JDR Clinical & Translational Research最新文献

Objectives: This study examines the relationship between prior incarceration and dental insurance trajectories throughout older adulthood.

Methods: A nationally representative sample of adults aged 55 y and older who participated in the 2012-2020 Health and Retirement Survey was analyzed (n = 6,383). Group-based trajectory modeling was used to identify distinct patterns of dental insurance coverage across the 8 survey waves. Multinomial logistic regression was used to assess the association between prior incarceration and dental insurance trajectory group membership.

Results: Four dental insurance trajectories were identified: persistent dental insurance (30.0%), intermittent high insurance (16.4%), intermittent low insurance (20.4%), and no insurance (33.3%). Bivariate analyses revealed that formerly incarcerated older adults were significantly more likely to be in the intermittent low dental insurance (relative risk ratio [RRR] = 2.31, 95% confidence interval [CI] = 1.67-3.20) and no dental insurance (RRR = 1.51, 95% CI = 1.09-2.11) groups relative to the persistent dental insurance group. Covariate-adjusted models that accounted for sociodemographic, health, and economic covariates found a significant association between prior incarceration and membership in the intermittent low dental insurance group (RRR = 1.48, 95% CI = 1.03-2.11).

Conclusions: Formerly incarcerated older adults were less likely to have consistent dental insurance coverage over time. Additional research is needed to understand why formerly incarcerated individuals are less likely to have consistent dental insurance over time and what policy and programmatic responses may increase access to dental care coverage for this population.Knowledge Transfer Statement:This study shows that formerly incarcerated older adults are more likely to experience periods without dental insurance over time. These findings can inform efforts by dental care providers, policymakers, and community health programs to improve dental care access by expanding insurance coverage and tailoring oral health services to meet the needs of individuals with incarceration histories.

Objectives: The aim of this study was to analyze private dental fees in Australia in relation to weekly earnings as a measure of relative affordability, looking at changes from 2014 to 2022 and geographic differences within Australia.

Methods: Using publicly available data from the Australian Dental Association, fees for select dental procedures were calculated based on national averages and compared with weekly full-time earnings across 2014 to 2022. The proportion of full-time weekly earnings (at various percentile levels) required to pay for procedures was analyzed.

Results: Mean private practice fees for the 6 dental procedures increased 5.3% to 16.8% between 2014 and 2022. Median weekly full-time earnings increased 24.2% from $1,208 to $1,500. There were smaller increases in income for those below the 25th percentile and larger increases above the 75th percentile. The proportion of median weekly full-time income required to pay for various procedures declined from 2014 to 2022, with a dental checkup costing 22% of median income in 2014 and 18.7% in 2022. Variations were apparent across and within states. For those in the lower income groups, dental treatment consumed a much larger proportion of their weekly earnings than those on higher incomes.

Conclusion: Private dental fees have not increased greater than average weekly earnings over the past decade. Focusing on price misses only the additional context of the competing costs of other necessities, particularly when they are increasing at a rate higher than inflation and income. Improving our understanding of relative affordability is important in informing policies designed to address the broader inequalities evident in access to dental care.Knowledge Transfer Statement:This study found that although private dental fees have not increased greater than average weekly earnings over the past decade, income inequality and geographic fee variability are likely to affect dental visiting patterns. This is important for those advocating measures to improve access to care through a better understanding of dental care affordability.

Objective: This cross-sectional observational study analyzed patterns of tooth loss across different population groups using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018, aiming to identify the teeth most at risk and the key contributing factors.

Methods: Data from 24,945 adults aged 20 y and older were analyzed. Tooth presence/absence was modeled in relation to age, income, education, smoking history, and glycemic status. To improve robustness, missing covariate data were imputed using k-nearest neighbors, and survey weights were applied in regression analyses to account for NHANES's complex sampling design. A 2-step analytic approach was used: (1) survey-weighted quasi-Poisson regression estimated associations with total tooth count and (2) unweighted generalized estimating equations identified explanatory variables associated with individual tooth loss, accounting for intraoral clustering. Dental implants were excluded.

Results: Tooth-level models suggested distinct intraoral and demographic patterns. Males retained more posterior teeth but lost more mandibular incisors than females did. Older adults (≥60 y) exhibited markedly higher loss in mandibular anterior and premolar regions. High-income and high-education participants retained more teeth overall but were more likely to lack first premolars, likely reflecting orthodontic extractions. Smoking and diabetes were associated with anterior tooth loss, especially in visible, functionally important regions. Glycemic control showed a clear gradient, with low-normal HbA1c levels protective in posterior sites.

