Opioids for acute and chronic pain when receiving psychiatric medications.

BACKGROUND: People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS: Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS: Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.

Tobacco Use and Incidence of Adverse Oral Health Outcomes Among US Adults in the Population Assessment of Tobacco and Health Study.

Importance: Evolving tobacco use patterns, including increasing electronic nicotine delivery systems (ENDS) use, warrant re-examination of the associations between tobacco use and oral health. Objective: To examine associations between tobacco product use and incidence of adverse oral health outcomes. Design, Setting, and Participants: This cohort study used nationally representative data from wave (W) 1 to W5 (2013-2019) of the Population Assessment of Tobacco and Health Study. Recruitment used a stratified address-based, area-probability household sample of the noninstitutionalized US civilian population. The W1 cohort included respondents aged 18 years and older without lifetime history of oral health outcomes at W1 or W3, depending on when the outcome was first assessed. Data analysis was performed from October 2021 to September 2022. Exposures: Current (every day or someday use) established (lifetime use of at least 100 cigarettes or "fairly regular" use of other products) use of cigarettes, ENDS, cigars, pipes, hookah, snus, and smokeless tobacco, excluding snus at W1 to W4. Main Outcomes and Measures: The primary outcomes were past 12-month self-reported diagnosis of gum disease and precancerous oral lesions (W2-W5) and bone loss around teeth, bleeding after brushing or flossing, loose teeth, and 1 or more teeth removed (W4-W5). Results: Sample sizes varied across the 6 oral health outcomes (13 149 respondents for the gum disease sample, 14 993 respondents for the precancerous oral lesions sample, 16 312 respondents for the bone loss around teeth sample, 10 286 respondents for the bleeding after brushing or flossing sample, 15 686 respondents for the loose teeth sample, and 12 061 respondents for the 1 or more teeth removed sample). Slightly more than half of adults (52%-54% across the 6 samples) were women, and the majority were of non-Hispanic White race and ethnicity. Cox proportional hazards models were developed with covariates that included time-dependent tobacco use variables mutually adjusted for each other. Cigarette smoking was positively associated with incidence of gum disease diagnosis (adjusted hazard ratio [AHR], 1.33; 95% CI, 1.11-1.60), loose teeth (AHR, 1.35; 95% CI, 1.05-1.75), and 1 or more teeth removed (AHR, 1.43; 95% CI, 1.18-1.74). Cigar smoking was positively associated with incidence of precancerous oral lesions (AHR, 2.18; 95% CI, 1.38-3.43). In addition, hookah smoking was positively associated with incidence of gum disease diagnosis (AHR, 1.78; 95% CI, 1.20-2.63), and ENDS use was positively associated with incidence of bleeding after brushing or flossing (AHR, 1.27; 95% CI, 1.04-1.54). No associations were observed between snus and smokeless tobacco excluding snus and incidence of oral health outcomes. Conclusions and Relevance: The observed associations of combustible tobacco use with incidence of several adverse oral health outcomes and ENDS use with incidence of bleeding after brushing or flossing highlight the importance of longitudinal studies and emphasize the continued importance of tobacco cessation counseling and resources in clinical practice.

Tooth retention, health, and quality of life in older adults: a scoping review.

OBJECTIVE: This scoping review describes the relationship between tooth retention, health, and quality of life in older adults. METHODS: Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool. RESULTS: 140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life. DISCUSSION: There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.

The use of teledentistry in facilitating oral health for older adults: A scoping review.

BACKGROUND: Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services. TYPES OF STUDIES REVIEWED: Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria. RESULTS: Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.

Self-Reported Dental Visits Among Older Adults Receiving Home- and Community-Based Services.

Objective: To investigate factors associated with infrequent dental use among older adults receiving home- and community-based services. Method: This cross-sectional study analyzed responses from the 2014 National Survey of Older Americans Act participants who received home- and community-based services. Descriptive and multivariable analyses were conducted to examine the association between infrequent dental use and key sociodemographic and health indicators. Results: Infrequent dental use was highest among adults participating in case management and home-delivered meals (63%); the lowest among those participating in congregate meals (41%). Participants who did not complete high school were 2 to 5 times more likely to be infrequent dental users compared to those with educational attainment beyond high school. Discussion: Among older adults receiving home- and community-based services, improving oral health knowledge and health literacy may reduce infrequent dental use.

