Understanding the risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during oral health care delivery and assessing mitigation strategies for dental ...offices are critical to improving patient safety and access to oral health care.
The authors invited licensed US dentists practicing primarily in private practice or public health to participate in a web-based survey in June 2020. Dentists from every US state (n = 2,195) answered questions about COVID-19–associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices.
Most of the dentists (82.2%) were asymptomatic for 1 month before administration of the survey; 16.6% reported being tested for SARS-CoV-2; and 3.7%, 2.7%, and 0% tested positive via respiratory, blood, and salivary samples, respectively. Among those not tested, 0.3% received a probable COVID-19 diagnosis from a physician. In all, 20 of the 2,195 respondents had been infected with SARS-CoV-2; weighted according to age and location to approximate all US dentists, 0.9% (95% confidence interval, 0.5 to 1.5) had confirmed or probable COVID-19. Dentists reported symptoms of depression (8.6%) and anxiety (19.5%). Enhanced infection control procedures were implemented in 99.7% of dentists’ primary practices, most commonly disinfection, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention.
COVID-19 prevalence and testing positivity rates were low among practicing US dentists. This indicates that the current infection control recommendations may be sufficient to prevent infection in dental settings.
Dentists have enhanced their infection control practices in response to COVID-19 and may benefit from greater availability of personal protective equipment. ClinicalTrials.gov: NCT04423770.
The authors conducted a systematic review to assess the efficacy and safety of fluoride toothpaste use in children younger than 6 years.
The authors defined research questions to formulate a search ...strategy. They screened studies, extracted data and assessed risk of bias systematically. They conducted meta-analyses to determine the effects of brushing with fluoride toothpaste.
Use of fluoride toothpaste brushing had a statistically significant effect on mean decayed, missing and filled primary tooth surfaces and decayed, missing and filled primary teeth for populations at high risk of developing caries (standard mean difference 95 percent confidence interval {CI}, -0.25 -0.36 to -0.14 and -0.19 -0.32 to -0.06, respectively). The effects of using different fluoride concentration toothpastes on caries varied. Study findings showed either a decrease in the odds of having fluorosis (odds ratio OR 95 percent CI = 0.66 0.48-0.90) when the use of fluoride toothpaste was initiated after 24 months or no statistically significant difference (OR 95 percent CI = 0.92 0.71-1.18). Beginning use after 12 or 14 months of age decreased the risk of fluorosis (OR = 0.70 0.57-0.88).
Limited scientific evidence demonstrates that for children younger than 6 years, fluoride toothpaste use is effective in caries control. Ingesting pea-sized amounts or more can lead to mild fluorosis. Practical Implications. To minimize the risk of fluorosis in children while maximizing the caries-prevention benefit for all age groups, the appropriate amount of fluoride toothpaste should be used by all children regardless of age. Dentists should counsel caregivers by using oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.
Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
A panel of experts ...convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence.
The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers).
With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.
This objective of this umbrella review was to summarize the evidence on safety, efficacy, and effectiveness of human papillomavirus (HPV) vaccines in the general population.
The authors conducted a ...literature search and selected systematic reviews if they were published from January 2006 through November 2018, included randomized controlled trials or observational studies, related to the general population, and evaluated HPV vaccine-related clinical outcomes. The authors independently and in duplicate screened literature, extracted data, and appraised reviews using AMSTAR 2, a critical appraisal tool for systematic reviews.
The authors selected 30 systematic reviews that included male and female participants aged 9 through 76 years from multiple countries. Reviews evaluated postvaccine seroconversion, HPV infection rates, precancerous or benign lesions, and adverse events; none of the researchers reported on oral or oropharyngeal lesions. Results from the reviews showed that, compared with those who received a placebo or non-HPV-type vaccine, HPV-vaccinated participants had statistically significantly higher rates of seroconversion and local adverse events, statistically significantly lower rates of HPV infection and condylomata lesions, and decreased rates of HPV-related precancerous lesions, which did not always attain statistical significance.
Systematic reviews have found evidence that the available HPV vaccines are safe, effective, and efficacious against vaccine-type HPV infection and HPV-associated cellular changes, including precancerous and benign lesions.
Dentists may use this resource to better understand the literature on the potential harms and benefits of HPV vaccination.
In the context of evolving dental materials and techniques and a national agenda to phasedown use of dental amalgam, estimates of dental amalgam placement are necessary for monitoring purposes.
...Numbers of amalgam and composite posterior restorations from 2017 through 2019 were calculated using retrospective dental claims analysis of privately insured patients. Kruskal-Wallis and multilevel, multivariable negative binomial regression models were used to test for differences in rates of amalgam and composite restoration placement by age group, sex, urban or rural area, and percentage race and ethnicity area distribution. Statistical significance was set at 0.05, with Benjamini-Hochberg correction for false discovery rate.
