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4.
Head Neck ; 43(1): 164-172, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32991009

RESUMEN

BACKGROUND: Approximately 50% of patients with head and neck cancer (HNC) initially were seen with advanced disease. We aimed to evaluate the association of epidemiologic factors with advanced HNC at diagnosis. METHODS: The OraRad multicenter prospective cohort study enrolled HNC patients receiving curative-intent radiation therapy. Factors assessed for association with advanced HNC presentation at diagnosis included demographics, social and medical history, cancer characteristics, human papilloma virus (HPV) status, and dental disease measures. RESULTS: We enrolled 572 participants; 77% male and mean (SD) age of 61.7 (11.2) years. Oropharyngeal squamous cell carcinomas (88% HPV-related) were seen with smaller tumors, but more frequent nodal involvement. Private medical insurance and no Medicaid were associated with smaller tumors. A higher dental disease burden was associated with larger tumors. CONCLUSIONS: Insurance status, cancer type/location, and dental disease are associated with advanced HNC and may represent potentially modifiable factors or factors to be considered in the screening process of new lesions.

5.
Oral Dis ; 26 Suppl 1: 91-102, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862535

RESUMEN

Oral candidiasis (OC) is the most prevalent HIV-related oral lesion in patients on combined anti-retroviral therapy (cART) or without cART. Management is challenged in some patients by development of resistance to azole drugs, such as fluconazole. Recent scientific knowledge about OC pathogenesis, the role of OC in the immune reconstitution inflammatory syndrome (IRIS), the relationship of OC with the microbiome, and novelties in OC treatment was discussed in an international workshop format. Literature searches were conducted to address five questions: (a) Considering the pathogenesis of Candida spp. infection, are there any potential therapeutic targets that could be considered, mainly in HIV-infected individuals resistant to fluconazole? (b) Is oral candidiasis part of IRIS in HIV patients who receive cART? (c) Can management of the oral microbiome reduce occurrence of OC in patients with HIV infection? (d) What are the recent advances (since 2015) regarding plant-based and alternative medicines in management of OC? and (e) Is there a role for photodynamic therapy in management of OC in HIV-infected patients? A number of the key areas where further research is necessary were identified to allow a deeper insight into this oral condition that could help to understand its nature and recommend alternatives for care.


Asunto(s)
Antifúngicos , Candidiasis Bucal , Infecciones por VIH , Antifúngicos/uso terapéutico , Candidiasis Bucal/tratamiento farmacológico , Candidiasis Bucal/prevención & control , Fluconazol/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos
6.
J Am Dent Assoc ; 151(4): 303-304.e2, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32222178

RESUMEN

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.


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , American Dental Association , Conocimientos, Actitudes y Práctica en Salud , Humanos , Encuestas y Cuestionarios , Estados Unidos
7.
J Am Dent Assoc ; 151(4): 245-254.e24, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31983391

RESUMEN

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.


Asunto(s)
Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Anciano , Odontólogos , Femenino , Humanos , Inmunización , Masculino , Vacunación
9.
J Am Dent Assoc ; 150(12): e179-e216, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31761029

RESUMEN

BACKGROUND: Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED: The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.


Asunto(s)
Antibacterianos , Periodontitis Periapical , Pulpitis , Absceso , Adulto , American Dental Association , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estados Unidos
10.
J Am Dent Assoc ; 150(11): 906-921.e12, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31668170

RESUMEN

BACKGROUND: An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. TYPES OF STUDIES REVIEWED: The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. RESULTS: The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. CONCLUSION AND PRACTICAL IMPLICATIONS: Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.


