Portuguese Dentists' Attitudes Towards Their Role in Addressing Obesity.

PURPOSE: To determine Portuguese dentists' role in addressing obesity. MATERIALS AND METHODS: For this pilot study, the original version of the Dentists' Role In Addressing Obesity questionnaire was translated from English into Portuguese and validated to ensure that it was culturally adapted for Portuguese dentists. The questionnaire was distributed to a random sample of 400 Portuguese dentists. SPSS Statistics 20 was used to analyse the survey sampling design and assess respondents' attitudes and opinions, outcome expectations and self-efficacy both as ordinal and dichotomised variables. The analysis was a descriptive statistic based on frequencies, without symmetry test. RESULTS: In all, 141 dentists responded. Overall, 22.0% of respondents offered a form of counseling services and 58.9% reported that they were interested in offering obesity-related services. A paucity of trained personnel (58.9%) was cited by the respondents as a major barrier, followed by patients' rejection of weight-loss advice (32.6%) and fears of offending patients (29.1%). 92% of respondents agreed that dentists would be more willing to intervene if obesity were linked to oral disease. CONCLUSION: Healthcare providers must coordinate prevention and interventional efforts for maximum effect. Given the positioning of dentists willing to assist in such an effort, it appears reasonable for experts in obesity intervention in conjunction with dental educators to develop intervention models to be implemented within the scope of the dental practice.

Randomized controlled trials: what are they and who needs them?

Dentistry is rapidly entering a new era of evidence-based practice, and society is demanding prevention and treatment that has been proven to be effective in terms of meaningful health outcomes. Practitioners, individual patients and the public need randomized controlled trials because they provide the highest level of scientific evidence to change clinical practice and inform public health policy. Well-designed randomized controlled trials are conceptually simple but deceptively complex to design, implement and translate into clinical practice. Randomized controlled trials are fundamentally different from observational clinical research because they randomly assign volunteers to receive test or control interventions, they are prospective and the success of the test intervention is based on a meaningful clinical outcome that is specified before the trial begins. To be successful, randomized controlled trials must be carefully designed and powered to answer a specific question that will be generalizable to the population under study. Randomized controlled trials can be designed to evaluate efficacy, effectiveness, superiority, equivalence or noninferiority. Prominent issues and challenges in designing and conducting randomized controlled trials include carefully defining enrollment criteria, establishing an organizational infrastructure, use of a data-coordinating center, developing a manual of procedures, obtaining informed consent, recruiting and ensuring the safety of volunteer subjects, ensuring data quality, analysis and publication of trial outcomes, and translating results into clinical practice.

Examining the safety of dental treatment in pregnant women.

BACKGROUND: Although clinicians generally consider it safe to provide dental care for pregnant women, supporting clinical trial evidence is lacking. This study compares safety outcomes from a trial in which pregnant women received scaling and root planing and other dental treatments. METHODS: The authors randomly assigned 823 women with periodontitis to receive scaling and root planing, either at 13 to 21 weeks' gestation or up to three months after delivery. They evaluated all subjects for essential dental treatment (EDT) needs, defined as the presence of moderate-to-severe caries or fractured or abscessed teeth; 351 women received complete EDT at 13 to 21 weeks' gestation. The authors used Fisher exact test and a propensity-score adjustment to compare rates of serious adverse events, spontaneous abortions/stillbirths, fetal/congenital anomalies and preterm deliveries (<37 weeks' gestation) between groups, according to the provision of periodontal treatment and EDT. RESULTS: Rates of adverse outcomes did not differ significantly (P> .05) between women who received EDT and those who did not require this treatment, or between groups that received both EDT and periodontal treatment, either EDT or periodontal treatment alone, or no treatment. Use of topical or local anesthetics during root planing also was not associated with an increased risk of experiencing adverse outcomes. CONCLUSIONS: EDT in pregnant women at 13 to 21 weeks' gestation was not associated with an increased risk of experiencing serious medical adverse events or adverse pregnancy outcomes. Data from larger studies and from groups with other treatment needs are needed to confirm the safety of dental care in pregnant women. CLINICAL IMPLICATIONS: This study provides evidence that EDT and use of topical and local anesthetics are safe in pregnant women at 13 to 21 weeks' gestation.

A randomized controlled trial of the effect of standardized patient scenarios on dental hygiene students' confidence in providing tobacco dependence counseling.

