共查询到20条相似文献，搜索用时 31 毫秒
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Mark W. Lingen Elliot Abt Nishant Agrawal Anil K. Chaturvedi Ezra Cohen Gypsyamber D’Souza JoAnn Gurenlian John R. Kalmar Alexander R. Kerr Paul M. Lambert Lauren L. Patton Thomas P. Sollecito Edmond Truelove Malavika P. Tampi Olivia Urquhart Laura Banfield Alonso Carrasco-Labra 《Journal of the American Dental Association (1939)》2017,148(10):712-727.e10
Background
An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity.Types of Studies Reviewed
This is an update of the ADA’s 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma. The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and diagnostic test accuracy studies. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions.Results
The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity. For patients seeking care for suspicious lesions, immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice. In exceptional cases, when patients decline a biopsy or live in rural areas with limited access to care, the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed (conditional recommendation, low-quality evidence).Conclusions and Practical Implications
The authors urge clinicians to remain alert and take diligent action when they identify a PMD. The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial. 相似文献3.
Branca Heloisa Oliveira Joana Cunha-Cruz Anjana Rajendra Richard Niederman 《Journal of the American Dental Association (1939)》2018,149(8):671-679.e1
Background
In this systematic review, the authors aim to assess the effect of silver diamine fluoride (SDF) in preventing and arresting caries in exposed root surfaces of adults.Types of Studies Reviewed
Two reviewers independently searched for controlled clinical trials with at least 12 months of follow-up, without language or date of publication restraints, in 8 electronic databases, 5 registries of ongoing trials, and reference lists of narrative reviews.Results
The authors found 2,356 unique records and included 3 trials in which the investigators randomly assigned 895 older adults. Investigators in all studies compared SDF with placebo; investigators in 1 also compared 38% SDF with chlorhexidine and sodium fluoride varnishes. The primary effect measures were the weighted mean differences (WMDs) in decayed or filled root surfaces (DFRS) and the mean differences in arrested carious lesions between SDF and control groups. The studies had low risk of bias in most domains. SDF applications had a significantly better preventive effect in comparison with placebo (WMD DFRS: 24 months, ?0.56; 95% confidence interval, ?0.77 to ?0.36; 30 months or more, ?0.80; 95% confidence interval, ?1.19 to ?0.42), and they were as effective as either chlorhexidine or sodium fluoride varnish in preventing new root carious lesions. SDF also provided a significantly higher caries arrest effect than did placebo (pooled results not calculated). Complaints about black staining of the carious lesions by SDF were rare among older adults.Conclusions and Practical Implications
Yearly 38% SDF applications to exposed root surfaces of older adults are a simple, inexpensive, and effective way of preventing caries initiation and progression. 相似文献4.
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Laura Fernández-Ferrer María Vicente-Ruíz Verónica García-Sanz José María Montiel-Company Vanessa Paredes-Gallardo José Manuel Almerich-Silla Carlos Bellot-Arcís 《Journal of the American Dental Association (1939)》2018,149(9):778-786.e2
Background
One of the adverse effects of orthodontic treatment is the appearance of white-spot lesions (WSLs) resulting from enamel demineralization. The objective of this systematic review was to investigate the effectiveness of remineralization therapies on WSLs after orthodontic treatment.Types of Studies Reviewed
In this systematic review, the authors identified relevant articles listed in 5 databases—PubMed, the Cochrane Library, Scopus, Embase, and Web of Science—by using a combination of search terms referring to orthodontics, demineralization, and treatment. Ten articles on the efficacy of WSL remineralization therapies met the inclusion criteria.Results
Among the studies of remineralizing therapy, neither fluoride mouthrinses nor phosphopeptide toothpastes with or without fluoride had any positive effect in addition to oral hygiene maintenance with fluoride toothpaste. A 5% sodium fluoride varnish was the only therapy to show a statistically significant improvement compared with results in the control group. The authors found large variations in results among the studies reviewed because of the different methods used.Conclusions and Practical Implications
None of the treatments was capable of remineralizing WSLs. A 5% sodium fluoride varnish could improve remineralization of WSLs. 相似文献6.