Conclusions: Tooth-level modeling suggested anatomically and socially patterned vulnerabilities often masked in whole-mouth analyses. Findings underscore the need for site-specific prevention strategies that address biological risk and structural inequity, advancing more equitable approaches to oral health care and policy.Knowledge Transfer Statement:This study identified which specific teeth are most at risk of loss across age, health, and socioeconomic groups. Understanding these tooth-level patterns can help clinicians tailor preventive care to vulnerable patients, guide patient education, and inform public health strategies that target oral health disparities. These findings support more precise, equitable dental care to help people keep their natural teeth longer.

In the complex and ever-evolving landscape of oral health research, community-based participatory research methods provide essential tools for meaningfully engaging with vulnerable and socially marginalized populations. These methods reflect community needs and integrate their perspectives into oral health research. However, issues of data control, equity, ownership, and sovereignty can lead to ethical and legal challenges. To discuss these concerns, a symposium was held in March 2025 in New York City at the American Association for Dental, Oral, and Craniofacial Research annual meeting. This event explored the intricate dynamics of data access, control, and sovereignty within the context of community-based participatory research, particularly involving vulnerable populations such as Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual orientations and gender identities (2SLGBTQ+), as well as Indigenous peoples, racial/ethnic minorities, and others. As oral health data become increasingly accessible across various platforms, it is incumbent on investigators to understand appropriate access, ownership, legitimate rights, and the ethical use and reuse of data to uphold equity, rights, and representation. The symposium examined the complex challenges surrounding data access, ownership, and control and their implications for community and individual rights, emphasizing the importance of implementing best practices in inclusive research and prioritizing the voices, rights, and meaningful integration of vulnerable populations. Speakers presented and advocated for multifaceted frameworks that integrate cultural values and traditions, aiming to promote equitable oral health outcomes. The symposium also underscored the critical role of ethical data stewardship in big data and community-based oral health research in American Indian, Hispanic, and Global East African contexts. Case studies showcased collaborative approaches that meaningfully engage community stakeholders and service users throughout the research process, ensuring that data are utilized ethically and yield genuine benefits for the populations involved.Knowledge Transfer Statement:This symposium emphasized the critical role of data ownership and sovereignty in advancing oral health equity, particularly for socially marginalized groups such as 2SLGBTQ+ communities, Indigenous peoples, racial minorities, and others. It highlighted best practices for ethical data stewardship and inclusive research that centers community voices. The session offered actionable frameworks to help researchers, policy makers, and institutions build trust, integrate community values, and ensure culturally sensitive outcomes in their efforts to advance health equity.

Introduction: Evaluating the antiviral potential of commercially available mouthrinses on SARS-CoV-2 holds potential for reducing transmission, particularly as novel variants emerge. Because SARS-CoV-2 is transmitted primarily through salivary and respiratory secretions and aerosols, strategies to reduce salivary viral burden in an antigen-agnostic manner are attractive for mitigating spread in dental, otolaryngology, and orofacial surgery clinics where patients may need to unmask.

Methods: Patients (n = 128) with confirmed COVID-19-positive status within 10 days of symptom onset or positive test result were enrolled in a double-blind randomized controlled trial of Food and Drug Administration-approved mouthrinses containing active ingredients ethanol, hydrogen peroxide, povidone iodine, chlorhexidine gluconate, cetylpyridinium chloride (CPC), or saline. The CPC, ethanol, and sterile water rinses were followed in a second double-blind randomized controlled trial (n = 230). Participants provided a saliva sample before rinsing (baseline) and again at 30 and 60 min after rinse. Quantitative polymerase chain reaction was used to determine salivary SARS-CoV-2 viral load at all time points. An adjusted linear mixed-effect model was employed to compare viral load after rinsing relative to baseline.

Results: The rinse containing CPC significantly reduced salivary SARS-CoV-2 viral load 30 min postrinse relative to baseline (P = .015), whereas no other rinse significantly affected viral load at 30 min after rinsing. At 60 min postrinsing, no group had a significant reduction in SARS-CoV-2 copy number relative to baseline, indicating a rebound in salivary viral load over a 1-hour window. Participants indicated a fair to good rinsing experience with the CPC product and high willingness to use oral rinses before and during dental and medical health care visits.

