Dental Association Research Articles

A comparison of subjective and objective caries risk assessment methods

Background: Dental caries is a serious public health problem significantly affecting oral health. Though there have been many advancements in treating dental caries, complete prevention of dental caries is still beyond reach. Several risk factors are associated with caries formation and progression. Previous studies have been conducted on dental caries and the efficiency of diagnosis using subjective and objective methodologies. Hence, this study was conducted to assess the contradictions in results of subjective and objective interpretations. Methods: A descriptive study was carried out in the clinical setting of rural areas near Chengalpattu. Using convenience sampling, 285 samples were collected according to inclusion and exclusion criteria within the age range of 7–20 years. The subjects were selected from the Outpatient Department of Karpaga Vinayaka Institute of Dental Sciences. American Dental Association (ADA) questionnaires were used for subjective caries risk assessment (CRA), unstimulated salivary samples were collected to measure salivary pH for objective CRA, and DMFT (decayed, missing, filled tooth) and def indices were measured for reference. After data collection, statistical analysis was performed using SPSS version 22. Chi-square and Pearson correlation tests were performed to find the statistical differences, and a correlation was found between subjective and objective assessment results. Results: In this study, the correlation between objective risk assessment based on salivary pH and actual caries status was slightly better (r=0.159) than other risk assessment methods (r=0.050). Moreover, a negative correlation was found between subjective and objective CRA (r=- 0.062). Conclusion: The study findings show a negative correlation between subjective and objective assessment. Objective CRA using salivary pH was positively correlated with actual caries status.

The Oral Health Statistics Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Explanation and Elaboration

Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the Oral Health Statistics Guidelines. Drafts were circulated to the editors of 85 oral health journals and to task force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the task force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.

Antibiotic Prescribing by General Dentists in the Outpatient Setting — United States, 2018–2022

Background: Inappropriate antibiotic use impacts patient safety and antimicrobial resistance patterns. In 2013, general dentists in the U.S. prescribed nearly 10% of all outpatient oral antibiotics (24.5 million prescriptions). The American Dental Association (ADA) published guidelines in 2019 recommending limited antibiotic prescribing for the treatment of dental pain and swelling. We characterized dental prescribing during 2018–2022 to assess whether antibiotic use decreased after the guideline’s release. In addition, we examined access to dental care. Methods: All antibiotic prescriptions dispensed during 2018–2022 were extracted from the IQVIA Xponent database, which captured ≥92% of all U.S. outpatient prescriptions and projected to 100% coverage. Prescriptions by general dentists were compared to total outpatient oral antibiotic prescriptions and summarized by patient sex, patient age, and prescriber geographic region. Census denominators were used to calculate prescribing rates per 1,000 persons. IQVIA general dentist counts were used to calculate dentists per 100,000 persons. Results: General dentists prescribed 24.7 million antibiotic prescriptions in 2018 (75 prescriptions per 1,000 persons) compared with 25.2 million (76 prescriptions per 1,000 persons) in 2022. During 2020–2022, general dentists prescribed >10% of all outpatient antibiotic prescriptions (range 10.7%–12.1%). In each year, prescription rates were higher for females, patients > 65 years, and among prescribers in the Northeast. In 2022, there were 58 general dentists per 100,000 persons in the United States. The highest general dentist rate was in District of Columbia (100 per 100,000 persons) and the lowest rate was in Delaware (41 per 100,000 persons). Conclusions: Despite the ADA’s 2019 guidelines, prescribing by general dentists remained stable during 2018–2022. Because the total number of antibiotic prescriptions overall decreased, general dentists’ share of all outpatient antibiotic prescriptions increased to >10% in recent years. Rate variation by patient characteristics and prescriber region may reflect differences in dental disease burden or may represent unnecessary antibiotic use. Dental antibiotic stewardship is needed, including dissemination and implementation of current prescribing guidelines. Further evaluation of prescribing indications and access to dental care is needed to inform dental stewardship priorities.

