How has the dental literature evolved over time? Analyzing 20 years of journal self-citation rates and impact factors.

Objective: As journal impact factors (IFs) can be artificially inflated by excessive journal self-citation practices, research quality evaluation based solely on IF ranking may be manipulated and, therefore, ethically challenged. This study aimed to analyze the longitudinal development of journal self-citation rates (SCRs) and IFs in dental literature and to determine possible confounders.Methods: Twenty-eight journals with scope within general dentistry and (sub)specialties listed in 1997-2016 Journal of Citation Reports® were scrutinized. The following information was retrieved: publication year, total number of citations, number of self-citations, IF, corrected IF, and SCR.Results: Endodontic journals had the highest SCR (median = 35.3, IQR = 21.6-47.5), journals related to periodontics had the lowest (median = 14.7, IQR = 8.9-25.5). Periodontics had the highest IF (median = 2.1, IQR= 1.7-2.8) and general dentistry had the lowest (median = 0.9, IQR = 0.7-1.2). SCR significantly decreased over time (p < .0001) by 1 unit per year. Additionally, 1 unit increase in corrected IF resulted in 15.2 units decrease in SCR. IFs significantly increased 0.06 units per year (p < .000).Conclusions: Overall, favourable changes in citation metrics have been observed for dental journals during the 20-year observation period. SCR significantly decreased per observation year whereas IFs significantly increased, indicating a healthy publishing environment in the dental literature. SCR was regulated both by time and corrected IF.

Dental Students' Exposure to Periodontal and Implant Placement Surgeries in U.S. Dental Schools.

The aim of this study was to assess nationwide trends in the exposure of dental students to periodontal and implant surgical procedures and to evaluate the potential factors that influence these clinical experiences. A 19-item questionnaire was sent to all 64 directors of predoctoral periodontics in U.S. dental schools. In addition to gathering information on the percentage of students who perform surgical periodontics or implant placement procedures in each program, data on student research groups, periodontics residency programs, and periodontics faculty practices were collected. A total of 33 responses were received, for a response rate of 51.5%. Among the responding institutions, 97% and 45.5% allowed dental students to perform periodontal and dental implant placement surgeries, respectively, although only 26.4% and 15.2% of the dental class ended up performing periodontal and dental implant placement surgeries, respectively. Crown lengthening was the most commonly reported (84.8%) periodontal surgical procedure performed by dental students. A negative correlation was found between the presence of a periodontics residency program and dental students' placing dental implants, while the size of the residency program positively correlated with dental students' placing dental implants. Overall, a wide variation in the exposure of dental students to periodontal and dental implant placement surgical experiences was found. Future surveys should assess clinical procedures performed in other special-ties to gain a broader picture of the experience students are gaining in these areas.

Practice characteristics and service provision rates of dental hygienists in Australia.

INTRODUCTION: Dental hygienists (DHs) have been practising in Australia since the early 1970s. OBJECTIVE: This study describes the clinical activity of Australian DHs. METHODS: A questionnaire was mailed to members of two professional associations representing DHs. Practitioner characteristics, employment characteristics and clinical activity on a self-reported typical practice day were collected. The proportion of each service item of all services provided was estimated. Associations between practice characteristics and service provision were assessed by log-binomial regression models. RESULTS: Adjusted response rate was 60.6%. Of the DHs included in analysis (n=341), 80% were employed in general practice, and nearly all (96%) worked in the private sector. About half (53.7%) of all service provided were preventive services, and one-fourth (23.9%) were diagnostic. Service provision varied by practice and practitioner characteristics, with the largest variations observed by practice type. Unadjusted analysis showed that general practice DHs provided a higher mean number of periodontal instrumentation and coronal polishing (0.92 vs 0.26), fluoride applications (0.64 vs 0.08), oral examinations (0.51 vs 0.22) and intraoral radiographs (0.33 vs 0.07) per patient visit and a lower mean number of impressions (0.05 vs 0.17) and orthodontic services (0.02 vs 0.59) than specialist practice DHs. In adjusted analysis, rates of periodontal services also significantly varied by practice type; other associations persisted. CONCLUSION: Service provision of DHs varied by practice type. Practice activity was dominated by provision of preventive services while provision of periodontal treatments, fissure sealants and oral examinations was relatively limited indicating areas in which DHs are possibly underutilized.

The impact of education on the probability of receiving periodontal treatment. Causal effects measured by using the introduction of a school reform in Norway.