Conclusions: Our findings suggest that preprocedural oral rinsing could be implemented as a feasible, inexpensive approach to mitigate spread of SARS-CoV-2 and potentially other enveloped viruses for short periods, which is relevant to clinical procedures involving the nasal and oropharyngeal region.Knowledge Transfer Statement:Rinsing with a cetylpyridinium chloride-containing mouthrinse can significantly reduce salivary SARS-CoV-2 viral load for up to 30 min; patients are willing to use mouthrinses in medical and dental settings to limit transmission risk in clinics.

Introduction: The main strategy to achieve equal provision of oral care in Sweden has been to offer partial subsidies for the adult population. However, their effects on unmet oral care needs (UOCNs) have not been extensively assessed.

Objective: This study used an intersectionality framework to examine 1) the overall frequency of UOCNs, 2) single-indicator inequities, and 3) intersectional inequities in total UOCNs and financial-related UOCNs (FUOCNs) in Sweden before and after implementation of a partial subsidization reform in 2008.

Methods: Data from 12 national surveys conducted over 2004 to 2018 were divided into 3 periods: prereform (2004 to 2007), early postreform (2008 to 2011), and late postreform (2012 to 2018). The analytic sample consisted of 98,177 respondents aged 24 to 84 y. Changes in the prevalence of UOCNs were estimated by inferential statistics. Single-indicator and intersectional inequities were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy, across 48 strata defined by gender, age, educational level, income, and immigrant status.

Results: The prevalence of total UOCNs and FUOCNs decreased significantly early after the reform, followed by a slight rebound. Relative inequities increased by education, income, and immigrant status after the reform and decreased for age. The discriminatory accuracy for both types of UOCNs was moderate and improved marginally but significantly with the inclusion of the intersectional strata. Most intersectional strata showed greater FUOCN inequities after the reform.

Conclusions: Contrary to expected, larger inequities in FUOCNs were identified in most intersectional strata after the reform. The moderate discriminatory accuracy suggested that Sweden could benefit from future strategies to foster equity that are universal but proportionately more intense among the intersectional strata with greater inequities (proportionate universalism).Knowledge Transference Statement:This analysis highlighted the benefit of adopting the principle of proportionate universalism as a strategy to reduce unmet oral care needs in Sweden. This would mean implementing universal strategies and specific support measures for the most vulnerable social groups as a future oral care policy change in Sweden.

Introduction: Chronic temporomandibular disorders (TMDs) affect a notable portion of the population, with a prevalence of 5% to 12%. These conditions often lead individuals to adopt a soft-food diet to manage pain, but such dietary adjustments can inadvertently cause nutritional deficiencies. This issue may be compounded by medications used to manage TMD symptoms, which can contribute to fatigue and reduced daily functioning. In addition, TMD encompasses not only pain but also functional disorders, such as joint locking, which can further affect the individual's quality of life.

Aim: This study aimed to delve into the lived experiences of individuals with chronic TMDs, focusing specifically on how their condition affected their daily activities including dietary habits and interactions within social settings.

Materials and methods: This study used interpretative phenomenological analysis (IPA) with semi-structured interviews with participants referred from specialists in Montreal, Canada, who were diagnosed with TMDs for at least 6 mo. The interviews were transcribed verbatim and analyzed to uncover the nuanced challenges faced by individuals living with TMDs.

Results: Six participants were interviewed. The thematic analysis identified 4 main themes: (1) limited functioning and energy levels highlighting fatigue and frustration by TMDs; (2) communication challenges due to pain, affecting professional roles and social interactions; (3) impact on social and professional life necessitating adjustments and accommodations; and (4) seeking medical assistance such as medications and physiotherapy, reflecting proactive approaches to managing TMDs' symptoms.

Discussion: The findings demonstrated the wide effects and complex needs of individuals enduring chronic TMD. These effects attributed to TMD medications causing fatigue and impairing daily activity levels suggest a need for comprehensive care approaches that address both physical and psychological dimensions.

Conclusion: The multifaceted effects of chronic TMDs on individuals' lives highlighted the necessity for integrated health care approaches that address diverse aspects of well-being. By incorporating patient perspectives and experiences into clinical practice, health care providers can enhance treatment outcomes and quality of life for TMDs' patients.Knowledge Transfer Statement:This study highlighted the daily challenges faced by individuals with temporomandibular disorders (TMDs), emphasizing the importance of tailored interventions to improve their quality of life. These insights can inform health care providers in developing holistic approaches to address the multifaceted needs of TMD patients, ultimately leading to improved health outcomes.

