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Ko A, O’Brien D, Rivera P, Mancl L, Hopkins S, Randall C, Nguyen DP, Chi DL. Identifying sources of variation in added sugar intake for Alaska Native children using a hair biomarker. Int J Circumpolar Health 2024; 83:2336286. [PMID: 38560896 PMCID: PMC10986438 DOI: 10.1080/22423982.2024.2336286] [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: 09/16/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Sugars from sugar-sweetened beverages (SSBs) are an important risk factor for tooth decay. The study goal was to determine if there was variation in added sugar intake across communities and between and within households. In this cross-sectional study, intakes of total sugar, added sugar, and sugar-sweetened beverages (SSBs) were estimated for 282 Alaska Native children ages 0-10 years from 131 households in three Yukon-Kuskokwim (YK) Delta communities using biomarker equations based on hair carbon and nitrogen isotope ratios previously developed for the Yup'ik population. ANOVA was used to assess associations between each predictor (community and household) and outcome (estimated total sugars, added sugars, and SSB intake). Between- and within-household variation was estimated using a linear mixed-effects model with a random intercept for households with three or more children. There was no significant difference in mean estimated total sugar (p = 0.29), added sugar (p = 0.24), or SSB intake (p = 0.40) across communities. Significant variations were observed between and within households, with within-household variation amounting to 59% of the between-household variation. Added sugar intake in Alaska Native children from the three study communities is higher than the recommended maximum, and the variation is greater within households than between households.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Diane O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Patricia Rivera
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Scarlett Hopkins
- Departments of Medicine and Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Cameron Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
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Frenkel ES, Mustafa M, Khosravi R, Woloshyn H, Mancl L, Bollen AM. Occlusal contact changes in patients treated with clear aligners: A retrospective evaluation using digital dental models. Am J Orthod Dentofacial Orthop 2024:S0889-5406(24)00062-3. [PMID: 38573295 DOI: 10.1016/j.ajodo.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/01/2024] [Accepted: 01/01/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION This study used digital intraoral scans to evaluate how clear aligner treatment affects occlusal contacts and to determine the influence of sex and age on contact changes. Results were compared with contact changes that occur during fixed appliance therapy. METHODS Patients included in this study were treated in a University setting and private practice. Inclusion criteria were a Class I malocclusion treated nonextraction with clear aligners and the presence of pretreatment and posttreatment digital intraoral scans. Scans were imported into specialized software, and occlusal contacts were analyzed. The effects of age and sex on contact changes during clear aligner treatment were determined. Changes in occlusal contacts were compared with changes that occur during nonextraction treatment of patients with a Class I relationship using fixed edgewise appliances. RESULTS A total of 45 clear aligner patients fit the eligibility criteria. Clear aligner treatment reduced the percentage of tight, near, and approximating contacts, whereas the percentage of open and no contacts increased. These changes in occlusal contacts were greater for the older age group studied. Genderinfluenced occlusal contact changes in the anterior dentition only where the decrease in near contacts and increase in open contacts were greater for males. These results for patients treated with clear aligners were similar to those for patients treated with fixed appliances; both treatment modalities reduced close occlusal contacts at the time active treatment was completed. CONCLUSIONS These results indicated that when clear aligners or fixed appliances are used to treat a Class I malocclusion, the resulting occlusion immediately after debonding is not as "tight" as it was at pretreatment.
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Affiliation(s)
- Erica Shapiro Frenkel
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash.
| | - Mariam Mustafa
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Roozbeh Khosravi
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Heather Woloshyn
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Lloyd Mancl
- Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Wash
| | - Anne-Marie Bollen
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
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Tom K, Mancl L, Woloshyn H, Khosravi R, Bollen AM. Association between crowding estimation and extraction recommendations in orthodontics. Am J Orthod Dentofacial Orthop 2024; 165:64-72.e12. [PMID: 37715755 DOI: 10.1016/j.ajodo.2023.07.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/01/2023] [Accepted: 07/01/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Little is known about how precisely orthodontists in the United States (US) assess crowding or at what range of crowding they recommend extraction. This study aimed to assess the relationship between estimated crowding in patients with a Class I relationship and extraction recommendation by orthodontists in the US. The secondary aims were to evaluate the accuracy and precision of clinician estimations and determine if clinician background traits play a role in extraction decision-making. METHODS An electronic survey was prepared using 4 patients with a Class I relationship with anterior crowding selected from a University Orthodontics Clinic and was sent to approximately 10,400 subjects through Facebook and the American Association of Orthodontists Partners in Research program. RESULTS From the 297 responses received, most clinicians recommended extraction once crowding reached 9-10 mm in either the maxilla or the mandible. The data from 2 patients suggest this decision was more strongly correlated with mandibular crowding. Clinician estimations varied widely but, on average, were precise within approximately 2 mm of objective measurements. There was a tendency to overestimate crowding, especially by Northeastern practitioners. Clinicians who reported routinely measuring crowding or who reported that they recommended extractions to >10% of their patients were 1.2-2.0 and 1.4-1.6 times more likely, respectively, to recommend extraction in the patients. CONCLUSIONS Crowding estimation was highly subjective and varied widely among clinicians. Most clinicians recommended extraction once maxillary or mandibular crowding approximated 9-10 mm. Some clinician demographics were correlated with the precision and accuracy of estimations and the likelihood of extraction in the patients.
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Affiliation(s)
| | - Lloyd Mancl
- Department of Orthodontics, University of Washington, Seattle, Wash
| | - Heather Woloshyn
- Department of Orthodontics, University of Washington, Seattle, Wash
| | - Roozbeh Khosravi
- Department of Orthodontics, University of Washington, Seattle, Wash
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Hoang E, Sheller B, Greenlee G, Susarla S, Mancl L. Factors Contributing to Canine Impaction in Patients With Unilateral Cleft Lip and Palate Undergoing Alveolar Bone Grafts. J Oral Maxillofac Surg 2023; 81:1286-1294. [PMID: 37500060 DOI: 10.1016/j.joms.2023.06.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Patients with unilateral cleft lip and palate (UCLP) undergo alveolar bone grafting (ABG) to unite the bony segments before eruption of the maxillary permanent canine. PURPOSE This study assessed the frequency of canine impaction after ABG in the UCLP patient population and identified associated demographic, anatomical, and operative factors. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study included 257 patients with UCLP who received ABG surgery at a single craniofacial center. PREDICTOR VARIABLES The variables were cleft characteristics, pre-ABG procedures, operative factors, and dental anomalies identified through electronic health records, radiographs, and intraoral photographs taken before ABG and at least 2 years after ABG. MAIN OUTCOME VARIABLE The primary outcome variable was the presence of an impacted maxillary canine, defined as malposition of a fully developed canine following ABG with full eruption of the contralateral canine. ANALYSES The t tests, χ2 tests, and logistic regression analysis were used to evaluate frequency of canine impaction and test for associations with the predictor variables. RESULTS Of 257 patients, 56% were male with a mean age of 9.2 years at the time of ABG. The frequency of canine impaction was 27% (n = 69, 95% confidence interval 22 to 33%). Significant associations were found for: complete clefts (30 vs 12%, P = .017), hypodivergent facial patterns (low angle: 46%; high angle: 29 vs 22% normal angle, P = .042), females (adjusted odds ratio [aOR] = 2.1, P = .015), early grafting with less than 1/3 developed canine root (aOR = 3.36, P = .024), pregraft extraction of primary canine (aOR = 2.3, P = .009) and greater permanent canine angulation (odds ratio = 1.1, P < .0001). No significant associations with pregraft orthodontic expansion or regrafting were detected. CONCLUSION AND RELEVANCE In this study, about one in four patients with UCLP had an impacted canine. Multiple factors including pregraft extraction of the primary canine and increased canine angulation were associated with impaction of the permanent canine.
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Affiliation(s)
- Ellen Hoang
- Resident, Department of Orthodontics, University of Washington, Seattle, WA.
| | - Barbara Sheller
- Division Chief of Pediatric Dentistry, Seattle Children's Hospital, Seattle, WA
| | - Geoffrey Greenlee
- Clinical Director and Clinical Associate Professor, Department of Orthodontics, University of Washington, Seattle, WA
| | - Srinivas Susarla
- Division Chief of Pediatric Oral and Maxillofacial Surgery, Seattle Children's Hospital, Seattle, WA
| | - Lloyd Mancl
- Research Associate Professor, Department of Oral Health Sciences, University of Washington, Seattle, WA
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Armijo L, Mancl L, Dennison CR, Houg K, Romanyk D, Popowics T. In-fiber Bragg sensor measurements assess fluid effects on strain in the periodontal space of an ex-vivo swine incisor complex under mechanical loading. J Biomech 2023; 157:111729. [PMID: 37473706 DOI: 10.1016/j.jbiomech.2023.111729] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
The purpose of this study is to determine whether in-fiber Bragg grating (FBG) sensors detect changes within the periodontal ligament (PDL) of ex-vivo swine tooth-PDL-bone complex (TPBC) when manipulating fluid content. Recording strain will allow for a better understanding of the biomechanics of viscoelastic load transfer from the tooth to the PDL during chewing and/or orthodontic tooth movement, as well as replication of these dynamics in regenerated PDL tissues. FBG sensors placed within the PDL of swine incisor teeth were used to measure strain resulting from an intrusive load. Specimens were mounted in a custom platform within an MTS machine and a compressive load was applied at 0.3 mm/s to a depth of 0.5 mm and held for 10 s. Median peak strain and load and median absolute deviation (MAD) were compared: dry vs. saline (n = 19) with bias-corrected bootstrap 95% CI. Dry vs. saline conditions did not statistically differ (median peaks of 5με, 103-105 N) and recorded strains showed high repeatability (MAD of 0.82με, 0.72με, respectively). FBG sensors did not detect the fluid changes in this study, suggesting that the deformation of tissues in the PDL space collectively determine FBG strain in response to tooth loading. The repeatability of measurements demonstrates the potential for FBG sensors to assess the strain in the PDL space of an in vivo swine model.
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Affiliation(s)
- Leigh Armijo
- Dept. of Orthodontics, University of Washington School of Dentistry, Seattle, WA 98195, USA.
| | - Lloyd Mancl
- Dept. of Oral Health Sciences, University of Washington School of Dentistry, Seattle, WA 98195, USA.
| | | | - Kathryn Houg
- Dept. of Mechanical Engineering and School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Dan Romanyk
- Dept. of Mechanical Engineering and School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Tracy Popowics
- Box 357475, Dept. of Oral Health Sciences, 1959 Pacific Ave. NE, University of Washington School of Dentistry, Seattle, WA 98195, USA.