The aim of the present study was to estimate the causal effect of education on the probability of receiving periodontal treatment in the adult Norwegian population. In Norway, a substantial part of the cost of periodontal treatment is subsidized by the National Insurance Scheme. In that case, one might expect that the influence of individual resources, such as education, on receiving treatment would be reduced or eliminated. Causal effects were estimated by using data on a school reform in Norway. During the period 1960-1972, all municipalities in Norway were required to increase the number of compulsory years of schooling from seven to nine years. The education reform was used to create exogenous variation in the education variable. The education data were combined with large sets of data from the Norwegian Health Economics Administration and Statistics Norway. Since municipalities implemented the reform at different times, we have both cross-sectional and time-series variation in the reform instrument. Thus we were able to estimate the effect of education on the probability of receiving periodontal treatment by controlling for municipality fixed effects and trend variables. The probability of receiving periodontal treatment increased by 1.4-1.8 percentage points per additional year of schooling. This is a reasonably strong effect, which indicates that policies to increase the level of education in the population can be an effective tool to improve oral health, including periodontal health.

[Clinical evaluation of periodontal-orthodontic treatment in patients with aggressive periodontitis and malocclusion].

OBJECTIVE: To evaluate the clinical effect and safety of periodontal-orthodontic treatment in patients with aggressive periodontitis (AgP) and malocclusion. METHODS: A retrospective analysis was conducted in 25 AgP patients, who had received periodontal-orthodontic treatment in Peking University School and Hospital of Stomatology. Clinical indexes, including probing depth (PD), bleeding index (BI) and percentage of sites with bleeding on probing (BOP%) were evaluated at three time points: Baseline (T0); active periodontal treatment finished and before orthodontic treatment (T1); and after orthodontic treatment (T2). Also changes of ratio of the residual alveolar bone height (RBH) and the occurrence of root resorption were evaluated by periapical radiographs. RESULTS: (1) Compared with T0, all the clinical parameters including PD, BI, BOP% and percentage of sites with PD>3 mm were significantly improved (P<0.001). (2) Significant difference was observed in the average RBH between T0 (68.37%±15.60% and T2 (70.27%±14.23%). RBH in upper incisors [(58.79%±16.71% at T0, 65.54% (55.74%, 78.13%) at T2], upper canines [77.62% (66.06%, 87.17%) at T0, 79.57% (69.75%, 86.52%) at T2] and upper molars [74.30% (61.69%, 84.45%) at T0, 76.76% (68.12%, 85.09%) at T2] showed significant increase (P<0.05). (3) After orthodontic treatment, varying degrees of root resorption occurred in (23.94%±13.45%) of teeth per capita, among which the lower and upper incisors showed the highest incidence (68.48% and 65.31% in homogeneous teeth, respectively). CONCLUSION: After active periodontal treatment, orthodontic treatment in AgP patients had not aggravated inflammation and alveolar bone resorption; root resorption occurred in two-thirds of incisors approximately.

[Evaluating productivity targets achievement in Dental Specialty Centers from Maranhão State, Brazil, 2011]. / Avaliação do cumprimento das metas de produtividade em Centros de Especialidades Odontológicas no Maranhão, 2011.

OBJECTIVE: to evaluate productivity targets achievement (PTA) in Dental Specialty Centers (DSCs) from Maranhão State, Brazil. METHODS: this was an ecologic study using secondary data; an indicator for PTA was created for each subgroup of procedures. RESULTS: 25 DSCs were evaluated; the PTA was higher for basic procedures (n=19), followed by endodontics (n=11), oral surgery (n=9) and periodontics (n=8); the best results were obtained at DSCs type II; higher PTA was associated with financial anticipation (basic procedures) and higher Human Development Index, life expectancy and social exclusion rate (endodontics); lower PTA was associated with larger population (endodontics/oral surgery), adherence to the Pact for Health (periodontics/endodontics), larger number of specialties (periodontics) and bigger DSC (oral surgery). CONCLUSION: most DSCs did not achieve productivity targets, except for basic procedures; socioeconomic and health management characteristics of the municipalities were associated with the PTA; the DSCs characteristics explained little about the PTA.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

An Investigation into Patient Non-Attendance and Use of a Short-Message Reminder System at a University Dental Clinic.