Impact of colloidal silver nanoparticles (AgNPs) added for their antimicrobial efficacy on the compressive strength of poly(methyl methacrylate)-based acrylic denture base resin subjected to two different curing cycles: An in vitro study

Abstract Introduction: Colloidal silver nanoparticles (AgNPs) have been incorporated into acrylic resins to induce antimicrobial properties. However, as additives, they can influence the mechanical properties of the final product. The aim of the present study was to evaluate compressive strength of acrylic denture base resin incorporated with different concentrations of AgNPs subjected to two different curing cycles. Materials and Methods: Lucitone 199 acrylic denture base resin was used in the present in vitro study design because of its high-impact strength, while AgNPs were incorporated at 0.5% and 5% concentration by polymer mass. Specimens devoid of AgNPs were used as controls. The specimens were fabricated according to the American Dental Association specification No. 12 for denture base resin: Second revision, BS specification 2482 and tested for compressive strength using universal testing machine. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA). Descriptive statistics was used to compare two different curing cycles; while one-way analysis of variance and Kruskal–Wallis H-test were used for statistical analysis. P <0.05 was considered statistically significant. Results: Colloidal silver nanoparticles (AgNPs) incorporation at 0.5% concentration increased the mean compressive strength in both the short and long curing cycles by 5.3% and 8.3% respectively when compared with the control group. Conclusions: The findings of the present study suggested that the mean compressive strength of acrylic denture base resin modified with 0.5% concentration of AgNPs was above the control group, both in the short and long curing cycles. However, at 5% concentration of AgNPs, decrease in compressive strength compared to the control group was observed, both in short and long curing cycles, giving it a questionable prognosis, while the results were found to be statistically significant. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge.

The effects of mouth rinsing and gargling with mouthwash containing povidone-iodine and hydrogen peroxide on the cycle threshold value of Severe Acute Respiratory Syndrome Coronavirus 2: A randomized controlled trial of asymptomatic and mildly symptomatic patients.

Coronavirus disease 2019 can spread rapidly. Surgery in the oral cavity poses a high risk of transmission of severe acute respiratory syndrome coronavirus 2. The American Dental Association and the Centers for Disease Control and Prevention recommend the use of mouthwash containing 1.5% hydrogen peroxide (H 2O 2) or 0.2% povidone iodine (PI) to reduce the viral load in the upper respiratory tract and decrease the risk of transmission. The aim of the present study was to analyze the effect of mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water on the cycle threshold (CT) value obtained by real-time reverse transcription polymerase chain reaction (RT-PCR). This study is a randomized single blind controlled clinical trial which has been registered in the International Standard Randomized Controlled Trial Number (ISRCTN) registry on the 3 rd February 2022 (Registration number: ISRCTN18356379). In total, 69 subjects recruited from Persahabatan General Hospital who met the inclusion criteria were randomly assigned to one of four treatment groups or the control group. The subjects were instructed to gargle with 15 mL of mouthwash for 30 s in the oral cavity followed by 30 s in the back of the throat, three times per day for 5 days. CT values were collected on postprocedural days 1, 3, and 5. The results of the Friedman test significantly differed among the groups (n=15). The CT values increased from baseline (day 0) to postprocedural days 1, 3, and 5. Mouth rinsing and gargling with mouthwash containing 1% PI, 0.5% PI, 3% H 2O 2, or 1.5% H 2O 2 and water increased the CT value.

Potential barriers to the rational antibiotic use in dental and periodontal practice: A questionnaire-based online survey.

Dentists, through inappropriate antibiotic prescription, may contribute to the global problem of antibiotic resistance (AR). Understanding dentists' antibiotic prescription patterns, source of knowledge, and the driving forces behind their prescription practices may be crucial for the effective implementation of the rational use of antibiotics (RUA) in dentistry. Active members of the Turkish Dental Association were invited to participate in an electronic survey comprising questions focusing on their role, knowledge and perceptions regarding RUA, the perceived barriers to adapting RUA in daily dental work, and the actual antibiotic prescription practices. The potential impact of age, gender, professional experience, and the mode of dental practice was also evaluated. Dentists' prescription practices for periodontal disease/conditions were evaluated as well. Based on 1,005 valid responses, there was consensus on the necessity of RUA (99.1%); however, its implementation was low. The main barriers were dentists' own safety concerns (74.4%), strong patients' demands (42.2%) and the fact that prescribing antibiotics became a professional habit (35.8%). Different educational background resulted in clear variances in everyday prescription practices. The implementation of RUA was not sufficient and the perceived barriers had an impact on daily prescribing habits. Support for dental professionals through the efficient dissemination of evidencebased clinical guidelines and decision-making aids is likely to require additional help from professional organizations in order to actively combat AR.