John A. Curiel Anne E. Sanders Thu-Mai L. Christian Sophia Lafferty-Hess Thomas M. Carsey Lewis N. Lampiris Gary D. Slade 《Journal of the American Dental Association (1939)》2018,149(4):273-280.e3
Background
Despite supporting scientific evidence, community water fluoridation (CWF) often fails in public referenda. To understand why, the authors quantitatively analyzed text from news media coverage of CWF referenda.Methods
The authors analyzed text from 234 articles covering 11 CWF referenda conducted in 3 US cities from 1956 through 2013. The authors used cluster analysis to identify each article's core rhetoric and classified it according to sentiment and tone. The authors used multilevel count regression models to measure the use of positive and negative words regarding CWF.Results
Media coverage more closely resembled core rhetoric used by fluoridation opponents than the rhetoric used by fluoridation proponents. Despite the scientific evidence, the media reports were balanced in tone and sentiment for and against CWF. However, in articles emphasizing children, greater negative sentiment was associated with CWF rejection.Conclusions
Media coverage depicted an artificial balance of evidence and tone in favor of and against CWF. The focus on children was associated with more negative tone in cities where voters rejected CWF.Practical Implications
When speaking to the media, advocates for CWF should emphasize benefits for children and use positive terms about dental health rather than negative terms about dental disease. 相似文献7.
Carrigan L. Parish Margaret R. Pereyra Stephen N. Abel Karolynn Siegel Harold A. Pollack Lisa R. Metsch 《Journal of the American Dental Association (1939)》2018,149(2):112-121
Background
The dental setting is a potential venue for identifying patients experiencing intimate partner violence (IPV). The study objective was to assess dentists’ current practices and attitudes about IPV screening.Methods
A nationally representative survey of US general dentists assessed dentists’ use of health history forms that queried about IPV and their acceptance of IPV screening as part of their professional roles. Parsimonious Poisson regression models were used in multivariable analysis to estimate risk ratios for the 2 dependent variables.Results
Almost all dentists did not include a question to screen for IPV on their patient history forms. More than one-half of dentists also did not know of a referral place for patients experiencing IPV and did not believe that IPV screening should be part of their professional roles.Conclusions
Uptake of IPV screening and favorable attitudes toward screening were low among dentists studied. However, prior IPV training and clinical knowledge plus awareness of IPV referral mechanisms were positively associated with greater screening uptake and attitudes.Practical Implications
The inclusion of brief, focused IPV interventions in dental education and the establishment of collaborations between dentists and IPV agencies for referral mechanisms, in conjunction with an overall shift in dentists’ attitudes about their professional responsibilities, may facilitate IPV screening uptake in the dental setting. 相似文献8.
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9.
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10.
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Flávia Aparecida Cariolatto Julia Carelli Taís de Campos Moreira Ricardo Pietrobon Clarissa Rodrigues Ana Paula Bonilauri Ferreira 《Journal of Evidence》2018,18(2):142-152
Objectives
The aim of this study was to assess the quality of and outline the differences among recommendations of published clinical practice guidelines (CPGs) for the management of bisphosphonate-associated osteonecrosis of the jaw.Methods
We conducted a systematic literature search in PubMed, Cochrane, Embase, Web of Science, and Google web site. We selected CPGs supported by a nongovernmental organization or national institutes, related to bisphosphonate-associated osteonecrosis of the jaw in adults, in English language, and dated from January 2008 onward. The validity of each included CPG was appraised according to 2 validated appraisal tools for CPG that were independently used by 2 reviewers.Results
We identified 724 articles, of which 13 were included based on our eligibility criteria. Most CPGs were of good quality based on the appraisal tools for CPGs used in this study.Conclusion
We did not find consensus on all the recommendations of the evaluated CPGs. Thus, each clinical case must be assessed individually, considering the risks and benefits on the proposed dental treatment. 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.
