Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea.

PURPOSE: The purpose of this study was to compare objective and self-reported outcomes of two treatments for managing mild, moderate, and severe obstructive sleep apnea (OSA) in adults: a mandibular advancement device (MAD) and continuous positive airway pressure (CPAP). METHODS: Patients diagnosed with OSA by means of polysomnography (PSG) included one group treated with a custom-made, two-piece, adjustable MAD and a second group treated with CPAP for 8 weeks. Before the initiation of the treatment, all patients assigned to MAD underwent drug-induced sleep endoscopy (DISE), and all CPAP group patients underwent manual titration of CPAP after PSG. Objective (PSG) and self-reported (Epworth Sleepiness Scale [ESS] and Short Form Health Survey [SF-36]) data were used to assess outcomes. Collected data included apnea-hypopnea index (AHI), mean capillary oxygen saturation (SpO2), oxygen desaturation index (ODI), arousal index (AI), degree of daytime sleepiness, and quality of life. A PSG follow-up after 8 weeks with MAD in situ, and data from the CPAP data card were used to assess the effect of the two treatments. RESULTS: A total of 59 patients included 30 treated with MAD and 29 treated with CPAP. Between baseline and the 8-week follow-up, the mean AHI score decreased significantly from 35.1 to 6.8 episodes/h (p < 0.001) in patients treated with MAD and from 35.2 to 3.0 episodes/h (p < 0.001) in patients treated with CPAP. The mean AHI score at the 8-week follow-up was significantly lower in CPAP group than in MAD group (p = 0.003). The two groups did not differ significantly at follow-up regarding SpO2 (p = 0.571), ODI (p = 0.273), AI (p = 0.100), ESS score (p = 0.648), and SF-36 score (p = 0.237). CONCLUSION: In the short term, patients on CPAP attained better PSG outcomes in terms of AHI reduction. Both MAD after DISE evaluation and CPAP resulted in similar improvements in clinical symptoms and health-related quality of life, even in patients with severe OSA.

Effect of decontamination procedures on marginal and internal adaptation in saliva-contaminated composite resin restorations.

The aim of the present study was to evaluate the effect of natural saliva contamination of dentin on the adaptation of composite resin restorations as well as the efficacy of various decontamination techniques. A total of 120 human molars and premolars were randomly distributed into 6 groups (n = 20). Standardized dentin cavities were prepared and restored with composite resin after 1 of 6 different surface treatments, which included a 2-step etch-and-rinse adhesive: 1, dentin etching, adhesive application following the manufacturer's instructions (control), light curing; 2, dentin etching, saliva contamination, air drying, adhesive application, light curing; 3, dentin etching, saliva contamination, water rinsing, air drying, adhesive application, light curing; 4, dentin etching, adhesive application, light curing, saliva contamination, air drying; 5, dentin etching, adhesive application, light curing, saliva contamination, water rinsing, air drying; or 6, dentin etching, adhesive application, light curing, saliva contamination, water rinsing, air drying, adhesive reapplication. The adaptation was evaluated at the top surface and at depths of 0.5 and 1.0 mm by measuring the length of the debonded margin and calculating its percentage relative to the cavity perimeter (%DM). The internal adaptation was evaluated by measuring the width of the maximum marginal gap (MMG). Inferior adaptation was observed after saliva contamination took place. Group 1 presented the most satisfactory adaptation at the top surface, whereas groups 4 and 5 had the highest %DM and greatest MMG at all surfaces (P < 0.05). The %DM and MMG values in groups 2, 3, and 6 were not significantly different from those of group 1 or each other. Saliva contamination after adhesive application (groups 4 and 5) resulted in deterioration of marginal and internal adaptation. Reapplication of the adhesive restored adaptation, as evidenced by the %DM and MMG values in group 6.

Multicenter study to develop and validate a risk assessment tool as part of composite scoring system for erosive tooth wear.

