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France K, Urquhart O, Ko E, Gomez J, Ryan M, Hernandez M, Gabinskiy M, Corby PM, Wolff MS. A Pilot Study Exploring Caregivers' Experiences Related to the Use of a Smart Toothbrush by Children with Autism Spectrum Disorder. Children (Basel) 2024; 11:460. [PMID: 38671677 PMCID: PMC11049656 DOI: 10.3390/children11040460] [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] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Research on caregivers for children with intellectual disabilities, particularly those with autism spectrum disorder (ASD), has highlighted several obstacles to achieving better oral health. These include challenges with tolerating oral care, sensory processing differences, uncooperative behaviors, and communication impairments. There is limited understanding of what caregivers would consider "successful assistance" in improving oral health for these children. OBJECTIVES This pilot study aimed to examine caregivers' and user's experiences with a Kids Smart Electric Toothbrush used by children with ASD. METHODS It involved open-ended interviews and questionnaires with caregivers prior to utilization of the toothbrush and after 4 weeks of product use by the child. RESULTS Seventeen children with ASD, aged 5-12, participated. A total of 58.8% of caregivers said their child brushed more often, and all reported brushing at least twice a day by week 4. Caregivers reported that children became more independent while brushing their teeth and achieved better quality brushing. Caregivers' frustration with the brushing process, satisfaction with the device, and need to assist the child with brushing were improved. Caregivers did encounter some technical difficulties with the app. CONCLUSION This study will assist in exploring "smart" toothbrush technologies for oral hygiene in children with ASD.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
| | - Olivia Urquhart
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Eugene Ko
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Juliana Gomez
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Maria Ryan
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Matilde Hernandez
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Marta Gabinskiy
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Patricia M. Corby
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mark S. Wolff
- Center Care for Persons with Disabilities, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Alshahrani AM, Lim CH, Wolff MS, Janal MN, Zhang Y. Current speed sintering and high-speed sintering protocols compromise the translucency but not strength of yttria-stabilized zirconia. Dent Mater 2024; 40:664-673. [PMID: 38378371 PMCID: PMC11015968 DOI: 10.1016/j.dental.2024.02.012] [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: 09/07/2023] [Revised: 01/05/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To investigate the impacts of speed and high-speed sintering on the densification, microstructure, phase composition, translucency, and flexural strength of yttria-stabilized zirconia (YSZ). METHODS A total of 162 disc-shaped specimens (n = 18) were cold-isostatically pressed from 3YSZ (Zpex), 4YSZ (Zpex 4), and 5YSZ (Zpex Smile) powders (Tosoh Corporation) and sintered according to the following protocols: conventional (control, ∼12 h), speed (∼28 min for 3YSZ; ∼60 min for 4YSZ and 5YSZ), and high-speed (∼18 min) sintering. Dimensions of zirconia specimens after sintering and polishing (1-μm diamond grit finish) were Ø13.75 × 1 mm. Density, microstructure, phase content, translucency parameter, and biaxial flexural strength were evaluated using Archimedes', SEM, XRD, spectrophotometric, and piston-on-3-ball methods, respectively. Data were analyzed with either one-way ANOVA and Tukey's test or Kruskal-Wallis with Dunn's test (α = 0.05). RESULTS For all YSZ compositions, conventional sintering yielded the highest density followed by speed then high-speed sintering. All sintering protocols resulted in similar strength values; however, speed and high-speed sintering protocols afforded significantly lower translucency relative to conventional sintering. XRD analysis revealed similar spectra for YSZs sintered by various protocols. The speed sintered specimens had the smallest grain size whereas the high-speed sintered 5YSZ possessed the largest grain size among all groups. SEM examination of all YSZ compositions revealed that the average pore size was an order of magnitude smaller than the average grain size. SIGNIFICANCE Speed and high-speed sintering of YSZs yield similar strength but diminished density and translucency relative to their conventionally sintered counterparts.
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Affiliation(s)
- Abdulaziz M Alshahrani
- Laboratories for Microstructure Physics & Mechanics of Materials, Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - Chek Hai Lim
- Laboratories for Microstructure Physics & Mechanics of Materials, Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mark S Wolff
- Morton Amsterdam Dean, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Malvin N Janal
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY 10010, USA
| | - Yu Zhang
- Laboratories for Microstructure Physics & Mechanics of Materials, Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Heyman RE, Daly KA, Slep AMS, Wolff MS. Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study. J Public Health Dent 2024; 84:36-42. [PMID: 38114444 DOI: 10.1111/jphd.12598] [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: 03/02/2023] [Revised: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.
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Affiliation(s)
- Richard E Heyman
- Family Translational Research Group, New York University College of Dentistry, New York, New York, USA
| | - Kelly A Daly
- Family Translational Research Group, New York University College of Dentistry, New York, New York, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University College of Dentistry, New York, New York, USA
| | - Mark S Wolff
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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Daly KA, Heyman RE, Shuster M, Smith Slep AM, Wolff MS. Exploring dental students' attitudes toward patient-centered management of dental fear. J Dent Educ 2024; 88:42-50. [PMID: 37920097 PMCID: PMC10842468 DOI: 10.1002/jdd.13400] [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: 01/11/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE/OBJECTIVES A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. METHODS In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. RESULTS Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. CONCLUSION(S) Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.
