A Scoping Review of the Relation Between Toothbrushing and Diabetes Knowledge, Glycemic Control, and Oral Health Outcomes in People With Type 2 Diabetes.

Objective: Given the bidirectional relationship between type 2 diabetes and periodontal disease, this study sought to compile the available data regarding the relationship between home oral hygiene, specifically toothbrushing, and glycemic control and oral health in people with type 2 diabetes. Methods: A systematic scoping review was conducted using a combination of controlled vocabulary and keyword terms for type 2 diabetes and home oral care in PubMed and CINHAL. Publications from the past 20 years were considered for inclusion. Study data were summarized. Results: A total of 11 studies met our inclusion criteria. In all survey research identified, self-report of more frequent toothbrushing in people with type 2 diabetes was always found to be associated with self-report of better glycemic control and was often associated with better clinician-conducted measures oral health. In the interventional studies identified, health coaching about oral health was associated with improvements in glycemic control, and health coaching compared with health education was found to be associated with enhanced improvement in glycemic control and self-reported toothbrushing behavior. Conclusion: The available data suggest that improved engagement in toothbrushing behavior may be associated with improved oral health and better glycemic control in people with type 2 diabetes. Whether improvement in glycemic control is a direct result of change to the oral environment, succeeding with one behavior change stimulating engagement in other health behavior changes, a combination of the two, or something else cannot be determined from this review. Additional studies are needed to further explore the potential for oral health coaching to improve the well-being of people with type 2 diabetes.

Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes--United States, 2011-2012.

Diabetes is a complex chronic disease that requires active involvement of patients in its management. Diabetes self-management education and training (DSMT), "the ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care," is an important component of integrated diabetes care. It is an intervention in which patients learn about diabetes and how to implement the self-management that is imperative to control the disease. The curriculum of DSMT often includes the diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making. The American Diabetes Association recommends providing DSMT to those with newly diagnosed diabetes, because data suggest that when diabetes is first diagnosed is the time when patients are most receptive to such engagement. However, little is known about the proportion of persons with newly diagnosed diabetes participating in DSMT. CDC analyzed data from the Marketscan Commercial Claims and Encounters database (Truven Health Analytics) for the period 2009-2012 to estimate the claim-based proportion of privately insured adults (aged 18-64 years) with newly diagnosed diabetes who participated in DSMT during the first year after diagnosis. During 2011-2012, an estimated 6.8% of privately insured, newly diagnosed adults participated in DSMT during the first year after diagnosis of diabetes. These data suggest that there is a large gap between the recommended guideline and current practice, and that there is both an opportunity and a need to enhance rates of DSMT participation among persons newly diagnosed with diabetes.

Declining US dental amalgam restorations in US Food and Drug Administration-identified populations: 2017-2023.

BACKGROUND: In light of the Minamata Convention on Mercury and efforts to phase down dental amalgam use, tracking dental amalgam proportions across US Food and Drug Administration (FDA)-identified at-risk populations is of interest to optimize material selection aligned with patient needs. METHODS: A retrospective observational study of Epic's Cosmos electronic health records data set was conducted to calculate the rates of dental amalgam restorations from 2017 through 2023 and stratified using the social vulnerability index (quartile 4 indicates the highest social vulnerability and quartile 1 indicates the lowest) and payer type (Medicare, Medicaid, self-pay, miscellaneous or other). The authors included the following FDA-identified at-risk populations: pregnant people, children younger than 6 years, people with preexisting neurologic conditions, and people with impaired kidney function (n = 1,897,976). RESULTS: The overall rate of dental amalgam restoration placements in the general population declined from 21.8% in 2017 to 4.1% in 2023. Dental amalgam restoration trends, according to social vulnerability index quartile and payer type, decreased consistently across all 4 evaluated populations. Of all the social vulnerability index quartiles, quartile 4, representing the most socially vulnerable group, had the smallest decrease in dental amalgam placement rates among the FDA-identified populations examined. CONCLUSIONS: The study results showed a decreasing trend in dental amalgam restorations from 2017 through 2023 among FDA-identified populations, consistent with the Minamata Convention on Mercury directive for a phasedown in dental amalgam use. Notwithstanding improvements, lingering disparities persist among the most vulnerable population. PRACTICAL IMPLICATIONS: Even within the groups identified as most vulnerable to harm, more targeted interventions and strategies are required to improve treatment among the most socially vulnerable.

