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1.
Bruce A. Dye Gabriela Lopez Mitnik Timothy J. Iafolla Clemencia M. Vargas 《Journal of the American Dental Association (1939)》2017,148(8):550-565.e7
Background
Except for a small increase in caries prevalence in young children from 1999 through 2004, the prevalence of pediatric caries in the United States has remained consistent for the past 3 decades.Methods
The authors used data from the National Health and Nutrition Examination Survey (NHANES) (from 1999 through 2004 and from 2011 through 2014) to ascertain changes in caries prevalence in youth aged 2 to 19 years. The authors evaluated changes in the prevalence of caries experience, untreated caries, and severe caries (3 or more teeth with untreated caries) in the primary, mixed, and permanent dentition according to poverty status.Results
Untreated dental caries in the primary dentition decreased (24% versus 14%) for children aged 2 to 8 years regardless of poverty status from the period from 1999 through 2004 to the period from 2011 through 2014. Severe caries in primary teeth decreased between the period from 1999 through 2004 and the period from 2011 through 2014 for 2- to 8-year-olds (10% versus 6%). Among preschool-aged children in families with low incomes, caries experience decreased from nearly 42% to 35%, and untreated caries decreased from 31% to 18%. Furthermore, there were significant reductions in the number of carious dental surfaces and significant increases in the number of restored dental surfaces. Overall, there was little change in the prevalence of caries in older children and adolescents.Conclusions
The prevalence of caries in primary teeth in preschool-aged children has improved in the previous decade in the United States; however, the prevalence of having no caries experience in permanent teeth in children and adolescents remains unchanged.Practical Implications
Although the oral health status of young children has improved in the previous decade, few changes have occurred for many older children and adolescents. 相似文献2.
Jason Clague Thomas R. Belin Vivek Shetty 《Journal of the American Dental Association (1939)》2017,148(6):377-386
Background
The authors clarified the causal mechanisms underlying the high prevalence of dental disease encountered in people who habitually use methamphetamine (meth).Methods
Using a stratified sampling approach, the authors conducted comprehensive oral examinations and psychosocial assessments for 571 study participants who used meth. Three calibrated dentists, who used National Health and Nutrition Examination Survey (NHANES) protocols, characterized the study participants’ dental disease. The authors also collected data related to study participants’ history of meth use and other attributes linked to dental disease.Results
Study participants who used meth manifested higher rates of xerostomia and caries experience compared with NHANES control participants. Participants who used meth had a higher level of daily consumption of sugary beverages compared with NHANES control participants. Smoking meth did not increase caries experience over other modes of intake. Dental hygiene was a significant determinant of dental health outcomes.Conclusions
Mode of intake and frequency of meth use have a minimal impact on dental health outcomes. Behaviors, such as sugary beverage consumption and poor oral hygiene, better explain dental health outcomes.Practical Implications
Having a better understanding of the causal mechanisms of “meth mouth” sets the stage for clinicians to provide more personalized interventions and management of dental disease in people who use meth. 相似文献3.
Michael T. Brennan Nathaniel S. Treister Thomas P. Sollecito Brian L. Schmidt Lauren L. Patton Kusha Mohammadi Leslie Long Simpson Helen Voelker James S. Hodges Rajesh V. Lalla 《Journal of the American Dental Association (1939)》2017,148(12):868-877
Background
No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT.Methods
As part of OraRad, the authors assessed caries, periodontal disease, dental recommendations, and dental interventions performed before RT.Results
Baseline measures were reported for 356 participants (77% men) with mean (standard deviation) age of 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least 1 tooth with caries (37.2%), and participants with at least 1 tooth with probing depth 5 millimeters or greater (47.4%). Factors associated with less extensive dental disease before RT included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the dental examination before RT, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently.Conclusion
Many patients with HNC require dental treatment before RT; more than one-third require extractions.Practical Implications
Most patients have some level of dental disease at the start of RT, indicating the importance of dental evaluation before RT. By observing dental outcomes after RT, OraRad has the potential to determine the best dental treatment recommendations for patients with HNC. 相似文献4.
