American Dental Association Research Articles

Comparison of Black Student Enrollment in US Schools and Colleges of Pharmacy, Medicine, and Dentistry

Objective. Promoting equity and diversity in health care must include increasing the population of minority health care professionals. The purpose of this study was to: evaluate changes in Black professional student enrollment in schools and colleges of pharmacy, medicine, and dentistry; determine whether significant differences exist in Black professional student enrollment among these schools; and rate schools on how well Black professional student enrollment reflects state populations and compare ratings between 2010 and 2019 (for purposes of this study, professional student refers to students enrolled in Doctor of Medicine [MD], Doctor of Pharmacy [PharmD], or Doctor of Dental Medicine [DMD]/Doctor of Dental Surgery [DDS] degree programs).Methods. Enrollment data were obtained through the American Association of Colleges of Pharmacy, Association of American Medical Colleges, and American Dental Association for fall 2010 through fall 2019. The average percentage of Black students enrolled and the rate of change over time was determined. Schools were rated on their percentage of Black students relative to the percentage of Black residents in their state. Kruskal-Wallis H test, Wilcoxon signed rank tests, and chi-square tests were performed to quantify differences in enrollment and college ratings.Results. Schools of pharmacy and medicine experienced a significant increase in Black student enrollment between 2010 and 2019, but schools of dentistry did not. Pharmacy and medical schools also had significantly greater Black student enrollment in 2019 compared to dentistry. The proportion of schools of pharmacy and medicine with failing ratings decreased between 2010 and 2019.Conclusion. To facilitate improved access and limit health and health care disparities, it is important that health professions schools and colleges reflect the diversity of the patient populations they serve. Serious and intentional efforts toward diversification, inclusivity, and equity are necessary to improve Black student enrollment.

Smoking cessation counseling and treatment: An American Dental Association Clinical Evaluators Panel survey

BackgroundGiven the oral health implications of smoking, vaping, and using smokeless tobacco products (STPs), the dental office can be an effective setting for clinicians to offer smoking cessation counseling and treatment (SCCT). MethodsA survey tool was developed to assess dentists’ approach and experience with SCCT. This survey was deployed electronically on May 21, 2021, to the American Dental Association Clinical Evaluators (ACE) Panel (N = 982), and 1 week later, nonresponders were sent reminders. Results were summarized in SAS Version 9.4. ResultsOf the 283 survey responders, one-half offered SCCT to their patients. Of those who offered SCCT, 69% would be willing to prescribe pharmacologic agents to help with cessation. Nine of 10 times, SCCT conversations included the dentist. Of the 49% of respondents who did not offer SCCT, one-quarter were current or past smokers, vapers, or STP users. Out of all of the survey respondents, 40% were aware that SCCT is part of most medical benefits. Most respondents (82%) perform surgeries on patients who smoke, vape, or use STPs. ConclusionsImplementation of SCCT in the dental office was split among ACE panelists, but when it was offered, the dentist was almost always involved. Awareness about SCCT medical benefits and surgical protocols for current smokers, vapers, and STP users differed among this sample. Practical ImplicationsDentists can benefit from more formal training and resources around SCCT and access to reimbursement for having these crucial conversations with their patients.

Gessos pedra, usualmente empregados pelo cirurgião-dentista brasileiro, face a norma proposta pela Associação Dentária Americana

The main objective of this research was to analyse four dental gypsum products by brazilian dentists, according to the proposed American Dental Association specification for Dental Gypsum Products. (Six Draft) Iuated: consistency, setting time, compressive strenght, setting expansion and reproduction of detail. Only one the products tested (products tested (product D) met all the requirements. The other three products, (A, B and C) althought and reproduction of detail requirements, failed with regard to setting time and setting expansion requirements.

Limited, uneven progress in increasing racial and ethnic diversity of dental school graduates.

