JDR Clinical & Translational Research最新文献

Introduction: In long-term care settings (LTCs), oral health care often remains fragmented from other geriatric care services. Medical practitioners (MPs) typically take the lead in addressing medical aspects of geriatric care plans, making it essential for them to understand the importance of oral health and to collaborate with dental professionals. However, little is known about MPs' perceptions toward oral health management in LTCs. This qualitative study aimed to gain an in-depth understanding of MPs' views on oral health management in LTCs and explore challenges in collaborating with dental professionals in Singapore.

Methods: Participants were recruited using a purposive sampling strategy, initially through targeted outreach to those with experience in LTCs, followed by snowball sampling to identify additional participants until data saturation was achieved. One-to-one interviews with participants were conducted via teleconferencing using a semi-structured interview guide. The transcripts were analyzed using a hybrid (inductive and deductive) thematic analysis supported by NVivo data management software.

Results: Participants (n = 13) felt that oral health care was currently not well-integrated into the existing LTC system. They frequently encountered oral health issues but arranged for dental appointments only when their patients complained of acute symptoms. Key barriers identified were (1) a cultural misconception within the eldercare community that poor oral health was an inevitable part of aging, (2) systemic barriers related to the inadequate geriatric oral health care services and infrastructure, and (3) knowledge gaps in geriatric oral health management among MPs. These factors collectively hindered effective collaboration with dental professionals in LTCs.

Conclusion: Participants emphasized the lack of oral health care integration in LTCs, identifying cultural, systemic, and internal barriers. Strengthening collaboration with dental professionals in LTCs, implementing oral health education for the eldercare community, and introducing domiciliary services could address these challenges and support more effective geriatric care, with insights for similar systems globally.Knowledge Transfer Statement:This qualitative study highlighted a critical gap in oral health care integration within eldercare described by the MPs in this study in Singapore's long-term care settings. Although findings are context specific, they may offer insights for aging nations facing similar challenges. Overcoming misconceptions about aging and oral health, improving systems, and educating MPs are key to fostering interdisciplinary collaboration and enhancing eldercare. Addressing these barriers could improve the overall well-being of care-dependent older adults.

Objective: This cross-sectional study evaluates the association between the oral microbiome and the presence of untreated dental caries among Kenyan children and adolescents living with HIV (CALHIV).

Methods: We collected 83 oral swab samples from CALHIV receiving medical care at Kenyatta National Hospital. We used the 16S rRNA sequencing technique on oral swab samples to profile bacterial composition. Only CALHIV with results of oral microbiome and dental examinations simultaneously were included in the further analysis. We compared the alpha and beta diversity of the oral microbiome between individuals with and without dental caries. Log-ratio LASSO regression with 2-stage estimation, 10-fold cross-validation, and adjustment for the false discovery rate was applied to select the best features that can predict caries status at the phylum level.

Results: Of the 70 participants with both oral health data and oral microbiome data available, 66% had dental caries. The group with dental caries had higher Chao 1 alpha diversity (P = 0.046) but not beta diversity. Log-ratio LASSO regression had a higher ratio of paired features proteobacteria/SR1 (P = 0.0067), Euryarchaeota/SR1 (P = 0.0074), Acidobacteria/SR1 (P = 0.0079), and Fusobacteria/SR1 (P = 0.0125) at the phylum level and was significantly associated with a lower prevalence of untreated dental caries. A higher abundance of SR1 together with certain bacteria was associated with a higher prevalence of untreated dental caries.

Conclusions: This is the first study to analyze the oral microbiome of CALHIV and untreated dental caries in a cohort that had received medical care since their first years of life. While this study provides information about the paired feature selection for dental caries in CALHIV on ART using cross-validation, SR1 may interact with other bacteria to increase the prevalence of untreated dental caries. Longitudinal microbiome data and samples from multiple sites in the oral cavity will be essential for understanding and confirming these findings.Knowledge Transfer Statement:The results of this study can help clinicians understand how SR1 interacts with other bacteria that may increase the prevalence of untreated dental caries in children and adolescents living with HIV and on long-term antiretroviral therapy. Furthermore, these findings may provide valuable insights for future research, informing longitudinal microbiome data and sampling from various sites in the oral cavity.

