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1.
J Dent Educ ; 84(3): 279-282, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32115710

RESUMO

Population demographic shifts in the United States and Canada have led to an increasingly diverse postsecondary student population. However, the largely homogenous dental faculty in the United States and Canada does not reflect the rapidly changing student body and the diverse patient population academic dentistry has been called to serve. Therefore, recruitment and retention of diverse dental faculty in dental education must be a priority. Substantial evidence also indicates improved outcomes for faculty, students, and institutions when faculty diversity on campus is increased. Beyond the positive impact faculty diversity can deliver to the learning and working environments of an academic institution, a variety of regulatory bodies mandate good faith efforts to maintain a diverse faculty, including the Commission on Dental Accreditation (CODA) standards for dental schools and dental therapy education programs. To assist its member institutions with answering the call for improved faculty diversity, the American Dental Education Association (ADEA) worked with its members to develop the ADEA Faculty Diversity Toolkit (ADEA FDT), a landmark evidence-based resource designed to assist dental education with the design and implementation of faculty recruitment and retention initiatives that can be tailored to their unique needs. This article provides an overview of the changing landscape of the United States and Canadian populations, shares the historic homogeneity of dental education faculty, provides an overview of some of the benefits associated with faculty diversity and highlights the challenges and barriers related to recruiting and retaining diverse faculty. Most importantly, it introduces the ADEA FDT and the need for dental schools and allied dental programs to use the Toolkit as a proactive resource in increasing and maintaining faculty diversity. Furthermore, it provides an overview of how to utilize and adapt the highlighted best practices and model programs to improve faculty diversity on their campuses.


Assuntos
Educação em Odontologia , Docentes de Odontologia , American Dental Association , Canadá , Humanos , Faculdades de Odontologia , Estados Unidos
2.
J Am Dent Assoc ; 151(4): 303-304.e2, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32222178

RESUMO

BACKGROUND: Human papillomavirus (HPV) is a sexually transmitted oncovirus associated with several malignancies, including oropharyngeal squamous cell carcinoma. The 9-valent HPV vaccine can help protect against the high-risk HPV strains most commonly associated with HPV-related cancers. METHODS: The authors used an electronic survey to assess the roles of dentists and their team members in discussing the HPV vaccine, as well as administering the vaccine in a dental setting. On December 6, 2019, the authors e-mailed a survey link to the American Dental Association Clinical Evaluators (ACE) Panel (n = 813), a sample of American Dental Association member dentists. After 1 e-mail reminder, the survey closed on December 19, 2019, and the authors conducted exploratory and descriptive data analyses using SAS Version 9.4 (SAS). RESULTS: A total of 329 dentists responded to the survey, and 83 (25%) of them reported that they or their team members discuss the implications of the HPV vaccine with age-eligible patients or their parents or guardians. Dentists lead two-thirds (n = 218) of the discussions, and the clinical examination is the most frequent moment during the patient visit in which HPV-related topics are discussed. Some of the top reasons respondents mentioned for not discussing the vaccine in their practice were the perception that these discussions are best left to other health care professionals and not knowing how to address the topic with patients. If the scope of dental practice is expanded to include administering the vaccine, 125 (38%) of respondents would feel uncomfortable administering the vaccine. The most common potential barriers to administering the vaccine in a dental setting include obtaining reimbursement and vaccine management and preservation. CONCLUSIONS: The survey results suggest that dentists' comfort levels and perceived roles in discussing and administering the HPV vaccine vary. PRACTICAL IMPLICATIONS: There is a need to further define the role of dentists and their team members in the promotion and administration of the HPV vaccine. Resources for dentists and dental team members may be helpful to support professional education and communication about the HPV vaccine.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , American Dental Association , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e Questionários , Estados Unidos
3.
J Am Dent Assoc ; 151(1): 72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31902404
5.
J Am Dent Assoc ; 150(11): 906-921.e12, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31668170

RESUMO

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


Assuntos
American Dental Association , Abscesso Periapical , Adulto , Antibacterianos , Odontologia Baseada em Evidências , Humanos , Odontalgia
7.
J Am Dent Assoc ; 150(12): e179-e216, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31761029

