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Padilla Cáceres TC, Cervantes-Alagón S, Castillo JL, Vera Reyes CM, Rothen M, Mancl LA, Milgrom P. Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment. J Am Dent Assoc 2024:S0002-8177(24)00115-6. [PMID: 38678451 DOI: 10.1016/j.adaj.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed. METHODS The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year. RESULTS Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0). CONCLUSIONS Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction. PRACTICAL IMPLICATIONS Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.
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Kern A, Renteria T(W, Rothen ML, Mancl LA, Milgrom P. Effectiveness of silver diamine fluoride 38% on reduction of gingivitis in dogs: a randomized clinical trial. Front Vet Sci 2023; 10:1255834. [PMID: 37799409 PMCID: PMC10548197 DOI: 10.3389/fvets.2023.1255834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Periodontal disease is a ubiquitous disease in small animal veterinary medicine. Currently regular professional dental cleaning and daily tooth brushing are considered gold standards in the prevention of periodontal disease. Efforts to find a noninvasive, cost effective and easy to use preventative for periodontal disease are ongoing. The primary objective of this double-blind randomized clinical trial was to determine if a single application of silver diamine fluoride (SDF) 38% on the buccal surface of all teeth would reduce gingivitis within 3 months in dogs with stage two periodontal disease. Methods Twenty-nine client-owned dogs 3-12 years old, 6-35 pounds were randomized 1:1 into active and placebo-control groups. Both groups underwent a baseline treatment and a three-month follow-up under general anesthesia. Gingival Index (GI), Plaque Index (PI), and Calculus Index (CI) were assessed and recorded at each event. Results A single application of SDF 38% did not significantly lower GI relative to the control group. However, the GI score dropped significantly in both groups relative to baseline, with a 53% reduction in the average GI score for dogs that received SDF 38% treatment and a 44% reduction for dogs that received placebo treatment. There were no differences in PI or CI scores compared to control groups. Conclusion Further research is needed to determine if a more frequent application or a longer study duration would yield a different outcome.
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Affiliation(s)
- Amarett Kern
- Inland Northwest Veterinary Dentistry and Oral Surgery, Coeur d’Alene, ID, United States
| | - Tammy (White) Renteria
- Inland Northwest Veterinary Dentistry and Oral Surgery, Coeur d’Alene, ID, United States
| | - Marilynn L. Rothen
- School of Dentistry and Research Implementation Manager, Institute of Translational Health Sciences Regional Clinical Dental Research Center, University of Washington, Seattle, WA, United States
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
| | - Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States
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Hill CM, Chi DL, Mancl LA, Jones-Smith JC, Chan N, Saelens BE, McKinney CM. Sugar-sweetened beverage intake and convenience store shopping as mediators of the food insecurity-Tooth decay relationship among low-income children in Washington state. PLoS One 2023; 18:e0290287. [PMID: 37699013 PMCID: PMC10497152 DOI: 10.1371/journal.pone.0290287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION There are oral health disparities in the U.S. and children in food-insecure households have a higher burden of tooth decay. Identifying the mechanisms underlying the food insecurity-tooth decay relationship could inform public health interventions. This study examined how sugar-sweetened beverage (SSB) intake and frequent convenience store shopping mediated the food insecurity-tooth decay relationship for lower-income children. MATERIALS AND METHODS Cross-sectional study data included a household survey, beverage questionnaire, and dental examination. The sample included 452 lower-income, racially-diverse, child-caregiver dyads in 2018 from King County in Washington state. The exposure was household food insecurity, the outcome was untreated decayed tooth surfaces, and the proposed mediators were SSB intake and frequent convenience store shopping (≥2 times/week). Causal mediation analyses via the potential outcomes framework was used to estimate natural indirect and direct effects. RESULTS Fifty-five percent of participants were in food-insecure households, the mean number of decayed tooth surfaces among children was 0.87 (standard deviation [SD] = 1.99), the mean SSB intake was 17 fluid ounces (fl/oz)/day (SD = 35), and 18% of households frequently shopped at a convenience store. After adjusting for confounders, household food insecurity and log-transformed SSB intake (fluid ounces/day) were positively associated with decayed tooth surfaces, but not at the a α = 0.05 level (mean ratio [MR] 1.60; 95% confidence interval [CI] 0.89, 2.88; p = .12 and MR 1.16; 95% CI 0.93, 1.46; p = .19, respectively). Frequent convenience store shopping was associated with 2.75 times more decayed tooth surfaces (95% CI 1.61, 4.67; p < .001). SSB intake mediated 10% of the food insecurity-tooth decay relationship (p = .35) and frequent convenience store shopping mediated 22% (p = .33). CONCLUSIONS Interventions aimed at addressing oral health disparities in children in food-insecure households could potentially focus on reducing intake of SSBs and improving access to healthful foods in lower-income communities.
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Affiliation(s)
- Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Jessica C. Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States of America
| | - Nadine Chan
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health-Seattle & King County, Assessment, Policy, Development and Evaluation Division, Seattle, WA, United States of America
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
| | - Christy M. McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, United States of America
- Seattle Children’s Research Institute, Seattle, WA, United States of America
- Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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Imani K, Mancl LA, Hill CM, Chi DL. Preventive dental care utilization and dental caries for Medicaid-enrolled adolescents in Oregon. J Public Health Dent 2023; 83:309-316. [PMID: 37525392 PMCID: PMC10528592 DOI: 10.1111/jphd.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES This study aimed to evaluate the relationship between preventive dental care utilization and untreated dental caries for Medicaid-enrolled adolescents and to determine if the relationship is moderated by chronic conditions (CC). METHODS This analysis was based on 2015-2016 Medicaid claims files and survey data collected from adolescents ages 12-18 years enrolled in Oregon Medicaid, who received a dental screening between December 2015 and December 2016 (n = 240). To assess the relationship between preventive dental care utilization and untreated dental caries (defined as decayed tooth surfaces), prevalence ratios (PR) and 95% confidence intervals (CI) were generated using log-linear regression models. We also tested for an interaction between preventive dental care utilization and CC. RESULTS About 60.4% of adolescents utilized preventive dental care, 21.7% had CC, and 29.6% had ≥1 decayed tooth surfaces. There were no significant differences in untreated dental caries between adolescents who did and did not utilize preventive dental care (PR: 0.73, 95% CI: 0.33-1.60; p = 0.43). There was not a significant interaction between preventive dental care utilization and CC (p = 0.65). Preventive dental care utilization was not significantly associated with untreated dental caries for adolescents with CC (PR: 0.51, 95% CI: 0.10-2.65; p = 0.42) nor among adolescents without CC (PR: 0.79, 95% CI: 0.33-1.91; p = 0.61). CONCLUSIONS Preventive dental care was not shown to be associated with lower untreated dental caries for Medicaid-enrolled adolescents or those with CC. Future work that is adequately powered should continue to elucidate this relationship in Medicaid enrollees.
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Affiliation(s)
- Kimia Imani
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Lloyd A. Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Alkhateeb AA, Mancl LA, Ramos KJ, Rothen ML, Kotsakis GA, Trence DL, Chi DL. Periodontitis Risk Factors in Adults with Cystic Fibrosis: A pilot study. J Dent Hyg 2023; 97:7-21. [PMID: 37068884 PMCID: PMC10694797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/16/2022] [Indexed: 04/19/2023]
Abstract
Purpose Individuals with cystic fibrosis (CF) present with multiple condition-specific risk factors for periodontitis including CF-related diabetes, chronic inhaled treatments that induce xerostomia, and increased systemic inflammation because of frequent lung infections. General factors like age, oral hygiene, and diet may also contribute to the risk of periodontitis. However the relative importance of these specific risk factors and periodontitis in individuals with CF has not yet been evaluated. The purpose of this pilot study was to assess the associations between CF condition-specific and general risk factors and the prevalence of periodontitis in adults with CF.Methods This cross-sectional pilot study was designed to assess a multifactorial model of periodontitis risk factors in a population in adults with CF who were recruited from the University of Washington Adult CF center. Periodontitis was defined using the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) case definition. Risk factors included condition-specific and general factors. Differences between participants with moderate/severe periodontitis and those with no/mild periodontitis was assessed using the Mann-Whitney test, the Fisher's exact test, and the exact chi-square test (α=0.05).Results Thirty-two participants were enrolled. Twenty-eight percent of the participants had moderate periodontitis, 72% had no/mild periodontitis; none of the participants had severe periodontitis. There were no significant differences in condition-specific factors between between the two study groups. Participants with moderate periodontitis were older (p=0.028) and reported daily flossing in higher proportions than those with no/mild periodontitis (p=0.023).Conclusions The findings from this pilot study suggest that future research is needed to determine whether sociodemographic and other general risk factors are more important contributors to periodontitis risk than CF-specific factors.
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Affiliation(s)
- Alaa A Alkhateeb
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA.