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Cunha-Cruz J, Ko LK, Mancl L, Rothen ML, Harter C, Hilgert JB, Koday MK, Davis S. Feasibility and acceptability of home delivery of water for dental caries control in Latinx children-"Sediento por una Sonrisa," Thirsty for a Smile: Single-arm feasibility study. Front Public Health 2022; 10:916260. [PMID: 36203695 PMCID: PMC9531650 DOI: 10.3389/fpubh.2022.916260] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/11/2022] [Indexed: 01/22/2023] Open
Abstract
Background Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage. Methods A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants' homes and caregivers received patient-centered counseling for setting goals to increase children's water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented. Results Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child's drinking habits was 9.62 and for the water delivery component, 8.86. Conclusions This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Joana Cunha-Cruz
| | - Linda K. Ko
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Marilynn L. Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Catherine Harter
- Department of Assessment, Planning and Development, Tacoma Pierce County Health Department, Tacoma, WA, United States
| | - Juliana B. Hilgert
- Department of Preventive and Social Dentistry, Dental School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mark K. Koday
- Yakima Valley Farm Workers Clinic, Yakima, WA, United States
| | - Stephen Davis
- Yakima Valley Farm Workers Clinic, Yakima, WA, United States
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Cunha-Cruz J, Ko LK, Mancl L, Rothen ML, Harter C, Davis S, Koday M. Home Delivery of Water for Caries Prevention in Latinx Children (“Sediento por una Sonrisa,” Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study. JMIR Res Protoc 2022; 11:e37200. [PMID: 35436235 PMCID: PMC9055491 DOI: 10.2196/37200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children. Objective This protocol describes the rationale, design, and methods of the “Thirsty for a Smile” feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage. Methods This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants’ homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children’s water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention. Results Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019. Conclusions This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions. International Registered Report Identifier (IRRID) RR1-10.2196/37200
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
| | - Linda K Ko
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
| | - Marilynn L Rothen
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
| | - Catherine Harter
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
- Department of Assessment, Planning and Development, Tacoma Pierce County Health Department, Tacoma, WA, United States
| | - Stephen Davis
- Dental Department, Yakima Valley Farm Workers Clinic, Yakima, WA, United States
| | - Mark Koday
- Dental Department, Yakima Valley Farm Workers Clinic, Yakima, WA, United States
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van Tilburg MAL, Levy RL, Stoner S, Romano JM, Murphy TB, Abdullah B, Mancl L, Feld AD. Mediation of outcomes for cognitive behavioral therapy targeted to parents of children with Functional Abdominal Pain Disorders. J Psychosom Res 2021; 150:110618. [PMID: 34598050 PMCID: PMC8526395 DOI: 10.1016/j.jpsychores.2021.110618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There is a large body of evidence for the efficacy of Cognitive Behavioral Therapy (CBT) in treating Functional Abdominal Pain Disorders (FAPD) in children. In most CBT interventions for FAPD, parents participate together with their children. However, only one study to date has examined targeting parents alone for treatment. The aim of the current study was to examine mediators of a parent-only CBT treatment incorporating social learning (SLCBT) for FAPD in children. METHODS We examined mediators of child outcomes in an existing randomized controlled trial (n = 316) of parent-only social learning CBT compared to an education condition. Hypothesized mediators (parental protectiveness, perceived threat of pain, catastrophizing) were assessed at 3 months post-treatment, and outcomes (parent ratings of disability, quality of life, school absences, and health care visits) were assessed at 6 months post-treatment. Mediation analyses were performed using Hayes' PROCESS macro. RESULTS Pain catastrophizing significantly mediated treatment effects for all outcomes (B ranged from -1.65 to 2.22). Reduction in pain threat was a significant mediator for all outcomes (B ranged from -1.84 to 3.13) except school absences and health care visits. Decrease in parental protectiveness mediated effects on disability and missed school (B ranged from -1.47 to 1.34). Mediation effects did not differ by in-person or remote delivery of SLCBT. CONCLUSION Changes in maladaptive parental thoughts and behaviors following parent-only SLCBT intervention appeared to mediate the effects of the intervention. Parental catastrophizing appears to be a particularly important target given that decreases in that variable mediated all outcomes.
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Affiliation(s)
- Miranda A L van Tilburg
- School of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States of America; School of Social Work, University of Washington, Seattle, WA, United States of America; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Susan Stoner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, United States of America
| | - Joan M Romano
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Tasha B Murphy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Bisher Abdullah
- CHI Franciscan, Prime Health Clinic, Tacoma, WA, United States of America
| | - Lloyd Mancl
- Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Andrew D Feld
- Division of Gastroenterology, Washington Permanente Medical Group, University of Washington, Seattle, WA, United States of America
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Mitchell C, Zaku H, Milgrom P, Mancl L, Prince DB. The accuracy of laser fluorescence (DIAGNOdent) in assessing caries lesion activity on root surfaces, around crown margins, and in furcations in older adults. BDJ Open 2021; 7:14. [PMID: 33758162 PMCID: PMC7988107 DOI: 10.1038/s41405-021-00069-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/21/2021] [Accepted: 03/05/2021] [Indexed: 11/09/2022] Open
Abstract
The authors conducted a case series to assess accuracy of DIAGNOdent (DD) in assessment of activity of dental caries lesions in root surfaces and in furcations and at crown margins. The study was a prospective, single center case series. The patients were 123 adults (age ≥ 55 years). To be included, a patient needed to have at least one active root caries lesion. The study was conducted at the Roseman College of Dental Medicine in South Jordan, Utah, USA and at area nursing homes. Lesions were rinsed and dried with air, and DD readings were obtained. Lesions were then isolated and 38% silver diamine fluoride was applied repeatedly for two minutes with a microbrush. DD readings and treatments were repeated every six months. Mean DD values were significantly different between active (unarrested) and inactive (arrested) caries for all comparisons, p-value < 0.0001. The optimal cut-off values for DD were between 20 and 35 except optimal cut-offs were higher for furcation and crown margin surfaces, particularly in the posterior (optimal cut-offs 40-45). This study demonstrates DD is a potentially valuable tool for assessing lesion activity in root surfaces, at restoration margins, and in furcations.
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Affiliation(s)
- Chelsea Mitchell
- Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT, USA
| | - Hiba Zaku
- Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT, USA
| | - Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - David B Prince
- Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT, USA.
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Banks JT, Rosenfeld M, Mancl L, Chi DL. Survey and electronic health record-based medication use agreement in children with cystic fibrosis: A retrospective cross-sectional study. Int J Paediatr Dent 2021; 31:247-253. [PMID: 32936971 DOI: 10.1111/ipd.12724] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication use is important to collect accurately in medically complex patients in both clinical and research settings. AIM We assessed patient-level agreement for medication use between self-reported survey and electronic health record (EHR) for children with cystic fibrosis (CF). METHODS Our retrospective cross-sectional study focused on children with CF ages 6-20 years from Seattle Children's Hospital in Washington state, USA (N = 85). A self- or parent-reported survey included questions on current use of specific medications and antibiotic use in the past 2 months. We compared survey data with data abstracted from the individual's EHR and derived Cohen's Kappa statistics to estimate the level of agreement between the two methods. RESULTS Self-reported medication use was generally higher in the survey than in the EHR. The level of agreement ranged from slight for probiotics (74.1% agreement; 95% confidence interval [CI]: 64.6%-83.6%; kappa: 0.07), pancreatic enzymes (80% agreement; 95% CI: 71.3%-88.7%; kappa: 0.12), and vitamin D (55.3% agreement; 95% CI: 44.5%-66.1%; kappa: 0.20) to moderate for chronic azithromycin (80% agreement; 95% CI: 7.13%-88.7%; kappa: 0.50), proton pump inhibitors (76.5% agreement; 95% CI: 67.3%-85.7%; kappa: 0.46), and oral antibiotics (70.6% agreement; 95% CI: 60.7%-80.5%; kappa: 0.42). CONCLUSION There is considerable heterogeneity in level of agreement in medication use between self-reported survey and EHR data for children with CF. Standardized approaches are needed to improve the accuracy of medication data collected in clinical practice and research.
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Affiliation(s)
- Jordan T Banks
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Margaret Rosenfeld
- Department of Pulmonology, Seattle Children's Hospital, Seattle, WA, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Chi DL, Mancl L, Hopkins S, Randall CL, Orr E, Zahlis E, Dunbar M, Lenaker D, Babb M. Supply of care by dental therapists and emergency dental consultations in Alaska native communities in the Yukon-Kuskokwim delta: a mixed methods evaluation. Community Dent Health 2020; 37:190-198. [PMID: 32673470 DOI: 10.1922/cdh_00022chi09] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Examine the relationship between supply of care provided by dental therapists and emergency dental consultations in Alaska Native communities. METHODS Explanatory sequential mixed-methods study using Alaska Medicaid and electronic health record (EHR) data from the Yukon-Kuskokwim Health Corporation (YKHC), and interview data from six Alaska Native communities. From the Medicaid data, we estimated community-level dental therapy treatment days and from the EHR data we identified emergency dental consultations. We calculated Spearman partial correlation coefficients and ran confounder-adjusted models for children and adults. Interview data collected from YKHC providers (N=16) and community members (N=125) were content analysed. The quantitative and qualitative data were integrated through connecting. Results were visualized with a joint display. RESULTS There were significant negative correlations between dental therapy treatment days and emergency dental consultations for children (partial rank correlation = -0.48; p⟨0.001) and for adults (partial rank correlation = -0.18; p=0.03). Six pediatric themes emerged: child-focused health priorities; school-based dental programs; oral health education and preventive behaviors; dental care availability; healthier teeth; and satisfaction with care. There were four adult themes: satisfaction with care; adults as a lower priority; difficulties getting appointments; and limited scope of practice of dental therapy. CONCLUSIONS Alaska Native children, and to a lesser extent adults, in communities served more intensively by dental therapists have benefitted. There are high levels of unmet dental need as evidenced by high emergency dental consultation rates. Future research should identify ways to address unmet dental needs, especially for adults.