Dental unit waterline infection control practice and knowledge gaps.

BACKGROUND: Dental unit waterline (DWL) infection control is critical to infection prevention. Identifying challenges and barriers to its implementation is a first step toward understanding how to improve engagement. METHODS: A survey was distributed to dentists, dental hygienists, and dental assistants via the Qualtrics XM platform (Qualtrics). Responses were analyzed to quantify engagement in practices contrary to Centers for Disease Control and Prevention guidance and identify avenues to improve engagement. RESULTS: Although oral health care providers recognized DWL infection control was important, there was a lack of clarity about appropriate routine engagement (eg, what lines should be tested), what should be noted in practice infection control records, and steps to be taken in response to a failed test result (ie, ≥ 500 colony-forming units/mL), such as taking a chair out of service. CONCLUSIONS: Survey results showed there were considerable gaps in knowledge and practice that could lead to patient harm. Oral health care provider training may not prepare personnel adequately to engage in, let alone supervise, DWL infection control. DWL infection control, like other aspects of infection control, requires action informed via an understanding of what needs to be done. Although good intentions are appreciated, better approaches to DWL infection control information dissemination and strategies to engage dental assistants, dental hygienists, and dentists in best practices are needed. PRACTICAL IMPLICATIONS: Evolving standards of care, including infection control, should be reflected in the provision of dental treatment. Improvements in communicating and ensuring engagement in best practices are needed when it comes to DWL infection control.

Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations.

BACKGROUND: The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory guidance regarding dental radiography and cone-beam computed tomography. An expert panel presents recommendations on radiation safety, appropriate imaging practices, and reducing radiation exposure. TYPES OF STUDIES REVIEWED: A systematic search run in Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews identified relevant topical systematic reviews, organizational guidelines, and regulatory reviews published in the peer-reviewed literature since 2010. A supplemental search of the gray literature (eg, technical reports, standards, and regulations) identified topical nonindexed publications. Inclusion criteria required relevance to primary oral health care (ie, general or pediatric dentistry). RESULTS: A total of 95 articles, guidance documents, and regulations met the inclusion criteria. Resources were characterized as applicable to all modalities, operator and occupational protection, dose reduction and optimization, and quality assurance and control. PRACTICAL IMPLICATIONS: Understanding factors affecting imaging safety and applying fundamental principles of radiation protection consistent with federal, state, and local requirements are essential for limiting patient ionizing radiation exposure, in conjunction with implementing optimal imaging procedures to support prudent use of dental radiographs and cone-beam computed tomographic imaging. The regulatory guidance and best practice recommendations summarized in this article should be followed by dentists and other oral health care providers.

Posterior dental restoration material choices in privately insured people in the United States, 2017 through 2019.

BACKGROUND: In the context of evolving dental materials and techniques and a national agenda to phasedown use of dental amalgam, estimates of dental amalgam placement are necessary for monitoring purposes. METHODS: Numbers of amalgam and composite posterior restorations from 2017 through 2019 were calculated using retrospective dental claims analysis of privately insured patients. Kruskal-Wallis and multilevel, multivariable negative binomial regression models were used to test for differences in rates of amalgam and composite restoration placement by age group, sex, urban or rural area, and percentage race and ethnicity area distribution. Statistical significance was set at 0.05, with Benjamini-Hochberg correction for false discovery rate. RESULTS: The rate of amalgam restorations declined over time from a mean of 6.29 per 100 patients in 2017 to 4.78 per 100 patients in 2019, whereas the composite restoration rate increased from 27.6 per 100 patients in 2017 to 28.8 per 100 in 2019. The mean number of amalgam restorations placed per person were lowest in females compared with males, in urban areas compared with rural areas, and in areas with more than 75% non-Hispanic White residents. CONCLUSIONS: Amalgam restoration placements in privately insured people in the United States declined from 2017 through 2019. Amalgam restoration placements may be unevenly distributed by location. PRACTICAL IMPLICATIONS: Achieving further declines of dental amalgam use may require changes to insurance coverage, incentives, and provider training as well as augmented disease prevention and health promotion efforts. These efforts should focus particularly on groups with high caries risk or higher rates of amalgam placement.

