JDR Clinical & Translational Research最新文献

Introduction: There are concerns that the COVID-19 pandemic exacerbated oral care inequities globally. In Sweden, declines in oral care utilization, particularly among certain regions and public clinics, suggest disproportionate impacts across population groups. Yet, the effects of the pandemic on oral care equity in Sweden remain unexplored, highlighting a critical gap in evidence to guide ongoing equity initiatives and strengthen future pandemic preparedness.

Objective: To examine changes in unmet oral care needs (UOCNs) inequities among Swedish adults before and during the pandemic, following an intersectional approach.

Methods: Data came from the 2018 and 2021 waves of a national survey, including 31,493 adults. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 groups defined by gender, age, education, income, and immigrant status.

Results: The prevalence of UOCNs increased during the pandemic. Notable shifts in single-indicator inequities included a decrease among immigrants but an increase among older adults. Modest increases were observed among individuals with low education and low income, while inequities decreased slightly for men and younger adults. The intersectional analysis revealed that inequities increased primarily among socially advantaged older adults, whereas decreases were more evident among immigrants and younger individuals facing other forms of social disadvantage. The discriminatory accuracy of both the single-indicator and intersectional inequities decreased during the pandemic, although intersectional models consistently showed slightly better accuracy.

Conclusions: Patterns of UOCNs inequities shifted during the pandemic, with increased intersectional inequities among socially privileged older adults and decreased inequities among immigrants. These findings may reflect Sweden's unique pandemic context, which emphasized individual responsibility over restrictive measures and may have influenced how people approached health-related behaviors, including seeking oral care.Knowledge transference statement:The reconfiguration of inequities in unmet oral care needs during the pandemic might be explained by the unique response in Sweden, which adopted less restrictive measures. These findings highlight the importance of tailoring future pandemic strategies to ensure equitable oral care access, that is, targeted interventions addressing the needs and challenges of both medically vulnerable populations, such as the elderly, and socially marginalized groups, such as immigrants facing structural disadvantages.

Introduction: Oral potentially malignant disorders (OPMDs) can lead to oral cancer, which is one of the most common cancers worldwide. Prevention is crucial in the avoidance of malignant transformations of OPMDs. Artificial intelligence (AI) provides a new and noninvasive tool for analyzing medical data, such as patient data, radiologic images, and clinical photographs. These AI-based tools can help in the decision-making process. However, histological examination is still the gold standard for diagnosing OPMDs.

Objectives: This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of artificial intelligence on intraoral photographs of patients with OPMDs.

Methods: A systematic search was conducted on 5 major databases (MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science) on November 10, 2023. Included studies compared AI methods to histology examination as the reference. A quantitative analysis was carried out to assess sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), positive likelihood ratio (LR⁺), and negative likelihood ratio (LR^-) calculated with 95% confidence intervals (CIs).

Results: Six eligible articles were included, with 898 images out of 4,046 tested using AI-based architectures. Five studies investigated at least 2 AI models. The overall sensitivity, specificity, DOR, LR⁺, and LR^- were 0.94 (95% CI, 0.88 to 0.95), 0.95 (95% CI, 0.85 to 0.98), 212.39 (95% CI, 56.39 to 800.00), 16.89 (95% CI, 5.72 to 48.68), and 0.08 (95% CI, 0.05 to 0.13) for the best-performing AI-based architectures in terms of sensitivity, respectively.

Conclusion: AI-based diagnostic tools have high negative predictive value that could help identify OPMD lesions using intraoral photographs.Knowledge Transfer Statement:This systematic review on AI-based methods to diagnose oral potentially malignant disorders showed that although their high negative predictive value could reduce unnecessary specialist consultations, clinical judgment remains paramount. Further prospective studies are needed to evaluate the integration of AI diagnostics into routine care and screening and policies to enhance efficiency and support early detection and prevention of oral cancer.

Purpose: This study aimed to examine the association between osteoporosis, cumulative breastfeeding duration, and remaining teeth in postmenopausal women and to investigate whether osteoporosis status modifies the relationship between breastfeeding duration and oral health outcomes.

Methods: We analyzed cross-sectional data from 1,788 Korean women aged ≥50 y who participated in the 2010 to 2011 Korea National Health and Nutrition Examination Survey. Complete data were available for participants on breastfeeding duration, bone mineral density, and oral health examinations. Multiple linear regression analysis was used to assess the association between breastfeeding duration and the number of remaining teeth, stratified by osteoporosis status. Interaction analysis was conducted to examine the combined effects of osteoporosis and breastfeeding duration on tooth retention. Analyses were adjusted for potential confounding variables including age, socioeconomic factors, health behaviors, reproductive history, and oral hygiene practices.