Gerardo Maupomé Juan F. Yepes Madison Galloway Qing Tang George J. Eckert Timothy Downey LaQuia Vinson 《Journal of the American Dental Association (1939)》2017,148(10):760-766
Background
The effectiveness of stainless steel crowns (SSCs) versus direct restorations when placed in primary mandibular molars (teeth nos. L and S) is uncertain. The authors evaluated effectiveness by gauging longevity of treatment.Methods
The authors obtained private dental insurance claims (2004-2016) from a national dental data warehouse. Paid insurance claims records (n = 1,323,489) included type of treating dentist, treatment placed, and patient age.Results
Dentist specialty, type of treatment, and patient age were significant in predicting failure after the first restoration. The authors found high survival rates for all treatments (> 90%) after 5 years; however, as soon as within 3 years after treatment, SCCs had approximately 6% better survival.Conclusions
Teeth nos. L and S first treated with SSCs lasted longer without new treatment compared with teeth first treated with direct restorations; the difference was small. Teeth treated by pediatric dentists had better survival rates.Practical Implications
Primary mandibular first molars initially treated with SSCs lasted longer without new treatment compared with direct restorations. Overall dental care costs of the former were considerably higher. 相似文献5.
Jamie Moeller Rebecca Starkel Carlos Quiñonez Marko Vujicic 《Journal of the American Dental Association (1939)》2017,148(6):361-368
Background
The authors explored the relationship between income inequality and self-reported oral health and oral health–related quality of life.Methods
The authors used an online survey to gather data about US adults’ perceptions of their overall oral health and how oral health affected their quality of life. The authors categorized respondents as coming from areas of low, medium, or high income inequality on the basis of a county-level Gini coefficient.Results
Results of χ2 tests and an analysis of variance indicated that there was a significant association between income inequality and oral health as measured by using the overall condition of the mouth and teeth, life satisfaction, and frequency of experiencing functional and social problems related to oral health. Generally, adults from areas of lower income inequality reported better oral health and oral health–related quality of life.Conclusions
Income inequality has the potential to affect both functional and social dimensions of oral health, possibly through a psychosocial pathway. Future research is necessary to determine whether any causal link exists.Practical Implications
Our findings may inform oral health policy. Long-term policies designed to improve the oral health of Americans could work best when supported by policies designed to reduce levels of income inequality, and thereby, may reduce oral health inequalities. Further research is needed to examine the effectiveness of such policies. 相似文献6.
7.
Travis Nelson Amelia Chim Barbara L. Sheller Christy M. McKinney JoAnna M. Scott 《Journal of the American Dental Association (1939)》2017,148(7):485-492
Background
The authors evaluated the effectiveness of a dental desensitization program for children with autism spectrum disorder (ASD) and determined characteristics associated with a successful dental examination.Methods
The authors performed a retrospective review of clinical behavioral data and previsit questionnaires for 168 children with ASD who attended a university-based dental desensitization program. Data elements included demographic, treatment, and behavioral characteristics. The primary outcome was receiving a minimal threshold examination (MTE) while seated in a dental chair.Results
An MTE was achieved for 77.4% of all children within 1 to 2 visits and 87.5% in 5 visits or less. Several factors predicted a successful dental examination: ability to be involved in group activities (relative risk [RR], 1.18; P = .02), ability to communicate verbally (RR, 1.17; P < .01), understanding of most language (RR, 1.14; P = .02), moderate versus severe caregiver-rated ASD severity (RR, 1.24; P = .04), and ability to dress self (RR, 1.27; P = .04).Conclusions
Desensitization was effective in achieving an MTE for most children. Those with characteristics consistent of a milder presentation of ASD were more likely to be successful.Practical Implications
Desensitization can be a successful approach to providing dental care for children with ASD. 相似文献8.
Ana Neumann Elsbeth Kalenderian Rachel Ramoni Alfa Yansane Bunmi Tokede Jini Etolue Ram Vaderhobli Kristen Simmons Joshua Even Joanna Mullins Shwetha Kumar Suhasini Bangar Krishna Kookal Joel White Muhammad Walji 《Journal of the American Dental Association (1939)》2017,148(9):634-643.e1
Background
Patients with diabetes are at increased risk of developing oral complications, and annual dental examinations are an endorsed preventive strategy. The authors evaluated the feasibility and validity of implementing an automated electronic health record (EHR)–based dental quality measure to determine whether patients with diabetes received such evaluations.Methods
The authors selected a Dental Quality Alliance measure developed for claims data and adapted the specifications for EHRs. Automated queries identified patients with diabetes across 4 dental institutions, and the authors manually reviewed a subsample of charts to evaluate query performance. After assessing the initial EHR measure, the authors defined and tested a revised EHR measure to capture better the oral care received by patients with diabetes.Results
In the initial and revised measures, the authors used EHR automated queries to identify 12,960 and 13,221 patients with diabetes, respectively, in the reporting year. Variations in the measure scores across sites were greater with the initial measure (range, 36.4-71.3%) than with the revised measure (range, 78.8-88.1%). The automated query performed well (93% or higher) for sensitivity, specificity, and positive and negative predictive values for both measures.Conclusions
The results suggest that an automated EHR-based query can be used successfully to measure the quality of oral health care delivered to patients with diabetes. The authors also found that using the rich data available in EHRs may help estimate the quality of care better than can relying on claims data.Practical Implications
Detailed clinical patient-level data in dental EHRs may be useful to dentists in evaluating the quality of dental care provided to patients with diabetes. 相似文献9.