Evaluation of the contribution of different groups of teeth to occlusion of patients with symptoms of temporomandibular disorders

AbstractPurposeThe purpose of this study was to analyse the distribution of occlusal forces in the dental arches released during tooth clenching in patients with symptoms of temporomandibular disorders, and to analyse the age and gender structure of the patients in the study group and the control group.Materials and methodThe study was carried out on a group of 58 patients, of both genders, aged 18–40 years, with full dental arches, who presented for treatment at the Prosthodontics Clinic of the University Dental Clinic in Kraków due to symptoms of temporomandibular disorders. The patients were divided into two groups. The first group (study group) comprised 26 patients with painful temporomandibular disorders, while the second group (control group) comprised 32 patients without pain. The study only included patients over 18 years of age, with full dental arches with symptoms of temporomandibular disorders. All patients underwent a basic dental examination and a specialized functional examination of the masticatory organ. A T‐Scan III‐Novus instrument with electronic occlusal articulation paper was used to assess the distribution of occlusal contacts.ResultsIn the study, women (43) were a larger group than men (15). Statistically significant values for the percentage distribution of occlusal contacts were obtained in group of women in the study group on the right and left side, in the area of molars and premolars. In the analysis of the percentage distribution of occlusal contacts in both the study and control groups, it can be seen that the first molars (teeth 16 and 26) showed a larger percentage range of values than the other teeth. The smallest values can be observed on the second incisal teeth and on the canines.ConclusionsThe first molars are, in the majority of patients, the teeth on which the strongest occlusal contacts are generated. Excessive participation of incisal teeth in occlusion might influence the development of the pain form of TMD. In order to determine whether there is a correlation between an uneven distribution of occlusal contacts and TMD pain, studies on larger numbers of patients are needed. © 2024 Australian Dental Association.

The Effect Of Mouthwashes On Color Change In Universal Composite Resin

Background: The use of mouthwash has increased and become a habit since the Covid-19 pandemic. The use of mouthwash is recommended for prevention. The mouthwashes that American Dental Association (ADA) and Center for Disease Control and Prevention (CDC) recommended are chlorhexidine gluconate (CHX), hydrogen peroxide (H2O2), cetilpyridinium chloride (CPC), povidone iodine (PVP-I), dan chlorine dioxide (ClO₂). Universal composite resin is used for every tooth color requirement and has a chameleon effect that can disguise, eliminate, minimize, and neutralize mismatched colors. This study aims to determine various mouthwashes’ effects on the discoloration of universal composite resin. Method: This research is an experimental laboratory by comparing the color changes before and after treatment. Thirty samples of universal composite resin with a width of 10 mm and a height of 2 mm were divided into 5 mouthwash test groups and 1 control group. Color test using a Vita Easy Shade V spectrophotometer and the data were shown in DE assessment. Result: Data were analyzed with One Way ANOVA on DE assessment with the significance level p0.05 on 5 test groups. Conclusion: The 5 groups of mouthwashes showed there was a color change in the DE assessment of universal composite resin

Are sleep disorders associated with traumatic dental injuries in school children? A cross-sectional study.

To evaluate whether the prevalence of traumatic dental injuries (TDIs) in permanent anterior teeth among school children is associated with sleep behaviours and disorders. A cross-sectional study was carried out with a representative sample of schoolchildren aged 8 to 10 years (n = 1402) from Florianopolis, Brazil. Clinical examinations for TDIs were performed according to the classification proposed by Andreasen. Parents/caregivers completed a questionnaire addressing sociodemographic characteristics and sleep behaviours/disorders (sleep duration, insomnia, sleep rhythmic movement, snoring, and signs of sleep apnoea). Descriptive analysis and Poisson regression were performed. The prevalence of TDIs was 10.9%. Insomnia was observed in 3.0% of the children, snoring in 42.8%, sleep rhythmic movement in 27.9%, and signs of obstructive sleep apnoea in 33.6% of the schoolchildren. Most children (75.2%) slept less than eight hours a day. The prevalence of TDIs was higher among schoolchildren with an increased overjet (PR: 1.65; 95% CI: 1.15-2.35; P < 0.01), after adjusting for monthly family income, caregiver's schooling, and sleep behaviours. The prevalence of TDIs was not associated with sleep behaviours/disorders. Parent-reported sleep disorders such as insomnia, sleep rhythmic movement, snoring and signs of sleep apnoea were not associated with the prevalence of TDIs in schoolchildren. © 2024 Australian Dental Association.