Results: Among participants, 36.8% (n = 658) had osteoporosis and 63.2% (n = 1,130) had normal bone mineral density. Women with osteoporosis had a significantly longer duration of breastfeeding (6.42 vs 4.09 years) and fewer remaining teeth (20.16 vs 25.42) compared with those with normal bone density. Each additional year of breastfeeding was significantly associated with fewer remaining teeth in both the normal bone density group (β = -0.39, 95% confidence interval [CI]: -0.70 to -0.08, P = 0.015) and the osteoporosis group (β = -0.52, 95% CI: -0.85 to -0.20, P = 0.002). A significant interaction between osteoporosis status and breastfeeding duration was identified (β = -0.34, P < 0.05), indicating a stronger inverse association between breastfeeding duration and remaining teeth in women with osteoporosis.

Conclusion: These findings suggest statistical associations between prolonged breastfeeding duration and fewer remaining teeth in postmenopausal women, with stronger associations in those with osteoporosis. The interaction effect indicates that osteoporosis status may modify this relationship, highlighting the potential need for targeted oral health monitoring in this population.Knowledge Transfer Statement:Osteoporosis modifies the association between breastfeeding and remaining teeth in postmenopausal women. Health care providers should monitor oral health in women with osteoporosis and very prolonged breastfeeding histories, although clinical relevance remains limited.

Introduction: Quality improvement (QI) is important in ensuring standards in oral health care. Despite the growing literature on quality indicators, audit, and feedback, the perceptions and expectations of oral health professionals toward QI remain unclear. Understanding these perspectives, barriers, and facilitators is important to effectively encourage and maintain QI activities in dental practices. This is the first of 6 publications in a series titled "Situational Analysis of QI in Oral Health Care in Europe."

Aim: This study aimed to investigate how QI was conducted and perceived in dental practices in the United Kingdom and Germany.

Methods: A situational analysis, comprising desk research and semistructured interviews, was conducted. Data collection was conducted from May to October 2023. Purposive and snowball sampling techniques were used to recruit dental practice participants in the United Kingdom and Germany. Interviews and key texts were thematically analyzed to synthesize 3 maps: a situational map, a social world map, and a positional map.

Results: Eighteen participants were interviewed, comprising dentists, dental hygienists, dental therapists, dental nurses, and practice managers. The participants described 6 competing positions surrounding QI: QI activities were expressed as being worthwhile or box-ticking exercises to satisfy regulators. Some felt that QI detracted from service delivery and should not be the role of the dentist, whereas others stressed the need for a whole-team approach. Some felt that patients were important to judge quality, whereas others felt quality in dentistry required understanding of technical processes beyond the reach of patients.

Conclusion: This study provided insights into how QI activities were carried out in dental practices in the United Kingdom and Germany and how it is was perceived by those working in this environment. This study offers key observations into the situations, social worlds and arenas, and positions that influence QI in dental practices.Knowledge Transfer Statement:The findings from this study highlight several contextual barriers and facilitators to quality improvement in general dental practice. Understanding these determinants of quality improvement is relevant for oral health teams and dental practice managers who aim to develop and implement quality improvement strategies in dental practice.

Introduction: In the United States, dentists are one of the leading prescribers of opioids and antibiotics. Because dental schools are the training grounds for future dentists, it is crucial to understand how prescribing has changed and why these medications are being prescribed in academic settings.

Objectives: The objective of this research was to describe the prescribing trends and factors associated with opioid and antibiotic medication prescribing at US academic dental institutions between 2011 and 2020.

Methods: Data from electronic dental records collected through the BigMouth data repository from 9 anonymized dental institutions between 2011 and 2020 were used. Prescribing rates were defined as the percentage of patients who received an opioid/antibiotic prescription. The primary outcome was whether at least 1 opioid or antibiotic medication was prescribed at the encounter. Monotonicity and statistical significance of prescribing trends by year were assessed using the Mann-Kendall test, and a statistical analysis using an adjusted multilevel mixed-effects logistic regression model was performed to identify significant patient-, visit-, and dental provider-level factors associated with prescribing of these medications.

