Elevated Salivary Inflammatory Biomarkers are Associated with SARS-CoV-2 Infection Severity.

High levels of inflammatory cytokines in serum have been reported in patients with severe SARS-CoV-2 infection. There is growing interest in recognizing the role of inflammatory biomarkers in saliva in diagnosing systemic diseases. This study assumed that estimating biomarkers in saliva samples from patients infected with SARS-CoV-2 would distinguish between mild and severe cases. Saliva was collected from 142 controls and 158 SARS-CoV-2 patients (mild 72 and severe 86) to measure interleukin-6 (IL-6), C-reactive protein (CRP), and C-X-C motif chemokine ligand-10 (CXCL-10). IL-6 and CXCL-10 were significantly increased in patients with mild and severe SARS-CoV-2 infections. CRP was significantly increased only in severe SARS-CoV-2 cases. All biomarkers were significantly higher in severe cases than in mild cases (p < 0.001). Among patients with SARS-CoV-2 infection, men showed significantly higher CRP and CXCL-10 levels than females (p < 0.01 and 0.05, respectively). In addition, elderly patients (40-80 years) had significantly higher IL-6, CRP, and CXCL-10 (p < 0.001). Patients with diabetes and hypertension showed elevated IL-6, CRP, and CXCL-10 (p < 0.001). There was a significant positive correlation between IL-6, CRP, CXCL-10, and between age, IL-6, CRP, and CXCL-10. Saliva may have a future value in measuring the inflammatory biomarkers associated with the severity of SARS-CoV2 infection and therapeutic monitoring.

The role of lip thickness in upper lip response to sagittal change of incisor position.

OBJECTIVES: To investigate the association between upper lip thickness and the amount of upper lip repositioning upon retraction of maxillary incisors. SETTING AND SAMPLE POPULATION: Pre- and post-treatment lateral cephalograms of 101 patients were reviewed. All subjects were treated with fixed orthodontic appliances including extraction of two maxillary premolars. Only subjects without change in lip thickness between pre- and post-treatment cephalograms were included. MATERIAL AND METHODS: Digital software measurements for lip thickness, pre- and post-treatment upper lip position were performed. Appropriate regression models were developed to explore the correlation between maxillary incisor retraction and lip retraction when controlling for lip thickness and other confounding factors. The level of statistical significance was set at 0.05 for all analyses. RESULTS: A significant correlation was found between change in maxillary incisor position following premolars extraction and change in upper lip position (r = 0.95, P < 0.001). The average ratio between maxillary incisor retraction and upper lip repositioning was 1.43:1. Upper lip thickness was not significantly associated with this ratio (r = 0.003, P > 0.05). CONCLUSION: Although there is a highly significant correlation between maxillary incisor retraction and upper lip repositioning, lip thickness is not significantly associated with the amount of repositioning.

Efficacy of collagen matrix seal and collagen sponge on ridge preservation in combination with bone allograft: A randomized controlled clinical trial.

AIM: To test whether the use of collagen matrix seal (CMS) results in similar hard and soft tissue remodelling to that with collagen sponge (CS) used as barriers 4 months following alveolar ridge preservation (ARP), in combination with freeze-dried bone allograft (FDBA). MATERIALS AND METHODS: Twenty-eight patients were randomly assigned to the two groups. Clinical and radiographic measurements were recorded with the same stent at baseline and 4 months for standardization. The flapless technique following a traumatic extraction was used for the two types of barriers. RESULTS: All patients completed the study, 14 in the CMS group and 14 in the CS group. Reduction in coronal ridge width (1.21 mm-14.91% CMS and 1.47 mm-20.40% CS) and vertical buccal bone resorption (0.30 mm CMS and 0.79 mm CS) were not significantly different. A slight increase in buccal gingival thickness at the coronal part was observed in both groups (0.9 mm CMS and 0.5 mm CS). CONCLUSIONS: Collagen matrix seal and CS, when combined with FDBA, significantly minimized ridge resorption in all dimensions and maintained buccal soft tissue thickness in sockets with a buccal plate loss of <2 mm in comparison to previously reported findings recorded after tooth extraction without ARP.