Decoding the nuances of scholarly output and publication metrics in orthodontics

This comprehensive manuscript endeavors to furnish orthodontic researchers with the necessary tools and knowledge to adeptly navigate the multifaceted landscape of academic publishing, thereby enhancing the efficacy and reach of their scholarly endeavors. It meticulously imparts critical insights and methodologies for comprehending and leveraging publication metrics, such as citation counts, the h-index, and Journal Impact Factors, to strategically plan research trajectories. Furthermore, it offers guidance on adeptly engaging with evaluation agencies such as the American Dental Association (ADA) and the National Institute of Dental and Craniofacial Research (NIDCR), thereby optimizing alignment with grant opportunities. Through the adept utilization of orthodontic bibliometrics, researchers can gain invaluable insights into prevailing collaboration trends and emerging research domains, thus facilitating informed decision-making and prioritization of scholarly pursuits. Additionally, the manuscript delves into the nuanced optimization of publication guidelines to maximize research impact. Spanning both established domains such as biomechanics, anchorage control, and aligner therapy, as well as burgeoning frontiers including 3D printing and artificial intelligence applications in aligner treatment, this manuscript equips orthodontic researchers with the requisite acumen to embark upon a journey of impactful scholarly contributions, thereby catalyzing advancements in patient care within the discipline.

Propositions pour la prévention et la promotion de la santé bucco-dentaire chez les enfants

At the last congress of the Association Dentaire Fran&#231;aise (ADF) (French Dental Association), the minister of health and prevention, Fran&#231;ois Braun, stressed the importance he attached to oral health prevention. He also emphasized his desire to roll out and extend prevention campaigns, targeting young people in particular. With this in mind, we are working to lay the political foundations for the mass, free distribution of single-use toothbrushes with fluoride toothpaste in schools. This oral health promotion campaign would aim to debunk any myths or misinformation spread by manufacturers and to encourage a profound cultural change in the way children and their parents learn about oral hygiene. The "cavity-score," which is still under development, could help to reinforce the idea, both among the general public and among healthcare professionals, that oral health is not isolated from the rest of the body, and that this health issue cannot be dealt with in isolation, but in conjunction with all healthcare professionals.

Bridging the evidence-to-practice gap: exploring dental professionals' perspectives on managing oral health during pregnancy in Tasmania, Australia.

Poor oral health is associated with adverse health, social and economic consequences for pregnant women. While dental professionals promote good oral health within the dental practice context, more broadly, women in the antenatal period face poor oral health outcomes. Therefore, this study explored dental professionals' perceptions of their role in managing the oral health of pregnant women and identified the barriers and facilitators to improving maternal oral health. This study employed a descriptive qualitative method utilizing semi-structured interviews. Convenience and snowball sampling were used to recruit 13 dental professionals from Tasmania, Australia, comprising dentists (n = 10), oral health therapists (n = 2) and dental therapist (n = 1). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Three major themes were constructed from the interviews: (1) dental professionals' oral health care of women during pregnancy; (2) perceived challenges to maternal oral health; and (3) proposed strategies to improve maternal oral health. Findings suggest dental professionals' competence in maternal oral health, but that several barriers, such as dental care access and maternal factors, hinder oral health outcomes. To address these barriers, oral health policies that support interprofessional collaboration, professional training and evaluation of existing community oral health programmes are needed. © 2024 Australian Dental Association.

Gender equity in The Journal of the American Dental Association: A review of the past 2 plus decades

BackgroundConsidering evidence of closing the gender gap in dental scholarship, this study assessed women’s participation as authors, reviewers, and members of the editorial board for The Journal of the American Dental Association (JADA) from 2000 through 2022. MethodsThe study authors downloaded author names from PubMed and retrieved names of reviewers and editorial board members from JADA's pages. The authors used Gender-API software to determine gender on the basis of first names. They used logistic regression to test for trends. ResultsFrom January 2000 through December 2022, there were 2,935 full-length articles, 2,775 reviewers, 4 editors in chief, and 85 editorial board members. The percentage of women authors increased by 1.2% annually (95% CI, 1.03% to 1.33%), reaching 47% in 2022. First authorship increased by 2.1% annually (95% CI, 1.84% to 2.39%) and has been at more than 50% since 2016. In articles with multiple authors, there was a modest increase; second authorship increased 0.7% annually (95% CI, 0.36% to 1.09%) and last authorship by 0.7% (95% CI, 0.03% to 1.00%). Women reviewers increased 0.8% annually (95% CI, 0.68% to 0.97%), but the percentage of women on the editorial board did not increase significantly and was 41% in 2022. ConclusionsIt was anticipated that 50% of JADA authors would be women by 2024. However, women are still underrepresented on the editorial board. A comprehensive effort is needed to foster role models, provide mentorship opportunities for women, and support women’s professional advancement in dental research and publications. Practical ImplicationsGender-based disparities affect women in dental education and clinical practice. Serving as an editorial board member, reviewer, or author can affect academic promotion and the type of scientific investigation being conducted and indirectly affects women’s health outcomes.

