Substance-use screening and interventions in dental practices: Survey of practice-based research network dentists regarding current practices,policies and barriers

BackgroundDental visits represent an opportunity to identify and assist patients with unhealthy substance use, but little is known about how dentists are addressing patients’ use of tobacco, alcohol and illicit drugs. The authors surveyed dentists to learn about the role their practices might play in providing substance-use screening and interventions.MethodsThe authors distributed a 41-item Web-based survey to all 210 dentists active in the Practitioners Engaged in Applied Research and Learning Network, a practice-based research network. The questionnaire assessed dental practices’ policies and current practices, attitudes and perceived barriers to providing services for tobacco, alcohol and illicit drug use.ResultsOne hundred forty-three dentists completed the survey (68 percent response rate). Although screening was common, fewer dentists reported that they were providing follow-up counseling or referrals for substance use. Insufficient knowledge or training was the most frequently cited barrier to intervention. Many dentists reported they would offer assistance for use of tobacco (67 percent) or alcohol or illicit drugs (52 percent) if reimbursed; respondents who treated publicly insured patients were more likely to reply that they would offer this assistance.ConclusionsDentists recognize the importance of screening for substance use, but they lack the clinical training and practice-based systems focused on substance use that could facilitate intervention.Practical ImplicationsThe results of this study indicate that dentists may be willing to address substance use among patients, including use of alcohol and illicit drugs in addition to tobacco, if barriers are reduced through changes in reimbursement, education and systems-level support.     

Gagging and its associations with dental care–related fear,fear of pain and beliefs about treatment

BackgroundGagging is a behavioral response that interferes with oral health care and may be related to dental care–related fear. Little is known, however, about the epidemiology of gagging during dental treatment.MethodsTo explore this phenomenon, the authors recruited participants from the waiting area of an oral diagnosis clinic. Participants completed a gagging behavior questionnaire, the Dental Fear Survey, the Fear of Pain Questionnaire—9, the Revised Dental Beliefs Survey and a demographics questionnaire.ResultsAlmost one-half of the 478 participants reported gagging on at least one occasion during dental visits, and 7.5 percent of participants reported almost always or always gagging. With higher frequency of problems with gagging, patients were more likely to have greater levels of dental care–related fear, fear of pain and more negative beliefs about dental professionals and dental treatment. Furthermore, participants who gagged more readily had greater dental care–related fear than did participants who had less of a propensity to gag.ConclusionsGagging in the dental office is a prevalent problem, and dental care–related fear and fear of pain are associated with more frequent gagging.Practical ImplicationsGiven the prevalence of patients reporting problems with gagging, it may be helpful for providers to assess patients' propensity for gagging, which can be a barrier to treatment. By targeting dental care–related fear, fear of pain and negative beliefs about dental care in patients who often gag when receiving dental care, clinicians may be able to help reduce gagging in frequency or intensity, potentially making treatment more comfortable for patients and easier for dental care providers.     

Dental patients' self-reports of xerostomia and associated risk factors

BackgroundMost studies regarding xerostomia focus on elderly people. Therefore, the authors conducted a study of dental patients 18 years or older to determine the prevalence of self-reported xerostomia and associated risk factors.MethodsThe authors sent a total of 2,200 questionnaires to four dental clinics to assess patients’ self-reported xerostomia. They also collected sociodemographic data and information regarding personal behavior. They used logistic regression models to estimate odds ratios (OR) and 95 percent confidence intervals (CI) to explore the relationship between self-reported xerostomia and risk factors that reasonably might be expected to be associated with self-reported xerostomia.ResultsThe overall prevalence of xerostomia in participants was 7 percent. Participants with burning-mouth sensations were associated with having higher odds of experiencing dry mouth (OR, 2.1; 95 percent CI, 0.9–5.2). Participants 51 years or older were significantly more likely to report having dry mouth than were younger participants (P < .04). The prevalence of self-reported xerostomia increased with increasing numbers of medications patients reported using.ConclusionThe authors found that medication use and age were highly significant risk factors for dental patients reporting xerostomia.Clinical ImplicationsClinicians should interview their patients carefully regarding their use of medications and provide proper oral health care to improve xerostomia resulting from medication use.     