Development of Short-Form Versions of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study.

BACKGROUND: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item questionnaire designed to assess risk of aberrant medication-related behaviors in chronic pain patients. The introduction of short forms of the SOAPP-R may save time and increase utilization by practitioners. OBJECTIVE: To develop and evaluate candidate SOAPP-R short forms. DESIGN: Retrospective study. SETTING: Pain centers. SUBJECTS: Four hundred and twenty-eight patients with chronic noncancer pain. METHODS: Subjects had previously been administered the full-length version of the SOAPP-R and been categorized as positive or negative for aberrant medication-related behaviors via the Aberrant Drug Behavior Index (ADBI). Short forms of the SOAPP-R were developed using lasso logistic regression. Sensitivity, specificity, and area under the curve (AUC) of all forms were calculated with respect to the ADBI using the complete data set, training-test analysis, and 10-fold cross-validation. The coefficient alpha of each form was also calculated. An external set of 12 pain practitioners reviewed the forms for content. RESULTS: In the complete data set analysis, a form of 12 items exhibited sensitivity, specificity, and AUC greater than or equal to those of the full-length SOAPP-R (which were 0.74, 0.67, and 0.76, respectively). The short form had a coefficient alpha of 0.76. In the training-test analysis and 10-fold cross-validation, it exhibited an AUC value within 0.01 of that of the full-length SOAPP-R. The majority of external practitioners reported a preference for this short form. CONCLUSIONS: The 12-item version of the SOAPP-R has potential as a short risk screener and should be tested prospectively.

Patients' expectations about effects of chemotherapy for advanced cancer.

BACKGROUND: Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative. METHODS: We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national, prospective, observational cohort study) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer. We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records. RESULTS: Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient's role in decision making were not associated with such inaccurate beliefs about chemotherapy. CONCLUSIONS: Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them. (Funded by the National Cancer Institute and others.).

Shortening the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study for Customized Computer-Based Testing.

BACKGROUND: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument that was developed to aid providers in predicting aberrant medication-related behaviors among chronic pain patients. Although the SOAPP-R has garnered widespread use, certain patients may be dissuaded from taking it because of its length. Administrative barriers associated with lengthy questionnaires further limit its utility. OBJECTIVE: To investigate the extent to which two techniques for computer-based administration (curtailment and stochastic curtailment) reduce the average test length of the SOAPP-R without unduly affecting sensitivity and specificity. DESIGN: Retrospective study. SETTING: Pain management centers. SUBJECTS: Four hundred and twenty-eight chronic non-cancer pain patients. METHODS: Subjects had taken the full-length SOAPP-R and been classified by the Aberrant Drug Behavior Index (ADBI) as having engaged or not engaged in aberrant medication-related behavior. Curtailment and stochastic curtailment were applied to the data in post-hoc simulation. Sensitivity and specificity with respect to the ADBI, as well as average test length, were computed for the full-length test, curtailment, and stochastic curtailment. RESULTS: The full-length SOAPP-R exhibited a sensitivity of 0.745 and a specificity of 0.671 for predicting the ADBI. Curtailment reduced the average test length by 26% while exhibiting the same sensitivity and specificity as the full-length test. Stochastic curtailment reduced the average test length by as much as 65% while always exhibiting sensitivity and specificity for the ADBI within 0.035 of those of the full-length test. CONCLUSIONS: Curtailment and stochastic curtailment have potential to improve the SOAPP-R's efficiency in computer-based administrations.

Variable length testing using the ordinal regression model.

Health questionnaires are often built up from sets of questions that are totaled to obtain a sum score. An important consideration in designing questionnaires is to minimize respondent burden. An increasingly popular method for efficient measurement is computerized adaptive testing; unfortunately, many health questionnaires do not meet the requirements for this method. In this paper, a new sequential method for efficiently obtaining sum scores via the computer is introduced, which does not have such requirements and is based on the ordinal regression model. In the assessment, future scores are predicted from past responses, and when an acceptable level of uncertainty is achieved, the procedure is terminated. Two simulation studies were performed to illustrate the usefulness of the procedure. The first used artificially generated symptom scores, and the second was a post hoc simulation using real responses on the Center for Epidemiologic Studies Depression scale. In both studies, the sequential method substantially reduced the respondent burden while maintaining a high sum score quality. Benefits and limitations of this new methodology are discussed.

