Journal of the American Dental Association最新文献

Background: The authors examined whether use of preventive oral health care services or visits to a dentist or dental clinic for problems during pregnancy is associated with gestational diabetes and hypertensive disorders of pregnancy.

Methods: Data from the 2016-2020 Pregnancy Risk Assessment Monitoring System, comprising 206,080 unweighted responses, were analyzed using descriptive statistics and multivariable logistic regression. The regression estimates were adjusted for sociodemographic and lifestyle characteristics, health history, geography, and survey year.

Results: Women who received a diagnosis of gestational diabetes (7.0%) or hypertensive disorders of pregnancy (13.3%) had lower rates of preventive oral health care and visits to a dentist or dental clinic for problems during pregnancy than those who did not have these health outcomes. Women who did not receive preventive oral health care had 1.13-fold greater odds (95% CI, 1.06 to 1.20) of having gestational diabetes and 1.08-fold greater odds (95% CI, 1.03 to 1.13) of having hypertensive disorders of pregnancy than those who did. Lack of needed visits to a dentist or dental clinic during pregnancy was associated with 1.28-fold greater odds (95% CI, 1.13 to 1.44) of having hypertensive disorders of pregnancy than in women without dental problems.

Conclusions: Using oral health care preventive services and visits to a dentist or dental clinic for problems during pregnancy was associated with decreased odds of having gestational diabetes and hypertensive disorders of pregnancy.

Practical implications: Health care professionals should emphasize the importance of obtaining oral health care services to promote oral and overall health among pregnant women. Dentists need to improve their knowledge and willingness to treat pregnant women, especially those with pregnancy complications.

Background: Acute periapical abscesses (PAs) are a health risk to patients and require prompt and efficient treatment. The purpose of this cross-sectional study was to assess the prevalence of acute PAs in patients with periodontal disease (PD).

Methods: Data aggregated from 1,799,122 patients visiting a large health center were recorded. Data from the corresponding diagnosis codes for PD and acute PAs were retrieved by searching the appropriate query in the database. The odds ratios (ORs) of acute PA and its association with PD were calculated and analyzed statistically.

Results: Patients with PD showed significantly more PAs than did patients without PD (P < .0001). The OR for acute PAs in patients with PD was 46.2, and the difference in prevalence compared with the total hospital patient population was statistically significant (P < .0001). After adjustment for diabetes mellitus comorbidity, the OR for acute PAs in patients with a history of PD was 12.19, and the difference was statistically significant (P < .0001). After adjustment for smoking comorbidity, the OR for acute PAs in patients with a history of PD was 10.13, and the difference was statistically significant (P < .0001).

Conclusions: Under the conditions of this study, it appears that the odds for acute PAs are significantly higher in patients with PD seeking treatment for pain due to acute PAs.

Practical implications: Oral health care professionals should be aware of the possible association between PD and increased occurrence of acute PAs.

Background: The authors aimed to explore the association of fatty acids with periodontitis and its severity and to assess causality using Mendelian randomization (MR) analyses.

Methods: Data for participants with complete data were extracted from the 2009-2014 National Health and Nutrition Examination Survey. Weighted logistic regression was used to explore the relationship between dietary fatty acids and periodontitis and its severity. Univariable and multivariable MR analyses were performed to explore the causal association between plasma fatty acids and periodontitis.

Results: Two types of saturated fatty acids (hexadecanoic C16:0, octadecanoic C18:0) and monounsaturated fatty acids (hexadecenoic C16:1, docosenoic C22:1) and 3 types of polyunsaturated fatty acids (eicosatetraenoic C20:4, eicosapentaenoic C20:5, docosahexaenoic C22:6) were positively associated with periodontitis. Conversely, octadecadienoic (C18:2, a type of polyunsaturated fatty acid), total polyunsaturated fatty acids, and omega-6 fatty acids were negatively associated with periodontitis. Similar association patterns were also found between these fatty acids and the severity of periodontitis. Results of MR analyses revealed that no significant association was found between plasma fatty acids and periodontitis.

Conclusions: The authors provided evidence of significant associations between certain fatty acids and periodontitis and its severity, highlighting their contributory role, although the evidence does not support a causal role based on the results of MR-based analyses.

Practical implications: The results of this study support a contributory or inhibitory role of fatty acids in the progression of periodontitis, although not as a direct cause, and underscored the importance of maintaining a balanced dietary lipid profile for periodontal health.

Background: The opioid epidemic is a serious crisis in the United States. It has been proposed that opioid prescriptions after dental procedures are a major contributor to opioid use and abuse. The American Dental Association has been working to educate dental care providers about safe opioid prescribing practices. The authors hypothesized that oral and maxillofacial surgeons, following the efforts and publications from the American Dental Association, have been prescribing fewer postoperative opioids.

Methods: This was a multi-institutional retrospective study with a total of 3,710 patients from Loma Linda University and University of Texas Health Science Center at Houston undergoing ambulatory surgical tooth extraction under general anesthesia or sedation. The total quantity of postoperative opioids (ie, morphine milligram equivalents) was analyzed during the following 2 periods: from 2011 through 2016 and from 2017 through 2021.

Results: The amount of opioids prescribed decreased significantly over time at both study institutions across all demographic characteristics and cohorts. The mean (SD) morphine milligram equivalents prescribed per patient was significantly reduced from 143.01 (71.08) in the 2011 through 2016 period to 72.09 (55.40) in the 2017 through 2021 period (P < .001).

Conclusions: The data suggested that there has been a significant decrease in the amount of opioids prescribed after ambulatory oral surgery procedures during the 10-year study period. This provides evidence that dental care providers have responded to the opioid crisis.

Practical implications: By means of identifying opioid prescribing patterns, the authors presented an opportunity to help inform interventions and policies that promote responsible prescribing, enhance patient safety, and support optimal pain management.

Background: It is generally accepted that the greater palatine nerve and artery supply the palatal mucosa, gingiva, and glands, but not the bone or tooth adjacent to those tissues. When the bony palate is observed closely, multiple small foramina are seen on the palatal surface of the alveolar process. The authors hypothesized that the greater palatine nerve and artery might supply the maxillary teeth via the foramina on the palatal surface of the alveolar process and the superior alveolar nerve and artery. The authors aimed to investigate the palatal innervation and blood supply of the maxillary teeth.

Methods: Eight cadaveric maxillae containing most teeth or alveolar sockets were selected. The mean age at the time of death was 82.4 years. The samples were examined with colored water injection, latex injection, microcomputed tomography with contrast dye, gross anatomic dissection, and histologic observation.

Results: Through both injection studies and microcomputed tomographic analysis, the authors found that the small foramina on and around the greater palatine groove connected to the alveolar process and tooth sockets. The small foramina in the greater palatine and incisive canal also continued inside the alveolar process and the tooth sockets.

Conclusions: The alveolar branches of the greater palatine nerve and artery as well as the nasopalatine nerve and sphenopalatine artery supply maxillary teeth, alveolar bone, and periodontal tissue via the palatal alveolar foramina with superior alveolar nerves and arteries.

Practical implications: This knowledge is essential for dentists when administering local anesthetic to the maxillary teeth and performing an osteotomy. Anatomic and dental textbooks should be updated with this new knowledge for better patient care.