- Department of Dental Health Sciences, School of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Lloyd A Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Kathleen J Ramos
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Marilynn L Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Georgios A Kotsakis
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Dace L Trence
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Donald L Chi
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Alkhateeb AA, Lease ED, Mancl LA, Chi DL. Untreated dental disease and lung transplant waitlist evaluation time for individuals with cystic fibrosis. Spec Care Dentist 2021; 41:489-497. [PMID: 33749871 DOI: 10.1111/scd.12586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 12/20/2022]
Abstract
AIMS Dental clearance is typically part of the evaluation process prior to placement on the lung transplant waiting list. Individuals with cystic fibrosis (CF) are thought to be at low risk for dental disease. We hypothesized that individuals with CF in need of lung transplantation would have lower dental disease prevalence and shorter waitlist evaluation time than individuals with non-CF lung diseases. METHODS AND RESULTS We conducted a retrospective study of individuals who received a lung transplant between 2011 and 2017 at the University of Washington (Seattle, WA, USA) (N = 280). Untreated dental disease was assessed by the individual's dentist. Waitlist evaluation time was defined as the time, in days, from the initial evaluation by a transplant pulmonologist to placement on the lung transplant waiting list. We used logistic and linear regression models for hypothesis testing. The prevalence of untreated dental disease did not differ by CF status (p = 0.99). There was no difference in waitlist evaluation time for transplant recipients by CF status (p = 0.78) or by dental disease status (p = 0.93). CONCLUSIONS Our findings provide further evidence that individuals with CF are not at low risk for dental disease. Ensuring optimal oral health is important for all individuals with lung diseases.
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Affiliation(s)
- Alaa A Alkhateeb
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA.,Department of Dental Health Sciences, School of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Erika D Lease
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Lloyd A Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
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Masterson EE, Fitzpatrick AL, Enquobahrie DA, Mancl LA, Eisenberg DT, Conde E, Hujoel PP. Dental enamel defects predict adolescent health indicators: A cohort study among the Tsimane' of Bolivia. Am J Hum Biol 2018; 30:e23107. [PMID: 29399912 PMCID: PMC5980689 DOI: 10.1002/ajhb.23107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/15/2017] [Accepted: 01/19/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. METHODS This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs). RESULTS Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. CONCLUSIONS Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.
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Affiliation(s)
- Erin E. Masterson
- University of Washington, School of Dentistry, Department of Oral Health Sciences, 1959 NE Pacific Street, Health Sciences Building D-322, Box 357475, Seattle, WA, 98119 USA
| | - Annette L. Fitzpatrick
- University of Washington, School of Public Health, Department of Epidemiology, 1959 NE Pacific Street, Health Science Building F-262, Box 357236, Seattle, WA, 98195 USA
| | - Daniel A. Enquobahrie
- University of Washington, School of Public Health, Department of Epidemiology, 1959 NE Pacific Street, Health Science Building F-262, Box 357236, Seattle, WA, 98195 USA
| | - Lloyd A. Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, 1959 NE Pacific Street, Health Sciences Building D-322, Box 357475, Seattle, WA, 98119 USA
| | - Dan T.A. Eisenberg
- University of Washington, Department of Anthropology, 314 Denny Hall, Box 353100, Seattle, WA 98195, USA
| | - E. Conde
- Centro Boliviano de Investigación y Desarollo Socio-Integral, Correo Central, San Borja, Beni, Bolivia
| | - Philippe P. Hujoel
- University of Washington, School of Dentistry, Department of Oral Health Sciences, 1959 NE Pacific Street, Health Sciences Building D-322, Box 357475, Seattle, WA, 98119 USA
- University of Washington, School of Public Health, Department of Epidemiology, 1959 NE Pacific Street, Health Science Building F-262, Box 357236, Seattle, WA, 98195 USA
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Masterson EE, Fitzpatrick AL, Enquobahrie DA, Mancl LA, Conde E, Hujoel PP. Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon. Am J Phys Anthropol 2017; 164:416-423. [PMID: 28752513 DOI: 10.1002/ajpa.23283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 06/22/2017] [Accepted: 07/05/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.
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Affiliation(s)
- Erin E Masterson
- School of Dentistry, Department of Oral Health Sciences, University of Washington, Seattle, Washington, DC, 98119
| | - Annette L Fitzpatrick
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, Washinton, DC, 98195
| | - Daniel A Enquobahrie
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, Washinton, DC, 98195
| | - Lloyd A Mancl
- School of Dentistry, Department of Oral Health Sciences, University of Washington, Seattle, Washington, DC, 98119
| | - Esther Conde
- Centro Boliviano de Investigación y Desarollo Socio-Integral, Correo Central, San Borja, Beni, Bolivia
| | - Philippe P Hujoel
- School of Dentistry, Department of Oral Health Sciences, University of Washington, Seattle, Washington, DC, 98119
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Levy RL, Langer SL, van Tilburg MA, Romano JM, Murphy TB, Walker LS, Mancl LA, Claar RL, DuPen MM, Whitehead WE, Abdullah B, Swanson KS, Baker MD, Stoner SA, Christie DL, Feld AD. Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial. Pain 2017; 158:618-628. [PMID: 28301859 PMCID: PMC5370191 DOI: 10.1097/j.pain.0000000000000800] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pediatric functional abdominal pain disorders (FAPDs) are associated with increased health care utilization, school absences, and poor quality of life (QoL). Cost-effective and accessible interventions are needed. This multisite study tested the effects of a 3-session cognitive behavioral intervention delivered to parents, in-person or remotely, on the primary outcome of pain severity and secondary outcomes (process measures) of parental solicitousness, pain beliefs, catastrophizing, and child-reported coping. Additional outcomes hypothesized a priori and assessed included functional disability, QoL, pain behavior, school absences, health care utilization, and gastrointestinal symptoms. The study was prospective and longitudinal (baseline and 3 and 6 months' follow-up) with 3 randomized conditions: social learning and cognitive behavioral therapy in-person (SLCBT) or by phone (SLCBT-R) and education and support condition by phone (ES-R). Participants were children aged 7 to 12 years with FAPD and their parents (N = 316 dyads). Although no significant treatment effect for pain severity was found, the SLCBT groups showed significantly greater improvements compared with controls on process measures of parental solicitousness, pain beliefs, and catastrophizing, and additional outcomes of parent-reported functional disability, pain behaviors, child health care visits for abdominal pain, and (remote condition only) QoL and missed school days. No effects were found for parent and child-reported gastrointestinal symptoms, or child-reported QoL or coping. These findings suggest that for children with FAPD, a brief phone SLCBT for parents can be similarly effective as in-person SLCBT in changing parent responses and improving outcomes, if not reported pain and symptom report, compared with a control condition.
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Affiliation(s)
- Rona L. Levy
- School of Social Work, University of Washington, Seattle, WA
| | - Shelby L. Langer
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | | | - Joan M. Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Tasha B. Murphy
- School of Social Work, University of Washington, Seattle, WA
| | - Lynn S. Walker
- Vanderbilt University, Department of Pediatrics, Nashville, TN
| | - Lloyd A. Mancl
- University of Washington, Oral Health Sciences, Seattle, WA
| | - Robyn L. Claar
- University of North Carolina, Division of Gastroenterology and Hepatology, Chapel Hill, NC
| | | | - William E. Whitehead
- University of North Carolina, Division of Gastroenterology and Hepatology, Chapel Hill, NC
| | | | | | | | - Susan A. Stoner
- University of Washington, Alcohol and Drug Abuse Institute, Seattle, WA, USA
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Abstract
Although repeated tooth-surface-specific information is commonly collected during a longitudinal caries clinical trial, traditional methods often make limited use of the repeated measures. Newer methods of analysis, such as methods based on time-to-event and methods for longitudinal or clustered data, have the potential to increase the efficiency of the statistical analysis. We compare a range of analytical methods from the traditional analysis based only on the number of caries onsets to newer methods that incorporate time at risk and surface-specific information, such as Poisson regression methods for clustered data, with respect to the efficiency of treatment comparisons. Under most circumstances, the greatest gain in efficiency associated with time-to-event methods will be due to the ability of subjects to contribute caries onsets to the analysis until they are lost from the study. Incorporating the number of surfaces at risk, the surface time at risk, and surface-specific characteristics will typically produce only a modest gain in efficiency.
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Affiliation(s)
- L A Mancl
- Department of Dental Public Health Sciences, University of Washington, Seattle 98195-7475, USA.
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Alkhateeb AA, Mancl LA, Presland RB, Rothen ML, Chi DL. Unstimulated Saliva-Related Caries Risk Factors in Individuals with Cystic Fibrosis: A Cross-Sectional Analysis of Unstimulated Salivary Flow, pH, and Buffering Capacity. Caries Res 2016; 51:1-6. [PMID: 27846621 PMCID: PMC5337435 DOI: 10.1159/000450658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
Salivary flow rate, pH, and buffering capacity are associated with dental caries, but studies from the cystic fibrosis (CF) literature are inconclusive regarding these salivary factors and caries. The aim of this study was to evaluate these factors and their associations with dental caries in individuals with CF. Unstimulated whole saliva was collected from individuals aged 6-20 years at Seattle Children's Hospital CF Clinic, USA (n = 83). Salivary flow rate was measured in milliliters per minute. Salivary pH was assessed using a laboratory pH meter. Buffering capacity was assessed by titration with HCl. The outcome measure was caries prevalence, defined as the number of decayed, missing, or filled primary and permanent tooth surfaces. Spearman's rank correlation coefficient and the t test were used to test for bivariate associations. Multiple variable linear regression models were used to (1) run confounder-adjusted analyses and (2) assess for potential interactions. There was no significant association between salivary flow rate or buffering capacity and caries prevalence. There was a significant negative association between salivary pH and caries prevalence, but this association was no longer significant after adjusting for age. There was no significant interaction between salivary flow rate and buffering capacity or between antibiotic use and the 3 salivary factors. Our results indicate that unstimulated salivary factors are not associated with dental caries prevalence in individuals with CF. Future studies should investigate other potential saliva-related caries risk factors in individuals with CF such as cariogenic bacteria levels, salivary host defense peptide levels, and medication use.
