Journal of the American Dental Association最新文献

英文中文

The marginalized and underappreciated realities of periodontal and peri-implant diseases 牙周和种植体周围疾病的边缘化和低估的现实

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.12.006

Charles M. Cobb DDS, PhD , Guo-Hao Lin DDS , Richard T. Kao DDS, PhD

引用次数: 0

Visit-level quality measurement reveals missed opportunities and overuse in preventive oral health care 访问级质量测量揭示了在预防性口腔保健中错过的机会和过度使用。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.09.019

Bunmi Tokede DDS, MPH, DMSc, Suhasini Bangar BDS, MS, Swaroop Gantela MD, Ryan Brandon MS, Alfa Yansane PhD, Donald B. Rindal DDS, Don Worley DDS, Joel White DDS, MS, Joanna Mullins RDH, Ana Neumann DDS, PhD, Todd Johnson PhD, Nicholas Skourtes DDS, Gregory Olson DDS, MS, Janelle Urata MS, Heather Weidner RDH, Katie Lamberger BS, Aaron Truong BS, Heiko Spallek DDS, PhD, Elsbeth Kalenderian DDS, MPH, PhD, Muhammad F. Walji PhD

Background

Traditional annual dental quality measures fail to capture real-time care delivery and can mask critical gaps in patient-specific treatment. The authors developed and implemented visit-level adaptations of established caries quality measures to enable actionable, point-of-care assessment.

Methods

The authors conducted a retrospective analysis of 1.09 million dental visits across 400,000 patients (2021-2023) at 4 US institutions using axiUm (Henry Schein Corp) or Epic (Epic Systems) electronic health records. The authors transformed 2 annual measures involving caries risk assessment and risk-based preventive treatment into visit-level metrics using a 2 × 2 matrix framework: action due and performed, due and not performed, not due and performed, not due and not performed. Risk-stratified recall visit intervals determined when actions were due.

Results

Visit-level performance consistently underperformed annual metrics. Annual caries risk assessment completion ranged from 60% through 99% across sites; however, visit-level adherence when actions were due dropped, ranging from 41% through 72%. Results of preventive treatment showed greater disparities; only from 28% through 35% of indicated treatments were delivered when due, and from 7% through 32% of visits included treatment when not indicated. Sites with the highest annual performance paradoxically had the most overtreatment.

Conclusions

Visit-level quality measurement exposes substantial undertreatment and inappropriate overtreatment invisible in annual reporting. This granular approach revealed that high-performing institutions according to traditional metrics may be delivering unnecessary care and missing critical prevention opportunities. These findings provide an empirical case study of how misaligned incentives and flawed metrics could systematically drive misuse of resources. Implementation of real-time, visit-based quality measures in clinical workflows could fundamentally transform electronic health records from documentation tools into active instruments for delivering appropriate, value-based, person-centered care.

Practical Implications

Oral health care systems should consider visit-level quality measurement as a means to provide actionable, real-time feedback that can improve clinical decision making at the point of care and prevent waste associated with volume-based care.

背景：传统的年度牙科质量测量无法捕捉实时护理交付，并可能掩盖患者特异性治疗的关键差距。作者开发并实施了已建立的龋齿质量措施的访问级调整，以实现可操作的护理点评估。方法：作者对美国4家机构使用axiUm （Henry Schein Corp）或Epic （Epic Systems）电子健康记录的40万名患者（2021-2023年）的109万次牙科就诊进行了回顾性分析。作者使用2 × 2矩阵框架将涉及龋病风险评估和基于风险的预防治疗的2项年度措施转化为访问级指标：应采取和执行的行动、应采取和未采取的行动、未采取和未采取的行动、未采取和未采取的行动。风险分层召回访问间隔决定何时采取行动。结果：访问级别的表现始终低于年度指标。各站点的年度龋齿风险评估完成率从60%到99%不等；然而，当行动到期时，访问级别的依从性下降了，从41%到72%不等。预防治疗结果差异较大；只有28%到35%的指定治疗按时提供，7%到32%的就诊包括未指定的治疗。相反，年度绩效最高的站点却有最多的过度处理。结论：访问级质量测量暴露了年度报告中不可见的大量治疗不足和不适当的过度治疗。这种细粒度方法表明，根据传统指标，高绩效机构可能会提供不必要的护理，并错过关键的预防机会。这些发现提供了一个实证案例研究，说明不一致的激励措施和有缺陷的指标是如何系统性地推动资源滥用的。在临床工作流程中实施实时的、基于访问的质量措施，可以从根本上将电子健康记录从文件工具转变为提供适当的、基于价值的、以人为本的护理的积极工具。实际意义：口腔卫生保健系统应考虑访问级质量测量作为一种提供可操作的实时反馈的手段，可以改善护理点的临床决策，并防止与基于量的护理相关的浪费。