Non-attended appointments in health care facilities create inefficiencies and loss of clinical productivity: clinical teaching hours are reduced, impacting students' ability to meet the competencies necessary for professional registration. The aim of this study was to assess demographic and time-related factors for patient non-attendance at a dental school clinic in Australia. Appointment data were extracted from the patient management system for the years 2011 and 2012. Data included the status of appointment (attended, cancelled, or failed to attend [FTA]) and an array of demographic and time-related factors. Multinomial logistic regression was conducted to assess relationships between these factors and appointment status. Attendance rates were also compared by year following implementation of a short message service (SMS) reminder at the beginning of 2012. The results showed that, of 58,622 appointments booked with students during 2011 and 2012, 68% of patients attended, 23% cancelled, and 9% were FTA. The percentage of non-attended (cancelled or FTA) appointments differed by demographic and time-related factors. Females were 7% less likely to be FTA, those aged 16-24 years were five times more likely to be FTA, and early morning appointments were 18% less likely to be cancelled and FTA. With the SMS reminder system, the odds of a cancellation were 15% higher, but FTAs were 14% lower (both were statistically significant differences). This study found that failing to attend an appointment was significantly related to a number of factors. Clinical scheduling and reminder systems may need to take these factors into account to decrease the number of teaching hours lost due to patients' missing their appointments.

Linear mixed model approach to network meta-analysis for continuous outcomes in periodontal research.

AIM: Analysing continuous outcomes for network meta-analysis by means of linear mixed models is a great challenge, as it requires statistical software packages to specify special patterns of model error variance and covariance structure. This article demonstrates a non-Bayesian approach to network meta-analysis for continuous outcomes in periodontal research with a special focus on the adjustment of data dependency. DATA: Seventeen studies on guided tissue regeneration were used to illustrate how the proposed linear mixed models for network meta-analysis of continuous outcomes. METHODS & RESULTS: Arm-based network meta-analysis use treatment arms from each study as the unit of analysis; when patients are randomly assigned to each arm, data are deemed independent and therefore no adjustment is required for multi-arm trials. Trial-based network meta-analysis use treatment contrasts as the unit of analysis, and therefore treatment contrasts within a multi-arm trial are not independent. This data dependency occurs also in split-mouth studies, and adjustments for data dependency are therefore required. CONCLUSIONS: Arm-based analysis is the preferred approach to network meta-analysis, when all included studies use the parallel group design and some compare more than two treatment arms. When included studies used designs that yield dependent data, the trial-based analysis is the preferred approach.

Periodontal probing: a review.

Periodontal probes are the main instruments that are used to assess the status of the periodontium, either for screening purposes or to evaluate periodontal changes throughout the treatment process. With increased knowledge and understanding of periodontal disease, the probes have evolved from a unidimensional manual shape into a more sophisticated computerised instrument. This is due to the need to increase the accuracy and reproducibility of readings and to improve efficiency (time, effort, money). Each probe has characteristic features that makes it unique and, in some cases, specific and limited to use. The aim of this paper is to present a brief introduction to periodontal disease and the methodology of measuring it, followed by probing limitations. The paper will also discuss the methodology of reducing probing error, examiner calibration and probing reproducibility.

Specialty education in periodontics in Japan and the United States: comparison of programs at Nippon Dental University Hospital and the University of Texas Health Science Center at San Antonio.

Japan has institutions that train qualified postdoctoral students in the field of periodontics; however, Japan does not have comprehensive advanced periodontal programs and national standards for these specialty programs. To help Japanese programs move toward global standards in this area, this study was designed to describe overall differences in periodontics specialty education in Japan and the United States and to compare periodontics faculty members and residents' characteristics and attitudes in two specific programs, one in each country. Periodontal faculty members and residents at Nippon Dental University (NDU) and the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School participated in the survey study: four faculty members and nine residents at NDU; seven faculty members and thirteen residents at UTHSCSA. Demographic data were collected as well as respondents' attitudes toward and assessment of their programs. The results showed many differences in curriculum structure and clinical performance. In contrast to the UTHSCSA respondents, for example, the residents and faculty members at NDU reported that they did not have enough subject matter and time to learn clinical science. Although the residents at NDU reported seeing more total patients in one month than those at UTHSCSA, they were taught fewer varieties of periodontal treatments. To provide high-quality and consistent education for periodontal residents, Japan needs to establish a set of standards that will have positive consequences for those in Japan who need periodontal treatment.

Bibliometrics study on authorship trends in periodontal literature from 1995 to 2010.

