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Arany S, Cavalcanti L, Phildor D, Watson GE, Kopycka-Kedzierawski DT, Eliav E, Medina-Walpole A, Caprio T. Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic. J Am Geriatr Soc 2024. [PMID: 38661080 DOI: 10.1111/jgs.18925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. METHODS The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. RESULTS This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. CONCLUSIONS This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.
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Affiliation(s)
- Szilvia Arany
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Lia Cavalcanti
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Doris Phildor
- Alzheimer's Association Rochester New York Chapter, Rochester, New York, USA
| | - Gene E Watson
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Pharmacology and Physiology, University of Rochester, Rochester, New York, USA
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Annette Medina-Walpole
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Thomas Caprio
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Kopycka-Kedzierawski DT, Feng C, Billings RJ, Watson GE, Ragusa PG, Flint K, Wong CL, Gill SR, Manning S, O'Connor TG. Psychosocial Risk Exposure Limits Routine Pediatric Oral Health Care. AJPM Focus 2024; 3:100191. [PMID: 38357551 PMCID: PMC10864889 DOI: 10.1016/j.focus.2024.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction This study aimed to identify social, psychological, and contextual factors that influenced attendance at routine oral health visits in a cohort of 189 preschool children who were followed over a 2-year period. Methods Generalized estimating equation was used to examine the association between clinic attendance and the predictors. ORs and 95% CIs were reported in the multiple logistic regression models. The study was conducted in Rochester, New York, between February 2016 and February 2021. Results Prior to the COVID-19 pandemic declaration, the rate of canceled and no-show appointments was greater for routine clinic visits (20% and 24%, respectively) than for research visits (14% and 9%, respectively) for the same participants; these rates increased during the pandemic. After adjusting for sociodemographic factors, the likelihood of a canceled or no-show appointment was associated with parental depression (OR=1.06, CI=1.03, 1.09), regardless of the type or occurrence of the visit. Conclusions Findings from this study demonstrate that attendance to oral health care in young children is reliably reduced with parental depression and that this may provide one mechanism for early emerging health inequalities of oral health.
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Affiliation(s)
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Ronald J. Billings
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Gene E. Watson
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pharmacology & Physiology, University of Rochester, Rochester, New York
- Department of Environmental Medicine, University of Rochester, Rochester, New York
| | - Patricia G. Ragusa
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Kimberly Flint
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Cynthia L. Wong
- Department of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pediatrics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Steven R. Gill
- Department of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Pediatrics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
- Department of Microbiology and Immunology, University of Rochester, Rochester, New York
| | - Samantha Manning
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Thomas G. O'Connor
- Department of Psychiatry, University of Rochester, Rochester, New York
- Department of Psychology, University of Rochester, Rochester, New York
- Department of Neuroscience, University of Rochester, Rochester, New York
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
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Cunha-Cruz J, Gilbert GH, Allareddy V, Cochran DL, Fellows J, Kopycka-Kedzierawski DT, McBurnie M, Meyerowitz C, Mungia R, Rindal DB, Gordan VV. Characteristics of dentists in the National Dental Practice-Based Research Network. J Dent 2023; 137:104653. [PMID: 37572986 PMCID: PMC10528504 DOI: 10.1016/j.jdent.2023.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States
| | - Veerasathpurush Allareddy
- University of Illinois Chicago College of Dentistry, 801 S. Paulina Street, Chicago, Illinois 60612, United States
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Jeffrey Fellows
- Center for Health Research, Kaiser Permanente, 3800N. Interstate Avenue, Portland, OR 97227-1098, United States
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, PO Box 683, Rochester, NY 14620, United States
| | - MaryAnn McBurnie
- Kaiser Permanente Center for Health Research, 3800N. Interstate Avenue, Portland, OR 97114, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester. 601 Elmwood Avenue, Box 686, Rochester, NY 14642, United States.
| | - Rahma Mungia
- Department of Periodontics, The University of Texas Health San Antonio, 8403 Floyd Curl Drive; MC 8258; Suite 300.29, San Antonio, TX 78229, United States
| | - D Brad Rindal
- HealthPartners Institute, HealthPartners Dental Group, 8170 33rd Avenue South | P.O. Box 1524, MS 21112R, Minneapolis MN 55440-1524, United States
| | - Valeria V Gordan
- University of Florida College of Dentistry, Restorative Dental Sciences Department, PO Box 100415, Gainesville FL 32610-0415, United States
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Gill SR, O'Connor TG, Kopycka-Kedzierawski DT. Early childhood caries prevention through a developmental origins model of the oral microbiome, host and oral environment, and sociodemographic influences. Quintessence Int 2023; 54:610-611. [PMID: 37724759 DOI: 10.3290/j.qi.b4417923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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Funkhouser E, Ferracane JL, Hilton TJ, Gordan VV, Gilbert GH, Mungia R, Burton V, Meyerowitz C, Kopycka-Kedzierawski DT. Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network. J Dent 2022; 119:104078. [PMID: 35227834 PMCID: PMC8988449 DOI: 10.1016/j.jdent.2022.104078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cracked teeth may be associated with pain, especially biting pain, and to a lesser degree cold and spontaneous pain. Described are how commonly these pains remain constant, develop, or resolve over time, none of which have been well-described, especially among untreated cracked teeth. METHODS Cracked teeth from the Cracked Tooth Registry (CTR) study were followed for 3 years. Assessments of cold, biting, and spontaneous pain and treatments performed were completed at enrollment (Y0) and at each annual recall visit. RESULTS 209 practitioners enrolled 2,858 patients, each with a visible crack on a posterior tooth; 2601 (91%) patients attended at least one recall visit. Overall, 960 (37%) were treated, primarily with crowns. Among both treated and untreated cracked teeth with biting pain or spontaneous pain at Y0, the vast majority (92-99%) had their pain resolved by the time of a recall visit and 85-93% remained pain-free after initial resolution. The observations for cold pain were similar: 68% (untreated) and 78% (treated) became free of cold pain at some point during follow-up, and 84% of these stayed free of cold pain after initial resolution. Few teeth developed biting or spontaneous pain (4-8%) and 44-67% of these had pain resolution during the follow-up period. CONCLUSION In this study, treatment resolved a preponderance of pain associated with a cracked tooth. Pain was also resolved for most untreated cracked teeth, especially biting pain, and to a lesser degree spontaneous and cold pain, although not to the same degree as with the treated cracked teeth.
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Affiliation(s)
- Ellen Funkhouser
- School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States.
| | - Jack L Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave. Portland, OR 97201-5042, United States
| | - Thomas J Hilton
- Alumni Centennial Professor in Operative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave. Portland, OR 97201-5042, United States
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd. Gainesville, FL 32610, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive; MC 8258, San Antonio, TX 78229, United States
| | - Vanessa Burton
- HealthPartners, 5901 John Martin Dr. Brooklyn Center, MN 55430, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 686. Rochester, NY 14642, United States
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Ferracane JL, Hilton TJ, Funkhouser E, Gordan VV, Gilbert GH, Mungia R, Burton V, Meyerowitz C, Kopycka-Kedzierawski DT. Outcomes of treatment and monitoring of posterior teeth with cracks: three-year results from the National Dental Practice-Based Research Network. Clin Oral Investig 2022; 26:2453-2463. [PMID: 34628545 PMCID: PMC8898304 DOI: 10.1007/s00784-021-04211-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe treatment and monitoring outcomes of posterior teeth with cracks at baseline followed in the National Dental Practice-Based Research Network for up to three years. MATERIALS AND METHODS Two hundred and nine dentists enrolled a convenience sample of 2,858 patients, each with a posterior tooth with at least one visible crack and followed them for three years. Characteristics at the patient, tooth, and crack level were recorded at baseline and at annual recall visits. Data on all teeth referred for extraction were reviewed. Data on all other teeth, treated or monitored, seen at one or more recall visits were reviewed for evidence of failure (subsequent extraction, endodontics, or recommendation for a re-treatment). RESULTS The survival rate for teeth with cracks at baseline exceeded 98% (only 37 extractions), and the failure rate for teeth that were treated restoratively was only 14%. Also, only about 14% of teeth recommended at baseline for monitoring were later recommended to be treated, and about 6.5% of teeth recommended for monitoring at baseline were later treated without a specific recommendation. Thus, about 80% of teeth recommended at baseline for monitoring continued with a monitoring recommendation throughout the entire three years of the study. Treatment failures were associated with intracoronal restorations (vs. full or partial coverage) and male patients. CONCLUSIONS In this large 3-year practice-based study conducted across the USA, the survival rate of posterior teeth with a visible crack exceeded 85%. Clinical relevance Dentists can effectively evaluate patient-, tooth-, and crack-level characteristics to determine which teeth with cracks warrant treatment and which only warrant monitoring.
