Journal of the American Dental Association最新文献

Background: Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted.

Methods: To determine whether combination nonopioid analgesics are at least as good as opioid analgesics, a multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial was conducted, which examined patient-centered outcomes after impacted mandibular third-molar extraction surgery. Participants were randomized to receive 5 mg of hydrocodone with 300 mg of acetaminophen (opioid) or 400 mg of ibuprofen and 500 mg of acetaminophen (nonopioid). After an initial dose, analgesic was taken every 4 through 6 hours as needed for pain.

Results: In this randomized multisite clinical trial (n = 1,815 adults), those not taking opioids experienced significantly less pain (numeric rating scale ranging from 0 [no pain] through 10 [worst pain imaginable]) for first day and night (mean difference, -0.70; 95% CI, -0.94 to -0.45; P < .001) and second day and night (mean difference, -0.28; 95% CI, -0.52 to -0.04; P = .015), and experienced no more pain than participants taking opioids over the entire postoperative period (mean difference, -0.20; 98.75% CI, -0.45 to 0.05; P = .172). Participants not taking opioids had higher overall satisfaction at the postoperative visit (85.3% extremely satisfied or satisfied vs 78.9%; 95% CI, 1.21 to 1.98; P = .006).

Conclusions: The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen. At no time did hydrocodone outperform the nonopioid.

Practical implications: Routine opioid prescribing after dental surgery is not supported. The results of this study confirmed the American Dental Association's recommendations that ibuprofen and acetaminophen in combination should be the first-line therapy for acute pain management. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04452344.

Background: This single-blind, noninferiority trial evaluated whether 10% carbamide peroxide (CP) applied for 2 or 4 hours daily is noninferior to 8 hours.

Methods: A total of 120 healthy adults, with teeth shade A2 or darker, were randomly allocated to 3 groups (n = 40). All participants used 10% CP gel in a bleaching tray for 2, 4, and 8 hours daily for 14 days, with the option to extend treatment if they were dissatisfied. Color change was measured using a spectrophotometer and shade guides at baseline, every 5 days, and 1 month posttreatment. Risk and intensity of tooth sensitivity (TS) were assessed daily using a 0 through 10 visual analog scale. Satisfaction was recorded via a Likert scale wherein 1 corresponded to very dissatisfied and 7 corresponded to very satisfied and the Orofacial Esthetic Scale. Noninferiority was tested for color change using the 1976 formula (ΔEab) at 1 month postbleaching (primary outcome), color change using the 2000 formula (ΔE00), Whiteness Index, and shade guide units, whereas TS and satisfaction were analyzed with χ², analysis of variance, Kruskal-Wallis, and Friedman tests.

Results: Color change in ΔEab (2 vs 8 h: mean difference, -0.6; 90% CI, -2.1 to 1.0, 4 vs 8 h: mean difference, 0.0; 90% CI, -1.6 to 1.6) and ΔE00 values for shorter durations were noninferior to 8 hours at 1 month. Whiteness Index results were inconclusive. TS risk and intensity were similar (P > .05), and patient satisfaction improved across all groups similarly (P > .05).

Conclusions: Shorter 2- and 4-hour daily bleaching with 10% CP is noninferior to the 8-hour protocol.

Practical implications: Shorter periods of at-home bleaching (2 and 4 h) can be prescribed depending on the patient's availability or preferences without jeopardizing the bleaching efficacy. This clinical trial was registered at Registro Brasileiro de Ensaios Clínicos (RBR-10vvfpcm).

Background: The aim of this study was to examine the association of frequent recreational cannabis (FRC) use with untreated coronal caries, untreated root surface caries, and severe tooth loss.

Methods: This cross-sectional study analyzed data obtained from 5,656 people, aged 18 through 59 years, who participated in the National Health and Nutrition Examination Survey from 2015 through 2018. FRC use was defined as self-reported use of marijuana or hashish at least once per month for the past 12 months. Log-binomial and logistic regression analyses were conducted before and after controlling for sociodemographic and behavioral factors to examine the association between FRC use and untreated coronal caries, root surface caries, and severe tooth loss.