Data visualization of the relationship between smoking and periodontal site-specific effects across the lifespan in the US adult population.

BACKGROUND: Data visualization techniques were used to ascertain (1) site-specific effects of cigarette smoking on the periodontium compared to never-smokers; (2) patterns of site-specific effects by age among current and never-smokers using contour maps. METHODS: Data from 10,713 dentate participants aged ≥30 years in NHANES 2009-2014 were used. Pocket depth (PD) and clinical attachment level (CAL) for six sites/tooth were ascertained by smoking status and plotted using contour maps to identify new patterns. RESULTS: In the overall sample, 19% (n = 2015) were current smokers and 56% (n = 6013) were never-smokers. Contour maps of the overall sample showed teeth/sites most affected with mean PD > 2.1 mm were molars (2,3,15,18,19,30,31) in mesio-lingual (ML) and disto-lingual (DL) sites. Most affected sites for current smokers were interproximal sites of most posterior teeth. Among never-smokers, fewer teeth/sites were affected with PD > 2.1 mm, whereas among smokers, number of affected teeth/sites increased with age. Overall, teeth/sites most affected with mean CAL≥2.1 mm were noted in 2,3(ML), 3(DL), 14(DF, DL), 15(MF, ML), 18(ML), 19(DL, ML), and 30-31(ML, DL) with upper anterior teeth least affected. Among current smokers, several teeth/sites were affected (CAL≥2.1 mm): 2,3(all six sites), 4(ML, DL), 9(ML), 11-21(DL), 13-18(DF, ML, MIL, DL), 19-20(DF, ML, MIL), 14-18(MIF), 21(MIF, ML, DL), 22(MF), 23-27(MIL), 24-26(MIL, MF, DF in 26), 27(MF), 28(MF, ML, DL), 29-31(all 6 sites except MIF 30,31). As age increased, more teeth/sites were affected among smokers and by the 5th decade nearly all teeth/sites had CAL≥2.0 mm. CONCLUSIONS: Contour mapping identifies patterns and dramatically visualizes the substantial periodontal site-specific differences. Current smokers had more affected teeth and/or periodontal sites with a different contour pattern than never-smokers.

Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis.

BACKGROUND: Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive. OBJECTIVE: To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults. METHODS: We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals. RESULTS: A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97-2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42-0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14-2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23-7.05)). CONCLUSION: For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.

Cultural factors and oral health-related quality of life among dentate adults: Hispanic community health study/study of Latinos.

Objective: Research on the relationships between acculturation, ethnic identity, and oral health-related quality of life (OHRQOL) among the U.S. Hispanic/Latino population is sparse. The aim of this study is to examine the association between acculturation, ethnic identity, and OHRQOL among 13,172 adults in the 2008-2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Design: Participants self-reported their acculturation (immigrant generation, birthplace, residence in the U.S., language, and social acculturation), ethnic identity (sense of belonging and pride), and four OHRQOL measures. Key socio-demographic, behavioral, and oral health outcomes were tested as potential confounders.Results: Overall, 57% of individuals experienced poor OHRQOL in at least one of the domains examined. In multivariable analyses, some elements of higher acculturation were associated with greater food restriction and difficulty doing usual jobs/attending school, but not associated with pain or difficulty chewing, tasting, or swallowing. While sense of belonging to one's ethnic group was not associated with poor OHRQOL, low sense of pride was associated with food restriction. Socio-behavioral characteristics were significant effect modifiers.Conclusion: This study contributes to the understanding of the role of Hispanic/Latino's cultural factors in OHRQOL perception and can inform targeted strategies to improve OHRQOL in this diverse population.

Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid.

