The malignant transformation of oral lichen planus and oral lichenoid lesions: A systematic review

BackgroundDetermining the potential for malignant transformation of oral lichen planus (OLP) is complicated by difficulties in diagnosis, differentiation from oral lichenoid lesions (OLLs) and the phenomenon of premalignant lesions' exhibiting lichenoid characteristics. The authors of this systematic review evaluated evidence regarding malignant transformation of OLP and characterized transformation prevalence, clinical characteristics of OLP lesions developing into squamous cell carcinoma (SCC) and time to transformation.Types of Studies ReviewedThe authors searched PubMed, Embase and Thomson Reuters Web of Science in a systematic approach. They evaluated observational English-language studies involving human participants published in peer-reviewed journals. Inclusion required patients to have the diagnosis of OLP or OLL as confirmed with biopsy results on initial enrollment. They excluded all patients who had dysplasia on initial biopsy of OLP or OLL lesions.ResultsSixteen studies were eligible. Among 7,806 patients with OLP, 85 developed SCC. Among 125 patients with OLL, four developed SCC. The rate of transformation in individual studies ranged from 0 to 3.5 percent. The overall rate of transformation was 1.09 percent for OLP; in the solitary study in which investigators evaluated OLL, the rate of transformation was 3.2 percent. Patients' average age at onset of SCC was 60.8 years. The authors noted a slight predominance of female patients among those who experienced malignant transformation. The most common subsite of malignant transformation was the tongue. The average time from diagnosis of OLP or OLL to transformation was 51.4 months.Practical ImplicationsA small subset of patients with a diagnosis of OLP eventually developed SCC. The most common demographic characteristics of patients in this subset were similar to the most common demographic characteristics associated with OLP in general (that is, being female, being older and being affected in areas common to this condition). It is prudent for clinicians to pursue continued regular observation and follow-up in patients with these conditions, even in patients who do not fit a traditional high-risk category for oral SCC.     

Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: Findings from The National Dental Practice-Based Research Network

Background.A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions.Methods.Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months.Results.At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion&apos;s being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinician&apos;s deciding at some point after follow-up to seal the lesion or treat it invasively.Conclusions.Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions.Practical Implications.Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions.     

An adverse event trigger tool in dentistry: A new methodology for measuring harm in the dental office

BackgroundThere is a dearth of knowledge about the type and frequency of adverse events (AEs) in dentistry. Current approaches to obtaining information rely on reviews of randomly selected records, which may not be the most efficient or effective methodology.MethodsInspired by the Institute for Healthcare Improvement's (IHI) global and outpatient trigger tools, which identifies records with characteristics (”triggers“) that are associated with AEs, the authors created the dental clinic trigger tool. The triggers included procedures for incision and drainage, failed implants and selected treatment patterns. The authors ran the trigger tool against six months of electronic health records data and compared its performance with that of a review of 50 randomly selected patient records.ResultsIn total, 315 records were triggered, 158 (50 percent) of which were positive for one or more AEs; 17 (34 percent) of the 50 randomly selected records were positive for at least one AE. The authors assigned each AE an IHI severity ranking. Most AEs caused temporary harm, but nine were considered to have caused permanent harm according to a modified IHI severity ranking.ConclusionsThe study results demonstrate the promise of a directed records review approach, as the dental clinic trigger tool was more effective in identifying AEs than was a review of randomly selected records.Practical ImplicationsAll dental practices should proactively monitor the safety of the care they provide. Use of the trigger tool will help make this process more efficient and effective.     

Screening for diabetes mellitus in dental practices: A field trial

BackgroundIn this field trial, the authors assess the feasibility of screening for diabetes and prediabetes in dental practices and in a community health center.MethodsDental patients 45 years and older who were not aware of their diabetic status underwent evaluation for diabetes risk with an American Diabetes Association Diabetes Risk Test and with hemoglobin (Hb) A_1c measurement. Participants with an HbA_1c level of 5.7 percent or greater were referred to their physicians for diagnosis.ResultsOf the 1,022 patients screened, 416 (40.7 percent) had an HbA_1c blood level of 5.7 percent or greater and were referred for diagnosis. The HbA_1c and the American Diabetes Association Diabetes Risk Test were correlated (P < .001). Of the 416 participants who were referred, 35.1 percent received a diagnosis from their physicians within one year; 78.8 percent of these patients were seen in the community health center and 21.4 percent were seen in private dental offices. The diagnoses were diabetes (12.3 percent of patients), high risk of developing diabetes (that is, prediabetes) (23.3 percent) and no diabetes (64.4 percent).ConclusionsThe study results show that screening for prediabetes and diabetes is feasible in a dental office, with acceptance by the dentist and dental office staff members, patients&apos; physicians and patients. Patients from the community health center demonstrated good compliance with referrals to physicians; however, compliance was poor among those in the private dental offices.Practical ImplicationsScreening for diabetes and prediabetes in the dental office may provide an important benefit to patients and encourage interprofessional collaboration to achieve a chronic care model in which health care professionals work together to care for a panel of patients.     