BACKGROUND: Biomedical research has grown considerably in the last few decades, and the authorship characteristics of the dental literature as a whole and of its specialty fields has changed significantly. Unfortunately, the bibliometrics of the periodontal literature have not been thoroughly investigated. The aim of this study is to investigate the bibliometrics of periodontal literature, assessing the geographic origin, study design, and topics investigated in periodontal research published from 1995 to 2010. METHODS: Articles published in periodontal journals during 1995 to 2010 were retrieved through hand search. Inclusion/exclusion criteria were applied. The following variables were extrapolated from each article: number of authors, study design, topic investigated, financial support, and geographic origin. The general linear model assessed the influence of independent variables on number of authors per article, and χ(2) test assessed the statistical difference of the variables over years 1995 to 2010. RESULTS: A total of 2,260 articles were reviewed; 2,076 met the inclusion criteria. The number of authors per article increased (P <0.001) from 4.0 (1995) to 5.1 (2010). The proportion of articles published from North America and Europe decreased (P <0.001) from 84.3% (1995) to 58.6% (2010), whereas for Asia and South America the article proportion increased (P <0.001) from 13.8% (1995) to 40% (2010). Research targeting prevention and treatment of periodontal disease is decreasing (P <0.001) in favor of implant-related research. Governmental research funding is increasing (P <0.001). CONCLUSION: Periodontal research significantly changed during the last 15 years.

Ergonomics and musculoskeletal disorder: as an occupational hazard in dentistry.

OBJECTIVE: Musculoskeletal disorders (MSDs) are commonly experienced in dentistry. The objective of this study is to determine the prevalence of ergonomics and MSDs among dental professionals. MATERIALS AND METHODS: A cross-sectional survey was conducted among 170 dentists of different specialties. The questionnaire gathered information regarding demographic details, MSDs, work duration, working status, awareness of ergonomics, etc. Data was analyzed using SPSS version 15.0. Student's t-test and analysis of variance (ANOVA) test was used for comparison in mean scores. Stepwise multiple linear regression analysis was used to assess the independent variables that significantly influenced the variance in the dependent variable (pain). RESULTS: It was found that 73.9% of the participants reported musculoskeletal pain and most common painful sites were neck and back. More than half of the participants, i.e. 232 (59.3%) were aware of correct ergonomic posture regarding dental. Almost percentage of pain increased significantly with increase in age and working time. Among all specialties, prosthodontics were found to have more prevalence of MSDs. CLINICAL SIGNIFICANCE: The appearance of musculoskeletal symptoms among dental professionals was quite common. It suggested that ergonomics should be covered in the educational system to reduce risks to dental practitioners.

Inferior alveolar neurosensory deficiency associated with placement of dental implants.

BACKGROUND: This study reports and analyzes a large series of patients with neurosensory deficiency related to the placement of dental implants (DIs) and resulting in liability claims (LCs). METHODS: From 1998 to 2009, there were 92 LCs related to persistent altered sensation post DI placements in Israel. Patients' demographics, year and source of LCs, interval between the procedure that resulted in a neurosensory deficiency and the LC, qualifications of the surgeon, preoperative imaging modality, DI length, available alveolar bone for DI placement, placement site, timing of DI placement (immediately after tooth extraction or after socket healing), and treatment after the diagnosis of neurosensory deficiency were recorded and analyzed. RESULTS: There were 21 cases during the first 5 years of the study (mean 4.2/year) and 63 cases (mean 12.6/year) over the following 5 years. Thirty LCs were issued during the second postoperative year and 15 LCs after >5 years. Most LCs (76%) involved procedures that were planned and performed according to radiographs and 24% after computed tomography. Sixty-five percent of the LCs were performed by general dental practitioners and 35% by specialists. More than one DI was performed during the surgical procedure that resulted in a neurosensory deficiency in 73 LCs (79.3%), and the DI was >10 mm in 55 (59.8%) cases. CONCLUSIONS: LCs for DIs that result in a neurosensory deficiency pose a legal risk to the practitioner long after the injury has occurred.

Condições periodontais, determinantes sociais e estilo de vida: estudo epidemiológico de base populacional / Periodontal conditions, social determinants of health, lifestyle: an epidemiological population- based study

O presente estudo tem como objetivo avaliar a prevalência da doença periodontal e associá-la aos determinantes sociais da saúde e ao estilo de vida em adultos de 35 a 44 anos de idade, residentes no sudeste do Brasil, município de Betim-MG. Este estudo transversal utilizou um questionário aplicado em uma amostra de 743 adultos. A avaliação da doença periodontal foi realizada através do CPI. Os dados obtidos através deste índice foram catergorizados em periodonto saudável, gengivite, gengivite/cálculo, bolsa periodontal de 4-5mm e bolsa periodontal de 6mm ou mais e periodontite. A condição periodontal foi o desfecho estudado...

