Journal of the American Dental Association最新文献

Background: Given the recognized link between periodontal disease and cardiovascular conditions, the authors tested whether omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), could reduce key inflammatory markers.

Methods: In this secondary analysis, 240 patients with stable coronary artery disease undergoing statin therapy were randomized to receive 3.36 g/d of EPA and DHA (test group) or no supplementation (control group) for 30 months. Of these, 199 patients had gingival crevicular fluid collected in the maxillary left and right quadrants. Oral and systemic inflammatory markers were compared.

Results: The EPA and DHA group had significantly lower gingival crevicular fluid levels of macrophage inflammatory protein-1β in the left quadrant (P = .038) and a lower systemic neutrophil to lymphocyte ratio (P = .021) than the control group. The authors hypothesized that handedness may account for the localized anti-inflammatory effect in the left quadrant because right-handed people have better plaque removal on the left side.

Conclusions: EPA and DHA supplementation lowered oral and systemic inflammation, potentially contributing to improved periodontal health and reducing cardiovascular risk. The site-specific difference may be influenced by means of handedness or toothbrushing behavior and warrants further investigation.

Practical implications: Supplementation with EPA and DHA can complement mechanical oral hygiene. Recommending powered toothbrushes may eliminate handedness-related differences, providing a more uniform anti-inflammatory effect alongside EPA and DHA supplementation. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT01624727.

Background: Periapical abscess (PA) is a preventable disease that can potentially be fatal if untreated. In the United States, an average of 300 patients die in hospital settings annually from PA, highlighting barriers to oral health care. The authors conducted a nationwide study to identify key factors for efficient hospital resource use and better patient outcomes.

Methods: The authors used data from 2020 through 2022 from the National Inpatient Sample database. All hospitalizations for a primary or secondary diagnosis of PA were examined. The characteristics of patients and hospitals were explored. To find the factors contributing to higher hospital charges and longer length of stay, multivariable linear regression models were used.

Results: From 2020 through 2022, there were 26,985 and 118,140 admissions for PA as a primary diagnosis and secondary diagnosis, respectively. Mean hospital charges were $35,042 and $86,600 for a primary diagnosis and a secondary diagnosis, respectively. Results of regression analysis showed that age, type of admission, race and ethnicity, insurance status, region, urban or rural status of the hospital, and comorbid conditions were related to higher charges. Length of stay, age, region, income levels, and comorbid conditions were associated with longer stays.

Conclusions: PA is associated with considerable resource use when it is treated in hospitals. Concerted efforts at various levels are imperative and should be focused on the various identified contributing factors and lowering barriers to prevention and routine care.

Practical implications: The findings can serve as the basis for changes in practice models and policy, such as adoption of prevention-oriented and value-based care as well as in further research to reduce the disease and economic burden of PA.

Background: Oral findings may serve as early indicators of sexually transmitted infections (STIs), yet evidence of their diagnostic relevance remains limited. In this systematic review, the authors aimed to identify and synthesize the most frequent oral manifestations and associated conditions observed in patients with STIs, emphasizing their clinical diagnostic value.

Types of studies reviewed: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in MEDLINE, Web of Science, Scopus, Cochrane Library, and Scientific Electronic Library Online databases for observational studies published from 2015 through 2024. The population, exposure, comparator, and outcomes framework guided study selection, and quality was assessed using the Joanna Briggs Institute checklist. Seventeen studies met inclusion criteria.

Results: Of the 17 studies included, 7 had low risk of bias and 10 had moderate risk of bias. Reported oral findings included ulcers, plaques, papules, and papillomatous lesions directly linked to STIs. Associated conditions, such as periodontal disease, oral cancer, candidiasis, and temporomandibular disorders, were also described. The most frequently affected oral sites were the tongue, commissures, and palate. Variability among studies was due mainly to differences in population characteristics, diagnostic approaches, and sample size.

Practical implications: Interdisciplinary collaboration between dental care professionals and health care professionals is crucial for prevention, early diagnosis, and comprehensive management of STIs. Dentists play a key role in identifying oral manifestations and distinguishing between direct lesions and associated conditions, facilitating prompt referral and treatment. This systematic review was registered at PROSPERO. The registration number is CRD42025640143.

Background: Medically complex patients are increasingly common in dental practice, requiring dentists to make informed decisions regarding medical clearance. The authors aimed to provide general dentists with evidence-based tools to determine when medical clearance is necessary before outpatient oral health care.

Types of studies reviewed: The authors synthesized peer-reviewed literature and clinical guidelines from leading medical societies. Sources include guidelines from the American Heart Association, American Dental Association, American Association of Oral and Maxillofacial Surgeons, American College of Cardiology, American Diabetes Association, and Global Initiative for Chronic Obstructive Lung Disease. European guidelines from the European Society of Cardiology, European Society of Anaesthesiology and Intensive Care, and European Association for the Study of the Liver were also reviewed. Literature published from 2000 through 2024 was selected on the basis of relevance, publication date, and applicability to dental treatment planning.

Results: The authors consolidated guidance on when medical clearance is required before dental treatment for patients with cardiovascular, pulmonary, cerebrovascular, hepatic, kidney, endocrine, orthopedic, and oncologic conditions. They emphasized using the American Society of Anesthesiologists physical status classification, disease stability, symptom severity, and procedural risk to guide decision making. Condition-specific thresholds are outlined to help clinicians identify when care should be modified, deferred, or coordinated with a physician.

Conclusions and practical implications: By means of integrating the latest medical guidelines into a single resource, the authors equip general dentists with a unified resource to support clinical decision making around medical clearance, reducing the need to consult multiple sources. They reinforced the importance of timely physician collaboration and risk-based treatment planning to enhance safety in managing the treatment of medically complex patients.