Oral Health Status of Hospitalized Patients With Type 2 Diabetes.

BACKGROUND: Diabetes is associated with poor oral health, as well as reduced access to dental care. A large percentage of patients hospitalized in the United States carry a diagnosis of diabetes; however, the oral health status of patients with diabetes who are hospitalized is unknown. METHODS: All patients meeting inclusion criteria on the general medicine service of a tertiary care hospital were invited to participate. Subjects were asked about their access to dental care and perceptions of their oral health. A dental hygienist conducted examinations, including decayed, missing, and filled teeth (DMFT) and periodontal screening and recording (PSR) indices on a subset of subjects. RESULTS: The 105 subjects had a mean age of 69 ± 12 years and a median A1C of 7.5 ± 2.1%. Rates of comorbidity and polypharmacy were high. The mean number of DMFT was 23.0 ± 7.2, with 10.1 ± 7.2 missing teeth. Forty- four percent of subjects had a removable prosthesis. Sixty-eight percent had a PSR index ≥4 in at least one sextant, indicating moderate periodontal disease. CONCLUSION: Rates of missing teeth, removable prostheses, and periodonal inflammation were high among hospitalized patients with diabetes, but patients did not perceive their oral health to be poor. Health care providers should be aware of the oral health risks of patients with diabetes during hospitalization, and dentists should consider screening patients with diabetes for recent hospitalization.

How Often Do Oral Maxillofacial Surgeons Lose Malpractice Cases and Why?

PURPOSE: Although oral maxillofacial surgeons (OMSs) carry high legal risk in malpractice lawsuits, data elucidating the reason behind those claims and their outcomes are scarce. The purpose of the present study was to characterize the trends, analyze the payouts, and determine the etiology of malpractice cases against OMSs. MATERIALS AND METHODS: A retrospective case series study was performed using the Westlaw database to access medical malpractice cases filed against OMSs from 1980 to 2017. The inclusion criterion was that the defendants had included an OMS. Two of us independently collected the demographic data, verdicts, payouts, and etiology of the litigation. RESULTS: The study sample included 183 cases adjudicated from 1980 to 2017. The results highlighted the temporal and geographic trends, payout information, and etiology of the cases. The total number of malpractice cases had decreased by 60% from 2011 to 2015 compared with the previous 5 years. The greatest incidence of malpractice cases filed per 100 practicing OMSs was in New York, followed by California and Massachusetts. Ruling in favor of the defendant OMS was noted in 55% of the cases, of the plaintiffs in 40% of the cases, and had reached a settlement before trial in 3% of the cases. In the cases in which the ruling had favored the plaintiff, the average payment was $812,449.08, with a median payment of $250,000.00 (range, $13,750.00 to $14,887,525.95). Extraction cases represented 53% of all malpractice litigations. Of these, 65% had been third molar extractions that had resulted in lingual nerve injury (26%), postoperative infection (17%), wrong site extractions (15%), and death or brain damage (10%), among other injuries. CONCLUSIONS: Approximately one half of the malpractice cases favored the defendant OMS. Most cases were third molar extractions resulting in injuries ranging from lingual nerve injury to death. Complementary data from insurance companies would be helpful to provide more specific analysis of the etiology and trends of the malpractice cases.

Catheter related thrombosis in hospitalized infants: A neural network approach to predict risk factors.

INTRODUCTION: We sought to investigate the predictors of catheter-related thrombosis (CRT) in a cohort of critically ill hospitalized infants and using a novel approach (the artificial neural network - ANN) in combination with conventional statistics to identify/confirm those predictors. METHODS: We performed a retrospective analysis of all infants with a central or peripherally inserted central venous catheter (CVC/PICC) between 2015 and 2018. ANN was generated to investigate the predictors of CRT. The predictive variables examined in the ANN were age, gender, weight, co-morbid conditions, line type, use of ultrasound (USG), emergent line placement, location of line tip, any major surgical procedures, use of mechanical ventilation, exposure to cardio-pulmonary bypass (CPB), past-history of CVC/PICC, or thrombosis. Binary logistic regression was performed to calculate odds ratios (ORs) and determine which factors were significant in predicting CRT. RESULTS: Of total of 613 infants, 59.9% of patients had a history of previous CVC or PICC and 12.2% had a history of thrombus as documented by USG in the past three months. CPB exposure was present in 48.1%. The incidence of CRT was 10.7%. Independent predictors of CRT were the line tip in IVC (OR: 2.37, 1.08-5.21, P = 0.032), history of thrombosis (OR: 2.40, 1.16-4.96, P = 0.019), previous CVC/PICC (OR: 2.80, 1.24-6.33, P = 0.014) and exposure to CPB (OR: 2.749, 1.08-6.98, P = 0.034). A sensitivity analysis was performed to determine the normalized importance of each variable used to create the ANN. The most important variables were age (with normalized importance of 100%), history of thrombosis, weight, and exposure to CPB (normalized importance of 68.2%). CONCLUSIONS: Nearly 1 in 10 infants developed CRT. We found that catheter tip in IVC, exposure to CPB, history of vein thrombosis and history of CVC/PICC placement in the past 3 months are independently associated with a higher risk of CRT in infants by using conventional and neural network methods.