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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15.
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Statement of problem
Lack of an accepted definition for the ascending ramus of the mandible means no common reference point is available for clinical or research dialogue.Purpose
The purpose of this review was to determine whether the ascending ramus has been defined, by using a search of published studies.Material and methods
PubMed was searched, using terms “ascending ramus” and “mandible.”Results
The search found no acceptable definition of the ascending ramus of the mandible.Conclusions
An acceptable definition for the ascending ramus of the mandible is lacking, and one is proposed here. 相似文献17.
Douglas A. Conrad Peter Milgrom R. Mike Shirtcliff Howard L. Bailit Sharity Ludwig Jeanne Dysert Gary Allen Joana Cunha-Cruz 《Journal of the American Dental Association (1939)》2018,149(5):348-352
Background
Dentists increasingly are employed in large group practices that use financial incentive systems to influence provider performance. The authors describe the design and initial implementation of a pay-for-performance (P4P) incentive program for a large capitated Oregon group dental practice that cares primarily for patients receiving Medicaid. The authors do not assess the effectiveness of the incentive system on provider and staff member performance.Methods
The data come from use of care files and integrated electronic health records, provider and staff member surveys, and interviews and community surveys from 6 counties. Quarterly individual- and team-level incentives focused on 3 performance metrics.Results
The program was challenged by many complex administrative issues. The key issues included designing a P4P system for different types of providers and administrative staff members who were employed centrally and in different communities, setting realistic performance metrics, building information systems that provided timely information about performance, and educating and gaining the support of a diverse workforce. Adjustments are being made in the incentive scheme to meet these challenges.Conclusions
This is the first report of a P4P compensation system for dental care providers and supporting staff members. The complex administrative challenges will require several years to address.Practical Implications
Large, capitated dental practice organizations will employ more dental care providers and administrative staff members to care for patients who receive Medicaid and patients who are privately insured. It is critical to design and implement a P4P system that the workforce supports. 相似文献18.
K. Siva sankar K. Pranitha A.J. Sai Sankar B. Sujatha V. Sai krishna K. Kiran kumar 《Pediatric Dental Journal》2018,28(3):160-164
Background
Remineralizing agents are found to be effective in the remineralization of early enamel caries and the remineralized enamel crystallites are more resistant to decalcification and also have the same orientation as the original enamel crystallites. Although child formula fluoridated dentifrices are used safely by young children their remineralizing capability remains questionable.Aim
To evaluate the remineralizing potential of three commercially available pediatric dentifrices on artificial carious lesions in primary teeth.Materials and methods
A total of fifty sound human primary teeth were coated with nail varnish leaving a window of 2 mm × 4 mm on buccal surface and were subjected to demineralization for a period of 96 h and then sectioned. Out of the hundred sections obtained, ninety sections are equally divided into three groups with thirty in each group: Group I (Colgate Spider man), Group II (Kids bunny), Group III (Kidodent) subjected to remineralization respectively for 10 days using pH cycling model. The sections were then evaluated under the stereomicroscope for the remineralization values using MICAP image analyser software.Results
Statistical analysis was done by using ANOVA test which showed that all the three dentifrices showed remineralization with artificial carious lesions. Among the three test groups, Group I showed higher remineralization potential compared with the other two pediatric dentifrices which was statistically significant (p < 0.05).Conclusion
All the three dentifrices demonstrated remineralization of carious lesions by virtue of decrease in lesion depth. 相似文献19.
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20.
Assessing dentists’ human papillomavirus–related health literacy for oropharyngeal cancer prevention
Coralia Vázquez-Otero Cheryl A. Vamos Erika L. Thompson Laura K. Merrell Stacey B. Griner Nolan S. Kline Frank A. Catalanotto Anna R. Giuliano Ellen M. Daley 《Journal of the American Dental Association (1939)》2018,149(1):9-17