Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania.

BACKGROUND: A panel convened by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania conducted systematic reviews and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after simple and surgical tooth extraction(s) and for the temporary management (ie, definitive dental treatment not immediately available) of toothache associated with pulp and periapical diseases in adolescents, adults, and older adults. TYPES OF STUDIES REVIEWED: The panel conducted 4 systematic reviews to determine the effect of opioid and nonopioid analgesics, local anesthetics, corticosteroids, and topical anesthetics on acute dental pain. The panel used the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations, Assessment, Development and Evaluation Evidence-to-Decision Framework to formulate recommendations. RESULTS: The panel formulated recommendations and good practice statements using the best available evidence. There is a beneficial net balance favoring the use of nonopioid medications compared with opioid medications. In particular, nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen likely provide superior pain relief with a more favorable safety profile than opioids. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Nonopioid medications are first-line therapy for managing acute dental pain after tooth extraction(s) and the temporary management of toothache. The use of opioids should be reserved for clinical situations when the first-line therapy is insufficient to reduce pain or there is contraindication of nonsteroidal anti-inflammatory drugs. Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults.

A True "Uomo Universale" from the 1800s - Dr. George Watt.

A hot bed of organized dental leadership and visionary thinking in the mid-to-late 1800s came from Ohio, as many presidents of the American Dental Association were from that state. They were quite influential in leading this organization into the 20th century. One of the most dynamic and well-rounded individuals was Dr. George Watt…this paper will highlight his life as viewed by one of his peers.

Teledentistry adoption and applications: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: The rise of teleworking technologies has affected various industries, including dentistry. Although some dentists have used it for some time, many are discovering the benefits of incorporating this technology to complement their existing patient care capabilities. METHODS: To assess how clinicians are using teledentistry in their practices, an electronic survey was developed and deployed to the American Dental Association Clinical Evaluators (ACE) Panel on February 27, 2023. The survey link remained open for 2 weeks. Nonrespondents received reminders after 1 week. RESULTS: Of the 244 respondents (24% response rate), 30% use teledentistry in their practices, with more than one-half of those using synchronous (53%) or asynchronous teledentistry (63%). The most common reasons for incorporating teledentistry were increased convenience for patients (53%), COVID-19 (50%), and increased accessibility to providers (39%). Teledentistry can help serve patients of all ages (the lowest represented age group [0-5 years] had 42% of dentists treating them) and distances, with 63% of teledentistry patients fewer than 20 miles away. Most users adopted teledentistry within the past 3 years and use it fewer than 5 hours per month. Benefits cited include a reduced number of in-person patient visits (63%) and increased access and quality of care (57%). Among nonusers, 60% felt there was no need, and 39% had concerns with reimbursement. CONCLUSIONS: Teledentistry has gained popularity in since the onset of the COVID-19 pandemic but may be underused, despite its potential to benefit a wider range of patients and applications than many believe. PRACTICAL IMPLICATIONS: Education on the capabilities and benefits of teledentistry may help increase adoption and improve patient care.

Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania.

BACKGROUND: A guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years). TYPES OF STUDIES REVIEWED: The authors conducted a systematic review to determine the effect of analgesics and corticosteroids in managing acute dental pain. They used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations. RESULTS: The panel formulated 7 recommendations and 5 good practice statements across conditions. There is a small beneficial net balance favoring the use of nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen compared with not providing analgesic therapy. There is no available evidence regarding the effect of corticosteroids on acute pain after surgical tooth extractions in children. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Nonopioid medications, specifically nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen alone or in combination with acetaminophen, are recommended for managing acute dental pain after 1 or more tooth extractions (that is, simple and surgical) and the temporary management of toothache in children (conditional recommendation, very low certainty). According to the US Food and Drug Administration, the use of codeine and tramadol in children for managing acute pain is contraindicated.

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association.

BACKGROUND: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED: The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS: The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS: The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.

Men of color in the health professions: Proceedings from the 2022 ADEA Men of Color in the Health Professions Summit.

The purpose of the American Dental Education Association (ADEA) Men of Color in the Health Professions Summit, held in August 2022 at ADEA's headquarters in Washington, DC, was to gather key thought leaders across a myriad of health professions and healthcare organizations and schools to cultivate intentional cross-disciplinary efforts in championing the need to address the low number of men of color entering not only dental, but also medicine, pharmacy, and health-related research careers. A pivotal follow-up step from the inaugural ADEA President's Symposium on Men of Color in the Health Professions at the March 2022 ADEA Annual Session & Exhibition in Philadelphia, the summit brought together academic health professions leaders, government agencies, health professions associations, and other key stakeholders to develop an action plan to support men of color entering the health professions. Moving the needle forward and increasing opportunities for underrepresented men of color in the health professions requires all academic health professions to work together. Highlights of the Summit included a keynote presentation by David Satcher, MD, PhD, the 16th Surgeon General of the United States; workgroup consensus statement development; health career pathways program presentations; strategic forecasting regarding challenges and opportunities in developing a coalition of health professions organizations to support men of color in the health professions; and frameworks for exploring coalition building.

Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs. RESULTS: Thirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass isomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Owing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.

Assessment of the Quality of Current American Dental Association Clinical Practice Guidelines.

INTRODUCTION: The American Dental Association (ADA) defines evidence-based dentistry (EBD) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." Clinical practice guidelines (CPGs) are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Therefore, ADA CPGs are the most rigorous examples of EBD to inform clinical practice. CPGs should be of the highest level of quality to ensure the appropriateness and timeliness of clinical recommendations. OBJECTIVES: The aim of this study was to measure the methodological rigor and transparency of the ADA CPGs. METHODS: Each ADA CPG was appraised by 4 independent assessors using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Quantitative quality scores were obtained for 6 domains and overall quality. In addition, assessors provided a qualitative analysis by providing comments for each item and an appraisal of the full recommendation. RESULTS: A quality score of 75% was used as the threshold for high-quality guidelines. Using this metric, 6 of the current 10 current ADA CPGs were considered to be of high quality, 1 was slightly below the quality threshold, and 3 were considered marginal. Even among those evaluated to be high quality in overall assessment, certain domains did not reach the quality threshold of 75%. CONCLUSION: Overall, the ADA CPGs collectively provide high-quality guidance for the clinician. While the AGREE appraisal guidelines have been used in CPG development since 2016, there is still room for improvement in certain domains (i.e., stakeholder involvement, rigor of development, applicability, and editorial independence). KNOWLEDGE TRANSFER STATEMENT: The results of this study summarize the methodological rigor and transparency of the 10 current ADA clinical practice guidelines. Since adoption of AGREE standards (2016), CPGs have been uniformly of high quality. The quality of older CPGs was somewhat lower but overall deemed acceptable. Thus, ADA CPGs may be used with confidence to inform practitioners of treatment options supported by rigorous evidence-based dentistry standards. However, there is still room for improvement in methodological quality.

Intraoral appliance use in dental practice: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: A growing variety of intraoral appliances are being used in dental practice. Insight about the range of applications and practice workflow as well as factors effecting change in practice trends was sought. METHODS: A survey was developed to ascertain intraoral appliance use, fabrication methods, staff involvement, and patient experiences in dental practice. The survey was sent to ADA Clinical Evaluators Panel members on July 25, 2022, in Qualtrics and remained open for 2 weeks. After 1 week, those who had not responded yet were sent reminders. Data were analyzed descriptively in SAS Version 9.4. RESULTS: Of the 286 respondents (a 28% response rate), 88% reported providing patients with intraoral appliances apart from providing patients with removable partial dentures. More than one-half of the respondents reported offering bleaching trays (88%), flippers or Essix retainers (83%), splints (81%), athletic mouthguards (72%), orthodontic retainers (60%), fluoride trays (56%), and clear aligners (55%). The biggest changes to practice in the past 5 years with respect to intraoral appliances have been intraoral scanning (56%) and the increase in the variety of intraoral appliances in use. Although 72% reported dental assistants were involved in obtaining impressions and fabricating models for intraoral appliances and 76% reported that laboratory technicians were involved in fabricating intraoral appliances, nearly all (97%) respondents indicated that the dentist was involved in the delivery of appliances to patients. Patient education about the use of their appliances appeared to be delivered using multiple approaches, given that it was reported to occur orally (95%), in print (61%), and visually (42%). That 90% of respondents reported having engaged in continuing education courses about intraoral appliances aligns with these appliances becoming a routine part of dental practice, with both increasing applications and improvements in the relevant technology. CONCLUSIONS: Intraoral appliances were found to be used commonly in dental practice, and often multiple members of the dental care team were engaged in the fabrication processes. PRACTICAL IMPLICATIONS: There likely will be ongoing interest in relevant learning opportunities about technologic advances as well as the increasingly diverse list of applications for intraoral appliances.

Factors Influencing the Professional Identity of Student and Licensed Professional Members of the American Dental Hygienists' Association.

