JDR Clinical & Translational Research最新文献

Background: To assess the adherence to clinical practice guidelines (CPGs) reporting guidelines for oral health.

Methods: A literature search was carried out in PubMed, Embase and Web of Science from March 2016 to December 2023, selecting CPGs related to oral health. The study selection and data extraction were conducted independently by 2 researchers. Guidelines were cross-checked against the 23-item Appraisal of Guidelines, Research, and Evaluation (AGREE). The results were then collected, and the overall adherence and adherence to each AGREE item and section were calculated. Regression analyses were performed considering journal characteristics, such as quartile, year, and publishing options in journals' guideline endorsement. There were no language restrictions.

Results: Twenty-one CPGs were included in this study. The mean overall AGREE adherence was 48.7%. The results showed considerable variability in the rates of compliance with the reporting guidelines. Three areas appear to have (much) higher levels of compliance than the others, notably "Clarity of Presentation" (83.6%, 95% confidence interval [CI]: 75.4%-91.8%), "Scope and Purpose" (74.0%, 95% CI: 67.1%-80.9%), and "Stakeholder Involvement" (54.5%, 95% CI: 43.4%-65.7%). The lowest level of agreement was found in "Applicability," with a level of agreement of 18.5% (95% CI: 11.4%-25.6%). Four of the 6 domains had a complete lack (0.0%) of adherence. Journal quartiles were significant, as guidelines published in the second- (B = -27.3%; standard error [SE] = 6.1) and third-quartile (B= -22.8%; SE = 10.6) impact factor journals displayed a lower overall adherence than those published in first-quartile journals. Guideline endorsement by journals was also a significant variable (B = -20.9%, SE = 5.9).

Conclusion: Reporting completeness in dental/oral CPGs is suboptimal and is associated with the journal's quartile and guideline endorsement. Increasing awareness of CPG reporting guidelines and ensuring their rigorous application are decisive toward better adherence.Knowledge Transfer Statement:The quality of reporting in dental and oral clinical practice guidelines (CPGs) is low and linked to the journal's impact factor and the endorsement of the guidelines. Enhancing knowledge of CPG reporting guidelines and implementing them rigorously are critical for improved adherence.

Background: Dental caries remains a significant oral health burden globally. Scientific evidence has demonstrated the dose-dependent anticaries action of fluoride; however, more effective, comprehensive, and alternative prevention strategies are required.

Methods: A 2-y, phase 3, randomized controlled trial based on a double-blind, 3-arm, parallel-group design was conducted from April 15, 2019, through March 12, 2022 across 3 centers in China. Six thousand children aged 10 to 14 y with ≥2 active caries lesions were assigned 1 of 3 study dentifrices: 8.0% arginine, 1.5% arginine, and 0.32% sodium fluoride (NaF). The primary efficacy outcomes were incremental DMFS (decayed, missing, and filled surfaces) and DMFT (decayed, missing, and filled teeth) caries indices scores after 2 y of product use. The secondary efficacy outcomes were the incremental caries indices scores after 1 y and 6 mo of product use. Noninferiority was achieved if the 95% CI of the mean difference in scores was below the noninferiority margin of 0.2545 after 2 y, 1 y, and 6 mo of product use.

Results: After 2 y, the 8.0% arginine-containing dentifrice demonstrated a statistically significant reduction of 26.0% in DMFS scores (-0.16; 95% CI, -0.22 to -0.10; P < .001) and 25.3% in DMFT scores (-0.17; 95% CI, -0.24 to -0.11; P < .001) versus control. No statistical difference was measured between the 1.5% arginine-containing dentifrice and control in DMFS (-0.01; 95% CI, -0.07 to 0.05; P = .819) and DMFT (-0.01; 95% CI, -0.07 to 0.05; P = .739).

Conclusions: Dentifrice containing 8.0% arginine showed a statistically significant reduction in caries incidence versus the NaF control, while the 1.5% arginine dentifrice showed equivalence to the NaF control regarding caries reduction. This clinical study confirms that arginine dentifrices are effective alternatives to fluoride in providing anticaries protection.Knowledge Transfer Statement:This study demonstrates that arginine is an efficacious anticaries agent at the examined doses of 1.5% and 8%. Clinicians and consumers can consider this a new caries preventive agent providing choice to people seeking fluoride-free alternatives. Policy makers could leverage these findings to guide oral health initiatives and inform regulations on dentifrice composition, promoting broader access to effective caries prevention methods.