An in vitro comparison of shear bond strength of zirconia to enamel using different surface treatments.

PURPOSE: The purpose of this in vitro study was to compare the shear bond strength of an airborne-particle abraded zirconia, an acid-etched zirconia (Piranha solution), an Alloy Primer treated zirconia, and a silaned zirconia to enamel, all bonded with a phosphate-methacrylate resin luting agent. MATERIALS AND METHODS: Seventy extracted intact human molars were collected, cleaned, and mounted in autopolymerizing acrylic resin, with the experimental surface of the teeth exposed. The specimens were randomly divided into seven groups of zirconia specimens (4 mm diameter, 2 mm thick). Group 1: Airborne-particle abrasion; group 2: Airborne-particle abrasion and Z-PRIME Plus; group 3: Airborne-particle abrasion and alloy primer; group 4: Piranha solution 7:1; group 5: Piranha solution 7:1 and Z-PRIME Plus; group 6: Piranha solution 7:1 and Alloy primer; group 7: CoJet and silane. All specimens were luted with a phosphate-methacrylate resin luting agent (Panavia F2.0) and stored in distilled water for 1 day, then thermocycled (5°C and 55°C) for 500 cycles and tested for shear bond strength (SBS), measured in MPa, with a universal testing machine at a 0.55 mm/min crosshead speed. All specimens were inspected under a scanning electron microscope to determine mode of failure. The mean values and standard deviations of all specimens were calculated for each group. A one-way ANOVA was performed, and multiple pairwise comparisons were then completed with post hoc Tukey test (alpha = 0.05). RESULTS: The airborne-particle abrasion and Z-PRIME Plus group resulted in a significantly higher SBS than the other groups (21.11 ± 6.32 MPa) (p < 0.001). The CoJet and silane group (15.99 ± 8.92 MPa) and airborne-particle abrasion and alloy primer group (11.07 ± 4.34 MPa) showed high shear bond strength but not statistically significant from the airborne-particle abrasion group (14.23 ± 5.68 MPa). Failure mode was predominately mixed in groups 1, 2, 3, and 7 with islands of retained resin on the zirconia and enamel surfaces; however, groups 4, 5, and 6 showed mostly adhesive failures, which left the zirconia surface free of the adhesive materials. No cohesive failures of the substrates (ceramic, resin, or enamel) were observed. CONCLUSION: Airborne-particle abrasion followed by the application of a zirconia primer produced the highest bond strength to enamel. Therefore, it can be recommended as a promising surface treatment method to achieve a durable bond to densely sintered zirconia ceramics.

The effect of variations in translucency and background on color differences in CAD/CAM lithium disilicate glass ceramics.

PURPOSE: The purpose of this study was to compare the effect of variations in translucency and background on color differences (ΔE) for different shades of computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate glass ceramics. MATERIALS AND METHODS: A pilot study suggested n = 10 as an appropriate sample size for the number of lithium disilicate glass ceramic cylinders per group. High-transparency (HT) and low-transparency (LT) cylinders (diameter, 12 mm; length, 13 mm) were fabricated in three ceramic shades (BL1, A2, C3) using CAD/CAM technology and were cut into specimen disks (thickness, 1.2 mm; diameter, 12 mm) for placement on Natural Die (ND1 and ND4) backgrounds. Four combinations of translucency and background color were evaluated in terms of color differences for the three ceramic shades: group 1 (HT ND1, reference), group 2 (HT ND4), group 3 (LT ND1), and group 4 (LT ND4). A spectrophotometer was used to measure the color differences. Nonparametric tests (Kruskal-Wallis tests) were used to evaluate the color differences among the tested groups, and Mann-Whitney U tests with Bonferroni correction were used as post hoc tests. Furthermore, for each ceramic shade, the HT groups were compared to the LT groups using the Mann-Whitney U test. RESULTS: Significant differences were present among the tested groups of the same ceramic shade (p < 0.001). The highest ΔE values were observed in the HT ND4 group for BL1, while the lowest ΔE values were found in the LT ND1 group for both A2 and C3. Further, the HT groups and the groups with a darker background (ND4) showed increased ΔE values compared with the other groups (p < 0.001). CONCLUSIONS: Within the limitations of this study, the results suggested that the translucency and background color significantly influenced the lithium disilicate glass ceramic color among the BL1, A2, and C3 ceramic shades. Changing the underlying color from a lighter background to a darker background resulted in increased color differences.