OBJECTIVES: (i) To develop, validate, and apply in practice a new risk assessment tool for erosive tooth wear (ETW) including a risk factors questionnaire and a saliva secretion evaluation, which combined with a clinical index, can be part of an ETW composite scoring system; (ii) to assess ETW lesions and current and past erosive challenges in younger age groups. METHODS: The Tooth Surface Loss/Erosion Working Group of the European Association of Dental Public Health consisted of an international panel of experts designed the survey component of the new tool (Erosive Wear Assessment of Risk-EWAR) and confirmed its construct and content validity. After receiving ethical approvals and informed consents, the EWAR tool (questionnaire + saliva secretion evaluation) was applied in a multicenter cross-sectional study with 207 participants aged 15-21 years old from four countries (Finland, Greece, Romania, the USA). BEWE score was used for the clinical assessment of ETW. RESULTS: A total of 58.5% of participants had ETW. 10.9% and 20.3% of participants had low secretion of stimulated (< 1 ml/min) and unstimulated saliva (< 0.25 ml/min), respectively. The following factors were bivariately significantly associated with ETW: energy drink consumption, low secretion of stimulated saliva, juices consumption, erosive drink consumption for quenching thirst between meals, erosive drink kept in the mouth, feeling pain/icing after consuming something acidic or cold, and co-existence of other type of tooth wear. In regression analysis, only energy drink consumption (OR = 3.5, 95% CI: 1.39, 8.9), low secretion of stimulated saliva (OR = 36.3, 95% CI: 4.71, 78.94), and feeling pain/icing (OR = 8.8, 95% CI: 1.92, 40.04) remained significant. CONCLUSIONS: The examiners of the study reported that the EWAR tool appeared to be an affordable and easy-to-use instrument. Some challenges occurred during the saliva collection process. Inferential analysis revealed that the risk factors/indicators of low stimulated salivary flow, energy drink consumption, and pain/icing with ETW were considered the most important in ETW occurrence. CLINICAL RELEVANCE: EWAR tool combined with the BEWE clinical index can be used for ETW risk assessment for epidemiological studies and chairside use.

Color comparison of three layered resin composite systems with three shade guides.

OBJECTIVE: To investigate the color difference using both ΔE*ab and CIEDE2000 formulas of all combinations of all enamel and dentin shades of three different composite systems with three different shade guides, to compare the coverage error (CE) of the shade guides for each composite and to investigate whether coverage error is affected by enamel shade layer thickness (0.5 vs 1 mm). MATERIALS AND METHODS: Disk specimens from all enamel and dentin shades of Essentia, Enamel Plus HRi, and IPS Empress Direct composites were fabricated. Color measurements were performed for all enamel-dentin combinations and for two thicknesses per enamel shade: 0.5 and 1 mm. Color was measured for three shade guides: Vitapan Classical, 3DMaster, and Ivoclar. Minimum color difference between layered composites and shade tabs, closest shade tab match and CE of all shade guides were calculated for all composite shade combinations. RESULTS: In most cases, the closest match was a mismatch. CE of 3DMaster was significantly lower for IPS Empress Direct and Enamel Plus HRi at 0.5 mm enamel thickness. Shade guides exhibited higher lightness values compared to composites and composites lower chroma values compared to shade guides. CONCLUSIONS: Shade guides do not match well to the layered composites. 3DMaster performed better than the other two shade guides, in most cases.

Accuracy of complete-arch implant impression made with occlusal registration material.

