JDR Clinical & Translational Research最新文献

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.

Introduction: There is no recent consensus on the effectiveness of teledentistry versus in-person examination in the diagnosis of dental caries, especially after the COVID-19 pandemic.

Objective: To assess the diagnostic accuracy of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO #CRD42023410962).

Methods: This systematic review and meta-analysis compared the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 and December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA-DTA guidelines, following a review for quality assessment and risk of bias using the QUADAS-2 and JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the MADA package. A descriptive analysis of the sensitivity, specificity, diagnostic odds ratio, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane Q and Higgins's I² tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect and reported summary diagnostic odds ratios.

Results: Twelve studies met the inclusion criteria and were reviewed and included in the meta-analysis. The diagnostic parameters ranged from 45.6% to 88.3% for sensitivity, 55.2% to 98.3% for specificity, 79% to 92% for positive predictive value, 48% to 97% for negative predictive value, and 70% to 96% for accuracy. The κ scores ranged from 0.46 to 0.89 for teledentistry modalities. Tests for equality of sensitivities and specificities were significant (P < 0.001). The studies were not heterogeneous with Cochran's Q: 14.502 (P = 0.206) and Higgins's I² of 24%. The multivariable analysis showed a diagnostic odds ratio based on the DerSimonian-Laird random effect of 35.14, which indicates that the odds of caries detection via teledentistry is 35 times more true positive (i.e., correctly identifying a positive condition) than false positive.

Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries.Knowledge Transfer Statement:This systematic review and meta-analysis added to the evidence about using teledentistry assessment as a diagnostically accurate tool to detect dental caries. Using teledentistry dental practices could promote greater access to dental and oral health care in the absence of in-person assessment.

Evidence-based medicine (EBM) enhances clinical decision-making but faces implementation challenges, particularly in dentistry, where patient-specific complexities limit its effectiveness. This article examines EBM through the lens of Aristotelian logic, exploring its use of deductive and inductive reasoning and its limitations in addressing real-world variability. We then discuss how artificial intelligence (AI) can enhance EBM by synthesizing data, automating evidence appraisal, and generating personalized treatment insights. While AI offers a promising solution, it also presents challenges related to ethics, transparency, and reliability. Integrating AI into EBM requires careful consideration to ensure precise, adaptive, and patient-centered decision-making.Knowledge Transfer Statement:This commentary provides a critical discourse on the challenges of evidence-based medicine and how artificial intelligence could help address these shortcomings.

Introduction: Bisphenol A (BPA), known for its endocrine-disrupting properties, is a concern when leaching from dental sealants. This study investigates the systemic BPA exposure following the placement of Bis-GMA-based dental sealants in Thai primary school students.

Objectives: The main objective was to evaluate the changes in urinary BPA concentrations after the application of Bis-GMA dental sealants in a cohort of Thai students.

Methods: In a prospective cohort of Thai primary school students participating in a voluntary sealant placement program, urinary BPA concentrations were measured at 4 time points: immediately before and on days 1, 7, and 14 after sealant application. BPA levels were measured using high-performance liquid chromatography. Repeated-measures analysis using generalized estimating equations was performed to determine the correlation between BPA concentration and time. Beta coefficient was used to estimate the mean change in BPA concentration following sealant placement. The associated cofactors were evaluated by calculating the incidence rate ratio.

Results: Sixty-seven children (50.7% boys) with a mean age of 9.9 ± 1.3 years and a body mass index of 17.7 ± 4.4 kg/m² participated. On average, students had 2.9 ± 1.9 (range, 1-11) teeth with filled sealants. The median adjusted BPA levels before sealant placement and on days 1, 7, and 14 were 0.01, 0.03, 0.19, and 0.23 µg/g creatinine, respectively. The analysis showed a significant association between the number of sealed teeth and increased BPA levels at all visits.

Conclusion: The application of Bis-GMA-based dental sealants in children results in low-level systemic BPA exposure due to chemical leaching. Despite such a low level of BPA exposure, approved by international health authorities, it could be considered a silent, chronic, and persistent systemic event, the long-term implications of which are yet to be deciphered.Knowledge Transfer Statement:This research shows that Bis-GMA dental sealants cause minimal bisphenol A (BPA) exposure in children, within safe international limits. However, the long-term effects are unknown. This information should inform dental care practices and guide policymakers in assessing the chronic impacts of BPA exposure from dental materials.

Background: Maternal oral health is associated with the oral health of children. However, the role of free sugar intake as a potential effect modifier in this relationship remains unclear. We examined the association between maternal and child caries and assessed whether free sugar intake modifies this relationship.

Methods: Data were obtained from the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE), an Australian population-based birth cohort study. Maternal caries experience, measured by the number of decayed, missing, and filled surfaces (DMFS; 0 to 9, 10 to 19, 20 to 29, or ≥30 surfaces) when children were at age 2 y was the exposure. Outcomes were children's caries experience (dmfs/DMFS) and prevalence (dmfs/DMFS>0) at age 5 y. We investigated the association between maternal caries experience and children's caries status using negative binomial and Poisson regression models, adjusting for potential confounders. We also assessed the interaction to investigate whether free sugar intake (<12 g: <5% estimated energy requirement [EER], 12 to 24.9 g, ≥25g: ≥10% EER) modified this relationship.

