National Dental Research Articles

Modelling risk factors for high/low Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) in the Australian adults.

Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception needed for orthodontic treatment (OT). The study aimed to (1) evaluate the psychosocial impact of dental aesthetics and the potential role of OT and (2) determine associations between PIDAQ with self-rated general and oral health, oral health-related quality of life (OHRQOL), and receipt of OT among Australian adults. Data were obtained from the 2013 Australian National Dental Telephone Interview Survey (NDTIS). The PIDAQ was utilized as main outcome, comprising items from four conceptual domains: self-confidence, social impact, psychological impact, and aesthetic concern. Participants reported their socio-demographic, behavioural, self-rated general and oral health as well as the poor OHRQOL using the Oral Impact on Daily Performance (OIDP) instrument and OT. The mean of PIDAQ and four subscales score and their 95% confidence intervals (CI) were estimated. Generalized liner regression was used to estimate association between PIDAQ and covariates by calculating the mean ratio (MR) and their 95% CI. There were 2936 Australian adults who completed the PIDAQ items. The mean PIDAQ score was 28.8 (95% CI: 28.0-29.6). Higher PIDAQ scores were identified among those who reported non-Australian birth, lower incomes, infrequent dental visits, less than 21 teeth and brushing teeth less than twice a day, fair/poor self-rated general and oral health, and poor OHRQOL. In multivariable modelling, the mean PIDAQ score was 1.91 (95% CI: 1.82-2.00) times higher among those with OIDP score >3 and 1.06 (95% CI:1.01-1.10) times higher in those who had OT, comparing with their counterparts. Also, higher PIDAQ scores were identified among females, last visiting a dentist more than 2 years ago, fair or poor self-rated oral and general health. Higher PIDAQ scores that have a greater impact on OHRQOL were associated with poorer self-rated general and oral health. This may be explained by unfavourable dental attendance and oral health habits. The positive correlation with OIDP scores verifies the validity of the PIDAQ. Those who had received OT had lower PIDAQ and OIDP scores.

A Risk-Based Approach to the COVID-19 Pandemic: The Experience in National Dental Centre Singapore.

The emergence of a highly infectious coronavirus strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a major global public health emergency. The increasing number of infected cases and fatalities worldwide forced several countries into lockdown in a bid to control virus transmission. The practice of dentistry is considered high-risk due to the generation of aerosols associated with most dental procedures, and healthcare professionals must take appropriate precautions whilst working in this challenging environment. This review aims to provide an overview on transmission routes and shares a risk-based approach to coronavirus disease 2019 (COVID-19) in a specialty tertiary center. Risk assessment and mitigation focussed on staff and patient safety, adopting a wide safety margin, and responding dynamically to the level of risk at the workplace. As the severity of the pandemic depends on many still-unknown factors and shows little sign of abating, the routine practice of dentistry will continue to be disrupted in the near future. We describe a color-coded framework to maximize safety and to minimize disease spread. Areas covered include healthcare team management, personal protective equipment, clinical work, and dental education. Guidelines in each category change with the corresponding severity of the situation, and we believe it will be useful for the safer practice of dentistry in this current climate and can be modified for future similar disease outbreaks.

National Dental Practice‐Based Research Network (NIDCR)

National Dental Practice‐Based Research Network (NIDCR)

Diagnostic ability of salivary matrix metalloproteinase-9 lateral flow test point-of-care test for periodontitis.