RESUMO

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


Assuntos
Antibacterianos , Periodontite Periapical , Pulpite , Abscesso , Adulto , American Dental Association , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos
9.
11.
Evid Based Dent ; 20(1): 7-8, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30903116

RESUMO

Scope and purpose This guideline concerns patients with no lesions, innocuous or nonsuspicious lesions, lesions suspected to be potentially malignant as well as malignant lesions of the oral cavity. The audience for this guideline is health care workers who examine the mouth as well as community dental health co-ordinators and policy makers. Methodology The Appraisal of Guidelines Research & Evaluation reporting checklist II and the GIN-McMaster Guideline Development Checklist were followed and the guideline is partly informed by systematic reviews and diagnostic test accuracy meta-analyses. Studies assessing patients' values and preferences were also considered. The process of moving from the evidence to decisions and the formulation was guided by GRADE (Grading of Recommendations Assessment, Development and Evaluation).Review and Updating Updates for this guideline will be conducted every five years or when new emerging evidence indicates a potential change in the recommendation statements from the expert panel. Any updated versions of this guideline will be available at the ADA Center for Evidence-Based Dentistry's website: www.ebd.ada Recommendations The expert panel developed six conditional recommendations, all based on evidence rated as low to very low quality using GRADE. 1. For patients with a clinically evident oral mucosal lesion with an unknown clinical diagnosis considered to be seemingly innocuous or nonsuspicious of malignancy, or other symptoms, clinicians should follow up periodically to determine the need for further evaluation. If the lesion has not resolved and the clinical diagnosis of a potentially malignant disorder cannot be ruled out, then clinicians should perform a biopsy of the lesion or refer the patient to a specialist.2. For patients with a clinically evident oral mucosal lesion considered to be suspicious of a potentially malignant or malignant disorder, or other symptoms, clinicians should perform a biopsy of the lesion or provide immediate referral to a specialist.3. Cytologic adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions are not recommended. Should a patient decline the clinician's recommendation for performing a biopsy of the lesion or referral to a specialist, the clinician can use a cytologic adjunct to provide additional lesion assessment. A positive or atypical cytologic test result reinforces the need for a biopsy or referral.A negative cytologic test result indicates the need for periodic follow-up of the patient. If the clinician detects persistence or progression of the lesion, immediately performing a biopsy of the lesion or referral to a specialist is indicated.4. The panel does not recommend autofluorescence, tissue reflectance or vital staining adjuncts for the evaluation of potentially malignant disorders among adult patients with clinically evident, seemingly innocuous or suspicious lesions.5. The panel suggests that for patients with no clinically evident lesions or symptoms, no further action is necessary at that time.6. The panel does not recommend commercially available salivary adjuncts for the evaluation of potentially malignant disorders among adult patients with or without clinically evident, seemingly innocuous or suspicious lesions and their use should be considered only in the context of research.Research recommendations There is a need for better estimation of the prevalence of potentially malignant disorders (PMDs) and oral squamous cell carcinoma (OSCC) in populations with different baseline risks. More information on patients' values and preferences is required as well as studies on the diagnostic test accuracy of cytologic and salivary adjuncts.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Adulto , American Dental Association , Humanos , Encaminhamento e Consulta
12.
J Am Dent Assoc ; 150(3): 200-203, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30803492

RESUMO

BACKGROUND: The basis and rationale for recognition of specialties in the health care-related professions are similar. Recognition criteria are common across health care-related professions and include the demonstrated ability to form a certifying board, a distinct and well-defined field that requires unique knowledge and skills beyond general professional education, knowledge and skills that are separate and distinct from any other specialty, active contribution to research needs of the profession, direct benefit to some aspect of patient care, and the existence of formal, advanced education programs. A new paradigm that has been outlined does not appear to be significantly different from this existing paradigm. METHODS: The authors used archived, historic transcripts, transactions, and reports from the American Dental Association House of Delegates that are housed in the American Dental Association Library and Archives. In addition, information on specialty recognition from other health care-related professions was cited from the respective health care-related profession Web sites. RESULTS: The authors believe the current paradigm of specialty recognition in dentistry comports with the paradigm of other health care-related professions. CONCLUSIONS: The new paradigm that has been outlined does not appear to be significantly different from the existing paradigm. Subspecialization may be right for medicine but not necessarily needed for dentistry. Given that specialty recognition standards are virtually identical in all the health care-related professions, it begs the question as to what other factors unique to other health care-related professions have driven the development of subspecialties. PRACTICAL IMPLICATIONS: There is no need to radically restructure the criteria or process of specialty recognition in dentistry.