Prevalence and association of dental injuries with socioeconomic conditions and alcohol/drug use in adolescents between 15 and 19 years of age

Abstract –  Background: The aim of the present study was to investigate the prevalence of dental trauma, etiological factors, predisposing factors, and associations with socioeconomic status and the risk of alcohol and illicit drug use among adolescents in the city of Belo Horizonte, Brazil. Methods: A cross‐sectional study was carried out that included clinical examinations and self‐administered questionnaires. The sample population was composed of 891 adolescents from public and private schools. The Social Vulnerability Index (SVI) was used for socioeconomic classification. Information on alcohol and illicit drug use was obtained using two questionnaires: the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Results: The prevalence of traumatic dental injury (TDI) was 24.7%. Falls (17.7%) was the most frequently cited etiological factor in dental injury. Among the participants with TDI, 32.8% were students in the private school system (P = 0.006). A total of 56.8% of individuals with accentuated overjet had some type of TDI (P = 0.000). There was a high prevalence of adolescents who consumed alcoholic beverages (50.3%) and used illicit substances (15.2%). However, no statistically significant associations were found between these variables and the presence of TDI. The results of the analysis demonstrate that individuals in a private school system [prevalence ratio (PR) = 1.11; 95% confidence interval (CI): 1.03–1.20] and those with accentuated overjet (>3 mm) (PR = 1.17; 95% CI: 1.10–1.25) had a 1.11‐ and 1.17‐fold greater chance of belonging to the group of individuals diagnosed with some type of TDI. Conclusions: The prevalence of dental trauma in the study population was high. The same was true regarding alcohol and illicit drug use among the adolescents examined, although no statistically significant associations were found between these variables and a history of TDI. Private school system and accentuated overjet were significantly associated with dental trauma.     

How Patients&apos; Lack of Knowledge About Oral Bisphosphonates Can Interfere With Medical and Dental Care

BackgroundOral bisphosphonate use has been associated with a small risk of developing oral osteonecrosis that occurs spontaneously or after the patient has undergone dental surgery. The authors conducted a study to determine whether patients taking bisphosphonates had knowledge about the medical indication for the therapy and the duration of treatment, as well as whether they had been educated by their physicians about possible adverse reactions.MethodsFrom June 2008 through April 2009, people seeking routine care in a dental clinic and who were being treated with bisphosphonates were invited to participate in the study. The participants were asked questions involving knowledge about the medical indications related to their taking bisphosphonates, the duration of their therapy and whether they had been educated about possible adverse reactions.ResultsThe authors interviewed 73 participants; 84 percent stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of therapy, and 82 percent could not recall if they had been told about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians.ConclusionPeople taking bisphosphonates may be unfamiliar with the drug and its possible adverse oral side effects.Clinical ImplicationsDentists should be prepared to educate patients about the risks of developing oral complications resulting from bisphosphonate use and the need for appropriate dental care. Questions regarding discontinuation of bisphosphonate therapy should be answered by the physician.     

The Relationship Between Methamphetamine Use and Increased Dental Disease

BackgroundMethamphetamine (MA) use has been linked anecdotally to rampant dental disease. The authors sought to determine the relative prevalence of dental comorbidities in MA users, verify whether MA users have more quantifiable dental disease and report having more dental problems than nonusers and establish the influence of mode of MA administration on oral health outcomes.MethodsParticipating physicians provided comprehensive medical and oral assessments for adults dependent on MA (n = 301). Trained interviewers collected patients' self-reports regarding oral health and substance-use behaviors. The authors used propensity score matching to create a matched comparison group of nonusers from participants in the the Third National Health and Nutrition Examination Survey (NHANES III).ResultsDental or oral disease was one of the most prevalent (41.3 percent) medical cormorbidities in MA users who otherwise were generally healthy. On average, MA users had significantly more missing teeth than did matched NHANES III control participants (4.58 versus 1.96, P < .001) and were more likely to report having oral health problems (P < .001). Significant subsets of MA users expressed concerns with their dental appearance (28.6 percent), problems with broken or loose teeth (23.3 percent) and tooth grinding (bruxism) or erosion (22.3 percent). The intravenous use of MA was significantly more likely to be associated with missing teeth than was smoking MA (odds ratio = 2.47; 95 percent confidence interval = 1.3–4.8).ConclusionsOvert dental disease is one of the key distinguishing comorbidities in MA users. MA users have demonstrably higher rates of dental disease and report long-term unmet oral health needs. Contrary to common perception, users who smoke or inhale MA have lower rates of dental disease than do those who inject the drug. Many MA users are concerned with the cosmetic aspects of their dental disease, and these concerns could be used as behavioral triggers for targeted interventions.Clinical ImplicationsDental disease may provide a temporally stable MA-specific medical marker with discriminant utility in identifying MA users. Dentists can play a crucial role in the early detection of MA use and participate in the collaborative care of MA users.     

