FINDINGS AND FUTURE DIRECTIONS FROM A SMOKING CESSATION TRIAL UTILIZING A CLINICAL DECISION SUPPORT TOOL.

BACKGROUND: Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. OBJECTIVES: To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months. METHODS: Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. RESULTS: Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant. CONCLUSIONS: Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.

Analyzing Medication Documentation in Electronic Health Records: Dental Students' Self-Reported Behaviors and Charting Practices.

The aim of this two-part study was to assess third- and fourth-year dental students' perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients' medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents' most frequently cited perceived barriers to medication documentation were patients' not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low.

A Snapshot of the Depiction of Electronic Cigarettes in YouTube Videos.

OBJECTIVE: To assess the depiction of e-cigarettes in YouTube videos. METHODS: The sample (N = 63) was selected from the top 20 search results for "electronic cigarette," and "e-cig" with each term searched twice by the filters "Relevance" and "View Count." Data collected included title, length, number of views, "likes," "dislikes," comments, and inferred demographics of individuals appearing in the videos. RESULTS: Seventy-six percent of videos included at least one man, 62% included a Caucasian, and 50% included at least one young individual. Video content connotation was coded as positive (76%), neutral (18%), or negative (6%). Videos were categorized as advertisement (33%), instructional (17%), news clip (19%), product review (13%), entertainment (11%), public health (3%), and personal testimonial (3%). CONCLUSION: Most e-cigarette YouTube videos are non-traditional or covert advertisements featuring young Caucasian men.

Increasing Tobacco Intervention Strategies by Oral Health Practitioners in Indiana.

PURPOSE: To implement and assess an evidence-based 7-hour continuing education program for Indiana oral health care practitioners on tobacco use, dependence and treatment using a team-based approach. Program effectiveness was assessed by participants' reported increase in knowledge and the extent to which they implemented course concepts and strategies into dental practice. METHODS: Course attendees' study participation was based on agreeing to provide their contact information and to complete two surveys (an 18 item post-session and 14 item 3-month follow-up) which captured their self-reported knowledge and application of course concepts. Surveys included open-ended and multiple choice (dichotomous or 5-point Likert scale) items. Follow-up surveys were mailed / delivered electronically to participants; non-responders were sent two reminders. De-identified data were analyzed in an aggregate using descriptive statistics, percentages and counts. RESULTS: Eleven programs were attended by 626 practitioners. Initial survey response rate was 91% (565); hygienists (70%), dentists (25%); unidentified (5%). Most indicated the program enhanced their knowledge of most course concepts; 98% (522) planned to use learned communication strategies. Of dentists, 90% (113) planned to refer to the Indiana quitline and 60% (71) planned to provide patient cessation materials. Follow-up response rate was 40% (250); 79% (184) reported implementing cessation communication strategies. One-third of respondents reported referring patients to the quitline for counseling. CONCLUSION: Continuing education for oral health providers in understanding tobacco use, dependence and treatment may be beneficial to enhance their capacity and willingness to integrate tobacco cessation interventions into oral healthcare settings. However, this does not necessarily assure that they will change their practice behaviors by utilizing the learned concepts and skills with patients.

GABA and glutamate levels in occlusal splint-wearing males with possible bruxism.

OBJECTIVE: The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions. DESIGN: MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic-pituitary-adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC). Eight occlusal splint-wearing men (OCS) with possible tooth-grinding and clenching behaviours and nine male controls (CON) with no such behaviour were studied. RESULTS: Repeated-measures ANOVA showed significant Group×Region interaction for GABA+ (p = 0.001) and glutamate (Glu) (p = 0.031). Between-group post hoc ANOVA showed significantly lower levels of GABA+ (p = 0.003) and higher levels of Glu (p = 0.002) in DLPFC of OCS subjects. These GABA+ and Glu group differences remained significant (GABA+, p = 0.049; Glu, p = 0.039) after the inclusion of anxiety as a covariate. Additionally, GABA and Glu levels in the DLPFC of all subjects were negatively related (Pearson's r = -0.75, p = 0.003). CONCLUSIONS: These findings indicate that the oral behaviours of tooth-grinding and clenching, generally known as bruxism, may be associated with disturbances in brain GABAergic and glutamatergic systems.

