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.

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

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

Oral-systemic health considerations in dental settings: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: With an increased emphasis on considering optimal oral health in the context of overall health and well-being, there is interest in understanding how practicing dentists are using information about their patients' overall health status. METHODS: A survey tool was developed to understand how dentists assess the health status of their patients, the frequency at which they are gathering this information, and how they work with their medical colleagues. Emails with an electronic survey link were sent to 997 American Dental Association Clinical Evaluators (ACE) panel members on November 23, 2021. The survey closed after 2 weeks, and data were analyzed descriptively. RESULTS: A total of 258 (26%) ACE panel members responded to the survey. At initial visits, the dentist (60%) often discusses and reviews the patient's medical history, but in subsequent appointments, this task is often completed by the dental assistant (34%) or dental hygienist (32%). At every dental visit, 75%, 66%, and 33% of the respondents ask about and record changes to medical history, medication list, and visits with other health care professionals, respectively. Of the respondents, 85% collect at least 1 vital sign, and more than 90% use the medical history, medication list, and patient interview. A total of 32% of respondents reported disease monitoring is in their scope of practice, and, among them, cardiovascular conditions are the most frequent health condition seen. On average, 12% of patients are referred to another health care provider weekly. CONCLUSIONS: Most dentists use the patient's medical history and medication list and collect vital signs, but the frequency and application of these assessments vary. PRACTICAL IMPLICATIONS: Optimal oral health is integral to overall health, and identifying opportunities to improve communication and data sharing among all health care professionals can affect the patient's health positively.

Dentist-administered vaccines: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: With many states in the United States permitting dentists to administer the COVID-19 vaccine, there is much discussion about their scope of practice in relation to delivering other vaccines. METHODS: Survey questions were developed to assess dentists' awareness about their vaccine administration scope of practice and attitudes and barriers if choosing to incorporate vaccine delivery into their practice scope. The survey was deployed electronically to members of the American Dental Association Clinical Evaluators (ACE) Panel (N = 989) on September 2, 2021, and remained open for 2 weeks. Data were summarized descriptively in Qualtrics and SAS Version 9.4. RESULTS: Of the 330 ACE Panel members who responded to the survey, 42% were not aware of which vaccines their state permits them to deliver. More than one-half (55%) would be willing to administer influenza or COVID-19 vaccines in their practice setting, but at present only 2% of respondents administer vaccines. To overcome vaccine administration barriers, the top 3 resources respondents want access to are the following: training or education, financial support, and access to protocols. Of all the respondents, 91% indicated the dental hygienist should be involved in certain capacities. CONCLUSIONS: Few dentists are administering vaccines, possibly owing to a number of challenges. Dental hygienists may play an integral role in the administration of vaccines in the dental clinic, but few dentists are educating their patients about vaccines. PRACTICAL IMPLICATIONS: Although dentists wishing to administer vaccines in their practice may encounter barriers, support at the state, federal, and organizational levels could help them overcome these challenges.

Smoking cessation counseling and treatment: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Given the oral health implications of smoking, vaping, and using smokeless tobacco products (STPs), the dental office can be an effective setting for clinicians to offer smoking cessation counseling and treatment (SCCT). METHODS: A survey tool was developed to assess dentists' approach and experience with SCCT. This survey was deployed electronically on May 21, 2021, to the American Dental Association Clinical Evaluators (ACE) Panel (N = 982), and 1 week later, nonresponders were sent reminders. Results were summarized in SAS Version 9.4. RESULTS: Of the 283 survey responders, one-half offered SCCT to their patients. Of those who offered SCCT, 69% would be willing to prescribe pharmacologic agents to help with cessation. Nine of 10 times, SCCT conversations included the dentist. Of the 49% of respondents who did not offer SCCT, one-quarter were current or past smokers, vapers, or STP users. Out of all of the survey respondents, 40% were aware that SCCT is part of most medical benefits. Most respondents (82%) perform surgeries on patients who smoke, vape, or use STPs. CONCLUSIONS: Implementation of SCCT in the dental office was split among ACE panelists, but when it was offered, the dentist was almost always involved. Awareness about SCCT medical benefits and surgical protocols for current smokers, vapers, and STP users differed among this sample. PRACTICAL IMPLICATIONS: Dentists can benefit from more formal training and resources around SCCT and access to reimbursement for having these crucial conversations with their patients.