Dental needs and conditions of individuals with Lowe syndrome: An observational study.

INTRODUCTION: Lowe syndrome (LS) is an uncommon condition that affects the brain, kidneys, nervous system, and eyes, predominantly in males. The aim of this study was to examine dental conditions, dental treatments, and access and/or barriers to care for those with LS compared to healthy individuals. METHODS: Surveys assessing dental conditions, dental treatments, and access and/or barriers to care were administered to families in the Lowe Syndrome Association and families with healthy children who had dental appointments at the Tufts University School of Dental Medicine (TUSDM) pediatric dental clinic. One parent or a guardian of pediatric patients with LS or not at TUSDM was asked to complete an online survey. RESULTS: One hundred and eight surveys were obtained (n:58 from the LS group and n:50 from the healthy group). The LS group was significantly more likely (p < .05) to report "crooked/misaligned teeth," "difficult time chewing," "bad breath," and "mouth cysts" and was significantly less likely to report 6-month examination, "cleaning," and "filling." The LS group reported significantly greater difficulty locating a dentist. CONCLUSION: The findings of this study indicate that individuals with LS are more vulnerable to developing severe dental conditions and experiencing difficulties in accessing dental care than healthy individuals. Additionally, those who present with this syndrome may be less likely to receive specific necessary dental treatments. As a result, it is essential to offer appropriate dental care and support to individuals with LS to guarantee they achieve optimal oral health.

Depressive symptoms and their correlates among predoctoral dental students in the United States.

OBJECTIVE: To investigate the prevalence of self-reported depressive symptoms among predoctoral dental students in the United States and examine potential correlates. METHODS: A survey was emailed to all 66 dental schools in the United States, inviting them to distribute it to their predoctoral students. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Data collection occurred from February to April 2020. Multivariable ordinal logistic regression was used to assess associations between demographic variables and depressive symptom severity category, adjusting for potential confounding. RESULTS: Of an estimated 25,000 predoctoral dental students at the 66 schools, 631 students from 21 schools completed the survey. A total of 24.1% were categorized as having minimal or no depressive symptoms, 33.6% as having mild depressive symptoms, and 42.3% as having moderate, moderately severe, or severe depressive symptoms. Gender (p = 0.015) and race/ethnicity (p = 0.002) were significant predictors of severity, adjusting for other variables. Students identifying as female had higher odds of self-reporting greater depressive severity symptoms compared with students identifying as male. Students identifying as African American/Black (non-Hispanic) and Asian/Pacific Islander had higher odds of self-reporting greater depressive severity symptoms compared with students identifying as White. CONCLUSION: There is evidence of a high prevalence of depressive symptoms among predoctoral dental students in the United States. Demographic variables may be risk indicators within this population. Approaches to reduce depressive symptoms among US predoctoral dental students are needed.

An investigation of the association between parenting style and child's dental caries: a cross-sectional study.