This cross-sectional study aimed to examine the diagnostic ability of salivary matrix metalloproteinase (MMP)-9 lateral flow test (LFT) point-of-care (POC) kit and develop an algorithm for diagnosis of periodontitis. Through Seoul National Dental Hospital, 137 participants (46 LFT negatives, 91 LFT positives) were recruited. For salivary diagnostics, 150μl of the unstimulated saliva was applied to LFT-POC kit. To make a diagnosis of periodontitis, stage II-IV in modified new international classification system was used. Covariates encompassing age, sex, smoking and obesity were evaluated through face-to-face interview. Enzyme-linked immunosorbent assay was used for quantification of salivary MMP-9. To develop a diagnostic algorithm, multivariable logistic regression analysis was used. Receiver operating characteristic curve was applied for evaluating diagnostic ability. Diagnostic ability of salivary MMP-9 LFT-POC test was 0.82 (sensitivity of 0.92, specificity of 0.72) in total participants. Diagnostic algorithm using POC test resulted in a response equation, that is algorithm score = -3.675+2.877*LFT+0.034*age+0.121*sex+0.372*smoking+0.192*obesity. Diagnostic ability of the algorithm was 0.88 (sensitivity of 0.92, specificity of 0.85) with cut-off score of 0.589. Salivary MMP-9 LFT-POC kit showed appropriate diagnostic ability for periodontitis and would be an efficient tool for screening of periodontitis.

The Role of Dentists in COVID-19 Is Beyond Dentistry: Voluntary Medical Engagements and Future Preparedness.

The emergence of the highly infectious novel coronavirus SARS-CoV-2 has led to a global COVID-19 pandemic. Since the outbreak of COVID-19, worldwide healthcare systems have been severely challenged. The rapid and explosive surge of positive cases has significantly increased the demand for medical care. Herein we provide a perspective on the role dentists can play in voluntary medical assistance and future preparedness for a similar pandemic. Though dentists and physicians have different scopes of practice, their trainings share many similarities. Hence, dental professionals, with their knowledge of basic human science and sterile surgical techniques, are an invaluable resource in the COVID-19 pandemic response. Overall, it is commendable that many dentists have risen to the challenge in the fight against COVID-19. For example, in Singapore, National Dental Centre Singapore (NDCS) deployed dental clinicians as well as volunteers from research laboratories to screen for suspected cases, provide consultations as well as conduct swabbing operations. Dental practice will be considerably changed in the post-COVID-19 era. There is a greater need to have refresher courses for practicing dentists on new infection control strategies. Moreover, the curriculum in dental schools should be expanded to include competencies in pandemic and disaster relief. In addition, voluntary medical work should be made a part of the community dentistry curriculum. This volunteerism will leave a positive impact on developing the careers of young dentists. Hence, the contribution of dentists beyond dental practice in this pandemic situation will be appreciated by future generations.

Intersectionality, racial discrimination and oral health in Australia.

There is a dearth of studies on the extent to which perceived racial discrimination shapes oral health. Following an intersectional perspective, we estimated the prevalence of perceived racial discrimination in Australia, its association with oral health impairment, and examined whether this association was more severe among low socioeconomic status (SES) groups. Data came from the 2013 National Dental Telephone Interview Survey (N=2798), a population-based study of Australian adults. Multivariable Poisson regression models were estimated to test the relationship between perceived racial discrimination and self-reported oral health impairment, as well as to investigate whether the magnitude of this association was greater among low-SES respondents. Relative Excess Risks due to Interaction (RERI) were used to indicate the presence of potentially large discrimination effects within low-SES strata. Racial discrimination in the past 12months was reported by 11.5% of all participants. Australians reporting racial discrimination had 1.4 (95% CI 1.1, 1.7) times the prevalence of impaired oral health. The association between perceived racial discrimination and oral health impairment was stronger among low-SES groups. The RERI was 0.55, indicating a super-additive Effect Measure Modification (EMM) by income on the additive scale. Similar results were observed with the EMM analyses by educational attainment. Our findings indicate that perceived racial discrimination, as a specific form of widespread inequality, is associated with higher frequencies of oral health impairment among Australian adults. We also suggest that socially marginalized groups bear a greater burden of the oral health effects of racial discrimination.