Antibiotic prescription patterns among US general dentists and periodontists.

BACKGROUND: In the absence of a full spectrum of evidence-based guidelines for the appropriate use of antimicrobial agents, dentists, including periodontists, remain a highly frequent antibiotic prescribing group. With the goal of understanding antibiotic prescribing practices, the authors surveyed a convenience sample of dental practitioners and periodontists to identify differences between the 2 cohorts and assess the factors that affect prescribing practices. METHODS: An institutional review board-approved 15-item survey was developed to capture antibiotic prescribing practices addressing the main research question, factors affecting systemic antibiotic prescription patterns, and prescription timing. The authors collaborated with the American Dental Association (ADA) and the American Academy of Periodontology (AAP) for survey dissemination. Responses were summarized using descriptive statistics. Multivariable models were developed to identify antibiotic prescription predictors. RESULTS: Overall, 32.4% of the participants prescribed systemic antibiotics with scaling and root planing. When comparing the 2 groups, the authors found that 46.4% and 18.7% of the AAP and ADA members, respectively, prescribed systemic antibiotics with scaling and root planing (P = .0001). The authors found a significant difference between the AAP and ADA groups in prescription timing (P = .01). The multivariable model revealed that practitioner sex (P = .03), AAP membership (P = .0001), and years of practitioner experience (P = .04) predicted antibiotic prescription practices. The geographic location, practice setting, and occupation type did not predict antibiotic prescription patterns. CONCLUSION: The authors found a lack of clarity related to prescription timing, factors determining prescription patterns, and selection of patient population who would benefit more from antibiotics. PRACTICAL IMPLICATIONS: This study confirmed a lack of clarity related to antibiotic prescription patterns in combination with nonsurgical periodontal treatment.

Effect of preradiation dental intervention on incidence of osteoradionecrosis in patients with head and neck cancer: A systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC). TYPES OF STUDIES REVIEWED: The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of Recommendations Assessment, Development, and Evaluation approach. Random-effects models were used to calculate pooled relative risk estimates and hazard ratios. When meta-analysis was not possible, study-level measures of association and narrative summaries of the evidence were reported. RESULTS: Twenty-two studies were included. From the pooled, unadjusted analysis, patients undergoing pre-RT extractions may have a 55% increased risk of experiencing ORNJ (relative risk, 1.55; 95% CI, 0.85 to 2.86; very low certainty); the unadjusted pooled hazard ratio was 3.19 (95% CI, 0.99 to 10.31; very low certainty), corresponding to a possible increased hazard of developing ORNJ (very low certainty). Findings for other pre-RT procedures manipulating bone or tissue relied on limited, observational studies with low or very low certainty evidence. CONCLUSIONS: Mostly very low certainty evidence suggests that patients with HNC who need pre-RT dental intervention may have an increased risk of developing ORNJ compared with those who do not. PRACTICAL IMPLICATIONS: Maintaining optimal oral health may help reduce the need for urgent pre-RT dental treatment, potentially reducing ORNJ risk and minimizing delay of oncologic treatment in patients with HNC.

Dental amalgam restorations in nationally representative sample of US population aged ≥15 years: NHANES 2011-2016.

OBJECTIVES: Estimate the proportion of amalgam restorations among the US population. METHODS: Data from ≥15 year old clinically examined dentate participants in three 2-year survey cycles (NHANES 2011-2016) were analyzed. The 2015-2016 data include restorative material type, allowing for the first time a US estimate of amalgam-restored teeth. RESULTS: The percent of the US population with at least one restoration (65.8 ± 1.4) was relatively constant in 2011-2016. Among those with restored teeth, the mean number of teeth with amalgam restorations increased with age from 4.71 among 15-24 year olds to 7.03 among those ≥75 years. Non-Hispanic Whites with restored teeth had the highest mean of teeth with amalgam restorations (5.94), while non-Hispanic Blacks had the lowest (5.08). CONCLUSION: In 2015-2016, about half (51.5 percent) of restored teeth in the US population contained amalgam. Amalgam presence varied by age, tooth type, and race/ethnicity, but not by sex. These estimates can be used to assess future US caries prevention and dental amalgam reduction efforts.