Results: A total of 879 mother-child dyads were analyzed (54.0% male). The average number of caries surfaces was 11.8 for mothers and 1.4 for children. Among children, 24.9%, 31.7%, and 43.3% consumed <12 g, 12 to 24.9 g, and ≥25 g of free sugar daily, respectively. At age 5 y, children whose mothers had ≥30 surfaces with caries experienced a 2.84 times greater number of surfaces with caries experience (95% confidence interval [CI], 1.52 to 5.30) and had a 1.68 times higher risk of having caries (95% CI, 1.19 to 2.36). Interactions between maternal caries experience (≥30 surfaces) and both 12 to 24.9 g or ≥25 g free sugar intake were observed (mean ratios [95% CI] for interaction terms: 11.16 [1.55 to 80.34] for 12 to 24.9 g and 17.91 [2.76 to 116.44] for ≥25 g).

Conclusions: Having a mother with higher caries experience increases the risk of caries among children; however, limiting free sugar intake mitigates the risk.Knowledge Transfer Statement:This study demonstrates that having a mother with higher caries experience increases a child's risk of developing caries; limiting free sugar intake mitigates the risk. Policymakers and clinicians could promote lower caries prevalence and prevent caries severity of children by encouraging upstream policies of reducing sugar intake.

Introduction: An established body of literature highlights a higher prevalence of oral health concerns among Indigenous Australians including untreated dental caries and periodontal disease. In South Australia, access to and provision of culturally safe oral health care for these communities remains a challenge in dental services, and less is known around what culturally safe dental care means for Indigenous communities.

Objectives: This study explored (1) the barriers to accessing culturally safe oral health care for Indigenous Australians and (2) the enablers to promote and support culturally safe oral health care.

Methods: This qualitative study involved semi-structured interviews with 136 Indigenous South Australian adults who participated in a dental care intervention involving oral epidemiological examinations at baseline and 12-mo follow-up (after receiving formal dental care) and health assessments. Reflexive thematic analysis was used to analyze qualitative data on participants' oral health care experiences more broadly, the dental care received as part of the study, and their perspectives on improving dental care for Indigenous communities, including culturally safe care.

Results: Participants reported a range of experiences in formal dental care settings including discrimination, fear, and limited access to dental care due to cost or location. Various enablers to improve culturally safe dental care were highlighted, including continuity of care, Indigenous-led dental services, mobile services and at-home care, trauma-informed clinics, early intervention, oral health promotion, and improving accessibility through free or low-cost dental care.

Conclusion: Overall, this study emphasized the need for further action to ensure cultural safety in Australian dental services.Knowledge Transfer Statement:This study found that Indigenous Australians' access to culturally safe oral health care is limited. Culturally safe care was affected by discrimination and distressing experiences in dental care settings. Dental care remains costly and regional areas remain underserviced, affecting access. Mobile services, continuity of care, early intervention, and Indigenous-led care can improve access. Findings from this study may shape health services planning regarding models of care that are family-centered, affordable, accessible, and prioritize cultural safety.

Objectives: Despite being a central concept in dentistry, minimum intervention dentistry (MID) still faces a gap between evidence and practice. The aim of this study was to investigate the management decisions of French general dental practitioners (FrGDPs) for occlusal carious lesions (OCL) in 2023 and to compare the results to those obtained in 2002 and 2012 using the same questionnaire.

Methods: An online, cross-sectional survey was conducted using a precoded questionnaire among the French dental practice-based research network (ReCOL). The structured questionnaire assessed the restorative threshold and management strategies for OCL. Three simulated clinical scenarios are presented: 1 illustrating a discrete progression of an OCL (assessing the intervention threshold) and 2 clinical cases (focusing on diagnosis and caries management). Descriptive and statistical analyses were performed to study the evolution over 2 decades.

Results: The response rate was 45.4%. The 2023 sample included 56% female dentists and was younger and less experienced than the 2002 and 2012 population studies. In 2023, 68.5% of the respondents stated a restorative threshold when the OCL reached the outer third of dentine. Over the last 2 decades, this threshold has been significantly delayed to later stages of carious progression and so is shifting the cavity preparation to a more conservative approach. Over the 2 decades, for clinical cases 1 and 2, diagnosis, management strategies, and material selection have significantly evolved toward earlier grades of carious extension, a more micro- and non-invasive approach, and composite (P < 0.0001). Substantial variability persists among respondents.