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Affiliation(s)
- Kelly A Daly
- Center for Oral Health Policy and Management, New York University College of Dentistry, New York, New York, USA
| | - Richard E Heyman
- Center for Oral Health Policy and Management, New York University College of Dentistry, New York, New York, USA
| | - Michelle Shuster
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Amy M Smith Slep
- Center for Oral Health Policy and Management, New York University College of Dentistry, New York, New York, USA
| | - Mark S Wolff
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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5
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Petimar J, Gibson LA, Wolff MS, Mitra N, Corby P, Hettinger G, Gregory EF, Edmondson E, Block JP, Roberto CA. Changes in Dental Outcomes After Implementation of the Philadelphia Beverage Tax. Am J Prev Med 2023; 65:221-229. [PMID: 36863896 PMCID: PMC10363192 DOI: 10.1016/j.amepre.2023.02.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Beverage taxes are associated with declines in sugar-sweetened beverage sales and consumption, but few studies have evaluated the associations of these taxes with health outcomes. This study analyzed changes in dental decay after the implementation of the Philadelphia sweetened beverage tax. METHODS Electronic dental record data were obtained on 83,260 patients living in Philadelphia and control areas from 2014 to 2019. Difference-in-differences analyses compared the number of new Decayed, Missing, and Filled Teeth with that of new Decayed, Missing, and Filled Surfaces before (January 2014-December 2016) and after (January 2019-December 2019) tax implementation in Philadelphia and control patients. Analyses were conducted in older children/adults (aged ≥15 years) and younger children (aged <15 years). Subgroup analyses stratified by Medicaid status. Analyses were conducted in 2022. RESULTS The number of new Decayed, Missing, and Filled Teeth did not change after tax implementation in Philadelphia in panel analyses of older children/adults (difference-in-differences= -0.02, 95% CI= -0.08, 0.03) or younger children (difference-in-differences=0.07, 95% CI= -0.08, 0.23). There were similarly no post-tax changes in the number of new Decayed, Missing, and Filled Surfaces. However, in cross-sectional samples of patients on Medicaid, the number of new Decayed, Missing, and Filled Teeth was lower after tax implementation in older children/adults (difference-in-differences= -0.18, 95% CI= -0.34, -0.03; -22% decline) and younger children (difference-in-differences= -0.22, 95% CI= -0.46, 0.01; -30% decline), with similar results for number of new Decayed, Missing, and Filled Surfaces. CONCLUSIONS The Philadelphia beverage tax was not associated with reduced tooth decay in the general population, but it was associated with reduced tooth decay in adults and children on Medicaid, suggesting potential health benefits for low-income populations.
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Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark S Wolff
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patricia Corby
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary Hettinger
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily F Gregory
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emma Edmondson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Guan H, Nuth M, Weiss SR, Fausto A, Liu Y, Koo H, Wolff MS, Ricciardi RP. HOCl Rapidly Kills Corona, Flu, and Herpes to Prevent Aerosol Spread. J Dent Res 2023:220345231169434. [PMID: 37246843 PMCID: PMC10227542 DOI: 10.1177/00220345231169434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The COVID-19 pandemic has escalated the risk of SARS-CoV-2 transmission in the dental practice, especially as droplet-aerosol particles are generated by high-speed instruments. This has heightened awareness of other orally transmitted viruses, including influenza and herpes simplex virus 1 (HSV1), which are capable of threatening life and impairing health. While current disinfection procedures commonly use surface wipe-downs to reduce viral transmission, they are not fully effective. Consequently, this provides the opportunity for a spectrum of emitted viruses to reside airborne for hours and upon surfaces for days. The objective of this study was to develop an experimental platform to identify a safe and effective virucide with the ability to rapidly destroy oral viruses transported within droplets and aerosols. Our test method employed mixing viruses and virucides in a fine-mist bottle atomizer to mimic the generation of oral droplet-aerosols. The results revealed that human betacoronavirus OC43 (related to SARS-CoV-2), human influenza virus (H1N1), and HSV1 from atomizer-produced droplet-aerosols were each fully destroyed by only 100 ppm of hypochlorous acid (HOCl) within 30 s, which was the shortest time point of exposure to the virucide. Importantly, 100 ppm HOCl introduced into the oral cavity is known to be safe for humans. In conclusion, this frontline approach establishes the potential of using 100 ppm HOCl in waterlines to continuously irrigate the oral cavity during dental procedures to expeditiously destroy harmful viruses transmitted within aerosols and droplets to protect practitioners, staff, and other patients.
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Affiliation(s)
- H Guan
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Nuth
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S R Weiss
- Department of Microbiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A Fausto
- Department of Microbiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Liu
- Department of Orthodontics, Divisions of Pediatric Dentistry and Community Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - H Koo
- Department of Orthodontics, Divisions of Pediatric Dentistry and Community Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M S Wolff
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R P Ricciardi
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Daniell H, Nair SK, Guan H, Guo Y, Kulchar RJ, Torres MD, Shahed-Al-Mahmud M, Wakade G, Liu YM, Marques A, Graham-Wooten J, Zhou W, Wang P, Molugu SK, de Araujo WR, de la Fuente-Nunez C, Ma C, Short WR, Tebas P, Margulies KB, Bushman FD, Mante FK, Ricciardi R, Collman RG, Wolff MS. Debulking different Corona (SARS-COV-2 delta, omicron, OC43) and influenza (H1N1, H3N2) virus strains by plant viral trap proteins in chewing gums to decrease infection and transmission. Biomaterials 2022; 288:121671. [PMID: 35953331 PMCID: PMC9290430 DOI: 10.1016/j.biomaterials.2022.121671] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/13/2022]
Abstract
Because oral transmission of SARS-CoV-2 is 3–5 orders of magnitude higher than nasal transmission, we investigated debulking of oral viruses using viral trap proteins (CTB-ACE2, FRIL) expressed in plant cells, delivered through the chewing gum. In omicron nasopharyngeal (NP) samples, the microbubble count (based on N-antigen) was significantly reduced by 20 μg of FRIL (p < 0.0001) and 0.925 μg of CTB-ACE2 (p = 0.0001). Among 20 delta or omicron NP samples, 17 had virus load reduced below the detection level of spike protein in the RAPID assay, after incubation with the CTB-ACE2 gum powder. A dose-dependent 50% plaque reduction with 50–100 ng FRIL or 600–800 μg FRIL gum against Influenza strains H1N1, H3N2, and Coronavirus HCoV-OC43 was observed with both purified FRIL, lablab bean powder or gum. In electron micrographs, large/densely packed clumps of overlapping influenza particles and FRIL protein were observed. Chewing simulator studies revealed that CTB-ACE2 release was time/dose-dependent and release was linear up to 20 min chewing. Phase I/II placebo-controlled, double-blinded clinical trial (IND 154897) is in progress to evaluate viral load in saliva before or after chewing CTB-ACE2/placebo gum. Collectively, this study advances the concept of chewing gum to deliver proteins to debulk oral viruses and decrease infection/transmission.