Prophylactic antibiotic prescribing in dental practice: Findings from a National Dental Practice-Based Research Network questionnaire

BackgroundLittle is known about antibiotic prescribing practices of dentists. The objective of this study was to gain a better understanding of dentists’ beliefs and behaviors regarding the use of antibiotic prophylaxis (AP) before invasive dental procedures. MethodsA multidisciplinary team developed and disseminated a questionnaire to 3,584 dentist members of the National Dental Practice-Based Research Network. ResultsOverall, 2,169 network dentists (61%) responded. Respondents saw patients at risk of developing infective endocarditis (IE) and prosthetic joint infection (PJI) at least once per week (35% and 65%, respectively). Although 78% of dentists agreed that the 2007 American Heart Association guidelines for the prevention of IE are well-defined and clear, only 49% agreed concerning PJI guidelines. Differences for the IE and PJI patient populations also existed for questions regarding dentists’ understanding of the specific patient groups at risk, the recommended antibiotic regimens, and the need to consult with a patient’s cardiologist or orthopedic surgeon. ConclusionsThe survey results indicate that decision making regarding the use of AP occurs frequently among dentists. Moreover, dentists reported uncertainty about the appropriate use of AP as defined by both IE and PJI guidelines, which may have resulted in a lack of concordance between dentists’ beliefs and their practice behaviors. Practical ImplicationsThe results reported by the authors highlight the need to develop better educational programs that address antimicrobial stewardship in AP for patients at risk of developing IE and PJI and target the dental profession.

A common European curriculum for dental hygiene.

The European Dental Hygienists Federation (EDHF) is a not-forprofit organisation that, to date, represents 24 national Dental Hygiene Associations across the European Union, European Economic Area and the World Health Organisation (WHO) European Region (Table 1). Founded in 1999, the EDHF now represents associations with an estimated membership of 38 000 dental hygienists,1 and the aims of EDHF have thus developed to include: • Improving access to high quality preventive oral health care. • Providing a platform from which to exchange information and promote dialogue between member associations. • Supporting professional development and continued professional education of dental hygienists. • Collaborating with oral health and wider health organisations for the benefit of the profession and for the health of patients. The EDHF meets annually at its pan-European conference, and various internal taskforces exist longitudinally relating to enhancing oral health literacy, and harmonising the skills and training of dental hygienists across Europe. The latter, in relation to the training of dental hygienists, forms the basis for this series of curriculum papers. This introductory paper aims to describe the current situation with respect to the training of dental hygienists across Europe, and to outline the process by which EDHF has established a new Common European Curriculum (CEC). It is expected that dental hygiene educators will use the CEC as a starting template when authoring or updating curricula, taking into account their own local levels of regulatory practice.

There seems to be a low proportion of persistent pain 3 years after root canal treatment in patients who experience pain 6 months after treatment

Daline IH, Nixdorf DR, Law AS, et al. 3-year outcome of patients with persistent pain after root canal treatment: The National Dental Practice-Based Research Network [published online ahead of print March 11, 2020]. Endod. https://doi.org/10.1016/j.joen.2020.01.018.

Perception of Dental Students of COMS-TH regarding Future of Dentistry in Nepal amid COVID-19 Pandemic.

There is a global crisis which has been led by COVID-19. The patients undergoingdental procedures and dental professionals are at higher risk of contracting this disease owing toaerosols generated and a lot of face to face contact during the procedures. The aim of this study was to know the perceptions of dental students of COMS-TH regarding future of dentistry in Nepal amidCOVID-19 pandemic. The present cross-sectional descriptive study was conducted at COMS-TH, Bharatpur by sending an online e-survey questionnaire to 146 dental students out of which 99 responded. The e-survey questionnaire consisted of three parts which consisted of questions about demographics, knowledge about COVID-19 and their perceptions about future of dentistry. The results of the study depicted that most of the students thought dentistry is good and noble profession and will recommend it to young medical aspirants. Most of them wanted to pursue post graduation courses in future giving preference to Oral and Maxillofacial Surgery. The study concluded that most of the dental students were satisfied with dentistry as their profession and wanted National Dental Association to fix the minimum charges of each dental procedure. Also there is a need to start more post graduation courses in existing institutions providing dental education as most of the students want to pursue it in future.

