JDR Clinical & Translational Research最新文献

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: 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.

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.

The COVID-19 pandemic enhanced the known importance of good interprofessional communication and cooperation to ensure proper patient care. In dentistry, there is often no proper integration across teaching, research, and care. There is too little communication and cooperation among the members of the dental team and the health care team in general. There is a critical need to improve coordination and cooperation among dental professionals and with medical professionals in general. Health in all policies should include addressing interprofessional medical and dental care at all stages of professional human resource training and service planning. Dentists should play a leadership role since they are frontline professionals in the prevention, early detection, and treatment of oral and systemic diseases.Knowledge Transfer Statement:Postgraduate dental training programs can use the recommendations from this article to improve clinical teaching and ensure the education and competency of dental residents.

Introduction: Obesity is associated with increased periodontal disease prevalence and incidence. This retrospective cohort study examined whether body mass index (BMI) is an effect modifier of periodontal treatment outcomes in patients attending an urban dental school clinic.

Methods: Data were extracted from electronic health records of 344 patients at a large urban dental school clinic who had at least 1 tooth with a probing pocket depth (PD) ≥5 mm at baseline and who subsequently received nonsurgical periodontal treatment. BMI was computed from self-reported weight and height and categorized as obese (≥30 kg/m²), overweight (25-29.9 kg/m²), or healthy (18-24.9 kg/m²). The primary treatment outcome of interest was defined as having no teeth with PD ≥5 mm in a quadrant on follow-up after nonsurgical periodontal therapy. That outcome was considered to represent treatment success in this study. Secondary outcomes included changes in mean PD and clinical attachment loss (CAL). Analyses included 879 treated quadrants among 344 patients (185 males, 159 females; mean age 49 ± 12 y at baseline; mean posttreatment follow-up of 6 ± 2 mo). Clinical outcomes in patients who were overweight or obese were compared to healthy-weight patients using generalized linear models for binary or continuous outcomes, accounting for clustering within patients. Covariates were age, gender, tobacco use, history of diabetes, insurance type, and number of baseline sites ≥5 mm.

Results: Obesity was associated with a significantly lower likelihood of successful nonsurgical treatment (odds ratio = 0.47; 95% confidence interval, 0.25-0.88) than healthy weight. Being overweight was not associated with treatment success. Posttreatment reductions in the percentage of sites with pockets ≥5 mm and CAL ≥5 mm were greater in patients with healthy weight as compared to those either overweight or obese. However, posttreatment changes in mean PD and CAL did not differ among the BMI groups.

Conclusions: Obesity adversely modifies the effectiveness of nonsurgical periodontal treatment among dental school clinic patients.Knowledge Transfer Statement:The results of this study may be used by dental providers to better understand and manage periodontal therapy in patients with obesity. Furthermore, patients will be better informed about their therapeutic options and outcome success.

The National Dental Faculty Development Center, funded by the Health Resources and Services Administration, was developed and implemented by faculty at the Eastman Institute for Oral Health and the University of Rochester School of Medicine and Dentistry. Programs like this are critically needed, as many dental faculty positions remain unfilled across the United States. This initiative aims to address these shortages by providing junior faculty at dental schools with a first-of-its-kind center dedicated to preparing them as interprofessional clinical educators in today's evolving dental education landscape.Knowledge Transfer Statement:The recommendations from this article can be used by dental school leadership to improve junior faculty mentoring and increase dental faculty retention at their school.

Background: This rapid review assessed evidence to inform policy on the clinical effectiveness and optimal frequency of dental scaling and polishing (S&P) for adults, including those with low incomes eligible for the Canadian Dental Care Plan.

Methods: A rapid review was conducted according to Cochrane Recommendations for Rapid Reviews. Populations included all adults, adults with periodontitis, and those with inequitable access to dental care. Primary outcomes included gingival inflammation, probing depths, and tooth loss. Secondary outcomes included oral health-related quality of life and economic impact. Four databases were searched for randomized clinical trials, systematic reviews, cohort studies, and practice guidelines. Risk of bias was evaluated using Cochrane Risk of Bias, Newcastle-Ottawa, ROBIS, and AGREE II tools. A qualitative synthesis was planned.

Results: In total, 3,181 references were retrieved: 4 applied to "all adults" and 4 to those with periodontitis. All reports had low risk of bias. One systematic review and one multicenter trial of adults with regular dental care found no clinical benefit regardless of S&P interval; however, patients valued and were willing to pay for regular scaling. One claims-based study reported regular S&P reduced tooth loss, and 2 clinical practice guidelines found a reduced risk of future attachment and tooth loss, lower overall health care costs for diabetes, and reduced costs for and incidence of acute myocardial infarction in those with regular S&P. There were no studies of underserved populations.