Survival Analysis up to 8 Years of 304 Anatomic-Contour Implant Zirconia Crowns Fabricated with a Fully Digital Cast-Free Workflow and Directly Screwed on External Hexagonal Implant Connections without the Interposition of a Ti-Base: A Multicentric Retrospective Study.

Data on the clinical performance of monolithic Zirconia screw-retained crowns on external hexagon implants fabricated from digital scans through a cast-free, fully digital workflow is lacking and needs to be included. This retrospective multicentric study aimed to evaluate the real-life clinical results of monolithic Zirconia screw-retained crowns without the interposition of a Ti-base on external hexagon implants fabricated from intraoral scans and a cast-free approach in private practices. Single external hex implant fixtures were restored with monolithic zirconia crowns without the interposition of a Tibase. The crowns were directly screwed on external hexagonal implant connections with a castfree, fully digital workflow. Data were analyzed using descriptive statistics and the Kaplan- Meier test. Between September 2022 and March 2023, the California Dental Association modified criteria were adopted for clinical evaluation after recalling all patients. A total of 304 single tooth restorations in the maxillary and mandibular posterior regions fabricated between July 2014 and July 2022 in 252 patients (120 males and 132 females, mean age 53.6 years, SD 23.3). Seven crowns were excluded because of patient dropout. The most common minor technical complications were screw loosening (3 crowns) and loss of the screw-access hole filling (3 crowns). Four failures included two implant failures with mobility and two fractured crowns. No screw or implant fractures were recorded. The overall cumulative survival rate was 98.6% and the average success rate (crowns experiencing no failures or complications) was 96.0%. The mean overall survival time was 101.3 months (standard error, 0.847; 95% confidence interval for the mean, 99.67-102.99). The overall survival probability was 87.9% up to 97 months. With careful case selection and comprehensive periodontal maintenance program, single crowns directly screwed onto an external hexagon platform have shown to have excellent survival and success (complication-free) rates, comparable to available data regarding single crowns with a metal implant- prosthetic interface.

Commercially available mouthguards: Unearthing trace elements for the first time

The use of mouthguards is advocated by the American Dental Association for orofacial injury prevention and teeth protection. However, the chemical environment in the mouth may cause harmful substances within the mouthguard's polymer material to leach out and be absorbed by the user. Considering this, the present study for the first time analyzed commercially available mouthguards and disclosed the presence of trace elements. Specifically, an analytical method was developed based on closed-vessel microwave-assisted digestion and plasma-based atomic spectrometry for determining toxic trace elements in mouthguard samples. Initially, 75 elements were assessed and, thereafter, quantified cadmium (Cd), copper (Cu) and lead (Pb) in each sample by inductively coupled plasma mass spectrometry (ICP-MS). Method validation was carried out by analyzing a certified reference material of Low-Density Polyethylene, and by addition and recovery experiments. Results for copper were further validated by ICP optical emission spectrometry (ICP-OES). While most samples exhibited elemental levels beneath the method's limit of quantification, Cd, Cu and Pb were detected in four samples. Remarkably, one sample had Cu levels exceeding safe limits by 109 times, highlighting potential toxicity risks. This initial research underscores the need for stricter contamination control in mouthguard materials to minimize potentially health hazards.

Comparison of Dental Emergencies Among U.S. Military and Civilian Personnel During Combat Operations in 2007-2009.

