Association of Osteonecrosis of the Jaw With Zoledronic Acid Treatment for Bone Metastases in Patients With Cancer.

IMPORTANCE: Osteonecrosis of the jaw (ONJ) affects patients with cancer and metastatic bone disease (MBD) treated with bone-modifying agents (BMAs), yet the true incidence is unknown. OBJECTIVE: To define the cumulative incidence of ONJ at 3 years in patients receiving zoledronic acid for MBD from any malignant neoplasm. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective observational cohort study (SWOG Cancer Research Network S0702) included patients with MBD with either limited or no prior exposure to BMAs and a clinical care plan that included use of zoledronic acid within 30 days of registration. Medical, dental, and patient-reported outcome forms were submitted at baseline and every 6 months. Follow-up was 3 years. Osteonecrosis of the jaw was defined using established criteria. Data were collected from January 30, 2009, to December 13, 2013, and analyzed from August 24, 2018, to August 6, 2020. INTERVENTIONS/EXPOSURES: Cancer treatments, BMAs, and dental care were administered as clinically indicated. MAIN OUTCOMES AND MEASURES: Cumulative incidence of confirmed ONJ, defined as an area of exposed bone in the maxillofacial region present for more than 8 weeks with no concurrent radiotherapy to the craniofacial region. Risk factors for ONJ were also examined. RESULTS: The SWOG S0702 trial enrolled 3491 evaluable patients (1806 women [51.7%]; median age, 63.1 [range, 2.24-93.9] years), of whom 1120 had breast cancer; 580, myeloma; 702, prostate cancer; 666, lung cancer; and 423, other neoplasm. A baseline dental examination was performed in 2263 patients (64.8%). Overall, 90 patients developed confirmed ONJ, with cumulative incidence of 0.8% (95% CI, 0.5%-1.1%) at year 1, 2.0% (95% CI, 1.5%-2.5%) at year 2, and 2.8% (95% CI, 2.3%-3.5%) at year 3; 3-year cumulative incidence was highest in patients with myeloma (4.3%; 95% CI, 2.8%-6.4%). Patients with planned zoledronic acid dosing intervals of less than 5 weeks were more likely to experience ONJ than patients with planned dosing intervals of 5 weeks or more (hazard ratio [HR], 4.65; 95% CI, 1.46-14.81; P = .009). A higher rate of ONJ was associated with fewer total number of teeth (HR, 0.51; 95% CI, 0.31-0.83; P = .006), the presence of dentures (HR, 1.83; 95% CI, 1.10-3.03; P = .02), and current smoking (HR, 2.12; 95% CI, 1.12-4.02; P = .02). CONCLUSIONS AND RELEVANCE: As the findings show, the cumulative incidence of ONJ after 3 years was 2.8% in patients receiving zoledronic acid for MBD. Cancer type, oral health, and frequency of dosing were associated with the risk of ONJ. These data provide information to guide stratification of risk for developing ONJ in patients with MBD receiving zoledronic acid.

School-Based Preventive Dental Program in Rural Communities of the Republic of Armenia.

Objectives: This paper describes a school-based preventive dental program implemented in 14 rural schools within nine villages of Armenia. As part of the program, school-based toothbrushing stations (called Brushadromes) were installed in the participating schools. The intervention included school-based supervised toothbrushing with fluoride toothpaste and oral hygiene education. Methods: The study evaluates the prevalence and levels of dental caries among rural schoolchildren in 2013 (before the implementation of the preventive program, referred to as a pre-intervention group) and 2017 (4 years after the start of the program, referred to as an intervention group) in two randomly selected villages where the program was implemented. A repeated cross-sectional study design was used. The prevalence of caries and the number of decayed, missing, and filled teeth in permanent dentition (DMFT) and primary dentition (dmft) were recorded among 6-7 and 10-11-year-old schoolchildren in 2013 (n = 166) and 2017 (n = 148). The pre-intervention and intervention groups include different children in the same age range, from the same villages, examined at different time points. In both instances, they represented over 95% of the 6-7 and 10-11-year-old student populations of the studied villages. Pearson Chi-square, Fisher's Exact test, independent t-test, and quasi-likelihood Poisson regression were utilized for data analysis. Results: Schoolchildren involved in the intervention had significantly less decay levels compared to same-age pre-intervention groups. For 10-11-year-old schoolchildren involved in the program, the mean number of permanent teeth with caries was lower by a factor of 0.689 (lower by 31.1%), p = 0.008, 95% CI, 0.523; 0.902, compared to the 10-11-year-old pre-intervention group, after controlling for age, sex, child's socio-economic vulnerability status, the village of residence, and the number of permanent teeth with fillings. Conclusions: The study indicates a significantly lower level of caries among schoolchildren in the studied two villages where the intervention was implemented. The described intervention is particularly suitable in rural settings where water fluoridation is not available and homes have limited availability of running water.