Practitioner Engagement in Activities of the National Dental Practice-Based Research Network (PBRN): 7-Year Results.

To 1) quantify practitioner activities of the National Dental Practice-Based Research Network (Network) for which Continuing Education (CE) credits were received (study training, videos, webinars, meetings, and symposia); 2) quantify practitioner coauthoring Network publications and presentations; and 3) test whether practitioner characteristics were associated with participation in these activities. A retrospective analysis of 4361 practitioners who enrolled in the Network between April 12, 2012 and October 12, 2018. Overall, 59% (n = 2586) of practitioners earned CE credit from the Network; among these, 68% (n = 1757) from a video, 38% (n = 993) attended an annual Network meeting, 31% (n = 798) due to training for a Network clinical study, 9% (n = 226) attended a national symposium, and 7% (n = 170) participated in a Network webinar. Members of 2 large group practices earned on average more CEs than practitioners from other practice settings. Four percent (n = 159) of practitioners coauthored a Network presentation or publication. Practitioners who received their dental degree before 2000, were general practitioners, or were members of 2 large group practices, were more likely to have coauthored a publication or presentation. This Network used a broad range of activities to engage community practitioners. These activities were successful in sustaining a high level of practitioner engagement in clinical research and its relevance to everyday clinical practice.

Effects of National Dental Screening on Dental Caries Experience, Treatment, and Cost in Children

This study aimed to evaluate the effects of national dental screening for children in Korea in the aspects of prevention of dental caries, the number of treatments related to dental caries, and cost of dental care.The study used the national cohort data on children health screening provided by National Health Insurance Service, and analyzed 32,937 1st dental screening, 22,608 2nd dental screening, 13,708 3rd dental screening, and 241,043 cases from the dental care of 27,944 children born in year 2008 and 2009. The decayed-filled teeth index and decayed-filled person rate, calculated from the results of the 2nd and 3rd dental screening, decreased as the number of preceding dental screening increased. Glass ionomer and amalgam restoration, pulp treatment of primary teeth and extraction of primary canine and molar were shown to decrease as the number of examined dental screening increased, and the total cost of dental care covered by national health insurance also decreased as the number of dental screening increased.In conclusion, national dental screening for children is an efficient and economical oral health care method that prevents dental caries and lowers the possibility of dental caries related treatment, thereby reducing cost of dental care.

Clinical Orodental Anomalies in Taiwanese Children under Age Six: a Study Based on the 1995-1997 National Dental Survey.

There are few published studies that report the prevalence of intraoral anomalies for young children. The purpose of this study was to investigate the prevalence and distribution of several congenital oral and paraoral anomalies in Taiwanese children under age six. Twenty-five cities and townships were randomly sampled in different areas of Taiwan using the stratified method. These cities and townships represent cross-sectional samples of geographic locations and socioeconomic levels. A total of 981 Taiwanese children under age six were examined with dental mirrors and explorers as part of the national dental survey. The results of this survey indicated an 11.31% prevalence of geographic tongue. This number is higher than that reported in studies previously performed in different countries. The occurrence of double teeth in primary dentition was found to be 2.14%. Ankyloglossia had a frequency of 1.22%, and primary talon cusp a frequency of 0.61%. Seven (0.71%) children exhibited fissured tongues. Thirteen (1.33%) cases of hypodontia were found. These values were different from those reported in several other countries, which may be attributed to differences in the ethnic and racial composition of the population studied.

Influence of periodontal maintenance and periodontitis susceptibility on implant success: A 5-year retrospective cohort on moderately rough surfaced implants.