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Affiliation(s)
- D L Chi
- University of Washington, Department of Oral Health Sciences, Seattle, WA, USA
- University of Washington, Department of Health Services, Seattle, WA, USA
| | - L Mancl
- University of Washington, Department of Oral Health Sciences, Seattle, WA, USA
| | - S Hopkins
- Oregon Health and Science University, Department of Obstetrics and Gynecology, Portland, OR
| | - C L Randall
- University of Washington, Department of Oral Health Sciences, Seattle, WA, USA
| | - E Orr
- University of Washington, Department of Oral Health Sciences, Seattle, WA, USA
| | - E Zahlis
- University of Washington, Department of Oral Health Sciences, Seattle, WA, USA
| | - M Dunbar
- University of Washington, Center for Studies in Demography and Ecology, Seattle, WA, USA
| | - D Lenaker
- Southeast Alaska Regional Health Consortium, Dental Department, Sitka, AK
| | - M Babb
- University of Washington, Center for Studies in Demography and Ecology, Seattle, WA, USA
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Milgrom P, Tut O, Rothen M, Mancl L, Gallen M, Tanzer JM. Addition of Povidone-Iodine to Fluoride Varnish for Dental Caries: A Randomized Clinical Trial. JDR Clin Trans Res 2020; 6:195-204. [PMID: 32437626 DOI: 10.1177/2380084420922968] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Dental caries is the most common chronic childhood disease. Products of metabolism by bacteria populating the tooth surface induce development and progression of cavities. OBJECTIVES We sought to determine whether a polyvinylpyrrolidone-iodine (PVP-I; povidone-iodine) and NaF topical varnish was superior to one containing only NaF in prevention of new dental caries lesions in a single-center randomized active-controlled trial based on a double-blind, parallel-group design. METHODS The site was Pohnpei State, Federated States of Micronesia. The study population was healthy children 49 to 84 mo old who were enrolled in early childhood education: 284 were randomized (1:1 allocation), and 273 were included in year 1 analysis and 262 in year 2. The test varnish contained 10% PVP-I and 5.0% NaF. The comparator contained only 5.0% NaF but was otherwise identical. Varnishes were applied every 3 mo during 2 y. The primary outcome was the surface-level primary molar caries lesion increment (d2-4mfs) at 2 y. Caries lesion increments from baseline to year 1 and year 2 were compared between conditions with log-linear regression, adjusting for age and sex and whether the tooth was sound at baseline (free of caries lesions). RESULTS At year 1, the caries lesion increment for primary molars sound at baseline was 0.9 surfaces (SD = 1.5) for the test varnish versus 1.8 (SD = 2.2) for the comparator varnish with fluoride alone (adjusted rate ratio, 0.50; 95% CI, 0.31 to 0.81; P = .005). At year 2, the caries lesion increment for primary molars sound at baseline was 2.3 surfaces (SD = 2.8) for the test varnish as compared with 3.3 (SD = 2.7) for the comparator (adjusted rate ratio, 0.74; 95% CI, 0.52 to 1.03; P = .073). Teeth that were already cavitated at baseline did not show a preventive effect. There were no harms. CONCLUSIONS A dental varnish containing PVP-I and NaF is effective in the primary prevention of cavities in the primary dentition (NCT03082196). KNOWLEDGE TRANSFER STATEMENT This study demonstrates that periodic application of a varnish containing NaF and PVP-I is effective in prevention of caries lesions and useful in assessing the potential of combined treatment.
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Affiliation(s)
- P Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Advantage Silver Dental Arrest, LLC, Salem, Oregon
| | - O Tut
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M Rothen
- Regional Clinical Dental Research Center, Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
| | - L Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M Gallen
- Department of Dental Services, Pohnpei State Department of Health Services, Kolonia, Federated States of Micronesia
| | - J M Tanzer
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Connecticut Health, Farmington, CT, USA
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Pett RG, Mancl L, Revere D, Stergachis A. Prescription drug monitoring program use and utility by Washington State pharmacists: A mixed-methods study. J Am Pharm Assoc (2003) 2020; 60:57-65. [DOI: 10.1016/j.japh.2019.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022]
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Randall CL, Hort K, Huebner CE, Mallott E, Mancl L, Milgrom P, Nelson L, Senturia K, Weiner BJ, Cunha-Cruz J. Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization. JDR Clin Trans Res 2019; 5:156-165. [PMID: 31499017 DOI: 10.1177/2380084419871904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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 Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure. OBJECTIVES The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness. METHODS A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics. RESULTS Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for. CONCLUSION Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.
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Affiliation(s)
- C L Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - K Hort
- Southeast Alaska Regional Health Consortium, Juneau, AK, USA
| | - C E Huebner
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - E Mallott
- Southeast Alaska Regional Health Consortium, Juneau, AK, USA
| | - L Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - P Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - L Nelson
- School of Nursing, Washington State University, Spokane, WA, USA
| | - K Senturia
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - B J Weiner
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - J Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Chi DL, Hopkins S, Zahlis E, Randall CL, Senturia K, Orr E, Mancl L, Lenaker D. Provider and community perspectives of dental therapists in Alaska's Yukon-Kuskokwim Delta: A qualitative programme evaluation. Community Dent Oral Epidemiol 2019; 47:502-512. [PMID: 31464356 DOI: 10.1111/cdoe.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental therapists deliver preventive and basic restorative care and have been practicing since 2006 in Alaska's Yukon-Kuskokwim (YK) Delta. In this qualitative programme evaluation, we documented health providers' and community members' experiences with dental therapy. The goal of the evaluation was to develop a conceptual model of dental care delivery in Alaska Native Communities centred on dental therapists. METHODS We developed semi-structured interview scripts and used snowball sampling to recruit 16 health providers with experience providing care in the YK Delta and 125 community members from six YK Delta Communities in 2017 and 2018. The six communities were a stratified convenience sample based on community-level exposure to dental therapists (high, medium and no exposure). Interview data were digitally recorded, transcribed, verified for accuracy and coded inductively into conceptual domains using content analytic methods. RESULTS Providers believed individuals living in the YK Delta have benefited from clinic-based restorative care and community-based education provided by dental therapists. The restricted scope of dental therapy practice limits the complexity of care that may be offered to patients. However, community members expressed high satisfaction with the quality of care provided by dental therapists. Community members noted more widespread knowledge and evolving norms about oral health and believed dental therapists are helping to prevent disease and improve quality of life. Participants believed access to dental care for children has improved over the years, but felt that many adults in the YK Delta continue to have unmet needs. A potential barrier to sustained programme effectiveness is low retention of dental therapists in the region, driven primarily by reports that dental therapists feel overworked, stressed and geographically isolated. CONCLUSIONS Dental therapists have contributed to the dental care delivery system in Alaska's YK Delta. Future opportunities remain within the system to address the needs of adults, develop strategies to retain dental therapists in the region and incorporate evidence-based, prevention-oriented strategies to improve oral health behaviours and reduce oral diseases.
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Affiliation(s)
- Donald L Chi
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | | | - Ellen Zahlis
- University of Washington School of Dentistry, Seattle, Washington
| | | | - Kirsten Senturia
- University of Washington School of Dentistry, Seattle, Washington.,University of Washington School of Public Health, Seattle, Washington
| | - Eliza Orr
- University of Washington School of Dentistry, Seattle, Washington
| | - Lloyd Mancl
- University of Washington School of Dentistry, Seattle, Washington
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, Alaska
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Jacobson D, Jacobson J, Leong T, Lourenco S, Mancl L, Chi DL. Evaluating Child Toothbrushing Behavior Changes Associated with a Mobile Game App: A Single Arm Pre /Post Pilot Study. Pediatr Dent 2019; 41:299-303. [PMID: 31439090 PMCID: PMC6709707] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose: The purpose of this pilot study was to evaluate changes in toothbrushing behaviors associated with a mobile game app. Methods: Thirty-four five- to six-year-olds were taught to use the Brush UpTM game app and played it once per day at home for seven days. The primary outcome was toothbrushing quality measured as duration and distribution. The paired t test was used to assess pre/post changes and Holm's method adjusted for multiple testing (α equals 0.05). Results: The mean age was 73.7±6.6 months; 29.4 percent were female, and 47.1 percent were Caucasian. After seven days, toothbrushing duration increased significantly (P<0.001). Toothbrushing distribution improved with increased brushing of the lingual, maxillary occlusal, and posterior buccal surfaces. For 15 children who played the game for 14 days, even greater improvements in quality and distribution were observed. Improvements in toothbrushing did not persist one year later without further app use but there were noted changes that could be clinically meaningful. Conclusions: Mobile health game apps can potentially improve toothbrushing quality in children. Additional trials are needed to assess mobile toothbrushing game apps.
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Affiliation(s)
- Dov Jacobson
- Mr. D. Jacobson, principals, at GamesThatWork, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - Jesse Jacobson
- Mr. J. Jacobson, principals, at GamesThatWork, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - Traci Leong
- Dr. Leong is an assistant research professor, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - Stella Lourenco
- Dr. Lourenco is an associate professor, Department of Psychology, Emory University, Atlanta, Ga
| | - Lloyd Mancl
- Dr. Mancl is a research associate professor, Department of Oral Health Sciences, UW School of Dentistry, University of Washington School of Dentistry, Seattle, Wash., USA
| | - Donald L Chi
- Dr. Chi is a professor, Department of Oral Health Sciences, UW School of Dentistry, University of Washington School of Dentistry, Seattle, Wash., USA;,
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Chi DL, Coldwell SE, Mancl L, Hopkins S, Senturia K, Randall CL, Orr E, Cruz S. Alaska Native Children Do Not Prefer Sugar-Sweetened Fruit Drinks to Sugar-Free Fruit Drinks. J Acad Nutr Diet 2019; 119:984-990. [PMID: 30987919 PMCID: PMC6536342 DOI: 10.1016/j.jand.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/24/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alaska Native children, including children of Yup'ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks. OBJECTIVE The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks. DESIGN This was an experimental two-alternative forced-choice paired preference test. PARTICIPANTS/SETTING The study focused on a convenience sample of Yup'ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89). INTERVENTION Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs. MAIN OUTCOME MEASURES The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink. STATISTICAL ANALYSES PERFORMED A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests. RESULTS The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup'ik and non-Yup'ik children, boys and girls, and children of different ages. CONCLUSIONS Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup'ik children in Alaska Native communities.
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Affiliation(s)
- Donald L. Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Susan E. Coldwell
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Lloyd Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Scarlett Hopkins
- Oregon Health Sciences University, School of Medicine, Department of Obstetrics and Gynecology, Portland, OR 97239, USA; Phone: 503 494-8311; Fax: 206-685-4258; scarlett.
| | - Kirsten Senturia
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Cameron L. Randall
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
| | - Eliza Orr
- University of Alaska Fairbanks, Center for Alaska Native Health Research, 216B Arctic Health Research Bldg, Fairbanks, AK, 99775, USA; Phone: 907-474-5172; Fax: 206-685-4258;
| | - Stephanie Cruz
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; Phone: 206-616-4332; Fax: 206-685-4258;
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Chi DL, Rosenfeld M, Mancl L, Chung WO, Presland RB, Sarvas E, Rothen M, Alkhateeb A, McNamara S, Genatossio A, Virella-Lowell I, Milla C, Scott J. Age-related heterogeneity in dental caries and associated risk factors in individuals with cystic fibrosis ages 6-20 years: A pilot study. J Cyst Fibros 2018; 17:747-759. [PMID: 30005828 PMCID: PMC6589399 DOI: 10.1016/j.jcf.2018.06.009] [Citation(s) in RCA: 9] [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: 03/15/2018] [Revised: 05/26/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The literature conflicts regarding dental caries risk in cystic fibrosis (CF) relative to controls. METHODS Prospective, observational study of age-related heterogeneity in caries rates and potential risk factors in individuals with CF ages 6-20 at a single clinic in Washington state (N=85). Caries rates for enrolled CF participants and historical controls from NHANES were compared using cubic spline regression models. Generalized linear regression models identified correlates of age and caries in CF. RESULTS Children ages 6-9 with CF had significantly lower caries than controls (Holm's P<0.05). There was no difference for ages 10-20 by CF status (Holm's P>0.05). Various biological/intraoral, medical, and behavioral factors were associated with caries and age in CF. CONCLUSIONS Younger children with CF may be protected from caries, but there is apparent loss of protection in early adolescence associated with multiple risk factors. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Donald L Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA.