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Affiliation(s)
- Jack L. Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Thomas J. Hilton
- School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007
| | - Valeria V. Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio
| | - Vanessa Burton
- HealthPartners, 5901 John Martin Dr., Brooklyn Center, MN 55430
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 686, Rochester, NY 14642
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Xiao J, Meyerowitz C, Ragusa P, Funkhouser K, Lischka TR, Mendez Chagoya LA, Al Jallad N, Wu TT, Fiscella K, Ivie E, Strange M, Collins J, Kopycka-Kedzierawski DT. Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice-Based Research Network: Protocol for Design, Implementation, and Usability Testing. JMIR Res Protoc 2021; 10:e32345. [PMID: 34597259 PMCID: PMC8549859 DOI: 10.2196/32345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. OBJECTIVE In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient's capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). METHODS This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient's capability of taking intraoral photos, by analyzing obtained photos and recorded videos. RESULTS The study is supported by the US National Institute of Dental and Craniofacial Research. This study received "single" institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. CONCLUSIONS The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32345.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Patricia Ragusa
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Tamara R Lischka
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | | | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Eden Ivie
- Mouthwatch LLC, Metuchen, NJ, United States
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Arany S, Kopycka-Kedzierawski DT, Caprio TV, Watson GE. Anticholinergic medication: Related dry mouth and effects on the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:662-670. [PMID: 34593340 DOI: 10.1016/j.oooo.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Salivary glands are among the most sensitive target organs of medications with anticholinergic (AC) properties, interrupting the neural stimulation of saliva secretion and reducing saliva flow. Hyposalivation results in dry mouth, leading to dental caries, intraoral infection, orofacial pain, problems with speaking and swallowing, and diminished oral health--related quality of life. Current understanding of the pharmacokinetics of AC medications and their effect on muscarinic receptors in the salivary glands were reviewed to assist clinicians in predicting salivary damage in patients with AC medication-induced dry mouth. STUDY DESIGN We summarized the literature related to the mechanisms and properties of AC medications, anticholinergic adverse effects, and their effect on salivary function and management strategies to prevent oral health damage. RESULTS Although a large number of studies reported on the frequencies of medication-induced dry mouth, we found very limited data on predicting individual susceptibility to AC medication--caused hyposalivation and no prospective clinical studies addressing this issue. CONCLUSION Dry mouth is most frequently caused by medications with AC properties, which interrupt the neural stimulation of saliva secretion. Interdisciplinary care should guide pharmacotherapeutics and dental interventions should aim in preventing AC salivary adverse effects and reducing the oral health burden from AC medication-induced dry mouth.
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Affiliation(s)
- Szilvia Arany
- Specialty Care, Department of General Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, NY, USA.
| | - Dorota T Kopycka-Kedzierawski
- Department of Community Dentistry and Oral Disease Prevention, University of Rochester, Rochester, NY, USA; Center for Oral Biology, University of Rochester, Rochester, NY, USA
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Gene E Watson
- Center for Oral Biology, University of Rochester, Rochester, NY, USA; Department of Dentistry, University of Rochester, Rochester, NY, USA; Department of Environmental Medicine and Pharmacology and Physiology, University of Rochester, Rochester, NY, USA
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Ben-Omran MO, Livinski AA, Kopycka-Kedzierawski DT, Boroumand S, Williams D, Weatherspoon DJ, Iafolla TJ, Fontelo P, Dye BA. The use of teledentistry in facilitating oral health for older adults: A scoping review. J Am Dent Assoc 2021; 152:998-1011.e17. [PMID: 34521539 DOI: 10.1016/j.adaj.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services. TYPES OF STUDIES REVIEWED Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria. RESULTS Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up. CONCLUSIONS AND PRACTICAL IMPLICATIONS Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.
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Quivey RG, O'Connor TG, Gill SR, Kopycka-Kedzierawski DT. Prediction of early childhood caries onset and oral microbiota. Mol Oral Microbiol 2021; 36:255-257. [PMID: 34314578 DOI: 10.1111/omi.12349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Robert G Quivey
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Thomas G O'Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Steven R Gill
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dorota T Kopycka-Kedzierawski
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Dentistry, Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Kopycka-Kedzierawski DT, Scott-Anne K, Ragusa PG, Cvetanovska M, Flint K, Feng C, Watson GE, Wong CL, Billings RJ, Quivey RJ, O'Connor TG. Social, Psychological, and Behavioral Predictors of Salivary Bacteria, Yeast in Caries-Free Children. JDR Clin Trans Res 2021; 7:163-173. [PMID: 33719664 DOI: 10.1177/2380084421999365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Early childhood caries (ECC) is a complex, multifactorial oral disease that is a major public health concern because it is prevalent, profoundly alters a child's quality of life, is difficult to treat effectively, and has a distressing tendency to recur following treatment. OBJECTIVES The purpose of the study was to examine social, psychological, and behavioral predictors of salivary bacteria and yeast in young children at risk for ECC. METHODS A sample of 189 initially caries-free preschool children was assessed for child stress physiology from salivary cortisol, child and family stress exposure, diet, oral health behaviors, and sociodemographic risks. Multiple logistic regression analysis was implemented to examine the associations between these risk factors and cariogenic microorganisms: mutans streptococci (MS), lactobacilli (LB), and Candida species. RESULTS Higher baseline salivary cortisol (odds ratio [OR] = 6.26; 95% confidence level [CL], 1.69-23.16) and a blunted response to an acute laboratory stressor (OR = .56; 95% CL, .37-.83) were associated with an increased likelihood of elevated salivary MS (≥105 colony-forming units/mL) in caries-free children. Sociodemographic risk for cariogenic microorganisms was also found. Specifically, lower education attainment of the parent/primary caregiver was associated with children being more likely to carry salivary Candida species and elevated salivary MS; in addition, children from households with an unemployed parent/primary caregiver were more likely (OR = 3.13; 95% CL, 1.2-8.05) to carry salivary Candida species and more likely (OR = 3.03; 95% CL, 1.25-7.33) to carry elevated levels of MS and/or salivary Candida and/or LB. CONCLUSIONS The impact of sociodemographic risk and stress physiology on cariogenic disease processes are evident prior to ECC onset. The findings provide novel data on the early onset of cariogenic processes in children and the importance of considering sociodemographic, psychosocial, and behavioral factors when judging ECC risk. KNOWLEDGE TRANSFER STATEMENT The findings provide valuable and novel findings that, pre-ECC onset, the caries disease process is explicable from a detailed assessment of behavioral, sociodemographic, and psychosocial stress variables.
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Affiliation(s)
- D T Kopycka-Kedzierawski
- Department of Dentistry and Center for Oral Biology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - K Scott-Anne
- Center for Oral Biology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - P G Ragusa
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - M Cvetanovska
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - K Flint
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - C Feng
- Department of Biostatistics and Computational Biology and Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, USA
| | - G E Watson
- Department of Dentistry and Center for Oral Biology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.,Department of Pharmacology and Physiology and Department of Environmental Medicine, University of Rochester, Rochester, NY, USA
| | - C L Wong
- Department of Pediatric Dentistry and Pediatrics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - R J Billings
- Department of Dentistry and Center for Oral Biology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - R J Quivey
- Center for Oral Biology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.,Department of Microbiology and Immunology, University of Rochester, Rochester, NY, USA
| | - T G O'Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA
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12
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Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Gordan VV, Kopycka-Kedzierawski DT, Meyerowitz C, Mungia R, Burton V. Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2020; 152:146-156. [PMID: 33358237 DOI: 10.1016/j.adaj.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes. METHODS Two-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified. RESULTS Of the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression. CONCLUSIONS Development of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both. PRACTICAL IMPLICATIONS This information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.