An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Human papillomavirus (HPV) is a sexually transmitted oncovirus associated with several malignancies, including oropharyngeal squamous cell carcinoma. The 9-valent HPV vaccine can help protect against the high-risk HPV strains most commonly associated with HPV-related cancers. METHODS: The authors used an electronic survey to assess the roles of dentists and their team members in discussing the HPV vaccine, as well as administering the vaccine in a dental setting. On December 6, 2019, the authors e-mailed a survey link to the American Dental Association Clinical Evaluators (ACE) Panel (n = 813), a sample of American Dental Association member dentists. After 1 e-mail reminder, the survey closed on December 19, 2019, and the authors conducted exploratory and descriptive data analyses using SAS Version 9.4 (SAS). RESULTS: A total of 329 dentists responded to the survey, and 83 (25%) of them reported that they or their team members discuss the implications of the HPV vaccine with age-eligible patients or their parents or guardians. Dentists lead two-thirds (n = 218) of the discussions, and the clinical examination is the most frequent moment during the patient visit in which HPV-related topics are discussed. Some of the top reasons respondents mentioned for not discussing the vaccine in their practice were the perception that these discussions are best left to other health care professionals and not knowing how to address the topic with patients. If the scope of dental practice is expanded to include administering the vaccine, 125 (38%) of respondents would feel uncomfortable administering the vaccine. The most common potential barriers to administering the vaccine in a dental setting include obtaining reimbursement and vaccine management and preservation. CONCLUSIONS: The survey results suggest that dentists' comfort levels and perceived roles in discussing and administering the HPV vaccine vary. PRACTICAL IMPLICATIONS: There is a need to further define the role of dentists and their team members in the promotion and administration of the HPV vaccine. Resources for dentists and dental team members may be helpful to support professional education and communication about the HPV vaccine.

Summary of the evidence on the safety, efficacy, and effectiveness of human papillomavirus vaccines: Umbrella review of systematic reviews.

BACKGROUND: This objective of this umbrella review was to summarize the evidence on safety, efficacy, and effectiveness of human papillomavirus (HPV) vaccines in the general population. METHODS: The authors conducted a literature search and selected systematic reviews if they were published from January 2006 through November 2018, included randomized controlled trials or observational studies, related to the general population, and evaluated HPV vaccine-related clinical outcomes. The authors independently and in duplicate screened literature, extracted data, and appraised reviews using AMSTAR 2, a critical appraisal tool for systematic reviews. RESULTS: The authors selected 30 systematic reviews that included male and female participants aged 9 through 76 years from multiple countries. Reviews evaluated postvaccine seroconversion, HPV infection rates, precancerous or benign lesions, and adverse events; none of the researchers reported on oral or oropharyngeal lesions. Results from the reviews showed that, compared with those who received a placebo or non-HPV-type vaccine, HPV-vaccinated participants had statistically significantly higher rates of seroconversion and local adverse events, statistically significantly lower rates of HPV infection and condylomata lesions, and decreased rates of HPV-related precancerous lesions, which did not always attain statistical significance. CONCLUSIONS: Systematic reviews have found evidence that the available HPV vaccines are safe, effective, and efficacious against vaccine-type HPV infection and HPV-associated cellular changes, including precancerous and benign lesions. PRACTICAL IMPLICATIONS: Dentists may use this resource to better understand the literature on the potential harms and benefits of HPV vaccination.

Stress responses and baroreflex function in coronary disease.

Exaggerated pressor responses to mental stress in patients with coronary artery disease (CAD) are associated with increased risk for subsequent cardiovascular events. The integrated baroreflex gain and its mechanical and neural component were estimated and then related to the blood pressure and heart rate responses to simulated real-life stressors: mental arithmetic and public speaking. Eighteen healthy individuals (aged 61 +/- 8 yr) and 29 individuals with documented CAD but no other comorbidities (aged 59 +/- 8 yr) were studied. Heart rate and blood pressures were continuously assessed before, during preparation for, and during performance of a math task and a speech task. The assessment of beat-to-beat carotid diameters during baroreflex engagement was used to estimate the integrated baroreflex gain and its mechanical and neural component. The CAD subjects demonstrated significantly greater increases in heart rate and blood pressures for the performance of the speech task. However, there were no group differences in integrated cardiovagal baroreflex gain or either mechanical or neural baroreflex component. These findings indicate that the augmented pressor responses in CAD do not result from a generalized arterial baroreflex deficit.