Introduction: Associations between cardiometabolic comorbidities and self-reported oral health (OH) are often underexplored in large biobank datasets. While these associations are unaffected by dental care access, they could be mediated by immune responses and inflammation.

Objectives: This study assessed the associations between cardiometabolic comorbidities and self-reported OH, periodontitis, and tooth loss using the International Classification of Diseases (ICD) codes in participants from the U.S. Veterans Affairs Million Veteran Program (MVP), adjusting for immune and inflammatory covariates.

Methods: Data from 154,167 MVP participants were extracted from January 2011 to September 2021, including lifetime cardiometabolic comorbidities, self-reported OH, ICD-coded periodontitis and tooth loss, and laboratory measurements. Multivariate logistic regression analysis was used to calculate the odds ratios of cardiometabolic comorbidities for self-reported OH, periodontitis, and tooth loss, adjusting for demographic, socioeconomic, cardiovascular, and inflammatory (neutrophil and lymphocyte cell counts) risk factors. A separate dataset was used for additional sensitivity analyses, adjusting for serum levels of C-reactive protein and albumin.

Results: Complete data were analyzed for 154,167 participants (19%). Most participants (92%) were male and from European ancestry (94%). The mean age was 65.5 y (SD 11.4 y). Ten percent of participants had excellent self-reported OH. Fourteen percent had any periodontitis, and 17% had any tooth loss. Significant associations were found between tooth loss and congestive heart failure (odds ratio [OR], 1.74, P < 0.001) and peripheral vascular diseases (OR, 1.82, P < 0.001). There were also significant associations between congestive heart failure and self-reported OH (excellent versus "poor/fair/good/very good"), with increasing odds as self-reported OH declined (P < 0.001 for trend). These associations remained significant even after sensitivity analyses, albeit with slight attenuation.

Conclusion: This study of veterans underscores the important cardiometabolic links of self-reported poor OH and tooth loss, akin to those observed with periodontitis, even after adjusting for potential confounders related to demographics, lifestyle, and inflammation.Knowledge Transfer Statement:Exploring cardiometabolic associations with self-reported OH, clinically diagnosed periodontitis, and tooth loss using the ICD in the Veterans Affairs Million Veteran Program, we found significant associations. These associations persisted after adjustment for inflammatory confounders. These findings emphasized the benefit of assessing OH as a vital indicator of overall cardiometabolic health in large-scale biobank studies.

Aim: Pressing oral health care challenges pose prioritization dilemmas for governments. This study aimed to identify key determinants of prioritization in oral health policy in Denmark, Germany, the Netherlands, and the United Kingdom, as part of a series of the DELIVER project.

Methods: A literature review based on a search of PubMed and Google Scholar articles related to these countries from January 1, 2000, to October 17, 2023, and key informant interviews with policy makers were conducted to identify key trends in oral health policy choices and determinants of priority setting and resource allocation processes.

Results: A total of 249 articles were included, and 6 key informants were interviewed. The overarching focus identified was the accessibility of dental care, primarily characterized by incremental and localized programs for vulnerable groups. Supply-side arrangements consisted of adaptations to population needs, including financial incentives for providers and adjusted service delivery models such as task shifting. Several interventions of quality management were found, particularly in Germany. A funnel was produced to illustrate 3 stages driving oral health policy choices. These were political accountability to address population demand, stakeholder influence through negotiations and lobbying, and bureaucratic justification of policy innovations. While findings highlighted political attention on oral health care through public outcry, complex negotiations and limited data formed bottlenecks of prioritization.