To investigate the effect of defined versus undefined periodontal maintenance after implant therapy on the prevalence of peri-implant complications. Two hundred patients who underwent dental implant therapy in the National Dental Centre Singapore (NDCS) from 2005 to 2012 were recruited. One hundred patients had regular periodontal maintenance (defined maintenance programme group, DMP), and the other 100 patients had no documentation of periodontal maintenance (undefined maintenance programme group, UMP). Full-mouth bleeding scores (FMBS), periodontal probing depths (PPD) and peri-implant probing depths (PiPD) were evaluated within 6months of prostheses delivery (T0 ) and at re-examination (T1 ). Peri-implant bone level changes were analysed radiographically. The mean follow-up time was 6.8years. Five out of 289 implants were lost (cumulative survival rate=98.3%). 6.0% of DMP patients and 20.0% of UMP patients had peri-implantitis (p=.003). Peri-implantitis was defined as bleeding on probing, increase in PiPD and peri-implant bone loss≥0.5mm. At the implant level, 4.0% of the DMP group implants and 17.2% of the UMP group implants were diagnosed with peri-implantitis (p=.0003). One implant in the DMP group and 13 implants in the UMP group had bone loss≥2mm (p<.0001). Multivariate regression showed that absence of regular maintenance (OR=0.24, p=.003) was significantly associated with peri-implantitis. Regular periodontal maintenance was associated with a lower prevalence of peri-implantitis and peri-implant bone loss. Patients with treated periodontitis without regular maintenance after implant placement were at higher risk for developing peri-implantitis.

The Dental Licensure OSCE: A Modern Licensure Examination for Dentistry

Objective structured clinical examinations (OSCEs) have been used to assess clinical skills in the health sciences for over 40 years and have a proven track record when used by boards to determine whether a licensure candidate possesses the necessary level of skills to practice. A dental licensure OSCE is being developed by the Joint Commission on National Dental Examinations. Extensive field testing will be conducted to ensure there is validity evidence supporting use of the dental licensure OSCE. Dental boards will be provided the necessary validity evidence supporting use of the DLOSCE to identify candidates who do and do not possess the level of dental clinical skills that are necessary to safely practice.

Methodology for the development of a national Dental Practice-Based Research Network survey on dentist's beliefs and behaviors concerning antibiotic prophylaxis.

Dentists are high prescribers of antibiotics for both treatment and prevention of infection, although there are few guidelines to aid clinicians. Given the worldwide concerns about unnecessary use of antibiotics, there is a need for a better understanding of dentists' use of these drugs for antibiotic prophylaxis (AP) to prevent distant site infections (i.e., infective endocarditis and prosthetic joint infection). The aim of this study was to develop and implement an effective, self-reporting, cross-sectional, survey instrument that optimized the response rate and maximized reliability and validity for determining the beliefs and behaviors of a large and nationally representative group of generalist and specialist dentists concerning their use of AP. A 15-question survey (58 items) was developed in a structured process by a multidisciplinary team and configured for automated online dissemination to 3584 national Dental Practice-Based Research Network (DPBRN; hitherto referred to as "Network") practitioners. The implementation phase consisted of 3 waves of greater than 1000 Network members. Additionally, 47 randomly selected dentists were surveyed twice to assess test-retest reliability. Of 3584 eligible Network members, 2169 (60.5%) completed the survey. The age and geographic distributions of responders was similar to those of dentists in the 2019 American Dental Association census. Furthermore, test-retest weighted kappa values for the survey were acceptable (median 0.56; interquartile range 0.42-0.64). We developed a highly structured survey with a high response rate and good reliability that will allow us to obtain unique data on dentists' beliefs and practices regarding AP prescribing.

Forensic odontology identification response to terrorist attacks in Paris November 2015

The terrorist attacks of November 2015 led to the immediate death of 129 victims admitted to the Legal and Forensic Medicine Institute of Paris, including 41 unidentified. During the Disaster Victim Identification (DVI) operations, 22 bodies were examined by the postmortem (PM) dental team with the aim of establishing PM odontograms. At the same time, the dental expert in the antemortem (AM) unit collected a large number of dental files, progressively filtered as the list of missing persons became reduced. Feedback from these events has highlighted the difficulties of implementing the DVI chain principles in a legal framework, published the day before the attacks, and also the technical complexity of collecting dental data on a week end of terror. The return on experience after this event has represented a paradigm shift on previous methods of DVI in Paris and even more in France. Indeed, the victim identification procedure was redesigned, integrating new technical means such as a CT scan directly on spot, allowing the extraction of maxillofacial data as soon as possible in order to support the PM dental examination team. Moreover, the National Dental Council proceeded to the overall remodeling of the dental identification unit, which is composed of trained members, from local, regional and national aspects. These forensic experts are dedicated, at the request of the legal authorities, to DVI operations and deployed throughout the country capable of managing AM and PM data. This unit aims also to share experiences and awareness-raising among health professionals and investigators in order to optimize a better submission of AM elements and also to enhance the major interest of odontology as a primary identifier in disaster.