STATEMENT OF PROBLEM: Which impression material, impression tray type, and implant impression technique combination produces the most accurate complete-arch impression is unclear. PURPOSE: The purpose of this in vitro study was to compare the implant impression accuracy of a completely edentulous arch made with addition silicone occlusal registration material and an open tray with the implant impression accuracy of other conventional impression techniques. MATERIAL AND METHODS: A master cast was fabricated from Type IV gypsum with four 3.8-mm diameter implants with internal hexagon located in the area of mandibular canines and first molars. Impressions (N=60) were made from the master cast using the 6 techniques investigated: group B-OC-N with occlusal registration impression material (B), open custom tray (OC), and nonsplinted impression pins (N); group B-OS-N with occlusal registration impression material (B), open plastic perforated stock tray (OS), and nonsplinted impression pins (N); group PE-OC-N with polyether medium-body impression material (PE), open custom tray (OC), and nonsplinted impression pins (N); group PE-OC-S with polyether medium-body impression material (PE), open custom tray (OC), and impression pins splinted (S) with autopolymerizing resin cut after 17 minutes and reconnected; group PE-CC-N with polyether medium-body impression material (PE), closed custom tray (CC), and nonsplinted impression pins (N); group PVS-CS-N with simultaneous double-mix polyvinyl siloxane impression material (PVS), closed stock perforated metal tray (CS), and nonsplinted impression pins (N). Type IV gypsum casts were fabricated 24 hours after making the impressions. A computerized numerical control 3D coordinate measuring machine was used to measure the absolute differences of the distances between the centroids of the 4 implants among the casts produced and the distances measured at the master cast. The Kruskal-Wallis test was used to determine differences among the experimental groups (α=.05). The Mann-Whitney U post hoc analysis was used for all group combinations. RESULTS: No significant differences were found between the test groups B-OC-N and PE-OC-S, which were more accurate than the other groups. Group B-OS-N resulted in the least accurate impressions of all experimental groups. Group PE-OC-S resulted in more accurate impressions than the PE-OC-N group. No statistically significant differences were found between groups PE-OC-N and PE-CC-N or between groups PVS-CS-N and PE-CC-N. CONCLUSIONS: For complete edentulism, the use of silicone occlusal registration material with an open custom tray and nonsplinted impression pins resulted in impressions as accurate as those produced with PE open custom tray with splinted impression pins. These 2 techniques resulted in more accurate impressions than the other 4 techniques studied.

Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska.

BACKGROUND: The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents. METHODS: The analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race. RESULTS: The statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation. CONCLUSIONS: These results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.

Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia.

This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

Does Sterilization Affect the Performance of Single-Step Resin Composite Polishers?

(1) Background: Single-step polishers are used extensively for resin-composite polishing. The purpose of this study was to evaluate the effect of sterilization on their performance. (2) Methods: Optrapol Next Generation/Ivoclar-Vivadent, Jazz Supreme/SS White, Optishine Brush/Kerr and Jiffy Polishing Brush/Ultradent were used for polishing a nanohybrid resin composite (IPS Empress Direct/Ivoclar-Vivadent). Polishers (n = 40) were microscopically inspected before use. After polishing, surface roughness (Sa, Sz, Sdr, Sci) and gloss were determined. Polishers were subsequently sterilized and microscopically re-examined. The process was repeated four times on new samples (n = 200). Data were analyzed using the Friedman test and Wilcoxon post hoc test, at α = 0.05. (3) Results: Optrapol's performance improved after the first sterilization for Sa and gloss, whereas it declined after the fourth sterilization for Sa. Jazz's, improved after the second sterilization for Sa and gloss and after the third sterilization for Sdr. An improvement trend was observed for Optishine after the first sterilization, but not statistically significant. Sa, Sz, and gloss declined after the fourth sterilization. Jiffy's performance was inconsistent, with a trend of performance loss after the fourth sterilization. (4) Conclusions: Performance of all polishing systems improved after the initial sterilization, but deteriorated after the fourth sterilization cycle. However, their performance can be considered clinically acceptable for a longer period of use.

Risk indicators of coronal and root caries in Greek middle aged adults and senior citizens.