Results: In total, 5,720,166 patient encounters from 905,426 patients had aggregate opioid and antibiotic prescribing rates of 2.0% and 2.7%, respectively, between 2011 and 2020. For both medications, a downward prescribing trend was observed from 2013, which increased in 2020. Opioid prescribing was most likely for young adults aged 15 to 24 y (odds ratio [OR] = 5.26;95% confidence interval [CI]: 4.99-5.55) and by oral surgeons (OR = 10.03; 95% CI: 8.02-12.55). Antibiotic prescribing had a higher odds for patients aged >65 y (OR = 5.04; 95% CI: 4.62-5.49) and by periodontists/implant specialists (OR = 6.21; 95% CI: 4.96-7.78). Multiple treatments at the same dental visit and pain-associated dental procedures were associated with statistically significantly higher odds of being prescribed both medications.

Conclusion: There are significant differences in opioid and antibiotic prescribing by dentist specialty, patient age, whether the dental visit had multiple treatment procedures, and whether 1 or more postoperative dental pain-associated procedures were performed.Knowledge Transfer Statement:This study provides an understanding of patient-, dentist-, and visit-level factors associated with opioid and antibiotic medication prescriptions issued by clinicians at academic dental institutions in the United States. The results can contribute further to predict clinical scenarios related to the prescribing of these medications and the development of specific interventions to reduce inappropriate and excessive opioid and antibiotic medication prescribing.

Objective: The aim of this study was to conduct a longitudinal investigation of the associations between changes in dietary factors and changes in caries experience among Finnish children and adolescents participating in the Physical Activity and Nutrition in Children (PANIC) study.

Methods: Among 487 children included at baseline at the age of 6 to 8 y, 406 were reexamined at 2-y follow-up and 202 at 8-y follow-up. Food consumption, nutrient intake, and eating frequency were assessed using 4-d food records; diet quality was assessed using the Baltic Sea Diet Score; and eating behavior was evaluated using the Children's and Adult's Eating Behaviour Questionnaires. At baseline and 2-y follow-up, caries findings were recorded using the World Health Organization guidelines and at 8-y follow-up using the International Caries Detection and Assessment System criteria. Generalized linear mixed-effects regression analyses were used.

Results: Over 8 y from childhood to adolescence, improved diet quality (β = -0.017, P = 0.046) and increased consumption of butter and butter-oil mixtures (β = -0.009, P = 0.044) were associated with decreased caries experience. Increased number of snacks (β = 0.072, P = 0.032), increased consumption of sour milk products (β = 0.001, P = 0.039) and salty snacks (β = 0.006, P = 0.010), and increased calcium intake (β = 2.41 × 10^-4, P = 0.022) were associated with increased caries experience. However, the latter association was explained by the consumption of sour milk products (β = 1.88 × 10^-4, P = 0.090). Increased enjoyment of food was associated with decreased caries experience (β = -0.121, P = 0.046), and increased slowness in eating (β = 0.113, P = 0.051) and food fussiness (β = 0.140, P = 0.009) were associated with increased caries experience.

Conclusions: A healthy diet is vital for oral health among children and adolescents. Dietary behaviors developing from childhood to adolescence seem to be associated with caries experience in adolescence. Dietary counseling aimed at improving dental health from childhood to adolescence should include avoiding frequent snacking, strengthening healthy eating behavior, and composing good overall diet quality.Knowledge Transfer Statement:Results of this longitudinal study showed how crucial a healthy diet is for oral health among growing children. Eating behaviors and enjoyment of food play also a role in maintaining good oral health. Research results can be used when planning dietary recommendations and health education for children and adolescents.

Introduction: Despite increasing dental expenditures, the burden of oral diseases has not decreased. The room for improving the quality of oral health care (OH) remains large. The purpose of this study was to explore the current understanding, needs, efforts, and actions in European and global policy making for oral health quality improvement.

Methods: Drawing from qualitative methodology comprising desk research and semi-structured interviews, a situational analysis was carried out. Interviews with experts in international oral health policy were recorded, transcribed, and analyzed inductively and iteratively.

Results: The interviews with 13 participants representing 11 organizations provided diverse insights into policy making for improving the quality of OH. Thematic analyses identified 4 main themes: (1) perception and understanding of quality improvement (QI) in OH policy making, (2) prioritization of QI, (3) efforts and actions for QI, and (4) stakeholder engagement. Three maps were also generated: situational map, social world map, and positional map. Participants acknowledged several facilitators and barriers and provided QI ideas but also expressed concerns. They said that QI was underserved and not properly prioritized. Competing goals and financial limitations were considered major barriers for QI. Some organizations described that they are involved in OH QI and took various initiatives to improve quality, whereas others acknowledged that QI efforts could be expanded. Participants also expressed a necessity for better coordination among stakeholders and joint action on QI to enhance the overall OH of the population in Europe and globally.

