Journal of the American Dental Association最新文献

Background: Imaging advancements markedly enhance the assessment of skeletal and dental pathologies in clinical and archaeological contexts. Among the most frequently observed dental conditions in bioarcheological studies are periodontal disease and caries, both of which can provide valuable insights into systemic conditions (eg, cardiovascular disease). When identified in mummified remains, dental pathologies offer a unique perspective on the health status and disease burden of past populations and the interplay between oral and systemic health across human history.

Methods: Using a database of computed tomographic scans of Egyptian mummies, the authors investigated the prevalence and extent of dental pathologies, including periapical lucencies and teeth with caries, and the distance from the cementoenamel junction to the alveolar crest. Regression analyses were used to examine the associations between oral health variables and vascular pathology.

Results: Advanced demineralization, indicative of destructive carious processes, and periodontal disease were highly prevalent in this mummified cohort. Furthermore, oral pathologies were determined to be correlated with the number of calcified vascular beds, although these findings were not independent of age- or sex-related effects at large.

Conclusions: The authors established evidence of periodontitis, teeth with caries, and impacted teeth in mummified remains, along with correlations between oral health and cardiovascular disease.

Practical implications: Findings from these ancient remains highlight the long-standing presence of oral disease, reinforcing that oral health problems are not only modern. For contemporary clinicians, this historical perspective underscores the value of culturally sensitive dentistry and how population behaviors contribute to distinct oral health challenges.

Background: Balance is essential for athletic performance, contributing to power generation, control, and precision while reducing risk of experiencing an injury. In dental sports medicine, there is ongoing debate regarding whether mouthguard use influences balance by means of affecting jaw alignment and postural stability.

Types of studies reviewed: This scoping review examined peer-reviewed studies assessing the effects of mouthguards on balance in athletes. A comprehensive search of PubMed, Scopus, and Web of Science was conducted. Studies were selected on the basis of predefined eligibility criteria, and 2 independent reviewers screened articles and extracted relevant data. The qualitative analysis focused on balance-related outcomes, including postural stability, muscle activation, and response times.

Results: A total of 23 studies were analyzed. Five studies reported statistically significant improvements in balance, postural control, and muscle symmetry, particularly with custom-made mouthguards. Another 5 studies observed positive but not statistically significant effects. Thirteen studies found no impact on dynamic balance or other performance measures. The variation in results may be attributed to differences in study methodologies, athlete populations, and mouthguard designs.

Conclusions and practical implications: On the basis of the available limited evidence, it cannot be conclusively stated that custom-made mouthguards influence balance and performance in sports requiring precision movements, such as gymnastics, weightlifting, basketball, and football. Standardized methodologies and sport-specific trials are needed to further investigate the mechanisms underlying these effects.

Background: Although Medicare is barred from covering most oral health care, policies enacted by the Centers for Medicare & Medicaid Services have expanded coverage of dental procedures for Medicare beneficiaries receiving certain medical treatments and made it easier for dentists to submit claims electronically.

Methods: The authors extracted monthly counts of the number of Medicare-billing dentists from the Centers for Medicare & Medicaid Services "Doctors and Clinicians" files from January 2021 through December 2024. Considering the implementation dates of the reforms, we estimated a single-group interrupted time-series analysis separately for all dentists, oral surgeon dentists, and non-oral surgeon dentists to measure any association of the reforms with dental care provider participation in Medicare.

Results: After the Medicare dental benefit expansions, the preexisting downward trend in the number of Medicare-billing oral surgeons continued, although the transition to electronic claim forms appeared to be associated with a reverse in this decline. Among non-oral surgeon dentists, after the first dental benefit expansion, the monthly increase in the number of billing dental care providers accelerated 0.8% (95% CI, 0.47% to 1.12%).

Conclusions: Despite new opportunities for Medicare beneficiaries to access oral health care, there have not been marked increases in the number of dentists billing Medicare, a trend largely associated with oral surgeons. Dentists may remain hesitant to participate in Medicare or are unaware of the new policies.

