Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial.

BACKGROUND: Dentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations. METHODS: This multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12-25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant's electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants' perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.). DISCUSSION: This real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA. CLINICALTRIALS: GOV: NCT06275191.

Diagnosing and recording root caries: A survey among Swiss dentists.

OBJECTIVES: Despite the increase in the root caries prevalence, little is still known about how dentists manage this condition. The present study aimed to evaluate the knowledge of dentists on diagnosing and recording root caries lesions (RCL). METHODS: The survey consisted of three domains: (1) dentists' knowledge on diagnosing, recording and managing RCL; (2) information about their current general clinical routines; and (3) their demographics. The four Swiss Universities distributed the survey via e-mail lists for alumni or professionals participating in continuing education. The data was quality checked. Construct validity, internal reliability and intraclass correlation (ICC) were assessed. RESULTS: The survey was answered by 383 dentists from 25(out of 26) cantons [mean(SD) working experience: 22.5(12) years]. The majority replied that they see less than 5 patients with RCL per week, whereas 41 have at least 5 per week, and 40 % (157 dentists) do not distinguish RCL from coronal caries in their patients' medical records. When diagnosing active RCL, tactile sensation was the most predominant criterion (n = 380), whereas color (n = 224) and visual appearance (n = 129) of the lesion were less often selected. The most often chosen risk factors for RCL were poor oral hygiene and presence of biofilm.The responses were significantly influenced by the participants' place of education, their age and working area. CONCLUSION: The present survey highlights the huge diversity in diagnosing, recording and assessing risk factors of RCL. The benefits of an appropriate diagnosis, recording and management of risk factors of RCL should be highlighted in under- and postgraduate dental education. CLINICAL SIGNIFICANCE: A great diversity in diagnosing, recording and assessing risk factors of RCL was observed, which migh strongly impact how dentists manage RCL. The study emphasizes the necessity for intensive efforts to bridge the gap between guideline recommendations and their implementation in private dental practices.

The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil.

OBJECTIVES: This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries. METHODS: We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions. RESULTS: Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05). CONCLUSIONS: Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.

An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study.

This collaborative European Academy of Plastic Surgery (EAFPS) study aimed to provide an overview of rhinoplasty practices, informing clinician and patient decision making. It is a multicenter cross-sectional study, reported as per Strengthening the Reporting of Observational Studies in Epidemiology guidelines. All EAFPS members were contacted via email, inviting them to participate. Members expressing an interest to participate were asked to anonymously complete a questionnaire, related to rhinoplasties that they performed as first/supervising surgeon over a period from January 1, 2019 to January 1, 2022. A descriptive analysis was performed. One hundred and fifteen surgeons submitted data on 41,259 rhinoplasties from 33 countries. Eighty percent of rhinoplasties were primary, and 20% were secondary. Thirty five percent of primary rhinoplasties were closed and 65% were open. Thirty one percent of primary rhinoplasties were for cosmetic indications, 11% functional and 58% were for both. Of the 8147 secondary rhinoplasties, 44% were closed and 56% were open. Thirty percent were for cosmetic indications, 11% functional, and 59% for both cosmetic and functional. Ninety-one percent of rhinoplasties were performed by ENT surgeons, 3% by plastic surgeons, 5% by maxillofacial surgeons, and 1% were dual (maxillofacial and ENT) trained. One-thousand seven-hundred thirty primary rhinoplasties underwent revision surgery (5%) and 102 secondary rhinoplasties underwent revision surgery (1%). The most commonly reported indications for revision surgery were dorsal asymmetry, nasal blockage, and dissatisfaction with nasal tip. Three percent of rhinoplasties underwent preoperative psychological assessment. To the authors knowledge, this is the largest published rhinoplasty dataset. This study provides an overview of rhinoplasty practices that can be used for benchmarking and to guide clinician and patient decision making. Psychological assessment of prerhinoplasty appears insufficient with higher levels recommended to minimize unsuccessful outcomes. This study showcases the power of collaborative research and may serve as a catalyst for future collaborative facial plastic surgery research.

