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1.
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2.
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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5.
Amrita Mukherjee Alicia A. Livinski Joseph Millum Steffany Chamut Shahdokht Boroumand Timothy J. Iafolla Margo R. Adesanya Bruce A. Dye 《Journal of the American Dental Association (1939)》2017,148(4):211-220
Background
Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue.Methods
The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research.Results
The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research.Conclusions
Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research.Practical Implications
This review is the first attempt, to the authors’ knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients. 相似文献6.
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7.
Cameron G. Estrich Stephen E. Gruninger Ruth D. Lipman 《Journal of the American Dental Association (1939)》2017,148(3):164-171
Background
In this study, the authors compared the odds of exposure to Legionella pneumophila among currently active dental practitioners with that of nonpractitioners and evaluated demographic and clinical practice predictors of exposure.Methods
The authors obtained demographic characteristics and dental practice behaviors from participants in the annual American Dental Association Health Screening Program survey administered from 2002 through 2012. The authors assayed serum samples obtained from participants for L pneumophila antibodies. The authors used an adjusted logit model to evaluate predictors of positive results.Results
Among 5,431 participants, approximately 10% were positive for L pneumophila, with no significant differences between dental practitioners and nonpractitioners. Geographic location was the only significant predictor of seropositivity, with no increased risk of being exposed to L pneumophila associated with age, race, sex, years in practice, hours of practice per week, use of barrier protection, or infection control practices.Conclusions
Prevalence of L pneumophila antibodies was 10.4% among dental and nondental personnel. US Census division was the only significant predictor of seropositivity. The authors conclude that provision of dental care did not increase the risk of being exposed to Legionella.Practical Implications
Dentists should be aware of the prevalence of Legionella species in their practice areas to understand their personal risk of developing an infection. 相似文献8.
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9.
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Wenhao Li Jingming Liu Su Chen Yao Wang Zhenting Zhang 《The Journal of prosthetic dentistry》2017,117(1):48-54
Statement of problem
Gastroesophageal reflux disease (GERD) is typically diagnosed based on symptoms of regurgitation and heartburn, although it may also manifest as asthma-like symptoms, laryngitis, or dental erosion.Purpose
The purpose of this prospective, cross-sectional study was to assess the prevalence of dental erosion in people with GERD and to evaluate the association between GERD and dental erosion.Material and methods
The presence, severity, and pattern of dental erosion was assessed in 51 participants with GERD and 50 participants without GERD using the Smith and Knight tooth wear index. Medical, dietary, and dental histories were collected by questionnaire. Factors potentially related to dental erosion, including GERD, were evaluated by logistic regression.Results
Dental erosion was observed in 31 (60.8%) participants with GERD and 14 (28%) participants without GERD. Bivariate analysis revealed that participants with GERD were more likely to experience dental erosion (crude odds ratio [cOR]: 2.74; 95% CI: 1.19, 6.32) than participants without GERD. Multivariate analysis also revealed that participants with GERD had a higher risk of dental erosion (adjusted odds ratio [aOR]: 3.97; 95% CI: 1.45, 10.89). Consumption of grains and legumes, the most frequently consumed foods in China, did not correlate with dental erosion. However, carbonated beverage consumption was significantly associated with GERD and dental erosion (aOR: 3.34; 95% CI: 1.01, 11.04; P=.04).Conclusions
GERD was positively correlated with dental erosion. Carbonated beverage consumption can increase the risk of both GERD and dental erosion. 相似文献11.