Conclusion: Prioritization in oral health policy seems to be dominated by fragmented investments in incremental services of delivery rather than synergized reforms such as granular package designs. While some contexts showed political traction for oral health policy, complex negotiations strained by interests of private professionals and challenges of limited evidence result in difficulties in constraining oral health care within public spending targets. This has placed oral health policy in a state of inertia, where insufficient public resources meet the force of content exerted by the private sector.Knowledge Transfer Statement:This study can inform policy makers and researchers to understand the various stakeholder roles in maintaining the status quo of oral health policy and the processes creating the bottlenecks preventing progression in improving oral health care systems. This understanding could lead to novel approaches to oral health policy making and the appropriate data acquisition and analysis to aid oral health policy.

Introduction: Periodontitis is a chronic inflammatory disease that leads to progressive destruction of periodontal tissues and eventual tooth loss, significantly affecting the patient's quality of life. Dysregulated mechanistic target of rapamycin (mTOR) signaling contributes to periodontitis pathogenesis by influencing inflammation, autophagy, senescence, and bone metabolism. Rapamycin, a well-established mTOR inhibitor with geroprotective properties, has emerged as a promising therapeutic candidate in mitigating periodontal inflammation and preserving alveolar bone.

Objective: This scoping review systematically synthesizes preclinical and clinical evidence on rapamycin's effects on periodontal structures and disease etiopathogenesis, evaluating its potential as a therapeutic intervention for periodontitis.

Methods: A systematic literature search was conducted in PubMed to identify studies evaluating rapamycin's effect on periodontal health. Eligible studies were characterized into in vitro, animal, and clinical studies in terms of study design and research focus.

Results: From 122 screened studies, 53 met inclusion criteria (18 in vitro, 21 in vivo, and 9 clinical). In vitro studies demonstrated that rapamycin enhances osteogenic differentiation, upregulates autophagy, suppresses inflammatory cytokines, and delays cellular senescence. Animal studies confirmed rapamycin's role in alveolar bone preservation, inhibition of biofilm formation, immune modulation, and periodontal inflammation attenuation. Clinical studies primarily focused on rapamycin's effects on gingival overgrowth in transplant recipients, with limited data on periodontitis outcomes. However, survey data from off-label rapamycin users reported improved periodontal health and reduced caries.

Conclusion: Rapamycin exerts a multifaceted role in periodontal health by regulating autophagy, osteogenesis, inflammation, microbial composition, and cellular senescence. Given the U.S. Food and Drug Administration's approval of rapamycin for other conditions, well-designed clinical trials are needed to establish its efficacy, optimize dosing strategies, and ensure long-term safety for periodontal therapy.Knowledge Transfer Statement:The findings highlighted in this scoping review can help researchers understand the potentially mechanistic pathways of rapamycin on periodontal tissues and guide future research on the therapeutic potential of rapamycin for the treatment of periodontitis.

Objectives: This study aimed to identify strategies for implementing and integrating the Canadian Caries Risk Assessment (CRA) tool for preschoolers into the primary care of First Nations and Métis children in Manitoba, Canada, based on the perspectives of nondental primary care providers (NDPCPs).

Methods: An exploratory qualitative design was employed to gather insights from NDPCPs who provide care to Indigenous children aged <6 y. Fifty participants were purposefully recruited from 10 urban, rural, and remote communities across Manitoba. Data were collected through 8 focus groups and 12 in-depth key informant interviews conducted between April 2023 and September 2024. Interviews were transcribed verbatim and analyzed thematically via an inductive approach informed by a social constructivist framework.

Results: Four interrelated themes were identified by participants as central to CRA implementation and integration. Strengthening primary care systems involved training in fluoride varnish application, management endorsement, electronic medical record integration, standardized documentation, and incentives such as fee-for-service models. Building trust and culturally safe connections with Indigenous communities included establishing respectful relationships, embedding CRA into trusted programs, and addressing access barriers such as transportation and oral health supplies. Educating and engaging families focused on developing accessible educational materials and using trusted communication channels such as Facebook and local radio to improve oral health literacy. Advocating for policy changes involved calls for billing codes, sugar reduction policies, and CRA integration into existing well-child programs.