Trajectories of opioid prescribing by general dentists, specialists, and oral and maxillofacial surgeons in the United States, 2015-2019.

BACKGROUND: Despite decreases in opioid prescribing from 2016 through 2019, some dentists (general, specialists, oral and maxillofacial surgeons) in the United States continue to prescribe opioids at high rates. The authors' objective was to define dentists' trajectories of opioid prescribing. METHODS: The authors identified actively prescribing dentists from the IQVIA Longitudinal Prescription data set, from 2015 through 2019. Group-based trajectory modeling identified opioid prescribing trajectories on the basis of dentists' annual prescribing rates for the overall sample (model 1) and for high prescribers (model 2). The authors used χ2 or Mann-Whitney U tests to characterize the model 2 trajectory groups. RESULTS: In model 1 (n = 199,145 prescribers), group-based trajectory modeling identified 8 trajectories that were grouped into 5 categories. A total of 14.8% were nonprescribers who composed less than 1% of all prescriptions, low prescribers (3 groups; 46.0%) prescribed at low rates (2015: 5.5%-16.9%; 2019: 1.5%-11.9%), decliners (7.3%) decreased prescribing rapidly (2015: 29.4%; 2019: 5.1%), moderately high prescribers (2 groups; 28.5%) prescribed moderately (2015: 28.7% and 39.2%; 2019: 18.1% and 28.8%), and consistently high prescribers (3.4%) prescribed at high rates (2015: 54.6%; 2019: 44.7%). In model 2, from consistently high prescribers (n = 6,845), 4 trajectories were identified. Of these 4 groups, 1 group (7.5%) declined prescribing rapidly. The groups did not differ meaningfully; however, the rapid decliners included fewer oral and maxillofacial surgeons (13.0% vs 18.4%), saw more Medicaid patients (2.5% vs 1.0%), and had higher opioid prescribing rates in 2015 (95.5% vs 91.6%) (P < .001 for all). CONCLUSIONS: The authors identified variations in dentists' opioid prescribing rates. Although 60% of dentists decreased prescribing rates by 30% through 83%, 3.4% of dentists consistently prescribed at high rates. PRACTICAL IMPLICATIONS: Some dentists continue to prescribe opioids at high levels, indicating that additional information is needed to better inform policy and clinical decision making.

Prescription of antibiotic prophylaxis in implant placement among Portuguese dentists: A web survey.

OBJECTIVES: This study aims to assess whether antibiotic prophylaxis for dental implant placement is commonly used by dentists in Portugal. MATERIALS AND METHODS: This cross-sectional survey study was based on a web survey with 22 questions divided into 5 parts. The 1st part focused on demographic details, work experience, and academic expertise, whereas the 2nd and 3rd parts were about the pre- and postoperative antibiotic prescriptions. The 4th and 5th parts focused on dentists' motivation for using/avoiding antibiotic prophylaxis and the use of a protocol, respectively. Data interpretation included descriptive analysis and statistical inference via cross-tabling with chi-square adjusted standardised for residual effects. RESULTS: Of the 204 valid surveys, at least one was received from every large Portuguese city which ensured the national coverage of the survey. Most respondents are not specialist dentists (72%). Sixty-four percent of the respondents always use antibiotic prophylaxis, while 29% adopt it only when grafting materials are employed. Most respondents use both pre- and postoperative regimens (55%). Amoxicillin 875 mg + clavulanic acid 125 mg is the most prescribed antibiotic (57%). Finally, the risk reduction of postoperative infection is the most frequent justification for the use of antibiotic prophylaxis (60%). CONCLUSIONS: The results highlight that most of the respondents do not follow the consensual international guidelines for prophylactic antibiotherapy in dental implant placement surgeries. This finding should serve as a rationale to increase the dissemination of those guidelines.

Impact of artificial intelligence on dentists' gaze during caries detection: A randomized controlled trial.

