JDR Clinical & Translational Research最新文献

Introduction: Children referred for comprehensive dental care under general anesthesia, due to severe early childhood caries, have a high risk of continued caries progression in posttreatment years.

Objectives: To assess the effect of a phone-delivered, motivational interviewing-based parental support program on caries recurrence and oral health habits in preschool children treated under general anesthesia for severe early childhood caries.

Methods: The prospective design of this 2-arm randomized clinical trial (allocation ratio 1:1; blinded outcome assessment) comprised 151 patients from pediatric dental departments in the Stockholm region of Sweden. Inclusion criteria were healthy children aged <6 y with early childhood caries who were scheduled for treatment under general anesthesia. Control group parents received standard advice on toothbrushing and sugar reduction. Intervention group parents received planned phone counseling with an oral health coach every other week for 1 y, based on motivational interviewing principles, offered in Arabic, English, Polish, Turkish, and Swedish. The primary outcome was caries progression 1 and 2 y postsurgery, assessed using the International Caries Detection and Assessment System. Secondary outcomes were parent-reported daily toothbrushing and dietary habits.

Results: Sixty-five percent of the control group and 77% of the intervention group experienced caries relapse on at least 1 new surface after 1 y (nonsignificant). At the 2-y follow-up, relapse rates were 53% (control group) and 71% (intervention group; P < 0.05) compared with baseline. The intervention group was significantly less likely to engage in adverse oral health behaviors such as snacking on sweets (intervention group, 10%; control group 33%) and sweet drinks (intervention group 9%; control group, 29%) after 1 y. No group differences in daily fluoride toothpaste brushing occurred.

Conclusion: The motivational interviewing-based parental support program improved dietary habits but showed no effect on caries recurrence in children treated under general anesthesia for early childhood caries.

Clinicaltrials: gov NCT02487043Knowledge Transfer Statement:The findings of this study can assist clinicians, public health leaders, and researchers in tailoring preventative behavior-focused programs for early childhood caries. These results may improve the understanding of how behavioral interventions that involve parents of young children affect caries prevention, highlighting approaches that are less likely to be effective and guiding future efforts toward more promising strategies for high-risk populations.

Background: U.S. dental school graduates must complete competencies in oral health care across the life course. While they have met these requirements, little is known about graduates' assessment of how this training prepared them for practice. Future practice setting may affect the training needs of dental school graduates. This quality improvement survey looked at alumni narratives regarding their predoctoral training in pediatric dentistry, the adequacy of this training, how practice setting influenced their training needs, and what recommendations they would make for curriculum change.

Methods: As part of a larger survey, semi-structured interviews were conducted of 14 recent alumni in general dental practice; the questions covered their graduation year, current practice setting, recollection of their predoctoral pediatric dental training, the adequacy of that training, and recommendations on how to prepare future graduates to care for pediatric dental patients. Interviews were transcribed and assessed for these themes.

Results: Half of the practitioners were in private practice, and half worked in rural or community clinics. Recent alumni felt comfortable and confident treating the oral health needs of a pediatric population but overwhelmingly said that they wanted more hands-on experience in dental school. They especially highlighted the need to see patients with challenging behavior and more complex operative treatment needs. Alumni working in rural areas or community clinics emphasized the need for these skills because of the lack of referral options.

Conclusions: Recent alumni wish they had had more hands-on pediatric dental experiences in dental school to better prepare them for the challenges they face in practice. These experiences may be limited, and one suggestion would be to channel these opportunities to practitioners who will work in areas where there are insufficient resources and fewer options for referral.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.

Clinician educators who teach dental residents in the fast-paced clinic, such as in emergency dental care, often face numerous challenges. Time for clinical teaching is limited in the setting of significant clinical workload, complex medical conditions of patients, and the need for documentation and satisfaction of clinic productivity goals at the same time. Little is known about effective clinical teaching methods or tools that could enrich learning opportunities and increase dental residents' clinical competency in a busy clinic environment when there are time constraints to teach. The One-Minute Preceptor (OMP) model is an innovative teaching method originally used for clinical teaching in family medicine residency trainings that has been shown to be an effective teaching tool, resulting in the increased confidence and clinical skills of residents. It focuses on identifying the needs of each individual learner, teaching to the needs, and providing feedback by using a 5 micro-skill approach: get a commitment, probe for supporting evidence, teach general rules, reinforce what was right, and correct mistakes. We propose using the OMP model to teach dental residents in a dental emergency clinical setting to allow the clinician educator to take full advantage of the entire encounter to maximize the time available for teaching and improve clinical teaching efficacy and efficiency and for dental residents to practice clinical reasoning and identify their own knowledge gaps in emergency dental care settings.Knowledge Transfer Statement:The recommendations from this article can be used by postgraduate dental training programs to improve clinical teaching and ensure dental residents' education and competency.