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Affiliation(s)
- Alaa A. Alkhateeb
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Lloyd A. Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Richard B. Presland
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
- University of Washington, School of Medicine, Division of Dermatology, Seattle, Washington 98195, U.S.A
| | - Marilynn L. Rothen
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
| | - Donald L. Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences, Seattle, Washington 98195, U.S.A
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Dogan S, Raigrodski AJ, Zhang H, Mancl LA. Prospective cohort clinical study assessing the 5-year survival and success of anterior maxillary zirconia-based crowns with customized zirconia copings. J Prosthet Dent 2016; 117:226-232. [PMID: 27765396 DOI: 10.1016/j.prosdent.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Studies evaluating anterior zirconia-based crowns are limited. PURPOSE The purpose of this prospective cohort clinical study was to assess the efficacy of zirconia-based anterior maxillary crowns with 0.3-mm customized copings at the cervical third and anatomical design elsewhere for up to 5 years of service. MATERIAL AND METHODS Eighteen participants who required an anterior maxillary crown (n=20) and who had signed a consent form approved by the University of Washington Health Sciences Center Human Subjects Division were enrolled. All preparations were standardized and prepared with an occlusal reduction of 1.5 to 2 mm and an axial reduction of 1 to 1.5 mm with 10 degrees of convergence angle. All finish lines were located on the sound tooth structure. Zirconia copings (Lava; 3M ESPE) were custom designed and milled to a 0.3-mm thickness at the cervical third and with selective thickness elsewhere to support the veneering porcelain. All restorations were luted with self-etching self-adhesive composite resin cement. Recall appointments were at 2 weeks, 6 months, and 12 months, and annually thereafter for 5 years. Modified Ryge criteria were used to assess the clinical fracture measurements, esthetics, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses. Descriptive statistics and 95% confidence intervals were used to describe the number and rate of complications and self-reported satisfaction with the crowns. RESULTS Twenty crowns with a mean follow-up of 58.7 months were evaluated. All crowns were rated as Alfa for fracture measurements (smooth surface, no fracture/chipping). Twelve crowns were rated esthetically as Romeo (no mismatch in color and shade) and 8 as Sierra (mismatch in color and shade within normal range). Twelve crowns were rated as Alfa (no visible evidence of crevice) and 8 as Bravo (visible evidence of crevice, no penetration of explorer) for marginal integrity. Nineteen were rated as Alfa (no discoloration) and 1 as Bravo (superficial discoloration) for marginal discoloration. No proximal caries or periapical pathoses were detected in 5 years. Participants were highly satisfied with their crowns after 5 years (mean ±SD: 9.8 ±0.4 on 0 to 10 scale). CONCLUSIONS Zirconia-based anterior maxillary crowns with customized copings with 0.3-mm thickness at the cervical third and zirconia margins performed well after 5 years of service.
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Affiliation(s)
- Sami Dogan
- Assistant Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.
| | - Ariel J Raigrodski
- Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash
| | - Hai Zhang
- Associate Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash
| | - Lloyd A Mancl
- Research Associate Professor, Department of Dental Public Health Sciences, University of Washington, Seattle, Wash
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Flinn BD, Raigrodski AJ, Mancl LA, Toivola R, Kuykendall T. Influence of aging on flexural strength of translucent zirconia for monolithic restorations. J Prosthet Dent 2016; 117:303-309. [PMID: 27666494 DOI: 10.1016/j.prosdent.2016.06.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 02/04/2023]
Abstract
STATEMENT OF PROBLEM Concern has been raised with regard to the low-temperature degradation (LTD) of translucent yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) for monolithic zirconia restorations. PURPOSE The purpose of this in vitro study was to assess the LTD behavior of 4 commercially available translucent Y-TZP materials by accelerated aging specimens in steam at 134°C, 0.2 MPa. MATERIAL AND METHODS Thin bars (22×3×0.2 mm) of Y-TZP, including Katana ML (Kuraray Noritake Dental Inc), Katana HT13 (Kuraray Noritake Dental Inc), Prettau (Zirkonzahn), and BruxZir (Glidewell Laboratories) (n=30 for each group), were machined from sintered blocks. Control specimens were assessed in the nonaged condition. Artificially ageing (n=5 per group at 5, 50, 100, 150, and 200 hours) was conducted in steam at 134°C at 0.2 MPa. The specimens were characterized, tested in 4-point flexure, and the fracture surfaces were analyzed. The monoclinic-to-tetragonal (m/t) peak intensity ratio measured by x-ray diffraction was used to calculate the monoclinic phase fraction and monitor LTD. Linear regression with heteroscedasticity-consistent robust standard errors was used to test for the effect of LTD (aging time) on (σf) and m/t. The Spearman rank correlation coefficient was used to assess the relationship between σf and monoclinic phase fraction (α=.05). RESULTS Artificial aging resulted in LTD as shown by an increase in the monoclinic phase fraction for all specimens. After aging for 200 hours, the mean ±SD monoclinic phase fraction increased from 2.90 ±0.34% to 76.1 ±0.64% for Prettau, 2.69 ±0.18% to 76.0 ±0.26% for BruxZir, 4.6 ±0.19% to 35.8 ±0.80% for Katana HT13, and 3.57 ±0.35% to 33.2 ±1.1% for Katana ML (all P<.001). Flexural strength changed from a mean ±SD of 1612 ±197 MPa to all fractured during aging for Prettau (P<.001); 1248 ±73.5 MPa to all fractured during aging for BruxZir (P<.001); 1052 ±84.2 to 1099 ±70 MPa ±130 for Katana HT13 (P=.45); and from 875 ±130 to 909 ±70 MPa (P=.82) for Katana ML. The mean flexural strength values of Prettau and BruxZir decreased with an increase in the monoclinic phase with Spearman rank correlation coefficients of -0.80 (P=.001) for Prettau and -0.63 (P=.022) for BruxZir. No significant changes in flexural strength were measured for Katana ML or Katana HT13 (P>.05). CONCLUSIONS The LTD of Y-TZP resulted in a significant decrease in flexural strength of Prettau and BruxZir, whereas Katana ML and Katana HT13 exhibited less LTD and no significant decrease in flexural strength.
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Affiliation(s)
- Brian D Flinn
- Research Associate Professor, Department of Material Science and Engineering, University of Washington, Seattle, Wash.
| | - Ariel J Raigrodski
- Professor, Department of Restorative Dentistry, School of Dentistry, and Adjunct Professor Department of Materials Science and Engineering, University of Washington, Seattle, Wash
| | - Lloyd A Mancl
- Research Associate Professor, Department of Oral Health Sciences, University of Washington, Seattle, Wash
| | - Ryan Toivola
- Postdoctoral Research Associate, Department of Material Science and Engineering, University of Washington, Seattle, Wash
| | - Tuesday Kuykendall
- Research Engineer, Department of Material Science and Engineering, University of Washington, Seattle, Wash
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Levy RL, van Tilburg MA, Langer SL, Romano JM, Walker LS, Mancl LA, Murphy TB, Claar RL, Feld SI, Christie DL, Abdullah B, DuPen MM, Swanson KS, Baker MD, Stoner SA, Whitehead WE. Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:2134-48. [PMID: 27542131 PMCID: PMC4995069 DOI: 10.1097/mib.0000000000000881] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies testing the efficacy of behavioral interventions to modify psychosocial sequelae of inflammatory bowel disease in children are limited. This report presents outcomes through a 6-month follow-up from a large randomized controlled trial testing the efficacy of a cognitive behavioral intervention for children with inflammatory bowel disease and their parents. METHODS One hundred eighty-five children aged 8 to 17 years with a diagnosis of Crohn's disease or ulcerative colitis and their parents were randomized to one of two 3-session conditions: (1) a social learning and cognitive behavioral therapy condition or (2) an education support condition designed to control for time and attention. RESULTS There was a significant overall treatment effect for school absences due to Crohn's disease or ulcerative colitis (P < 0.05) at 6 months after treatment. There was also a significant overall effect after treatment for child-reported quality of life (P < 0.05), parent-reported increases in adaptive child coping (P < 0.001), and reductions in parents' maladaptive responses to children's symptoms (P < 0.05). Finally, exploratory analyses indicated that for children with a higher level of flares (2 or more) prebaseline, those in social learning and cognitive behavioral therapy condition experienced a greater reduction in flares after treatment. CONCLUSIONS This trial suggests that a brief cognitive behavioral intervention for children with inflammatory bowel disease and their parents can result in improved child functioning and quality of life, and for some children may decrease disease activity.
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Affiliation(s)
| | | | | | - Joan M. Romano
- University of Washington, Psychiatry & Behavioral Sciences
| | | | | | | | - Robyn L. Claar
- University of North Carolina, Division of Gastroenterology and Hepatology
| | - Shara I. Feld
- University of Wisconsin, School of Medicine and Public Health
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15
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Harada K, Raigrodski AJ, Chung KH, Flinn BD, Dogan S, Mancl LA. A comparative evaluation of the translucency of zirconias and lithium disilicate for monolithic restorations. J Prosthet Dent 2016; 116:257-63. [DOI: 10.1016/j.prosdent.2015.11.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 01/08/2023]
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Abstract
In this article, methods are proposed for design and analysis of clinical trials that gather longitudinal data on multiple outcome variables. A valid test of the null hypothesis of no treatment group differences can be obtained for any choice of a working alternative hypothesis and a working covariance matrix for the outcome variables. Increased power can be achieved by accurate modeling of the true treatment effect and covariance structure. Implementation of the procedure is simple using existing software for generalized estimating equations. The procedure is an extension of the ‘derived variable’ technique (univariate analysis applied to a linear combination of the outcome variables) and also of O’Brien’s generalized least squares test. The procedure is extended to allow sequential testing using an arbitrary division of the total type I error rate among repeated hypothesis tests. The methods are illustrated by the design of a study on the safety of dental amalgam fillings, which served as the motivation for the research.