OBJECTIVES: We aimed to understand how artificial intelligence (AI) influences dentists by comparing their gaze behavior when using versus not using an AI software to detect primary proximal carious lesions on bitewing radiographs. METHODS: 22 dentists assessed a median of 18 bitewing images resulting in 170 datasets from dentists without AI and 179 datasets from dentists with AI, after excluding data with poor gaze recording quality. We compared time to first fixation, fixation count, average fixation duration, and fixation frequency between both trial groups. Analyses were performed for the entire image and stratified by (1) presence of carious lesions and/or restorations and (2) lesion depth (E1/2: outer/inner enamel; D1-3 outer-inner third of dentin). We also compared the transitional pattern of the dentists' gaze between the trial groups. RESULTS: Median time to first fixation was shorter in all groups of teeth for dentists with AI versus without AI, although p>0.05. Dentists with AI had more fixations (median=68, IQR=31, 116) on teeth with restorations compared to dentists without AI (median=47, IQR=19, 100), p = 0.01. In turn, average fixation duration was longer on teeth with caries for the dentists with AI than those without AI; although p>0.05. The visual search strategy employed by dentists with AI was less systematic with a lower proportion of lateral tooth-wise transitions compared to dentists without AI. CONCLUSIONS: Dentists with AI exhibited more efficient viewing behavior compared to dentists without AI, e.g., lesser time taken to notice caries and/or restorations, more fixations on teeth with restorations, and fixating for shorter durations on teeth without carious lesions and/or restorations. CLINICAL SIGNIFICANCE: Analysis of dentists' gaze patterns while using AI-generated annotations of carious lesions demonstrates how AI influences their data extraction methods for dental images. Such insights can be exploited to improve, and even customize, AI-based diagnostic tools, thus reducing the dentists' extraneous attentional processing and allowing for more thorough examination of other image areas.

Assessing dentists' awareness of the orthodontic-restorative interface.

OBJECTIVES: Awareness of the interface between restorative and orthodontic treatments is essential for dentists to facilitate a meaningful interdisciplinary approach by integrating the knowledge and skills of different dental disciplines into patients' treatment to enhance outcomes. The aim of this study was to investigate General Dental Practitioners' (GDPs) awareness of the orthodontic-restorative interface. METHODS: This was a mixed-method study involving the collection of a) quantitative data via a bespoke online questionnaire and b) qualitative data through open questions. A weblink was created to the questionnaire using Opinio®. The questionnaire was distributed to GDPs practising in the UK. Clinical vignette-based questions assessed GDPs awareness and the results were categorised into two groups: aware and unaware. Two months after the primary survey, respondents were sent an email with follow-up (reliability) survey. Reliability responses were compared against the primary responses to assess the repeatability using intraclass correlation coefficient. Data were analysed using independent t-test and X2 test. RESULTS: 118 complete responses were received. 63 GDPs (53.4 % [95 % CI 44 %-63 %]) demonstrated a good understanding of the orthodontic-restorative interface. These GDPs were characterised by greater age (t = 2.75, p = 0.007) and experience (t = 3.54, p < 0.001). Qualitative data showed that respondents perceived orthodontic-restorative treatments as minimally invasive and aesthetics enhancing. CONCLUSIONS: Orthodontic-restorative treatment aids in minimal invasive dentistry. GDPs lack adequate awareness of the orthodontic-restorative interface in relation to patient care and communication with patients. More quality and structured undergraduate and postgraduate training are imperative to facilitate GDPs to understand and utilise aspects of orthodontic-restorative treatments to raise the standard of patient care. Additionally, to support these patients, the educational pathway between GDPs and specialist orthodontists is crucial. CLINICAL SIGNIFICANCE: GDPs ability to assess and carry out orthodontic-restorative treatments would conserve natural teeth. Dependable access to orthodontic services would encourage GDPs to refer challenging cases to specialists or dentists with enhanced skills. When the circumstances call for it, patients should be given orthodontic-restorative alternatives, regardless of the potential consequences of their acceptance of the procedures.

Appropriate antibiotic use in dentistry: a review of the literature and clinical recommendations.