To assess racial and ethnic diversity of graduates of each dental school compared to the diversity of populations they draw from and to assess changes over time nationally and by school. We calculated diversity of graduates by school and nationally between 2010-2012 and 2017-2019 using the Integrated Post-secondary Education Data System (IPEDS) and compared the diversity of each state's college age population using data from the American Community Survey. We accounted for differences between in-state and out-of-state students attending public and private schools based on data from the American Dental Association's Survey of Dental Education Series. A diversity index (DI) was calculated for each school. A DI of 0.5 means that the representation of Black or Hispanic individuals among the graduates is half of their representation in the benchmark population. Among the 63 dental schools analyzed, only seven had a DI of greater than 0.5 for Black graduates (two of which were Historically Black Colleges and Universities) in 2017-2019. For Hispanic graduates, 20 schools had a DI above 0.5. Nationally, while the number of Black graduates increased between 2010-2012 and 2017-2019, the percentage decreased from 5.8% to 5.1%. The percentage of Hispanic graduates increased from 6.4% to 8.7%. Black and Hispanic individuals are underrepresented among dental school graduates. Increasing the diversity of the dental workforce could help address significant oral health disparities experienced by Black and Hispanic people. More needs to be done by the dental education community to increase racial and ethnic diversity of dental graduates.

Identifying factors that impact general dentists’ referrals to orthodontists

Referrals from general dentists are a significant source of orthodontic patients, but our knowledge of factors guiding referral decisions predates recent marketplace trends of direct-to-consumer products and broad digitization. To provide orthodontists with current, nationwide data on referral values and communication preferences, a mixed-methods study was conducted. Semistructured interviews were conducted with practicing general dentists (n=23), and interviews were analyzed to identify factors important to communication and referrals. Qualitative data provided the foundation to develop and pretest a survey distributed nationally to American Dental Association general dentists through email (n=373). Survey results were evaluated using bivariate and descriptive statistics. Although 42% of general dentists provide orthodontics, of those, 68% report insufficient orthodontic training in dental school, and 61% have increased orthodontic care in recent years. General dentists refer to orthodontists for complex cases and growing patients, with the orthodontist's perceived skill and proximity to the patient being important for choosing a specific orthodontic practice. Phone (70%) and email (61%) are the most used interoffice communication methods, with email (40%) and then phone (30%) being the most preferred. The most important aspects of a working relationship were patient satisfaction and final occlusal outcome, whereas the best way to boost referrals was through improving communication. Excellent care and patient satisfaction remain primary motivators for referrals from generalists to orthodontists. An improved orthodontic curriculum is needed for general dentists. Good communication with dentists is critical for growing referral streams and enhancing patient care.

Repair versus replacement of defective direct restorations: A cross-sectional study among US dentists

BackgroundRepair increases the longevity of restorations and is well-accepted by patients. In this study, the authors assessed the acceptance of dental restoration repair by dentists and determined the main variables of repair versus replacement of defective restorations. MethodsA 15-item questionnaire was developed and distributed electronically to the American Dental Association Clinical Evaluators panel members (n = 785) during a 2-week period in 2019. Descriptive, bivariate, and multivariable analyses were conducted. ResultsOf the 387 respondents, 83.7% stated that they repair defective restorations, and 16% stated that they always replace them. Reasons to forego a restoration repair among dentists who perform repairs included defect size and carious lesion extension (42%) and negative personal experience or lack of success (37.9%). However, the latter was considerably higher for dentists who do not perform repairs (60.7%). The most commonly cited patient-related reason and tooth condition to repair restorations were limited patient finances (67%) and noncarious marginal defects (86%), respectively. Neither sex nor age group was significantly associated with the practice of restoration repair (P = .925 and P = .369, respectively). However, sole proprietors were more likely to perform repairs than those in an employee, associate, or contractor practice setting (P = .008). The most significant reason to forego restoration was negative experience or lack of success (P = .002). ConclusionsRestoration repair is considered a treatment option for managing defective restorations. Negative personal experience or lack of success and practice setting influenced the dentists’ decision to repair or replace a defective restoration. Practical ImplicationsUnderstanding dentists’ clinical challenges and practice environment is necessary when advocating for this approach.

What Is Best for the Child? Pediatric Dental Care during COVID-19

The coronavirus (COVID-19) pandemic has challenged the dental health profession in an unprecedented manner. Suspension of elective dental care across the United States during the initial phase of the pandemic was necessary to prevent viral transmission. The emergency dental care that was provided had to be tailored to minimize the generation of aerosols. With the suspension of elective care, over time, the proportion of dental emergencies was anticipated to rise. Dentists who care for children have continued to provide emergency dental treatment to this vulnerable population. Treatment decisions for pediatric dental emergencies had to be tailored to principles of public health that best mitigated risk of viral transmission. Decisions needed to balance the benefits of chosen treatment modality for the individual child with the risk of viral transmission to dental professionals and their staff, patients, and community. The paucity of reliable research for dentists to aid in clinical decision making may have left careproviders feeling ethically and morally insecure in shifting from a patient-centered to a community-centered paradigm. We present analysis of four pediatric emergency case scenarios that are representative of those likely to present to a private practice, academic setting, or emergency department during the COVID-19 pandemic. This analysis aims to empower dentists who care for children to implement the American Dental Association's Principles of Ethics and Code of Professional Conduct within the context of a global health crisis.

Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics

BackgroundThe American Dental Association (ADA) recommends dental providers apply dental sealants to the occlusal surfaces of permanent molars for the prevention or treatment of non-cavitated dental caries. Despite the evidence-based support for this guideline, adherence among general dentists is low, ranging from less than 5 to 38.5%. Thus, an evidence-to-practice gap exists, and it is unclear which implementation strategies would best support providers in adopting and implementing the evidence-based practice. One potential approach to selecting and tailoring implementation strategies is a deliberative loop process, a stakeholder-engaged approach to decision-making. This trial aims to test the acceptability, feasibility, and effectiveness of using a deliberative loop intervention with stakeholders (i.e., providers and staff) to enable managers to select implementation strategies that facilitate the adoption of an evidence-based dental practice.MethodsSixteen dental clinics within Kaiser Permanente Northwest Dental will be cluster randomized to determine the timing of receiving the intervention in this stepped-wedge trial. In the three-part deliberative loop intervention, clinic stakeholders engage in the following activities: (1) receive background information, (2) participate in facilitated small-group discussions designed to promote learning from each other’s lived experiences and develop informed opinions about effective clinic-level implementation strategies, and (3) share their informed opinions with clinic leaders, who may then choose to select and deploy implementation strategies based on the stakeholders’ informed opinions. The primary outcome of Reach will be defined as patient-level receipt of guideline-concordant care. Secondary outcomes will include the cost-effectiveness, acceptability, and feasibility of the deliberative loop process. Implementation strategies deployed will be catalogued over time.DiscussionThese results will establish the extent to which the deliberative loop process can help leaders select and tailor implementation strategies with the goal of improving guideline-concordant dental care.Trial registrationThis project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730

Decoding the ergonomics in the new normal for dentistry: A narrative review

Focus and precision are the sine qua non of dentistry, wherein the routine tasks require a peak pinch force and results in finger fatigue and cumulative trauma disorders combined with impaired vision. Dentists’ posture is treated with great care and oft repeated in Ergonomics, studied in undergraduate courses and the continuing education courses, though many still do not know the subject well enough. The study selection was done upon selecting the dental surgeons, hygienists, assistant working on their patients and included the findings relating to practice environment. The electronically searched sources until 2021 were the MEDLINE Pub med, EMBASE, Wiley Online Library, Science direct, American Dental Association (ADA) website and Google Scholar. An additional manual search and queries with cross-reference yielded around fifty studies ultimately. The International Ergonomic Association (IEA) recognized certain domains long ago and its noteworthy application for dental office is set forth in the present review. Ergo-dentistry may come to be realized as a new essential in the new normal for our profession. Evidence echoes that dentists are at risk for developing health problems, particularly the musculoskeletal disorders and impaired vision. Beyond doubt, a healthy dentist is a pre-requisite for a successful dental practice. Ergodontics is the key to keep check on the same and following its core principles is essential.

Recommendations for managing endodontic emergencies during coronavirus disease 2019 outbreak

The management of endodontic emergencies has been particularly challenging during the coronavirus disease 2019 (COVID-19) outbreak because of the possible generation of airborne particles and aerosols. The aim of this report was to contribute to the practice of endodontics by proposing a general protocol for the management of emergencies showing the rationale for remote diagnosis, clinical procedures, and the use of personal protective equipment and barriers at the dental office during the COVID-19 outbreak. A review of the literature was conducted up to May 2020 on relevant institutional sites, aiming to retrieve the best updated evidence. The reporting considered the Reporting Tool for Practice Guidelines in Health Care statement. Recommendations from Cochrane Oral Health, the American Dental Association, and the Centers for Disease Control and Prevention were included along with the American Association of Endodontists resources and scientific articles that addressed the issue. According to this article the proposed protocol could contribute to the management of endodontic emergencies at the dental office during the COVID-19 outbreak.