Dental care and associated factors among older adults with schizophrenia

BackgroundFew data are available concerning dental care in older adults with schizophrenia. The authors examined the utilization of dental care and factors related to dental treatment in this population.MethodsThe sample consisted of 198 community-dwelling participants 55 years and older with schizophrenia and a community comparison group of 113 participants. The authors adapted a model of illness behavior in later life as the basis for selection of 18 predictor variables of annual dental care visits.ResultsThe study results showed no significant differences between the schizophrenia and community comparison groups with regard to the percentage of participants (28 and 31 percent, respectively) reporting having had at least two dental visits in the previous year or one dental visit (48 and 54 percent, respectively). However, the results showed significant differences in the percentage of participants in the schizophrenia and community comparison groups who stated that they experienced problems with their teeth or dentures (41 and 23 percent, respectively). When examining participants in the schizophrenia group separately, the authors found four variables that were significantly associated with having had at least one dental visit: financial well-being (odds ratio [OR] = 1.12), better executive cognitive functioning (OR = 1.11), fewer perceived problems with teeth or dentures (OR = 0.33) and fewer oral dyskinesias (OR = 0.86).ConclusionsMost older adults with schizophrenia in this study did not receive at least two dental visits per year, although their frequency of care was no worse than that of their age-matched peers. Psychiatric assessments should include questions about dental care. The greatest improvement in dental care for such patients likely is to occur by targeting people who report having more problems with their teeth, including oral dyskinesias; those who have greater cognitive impairments, especially in executive functioning; and those who have diminished financial resources.     

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.     

Hyposalivation and Xerostomia in Dentate Older Adults

BackgroundOlder adults are susceptible to reduced saliva production related to certain medications, radiation and chronic conditions. Many of these people have many physical and oral health problems and limited access to dental care. The use of effective screening tools for xerostomia and hyposalivation would be helpful in identifying those at risk. The authors conducted a study to investigate the association between three measures of oral dryness: hyposalivation (low unstimulated salivary flow), self-reported xerostomia and clinically assessed dry mouth.MethodsThe authors included a convenience sample of 252 nondemented and dentate West Virginia participants 70 years and older who were part of a larger study on oral health and cognition among older adults. Participants completed a self-reported xerostomia index, provided an unstipulated salivary sample and underwent an oral assessment for the study.ResultsTwenty-eight participants (11.1 percent) had hyposalivation, eight of whom reported having xerostomia (sensitivity = 28.6 percent). Of the 43 participants who reported having xerostomia, only eight had hyposalivation (positive predictive value = 18.6 percent). Hyposalivation and self-reported xerostomia were not significantly related. Clinically assessed dry mouth correlated modestly, but significantly, with hyposalivation and self-reported xerostomia.ConclusionsObtaining routine unstimulated salivary flow rates in addition to self-reported information and oral evaluations may increase early detection of oral dryness, which would assist in implementing early interventions to improve patients' quality of life.Clinical ImplicationsVisually inspecting oral tissues for dryness and asking a patient if his or her mouth is dry are insufficient measures for clinicians to use to determine if the patient has hyposalivation. The authors recommend that clinicians determine the patient's unstimulated salivary flow rate.     