PURPOSE: Dental hygienists report a lack of confidence in initiating Tobacco Dependence Counseling (TDC) with their patients who smoke. The purpose of this study was to determine if the confidence of dental hygiene students in providing TDC can be increased by Standardized Patient (SP) training, and if that confidence can be sustained over time. METHODS: This 2-parallel group randomized design was used to compare the confidence of students receiving SP training to stu dents with no SP training. After a classroom lecture, all subjects (n=27) received a baseline test of knowledge and confidence. Subjects were randomly assigned to test and control groups with equivalent mean knowledge scores. The test group subjects participated in a SP TDC session. Both groups gained parallel experience to treating patients who were smokers and giving TDC in clinical scenarios during the 6 month time period. One week end-training and 6 month post-training assessments were administered to both groups. ANCOVA compared mean confidence scores. RESULTS: End-training scores at 1 week showed a statistically significant increase (p=0.002) in overall mean confidence following SP training for individuals in the test group. The 6 month follow-up test results showed a slight decline in confidence scores among subjects in the test group and an overall gain in confidence for control group participants. However, overall confidence scores were comparable for the groups. CONCLUSION: SP training improved dental hygiene students' initial confidence in providing TDC and was sustained, but not to a significant degree. Clinical experience alone increased confidence. Further studies may help determine how the initial confidence gained by SP training can be sustained and what the role of clinical experience plays in overall confidence in providing TDC.

US pediatric dentists' counseling practices in addressing childhood obesity.

PURPOSE: Pediatric dentists could be in an excellent position to identify and intervene early for children at high risk for overweight or obesity; however, current practices and attitudes are uncertain. This study's purpose was to explore the practices and attitudes of pediatric dentists regarding weight-and caries-related counseling. METHODS: Data were analyzed from 1,779 pediatric dentists responding to a 2008-09 survey of 4,154 randomly selected pediatric and 3,846 general dentists. Data were weighted to account for unequal probability of selection and nonresponse rates among regions and dentist types. RESULTS: Sixty-five percent of respondents reported increased proportions of overweight/obese pediatric patients since they began practice, and approximately 9% offered weight-related counseling. By contrast, approximately 80% provided caries-related counseling. Major barriers to providing weight-related counseling included fears of offending parents/patients (~54%) and appearing judgmental (~53%), lack of patient acceptance of weight-loss advice from dentists (~47%), not enough trained personnel to provide counseling (~43%), and insufficient time (~28%). Multivariable predictors of providing weight-related counseling included female sex, Hispanic ethnicity, nongroup practice setting, practice ownership, and dentist self-reported normal- or underweight status. CONCLUSIONS: Primary barriers to weight-related counseling cited by pediatric dentists reflect concerns about offending patients and caregivers. Training and counseling addressing these concerns may help boost counseling rates.

Factors affecting North Carolina dental hygienists' confidence in providing obesity education and counseling.

PURPOSE: Obesity is a major public health issue in the United States. Dental hygienists influence their patients' oral health by providing dietary and behavioral recommendations that encourage good oral health practices. However, it is not known if they are ready to provide behavioral counseling strategies for weight loss. This study investigates whether dental hygienists in North Carolina are confident to counsel patients who are at-risk for obesity. METHODS: A questionnaire was used to survey 246 dental hygienists attending a continuing education (CE) course. It investigated self-reported confidence in providing obesity counseling, educational preparation, outcome expectations and self-efficacy. The primary outcome was confidence in providing weight loss counseling. Mantel Haenszel statistics were used to compare group of interest. RESULTS: Of the dental hygienists surveyed, 43% perceived an increase of overweight patients in their practices. Nearly all (95%) felt that dental hygienists have a role in helping patients improve nutrition. Over half (65%) expressed confidence in discussing obesity-related health risks. On average, the confidence in getting patients to follow weight loss advice was significantly different (p=0.02) for those with a 2 year degree and those with a 4 year degree. CONCLUSIONS: The findings indicate that many North Carolina dental hygienists are willing to discuss obesity with patients.

Dentists' attitudes about their role in addressing obesity in patients: a national survey.

BACKGROUND: Reducing the incidence of obesity requires coordination among primary health care providers. Because of their frequent contact with patients, dentists are positioned to recognize patients at risk of developing obesity. The authors conducted a study to assess dentists' interest in and barriers to providing obesity counseling to patients. METHODS: The authors surveyed a random sample of 8,000 American Dental Association members by mail, stratified according to census region (West, Midwest, South, Northeast) and dentist type (general, pediatric). The authors weighted respondents' data to account for the unequal probability of selection and nonresponse rates among regions and dentist types. RESULTS: In all, 2,965 dentists responded. Overall, 4.8 percent of respondents offered a form of counseling services and 50.5 percent reported that they were interested in offering obesity-related services. More than one-half of the respondents cited fears of offending patients (53.8 percent) and appearing judgmental (52 percent) as major barriers, followed by a paucity of trained personnel (46.3 percent) and patients' rejection of weight-loss advice (45.7 percent). Eighty-two percent of respondents agreed that dentists would be more willing to intervene if obesity were linked definitively to oral disease. CONCLUSIONS: Given continued increases in obesity in the United States and the willingness of dentists to assist in preventive and interventional efforts, experts in obesity intervention, in conjunction with dental educators, should develop models of intervention within the scope of dental practice. CLINICAL IMPLICATIONS: Educating dentists about obesity and counseling may reduce barriers for those interested in addressing obesity in their practices.