BACKGROUND: Dental caries is the result of a complex interplay of multiple determinants which may change overtime. Therefore, periodic surveys of caries experience and redetermination of the risk indicators of the disease are needed. The aim of this study was to assess the prevalence and severity of coronal and root caries in Greeks aged 35-44 and 65-74-year-old in relation to socio-demographic parameters. Furthermore, trends in coronal caries experience of the 35-44-year-olds were investigated. METHODS: A sample of 1188 35-44-year-old and 1093 65-74-year-old individuals was selected in 2005 according to WHO guidelines for national pathfinder surveys. Caries was assessed in dentate subjects using the DMFT, DMFS, RDFS and RCI indices. Socio-demographic data were also collected. Univariate and multivariate regression analyses were performed to identify the effect of socio-demographic parameters. RESULTS: The mean DMFT and DMFS scores of the adults were 14.06 and 45.78 respectively, while those of the senior citizens were 20.63 and 89.82. Among the 35-44-year-ods, men and those having a higher educational attainment had significantly lower DMFS values (women OR = 1.679, CI: 1.243-2.267 and >12 years of education OR = 0.321, CI: 0.193-0.535 respectively), while educational level was the only predictor of DMFS in senior citizens (OR = 0.279, CI: 0.079-0.992). The mean DMFT score of the 35-44-year-olds has not improved since 1985, but there was a remarkable reduction in the number of DT related to a simultaneous increase in the number of FT. The mean RDFS rose from 0.39 in adults to 2.66 in senior citizens. The mean RDFS score of the middle aged adults was significantly correlated with education (OR = 0.346, CI: 0.180-0.664). The RCI was almost four times greater in seniors (9.73) than in adults (2.53). There were significant differences in caries experience between the surveyed regions. MS and RDS were the major components of the DMFS and RDFS indices respectively, in both age groups. CONCLUSIONS: Caries experience in Greek adults is similar to what is observed in most industrialized countries. The mean DMFT score of the 35-44-year-olds has not improved since 1985, but a great improvement in restorative care has been observed. Senior citizens had a high percentage of untreated coronal and root surfaces. Region and education were the strongest predictors of caries experience. An increase in oral care utilization and effective prevention over the whole lifespan are needed to improve the dental health of the Greek adult population.

Apical periodontitis in association with the quality of root fillings and coronal restorations: a 14-year investigation in young Greek adults.

PURPOSE: To examine the possible association between the presence of apical periodontitis (AP) and the quality of endodontic treatment and coronal restoration over a time period of 14 years. MATERIALS AND METHODS: 1781 panoramic radiographs of freshmen cadets, taken between the years 1995-2008 were included in this study. The periapical status was evaluated using the Periapical Index (PAI) scoring system. The chisquare test and logistic regression analysis were used to examine associations between apical disease and the quality of both the root filling and the coronal restoration. RESULTS: 62.3% of the examined teeth demonstrated AP. The number of root-filled teeth and the prevalence of AP were found to be higher in OPGs taken between 1995 and 2001 than those taken between 2002 and 2008. Both the quality of the coronal restoration and the quality of the root filling (length and lateral seal) were found to be correlated with the presence of AP, but the factor most significantly associated seemed to be the coronal restoration (OR = 0.404, 95% CI: 0.174-0.940). CONCLUSION: The quality of the endodontic treatment in young Greek adults was poor but improved over the years. Both the quality of the endodontic treatment and coronal restoration appeared to affect the periapical status of the treated teeth. The factor that probably most determined the periapical health was the quality of the coronal restoration.

The Impact of Water Fluoridation on Medicaid-Eligible Children and Adolescents in Alaska.

Juneau, Alaska, ceased community water fluoridation (CWF) in 2007, and previous research found a substantial increase in dental caries-related procedures and treatment costs for children from low-income families in Juneau between 2003 and 2012. We collected comparable dental caries-related procedures and treatment cost data for the same years for children in Anchorage, Alaska, where CWF has been continuously maintained. This retrospective study analyzed all Medicaid dental claims records in two separate years for caries-related procedures and associated costs among children (aged 0 to 18 years) residing in Anchorage's 99502 zip code and compared these records to data from Juneau. We obtained descriptive statistics and conducted bivariate analyses and binomial logistic regression. Between 2003 and 2012, children in Anchorage experienced a nonsignificant modest decrease in the mean number of caries-related procedures and only small, statistically nonsignificant changes to the mean inflation-adjusted service costs of caries-related restorative care. The lack of significant change in child dental caries-related procedures and treatment costs in Anchorage between 2003 and 2012 contrasted with the substantial increase in caries-related procedures and treatment costs over the same period in Juneau. Our results are consistent with previous research that has demonstrated a significant protective effect of CWF against dental caries.

Intention of Collaboration among Dental Students during the COVID-19 Pandemic.