Dental health status and patient-reported outcomes at baseline in patients participating in the osteonecrosis of the jaw registry study, SWOG S0702.

PURPOSE: SWOG S0702 was a cohort study of patients with cancer with bone metastases due to any cancer. Using baseline data from S0702, this report characterizes the oral health and oral health-related quality of life (OHRQoL) of patients with advanced cancer. METHODS: S0702 case report forms captured dental assessment and patient-reported outcome (PRO) data. This analysis compares PRO dental discomfort with selected clinical assessments of dental health. This analysis focuses on the 2294 patients who underwent baseline dental examination prior to study registration, but also reports on the 1235 patients for whom only OHRQol data are available. Dental characteristics including the number of teeth and the presence of gingivitis and periodontal disease were examined for correlation with PRO of oral pain, interference with eating, smiling, speech, or quality of life. RESULTS: The median age of the study participants was 62. Greater than 60% of the 2294 patients with baseline dental assessments had none to mild plaque, calculus, gingivitis, or periodontal disease, suggesting that most of this cohort had good oral hygiene. However, in each of these same categories, approximately 6% had dental findings classified as severe conditions (poor oral hygiene). There was strong evidence that the presence of periodontal disease, gingivitis, and number of teeth was correlated with lower OHRQoL across multiple domains, including pain (mouth or jaw), interference with eating, smiling and speech, and overall quality of life. CONCLUSIONS: This report characterizes the oral health and OHRQoL of patients with advanced bone metastases receiving palliative therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00874211.

High caries prevalence and risk factors among young preschool children in an urban community with water fluoridation.

BACKGROUND: Singapore is unique in that it is a 100% urban community with majority of the population living in a homogeneous physical environment. She, however, has diverse ethnicities and cultures as such; there may be caries risk factors that are unique to this population. AIM: The aims were to assess the oral health of preschool children and to identify the associated caries risk factors. DESIGN: An oral examination and a questionnaire were completed for each consenting child-parent pair. RESULTS: One hundred and ninety children (mean age: 36.3 ± 6.9 months) were recruited from six community medical clinics. Ninety-two children (48.4%) were caries active. The mean d123 t and d123 s scores were 2.2 ± 3.3 and 3.0 ± 5.6, respectively. Higher plaque scores were significantly (P < 0.0005) associated with all measures of decay (presence of decay, dt, ds). The risk factors for severity of decay (i.e., dt and ds) include child's age, breastfeeding duration, and parents' ability to withhold cariogenic snacks from their child. CONCLUSIONS: The high caries rate suggests that current preventive methods to reduce caries in Singapore may have reached their maximum effectiveness, and other risk factors such as child's race, and dietary and breastfeeding habits need to be addressed.

Mentoring of dental and dental hygiene faculty: a case study.

Given the predicted shortages of dental faculty in the United States, it is important to retain faculty members. Mentoring could play a crucial role in this context. The objectives of this case study were to explore how a six-year mentoring program in the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry changed faculty members' perceptions of support from colleagues and their mentoring expectations. In addition, we sought to determine how junior versus senior faculty members and mentors versus mentees differed in their perceptions of faculty roles, their self-perceived competence, and their awareness of departmental expectations at the end of the program. Data were collected with self-administered surveys from twenty-five of the thirty-six faculty members in this department in 2002 (response rate: 69 percent) and from thirty-seven of the fifty-four faculty members in 2008 (response rate: 69 percent). The results showed that the perceptions of support from colleagues improved significantly over the six-year period. During the same time period, mentoring expectations increased. In 2008, junior faculty members as compared to senior faculty members remained less positive about their role as faculty members, felt less well prepared for their professional life, and were less aware of departmental expectations. In conclusion, a departmental mentoring program resulted in improved support from colleagues and increased expectations concerning mentoring experiences. However, future targeted interventions are needed to address the identified differences between junior and senior faculty members. Recommendations for faculty mentoring efforts are discussed.

