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Nath S, Jiang T, Barrow J, Simon L. Treatment deferral for elevated blood pressure at a dental school clinic. J Dent Educ 2024; 88:51-55. [PMID: 37727061 DOI: 10.1002/jdd.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Current guidelines by the American Dental Association (ADA) recommend deferral of elective dental care for elevated blood pressure. However, it is unknown how frequently this impacts dental treatment. The purpose of this study was to evaluate rates of asymptomatic hypertension and treatment deferral at a dental school clinic. METHODS This was a retrospective study with data extracted from a chart review of all patients presenting for care at a dental school teaching practice. Differences in dental procedures, the time between visits, and the number of antihypertensive medications were calculated between patients with and without a blood pressure reading exceeding current guidelines for elective treatment. RESULTS Among 26,821 individuals, 1265 had a visit with elevated blood pressure. Blood pressure readings at the next visit were significantly lower (systolic blood pressure 137 [95% confidence interval {CI} 135-138] mmHg, diastolic blood pressure 82 [95% CI 81-83 mmHg], p < 0.001), although only 24 patients reported taking a new medication. Only 4.1% of these patients had a procedure deferred; for those that did, the average intervisit time was 88.2 days (95% CI 77.7-98.7 days). CONCLUSIONS The majority of patients with blood pressure readings exceeding current ADA recommendations for treatment were treated without evidence of harm. Patients were also unlikely to return to the clinic with new medications for blood pressure after a visit with an elevated blood pressure reading. Oral health providers must weigh the risks and benefits of care deferral and can consider an expanded role in hypertension management in dental settings when caring for patients with elevated blood pressure.
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Affiliation(s)
- Sapna Nath
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Tien Jiang
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jane Barrow
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Steinbaum S, Jagannath J, Seymour L, Corby P, Kulkarni R, France K. Oral healthcare providers play a vital role in vaccination efforts: Patient perspectives. Clin Exp Dent Res 2023; 9:1169-1179. [PMID: 37803883 PMCID: PMC10728510 DOI: 10.1002/cre2.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) is associated with 70% of oropharyngeal squamous cell carcinomas. Coronavirus disease 2019 (COVID-19) is the infectious cause of a global pandemic that killed millions worldwide. Effective vaccinations exist against both diseases, but patient acceptance remains a challenge. The objective of this study was to assess patients' attitudes toward oral healthcare providers' (OHCPs) roles in HPV and COVID-19 vaccinations. METHODS A cross-sectional survey of young adult patients was distributed in Philadelphia, PA, between April and June 2021. The survey assessed knowledge and attitudes around OHCPs serving various roles in COVID-19 and HPV vaccination. RESULTS Nearly 70% of 163 respondents would accept the recommendation for a COVID-19 vaccine from an OHCP, while 56% would for HPV. Those previously vaccinated against COVID-19 were more comfortable discussing COVID-19 vaccines (92%, p < .001) or HPV vaccines (76%, p < .001) with OHCPs compared to those who were unvaccinated against COVID-19. African American/Black patients were less comfortable discussing vaccines, irrespective of vaccination status. CONCLUSIONS OHCP can play a vital role in increasing the overall COVID-19 and HPV vaccination status of the public, as demonstrated by the high acceptance of dental involvement in both vaccine campaigns. Racial disparity in vaccination attitude is a public health challenge that needs to be addressed.