To investigate the association between parenting style and child's dental caries. Parents presenting with their children to the Department of Pediatric Dentistry at Tufts University School of Dental Medicine for an initial exam or re-care appointment completed a demographic survey and the parenting styles and dimensions questionnaire. Recruitment of subjects started in May 2019 and ended in February of 2020. Child's decayed, missing, and filled teeth (dmft) index, diet score, sex, and age were recorded, as were parent's race, education level, and form of payment. Adjustment for confounders was done using multivariable negative binomial regression. The sample size was 210 parent/child dyads. In the multivariable analysis, parenting style and child's dmft were not significantly associated (p > 0.05). Parents with an education level less than high school (p = 0.02) and at the high school graduate level (p = 0.008) were significantly associated with children who had higher dmft, compared to parents with a college degree or higher. Children with excellent diet scores had significantly lower dmft than children with a diet score in the "needs improvement" category (p = 0.003). There was no significant evidence that parenting style is associated with child's dental caries. Parent's education level and child's diet score were significantly associated with child's dmft, less than high school (p = 0.02) and at the level of high school graduate (p = 0.008). Pediatric dental professionals should be aware of these risk indicators.

A retrospective case series on bisphosphonate related osteonecrosis of the jaw in 20 cats.

Introduction: This retrospective study highlights the salient aspects of a series of feline patients affected with bisphosphonate related osteonecrosis of the jaw. Though more commonly published in human literature, this presentation is rare in cats. The authors hope that this study will assist in making this a more globally known entity with subsequent improved prognosis. Methods: Data was retrospectively obtained from the medical records between 2015 and 2021 of 20 cats with Medication Related Osteonecrosis of the Jaw. Data included patient information, clinical history, presenting complaint, systemic diseases, details referable to hypercalcemia and treatment thereof, bisphosphonate specifics (dose and duration), clinical presentation of the lesion, diagnostic testing including radiographic and histopathologic descriptions, treatment, and outcome. Results: Pertinent results include that all 20 cats who developed Medication Related Osteonecrosis of the Jaw had been treated for idiopathic hypercalcemia with the bisphosphonate medication alendronate. Eighty-five percent of the cases had prior dental extractions at the site of MRONJ lesion. Ninety-five percent of the affected cats required a surgical procedure to control the disease. Thirty-five percent of cases required at least one revision surgery after the initial procedure was performed. Diagnosis of MRONJ was made by a correlation of diagnostic findings and patient history. No single diagnostic, or combination was pathognomonic for lesion diagnosis. As well, there were no statistically significant associations between patient variables assessed and the overall patient outcome. Discussion: The case series reveals that cats with feline idiopathic hypercalcemia treated with alendronate may be at a risk for development of MRONJ, a serious oral condition with significant morbidity. Prior dental extraction sites in patients concurrently treated with bisphosphonate medications were often associated with MRONJ lesions. Therefore, any needed dental surgery should be performed prior to the use of bisphosphonates where possible. The authors have also included a relevant comparative literature review.

Shortening the Current Opioid Misuse Measure via computer-based testing: a retrospective proof-of-concept study.

BACKGROUND: The Current Opioid Misuse Measure (COMM) is a self-report questionnaire designed to help identify aberrant drug-related behavior in respondents who have been prescribed opioids for chronic pain. The full-length form of the COMM consists of 17 items. Some individuals, especially compromised individuals, may be deterred from taking the full questionnaire due to its length. This study examined the use of curtailment and stochastic curtailment, two computer-based testing approaches that sequentially determine the test length for each individual, to reduce the respondent burden of the COMM without compromising sensitivity and specificity. METHODS: Existing data from n = 415 participants, all of whom had taken the full-length COMM and had been classified via the Aberrant Drug Behavior Index (ADBI), were divided into training (n = 214) and test (n = 201) sets. Post-hoc analysis of the test set was performed to evaluate the screening results and test lengths that would have been obtained, if curtailment or stochastic curtailment had been used. Sensitivity, specificity, and average test length were calculated for each method and compared with the corresponding values of the full-length test. RESULTS: The full-length COMM had a sensitivity of 0.703 and a specificity of 0.701 for predicting the ADBI. Curtailment reduced the average test length by 22% while maintaining the same sensitivity and specificity as the full-length COMM. Stochastic curtailment reduced the average test length by as much as 59% while always obtaining a sensitivity of at least 0.688 and a specificity of at least 0.701 for predicting the ADBI. CONCLUSIONS: Curtailment and stochastic curtailment have the potential to achieve substantial reductions in respondent burden without compromising sensitivity and specificity. The two sequential methods should be considered for future computer-based administrations of the COMM.