Conclusion: NDPCPs in Manitoba are supportive of integrating the CRA tool into Indigenous pediatric primary care. Their recommendations offer a practical road map for CRA implementation, emphasizing systemic support, culturally responsive care, education, and policy alignment. These findings contribute to broader efforts to reduce oral health disparities and improve early childhood caries prevention in underserved populations.Knowledge Transfer Statement:Nondental primary care providers recommend integrating Caries Risk Assessment tools into Indigenous children's care through enhanced training, culturally safe engagement, and supportive policy development to address persistent oral health inequities.

Introduction: Periodontal disease is a multifactorial chronic inflammatory condition that progressively destroys the periodontal supportive tissues. While periodontal surgical therapy is a successful treatment for periodontal disease, patients often experience postoperative complications such as pain, swelling, and discomfort, which affect their quality of life. This systematic review evaluated the efficacy and safety of perioperative steroidal and nonsteroidal anti-inflammatory drugs (SAIDs and NSAIDs) on postoperative pain and swelling and rescue medication consumption in adults undergoing periodontal surgeries.

Methods: A protocol guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was followed. Multiple online databases were searched up to April 2025 for randomized clinical trials (RCTs) comparing perioperative SAIDs and NSAIDs after periodontal surgery. The primary outcome measure was postoperative pain, while the secondary outcome measures were swelling and rescue medication consumption using a random-effects model. The GRADE system assessed the quality of the evidence for each included study.

Results: Of 2,354 articles screened, 6 RCTs with 262 participants were included. Perioperative NSAIDs showed a statistically significant reduction in postoperative pain for the first 6 h postoperatively compared with perioperative SAIDs (mean difference [MD]: 1.00 to 2.23; 95% confidence interval [CI]: 0.21, 3.77). Perioperative SAIDs yielded a statistically significantly greater reduction in postoperative pain 48 h postoperatively than perioperative NSAIDs did (MD: -0.23, 95% CI: -0.31, -0.14). Perioperative SAIDs and NSAIDs had comparable outcomes in terms of postoperative swelling and rescue medication consumption.

Discussion: Perioperative NSAIDs may be more effective in reducing early postoperative pain while SAIDs might offer better longer-term pain management postoperatively after periodontal surgery. However, these findings should be viewed with caution because of the clinically insignificant differences and the evidence based on few studies, with moderate-to-low certainty of evidence, due to methodological biases and discrepancies in drugs used and regimens. Therefore, further optimized RCTs confirming the efficacy and safety of perioperative SAIDs and NSAIDs in periodontal surgical procedures are still needed.Knowledge Transfer Statement:This systematic review and analysis found moderate-to-low-certainty evidence and limitations in the studies assessing the effectiveness of perioperative anti-inflammatory drugs to improve postoperative recovery after periodontal surgical therapies. This emphasizes the need for individualized perioperative therapeutic protocols based on surgical complexity and the need for tension-free wound healing pending further high-quality trials.

Background: The assessment of epidemiological information on the oral health of children younger than 6 y in the region of the Americas is challenging due to methodological differences. An International Association for Dental Research Regional Development Project supported researchers from 11 Latin American countries in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Panama, Paraguay, Peru, Uruguay, and Venezuela to train and conduct standardized epidemiological studies of dental caries in children <6 y of age.

Objectives: To assess the feasibility of an International Caries Detection and Assessment System (ICDAS)-adapted protocol in early childhood caries (ECC) epidemiological studies and provide comparable data.

Methods: Eleven researchers from the selected countries were standardized using the following simplified criteria and protocol aimed to reduce the time of evaluation: (1) starting the examination with the detection of caries lesions, (2) eliminating ICDAS category 1 (as no air for drying), (3) applying one code for tooth surfaces with the same clinical finding (e.g., missing), and (4) using a customized data entry form. The 11 researchers trained and standardized 10 to 15 local examiners in each country and conducted cross-sectional studies in convenience samples of preschool children aged 12 to 71 mo living in disadvantaged communities according to each country's criteria.