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Chi DL, Momany ET, Mancl LA, Lindgren SD, Zinner SH, Steinman KJ. Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program. Am J Prev Med 2016; 50:609-615. [PMID: 26514624 PMCID: PMC4838561 DOI: 10.1016/j.amepre.2015.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities. METHODS Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015. RESULTS In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively). CONCLUSIONS Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.
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Affiliation(s)
- Donald L Chi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington.
| | | | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | | | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kyle J Steinman
- Department of Neurology, University of Washington, and Seattle Children's Research Institute, Seattle, Washington
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18
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Huebner CE, Milgrom P, Mancl LA, Smolen D, Sutherland M, Weinstein P, Riedy CA. Implementation partnerships in a community-based intergenerational oral health study. Community Dent Health 2014; 31:207-211. [PMID: 25665353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND University-community partnerships are a common strategy used in implementing community-based health promotion trials, yet few published studies report these interactions in detail. "Baby Smiles" was a five-year intervention study in Oregon, USA. The study involved 400 low-income women during and after pregnancy across four rural counties. In this report, we describe and assess four university-community health partnerships formed to support the intervention. METHODS A community health partnership advisory group for the study was established in each of the four participating counties. Group membership ranged from 9 to 23 individuals. A survey was administered to the groups five times in a 2.5 year period. The survey asked members' opinions of the intervention's goals, scientific basis and relevance to their organisation. Questions also asked about members' knowledge of oral health, beliefs about access to dental care for low-income pregnant women and children in their county and how their organisation functioned. RESULTS There was strong overall support by each partnership group despite differences in the groups' structure, foci and turnover in membership during intervention period. Responses to specific survey items indicating misinformation or negative opinions about oral health care were used to address weaknesses in study implementation throughout the conduct of the study. CONCLUSION Systematic monitoring of community support for a multi-year oral health intervention is feasible and can identify potential barriers to address while the study is underway.
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Devic I, Shi M, Schubert MM, Lloid M, Izutsu KT, Pan C, Missaghi M, Morton TH, Mancl LA, Zhang J, Presland RB. Proteomic analysis of saliva from patients with oral chronic graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1048-55. [PMID: 24704387 DOI: 10.1016/j.bbmt.2014.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/26/2014] [Indexed: 12/13/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is an immune-mediated disorder and is the major long-term complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The oral mucosa, including the salivary glands, is affected in the majority of patients with cGVHD; however, at present there is only a limited understanding of disease pathobiology. In this study, we performed a quantitative proteomic analysis of saliva pooled from patients with and without oral cGVHD-cGVHD(+) and cGVHD(-), respectively-using isobaric tags for relative and absolute quantification labeling, followed by tandem mass spectrometry. Among 249 salivary proteins identified by tandem mass spectrometry, 82 exhibited altered expression in the oral cGVHD(+) group compared with the cGVHD(-) group. Many of the identified proteins function in innate or acquired immunity, or are associated with tissue maintenance functions, such as proteolysis or the cytoskeleton. Using ELISA immunoassays, we further confirmed that 2 of these proteins, IL-1 receptor antagonist and cystatin B, showed decreased expression in patients with active oral cGVHD (P < .003). Receiver operating curve characteristic analysis revealed that these 2 markers were able to distinguish oral cGVHD with a sensitivity of 85% and specificity of 60%, and showed slightly better discrimination in newly diagnosed patients evaluated within 12 months of allo-HSCT (sensitivity, 92%; specificity 73%). In addition to identifying novel potential salivary cGVHD biomarkers, our study demonstrates that there is coordinated regulation of protein families involved in inflammation, antimicrobial defense, and tissue protection in oral cGVHD that also may reflect changes in salivary gland function and damage to the oral mucosa.
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Affiliation(s)
- Ivana Devic
- Department of Pathology, University of Washington, Seattle, Washington
| | - Min Shi
- Department of Pathology, University of Washington, Seattle, Washington
| | - Mark M Schubert
- Department of Oral Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michele Lloid
- Department of Oral Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Kenneth T Izutsu
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Catherine Pan
- Department of Pathology, University of Washington, Seattle, Washington
| | - Melody Missaghi
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Thomas H Morton
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Lloyd A Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, Washington
| | - Richard B Presland
- Department of Oral Health Sciences, University of Washington, Seattle, Washington; Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington.
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20
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Chi DL, Masterson EE, Carle AC, Mancl LA, Coldwell SE. Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008. Am J Public Health 2014; 104:860-4. [PMID: 24625141 DOI: 10.2105/ajph.2013.301699] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. METHODS We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS Interventions and policies to ensure food security may help address the US pediatric caries epidemic.
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Affiliation(s)
- Donald L Chi
- Donald L. Chi, Erin E. Masterson, Lloyd A. Mancl, and Susan E. Coldwell are with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle. Adam C. Carle is with the Department of Pediatrics, School of Medicine, and the Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH
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21
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Weinstein P, Milgrom P, Riedy CA, Mancl LA, Garson G, Huebner CE, Smolen D, Sutherland M, Nykamp A. Treatment fidelity of brief motivational interviewing and health education in a randomized clinical trial to promote dental attendance of low-income mothers and children: Community-Based Intergenerational Oral Health Study "Baby Smiles". BMC Oral Health 2014; 14:15. [PMID: 24559035 PMCID: PMC3996055 DOI: 10.1186/1472-6831-14-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fidelity assessments are integral to intervention research but few published trials report these processes in detail. We included plans for fidelity monitoring in the design of a community-based intervention trial. METHODS The study design was a randomized clinical trial of an intervention provided to low-income women to increase utilization of dental care during pregnancy (mother) or the postpartum (child) period. Group assignment followed a 2 × 2 factorial design in which participants were randomly assigned to receive either brief Motivational Interviewing (MI) or Health Education (HE) during pregnancy (prenatal) and then randomly reassigned to one of these groups for the postpartum intervention. The study setting was four county health departments in rural Oregon State, USA. Counseling was standardized using a step-by-step manual. Counselors were trained to criteria prior to delivering the intervention and fidelity monitoring continued throughout the implementation period based on audio recordings of counselor-participant sessions. The Yale Adherence and Competence Scale (YACS), modified for this study, was used to code the audio recordings of the counselors' delivery of both the MI and HE interventions. Using Interclass Correlation Coefficients totaling the occurrences of specific MI counseling behaviors, ICC for prenatal was .93, for postpartum the ICC was .75. Participants provided a second source of fidelity data. As a second source of fidelity data, the participants completed the Feedback Questionnaire that included ratings of their satisfaction with the counselors at the completion of the prenatal and post-partum interventions. RESULTS Coding indicated counselor adherence to MI protocol and variation among counselors in the use of MI skills in the MI condition. Almost no MI behaviors were found in the HE condition. Differences in the length of time to deliver intervention were found; as expected, the HE intervention took less time. There were no differences between the overall participants' satisfaction ratings of the HE and MI sessions by individual counselor or overall (p > .05). CONCLUSIONS Trial design, protocol specification, training, and continuous supervision led to a high degree of treatment fidelity for the counseling interventions in this randomized clinical trial and will increase confidence in the interpretation of the trial findings.
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Affiliation(s)
- Philip Weinstein
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Christine A Riedy
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Lloyd A Mancl
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Gayle Garson
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Colleen E Huebner
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | - Darlene Smolen
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
| | | | - Ann Nykamp
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, Box 357475, University of Washington, Seattle, WA 98195-7475, USA
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Chi DL, Milgrom P, Carle AC, Huebner CE, Mancl LA. Multilevel factors associated with dentists' counseling of pregnant women about periodontal health. Spec Care Dentist 2014; 34:2-6. [PMID: 24382365 PMCID: PMC3879956 DOI: 10.1111/scd.12014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify factors associated with dentists' counseling of pregnant patients about periodontal health. METHODS Survey data from Oregon general dentists (N = 771) were linked to county-level data from the U.S. Area Resource Files and analyzed using two-level hierarchical linear models. RESULTS Dentists who believed there is an important relationship between periodontal disease and adverse pregnancy outcomes counseled significantly larger proportions of pregnant patients (p < .0001). Female dentists (p < .05) and those who saw a greater number of pregnant patients (p < .05) were more likely to counsel. County-level health workforce characteristics (e.g., percent female physicians, obstetricians or gynecologists, female dentists) were not significantly associated with dentists' counseling. CONCLUSIONS Dentists who were knowledgeable about periodontal disease were more likely to counsel pregnant patients. Future interventions should improve the oral health knowledge of dentists and other healthcare professionals regarding the importance of comprehensive dental care, including periodontal treatment when needed, for all pregnant patients.