Correlates of burnout in predoctoral dental students in the United States.

OBJECTIVE: The purpose of this research was to investigate correlates of burnout among predoctoral dental students in the United States. METHODS: All 66 dental schools in the US were invited to distribute a survey on topics such as demographics, year of dental school, and burnout to their predoctoral students. Burnout was assessed via the Maslach Burnout Inventory-Human Services Survey, which has three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Multivariable modeling was conducted via generalized linear models using the lognormal distribution to adjust for confounding. RESULTS: The survey was completed by 631 students from 21 dental schools. When adjusting for confounding, students identifying as African American/Black (Non-Hispanic) (regression coefficient [95% CI]: -0.13 (-0.23, -0.02]) or Asian/Pacific Islander (-0.08 [-0.13, -0.02]) reported feeling significantly lower PA than students identifying as white. Students identifying as female reported feeling significantly greater EE (0.18 [0.10, 0.26]), but significantly less DP (-0.26 [-0.44, -0.09]), than students identifying as male. Third- (0.28 [0.07, 0.50]) and fourth-year (0.40 [0.17, 0.63]) students reported significantly higher EE than first-year students, while second- (0.40 [0.18, 0.62]), third- (1.06 [0.59, 1.53]), and fourth-year (1.31 [0.82, 1.81]) students reported significantly higher DP than first-year students. CONCLUSIONS: Risk indicators for burnout among US predoctoral dental students may depend on the dimension of burnout. Identifying those at higher risk of burnout can facilitate the implementation of counseling and other effective intervention strategies. Such identification can also provide insight into how the dental school environment might be contributing to the marginalization of those at higher risk.

Incidental Findings in Small Field of View Cone-beam Computed Tomography Scans, Part 2: Interpretation with Aid of a Checklist.

INTRODUCTION: Cone-beam computed tomography (CBCT) scans are routinely used by endodontic residents and faculty at Tufts University School of Dental Medicine for diagnostic purposes but are not routinely read for pathologic findings by a radiologist. In a 2017 study by Oser et al (part 1), endodontic residents and a radiologist interpreted CBCT scans taken for endodontic diagnostic purposes, and their findings were compared. The results demonstrated that a radiologist is significantly more likely to report incidental findings in small field of view (FOV) scans. A limitation of this study was that the radiologist used a checklist of common findings to review the scans. The purpose of this study was to examine whether the use of a checklist would improve the sensitivity of the endodontic residents' reporting of incidental findings in small FOV CBCT scans. METHODS: The 203 small FOV CBCT scans used in part 1 were obtained and reviewed by endodontic residents in a systematic fashion. Radiographic findings were reported using a blank checklist. The results were compared with those previously reported. RESULTS: The radiologist reported abnormalities in 176 of the 203 subjects (87%), and the residents reported abnormalities in 184 of the 203 subjects (91%). There was an increase in false positive findings when the residents were using a checklist. CONCLUSIONS: The use of a checklist improved the sensitivity but decreased the specificity of the reporting of incidental findings in small FOV CBCT scans by endodontic residents.

Assessment of implementation of the caries management by risk assessment philosophy in a dental school.

OBJECTIVE: This cross-sectional study assessed the implementation of documenting a baseline caries risk assessment (CRA) of patients seen by predoctoral dental students and its association with the presence of caries risk management (CRM) treatment. METHODS: A convenience sample of 10,000 electronic axiUm patient records at Tufts University School of Dental Medicine was retrospectively assessed for the presence or absence of a completed CRA and CRM after IRB approval following predetermined inclusion and exclusion criteria. The CRM variables (nutrition counseling, sealant, fluoride) were identified by procedure codes that were completed by the student. Associations were assessed via the chi-square test, Kruskal-Wallis test (with Dunn's test and the Bonferroni correction used in post-hoc tests) and Mann-Whitney U test. RESULTS: Most patients (70.5%) had a CRA completed. However, only 24.9% (out of the 7045 patients with a completed CRA) received CRM, while 22.9% of the 2,955 patients without a CRA received CRM. The difference between the groups with and without a completed CRA in terms of the percentage receiving CRM was not clinically significant. Significant associations were found between a completed CRA and in-house fluoride treatment (p = .034) and between a completed CRA and sealant treatment (p = .001). Patients with higher baseline CRA levels (i.e., greater risk) were more likely to have CRM (16.9% of the 785 patients at low risk, 21.1% of the 1282 patients at moderate risk, 26.3% of the 4347 patients at high risk, and 32.6% of the 631 patients at extreme risk). The association between these two variables was significant (p < .001). CONCLUSION: There is evidence that students were mostly compliant with completing a CRA for most patients; however, there is a deficiency in implementation of CRM approach to help support dental caries management, and there is still much room for improvement.