Faculty development in dental education is very important in enhancing competence and the effectiveness of the teaching and educational leadership of dental clinician educators. The Clinician Educator Milestones can serve as a competency framework and a road map for the professional development of dental educators, ultimately improving the quality of clinical training in dentistry and the quality of patient care.Knowledge Transfer Statement:Professional development for dental educators is important for career advancement and in enhancing the quality of teaching. The Clinician Educator Milestones provide an opportunity for faculty development and professional identity formation of dental clinician educators.

There is a growing sense of urgency to address the oral health needs in the United States. The increased burden of oral diseases is compounded by the lack of access to dental care, including the lack of adequate providers to treat the underserved and disadvantaged population, leading to an exponential use of the emergency department for nontraumatic dental conditions. Strategies need to focus on the inadequacies of the current U.S. oral health care system not only to prevent and treat oral diseases but also to reduce oral health disparities. Several studies have underscored the need for collaborative efforts and community partnerships to improve oral health care access for the disadvantaged population. Public health as well as institutions in charge of professional training should implement innovative strategies that address barriers to increasing access to dental care through organized community efforts. Community-based learning and interprofessional collaboration are key strategies proposed by international and national organizations to address these concerns. Opportunities for extramural rotations are now provided by dental schools to all dental students and trainees to fulfill the Commission on Dental Accreditation's requirement of community-based learning. Community partnerships with academia can help improve access to dental care and increase the efficacy and efficiency between dental and primary care professionals for better integration and care coordination. In this article, the authors reviewed policy statements and position papers of health care agencies as well as the scientific literature on interprofessional dental education and collaborative practice in the community. Working with multidisciplinary teams, dental providers can provide distinctive insights and can add value to the team. With appropriate interprofessional education and practice in communities, robust community-academic partnerships can be built. The future health care workforce can address the needs of the diverse and ever-evolving patient population to prevent, diagnose, and treat oral and systemic diseases.Knowledge Transfer Statement:This article will help dental students, trainees, and academicians understand the issues related to access to dental care and how collaborative partnerships in the community, including interprofessional dental education and care, can help alleviate this problem.

Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.

Knowledge Transfer Statement:The Health Resources and Services Administration's support for initiatives in interprofessional education, research, and community engagement strengthens dentistry's integration within broader health care systems. The articles in this special supplement showcase influential research and expert contributions that advance dentistry and interprofessional health care, helping to bridge gaps and improve access to care.

Introduction: The effectiveness of nonsurgical periodontal treatment is related to patient- and tooth-related factors. To overcome the limitations of the conventional approach, probiotics are one of the adjunct therapies that have been studied.

Objectives: This umbrella review answered the focused question: in adult patients with periodontal diseases or peri-implant diseases, does the use of probiotic therapy as an adjuvant to nonsurgical periodontal treatment when compared with nonsurgical periodontal treatment alone affect treatment effectiveness and clinical disease parameters?

Methods: A systematic electronic search to identify systematic reviews according to PICOS criteria, defined a priori, was used, and 5 electronic databases were searched (Medline, LILACS, Cochrane Central Registry of Controlled Trials, Google Scholar, and DANS EASY). Included systematic reviews were rated using quality assessment tools by 2 independent reviewers.

Results: Thirty systematic reviews were identified evaluating the effectiveness of probiotics in periodontal and peri-implant disease treatment. A quantitative analysis of the results was not possible due to the high heterogeneity of clinical data. Seventeen of 31 reviews reported clinically relevant benefits of probiotic therapy as an adjuvant to scaling and root planning. Twenty-two reviews had a low risk of bias, 7 had a moderate risk, and 2 had a high risk.