Background: While the relevance of implementation research in dentistry is increasingly emphasized, practice-based trials are still relatively uncommon in dental research. Despite being critical for successful practice-based research, little is known about the recruitment of dental professionals to participate in practice-based trials. Against this background, the purpose of this study was to extract key learnings about the opportunities and challenges for recruiting dental practices from a large-scale practice-based trial in Germany.

Methods: Leveraging quantitative and qualitative methods, participation rates of dental practices and experiences of researchers involved in a large-scale trial in German dental practices were examined. Quantitative analyses focused on the rate of practices that initially expressed interest to participate in the trial, the rate of practices that subsequently gave informed consent to participate in the trial, and variations in participation by different modes of invitation for the study. Qualitative data from dental practices and a focus group with the research coordinators were analyzed by means of thematic analysis, focused on drivers and barriers for practices to participate in the trial.

Results: Of 6,840 invited practices, 287 (4.2%) practices indicated their interest and 159 (2.3%) participated. The mode of invitation was significantly associated with participation (p < 0.05). The practices' reasons for nonparticipation included shortage of staff and time to adequately integrate the study processes into practice workflows. The research coordinators also identified a lack of established practice-based research networks in dentistry.

Discussion: While practice-based research is key to driving positive change in oral health systems, the findings of this study suggest considerable barriers for recruiting dental practices to participate in research. Understanding the mechanisms through which participation rates can be increased is crucial for the successful operationalization of practice-based research in dentistry. Implementation-oriented research in dentistry would benefit substantially from enhancements of practice-based research networks.

Trial registration: The underlying project was registered prospectively on July 3, 2023, at the German Clinical Trials Register (www.drks.de) under ID DRKS00030587.Knowledge Transfer Statement:The results of this study can be used by clinicians and clinical researchers when planning practice recruitment for practice-based trials. This could allow for more precise sample size planning and ultimately contribute to improved patient health through the increased validity of studies.

Introduction: As global momentum builds for universal health coverage (UHC), it is unclear whether orthodontic care should be included in UHC packages. The concept of medically necessary orthodontic care (MNOC) and its criteria thus have far-reaching implications for priority setting and resource allocation in public and private oral health care programs.

Objective: To identify factors that contribute to the determination of MNOC based on perspectives from leaders of dental professional organizations, academics, clinicians, funders, patient advocates, and patients from 7 countries: Canada, United States, Germany, Greece, United Kingdom, Switzerland, and Australia.

Methods: A qualitative description design was used with semi-structured virtual interviews conducted via Zoom from November 2021 to August 2022. Interviews were transcribed verbatim, coded, and analyzed for themes.

Results: Sixteen interviews were conducted. Participants described their concept of MNOC through 4 interrelated categories: (1) dental factors including dental health, the goals of treatment, and methods of needs assessment; (2) medical factors including the meaning of medical necessity, systemic health considerations, and treatment of craniofacial anomalies; (3) psychosocial factors including societal standards of beauty, social functioning, and mental health; and (4) funding factors including resource allocation considerations and the goals of funding.

Conclusion: The diversity of factors identified highlights the complex interplay between the dental profession, funders of care, society, and individual patients in understanding MNOC. Given this complexity, MNOC is arguably not amenable to a concise definition or list of criteria. Instead, a decision-making process that incorporates key actor perspectives can enhance transparency, fairness, and accountability in priority setting and resource allocation as related to MNOC and medically necessary oral health care more broadly. This approach would ensure coverage for those with demonstrated need in the context of health, well-being, and quality of life.Knowledge Transfer Statement:This study provides critical insights into the dental, medical, psychosocial, and funding factors that influence the meaning of medically necessary orthodontic care (MNOC) from the perspectives of key actors in 7 high-income countries. The findings reveal that MNOC cannot be defined by a simple set of criteria. Instead, determinations of MNOC should be made through a decision-making process that incorporates a wide array of viewpoints. This approach ensures transparent and fair resource allocation, improving access to essential orthodontic services, thereby enhancing patient health and well-being.

Introduction: The war in Ukraine has resulted in a mass exodus of Ukrainians fleeing their country and seeking resettlement in many countries, including Canada. There is a lack of literature, particularly qualitative, that explores past experiences with oral health care in the country of origin for newcomers and the experience of access and utilization of oral health care once in Canada. The increase in Ukrainian newcomers to Canada requires an exploration of barriers and facilitators to oral health care access to inform policy.