Ronald E. Goldstein Wendy Auclair Clark 《Journal of the American Dental Association (1939)》2017,148(6):387-391
Background
Awake bruxism is a common clinical condition that often goes undetected, often leading to pain or damaged teeth and restorations.Methods
The authors searched electronic databases regarding the treatment and effects of awake bruxism compared with those of sleep bruxism. The authors used the search terms diurnal bruxism and oral parafunction. The authors combined information from relevant literature with clinical experience to establish a recommended protocol for diagnosis and treatment.Results
The authors found articles regarding the diagnosis and treatment of bruxism. The authors combined information from the articles with a review of clinical cases to establish a treatment protocol for awake bruxism.Conclusions
Literature and clinical experience indicate a lack of patient awareness and, thus, underreporting of awake bruxism. As a result, myriad dental consequences can occur from bruxism. The authors propose a need for increased awareness, for both patients and professionals, particularly of the number of conditions related to awake bruxism.Practical Implications
Clinicians should look for clinical signs and symptoms of awake bruxism and use minimally invasive treatment modalities. 相似文献10.
11.
Yasmi O. Crystal Malvin N. Janal Dylan S. Hamilton Richard Niederman 《Journal of the American Dental Association (1939)》2017,148(7):510-518.e4
Background
The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.Methods
The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents’ demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.Results
Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child’s posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child’s anterior teeth. As the number of children’s behavioral barriers increased, so did the parents’ level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents’ acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents’ acceptance of the treatment also varied according to their socioeconomic status.Conclusions
Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.Practical Implications
Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients. 相似文献12.
Mahshid Majlessi Koopaeei Marita R. Inglehart Neville McDonald Margherita Fontana 《Journal of the American Dental Association (1939)》2017,148(2):64-74
Background
There is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists’ (GDs), pediatric dentists’ (PDs), and endodontists’ (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs.Methods
A total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey.Results
Most EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions.Conclusions
Most respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs.Practical Implications
Efforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs. 相似文献13.
14.
15.
Natalia S. Rozas June M. Sadowsky Cameron B. Jeter 《Journal of the American Dental Association (1939)》2017,148(4):236-245.e3
Background
Cognitive impairment is the gradual loss of one’s ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining.Types of Studies Reviewed
In a comprehensive search of multiple databases, the authors identified 2,255 studies published in the English language from 1995 through March 2016. The authors included studies if the investigators evaluated oral health measures after an intervention in patients 65 years or older with cognitive impairment or dementia. Nine full-text articles met the criteria for inclusion.Results
Only 1 study was a randomized control trial, whereas all others lacked appropriate controls. Investigators studied the effects of dental treatments, battery-powered devices for oral hygiene, and training of care staff members. Most interventions improved some aspect of the oral health of patients with dementia, and results were more pronounced when patients required assistance while performing oral hygiene tasks or had poor oral health at baseline.Conclusions and Practical Implications
A basic care plan for patients with dementia should, at the minimum, match prevention strategies recommended for healthy elderly patients. Dental health care professionals should promote oral hygiene education for caregivers for elderly patients with cognitive impairment. There is a wide gap in knowledge regarding effective methods specifically to improve oral health in patients with dementia. 相似文献16.
Dental plan premiums in the Affordable Care Act marketplaces trended downward from 2014 through 2016
Background
Pediatric dental benefits must be offered in the health insurance marketplaces created under the Affordable Care Act. The authors analyzed trends over time in premiums and the number of dental insurers participating in the marketplaces.Methods
The authors collected dental benefit plan data from 35 states participating in the federally facilitated marketplaces in 2014, 2015, and 2016. For each county, they counted the number of issuers offering stand-alone dental plans (SADPs) and medical plans with embedded pediatric dental benefits. They also analyzed trends in premiums.Results
From 2014 through 2016, the number of issuers of stand-alone dental plans and medical plans with embedded pediatric dental benefits either did not change or increased in most counties. Average premiums for low–actuarial-value SADPs declined from 2014 through 2016.Conclusions
The increase in the number of issuers of stand-alone dental plans and medical plans with embedded dental benefits may be associated with lower premiums. However, more research is needed to determine if this is the case.Practical Implications
Affordable dental plans in the marketplaces could induce people with lower incomes to sign up for dental benefits. Newly insured people could have significant oral health needs and pent-up demand for dental care. 相似文献17.