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Affiliation(s)
- Donald L. Chi
- University of Washington, School of Dentistry, Department of Oral Health Sciences
| | - Peter Milgrom
- University of Washington, School of Dentistry, Department of Oral Health Sciences
| | - Adam C. Carle
- University of Cincinnati, School of Medicine, Department of Pediatrics
| | - Colleen E. Huebner
- University of Washington, School of Public Health, Department of Health Services
| | - Lloyd A. Mancl
- University of Washington, School of Dentistry, Department of Oral Health Sciences
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Tajbakhsh S, Rubenstein JE, Faine MP, Mancl LA, Raigrodski AJ. Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: A multicenter longitudinal assessment. J Prosthet Dent 2013; 110:252-8. [DOI: 10.1016/s0022-3913(13)60371-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Raigrodski AJ, Yu A, Chiche GJ, Hochstedler JL, Mancl LA, Mohamed SE. Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results. J Prosthet Dent 2013; 108:214-22. [PMID: 23031727 DOI: 10.1016/s0022-3913(12)60165-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STATEMENT OF PROBLEM In recent years, zirconium dioxide-based partial fixed dental prostheses (FDP) have been suggested as an alternative treatment to traditional metal ceramic FDPs. However, clinical studies evaluating their longevity and related complications are limited. PURPOSE The purpose of this cohort clinical study was to assess the efficacy of zirconium dioxide-based posterior 3-unit FDPs. MATERIAL AND METHODS Twenty 3-unit posterior FDPs (Lava) were placed in 16 participants missing a second premolar or a first molar. All participants met specific inclusion and exclusion criteria and provided informed consent. All teeth were prepared in a standardized manner: occlusal reduction of 1.5 to 2 mm; axial reduction of 1 to 1.5 mm; a 1.0 mm 360-degree rounded shoulder placed 0.5 mm subgingivally on the facial aspect and supragingivally on the lingual aspect on sound tooth structure; and rounded internal line angles. Definitive impressions were made with vinyl polysiloxane impression material. Frameworks were fabricated by using computer-aided design and computer-aided manufacturing (CAD/CAM) technology with a uniform retainer thickness of 0.6 mm and a minimal connector surface area of 9 mm(2). Restorations were luted with resin-modified glass ionomer cement (Rely-X Luting). Participants were recalled at 2 weeks, 6 months, and 12 months, and thereafter, annually for up to 60 months. Clinical fracture measurements, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses were assessed over time by using modified Ryge criteria. The probability distributions of these variables were calculated for the baseline data and for the recall data. An analysis of survival was made by using the Kaplan-Meier method. RESULTS Eighteen FDPs were clinically evaluated at 5 years and 1 at 48 months. Fifteen were rated Alpha for fracture measurements, and 2 were rated Bravo (minor chipping of veneering porcelain and not requiring restoration replacement). Two were rated Charlie (major chipping of veneering porcelain and requiring restoration replacement). Eighteen FDPs were rated Alpha for marginal integrity, and 1 rated Bravo. All restorations were rated Alpha for marginal discoloration. One participant experienced root fracture after 60 months, while another was treated surgically for a periapical pathosis on an endodontically treated abutment. CONCLUSIONS Zirconium dioxide-based posterior 3-unit FDPs performed well after 5 years of service.
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Affiliation(s)
- Ariel J Raigrodski
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA 98195-7456, USA.
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Milgrom P, Riedy CA, Weinstein P, Mancl LA, Garson G, Huebner CE, Smolen D, Sutherland M. Design of a community-based intergenerational oral health study: "Baby Smiles". BMC Oral Health 2013; 13:38. [PMID: 23914908 PMCID: PMC3751087 DOI: 10.1186/1472-6831-13-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/02/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rural, low-income pregnant women and their children are at high risk for poor oral health and have low utilization rates of dental care. The Baby Smiles study was designed to increase low-income pregnant women's utilization of dental care, increase young children's dental care utilization, and improve home oral health care practices. METHODS/DESIGN Baby Smiles was a five-year, four-site randomized intervention trial with a 2 × 2 factorial design. Four hundred participants were randomly assigned to one of four treatment arms in which they received either brief Motivational Interviewing (MI) or health education (HE) delivered during pregnancy and after the baby was born. In the prenatal study phase, the interventions were designed to encourage dental utilization during pregnancy. After childbirth, the focus was to utilize dental care for the infant by age one. The two primary outcome measures were dental utilization during pregnancy or up to two months postpartum for the mother, and preventive dental utilization by 18 months of age for the child. Medicaid claims data will be used to assess the primary outcomes. Questionnaires were administered at enrollment and 3, 9 and 18 months postpartum (study end) to assess mediating and moderating factors. DISCUSSION This trial can help define the most effective way to provide one-on-one counseling to pregnant women and new mothers regarding visits to the dentist during pregnancy and after the child is born. It supports previous work demonstrating the potential of reducing mother-to-child transmission of Streptococcus mutans and the initiation of dental caries prevention in early childhood. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01120041.
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Affiliation(s)
- Peter Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
| | - Christine A Riedy
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
| | - Philip Weinstein
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
| | - Lloyd A Mancl
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
| | - Gayle Garson
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
| | - Colleen E Huebner
- Northwest Center to Reduce Oral Health Disparities, Department of Health Services, University of Washington, Box 357230, 98195-7230 Seattle, WA, USA
| | - Darlene Smolen
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Box 357475, 98195-7475 Seattle, WA, USA
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Milgrom P, Huebner CE, Mancl LA, Chi DL, Garson G, Grembowski D. County-level characteristics as predictors of dentists' ECC counseling in the USA: a survey study. BMC Oral Health 2013; 13:23. [PMID: 23688178 PMCID: PMC3679951 DOI: 10.1186/1472-6831-13-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/16/2013] [Indexed: 11/27/2022] Open
Abstract
Background Transmission of Streptococcus mutans from mother-to-child can lead to Early Childhood Caries. A previous study identified characteristics and beliefs of general dentists about counseling pregnant women to reduce risk of infection and Early Childhood Caries. This study extends those findings with an analysis of county level factors. Methods In 2006, we surveyed 732 general dentists in Oregon, USA about dental care for pregnant women. Survey items asked about individual and practice characteristics. In the present study we matched those data to county level factors and used multinomial logistic regression to test the effects of the factors (i.e., dentist to population ratio, percentage of female dentists, percentage of females of childbearing age, and percentage of individuals living in poverty) on counseling behavior. Results County level factors were unrelated to counseling behavior when the models controlled for dentists' individual attitudes, beliefs, and practice level characteristics. The adjusted odds ratios for no counseling of pregnant patients (versus 100 percent counseling) were 1.1 (95% CI .8-1.7), 1.0 (1.0-1.1), 1.2 (.9-1.5), and 1.1 (1.0-1.2) for dentist/population ratio, percent female dentists, percent females of childbearing age, and percent in poverty, respectively Similar results were obtained when dentists who counseled some patients were compared to those counseling 100 percent of patients. Conclusions Community level factors do not appear to impact the individual counseling behavior of general dentists in Oregon, USA regarding the risk of maternal transmission of Early Childhood Caries.
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Affiliation(s)
- Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, USA.
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Flinn BD, deGroot DA, Mancl LA, Raigrodski AJ. Accelerated aging characteristics of three yttria-stabilized tetragonal zirconia polycrystalline dental materials. J Prosthet Dent 2012; 108:223-30. [DOI: 10.1016/s0022-3913(12)60166-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Schauer GL, Halperin AC, Mancl LA, Doescher MP. Health professional advice for smoking and weight in adults with and without diabetes: findings from BRFSS. J Behav Med 2011; 36:10-9. [PMID: 22083143 DOI: 10.1007/s10865-011-9386-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 11/02/2011] [Indexed: 01/09/2023]
Abstract
Health risk behaviors including smoking and weight-gain can cause and exacerbate chronic diseases like diabetes. Brief provider advice is an effective intervention to reduce risk from these behaviors. However, behavioral advice is provided more often to those who already have a chronic illness when compared with those who are at risk. The purpose of this study is to determine whether the frequency of provider advice for smoking cessation and weight loss varies between overweight or obese smokers with and without diabetes. BRFSS data from a subset of overweight and obese smokers with (n = 848) and without (n = 6,279) diabetes were analyzed to determine differences in reported provider advice. Overweight and obese smokers with diabetes reported receiving more advice for both weight (46.4% vs. 23.4%, P < 0.001) and smoking (84.5% vs. 72.8%, P < 0.001) compared to those without diabetes. Advice for smoking cessation was reported two to three times more often than advice for weight. Nearly a quarter of those with diabetes and almost half of those without reported no receipt of advice about weight. Results indicate that providers are not adequately addressing overweight and obesity in patients with and at risk for diabetes.
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Affiliation(s)
- Gillian L Schauer
- Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University, 1815 Clifton Road NE, Atlanta, GA 30322, USA.
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Milgrom PM, Tut OK, Mancl LA. Topical iodine and fluoride varnish effectiveness in the primary dentition: a quasi-experimental study. J Dent Child (Chic) 2011; 78:143-147. [PMID: 22126926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Combining fluorides with antimicrobials may be of value because fluorides alone do not provide complete protection. The purpose of this quasi-experimental study was to compare the effectiveness of combined topical treatment with 10% polyvinyl-pyrollidone iodine (PVP-I) and 5% sodium fluoride varnish (FV) with FV alone. METHODS One hundred seventy-two 12- to 30-month-old children received either combined or single therapy in Majuro, Republic of the Marshall Islands, between June 2008 and March 2009. The children received a mean of 2.5 treatments in the PVP-I combined group (range=2-3) and 2.8 treatments in the FV group (range=2-4) and were then examined. RESULTS The percentage of children with any new decayed primary teeth was 41% (n=81) in the PVP-I combined group and 54% (n=90) in the FV group. Multivariate log-binomial regression was used to compare the rate of any new decay between groups, controlling for the number of teeth at baseline and the number of treatment visits. The risk ratio for treatment is 0.69 (95% confidence interval [CI]=0.51-0.94). No adverse effects were observed. CONCLUSION Combined treatment with 10% polyvinylpyrollidone iodine and 5% sodium fluoride varnish reduced the rate of new tooth decay by 31% over fluoride varnish alone.