Tobacco dependence education in U.S. Dental assisting programs' curricula.

The aim of this study was to assess the level of tobacco dependence education (TDE) in the curricula of U.S. dental assisting programs and to compare the findings to those from a similar assessment of dental hygiene curricula. In the 2012-13 academic year, a 51-item survey was sent to directors of all 298 accredited dental assisting programs. Assessed were curricular TDE content, time spent on each topic, expected levels of clinical competence, and resources used. Of the 298 potential participants, 89 programs returned completed surveys, for a response rate of 30%. Of the 13 TDE-related content areas, those most often covered were oral disease related to tobacco use (100%) and general diseases related to tobacco use (93%); those least often covered were stages of (behavior) change (29%), how to develop a comprehensive tobacco intervention program in a private office setting (23%), and strategies for community-based tobacco control (22%). Responding program directors indicated the following levels of tobacco cessation intervention at which students should demonstrate competence: brief, 44%; moderate, 55%; intensive, 8%. Less than half of the reporting programs conducted a formal assessment of clinical competence in any TDE-related skills; however, skills in assessing patient tobacco use and associating head and neck findings to tobacco use were formally or informally assessed by 74% and 61%, respectively. Compared to dental hygiene programs, TDE appeared to play a smaller role in the curricula of dental assisting programs, and dental assisting programs were less likely to formally assess clinical competence in TDE.

Comparing Tobacco Use Knowledge, Attitudes and Practices between Engineering Students at a Public and Islamic Azad University in Shiraz, Iran 2011.

BACKGROUND: To compare the level of knowledge, the attitudes, and practices with regards to tobacco use between Iranian students at a public (PBU) and Islamic Azad (IAU) university. METHODS: A cross-sectional design was used in this study. As the number of students at the IAU were three times greater than that of the PBU, we selected 150 students from the PBU and 450 students from the IAU using simple random sampling. A 57-item survey instrument was utilized for this study. The collected data were recorded by SPSS version 15 software and then it underwent statistical analysis using descriptive statistics and ANOVA to compare the difference between means of knowledge, attitude and practice scores. Logistic regression analysis was conducted to identify variables that have an independent association with students smoking and to describe possible variations in these relationships. The P value level for statistical significance was set at 0.05. RESULTS: From participants, 46.8% were females, 10% of 327 students reported being daily smokers; of these, 84% were from the IAU. Totally, among the 107 smokers, 61 (57%) and 29 (27.1%) were water pipe and cigarettes smokers, respectively. Ninety-three IAU students (21.7%) and 30 PBU students (20.7%) reported smoking during the past 30 days. The mean of the knowledge items between the students of IAU was lower than PBU students. Female gender, smoking in the home, and allowing visitors to smoke in the home were significant predictors of smoking in the past 30 days in PBU, respectively. In IAU, female gender, smoking by friends, and health status were predictors for smoking in the past 30 days. CONCLUSIONS: Future studies should assess the factors affecting smoking initiation, as well as effective techniques for the prevention of smoking initiation and substance abuse in Iranian adolescents and young adults.

Can midlevel dental providers be a benefit to the American public?

The use of midlevel dental providers (MLDPs) is being debated as a means of reducing oral health disparities and increasing access to care among underserved populations. Midlevel dental providers include the advanced dental hygiene practitioner, community dental health coordinator, dental health aide therapist, and dental therapist. While midlevel providers are new to the U.S. dental profession, medicine has utilized these positions for years. Medical literature has shown mixed results as to whether midlevel providers improve access to care and increased practice efficiency, however, it has demonstrated clearly that the quality of care outcomes of these providers have been comparable to those of physicians. Studies of MLDPs suggest potential practice and public health benefits. With appropriate training, licensure, supervision, and deployment to geographical areas of significant need, we believe MLDPs could increase access to care to underserved populations and help in the prevention of deaths attributable to untreated dental disease.