| | - Margaret Rosenfeld
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Lloyd Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Whasun O Chung
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Richard B Presland
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA; University of Washington, Department of Medicine, Division of Dermatology, Box 356524, Seattle, WA 98195, USA
| | - Elise Sarvas
- University of Minnesota, School of Dentistry, Department of Pediatric Dentistry, 515 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Marilynn Rothen
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Alaa Alkhateeb
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA
| | - Sharon McNamara
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Alan Genatossio
- Seattle Children's Hospital, Cystic Fibrosis Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Isabel Virella-Lowell
- University of Alabama - Birmingham, Division of Pediatric Pulmonology and Sleep Medicine, 1600 7th Ave S, Birmingham, AL 35233, USA
| | - Carlos Milla
- Stanford University Medical School, 770 Welch Rd, Ste. 350, Palo Alto, CA 94304, USA
| | - JoAnna Scott
- University of Missouri - Kansas City, School of Dentistry, Department of Dental Public, Health and Behavioral Science, 650 E. 25th St., Kansas City, MO 64108, USA
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Fadol Y, Leresche L, Mancl L, Heaton L, Truelove E. Referred Pain in Temporomandibular Disorders: Prevalence, Associated Factors and Effects on TMD Prognosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Chi DL, Lenaker D, Mancl L, Dunbar M, Babb M. Dental therapists linked to improved dental outcomes for Alaska Native communities in the Yukon-Kuskokwim Delta. J Public Health Dent 2018; 78:175-182. [PMID: 29377127 PMCID: PMC6019600 DOI: 10.1111/jphd.12263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/15/2017] [Revised: 11/14/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Dental Health Aide Therapists (DHATs) have been part of the dental workforce in Alaska's Yukon-Kuskokwim (YK) Delta since 2006. They are trained to provide preventive and restorative care such as filling and extractions. In this study, we evaluated community-level dental outcomes associated with DHATs. METHODS This was a secondary data analysis of Alaska Medicaid and electronic health record data for individuals in Alaska's YK Delta (2006-2015). The independent variable was the number of DHAT treatment days in each community. Child outcomes were preventive care, extractions, and general anesthesia. Adult outcomes were preventive care and extractions. We estimated Spearman partial correlation coefficients to test our hypotheses that increased DHAT treatment days would be associated with larger proportions utilizing preventive care and smaller proportions receiving extractions at the community-level. RESULTS DHAT treatment days were positively associated with preventive care utilization and negatively associated with extractions for children and adults (P < 0.0001). DHAT treatment days were not associated with increased dental treatment under general anesthesia for children. CONCLUSIONS Dental therapists are associated with more preventive care and fewer extractions. State-level policies should consider dental therapists as part of a comprehensive solution to meet the dental care needs of individuals in underserved communities and help achieve health equity and social justice.
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Affiliation(s)
- Donald L Chi
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Dane Lenaker
- Southeast Alaska Regional Health Consortium, Sitka, AK, USA
| | - Lloyd Mancl
- School of Dentistry, University of Washington, Seattle, WA, USA
| | - Matthew Dunbar
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Michael Babb
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
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Studebaker B, Hollender L, Mancl L, Johnson JD, Paranjpe A. The Incidence of Second Mesiobuccal Canals Located in Maxillary Molars with the Aid of Cone-beam Computed Tomography. J Endod 2017; 44:565-570. [PMID: 29153734 DOI: 10.1016/j.joen.2017.08.026] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/16/2017] [Accepted: 08/26/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Many endodontic treatment failures in maxillary molars result from missed second mesiobuccal (MB2) canals. An MB2 canal orifice is present in as many as 95% of maxillary molars, but these canals are not always located during endodontic procedures. Additional tools, such as cone-beam computed tomographic (CBCT) imaging, may be needed to locate these canals in maxillary molars. Hence, the aims of this study were to investigate the frequency of use of CBCT imaging during the treatment of maxillary molars and to evaluate the influence of its use on the detection of MB2 canals. METHODS Endodontic treatment records, digital intraoral radiographs (when present), and CBCT images from all maxillary first and second molars treated at the University of Washington, Seattle, WA, between 2010 and 2014 (N = 886) were reviewed. Statistical analysis was performed to assess differences between the groups. RESULTS Overall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals. CBCT imaging was used in 16.5% of the cases treated and was used significantly more for retreatment cases. CBCT imaging was used preoperatively in 5.6% of cases, and the data show that significantly more MB2 canals were located when a preoperative CBCT image was available. More MB2 canals were located in first molars without full-coverage crowns. CONCLUSIONS The data show that CBCT imaging is a valuable tool in locating MB2 canals. Based on the results of his study, the use of CBCT imaging could be warranted when treating maxillary molars.
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Affiliation(s)
- Ben Studebaker
- Department of Endodontics, University of Washington, Seattle, Washington
| | - Lars Hollender
- Department of Oral and Maxillofacial Radiology, University of Washington, Seattle, Washington
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - James D Johnson
- Department of Endodontics, University of Washington, Seattle, Washington
| | - Avina Paranjpe
- Department of Endodontics, University of Washington, Seattle, Washington.
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Milgrom P, Horst JA, Ludwig S, Rothen M, Chaffee BW, Lyalina S, Pollard KS, DeRisi JL, Mancl L. Topical silver diamine fluoride for dental caries arrest in preschool children: A randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent 2017; 68:72-78. [PMID: 28866468 DOI: 10.1016/j.jdent.2017.08.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 04/28/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions. MATERIALS AND METHODS The study was a double-blind randomized placebo-controlled superiority trial with 2 parallel groups. The sites were Oregon preschools. Sixty-six preschool children with ≥1 lesion were enrolled. Silver diamine fluoride (38%) or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group. RESULTS AND CONCLUSION Average proportion of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, based on the number of arrested lesions and accounting for the number of treated surfaces and length of follow-up, indicates the risk of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride is effective and safe in arresting cavities in preschool children. CLINICAL SIGNIFICANCE The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.
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Affiliation(s)
- Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA.
| | - Jeremy A Horst
- Department of Biochemistry, University of California San Francisco,1700 4th Street, QB3 Room 404, San Francisco, CA 94158 USA
| | - Sharity Ludwig
- Advantage Dental Services, 442 SW Umatilla, Suite 200, Redmond, OR 97756 USA
| | - Marilynn Rothen
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA; Institute of Translational Health Sciences, Regional Clinical Dental Research Center, Box 357475, Seattle, WA 98195-7475 USA
| | - Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, 94143 USA
| | - Svetlana Lyalina
- Department of Epidemiology & Biostatistics, University of California San Francisco,550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Katherine S Pollard
- Department of Epidemiology & Biostatistics, University of California San Francisco,550 16th Street, 2nd Floor, San Francisco, CA 94158 USA; Gladstone Institutes,1650 Owens Street, San Francisco, CA 94158 USA
| | - Joseph L DeRisi
- Department of Biochemistry, University of California San Francisco,1700 4th Street, QB3 Room 404, San Francisco, CA 94158 USA; Chan-Zuckerberg BioHub, 499 Illinois St, San Francisco, CA 94158 USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475 USA
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Rudolf G, Walsh J, Plawman A, Gianutsos P, Alto W, Mancl L, Rudolf V. A novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment. Am J Drug Alcohol Abuse 2017; 44:302-309. [PMID: 28795846 DOI: 10.1080/00952990.2017.1334209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical feasibility of a novel non-opioid and benzodiazepine-free protocol was assessed for the treatment of medically supervised opioid withdrawal and transition to subsequent relapse prevention strategies. METHODS A retrospective chart review of DSM-IV diagnosed opioid-dependent patients admitted for inpatient medically supervised withdrawal examined 84 subjects (52 males, 32 females) treated with a 4-day protocol of scheduled tizanidine, hydroxyzine, and gabapentin. Subjects also received ancillary medications as needed, and routine counseling. Primary outcomes were completion of medically supervised withdrawal, and initiation of injectable extended release (ER) naltrexone treatment. Secondary outcomes included the length of hospital stay, Clinical Opiate Withdrawal Scale (COWS) scores, and facilitation to substance use disorder treatment intervention. Ancillary medication use and adverse effects were also assessed. RESULTS A total of 79 (94%) of subjects completed medically supervised withdrawal. A total of 27 (32%) subjects chose to pursue transition to ER naltrexone, and 24 of the 27 (89%) successfully received the injection prior to hospital discharge. The protocol subjects had a mean length of hospital stay of 3.6 days, and the mean COWS scores was 3.3, 3.4, 2.8, and 2.4 on Day 1, 2, 3, and 4, respectively. Furthermore, 71 (85%) engaged in an inpatient or outpatient substance use disorder (SUD) treatment program following protocol completion. CONCLUSION This retrospective chart review suggests the feasibility of a novel protocol for medically supervised opioid withdrawal and transition to relapse prevention strategies, including injectable ER naltrexone. This withdrawal protocol does not utilize opioid agonists or other controlled substances..
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Affiliation(s)
- Gregory Rudolf
- a Department of Pain Services , Swedish Medical Center , Seattle , WA , USA
| | - Jim Walsh
- b Addiction Recovery Service, Swedish Medical Center , Seattle , WA , USA
| | - Abigail Plawman
- b Addiction Recovery Service, Swedish Medical Center , Seattle , WA , USA
| | - Paul Gianutsos
- c Department of Family Medicine , Swedish Medical Center Cherry Hill Campus , Seattle , WA , USA
| | - William Alto
- c Department of Family Medicine , Swedish Medical Center Cherry Hill Campus , Seattle , WA , USA
| | - Lloyd Mancl
- d Department of Biostatistics , University of Washington , Seattle , WA , USA
| | - Vania Rudolf
- b Addiction Recovery Service, Swedish Medical Center , Seattle , WA , USA
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Abstract
INTRODUCTION Dental caries (tooth decay) is a common disease in which the products of sugar metabolism by certain bacteria that populate the tooth surface induce the development and progression of lesions (cavities). This is a phase II single-centre randomised, double-blind, active-controlled, parallel-group trial to assess the efficacy of a combination povidone iodine and sodium fluoride dental varnish to determine if it is superior to a varnish containing only sodium fluoride in the prevention of new caries lesions. The objective of this report is to describe the rationale and protocol for the trial. METHODS AND ANALYSIS The study site is Pohnpei State, Federated States of Micronesia. The study population is 284 children 48-84 months old. The primary outcome will be the surface-level primary molar caries increment (d2-3mfs/DMFS) at 2 years post baseline. The incremental dental caries at 1 year will also be compared between the two interventions. The secondary outcome is the Facial Image Scale after the initial treatment and after the fifth treatment at 1 year that gauges the child's response to the treatment. ETHICS AND DISSEMINATION The Western Institutional Review Board (designated IRB) and the Institutional Review Board of the College of Micronesia-FSM approved all study procedures. The US Food and Drug Administration (FDA) has issued IND 128835 covering this study. The study results will be published and submitted to the FDA in support of a new drug application. TRIALREGISTRATION NUMBER NCT03082196.