Treating patients with autism spectrum disorder--SCDA members' attitudes and behavior.

The goal of this study was to explore (a) the attitudes and behavior of members of the Special Care Dentistry Association (SCDA) who self-identified as treating patients with Autism Spectrum Disorders (ASD) and (b) the relationship between their professional attitudes and behaviors concerning these patients. Data were collected from 75 SCDA members who responded to an anonymous web-based survey on the SCDA website. The majority of respondents liked to treat children and adults with ASD (57%/56.9%). They treated approximately nine patients with ASD in an average week. The more they liked to treat children with ASD, the more patients with ASD they treated (r = .313; p = .018), and the more accommodations to overcome problems with communication, social interactions and aversion to change they made (r = .404; p < .001). Providers' attitudes concerning patients with ASD were quite positive and correlated with professional behavior concerning these patients. Future research should explore whether improving attitudes towards providing care for special needs patients could increase professional behavior and thus contribute to reducing the access to care problems these patients face.

The influence of the bucco-palatal distance on sinus augmentation outcomes.

BACKGROUND: Maxillary sinus augmentation is one of the most reliable implant site development options to increase vertical bone height. However, graft consolidation requires adequate angiogenesis and migration of cells involved in osteogenesis and bone remodeling. It is speculated that these biologic events are greatly determined by the dimensions of the maxillary sinus cavity. Hence, the purpose of this study is to assess the influence of the distance from the lateral to the medial wall of the maxillary sinus on the outcomes of sinus augmentation procedures. METHODS: A total of 25 patients in need of sinus augmentation were recruited for the study. After initial examination, customized radiographic and surgical guides were fabricated and a cone-beam computerized tomography scan was obtained per patient. The bucco-palatal distance (BPD) was measured at 8, 10, and 12 mm from the alveolar crest. Sinus grafting was performed by a lateral window approach using a particulated allograft material. Patients were followed-up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic-surgical guide. Sections of the bone cores at 8, 10, and 12 mm from the alveolar crest were histomorphometrically analyzed. The proportion of vital bone (%VB) was correlated with the BPD using a statistical model. RESULTS: Twenty-one patients underwent sinus augmentation for a total of 24 sinuses; however, the data analyzed contained only one sinus per patient. One sinus developed an infection after grafting, resulting in a 96% success rate for the sinus grafting procedure. Twenty sinuses were used in the final statistical analysis. Histomorphometric analysis revealed that mean %VB was 22.71 +/- 19.08, mean percent of remaining allograft was 23.39 +/- 20.85, and average percent of non-mineralized connective tissue was 53.90 +/- 13.23. Analysis of the correlation between %VB and BPD by linear regression, using the actual values of BPD showed a strong negative association (R(2) = 0.141; P <0.001). CONCLUSION: The findings suggest that the %VB formation after maxillary sinus augmentation is inversely proportional to the sinus BPD.

The global increase in dental caries. A pending public health crisis.

A current review of the available epidemiological data from many countries clearly indicates that there is a marked increase in the prevalence of dental caries. This global increase in dental caries prevalence affects children as well as adults, primary as well as permanent teeth, and coronal as well as root surfaces. This increase in dental caries signals a pending public health crisis. Although there are differences of opinion regarding the cause of this global dental caries increase, the remedy is well known: a return to the public health strategies that were so successful in the past, a renewed campaign for water fluoridation, topical fluoride application, the use of fluoride rinses, a return to school oral health educational programs, an emphasis on proper tooth brushing with a fluoride dentifrice, as well as flossing, a proper diet and regular dental office visits. If these remedies are not initiated, there could be a serious negative impact upon the future oral health (and systemic health) of the global community, as well as a strain on the dental profession along with a major increase in the cost of dental services.