Intraoral scanners: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Dentists may choose to integrate intraoral scanners (IOSs) into their practices, but there are many different IOS technologies and system generations to choose from, posing a challenge for dentists who want to invest in them. METHODS: A survey of IOS use rates, advantages, satisfaction, and training was developed and deployed through Qualtrics to the 968 members of the American Dental Association Clinical Evaluators (ACE) Panel on February 19, 2021. Nonrespondents were sent reminders, and data were analyzed in SAS Version 9.4 (SAS). RESULTS: A total of 369 panelists responded to the survey. IOS use was split among the ACE Panel; 53% indicated they use one in their practice. The top reason respondents began using IOSs was to improve clinical efficiency (70%). Ninety percent of respondents use IOSs for single tooth-supported crowns, and 58% began using IOSs less than 4 years ago. Most users are at least mostly satisfied (91%) with the results. Among nonusers, the top reason for not using an IOS was the high level of financial investment (66%); 34% and 40% of nonusers are thinking of buying or training with IOSs in 2021, respectively. CONCLUSIONS: Uptake of IOSs is split; most users are satisfied with their results, and nonusers cited financial barriers as the most common reason for not investing in one. PRACTICAL IMPLICATIONS: As IOSs continue to penetrate the market and dentists are faced with a decision whether to invest in one, they will need guidance on how to choose the most appropriate device for their patients.

Defective restoration repair or replacement: An American Dental Association Clinical Evaluators Panel survey.

BACKGROUND: Clinicians often encounter defective restorations and are faced with the difficult decision of whether to repair the existing restoration or replace it. METHODS: An electronic survey on repairing or replacing defective restorations was developed to assess how clinicians are making these decisions and the technical aspects considered when making a repair. E-mails containing the survey link were sent to the American Dental Association Clinical Evaluators (ACE) Panel on August 14, 2019, and the survey remained open for 2 weeks. Nonrespondents were sent reminders 1 week after deployment. RESULTS: Approximately 4 of every 5 respondents repair defective restorations. The top 3 conditions for making these repairs were noncarious marginal defects (87%), partial loss or fracture of the restoration (79%), and crown margin repair due to carious lesions (73%). Among respondents who repair defective restorations, almost all repair direct resin composite (98%), whereas approximately one-third do not repair the other restorative materials (that is, amalgam, glass ionomer, and fractured indirect all-ceramic crowns). Resin composite is used most often to repair resin direct composite restorations, and likewise, glass ionomer is used most often to repair glass ionomer restorations. Only 54% of respondents use amalgam to repair amalgam restorations. Surface treatments varied among the 3 available restorations types. CONCLUSIONS: Many dentists are actively making restoration repairs, but choosing clinical scenarios to make these repairs is material dependent. PRACTICAL IMPLICATIONS: The repair of defective restorations is an acceptable and more conservative alternative than restoration replacement, and its success depends on proper case selection, material, and technique.

The current status of orthodontic education in U.S. pediatric dental residencies.

PURPOSE/OBJECTIVES: The purpose of this study was to survey the current status of orthodontic education at pediatric dental residencies in the United States. A similar survey was conducted >10 years ago. With changing healthcare politics, social demands, and technology, it is important to have current information about dental education. METHODS: A 23-item anonymous survey was sent to individual pediatric dental residency program directors via Qualtrics email software. The survey was sent a total of 4 times over an 8-week period. If the surveys were not completed in a predetermined amount of time, they were resent to those who had not yet completed them. RESULTS: There were 34 responders for a 24% response rate. Of the respondents, 73% reported teaching biomechanics of tooth movement, and 45% reported teaching 2 × 4 mechanics to "marginally acceptable" level. Early (91%) to late mixed dentition (77%) is the most commonly treated orthodontic case. While most programs do not require a minimum number of orthodontic cases for graduation (85%), residents' understanding of growth and development is mostly (71%) evaluated through the results of the American Board of Pediatric Dentistry Qualifying Examination. CONCLUSION: This study summarizes the current climate of the orthodontic education component in U.S. pediatric dental residencies.