Background
The authors examined the relationship between education debt and career choice, particularly dentists’ decisions to specialize, participate in public health insurance programs, and join dental management service organizations (DMSOs).Methods
The authors used data from the American Dental Association 2015 office database, which contains dentist demographic information and identifies dentists who participate in public health insurance programs for pediatric dental care services. The authors merged this database with the 2002-2015 American Dental Association Survey of Dental Graduates, which contains information about education debt, to assess the relationship between education debt and career choices. The authors used probit and multinomial logit models to determine the relationships among education debt, demographic characteristics, and dentist career choices.Results
For each $10,000 increase in education debt, dentists were 0.9% more likely to join a DMSO (relative risk ratio, 1.009; 95% confidence interval, 1.0021 to 1.0164) and 0.6% less likely to join a non-DMSO group practice (relative risk ratio, 0.994; 95% confidence interval, 0.9897 to 0.9987) over a solo practice. Education debt did not have a statistically significant association with the decision to participate in public health insurance programs, but it did have a statistically significant association with the decision to specialize.Conclusions
Education debt had a modest association with some career choices among dentists. Demographic characteristics, such as race and sex, had a greater association.Practical Implications
Dental education debt has increased substantially in recent years. Debt had only a modest association with some career choices. Policy makers could consider this when considering education debt relief. 相似文献12.
Olavo B. de Oliveira-Neto Fabiano Timbó Barbosa Célio Fernando de Sousa-Rodrigues Fernando José C. de Lima 《The Journal of prosthetic dentistry》2017,117(5):601-605
Statement of problem
With the increased number of published systematic reviews and in view of their wide clinical applicability, these studies must be carefully assessed before professionals begin to use their recommendations in daily practice, and above all, the methodological quality of this study design must be considered. In implant dentistry, one topic that has been arousing particular interest is the immediate placement of dental implants into infected sites.Purpose
The purpose of this systematic review was to determine the methodological quality of systematic reviews that evaluated the immediate placement of dental implants into infected sites.Material and methods
A systematic search was performed by 2 independent reviewers of PubMed, LILACS, and ISI Web of Knowledge up to March 2016. All selected articles were published in the English language. Systematic reviews of original papers that assessed the immediate placement of dental implants into infected sites were eligible for the overview. Narrative reviews, randomized clinical trials, and case reports were excluded. Methodological quality assessment was performed using A Measurement Tool to Assess Systematic Reviews.Results
Of the 5 selected systematic reviews, 3 were low methodological quality and 2 were assessed as moderate. None were high methodological quality. The first systematic review of the topic was published in 2010, and the most recent, published in 2015, was the only one that performed meta-analysis.Conclusions
The systematic reviews that assessed the immediate placement of dental implants into infected sites were assessed as low or moderate methodological quality. The topic focus remains controversial because the implant survival rate, the main outcome considered for the implant placement prognosis, presents contradictory results. 相似文献13.
Clayton J. Warder Burton L. Edelstein 《Journal of the American Dental Association (1939)》2017,148(1):26-32.e2
Background
The availability of dentists to care for Medicaid beneficiaries is a longstanding concern of many families and those who serve them in the dental profession as well as policy makers. Yet, little information beyond the number of enrolled dentists has been reliably determined. The American Dental Association (ADA) Health Policy Institute has called for more nuanced measures that better reflect dentistry’s contribution to the care of Medicaid beneficiaries.Methods
The authors calculated percentages of general and pediatric dentists who enrolled in Medicaid, billed Medicaid, and treated Medicaid beneficiaries in each state for which data were available from the ADA’s 2008 study, the Association of State and Territorial Dental Directors’ 2013 report, and the 2013 federal Web site InsureKidsNow.org. To determine the number of primary dentists available to treat Medicaid beneficiaries, the ADA masterfile list of clinically active dentists was adjusted to remove nonpediatric dental specialists.Results
The authors determined that the ADA’s 2015 analysis of dentists enrolled in Medicaid was the most rigorously assessed source for enrollment but did not report numbers of billing or treating dentists. Increasingly stringent metrics of participation are associated with considerable declines in dentist participation. They found the underlying data sources unreliable, inaccurate, and incomparable within and among states.Conclusions
The authors concluded that no consistent, comparable, ongoing source of dentist participation in Medicaid exists that reliably provides substantive information to the profession and policy makers.Practical Implications
Dentistry’s ability to respond to policymakers’ concerns about service to Medicaid beneficiaries depends on the development and implementation of a standardized, reliable, systematic, and ongoing method to measure meaningful participation. 相似文献14.
