Journal of the American Dental Association最新文献

Background: Oral cancers account for considerable morbidity and mortality worldwide, and their incidence has increased in the past several years, despite growing awareness and screening and preventive efforts advocated in articles and guidelines. Visual examination remains the mainstay for oral cancer screening. In contradistinction, optical devices used for cutaneous screening in dermatologic practice have been found to be beneficial and have great accuracy when coupled with artificial intelligence.

Types of studies reviewed: The authors used PubMed searches for data on the incidence and prevalence of oral cancers worldwide as well as challenges and options related to improvements in diagnosis and surveillance for oral cancer. Available optical technologies, biomarkers, and related biosensor technologies were also reviewed.

Results: Optical devices have been tested in oral cancer screening with good sensitivity and specificity. Predictive biomarkers for oral cancer screening are well described. Although wearable biosensors have proven valid, widely adopted, and a benefit for various conditions, their application in general use for oral cancer screening and surveillance remains insufficient.

Conclusions and practical implications: Advancements in miniaturization, noninvasive, and high-resolution imaging technologies can enhance oral cancer screening. Developments in multivariant biosensor technologies that can detect an expanding catalog of oncological biomarkers may hold promise in improving diagnostic efficacy and accuracy, particularly in early and often subtle manifestations and recurrence. Incorporating these strategies along with evolving technologies that use artificial intelligence and machine learning can augment and improve oral cancer surveillance in patients at risk of developing oral cancer.

Background: Use of ambulatory surgery centers (ASCs) relative to hospital outpatient departments (HOPDs) for outpatient surgeries for caries in children with intellectual disabilities and related conditions (IDRC) and autism has not been characterized.

Methods: In this cross-sectional analysis of Medicaid data (2016-2020) from 40 states, the authors examined 601,286 outpatient dental surgeries performed in ASCs and HOPDs in children (1-18 years) with IDRC, with autism, and without IDRC or autism (IDRC/A), overall and according to race and ethnicity. Multivariable regression models estimated regression-adjusted probabilities of receiving care in ASCs. Models included year and state fixed effects and child-level clustered SEs.

Results: Among surgeries in ASCs and HOPDs, the regression-adjusted predicted probability of ASC use was 14.0 percentage points lower for children with IDRC (15.9%; P < .001) and 3.8 percentage points lower for children with autism (26.1%: P < .001) than for children without IDRC/A (29.9%). Racial and ethnic differences within disability groups were small. Among surgeries in ASCs and HOPDs, the probability of ASC use was 1.8 percentage points lower for Hispanic autistic children (P = .009) than White autistic children. Among children without IDRC/A who were treated in an ASC or HOPD, ASC use was 0.6 percentage points higher for Black children (P < .001) and 1.1 percentage points higher for Hispanic children (P = .001) than for White children.

Conclusions: Children with IDRC and autism were less likely to receive care in ASCs than HOPDs than children without IDRC/A.

Practical implications: Because ASCs are less costly than HOPDs, providing more care at ASCs for children with IDRC and autism may help reduce costs for this population.

Background: Dentists' professional values are shaped by means of both career stage and competitive environments. The authors examined how clinical experience and perceived competitive pressure influence Korean dentists' professional values and explored their broader applicability.

Methods: An online cross-sectional, web-based survey was conducted in May 2024 among 28,949 members of the Korean Dental Association, of whom 1,932 completed the questionnaire. Professional values (eg, prestige, service, business expansion, scholarly pursuit, lifestyle, autonomy, and the dentist-patient relationship) were assessed as outcome variables and the following 2 explanatory variables were examined: years of clinical experience and perceived competitive pressure. Data were analyzed using t tests, 1-way analysis of variance, and multivariable linear regression analyses (α = .05).

Results: Among respondents, 40.0% had 20 years or more of clinical experience and 57.0% reported experiencing high competitive pressure. Dentists with more experience placed greater importance on prestige, service, and scholarly pursuit, and those with fewer years emphasized lifestyle and business expansion. Competitive pressure had weaker effects; dentists experiencing high competitive pressure valued lifestyle more but service less. Autonomy and the dentist-patient relationship consistently had no significant group differences (P value of autonomy .369 and .597, P value of dentist-patient relationship .075 and .380 for years of clinical experience and competitive pressure, respectively). Multivariable regression confirmed that clinical experience was a stronger and more consistent predictor of professional values than competitive pressure.

Conclusions: Dentists' professional values are dynamic and context-dependent, evolving with career stage while retaining stable core elements of professionalism. Understanding these dynamics requires a life course perspective that accounts for practice environments.

Practical implications: Dental workforce planning and continuing education programs should account for generational and practice environment differences, providing targeted support for younger dentists, strengthening professional identity, and ensuring sustainability of the profession.

Background: Providing effective oral hygiene (OH) instructions is critical for preventive oral health care and oral health maintenance. The authors evaluated the effectiveness of video-based OH instructions alone vs video-based OH instructions supplemented with images highlighting the consequences of poor OH.