Deprivation and child dental attendance in England: exploring the shape and moderators.

To describe the shape of the relationship between area deprivation and dental attendance (DA) in children aged 5 years and under in England and the modifying effect of caries prevalence, ethnicity, family profile and dentist-to-population ratio. DA rates were calculated at lower-tier local authority level (LA, n=326) using NHS data for the year to March 2017. LA deprivation was determined by Index of Multiple Deprivation 2015. Caries prevalence was retrieved from the 2016/17 National Dental Epidemiology Programme; ethnicity and family profile from Census 2011 and dentist-to-population ratio from NHS statistics. Fractional polynomial (FP) models explored the shape of the relationship. Multivariable regression models were adjusted for covariates. The effect of moderators was estimated by adjusted marginal effects. English Lower-tier LAs. Shape of the relationship between DA and deprivation and its moderators. Best-fitting second-order FP model (p=0.582) did not provide a better fit for the relationship than the linear model. Therefore, the linear model was selected for final analysis. Deprivation was associated with decreased DA rates (Coefficient=-0.39, 95%CI=-0.53,-0.24; p=⟨0.001); while White ethnicity (Coefficient=0.35, 95%CI=0.29, 0.41; p=⟨0.001), single parenthood (Coefficient = 2.21, 95%CI=0.91,3.51; p=0.001) and caries prevalence (Coefficient =0.34, 95%CI=0.25,0.44; p=⟨0.001) with increased rates. These moderated the relationship. We hypothesised that the shape of the relationship between deprivation and DA could be curvilinear with higher rates in the extreme ends of deprivation. However, the analysis showed a linear association, moderated by the effect of ethnicity, single parenthood and disease level.

Cues used by dentists in the early detection of oral cancer and oral potentially malignant lesions: findings from the National Dental Practice-Based Research Network

The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities. We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant. Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue. Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.

Interceptive orthodontic treatment in Singapore: A descriptive study

Background: The benefits of interceptive orthodontic treatment have always been a subject of much debate, and it is understandable that clinicians are confused about how to advise parents of potential interceptive orthodontic patients. Objective: The aim is to study the treatment outcomes of interceptive orthodontics associated with different appliances. Demographic information on patients presenting for interceptive treatment, prevalence and types of dental conditions treated, types and frequency of appliances used, treatment duration and the number of visits taken were also investigated. Methods: This study involved analyzing records of interceptive orthodontic patients seen at the National Dental Centre Singapore from January 2011 to December 2017. Treatment outcomes were divided into success, improvement and failure according to pre-determined treatment objective parameters. Results: A total of 1324 patient records (654 females, 670 males) were studied, with an average age of 10.6±1.9 years. The most common dental condition seen was the anterior crossbite while the most common interceptive orthodontic appliance used was the bite plate. Average treatment duration was 10.8±6.8 months (9.8±9.2 visits) for fixed appliances, 7.5±6.5 months (6.9±3.4 visits) for removable appliances and 10.8±3.2 months (12.6±3.3 visits) for a combination. Interceptive orthodontic treatment had an overall success rate of 75.5%, improvement rate of 9.5% and failure rate of 15.0%. The most common reason for failure was attributed to non-compliance. Conclusion: The data above shed light on interceptive orthodontic treatment in an Asian population and gives useful information for primary care clinicians to provide for concerned parents.