Dental Services Utilization by Rurality Among Privately Insured Children in the United States.

Purpose: The purpose of this study was to determine differences in dental services received between rural and urban residents in a national sample of children with private insurance. Methods: This was a retrospective study of deidentified claims data from a major national private insurer. Children younger than 18 years of age enrolled throughout 2018 and who had at least one visit to the dentist that year were included. Differences in the frequency of dental procedures received were determined by chi-square tests. Multilevel logistic regression was used to evaluate the effect of individual-level and ZIP Code-level covariates, including rurality, on the odds of receiving a preventive dental service or having a tooth extracted. Results: A total of 603,064 children, with an average age of 10.2±4.4 (standard deviation) years, visited a dentist, and 6.52 percent lived in a rural area. In a multilevel logistic regression correcting for patient age, patient gender, ZIP Code average income, and dental provider density, rurality was positively associated with receiving a tooth extraction (odds ratio [OR] equals 1.06; P<0.001) and negatively associated with receiving a preventive service (OR equals 0.85; P<0.001). Female gender was a negative predictor of preventive services and a predictor of having a tooth extracted. Conclusion: Children living in rural areas had reduced rates of preventive dental care and higher rates of tooth extraction than their nonrural counterparts.

Gender Differences in Academic Productivity and Advancement Among Pediatric Dental Faculty.

Purpose: The purpose of this study was to examine whether disparities in promotion and academic productivity exist within academic pediatric dentistry. Methods: The top 15 schools funded by the National Institute of Dental and Craniofacial Research were included in this study. Gender differences in productivity and advancement were evaluated. Results: Women comprised 48.9 percent of all faculty surveyed (n=184). Less than a third of full professors were women. Female faculty graduated more recently (18.2 years; [95 percent confidence interval (95% CI) equals 15.4 to 20.9], versus 28.5 years for men [95% CI equals 24.8 to 32.1]; P<0.001) and had fewer senior author publications (1.6 [95% CI equals 1.9 to 5.1] versus 3.5 [95% CI equals 0.7 to 2.4]; P=0.03) than their male colleagues. In a linear regression correcting for number of publications and years since graduation, gender was not a significant predictor of academic advancement. Conclusions: Most women in academic pediatric dentistry remain in lower academic tiers with fewer senior author publications. This discrepancy is explained by the years since graduation between male and female faculty at lower levels of academic advancement. Increasing scholarship opportunities and compensation for female faculty members may help improve gender equity in dental academia.

Gender Differences in Academic Productivity and Advancement Among Dental School Faculty.

Background: An equal number of women and men are now graduating from dental school, but women dentists have lower income and are less likely to achieve positions of leadership, including within dental academia. Materials and Methods: Demographic information and academic rank were obtained for all faculty at the eight dental schools who received the most funding from the National Institute of Dental and Craniofacial Research in 2017. Years since dental school graduation, total number of PubMed-indexed citations, first- and last-author publications, and H-index were determined for each faculty member. Gender differences in productivity and advancement were evaluated. Results: Of 702 faculty members, 36.5% were female; only 24.4% of full professors were women. Men had significantly higher numbers of publications (30.2 [95% confidence interval [CI, 28.6-39.5] vs. 20.4 [95% CI 16.3-24.6], p = 0.02) and higher H-index (8.2 [95% CI 7.1-9.1] vs. 4.7 [95% CI 3.9-5.5], p < 0.0001). Women had graduated more recently than their male colleagues at all levels of academic advancement (overall 22.83 years [95% CI 21.29-24.39] vs. 30.19 years [95% CI 28.84-31.55], p < 0.0001). When corrected for academic productivity and years since graduation, the association between gender and academic rank was not significant. Conclusions: Women are underrepresented at each academic rank except instructor; however, women may advance more quickly than their male counterparts. Increasing scholarship and mentorship opportunities for female faculty members may help improve gender equity in dental academia.