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Affiliation(s)
- Peter M Milgrom
- Northwest Center to Reduce Oral Health Disparities, Department of Oral Health Sciences, University of Washington, Seattle, USA.
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Janssens KAM, Rosmalen JGM, Ormel J, Verhulst FC, Hunfeld JAM, Mancl LA, Oldehinkel AJ, LeResche L. Pubertal status predicts back pain, overtiredness, and dizziness in American and Dutch adolescents. Pediatrics 2011; 128:553-9. [PMID: 21807699 PMCID: PMC3164091 DOI: 10.1542/peds.2010-2364] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Functional somatic symptoms, symptoms for which no organic pathologic basis can be found, are more prevalent in girls than in boys, and this difference tends to increase during adolescence. This might be explained, at least in part, by pubertal development. We hypothesized that pubertal maturation predicts the development of most functional somatic symptoms and that this especially is true for girls. METHOD We used 2 longitudinal population-based studies to examine our hypotheses: the Longitudinal Study of Pain in Adolescents in Seattle (n = 1996 [49.7% girls]) and the Dutch Tracking Adolescents' Individual Lives Survey (n = 2230 [51.0% girls]). Two assessment waves of each study were used. American adolescents were younger than Dutch adolescents at the first (11.6 vs 13.6) and second (14.5 vs 16.2) assessment waves, but they were in about the same pubertal development stage. Functional somatic symptoms were measured by pain questions, the Symptom Checklist-90, and the Youth Self-report. The Pubertal Development Scale was used to assess pubertal development on a continuous scale in both cohorts. RESULTS Ordinal logistic regression analyses revealed that American and Dutch adolescents at a later pubertal status at baseline were more likely (odds ratios ranged from 1.24 to 1.61) to report back pain, overtiredness, and dizziness but not stomach pain and headache 2 to 3 years later. Although these relationships were not equally strong for boys and girls, no significant gender differences were found. CONCLUSIONS Pubertal status predicted the frequency of some, but not all, functional somatic symptoms at follow-up.
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Affiliation(s)
- Karin A. M. Janssens
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Judith G. M. Rosmalen
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Johan Ormel
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Joke A. M. Hunfeld
- Medical Psychology and Psychotherapy, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands; and
| | | | - Albertine J. Oldehinkel
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Linda LeResche
- Oral Medicine, University of Washington, Seattle, Washington
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Richman JA, Huebner CE, Leggott PJ, Mouradian WE, Mancl LA. Beyond word recognition: understanding pediatric oral health literacy. Pediatr Dent 2011; 33:420-425. [PMID: 22104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Parental oral health literacy is proposed to be an indicator of children's oral health. The purpose of this study was to test if word recognition, commonly used to assess health literacy, is an adequate measure of pediatric oral health literacy. This study evaluated 3 aspects of oral health literacy and parent-reported child oral health. METHODS A 3-part pediatric oral health literacy inventory was created to assess parents' word recognition, vocabulary knowledge, and comprehension of 35 terms used in pediatric dentistry. The inventory was administered to 45 English-speaking parents of children enrolled in Head Start. RESULTS Parents' ability to read dental terms was not associated with vocabulary knowledge (r=0.29, P<.06) or comprehension (r=0.28, P>.06) of the terms. Vocabulary knowledge was strongly associated with comprehension (r=0.80, P<.001). Parent-reported child oral health status was not associated with word recognition, vocabulary knowledge, or comprehension; however parents reporting either excellent or fair/poor ratings had higher scores on all components of the inventory. CONCLUSIONS Word recognition is an inadequate indicator of comprehension of pediatric oral health concepts; pediatric oral health literacy is a multifaceted construct. Parents with adequate reading ability may have difficulty understanding oral health information.
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Affiliation(s)
- Julia Anne Richman
- Department of Pediatric Dentistry, School of Dentistry, The University of Washington, Seattle, Wash., USA.
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Chen IC, Brudvik JS, Mancl LA, Rubenstein JE, Chitswe K, Raigrodski AJ. Freedom of rotation of selected overdenture attachments: An in vitro study. J Prosthet Dent 2011; 106:78-86. [PMID: 21821161 DOI: 10.1016/s0022-3913(11)60099-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Fletcher-Stark ML, Chung KH, Rubenstein JE, Raigrodski AJ, Mancl LA. Shear Bond Strength of Denture Teeth to Heat- and Light-Polymerized Denture Base Resin. J Prosthodont 2010; 20:52-9. [DOI: 10.1111/j.1532-849x.2010.00639.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Walter RD, Brudvik JS, Raigrodski AJ, Mancl LA, Chung KH. A comparison of the rigidity of five mandibular major connectors for partial removable dental prostheses via load deflection. J Prosthet Dent 2010; 104:182-90. [DOI: 10.1016/s0022-3913(10)60118-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnson GH, Mancl LA, Schwedhelm ER, Verhoef DR, Lepe X. Clinical trial investigating success rates for polyether and vinyl polysiloxane impressions made with full-arch and dual-arch plastic trays. J Prosthet Dent 2010; 103:13-22. [PMID: 20105676 DOI: 10.1016/s0022-3913(09)60208-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ohrbach R, Turner JA, Sherman JJ, Mancl LA, Truelove EL, Schiffman EL, Dworkin SF. The Research Diagnostic Criteria for Temporomandibular Disorders. IV: evaluation of psychometric properties of the Axis II measures. J Orofac Pain 2010; 24:48-62. [PMID: 20213031 PMCID: PMC3115780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To evaluate the psychometric properties of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) biobehavioral (Axis II) screening instruments. METHODS Participants with Axis I TMD diagnoses (n = 626) completed the Axis II instruments (Depression, Nonspecific Physical Symptoms, Graded Chronic Pain) and other instruments assessing psychological distress, pain, and disability at three study sites. Internal consistency, temporal stability, and convergent/discriminant validity of the Axis II measures were assessed. To assess criterion validity of Nonspecific Physical Symptoms and Depression instruments as screeners, 170 participants completed a structured psychiatric diagnostic interview. RESULTS The Axis II instruments showed very good to excellent internal consistency (Cronbach's alpha coefficients = 0.80 to 0.95). Their convergent (correlation range 0.3 to 0.9) and discriminant (range 0.0 to 0.6) validity were generally supported, although Nonspecific Physical Symptoms was more strongly associated with depressive than with somatic symptoms. Temporal stability was high for characteristic pain intensity (Lin's correlation concordance coefficient [CCC] = 0.91), interference (CCC = 0.89), and chronic pain grade (weighted kappa = 0.87), and fair to good for Depression and Nonspecific Physical Symptoms (CCC = 0.63 to 0.78). The Depression instrument normal versus moderate to severe cutoff point was good at identifying current-year depression and dysthymia diagnoses (sensitivity 87%, specificity 53%). Nonspecific Physical Symptoms did not have high utility for detecting psychiatric disorders (sensitivity 86%, specificity 31%). CONCLUSION The Axis-II Depression and Graded Chronic Pain instruments have clinically relevant and acceptable psychometric properties for reliability and validity and utility as instruments for identifying TMD patients with high levels of distress, pain, and disability that can interfere with treatment response and course of Axis I disorders.
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Affiliation(s)
- Richard Ohrbach
- Department of Oral Diagnostic Sciences, University of Buffalo, Buffalo, NY, USA.
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Truelove E, Pan W, Look JO, Mancl LA, Ohrbach RK, Velly AM, Huggins KH, Lenton P, Shiffman EL. The Research Diagnostic Criteria for Temporomandibular Disorders. III: validity of Axis I diagnoses. J Orofac Pain 2010; 24:35-47. [PMID: 20213030 PMCID: PMC3157051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To estimate the criterion validity of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I TMD diagnoses. METHODS A combined total of 614 TMD community and clinic cases and 91 controls were examined at three study sites. RDC/TMD Axis I diagnoses were algorithmically derived from an examination performed by calibrated dental hygienists. Reference standards ("gold standards") were established by means of consensus diagnoses rendered by two TMD experts using all available clinical data, including imaging findings. Validity of the RDC/TMD Axis I TMD diagnoses was estimated relative to the reference-standard diagnoses (gold standard diagnoses). Target sensitivity and specificity were set a priori at greater than or equal to 0.70 and greater than or equal to 0.95, respectively. RESULTS Target sensitivity and specificity were not observed for any of the eight RDC/TMD diagnoses. The highest validity was achieved for Group Ia myofascial pain (sensitivity 0.65, specificity 0.92) and Group Ib myofascial pain with limited opening (sensitivity 0.79, specificity 0.92). Target sensitivity and specificity were observed only when both Group I diagnoses were combined (0.87 and 0.98, respectively). For Group II (disc displacements) and Group III (arthralgia, arthritis, arthrosis) diagnoses, all estimates for sensitivity were below target (0.03 to 0.53), and specificity ranged from below to on target (0.86 to 0.99). CONCLUSION The RDC/TMD Axis I TMD diagnoses did not reach the targets set at sensitivity of > or = 0.70 and specificity of > or = 0.95. Target validity was obtained only for myofascial pain without differentiation between normal and limited opening. Revision of the current Axis I TMD diagnostic algorithms is warranted to improve their validity.