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13
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Grier A, Myers JA, O'Connor TG, Quivey RG, Gill SR, Kopycka-Kedzierawski DT. Oral Microbiota Composition Predicts Early Childhood Caries Onset. J Dent Res 2020; 100:599-607. [PMID: 33356775 DOI: 10.1177/0022034520979926] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
As the most common chronic disease in preschool children in the United States, early childhood caries (ECC) has a profound impact on a child's quality of life, represents a tremendous human and economic burden to society, and disproportionately affects those living in poverty. Caries risk assessment (CRA) is a critical component of ECC management, yet the accuracy, consistency, reproducibility, and longitudinal validation of the available risk assessment techniques are lacking. Molecular and microbial biomarkers represent a potential source for accurate and reliable dental caries risk and onset. Next-generation nucleotide-sequencing technology has made it feasible to profile the composition of the oral microbiota. In the present study, 16S ribosomal RNA (rRNA) gene sequencing was applied to saliva samples that were collected at 6-mo intervals for 24 mo from a subset of 56 initially caries-free children from an ongoing cohort of 189 children, aged 1 to 3 y, over the 2-y study period; 36 children developed ECC and 20 remained caries free. Analyses from machine learning models of microbiota composition, across the study period, distinguished between affected and nonaffected groups at the time of their initial study visits with an area under the receiver operating characteristic curve (AUC) of 0.71 and discriminated ECC-converted from healthy controls at the visit immediately preceding ECC diagnosis with an AUC of 0.89, as assessed by nested cross-validation. Rothia mucilaginosa, Streptococcus sp., and Veillonella parvula were selected as important discriminatory features in all models and represent biomarkers of risk for ECC onset. These findings indicate that oral microbiota as profiled by high-throughput 16S rRNA gene sequencing is predictive of ECC onset.
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Affiliation(s)
- A Grier
- Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - J A Myers
- Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - T G O'Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - R G Quivey
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - S R Gill
- Genomics Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - D T Kopycka-Kedzierawski
- Center for Oral Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,Department of Dentistry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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14
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Wang L, Ren J, Fiscella KA, Bullock S, Sanders MR, Loomis EL, Eliav E, Mendoza M, Cacciato R, Thomas M, Kopycka-Kedzierawski DT, Billings RJ, Xiao J. Interprofessional collaboration and smartphone use as promising strategies to improve prenatal oral health care utilization among US underserved women: results from a qualitative study. BMC Oral Health 2020; 20:333. [PMID: 33228617 PMCID: PMC7685586 DOI: 10.1186/s12903-020-01327-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Data on barriers and facilitators to prenatal oral health care among low-income US women are lacking. The objective of this study was to understand barriers/facilitators and patient-centered mitigation strategies related to the use of prenatal oral health care among underserved US women.
Methods We used community-based participatory research to conduct two focus groups with eight pregnant/parenting women; ten individual in-depth interviews with medical providers, dental providers and community/social workers; and one community engagement studio with five representative community stakeholders in 2018–2019. Using an interpretive description research design, we conducted semi-structured interviews and focus groups which were audio-recorded, transcribed, and analyzed for thematic content. Results We identified individual and systemic barriers/facilitators to the utilization of prenatal oral health care by underserved US women. Strategies reported to improve utilization included healthcare system-wide changes to promote inter-professional collaborations, innovative educational programs to improve dissemination and implementation of prenatal oral health care guidelines, and specialized dental facilities providing prenatal oral health care to underserved women. Moreover, smartphones have the potential to be an innovative entry point to promote utilization of prenatal oral care at the individual level. Conclusions Low-income women face multiple, addressable barriers to obtaining oral health care during pregnancy. Inter-professional collaboration holds strong promise for improving prenatal oral health care utilization.
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Affiliation(s)
- Lin Wang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.,Peking University School of Stomatology, Beijing, China
| | - Johana Ren
- University of Rochester River Campus, Rochester, NY, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mechelle R Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Elizabeth L Loomis
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Mendoza
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Monroe County Department of Public Health, Rochester, NY, USA
| | - Rita Cacciato
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie Thomas
- University of Rochester River Campus, Rochester, NY, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
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15
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Marzouk T, Alves IL, Wong CL, DeLucia L, McKinney CM, Pendleton C, Howe BJ, Marazita ML, Peter TK, Kopycka-Kedzierawski DT, Morrison CS, Malmstrom H, Wang H, Shope ET. Association between Dental Anomalies and Orofacial Clefts: A Meta-analysis. JDR Clin Trans Res 2020; 6:368-381. [PMID: 33030085 DOI: 10.1177/2380084420964795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis to assess whether individuals with nonsyndromic orofacial clefts (OCs) display a higher frequency of dental anomalies (DAs) when compared with individuals without OCs. METHODS A literature search of indexed databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and LILACS) was conducted without language restriction up to and including February 1, 2020. Cross-referencing was used to further identify articles. Several cleft teams across the United States and Europe were contacted to obtain unpublished data. The eligibility criteria were observational studies with original data that statistically compared individuals with OC without syndromes and those without OC on any type of DA in primary and/or permanent dentition. Random effects meta-analysis through the Mantel-Haenszel estimator was used to evaluate the association between OC and DA based on odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS The literature search generated 933 records, and 75 full-text articles were reviewed. Twenty-six studies encompassing 15,213 individuals met the inclusion criteria. The meta-analysis revealed statistically significant associations between OC and agenesis (OR, 14.2; 95% CI, 9.4 to 21.3), supernumerary teeth (OR, 5.7; 95% CI, 3.3 to 9.7), developmental enamel defects (OR, 5.6; 95% CI, 3.5 to 9.0), microdontia (OR, 14.8; 95% CI, 4.0 to 54.6), peg-shaped anterior teeth (OR, 12.2; 95% CI, 3.6 to 41.2), taurodontism (OR, 1.7; 95% CI, 1.0 to 2.7), tooth malposition and/or transposition (OR, 5.6; 95% CI, 2.8 to 11.5), tooth rotation (OR, 3.2; 95% CI, 1.3 to 8.2), and tooth impaction (OR, 3.6; 95% CI, 1.1 to 12.2). The OR estimates of the reviewed studies exhibited significant heterogeneity (P < 0.0001). No association was observed between OC and fusion and/or gemination. CONCLUSION Within the limitations of this study, the available evidence suggests that individuals with OCs are more likely to present with a range of DAs than their unaffected peers. KNOWLEDGE TRANSFER STATEMENT The findings of the current review suggest that individuals with orofacial clefts (OCs) are more likely to present with a range of dental anomalies than their unaffected peers. Understanding the association between OCs and dental anomalies is essential in guiding clinicians during treatment-planning procedures and is important in raising our awareness of the possible need for future dental treatment for patients with OCs.
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Affiliation(s)
- T Marzouk
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.,Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - I L Alves
- Dentistry Faculty, Federal University of Bahia, Salvador, BA, Brazil
| | - C L Wong
- Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - L DeLucia
- Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - C M McKinney
- Division of Craniofacial Medicine and Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - C Pendleton
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.,Iowa Institute for Oral Health Research, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - B J Howe
- Iowa Institute for Oral Health Research, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.,Department of Family Dentistry, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - M L Marazita
- Center for Craniofacial and Dental Genetics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - T K Peter
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA.,Iowa Institute for Oral Health Research, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - D T Kopycka-Kedzierawski
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - C S Morrison
- Golisano Cleft and Craniofacial Center, University of Rochester, Rochester, NY, USA.,Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - H Malmstrom
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - H Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - E T Shope
- Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.,Golisano Cleft and Craniofacial Center, University of Rochester, Rochester, NY, USA
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16
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Xiao J, Kopycka-Kedzierawski DT, Billings RJ. Intergenerational task: Helping expectant mothers obtain better oral health care during pregnancy. J Am Dent Assoc 2019; 150:565-566. [PMID: 31248477 DOI: 10.1016/j.adaj.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 11/27/2022]
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Kopycka-Kedzierawski DT, McLaren SW, Billings RJ. Advancement Of Teledentistry At The University Of Rochester's Eastman Institute For Oral Health. Health Aff (Millwood) 2019; 37:1960-1966. [PMID: 30633668 DOI: 10.1377/hlthaff.2018.05102] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dental caries is the most prevalent infectious disease among US children. National surveys have shown that poor and minority-group children are not only disproportionately affected by dental caries but also have limited access to oral health care. Following successful exploratory applications of both synchronous and asynchronous models at the Eastman Institute for Oral Health, teledentistry has been demonstrated to be a practical and cost-effective way to improve oral health care for rural and disadvantaged children. These models support the role of teledentistry in reducing the costs of and barriers to accessing oral health care, improving oral health outcomes, increasing use of oral health care resources, and leading to the establishment of a dental home for underserved children. The advancement of teledentistry underscores the need for its integration with local, regional, and national telehealth programs and the role of policy makers in establishing a balanced framework for teledentistry within the overarching health care system.