An evaluation of 10 percent and 20 percent benzocaine gels in patients with acute toothaches: Efficacy,tolerability and compliance with label dose administration directions

BackgroundThe authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief of toothache pain. They also assessed the compliance with the label dose administration directions on the part of participants with toothache pain.MethodsUnder double-masked conditions, 576 participants self-applied study gel to an open tooth cavity and surrounding oral tissues. Participants evaluated their pain intensity and pain relief for 120 minutes. The authors determined the amount of gel the participants applied.ResultsThe responders’ rates (the primary efficacy parameter), defined as the percentage of participants who had an improvement in pain intensity as exhibited by a pain score reduction of at least one unit on the dental pain scale from baseline for two consecutive assessments any time between the five- and 20-minute points, were 87.3 percent, 80.7 percent and 70.4 percent, respectively, for 20 percent benzocaine gel, 10 percent benzocaine gel and vehicle gel. Both benzocaine gels were significantly (P ≤ .05) better than vehicle gel; the 20 percent benzocaine gel also was significantly (P ≤ .05) better than the 10 percent benzocaine gel. The mean amount of gel applied was 235.6 milligrams, with 88.2 percent of participants applying 400 mg or less.ConclusionsBoth 10 percent and 20 percent benzocaine gels were more efficacious than the vehicle gel, and the 20 percent benzocaine gel was more efficacious than the 10 percent benzocaine gel. All treatments were well tolerated by participants.Practical ImplicationsPatients can use 10 percent and 20 percent benzocaine gels to temporarily treat toothache pain safely.     

Using hand-held dental x-ray devices: Using hand-held dental x-ray devices

Background.Since the introduction of hand-held x-ray units in dentistry, a few inexpensive devices have emerged that lack the necessary safety measures and failed to meet U.S. Food and Drug Administration (FDA) standards. They are advertised actively and sold online in the United States.Methods.The authors present several safety issues associated with an imported hand-held x-ray device that has not been cleared by the FDA and compare the device with an FDA-cleared unit.Results.The authors found that the non-FDA—cleared device posed major safety hazards, including high radiation doses to patients and operators, lack of operator shielding, lower-than-acceptable kilovolt (peak) value, inadequate collimation, lack of an audible signal of x-ray generation and absence of a so-called dead-man switch.Conclusions and Practical Implications.Dental professionals must be aware of unsafe x-ray equipment and use only those devices that have been cleared by the FDA to protect themselves and their patients.     

Dental care providers&apos; and patients&apos; perceptions of the effect of health information technology in the dental care setting

BackgroundThe use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers&apos; interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers&apos; and patients&apos; perception of EHR use in the dental clinic setting during patient visits.MethodsThe authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers.ResultsThe provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers&apos; use of EHRs during the visit.ConclusionsThe provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient&apos;s dental visit.Practical ImplicationsA new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.     

At-home oral care for adults with developmental disabilities: A survey of caregivers

BackgroundLittle is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance.MethodsA convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers' at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members.ResultsCaregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training.ConclusionsAt-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults.Practical ImplicationsCaregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.     

Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

Background and OverviewThe authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings—2003.MethodsIn 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.ResultsResponding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.ConclusionsImplementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, Atlanta.The authors thank Jon Ruesch, who when this study was conducted was the director, Survey Center, American Dental Association, Chicago, for his effort in the collection of the data for this research project. Mr. Ruesch is now retired.     

Minimally invasive management of dental caries: contemporary teaching of posterior resin-based composite placement in U.S. and Canadian dental schools

BackgroundResin-based composites are an increasingly popular material for restoring posterior teeth, permitting minimally invasive cavity preparations and esthetic restorations. The authors investigated current teaching of the placement of posterior resin-based composites in U.S. and Canadian dental schools.MethodsIn late 2009 and early 2010, the authors, with the assistance of the Consortium of Operative Dentistry Educators (CODE), invited 67 dental schools to participate in an Internet-based survey.ResultsThe response rate was 73 percent. Although all schools taught the placement of resin-based composites in occlusal and most occlusoproximal cavities, eight schools (16 percent) did not teach placement of three-surface occlusoproximal resin-based composite restorations in permanent molars. Resin-based composites accounted for 49 percent of direct posterior restorations placed by dental students in 2009 and 2010, a 30 percent increase from 2005.ConclusionsTeaching placement of posterior resin-based composites continues to increase in dental schools in the United States and Canada, with predoctoral students gaining, on average, an equal amount of experience placing posterior resin-based composites and amalgams in terms of numbers of restorations.Clinical ImplicationsEvidence-based, up-to-date teaching programs, including those in operative dentistry, are needed to best prepare students for careers in dentistry.     