Introduction: Black children in the United States have lower rates of dental visits and higher rates of poor oral health. However, few studies have examined the role of structural racism as a contributor to racial gaps in children's oral health. This study assessed associations between state-level structural racism and oral health outcomes of children and the related Black-White disparities.

Methods: This repeated cross-sectional observational study examined children aged 1 to 17 y in the 2016 to 2021 National Survey of Children's Health (NSCH). Three outcomes were examined: utilization (dentist visit in past 12 mo), any oral health problem (difficulty in past 12 mo with bleeding gums, cavities, or toothaches), and oral health (teeth in excellent or very good condition). A state-level index was constructed to measure Black-White structural racism composed of 5 dimensions (judicial, educational, economic, political, and neighborhood segregation) and linked to the NSCH. Estimated population-weighted logit regression models were used to assess associations between the outcomes and race and structural racism, adjusting for demographics and socioeconomic status.

Results: The dataset consisted of 98,423 Black (11%) or White (88%) children. Black children had relatively worse outcomes than White children did, with the largest difference observed for the children having teeth in excellent or very good condition (73% vs. 83%). State-level structural racism was not statistically significantly associated with a child receiving dental care, having any oral health problem, or having teeth in excellent or very good condition. US Black-White disparities in these outcomes were unchanged after adjustment for state-level structural racism.

Conclusions: Expanded efforts are needed to address US Black-White disparities in child oral health outcomes. State-level structural racism was not associated with these outcomes. Future research should explore whether findings change when examining these associations at a different geographic level and whether indices of structural racism should explicitly include items specific to health care access and child-specific institutional domains.Knowledge Transfer Statement:Black children in this US study had relatively worse oral health and were less likely to have a dental visit than White children were. Structural racism did not explain these disparities, which suggests the need for further research to study mechanisms driving these disparities and how to address them. Policy makers should consider policies that expand where care is delivered, who delivers care, and increase dentists' Medicaid participation, strategies identified previously for reducing disparities.

Introduction: Oral health care impacts of unemployment are not well understood. This is particularly important as many people, even in high-income countries, lack publicly funded oral health care, creating a financial burden for working-age individuals. This study aims to investigate the short-term effect of becoming unemployed on affordability of oral health care among working-age Australian adults.

Methods: Longitudinal data from the Household, Income and Labour Dynamics in Australia Survey facilitated analysis of those employed in 2016 and examined the effect of becoming unemployed in 2017 on affordability of oral health care in 2018, adjusted for confounding with inverse probability weighting.

Results: Individuals who became unemployed were 2.95 (95% CI, 1.88 to 4.63) times more likely to not receive dental treatment when needed due to a lack of affordability as compared with individuals who remained employed (N = 6,529). On an absolute scale, the aforementioned difference in probability was 9% (95% CI, 3% to 15%).

Discussion: Becoming unemployed had a considerable and immediate negative impact on the affordability of oral health care among working-age Australian adults. Adequate welfare support services are needed to address the immediate financial hardship and consequences that may result due to unemployment.Knowledge Transfer Statement:Using large population-based cohort data, we established that becoming unemployed hampers the ability to afford oral health care. Our study showed that this impact occurs within a year of unemployment, highlighting how quickly unemployment can create ripple effects for oral health care utilization, cascading into a potential lack of timely treatment or preventive therapies. Our findings highlight the need for adequate welfare support policies to address the immediate financial hardship and consequences that may result due to unemployment.

The race for developing and marketing the best inline artificial intelligence (AI) solutions is already in full swing in the dental industry. While regulators are trying to keep up with this fast-paced innovation, end users of these technologies must be on guard to navigate this new landscape safely. Trust is the foundation for this guardrail. Although regulatory approvals can provide some level of trust to an AI solution, users must be empowered with the knowledge of essential vocabulary and semantics to ask the right questions to assess the trustworthiness of the solution. This commentary elaborates on one technology proposed to build trustworthiness in AI solutions: blockchain. Further, we enlist a nonexhaustive list of questions for the users to ask when considering AI solutions in dentistry that may claim to use blockchain technology.Knowledge Transfer Statement:The topic discussed in this commentary could serve as an initial inquiry point that deeply probes into the trustworthiness of an AI solution that a user might consider applying in the field of dentistry.