Effect of intracanal corticosteroids on healing of replanted dog teeth after extended dry times.

This study investigated the effect of potent intracanal corticosteroids on periodontal healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids. Sixty-seven extracted dog premolar roots were randomly assigned to one of the following groups: groups 1-3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes, respectively; groups 4 and 5 filled with 0.05% clobetasol; and groups 6 and 7 filled with 0.05 % fluocinonide. Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes. After 4 months, roots were evaluated histologically for signs of periodontal healing. Roots treated with clobetasol and fluocinonide healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes. No change in the systemic corticosteroid blood concentration was observed in any group. Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing.

Periapical microsurgery: an in vivo evaluation of endodontic root-end filling materials.

The purpose of this study was to assess the healing of periapical tissues using three different materials (IRM [L.D. Caulk Inc, Dentsply International Inc, Milford, DE], Geristore [Den-Mat, Santa Maria, CA], and MTA [ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK]) after endodontic microsurgery in an animal model. Using beagle dogs as a study model, 48 bicuspids were accessed, instrumented, and intentionally infected. The surgical procedures were performed after 30 days following the radiographic confirmation of periapical radiolucencies. The root canals were still infected and had no disinfection procedure carried out. The root ends were resected, retrograde preparations were completed, and the experimental materials were placed under surgical operating microscopy. After a period of 6 months, digital radiographic images of the periradicular areas were taken. The samples were prepared for histologic evaluation. Although Geristore showed no radiographic difference when compared with the other groups, it showed the least favorable healing in the histologic evaluation. Our histologic and radiographic results showed no statistical difference between MTA and IRM.

North Carolina dental hygiene students' opinions about tobacco cessation education and practices in their programs.

Inadequate training in tobacco cessation counseling (TCC) is a recognized, but mutable, barrier to implementation of tobacco cessation education (TCE) and intervention strategies in dental practice. The objective of this study was to identify the opinions and practices of senior dental hygiene (DH) students in North Carolina regarding their didactic training in TCE and integration of TCE into their clinical curricula. A pilot-tested questionnaire designed by the authors was administered to a cross-sectional, non-random convenience sample of 241 graduating senior DH students enrolled in all twelve North Carolina DH educational programs. Response rate was 65 percent (n=156). Of the respondents, 99 percent agreed that hygienists should be trained to provide TCE. Nearly all respondents (99 percent) had one or more patients who smoked, and 81 percent had one or more patients who used spit tobacco. Eighty-nine percent had one or more patients who had expressed a desire to quit. Most students were comfortable providing TCC to both smokers (92 percent) and spit tobacco users (93 percent); however, 26 percent reported that they were not comfortable providing quit messages to patients unwilling to quit. Enhancements to TCE in DH curricula may increase hygienists' incorporation of TCE into their future practice.

Pathologically significant pericoronal lesions in adults: Histopathologic evaluation.

PURPOSE: Oral and maxillofacial surgeons devote a large portion of their practice to the removal of impacted teeth. Many of these teeth have associated soft tissue that is submitted along with or without the tooth for histopathologic examination. This study reports the histopathologic diagnoses of a large series of pericoronal lesions in adults submitted to an oral and maxillofacial pathology biopsy service. MATERIALS AND METHODS: Two thousand six hundred forty-six pericoronal lesions received during a 6-year period were reviewed for location, age, and histopathologic diagnosis. RESULTS: Retrospective evaluation showed that 67.1% of all submissions were nonpathologic follicular tissue. Pathologically significant lesions were diagnosed in 32.9% of cases. Among these lesions were 673 dentigerous cysts (28.4%), 79 dentigerous cysts with mucous cell prosoplasia, 71 odontogenic keratocysts (2.68%), 19 odontomas (0.7%), 13 ameloblastomas (0.5%), 6 carcinomas (0.23%), 6 calcifying odontogenic cysts (0.23%), 4 calcifying epithelial odontogenic tumors, and 1 odontogenic myxoma (0.04%). When stratified by age, the data showed pathologically significant lesions and age are related (chi(2), P <.0001). CONCLUSIONS: Because of selection bias inherent in a study of this nature, population generalizations cannot be made. However, this study serves to show that the potential for the development of significant, even life-threatening, disease associated with impacted teeth is real and should be a factor in the decision-making process when oral surgeons and others are confronted with the dilemma of managing an impacted tooth.