JDR Clinical & Translational Research最新文献

Introduction: Xerostomia is a subjective sensation of dry mouth affecting millions of people worldwide. Current management has limitations, often causing side effects. This study aims to investigate whether electrical stimulation of the lingual nerve could offer effective relief for xerostomia sufferers.

Methods: Eligible participants were randomly assigned (1:1) to either the experimental or sham group, receiving electrical stimulation of the lingual nerve (n = 24) or sham stimulation (n = 23) for 12 wk. The primary outcome is the changes in xerostomia score using a 100-mm visual analog scale throughout the therapy. Participants assessed their dryness and assigned corresponding scores, with lower scores indicating more severe dry mouth. Secondary outcomes included remission rate in dry mouth frequency, changes in stimulated/unstimulated salivary flow rate (SSFR/USFR), and changes in Oral Health Impact Profile-14 (OHIP-14) questionnaire scores, where higher scores indicate greater impact on oral quality of life.

Results: At week 12, the electrical stimulation group showed greater improvement in xerostomia score compared to the sham group, with a mean between-group difference of 13.8 (95% confidence interval [CI], 10.0-17.6). The therapeutic effect of electrical stimulation was also confirmed by secondary outcomes. The remission rate of dry mouth was higher at 12 wk in the electrical stimulation group (61.9% [95% CI, 40.9%-79.3%] vs. 28.6% [95% CI, 13.8%-50.0%]). Participants in the electrical stimulation group also experienced a greater increase in USFR, with a mean difference of 14.5 (6.1-23.0) μL/min. Moreover, they exhibited significant improvement in OHIP-14 score after 12 wk of therapy, with a mean between-group difference of -10.0 (-13.9 to -6.2). No significant difference was observed between the 2 groups for SSFR (P = 0.702).

Conclusions: Electric stimulation offers promise as a noninvasive, nonpharmacological strategy for the management of xerostomia. Further research is needed to understand its long-term effectiveness, optimal parameters, and underlying mechanisms.Knowledge Transfer Statement:The study confirmed that electrical stimulation of the lingual nerve is a promising noninvasive and nonpharmacological modality for relief of xerostomia.

Introduction: The effects of racism, oppression, and colonization in Australia are reflected in the inequitable experience of chronic kidney disease (CKD) among Aboriginal and Torres Strait Islander peoples. Despite having the highest incidence of CKD, Aboriginal and Torres Strait Islander people have the lowest rate of kidney transplant, with poor oral health commonly being an obstacle to receiving a transplant. This research reflects the exploratory phase of a larger project aimed at maximizing oral health outcomes for Aboriginal and Torres Strait Islander people living with CKD in Australia through the provision of culturally secure dental care.

Methods: The present research uses reflexive thematic analysis to analyze qualitative data from yarns, interviews, and focus groups with dental, renal, and Aboriginal and Torres Strait Islander stakeholders to generate a conceptual understanding of equity at the nexus of oral health and kidney health. NVivo software was used for organizing data and an inductive line-by-line coding approach.

Results: Twenty-eight stakeholders participated; 12 of the stakeholders identified as Aboriginal and/or Torres Strait Islander, and most were female. Factors at the nexus of oral health and CKD included the continuous effects of colonization, the centrality of cultural security for improved care, as well as several challenges and opportunities at a system level. Challenges included the luxury of oral health access, limited health care team involvement in oral health pathways, high-intensity engagement with medical systems, and no communication between dental and renal teams. Opportunities identified included the role of integrated care, cross-discipline knowledge sharing, Aboriginal and Torres Strait Islander leadership, clear referral pathways, prevention, and assistance with navigating the oral health system.

Conclusion: We argue that collective responsibility for the oral health of Aboriginal and Torres Strait Islander people living with CKD is required for improved health and eligibility for kidney transplant. Cross-discipline collaboration is required to overcome the rigidness of the current colonial and biomedical model that silos oral health and CKD.Knowledge Transfer Statement:The siloed approach to management of oral health for Aboriginal and Torres Strait Islander peoples with chronic kidney disease results in low knowledge sharing and communication across chronic disease management teams and can prevent kidney transplantation. Collective responsibility for oral health within this context is required to ensure that just and equitable access to kidney transplant can be achieved.

Objective: To examine the gender and geographic distribution of the International Association for Dental, Oral, and Craniofacial Research (IADR) Distinguished Scientist Awards (DSA; data: 2019-2024), group awards (data: 1982-2024), and fellowships (data: 1987-2024).

Methods: Publicly available data were obtained from the IADR awards website. Information on gender and location of the awardees was gathered from photographs and affiliations if available or otherwise from online profiles or using Genderize, an online gender allocation platform.

Results: Of the 99 DSA awardees in 2019 to 2024, 35% were women; 38% were from the United States, 12% were from the United Kingdom, and 11% were from Australia. Of the 35 DSA women awardees, 54% were from the United States and 11% from Finland. Of the 795 group awardees, 45% were women. Data on the location of awardees were readily available for 681 group awards; of these, 39% were from the United States and 87% were from high-income countries. Of the 113 fellowships awarded, 58% were to women. Of the 32 fellowships since 2018, 44% were for awardees from upper-middle income countries.