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引用次数: 0

Authors’ Response 作者的回应。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.12.003

Tracey E. Barnett PhD, Aro Choi MS, Stacey B. Griner PhD, MPH, Rahma Mungia BDS, MSc, DDPHRCS, David Gimeno Ruiz de Porras PhD, Scott L. Tomar DMD, DrPH

引用次数: 0

Radiolucent area found incidentally in the anterior mandible 在前下颌骨偶然发现了一个透光区。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.02.017

Éder Gerardo Santos-Leite DDS, MSc, Vitória Maria Sousa Cruz DDS, MSc, Augusto César Leal da Silva Leonel DDS, PhD, Vinicius Balan Santos Pereira DDS, Elaine Judite de Amorim Carvalho DDS, PhD, Danyel Elias da Cruz Perez DDS, PhD

引用次数: 0

Defending community water fluoridation 捍卫社区饮水氟化：基于证据的公共卫生必要性。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.08.012

Yanfang Ren DDS, PhD, MPH, Lainie Friedman Ross MD, PhD, Jin Xiao DDS, PhD, Dorota T. Kopycka-Kedzierawski DDS, MPH, William Calnon DDS, Eli Eliav DMD, MBA, PhD, Cyril Meyerowitz DDS, MS

引用次数: 0

What dentists need to know about new guidelines for the treatment of patients with prosthetic joints 牙医需要了解的关于治疗假体关节患者的新指南。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.05.013

Thomas M. Paumier DDS, Peter B. Lockhart DDS, Bryan Springer MD, Martin H. Thornhill MBBS, BDS, MSc, PhD

引用次数: 0

The ethics of safety 安全伦理：谁将成为牙医界的卢西安·利普？

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.12.002

Charles Czerepak DMD, MS , Paul S. Casamassimo DDS, MS

引用次数: 0

Oral cancer 口腔癌

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.12.010

Anita M. Mark

引用次数: 0

Efficacy of supportive peri-implant therapy in the management of peri-implant mucositis and peri-implantitis 支持种植体周围治疗治疗种植体周围粘膜炎和种植体周围炎的疗效：一项系统综述。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.08.015

Sean Mojaver DDS, Alvin Zad DMD, ML, Hector Sarmiento DMD, MSoB, Joseph P. Fiorellini DMD, DMSc

Background

Peri-implant mucositis and peri-implantitis are increasingly prevalent, necessitating evidence-based maintenance strategies. Supportive peri-implant therapy (SPiT) protocols are proposed to limit disease progression and enhance clinical outcomes, yet their effectiveness remains variably reported. The authors aimed to systematically evaluate the effectiveness of SPiT protocols in preventing or reducing the progression of peri-implant diseases, with a primary focus on radiographic bone loss, clinical parameters, and patient-reported outcomes.

Types of Studies Reviewed

A comprehensive systematic search was conducted in MEDLINE, Embase, Cochrane Library, and Web of Science through April 30, 2025. Eligible studies included randomized controlled trials, cohort studies, and case-control studies assessing professionally delivered SPiT. Risk of bias was assessed using the Cochrane of risk of bias tool for randomized trials ROB 2.0 and the Newcastle-Ottawa Scale for observational studies. Due to considerable clinical and methodological heterogeneity, results were synthesized narratively.

Results

Twenty-five studies met inclusion criteria: 9 randomized controlled trials, 13 cohort studies, and 3 case-control studies. SPiT, particularly with individualized, risk-based recall intervals, consistently improved clinical outcomes, such as probing depth and bleeding on probing compared with standard or no maintenance. However, substantial variability existed regarding adjunctive therapies, patient compliance, and reporting of systemic comorbidities. High clinical and methodological heterogeneity among studies, inconsistent documentation of systemic conditions, and variability in adjunctive therapies limited definitive conclusions and generalizability.

Conclusions and Practical Implications

Individualized risk-based SPiT protocols substantially enhance clinical outcomes and implant longevity compared with standard fixed-interval maintenance or no supportive therapy. Future research should standardize reporting, better account for patient-specific risk factors, and clarify the long-term effectiveness of adjunctive therapies. Risk-based SPiT protocols should be integrated into routine implant maintenance to improve clinical outcomes and reduce disease progression. Clinicians are encouraged to tailor recall intervals and adjunctive measures on the basis of patient-specific risk factors, including history of periodontitis, smoking status, and systemic health. Adopting individualized SPiT protocols can enhance implant longevity and minimize complications.