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Affiliation(s)
- Dorota T Kopycka-Kedzierawski
- Dorota T. Kopycka-Kedzierawski ( ) is an associate professor in the Division of Community Dentistry and Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester, in New York
| | - Sean W McLaren
- Sean W. McLaren is an associate professor in and chair of the Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester
| | - Ronald J Billings
- Ronald J. Billings is a professor emeritus at the Division of Community Dentistry and Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester
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18
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Litaker MS, Kopycka-Kedzierawski DT, Rindal DB, Fellows JL, Heft MW, Meyerowitz C, Chonowski S, Gilbert GH. Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network. BMC Oral Health 2019; 19:112. [PMID: 31200689 PMCID: PMC6570951 DOI: 10.1186/s12903-019-0772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations. METHODS A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated. RESULTS For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low. CONCLUSIONS Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.
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Affiliation(s)
- Mark S Litaker
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL, 35294-0007, USA.
| | | | - D Brad Rindal
- Health Partners Institute for Education and Research, 8170 33rd Avenue South, Mail Stop 21111R, PO Box 1524, Bloomington, MN, 55440-1524, USA
| | - Jeffrey L Fellows
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Marc W Heft
- Department of Oral & Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL, 32610-0416, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14620, USA
| | - Sidney Chonowski
- Private Practice of General Dentistry, 66 Maple Ave, Morristown, NJ, 07960, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL, 35294-0007, USA
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Kopycka-Kedzierawski DT, Cacciato R, Hennessey R, Meyerowitz C, Litaker MS, Heft MW, Johnson KS, Reyes SC, Johnson JD, Baltuck CT, Gilbert GH. Electronic and paper mode of data capture when assessing patient-reported outcomes in the National Dental Practice-Based Research Network. ACTA ACUST UNITED AC 2019; 10:e12427. [PMID: 31155859 DOI: 10.1111/jicd.12427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
AIM Our objectives were to describe the approach used in the National Dental Practice-Based Research Network to capture patient-reported outcomes and to compare electronic and paper modes of data capture in a specific network study. METHODS This was a prospective, multicenter cohort study of 1862 patients with dentin hypersensitivity. Patient-reported outcomes were assessed based on patients' perception of pain using Visual Analog Scales and Labeled Magnitude scales at baseline and at 1, 4 and 8 weeks post-baseline. RESULTS Eighty-five percent of study patients chose to complete follow-up assessments via an electronic mode; 15% completed them via a paper mode. There was not a significant difference in the proportions of patients who completed the 8-week assessment when comparing the electronic mode to the paper mode (92% vs. 90.8%, P = 0.31, Rao-Scott clustered χ2 -test). CONCLUSION The electronic mode of data capture was as operational as the traditional paper mode, while also providing the advantage of eliminating data entry errors, not involving site research coordinators in measuring the patient-reported outcomes, and not incurring cost and potential delays due to mailing study forms. Electronic data capture of patient reported outcomes could be successfully implemented in the community dental practice setting.
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Affiliation(s)
| | - Rita Cacciato
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | | | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Mark S Litaker
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marc W Heft
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Stephanie C Reyes
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James D Johnson
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Melkers J, Hicks D, Isett KR, Kopycka-Kedzierawski DT, Gilbert GH, Rosenblum S, Burton V, Mungia R, Melkers MJ, Ford G. Preferences for peer-reviewed versus other publication sources: a survey of general dentists in the National Dental PBRN. Implement Sci 2019; 14:19. [PMID: 30823931 PMCID: PMC6397483 DOI: 10.1186/s13012-019-0854-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Medical professionals have access to a broad range of resources to address clinical information needs. While much attention is given to new sources of data such as those available on the internet, it is less clear how clinicians choose between peer-reviewed research literature and other publication-based sources. This analysis distinguishes between possible drivers of publication type preference (namely, practice setting, advanced training, professional development experiences). Dentists enrolled in the National Dental Practice-Based Research Network (PBRN) are the population for this study. Theories of human and intellectual capital and institutional logics theory are used to understand how advanced training and other clinical experiences may explain the choices that dentists make when faced with clinical questions. Methods An online questionnaire was implemented with general dentists in the US National Dental PBRN. A series of logistic and Ordinary Least Squares (OLS) regression models were used to explain the use of peer-reviewed and other publications. Measures of knowledge-based human capital distinctions (advanced clinical training and research engagement, advanced professional status, personal motivation for professional advancement) were used to explain preferences for research literature as a clinical resource. Results General dentists with advanced training, as well as those with a skill advancement motivation, show a preference for peer-reviewed materials. General dentists who have been practicing longer tend to favor other dental publications, preferring those sources as a resource when faced with clinical challenges. Human capital and professional motivation distinguish the information preferences among general dentists. Further, these factors explain more variance in use of peer-reviewed materials than practice setting does. Few differences by demographic groups were evident. Conclusions Results point to a distinct variation in the general dentistry professional community. Advanced training among general dentists, as well as the types of procedures typically conducted in their practice, distinguishes their information preferences from other general dentists, including those with more years of clinical experience.
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Affiliation(s)
- Julia Melkers
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kimberley R Isett
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Rahma Mungia
- University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | | | - George Ford
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.,, Lawrenceville, USA
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Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, Rasubala L, Malmstrom H, Ren Y, Eliav E. Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis. Caries Res 2019; 53:411-421. [PMID: 30630167 PMCID: PMC6554051 DOI: 10.1159/000495187] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA,
| | - Naemah Alkhers
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Daniel A Castillo
- Miner Library, University of Rochester Medical Center, Rochester, New York, USA
| | - Linda Rasubala
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
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Xiao J, Grier A, Faustoferri RC, Alzoubi S, Gill AL, Feng C, Liu Y, Quivey RG, Kopycka-Kedzierawski DT, Koo H, Gill SR. Association between Oral Candida and Bacteriome in Children with Severe ECC. J Dent Res 2018; 97:1468-1476. [PMID: 30049240 DOI: 10.1177/0022034518790941] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Candida albicans is an opportunistic fungal organism frequently detected in the oral cavity of children with severe early childhood caries (S-ECC). Previous studies suggested the cariogenic potential of C. albicans, in vitro and in vivo, and further demonstrated its synergistic interactions with Streptococcus mutans. In combination, the 2 organisms are associated with higher caries severity in a rodent model. However, it remains unknown whether C. albicans influences the composition and diversity of the entire oral bacterial community to promote S-ECC onset. With 16s rRNA amplicon sequencing, this study analyzed the microbiota of saliva and supragingival plaque from 39 children (21 S-ECC and 18 caries-free [CF]) and 33 mothers (17 S-ECC and 16 CF). The results revealed that the presence of oral C. albicans is associated with a highly acidogenic and acid-tolerant bacterial community in S-ECC, with an increased abundance of plaque Streptococcus (particularly S. mutans) and certain Lactobacillus/Scardovia species and salivary/plaque Veillonella and Prevotella, as well as decreased levels of salivary/plaque Actinomyces. Concurrent with this microbial community assembly, the activity of glucosyltransferases (cariogenic virulence factors secreted by S. mutans) in plaque was significantly elevated when C. albicans was present. Moreover, the oral microbial community composition and diversity differed significantly by disease group (CF vs. S-ECC) and sample source (saliva vs. plaque). Children and mothers within the CF and S-ECC groups shared microbiota composition and diversity, suggesting a strong maternal influence on children's oral microbiota. Altogether, this study underscores the importance of C. albicans in association with the oral bacteriome in the context of S-ECC etiopathogenesis. Further longitudinal studies are warranted to examine how fungal-bacterial interactions modulate the onset and severity of S-ECC, potentially leading to novel anticaries treatments that address fungal contributions.