Conclusions: For adults with no or early periodontal disease and regular access to dental care, routine S&P may have little clinical benefit but reduces tooth loss and some health care expenses. In patients with periodontitis, scaling intervals tailored to individual risk profile and periodontal status can maintain health. There is no evidence on the impact of routine S&P on patients with barriers accessing care.Knowledge Transfer Statement:In terms of the benefits of routine scaling and polishing in adults, this rapid review found mixed evidence with a high level of certainty due to minimal risk of bias in the appraised studies for "regular dental attenders" and those with a diagnosis of periodontal diseases. Tailored intervals for dental scaling are beneficial for those diagnosed with periodontitis but may not provide the clinical benefits previously expected for adults at low risk. There is no evidence that dental polishing is effective. No evidence was found to support recommendations about the clinical effectiveness of scaling or the most appropriate recall intervals for scaling for low-income Canadians eligible for dental services under the new Canadian Dental Care Plan.

Introduction: The adolescent diet is high in sugars compared with other age groups. Effective approaches to support sugar reduction by adolescents are needed as part of caries prevention.

Objective: To systematically review peer-reviewed evidence (1990 to 2023) to identify effective behavior change techniques (BCTs) for sugars reduction in adolescents aged 10 to 16 y.

Methods: Nine databases (CINAHL, Cochrane, Dental and Oral Sciences Source, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus, and Web of Science) were searched. Identified articles were screened independently in duplicate for eligibility. Interventions were eligible if they aimed to change adolescent dietary behavior(s) and reported pre- and postsugar-relevant outcome measures. Interventions from included studies were coded using a 93-item BCT Taxonomy (Michie Taxonomy v1). Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Evidence synthesis by vote counting (number of studies showing positive versus null or negative effects) was applied to BCTs that were present in more than 5 interventions.

Results: Of 16,271 articles identified, 764 were screened in full, yielding 35 studies (in 43 papers), of which 3 were uncodeable. BCTs coded in interventions covered 11 of 16 BCT clusters and 25 of 93 individual BCTs in the BCT taxonomy. The median number of BCTs applied per study was 3 (interquartile range 2-6). Evidence synthesis indicated that the BCTs most positively associated with a positive reduction in sugars were (with the percentage of strong-/moderate-quality studies applying these techniques that successfully reduced sugars intake in brackets) feedback on behavior (100%), information on social and environmental consequences (100%), problem solving (75%), and social comparison (75%).

Conclusion: Notwithstanding limitations in available data, the current evidence most strongly supports the use of BCTs relating to feedback on behavior, providing information on the social and environmental consequences, include problem solving and making social comparisons, to lower sugars intake in adolescents.Knowledge Transfer Statement:The results of this study will enable clinicians to provide more effective dietary advice when supporting dietary behavior change to reduce sugars intake in adolescents. The results may also be used by researchers to guide future directions for research into effective sugars reduction in adolescents.

Objective: Dental caries is associated with immunologic response, yet its association with hematologic parameters and inflammatory markers is unclear. This study aimed to examine the relationship between some surrogate markers of inflammation and dental caries in the context of perinatal exposure to human immunodeficiency virus (HIV).

Methods: This cross-sectional study involved 2 groups of children aged 4 to 11 y who were (1) HIV exposed but uninfected (HEU) and (2) HIV unexposed/uninfected (HUU) and recruited from HIV pediatric and child outpatient clinics, respectively, at a tertiary health facility in Nigeria. Medical records were reviewed, and trained dentists conducted oral and dental examinations. Five milliliters of EDTA blood was obtained and used for CD4 and CD8 and complete blood analysis, from which other inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic inflammatory index (SII), CD4/CD8 ratio were calculated using referenced formulas.

Results: In total, 245 (125 HEU and 120 HUU) children with a mean (standard deviation) age of 7 (2) y were included in this study. No differences in caries experience were observed in both groups of children (38 children [16%] were caries affected; 19 [16%] and 19 [15%] from the HEU and HUU groups, respectively). Examining the relationship between studied inflammatory markers and caries showed that leucocyte counts were slightly lower in caries-affected children compared with their caries-free counterparts (P = 0.05). Lower levels of neutrophils (P = 0.04) and higher levels of lymphocytes (P = 0.02) were associated with caries prevalence. Although not significant, NLR, PLR, and SII were lower in caries-affected children.

Conclusion: Caries is associated with leucocytes and some of its subsets in both groups of children and independent of perinatal HIV exposure, highlighting the potential of evaluating inflammatory markers in caries prevention, treatment, and research.Knowledge Transfer Statement:This study provides evidence that a relationship exists between dental caries, HIV exposure, and inflammation using affordable methods and advocates the inclusion of these markers in caries care in resource-limited settings.