A survey of alcohol and drug use among UK based dental undergraduates

OBJECTIVE: This study was designed to investigate the prevalence of alcohol and drug use. DESIGN: Anonymous self-report questionnaire. SETTING: A UK dental school in May 1998. SUBJECTS AND METHODS: 1st-5th year dental undergraduates (n = 264) were questioned on their use of alcohol and tobacco, cannabis and other illicit drugs whilst at dental school, and before entry. RESULTS: Eighty two per cent of male and 90% of female undergraduates reported drinking alcohol. Of those drinking, 63% of males and 42% of females drank in excess of sensible weekly limits (14 units for females, 21 units for males), with 56% of males and 58.5% of females 'binge drinking'. Regular tobacco smoking (10 or more cigarettes a day) was found to have a statistically significant association with year of study, 4th-5th year undergraduates being eight times more likely to regularly smoke than their junior colleagues. Fifty five per cent of undergraduates reported cannabis use at least once or twice since starting dental school, with 8% of males and 6% of females reporting current regular use at least once a week. CONCLUSION: Dental undergraduates are drinking above sensible weekly limits of alcohol, binge drinking and indulging in illicit drug use. Dental Schools should designate a teacher responsible for education of undergraduates regarding alcohol and substance abuse.     

Oral Health Needs Among Adults in the United States With Chronic Diseases

BackgroundOral and dental diseases may be associated with other chronic diseases.MethodsUsing data from the National Health and Nutrition Examination Survey 1999–2004, the authors calculated the prevalence of untreated dental diseases, self-reported poor oral health and the number of missing teeth for adults in the United States who had certain chronic diseases. The authors used multivariate analysis to determine whether these diseases were associated with indicators of dental disease after controlling for common risk factors.ResultsParticipants with rheumatoid arthritis, diabetes or a liver condition were twice as likely to have an urgent need for dental treatment as were participants who did not have these diseases. After controlling for common risk factors, the authors found that arthritis, cardiovascular disease, diabetes, emphysema, hepatitis C virus, obesity and stroke still were associated with dental disease.ConclusionsThe authors found a high burden of unmet dental care needs among participants with chronic diseases. This association held in the multivariate analysis, suggesting that some chronic diseases may increase the risk of developing dental disease, decrease utilization of dental care or both.Clinical ImplicationsDental and medical care providers should work together to ensure that adults with chronic diseases receive regular dental care.     

Oral care behavior after purging in a sample of women with bulimia nervosa

BackgroundBulimia nervosa (BN) is a mental health disorder associated with serious dental problems. The authors surveyed patients with a diagnosis of BN about their oral health behaviors after purging and their perspectives on barriers to patient-initiated discussion of eating disorders (EDs) with oral health professionals (OHPs).MethodsA convenience sample of women with BN who were receiving treatment at major ED treatment centers (those centers that are members of the Academy of Eating Disorders, Deerfield, Ill.) completed a 45-item, self-reported online survey that the authors use to assess oral care behaviors after purging, dental problems and barriers to communication with their dentists. Inclusion criteria were being 18 years or older, female and a U.S. resident, as well as having a clinical diagnosis of BN. A sample of 292 women began the survey, and 201 (68.8 percent) completed the survey.ResultsThe survey results indicated that 32.5 percent of participants reported brushing their teeth immediately after purging, which is contraindicated. Although 92.4 percent of participants acknowledged having dental problems, only 29.2 percent of these participants discussed their BN with a dentist.ConclusionsThe survey results show that although participants with BN had a high level of concern about their oral health and a high incidence of oral health problems, less than one-third considered their OHPs to be the most helpful source of oral health information.Practical ImplicationsOHPs must be educated about how to approach patients when an ED is suspected, develop practice protocols for discussing secondary prevention with patients and develop practice policies about disclosing ED (for example, purging) to a parent or guardian.     