Conclusions: The findings of this study suggest that there is substantial room for improvement in European and global policy making concerning the QI of OH. While stakeholders seem to recognize the relevance of OH QI, competing priorities and limited resources seem to be perceived as barriers to scaling up QI efforts. The potential of international synergies in QI for OH is emphasized.Knowledge Transfer Statement:The findings of this study provide valuable insights for decision makers and stakeholders who aim to improve oral health care policy making to optimize oral health care in Europe and beyond by offering a deeper understanding of the current situation of international quality improvement efforts for oral health care.

Aim: To understand the barriers and facilitators faced by clinicians in the treatment of periodontitis and to explore the barriers and facilitators to periodontal care encountered by patients when navigating the health care system.

Materials and methods: Semistructured in-depth interviews were conducted with clinicians (n = 22) and patients (n = 18) selected through purposive sampling. Audio recordings were transcribed, coded, and analyzed thematically to identify key issues.

Results: Four main themes were identified by clinicians: 1) psychological barriers and dissatisfaction caused by uncertain treatment outcomes when managing periodontitis; 2) professional barriers caused by referral processes and decisions about shared care; 3) barriers caused by patients' undervaluing specialist care; and 4) participatory care, standardized referral processes, and aligning treatment expectations in primary and tertiary care-facilitated management. Three main themes were identified for patients: 1) first contact with general dentists facilitated patients' perceptions about good dental care; 2) recognizing the emotional and social impact of periodontitis promoted health seeking and engagement in dental care; and 3) problems with navigating and understanding the health care system negatively affected patients' journeys. Both groups highlighted the importance of primary care services in playing a key role in managing periodontitis and raising public awareness of periodontitis.

Conclusion: Close collaboration between primary and tertiary levels of health care is required to ensure an efficient referral process and continuity of care. Prioritizing empathetic approaches and raising awareness of periodontitis at clinical and policy levels is needed to address the structural and interpersonal barriers in care delivery.Knowledge Transfer Statement:Primary care services play a key role in treating patients with periodontitis. Closer collaboration is required to ensure a seamless transition of care between specialists and general dental practitioners. Patients need to be engaged and play a participatory role when planning for care integration at a health care system level. Greater public health education is needed to improve awareness of the etiology and treatment of periodontitis.

Background: Previous studies have demonstrated a significant association between maternal oral health and pregnancy complications, including preterm birth (<37 wk). However, research on the impact of dental care utilization during pregnancy on these outcomes has produced both positive and negative results.

Objective: The current study investigated the association between preterm birth and dental care utilization, focusing on dental visits for cleaning during pregnancy as well as the perceived benefits of oral health during pregnancy.

Methods: This secondary data analysis cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System in the United States from 2009 to 2021. Descriptive and multivariate logistic regression analyses were performed to examine the association between dental variables and preterm birth.

Results: The study included 399,847 women with a recent single live birth, representing 21,218,114 women across 48 states and New York City. After adjusting for factors such as race and ethnicity, age, marital status, medical insurance type, education level, adequacy of prenatal care, and other medical variables associated with preterm birth, women who had dental visits for cleaning during pregnancy had a lower odds of preterm birth (adjusted odds ratio [aOR] = 0.90, 95% confidence interval [CI] [0.86, 0.93], P < 0.001) compared with those who did not. A significant association between prenatal dental cleaning and reduced preterm birth was observed only among women who perceived the benefits of oral health during pregnancy (aOR = 0.93, 95% CI [0.88, 0.97], P = 0.002) and among non-Hispanic White women (aOR = 0.88, 95% CI [0.83, 0.93], P < 0.001).

Conclusion: This study revealed an inverse relationship between dental cleaning visits during pregnancy and preterm birth outcomes, notably among women who recognized the benefits of oral health and among non-Hispanic White women. The results emphasize the significance of dental visits and the perception of oral health benefits during pregnancy.Knowledge Transfer Statement:The study demonstrated an inverse association between dental visits for cleaning during pregnancy and preterm birth outcomes, with this relationship being significant among women who perceived the benefits of oral health during pregnancy and among non-Hispanic White women. These findings suggest that both the dental visits and the perception of oral health benefits may be important factors linked to preterm birth outcomes, with potential racial and ethnic variations. Policy makers and clinicians could integrate oral health care and prenatal oral health education into prenatal care as essential components of primary health care to improve both oral and overall health outcomes for women.