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Affiliation(s)
- J Xiao
- 1 Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - A Grier
- 2 Genomics Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - R C Faustoferri
- 1 Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - S Alzoubi
- 1 Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - A L Gill
- 3 Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA
| | - C Feng
- 4 Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Y Liu
- 5 Divisions of Pediatric Dentistry and Community Oral Health, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R G Quivey
- 1 Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.,2 Genomics Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | | | - H Koo
- 5 Divisions of Pediatric Dentistry and Community Oral Health, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S R Gill
- 2 Genomics Research Center, University of Rochester Medical Center, Rochester, NY, USA.,3 Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA
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Xiao J, Huang X, Alkhers N, Alzamil H, Alzoubi S, Wu TT, Castillo DA, Campbell F, Davis J, Herzog K, Billings R, Kopycka-Kedzierawski DT, Hajishengallis E, Koo H. Candida albicans and Early Childhood Caries: A Systematic Review and Meta-Analysis. Caries Res 2017; 52:102-112. [PMID: 29262404 DOI: 10.1159/000481833] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Oral Candida albicans has been detected in children with early childhood caries (ECC) and has demonstrated cariogenic traits in animal models of the disease. Conversely, other studies found no positive correlation between C. albicans and caries experience in children, while suggesting it may have protective effects as a commensal organism. Thus, this study aimed to examine whether oral C. albicans is associated with ECC. Seven electronic databases were searched. The data from eligible studies were extracted, and the risk of bias was evaluated. A fixed effects model (Mantel-Haenszel estimate) was used for meta-analysis, and the summary effect measure was calculated by odds ratio (OR) and 95% confidence interval (CI). Fifteen cross-sectional studies were included for the qualitative assessment and 9 studies for meta-analysis. Twelve studies revealed higher oral C. albicans prevalence in ECC children than in caries-free children, while 2 studies indicated an equivalent prevalence. A pooled estimate, with OR = 6.51 and 95% CI = 4.94-8.57, indicated a significantly higher ECC experience in children with oral C. albicans than those without C. albicans (p < 0.01). The odds of experiencing ECC in children with C. albicans versus children without C. albicans were 5.26 for salivary, 6.69 for plaque, and 6.3 for oral swab samples. This systematic review indicates that children with oral C. albicans have >5 times higher odds of having ECC compared to those without C. albicans. Further prospective cohort studies are needed to determine whether C. albicans could be a risk factor for ECC, and whether it is dependent on different sample sources (saliva/plaque).
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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Heft MW, Litaker MS, Kopycka-Kedzierawski DT, Meyerowitz C, Chonowski S, Yardic RL, Gordan VV, Mungia R, Gilbert GH. Patient-Centered Dentinal Hypersensitivity Treatment Outcomes: Results from the National Dental PBRN. JDR Clin Trans Res 2017; 3:76-82. [PMID: 29276777 DOI: 10.1177/2380084417742099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dentinal hypersensitivity (DH) can have a significant impact on oral health and functioning, and it is a clinical symptom commonly managed by dentists during routine clinical practice. DH symptoms are typically elicited by otherwise innocuous, nonpainful stimuli applied to exposed dentin (e.g., tactile stimuli, warming or cooling temperatures or air puffs). Treatment approaches have sought to directly target the dentinal pulp tissues or close dentinal tubules via dental office care and treatment services (fluoride varnishes, glutaraldehydes, bonding agents, sealants, oxalates, or lasers) or home care services (toothpastes or dentifrices containing fluoride or potassium nitrate compounds). The purpose of this prospective multicenter cohort study was to assess how community-based dentists from the National Dental Practice-Based Research Network (National Dental PBRN) manage DH and whether the effectiveness of DH treatments can be assessed in those settings. A total of 171 dentists recruited 1862 subjects with DH from their existing patients. Dentists then recommended and provided DH treatment as appropriate. Treatment choice was at the discretion of the dentists. Patients rated their DH pain at baseline and 1, 4, and 8 wk during the course of their treatments. They used pain intensity and unpleasantness visual analog scales and 4 labeled magnitude scales and rated their satisfaction with treatment after 8 wk. Patients were provided reminders postbaseline via email, texting, or voice mail. These patient-centered outcomes served as the principal measures for the assessment of treatment because treatments sought to alleviate DH symptoms. The patients with DH who reported pain reduction from dentist-provided treatments (glutaraldehyde/HEMA [hydroxyethyl methacrylate] compounds, oxalates, and bonding agents), dentists' advice and counseling regarding oral habits and diet, and patient-applied fluoride toothpaste reported a concomitant positive rating of satisfaction with DH treatments. The results from this study support the feasibility of engaging network practices to assess the effectiveness of clinical DH treatments. Knowledge Transfer Statement: National Dental PBRN dentists provide a range of procedures to treat dentinal hypersensitivity. In this large nonrandomized study designed to assess clinical care and to capture patient-reported outcomes, about 60% of patients reported improvement in pain. This study demonstrated the feasibility of engaging network dentists and their patients to assess treatment effectiveness. Future studies will explore the feasibility of imposing randomization and measuring patient compliance with treatment in the manner that this treatment is provided.
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Affiliation(s)
- M W Heft
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - M S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - C Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - S Chonowski
- Private practice, general dentistry, Morristown, NJ, USA
| | - R L Yardic
- HealthPartners Apple Valley Dental Clinic, Apple Valley, MN, USA
| | - V V Gordan
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - R Mungia
- Department of Periodontology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - G H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Kopycka-Kedzierawski DT, Meyerowitz C, Litaker MS, Heft MW, Tasgaonkar N, Day MR, Porter-Williams A, Gordan VV, Yardic RL, Lawhorn TM, Gilbert GH. Management of dentin hypersensitivity by practitioners in The National Dental Practice-Based Research Network. J Am Dent Assoc 2017. [PMID: 28629602 DOI: 10.1016/j.adaj.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dentin hypersensitivity (DH) is a condition commonly encountered in clinical dental practice. The authors conduct a study to identify the treatments recommended to manage DH among dentists in the United States. METHODS The authors conducted a multicenter study of 1,862 patients with DH who received a diagnosis and were treated by 171 dentists with The National Dental Practice-Based Research Network. RESULTS The most common treatment recommended was desensitizing over-the-counter (OTC) potassium nitrate toothpaste (alone or in combination with other treatments) for 924 of 1,862 patients (50%). This was followed by an application of fluoride varnish (FV) for 516 patients (28%) and a prescription for fluoride toothpaste for 314 patients (17%). Restorative treatments were recommended to 151 patients (8%). The most common single treatment recommendation was desensitizing OTC potassium nitrate toothpaste, recommended to 335 patients (18%). The most frequent combination of 2 treatment modalities was FV and desensitizing OTC potassium nitrate toothpaste, recommended to 100 patients (5%). A total of 890 of 1,862 patients (48%) with DH received a recommendation for 1 treatment modality, and 644 of 1,862 patients (35%) received a recommendation for a combination of 2 treatment modalities, most frequently an application of FV along with desensitizing OTC potassium nitrate toothpaste (100/1,862; 5%). CONCLUSIONS Desensitizing OTC potassium nitrate toothpaste and fluoride products were the most widely recommended products to manage DH in the practice setting. PRACTICAL IMPLICATIONS Our results suggest that most network clinicians preferred noninvasive treatment modalities when treating DH.
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Kopycka-Kedzierawski DT, Meyerowitz C, Litaker MS, Chonowski S, Heft MW, Gordan VV, Yardic RL, Madden TE, Reyes SC, Gilbert GH. Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic. BMC Oral Health 2017; 17:41. [PMID: 28086862 PMCID: PMC5237301 DOI: 10.1186/s12903-017-0334-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. Methods One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. Results Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist’s query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). Conclusions The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.