BACKGROUND: The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis. METHODS: The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 U.S. states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9. RESULTS: During the 2013 through 2015 study period, among the more than 1,008,400 Medicaid patients with a dental diagnosis, 19.8% filled an opioid prescription within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid prescription for pain management of a dental condition than were men (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.49 to 1.52). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.12; 95% CI, 2.05 to 2.19; OR, 1.90; 95% CI, 1.84 to 1.96, respectively). Patients receiving oral health care in an emergency department were more than 7 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 7.28; 95% CI, 7.13 to 7.43). Patients with a dental condition diagnosed were more than 4 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 4.31; 95% CI, 4.19 to 4.44). Opioid use was substantially higher among African American female patients (OR, 2.02; 95% CI, 1.93 to 2.10) and non-Hispanic white female patients (OR, 2.16; 95% CI, 2.07 to 2.24) than among Hispanic female patients. CONCLUSIONS: Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States. PRACTICAL IMPLICATIONS: Dentists are providing substantially fewer opioid prescriptions compared with their medical colleagues for pain treatment after a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.

Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries.

INTRODUCTION: Millions of Americans are affected by acute or chronic pain every year. This study investigates opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients. METHODS: The study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study. RESULTS: There were 5,051,288 patients with 1 of the 7 diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental conditions (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, such as otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic conditions (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, compared with general practitioners, other providers were more likely to prescribe opioids for conditions associated with chronic pain management. CONCLUSIONS: More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Modifications to the guidelines addressing temporary acute pain management practices with opioids would be likely to benefit emergency department providers the most.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2011-2014.

BACKGROUND: Following implementation in 2009-2010 to the oral health component for the National Health and Nutrition Examination Survey (NHANES), a full-mouth periodontal examination was continued during 2011-2014. Additionally, a comprehensive dental caries assessment was re-introduced in 2011 after a 6-year absence from NHANES. This report provides oral health content information and results of dental examiner reliability statistics for key intraoral assessments conducted by dentists during 2011-2014. METHODS: During the 2011-2014 NHANES 17,463 persons age 1 and older representing the US civilian, non-institutionalized population received an oral health examination. From this group, 387 individuals underwent a repeat examination conducted by the survey reference examiner. A combination of examiner training and calibration, electronic data capture, and ongoing performance evaluation with statistical monitoring was used to ensure conformance with NHANES protocols and data comparability to prior data collection periods. RESULTS: During 2011-2014, the Kappa statistics for the tooth count assessment ranged from 0.96 to 1.00, for untreated dental caries Kappa scores were 0.93 to 1.00. The overall Kappa statistics for identifying combined moderate-severe periodontitis using the CDC/AAP case definition was 0.66 and 0.69 with percent agreement of 83 to 85% during 2011-2014. When evaluating inter-examiner agreement using information collected from 3 periodontal sites for comparability to the NHANES 2003-04 periodontal examination protocols, Kappa scores for combined moderate-severe periodontitis was 0.65 and 0.80 during 2011-2014. For total mean attachment loss and pocket depth across all 6 periodontal sites, the inter-class coefficients (ICCs) ranged from 0.80-0.90 and 0.79-0.86 respectively. Site-specific mean attachment loss ICCs were generally higher for the 4 interproximal measurements compared to the 2 mid-site probing measurements and this observation was similar in 2009-2010. CONCLUSION: During 2011-2014, results overall indicate a high level of data quality and substantial examiner reliability for tooth count and dentition; reliability for periodontal disease, across various assessments, was at least moderate. When comparing the 2011-2014 examiner performance to findings from 2003 to 2004, comparable concordance between the examiners and the reference examiner exists.

Self-perceived oral health, normative need, and dental services utilization among dentate adults in the United States: National Health and Nutrition Examination Survey (NHANES) 2011-2014.