Evaluating the Impact of Year-Long, Augmented Diabetes Self-Management Support.

This was a randomized controlled study to test a scalable intervention model addressing the need for ongoing diabetes support. The study included individuals receiving care in a Federally Qualified Health Center (FQHC) with HbA1c >8. The aim of this project was to determine whether augmenting diabetes self-management education (DSME) with support for an economically vulnerable population might better meet patient needs and reduce morbidity and premature mortality. The intervention utilized pre and post comparisons and was designed to test the efficacy of a telephonic diabetes support intervention to increase patient engagement in self-care and with the health care system as a means to improve clinical outcomes. There were significant improvements in HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and depression screening scores in the year following DSME. However, there was no statistically significant difference between the 2 groups. This randomized controlled study demonstrated that comprehensive face-to-face care with consistent assessment and documentation over time in FQHCs produce clinically significant and predictable improvement for people with diabetes. The addition of structured provision of telephonic support overlapping in time with the comprehensive face-to-face process of care in this environment did not produce statistically significant clinical or behavioral care improvement.

Effect of dental treatment before cardiac valve surgery: Systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality. TYPES OF STUDIES REVIEWED: The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference. RESULTS: Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, -2.3 to 8.1). CONCLUSIONS AND PRACTICAL IMPLICATIONS: From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.

The 2017 Diabetes Educator and the Diabetes Self-Management Education National Practice Survey.

Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about factors influencing the work of the diabetes educator. Method The 2017 NPS was comprised of 100 questions covering diabetes educator demographics, profile populations of people with diabetes, practice information, program accreditation, program curriculum, staffing, education delivery methods, data collection, and reporting. The basic survey consisted of 22 questions using branch logic, from which respondents were then directed to questions tailored to their particular practice setting, enabling them to answer only a relevant subset of the remaining questions. The web-based survey was sent to approximately 32 000 individuals who were either members of the American Association of Diabetes Educators (AADE) or Certified Diabetes Educators (CDE) with the National Certification Board for Diabetes Educators (NCBDE) but not AADE members. Weekly reminder e-mails were sent to recipients who had not yet responded. The outreach efforts resulted in the survey being completed by 4696 individuals, a 17% response rate yielding 95% confidence that these responses are within ±5% accuracy. Results Diabetes Self-Management Education and Support (DSMES) continues to be a field dominated by women (95%). Diabetes educators represent a diverse health care profession, with educators indicating most commonly that their primary discipline is nursing (48%), nutrition (38%), and pharmacy (7%). When asked about credentials, 82.6% indicated that they held a CDE, 3.8% held the Board Certified-Advanced Diabetes Management (BC-ADM) credential, and 16.5% held neither the CDE nor the BC-ADM. Nearly 75% characterized their role as a diabetes educator as providing direct patient care. DSMES continued to be provided in a varied array of settings to educationally, socioeconomically, and racially diverse patient populations. DSMES was delivered using a number of different educational strategies. Diabetes educators have direct influence in care and services that people with diabetes receive. Conclusions The results of the 2017 NPS demonstrate that diabetes educators are meeting the needs of varied populations in various practice settings. They are working with individuals with type 1 and type 2 diabetes, those at risk for diabetes, and women with gestational diabetes and are involved in recommending, implementing, and providing key referrals and recommendations for diabetes care, including insulin initiation, titration, medication adjustments, recommendations on devices, and technology. Identified areas for improvement include needs for increased racial and ethnic diversity in the workforce, recruiting young professionals, drawing practice approaches from related disciplines (eg, mental health and disability rehabilitation), and encouraging tracking of more areas of outcomes data. Diabetes educators are playing an increasingly central role within multidisciplinary care teams with people at risk for diabetes, those who have diabetes, and those with other chronic conditions.

Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews.

