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Introduce evidence-based information that will help with the selection of the
most appropriate analgesic for the management of pain in the postoperative
period.
Systemic adverse drug reactions (ADRs) may occur any
time a drug is administered to a patient. This program describes allergy,
overdose and idiosyncrasy, and goes on to discuss the problem of local
anesthetic overdose and overdose of sedative drugs, their prevention,
recognition and management.
July 2016 Despite increased attention to dentists’ roles in
curbing opioid misuse, abuse, and diversion, information regarding prescribing
practices and the frequency of multiple concurrent opioid prescriptions among
dental patients is limited. The authors reviewed South Carolina prescription
drug monitoring program data representing dispensed medication for patients
prescribed at least 1 opioid by a dentist during the most recently available
2-year time frame (2012-2013). The authors used descriptive analyses to examine
the types and frequency of dental opioid prescriptions and the frequency of
existing multiple concurrent opioid prescriptions among dental
patients.
April 2018 Dentists wrote 6.4% of all opioid prescriptions in the
United States in 2012. The purpose of this study was to examine opioid
prescription rates, dosage of opioids prescribed, type of opioid drug
prescribed, and type of dental visit at which dentists prescribe opioids. The
authors used the 2010 through 2015 Truven Health Marketscan Research databases
and the Prescription Drug Monitoring Program (PDMP) Training and Technical
Assistance Center conversion data set. The authors conducted descriptive
analyses for days’ supply, quantity prescribed, and daily morphine milligram
equivalent dose.
May 2018 Minimal information exists regarding the consistency and
correlates of dentists’ implementation of risk mitigation strategies when
prescribing opioids, including risk screening, prescription drug monitoring
program (PDMP) use, and patient education. The authors conducted a Web-based,
cross-sectional survey among practicing dentist members of The National Dental
Practice-Based Research Network. The authors used the survey to assess pain
management prescribing practices and risk mitigation implementation. The authors
linked survey data with network enrollment questionnaire data to include
practitioner demographic and practice characteristics.
May 2018 The
purpose of this study was to assess dental antibiotic prescribing trends over
time, to quantify the number and types of antibiotics dentists prescribe
inappropriately, and to estimate the excess health care costs of inappropriate
antibiotic prescribing with the use of a large cohort of general dentists in the
United States. We used a quasi-Poisson regression model to analyze antibiotic
prescriptions trends by general dentists between January 1, 2013, and December
31, 2015, with the use of data from Express Scripts Holding Company, a large
pharmacy benefits manager. We evaluated antibiotic duration and appropriateness
for general dentists. Appropriateness was evaluated by reviewing the antibiotic
prescribed and the duration of the prescription.
Key Words. Antibiotics; dentistry; prophylaxis; treatment; epidemiology;
public health.
June 2018 Few
investigators have explored differences in oral health status between immigrants
and natives. To address this gap, the authors used nationally representative
data to characterize disparities in oral health among noncitizens, naturalized
citizens, and native adults. The 2013 to 2014 National Health and Nutrition
Examination Survey, a nationally representative in-person survey, provides oral
health data for US natives, naturalized citizens, and noncitizens. Univariate
and multivariate regression analyses were conducted to compare evidence of
caries and periodontal disease, as well as recommendations for oral health care,
stratified by immigration status for adults.
Key Words. Dental health services; caries; periodontal diseases; health
policy; dental care; dental public health; minority groups; public policy;
public health or community dentistry; vulnerable populations.
The basic armamentarium for the administration of local anesthetics includes
the syringe, cartridge and needle. Proper assembly and use of these items
minimizes the risk of complications arising during injection, such as shattering
of cartridges and needle breakage. Prior to the administration of drugs the
doctor is expected to have knowledge of the health status of the patient
receiving the injection. The medical history questionnaire is reviewed with an
emphasis on local anesthetic-related concerns. As the delivery of ‘painless’
injections is foremost on the patient’s list of dental desires, the basic local
anesthetic injection technique is reviewed.