OBJECTIVE: This study investigated the role of self-perceived oral health and normative need on dental services utilization by US adults aged ≥30 years from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). METHODS: Data on 5,806 dentate adult NHANES participants were analyzed. Key independent variables were self-perceived oral health and normative need assessed by a dentist. The dependent variable was dental visit within the past 12 months. Select sociodemographic variables were adjusted for in logistic regression models using SAS survey procedures. RESULTS: Overall, 33.8 percent of adults did not have a dental visit in the past 12 months. About 26.9 percent reported they were unsatisfied with their oral health and 53.4 percent needed to seek care. Individuals unsatisfied with their oral health were less likely to have a dental visit in the past 12 months compared to those who were satisfied with their oral health (57 versus 25 percent). Overall, participants who were unsatisfied with their oral health received a recommendation to seek care. These participants had more normative needs and were less likely to have a dental visit in the past 12 months; however, this relationship varied by race/ethnicity. For Asian-Americans, there was no association between those unsatisfied with their oral health and dental visits. Also, there was no association across all race/ethnicities between number of teeth present and dental visits. CONCLUSION: Both self-perceived oral health and normative need are associated with dental utilization. Results will contribute to health policy discussions and program development that aim to improve oral health status in the United States.

Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011-2014.

BACKGROUND: Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions. RESULTS: The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51-1.90) and (RR 1.68; 95%CI: 1.52-1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20-44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04-1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model. CONCLUSIONS: Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.

Further opportunities for digital imaging in dental epidemiology.

Dental epidemiological research permits accurate tracking of the prevalence and distribution of oral disease across population groups, enabling planning and evaluation of public health interventions and healthcare service provision. This first section of this paper aimed to review traditional assessment methods in dental epidemiology and to consider the methodological and logistical benefits provided by digital imaging, both generally and specifically in relation to an established dual-camera system. The remainder of this paper describes the results of a semi-structured examination of an image archive from previous research utilising a dual-camera system, exploring whether the diagnostic yield of the images might be increased. Common oral conditions are presented alongside suggestions of the diagnostically useful data displayed in example images. Possible scoring mechanisms are discussed with consideration of the limitations that might be encountered for each condition. The retrospective examination suggests further data is obtainable from images acquired using the dual-camera system, however, consideration should be given to how best to validate this clinically. Additionally, other imaging modalities are discussed whilst taking into account the potential limitations of the dual-camera system.

Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid.

BACKGROUND: The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis. METHODS: The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 US states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9. RESULTS: During the 2013-2015 study period, among the more than 890,000 Medicaid patients with a dental diagnosis, 23% received an opioid within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid for pain management of a dental condition than were men (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.52 to 1.55). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.11; 95% CI, 2.05 to 2.17 and OR, 1.88; 95% CI, 1.83 to 1.93, respectively). Patients receiving oral health care in an emergency department were nearly 5 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 4.66; 95% CI, 4.59 to 4.74). Patients with a dental condition diagnosed were nearly 3 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 2.64; 95% CI, 2.57 to 2.70). Opioid use was substantially higher among African American female patients (OR, 3.29; 95% CI, 3.18 to 3.40) and non-Hispanic white female patients (OR, 3.24; 95% CI, 3.14 to 3.35) than among Hispanic female patients. CONCLUSIONS: Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States. PRACTICAL IMPLICATIONS: Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.

Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014.

BACKGROUND: Except for a small increase in caries prevalence in young children from 1999 through 2004, the prevalence of pediatric caries in the United States has remained consistent for the past 3 decades. METHODS: The authors used data from the National Health and Nutrition Examination Survey (NHANES) (from 1999 through 2004 and from 2011 through 2014) to ascertain changes in caries prevalence in youth aged 2 to 19 years. The authors evaluated changes in the prevalence of caries experience, untreated caries, and severe caries (3 or more teeth with untreated caries) in the primary, mixed, and permanent dentition according to poverty status. RESULTS: Untreated dental caries in the primary dentition decreased (24% versus 14%) for children aged 2 to 8 years regardless of poverty status from the period from 1999 through 2004 to the period from 2011 through 2014. Severe caries in primary teeth decreased between the period from 1999 through 2004 and the period from 2011 through 2014 for 2- to 8-year-olds (10% versus 6%). Among preschool-aged children in families with low incomes, caries experience decreased from nearly 42% to 35%, and untreated caries decreased from 31% to 18%. Furthermore, there were significant reductions in the number of carious dental surfaces and significant increases in the number of restored dental surfaces. Overall, there was little change in the prevalence of caries in older children and adolescents. CONCLUSIONS: The prevalence of caries in primary teeth in preschool-aged children has improved in the previous decade in the United States; however, the prevalence of having no caries experience in permanent teeth in children and adolescents remains unchanged. PRACTICAL IMPLICATIONS: Although the oral health status of young children has improved in the previous decade, few changes have occurred for many older children and adolescents.