Asunto(s)
American Dental Association , Absceso Periapical , Adulto , Antibacterianos , Odontología Basada en la Evidencia , Humanos , Odontalgia
11.
Oral Dis ; 25 Suppl 1: 174-181, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31140699

RESUMEN

OBJECTIVES: To evaluate the evidence for a 50,000/µl platelet count threshold for platelet transfusion for invasive dental procedures in thrombocytopenic patients. SUBJECTS AND METHODS: We searched in MEDLINE/PubMed, EMBASE, the Cochrane Library (Wiley) and Scopus from 1960 through April 2018 for studies on patients with quantitative platelet disorders not related to medical co-morbidities or medications and undergoing invasive dental procedures. Two reviewers conducted assessments independently. RESULTS: We found a total of 176 non-duplicate articles, of which 9 cohort studies met our inclusion criteria. The incidence of postoperative bleeding in thrombocytopenic patients was low (4.9%), and we found no difference in bleeding incidence between patients who had platelet transfusion and those who did not. There was no difference in the mean platelet count for patients with and without bleeding. Different modalities are now available to prevent and control bleeding, which may reduce the need for platelet transfusion. CONCLUSIONS: There is no evidence to support the long-standing dogma of a need for a platelet count ≥ 50,000/µl for safe invasive dental procedures. Platelet transfusion effectiveness for haemostasis support could not be determined based on available data. Local measures and antifibrinolytics are the mainstay for the prevention and management of bleeding.


Asunto(s)
Recuento de Plaquetas , Transfusión de Plaquetas , Hemorragia Posoperatoria/prevención & control , Trombocitopenia/complicaciones , Extracción Dental/métodos , Congresos como Asunto , Atención Odontológica , Humanos , Resultado del Tratamiento
12.
Oral Dis ; 25 Suppl 1: 157-173, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31140701

RESUMEN

OBJECTIVES: This systematic review aimed to evaluate the current literature regarding the importance of discontinuing or not discontinuing direct oral anticoagulants (DOACs) before invasive oral procedures, and to establish the frequency and type of postoperative bleeding events in patients. MATERIAL AND METHODS: We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up until November 5, 2018. Selection of the studies, extraction of data, qualitative, and bias assessment was performed independently by two authors. RESULTS: Twenty-one studies were included. No randomized controlled studies were identified. Six studies reported a direct comparison between patients taking DOACs and those who discontinued DOACs. The meta-analysis of these studies resulted in an OR of 0.92 (95% CI = 0.37-2.27, I2  = 9%) for postoperative bleeding events for patients taking DOACs. We found that 59/497 (11.8%) postoperative bleeding events occurred in patients who continued DOACs, while 27/200 (13.5%) events were reported for patients who discontinued treatment. All postoperative bleeding events were controlled with local measures. CONCLUSION: Results from the included studies did not discern any important differences in postoperative bleeding events in patients who continued versus patients who discontinued DOACs. Furthermore, no thromboembolic events were recorded. However, the low quality of the studies must be considered.


Asunto(s)
Anticoagulantes/administración & dosificación , Procedimientos Quirúrgicos Orales , Hemorragia Posoperatoria/prevención & control , Administración Oral , Congresos como Asunto , Humanos
14.
Am J Orthod Dentofacial Orthop ; 155(3): 355-361, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30826038

RESUMEN

INTRODUCTION: This study aimed to evaluate the associations between normative orthodontic treatment need and oral health-related quality of life (OHRQoL) at an item level as well as subscale and total score levels among schoolchildren. METHODS: A cross-sectional study was conducted on 2,010 randomly selected children aged approximately 8, 10, 12, and 15 years residing in the Gyeonggi province, Korea. Children were clinically examined with the Index of Orthodontic Treatment Need (IOTN). To measure OHRQoL, the Child Oral Health Impact Profile (COHIP) was used. RESULTS: In the physical health domain of COHIP, crooked teeth, discoloration, "food sticking," and "difficulty keeping teeth clean" were significantly associated with IOTN levels (P < 0.05), whereas pain, sensitivity and bleeding, bad breath, mouth breathing, and dry mouth were not. In addition, present and future dental health were significantly associated with IOTN levels, although self-confidence, attractiveness, and future health were not. As expected, the 5 subscale scores and total score of COHIP were significantly associated with IOTN levels after adjustment for gender, age, socioeconomic level, and caries state. CONCLUSIONS: This study suggests the importance of in-depth investigation at the item level of OHRQoL assessment scales to better evaluate the impact of malocclusion that might be alleviated by orthodontic treatment.