Using the patient's medication history as a learning tool in clinical pharmacology instruction for dental students.

The purpose of this study was to determine if a pharmacology medical history assignment would enable dental students to demonstrate improved knowledge and understanding of pharmacology by researching the drugs their patients were taking and recording pharmacological information in their patients' health records. The study followed a pretest-posttest design and evaluated students' knowledge of ten commonly prescribed drugs. Students were given the pretest prior to entry into the clinic. Subsequently, for an eight-month period, students completed the medication history assignment. Pretest and posttest scores were compared and analyzed with one-way ANOVA and Pearson product moment correlation statistics. The Pearson product moment correlation showed a positive correlation between the drugs per patient and the change in score between the pre- and posttests (correlation coefficient=0.254, p=0.016) and between the assignment grade and the change in pre- and posttest scores (correlation coefficient=0.198, p<0.001), as well as a significant correlation between the number of times a drug was charted and the change in score on the pretest-posttest item concerning that drug (correlation coefficient=0.798, p=0.006). By documenting patient drug information, dental students can improve their pharmacology knowledge base and enhance their potential to positively impact patient care and safety.

Controlling bacterial contamination of dental impression guns.

BACKGROUND: Dental impression material handgun cartridge dispensers are contaminated easily during clinical use. The authors attempted to quantify contamination by bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), of impression guns used in an academic dental clinic after five infection-prevention protocols were followed. METHODS: The authors obtained samples from four commercially available impression guns at four specific sites (button, handle, latch, trigger) after routine clinical use, disinfection, steam sterilization (also known as autoclaving), steam sterilization followed by use of plastic impression gun covers and steam sterilization followed by use of plastic impression gun covers and disinfection. RESULTS: The authors found that after routine clinical use, bacteria-including MRSA-heavily contaminated the impression guns. After the impression guns underwent disinfection, there was a 6 percent decrease in bacterial counts. The use of steam sterilization achieved sterility without harming the impression guns. Use of steam-sterilized impression guns with plastic impression gun covers decreased bacterial isolates by approximately 60 percent. Use of steam-sterilized impression guns plus covers and disinfection resulted in an approximately 95 percent reduction in contamination. CONCLUSIONS: The use of common infection-prevention methods appears to reduce the bacterial counts, including those of MRSA. Bacterial contamination was lowest after steam sterilization, followed by the use of plastic impression gun covers and disinfection. CLINICAL IMPLICATIONS: Use of contaminated impression guns on successive patients could increase the risk of causing cross-transmission of disease. The use of sterilization, plus plastic impression gun covers and disinfection, for impression guns after each use could be an effective and practical infection-control method for dental practices.

Relationship of biomedical science content acquisition performance to students' level of PBL group interaction: are students learning during PBL group?

This study assessed biomedical science content acquisition from problem-based learning (PBL) and its relationship to students' level of group interaction. We hypothesized that learning in preparation for exams results primarily from individual study of post-case learning objectives and that outcomes would be unrelated to students' group involvement. During dental curricular years 1 and 2, student-generated biomedical learning issues (LIs) were identified from six randomly chosen PBL cases. Knowledge and application of case concepts were assessed with quizzes based on the identified LIs prior to dissemination of the learning objectives. Students and facilitators were surveyed on students' level of group involvement for the assessed LI topics. Year 1 students had significantly higher assessment scores (p=0.0001). For both student classes, means were significantly higher for the recall item (Q1) than for the application item (Q2). Q1 scores increased along with the student's reported role for Year 1 (p=0.04). However, there was no relationship between the student's reported role and Q1 for Year 2 (p=0.20). There was no relationship between the student's reported role and Q2 for Year 1 (p=0.09) or Year 2 (p=0.19). This suggests that students' level of group involvement on the biomedical learning issues did not significantly impact students' assessment performance.