Lydie A. Lebrun-Harris María Teresa Canto Pamella Vodicka 《Journal of the American Dental Association (1939)》2019,150(4):246-258
Background
Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children’s preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics.Methods
Data for this observational, cross-sectional study came from the 2016 National Survey of Children’s Health. Children aged 2 through 17 years were included (n = 46,100). Caregiver-reported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted.Results
As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care.Conclusions
Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services.Practical Implications
Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds. 相似文献18.
Nicolas M. Oreskovic German O. Gallucci Isabelle I. Chase Carly E. Milliren Tracy K. Richmond 《Journal of the American Dental Association (1939)》2017,148(12):930-935
Background
Dental and cardiometabolic diseases are highly prevalent, share many common risk factors, and begin during youth. Despite poor dental health being known to influence dietary behaviors that are in turn linked to cardiometabolic health, the role of oral health on concomitant and future cardiometabolic disease is understudied. We sought to determine the association of oral health with cardiometabolic markers during adolescence and early adulthood.Methods
Our sample included 11,556 participants with data from waves 1 (when participants were aged 12 to 19 years) and 4 (when they were aged 26 to 32 years) of the National Longitudinal Study of Adolescent to Adult Health. Multivariable linear and logistic regression separately examined associations between different markers of oral health (that is, missing teeth, periodontal disease, and deferred dental care) and markers of cardiometabolic health (that is, lipids, blood pressure, and body mass index), adjusting for sociodemographic characteristics.Results
Mean age was 29 years at follow-up (wave 4). In adjusted analyses, deferred dental care during both adolescence (β = 1.25; 95% confidence interval [CI], 0.6 to 2.0; P = .001) and early adulthood (β = 0.9; 95% CI, 0.4 to 1.3; P < .001) was associated with an increased body mass index during early adulthood. Deferred dental care in early adulthood was also associated with increased systolic (β = 0.9; 95% CI, 0.4 to 1.5; P = .002) and diastolic (β = 1.0; 95% CI, 0.5 to 1.5; P < .001) blood pressure values and an increased likelihood of being hypertensive (odds ratio = 1.2; 95% CI, 1.0 to 1.3; P = .03).Conclusions
In this nationally representative study deferred dental care during adolescence and concurrently in early adulthood was associated with poorer cardiometabolic disease during early adulthood. Providing better access to dental care may have benefits not only for oral health but also for long-term cardiometabolic health.Practical Implications
Deferred dental care during adolescence and early adulthood, but not recent tooth loss or periodontal disease, is associated with increased risk of cardiometabolic disease. 相似文献19.
John K. Brooks Nasir Bashirelahi Mark A. Reynolds 《Journal of the American Dental Association (1939)》2017,148(9):661-670
Background
Sales of charcoal dentifrices and powders have rapidly emerged into the Internet marketplace. The authors conducted a literature review to examine the efficacy and safety of charcoal and charcoal-based dentifrices.Methods
The authors searched the MEDLINE and Scopus databases for clinical studies on the use of charcoal and charcoal-based dentifrices and laboratory investigations on the bioactivity or toxicity of charcoal and charcoal-based dentifrices, published through February 2017. The authors used a defined search strategy to identify randomized, controlled clinical trials with a follow-up duration of 3 months or longer. In addition, the authors selected the first 50 consecutive charcoal dentifrices from Google.com and Amazon.com for ascertainment of product assortment and advertising promotions.Results
The authors’ literature search identified 118 potentially eligible articles. Thirteen studies reported brushing the teeth with raw charcoal or soot; however, none of these studies met the inclusion criteria. Two studies offered nonspecific caries reductions, 3 studies reported deleterious outcomes (increased caries, enamel abrasion, nonquantified negative impact), and 1 study indicated only that brushing with raw charcoal had no adverse effects on oral hygiene. Seven other studies reported only on the use of charcoal for oral hygiene. Internet advertisements included unsubstantiated therapeutic claims—such as antibacterial, antifungal, antiviral, and oral detoxification, as well as potentially misleading product assertions. One-third of the charcoal dentifrices contained bentonite clay, and 1 contained betel leaves.Conclusions
The results of this literature review showed insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence.Practical Implications
Dental clinicians should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety. 相似文献20.
Sonia K. Makhija Daniel A. Shugars Gregg H. Gilbert Mark S. Litaker James D. Bader Rebecca Schaffer Valeria V. Gordan D. Brad Rindal Daniel J. Pihlstrom Rahma Mungia Cyril Meyerowitz 《Journal of the American Dental Association (1939)》2017,148(12):922-929