背景：种植体周围粘膜炎和种植体周围炎越来越普遍，需要循证维持策略。支持性种植体周围治疗（SPiT）方案被提出用于限制疾病进展和提高临床结果，但其有效性仍有不同的报道。作者的目的是系统地评估吐槽方案在预防或减少种植体周围疾病进展方面的有效性，主要关注放射学骨质流失、临床参数和患者报告的结果。综述的研究类型：到2025年4月30日，在MEDLINE、Embase、Cochrane图书馆和Web of Science中进行了全面的系统检索。符合条件的研究包括随机对照试验、队列研究和评估专业提供唾液的病例对照研究。使用随机试验的Cochrane偏倚风险工具ROB 2.0和观察性研究的Newcastle-Ottawa量表评估偏倚风险。由于相当大的临床和方法学的异质性，结果是综合叙述。结果：25项研究符合纳入标准：9项随机对照试验，13项队列研究，3项病例对照研究。与标准维持或不维持相比，唾液，特别是个性化的、基于风险的回忆间隔，持续改善临床结果，如探探深度和探探出血。然而，在辅助治疗、患者依从性和全身性合并症的报告方面，存在着实质性的差异。研究之间的临床和方法学高度异质性、系统性疾病的不一致记录以及辅助治疗的可变性限制了明确的结论和普遍性。结论和实际意义：与标准的固定间隔维持或无支持治疗相比，基于风险的个性化SPiT方案显著提高了临床结果和种植体寿命。未来的研究应该规范报告，更好地解释患者特定的风险因素，并阐明辅助治疗的长期有效性。应将基于风险的体外循环方案整合到常规种植体维护中，以改善临床结果并减少疾病进展。鼓励临床医生根据患者的特定危险因素（包括牙周炎史、吸烟状况和全身健康状况）量身定制召回间隔和辅助措施。采用个性化的吐槽方案可以延长种植体寿命并减少并发症。

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引用次数: 0

Use of extracted human teeth in oral research 在口腔研究中使用人类拔牙：伦理和法律考虑。

IF 3.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association

Pub Date : 2026-02-01 DOI: 10.1016/j.adaj.2025.10.008

Rita Elizabeth Martínez-Martínez MSc, PhD, José Arturo Garrocho-Rangel MSc, PhD

Background

Extracted human teeth are considered an invaluable supply of biological resources for oral research. They can be used as models to test dental equipment, evaluate biomaterials, isolate bioactive compounds, and cultivate cells. The legal and ethical frameworks controlling their collection and use are still vague and applied unevenly across countries, despite their extensive use in laboratory research. In this narrative review, the authors explored the ethical and legal issues surrounding the use of extracted human teeth in oral research by means of addressing existing legislative framework gaps and suggesting standardized procedures for their purchase and use.

Types of Studies Reviewed

This review was based on dental and medical articles published during the 21st century that were relevant to the topic and retrieved from PubMed and Google Scholar.

Results

Although most countries classify extracted teeth as clinical waste, their use in oral research turns them into biological samples that need special ethical consideration. Subsequently, a function of research ethics committees is the establishment of rules for consent processes, privacy protection, and appropriate tissue-handling techniques.

Conclusions and Practical Implications

It is necessary to preserve donor rights when promoting oral health research, set up explicit permission processes, put strong biobanking protocols into place, and ensure that the process is properly monitored.

摘出的人类牙齿被认为是口腔研究的宝贵生物资源。它们可以用作测试牙科设备、评估生物材料、分离生物活性化合物和培养细胞的模型。尽管它们在实验室研究中广泛使用，但控制其收集和使用的法律和伦理框架仍然含糊不清，在各国之间的应用也不均衡。在这个叙述性的回顾，作者探讨了伦理和法律问题周围的使用拔出来的人的牙齿在口腔研究中通过解决现有的立法框架的差距，并建议标准化的程序为他们的购买和使用。综述的研究类型：本综述基于21世纪发表的与主题相关的牙科和医学文章，并从PubMed和谷歌Scholar检索。结果：虽然大多数国家将拔牙归为医疗废物，但将拔牙用于口腔研究，使其成为需要特殊伦理考虑的生物样本。随后，研究伦理委员会的功能是建立同意程序、隐私保护和适当的组织处理技术的规则。结论和实际意义：在促进口腔健康研究时，有必要维护捐赠者的权利，建立明确的许可程序，制定强有力的生物库协议，并确保对这一过程进行适当的监测。

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Journal of the American Dental Association

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