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Berenblum JR, Schlesinger KT, Aigbokhan IO, Wolff MS, Gluch JI. Penntorship: The value of mentoring during a pandemic. J Dent Educ 2022; 86:1326-1331. [PMID: 35419834 DOI: 10.1002/jdd.12930] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/11/2022]
Abstract
COVID-19 presented learning and social challenges for dental and high-school students alike due to isolating environments with fewer interpersonal interactions. After recognizing these challenges, two pre-doctoral dental students developed Penntorship, a program at University of Pennsylvania, School of Dental Medicine, where dental students' mentor students at West Philadelphia High School (WPHS) utilizing online technology. PURPOSE This survey study explored the benefits of a newly developed mentoring program, Penntorship, for mentors and mentees. METHODS Seventy dental students volunteered to mentor WPHS students throughout the 2020-2021 school year. After receiving training by Mentor Independence Region, mentors coordinated weekly meetings with mentees on Zoom to assist with homework assignments, discuss interests, and assess mentee's career goals. Over six months, 185 mentor meetings were held by 56 dental students with 28 different high-school students participating in the program. Surveys were distributed and analyzed to determine outcomes of the program. RESULTS Survey results revealed that both dental students and high-school students gained new friendships, improved communication skills, and developed a positive perspective during the pandemic. CONCLUSION With online learning formats and social distancing during the pandemic, dental students expressed a need for more social interaction. Penntorship served to support dental students during this challenging year and filled a social need for young individuals in the community. Both mentors and mentees benefited from the program and will continue to work together in the coming academic year. *IRB approval obtained 8/30/2021.
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Affiliation(s)
- Julie R Berenblum
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kylie T Schlesinger
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Iyayi O Aigbokhan
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark S Wolff
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joan I Gluch
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wolff MS, Glick M. COVID-19 Vaccination: To Lead by Example or an Opportunity Lost. J Dent Res 2021; 100:1421-1422. [PMID: 34617480 DOI: 10.1177/00220345211049192] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has created a global health emergency. Vaccine hesitancy and tremendous misinformation about the actual science are leaving the public with significant confusion. However, sound epidemiologic science is guiding us to a clear path toward mitigating this modern-day scourge. It is remarkable how putting an end to current COVID-19 outbreaks has such a simple solution-convincing the public to accept getting vaccinated. The dental research, dental education, and dental practice communities have a unique opportunity to act as trusted public exemplars as well as trusted interpreters of the science for the public.
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Affiliation(s)
- M S Wolff
- University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - M Glick
- Center for Integrative Global Oral Health, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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10
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Rodrigues CS, Dhital S, Kim J, May LG, Wolff MS, Zhang Y. Residual stresses explaining clinical fractures of bilayer zirconia and lithium disilicate crowns: A VFEM study. Dent Mater 2021; 37:1655-1666. [PMID: 34481666 DOI: 10.1016/j.dental.2021.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/17/2020] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the stress development in porcelain-veneered zirconia (PVZ) and porcelain-veneered lithium disilicate (PVLD) crowns with different veneer/core thickness ratios and cooling rates. To provide design guidelines for better performing bilayer restorations with the aid of Viscoelastic Finite Element Method (VFEM). METHODS The VFEM was validated by comparing the predicted residual stresses with experimental measurements. Then, the model was used to predict transient and residual stresses in the two bilayer systems. Models with two different veneer/core thickness ratios were prepared (2:1 and 1:1) and two cooling protocols were simulated (Fast: ∼300 °C/min, Slow: ∼30 °C/min) using the heat transfer module, followed by stress analysis in ABAQUS. The physical properties of zirconia, lithium disilicate, and the porcelains used for the simulations were determined as a function of temperature. RESULTS PVLD showed lower residual stresses than PVZ. The maximum tensile stresses in PVZ were observed in the cusp area, whereas those in PVLD were located in the central fossa. The 1:1 thickness ratio decreased stresses in both layers of PVZ. Slow cooling slightly decreased residual stresses in both systems. However, the cooling rate effect was more evident in transient stresses. SIGNIFICANCE Slow cooling is preferable for both systems. A thinner porcelain layer over zirconia lowers stresses throughout the restoration. The different stress distributions between PVZ and PVLD may affect their failure modes. Smaller mismatches in modulus, CTE, and specific heat between the constituents, and the use of low Tg porcelains can effectively reduce the deleterious transient and residual tensile stresses in bilayer restorations.
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Affiliation(s)
- Camila S Rodrigues
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, 777 Eng. Francisco José Longo Av, 12245-000, São José dos Campos, SP, Brazil
| | - Sukirti Dhital
- Department of Civil and Environmental Engineering, University of Connecticut, 261 Glenbrook Rd., U-3037, Storrs, CT 06269, USA
| | - Jeongho Kim
- Department of Civil and Environmental Engineering, University of Connecticut, 261 Glenbrook Rd., U-3037, Storrs, CT 06269, USA
| | - Liliana Gressler May
- Department of Restorative Dentistry, School of Dentistry, Federal University of Santa Maria, 1000 Roraima Av., T Street, Building 26F, 97105-900, Santa Maria, RS, Brazil
| | - Mark S Wolff
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, 240 S. 40th Street, Philadelphia, PA 19104, USA
| | - Yu Zhang
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, 240 S. 40th Street, Philadelphia, PA 19104, USA.