Asunto(s)
Indice de Necesidad de Tratamiento Ortodóncico , Salud Bucal , Calidad de Vida , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Masculino , República de Corea , Factores Socioeconómicos
15.
Oral Dis ; 25 Suppl 1: 182-192, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30811811

RESUMEN

OBJECTIVE: To evaluate the current evidence regarding the effectiveness of non-opioid interventions for the therapeutic management of pain in head and neck cancer patients with oral mucositis resulting from radiotherapy only or chemoradiotherapy. MATERIALS AND METHODS: A literature search was conducted which included randomised controlled trials that assessed patient-related outcome of pain in patients with oral mucositis associated with radiation therapy only or chemoradiotherapy. Literature searches were conducted in MEDLINE via Pubmed, Embase, Scopus and CINAHL. RESULTS: The electronic searches identified 846 articles. Screening revealed that six articles met all eligibility inclusion criteria. Interventions showing statistically significant benefits to reduce oral mucositis associated pain compared to placebo included doxepin (p < 0.001, 95% CI -6.7 to -2.1), amitriptyline (p = 0.04), diclofenac (p < 0.01) and benzydamine (p = 0.014). CONCLUSIONS: Non-opioid interventions, including topical doxepin, amitriptyline, diclofenac and benzydamine, were found to provide relief of pain due to mucositis, and when effective may allow for reduction in the use of opioids in pain management.


Asunto(s)
Antineoplásicos/efectos adversos , Quimioradioterapia/efectos adversos , Mucositis/inducido químicamente , Mucositis/terapia , Manejo del Dolor/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Congresos como Asunto , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Dolor
17.
J Am Dent Assoc ; 148(12): 868-877, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29173331

RESUMEN

BACKGROUND: No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT. METHODS: As part of OraRad, the authors assessed caries, periodontal disease, dental recommendations, and dental interventions performed before RT. RESULTS: Baseline measures were reported for 356 participants (77% men) with mean (standard deviation) age of 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least 1 tooth with caries (37.2%), and participants with at least 1 tooth with probing depth 5 millimeters or greater (47.4%). Factors associated with less extensive dental disease before RT included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the dental examination before RT, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently. CONCLUSION: Many patients with HCN require dental treatment before RT; more than one-third require extractions. PRACTICAL IMPLICATIONS: Most patients have some level of dental disease at the start of RT, indicating the importance of dental evaluation before RT. By observing dental outcomes after RT, OraRad has the potential to determine the best dental treatment recommendations for patients with HCN.


Asunto(s)
Atención Dental para Enfermos Crónicos , Neoplasias de Cabeza y Cuello/radioterapia , Enfermedades Estomatognáticas/epidemiología , Enfermedades Estomatognáticas/terapia , Caries Dental , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Estados Unidos/epidemiología
18.
J Am Dent Assoc ; 148(11): 797-813.e52, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-29080605

RESUMEN

BACKGROUND: Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity. TYPES OF STUDIES REVIEWED: The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de la Boca/diagnóstico , American Dental Association , Carcinoma de Células Escamosas/patología , Pruebas Diagnósticas de Rutina , Detección Precoz del Cáncer , Humanos , Neoplasias de la Boca/patología , Sensibilidad y Especificidad , Estados Unidos
19.
J Am Dent Assoc ; 148(10): 712-727.e10, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28958308

RESUMEN

BACKGROUND: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity. TYPES OF STUDIES REVIEWED: This is an update of the ADA's 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma. The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and diagnostic test accuracy studies. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions. RESULTS: The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity. For patients seeking care for suspicious lesions, immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice. In exceptional cases, when patients decline a biopsy or live in rural areas with limited access to care, the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed (conditional recommendation, low-quality evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The authors urge clinicians to remain alert and take diligent action when they identify a PMD. The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial.


Asunto(s)
Neoplasias de la Boca/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Odontología Basada en la Evidencia , Humanos , Boca/patología , Neoplasias de la Boca/patología
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