BACKGROUND: Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of this study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. TYPES OF STUDIES REVIEWED: An overview of systematic reviews was conducted to evaluate the efficacy or reported adverse events associated with orally administered medication or medication combinations for relief of acute pain. Reviews were inclusive of all age populations but were limited to those that evaluated medication and medication combinations marketed in the United States and had moderate or high methodological quality according to the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. RESULTS: Five reviews were found eligible for inclusion. The data identified combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations. PRACTICAL IMPLICATIONS: The best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.

Benefits and harms of capnography during procedures involving moderate sedation: A rapid review and meta-analysis.

BACKGROUND: Patient safety is a priority in dentistry. Evaluating the benefits and harms associated with the addition of capnography to standard monitoring during moderate sedation for adult patients in the dental practice setting is needed. TYPES OF STUDIES REVIEWED: The authors used rapid review methodology to identify relevant systematic reviews, which they updated through a systematic search by using the same search strategy as the identified reviews. The authors searched PubMed and Google Scholar and through the references of the identified systematic reviews, which yielded 2,892 studies. Inclusion criteria were that the article was available in English, was original research in adult humans who had undergone moderate procedural sedation, and involved comparing standard monitoring with the addition of capnography. RESULTS: Sixteen studies were eligible, involving 3,866 adults undergoing procedural sedation. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the evidence and rate it as being of moderate to low quality because of high risk of bias and heterogeneous effects for the outcomes of hypoxemia and adverse respiratory events. Capnography had higher sensitivity to detect adverse respiratory events than did standard monitoring alone (0.92; 95% confidence interval, 0.65 to 0.99) and may reduce the risk of developing hypoxemia by 31% (risk ratio, 0.69; 95% confidence interval, 0.57 to 0.82). Capnography did not affect the risk of developing serious adverse events, procedure time, sedation quality, or patient satisfaction. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Adding capnography to standard monitoring of adults during moderate sedation may reduce the risk of developing hypoxemia, increase detection of adverse respiratory events, and is not associated with additional harms. These findings suggest routine use of capnography during moderate sedation has the potential to reduce adverse anesthetic outcomes in dental practice.

Rates and predictors of exposure to Legionella pneumophila in the United States among dental practitioners: 2002 through 2012.

BACKGROUND: In this study, the authors compared the odds of exposure to Legionella pneumophila among currently active dental practitioners with that of nonpractitioners and evaluated demographic and clinical practice predictors of exposure. METHODS: The authors obtained demographic characteristics and dental practice behaviors from participants in the annual American Dental Association Health Screening Program survey administered from 2002 through 2012. The authors assayed serum samples obtained from participants for L pneumophila antibodies. The authors used an adjusted logit model to evaluate predictors of positive results. RESULTS: Among 5,431 participants, approximately 10% were positive for L pneumophila, with no significant differences between dental practitioners and nonpractitioners. Geographic location was the only significant predictor of seropositivity, with no increased risk of being exposed to L pneumophila associated with age, race, sex, years in practice, hours of practice per week, use of barrier protection, or infection control practices. CONCLUSIONS: Prevalence of L pneumophila antibodies was 10.4% among dental and nondental personnel. US Census division was the only significant predictor of seropositivity. The authors conclude that provision of dental care did not increase the risk of being exposed to Legionella. PRACTICAL IMPLICATIONS: Dentists should be aware of the prevalence of Legionella species in their practice areas to understand their personal risk of developing an infection.

Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control.

OBJECTIVE: Assess effect of diabetes self-management education and support methods, providers, duration, and contact time on glycemic control in adults with type 2 diabetes. METHOD: We searched MEDLINE, CINAHL, EMBASE, ERIC, and PsycINFO to December 2013 for interventions which included elements to improve participants' knowledge, skills, and ability to perform self-management activities as well as informed decision-making around goal setting. RESULTS: This review included 118 unique interventions, with 61.9% reporting significant changes in A1C. Overall mean reduction in A1C was 0.74 and 0.17 for intervention and control groups; an average absolute reduction in A1C of 0.57. A combination of group and individual engagement results in the largest decreases in A1C (0.88). Contact hours ≥10 were associated with a greater proportion of interventions with significant reduction in A1C (70.3%). In patients with persistently elevated glycemic values (A1C>9), a greater proportion of studies reported statistically significant reduction in A1C (83.9%). CONCLUSIONS: This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels. PRACTICE IMPLICATIONS: The data suggest mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.