Information from published studies describing dental treatment of nonmilitary personnel in a military theater of operations is sparse. The primary objective of this study is to determine the number of dental emergencies (DEs) and the types of dental treatment rendered on non-U.S. military (civilian) personnel treated by Navy dentists in 2007-2008 in Iraq and 2009 in Afghanistan. The second objective is to compare the type of DE treatment procedures provided to civilian personnel to the type of DE treatment procedures performed on U.S. military personnel. Navy Dental Officers documented the diagnoses of unscheduled DEs. All treatment provided was described at the time of treatment using the Current Dental Terminology codes of the American Dental Association. Current Dental Terminology Code A0145 (2007 and earlier) and A0199 (2008 onward) in the patient encounter indicated a DE. This study is limited to DE occurring in (1) patient categories: U.S. civilian employees, other beneficiaries of the U.S. Government, foreign national civilian/dependents, and civilian, no government connection and (2) U.S. military service members. Chi-square analysis was performed to compare the proportion of dental treatment category procedures on civilian patients compared to those on U.S. military patients. During the reporting period, 308 patients were treated for DE in Afghanistan. Civilians treated accounted for 18.5% (n = 57) of all DEs. Nearly 93.0% of civilians who were treated were U.S. (DoD) civilian employees. Of the 57 civilian patients treated for DE, 61.4% of patients (n = 35) received oral surgery. There were 251 U.S. military patient encounters (81.5% of all DEs). Restorative dentistry was the most common dental procedure for military personnel DE. When comparing civilian and military patients, civilian patients are statistically more likely than military patients to receive oral surgery treatment for DE (P < .00001). In Iraq, 3,198 patients were treated for DE during the reporting period. Civilians treated accounted for 18.8% (n = 601) of all DEs. About 56.9% (n = 342) of civilians who were treated were U.S. contract employees. Of the 601 civilian patients treated for DE, 37.1% (n = 223) received oral surgery. There were 2,597 U.S. military patient DE encounters, and restorative dentistry was the most common dental procedure. When comparing civilian and U.S. military patients in Iraq, civilians are statistically less likely to have their DE treated by restorative dentistry (P < .00001) and are more likely have it treated by oral surgery/extractions (P < .00001). It is significantly more likely for civilians to have multiple categories of DE that must be treated (P< .00001). The primary group of civilians treated for DE in Afghanistan was U.S. civilian employees. The primary group of civilians treated for DE in Iraq were contract employees of the U.S. Government. The primary dental treatment of civilian beneficiaries in both the theaters of operation was oral surgery. This brings into question what dental fitness standards are there for primarily U.S. civilian and contract employees.

Dentists’ Perspective on Osteoporosis Therapy: A Pilot Survey Study

Objective: Osteoporotic fractures are a major public health problem worldwide. Effective therapies have been available since 1995, with bisphosphonates (BPs) as the most used first-line drugs. Zoledronic acid and denosumab (Dmab) became available soon thereafter. However, both BPs and Dmab, but not other osteoporosis therapies, are associated with rare occurrences of osteonecrosis of the jaw (ONJ) and atypical femur fracture (AFF), the two most common major barriers either for initiating or maintaining effective anti-fracture therapies. In this pilot study, we aimed to determine dentists’ perceptions and practice patterns to mitigate ONJ. Methods: After approval from the Institutional Review Board, we e-mailed an online 7-point survey questionnaire to licensed dental practitioners, the members of the Michigan Dental Association (MDA), to ascertain the range of approaches dentists would take to treat patients who were using osteoporosis medications. Results: Members of the MDA were surveyed with a series of questions, and 40 responses were received. Respondents were 50% women, and 28 worked in suburban areas, 8 in urban areas, and 4 in rural areas. 48% of the dentists have been practicing for &gt; 20 years, 32% for 5–20 years, and 20% for &lt; 5 years. When asked about the interruption of osteoporosis medications for low-risk dental procedures, such as cavities, 68% never stopped therapy, 17% stopped in certain scenarios, and 15% reported stopping after a discussion with the patient’s provider. When asked about the interruption of osteoporosis medications for high-risk dental procedures, such as tooth extractions, 15% would not interrupt therapy, 23% would interrupt in certain scenarios, 7% would always interrupt therapy, and 55% would interrupt therapy after discussion with the patient’s provider. Conclusion: Despite the extreme rarity of ONJ, no specific guidelines exist from the American Dental Association (ADA), and dentists’ perspectives on mitigating ONJ are quite varied. Our study suggests that many dentists feel that osteoporosis therapy is a major barrier to safe dental practice and indicates an urgent need for education of our dentist colleagues on the rationale and validity of interrupting osteoporosis therapies.