Oral Hygiene Practices and Dental Service Utilization Among Pregnant Women

BackgroundDaily oral hygiene and regular dental visits are important components of oral health care. The authors&apos; objective in this study was to examine women&apos;s oral hygiene practices and use of dental services during pregnancy.MethodsThe authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used χ² and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables.ResultsOf the 599 participants, 83 percent (n = 497) reported brushing once or twice per day. Twenty-four percent (n = 141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P < .001). Seventy-four percent (n = 442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P < .001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33–4.92]; 2.19 [1.11–4.29]; 2.02 [1.12–3.65]; 1.86 [1.13–3.07]; and 4.35 [2.5–7.69], respectively). A woman&apos;s lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy.ConclusionRacial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist.Clinical ImplicationsMedical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population&apos;s access barriers to, and use of, dental care services.     

Length of tooth survival in older adults with complex medical, functional and dental backgrounds

BackgroundTooth loss can be considered a failure of current oral health care strategies. Knowing how soon this failure will occur can help clinicians enhance preventive strategies for preventing tooth loss and minimizing its impact. The authors conducted a study to detail tooth survival patterns in an older cohort.MethodsThe authors conducted a retrospective longitudinal study of 491 participants aged 43 to 102 years. They treated the participants' dental conditions before they entered the study. They also collected participants' sociodemographic, medical, functional, cognitive and dental data when they first arrived at the clinic. The authors used Fisher exact tests, χ² tests and analysis of variance to examine the association between baseline characteristics and tooth survival. They generated Kaplan-Meier estimates and used Cox proportional hazards regression models to detail tooth survival and associated risk factors.ResultsThe authors found that tooth survival patterns differed among participants who had different numbers of carious teeth or retained roots (carious or broken teeth that were missing most of their coronal structures) when they first arrived at the clinic (P N/A .001) and between participants who wore removable prostheses and those who did not (P = .02). Participants' tooth loss at different times differed by sex, number of medications being taken and number of carious teeth or retained roots. The authors found that after they adjusted for other factors, tooth survival was associated with the number of carious teeth or retained roots (P = .01), as well as the interaction between the number of carious teeth or retained roots and use of prostheses (P = .02).ConclusionsCaries and the use of removable prostheses synergistically compromised tooth survival in older patients. Patients who wore prostheses and had multiple active carious teeth or retained roots at arrival had the highest risk of losing teeth soon after their existing conditions were treated.Clinical ImplicationsThese findings highlight the need for preventing tooth loss in older adults who wear removable prostheses and have poor oral health. Knowing the groups at the highest risk of experiencing tooth loss soon after dental treatment is received can help dentists better target and design preventive strategies.     

Hepatitis B virus transmissions associated with a portable dental clinic,West Virginia, 2009

BackgroundAlthough hepatitis B virus (HBV) transmission in dental settings is rare, in 2009 a cluster of acute HBV infections was reported among attendees of a two-day portable dental clinic in West Virginia.MethodsThe authors conducted a retrospective investigation by using treatment records and volunteer logs, interviews of patients and volunteers with acute HBV infection as well as of other clinic volunteers, and molecular sequencing of the virus from those acutely infected.ResultsThe clinic was held under the auspices of a charitable organization in a gymnasium staffed by 750 volunteers, including dental care providers who treated 1,137 adults. Five acute HBV infections—involving three patients and two volunteers—were identified by the local and state health departments. Of four viral isolates available for testing, all were genotype D. Three case patients underwent extractions; one received restorations and one a dental prophylaxis. None shared a treatment provider with any of the others. One case volunteer worked in maintenance; the other directed patients from triage to the treatment waiting area. Case patients reported no behavioral risk factors for HBV infection. The investigation revealed numerous infection control breaches.ConclusionsTransmission of HBV to three patients and two volunteers is likely to have occurred at a portable dental clinic. Specific breaches in infection control could not be linked to these HBV transmissions.Practical ImplicationsAll dental settings should adhere to recommended infection control practices, including oversight; training in prevention of bloodborne pathogens transmission; receipt of HBV vaccination for staff who may come into contact with blood or body fluids; use of appropriate personal protective equipment, sterilization and disinfection procedures; and use of measures, such as high-volume suction, to minimize the spread of blood.     

