JDR Clinical & Translational Research最新文献

Introduction: Concurrent pain in the jaw and neck is common; however, little is known about how it develops. Previous studies have focused mainly on biological factors with limited focus on psychosocial factors and patients' perspectives. To enhance understanding of concurrent jaw and neck pain, knowledge is needed about patients' perspectives on the development of symptoms and their management within health care that also includes dentistry.

Objective: To explore patients' perspectives on the development of concurrent jaw and neck pain in relation to navigating the health care system.

Methods: Sixteen individuals (11 women and 5 men, aged 19 to 56 y) with concurrent jaw and neck pain were recruited using purposive sampling. Participants were patients referred to an orofacial pain specialist in Sweden. Individual semi-structured interviews were used and analyzed using qualitative content analysis.

Results: Data analysis resulted in the theme "Seeking understanding, confirmation, and simplified navigation in the health care system." The main theme consisted of 3 subthemes: (1) understanding and interpreting the body and emotions holistically, (2) seeking affirmation and legitimacy from health care, and (3) wishing for clear and easily navigable health care pathways. Patients expressed thoughts regarding their own sensemaking in respect to causes for their pain. Moreover, they requested confirmation from health care along with simplified health care navigation and a holistic approach regarding pain management.

Conclusions: A mismatch exists between the patient's own sensemaking regarding the cause of their jaw and neck pain and the care they receive from their health care provider. Having pain from multiple sites that is managed in different medical systems makes it difficult to navigate within health care. A clear care pathway could reduce the risk of pain chronicity, and an increased collaboration between dentistry and medical care would be desirable.Knowledge Transfer Statement:Concurrent jaw and neck pain is common but often managed separately in dentistry and health care. This can result in a mismatch between a patient's understanding regarding concurrent jaw and neck pain and directions from their health care provider. A holistic approach and increased collaboration between dentistry and health care are needed to support patients navigating health care providers and reduce the risk of pain chronification.

Introduction: Racial inequalities are expressions of racism, a phenomenon that is pervasive in different countries in Latin America and reinforced by social structure. This research analyzed the intersections between race and income in dental care utilization in Brazil and Colombia.

Methods: Two nationwide Brazilian and Colombian population oral health surveys were used, as conducted in 2010 and 2014, respectively. The samples included individuals from different age groups. Three outcomes were considered: 1) Ever been to a dentist (yes/no)? 2) Have you visited a dentist in <1 y (yes/no)? 3) Last dental visit for urgent treatment (yes/no)? The main explanatory variables were race and income (the per capita minimum wage). Relative excess risk due to interaction and synergy index were calculated to verify interactions between race and income, adjusted for age and sex. Specific age group analyses were carried out for both countries to assess pervasive racial inequities.

Results: Upper-income White persons in Brazil (odds ratio, 3.61; 95% CI, 3.20 to 4.07) and Colombia (odds ratio, 2.54; 95% CI, 2.21 to 3.07) had higher odds of not using urgent dental services than lower-income Black persons and lower-income Afro-Colombians. Relative excess risk due to interaction and synergy index showed synergistic interactions in both countries.

Conclusion: Compounded racial and income-related disparities in dental care utilization were observed in Brazil and Colombia, which may reflect underlying structural inequities. Public policies need to consider the complex intersections between socioeconomic conditions affecting underprivileged racial groups in Latin America.Knowledge Transfer Statement:This study highlights how structural racism and socioeconomic disparities intersect to limit dental care access in Brazil and Colombia, emphasizing the need for public policies addressing racial and economic inequities in oral health.

Objectives: Toothache is defined as pain originating from a tooth and its supporting structures, often described as the most frequent type of orofacial pain. Therefore, this systematic review aimed to assess the prevalence of toothache in adults.

Methods: The study selection process adhered to the PECOS inclusion criteria: Population (P): Adults; Exposure (E): Toothache; (C): None; Outcome (O): Prevalence; Studies (S): Observational studies.

Results: The initial search yielded 1,781 studies, and after eligibility criteria were applied, 48 studies were included in the analysis. The overall prevalence of toothache was found to be 24% (95% confidence interval [21, 27.2]; n = 447,373).