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Affiliation(s)
- Edmond Truelove
- Department of Oral Medicine, Univeristy of Washington, Seattle, Washington 98195, USA.
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Raigrodski AJ, Dogan S, Mancl LA, Heindl H. A Clinical Comparison of Two Vinyl Polysiloxane Impression Materials Using the One-Step Technique. J Prosthet Dent 2009; 102:179-86. [DOI: 10.1016/s0022-3913(09)60143-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ashkanani HM, Raigrodski AJ, Flinn BD, Heindl H, Mancl LA. Flexural and shear strengths of ZrO2 and a high-noble alloy bonded to their corresponding porcelains. J Prosthet Dent 2008; 100:274-84. [DOI: 10.1016/s0022-3913(08)60206-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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LeResche L, Mancl LA, Drangsholt MT, Huang G, Von Korff M. Predictors of onset of facial pain and temporomandibular disorders in early adolescence. Pain 2007; 129:269-278. [PMID: 17134830 PMCID: PMC1979093 DOI: 10.1016/j.pain.2006.10.012] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 09/25/2006] [Accepted: 10/13/2006] [Indexed: 11/19/2022]
Abstract
There are few prospective studies assessing risk factors for onset of temporomandibular (TMD) pain disorders in any age group. The aim of this prospective cohort study was to identify risk factors for onset of clinically significant TMD pain (i.e., pain meeting research diagnostic criteria for myofascial pain and/or arthralgia) during early adolescence. Subjects were 1,996 boys and girls, initially 11 years old, randomly selected from a large nonprofit health care system. Subjects completed a baseline telephone interview and were followed up with mailed questionnaires every 3 months for 3 years. At baseline and all follow ups, subjects were asked to report the presence of facial pain in the past 3 months. Subjects reporting a first onset of facial pain received a standardized clinical examination. In multivariate analyses, baseline predictors of clinically significant pain included female gender [Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3] and negative somatic and psychological symptoms including somatization (OR=1.8, CI=1.1-2.8), number of other pain complaints (OR=3.2, CI=1.7-6.1) and life dissatisfaction (OR=4.1, CI=1.9-9.0). Many of the risk factors for onset of clinically significant TMD pain in adolescents are similar to risk factors for onset of TMD and other pain problems in adults, as well as risk factors for onset of other pain conditions in adolescents. These findings suggest that the development of TMD pain in adolescence may reflect an underlying vulnerability to musculoskeletal pain that is not unique to the orofacial region.
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Affiliation(s)
- Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370
| | - Lloyd A. Mancl
- Department of Dental Public Health Sciences, University of Washington, Seattle, WA 98195-7475
| | - Mark T. Drangsholt
- Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370
- Department of Dental Public Health Sciences, University of Washington, Seattle, WA 98195-7475
| | - Greg Huang
- Department of Orthodontics, University of Washington, Seattle, WA 98195-7446
| | - Michael Von Korff
- Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Suite 1600 Seattle, WA 98101
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Nam J, Raigrodski AJ, Townsend J, Lepe X, Mancl LA. Assessment of preference of mixing techniques and duration of mixing and tray loading for two viscosities of vinyl polysiloxane material. J Prosthet Dent 2007; 97:12-7. [PMID: 17280886 DOI: 10.1016/j.prosdent.2006.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM Information regarding operators' preferences for different impression mixing techniques and duration of mixing and tray loading is limited. PURPOSE The purpose of this study was to assess operators' preferences, and the duration of mixing and tray loading using different mixing techniques. MATERIAL AND METHODS Thirty dentists, 30 dental assistants, and 30 inexperienced dental students evaluated mixing heavy-body vinyl polysiloxane material (VPS) using electronic mixing compared to automixing, and extra-heavy-body material using electronic mixing compared to hand mixing. Participants rated their level of preference using a scale from 0 to 10 for ease of mixing, control of loading, quality of mixing, level of cleanliness, and overall rating. The duration of mixing and tray loading was also measured. Mean values were compared within participant groups using the paired t test (alpha=.05) and between groups using 1-way analysis of variance (ANOVA) (alpha=.05). Holm's procedure was used to adjust the level of significance for the multiple comparisons. RESULTS The paired t test showed that mean values of level of preference for electronic mixing were significantly higher (P<.001 to .033) than those for automixing or hand mixing. The mean values of duration of mixing and tray loading with electronic mixing were significantly higher (P<.001 to .002) than those with automixing or hand mixing, except for students using heavy-body materials (P=.31). One-way ANOVA showed that there were no significant differences between the 3 participant groups in preference and duration of mixing and tray loading, both of heavy-body and extra-heavy-body VPS impression materials. CONCLUSIONS All participant groups preferred electronic mixing to automixing or hand mixing. Electronic mixing was significantly slower for all groups except for students using heavy-body materials. There was no significant difference between the 3 participant groups in the preference or duration of mixing and tray loading for the mixing techniques tested.
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Affiliation(s)
- Jung Nam
- School of Dentistry, University of Washington, Seattle 98195-7456, USA
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Smith JM, Wong CS, Salamonik EB, Hacker BM, McDonald RA, Mancl LA, Williams BJ, Ibrahim A, Roberts FA. Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients. Pediatr Nephrol 2006; 21:1753-9. [PMID: 16937132 DOI: 10.1007/s00467-006-0214-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 11/30/2022]
Abstract
Cyclosporine (CSA) is a commonly used immunosuppressive medication in pediatric transplantation. Drug-induced gingival overgrowth (DIGO) is a frequent side effect associated with CSA use and can impair the patient's ability to achieve good oral hygiene. This study tested the hypothesis that sonic tooth brushing and oral hygiene instruction can reduce the occurrence or severity of DIGO in CSA-treated pediatric renal transplant recipients. Twenty-three pediatric renal transplant patients with DIGO were randomly allocated to treatment or control groups. The treatment group received oral hygiene instruction and use of a sonic toothbrush, while the control group continued their usual home care with manual brushes. Dental impressions and photographs of all subjects were taken at baseline and every 3 months for a year. The casts and photographs were evaluated by a dental panel to compare the DIGO levels from baseline until the end of the study. After 12 months the control group had significantly more severe DIGO than did the sonic tooth brushing and oral hygiene instruction group (OR=4.5, 95%CI=1.2-16.0, P=0.03). Of the risk factors considered, only male gender was significantly associated with worse outcome (OR=6.1, 95%CI=2.3-16.1, P=0.03). The use of a powered toothbrush, together with oral hygiene instruction, may be an important component of health maintenance for pediatric transplant patients on CSA.
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Affiliation(s)
- Jodi M Smith
- Pediatric Nephrology, Children's Hospital and Regional Medical Center, Seattle, WA, USA
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Aaron LA, Turner JA, Mancl LA, Sawchuk CN, Huggins KH, Truelove EL. Daily pain coping among patients with chronic temporomandibular disorder pain: an electronic diary study. J Orofac Pain 2006; 20:125-37. [PMID: 16708830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIMS To describe patients' daily coping with the pain of chronic temporomandibular disorders (TMD), the conservative treatment received, and the self-care strategies used, and to examine the relationships between these strategies and daily pain intensity, activity interference, and jaw use limitations. METHODS TMD clinic patients (n = 137, 88% women) completed electronic diary measures of pain, interference, jaw use limitations, and use of 20 strategies 3 times daily for 2 weeks. RESULTS Reliability and validity were demonstrated for 4 scales of related coping items: cognitive coping, relaxation, activity reduction, and emotional support. Average scores were higher on the relaxation and activity reduction scales than on the cognitive coping and emotional support scales. Among the coping items not included in the scales, "did something to try to reduce pain" (direct action) was endorsed most frequently (reported in a median of 74% of interviews). Heat, cold, and seeking spiritual support were used least (< or = 5%). At times of increased pain, patients were more likely to use almost all types of strategies. Pain intensity was associated strongly with concurrent activity interference and jaw use limitations. When the design controlled for pain intensity, activity reduction and seeking emotional support were associated positively within-subjects with interference and jaw use limitations. CONCLUSION TMD clinic patients use a variety of treatment, self-care, and coping strategies to contend with daily pain. Inquiring about a broad range of strategies might help clinicians better understand how individual patients approach pain management. Research is needed to examine whether decreasing activity reduction and emotional support coping results in improved outcomes.