Interpersonal communication skills (ICS) are crucial for effective dental practice and interprofessional collaboration. The current study aimed to assess the attitudes of Greek dental undergraduate students towards team working and their cooperation abilities during the COVID-19 pandemic. One-hundred and twenty-seven fourth-semester dental students (N1 = 127) out of 145 (N0) filled in the online survey placed on Google forms. The "Dental Students Cooperation Questionnaire" (DSC) consisted of 49 questions and was available for completion for one week during April 2020. Bivariate (ANOVA) and linear regression analysis of data revealed that mean scores of the questionnaire increased as the parents' educational level also increased. Data analysis showed that dental students had the required ICS and the intention to collaborate with each other. Many participants managed to achieve group goals, were willing to support other members to fulfill the project's goals, and there was no competition among them. They acknowledged the importance of feedback, the reward at the end of a group project and social media as a tool for teamworking communication. The students reported that the most important characteristics of an academic teacher were patience, willingness to cooperate, friendliness, politeness, willingness to help, accessibility and availability. It is suggested that group work should be included in the curriculum of dental schools to enhance the integration and evolution of students' ICS, and the DSC questionnaire can be an effective tool to assess these skills.

Socio-behavioral factors, oral hygiene level and periodontitis prevalence in a 35-44-year-old Greek adult population: A cross-sectional survey.

BACKGROUND: Sub-optimal oral hygiene is considered as a primary risk factor for periodontitis occurrence. Various socio-behavioral determinants may contribute either independently or by influencing adversely the oral hygiene (OH) level. The aim of the present study was to examine the periodontal status of 35-44-year-old Greek adults and determine the contribution of risk indicators, including the socio-behavioral aspects and the population's oral hygiene level, on disease prevalence. MATERIAL AND METHODS: In 1218 participants, Community Periodontal Index (CPI), Loss of Attachment (LoA) and simplified Oral Hygiene Index (OHI-S) were calculated. Multivariable regression models examined the effect of socio-behavioral factors with/without the inclusion of OHI-S level on pocket depth (PD)≥4mm and LoA≥4mm presence. RESULTS: 11.8% of the participants had healthy periodontium, whereas 37.3% and 5.6% presented with shallow and deep pocketing, respectively. 60.4%, 28.8%, and 10.8.% of the adults demonstrated LoA≤3mm, 4-5mm, and ≥6mm, accordingly. Fair and poor oral hygiene significantly increased the likelihood for PD≥4mm (OR=4.8-20.3) and LoA≥4mm (OR=3.3-6.0) presence. 'Emergency-oriented dental visiting pattern' significantly elevated the chance for PD≥4mm presence (OR=1.7). 'Lower education level' 'urban location', and 'using an interdental brush' were significantly independently linked to LoA≥4mm occurrence (OR=1.7-2.1, 1.5, and 2.0, respectively). Lower educated individuals demonstrated inferior oral hygiene status, which in turn elevated significantly the chances of PD≥4mm presence. Smoking more than 10 cigarettes/day, emergency-oriented dental attendance pattern and not flossing were linked to worse oral hygiene levels, which consequently increased significantly the likelihood of LoA≥4mm occurrence. CONCLUSIONS: Fair and poor oral hygiene contribute strongly to periodontitis occurrence. Various socio-behavioral factors may influence adversely oral hygiene maintenance, leading to periodontitis manifestations. Key words:Community periodontal index, periodontal attachment loss, oral hygiene, adults 35-44, cross-sectional survey, socio-behavioral indicators.

Physical and psychological nicotine dependence in Greeks: an epidemiological study.