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Affiliation(s)
- Sara Steinbaum
- Department of OrthodonticsUniversity of Pennsylvania School of Dental MedicinePhiladelphiaPennsylvaniaUSA
| | | | - Lake Seymour
- Department of OrthodonticsHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Patricia Corby
- Department of Oral MedicineUniversity of Pennsylvania School of Dental MedicinePhiladelphiaPennsylvaniaUSA
| | - Roopali Kulkarni
- Department of Oral MedicineUniversity of Pennsylvania School of Dental MedicinePhiladelphiaPennsylvaniaUSA
| | - Katherine France
- Department of Oral MedicineUniversity of Pennsylvania School of Dental MedicinePhiladelphiaPennsylvaniaUSA
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Katramiz M, Saadé A, Al Ojaimi M, Gholmieh MN. Effect of Sleeping Disorders on the Growth Parameters of Lebanese Children. Mater Sociomed 2023; 35:201-205. [PMID: 37795160 PMCID: PMC10545929 DOI: 10.5455/msm.2023.35.201-205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 10/06/2023] Open
Abstract
Background Sleep is a vital physiological function for the maintenance of health and quality of life by ensuring body rest and restoring its energy levels. Remarkably, some children have sleep disordered breathing (SDB) that can disturb their normal sleep and affect the quality of their lives. Objective The aim of this study was to assess the correlation between SDB and growth impairments and wether the growth parameters vary among genders. Methods This study was conducted in two steps: 1500 questionnaires were distributed to children aged 3 to 12 years. The questionnaire covered personal information, medical history, and the Pediatric Sleep Questionnaire. The latter was used to evaluate the incidence of sleep-disordered breathing and was completed by parents of the involved children. Growth assessment was then determined for the population to find the correlation between sleep disorders and growth impairments. Results A total of 931 completed questionnaires were returned (70.7% response rate). Among the respondents, 56.3% were females whereas 43.3% were males. The mean age was 8 years. The result showed that 16.11% of children were at high risk of sleep-disordered breathing. A significant effect of SDB syndrome on growth parameters (weight-for-age parameter z-score and BMI for age z-score) was observed among males. Concerning the weight for age z-score, a significant difference was found between the means of control and SDB individuals (P = 0.0302). In male groups, the difference was significant (P=0.043), while non-significant difference was found in female groups (P = 0.69). Conclusion This study highlights a significant effect of SDB on growth parameters among males aged between 3 and 12 years.
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Affiliation(s)
| | - Antoine Saadé
- Department of Orthodontics and Dentofacial Orthopedics, Lebanese University, Beirut, Lebanon
| | - Mode Al Ojaimi
- Clinical Sciences Department, College of Medicine, University of Sharjah, UAE
| | - Mona Nahas Gholmieh
- Department of Pediatric and Community Dentistry, Lebanese University, Beirut, Leb
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Natsky AN, Vakulin A, Chai-Coetzer CL, McEvoy RD, Adams RJ, Kaambwa B. Preferred Attributes of Care Pathways for Obstructive Sleep Apnoea from the Perspective of Diagnosed Patients and High-Risk Individuals: A Discrete Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:597-607. [PMID: 35141851 PMCID: PMC9206920 DOI: 10.1007/s40258-022-00716-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 06/05/2023]
Abstract
BACKGROUND The current healthcare system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high risk of OSA. OBJECTIVES This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features. METHODS A discrete choice experiment was undertaken in two groups: those with a formal diagnosis of OSA (n = 421) and those undiagnosed but at high risk of having OSA (n = 1033). Participants were recruited from a large cross-sectional survey in Australia. The discrete choice experiment approach used mixed-logit regression models to determine preferences relating to eight salient features of the OSA management pathway, i.e. initial assessment provider, sleep study setting, diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow-up visits. RESULTS The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results and sleep specialists to recommend treatment. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for the initial assessment, sleep study testing and ongoing care provision. CONCLUSIONS The discrete choice experiment results offer a promising approach for systematic incorporation of patient and high-risk group preferences into the future design and delivery of care pathways for OSA management.
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Affiliation(s)
- Andrea N Natsky
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia.