Informed consent in dental care and research for the older adult population: A systematic review.

BACKGROUND: Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS: The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. RESULTS: The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research. CONCLUSIONS: Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. PRACTICAL IMPLICATIONS: This review is the first attempt, to the authors' knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.

Significance and Implications of Patient-reported Xerostomia in Sjögren's Syndrome: Findings From the National Institutes of Health Cohort.

BACKGROUND: Xerostomia is a chief complaint of patients with Sjögren's syndrome (SS). However, newer proposals for SS classification remove xerostomia and hyposalivation from the criteria list. Given these developments and the importance of patient-centered research outcomes, we sought to evaluate the utility of patient-reported xerostomia with implications for classification criteria, and clinical trials targeting SS treatment modalities. METHODS: A nested case-control study was designed within The National Institute of Dental and Craniofacial Research/National Institutes of Health (NIDCR/NIH) SS Cohort - one of the largest SS cohorts in the US. Clinical characteristics of those with and without xerostomia in SS and other salivary gland dysfunctions were compared. Several analytical methods were employed, including multivariable logistic regression modeling. FINDINGS: The NIDCR/NIH Sjögren's Syndrome Clinic has an open cohort with ongoing enrollment since 1984. This open cohort comprised of 2046 participants by August 27, 2015. Baseline data of 701 SS, 355 Sicca, and 247 ISS participants within the source cohort were analyzed. Xerostomia was highest among SS participants (87.4%, 95% CI: 84.8%-89.8%) compared to Sicca (72.4%, 95% CI: 67.4%-77.0%, p<0.001) and ISS groups (38.1%, 95% CI: 32.0%-44.4%, p<0.001). Those with xerostomia were more likely to have SS than Sicca/ISS (OR=4.98, 95% CI: 3.78-6.56). The ability of xerostomia to screen for SS among those with salivary gland dysfunction was higher than screening for Sicca/ISS. Screening diagnostics of xerostomia were of greater utility compared to hyposalivation. After adjusting for confounding in multivariable modeling, SS participants with xerostomia were more likely to be White (Black/African Americans (OR: 0.40, 95% CI: 0.23-0.68, p-value=0.001) and Asians (OR: 0.49, 95% CI: 0.25-0.96, p-value=0.038) were less likely to have xerostomia compared to Whites), have dry eye symptoms for >3months (OR: 5.80, 95% CI: 3.62-9.28, p-value <0.001), a lower Van Bijsterveld score (OR: 0.55, 95%CI: 0.34-0.90, p-value=0.017), a lower stimulated salivary flow rate (OR: 1.67, 95% CI: 1.06-2.65, p-value=0.028), a focus score of >2 (OR: 1.92, 95% CI: 1.20-3.09, p-value=0.007), and salivary gland swelling (OR: 49.39, 95% CI: 2.02-1206.30, p-value=0.017). Age, gender, fatigue, pain, anxiety, and autoantibodies were not significantly associated with xerostomia. INTERPRETATION: Findings from this study indicate that patient-reported xerostomia is highly prevalent among SS patients and is associated with several clinical phenotypes of this complex syndrome, thereby making it an important indicator of SS. The evidence also suggests that xerostomia is not limited to low salivary flow but might be reflective of compositional changes of saliva. Consequently, these findings suggest the need to consider xerostomia in the development of SS classification criteria and in patient-centered outcomes research in SS intervention trials. This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Institute of Dental and Craniofacial Research (NIDCR) Grant # DE000704-15. Dr. Baer is supported by RO1-DE-12354-15A1.

Sealants for Preventing and Arresting Pit-and-fissure Occlusal Caries in Primary and Permanent Molars.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly onefourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.

BACKGROUND: National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.