Effect of Incorporation of Different Concentrations of Silver Nanoparticles as an Antimicrobial Agent on the Flexural and Impact Strength of Heat-Cured Denture Base Resin

Abstract Aim This article evaluates the effect of incorporating different concentrations of silver nanoparticles as an antimicrobial agent on the flexural and impact strength of heat-cured denture base resin. Material and Methods A total of 80 specimens of polymethyl methacrylate resin were fabricated (40 for flexural strength and 40 for impact strength). Specimens were fabricated using stainless steel die of dimension 65 mm × 10 mm × 2.5 mm as per the American Dental Association specification no. 12, and 50 mm × 6 mm × 4 mm as per ISO 1567:1999 for flexural strength and impact strength, respectively, and were divided into four groups (A, B, C, and D) based on the concentrations of silver nanoparticles (0%, 2.5%, 5%, and 10%). The specimens were subjected to three-point bending test and Izod impact tester for testing flexural and impact strength, respectively. Data obtained was compiled and analyzed using one-way analysis of variance and post hoc tests. Results Results showed that for both the properties, maximum strength was observed in group A (control) followed by groups B and C, and minimum was observed in group D. A statistically significant difference in flexural strength was found among all the groups, whereas no statistically significant difference in impact strength was found among any of the groups. Conclusion Within the limitations of this in vitro study, it was concluded that though incorporation of silver nanoparticles exhibited no effect on the impact strength of heat cure denture base resin, it decreased the flexural strength, so it should be used cautiously.

Intraoral scanners: An American Dental Association Clinical Evaluators Panel survey

BackgroundDentists may choose to integrate intraoral scanners (IOSs) into their practices, but there are many different IOS technologies and system generations to choose from, posing a challenge for dentists who want to invest in them. MethodsA survey of IOS use rates, advantages, satisfaction, and training was developed and deployed through Qualtrics to the 968 members of the American Dental Association Clinical Evaluators (ACE) Panel on February 19, 2021. Nonrespondents were sent reminders, and data were analyzed in SAS Version 9.4 (SAS). ResultsA total of 369 panelists responded to the survey. IOS use was split among the ACE Panel; 53% indicated they use one in their practice. The top reason respondents began using IOSs was to improve clinical efficiency (70%). Ninety percent of respondents use IOSs for single tooth-supported crowns, and 58% began using IOSs less than 4 years ago. Most users are at least mostly satisfied (91%) with the results. Among nonusers, the top reason for not using an IOS was the high level of financial investment (66%); 34% and 40% of nonusers are thinking of buying or training with IOSs in 2021, respectively. ConclusionsUptake of IOSs is split; most users are satisfied with their results, and nonusers cited financial barriers as the most common reason for not investing in one. Practical ImplicationsAs IOSs continue to penetrate the market and dentists are faced with a decision whether to invest in one, they will need guidance on how to choose the most appropriate device for their patients.

Deep Margin Elevation for Indirect Restorations: A Systematic Review

Background: The evolution of adhesive dentistry has increased the demand for improving the clinical outcomes of indirect restorations. There are several challenging factors in restoring teeth with deep interproximal lesions. Surgical crown lengthening has been the primary procedure to avoid violation of the biological width. In recent years, deep marginal elevation (DME) has been proposed as an alternative procedure for maintaining biological width in cases with subgingival defects. The aim of this review was to search for the best available evidence concerning the clinical outcomes of DME.
 Methodology: A comprehensive online search was performed using three different databases (using PubMed, the Cochrane Library, and the American dental association library for evidence-based dentistry). Four independent authors reviewed studies, collected data, and assessed the risk of bias.
 Results: The initial search revealed 1,763 studies. Duplicates were removed, and an extensive review was performed. Only six studies met the inclusion criteria and were accepted in the review.
 Conclusions: The systematic review advocates that DME is a reasonable, predictable, and reliable clinical procedure. There is a limitation of clinical studies in this field; therefore, more clinical studies with long-term follow-up periods are necessary.