Objective: To explore the barriers and facilitators to oral health care experienced by Ukrainian newcomers during resettlement in Nova Scotia, Canada.

Methods: This study used a narrative qualitative methodology. Adult Ukrainian newcomers who arrived in Canada after the Russian invasion in 2022 were recruited via social media and through recruitment flyers advertised at the Immigrant Services Association of Nova Scotia. They were interviewed between February 17 and July 1, 2023, in the Ukrainian language. The interviews were audio recorded, transcribed, and analyzed via inductive and deductive line-by-line coding per the thematic analysis method. Codes were grouped to form categories and themes.

Results: Participants identified facilitators to oral health care that included friends and family, social networks, and information provided through the workplace. Barriers to access included cost, referral process, location and wait times for specialists, language, and lack of understanding the oral health care and dental insurance systems in Canada.

Conclusion: Ukrainian newcomers to Nova Scotia face several barriers to oral health care access. Interventions to address these barriers should be considered to ensure equitable access to oral health care services during the resettlement process.Knowledge Transfer Statement:The results of this study may be used to inform policy to facilitate timely access to oral health care for Ukrainian newcomers. The findings may also guide professionals when providing oral health care services to Ukrainian newcomers. Addressing the barriers and maximizing the facilitators to oral health care services for this population could help to improve access to oral health care services and oral health outcomes.

The objective of this study is to estimate the causal effect of tooth loss on the critical outcome of COVID-19, using 3 different propensity score methods. This retrospective study included patients aged >35 y with a diagnosis of COVID-19 between January 2020 and July 2021 at 2 hospitals in the Netherlands. The independent variable was number of teeth, dichotomized into 0 to 20 teeth (treatment) and 21 to 28 teeth (control). The critical outcome of COVID-19 (intensive care unit [ICU] admission and/or death) was the dependent variable. Potential confounders included patients' demographics, lifestyle habits, medical conditions, COVID-19-related parameters, and hospitals. Three different propensity score methods were used to balance the baseline characteristics between the treatment and control groups: including propensity score matching (PSM), inverse propensity score weighting (IPW), and marginal mean weighting through stratification (MMWS). Both univariate and multivariate logistic regression analyses were performed to assess the causal association between tooth loss and the critical outcome of COVID-19 after the propensity methods. A total of 399 patients were included in the analyses. The multivariate logistic regression analysis controlling for the confounders revealed a statistically significant association between tooth loss and the critical outcome of COVID-19 across all the 3 propensity score methods: PSM (causal risk ratio [cRR]: 2.00; 95% confidence interval [CI]: 1.07-3.74; P = 0.03), MMWS (cRR: 1.78; 95% CI: 1.07-2.06; P = 0.03), and IPW (cRR: 1.85; 95% CI: 1.09-3.15; P = 0.02). Tooth loss has a statistically significant causal effect on the critical outcome of COVID-19. Patients with fewer teeth have a higher risk of ICU admission or mortality due to COVID-19.Knowledge Transfer Statement:The findings of this study can help clinicians and policymakers recognize the important role of oral health in COVID-19 prognosis. By encouraging health care professionals to integrate oral health assessments into comprehensive evaluations, the study promotes more accurate risk stratification for COVID-19 prognosis. This enables early interventions and better management of high-risk patients, ultimately leading to improved health outcomes by preventing critical outcomes of COVID-19 and enhancing patient care.

Introduction: Nurses are key in the delivery of the basic package of oral care in the primary health care system. Whereas oral health care training is essential for apt oral care delivery, the scope and training approaches for the primary health care nurse are not well established. A mentorship approach has rarely been explored for oral health training.

Objective: This study aimed to develop a basic package of oral health care training program for primary health care nurses in Kenya. It also evaluated and compared the effects of workshop and mentorship approaches on a basic package of oral care training outcomes.

Methods: The Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional model was used to develop the training program. This used a scoping review approach to inform the design and development stages of the training. Implementation followed a quasi-experimental design to deliver a 1-y postworkshop mentorship program (experiment) against a workshop-only (control) group. The Kirkpatrick framework was used for evaluation.

Results: A training program with 7 learning areas and 37 subtopics covering nurses' basic package of oral care tasks was developed and evaluated. Summative analysis included 67 nurses (experiment, n = 33; control, n = 34) and 1,128 parents (experiment, n = 570; control, n = 558). Improvement was noted in nurses' overall knowledge (47.9% to 64.7%), confidence (77.3% to 92.2%), and oral health care services delivery (0.3% to 35.8%). Overall parental child oral health practices improved from 31.3% to 44.4%. The experiment group exhibited significantly higher scores for confidence, oral health care services delivery, and parental child oral health practices. Longitudinal decay in knowledge and confidence was lower in the experiment group.