Pattern of periodontal treatments performed at the periodontology clinic of the Lagos University Teaching Hospital: 22 months review.

BACKGROUND: A critical evaluation of the pattern of periodontal procedures performed is important in providing useful data to the administrator for proper planning and budgeting for dental health service. OBJECTIVE: To assess the pattern of periodontal treatments performed over a given period of time at the Periodontology clinic of the Lagos University Teaching Hospital, Lagos, Nigeria. METHODS: This was a twenty two months retrospective study of all periodontal procedures performed on patients seen at the periodontology clinic of the Lagos University Teaching Hospital between January 2006 and October 2007. The periodontology treatment record was used to retrieve information which included the patient's age, gender, diagnosis and periodontal procedures given. The procedures were further categorized into surgical and nonsurgical groups. The information obtained was then analyzed using Epi Info 2007 statistical software. RESULTS: A total of 1,938 patients were seen during this period. Females were 1009 (52.1%) and males were 929 (47.9%). (F/M, 1.1:1). A total of 2,110 periodontal treatments were performed. Majority of the patients received non-surgical periodontal therapy which constituted the bulk (96.3%) of the therapies. Scaling and polishing was the most frequently performed non-surgical procedure accounting for 1261 (62.1%) with slightly more males receiving the treatment. Of the surgical treatment modalities, operculectomy accounted for 65.4% and was carried out on more females than males. Regenerative procedures were the least performed surgical treatments. CONCLUSION: This study highlighted that non-surgical periodontal therapy, particularly scaling and polishing was the most frequently utilized periodontal procedure. Operculectomy was the predominant surgical procedure performed. The low percentage of regenerative surgical procedures was however below the desired expectation.

Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.

BACKGROUND: In contrast to an expected increase in demand for periodontal services with aging of the population, it appears that referrals to periodontists are declining. OBJECTIVE: To determine the extent to which general dentists in Nova Scotia, Canada, provide periodontal and surgical implant therapies and to determine the factors influencing a dentist's decision to provide treatment or refer patients to a specialist. METHODS: A cross-sectional survey study was performed. The survey questionnaire was mailed to all 443 general dentists practising in Nova Scotia in summer 2009. The questionnaire presented several clinical scenarios and asked respondents whether they would treat the patient in the office or refer to a specialist. The data were analyzed by logistic regression. RESULTS: Of the 279 (63.0%) dentists responding to the survey, 272 (61.4% of the total) were eligible for inclusion in the analysis. The majority of dentists reported rendering nonsurgical periodontal therapy, including scaling (98.5%; 262/266), periodontal maintenance (95.9%; 255/266), and treatment for bruxism (95.1%; 252/265). The most common surgical procedures performed by dentists were frenectomy (29.4%; 78/265), gingivectomy (29.3%; 77/263) and crown-lengthening procedures (17.0%; 46/271). Eleven factors significantly influenced dentists' decisions to treat or refer patients. The most common criteria used in selecting a periodontist were satisfaction of previous patients, previous success with the treatment, and the personality of and good communications with the periodontist. CONCLUSIONS: In this study, dentists reported rendering nonsurgical periodontal therapy on a wide scale, whereas their involvement in oral or periodontal and implant surgical therapies was limited.

Critical issues in clinical periodontal research.

As periodontal researchers and clinicians, we are challenged every day to make decisions relating to the clinical management of our patients and about how best to conduct clinical periodontal research. This volume of Periodontology 2000 addresses some of the critical issues in contemporary clinical periodontics and periodontal research that are of direct relevance to clinicians, researchers, teachers and students. The 11 review articles in this volume of Periodontology 2000 focus on aspects of periodontal research methodology and clinical periodontology. In terms of research methodology, the articles aim to inform the reader on topics relating to randomized controlled trials in periodontal research, evidence-based dentistry, calibration of clinical examiners and statistics relevant to periodontal research. The clinical periodontology articles address issues relating to decisions on retaining periodontally compromised teeth or replacing them with implants, periodontal management in the patient with osteoporosis, surgical approaches for root coverage and the emerging science of advanced regenerative technologies, including the use of stem cells, for periodontal regeneration. It is hoped that these critical reviews will address many of the dilemmas that confront us on a regular basis and provide practical guidance to those engaged in both clinical periodontology and clinical periodontal research.