The basic armamentarium for local anesthetic delivery – the syringe,
cartridge and needle – is reviewed in this program along with evaluation of the
patient prior to receiving an injection. A step-by-step review of the basic
local anesthetic injection technique is provided.
Local anesthetics, the most used drugs in dentistry, are
the safest & most effective drugs for the prevention and management of pain.
However the act of receiving an injection – the ‘shot’ – is the most
fear-inducing part of the dental experience for most patients. 75% of all dental
office medical emergencies are ‘stress’ related and therefore preventable in
most situations. Techniques of managing fear including inhalation and oral
sedation are reviewed. The pain reaction threshold (PRT) is introduced followed
by a discussion of the effect of various clinical situations, e.g. pain,
infection and fear, on the PRT. The currently available (in North America) local
anesthetic formulations are discussed with an emphasis on their expected
duration of clinical action.
This program reviews the development of local anesthetics and the drug
formulations that are currently available in dentistry. The effect of fear &
anxiety on local anesthetic effectiveness is discussed along with an
introduction to sedation – a very important ally in the quest for effective pain
control.
July 2018 Multiple or high dosage opioid prescriptions increase the
risk of experiencing drug misuse and overdose. The authors examine index (first)
and follow-up opioid prescriptions for 1 year among privately insured dental
patients in the United States from 2010 through 2015. The authors used the 2010
through 2015 Truven Health MarketScan Research databases and the Prescription
Drug Monitoring Program Training Technical Assistance Center conversion data
set. The authors analyzed index prescriptions, repeat prescriptions over 1 year,
same-day multiple prescriptions, and concurrent prescriptions among dental
patients. Descriptive analyses were conducted for days’ supply, quantity of
opioids, daily morphine milligram equivalent (MME) dose, and total MME dose.
July 2018 The
effects of methamphetamine (MA) on caries have been well documented. Little,
however, is known about its effects on the periodontium. The authors conducted
this study to determine the prevalence and severity of periodontal disease in an
urban population of HIV-positive MA users. This cross-sectional survey was
conducted in one of the most populous urban areas of Los Angeles County,
California, beset with high rates of MA use. Participants were recruited by a
combination of street outreach methods, referral from drug treatment centers,
and word of mouth. Participants were eligible if they were older than 18 years,
spoke English or Spanish, used MA in the past 30 days, were willing to undergo a
dental examination and psychosocial assessments, and were willing to provide a
urine sample. Periodontal assessments were completed for 541 participants by 3
trained and calibrated dentists.
July 2018 This
report presents weighted average estimates of the prevalence of periodontitis in
the adult US population during the 6 years 2009-2014 and highlights key findings
of a national periodontitis surveillance project. Estimates were derived for
dentate adults 30 years or older from the civilian noninstitutionalized
population whose periodontitis status was assessed by means of a full-mouth
periodontal examination at 6 sites per tooth on all nonethird molar teeth.
Results are reported according to a standard format by applying the Centers for
Disease Control and Prevention/American Academy of Periodontology periodontitis
case definitions for surveillance, as well as various thresholds of clinical
attachment loss and periodontal probing depth.
Key Words. Adults; epidemiology; NHANES; periodontal diseases; periodontitis;
population surveillance; United States.
June 2018 The
authors assessed the trends of annual dental visits in dentate adults with
diabetes or prediabetes or no diabetes, and assessed whether the racial and
ethnic disparities in dental visits changed from 2004 through 2014. Data for
this analysis came from the Behavioral Risk Factor Surveillance System, a US
health survey that looks at behavioral risk factors that was developed by the
Centers for Disease Control and Prevention in cooperation with state health
departments. Respondents indicated whether they had a dental visit in the past
12 months. Weighted proportions were calculated for annual dental visits in
adults by diabetes status, and trends were assessed by racial and ethnic
groups.
June 2018 Evidence in the field of dentistry has demonstrated the
importance of pain-related disability and psychological assessment in the
development of chronic symptoms. The Diagnostic Criteria for Temporomandibular
Disorders offer a brief assessment for the diagnostic process in patients with
orofacial pain (Axis II). The authors describe relevant outcomes that may guide
general oral health care practitioners toward tailored treatment decisions and
improved treatment outcomes and provide recommendations for the primary care
setting. The authors conducted a review of the literature to provide an overview
of knowledge about Axis II assessment relevant for the general oral health care
practitioner.