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Hwang G, Blatz MB, Wolff MS, Steier L. Diagnosis of Biofilm-Associated Peri-Implant Disease Using a Fluorescence-Based Approach. Dent J (Basel) 2021; 9:dj9030024. [PMID: 33673438 PMCID: PMC7996852 DOI: 10.3390/dj9030024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
Dental implants have become a routine component of daily dental practice and the demand for dental implants is expected to increase significantly in the future. Despite the high success rates of dental implants, failures do occur, resulting in discomfort, rampant destruction of the oral health, or painful and costly surgical replacement of a failed implant. Peri-implant diseases are inflammatory conditions affecting the soft/hard tissues surrounding a functional dental implant. Plenty of experimental evidence indicates that the accumulation of dental plaque at the soft tissue-implant interface and the subsequent local inflammatory response seems to be key in the pathogenesis of the peri-implant mucositis. Such peri-implant-soft tissue interface is less effective than natural teeth in resisting bacterial invasion, enhancing vulnerability to subsequent peri-implant disease. Furthermore, in certain individuals, it will progress to peri-implantitis, resulting in alveolar bone loss and implant failure. Although early diagnosis and accurate identification of risk factors are extremely important to effectively prevent peri-implant diseases, current systematic reviews revealed that a uniform classification and diagnostic methodology for peri-implantitis are lacking. Recent progress on fluorescence-based technology enabled rapid diagnosis of the disease and effective removal of plaques. Here, we briefly review biofilm-associated peri-implant diseases and propose a fluorescence-based approach for more accurate and objective diagnoses. A fluorescence-based diagnosis tool through headlights combined with special-filtered dental loupes may serve as a hands-free solution for both precise diagnosis and effective removal of plaque-biofilms.
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Affiliation(s)
- Geelsu Hwang
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.H.); (M.B.B.); (M.S.W.)
- Center for Innovation and Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Markus B. Blatz
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.H.); (M.B.B.); (M.S.W.)
| | - Mark S. Wolff
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.H.); (M.B.B.); (M.S.W.)
| | - Liviu Steier
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (G.H.); (M.B.B.); (M.S.W.)
- Correspondence:
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Rhoades KA, Heyman RE, Eddy JM, Haydt NC, Glazman JE, Dispirito ZF, Fat SJ, Guerrera CM, Rascon AN, Wolff MS. Patient aggression toward dentists. J Am Dent Assoc 2020; 151:764-769. [PMID: 32979955 DOI: 10.1016/j.adaj.2020.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Workplace violence toward health care professionals is both widespread and widely overlooked. Only 4 studies of aggression toward dentists have been published-none in the United States-with the prevalence of aggression ranging from 29% through 80%. The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States. METHODS The authors surveyed 98 dentists recruited from the faculty and alumni network of a college of dentistry. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients. RESULTS Past-year aggression prevalence was 22.2%, 55.0%, and 44.4% for physical, verbal, and reputational aggression, respectively. Career prevalence was 45.5%, 74.0%, and 68.7% for physical, verbal, and reputational aggression, respectively. Rates did not differ by sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day. CONCLUSIONS Participants reported levels of physical, verbal, and reputational aggression at rates comparable with those of other health care professionals in the United States and abroad. Additional research with larger representative samples of dentists in the United States is necessary to confirm these prevalence estimates. Future research should also investigate predictors and outcomes of patient aggression and prevention and intervention strategies. PRACTICAL IMPLICATIONS Substantial rates of patient aggression highlight the need to address this problem in dental practices. The authors discuss implications for the dental profession, including proactive steps that could be taken to reduce patient aggression in dental offices.
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Rhoades KA, Heyman RE, Eddy JM, Fat SJ, Haydt NC, Glazman JE, Dispirito ZF, Rascon AN, Guerrera CM, Wolff MS. Patient aggression toward dental students. J Dent Educ 2020; 84:586-592. [DOI: 10.1002/jdd.12044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly A. Rhoades
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Richard E. Heyman
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - J. Mark Eddy
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Sammie Jo Fat
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Nicole C. Haydt
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Jacqueline E. Glazman
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Zachary F. Dispirito
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Allison N. Rascon
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Charlotte M. Guerrera
- Family Translational Research Group; Department of Cariology and Comprehensive Care; New York University College of Dentistry; New York New York USA
| | - Mark S. Wolff
- University of Pennsylvania School of Dental Medicine; Philadelphia Pennsylvania USA
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Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc 2019; 149:837-849.e19. [PMID: 30261951 DOI: 10.1016/j.adaj.2018.07.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
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Glotzer DL, Perelman SC, Wolff MS. Dentists: Critical aspects of their own and their community's disaster preparedness plan. Am J Disaster Med 2019; 13:289-296. [PMID: 30821342 DOI: 10.5055/ajdm.2018.0308] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The weather-related disasters in 2017 in Texas, Florida, Puerto Rico, the 2017-2018 wildfire seasons in California and Hurricanes Florence and Michael in 2018 have challenged all healthcare professionals, to have plans in place to protect their facility, patients, and staff from all possible hazards. These were "slowly developing" events, with enormous media coverage, and yet the results were still horrific. The need to have both a good evacuation plan and a good shelter-in-place plan has previously been dramatically demonstrated. When planning for disasters, it is critical for healthcare providers to understand the nature of a particular event and its possible consequences. When the concern arises about either an individual medical facility, or a whole community's well-being, a proper response requires significant levels of preparedness, education, and training. Comprehension of the threat and an understanding of the resources available to combat an event can significantly mitigate the possible damage. This article reviews a dental school curriculum to prepare students to respond to such contingencies while describing the goals, and sources for a disaster preparedness syllabus.
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Affiliation(s)
- David L Glotzer
- Clinical Professor, Department of Cariology and Comprehensive Care, NYU College of Dentistry, New York, New York
| | - Sharon C Perelman
- Assistant Professor, Chief Medical Informatics Officer, Division of Operative Dentistry, Columbia University College of Dental Medicine, New York, New York
| | - Mark S Wolff
- Morton Amsterdam Dean, Department of Preventative and Restorative Services, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Wang TT, Wolff MS, Panchal N. The Graying of America: Considerations and Training Needs for Geriatric Patient Care. J Oral Maxillofac Surg 2019; 77:1741-1742. [PMID: 31002788 DOI: 10.1016/j.joms.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tim T Wang
- DMD Candidate, School of Dental Medicine; MPH Candidate, Perelman School of Medicine; and Associate Fellow, Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Mark S Wolff
- Morton Amsterdam Dean and Professor, Division of Preventative and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neeraj Panchal
- Assistant Professor of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA; Section Chief of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; and Section Chief of Oral and Maxillofacial Surgery, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA.