Conclusion: The evidence from the available studies is conflicting, which means that no definitive conclusions can be made about the effectiveness of probiotic therapy as an adjuvant to nonsurgical periodontal treatment. High-quality primary research studies are needed that control for known confounding variables.Knowledge Transfer Statement:This umbrella review provides some evidence regarding the efficacy of probiotics as an adjunct to nonsurgical periodontal therapy, despite some equivocal findings. However, short-term probiotic use alongside therapy appears to be advantageous; there is currently no evidence supporting their long-term benefits. We have also identified that probiotic research is primarily constrained by its origins in gastrointestinal applications, resulting in a lack of approved probiotics for dental use. This review highlights the need for extensive clinical research to ascertain their effectiveness in the oral environment. Nevertheless, the utilization of probiotics alongside periodontal treatment seems safe, with no reported adverse effects in patients. Thus, further clinical validations in oral health care settings are crucial.

Fluoridation of community water supplies constitutes one of the most effective public health interventions for preventing dental caries. In recent years, questions have been raised about its effectiveness and safety. This study aims to systematically review and summarize the existing evidence on community water fluoridation (CWF) and dental caries in permanent and deciduous teeth. Five databases and 3 gray databases were searched for relevant studies. Paired reviewers independently screened the studies, extracted data, and assessed their methodological quality. Standard mean differences (SMDs) for dmf(s)/DMFT(S) (decayed, missing, and filled teeth/surface) and odds ratios (ORs) for caries prevalence were measured between exposure or not to CFW for deciduous and permanent teeth. Subgroup analysis was performed to explore whether the study design, continent, or decade of publication changed the point estimates. Seventy-four studies were included in the qualitative analysis: 57 cross-sectional, 13 before-and-after, and 4 cohort studies. Thirty-two studies provided sufficient data for meta-analyses. The overall SMD of DMFT and dmf in those exposed to CWF compared with unexposed were -0.32 (95% confidence interval [CI]: -0.48 to -0.17, I² = 96%, P < 0.01) and -0.30 (95% CI: -0.39 to -0.21, I² = 88%, P < 0.01), respectively. The prevalence of caries was smaller in those exposed to CWF for both the permanent (OR = 0.52, 95% CI: 0.43 to 0.63) and deciduous (OR = 0.60, 95% CI: 0.48 to 0.76) dentitions. Study design, continent, or decade of publication satisfactorily explained the heterogeneity between studies. Communities where water was fluoridated experienced less caries and differences expressed in terms of SMD and prevalence (OR) where of high magnitude, both in children and in adults. The results of the meta-analyses revealed significant differences in caries experience and prevalence in favor of CWF, which represents an effective and comprehensive public health intervention for caries prevention, especially in the primary dentition.Knowledge Transfer Statement:Based on the published literature, the results of this study show that fluoridation of community water supplies is still an effective public health intervention to prevent dental caries, both in children and adults, despite the widespread availability of fluoride-containing dental products, especially toothpaste. This result adds to the existing evidence to support its incorporation into public oral health policies.

Introduction: Dental caries is a significant public health problem in the United States. The evidence on the association between lead exposure and dental caries is conflicting because the impact of childhood lead exposure on the prevalence of caries in young adults has not been evaluated in prospective cohort studies.

Objective: To assess the association of prenatal and postnatal childhood lead exposure with dental caries in young adults living in Cincinnati, Ohio, United States.

Methods: We examined 206 predominately African American participants aged 16 to 22 y in the Cincinnati Lead Study, a prospective cohort study measuring prenatal and postnatal blood lead levels from the maternal, neonatal, and postnatal periods (from 3-78 mo of age) for dental caries. Caries experience was quantified as the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS) in permanent teeth. The impact of average childhood blood lead levels on stimulated and unstimulated salivary flow rate was also assessed.

Results: A significant positive association between average childhood blood lead levels and DMFS and DMFT was observed in young adults. A 2-fold increase in DMFS between 6 and 15 µg/dL, followed by a downturn at the highest blood lead quintile (P < 0.05), was observed. Statistically significant covariates were the number of sealants present, lactobacilli count in saliva, and maternal high school education. When adjusted for mutans streptococci, ever smoking, flossing, and the number of adults and children living in the household, the average childhood blood lead levels were associated with reduced salivary flow rate.

Conclusions: Childhood blood lead levels were associated with an increased DMFS/DMFT in young adulthood.Knowledge Transfer Statement:The results of this study support the need for continued reduction in lead exposure-especially in low- and middle-income countries-to further reduce the risk of dental caries in permanent teeth.