Validation of a Subjective Caries Risk Assessment Tool

The objective was to evaluate the predictive validity of the American Dental Association's caries risk assessment (CRA) tool, adapted with permission, and used by the U.S. Department of Veterans Affairs dental services within their electronic dental record. This analytic epidemiologic study with a retrospective longitudinal design included Veterans who had a minimum of three years of available data. The primary outcome was caries-related treatment during the twelve-month predictive period following the CRA category identification. The sample included 57,675 Veterans; 50.1% classified as low, 33.2% as moderate and 16.8% as high caries risk. During the twelve-month predictive period, both teeth/person and teeth with caries-related treatment rose sequentially from low to high CRA categories. However, poor sensitivity (0.34-0.58) and better specificity (0.53-0.78) values were observed. Similarly, better negative predictive values (0.72-0.79) compared to positive predictive values (0.28-0.34) were found. Adjusted logistic regression models showed that current treated caries (caries detected at the time of the CRA exam) was more strongly associated with future caries-related treatment than the subjective CRA determination. The subjective CRA tool evaluated in this study is better at identifying patients at low risk of requiring future caries-related treatment versus those at higher risk. This makes it difficult to target the most caries susceptible patients with preventive measures. Furthermore, we found that the amount of caries treatment required at the time of the CRA exam had the strongest association with caries-related treatment during the subsequent twelve-month predictive period. The amount of caries-related treatment required at the time of the caries risk classification is the strongest predictor of future caries.

Antimicrobial Activity, Physical Properties and Sealing Ability of Epoxy Resin-Based Sealer Impregnated with Green Tea Extract-Chitosan Microcapsules: An In-Vitro Study

Aim: To assess the effect of prepared green tea-chitosan microcapsules on the antibacterial efficiency against Enterococcus faecalis, the physical properties, and the sealing ability of resin-based endodontic sealer impregnated with these microcapsules. Materials and Methods: Green tea extract (GTE) and chitosan solution were prepared, then GTE was dissolved into this solution followed by precipitation of chitosan nanoparticles (CSNPs) loaded with GTE. Microcapsulation of GTE-CSNPs was performed and the solution was prepared (3 % w/v concentration). Characterization of microcapsules was conducted using Fourier-Transform Infrared Spectroscopy (FTIR), Zeta potential, and transmission electron microscope (TEM). The release of GTE at different pH values was evaluated. GTE-CSNPs solution was added to an epoxy resin-based sealer and the antibacterial activity was evaluated via direct contact test. The physical properties of the modified sealer were evaluated according to American Dental Association (ADA) specifications. Sealing ability was evaluated stereomicroscopically. Data were statistically analyzed. Results: FTIR and Zeta potential ensured the attachment between GTE and Chitosan. The particle size of CSNPs and GTE-CSNPs was around 20 nm, while microcapsules were greater than 1000 nm. A significantly higher percentage of GTE was released at pH 5 than pH 7.4, (𝑃 < 0.001). After sealer modification, the antibacterial evaluation showed significant decrease in optical density (𝑃 < 0.001). Also, the setting time, film thickness and microleakage were significantly decreased, however, the solubility was significantly increased (𝑃 < 0.001) but still within the acceptable limit of ADA specifications. Conclusions: GTE-Chitosan microcapsule is a proper natural candidate for improvement of sealer’s properties.

Nonventilator hospital-acquired pneumonia: A call to action.

In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non-ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans' Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia.

Evaluation of Relationship between Quality and Performance Measures Concepts of Pediatric Oral Health: A Cross-sectional Study.

Background:The dental quality alliance of the American Dental Association developed quality and performance measure concepts (QMCs) for pediatric dentistry to identify variations in care and to improve quality of care.Objectives:This study evaluated the relationship between the proposed QMCs and oral health, measured as caries status.Methodology:Parents/guardians of new patients presenting to the Nationwide Children's Hospital Dental Clinic for a nonurgent hygiene appointment were asked to complete a 10-question survey that reflected the QMCs. An oral examination was completed on each patient to determine his/her caries status.Results:For the majority of the QMCs evaluated in the study, there was no statistically significant difference in caries status between patients who had attended care according to the QMCs and those who had not.Conclusions:From the findings, attending care as outlined by the QMCs may be no better than counting procedures as a measure of quality oral health-care outcomes.

Comparative Evaluation of Surface Detail Reproduction and Dimensional Stability of Poly Ether, Vinyl Siloxane, and Vinyl Siloxane Ether Impression Materials: An In vitro Study.