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Abstract
Dental caries remains a world-wide disease despite the global distribution of fluoride. It has become apparent that the introduction of significant levels of sugar (fermentable carbohydrate) into the diet has resulted in a change in the biofilm, encouraging acid formation. Further, there has been a shift in the microbiota in the biofilm to a flora that produces acid, and thrives and reproduces in an acidic environment. The management of caries activity under these conditions has focused on brushing to remove the biofilm with fluoride pastes, and high-dose fluoride treatments. Kleinberg, in the 1970s, identified an arginine-containing compound in saliva that several oral biofilm bacterial species metabolize to produce base. Multiple in situ and in vivo studies have been conducted, and have discussed the ability of multiple bacteria to increase the resting pH of the biofilm and even reduce the decrease in pH when the biofilm is challenged with glucose. This shift in resting pH can shift the level of caries formation by the biofilm. Here, we present 8 clinical studies, with different clinical designs, measuring different clinical outcomes, for a diverse, world-wide population. Each of these studies demonstrates reductions in caries formation beyond that seen with fluoride alone and several demonstrate the reversal of early caries lesions. Significant clinical research has been shown that 1.5% arginine combined with fluoride toothpaste has superior anti-caries efficacy to toothpaste containing fluoride alone.
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Affiliation(s)
- M S Wolff
- 1 Department of Cariology and Comprehensive Care, NYU College of Dentistry, New York, NY, USA
| | - A B Schenkel
- 1 Department of Cariology and Comprehensive Care, NYU College of Dentistry, New York, NY, USA
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18
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Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res 2018; 98:14-26. [PMID: 30290130 PMCID: PMC6304695 DOI: 10.1177/0022034518800014] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride-
and nonfluoride-based interventions) is to manage the caries disease process at
a lesion level and minimize the loss of sound tooth structure. The purpose of
this systematic review and network meta-analysis was to summarize the available
evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal
of noncavitated and cavitated carious lesions on primary and permanent teeth and
2) adverse events. We included parallel and split-mouth randomized controlled
trials where patients were followed for any length of time. Studies were
identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane
Database of Systematic Reviews. Pairs of reviewers independently conducted the
selection of studies, data extraction, risk-of-bias assessments, and assessment
of the certainty in the evidence with the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) approach. Data were synthesized with a
random effects model and a frequentist approach. Forty-four trials (48 reports)
were eligible, which included 7,378 participants and assessed the effect of 22
interventions in arresting or reversing noncavitated or cavitated carious
lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride
(NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF)
toothpaste or gel were the most effective for arresting or reversing
noncavitated occlusal, approximal, and noncavitated and cavitated root carious
lesions on primary and/or permanent teeth, respectively (low- to
moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was
the most effective for arresting or reversing noncavitated facial/lingual
carious lesions (low certainty) and that 38% silver diamine fluoride solution
applied biannually was the most effective for arresting advanced cavitated
carious lesions on any coronal surface (moderate to high certainty). Preventing
the onset of caries is the ultimate goal of a caries management plan. However,
if the disease is present, there is a variety of effective interventions to
treat carious lesions nonrestoratively.
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Affiliation(s)
- O Urquhart
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - M P Tampi
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - L Pilcher
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - R L Slayton
- 2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M W B Araujo
- 3 Science Institute, American Dental Association, Chicago, IL, USA
| | - M Fontana
- 4 Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S Guzmán-Armstrong
- 5 Advance Education Program in Operative Dentistry, University of Iowa, Iowa City, IA, USA
| | - M M Nascimento
- 6 Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - B B Nový
- 7 DentaQuest Institute and DentaQuest Oral Health Center, Westborough, MA, USA
| | - N Tinanoff
- 8 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, College Park, MD, USA
| | - R J Weyant
- 9 Department of Dental Public Health and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Wolff
- 10 University of Pennsylvania, Philadelphia, PA, USA
| | - D A Young
- 11 Department of Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA
| | - D T Zero
- 12 Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - R Brignardello-Petersen
- 13 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- 14 Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - A Parikh
- 15 College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - G Joshi
- 16 GC America, Alsip, IL, USA
| | - A Carrasco-Labra
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.,17 Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
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Northridge ME, Schenkel AB, Birenz S, Estrada I, Metcalf SS, Wolff MS. "You Get Beautiful Teeth Down There": Racial/Ethnic Minority Older Adults' Perspectives on Care at Dental School Clinics. J Dent Educ 2017; 81:1273-1282. [PMID: 29093140 DOI: 10.21815/jde.017.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/12/2017] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
Abstract
To help eliminate reported racial/ethnic and socioeconomic inequities in oral health care, listening to the perspectives of racial/ethnic minority older adults on their experiences with dental school clinics is needed. The aim of this study was to examine the experiences of African American, Puerto Rican, and Dominican older adults who attend senior centers in upper Manhattan, New York City, regarding the care received at dental school clinics. Focus groups were conducted from 2013 to 2015 with 194 racial/ethnic minority men and women aged 50 years and older living in upper Manhattan. All of the 24 focus group sessions were digitally audiorecorded and transcribed for analysis. Groups conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Seven subthemes were manifest in the data related to these adults' positive experiences with dental school clinics: excellent outcomes and dentists, painless and safe treatment, affordable care, honest and reputable, benefits of student training, accepting and helpful, and recommended by family and friends. Negative experiences centered around four subthemes: multiple visits required for treatment, loss of interpersonal communication due to use of technology, inconvenient location, and perceived stigma with Medicaid. This study provided novel evidence of the largely positive experiences with dental schools of racial/ethnic minority senior center attendees. Interventions targeted at the organization and provider level, including organizational motivation, resources, staff attributes, climate, and teamwork plus payment programs and services, insurance and affordability, and provider- and system-level supports, may improve health care processes and patient experiences of care.