Stanley C. Onwubu Anisa Vahed Shalini Singh Krishnan M. Kanny 《The Journal of prosthetic dentistry》2017,117(2):310-314
Statement of problem
Excessive surface roughness of denture base resins adversely impacts oral health.Purpose
The purpose of this in vitro study was to examine the abrasive potential of eggshell powder in reducing the surface roughness of denture base resins.Material and methods
Thirty poly(methyl methacrylate) specimens were fabricated and polished with eggshell powders of different particle sizes and with pumice. The average surface roughness (Ra) after polishing was measured with a profilometer. Scanning electron microscope and optical electron microscope techniques were used to assess the surface roughness morphology of the specimens. ANOVA was used to analyze the Ra values. The Tukey honest significant differences and Bonferroni tests were used to identify differences between the 2 abrasive materials (α=.05).Results
Significant differences in the Ra values were observed between the fine and medium eggshell powder abrasives (P<.05). Similarly, significant differences were found between pumice and the fine eggshell powder abrasives (P<.001). No significant differences were found between pumice and the medium eggshell powder abrasive (P>.05). Specimens polished with pumice had the highest Ra values, whereas specimens polished with the fine eggshell powder abrasive had the lowest Ra values.Conclusions
By connecting the Ra values to the threshold limit value of 0.2 μm, eggshell powder abrasive finished denture acrylic resin surfaces better than pumice. 相似文献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.
Introduction
Human dental pulp stem cells (hDPSCs) are ideal candidates for regenerating damaged dental tissue. To examine the possibility that hDPSCs may be used to regenerate pulp, we tested their in vitro effects on acute allogeneic immune responses.Methods
A peripheral blood mononuclear cell (PBMC) proliferation assay and immunoglobulin (Ig) production assay were performed to evaluate the immunosuppressive properties of hDPSCs.Results
The mixed lymphocyte reaction was suppressed by incubation with hDPSCs. Transforming growth factor beta (TGF-β) was the major soluble factor responsible for inhibiting the allogeneic proliferation of PBMCs. The production of IgM and IgG by allogeneic activation of responder B lymphocytes was also completely abrogated by TGF-β released from hDPSCs via interferon gamma in response to activation of the responder T lymphocytes.Conclusions
hDPSCs inhibit acute allogeneic immune responses by their release of TGF-β as a result of allogeneic stimulation of T lymphocytes. This study provides an insight into the potential clinical use of hDPSCs for allogeneic transplantation. 相似文献17.
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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19.
Marcelo Coelho Goiato Henrique Rinaldi Matheus Rodrigo Antonio de Medeiros Daniela Micheline dos Santos Sandro Basso Bitencourt Aldiéris Alves Pesqueira 《The Journal of prosthetic dentistry》2017,117(5):685-689
Statement of problem
The rehabilitation of patients after a maxillectomy involves the use of an obturator to seal oral-nasal-sinus communication and to facilitate mastication, swallowing, and speech.Purpose
The purpose of this in vitro study was to evaluate different attachment systems used for implant-retained obturators at dissipation loads and under shear forces.Material and methods
Photoelastic models were fabricated with 3 external hexagon implants at the incisor, canine, and first molar regions. Subsequently, overdentures were made, and metal hooks were placed at the incisor and first molar regions to displace the prostheses in the vertical, anterior, and posterior directions, with a constant speed of 50 mm/min. A photoelastic model with an O-ring or bar-clip system was placed in a circular polariscope, and tested with a universal testing machine. The images were recorded and high-intensity fringes were counted using software. For strain gauge analysis, each strain gauge was placed horizontally at the mesial and distal sides of the implants. The registered strains were submitted to 2-way ANOVA (α=.05).Results
The O-ring showed the lowest number of high-intensity fringes in photoelastic imaging, while the strain gauge analysis showed the lowest stress values in the bar-clip group (P=.007).Conclusions
The stress around titanium implant necks was more damaging to surrounding bone, while the bar-clip attachment system had a better biomechanical performance. The bar-clip presented the lowest strain values around the dental implants and few high-intensity fringes. 相似文献20.
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