Purpose: Professional identity formation is positively influenced by roles models, mentors, and experiential learning. The purpose of this study was to investigate the role membership in the American Dental Hygienists' Association (ADHA) plays in developing and sustaining professional identity, and to explore whether differences exist between how students and licensed professionals perceive this role.Methods: A 48-item survey consisting of multiple choice, Likert scale, and open-ended items was created, and pilot tested before dissemination to student (SM) and licensed professional members (LM) of the ADHA via an electronic survey platform. Descriptive and inferential statistics were used to analyze the data.Results: Of the 31,479 surveys sent to ADHA members in the database, 1,983 were completed, for a response rate of 6.3%. Most respondents were licensed professionals (86%, n=1,699), female (98%, n=1,940) and White (84%, n=1,668). Over one-third were over 55 years of age (37%, n=727). Continuing Education and Evidence-based Research resources were identified as positively affecting professional identity (4.0 or higher means). Advocacy efforts, the Journal of Dental Hygiene, and Access Magazine had a significantly greater positive influence on LMs professional identity (p<0.05) while SMs reported patient care resources and career support had a greater influence on their professional identity (p< 0.05).Conclusion: Member benefits in the ADHA positively influence the professional identities of students and licensed professionals. Dental hygiene students most value benefits that will support their roles as future health care professionals, while licensed professionals identified evidence-based resources and advocacy efforts as instrumental in sustaining their professional identity.

Men of color in the health professions: Proceedings from the 2022 ADEA President's symposium.

The purpose of the American Dental Education Association (ADEA) President's Symposium on men of color in the health professions, hosted at the 2022 ADEA Annual Session and Exhibition, was to draw attention to the need to address the low numbers of men of color not only entering dental education but also across medicine and health-related research careers and to identify strategies for change. Stakeholders in health professions education shared their professional insights and best practices. Highlights of the Symposium included discussions of funding for pathway programs, leveraging data-driven metrics through strategic partnerships, mentorship, and accountability among dental schools, medical schools, and health science research organizations.

Faculty diversity, equity, and inclusion in academic dentistry: Revisiting the past and analyzing the present to create the future.

AIM: In 2021, NIDCR published the landmark report "Oral Health in America." It described that while oral health-related research and care has seen amazing progress, oral health inequities and lack of oral care for large segments of the US population have not improved. This situation plus the predicted increase of the diversification of the US population requires decisive actions to ensure that future dentists will be optimally prepared to provide the best possible care for all patients. A diverse dental educator workforce plays a crucial role in obtaining this goal. The objectives of this document were threefold. Aim 1 was to analyze past and current trends in the diversity and inclusion of historically underrepresented ethnic/racial (HURE) and marginalized (HURM) dental faculty members. Aim 2 focused on reviewing best practices and challenges related to achieving dental faculty and leadership diversity and inclusion. Aim 3 was to develop recommendations for increasing the diversity and inclusion of dental faculty in the present and future. METHODS: An analysis of ethnicity/race and gender faculty data collected by the American Dental Education Association (ADEA) in 2011-2012 and 2018-2019 showed that achieving faculty diversity and inclusion has been an ongoing challenge, with limited success for faculty from HURE backgrounds. In order to create this much-needed change, best practices to increase the applicant pool, change recruitment strategies, and develop solid retention and promotion efforts were described. Research discussing the challenges to creating such changes was analyzed, and strategies for interventions were discussed. CONCLUSION: In conclusion, evaluations of efforts designed to create a more diverse and inclusive work force is crucial. Institutions must evaluate their diversity data, practices utilized, and the policies implemented to determine whether the desired outcomes are achieved. Only then will the future dental workforce be optimally prepared to provide the best possible care for all patients in the United States.

Oral health care practice patterns for geriatric patients: An American Dental Association Clinical Evaluators Panel Survey.

BACKGROUND: The geriatric adult population is expanding rapidly in the United States, with more of these patients expected to visit the dentist in the coming years. Understanding the dental community's preparedness and comfort treating this demographic is timely. METHODS: Survey questions were developed to assess how dentists treat geriatric patients, what challenges they face, and what tools they need to provide the best care. This set of questions was administered electronically and emailed to the American Dental Association Clinical Evaluators (ACE) Panel on March 29, 2022. After 2 weeks, the survey closed, and data were summarized descriptively. RESULTS: Of the 269 respondents, 59% indicated that treating geriatric patients is more challenging than treating nongeriatric patients. The most frequently cited challenges include comorbidities and their management (86%), cognitive impairment (68%), and home care needs for some of these patients (69%). The top 3 symptoms seen in these patients are dry mouth (89%), carious lesions (86%), and tooth wear (75%). Seventy-six percent of respondents reported being comfortable treating this demographic, and most (58%) indicated that training as a student contributed to this competency. CONCLUSIONS: Most respondents are comfortable treating geriatric patients, but they still face many challenges, with managing comorbidities with dental treatment a top concern. PRACTICAL IMPLICATIONS: A sound understanding of the impact of aging and associated medical treatments on oral tissues and patient management is essential. Equally important is finding innovative ways to improve access to care for this vulnerable population.