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Affiliation(s)
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14620, USA
| | - Mark S Litaker
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Stephanie C Reyes
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Xiao J, Moon Y, Li L, Rustchenko E, Wakabayashi H, Zhao X, Feng C, Gill SR, McLaren S, Malmstrom H, Ren Y, Quivey R, Koo H, Kopycka-Kedzierawski DT. Candida albicans Carriage in Children with Severe Early Childhood Caries (S-ECC) and Maternal Relatedness. PLoS One 2016; 11:e0164242. [PMID: 27741258 PMCID: PMC5065202 DOI: 10.1371/journal.pone.0164242] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Candida albicans has been detected together with Streptococcus mutans in high numbers in plaque-biofilm from children with early childhood caries (ECC). The goal of this study was to examine the C. albicans carriage in children with severe early childhood caries (S-ECC) and the maternal relatedness. Methods Subjects in this pilot cross-sectional study were recruited based on a convenient sample. DMFT(S)/dmft(s) caries and plaque scores were assessed during a comprehensive oral exam. Social-demographic and related background information was collected through a questionnaire. Saliva and plaque sample from all children and mother subjects were collected. C. albicans were isolated by BBL™ CHROMagar™ and also identified using germ tube test. S. mutans was isolated using Mitis Salivarius with Bacitracin selective medium and identified by colony morphology. Genetic relatedness was examined using restriction endonuclease analysis of the C. albicans genome using BssHII (REAG-B). Multilocus sequence typing was used to examine the clustering information of isolated C. albicans. Spot assay was performed to examine the C. albicans Caspofungin susceptibility between S-ECC children and their mothers. All statistical analyses (power analysis for sample size, Spearman’s correlation coefficient and multiple regression analyses) were implemented with SAS 9.4 Results A total of 18 S-ECC child-mother pairs and 17 caries free child-mother pairs were enrolled in the study. Results indicated high C. albicans carriage rate in the oral cavity (saliva and plaque) of both S-ECC children and their mothers (>80%). Spearman’s correlation coefficient also indicated a significant correlation between salivary and plaque C. albicans and S. mutans carriage (p<0.01) and caries severity (p<0.05). The levels of C. albicans in the prepared saliva and plaque sample (1ml resuspension) of S-ECC children were 1.3 ± 4.5 x104 cfu/ml and 1.2 ± 3.5 x104 cfu/ml (~3-log higher vs. caries-free children). Among 18 child-mother pairs, >60% of them demonstrated identical C. albicans REAG-B pattern. C. albicans isolated from >65% of child-mother pairs demonstrated similar susceptibility to caspofungin in spot assay, while no caspofungin resistant strains were seen when compared with C. albicans wild-type strain SC5314. Interestingly, the regression analysis showed that factors such as antibiotic usage, birth weight, inhaler use, brushing frequency, and daycare attendance had no significant effect on the oral carriage of C. albicans in the S-ECC children. Conclusions Our results reveal that both the child with S-ECC and the mother were highly infected with C. albicans, while most of the strains were genetically related, suggesting that the mother might be a source for C. albicans acquisition in the oral cavity of children affected by the disease.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
| | - Yonghwi Moon
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Lihua Li
- Department of Dentistry, North Sichuan Medical University, Sichuan, China
| | - Elena Rustchenko
- Department of Biochemistry and Biophysics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hironao Wakabayashi
- Department of Biochemistry and Biophysics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Xiaoyi Zhao
- School of Dentistry, Peking University, Beijing, China
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Steven R. Gill
- Genomics Research Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sean McLaren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hans Malmstrom
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Robert Quivey
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hyun Koo
- Department of Orthodontics and Pediatric Dentistry & Community Oral Health Divisions, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Javed F, Feng C, Kopycka-Kedzierawski DT. Incidence of early childhood caries: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2016; 8. [DOI: 10.1111/jicd.12238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/11/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Fawad Javed
- Department of General Dentistry; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - Changyong Feng
- Department of Biostatistics and Computational Biology; University of Rochester; Rochester NY USA
| | - Dorota T. Kopycka-Kedzierawski
- Division of Community Dentistry and Oral Disease Prevention; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
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McLaren SW, Kopycka-Kedzierawski DT, Nordfelt J. Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic. J Telemed Telecare 2016; 23:710-715. [DOI: 10.1177/1357633x16661428] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The purpose of this study was to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. Methods A retrospective dental record review was completed of 251 rural pediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a board-certified pediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. Proportions of children who were referred for specific treatment modalities and who completed treatment and proportions of children for whom the treatment recommendation was changed were calculated. Fisher’s exact test was used to assess statistical significance. Results The initial treatment modality was not changed for 221/251 (88%) children initially seen for a teledentistry consultation. Thirty (12%) children had the initial treatment modality changed, most frequently children who were initially suggested treatment with nitrous oxide. Based on the initial treatment modality, changes to a different treatment modality were statistically significant (Fisher’s exact test, p < 0.0001). Conclusions Our data suggest that the use of a live-video teledentistry consultation can be an effective way of predicting the best treatment modality for rural children with significant dental disease. A live-video teledentistry consultation can be an effective intervention to facilitate completion of complex treatment plans for children from a rural area that have extensive dental needs.
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Affiliation(s)
- Sean W McLaren
- Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, USA
| | | | - Jed Nordfelt
- Division of Pediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, USA
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Abstract
In Rochester, NY, telehealth centres were established in six inner-city elementary schools and seven child-care centres. The teledentistry project complemented the existing telehealth model. Using an intraoral camera, telehealth assistants record digital images of children's teeth (768 × 494 pixels) and send the images to a computer at the expert dental site (the Eastman Department of Dentistry at the University of Rochester). The paediatric dentist at the expert site reviews the images, and provides referral and treatment recommendations. Subsequently, the telehealth assistant contacts the child's parents or guardians and assists them to obtain appropriate dental care for their child. In the pilot study, we screened 50 children. In the first nine months of 2005, we screened 123 children. The results of our initial teledental screenings of children aged 12–48 months attending inner-city child-care centres revealed that almost 40% had active dental caries, mainly early childhood caries (ECC). For the first time, many children attending inner-city child-care centres have had their teeth examined at an early age and been given prompt feedback on the need for dental care.
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McLaren SW, Kopycka-Kedzierawski DT. Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report. J Telemed Telecare 2015; 22:198-202. [DOI: 10.1177/1357633x15590705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/19/2015] [Indexed: 11/15/2022]
Abstract
Objective The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. Methods A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. Results The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher’s exact test, p > 0.05). Conclusions Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases.
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Affiliation(s)
- Sean W McLaren
- Division of Paediatric Dentistry, Eastman Institute for Oral Health, University of Rochester, NY, USA
| | - Dorota T Kopycka-Kedzierawski
- Division of Community Dentistry and Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester, NY, USA
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Kopycka-Kedzierawski DT. Maternal salivary bacterial challenge is associated with oral infection among children and predicts early childhood caries (ECC) incidence in a high-risk cohort of 36-month-old children. J Evid Based Dent Pract 2014; 14:147-8. [PMID: 25234219 DOI: 10.1016/j.jebdp.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kopycka-Kedzierawski DT, Billings RJ. Comparative effectiveness study to assess two examination modalities used to detect dental caries in preschool urban children. Telemed J E Health 2013; 19:834-40. [PMID: 24053114 PMCID: PMC3810618 DOI: 10.1089/tmj.2013.0012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/15/2013] [Accepted: 03/19/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children. SUBJECTS AND METHODS Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months. RESULTS At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001). CONCLUSIONS These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group.
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Kopycka-Kedzierawski DT. Child’s Age at the Time of Traumatic Injury to the Primary Dentition Contributes to the Increased Risk of the Presence of the Developmental Sequelae in the Permanent Dentition. J Evid Based Dent Pract 2012; 12:33-4. [DOI: 10.1016/j.jebdp.2011.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gill JB, Karp JM, Kopycka-Kedzierawski DT. Oral piercing injuries treated in United States emergency departments, 2002-2008. Pediatr Dent 2012; 34:56-60. [PMID: 22353459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to report the epidemiology and clinical history of oral piercing injuries presenting to US hospital emergency departments (EDs). METHODS A retrospective analysis of oral piercing injuries was performed using patient injury data collected from 2002 through 2008 using the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission. National estimates of ED visits were analyzed by injury type, anatomic site, and mechanism of injury according to age, gender, and race. RESULTS An estimated 24,459 oral piercing injuries presented to US EDs during the 7-year period. The male:female ratio for ED visits was 1:2.6. Patients 14- to 22-years-old accounted for 73% of the ED visits. Injuries to the lips (46%), tongue (42%), and teeth (10%) predominated. Infections (42%) and soft tissue puncture wounds (29%) caused injury most commonly. Thirty-nine percent of ED visits resulted from patients' inability to remove mucosally overgrown oral piercings. Hospitalization was rarely required (<1%). CONCLUSIONS Oral piercing injuries treated in US hospital emergency departments are most prevalent in teenagers and young adults. National data indicates that dentists working in emergency departments should be prepared to manage oral hard and soft tissue complications caused by oral piercings.