Results: Compared with non-FRC users, people reporting FRC use had 17% higher probabilities of having untreated coronal caries (95% CI, 1.02 to 1.35), 55% higher odds of having untreated root surface caries (95% CI, 1.21 to 1.99), and 41% higher odds of having severe tooth loss (95% CI, 1.00 to 1.99) after controlling for age, sex, race or ethnicity, nativity, education, family income to poverty ratio, and alcohol consumption.

Conclusions: This study suggests that FRC use is associated with increased coronal caries, root surface caries, and severe tooth loss in the US adult population. Further longitudinal studies are warranted to assess the impact of varying frequencies, quantities, and forms of cannabis use.

Practical implications: Dental care professionals should be aware that FRC use may be associated with caries and tooth loss.

Background: There is increasing evidence suggesting that daily oral hygiene self-care measures may alleviate cardiovascular disease (CVD) risk. The authors aimed to determine the influence of self-reported dental flossing behavior on the prevalence of CVD events, CVD-linked mortality, and a CVD risk marker of inflammation (ie, C-reactive protein [CRP]).

Methods: Data from 18,801 adult participants of the 2009-2016 National Health and Nutrition Examination Surveys were analyzed with regard to flossing behavior, prevalence of CVD events, mortality cause data, and CRP levels. Information on mortality was obtained from the US mortality registry, updated to 2019. Participants who answered the flossing question were divided into 4 groups according to their frequency of flossing: not flossing (0 d/wk); occasional flossing (1-3 d/wk); frequent flossing (4-6 d/wk); and daily flossing (7 d/wk). Multiple logistic regression and Cox proportional hazard regression were used for analysis.

Results: Daily flossing was associated with lower prevalence of CVD events after adjusting for age, sex, sociodemographic factors, and lifestyle habits (model 2); the odds ratio was 0.71 (95% CI, 0.59 to 0.85) for CVD prevalence in the daily flossing group compared with the not flossing group. The odds ratio for CVD prevalence for each additional day of flossing was 0.95 (95% CI, 0.93 to 0.98; P for linear trend < .001) in model 2, and remained statistically significant after model 2 was further adjusted for metabolic syndrome. Daily flossing compared with not flossing was associated with lower risk of experiencing CVD mortality (hazard ratio, 0.64; 95% CI, 0.49 to 0.84) in model 2. The hazard ratio of CVD mortality for each additional day of flossing was 0.94 (95% CI, 0.90 to 0.98; P for linear trend = .002) in model 2. Participants in the not flossing group had significantly elevated CRP levels, even after multivariable adjustments.

Conclusions: Poor flossing behavior is associated with higher prevalence of cardiovascular events, increased risk of experiencing CVD mortality, and elevated CRP levels.

Practical implications: Improvement in flossing behavior can have an additional benefit in the prevention of CVD events. Cardiologists need to advise patients to improve their personal oral hygiene practices, in addition to the standard diet and exercise advice.

Background: Nondental factors (ie, financial, psychological, or cultural considerations) can play a role in extraction requests. The purpose of this study was to investigate whether patients' perspectives on extraction without a valid clinical indication align with those of practitioners.

Methods: Dentists from 3 centers for special oral health care, oral and maxillofacial surgeons (OMFS) from 3 hospitals in the Netherlands, and their patients participated in this prospective observational study. Patients 18 years and older who requested extraction of permanent teeth other than third molars were included. Patients, dentists, and OMFS completed questionnaires.

Results: A total of 21 dentists and 20 OMFS participated in this study. Among 192 dental patients and 572 patients from OMFS, patients reported nondental reasons more often (7.1% of dental patients, 3.5% of OMFS patients) than professionals (1.6% of dentists, 1.7% of OMFS). Of all extraction requests, 96.4% were granted. Extraction was not performed if both practitioner and patient cited only nondental reasons.

Conclusions: Although dentists and OMFS received few requests for extraction on purely nondental grounds, patients were more likely to report extractions driven solely by nondental factors than practitioners.

Practical implications: The absence of extractions executed purely on nondental grounds is a reassuring finding, as it dovetails with the ethical principles that dental care professionals must adhere to.