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Affiliation(s)
- Leslie A Aaron
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle 98195, USA
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LeResche L, Mancl LA, Drangsholt MT, Saunders K, Von Korff M. Relationship of pain and symptoms to pubertal development in adolescents. Pain 2005; 118:201-9. [PMID: 16213087 DOI: 10.1016/j.pain.2005.08.011] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 07/26/2005] [Accepted: 08/08/2005] [Indexed: 02/06/2023]
Abstract
Temporomandibular disorder (TMD) pain, abdominal pain, migraine and tension-type headache are more prevalent in women than in men. This study assessed the relationship of back pain, headache, abdominal pain, TMD pain, and the presence of multiple pain conditions to gender and pubertal development in a cross-sectional, population-based survey of adolescents. We also examined the association between pubertal development and depressive and somatic symptoms, factors often associated with pain in adults. We hypothesized that prevalence of all pain conditions, as well as rates of other symptoms, would increase as puberty progresses in females, but not males. Subjects (3,101 boys and girls, 11-17 years old, selected from an HMO population) reported on the presence of each pain condition in the prior 3 months and completed scales assessing pubertal development, and depressive and somatic symptoms. Data were analyzed using descriptive statistics and multivariate logistic regression. Prevalence rates were weighted for factors affecting response. Prevalence of back pain, headache and TMD pain increased significantly (odds ratios, OR=1.4-2.0, P<0.001) and stomach pain increased marginally with increasing pubertal development in girls. Rates of somatization, depression and probability of experiencing multiple pains also increased with pubertal development in girls (P<0.0001). For boys, prevalence of back (OR=1.9, P<0.0001) and facial pain (OR=1.5, P<0.01) increased, stomach pain decreased somewhat and headache prevalence was virtually unchanged with increasing maturity. For both sexes, pubertal development was a better predictor of pain than was age. Thus it appears that pain, other somatic symptoms and depression increase systematically with pubertal development in girls.
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Affiliation(s)
- Linda LeResche
- Department of Oral Medicine, University of Washington, P.O. Box 356370, Seattle, WA 98195-6370, USA.
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Abstract
Temporomandibular disorders (TMD) diagnoses can be viewed as the most useful clinical summary for classifying subtypes of TMD. The Research Diagnostic Criteria for TMD (RDC/TMD) is the most widely used TMD diagnostic system for conducting clinical research. It has been translated into 18 languages and is used by a consortium of 45 RDC/TMD-based international researchers. While reliability of RDC/TMD signs and symptoms of TMD has been amply reported, the reliability of RDC/TMD diagnoses has not. The aim of the study was to determine the reliability of clinical TMD diagnoses using standardized methods and operational definitions contained in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data came from reliability assessment trials conducted at 10 international clinical centers, involving 30 clinical examiners assessing 230 subjects. Intraclass correlation coefficients (ICC) were calculated to characterize the reliability. The reliability of the diagnoses was fair to good. Median ICCs for the diagnoses myofascial pain with and without limited opening were 0.51 and 0.60, respectively. Median ICC for arthralgia was 0.47 and 0.61 for disc displacement with reduction. RDC/TMD diagnoses of disc displacement without reduction, osteoarthritis and osteoarthrosis were not prevalent enough to calculate ICC's, but percent agreement was always >95%. The reliability of diagnostic classification improved when diagnoses were grouped into pain versus non-pain diagnoses (ICC=0.72) and for detecting any diagnosis versus no diagnosis (ICC=0.78). In clinical decision-making and research, arriving at a reliable diagnosis is critical in establishing a clinical condition and a rational approach to treatment. The RDC/TMD demonstrates sufficiently high reliability for the most common TMD diagnoses, supporting its use in clinical research and decision making.
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Affiliation(s)
- Mike T John
- Department of Prosthodontics and Materials Science, School of Dentistry, University of Leipzig, Nürnberger Strabe 57, 04103 Leipzig, Germany.
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Abstract
BACKGROUND The authors conducted an in vivo investigation to compare the clinical performance of two commercial one-bottle adhesives and a two-bottle adhesive for restoration of noncarious cervical lesions (NCCLs). METHOD The patient pool consisted of 57 patients and 171 teeth (three teeth per patient), with one NCCL per tooth. Each patient received three resin-based composite restorations, each with a different adhesive: one tooth with a two-bottle, water-based adhesive as the control; another tooth with a one-bottle, ethanol-based adhesive; and a third tooth with a one-bottle, solvent-free adhesive. The authors assessed restorations in terms of retention, marginal integrity, margin discoloration and air sensitivity at baseline, six months, one year, two years and three years after initial placement. RESULTS The retention rates at 36 months were 88 percent for the first adhesive, 81 percent for the second adhesive and 90 percent for the third adhesive. No statistically significant differences in retention rates could be shown, with 86 percent of restorations retained overall. Measures of marginal integrity, marginal discoloration and sensitivity also had no statistically significant differences between the three adhesives (P > .05). CONCLUSIONS All three adhesives performed with acceptable outcomes after a 36-month period, with small differences between the one- and two-bottle systems and between the various solvents. Retention rate was moderately high and air sensitivity was markedly reduced; however, superficial marginal discoloration and marginal degradation was notable. Certain lesion, tooth and patient characteristics may predispose restorations to retention failure. CLINICAL IMPLICATIONS The type of solvent may not be a major factor in retention of Class V restorations in NCCLs. Both single-bottle adhesives and conventional two-bottle adhesives performed acceptably.
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Affiliation(s)
- Tar C Aw
- Department of Restorative Dentistry, University of Washington, School of Dentistry, Seattle 98195-7456, USA.
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Hirsch C, John MT, Drangsholt MT, Mancl LA. Relationship between overbite/overjet and clicking or crepitus of the temporomandibular joint. J Orofac Pain 2005; 19:218-25. [PMID: 16106715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIMS Since occlusal variables such as overbite and overjet have been thought to be associated with temporomandibular disorders (TMD), and joint sounds are some of the most prevalent signs of TMD, the aim of this study was to determine whether overbite and overjet are risk factors for temporomandibular joint (TMJ) sounds. METHODS A population-based cross-sectional study of 3,033 subjects (age range, 10 to 75 years; 53% female) was conducted in Germany. Overbite/overjet, reproducible reciprocal clicking (RRC) during open-close jaw movements that did not occur in the protrusive jaw position, and joint crepitus were assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS When age and gender were controlled for, high or low values of overbite and overjet were not associated with a greater risk of RRC and crepitus as compared to a reference category of a normal overbite and overjet of 2 to 3 mm (multiple logistic regression; odds ratios 0.7 to 1.3; P > .05 for all). CONCLUSION This study showed that higher or lower overbite or overjet jaw relationships, even extreme values, are not risk factors for TMJ sounds as assessed by clinical examination.
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Affiliation(s)
- Christian Hirsch
- Department of Preventive Dentistry and Pediatric Dentistry, School of Dentistry, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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LeResche L, Sherman JJ, Huggins K, Saunders K, Mancl LA, Lentz G, Dworkin SF. Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study. J Orofac Pain 2005; 19:193-201. [PMID: 16106712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIMS To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum. METHODS Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum. RESULTS At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain. CONCLUSION Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.
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Affiliation(s)
- Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370, USA.
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Sherman JJ, LeResche L, Mancl LA, Huggins K, Sage JC, Dworkin SF. Cyclic effects on experimental pain response in women with temporomandibular disorders. J Orofac Pain 2005; 19:133-43. [PMID: 15895836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIMS Since cyclic effects on experimental pain response in women with temporomandibular disorders (TMD) have not been adequately studied, the aim of this study was to assess variations in experimental pain response at 4 phases of the menstrual cycle. METHODS Eighteen normally cycling women with TMD, 25 women with TMD and taking oral contraceptives (OC), 25 normally cycling pain-free controls, and 26 pain-free controls taking OC underwent 3 experimental pain procedures at 4 phases during each of 3 menstrual cycles. These procedures included algometer palpations at fixed amounts of pressure and pressure pain thresholds at several body sites, and an ischemic arm pain task. Repeated measures analysis of variance was used to compare cycle phase, TMD group, and OC status differences in experimental pain response. RESULTS Significant phase-related differences were seen for palpation intensity measures (P values < .05). Normally cycling women with TMD showed higher palpation pain intensity at menses and midluteal phases, while women with TMD taking OC showed stable palpation pain intensity ratings at menses, ovulatory, and midluteal phases, with increased intensity at the late luteal phase. TMD subjects had greater palpation pain and ischemic pain intensity and lower pressure pain thresholds compared to controls. CONCLUSION Phase-related differences in experimental pain response were not strong and were more often found for experimental stimuli with greater clinical relevance (ie, palpation pain) compared with an ischemic pain task.
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Affiliation(s)
- Jeffrey J Sherman
- Department of Oral Medicine, University of Washington, Seattle, WA 98195-6370, USA.
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Abstract
OBJECTIVE The aim of this report is to examine whether scaling and root planing (SRP) in one area of the mouth may affect periodontal improvement in untreated areas in the same patient, possibly through systemic effects of treatment. MATERIAL AND METHODS Twenty patients diagnosed with generalized aggressive periodontitis were randomized into treatment (n=11) and no treatment (n=9) groups. Within the treatment group, three quadrants were treated by SRP at week 0, 3, 12, and 24, while a single experimental quadrant remained untreated throughout the study. The outcome for all teeth was assessed using clinical parameters, subtraction radiography, and pathogenic bacteria levels in the subgingival flora over the 24-week study period. RESULTS Compared with sites in no treatment patients, the treated sites in the treated patients showed a 1 mm decrease in probing depth (PD) (p<0.01) and a 0.5 mm increase in bone height (p<0.01) by 24 weeks. In untreated sites within treated subjects, however, PDs tended to improve (p=0.09) but at a reduced rate compared with treated sites. The levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythensis (Bacteroides forsythus) remained unchanged in untreated sites while levels of Prevetolla intermedia and Treponema denticola tended to decrease as compared with controls but did not reach significance. CONCLUSIONS This study indicates that untreated sites in treated periodontitis patients show a trend towards clinical improvement and exhibit reductions in some but not all periodontopathic bacterial species tested.
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