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health/FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Billingsley Kaambwa
- Department of Health Economics, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
- National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
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Mungia R, Valdez DN. Smoking, Vaping, and the Benefits Cessation in Times of COVID-19: A Public Health Perspective. FRONTIERS IN DENTAL MEDICINE 2020. [DOI: 10.3389/fdmed.2020.618364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of this article is to inform dental practitioners and specialists of the benefits of smoking and vaping cessation in relation to COVID-19 transmission. COVID-19 caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has affected more than 31.7 million people globally with infection rates continuing to rise rapidly. Smoking dramatically impairs lung function and gives rise to an increase in susceptibility for infection, allowing for a more difficult recovery due, in part, to the damage SARS-CoV-2 does to the lungs. Tobacco smoking is one of the primary causes of death in the United States (US), however, nearly 40 million adults still smoke cigarettes, with 4.7 million middle and high school students using at least one tobacco product, including electronic cigarettes. COVID-19 is transmitted through salivary droplets, causing severe bilateral pneumonia and significantly reduced lung function, putting smokers and vapers at greater risk through cross-contamination and face touching. So far, data from animal studies suggest that vaping leads to an increased susceptibility to infection, which coincides with evidence of increased rates of chronic bronchitis in vapers. There is yet to be data regarding the benefits of smoking and vaping cessation during the COVID-19 pandemic. However, there is evidence suggesting that 4 weeks or more of smoking cessation intervention reduces the risk of contracting COVID-19 and developing severe complications. Because of these probable connections, dental practitioners should advise their patients to stop smoking and/or vaping via the 5 As Cessation Strategy.
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Nguyen VT. Knowledge, attitude, and clinical practice of dentists toward obstructive sleep apnea: A literature review. Cranio 2020; 41:238-244. [PMID: 32870761 DOI: 10.1080/08869634.2020.1816408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the knowledge, attitude, and clinical practice of dentists and dental specialists toward obstructive sleep apnea (OSA). METHODS A literature search was performed on PubMed and ScienceDirect databases. Peer-reviewed English publications were reviewed. No time limit was applied. RESULTS Four articles were included for the review. Years in the profession, specialist training, and gender were associated with the level of knowledge about OSA. Weight control was the most recognizable treatment for patients with OSA. Dentists agreed that OSA is a life-threatening disease, and they could be involved in detecting and treating OSA. Most dentists had no clinical experience of managing patients with OSA. CONCLUSION Dentists had a certain level of knowledge about OSA and were willing to deal with OSA. However, they lacked clinical experience. They were also enthusiastic about further education on OSA.
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Pandian TNG, Sehra R, Narayan S. Breath variability increases in the minutes preceding obstructive sleep apneic events. Sleep Breath 2020; 25:271-280. [PMID: 32506203 DOI: 10.1007/s11325-020-02094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE It is unclear if there is a consistent signature in breath patterns prior to an impending obstructive apneic event in patients with sleep-disordered breathing (SDB). OBJECTIVE To use continuous recordings of ambient sound in sleep using a smartphone to track auditory signatures of breaths and measure their regularity preceding apneic events. METHODS We studied 50 patients evaluated for SDB in whom sound was recorded using smartphones concurrently with polysomnography (PSG). Whole-night sound files were analyzed for time and frequency domain analyses of breath periodicity during periods of normal and sleep-disordered breathing. RESULTS Fifty patients (44% women, 42.0 ± 9.4 years old, BMI 32.8 ± 10.8 kg/m2) recorded sound, of whom 30 were diagnosed with OSA and 20 were not. We analyzed a total of 497 apneic (≥10 s) and 481 non-apneic intervals, confirmed by PSG. Interbreath intervals were 3.75 ± 0.62 s for 1 min in quiet breathing, with SD 1.11 ± 0.48 s that increased to 4.16 ± 3.06 s in successive 60-s epochs up to apnea (p < 0.001). Interbreath SD in the 60 s immediately preceding apnea was higher than the SD in random non-apneic periods (p < 0.01, ANOVA). Interbreath SD ≥1.49 s gave 87.3% sensitivity and 86.5% specificity for predicting apnea in the next minute (c-statistic 0.94). CONCLUSIONS Breaths increase in variability minutes before proven obstructive apnea in patients with suspected SDB. These results suggest that it may be possible to predict and thus potentially avert apneic events and provide insights into events leading to SDB. TRIAL REGISTRATION NCT03288376, clinicaltrials.org.