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Affiliation(s)
- Peter Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
- Advantage Silver Dental Arrest, LLC, Redmond, Oregon, USA
| | - Ohnmar Tut
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Marilynn Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
- Regional Clinical Dental Research Center, Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Marcelle Gallen
- Department of Dental Services, Pohnpei State Health Department, Kolonia, Federated States of Micronesia
| | - Jason M Tanzer
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
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Horst OV, Cunha-Cruz J, Zhou L, Manning W, Mancl L, DeRouen TA. Prevalence of pain in the orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network. J Am Dent Assoc 2016; 146:721-8.e3. [PMID: 26409981 DOI: 10.1016/j.adaj.2015.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/28/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. METHODS Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. RESULTS The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). CONCLUSIONS One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. PRACTICAL IMPLICATIONS Pain in the muscles and temporomandibular joints was reported as frequently as that in the teeth and surrounding tissues in patients visiting general dentists. Although the dental curriculum is concentrated on the diagnosis and management of pain and related conditions from teeth and surrounding tissues, it is imperative to include the training for other types of orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues.
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Affiliation(s)
- Orapin V Horst
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, USA.
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Milgrom P, Tut OK, Gallen M, Mancl L, Spillane N, Chi DL, Ramsay DS. Symptoms with betel nut and betel nut with tobacco among Micronesian youth. Addict Behav 2016; 53:120-4. [PMID: 26476008 DOI: 10.1016/j.addbeh.2015.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Betel nut has been stated to be addictive, but evidence is lacking. This study describes dependence symptoms among adolescents using betel alone or with tobacco. In the first study, participants were 151 9th graders in Saipan. In the second study, participants were 269 9th graders in Pohnpei and Yap. Participants completed a confidential questionnaire adapted from the U.S. National Survey of Drug Use and Health, which measured dependence symptoms. The 15 items were summed to form a scale, with a range of 0-15, where higher scores indicated greater endorsement of dependence symptoms. In the first study, 39.1% had used betel. More than two-thirds of all users (69.5%) used betel in the previous month: 87.8% also used tobacco with the betel. The mean (SD) dependence symptoms scale score among tobacco users was 8.2±4.0 versus 3.4±2.9 among those who used betel alone [t(7)=3.3, p=0.015]. In the second study, 38% from Pohnpei and 85% from Yap had used betel and most of the current users used it in the previous month (67% from Pohnpei, 91% from Yap). Among those who had used betel in the previous month, 90% from Pohnpei and 64% from Yap were using betel with tobacco. The dependence score was positively associated with frequency of tobacco use (e.g., mean (SD)=11.3 (±2.4) among most frequent users versus a mean (SD)=4.8 (±3.5) among the never users [F(3109)=28.8, p<0.001]). Betel nut users who also use tobacco may benefit from tobacco cessation strategies.
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Chi DL, Hopkins S, O'Brien D, Mancl L, Orr E, Lenaker D. Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker. BMC Oral Health 2015; 15:121. [PMID: 26452647 PMCID: PMC4600323 DOI: 10.1186/s12903-015-0101-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dental caries (tooth decay) is a significant public health problem in Alaska Native children. Dietary added sugars are considered one of the main risk factors. In this cross-sectional pilot study, we used a validated hair-based biomarker to measure added sugar intake in Alaska Native Yup'ik children ages 6-17 years (N = 51). We hypothesized that added sugar intake would be positively associated with tooth decay. METHODS A 66-item parent survey was administered, a hair sample was collected from each child, and a dental exam was conducted. Added sugar intake (grams/day) was measured from hair samples using a linear combination of carbon and nitrogen ratios. We used linear and log-linear regression models with robust standard errors to test our hypothesis that children with higher added sugar intake would have a higher proportion of carious tooth surfaces. RESULTS The mean proportion of carious tooth surfaces was 30.8 % (standard deviation: 23.2 %). Hair biomarker-based added sugar intake was associated with absolute (6.4 %; 95 % CI: 1.2 %, 11.6 %; P = .02) and relative increases in the proportion of carious tooth surfaces (24.2 %; 95 % CI: 10.6 %, 39.4 %; P < .01). There were no associations between self-reported measures of sugar-sweetened food and beverage intake and tooth decay. CONCLUSIONS Added sugar intake as assessed by hair biomarker was significantly and positively associated with tooth decay in our sample of Yup'ik children. Self-reported dietary measures were not associated tooth decay. Most added sugars were from sugar-sweetened fruit drinks consumed at home. Future dietary interventions aimed at improving the oral health of Alaska Native children should consider use of objective biomarkers to assess and measure changes in home-based added sugar intake, particularly sugar-sweetened fruit drinks.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Scarlett Hopkins
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Diane O'Brien
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington School of Dentistry, Box 357475, Seattle, WA, 98195, USA.
| | - Eliza Orr
- University of Alaska Fairbanks, Center for Alaska Native Health Research, Fairbanks, AK, USA.
| | - Dane Lenaker
- Yukon Kuskokwim Health Corporation, Dentistry Department, Bethel, AK, USA.
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Riedy CA, Weinstein P, Mancl L, Garson G, Huebner CE, Milgrom P, Grembowski D, Shepherd-Banigan M, Smolen D, Sutherland M. Dental attendance among low-income women and their children following a brief motivational counseling intervention: A community randomized trial. Soc Sci Med 2015; 144:9-18. [PMID: 26372934 DOI: 10.1016/j.socscimed.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/20/2015] [Revised: 08/19/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children. It utilized a multi-site, single-blind, randomized trial design. Four hundred women were randomized into one of four conditions to receive prenatal or postpartum motivational interviewing/counseling (MI) or prenatal or postpartum health education (HE). Counselors also functioned as patient navigators. Primary outcomes were dental attendance during pregnancy for the mother and for the child by age 18 months. Attendance was obtained from the Oregon Division of Medical Assistance Programs and participant self-report. Statewide self-reported utilization data were obtained from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS). Maternal attendance was 92% in the prenatal MI group and 94% in the prenatal HE group (RR = 0.98; 95% CI = 0.93-1.04). Children's attendance was 54% in postpartum MI group and 52% in the postpartum HE group (RR = 1.03; 95% CI = 0.82-1.28). Compared to statewide PRAMS, attendance was higher during pregnancy for study mothers (45% statewide; 95% CI = 40-50%) and for their children by 24 months (36% statewide; 95% CI = 27-44%). MI did not lead to greater attendance when compared to HE alone and cost more to implement. High attendance may be attributable to the counselors' patient navigator function. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01120041.
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Affiliation(s)
- Christine A Riedy
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Philip Weinstein
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Lloyd Mancl
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Gayle Garson
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Colleen E Huebner
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - David Grembowski
- University of Washington School of Public Health, Box 357660, 1959 NE Pacific St, Seattle, WA 98195-7660, USA.
| | - Megan Shepherd-Banigan
- University of Washington School of Public Health, Box 357660, 1959 NE Pacific St, Seattle, WA 98195-7660, USA.
| | - Darlene Smolen
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA.
| | - Marilynn Sutherland
- Klamath County Department of Public Health, 305 Main Street, Klamath Falls, OR 97601, USA.
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Cunha-Cruz J, Milgrom P, Shirtcliff RM, Bailit HL, Huebner CE, Conrad D, Ludwig S, Mitchell M, Dysert J, Allen G, Scott J, Mancl L. Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial. Trials 2015; 16:278. [PMID: 26091669 PMCID: PMC4475615 DOI: 10.1186/s13063-015-0786-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022] Open
Abstract
Background To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. Methods/Design This is a parallel-group cluster randomized controlled trial. Fourteen rural Oregon counties with a publicly insured (Medicaid) population of 82,000 children (0 to 21 years old) and pregnant women served by a managed dental care organization are randomized into test and control counties. In the test intervention (PREDICT), allied dental personnel provide screening and preventive services in community settings and case managers serve as patient navigators to arrange referrals of children who need dentist services. The delivery system intervention is paired with a compensation system for high performance (pay-for-performance) with efficient performance monitoring. PREDICT focuses on the following: 1) identifying eligible children and gaining caregiver consent for services in community settings (for example, schools); 2) providing risk-based preventive and caries stabilization services efficiently at these settings; 3) providing curative care in dental clinics; and 4) incentivizing local delivery teams to meet performance benchmarks. In the control intervention, care is delivered in dental offices without performance incentives. The primary outcome is the prevalence of untreated dental caries. Other outcomes are related to process, structure and cost. Data are collected through patient and staff surveys, clinical examinations, and the review of health and administrative records. Discussion If effective, PREDICT is expected to substantially reduce disparities in dental care and oral health. PREDICT can be disseminated to other care organizations as publicly insured clients are increasingly served by large practice organizations. Trial registration ClinicalTrials.gov NCT02312921 6 December 2014. The Robert Wood Johnson Foundation and Advantage Dental Services, LLC, are supporting the evaluation.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA.
| | - Peter Milgrom
- Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA.
| | - R Michael Shirtcliff
- Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA.
| | - Howard L Bailit
- Department of Community Medicine and Health Care, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
| | - Colleen E Huebner
- Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195-7230, USA.
| | - Douglas Conrad
- Department of Health Services, University of Washington, Box 357230, Seattle, WA, 98195-7230, USA.
| | - Sharity Ludwig
- Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA.
| | - Melissa Mitchell
- Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA.
| | - Jeanne Dysert
- Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA.
| | - Gary Allen
- Advantage Dental Services, LLC, 442 SW Umatilla Ave, Suite 200, Redmond, OR, 97756, USA.
| | - JoAnna Scott
- Department of Pediatric Dentistry, University of Washington, Box 354915, Seattle, WA, 98195-4915, USA.
| | - Lloyd Mancl
- Department of Oral Health Sciences, Northwest Center to Reduce Oral Health Disparities, University of Washington, Box 357475, Seattle, WA, 98195-7475, USA.