Conclusions: The results reveal a significant shift over the last 2 decades among FrGDPs toward MID. Initial and continuing education are key factors in the improved implementation of MID into practice. Resistance and variability act as barriers, and uncertainty proves to be a challenge, all of which require further investigation.Knowledge Transfer Statement:This 2-decade study on the diagnosis and management of dental caries provides valuable insights for dental practitioners, academic institutions, policy-makers, and health system stakeholders. The findings underscore the importance of education, consideration of barriers, and tolerance for uncertainty. These findings are important for raising awareness of, and helping to reduce, the gap between evidence and clinical practice.

Background: Impaired chewing ability is a recognized risk factor for cognitive decline in older adults, potentially due to reduced neural stimulation in cognition-related brain regions. While short-term studies have demonstrated transient increases in neural activity from chewing, the sustained cognitive and neurophysiological effects of encouraging thorough chewing habits in daily life remain unclear.

Objective: This randomized controlled trial investigated whether promoting thorough chewing during meals could improve cognitive function and cerebral hemodynamics in older adults.

Methods: Fifty participants aged 65 y or older were randomly assigned to either a 1-mo intervention group, which used a wearable device to monitor and increase chewing strokes during meals, or a control group that maintained usual chewing habits. Chewing behavior, cognitive performance (including memory and executive function via the color Stroop test), and cerebral hemodynamics in the dorsolateral prefrontal cortex (DLPFC) were measured at baseline and after 1 mo. Statistical analyses included t tests, chi-square tests, 2-way analysis of variance with post hoc tests, Pearson correlations, and generalized linear models to evaluate group differences and associations between chewing and cognitive outcomes.

Results: Significant time-by-group interactions were observed for memory, F(1, 48) = 6.24, P = 0.043, and hemodynamic responses in the left DLPFC, F(1, 48) = 6.19, P = 0.013. The intervention group showed increased chewing frequency (P = 0.017), improved memory performance, and reduced left DLPFC responses compared with controls. Chewing frequency was positively correlated with Stroop test scores (r = 0.53, P = 0.010) and negatively with hemodynamic changes in the left DLPFC (r = -0.30, P = 0.040). Although improvements in other cognitive outcomes and hemodynamic measures favored the intervention group, these differences did not reach statistical significance.

Conclusions: Promoting intentional chewing habits for 1 mo may enhance memory-related cognitive performance and neural efficiency in the DLPFC during working memory tasks in older adults. This nonpharmacologic, low-burden strategy warrants further research with longer interventions to support cognitive health and dementia prevention.

Trial registration id: UMIN000044280Knowledge Transfer Statement:This study demonstrates that promoting thorough chewing habits in older adults can improve memory and enhance neural efficiency in the brain. Encouraging intentional mastication is a simple, nonpharmacologic approach that may help maintain cognitive health and prevent dementia, providing a practical strategy for clinicians and policymakers to support healthy aging.

Introduction: Individual variability determines host responses and disease progression. Inflammatory clusters (ICs) have been shown to influence host responses against bacterial challenges during the induction of human experimental gingivitis.

Objectives: This study aimed to evaluate the role of ICs in naturally occurring gingivitis and periodontitis.

Methods: Using a cross-sectional and split-mouth design, this study evaluated the immune regulation and tissue-remolding responses in sites with different disease severity of periodontal diseases to provide a comprehensive assessment of disease features on the basis of analyzing gingival crevicular fluids. Cluster analysis was performed based on the clinical indices, including gingival index, plaque index, and probing depth. Further comparisons of the host mediators and clinical indices among clusters based on the disease severity were also performed.

Results: A total of 48 patients were recruited in this study, including 24 patients with gingivitis only and 24 patients with stage III grade B generalized periodontitis. Our results demonstrate that 2 distinct ICs were found in the sites with naturally occurring gingivitis: low-ICs had less expression of myeloperoxidase, intercellular adhesion molecule-1, and interleukin-12 as well as greater expression of angiopoietin-1 than high-ICs did. At the sites with generalized severe periodontitis, however, low-ICs had significantly elevated expression of angiopoietin-1, fractalkine, granulocyte-macrophage colony-stimulating factor, matrix metalloproteinase-2, osteopontin, and vascular endothelial growth factor versus high-ICs. Our results for the first time confirmed the influence of ICs in naturally occurring gingivitis, showing that low-ICs displayed minimal inflammation and less neutrophil involvement compared with high-ICs. The influence of ICs in periodontitis was site specific rather than patient specific.

Conclusion: Our collective findings highlight the importance of ICs in disease progression, benefiting the modulation of immune responses and preventing further periodontal tissue destruction. By identifying specific ICs, clinicians can better predict disease progression and recurrence, ultimately improving patient outcomes through targeted interventions.Knowledge Transfer Statement:The present study discovered the role of inflammatory clusters (ICs) on the host responses in a cross-sectional setting, including immune regulation and tissue remodeling, during naturally occurring gingivitis, whereas the disease progression to periodontitis seems to be site specific. Low-ICs were more prevalent in the gingivitis-only group compared with the periodontitis group, suggesting that gingivitis sites in periodontitis patients may be at increased risk for disease progression compared with gingivitis sites in gingivitis-only patients.