Adverse events associated with chlorhexidine use: results from the Department of Veterans Affairs Dental Diabetes Study

BACKGROUND: The authors report adverse events (AEs) related to the use of chlorhexidine gluconate mouthrinse in a clinical trial of the efficacy of periodontal treatment in older adults with diabetes. METHODS: Participants were U.S. veterans with uncontrolled diabetes (hemoglobin A(1c) value > or =8.5 percent) and periodontal disease. Treatment included periodontal scaling, 0.12 percent chlorhexidine lavage during ultrasonic scaling and use of chlorhexidine mouthrinse at home. RESULTS: Forty-four (31 percent) of 140 subjects reported having AEs. Most common were taste changes and tooth staining, sore mouth and/or throat, tongue irritation and wheezing/shortness of breath; the latter was reported more commonly before chlorhexidine use than after. Only body mass index greater than 30 was significantly related to AEs. CONCLUSIONS: AEs are common among subjects using chlorhexidine mouthrinse. Most AEs (taste change and staining) were resolved easily by subjects' discontinuing mouthrinse use and receiving dental prophylaxis. No serious AEs were reported. CLINICAL IMPLICATIONS: Clinicians should advise patients using chlorhexidine mouthrinse of possible side effects. If necessary, patients should discontinue mouthrinse use and obtain medical care. Careful monitoring of AEs in patients using chlorhexidine is warranted.     

State Medicaid Early and Periodic Screening,Diagnosis, and Treatment guidelines: Adherence to professionally recommended best oral health practices

BackgroundThe authors evaluated the adherence of state Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) guidelines to recommended best oral health practices for infants and toddlers.MethodsThe authors obtained state EPSDT guidelines via the Internet or from the Medicaid-CHIP State Dental Association, Washington. They identified best oral health practices through the American Academy of Pediatric Dentistry (AAPD), Chicago. They evaluated each EPSDT dental periodicity schedule with regard to the timing and content of seven key oral health domains.ResultsThirty-two states and the District of Columbia (D.C.) had EPSDT dental periodicity schedules. With the exception of the dentist referral domain, 29 states (88 percent) adhered to the content and timing of best oral health practices, as established by the AAPD guideline. For the dentist referral domain, 31 of the 32 states and D.C. (94 percent) required referral of children to a dentist, but only 11 states (33 percent) adhered to best oral health practices by requiring referral by age 1 year.ConclusionsWith the exception of the timing of the first dentist referral, there was high adherence to best oral health practices for infants and toddlers among states with separate EPSDT dental periodicity schedules.Practical ImplicationsStates with low adherence to best oral health practices, especially regarding the dental visit by age 1 year, can strengthen the oral health content of their EPSDT schedules by complying with the AAPD recommendations.     

The prevalence of caries and tooth loss among participants in the Hispanic Community Health Study/Study of Latinos

Background.The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins.Methods.Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)—a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research—conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures.Results.The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men.Conclusions.Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics.Practical Implications.These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs.     

Racial and ethnic disparities in children's oral health: the National Survey of Children's Health

BackgroundThe authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents.MethodsThe authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health.ResultsThe results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities.ConclusionsSignificant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.     

Preventing percutaneous injuries among dental health care personnel

BACKGROUND: The Occupational Safety and Health Administration and the Centers for Disease Control and Prevention (CDC) recommend that health care personnel (HCP) adopt safer work practices and consider using medical devices with safety features. This article describes the circumstances of percutaneous injuries among a sample of hospital-based dental HCP and estimates the preventability of a subset of these injuries: needlesticks. METHODS: The authors analyzed percutaneous injuries reported by dental HCP in the CDC's National Surveillance System for Health Care Workers (NaSH) from December 1995 through August 2004 to describe the circumstances. RESULTS: Of 360 percutaneous injuries, 36 percent were reported by dentists, 34 percent by oral surgeons, 22 percent by dental assistants, and 4 percent each by hygienists and students. Almost 25 percent involved anesthetic syringe needles. Of 87 needlestick injuries, 53 percent occurred after needle use and during activities in which a safety feature could have been activated (such as during passing and handling) or a safer work practice used. CONCLUSIONS: NaSH data show that needlestick injuries still occur and that a majority occur at a point in the workflow at which safety syringes--in addition to safe work practices and recapping systems--could contribute to injury prevention. CLINICAL IMPLICATIONS: All dental practices should have a comprehensive written program for preventing needlestick injuries that describes procedures for identifying, screening and, when appropriate, adopting safety devices; mechanisms for reporting and providing medical follow-up for percutaneous injuries; and a system for training staff members in safe work practices and the proper use of safety devices.     