Results: A total of 4,535 children were included in the present analysis. There were notable differences by country and age. For example, the d_2-6 prevalence in the 12- to 23-mo group varied between 13% in Venezuela and 48% in Argentina, while the d_5-6 prevalence varied between 0% in Venezuela and 18% in Argentina. In general, the occurrence of more severe clinical presentations increased with age.

Conclusions: There was a considerable variation in the prevalence of dental caries in the 11 countries. The wide variation with age indicates the need to report ECC estimates by detection threshold and individual age groups. The ICDAS-adapted protocol is suitable for ECC epidemiological studies.Knowledge Transfer Statement:The results of this study show the high occurrence and variation of early childhood caries (ECC) in Latin American children, which shows the need for more detailed and comprehensive surveillance efforts in this age group. The ICDAS-adapted protocol facilitates data entry and the recording of clinical observations for epidemiological studies in young children by reducing examination time. We have contributed to the standardization of ECC data collection in Latin America by using common ICDAS-adapted criteria.

Maternal and child oral health disparities often share similar phenomena: high disease burdens, limited access to care, and insufficient preventive strategies. These systemic challenges undermine community confidence in oral health solutions. The Eastman Oral Health Institutes in the United Kingdom, Sweden, and the United States of America, through the Eastman International Alliance, facilitated critical discussions in November 2024 on this topic in international grand rounds by highlighting the need to translate research into impactful oral health policies. This special communication calls for global action to elevate maternal and child oral health into system health by leveraging policies, enhancing service integration, addressing inappropriate industry influence (particularly in terms of sugar consumption), and using digital technology. We describe the often-overlooked oral health divide in high-income countries, using the United States, United Kingdom, and Sweden as examples, to assess shared challenges, distinct obstacles, and opportunities for global collaboration. The differences between developed countries including the United States, United Kingdom, and Sweden and the challenges faced by lower-income nations underscore the need for shared learning and a global commitment to integrated oral health care. Policymakers, health care providers, and public health advocates worldwide must work together to break down barriers and strengthen services.Knowledge Transfer Statement:Improving maternal and child oral health requires a system-level approach in all countries. Integrating oral health into system health is not just an option but a necessity for building healthier communities. Leveraging partnerships between dental academic institutions and oral health delivery organizations that are embedded in medical institutions, such as the Eastman Oral Health Institutes globally, offers a powerful vehicle for identifying, sharing, and scaling effective solutions to improve system-level oral health.

Social media platforms, such as Facebook and Instagram, play a pivotal role in shaping public opinion on health interventions, including community water fluoridation (CWF). Despite its recognition as a safe and effective public health measure, CWF remains a polarizing topic, with misinformation on these platforms contributing to public mistrust. This study collected 109,117 Facebook and Instagram posts from 2014 to 2023 to examine public sentiment surrounding CWF. The analysis revealed a mix of opinions, with 42.1% positive, 39.1% negative, and 18.8% neutral sentiments. Trends highlighted a surge in negative sentiment during 2017-2019, likely influenced by misinformation and significant public events, while positive sentiment has gradually regained ground in recent years. Key themes included health benefits, safety concerns, and government trust, with positive discussions emphasizing CWF's role in public health and negative discussions focusing on risks and chemical exposure. The study employed advanced sentiment analysis models to highlight the importance of monitoring public discourse and addressing misinformation, thereby promoting trust and support for evidence-based health policies, such as CWF. These findings offer digital data-driven insights for public health communication strategies, enhancing community understanding and acceptance of vital health interventions.Knowledge Transfer Statement:The findings of this study can inform public health agencies and policymakers about public concerns and support for water fluoridation. By identifying sentiment trends and misinformation on social media, communication strategies can be tailored to improve public understanding and acceptance of fluoridation as a preventive health measure.