Need for dentists with post-graduate training in endodontology according to members of the Swiss Dental Association

This questionary-based study was financed by the Swiss Society for Endodontology (SSE). At the time of this survey (2022) there were merely 20 board-certified endodontists in Switzerland, and 239 other members of the SSE, i.e. general practitioners with some form of post-graduate endodontic training or a keen interest in the field. The aim of this investigation was to evaluate the need for a higher number of trained endodontists as viewed by the general population of dentists in Switzerland. An electronic questionary in either German, French, or Italian was sent to all 4072 active members of the Swiss Dental Association (SSO). The questionnaire focused on the background of the surveyed dentists, their willingness to refer endodontic cases to a specialist or colleague with a focus on endodontics, their propensity to do so, and their perceived need for endodontists in their region. The response rate was 21%, and was similar between the different regions and cantons. Seventy-nine (9%) of the dentists participating in the survey were members of the SSE, while 16 (2%) were board-certified. Merely 7% of the participants received endodontic referrals themselves, while 81% referred cases in some instances. However, only 13% of participants referred endodontic cases always or regularly. The main reason for not referring was the belief by the surveyed dentists that they could perform the endodontic treatments themselves. Long distance to the next endodontic specialist or expert was the second most frequently given reason not to refer cases. A total of 58% of the participants believed that there were enough endodontists in Switzerland to cover the encountered clinical problems.

Root canals disinfection with a paste based on metronidazole, chlorhexidine and levomycetin

AIM. To identify the ability of an ex tempore paste with metronidazole, chlorhexidine and chloramphenicol, to disinfect root canals in patients diagnosed with “Chronic apical periodontitis” K04.5.MATERIALS AND METHODS. The study involved 30 patients, 61 root canals diagnosed with “Chronic apical periodontitis” K04.5. Treatment was carried out in accordance with clinical recommendations (treatment protocols) for the diagnosis: “Diseases of periapical tissues”, approved by Resolution No. 18 of the Council of the Association of Public Associations “Dental Association of Russia” dated September 30, 2014, updated on August 2, 2018. Biological material from the contents of the root canal was taken before and after the introduction of a paste with metronidazole, chlorhexidine and chloramphenicol into the root canal for 5 days. The following methods were used: clinical, microbiological. The total microbial number, gram-positive and gram-negative microorganisms, fungi were determined. A polymerase chain reaction (PCR) was carried out. Statistical analysis of the data included a description of accounting characteristics and assessment of the statistical significance of changes in the studied indicators. p &lt; 0.05 was selected as the critical level of statistical significance of differences (p).RESULTS. Statistical analysis showed a pronounced, statistically significant negative dynamics for all microbiological indicators in the structure of the root canal biofilm.CONCLUSIONS. The data obtained allow us to conclude that an ex tempore paste with metronidazole, chlorhexidine and chloramphenicol can be used in the treatment of patients diagnosed with “Chronic apical periodontitis” K04.5 as an intracanal drug. It reduces all sown cultures of microorganisms in a short time (5 days).

Uncover your inner power: Breaking leadership biases in global healthcare.

Women currently represent approximately 70% of the global healthcare workforce, 60.9% of the global dental workforce, 77.6% of the US healthcare workforce, and 36.7% of the US dental workforce. The American Dental Association states that the number of practicing women dentists in the United States has increased by 2.25 times since 2001, with a projected trajectory to level off by 2040. Despite having a major impact on the healthcare sector globally, women earn 24% less than men and only serve in 25% of senior leadership positions. In the US dental schools, only 14% of faculty serve in administrative roles, and as of April 2022, 28.6% of the US dental school deans were women, indicating gender underrepresentation in the highest roles of academic leadership. This corresponds to the data on gender parity still not being the norm in many societies and workplaces and can be attributed to public policies, stereotypical perceptions, and individual factors. Five key factors have been identified to be crucial for women's entry or advancement in global health leadership: a) public policy, b) community, c) institutional, d) interpersonal, and e) individual. Individual self-improvement and institutional practices may be used to overcome these barriers to women's leadership in healthcare and shift the power dynamics toward reinforcing gender equality. These transformative changes are measured through women's collective capacities and skills, relationship dynamics, community perceptions, and environmental practices. This article recognizes the present obstacles to women in healthcare leadership and proposes strategies to achieve gender equality both through individual and institutional practices.