Dental treatment intensity in frail older adults in the last year of life

BackgroundPalliative care focusing on pain and infection is recommended for patients who are terminally ill. It is difficult to implement this strategy in practice because of the lack of clear guidelines. The authors conducted a study to examine dental treatment provided to a group of long-term care (LTC) residents in the last year of life.MethodsThe authors retrospectively followed 197 LTC residents (60 years or older) in the last year of life to death. On the basis of the dental services patients received between the new patient examination and death, the authors categorized the patients into three groups: no care (NC), limited care (LC) and usual care (UC). The authors developed a multivariable continuation ratio logit model with shared regression coefficients across two logits to identify the factors associated with the end-of-life dental care pattern.ResultsThe authors found that 50.8 percent of the patients received NC before death. Among those who received treatment, 62.9 percent received UC, and 60.7 percent of the patients in the UC group had completed their treatment in the last three months of life. A three-month increment in survival and having dental insurance resulted in 1.74 (95 percent confidence interval [CI], 1.32–2.30) and 2.59 (95 percent CI, 1.03–6.52) times greater odds, respectively, of receiving some dental treatment before death. Neither survival nor dental insurance, however, was associated with dental care intensity in the last year of life (that is, UC versus LC).ConclusionsWhile most of the patients who were in the last year of life received insufficient dental care, comprehensive treatment was provided commonly to frail patients at the end of life, raising questions about quality of care.Practical ImplicationsPalliative oral health management needs to be revisited to improve quality of care for frail older adults at the end of life.     

Acceptance among and impact on dental practitioners and patients of American Heart Association recommendations for antibiotic prophylaxis

BackgroundThe 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) called for a major reduction in the number of patients recommended for antibiotic prophylaxis (AP) and redefined the dental procedures considered to put these patients at risk of acquiring the infection. The purpose of the authors&apos; study was to determine the acceptance of these changes among and the impact of the changes on dentists and their patients.MethodsThe authors sent a survey to a random sample of 5,500 dentists in the United States.ResultsNinety-five percent of the 878 respondents indicated that they saw patients who receive AP. More than 75 percent were either satisfied or very satisfied with the AHA guidelines, and the respondents indicated that they believed almost three-quarters of their patients also were pleased. Seventy percent of dentists, however, had patients who took antibiotics before a dental procedure even though the guidelines no longer recommend it.ConclusionsAcceptance of the 2007 guidelines appears to be high, but controversy remains. Additional scientific data are needed to resolve these issues.Practical ImplicationsThe 2007 AHA guidelines have greatly simplified the identification of patients who need AP for dental procedures, given that, in general, far fewer people with cardiac abnormalities are considered to be at risk as a result of invasive procedures. Some physicians, however, continue to prescribe antibiotics for some patients whom the AHA no longer considers to need them. Patients also may choose to continue this practice themselves. There is ongoing controversy surrounding this common clinical question in dental practice, and the next guidelines from the AHA may change on the basis of data from future clinical studies.     

Concordance between clinical practice and published evidence: Findings from The National Dental Practice-Based Research Network

BackgroundDocumenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network (“the network”).MethodsNetwork dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent (“1”) or inconsistent (“0”) with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.ResultsThe authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).ConclusionDentists reported a medium-range concordance between practice and published evidence.Practical ImplicationsEfforts to bring research findings into routine practice are needed.     

Vitamin and mineral supplements: Friend or foe when combined with medications?

Background.Given the prevalence of vitamin and mineral supplement use among consumers and the potential for vitamin- and mineral-drug interactions, as well as oral and systemic adverse effects of excess consumption, oral health care providers (OHCPs) should ask all patients about their use. The challenges for OHCPs are how to recognize oral and systemic manifestations of these interactions and how to safely manage the care of these patients while avoiding potential interactions.Methods.The authors reviewed the literature regarding interactions between popular vitamin and mineral supplements and medications used commonly in dentistry. They used clinical databases and decision support tools to classify interactions according to their level of patient risk. They address interactions of greatest clinical concern with a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses.Conclusion.Most medications used commonly in dentistry can be prescribed safely without regard to vitamin- and mineral-drug interactions. However, patients taking anticoagulants or cytochrome P450 3A4 substrates (such as clarithromycin, erythromycin, ketoconazole, itraconazole, midazolam and triazolam) in addition to specific vitamin or mineral supplements (vitamins D, E, K, calcium, fluoride, iron, magnesium, selenium or zinc) may face additional challenges. OHCPs need to recognize these potential interactions and know how to manage the care of patients who may be receiving treatment with these combination therapies.Practical Implications.Recognition and avoidance of potential vitamin- and mineral-drug interactions will help clinicians optimize patient treatment while emphasizing patient safety.