Conclusions: When categorized, the prevalence among adults was as follows: 34.6% currently experiencing tooth pain, 14.5% in the past month, 19.5% in the past 6 mo, and 29.0% in the past 12 mo. Geographically, toothache prevalence varied as follows: 43.2% in Africa, 30.6% in Asia, 24.6% in Europe, 17.0% in South America, 15.0% in Oceania, and 13.44% in North America.

Clinical significance: Based on the available evidence, this systematic review suggests that the overall prevalence of toothache in adults is 24%, with higher rates in Africa (43.2%) and Asia (30.6%) and lower rates in Oceania (15.0%) and North America (13.4%).Knowledge Transfer Statement:The worldwide prevalence of toothache was found to be 24%. Toothache prevalence varied by continent as follows: 43.2% in Africa, 30.6% in Asia, 24.6% in Europe, 17.0% in South America, 15.0% in Oceania, and 13.44% in North America.

Objectives: Socioeconomic status (SES) has a significant effect on the burden of early childhood caries (ECC), yet addressing SES disparities remains challenging. This study aimed to identify and quantify the most impactful mediator linking SES effect to the occurrence of ECC using advanced causal mediation analysis, to inform targeted interventions that reduce SES-related disparities in ECC.

Methods: Data were drawn from the Study of Mothers' and Infants' Life Events, a cohort of 2,182 mother-child dyads recruited from Adelaide's 3 largest public hospitals (2013-2014). Baseline questionnaires captured family SES, while ECC clinical indicators were assessed at age 5 y. Three mediation pathways linking SES and ECC were examined including dietary intake represented by free sugar intake (FSI); oral hygiene practices, including toothbrushing habits and plaque presence; and dental visiting patterns. Mediation effects were quantified as natural indirect effects (NIE) using causal mediation analysis based on the counterfactual framework, with validation via 5-fold cross-validation to ensure robustness.

Results: FSI was the only pathway with a significant mediation effect. Each 1-standard-deviation increase or decrease in SES was associated with a corresponding 6% reduction or increase in ECC risk at age 5 y through the mediating effect of FSI at age 2 y. The NIE of FSI accounted for 52% of SES's total effect on ECC. In contrast, oral hygiene and dental visiting patterns showed no significant mediation effects.

Conclusions: Reducing early childhood FSI could mitigate half of SES-related disparities in ECC. Targeted interventions focusing on FSI reduction hold promise for lowering ECC risk, with future research needed to evaluate their effectiveness.Knowledge Transfer Statement:Clinicians and policymakers should prioritize nutrition education and sugar reduction initiatives as key components of early prevention in pediatric dentistry, especially for low-SES populations. Incorporating FSI screening into routine visits enables medical and dental practitioners to educate caregivers on the impact of free sugars on dental health.

Background: This systematic review aims to analyze the effectiveness of the combination of herbal medicine and corticosteroids in oral lichen planus (OLP) management. By providing an updated insight into the medicinal properties of this combined treatment approach, the review seeks to address the current gap in the understanding of its therapeutic potential for this chronic premalignant disorder.

Materials and methods: PubMed, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang databases were searched to identify randomized controlled trials comparing Chinese patent medicine (CPM) with corticosteroids and corticosteroids alone in treating OLP. Studies in English or Chinese that reported relief of symptoms and medicinal properties of CPM were included. Data on study and participant characteristics, intervention, and impact of therapy were extracted.

Results: Nineteen randomized controlled trials with a total of 1,164 participants were included in the study. Eleven CPMs were identified, with reported outcomes including improved treatment effectiveness, reduced OLP recurrence rates, and mitigated drug-related complications. All studies reported that combinatory pharmacotherapy demonstrated a significant reduction in burning sensation, a decrease in lesion size and severity, and an improvement in treatment effectiveness as compared with the utilization of corticosteroid alone.