Conclusion: Although women are overrepresented in the dental profession and the IADR has a global membership, women awardees remain underrepresented, and most awards are granted to researchers in high-income countries. These findings call attention to a deeper look at diversity, equity, and inclusion within the IADR.Knowledge Transfer Statement:Gender diversity of IADR research awards is moving in the right direction, but geographic diversity lags, with most Distinguished Scientist Awards and group awards to members in high-income countries. There is an urgent need to consider performance relative to opportunities and applications. This change in process could provide a much-needed intersectionality lens for recognizing the research performance of IADR members while increasing diversity and inclusivity.

Stark inequities exist in oral health care access with minoritized and marginalized populations facing more barriers to attaining care than the general population does. Considerably more individuals have access to primary health care than to dental services. The high prevalence of access to primary care services relative to dental services suggests a key role for primary care providers to address the oral health needs of patients. A limiting factor is a lack of uniformity of standards and curricula that exist for integrating oral health into primary care training disciplines. Based on the Center for Integration of Primary Care and Oral Health's (CIPCOH) research over the past 5 y, we have developed broad recommendations for training programs across the primary care spectrum: (1) support champion training programs that incorporate promising and/or best practices, (2) incorporate oral health into interprofessional standards, and (3) establish a curricular and evaluation framework for oral health integration into primary care training.Knowledge Transfer Statement:The recommendations from this article can be used by primary care educators and policy makers to better integrate oral health into primary care training programs and ensure a competent primary care workforce.

Introduction: Dental caries is the most common chronic childhood disease in the United States. Topical fluoride varnish (TFV) is a simple evidence-based preventive procedure shown to reduce early childhood caries and is approved for the primary care setting; however, rates of TFV application nationally are low. Less than 10% of eligible children received TFV at 1 academic family medicine group during well-child visits. This study assessed the clinician-reported barriers and facilitators to TFV application in that group to inform quality improvement efforts.

Methods: Using an exploratory sequential design, we developed a 29-item survey assessing knowledge, attitudes, and perceived barriers and facilitators to TFV application. The survey was distributed to outpatient family medicine practice clinicians in a mid-Atlantic academic health center in July 2020. Data were analyzed by univariate descriptive statistics.

Results: Of 163 eligible clinicians, 93 (57%) completed the survey, including 60 MD/DO attending physicians, 12 advanced practice clinicians (5 physician assistants, 7 nurse practitioners), and 21 resident physicians. The most frequently reported facilitator was having TFV supplies preplaced in the examination room (92%), followed by nursing staff providing patient education (84%). The most frequently reported barrier was time constraints (61%), followed by the belief that dentists already provide TFV (47%). Advanced practice clinicians expressed a greater need for hands-on training, while residents prioritized refreshers on eligibility and billing. Attending physicians were more likely to report insufficient time for parent education as a barrier.

Conclusions: The study highlights key workflow and education-related barriers affecting TFV application in family medicine. Strategies such as interprofessional workflow optimization, previsit planning, and enhanced EHR documentation may address these barriers. Findings support the need for quality improvement initiatives to integrate TFV more effectively into routine pediatric preventive care, ultimately improving early childhood caries prevention.Knowledge Transfer Statement:Despite recommendations for topical fluoride varnish in primary medical care, application rates remain low due to time constraints, workflow inefficiencies, and unclear clinician roles. This study identifies key barriers and facilitators, highlighting the need for team-based workflows, previsit planning, electronic health record enhancements, and targeted training. Findings can inform quality improvement initiatives to streamline topical fluoride varnish application, optimize interprofessional collaboration, and enhance early childhood caries prevention in primary medical care settings.

Background: Graduates of U.S. dental schools must meet curriculum and competency requirements set by the school and by the Commission on Dental Accreditation. Little is known about the impact of this training on recent alumni in practice. This cross-sectional study surveyed recent alumni about their preparedness and comfort in treating the oral health needs of children before and after a curriculum change in the predoctoral pediatric dental clinical course. Results were used to inform future curriculum improvement.

Methods: Five classes of dental school alumni were surveyed at least 6 mo after graduation. Information about their practice setting, patient pool demographics, comfort and preparedness in diagnosing and treating common pediatric oral health conditions, and open-ended thoughts on caring for the oral health needs of children were obtained. Responses were analyzed before and after a curriculum change that introduced predoctoral students to patient care in the graduate pediatric dental clinic.

Results: Electronic and mailed paper surveys were sent to 552 alumni, with 218 (39.3%) returned. A majority (91.1%) reported seeing pediatric dental patients in practice. There was no difference in the incidence of seeing pediatric patients before or after the curriculum change. Participants reported high comfort and confidence in diagnosing pediatric oral health conditions, and there were no significant differences seen pre or post intervention.