Practical implications: The authors lacked access to claims volume or patient outcome data and these elements will be needed in future research to further assess the association of Medicare dental reforms on patients.

Background: Silver diamine fluoride (SDF) is used to treat caries lesions in primary teeth in children and has been found to be effective. Older adults may also benefit from the use of SDF in treating initial coronal or root caries lesions, yet such studies are lacking. The authors aimed to determine the factors related to the longevity of adult patients' teeth after SDF treatment.

Methods: Data were obtained from the AxiUm database of the College of Dentistry, University of Iowa. Patients 18 years and older who underwent SDF treatment from January 1, 2016, through December 31, 2021, were included. Patient variables included demographic characteristics, medical history, tobacco use, and total number of SDF treatments. The tooth variables included tooth number, number of SDF applications, and any subsequent treatment. The outcome was tooth survival, defined as no need for subsequent treatment and no need for root canal or extraction. The analyses included χ² tests, Cox survival models, and Kaplan-Meier curves.

Results: The analysis included 1,772 patients and 2,985 SDF-treated teeth. Tobacco use was linked to more subsequent treatments, whereas multiple SDF applications reduced them. Teeth with preexisting crowns were more likely to require root canal therapy or extraction.

Conclusions: In adults, the application of SDF more than once increased the longevity of teeth. Tobacco use was associated with an increased chance of a tooth having subsequent treatment (eg, restoration, extraction, and root canal therapy) after SDF application.

Practical implications: Repeated SDF applications may enhance tooth survival in adults, although tobacco use and existing crowns could reduce SDF effectiveness.

Background: Datopotamab deruxtecan (Dato-DXd) is a trophoblast cell surface antigen 2-directed antibody-drug conjugate (ADC) approved for the treatment of unresectable, metastatic, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancers, and previously treated metastatic epidermal growth factor receptor-positive non-small cell lung cancers. Despite its considerable success in clinical oncology, ADC therapy can lead to severe adverse events, including oral mucositis (OM), which can negatively affect patients' quality of life and threaten patients' ability to tolerate treatment. Given its impact, a number of strategies have been suggested to mitigate ADC-associated OM, among which is the use of prophylactic topical steroid mouthrinses.

Case description: This is a case series of 4 patients with a history of breast and cervical cancers who developed extensive OM lesions secondary to initiation of Dato-DXd. Among the different treatments implemented, topical steroids failed to control the Dato-DXd-induced OM lesions and oral cryotherapy with and without dose reduction alleviated symptoms and prevented new lesions.

Practical implications: These findings highlight the need for larger, prospective studies to define optimal management strategies for ADC-induced OM.

Background: People with opioid use disorder (OUD) often experience poor oral health yet rarely receive adequate oral health care. This gap highlights the need to understand the barriers to and facilitators of care involved. The authors used qualitative methods to investigate the challenges dentists face in providing care to patients with OUD and explored potential solutions.

Methods: Seventeen dentists were interviewed individually using a semistructured interview created specifically for the study. Participants were selected through purposive sampling, with eligibility based on their experience in treating patients with OUD. Transcripts were coded using deductive and inductive approaches and enrollment continued until thematic saturation.

Results: Dentists reported challenges such as insufficient education, pain management difficulties, patient noncompliance, logistical barriers, and emotional strain. Dentists highlighted the importance of improved education and training, increased collaboration between addiction specialists and primary care providers, and colocation of services as key facilitators of better care. Systemic improvements such as centralized electronic health records and better insurance reimbursement were also identified as instrumental.

Conclusions: Dentists face substantial, overlapping barriers in treating patients with OUD. Enhanced education, reimbursement policies, and systemic support may improve provider confidence and care quality. Researchers should explore intervention effectiveness in addressing these challenges.

Practical implications: Addressing these barriers through increased education, interprofessional collaboration, and systemic support could improve access and oral health care outcomes for people with OUD.