Introduction:Impression making is an integral part of prosthetic dentistry. Development of material science has allowed integrating qualities of hydrophilic polyether and hydrophobic polyvinyl siloxane into a newer hybrid material, vinyl polysiloxane (VPS) ether. This study was aimed to compare the VPS ether with the polyether and polyvinyl siloxane in terms of accuracy and dimensional stability.Materials and Methods:Stainless steel dies with the American Dental Association specification 19 were made. Die has three horizontal and two vertical lines which are used for taking the impression. Two cross-points at the junction of the vertical lines with line 2 were marked as x and x' and served as beginning and end points of measurements for dimensional accuracy. Accuracy was evaluated 30 min after making each impression. If at least two of the three horizontal lines were reproduced continuously between cross-points, this impression was considered satisfactory. The specimens are poured with Type IV gypsum product and allowed to set completely for 24 h. Then, dimensional stability was measured in the model by measuring the distance between the two lines and comparing the distance with the measurement of line on metal die, which was used to make the impression.Results:The mean value obtained for light- and medium-bodied VPS ether was 0.05370 and 0.05330 and for light and medium-bodied polyvinyl siloxane was 0.06370 and 0.07150, respectively. The mean value for polyether monophase was 0.06430. Two-way ANOVA and post hoc test showed statistical significance.Conclusion:The newer VPS ether material showed good surface detail reproduction and dimensional stability when compared with polyvinyl siloxane and polyether.

COVID-19 among dentists in the United States: A 6-month longitudinal report of accumulative prevalence and incidence

BackgroundIn 2020, the Centers for Disease Control and Prevention and the American Dental Association released COVID-19 infection control interim guidance for US dentists, advising the use of optimal personal protection equipment during aerosol-generating procedures. The aim of this longitudinal study was to determine the cumulative prevalence and incidence rates of COVID-19 among dentists and to assess their level of engagement in specific infection control practices. MethodsUS dentists were invited to participate in a monthly web-based survey from June through November 2020. Approximately one-third of initial respondents (n = 785) participated in all 6 surveys, and they were asked about COVID-19 testing received, symptoms experienced, and infection prevention procedures followed in their primary practice. ResultsOver a 6-month period, the cumulative COVID-19 infection prevalence rate was 2.6%, representing 57 dentists who ever received a diagnosis of COVID-19. The incidence rates ranged from 0.2% through 1.1% each month. The proportion of dentists tested for COVID-19 increased over time, as did the rate of dentists performing aerosol-generating procedures. Enhanced infection prevention and control strategies in the dental practice were reported by nearly every participant monthly, and rates of personal protection equipment optimization, such as changing masks after each patient, dropped over time. ConclusionsUS dentists continue to show a high level of adherence to enhanced infection control procedures in response to the ongoing pandemic, resulting in low rates of cumulative prevalence of COVID-19. Dentists are showing adherence to a strict protocol for enhanced infection control, which should help protect their patients, their dental team members, and themselves. Practical ImplicationsCOVID-19 infections among practicing dentists will likely remain low if dentists continue to adhere to guidance.

Bones Versus Teeth

Introduction: A 200% increase in population growth among those over 85 is projected in the United States by 2050. Approximately half of women over 50 will experience an osteoporotic fracture in their lifetime. Osteoporosis disproportionately affects old-old adults (those between 85 and 95) as more than half of those admitted to the hospital for hip fracture are over 80 years of age. Older adults are also likely to need dental care. The American Dental Association guidelines offer preventive recommendations for those over 60 years of age but do not address the nuances of treatment options for nonagenarian persons. This case illustrates the treatment dilemma of nonagenarians wishing to optimize both bone and dental health. Case: We have a 95-year-old performance artist, who seeks to optimize bone health in the face of recommended dental work. She has been physically active her whole life and consumes adequate quantities of calcium and Vitamin D. She doesn’t smoke but has needed periodic glucocorticoids for exacerbations of chronic lung disease. At age 84 she began ibandronate but stopped due to worsening of esophageal reflux. She was then treated with teriparatide for 2 years. DEXA scans have shown declining hip T scores from -2.8 at age 88 to -3.5 at age 94 (osteoporotic bone density: T-score lower than -2.5). Her dentist recommended the extraction of several teeth before beginning zoledronate. She refused tooth extraction and sought treatment options to enhance her bone density. Discussion: Persons of advanced age are likely to have oral health problems requiring dental treatment. Bone health treatments such as bisphosphonates and denosumab are generally safe but can potentially cause osteonecrosis of the jaw even with simple tooth extraction in old-old population. Specific guidelines are lacking for treatment to maintain bone and dental health. The American Association of Oral and Maxillofacial Surgeons suggests that extractions and implants can be conducted as usual in patients who have been treated with oral bisphosphonates for less than four years and lack other clinical risk factors. A delay of two months is suggested for those who have been treated for more than four years or has taken glucocorticoids concomitantly. The approach is uncertain for old-old adults who are taking treatment but develop a need for dental surgery. More research is needed about options for optimizing dental health while enhancing bone density in aging population.