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Affiliation(s)
- J Brent Gill
- University of Rochester Medical Center, Rochester, NY, USA
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Berkowitz RJ, Amante A, Kopycka-Kedzierawski DT, Billings RJ, Feng C. Dental caries recurrence following clinical treatment for severe early childhood caries. Pediatr Dent 2011; 33:510-514. [PMID: 22353412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To determine the relapse rate within one year for a cohort of children treated for severe early childhood caries (S-ECC). METHODS In an earlier report, we assessed the suppressive effect of 10 percent povidone-iodine and the elimination of active caries on salivary mutans streptococci (MS) populations in 77 children with S-ECC; 49 children returned for a 6-month recall exam that occurred 5 to 12 months post dental surgery. Relapse declaration required at least one caries lesion needing a restoration. Contrasts of relapse (R) and non-relapse (NR) to the covariates of gender, race, ethnicity, age, surfaces available for relapse (SAR), time to appointment, and baseline salivary mutans streptococci (MS) counts were statistically evaluated. RESULTS 19 children (39%) were declared R and 30 (61%) were NR. The 2 groups did not statistically differ on: gender, race, ethnicity, age, SAR, baseline salivary MS counts and time to recall appointment. Statistical analyses also showed the covariates had no significant effect on probability of relapse or time to relapse (P>0.05). CONCLUSIONS None of the covariates were related to R. The R rate (39%) observed is consistent with earlier reports. Novel approaches are needed to improve relapse prevention.
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Affiliation(s)
- Robert J Berkowitz
- Department of Dentistry, School of Medicine and Dentistry, the University of Rochester Medical Center, Rochester, NY, USA.
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Kopycka-Kedzierawski DT, Billings RJ. Prevalence of dental caries and dental care utilisation in preschool urban children enrolled in a comparative-effectiveness study. Eur Arch Paediatr Dent 2011; 12:133-8. [PMID: 21640057 PMCID: PMC3111947 DOI: 10.1007/bf03262794] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To assess dental caries prevalence and dental care utilisation in pre-school children enrolled in urban childcare centres that participated in a comparative effectiveness study. STUDY DESIGN Cross-sectional study. METHODS Caries prevalence was determined in a cohort of children 12-60 months of age. Eligible children were randomised into two groups: group one received a traditional visual/tactile oral examination and group two received a teledentistry examination. Questionnaires were administered to the children's parents/guardians to gather demographics and information about using dental and medical services. RESULTS Of 234 children examined, approximately 28% had caries experience. The mean dfs score was 1.56 with a range of 0-34 carious surfaces. The mean dfs score for the children examined by means of teledentistry was 1.75 and for the children examined by means of the traditional visual/tactile method mean dfs was 1.40; the means between the two groups were not significantly different. Twenty-six children showed evidence of being treated for dental caries. According to the parents, 31.5% of the children had never had a dental check-up before, only 3% of the children were lacking dental insurance and majority of the parents (92%) did not perceive accessing dental care for the children as a problem. STATISTICS The Wilcoxon Mann-Whitney test and the Kruskal-Wallis test were used to assess statistical differences among groups of children. CONCLUSIONS The data showed that 28% of the children had caries and, of these, 61% had never been treated for caries, thus indicating that continued efforts are needed to improve oral health care utilisation by inner-city preschool children.
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Affiliation(s)
- D T Kopycka-Kedzierawski
- University of Rochester, Eastman Institute for Oral Health, 625 Elmwood Ave, Box 683, Rochester, NY 14620, USA.
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Berkowitz RJ, Koo H, McDermott MP, Whelehan MT, Ragusa P, Kopycka-Kedzierawski DT, Karp JM, Billings R. Adjunctive chemotherapeutic suppression of mutans streptococci in the setting of severe early childhood caries: an exploratory study. J Public Health Dent 2010; 69:163-7. [PMID: 19486465 DOI: 10.1111/j.1752-7325.2009.00118.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This investigational study assessed the suppressive effect of 10 percent povidone iodine (PI) coupled with elimination of active carious lesions on salivary mutans streptococci (MS) populations in children with severe early childhood caries (S-ECC). METHODS 77 children (38 females, 39 males) were treated for S- ECC in one session; a 0.2 ml PI solution was applied to the dentition after dental surgery was completed and immediately wiped off. The subjects aged from 2 to 5 years (mean = 3.78 years) at baseline. Whole nonstimulated saliva samples were obtained at baseline, 30 days, 60 days, and 90 days post dental surgery. Samples were placed on ice and processed within 2 hours. The MS level in each sample was expressed as colony forming units (CFUs) per ml of saliva. RESULTS Approximately 50 percent of subjects had a >95 percent reduction in CFU/ml of saliva at each time point after baseline. The percentages of subjects with a >50 percent reduction in MS level were 85 percent at 30 days, 83 percent at 60 days, 84 percent at 90 days. The median (25th, 75th percentiles) CFUs/ml of saliva counts were 8.40 x 10(5) (1.49 x 10(5), 5.00 x 10(6)) at baseline (n= 77), 4.12 x 10(4) (8.40 x 10(3), 1.89 x 10(5)) at 30 days (n = 74), 4.62 x 10(4) (7.00 x 10(3), 1.36 x 10(5)) at 60 days (n = 70), and 5.09 x 10(4) (1.16 x 10(4), 1.00 x 10(5)) at 90 days (n = 70). The changes from baseline to 30 days, 60 days, and 90 days were statistically significant (P < 0.0001). CONCLUSIONS PI coupled with dental surgery has a significant suppressive effect on salivary MS levels in the setting of S-ECC for at least 90 days. These data strongly suggest that treatment with PI may be an important adjunct to dental surgery for S-ECC.
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Affiliation(s)
- Robert J Berkowitz
- University of Rochester/Eastman Dental Center, 625 Elmwood Avenue, Rochester, NY 14620, USA.
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Pardi V, Kopycka-Kedzierawski DT, Billings RJ, Pereira SM, de Meneghim M, Pereira AC. Assessment of caries experience in 12-year-old adolescents in Piracicaba, Sao Paulo, Brazil. Oral Health Prev Dent 2010; 8:361-367. [PMID: 21180673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. MATERIALS AND METHODS A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. RESULTS The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. CONCLUSIONS The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk.
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Affiliation(s)
- Vanessa Pardi
- Departamento de odontologia Social, UNICAMP, Sao Paulo, Brazil.
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Iida H, Kumar JV, Kopycka-Kedzierawski DT, Billings RJ. Effect of Tobacco Smoke on the Oral Health of US Women of Childbearing Age. J Public Health Dent 2009; 69:231-41. [DOI: 10.1111/j.1752-7325.2009.00128.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kopycka-Kedzierawski DT, Bell CH, Billings RJ. Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry. Pediatr Dent 2008; 30:329-333. [PMID: 18767513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE This study's purpose was to assess caries prevalence by means of teledentistry in 12- to 60-month old children enrolled in Early Head Start inner-city child core centers. METHODS Images of the primary dentition were obtained by trained telehealth assistants using on intraoral camera. Images were entered into a Web-based storage and retrieval program. They were transmitted to a secure, remote-site computer and evaluated by a calibrated pediatric dentist. RESULTS Of 162 children screened, 93 were caries free and 69 had early childhood caries (ECC). Of these, 28 had severe early childhood caries (S-ECC). The mean dfs score for all 162 children was 1.88. The mean dfs score for the 69 ECC children was 4.42. The mean dfs for the subgroup of 28 S-ECC children was 7.61. Caries scores of S-ECC children were statistically significantly different from caries scores of the entire cohort and from caries scores of the ECC children. CONCLUSIONS This study's results show that: (1) almost half of the preschoolers enrolled in the study were affected by dental caries; (2) only a few children had ever had a dental visit; and (3) teledentistry offers a potentially efficient means of screening high-risk preschool children for signs of early childhood caries.