Conclusions: Surveyed alumni reported similar comfort levels in diagnosing and treating common pediatric oral health conditions both before and after the curriculum change. General dentist alumni still struggle with recommending that the first dental visit happen at the eruption of the first tooth or the child's first birthday. More information is needed to assess how to educate competent clinicians in a predoctoral setting.Knowledge Transfer Statement:The recommendations from this article can be used by dental educators to improve clinical and didactic teaching and to ensure dental learners' education and competency.

Each day there is growing evidence surrounding the relationship of oral disease and general health. With increasing recognition of the science describing the nature of associations between oral health and general health, as well as the global acknowledgment of oral disease as one of the most common noncommunicable diseases, global attention of dentistry's role in primary care and universal health coverage is increasing. As the evidence continues to mount, opportunities to modify existing health care systems and related barriers will elevate policy, programs, training, and the need for public health approaches to transcend existing inflexible health care operations, training, and research. Oral health has a critical role in collaborative actions to improve the health of individuals and communities.Knowledge Transfer Statement:Oral health is an essential component of general health. Including oral health within health systems, processes, and training is critical to the health of individuals and communities.

Aims: This work examines and describes dental health among people seeking asylum and refugees (PSAR) who are evaluated by the Respond service. This includes access to and use of oral health products, access to dental care, and experience of dental pain.

Materials and methods: The Respond service pilot offered holistic health assessments to PSAR in temporary accommodation within North Central London between July 2021 and March 2023. Relevant data were extracted from anonymized health records of individuals seen by Respond. Data were analyzed with SPSS (version 28.0.0.0; IBM) to produce descriptive statistics and regression models.

Results: An overall 1,390 PSAR were included; 78.7% were male. The mean ages of adults and children were 31.6 and 6.8 y. Seventy-seven countries of birth were reported, most commonly Iran (23.1%). Over two-thirds (67.1%) of PSAR were not accompanied by family members; only 17.2% had UK family links. The mean travel duration was 769.3 days; migration reasons were multifactorial, including persecution (31.2%) and conflict (20.5%). In addition, 77.3% of PSAR reported having access to a toothbrush; only 50.8% indicated routinely brushing their teeth, with 38.9% having seen a dentist in <36 mo. Dental pain was common (28.8%). Only 45.8% of children (<16 y) had access to a toothbrush, 32.3% were brushing their teeth twice daily, and 9.7% cited dental pain. Logistic regression identified significant predictors of routine toothbrushing, access to dental care, and dental pain. Female PSAR were more likely to routinely brush their teeth (adjusted odds ratio [OR], 3.19; P < 0.001) and access dental care (adjusted OR, 0.57; P < 0.05). PSAR aged 30 to 39 y (adjusted OR, 1.97; P < 0.05) and those with informal travel modes (adjusted OR, 1.82; P < 0.001) were more likely to experience pain.

Conclusion: There is variation in the dental experience of PSAR, but a significant proportion are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.Knowledge Transfer Statement: The results of this analysis suggest that there is variation in the dental experience of people seeking asylum and refugees, but many are failing to perform routine toothbrushing, are not regularly accessing dental care, and are experiencing dental pain.

Background: Dental providers frequently deliver care for individuals with chronic medical conditions (CMCs) such as hypertension, diabetes mellitus, and obesity and should be prepared to address their oral and systemic health needs. The goal of this study was to assess the current integration of CMC education into advanced education in general dentistry (AEGD) and general practice residency (GPR) curricula.

Methods: A 46-question cross-sectional survey was sent electronically to all 265 U.S. AEGD and GPR program directors (PDs) in February 2019. The survey consisted of multiple-choice questions about CMC curricular content, mode of delivery, barriers to teaching the content, evaluation technique, and competence of residents upon graduation. The survey was adapted from relevant literature and prior validated surveys. The data were analyzed using univariate statistics such as frequencies and percentages to describe all survey items.

Results: Of the 265 programs surveyed, 42% of PDs responded (N = 111). Most agreed that it was important for residents to receive training to identify diabetes (88%), hypertension (90%), and obesity (78%). However, only 62% of PDs taught their residents to identify obesity compared with hypertension (90%) and diabetes (85%). Regarding health assessments, nearly half the PDs reported that their residents do not collect body mass index for obesity, while only 12% and 4% were not collecting HbA1c values and blood pressure, respectively. In addition, among residents being evaluated, 65% of PDs agreed that their residents were competent in knowing health system resources for obesity compared with hypertension (78%) and diabetes (76%).

Conclusion: While most programs are teaching their residents to identify diabetes and hypertension, greater focus on obesity is needed. Increased efforts should be devoted to closing this gap in dental training so that residents are comfortable not only discussing medical conditions with their patients but also with performing regular chairside examinations, providing counseling, and making appropriate referrals.Knowledge Transfer Statement:The results of this study can be used by educators charged with creating and revising curricula for postgraduate dental residency programs. Knowing the current status of the integration of primary care topics into such programs can assist in the identification of existing curricular gaps and solutions to barriers. This could lead to the development of better integrated curricula, which will result in more comprehensive care for patients.