PURPOSE: Smoking is the most widespread addictive behaviour in the world, as it causes physical and psychological dependence on nicotine. The objective of the present study was to discern the prevalence and the relative risks of nicotine dependence of adult people in Athens, Greece, as this country holds first place in cigarette consumption in the European Union. MATERIALS AND METHODS: A random sample of 202 current smokers (82 men and 120 women) was drawn from residents aged v 18 years in Athens, the capital of Greece. A questionnaire on the physical (Fagerstrom Test of Nicotine Dependence) and psychological (American Psychiatric Association's diagnostic criteria of nicotine abuse) nicotine dependence was used. RESULTS: According to the results of the present study, 12.4% of the sample reported null physical nicotine dependence, and 31.7% had low, 25.7% had moderate and 30.2% had high nicotine dependence. Multiple logistic regression analysis revealed that younger people (aged 18 to 24 and 25 to 34, odds ratio [OR] = 0.047, P < or = 0.033 and OR = 0.096, P < or = 0.038, respectively) were less prone to developing physical dependence. Women tended to be systematically less dependent than men (25% and 37.8% high dependence, respectively). Furthermore, 75.7% of the sample had psychological nicotine dependence. Binary logistic regression analysis and chi-square test revealed that younger people (18- to 24-year-olds, OR = 0.081, P < or = 0.008) and individuals of inferior education (v2 = 7.826, P < or = 0.05) were less prone to develop psychological dependence. In addition, women showed a higher percentage of withdrawal symptoms compared with men (80% and 68%, respectively). CONCLUSIONS: The results of the present study provided compelling evidence that physical and, in particular, psychological nicotine dependence of adult people in Athens, Greece, was significant, and this calls for a course of action that should be taken by public health policy-makers to reduce smoke consumption.

Diffusion of innovation in radiation oncology in the United States.

OBJECTIVE: To develop an instrument for quantifying innovation and assess the diffusion of innovation in radiation oncology (RO) in the United States. METHODS: Primary data were collected for using total population convenience sampling. Innovation Score and Innovation Utilization Score were determined using 20 indicators. 240 medical physicists (MPs) practicing in RO in the United States completed a custom Internet-based survey. RESULTS: Centers with no academic affiliation are trailing behind in innovation in total (MD = 1.65, 95% C I[0.38,2.917], p = 0.011, d = 0.351), in patient treatment (MD = 0.39, 95% CI [0.021,0.76], p = 0.038, d = 0.282), and workflow innovation (MD = 7.09, 95% CI [0.78,13.39], p = 0.028, d = 0.330). Centers with no academic affiliation are trailing behind in innovation utilization in total (MD = 0.46, 95% CI [0.05,0.86], p = 0.028, d = 0.188). Rural center are trailing behind in patient positioning in innovation (MD = 0.31, 95% CI [0.011,0.612], p = 0.042, d = 0.293) and innovation utilization (MD = 16.22, 95% CI [0.73,31.72], p = 0.04, d = 0.608). Rural centers are trailing behind in innovative treatments (MD = 0.62, 95% CI [0.23,1.00], p = 0.002, d = 0.457). Motivation (rs = 0.224, p = 0.002) and appreciation (rs = 0.215, p = 0.003) were statistically significant personal factors influencing innovation utilization. CONCLUSIONS: There is a wide range of innovation across RO centers in the United States. RO centers in the United States are not practicing as innovative as reasonably achievable. ADVANCES IN KNOWLEDGE: This work quantified how innovative RO in the United States is and results provide guidance on how to improve it in the future.

Risk Factors for Bloodstream Infections Among an Urban Population with Skin and Soft Tissue Infections: A Retrospective Unmatched Case-Control Study.

INTRODUCTION: The prevalence of acute bacterial skin and skin structure infections (ABSSSIs) continues to increase. Bloodstream infection (BSI) is a severe secondary complication of ABSSSI. The objective of this study was to determine clinical and sociodemographic risk factors for BSI in patients with acute bacterial skin and skin structure infections (ABSSSIs) and to determine if sociodemographic factors impact severity at presentation. METHODS: This was a retrospective unmatched (1:1) case-control study. Predictors of BSI and severe infection were sought through multivariable logistic regression analyses. Cases and controls were collected from two major medical centers located in downtown Detroit, Michigan: the Detroit Medical Center and the Henry Ford Health System. The population of interest included adult patients with community-onset (CO) ABSSSI treated at a participating hospital between January 2010 and December 2015. Cases were defined as those developing BSI within 48 h of admission with CO-ABSSSI as the primary source, while controls were those with CO-ABSSSI without BSI. RESULTS: A total of 392 patients (196 cases, 196 controls) were included. Independent predictors of BSI were male gender (aOR 1.85: 95% CI 1.11, 3.66), acute renal failure (aOR 2.08: 95% CI 1.18, 3.66), intravenous drug use (aOR 4.38, 95% CI 2.22, 8.62), and prior hospitalization (aOR 2.41, 95% CI 1.24, 4.93). African American race (aOR 2.18, 95% CI 1.38, 3.4), leukocytosis (aOR 2.24, 95% CI 1.41, 3.55), and prior hospitalization (aOR 2.07, 95% CI 1.19, 3.00) were significantly associated with infection severity. CONCLUSION: Both clinical and sociodemographic factors were associated with BSI and severe infection underscoring the importance of social determinants of health in outcomes among underserved populations.

Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data.

BACKGROUND: The aim of this study was to investigate the oral health status and behavior of Greek dental students over time, and to meta-analyze these findings to test the widely documented hypothesis that women have better oral health behavior, oral hygiene, and periodontal status but higher dental caries rates than men. MATERIALS AND METHODS: A total sample of 385 students was examined using identical indices to assess oral health and behavioral data initially in 1981 while the years 2000 and 2010 were selected due to significant changes that took place in the dental curriculum in the 1990s and 2000s. Data by gender concerning the outcome variables recorded in every one of the three surveys were analyzed using Mantel-Haenszel and continuous outcomes methods. RESULTS: A significant improvement in the oral health status and behavior of students was observed over time. The meta-analysis of data by gender showed that females brushed their teeth significantly more often than males [summary odds ratio (OR): 1.95 and 95% confidence interval (CI): 1.08-3.54]. Males and females were found to have a similar risk of developing dental caries. CONCLUSION: The hypothesis that young women have better oral hygiene habits compared to men was confirmed. However, the hypothesis that women have better oral hygiene and periodontal status but exhibit higher dental caries experience than men was not supported by the findings of the study.

Minimally Invasive Alveolar Ridge Preservation Utilizing an In Situ Hardening ß-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series.

Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (ß-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that ß-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.

Oral health practices of state and non-state-funded licensed childcare centers in Wisconsin, USA.

OBJECTIVES: To determine whether there is a difference between state-funded childcare centers and non-state-funded centers in Wisconsin, USA, with regard to their oral health practices. MATERIALS AND METHODS: This is a cross-sectional study using an internet-based survey. The participants were licensed childcare centers in Wisconsin, USA. Of the 1265 eligible childcare centers invited (centers providing day time care to children aged 2-5), 322 chose to participate. The main outcome measures were the practice of tooth brushing as a routine classroom activity, any educational practice related to oral health, any screening and referral practice related to oral health issues, and any practice related to dental emergencies. Mediating variables were profit status, center location, center affiliation, years of operation, licensed capacity, and child to staff ratio. RESULTS: Of the 322 participating centers, 28 centers were classified as state-funded and 294 as non-state-funded. Logistic regression analysis revealed non-state-funded centers were three times [odds ratio (OR): 3.01; 95% confidence interval (CI): 1.23, 7.41] more likely to have some kind of oral health practice and five times (OR: 5.18; 95% CI: 2.17, 12.50) more likely to provide oral health education. However, state-funded centers were five times (OR: 5.09; 95% CI: 1.99-13.06) more likely to have tooth brushing as a routine classroom activity. CONCLUSION: There is a difference between the oral health practices of licensed childcare centers in Wisconsin. An increase in oral health practices of state-funded centers is warranted and could make a significant difference in the oral health of young children.

Challenges in assessing erosive tooth wear.

Indices for assessing erosive wear are expected to deliver more than is expected of an ideal index: simple with defined scoring criteria so that it is reproducible, reflective of the aetiology of the condition and accurately categorizing shape, area and depth of affect, both at a point in time (prevalence) and longitudinally (incidence/increment). In addition, the differential diagnosis of erosive wear is complex, as it usually co-exists with other types of tooth wear. Therefore, a valid recording of erosive wear at an individual as well as at a population level without a thorough history with respect to general health, diet and habits is a challenge. The aims of this chapter are to describe the potential methodological challenges in assessing erosive wear, to critique the strengths and limitations of the existing erosion indices and to propose the adoption of a validated erosion index for the purpose for which it is intended.