Conclusion: The combination of herbal medicine and corticosteroids holds promise as a superior approach for OLP management. Further research is necessary to quantify the active chemical components within herbal remedies and elucidate their underlying mechanisms of action. Advanced scientific methods are crucial for validating the composition of CPMs and confirming their therapeutic effectiveness. The investigations are crucial to overcoming the limitations of the current treatment strategies for OLP and other oral potentially malignant disorders.Knowledge Transfer Statement:The findings of this systematic review provide valuable insights for clinicians regarding the potential benefits of combining herbal medicine with corticosteroids in the management of oral lichen planus. This information can aid in making informed decisions on treatment strategies to enhance the health outcomes of individuals affected by this condition.

Objectives: This investigation aimed to examine the associations between xerostomia and the use of cigarettes, e-cigarettes, and cannabis in a nationally representative cross-sectional sample of adults.

Methods: Data from the Population Assessment of Tobacco and Health Study included N = 29,721 United States adults (age ≥18 y) surveyed during 2022 to 2023 about xerostomia (experiencing dry mouth "frequently" or "always") and their use of 9 types of tobacco products and cannabis. Survey-weighted multivariable regression models estimated the associations of xerostomia with various specifications of cigarette, e-cigarette, and cannabis use, adjusted for sociodemographic and health status variables.

Results: Overall, 9.7% of participants experienced xerostomia. In adjusted models, past 30-d use of cigarettes, e-cigarettes, and cannabis were each associated with greater odds of xerostomia. The daily use of cigarettes (adjusted odds ratio: 1.7; 95% confidence interval: 1.4, 2.0), e-cigarettes (1.8; 1.5, 2.2), and cannabis (2.1; 1.7, 2.7) was also associated with greater odds of xerostomia. The greatest odds of xerostomia was associated with the use of all 3 products in combination within the past 30 d (3.8; 2.8, 5.2).

Conclusions: The use of cigarettes, e-cigarettes, or cannabis, particularly when used together, is associated with a greater occurrence of oral dryness among adults. Among other adverse health effects of these products, potential xerostomia risk may encourage cessation, contribute to dental patient advising, and inform appropriate tobacco and cannabis regulations and policies.Knowledge Transfer Statement:Based on the findings of this study, dental professionals and patients should anticipate a higher prevalence of xerostomia among adults who use cigarettes, e-cigarettes, and/or cannabis. Dental professionals should incorporate this information into xerostomia management, treatment planning, and the guidance and cessation support provided to patients who use these products. Potential adverse oral health effects should be considered in tobacco and cannabis policies and regulations.

Introduction: Silver diamine fluoride (SDF) is an effective cariostatic agent that has reemerged globally in recent years. Its resurgence is timely as dental caries remains prevalent, necessitating an affordable and simple treatment option. Its implementation in Australia has been slow, with inconsistent views on its use among practitioners, but is likely imminent given the recent global uptake. There is currently no literature examining Australian dental stakeholder views on SDF's implementation.

Objectives: This study aims to investigate Australian dental stakeholder views on the use of SDF and to identify the challenges and facilitators to its implementation for managing dental caries.

Methods: Qualitative semi-structured interviews were conducted with Australian dental stakeholders. The analysis was carried out using Braun and Clarke's reflexive thematic analysis framework and NVivo14 software.

Results: Ten participants were interviewed (7 dentists, 2 hygiene therapists, and 1 hygienist) from 4 Australian states. The barriers and facilitators to Australia's use of SDF were found within the themes of policy, research, manufacturer, teaching and exposure, and clinical setting. Major barriers to SDF adoption include insufficient training in the undergraduate setting, lack of a standardized Australian guideline detailing use, no Therapeutic Goods Administration approval for caries, and the manufacturer's product design. Facilitators included continual professional development on SDF, manufacturer marketing of the product, and ample research supporting SDF's effectiveness for dental caries.

Conclusions: This study highlights both barriers and facilitators to SDF use in Australia, providing insight into factors that may influence its future integration into dental practice.Knowledge Transfer Statement:The results of this study show that successful implementation into Australia will require effort and changes by policymakers, universities, and manufacturers to support clinician use.