Conclusion: A basic package of oral health care training program for primary health care nurses in Kenya was successfully developed and evaluated. For all outcomes evaluated, the mentorship approach yielded better results than the workshop approach did. These results highlight mentorship as an integral component in a basic package of oral care training.Knowledge Transfer Statement:This study of primary health care nurses in Kenya provides insights to inform oral health and primary health care policy makers about oral health education, oral urgent treatment, referral, and oral health service documentation training requirements. It shows how planning and prioritization for in-service oral health training sessions could be maximized with limited resources. It also demonstrates the benefit of a mentorship training approach over a workshop-only approach to ensure optimal outcomes of oral health indicators.

Introduction: The cascade of care (COC) approach assesses key stages in care, including screening, diagnosis, treatment, and control. It has been applied to communicable and noncommunicable diseases but is yet to be used in oral health.

Objectives: To adapt the COC framework for pediatric oral health and apply it in a cross-sectional study of schoolchildren in Jeddah, Saudi Arabia, to assess dental needs, diagnosis, treatment, and follow-up.

Methods: A 2-stage process was used to first adapt the 4-step COC model for pediatric dental needs and to produce a survey questionnaire. Stratified random sampling was then used to recruit children in grades 4 to 6 in primary schools in Jeddah, Saudi Arabia, from October 2023 to January 2024. Parents completed COC questions, and children completed dental examinations. Descriptive statistics and multilevel logistic regression models were used to assess outcomes, including unmet dental needs in context.

Results: A total of 783 schoolchildren from 11 primary schools were included in the cross-sectional study. The largest loss of care occurred at the treatment stage, where 41.3% of those who had visited a dentist and were diagnosed had completed their treatment. Children who had not visited a dentist in >12 mo were less likely to be diagnosed, complete treatment, or receive follow-up care when compared with those who had seen a dentist within 12 mo ( P < 0.05).

Conclusion: This study is the first to adapt and apply the COC framework in pediatric oral health. The total unmet dental need was high, particularly for children visiting the dentist for symptomatic reasons (i.e., pain or extraction). This model lays the groundwork for more targeted assessments at national or subnational levels.Knowledge Transfer Statement:This is the first time that the cascade of care (COC) approach has been adapted and applied in a pediatric oral health case study in Jeddah, Saudi Arabia, to understand gaps in children's dental care. It showed how the COC can highlight where systems might be underperforming and where additional data are needed. Introducing the COC framework in pediatric oral health could improve data collection across key stages of care, such as access, diagnosis, treatment, and follow-up.

Purpose: To evaluate pediatric dentists' and dental residents' knowledge, attitudes, and practices toward human papillomavirus (HPV) education and vaccination anticipatory guidance.

Methods: The survey instrument was adapted from Patton et al. with permission from the American Dental Association (ADA) (copyright © 2020 ADA. All rights reserved. Reprinted with permission) and emailed to practicing American Academy of Pediatric Dentistry (AAPD) member pediatric dentists and dental residents between February and March 2023. Descriptive data analyses were conducted to evaluate correlations between knowledge, attitudes, and practices toward HPV anticipatory guidance, including the impact of the politicization of the COVID-19 vaccine.

Results: Of 7,960 surveys sent, the total response rate was 7.7%. Only 6.3% of respondents regularly provide HPV vaccination anticipatory guidance, and 56.8% never discuss the HPV vaccine. Those who practice in an academic dental school setting were almost 4 times more likely and those who felt they had adequate training and knowledge or who have an electronic health record prompt for HPV vaccine status were 2 times more likely to provide regular HPV anticipatory guidance. Other correlates with increased regular provision of HPV anticipatory guidance were older age, greater knowledge, awareness of the age recommendations for HPV vaccination, familiarity with the ADA or AAPD policy statements, and greater comfort (indicated by a lower comfort score).

Conclusions: The survey results suggest pediatric dentists and pediatric dental residents rarely provide HPV anticipatory guidance, a missed public health opportunity for increasing vaccination rates and an opportunity for dental educators.Knowledge Transfer Statement:This article aims to inform dentists and dental educators about human papillomavirus (HPV) vaccine anticipatory guidance.