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Affiliation(s)
- Mary E Northridge
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry.
| | - Andrew B Schenkel
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry
| | - Shirley Birenz
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry
| | - Ivette Estrada
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry
| | - Sara S Metcalf
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry
| | - Mark S Wolff
- Dr. Northridge is Associate Professor, Department of Epidemiology and Health Promotion, New York University College of Dentistry; Dr. Schenkel is Clinical Associate Professor, Department of Cariology and Comprehensive Care, New York University College of Dentistry; Prof. Birenz is Clinical Assistant Professor, Dental Hygiene Programs, New York University College of Dentistry; Ms. Estrada is Project Coordinator, Section of Population Oral Health, Columbia University College of Dental Medicine; Dr. Metcalf is Associate Professor, Department of Geography, State University of New York at Buffalo; and Dr. Wolff is Associate Dean for Predoctoral Clinical Education, Associate Dean for Development, and Professor and Chair, Department of Cariology and Comprehensive Care, New York University College of Dentistry
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Heyman RE, Slep AMS, White-Ajmani M, Bulling L, Zickgraf HF, Franklin ME, Wolff MS. Dental Fear and Avoidance in Treatment Seekers at a Large, Urban Dental Clinic. Oral Health Prev Dent 2016; 14:315-20. [PMID: 27351733 DOI: 10.3290/j.ohpd.a36468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% moderate or higher fear) and that fear would be associated with avoidance of routine dental care, increased use of urgent dental care and poor oral health. MATERIALS AND METHODS Participants were 1070 consecutive patients at a large, urban dental care center. All patients completed a clinical interview, including demographics, medical history, dental history and presenting concerns, and behavioral health history. Patients were also asked to rate their dental anxiety/fear on a 1 (none) to 10 (high) scale. RESULTS Over 20% of patients reported elevated anxiety/fear, of which 12.30% reported moderate and 8.75% high fear. Severity of dental anxiety/fear was strongly related to the likelihood of avoiding dental services in the past and related to myriad presenting problems. CONCLUSIONS As hypothesized, the prevalence of moderate or higher fear in dental patients was considerable and closely matched that found in general population surveys. Thus, the 'dental home' is an ideal location to treat clinically significant dental anxiety/fear.
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Affiliation(s)
| | | | | | | | - I J Selikoff
- Environmental Sciences Laboratory, Mount Sinai School of Medicine of the City University of New York, New York, NY 10029
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22
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Tanaka CB, Harisha H, Baldassarri M, Wolff MS, Tong H, Meira JB, Zhang Y. Experimental and finite element study of residual thermal stresses in veneered Y-TZP structures. Ceram Int 2016; 42:9214-9221. [PMID: 27087734 PMCID: PMC4831075 DOI: 10.1016/j.ceramint.2016.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The main complications of zirconia-based laminated systems are chipping and delamination of veneering porcelain, which has been found to be directly associated with the development of residual thermal stresses in the porcelain layer. This study investigates the effects of cooling rate and specimen geometry on the residual stress states in porcelain-veneered zirconia structures. Bilayers of three different shapes (bars, semi-cylindrical shells, and arch-cubic structures) with 1.5 mm and 0.7 mm thickness of dentin porcelain and zirconia framework, respectively, were subjected to two cooling protocols: slow cooling (SC) at 32 °C/min and extremely-slow cooling (XSC) at 2 °C/min. The residual thermal stresses were determined using the Vickers indentation method and validated by finite element analysis. The residual stress profiles were similar among geometries in the same cooling protocol. XSC groups presented significantly higher tensile stresses (p = 0.000), especially for curved interfaces. XSC is a time-consuming process that showed no beneficial effect regarding residual stresses compared to the manufacturer recommended slow cooling rate.
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Affiliation(s)
- Carina B. Tanaka
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 First Avenue, New York, NY 10010, USA
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Hossam Harisha
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 First Avenue, New York, NY 10010, USA
| | - Marta Baldassarri
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 First Avenue, New York, NY 10010, USA
| | - Mark S. Wolff
- Department of Cariology and Comprehensive Care, Associate Dean for Pre-doctoral Clinical Education, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
| | - Hui Tong
- School of Metallurgy and Environment, Central South University, Changsha, Hunan 410083, PR China
| | - Josete B.C. Meira
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Yu Zhang
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 433 First Avenue, New York, NY 10010, USA
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Thompson VP, Schenkel AB, Penugonda B, Wolff MS, Zeller GG, Wu H, Vena D, Grill AC, Curro FA. A pilot study of dentists' assessment of caries detection and staging systems applied to early caries: PEARL Network findings. Gen Dent 2016; 64:20-27. [PMID: 27148652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The International Caries Detection and Assessment System (ICDAS II) and the Caries Classification System (CCS) are caries stage description systems proposed for adoption into clinical practice. This pilot study investigated clinicians' training in and use of these systems for detection of early caries and recommendations for individual tooth treatment. Patient participants (N = 8) with a range of noncavitated lesions (CCS ranks 2 and 4 and ICDAS II ranks 2-4) identified by a team of calibrated examiners were recruited from the New York University College of Dentistry clinic. Eighteen dentists-8 from the Practitioners Engaged in Applied Research and Learning (PEARL) Network and 10 recruited from the Academy of General Dentistry-were randomly assigned to 1 of 3 groups: 5 dentists used only visual-tactile (VT) examination, 7 were trained in the ICDAS II, and 6 were trained in the CCS. Lesion stage for each tooth was determined by the ICDAS II and CCS groups, and recommended treatment was decided by all groups. Teeth were assessed both with and without radiographs. Caries was detected in 92.7% (95% CI, 88%-96%) of the teeth by dentists with CCS training, 88.8% (95% CI, 84%-92%) of the teeth by those with ICDAS II training, and 62.3% (95% CI, 55%-69%) of teeth by the VT group. Web-based training was acceptable to all dentists in the CCS group (6 of 6) but fewer of the dentists in the ICDAS II group (5 of 7). The modified CCS translated clinically to more accurate caries detection, particularly compared to detection by untrained dentists (VT group). Moreover, the CCS was more accepted than was the ICDAS II, but dentists in both groups were open to the application of these systems. Agreement on caries staging requires additional training prior to a larger validation study.