The rate of amalgam restorations declined over time from a mean of 6.29 per 100 patients in 2017 to 4.78 per 100 patients in 2019, whereas the composite restoration rate increased from 27.6 per 100 patients in 2017 to 28.8 per 100 in 2019. The mean number of amalgam restorations placed per person were lowest in females compared with males, in urban areas compared with rural areas, and in areas with more than 75% non-Hispanic White residents.
Amalgam restoration placements in privately insured people in the United States declined from 2017 through 2019. Amalgam restoration placements may be unevenly distributed by location.
Achieving further declines of dental amalgam use may require changes to insurance coverage, incentives, and provider training as well as augmented disease prevention and health promotion efforts. These efforts should focus particularly on groups with high caries risk or higher rates of amalgam placement.
A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic ...periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects.
For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.
During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. ...The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals.
We contacted jurisdictions during May-June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or
email.
Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained.
The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation.
Objectives
Estimate the proportion of amalgam restorations among the US population.
Methods
Data from ≥15 year old clinically examined dentate participants in three 2‐year survey cycles (NHANES ...2011–2016) were analyzed. The 2015–2016 data include restorative material type, allowing for the first time a US estimate of amalgam‐restored teeth.
Results
The percent of the US population with at least one restoration (65.8 ± 1.4) was relatively constant in 2011–2016. Among those with restored teeth, the mean number of teeth with amalgam restorations increased with age from 4.71 among 15–24 year olds to 7.03 among those ≥75 years. Non‐Hispanic Whites with restored teeth had the highest mean of teeth with amalgam restorations (5.94), while non‐Hispanic Blacks had the lowest (5.08).
Conclusion
In 2015–2016, about half (51.5 percent) of restored teeth in the US population contained amalgam. Amalgam presence varied by age, tooth type, and race/ethnicity, but not by sex. These estimates can be used to assess future US caries prevention and dental amalgam reduction efforts.
This study was designed to assess the prevalence of anxiety and depression symptoms and understand factors influencing mental health among dental health care workers (DHCWs) during the COVID-19 ...pandemic.
Beginning in June 2020, 8,902 DHCWs participated monthly in an anonymous longitudinal, web-based survey (response rate, 6.7%). The Patient Health Questionnaire-4 was used to estimate rates of anxiety and depression symptoms. Changes in mental health over time and differences by demographic and practice characteristics, COVID-19 community transmission level, and COVID-19 vaccination status were tested using χ
tests and multilevel multivariable logistic regression.
Anxiety symptom rates peaked in November 2020 (28% of dental hygienists, 17% of dentists) and declined to 12% for both professions in May 2021. Depression symptom rates were highest in December 2020 (17% of dental hygienists, 10% of dentists) and declined to 8% in May 2021. Controlling for gender, age, race or ethnicity, and COVID-19 community transmission level, the authors found that dentists had significantly lower odds of anxiety symptoms (adjusted odds ratio aOR, 0.82; 95% CI, 0.70 to 0.95) and depression symptoms (aOR, 0.79; 95% CI, 0.67 to 0.93) than dental hygienists. Compared with vaccinated respondents, those who were unvaccinated but planning on getting vaccinated had significantly higher rates of anxiety (aOR, 1.71; 95% CI, 1.20 to 2.44) and depression (aOR, 1.57; 95% CI, 1.07 to 2.29) symptoms.
DHCWs' mental health fluctuated during the pandemic. Anxiety and depression in DHCWs were associated with demographic and professional characteristics as well as perceived risk of COVID-19.
Mental health support should be made available for DHCWs. This clinical trial was registered at ClinicalTrials.gov. The registration numbers are NCT04423770 and NCT04542915.
BACKGROUNDLesbian women may perceive themselves to be at lower risk for sexually transmitted infections (STIs) and use reproductive health care at lower rates compared with heterosexual women. ...Therefore, STIs in sexual minority women may go undetected. The prevalence and risk factors of urogenital STIs in women of different sexual orientations were investigated.
METHODSThis is a cross-sectional study of women attending the STI clinic of Howard Brown Health Center in Chicago, Illinois. Women were eligible for inclusion in this study if they reported a sexual identity and were screened for urogenital gonorrhea (GC)/chlamydia (CT) in the clinic between January 2008 and December 2011.
RESULTSAmong the 669 women studied, the urogenital prevalence of GC was 1.5% and that of CT was 5.2%. Gonorrhea and CT were only diagnosed in women with recent male sex partners, but sexual identity was not necessarily consistent with sexual partner sex, and women of all sexual orientations were diagnosed as having STIs. Bisexual and heterosexual women had similar diagnosis and STI history rates, whereas lesbian women had a significantly lower history of STIs. Bisexual women had more sex partners than heterosexual or lesbian women, and their partners were less likely to be monogamous. Compared with heterosexual women, sexual minority women had twice the odds of drug use in the last year.
CONCLUSIONSChlamydia and GC were diagnosed in sexual minority women, and several cases would have been missed if lesbian women were not tested for STIs. High rates of substance use among sexual minority women highlight the need for targeted interventions.
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