This article reviews the latest evidence on the use of antibiotics in dentistry, beginning with the risks of antibiotic use, which include Clostridioides difficile infection and antimicrobial resistance. The article then reviews the clinical practice guidelines for antibiotic prophylaxis for patients with prosthetic joints or at high risk for infective endocarditis. In the absence of established guidelines, the discussion also examines the published evidence on best practices for antibiotic prophylaxis with regard to other medical conditions (eg, kidney disease, cancer, or immunosuppression), dental extractions, minor oral surgical procedures, and implant placement, offering sample prescriptions for these situations. In addition, the current clinical practice guideline for antibiotic use in patients with endodontic infections is reviewed. Due to the alarming rates of antibiotic-resistant bacterial infections and increasing antimicrobial resistance, it is imperative that dentists use evidence-based guidelines and recommendations when prescribing antibiotics to prevent and treat oral infections.

Education's impact on primary care dentists' confidence in treating patients with special health care needs.

INTRODUCTION: Special care dentistry (SCD) is still developing in XX. This study aimed to clarify whether primary care dentists are treating patients with special health care needs (SHCN), to know if they have had previous education on SCD (on an undergraduate or postgraduate level), whether their training level impacts their confidence when treating patients with SHCN, and to assess their opinion on SCD as a relevant topic in undergraduate education. METHODS: A survey was answered by 149 primary care dentists working for the National Health Service of the XX region in XX, including information on their daily clinical practice, undergraduate, and postgraduate training in SCD, and their opinions on them. RESULTS: Most interviewees would like to complement their training and believed that SCD should be formally incorporated into undergraduate programs. There was a significant association between confidence in treating patients with SHCN and the rating of their undergraduate training, and between confidence and the number of hours of continuous development courses. CONCLUSION: Most primary care dentists treat patients with SHCN regularly. Therefore, including training in the undergraduate curriculum and afterward becomes necessary to increase their confidence when facing this challenging group of patients.

Knowledge, attitude, and practice regarding different domains of pediatric obstructive sleep apnea among pediatric dentists from Kerala: A cross-sectional study.

Background: Pediatric dentists should play an essential role in obstructive sleep apnea (OSA) screening, referral, and management of their child patients. However, few studies have investigated pediatric dentists' knowledge, attitude, and practice aspects regarding different domains of pediatric OSA. Aim of the Study: This cross-sectional survey aimed to assess the knowledge, attitude, and practice aspects of different domains of pediatric OSA among pediatric dentists from Kerala. Methods: This cross-sectional study was conducted in Kerala. The sample frame consisted of 163 dentists, and the minimum required was 115. Ethical approval was obtained before starting the study. Settings and Design: An invitation E-mail explaining the purpose of the study with a survey link was sent to the pediatric dentists from Kerala (n = 163). Nonrespondents were contacted at timely intervals. Statistical Analysis: Categorical and quantitative variables were expressed as frequency (percentage) and mean ± standard deviation, respectively. Chi-square test was used to find an association between categorical variables. Statistical analysis was performed using a statistical software package, SPSS, version 20.0. Results and Conclusion: This cross-sectional study showed that pediatric dentists in Kerala have a moderate-to-good level of knowledge, along with a positive attitude toward different domains of pediatric OSA, but lag behind in the practice aspects. Hence, they are required to direct themselves toward continuing dental education programs in order to boost their routine practice. For this, steps must be taken to ensure proper networking of the practitioners and amendments in the dental billing system similar to the medical counterpart.

Pediatric Dentists' Use of Nonpharmacological Behavior Guidance Techniques and Experiences with Parent / Caregiver Acceptance: A National Survey.