Evaluating a dental sleep apnea mini-residency program using the Kirkpatrick model.

OBJECTIVE: The aim of this retrospective study was to evaluate a Dental Sleep Medicine Mini-Residency (DSMMR) continuing education (CE) program using the Kirkpatrick model. METHODS: After receiving ethical approval, data from participants in the 2019-2020 DSMMR CE course were included for the Kirkpatrick evaluation. The analysis was stratified and all the Kirkpatrick levels were integrated: level 1 (satisfaction) was assessed via Likert scale and open-ended questions; level 2 (learning) was evaluated using pretest and posttest knowledge data following Module 1 (M1) and an assessment of multiple-choice questions (MCQs) developed by participants; level 3 (behavior) was evaluated using Likert scale questions; and level 4 (results) was assessed via the percentage of participants who passed the American Board of Dental Sleep Medicine (ABDSM) examination on their first attempt. RESULTS: A total of 90 participants were included in the study. At least 83.1% of participants agreed/strongly agreed with positively worded statements about satisfaction. Knowledge scores significantly increased from pre-M1 to post-M1 (p < 0.001); however, only 15.2% of MCQs were evaluated as well-formulated. At least 88.6% of participants agreed/strongly agreed with positively worded statements about transfer of knowledge/skills to their practice. 91.1% passed the ABDSM examination on their first attempt. CONCLUSION: The evaluation of the 2019-2020 DSMMR using the Kirkpatrick model suggests its overall positive impact as a training program. The Kirkpatrick model provided information that can be used to improve the quality of a program. Future studies should assess other dental CE programs using the Kirkpatrick model or another evaluation model.

Shear bond strength of seventh generation bonding agents on dentin of primary teeth--an in vitro study.

This controlled, randomized, in vitro study evaluated the shear bond strength of several seventh generation bonding agents on the dentin of primary teeth. Six different adhesives were used: Xeno IV, Clearfil S3 Bond, Adper Prompt-L-Pop, AdheSE One, Bond Force, and Optibond (control). Ninety primary teeth were prepared by wet grinding with a 320-grit silicon carbide paper on a polishing wheel running at 110 RPM. After 24 hours of storage in water, shear bond strengths of each group were determined. The mean shear bond strength of the tested adhesive systems to primary dentin was 12.27 MPa. One-way ANOVA testing showed a statistically significant difference between adhesive products (P < 0.001). Tukey HSD post hoc tests were used to assess which means were significantly different from one another. There was no statistically significant difference between the fifth generation adhesive system (Optibond) and the two seventh generation systems (Xeno IV and Bond Force), with Optibond exhibiting a lower mean shear bond strength compared to Bond Force. Within the limitations of this study, there is a significant difference between seventh generation bonding materials. Bond Force and Optibond appear to exhibit higher shear bond strengths than the other products.

Stochastic curtailment of health questionnaires: a method to reduce respondent burden.

Stochastic curtailment is a sequential method to terminate a study when continuing to the end would be unlikely to change the outcome. This method has been researched most commonly in the context of clinical trials. The current paper explores its use in a different setting: the administration of a health questionnaire to patients via computer. A classification procedure augmenting logistic regression with stochastic curtailment is introduced to avoid burdening the patients with unnecessary questions. In a real-data simulation using responses from the Medicare Health Outcomes Survey, the new procedure substantially reduced the average number of questions administered with a minimal loss of classification accuracy.