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Wolff MS, Hill R, Wilson-Genderson M, Hirsch S, Dasanayake AP. Nationwide 2.5-Year School-Based Public Health Intervention Program Designed to Reduce the Incidence of Caries in Children of Grenada. Caries Res 2016; 50 Suppl 1:68-77. [PMID: 27100682 DOI: 10.1159/000439058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED This paper describes an innovative public health intervention, called 'Smile Grenada', targeting the oral health of children in Grenada utilizing the resources of a US dental school, several oral health care companies, local governmental and public health authorities, and Grenadian school personnel. METHODS Preintervention visual/tactile caries examinations were collected from 1,092 schoolchildren (mean age 9.9 years, standard deviation, SD = 3.7) in 2010. The intervention included: (1) classroom-based toothbrushing with fluoridated toothpaste, (2) fluoride varnish applied by trained dental students, teachers and local providers 3 times a year and (3) glass ionomer sealants placed on first permanent molars in children aged 6-8 years. Postintervention data were collected in May, 2013 (n = 2,301, mean age 9.8 years, SD = 3.7). Decayed and demineralized surfaces were examined for the whole sample and decay/demineralization and sealant retention on 6-year molars were examined separately (ages 6-8 in 2013 cohort). RESULTS The number of decayed/demineralized surfaces declined across all age groups. The average number of decayed surfaces dropped from 9 at baseline to just over 6 (F1, 3,393 = 69.8, p < 0.0001) and the average number of demineralized surfaces dropped from 6 to less than 2 (1.8 surfaces; F1, 3,393 = 819.0, p < 0.0001). For children aged 6-8 years, there were statistically significantly fewer decayed surfaces (t1, 2,086 = 12.40, p < 0.0001; mean baseline 0.93, SD = 1.75; mean follow-up 0.23, SD = 0.83) and demineralized surfaces (t1, 2,086 = 19.7, p < 0.0001; mean baseline 2.11, SD = 2.74; mean follow-up 0.50, SD = 0.97) on 6-year molars. The Smile Grenada program successfully demonstrated a locally sustainable model for improving oral health in children in a developing country.
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Affiliation(s)
- Mark S Wolff
- Department of Cariology, New York University College of Dentistry, New York, N.Y., USA
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Abstract
Fluorides and sealants have been shown to reduce caries in populations, making fluoride interventions a large part of the dental public health effort. Although public health programs have traditionally focused on fluoride vehicles delivering less than 1,000 ppm of fluoride, more recent efforts have shifted toward the use of high fluoride vehicles such as varnishes and prescription toothpastes. In the USA, states are developing innovative strategies to increase access to dental services by using primary care medical providers to deliver early preventive services as part of well-child care visits. Currently, Medicaid programs in 43 states reimburse medical providers for preventive services including varnish application. Still, there is uncertainty about the cost-effectiveness of such interventions. In many resource-strained environments, with shortages of dental health care providers, lack of fluoridated water and lower dental awareness, it is necessary to develop sustainable programs utilizing already established programs, like primary school education, where caries prevention may be set as a priority. Dental caries among the elderly is an ongoing complex problem. The 5,000-ppm F toothpaste may be a reasonable approach for developing public health programs where root caries control is the main concern. Fluoride varnish and high concentration fluoride toothpaste are attractive because they can easily be incorporated into well-child visits and community-based geriatric programs. Additional research on the effectiveness and costs associated with population-based programs of this nature for high risk groups is needed, especially in areas where a community-based fluoride delivery program is not available.
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Abstract
OBJECTIVES To review the current status of dental curricula on elder care, and the current curricula regarding elder care, and it's effect on altering practitioner behaviors while addressing the needs of a growing North American elder population. BACKGROUND An impending crisis is looming over the oral healthcare of our aging population. At the same moment that life expectancy is being extended through increasingly complex healthcare improvements, the numbers of trained dental providers capable and interested in delivering the needed care is failing to grow at an adequate rate. DISCUSSION The skills necessary to manage these increasingly complex patients require an interprofessional approach capable of delivering care to sicker patients, in a variety of living accommodations, while managing a variety of care givers. The dental skills necessary to treat these elderly are modifications of skills students routinely learn in dental school. As a matter of fact, the skills students acquire to treat an adult patient population may be contrary to the basic skills necessary to manage the elderly dependent adult patient. Teaching students the nuance differences needed to properly diagnose and care for this population is a difficult task that must be taught in a contextual environment. CONCLUSION Significant changes in the teaching of dental management of the elderly are critical within much of the education community. Just as teaching students to care for the pediatric population as general dentists, the clinical education must involve a sufficient number of quality experiences to address issues of both competency, that of the graduate to perform care independently, and attitudes, the actually willingness to treat the elderly.
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Affiliation(s)
- Mark S Wolff
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
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Pretty IA, Ellwood RP, Lo ECM, MacEntee MI, Müller F, Rooney E, Murray Thomson W, Van der Putten GJ, Ghezzi EM, Walls A, Wolff MS. The Seattle Care Pathway for securing oral health in older patients. Gerodontology 2015; 31 Suppl 1:77-87. [PMID: 24446984 DOI: 10.1111/ger.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 02/06/2023]
Abstract
There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.
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Affiliation(s)
- Iain A Pretty
- Colgate Dental Health Unit, School of Dentistry, University of Manchester, Manchester, UK
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Abstract
This article updates a simple checklist of foundational knowledge in aesthetic dental concepts that allows clinicians to organize their thoughts, to record the concerns of the patient, and to map out those improvements that must be addressed. This adjunct is called a Smile Evaluation Form. Along with other adjuncts such as radiographs, study casts, and diagnostic wax-ups, the Smile Evaluation Form allows clinicians to form a conceptual visualization of the expected end point. It provides a checklist for discussions with other disciplines in the team, to provide a logical sequence of treatment with a mutually agreed-on end point.