Retail promotions and perceptions of R.J. Reynolds' novel dissolvable tobacco in a US test market.

BACKGROUND: With declining cigarette sales, tobacco manufacturers have been developing and marketing new smokeless products, such as R. J. Reynolds' dissolvable tobacco, Camel Sticks, Strips and Orbs. This study assessed the availability, price and point-of-purchase promotional strategies for Camel Dissolvables, and investigated consumer awareness, interest and perception of these products in the Indiana test market. METHODS: An exploratory retail audit of point-of-purchase promotions was conducted in a random sample of retailers from 6 store categories (n = 81) in the test market area. Data included: store type, location, product placement, forms/flavors carried, price, types and locations of advertisements and promotions, and ad messages. An Awareness-Attitude-Usage (AAU) survey was used to gauge consumer awareness and knowledge of tobacco products including Camel Dissolvables. Respondents were shown promotional materials from a package onsert and perceptions and interest in the Camel Dissolvables were assessed. An Intended Target Survey (ITS) compared subjects' perceptions of ad targets for several non-tobacco products, as well as Camel Snus, Camel No. 9 and Camel Dissolvables. Respondents were asked to identify each ad's intended target category, perceived targetedness, and purchase intent. RESULTS: The products were carried by 46% of stores, most frequently gas stations (100%) and convenience stores (75%). They were shelved near smokeless tobacco (70%), cigarettes (25%) or candy (5%). Prices ranged from $3.59 -$4.19 per package; most stores carried at least 1 promotional item. Ad messages included: "Dissolvable Tobacco" (60%). "Free Trial" (24%), "Special Price" (24%), "What's Your Style?" (22%). At 14% of stores, free trial packs of Camel Dissolvables were offered with another Camel purchase. Awareness was reported by 42% of respondents (n = 243), and trial by 3%. Consumer interest was very low, but younger respondents (< 40 years) were more familiar with Camel Dissolvables (60% vs. 45% for those > 40 years, p < .01). Males, as well as current and former smokers had higher rates of interest and trial; only 1% of never smokers reported trial. In the ITS, only for the 3 tobacco product ads, was perceived targetedness for smokers significantly higher than for non-smokers. Smokers and nonsmokers perceived that the ads targeted smokers. CONCLUSIONS: Current retail promotional strategies for Camel Sticks, Strips & Orbs appear to be targeting a select audience, primarily current smokers. Overall, consumer awareness, interest and trial were low.

Motor control of jaw movements: An fMRI study of parafunctional clench and grind behavior.

Jaw-clenching and tooth-grinding associated with bruxism can contribute to abnormal tooth wear and pain in the masticatory system. Clench and tooth-grinding jaw-movement tasks were evaluated in a block-design fMRI study comparing a dental-control (DC) group with a tooth-grinding (TG) group. Group classification was made prior to imaging based upon self-reported parafunctional clench and grind behavior and clinical evidence of abnormal tooth wear. Group differences in brain activation patterns were found for each task compared to the resting baseline. The DC group showed a more widely distributed pattern; more extensive activity in the supplementary motor area (SMA) proper that extended into the pre-SMA; and, for clench, activity in the left inferior parietal lobule (IPL). The DC group activated more than the TG subjects the left IPL for clench, and pre-SMA for grind. Neither task elicited more activity in the TG than DC subjects. Our group findings suggest that jaw-movement tasks executed by the TG group elicited (1) more efficient brain activation pattern consistent with other studies that found less extensive activity with executing "over-learned" tasks; (2) "underactive" SMA activity that underlies reduced motor planning; (3) decreased inferior parietal activity that is associated with lesser motor-attentional demands. Thus orofacial parafunctional habits may influence brain circuits recruited for jaw movements, providing a possible basis for understanding involuntary jaw movements in bruxism and oral movement disorders in general.