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Otani T, Raigrodski AJ, Mancl L, Kanuma I, Rosen J. In vitro evaluation of accuracy and precision of automated robotic tooth preparation system for porcelain laminate veneers. J Prosthet Dent 2015; 114:229-35. [PMID: 25957239 DOI: 10.1016/j.prosdent.2015.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM Controlling tooth reduction for porcelain laminate veneers (PLVs) in fractions of millimeters is challenging. PURPOSE The purpose of this study was to assess an automated robotic tooth preparation system for PLVs for accuracy and precision compared with conventional freehand tooth preparation. MATERIAL AND METHODS Twenty maxillary central incisor tooth models were divided into 2 groups. Ten were assigned to a veneer preparation with a robotic arm according to preoperative preparation design-specific guidelines (experimental group). Ten were assigned to conventional tooth preparation by a clinician (control group). Initially, all tooth models were scanned with a 3- dimensional (3D) laser scanner, and a tooth preparation for PLVs was designed on a 3D image. Each tooth model was attached to a typodont. For the experimental group, an electric high-speed handpiece with a 0.9-mm-diameter round diamond rotary cutting instrument was mounted on the robotic arm. The teeth were prepared automatically according to the designed image. For the control group, several diamond rotary cutting instruments were used to prepare the tooth models according to preoperative preparation design guidelines. All prepared tooth models were scanned. The preoperative preparation design image and scanned postoperative preparation images were superimposed. The dimensional difference between those 2 images was measured on the facial aspect, finish line, and incisal edge. Differences between the experimental and the control groups from the 3D design image were computed. Accuracy and precision were compared for all sites and separately for each tooth surface (facial, finish line, incisal). Statistical analyses were conducted with a permutation test for accuracy and with a modified robust Brown-Forsythe Levene-type test for precision (α=.05). RESULTS For accuracy for all sites, the mean absolute deviation was 0.112 mm in the control group and 0.133 mm in the experimental group. No significant difference was found between the 2 (P=.15). For precision of all sites, the standard deviation was 0.141 mm in the control group and 0.185 mm in the experimental group. The standard deviation in the control group was significantly lower (P=.030). In terms of accuracy for the finish line, the control group was significantly less accurate (P=.038). For precision, the standard deviation in the control group was significantly higher at the finish line (P=.034). CONCLUSIONS For the data from all sites, the experimental procedure was able to prepare the tooth model as accurately as the control, and the control procedure was able to prepare the tooth model with better precision. The experimental group showed better accuracy and precision at the finish line.
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Affiliation(s)
- Takafumi Otani
- Graduate student, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.
| | - Ariel J Raigrodski
- Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash
| | - Lloyd Mancl
- Research Associate Professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Wash
| | - Ikuru Kanuma
- Student, Department of Computer Engineering, University of California, Santa Cruz, Calif
| | - Jacob Rosen
- Associate Professor, Department of Computer Engineering, University of California, Santa Cruz, Calif
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Abstract
OBJECTIVE To evaluate the importance of severe retrognathia as a risk factor for the development of recent onset painful TMJ disorders among adult females. DESIGN Case-control study. SETTING This study was conducted in a large health maintenance organization between 1998 and 1999 [Kaiser Permanente Northwest (KPNW), Portland, OR, USA]. PARTICIPANTS Adult females with recent onset painful TMJ disorders (n=29) and normal controls (n=104). METHODS Cases were recruited from the TMD clinic at Kaiser Permanente Northwest (KPNW). Controls were recruited from a dental clinic at KPNW. Case status was determined using a questionnaire; mandibular sagittal position was determined by measuring a research angle on facial photographs. The mean research angle for cases was compared to the mean for controls. Multivariable exact conditional logistic regression analysis was used to examine the demographic characteristics of cases and controls, and to determine the strength of association between recent onset painful TMJ disorders and severe retrognathia. The population attributable risk percentage (PAR%) and the attributable risk percentage (AR%) were calculated to further evaluate severe retrognathia as a risk factor. RESULTS The mean research angle among cases (67.7 degrees; 95% CI=66.0-69.4) was smaller than among controls (71.6 degrees; 95% CI=70.7-72.5, P<0.001). The odds ratio for the association between case status and the presence or absence of severe retrognathia was elevated (OR=6.3; 95% CI=1.1-47.5, P=0.039). The PAR% and AR%, associated with severe retrognathia, were 13.3 and 84.1%, respectively. CONCLUSIONS Severe retrognathia is strongly associated with recent onset painful TMJ disorders (OR=6.3). Only a small proportion of these disorders are attributable to severe retrognathia among the total population of adult females (PAR%=13.3%). However, a large proportion of these TMJ disorders are potentially attributable to severe retrognathia among adult females with severe retrognathia (AR%=84.1%).
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Rothen M, Cunha-Cruz J, Zhou L, Mancl L, Jones JS, Berg J. Oral hygiene behaviors and caries experience in Northwest PRECEDENT patients. Community Dent Oral Epidemiol 2014; 42:526-35. [PMID: 24766464 DOI: 10.1111/cdoe.12107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 10/11/2012] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the association between oral hygiene behaviors (toothbrushing, water rinsing after brushing, interproximal cleaning, and adjunctive use of fluoride products) and recent caries (past 24 months) in a random sample of patients in Northwest PRECEDENT practices. METHODS Practitioner-members of Northwest PRECEDENT, a dental practice-based research network, conducted a longitudinal study on caries risk assessment. At baseline, patients completed a questionnaire on oral self-care, snacking, health, and socio-demographics. A dental examination recorded readily visible heavy plaque and decayed, missing, and filled teeth; chart review captured new caries and treatments in the previous 24 months. Bivariate and multiple generalized estimating equations (GEE) log-linear regression models stratified by age-groups were used to relate oral hygiene behaviors to the primary outcome of mean dental caries in the past 24 months on data from 1400 patients in 63 practices. The primary exposure of interest was fluoride toothbrushing frequency. RESULTS Fluoride toothbrushing once per day or twice or more per day by patients 9-17 was significantly associated with a 50% lower mean caries rate compared with fluoride toothbrushing less than once per day, after adjustment for covariates [rate ratios (RR) = 0.5; 95% confidence intervals (CI) = 0.3-0.8]. After adjustment, for patients 18-64, fluoride toothbrushing two or more times per day was significantly associated with a 40% lower recent mean caries rate (RR = 0.6; 95% CI = 0.4-0.9); in patients 65+, twice a day or more fluoride toothbrushing was not associated with lower caries rates (RR = 1.1; 95% CI = 0.7-1.8). Of the other oral hygiene variables, after adjustment, patients 18-64 who rinsed with water after brushing had a 40% lower mean caries rate compared with no rinsing (RR = 0.6; 95% CI = 0.4-0.9) and the presence of readily visible heavy plaque was significantly associated with an increase in the mean caries rate for patients 18-64 (RR = 1.6; 95% CI = 1.2-2.2) and 65+ (RR = 2.5; 95% CI = 1.8-3.5). CONCLUSIONS In the present study, the frequency of fluoride toothbrushing and the presence of readily visible heavy plaque were the factors most strongly associated with mean caries rate. In young patients with permanent dentition, the daily application of fluoride toothpaste appears more important than emphasis on thorough plaque removal. While for adults, the protective effect of twice daily fluoride toothbrushing disappears with advancing age and the presence of readily visible heavy plaque becomes increasingly associated with caries risk.
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Affiliation(s)
- Marilynn Rothen
- Regional Clinical Dental Research Center, University of Washington, Seattle, WA, USA
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Abstract
This practice-based, randomized clinical trial evaluated and compared the success of direct pulp capping in permanent teeth with MTA (mineral trioxide aggregate) or CaOH (calcium hydroxide). Thirty-five practices in Northwest PRECEDENT were randomized to perform direct pulp caps with either CaOH (16 practices) or MTA (19 practices). Three hundred seventy-six individuals received a direct pulp cap with CaOH (n = 181) or MTA (n = 195). They were followed for up to 2 yrs at regular recall appointments, or as dictated by tooth symptoms. The primary outcomes were the need for extraction or root canal therapy. Teeth were also evaluated for pulp vitality, and radiographs were taken at the dentist's discretion. The probability of failure at 24 mos was 31.5% for CaOH vs. 19.7% for MTA (permutation log-rank test, p = .046). This large randomized clinical trial provided confirmatory evidence for a superior performance with MTA as a direct pulp-capping agent as compared with CaOH when evaluated in a practice-based research network for up to 2 yrs.
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Affiliation(s)
- T J Hilton
- Oregon Health & Science University, 611 S.W. Campus Drive, Portland, OR 97239, USA.
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Abstract
OBJECTIVE High levels of Streptococcus mutans on teeth of young children are predictive of Early Childhood Caries (ECC). Transmission from mother-to-child is common and studies have demonstrated treatment of the mother results in less ECC. The objective of this study was to determine how dentists have adopted the practice of counseling about ECC. METHODS In 2006 as part of a larger study on dental care for pregnant women, we surveyed 829 general dentists in Oregon. The questionnaire contained questions to capture the extent to which general dentists have adopted counseling pregnant women about ECC transmission, to describe personal and practice characteristics, and examine how dentists' views on the ease of adopting of new procedures related to ECC counseling. Multivariate logistic regression was used to identify separate and additive effects of demographic and practice characteristics, attitudes, and beliefs. RESULTS The adjusted odds of a dentist who strongly believed in the link between mothers and babies and provided ECC counseling were 1.60 (95% CI 1.3-2.0, P<0.01). The odds of a dentist who reported discussing ECC with staff members and provided counseling were 2.7 (95% CI 1.7-4.3, P<0.01). Male dentists were less likely to counsel patients than female dentists (Adjusted OR=0.5, 95% CI 0.3-1.0, p<0.05). CONCLUSIONS The strongest predictors of counseling patients about ECC were dentists' belief in the evidence of caries transmission and dentists' discussion of ECC during staff meetings.
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Affiliation(s)
- Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, University of Washington, Seattle, WA 98195-7475, USA.
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Kanuga S, Sheller B, Williams BJ, Mancl L. A one-year survey of inpatient dental consultations at a children's hospital. Special Care in Dentistry 2012; 32:26-31. [DOI: 10.1111/j.1754-4505.2011.00227.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Turner JA, Mancl L, Huggins KH, Sherman JJ, Lentz G, LeResche L. Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial. Pain 2011; 152:2074-2084. [PMID: 21680092 DOI: 10.1016/j.pain.2011.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/05/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
Abstract
Mounting evidence supports the importance of hormonal fluctuations in temporomandibular disorder (TMD) pain among women. Stabilizing influential hormones or having a plan and skills for coping with hormonally related increases in TMD pain, therefore, may be beneficial for women with TMD pain. This randomized clinical trial evaluated the short- and long-term efficacy of 3 interventions for women with TMD pain: (1) dental hygienist-delivered pain self-management training (SMT; n=59); (2) the same dental hygienist-delivered pain self-management training, but with a focus on menstrual cycle-related changes in pain and other symptoms (targeted SMT, or TSMT; n=55); and (3) continuous oral contraceptive therapy (6-month trial) aimed at stabilizing hormones believed to be influential in TMD pain (COCT; n=57). Study participants completed outcome (pain, activity interference, depression) and process (pain beliefs, catastrophizing, coping effectiveness) measures before randomization, and 6 and 12months later. Intent-to-treat analyses supported the benefits of the SMT and TSMT interventions relative to COCT. Targeting the self-management treatment to menstrual cycle-related symptoms did not increase the treatment's efficacy. The benefits of the self-management interventions relative to COCT for pain and activity interference were statistically significant at 12 months, but not at 6 months, whereas the benefits for the process measures generally were apparent at both time points. COCT was associated with multiple adverse events (none serious). The study provides further support for long-term benefits of a safe, low-intensity (2 in-person sessions and 6 brief telephone contacts), dental hygienist-delivered self-management treatment for TMD pain.