Assuntos
American Dental Association , Especialidades Odontológicas , Humanos , Estados Unidos
13.
Gerodontology ; 36(1): 36-44, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30318791

RESUMO

The consensus of a leading scientific panel in 1930 was that oral hygiene products could not prevent dental caries. Their view was that dental caries prevention required the proper mineralisation of teeth and that vitamin D could achieve this goal. Over a hundred subsequent controlled trials, conducted over seven decades, largely confirmed that this scientific panel had made the right decisions. They had, in 1930, when it comes to dental caries, correctly endorsed vitamin D products as dental caries prophylactics and oral hygiene products as cosmetics. And yet, despite this consistent scientific evidence for close to a century, an opposing conventional wisdom emerged which thrives to this day: oral hygiene habits (without fluoride) protect the teeth from dental caries, and vitamin D plays no role in dental caries prevention. This historical analysis explores whether persistent advertising can deeply engrain memes on dental caries prevention which conflict with controlled trial results. The question is raised whether professional organisations, with a dependence on advertising revenues, can become complicit in amplifying advertised health claims which are inconsistent with the principles of evidence-based medicine.


Assuntos
/história , Conservadores da Densidade Óssea/história , Cárie Dentária/história , Odontologia Baseada em Evidências/história , Higiene Bucal/história , Vitamina D/história , American Dental Association/história , Conservadores da Densidade Óssea/uso terapêutico , Ensaios Clínicos Controlados como Assunto/história , Cosmecêuticos/história , Cárie Dentária/etiologia , Cárie Dentária/prevenção & controle , História do Século XIX , História do Século XX , Humanos , Estados Unidos , Vitamina D/uso terapêutico
16.
J Am Dent Assoc ; 149(10): 837-849.e19, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30261951

RESUMO

BACKGROUND: An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED: The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS: The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.


Assuntos
Cárie Dentária , Adulto , American Dental Association , Criança , Odontologia Baseada em Evidências , Humanos , Selantes de Fossas e Fissuras , Ensaios Clínicos Controlados Aleatórios como Assunto , Dente Decíduo , Estados Unidos
17.
Bioethics ; 32(9): 602-610, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30194688

RESUMO

Cosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non-therapeutic intervention. This article re-evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business-focused interaction between clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations.


Assuntos
Assistência Odontológica/ética , Odontólogos/ética , Estética Dentária , Ética Odontológica , Profissionalismo/ética , American Dental Association , Humanos , Marketing de Serviços de Saúde/ética , Responsabilidade Social , Estados Unidos
20.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 53(5): 289-292, 2018 May 09.
Artigo em Chinês | MEDLINE | ID: mdl-29972984

RESUMO

Oral and maxillofacial radiology (OMR) in the United States is one of the nine dental specialties recognized by the American Dental Association (ADA). It has a nearly 100-year history of development and has also established a complete set of specialist training system. Staffing, base facilities, financial status, timing of training courses, contents, plans, and goals to be achieved are all clearly defined. All training centers need to undergo regular assessments every seven years with the ADA's Commission on Dental Accreditation (CODA). After graduation, the specialist graduates can be engaged in the clinical teaching and scientific research of radiological diagnosis in universities or general hospitals. They also have the option to open their own business by setting up imaging diagnostic centers or being specialized in tele-radiology to provide imaging diagnosis or consultation report to clinicians in other disciplines, or even assisting in the development of treatment planning for dental implants and orthodontic procedures. Of course, stomatology and OMR education systems are different in China and the United States due to different national conditions. Although the experience in the United States cannot be completely copied, many concepts, standards and goals of OMR specialty training there have been practiced and improved for a long period of time and are worth learning by the Chinese OMR counterparts or relevant agencies.


Assuntos
Patologia Bucal/educação , Radiologia/educação , Especialidades Odontológicas/educação , Acreditação , American Dental Association , China , Humanos , Patologia Bucal/normas , Radiologia/normas , Especialidades Odontológicas/normas , Estados Unidos
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