Assessing the effectiveness of text messages as appointment reminders in a pediatric dental setting

BackgroundText messaging is a dominant form of communication in our society. However, little research has been conducted to evaluate its effectiveness as an appointment reminder in the dental setting.MethodsFrom the patient pool of the pediatric dentistry clinic at the University of Washington, Seattle, the authors invited 543 caregiver/child dyads who met eligibility criteria to participate in this study. They randomly assigned 318 pairs (59 percent response) to receive a short message service (SMS) text message (n = 158) or a voice message (control group) (n = 160) as an appointment reminder.ResultsYounger caregivers were more likely to be nonattendees than were older caregivers (P = .02). Participants in the voice message group had a lower no-show attendance (8.2 percent) than did those in the text message group (17.7 percent) (P = .01). The unadjusted odds ratio (OR) for type of appointment reminder and no-show attendance was 2.41 (P = .01). After the authors adjusted for the caregiver's age, the OR was 2.12 (P = .04).ConclusionsSMS text messages were not as effective as voice reminders for patients in a dental school pediatric dentistry clinic. Future studies should investigate the effect of text message reminders when limited to patients who self-select that type of reminder and in patient populations outside the university setting.Clinical ImplicationsText messaging may not be the preferable method of reminding patients about appointments in a university pediatric dental clinic.     

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

Objectives: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

Methods: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

Results: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0–61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual’s daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p?p?p?=?.008).

Conclusion: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.     

Illicit drug use and traumatic dental injuries in adolescents

Objective: To explore the association between illicit drug use and traumatic dental injuries (TDI) among adolescents.

Method: We used data from 618 adolescents who participated in Phases I and III of Research with East Adolescents Community Health Survey (RELACHS), a longitudinal school-based study of adolescents in East London. Illicit drug use was collected when participants were 11–12 and 15–16 years old (Phases I and III, respectively). Clinical examinations for TDI were conducted in Phase III only. The association of lifetime prevalence of illicit drug use at ages 11–12 and 15–16 years with TDI was evaluated in crude and adjusted binary logistic regression models.

Results: Overall, 6.3% and 25.4% of adolescents reported having ever used illicit drugs at ages 11–12 (Phase I) and 15–16 years (Phase III), respectively. Also, 8.7% of adolescents were found to have TDI at age 15–16 years. There was no significant association between lifetime prevalence of illicit drug use reported at age 11–12 years (Odds Ratio: 1.07; 95% Confidence Interval: 0.45–2.54) or age 15–16 years (OR: 1.19; 95%CI: 0.74–1.93) and TDI.

Conclusion: This study found no support for an association between illicit drug use and TDI among adolescents from East London.     

Treating dental patients who use oral antithrombotic medication: a survey of dentists in the Netherlands

BackgroundFor many years, international guidelines have advised health care professionals not to adjust oral antithrombotic medication (OAM) regimens before invasive dental procedures. The authors conducted a study to examine the opinions of Dutch general dentists regarding the dental care of patients receiving treatment with these medications.MethodsThe authors invited via e-mail 1,442 general dentists in the Netherlands to answer a 20-item Internet-based questionnaire that they developed. Survey items consisted of questions about medical history taking, number of patients in the dental practice receiving OAM therapy, frequency of consulting with medical and dental colleagues and suggested dental treatment of patients during various invasive dental procedures.ResultsA total of 487 questionnaires were returned (response rate of 34 percent). The mean age of respondents was 47 years, and 77 percent were male. The majority of dentists responded that they obtain medical histories, but that they did not know how many of their patients were receiving OAM treatment. Dentists reported that they consult with medical colleagues frequently about antithrombotic medication. Ninety-one percent of respondents stated that they obtained their medical knowledge primarily in dental school. More than 50 percent of the dentists reported that they were not familiar with the international normalized ratio. The majority of dentists responded that they felt a need for clinical practice guidelines.ConclusionsAccording to the results of our survey, most dentists remain cautious when performing invasive dental procedures in patients who are treated with OAMs. Moreover, survey respondents tended to estimate that the risk of bleeding during dental procedures when OAM therapy is continued is higher than the risk of rethrombosis when use of antithrombotic medication is interrupted.Clinical ImplicationsA growing proportion of elderly patients and those with medically complex conditions are being treated in dental practices in the Netherlands. Consequently, more needs to be done to ensure that dentists are offered evidence-based guidance when treating patients who receive OAMs.