Purpose: To determine: (1) which nonpharmacological behavior guidance techniques recommended in the American Academy of Pediatric Dentistry's (AAPD) best practice statement are currently routinely used by pediatric dentists; and (2) their perception of parent/ caregiver acceptance of the techniques. Methods: All active AAPD dentist members were invited to participate in this cross-sectional study. Participants (n equals 518) completed an online questionnaire that queried the use of each nonpharmacological behavior guidance technique outlined in the AAPD best practice statement, the frequency with which parent / caregiver hesitancy/refusal is encountered for each, and practice characteristics and demo- graphics. Data were analyzed using descriptive statistics and tests of group differences. Results: Nearly all participants endorsed routine use of the foundational techniques tell-show-do (98.6 percent), counseling skills to build rapport (97.7 percent), and positive reinforcement (95.6 percent). Fewer endorsed using more complex techniques like desensitization (75.3 percent), memory restructuring (22.6 percent), and cognitive behavioral therapy (4.4 percent). There were significant differences in mean years of clinical experience between those who used and did not use some of the more complex techniques. Of the 26 techniques queried, parent / caregiver hesitancy/refusal was encountered most frequently for parental absence, physical restraints, and voice control, and never to rarely for the others. Conclusions: This first-ever study of all nonpharmacological behavior gui- dance techniques outlined in the AAPD's best practice statement suggests that pediatric dentists routinely use foundational techniques but less frequently use more resource-intensive or complex techniques. With few exceptions, these techniques are well accepted by parents / caregivers.

Global survey of endodontic practice and adoption of newer technologies.

AIM: To investigate current endodontic practices, adoption of technologies and continuing education attendance within specialist endodontic practice globally and to identify geographic trends. METHODOLOGY: A web-based survey of endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA on routine treatment preferences, armamentarium and education attendance was conducted. Chi-squared, independent sample t-tests, Cochran's Q test and McNemar's test were performed. RESULTS: The survey was completed by 543 endodontists or endodontic post-graduate students. Almost all respondents used the dental operating microscope (DOM, 91.3%), engine-driven nickel-titanium instruments (NiTi, 97.6%), electronic apex locators (EAL, 93.0%), cone-beam computed tomography (CBCT, 91.2%) and calcium silicate-based materials (CSBMs, 93.7%). Dental dam was always used by 99.1%. Over half used irrigation adjuncts (81.8%), warm vertical compaction (74.6%) and heat-treated NiTi (60.2%). Geographic comparison between AP (Asia-Pacific, n = 78), AM (Americas, n = 402) and EM (Europe and Middle East, n = 63) was performed. AM and EM preferred single-visit treatment more (p < .001) and used higher sodium hypochlorite concentrations than AP. AM had more access to CBCT in the workplace (86.6%) than AP (65.4%, p < .001) and used CBCT for routine preoperative assessment (39.6%) more than EM (7.3%, p < .001). Almost all of EM used irrigation adjuncts (95.2%), more than AM (78.1%, p = .001). AP used steroid/antibiotic medicaments most (p < .001) and had the highest attendance at continuing education programmes. CONCLUSION: Several endodontic-specific armamentaria have reached almost complete adoption within global specialist endodontic practice, whilst the continued uptake of newer technologies should be followed over time. Some practising philosophies varied significantly across different geographic regions.

Assessing the Acceptability of Less Invasive Caries Removal Techniques for treating Deep Carious Lesions: A Conjoint Survey among Dentists Practicing in a Midwestern American State.

This study identified factors that influence dentists' decisions regarding less invasive caries removal techniques such as stepwise removal (SW) and selective removal (SE) using a marketing research technique, conjoint analysis. A survey was sent to 1,434 dentists practicing in Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SW/SE in hypothetical clinical scenarios. The scenarios were carefully created by conjoint design and included three relevant attributes: depth of lesion, hardness of carious dentin, and patient age. Descriptive and conjoint analyses were performed to assess trade-offs between these attributes, using SPSS. The study revealed that depth of lesion was the most important factor in the dentists' decisions (49 importance value) when choosing a SW to treat a deep carious lesion, followed by hardness of carious dentin and patient age (21 importance value). For the SE group, depth of the lesion was also the predominant factor when selecting a treatment. The study also identified that a high proportion of dentists (24.9%) indicated they would never consider using SW or SE under any circumstances. Our survey showed that depth of lesion was the most important reason to select a less invasive caries removal method. The high proportion of dentists indicating they would never consider selective caries removal (SE) techniques suggests that these less invasive options are underutilized.