A survey of United States periodontists' knowledge, attitudes, and behaviors related to tobacco-cessation interventions.

BACKGROUND: Because of the clear causal relationship between smoking and periodontal disease, and the negative effect of smoking on wound healing, it is of great importance to evaluate the tobacco-cessation interventions provided by periodontal practices. The use of tobacco-cessation interventions in clinical practice can be measured by whether the practitioner uses any of the "5 A's" defined by the 2008 United States Public Health Services Clinical Practice Guideline. METHODS: Surveys were mailed to 1,000 active members of the American Academy of Periodontology. The surveys assessed the periodontists' demographic information, educational and professional background, knowledge and attitudes about tobacco cessation, and use of interventions in the daily practice of periodontics. RESULTS: Data were collected from 231 periodontists via a self-administered survey. Most (92%) believed that tobacco cessation is a responsibility of the dental profession. A pattern of declining levels of involvement was seen as the providers moved through the suggested "5 A's" for promoting tobacco cessation. Providers with formal tobacco-cessation training were more likely to perform interventions. The primary perceived barriers to providing tobacco-cessation interventions were low patient acceptance of treatment, lack of time, and lack of training. CONCLUSION: The findings of this study indicate that periodontists believe that tobacco-cessation interventions are a responsibility of the dental profession; however, because of several perceived barriers, reported rates of comprehensive tobacco interventions in periodontal practices are low.

Students' attitudes toward integrating problem-based learning into a D.D.S. pharmacology curriculum.

The purpose of this study was to determine student perceptions of the methods used to teach pharmacology content via problem-based learning (PBL) cases with respect to students' comprehension and application of pharmacology content, confidence in their own pharmacology knowledge after completion of PBL instruction, and confidence in treating clinical patients who are taking multiple medications. Our hypothesis was that the most effective presentation of pharmacology content is one that focuses on broad drug classes and includes a pharmacology assignment, a post-assignment group discussion and consensus, and a graded group response for the assignment. Via a five-question survey instrument, we assessed the students' perceptions of pharmacology education and learning of pharmacology concepts through PBL. Survey responses were anonymous, and results were reported as aggregate data. The survey statements were answered on a five-point Likert scale with 1 indicating strong disagreement and 5 indicating strong agreement. The percentage of each class that completed the survey was as follows: first years, 96 percent (n=97); second years, 92 percent (n=94); third years, 87 percent (n=91); and fourth years, 95 percent (n=73). A trend in the data shows that the closer the student is to graduation, the less he or she valued the pharmacology knowledge taught in PBL. Their responses seem to indicate that the newer teaching methods, a pharmacology assignment, a post-assignment group discussion and consensus, and a graded group response for the assignment employed in PBL cases lead to better understanding of pharmacology concepts and confidence in the students' own pharmacology knowledge.

Concrescence: report of a rare case.

Concrescence represents an uncommon developmental anomaly in which juxtaposed teeth are united in the cementum but not in the dentin. The incidence of concrescent teeth is reported to be highest in the posterior maxilla. The presence of concrescent teeth may influence surgical procedures as well as periodontal, endodontic and even orthodontic diagnoses and treatment. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning. The purpose of this article is to report a case of concrescence between an impacted third molar and an erupted second molar that was identified postextraction.

Introduction to nutrition and oral health.

Nutrition is vital to human growth, development, and life maintenance and, as such, is also important to oral health. Dietary nutrients include carbohydrates, proteins, fats, vitamins, minerals, and water. This article reviews these nutrients, their functions and sources, and how they relate to oral health and disease. Concepts about which the oral health care provider must be aware in order to counsel patients regarding the impact of diet on oral health and toward healthy lifestyle choices are discussed.