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Affiliation(s)
| | - Ruchir Sehra
- Resonea Inc., 16580 N. 92nd Street #3001, Scottsdale, AZ, 85260, USA
| | - Sanjiv Narayan
- Resonea Inc., 16580 N. 92nd Street #3001, Scottsdale, AZ, 85260, USA.
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Suarez OF. Commentary: The Role of Dentists and Primary Care Physicians in the Care of Patients With Sleep-Related Breathing Disorders. Front Public Health 2018; 6:354. [PMID: 30564565 PMCID: PMC6288391 DOI: 10.3389/fpubh.2018.00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Omar F Suarez
- Department of Dental Medicine, Postdoctoral Residency Program, Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, Brooklyn, NY, United States
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Noncontact identification of sleep-disturbed breathing from smartphone-recorded sounds validated by polysomnography. Sleep Breath 2018; 23:269-279. [PMID: 30022325 DOI: 10.1007/s11325-018-1695-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Diagnosis of obstructive sleep apnea by the gold-standard of polysomnography (PSG), or by home sleep testing (HST), requires numerous physical connections to the patient which may restrict use of these tools for early screening. We hypothesized that normal and disturbed breathing may be detected by a consumer smartphone without physical connections to the patient using novel algorithms to analyze ambient sound. METHODS We studied 91 patients undergoing clinically indicated PSG. Phase I: In a derivation cohort (n = 32), we placed an unmodified Samsung Galaxy S5 without external microphone near the bed to record ambient sounds. We analyzed 12,352 discrete breath/non-breath sounds (386/patient), from which we developed algorithms to remove noise, and detect breaths as envelopes of spectral peaks. Phase II: In a distinct validation cohort (n = 59), we tested the ability of acoustic algorithms to detect AHI < 15 vs AHI > 15 on PSG. RESULTS Smartphone-recorded sound analyses detected the presence, absence, and types of breath sound. Phase I: In the derivation cohort, spectral analysis identified breaths and apneas with a c-statistic of 0.91, and loud obstruction sounds with c-statistic of 0.95 on receiver operating characteristic analyses, relative to adjudicated events. Phase II: In the validation cohort, automated acoustic analysis provided a c-statistic of 0.87 compared to whole-night PSG. CONCLUSIONS Ambient sounds recorded from a smartphone during sleep can identify apnea and abnormal breathing verified on PSG. Future studies should determine if this approach may facilitate early screening of SDB to identify at-risk patients for definitive diagnosis and therapy. CLINICAL TRIALS NCT03288376; clinicaltrials.org.
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Jokubauskas L, Pileičikienė G, Žekonis G, Baltrušaitytė A. Lithuanian dentists' knowledge, attitudes, and clinical practices regarding obstructive sleep apnea: A nationwide cross-sectional study. Cranio 2018; 37:238-245. [PMID: 29431599 DOI: 10.1080/08869634.2018.1437006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To investigate the knowledge, attitudes toward, and aspects of clinical practice regarding obstructive sleep apnea (OSA) among Lithuanian dentists. Methods: A cross-sectional study was carried out during the period from December 2016 to March 2017. A survey instrument was designed and pilot tested prior to full-scale administration. Self-administered questionnaires, including a cover letter, were distributed to 550 dentists during continuing dental education programs. Results: A total of 353 participants (64.2%) completed and returned the questionnaire. Increased years of experience were significantly associated with lesser knowledge about OSA (p < 0.05). However, there were no significant differences between general practitioners and specialists (p = 0.243). Most respondents indicated strong positive attitudes regarding OSA. The majority did not have any clinical experience regarding the management of OSA patients. Discussion: Development of additional education and practical implementation strategies should be considered in order to overcome the examined barriers.
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Affiliation(s)
- Laurynas Jokubauskas
- a Department of Prosthodontics, Faculty of Odontology , Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Gaivilė Pileičikienė
- a Department of Prosthodontics, Faculty of Odontology , Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Gediminas Žekonis
- a Department of Prosthodontics, Faculty of Odontology , Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Aušra Baltrušaitytė
- a Department of Prosthodontics, Faculty of Odontology , Lithuanian University of Health Sciences , Kaunas , Lithuania
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