The Future of Oral Cancer Diagnosis: Merging Provider Awareness, Patient Education, and Technology to Achieve Early Detection.

Oral cancer screening may be performed by trained dental team members and requires only a few minutes. Because oral diseases and mucosal abnormalities may lead to malignancies, oral health providers need to be aware of the emerging roles that the human papillomavirus (HPV), fluorescent technology, and salivary biomarkers play in the prevalence and diagnosis of oral and/or oropharyngeal cancers. In addition to discussing HPV and head, neck, and oral cancers, this article examines the use of fluorescence as a useful tool in helping to screen oral soft tissue while describing various methods for visualization of oral tissue fluorescence. It also reviews the emergence of salivary biomarkers as a promising diagnostic and prognostic tool in oral squamous cell carcinoma and considers the potential for metabolomic analysis of oral specimens. Throughout this discussion of oral cancer diagnosis the authors encourage oral healthcare providers to engage patients regarding the risk factors and lifestyle habits related to increased risk for cancer.

U.S. Dental Schools' Preparation for the Integrated National Board Dental Examination.

An Integrated National Board Dental Examination (INBDE) combining basic, behavioral, and clinical sciences will be implemented in 2020 to replace the current two-part National Board Dental Examination required for all candidates who seek to practice dentistry in the U.S. The aims of this study were to determine how U.S. dental schools are preparing for implementation of the INBDE and to assess their top administrators' attitudes about the new exam. A total of 150 deans, academic deans, and other administrators at all 64 U.S. dental schools with graduating classes in 2016 were emailed a 19-question electronic survey. The survey questions addressed the respondents' level of support, perceived benefits and challenges, and planned preparation strategies for the INBDE. The individual response rate was 59%, representing 57 of the 64 schools. Approximately 60% of the respondents either agreed or strongly agreed that they support the integrated exam, while roughly 25% either somewhat or strongly disagreed. While most respondents (72%) reported that their institutions would be prepared for the INBDE, 74% reported that the merged exam created additional strain for their institutions. Respondents reported viewing content integration and clinical applicability as benefits of the INBDE, while required curriculum changes and student preparedness and stress were seen as challenges. Most of the respondents reported their schools were currently employing strategies to prepare for the INBDE including meetings with faculty and students and changes to curricula and course content. The beginning of the fourth year and the end of the third year were the most frequently reported times when schools planned to require students to take the INBDE, although almost half of the respondents did not yet know what it would be required at their school. Several schools were reconsidering using the boards as a passing requirement. This study found that support for the INBDE was not universal, but strategies are under way to prepare students, faculty, and curricula for this new means of assessment.

Access to dental care for people with bleeding disorders: survey results of hemophilia treatment centers in the U.S.

AIM: The goal of this project was to gather data and identify factors affecting access to dental care for people with bleeding disorders in the U.S. METHODS: The Arizona School of Dentistry & Oral Health and the National Hemophilia Foundation conducted a joint survey. The survey was completed by 102 of the 147 hemophilia treatment centers (HTCs) in the U.S. This represents 69% of the HTCs in the country. Each HTC provided specific information concerning the dental services and education provided for patients. RESULTS: Survey results revealed inconsistent levels of oral health services available to patients. Major factors limiting access to care include finances, patient anxiety with respect to dental treatment and a lack of providers with the skills to treat this population. CONCLUSION: Improvement in oral health for persons with bleeding disorders requires appropriate education for providers, patients and families. Additionally, both public and private health funding must be re-evaluated as it relates to people with bleeding disorders.