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Affiliation(s)
- Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Dental Public Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA Department of Oral Medicine, University of Washington School of Dentistry, Seattle, WA, USA Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
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Rothen M, Cunha-Cruz J, Mancl L, Leroux B, Davis BL, Coyne J, Gillette J, Berg J. Inter-examiner reliability of salivary diagnostic tests in a practice-based research network. J Dent Hyg 2011; 85:143-150. [PMID: 21619742 PMCID: PMC3631606] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Patient salivary characteristics are being measured as part of the Northwest PRECEDENT (Practice-based REsearch Collaborative in Evidence-based DENTistry) study on caries risk assessment. Prior to the implementation of these salivary diagnostic tests in a practice-based cohort study, inter-examiner reliability was assessed for resting salivary pH, stimulated salivary flow rate, pH and buffering capacity. METHODS An initial evaluation of inter-examiner reliability of the 4 salivary tests was conducted among 6 dental auxiliary examiners using a convenience sample of 40 dental students. An in complete block design was used to assign samples to examiners (3 examiners per sample and 20 samples per examiner). Inter-examiner reliability testing was conducted on a patient population representative of the practice-based network in 4 member practices. Two dental assistants per practice independently conducted the salivary tests on samples provided by a random selection of 20 to 25 patients. A separate analysis was performed for each study. For each test, an inter-examiner reliability index was computed. RESULTS Results from two studies are reported. In the first, stimulated salivary flow rate demonstrated excellent inter-examiner reliability, and resting salivary pH showed high inter-examiner reliability, while buffering capacity and stimulated salivary pH had moderate and very low inter-examiner reliability, respectively. In the second, inter-examiner reliability was excellent for the stimulated salivary flow rate and the resting salivary pH. The inter-examiner reliability for the stimulated salivary pH was also high and the stimulated salivary buffering capacity test had moderate reliability. CONCLUSION The small variance in stimulated salivary pH and buffering capacity in dental students may have artificially made the reliability appear low in the first attempt at inter-examiner reliability testing. In the second study, all 4 tests had an accept able performance.
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Dunn KM, Jordan KP, Mancl L, Drangsholt MT, Le Resche L. Trajectories of pain in adolescents: a prospective cohort study. Pain 2010; 152:66-73. [PMID: 20971561 PMCID: PMC3020286 DOI: 10.1016/j.pain.2010.09.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/10/2010] [Accepted: 09/08/2010] [Indexed: 01/24/2023]
Abstract
Identification of different patterns of change in pain over time - trajectories - has the potential to provide new information on the course of pain. Describing trajectories among adolescents would improve understanding of how pain conditions can develop. This prospective cohort study identified distinct trajectories of pain among adolescents (11-14 years) in the general population (n=1336). Latent class growth analysis was carried out on the self-reported frequency of back pain, headache, stomach pain and facial pain, which was collected every 3 months for 3 years. Forty four percent of adolescents had a 'painful' trajectory for at least one pain site, and 12% reported persistent pain at one or more pain site. Headache was the most common; 25% of subjects were in a 'painful' trajectory and 5% reported persistent pain. Back pain and stomach pain were also common, with 22% and 21% of subjects in painful trajectories, respectively. Facial pain was the least common, with only 10% in a painful trajectory, and 1% reporting persistent pain. Trajectory characteristics were similar at baseline across pain sites, with the more painful trajectories having significantly higher levels of depression and somatization, lower life satisfaction and more females. Trajectories did not differ significantly at baseline in physical activity levels or BMI. Agreement of trajectory membership among pain sites was moderate. In summary, reporting a painful trajectory was common among adolescents, but persistent pain was reported by a small minority, and was usually experienced at a single pain site.
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Affiliation(s)
- Kate M Dunn
- Arthritis Research UK Primary Care Centre, Keele University, UK Department of Dental Public Health Sciences, University of Washington, School of Dentistry, Seattle, WA, USA Department of Oral Medicine, University of Washington, School of Dentistry, Seattle, WA, USA
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Marshall J, Sheller B, Mancl L. Caries-risk assessment and caries status of children with autism. Pediatr Dent 2010; 32:69-75. [PMID: 20298657] [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: 05/29/2023]
Abstract
PURPOSE This paper's purpose was to describe the caries status of children with autism and explore associations with the Caries-risk Assessment Tool promoted by the American Academy of Pediatric Dentistry. METHODS Data was collected from children with autism, their parents, and dentists using interviews, surveys, and treatment records. Descriptive statistics and bivariate analysis explored the association of new caries activity and caries experience with oral health measures. RESULTS Subjects were 75 males and 24 females with a mean age (+/-SD) of 9.7 years (+/-3.7), (range=2.7 to 19 years). Children < or =7 years old had more new caries (60%) than older children (34%; P=.05). Although not statistically significant, all children who brushed less than once per day had new caries and a mean t-DMF-T (def + DMF) of 73. Children with poor oral hygiene had more new caries (59%) than those with good/excellent hygiene (28%; P=.06). Caries status was not associated with gender, socioeconomic status, medical history, appointment type, dental home, food rewards, restricted diets, and some hygiene habits. CONCLUSIONS This study confirms the validity of considering autism as an indicator of high caries risk. Oral hygiene may be the most influential risk indicator associated with new caries in children with autism.
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Milgrom P, Ly KA, Tut OK, Mancl L, Roberts MC, Briand K, Gancio MJ. Xylitol pediatric topical oral syrup to prevent dental caries: a double-blind randomized clinical trial of efficacy. ACTA ACUST UNITED AC 2009; 163:601-7. [PMID: 19581542 DOI: 10.1001/archpediatrics.2009.77] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries among very young children and to evaluate the effect of xylitol in reducing acute otitis media in a subsequent study. DESIGN Double-blind randomized controlled trial. SETTING Communities in the Republic of the Marshall Islands. PARTICIPANTS One hundred eight children aged 9 to 15 months were screened, and 100 were enrolled. Intervention Children were randomized to receive xylitol topical oral syrup (administered by their parents) twice a day (2 xylitol [4.00-g] doses and 1 sorbitol dose) (Xyl-2 x group) or thrice per day (3 xylitol [2.67-g] doses) (Xyl-3x group) vs a control syrup (1 xylitol [2.67-g] dose and 2 sorbitol doses) (control group). MAIN OUTCOME MEASURES The primary outcome end point of the study was the number of decayed primary teeth. A secondary outcome end point was the incidence of acute otitis media for reporting in a subsequent report. RESULTS Ninety-four children (mean [SD] age, 15.0 [2.7] months at randomization) with at least 1 follow-up examination were included in the intent-to-treat analysis. The mean (SD) follow-up period was 10.5 (2.2) months. Fifteen of 29 of the children in the control group (51.7%) had tooth decay compared with 13 of 32 children in the Xyl-3x group (40.6%) and eight of 33 children in the Xyl-2x group (24.2%). The mean (SD) numbers of decayed teeth were 1.9 (2.4) in the control group, 1.0 (1.4) in the Xyl-3x group, and 0.6 (1.1) in the Xyl-2x group. Compared with the control group, there were significantly fewer decayed teeth in the Xyl-2x group (relative risk, 0.30; 95% confidence interval, 0.13-0.66; P = .003) and in the Xyl-3x group (0.50; 0.26-0.96; P = .04). No statistical difference was noted between the 2 xylitol treatment groups (P = .22). CONCLUSION Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries.
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Affiliation(s)
- Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Dental Public Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98195-7475, USA.
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Miller JR, Mancl L. Risk factors for the occurrence and prevention of temporomandibular joint and muscle disorders: lessons from 2 recent studies. Am J Orthod Dentofacial Orthop 2008; 134:537-42. [PMID: 18929271 DOI: 10.1016/j.ajodo.2006.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 12/01/2006] [Accepted: 12/01/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our objectives were to demonstrate how standard epidemiologic measurements can assist in evaluating the risk factors for tempormandibular joint and muscle disorders (TMJMD) and to determine whether prevention is feasible. METHODS We reviewed 2 recent studies that examined third-molar extractions and severe mandibular retrognathia as risk factors for TMJMD. Cumulative incidences were available from these studies. By using these values, standard epidemiologic measurements of risk, including population attributable risk (PAR), attributable risk (AR), population attributable risk percent (PAR%), and attributable risk percent (AR%), were calculated. (PAR and AR are reported as the numbers of cases per 10,000 per year.) RESULTS In the third-molar extraction study, PAR, AR, PAR%, and AR% were 5, 10, 25%, and 40%; in the severe mandibular retrognathia study, they were 0.5, 17.5, 10%, and 80%, respectively. CONCLUSIONS This review supports the current consensus that most risk factors explain only a small portion of TMJMD in the population. However, some factors might explain a significant portion of TMJMD in persons exposed to particular risk factors. This review supports the current consensus that prevention, by screening the population for risk factors and intervening, is probably not justified. Modification of certain risk factors among exposed persons to prevent TMJMD might be warranted. Incidence data and epidemiologic measurements of risk are needed to evaluate the importance of risk factors for the occurrence and prevention of TMJMD, in both the population and exposed persons.
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Marshall J, Sheller B, Mancl L, Williams BJ. Parental attitudes regarding behavior guidance of dental patients with autism. Pediatr Dent 2008; 30:400-407. [PMID: 18942599] [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
PURPOSES The purposes of this study were to evaluate: (1) parents' ability to predict dental treatment cooperation by their autistic child; (2) behavior guidance techniques (BGTs) used during treatment; and (3) parental attitudes regarding basic and advanced BGTs. METHODS Data were collected from 85 parent/autistic child pairs and their dentists using surveys and treatment records. RESULTS Parents most accurately predicted if their child would permit an examination in the dental chair (> or = 88%) and would cooperate for radiographs (> or = 84%). BGTs utilized most often (> 50%) were positive verbal reinforcement (PVR), tell-show-do (TSD), mouthprops, and rewards. In general, basic BGTs were more acceptable (> 81%) than advanced BGTs (>54%). The most acceptable techniques (>90%) in order were: PVR, TSD, distraction, rewards, general anesthesia, hand-holding by parent, and mouth-props. When parents evaluated only BGTs used for their child, all BGTs, including a stabilization device, were highly acceptable (> 91%), except for staff restraint (74%). CONCLUSIONS Parents were accurate in predicting cooperation for some procedures. The most acceptable and efficacious BGTs in order were: PVR, TSD, distraction, rewards, and hand-holding by parent. Parental perceptions of BGTs were influenced by whether or not they had been used for their child.