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Kopycka-Kedzierawski DT, Auinger P, Billings RJ, Weitzman M. Caries status and overweight in 2- to 18-year-old US children: findings from national surveys. Community Dent Oral Epidemiol 2008; 36:157-67. [PMID: 18333880 DOI: 10.1111/j.1600-0528.2007.00384.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of overweight children in the United States continues to increase. OBJECTIVES To examine the relationship between being overweight and caries in primary and permanent dentition in a nationally representative sample of children. METHODS Data from the NHANES III (1988-1994) were analyzed using logistic regression and controlling for potential confounders for 10 180 children 2-18 years of age and from the NHANES 1999-2002 for 7568 children 2-18 years of age. RESULTS For children 2-5 years of age, there was no difference in caries experience among normal weight, at risk for overweight or overweight children for NHANES III and for NHANES 1999-2002. For children 6-11 years of age (NHANES III), at risk for overweight and overweight children were less likely to have caries experience in the primary dentition than normal weight children; overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 12-18 years of age (NHANES III), overweight children were less likely to have caries experience in the permanent dentition than normal weight children. For children 6-11 years of age and 12-18 years of age (NHANES 1999-2002), there was no difference in having caries experience among normal, at risk for overweight and overweight children. CONCLUSIONS The data from NHANES III and NHANES 1999-2002 provide no evidence to suggest that overweight children are at an increased risk for dental caries. Although no differences in caries rates by weight were found in younger children, interestingly results from NHANES III suggest that being overweight may be associated with decreased rates of caries in older children.
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Kopycka-Kedzierawski DT, Auinger P. Dental needs and status of autistic children: results from the National Survey of Children's Health. Pediatr Dent 2008; 30:54-58. [PMID: 18402100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the oral health status and dental needs of a nationally representative sample of 1- to 17-year-old children with or without autism. METHODS In the 2003 National Survey of Children's Health, parents reported their child's oral health status and needs. The condition of the child's teeth, demographics, time since last dental visit, and dental needs were assessed in autistic children (N=495) and nonautistic children (N=95,059). For a subset of children with reported fair or poor teeth, specific problems about their dentition were assessed for autistic children (N=69) and nonautistic children (N=7,002). Weighted percentages and chi-square statistics were calculated. RESULTS According to parents, 69% of nonautistic children and 52% of autistic children had their teeth in excellent or very good condition (P <.001). The dental status of children with autism and without autism, identified with fair or poor teeth, was comparable. CONCLUSIONS Overall, parents of US autistic children were more likely to report their children's dentition to be in fair or poor condition than parents of US nonautistic children. Children with or without autism who had fair or poor teeth are faced with similar dental problems.
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Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent 2007; 29:209-13. [PMID: 17688017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE The purpose of this study was to assess the feasibility and reliability of using intraoral cameras and telehealth communication technology to screen preschool children for oral disease, in particular early childhood caries (ECC). METHODS The authors used the existing infrastructure of the Health-e-Access telehealth Network to: (1) assess the diagnostic quality of dental images using the Dr. Camscope intraoral camera; and (2) compare the resulting images to a traditional oral examination. A calibrated dental examiner observed 50 preschool children 4 to 6 years old who were enrolled in an inner-city childcare center. Following the oral examination, images of the children's teeth were obtained by a trained telehealth assistant and transmitted to the remote site computer; identifiers were removed and the images were randomized. After a 2-week washout period, the images were read by the same examiner. RESULTS A complete set of dental images was obtained from all 50 children in the study. A greater proportion of children examined using the intraoral camera were observed to have caries (42%) compared to children examined visually (28%). Furthermore, a greater number of carious teeth were detected from the images than from the visual examinations. The mean teledentistry dfs score was 2.10, and the oral examination 1.50 (P > .05). The kappa agreement was 61 (kappa = 0.61; 95% CI = 039-0.89). CONCLUSIONS There was no statistically significant difference between a visual examination and an examination using an intraoral camera, thus suggesting that the intraoral camera is a feasible and potentially cost-effective alternative to a visual oral examination for caries screening, especially early childhood caries, in preschool children attending childcare centers.
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Abstract
OBJECTIVES Markov modeling is a useful mathematical procedure for calculating probabilities of disease prognosis. Increasingly, Markov models are being applied in medical and health services research and also in social sciences research. The purpose of our study was to use the Markov process to determine time-dependent transition probabilities for caries-free children to convert to a caries-active state and to assess the impact of salivary mutans streptococci (MS) levels on caries status. METHODS Our analysis was based on data obtained from a 6-year longitudinal study of risk factors associated with caries onset in children. RESULTS Based on a two-state Markov model, the probability that a caries-free child would convert to a caries-active state during the study ranged between 0.0046 and 0.0471. The highest probability of converting from a caries-free state to a caries-active state was 0.0471 at age 8.5 years. CONCLUSIONS In addition to standard statistical methods of analyzing longitudinal caries data, Markov models show promise for use in the analysis of caries risk.
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Kopycka-Kedzierawski DT, Billings RJ. A longitudinal study of caries onset in initially caries-free children and baseline salivary mutans streptococci levels: a Kaplan-Meier survival analysis. Community Dent Oral Epidemiol 2004; 32:201-9. [PMID: 15151690 DOI: 10.1111/j.1600-0528.2004.00153.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To apply survival analysis to a longitudinal study of the relationship between salivary mutans streptococci (MS) levels at baseline in initially caries-free children and caries onset in deciduous, mixed, and permanent dentition. METHODS The Kaplan-Meier survival analysis method was used to compare survival times to caries onset for initially caries-free children with low levels of MS at baseline with survival times to caries onset for initially caries-free children with high levels of MS at baseline. RESULTS Data from a 6-year longitudinal study of caries risk in initially caries-free children in Rochester and the Finger Lakes Region of western New York were utilized for this study. Of 464 children analyzed, 327 had a low level of MS and 137 had a high level of MS at baseline. Survival analyses showed that children with a low level of MS at baseline remained caries-free for a longer period than children with a high level of MS at baseline. Statistically significant relationships [hazard ratios (HR)] with onset of caries in deciduous, mixed and permanent teeth were found with high and low levels of salivary MS. CONCLUSIONS Based on our analysis, we concluded that children who were caries-free at baseline and who had high salivary MS levels at baseline would be at greater risk, i.e. more susceptible to caries onset, at any given time than caries-free children who had low salivary MS levels at baseline. Survival functions for deciduous, mixed and permanent dentitions with their 95% confidence limits have been calculated. Survival analysis for the exploration of longitudinal caries studies has an advantage over traditional statistical methods, as it takes into account censored observations and incorporates the concept of risk over time. Hence, survival analysis is well suited for studying transitions from one health state to another, in this case, from a caries-free state to a caries-active state.
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Almog DM, Devries JA, Borrelli JA, Kopycka-Kedzierawski DT. The reduction of broken appointment rates through an automated appointment confirmation system. J Dent Educ 2003; 67:1016-22. [PMID: 14518840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Broken appointments continue to be an important productivity, quality assurance, and access gauge for private dental practices and academic dental centers. In November 2001, the University of Rochester Eastman Dental Center, an urban academic dental center, installed an automated confirmation system to address a high incidence of broken appointments. Following the installation of the system, the Eastman Dental Center experienced a marked decrease in the broken appointment rate. Over a twelve-month period, the center's overall broken rate declined from 23.42 percent to 19.17 percent. The general dentistry rate declined from 23.67 percent to 19.77 percent, and the pediatric dentistry rate declined from 29.42 percent to 25.25 percent.
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Affiliation(s)
- Dov M Almog
- University of Rochester Eastman Dental Center, Rochester, NY 14620, USA.
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Almog DM, Devries JA, Borrelli JA, Kopycka-Kedzierawski DT. The Reduction of Broken Appointment Rates Through an Automated Appointment Confirmation System. J Dent Educ 2003. [DOI: 10.1002/j.0022-0337.2003.67.9.tb03684.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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