and periodontal disease (ß = .03, p = .015). Given the multifactorial nature of periodontal disease(s), similar results were demonstrated using the subscales of the periodontal self-report measure. CONCLUSIONS:Associations exist between psychological stress and overall reports of periodontal disease as well as more specific physiological and functional components. Additionally, this study provided preliminary data supporting the potential mechanistic role that gastrointestinal distress plays in connecting the gut-brain and the gut-gum pathways.

Interventions intended to reduce the consumption of dietary sugars among those population groups demonstrating disproportionately greater and more frequent consumption of sugar-sweetened beverages and foods (SSBF) would benefit from intervention strategies that are tailored to population-specific barriers and facilitators. The objective of this study was to develop and evaluate the acceptability of photo-enhanced and theory-based health promotion messages that target the reduction in SSBF among adult residents of public housing developments, a population known for their high rates of chronic disease. Using the message development tool as a framework, we developed a series of 15 SSBF reduction messages, using an iterative process with community member input. We then evaluated the acceptability of the messages and compared three delivery mechanisms: print, text, and social media. We recruited participants who were residents of urban public housing developments, and who spoke either English or Spanish. A majority of participants identified as being of Hispanic ethnicity (73%). The message acceptability scoring did not appear to differ according to the assigned delivery mechanism, despite some imbalances in participants' characteristics across delivery mechanisms. The messages that targeted motivation were least likely to be accepted. In conclusion, our findings suggest that engaging members of the community at all phases of the development process was a feasible method to develop SSBF reduction messages with a high perceived acceptability.

Purpose: Racial disparities in oral health are well-documented. Stress has been associated with both perceived racism and oral health, yet little research has directly investigated the association between perceived racism and oral health.Methods: We used data from the Black Women's Health Study, a longitudinal cohort study that includes a geographically diverse sample of Black women across the United States. Perceived exposure to racism was assessed via two scales, one assessing lifetime exposure and one everyday exposure. Self-rated oral health was subsequently assessed over multiple time points. We used Cox proportional hazard models to calculate adjusted incidence rate ratios estimating the association between higher levels of perceived racism and incident "fair" or "poor" oral health, and explored potential effect measure modification using stratified models. Results: The adjusted incidence rate ratios (n = 27,008) relating perceived racism to incident fair or poor oral health were 1.50 (95% confidence interval 1.35, 1.66) comparing the highest quartile of everyday racism to the lowest and 1.45 (95% confidence interval 1.31, 1.61) for the highest score of lifetime racism compared to the lowest. We did not see evidence of effect modification.Conclusions: Higher levels of perceived racism documented in 2009 were associated with declines in self rated oral health from 2011 to 2019.& COPY; 2023 Elsevier Inc. All rights reserved.

Research participation among vulnerable populations is often limited by the same socioeconomic factors that contribute to poor health. Identifying best practices for inclusion is critical to addressing health disparities. Urban public housing communities bear a disproportionate burden of chronic disease and may represent an opportunity to directly engage historically vulnerable populations in research designed to ultimately reduce that burden. We used mixed-method data to analyze recruitment effectiveness among a random sample of households (N = 380) across two public housing developments in Boston, MA who were approached for participation in a pre-COVID oral health study. Quantitative data from detailed recruitment tracking methods was analyzed to assess the relative efficiency of the methods employed. Field journals of study staff were qualitatively analyzed to identify community-specific recruitment barriers and facilitators. The participation rate among randomly sampled households was 28.6% (N = 131), with participation from primarily Hispanic (59.5%) or Black (26%) residents. Door-to-door knocking with response yielded the highest participation (44.8%), followed by responses to informational study flyers (31%). Primary barriers to enrollment included references to unemployment and employment variations, shift work, childcare responsibilities, time demands, and managing multiple appointments and social services. This study finds active, door-to-door knocking and return visits resolved barriers to participation, and reduced safety concerns and historic distrust. It’s time to consider how best to adapt effective pre-COVID recruitment practices for utilization under current and future exposure conditions as effective recruitment of populations such as urban public housing residents into research is only becoming more important.

Few studies have evaluated the association between periodontitis and spontaneous abortion (SAB), and all had limitations. We used data from the Pregnancy Study Online (PRESTO), a prospective preconception cohort study of 3,444 pregnancy planners in the United States and Canada (2019-2022), to address this question. Participants provided self-reported data on periodontitis diagnosis, treatment, and symptoms of severity (i.e., loose teeth) via the enrollment questionnaire. SAB (pregnancy loss at <20 weeks' gestation) was assessed via bimonthly follow-up questionnaires. Participants contributed person-time from the date of a positive pregnancy test to the gestational week of SAB, loss to follow-up, or 20 weeks' gestation, whichever came first. We fitted Cox regression models with weeks of gestation as the time scale to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), and we used inverse probability of treatment weighting to account for differential loss to follow-up. We used probabilistic quantitative bias analysis to estimate the magnitude and direction of the effect of exposure misclassification bias on results. In weighted multivariable models, we saw no appreciable association between preconception periodontitis diagnosis (HR = 0.97, 95% CI: 0.76, 1.23) or treatment (HR = 1.01, 95% CI: 0.79, 1.27) and SAB. A history of loose teeth was positively associated with SAB (HR = 1.38, 95% CI: 0.88, 2.14). Quantitative bias analysis indicated that our findings were biased towards the null but with considerable uncertainty in the bias-adjusted results.