Methods: Healthy adults (aged 18-40 years) were randomly assigned to receive either video-based OH instructions alone (group 1 [G1]) or video-based OH instructions supplemented with consequence-based images (group 2 [G2]). Bleeding on probing (BOP), bleeding index (BI), and plaque score (PS) were recorded at baseline and 4-week follow-up. Between-group, within-group, and sex differences were analyzed using paired and unpaired t tests (P < .05).

Results: Fifty-six participants were recruited for this study, with 28 participants in each group. Group differences were observed for PS only, which was 41.8% lower in G2 than in G1 at follow-up (P < .0001). Within-group reductions were -15.3% vs -44.0% for BOP, -27.8% vs -31.6% for BI, and -10.0% vs -53.4% for PS in G1 and G2, respectively. No significant sex-related differences were observed in BOP or BI; however, male and female participants in G2 had significantly lower PS scores than their counterparts in G1 (P = .001 and P = .011, respectively).

Conclusions: Although both interventions improved oral health, supplementing video instructions with consequence-based images achieved superior short-term plaque reduction, and the effect was consistent across sexes.

Practical implications: Incorporating images of poor OH outcomes into standard video-based education may enhance patient adherence to plaque control and represent a cost-effective tool for clinical practice. This clinical trial was registered at the Australian New Zealand Clinical Trials Registry. The registration number is ACTRN12624000048583.

Background: Replacement of diamond rotary instruments is critical for optimizing cutting efficiency. The authors aimed to assess and compare the cutting efficiency, surface roughness, and diameter of coarse-grit and medium-grit diamond rotary instruments after repeated cuts on indirect composite materials.

Methods: Medium-grit (115 μm) and coarse-grit (150 μm) diamond rotary instruments (NTI; Kahla GmbH) were tested on 2-mm-thick Ceramage (Shofu) (CM) and Lava Ultimate (3M ESPE) (LU) specimens and divided into 4 groups of 8 samples per group: LU-coarse, LU-medium, CM-coarse, and CM-medium. A high-speed handpiece with a cutting load of 0.9 N, speed of 400,000 rpm, and water flow rate of 25 mL/min was used. Cutting efficiency was assessed by measuring cutting time and surface roughness (roughness average) was measured using a surface analyzer and diameter was measured using calipers. Data were analyzed statistically using 2-way analysis of variance (ANOVA), followed by 1-way ANOVA with Tukey honestly significant difference post hoc test (P < .05). For comparison between cuts, 1-way repeated measures ANOVA was used for cutting time and surface roughness and paired samples t test was used for diameter (P < .05).

Results: Coarse-grit diamond rotary instruments had significantly higher (P < .05) cutting efficiency than medium-grit diamond rotary instruments at cut 1. At cut 10, significant differences (P < .05) in mean cutting time, surface roughness, and diameter were observed, with coarse-grit diamond rotary instruments having pronounced wear patterns compared with medium-grit diamond rotary instruments.

Conclusions: Differences in cutting time, surface roughness, and diameter after repeated cuts on indirect composite materials was instrument dependent. Coarse-grit rotary instruments had greater deterioration and wear than medium-grit rotary instruments.

Practical implications: Medium-grit diamond rotary instruments can be suggested for prolonged use (cut 10) on computer-aided designed and computer-aided manufactured composites. Diamond rotary instruments are recommended for replacement after cut 10 or 5 minutes of use on indirect composite materials.

Background: The authors evaluated predictive factors for alveolar bone regeneration at the distal aspect of the second molar after mandibular third-molar extraction.

Methods: Cone-beam computed tomography (CBCT) data from 146 patients (161 cases) who underwent horizontal or mesioangular impacted mandibular third-molar extractions were analyzed. Preoperative and postoperative scans using CBCT obtained at least 6 months apart were evaluated; the mean (SD) follow-up period was 37.3 (24.6) months. Multiple linear regression analysis was performed to determine predictors of bone regeneration. Multicollinearity was assessed and regression assumptions were verified via residual analysis.

Results: The mean (SD) initial defect depth was 5.42 (2.07) mm, final defect depth was 3.89 (1.75) mm, healing ratio was 27.3% (17.7%), and age of patients was 25.7 (9.0) years (72 male, 74 female). Regression analysis identified initial defect depth, patient age, and distance from ramus to second molar (ramus class) as significant predictors (R² = 0.713; P < .001); all variance inflation factor values were less than 2.0, indicating no significant multicollinearity. The predictive equation is: Y (final depth) = 0.243 + 0.636 × X₁ (initial depth) + 0.045 × X₂ (age) - 0.676 × X₃ (ramus class). Cases with initial defects greater than 6 mm or from 5 through 6 mm combined with a ramus Class I had a higher likelihood of limited bone recovery (> 4 mm final defect depth).

Conclusions: These findings emphasize the limited natural recovery of alveolar bone and the importance of initial defect depth, ramus class, and age in predicting outcomes and optimizing postoperative management.

Practical implications: Preoperative CBCT assessment of defect depth, ramus proximity, and patient age can help identify patients at risk of having limited bone regeneration.