Short-term effects of hygiene education for preschool (kindergarten) children: a clinical study.

AIM: To evaluate the outcomes of short (15 minutes) oral hygiene vs. hand hygiene education for preschool children 4 weeks after these interventions. MATERIALS AND METHODS: Sixty-one preschool children (age range 4-6 years) attending four kindergarten classes participated in a 15-minute health education programme on the importance of body cleanliness for general health. In addition, specific instructions on oral hygiene were provided for two randomly selected classes (30 children), while the remaining two classes (31 children) were given instruction of hand and nail cleaning. The oral hygiene status was assessed usingthe plaque control record (PCR). The cleanliness of the hands and fingernails was determined using a hand hygiene index (HHI) and a nail hygiene index (NHI). All three parameters were assessed before the intervention as well as 4 weeks thereafter. RESULTS: Four weeks after education, the PCR had improved for all children from 79.95% to 72.35% (p < 0.001). The NHI had improved from 74.91% to 61.71% (p < 0.001). In addition, the mean PCR of the children given oral hygiene instruction decreased from 83.67% to 72.40%, while the mean PCR of the children given hand and nail cleaning instruction decreased from 76.23% to 72.29% (interaction effect 'time x type of instruction': p = 0.044). Girls' PCR improved significantly more than boys' PCR (Girls, 80.98 vs. 69.71; boys, 78.33 vs. 75.31; p = 0.021). CONCLUSIONS: The results of the study show that even a short, school-based educational intervention at an early age may affect children's oral health promotion significantly. Teachers should, therefore, be encouraged to educate children from an early age about oral hygiene promotion.

Caries prevalence in northwest Michigan migrant children.

PURPOSE: The purpose of this study was to describe the prevalence of dental caries in a sample of Hispanic-American migrant workers' children and compare the results with an earlier Northwest Michigan migrant study to assess if migrant children have benefited from the global caries decline. METHODS: A non-probability convenience sample of migrant farm worker children was obtained from migrant schools in Northwest Michigan during the summer of 1999. Field dental equipment was used to examine caries, fluorosis, and urgent dental needs by 1 examiner. Statistical analysis was performed using SAS software with the student t-test used to test for differences between the samples. Intra-examiner reliability was high for caries at the surface level (kappa = 0.94). RESULTS: The sample consisted of 211 children with 95% ranging in ages from 5 to 13. Mean caries levels were as follows: DMFT = 1.1 (SD 1.6); DMFS = 1.6 (SD 2.5); dft = 3.0 (SD 2.9); dfs = 6.3 (SD 6.7) Fifty percent of children with at least 1 permanent tooth (189) were caries free, with 17% (34) having DMFT values greater than or equal to 3. The large number of caries-free children displayed a skewed distribution of caries where a small proportion of the population harbored the majority of the disease. A statistically significant decrease in caries was evident in permanent teeth (P = .0001) between 1999 and 1982 samples, but no change was realized in primary teeth (P = .7). CONCLUSIONS: Results indicated that the caries decline has extended to this long-neglected migrant group, but only in the permanent dentition. Caries remained moderate to high in the primary dentition and the caries burden was carried by a relatively small segment of the population. Dental treatment programs should be expanded to include preschool children who appear to be at the highest risk for caries.

Cost-efficiency of a community dental delivery program for migrant children.

PURPOSE: The purpose of this study was to describe an economically efficient dental prevention and treatment program aimed at migrant children, using dental school students. This dental treatment program aimed to provide comprehensive dental care to migrant children and to provide a unique learning experience for dental students expanding their knowledge of community delivery systems. METHODS: Twenty-four dental students treated 330 migrant children through a 6-week outreach treatment program sponsored by the University of Michigan School of Dentistry, as a part of the Northwest Michigan Migrant Health Program. RESULTS: The program cost $39,907 and resulted in just over $16,000 of Medicaid reimbursements. Factoring in the Medicaid reimbursements, the program cost $71.58 to treat each child comprehensively. CONCLUSIONS: In light of the reported oral health disparities throughout the United States, this program provides an alternative mechanism for efficient and cost-effective oral care in a group that has traditionally had poor oral health.