Journal of the American Dental Association最新文献

Background: Health care emissions account for approximately 8.5% of total US domestic greenhouse gas emissions. Staff member and patient travel is the largest contributor to dental office-related emissions, and this number has been increasing. One approach to reduce such emissions is to use telehealth instead of in-person office visits.

Methods: This pilot retrospective cross-sectional study included all children who completed a teledentistry visit from November 15, 2022, through June 23, 2023 in a pediatric dentistry clinic. Electronic health record data collected included age, race and ethnicity, insurance type, preferred language, and street address. Patient miles and travel time saved were calculated using mapping software. Emissions prevented were calculated using a miles-per-gallon fuel efficiency of 25 miles per gallon and 8.82 kg of carbon dioxide (CO₂) produced per gallon of gasoline consumed (standard US Environmental Protection Agency ratios).

Results: For the 101 patient visits, teledentistry saved 13,822.1 patient miles of round-trip travel distance, with a mean of 136.9 miles saved (range, 5.4-309.5 miles), and more than 15,000 minutes of round-trip drive time, with a mean of 150.3 minutes saved (range, 14.8-318.6 minutes), and resulted in 552.9 fewer gallons of gasoline consumed and 4,875.4 fewer kilograms of CO₂ emissions from gasoline consumption than in-person clinic visits. Most reduced carbon emissions realized were contributed from patients living in rural communities.

Conclusions: Teledentistry consultations reduced patient miles traveled and drive time traveled and resulted in fewer kilograms of CO₂ emissions and fewer gallons of gasoline used.

Practical implications: Teledentistry is a tool for patients and contributes to reducing greenhouse gas emissions and waste in dentistry.

Background: The authors reviewed a case involving the orofacial manifestations of Crohn disease (CD) in an adolescent whose treatment was ultimately managed with a newer class of biologic drug agent, ustekinumab (Stelara, Janssen Biotech). CD is a chronic inflammatory condition affecting the gastrointestinal tract that often causes extraintestinal complications. The underlying etiology of CD involves genetic, environmental, and local factors. Orofacial manifestations of CD include gingivitis, mucosal tags, aphthous ulcerations, labial swellings, cobblestoning, and linear ulcers of the oral vestibules.

Case description: A previously healthy 12-year-old boy presented with painful, constant, diffuse oral ulcerations. His diagnostic and laboratory testing supported a diagnosis of CD. The patient was then treated with budesonide (Entocort, Perrigo Company), prednisone (Deltasone, Pfizer Inc), and infliximab infusions (Remicade, Janssen Biotech). Later, he had high levels of anti-infliximab antibodies and inadequate control of his orofacial lesions. He then began taking a different class of biologic medication, ustekinumab. After initiation of ustekinumab, both his oral and intestinal manifestations markedly improved.

Practical implications: Collaboration between the treating dentist and treating gastroenterologist is recommended for management of the orofacial manifestations of CD. This may lead to an improvement in the patient's prognosis and quality of life. Ustekinumab is an anti-p40 antibody that inhibits interleukins 12 and 23. It is a newer biologic medication, and its use has been increasing in the pediatric population with CD. Its use is typical after failure of an antitumor necrosis factor drug, like infliximab.

Background: The purpose of this study was to investigate the color difference (ΔE₀₀) and translucency changes (ΔTP₀₀) of resin-composite computer-aided design and computer-aided manufacturing blocks after exposure to staining solutions.

Methods: A total of 250 rectangular specimens (1.0-mm thick) were prepared from 4 resin-based composites (Brilliant Crios [Coltène Whaledent], Lava Ultimate [3M], Hyramic [Upcera], and Shofu HC [Shofu]) and a polymer-infiltrated ceramic network material (Vita Enamic [Vita Zahnfabrik]). These specimens were divided into 5 groups and stored in 5 solutions (artificial saliva, cola, black tea, coffee, red wine) at 37 °C for 3, 7, and 14 days to simulate approximately 3, 7, and 14 months, respectively, of clinical staining in the oral environment. Then, toothbrushing was conducted for 4 minutes every 24 hours of immersion to remove extrinsic staining. Measurements of color coordinates were taken at baseline and subsequent testing intervals, and changes in color and translucency were calculated.

Results: The results of the 3-way repeated-measures analysis of variance indicated that material, staining beverages, and time interval and the interactions between these factors collectively affected the alterations in both color and translucency (P < .001). At the 14-day immersion period, the ΔE₀₀ values of all tested materials varied from 0.43 to 2.12 and were clinically acceptable (ΔE₀₀ < 1.8), except for Lava Ultimate and Hyramic in red wine. All materials showed a decrease in translucency, with the ΔTP₀₀ values ranging from -0.23 through -1.34 over 14 days and were clinically acceptable (translucency acceptability threshold < 2.62).

Conclusions: Differences in color and translucency changes were observed between resin-based composites and polymer-infiltrated ceramic network material. All tested materials showed acceptable color and translucency changes when exposed to different staining solutions after the 14-day staining and toothbrushing simulation.

Practical implications: Discoloration of resin-matrix ceramics due to immersion in solution is related to material type and solutions but is generally acceptable. The dietary habits of the patient should be considered in material selection.

Background: A high level of scientific evidence supports several nonrestorative strategies for the control of caries, with the goal of reducing progression of mineral loss and arresting existing lesions. The authors provide an overview of evidence for nonrestorative caries control and considerations in the decision making for selecting nonrestorative options.

Types of studies reviewed: The authors discuss findings from existing reviews, systematic reviews, and evidence-based guidelines (particularly from the American Dental Association) describing the effectiveness of nonrestorative strategies available in the US market for remineralization and arrest of caries lesions.

Results: Studies support a wide range of products for arresting caries lesions, such as fluorides, sealants, infiltration resins, and chlorhexidine varnish, among others, depending on the tooth surface, primary or permanent dentition, and whether lesions are noncavitated or cavitated. Decisions should be based on appropriate detection, diagnosis, and risk assessment.

Conclusions and practical implications: Effective nonrestorative strategies should be used to manage active, noncavitated caries lesions in primary and permanent teeth, and can be considered for managing active cavitated lesions when restorative intervention is not feasible. These lesion-centered interventions should be part of the required overall management of the caries disease process and existing modifiable risk variables at the patient level. They must be monitored over time and reapplied periodically, as needed.