Key Words. Orofacial pain; primary health care; general
practice.
November 2017 In this systematic review and metaanalysis, the authors evaluated the pain
during scaling and root planing with use of topical anesthetic versus that with
the use of injected anesthetic in adult patients. The authors searched 6
databases for randomized clinical trials in which the investigators compared the
clinical effectiveness of intrapocket and injectable anesthetics. The primary
outcome was the risk of developing pain or intensity of pain. Quality assessment
followed the guidelines from the Cochrane Collaboration’s risk-of-bias tool. The
authors performed meta-analyses on studies considered at low and unclear risk of
bias.
November 2017 This six article annual JADA supplement explores the
benefits of baking soda and oral health. This supplement has been sponsored by
Church & Dwight Co., Inc. All content has been peer reviewed by the
designated editors of The Journal of the American Dental Association (JADA). The
opinions or views expressed in this supplement are those of the authors, and do
not necessarily reflect the opinions or views of The Journal, Church &
Dwight Co., Inc., or those of the American Dental Association.
November 2017 Objectives were to determine the likelihood that a clinician accepts an
impression for a single-unit crown and document crown remake rates. The authors
developed a questionnaire that asked dentists about techniques used to fabricate
single-unit crowns. The authors showed dentists photographs of 4 impressions and
asked them to accept or reject each impression. The authors correlated answers
with dentist and practice characteristics. Other questions pertained to
laboratory use and crown remake rates.
November 2017 The authors examined the relationship between education debt and career
choice, particularly dentists’ decisions to specialize, participate in public
health insurance programs, and join dental management service organizations
(DMSOs). The authors used data from the American Dental Association 2015 office
database, which contains dentist demographic information and identifies dentists
who participate in public health insurance programs for pediatric dental care
services. The authors merged this database with the 2002-2015 American Dental
Association Survey of Dental Graduates, which contains information about
education debt, to assess the relationship between education debt and career
choices. The authors used probit and multinomial logit models to determine the
relationships among education debt, demographic characteristics, and dentist
career choices.
July 2017
Sugar-sweetened beverages (SSBs) are dietary sources of
sugar that are factors in caries development and tooth loss. Dietary sugar also
is linked to diabetes mellitus (DM). There is limited research related to SSBs
and tooth loss in people with DM. The authors investigated the association
between SSBs and tooth loss as it related to the presence or absence of DM. The
authors used a cross-sectional design with data reported by adults (18 years and
older) who responded to the 2012 Behavior Risk Factor Surveillance System
questionnaire, which was used in 18 states (N =
95,897; 14,043 who had
DM and 81,854 who did not have DM). The
authors conducted c2 and logistic regression analyses to determine associations
related to DM status.
August 2017 Except for a small increase in caries prevalence in young
children from 1999 through 2004, the prevalence of pediatric caries in the
United States has remained consistent for the past 3 decades. The authors used
data from the National Health and Nutrition Examination Survey (NHANES) (from
1999 through 2004 and from 2011 through 2014) to ascertain changes in caries
prevalence in youth aged 2 to 19 years. The authors evaluated changes in the
prevalence of caries experience, untreated caries, and severe caries (3 or more
teeth with untreated caries) in the primary, mixed, and permanent dentition
according to poverty status.
December 2017 A lesion on an
occlusal tooth surface with no cavitation and no radiographic radiolucency but
in which caries is suspected owing to surface roughness, opacities, or staining
can be defined as a suspicious occlusal carious lesion (SOCL). The authors’
objective was to quantify the characteristics of SOCLs and their relationship to
lesion depth and activity after these lesions were opened surgically.
Ninety-three dentists participated in the study. When a consenting patient had
an SOCL, information was recorded about the tooth, lesion, treatment provided,
and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott
cluster-adjusted c2 test was used to evaluate associations between lesion depth
and color, roughness, patient risk, and luster.
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