Variation in knowledge, attitude, and practices toward antibiotic use among diplomates of the American Veterinary Dental College: a survey-based study.

OBJECTIVE: To evaluate the knowledge, attitudes, and practices toward antibiotic use among board-certified veterinary dentists. SAMPLE: 104 veterinarians board certified by the American Veterinary Dental College. METHODS: A 30-question survey was generated from an online platform and sent via email listserv to board-certified veterinary dentists. Responses were examined to identify patterns or correlations among the variables of interest. RESULTS: There were 104 board-certified veterinary dentists who responded. The majority reported using prophylactic intraoperative antibiotics sparingly for dental procedures and predominately for patients with historic endocarditis or on immunosuppressive doses of steroids. For healthy patients, they reported that antibiotics are often prescribed during jaw fracture repair, maxillectomy/mandibulectomy, and treatment of stage 4 periodontal disease or periapical lucencies. Knowledge of antibiotic resistance and evidence-based antibiotic use were not significantly different between different practice sectors (academia vs private practice) or dependent on the duration of board certification. Dentists who did not believe antibiotics used postoperatively reduce local postoperative infection rates were less likely to prescribe injectable intraoperative antibiotics for the prevention of postoperative infection. No other variables were associated with the likelihood of prescribing intraoperative antibiotics. More than 95% of veterinary dentists surveyed agreed that specific antibiotic use guidelines for veterinary dentistry would help reduce inappropriate use of antibiotics. CLINICAL RELEVANCE: There are differences among veterinary dentists regarding which procedures and patient-specific comorbidities they believe necessitate the use of prophylactic antibiotics. The development of a consensus statement and prospective studies of current antibiotic use are important next steps to improving antibiotic stewardship in veterinary dentistry.

Characteristics of dentists in the National Dental Practice-Based Research Network.

OBJECTIVES: Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS: Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS: Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS: Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE: Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.

Management of dental care of patients on immunosuppressive drugs for chronic immune-related inflammatory diseases: a survey of French dentists' practices.

OBJECTIVES: The aim of the study was to provide an overview of the practices of French general dentists (GDs) and specialists (SDs) concerning the management of patients with inflammatory bowel diseases (IBDs), rheumatic inflammatory diseases (IRDs), and vasculitis on biologic disease-modifying antirheumatic drugs (bDMARDs), conventional DMARDs, or immunosuppressants (ISs). MATERIALS AND METHODS: An online national cross-sectional survey with 53 questions was developed by a multidisciplinary team including rheumatologists, gastroenterologists and dentists based on their clinical experience. It was refined following a test with nine dentists in private practice and in hospital before being disseminated to the members of French scientific societies and colleges of dentistry teachers over 3 months. Responses of general dentists versus specialists were compared with respect to their experience in managing patients with IRDs or IBDs, knowledge/training, type of invasive procedure performed, management of medical treatment, perioperative oral-care protocols, and frequency of postoperative complications after invasive dental care procedures. RESULT: In total, 105 practitioners fully completed the survey (participation rate 11.1%). SDs more frequently performed invasive surgical procedures and were more aware of the recommendations of learned societies than GDs. They encountered more post-operative complications for patients on bDMARDs. For both SDs and GDs, most patients were managed without stopping treatment and pre- and postoperative antibiotics were prescribed to more than 75% of patients. When medical treatment was stopped, the decision was made by the prescribing physician. CONCLUSION: Complications were reported more frequently by SDs when highly invasive procedures were performed on patients under active drug therapy. Certain common procedures, such as scaling and root planing, appear to be safe, regardless of treatment management. However, adapted guidelines for the practice of dentistry are needed to standardize the management of patients on bDMARDS, conventional DMARDs, or ISs. CLINICAL RELEVANCE: French dentists perform a wide range of oral procedures on patients on bDMARDS, conventional DMARDs, or ISs under antibiotic coverage and antiseptic mouthwashes. SDs reported more postoperative complications after extensive invasive procedures for patients under active drug therapy, despite their greater knowledge of recommendations on how to manage such patients.