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Marshall J, Sheller B, Williams BJ, Mancl L, Cowan C. Cooperation predictors for dental patients with autism. Pediatr Dent 2007; 29:369-376. [PMID: 18027770] [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: 05/25/2023]
Abstract
PURPOSE This study evaluated potential predictors of cooperation during dental appointments for children with autism. METHODS Data were collected from 108 parent/child pairs and their dentists. Questions included: (1) medical/dental history; (2)functional language; (3) personal hygiene skills; (4) academic setting; and (5) achievements. Behavior was scored using the Frankl scale. RESULTS Subjects were 80 males and 28 females 2.7 to 19 years old with a mean age of 9.8 years. Frankl scores were 65% uncooperative (definitely negative or negative) and 35% cooperative (positive or definitely positive). Multiple factors predicted uncooperative behavior: (1) appointment type (P=.03); (2) concurrent medical diagnoses (P=.04); (3) nonverbal/minimal or echololic language (P=.005); (4) inability to understand language appropriate for age (P=.02); (5) inability to follow multistep instructions (P=.04); (6) parents providing most/all tooth-brushing (P=.004); (7) partially or not toilet trained at 4+ years (P=.02); (8) inability to sit for a haircut (P=.01); (9) attending special education (P<.001); and (10) inability to read at 6+ years (P<.001). CONCLUSIONS Five questions readily answered by a caregiver may indicate a child's cooperative potential. Preappointment inquiry about toilet training, toothbrushing, haircuts, academic achievement and language can give the dentist insight into the child's ability to respond positively to behavior guidance techniques based on communication.
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Affiliation(s)
- Jennifer Marshall
- Children's Hospital and Regional Medical Center, Seattle, Wash., USA.
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Stapleton M, Sheller B, Williams BJ, Mancl L. Combining procedures under general anesthesia. Pediatr Dent 2007; 29:397-402. [PMID: 18027774] [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: 05/25/2023]
Abstract
PURPOSE The purpose of this study was to analyze cases in which dentistry was combined with other procedures during a single outpatient general anesthetic (GA) in a children's hospital. Financial and time savings were evaluated for a subgroup of combined care patients. METHODS Records of 120 patients who received combined dental and one other procedure under GA were reviewed. All were treated as outpatients, and dental procedures were more than just radiographs. Descriptive statistics were calculated for: (1) patient characteristics; (2) procedures; (3) times for procedures; (4) anesthesia; (5) recovery; and (6) total time in hospital. Records of 18 patients with combined dentistry and extraction of third molars were compared to 36 patients receiving the same procedures during separate GAs to evaluate time and costs for combined vs separate procedures. RESULTS Patients ranged from 2 to 21 years, and 98% had special health care needs. Oral surgery (41%) and otolaryngology (23%) were most frequently combined with dentistry. Estimated mean savings for patients receiving dentistry and third molar extractions in combination were 312 minutes and $2,177. CONCLUSIONS Combining care offers an economical vehicle for providing medical and dental care to patients needing multiple procedures. Awareness of the efficiency of combined care may lead to more combinations of procedures when possible.
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Affiliation(s)
- Mark Stapleton
- Children's Hospital and Regional Medical Center, Seattle, Wash., USA.
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Page RC, Lantz MS, Darveau R, Jeffcoat M, Mancl L, Houston L, Braham P, Persson GR. Immunization of Macaca fascicularis against experimental periodontitis using a vaccine containing cysteine proteases purified from Porphyromonas gingivalis. ACTA ACUST UNITED AC 2007; 22:162-8. [PMID: 17488441 DOI: 10.1111/j.1399-302x.2007.00337.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 12/01/2022]
Abstract
INTRODUCTION Periodontitis is a common infectious disease to which Porphyromonas gingivalis has been closely linked, in which the attachment tissues of the teeth and their alveolar bone housing are destroyed. We conducted a study to determine if immunization using a purified antigen could alter the onset and progression of the disease. METHODS Using the ligature-induced model of periodontitis in Macaca fascicularis, we immunized five animals with cysteine protease purified from P. gingivalis and used an additional five animals as controls. Alveolar bone loss was measured by digital subtraction radiography. RESULTS Immunization induced high titers of specific immunoglobuin G serum antibodies that were opsonic. Total bacterial load, levels of P. gingivalis in subgingival plaque and levels of prostaglandin E(2) in gingival crevicular fluid were significantly reduced. Onset and progression of alveolar bone loss was inhibited by approximately 50%. No manifestations of toxicity were observed. CONCLUSIONS Immunization using a purified protein antigen from P. gingivalis inhibits alveolar bone destruction in a ligature-induced periodontitis model in M. fascicularis.
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Affiliation(s)
- R C Page
- Department of Periodontics, and Regional Clinical Dental Research Center, School of Dentistry, Indiana University, Indianapolis, IN, USA.
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Abstract
The aim of this study was to characterize the normality of menstrual cycles on the basis of progesterone and estradiol levels in self-collected saliva samples. Twenty-two women, ages 19-40 years, self-collected whole unstimulated saliva specimens each morning for two consecutive menstrual cycles. On the basis of presence/timing of hormone peaks, two investigators classified 24 cycles as normal, 10 as likely normal, and 10 as clearly not normal with respect to expected profiles. Our results show that whole saliva samples collected at home on a daily basis provide a noninvasive, feasible method of determining menstrual cycle profiles.
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Affiliation(s)
- Beatrice K Gandara
- Department of Oral Medicine, Box 356370, School of Dentistry, University of Washington, Seattle, Washington 98195, USA.
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Abstract
OBJECTIVES The scientific evidence is conflicting as to whether there is an association between parental and child pain. The goal of this study was to assess whether there is an association between: (1) site-specific pain conditions in mothers and children and (2) the presence of multiple pain conditions in mothers and children. METHODS A population-based sample of 2466 children aged 11 to 17 years who were members of a prepaid health were interviewed about the occurrence of common pain conditions-back pain, headache, facial pain, and stomach pain. Their mothers were also interviewed about the presence of pain. RESULTS Children were at significantly increased risk of having back pain, headache, and stomach pain if their mothers also reported pain at the same site (index pain). The association between maternal and child back pain and headache remained significant after adjusting for mother and child demographic variables. A dose-response relationship was observed between maternal multiple pain sites (1, 2, 3, or more) and the presence of back pain, headache, and stomach pain in the child after adjusting for the mother having the index pain and other potential confounders. In multivariate analyses, children were at increased risk of having multiple (2 or more) pain conditions if their mothers had pain at multiple sites, with a dose-response relationship evident with increasing number of maternal pain sites. DISCUSSION There was an association between maternal and child pain in this population-based sample. The presence of multiple pain sites in the mother consistently predicted the presence of site-specific pains and multiple pains in the child. Future research on the association of child and parental pain should include multiple pain sites as both outcome and predictor variables.
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Affiliation(s)
- Kathleen Saunders
- Center for Health Studies, Group Health Cooperative Departments of Oral Medicine, University of Washington, Seattle, WA, USA.
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48
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Turner JA, Holtzman S, Mancl L. Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain 2006; 127:276-286. [PMID: 17071000 DOI: 10.1016/j.pain.2006.09.005] [Citation(s) in RCA: 356] [Impact Index Per Article: 19.8] [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] [Received: 07/10/2006] [Revised: 08/28/2006] [Accepted: 09/05/2006] [Indexed: 01/27/2023]
Abstract
Although cognitive-behavioral therapies (CBT) have been demonstrated to be effective for a variety of chronic pain problems, patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects. Furthermore, although cognitive-behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes, little research has systematically tested this. Therefore, we examined mediators, moderators, and predictors of treatment effects in a randomized controlled trial of CBT for chronic temporomandibular disorder (TMD) pain. Pre- to post-treatment changes in pain beliefs (control over pain, disability, and pain signals harm), catastrophizing, and self-efficacy for managing pain mediated the effects of CBT on pain, activity interference, and jaw use limitations at one year. In individual mediator analyses, change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome. Analyzing the mediators as a group, self-efficacy had unique mediating effects beyond those of control and the other mediators. Patients who reported more pain sites, depressive symptoms, non-specific physical problems, rumination, catastrophizing, and stress before treatment had higher activity interference at one year. The effects of CBT generally did not vary according to patient baseline characteristics, suggesting that all patients potentially may be helped by this therapy. The results provide further support for cognitive-behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain-related beliefs in CBT and in other health care encounters.
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Affiliation(s)
- Judith A Turner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA Department of Dental Public Health Sciences, University of Washington School of Dentistry, Seattle, WA 98195, USA
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49
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Abstract
BACKGROUND Treatment recommendations for patients with painful temporomandibular disorders (TMDs) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery. METHODS The authors randomized 200 subjects diagnosed with TMD into three groups: usual conservative, dentist-prescribed self-care treatment without any intraoral splint appliance (UT); UT plus a conventional flat-plane hard acrylic splint (HS); and UT plus a soft vinyl (a low-cost athletic mouth guard) splint (SS). Subjects completed questionnaires and clinical examinations at three, six and 12 months. RESULTS The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline (BL) or at any follow-up. The changes from BL were comparable for all three groups. The authors did not note any significant differences at any follow-up for compliance with study protocols or for occurrences of adverse effects from either splint type. For HS versus SS, there were significant differences in rates of splint use, but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings. CONCLUSIONS All patients improved over time, and traditional splint therapy offered no benefit over the SS splint therapy. Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy. CLINICAL IMPLICATIONS These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients.
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Affiliation(s)
- Edmond Truelove
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, 98195, USA.
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50
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Richardson LP, Garrison MM, Drangsholt M, Mancl L, LeResche L. Associations between depressive symptoms and obesity during puberty. Gen Hosp Psychiatry 2006; 28:313-20. [PMID: 16814630 DOI: 10.1016/j.genhosppsych.2006.03.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 03/07/2006] [Accepted: 03/07/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescent depression has been shown to be associated with later development of obesity. The purpose of this study was to examine the association between depressive symptoms and obesity with progressive pubertal development. METHODS We conducted an analysis of the association between depressive symptoms and obesity using data from a cross-sectional study of 3101 youth aged 11-17 years. Logistic regression analyses were used to control for maternal education level, race and age. Analyses were stratified by pubertal status and sex to examine how the relationship between depressive symptoms and obesity varies with pubertal development. RESULTS Depressive symptoms increased with pubertal development for both boys and girls, but the increase was larger for girls. Obesity prevalence was similar for all categories of pubertal development in boys and girls. After controlling for age, pubertal development, parental education and race, an association was noted between depressive symptoms and obesity among both males and females. Youth above the 90th percentile in the depressive symptom score had two times the odds of being obese [males: odds ratio (OR)=1.95, 95% confidence interval (95% CI)=1.19-3.18; females: OR=2.17, 95% CI=1.25-3.77]. With the exception of males in late puberty (OR=0.91, 95% CI=0.29-2.87), the magnitude of this association between depressive symptoms and obesity was similar for all levels of pubertal development, with no apparent increase in later puberty among girls. CONCLUSION Depressive symptoms and obesity were associated during adolescence, and this association did not increase with advancing pubertal development.
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Affiliation(s)
- Laura P Richardson
- Child Health Institute, University of Washington, Seattle, WA 98160, USA.
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