Introduction: The impact of tooth loss during adolescence, often a consequence of dental caries or traumatic injuries, extends beyond physical discomfort to significantly affect social interactions and self-esteem. Despite the established associations between poor oral health and various forms of social disadvantage, the potential for tooth loss to be associated with bullying victimization remains inadequately investigated.

Objectives: This study aims to investigate the causal association between tooth loss and bullying victimization among adolescents, using longitudinal data from Australian children.

Methods: We analyzed data from 4,476 children from wave 3 (aged 8 to 9 y) to wave 6 (aged 14 to 15 y) of the Longitudinal Study of Australian Children. Tooth loss was assessed through parent-reported dental extractions due to decay or trauma. Bullying victimization was measured through parent-reported incidents of school bullying. A fixed effects regression model was employed to control for time-invariant confounding and estimate the impact of tooth loss on bullying. Sensitivity analyses, including age restriction, lagged effects, and a negative control, were conducted to validate the findings.

Results: The fixed effects model revealed that adolescents experiencing tooth loss had 42% higher odds of being bullied at school (odds ratio, 1.42; 95% CI, 1.15 to 1.77), after adjusting for household income, disability, and maternal education. Sensitivity analyses supported the robustness of these findings, demonstrating a consistent effect of tooth loss on bullying victimization.

Conclusion: By leveraging longitudinal data, this study quantifies the within-individual association between tooth loss and bullying victimization during adolescence, underscoring the importance of preventing dental caries and trauma impacts. These findings suggest that tooth loss may be a modifiable determinant of bullying risk during adolescence, with potential implications for long-term mental health outcomes.Knowledge Transfer Statement:This study demonstrates a 42% higher risk of school bullying among adolescents who experience tooth loss due to decay or trauma. These findings emphasize the critical need for clinicians to prioritize preventive dental care and early intervention to reduce the social impacts of poor oral health. Policy makers should incorporate oral health interventions alongside antibullying initiatives in schools to mitigate the cascading effects of bullying on mental health and social well-being in adolescents.

Introduction: Early childhood caries is a significant problem affecting Aboriginal preschoolers in remote communities who lack access to dental services. A trial was conducted to assess the benefits of atraumatic restorative treatment combined with the Hall technique (ART-HT) versus usual care for managing early childhood caries in this population.

Objectives: This trial-based cost-utility analysis evaluates costs and quality-adjusted life-years (QALYs) of ART-HT compared with usual care within a 1-y time frame.

Methods: A decision-analytic model simulated the costs and QALYs for 2 scenarios: trial service delivery and minimum ART-HT delivery. The incremental cost per QALY gain ratio (ICER) was calculated for each scenario. QALY were estimated using the Early Childhood Oral Health Impact Scale-4D (ECOHIS-4D) and adjusted for baseline. Probabilistic sensitivity analyses were conducted to assess the robustness of the base-case results. Cost-effectiveness acceptability curves were generated to determine the likelihood of ART-HT being cost-effective at various willingness-to-pay thresholds. All costs are presented in Australian dollars for 2021.

Results: Children receiving ART-HT had slightly higher QALYs than those receiving usual care did (0.85 vs. 0.83). The base-case analysis showed an average ICER of $2,013/QALY gained (95% uncertainty interval -$45,246 to $21,676). In the sensitivity analysis, the average ICER was $2,573/QALY gained (95% uncertainty interval -$43,658 to $23,352). ART-HT had an 85% and 81% chance of being cost-effective at a $15,000/QALY gained threshold in the base-case and alternative scenario, respectively.

Conclusion: ART-HT showed potential cost-effectiveness compared with usual care within the observed period. While QALY gains were modest, ART-HT may offer a valuable strategy to improve service access for Aboriginal children in remote communities.Knowledge Transfer Statement:This study demonstrates that atraumatic restorative treatment combined with the Hall technique (ART-HT) is cost-effective in managing early childhood caries in remote Aboriginal communities. By providing a viable dental care strategy, ART-HT can improve access to essential dental services, enhance oral health outcomes for Aboriginal preschoolers, and offer value for money, thereby contributing to overall better health in these underserved populations.

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.