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Affiliation(s)
- John R Calamia
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA; Board of Directors American Academy of Cosmetic Dentistry.
| | - Mark S Wolff
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA
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Calamia JR, Trushkowsky RD, David SB, Wolff MS. Modern Concepts in Aesthetic Dentistry and Multidisciplined Reconstructive Grand Rounds. Dent Clin North Am 2015; 59:xiii-xiv. [PMID: 26140979 DOI: 10.1016/j.cden.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- John R Calamia
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA; American Academy of Cosmetic Dentistry, 402 West Wilson Street, Madison, WI 53703, USA.
| | - Richard D Trushkowsky
- NYU College of Dentistry, Department of Cariology and Comprehensive Care, 345 East 24th Street, New York, NY 10010, USA.
| | - Steven B David
- NYU College of Dentistry, Department of Cariology and Comprehensive Care, 345 East 24th Street, New York, NY 10010, USA.
| | - Mark S Wolff
- NYU College of Dentistry, Department of Cariology and Comprehensive Care, 345 East 24th Street, New York, NY 10010, USA.
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Strauss SM, Rosedale MT, Pesce MA, Rindskopf DM, Kaur N, Juterbock CM, Wolff MS, Malaspina D, Danoff A. The potential for glycemic control monitoring and screening for diabetes at dental visits using oral blood. Am J Public Health 2015; 105:796-801. [PMID: 25713975 DOI: 10.2105/ajph.2014.302357] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. METHODS In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired "gold-standard" HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. RESULTS About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. CONCLUSIONS Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients.
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Affiliation(s)
- Shiela M Strauss
- At the time of this study, Shiela M. Strauss, Mary T. Rosedale, and Navjot Kaur were with the College of Nursing, New York University, New York, NY. Michael A. Pesce was with the Columbia University Medical Center, New York. David M. Rindskopf was with the Graduate School and University Center of the City of New York. Caroline M. Juterbock, Dolores Malaspina, and Ann Danoff were with the NYU Langone Medical Center, New York University. Mark S. Wolff was with the College of Dentistry, New York University
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Wolff MS, Teitelbaum SL, McGovern K, Windham GC, Pinney SM, Galvez M, Calafat AM, Kushi LH, Biro FM. Phthalate exposure and pubertal development in a longitudinal study of US girls. Hum Reprod 2014; 29:1558-66. [PMID: 24781428 DOI: 10.1093/humrep/deu081] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
STUDY QUESTION Does phthalate exposure during early childhood alter the timing of pubertal development in girls? SUMMARY ANSWER Urinary concentrations of high-molecular weight phthalate (high-MWP) metabolites are associated with later pubarche. WHAT IS KNOWN ALREADY Phthalates are anti-androgenic environmental agents known to alter early development, with possible effects on pubertal onset. STUDY DESIGN, SIZE, AND DURATION This multi-ethnic study included 1239 girls from New York City, greater Cincinnati, and the San Francisco Bay Area who were 6-8 years old at enrollment (2004-2007) and who were followed until 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Phthalate metabolites were measured in urine collected at enrollment from 1170 girls; concentrations ranged from <1 to >10,000 µg/l. Breast and pubic hair stages and body size were assessed one to two times annually to determine the age at transition from stage 1 to 2 for breast and pubic hair development. Associations between exposures and pubertal ages were estimated using Cox proportional hazard ratios (HR) with 95% confidence intervals (CI) and survival analyses. Associations were examined with respect to age-specific body mass-index percentile, one of the strongest predictors of pubertal onset. MAIN RESULTS AND THE ROLE OF CHANCE Urinary concentrations of high-MWP including di(2-ethylhexyl) phthalate (ΣDEHP) metabolites were associated with later pubic hair development during 7 years of observation. The relationship was linear and was stronger among normal-weight girls. Among normal-weight girls, age at pubic hair stage 2 (PH2) was 9.5 months older for girls in the fifth compared with the first quintile of urinary ΣDEHP (medians: 510 and 59 µg/g creatinine, respectively; adjusted HR 0.70, CI 0.53-0.93, P-trend 0.005. Age at first breast development was older for fifth quintile of mono-benzyl phthalate versus first (HR 0.83, CI 0.68-1.02; P-trend 0.018). No associations were observed between low-molecular weight phthalate urinary metabolite concentrations and age at pubertal transition in adjusted analyses. LIMITATIONS, REASONS FOR CAUTION While there is evidence that phthalate exposures are fairly consistent over time, the exposure measure in this study may not reflect an earlier, more susceptible window of exposure. We investigated alternative explanations that might arise from exposure misclassification or confounding. WIDER IMPLICATIONS OF THE FINDINGS Phthalates are widespread, hormonally active pollutants that may alter pubertal timing. Whether exposures delay or accelerate pubertal development may depend on age at exposure as well as other factors such as obesity and exposures earlier in life. Whether exposures act independently or as part of real life mixtures may also change their effects on maturation from birth through childhood. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by the US National Institutes of Health, Environmental Protection Agency, New York State Empire Clinical Research Investigator Program and the Avon Foundation. L.H.K. is employed by Kaiser Permanente. The remaining authors declare they have no actual or potential competing financial interests.
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Sherwin GB, Nguyen D, Friedman Y, Wolff MS. The relationship between smoking and periodontal disease. Review of literature and case report. N Y State Dent J 2013; 79:52-57. [PMID: 24600766] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cigarette smoking has been associated with tooth loss from periodontal disease for a long time. Smoking cessation has been shown to reverse these effects. The purpose of this paper is to review the current literature regarding the possible mechanisms for destruction of the periodontium caused by smoking and to present a protocol for the implementation of a smoking cessation program at New York University College of Dentistry.
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Affiliation(s)
- Gene B Sherwin
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA.
| | - Diana Nguyen
- Department of Dental Surgery, Yale-New Haven Hospital, New Haven, CT, USA
| | | | - Mark S Wolff
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
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Vangeepuram N, Mervish N, Galvez MP, Brenner B, Wolff MS. Dietary and physical activity behaviors of New York City children from different ethnic minority subgroups. Acad Pediatr 2012; 12:481-8. [PMID: 22985985 PMCID: PMC3501563 DOI: 10.1016/j.acap.2012.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Received: 03/14/2012] [Revised: 06/22/2012] [Accepted: 06/29/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine racial/ethnic differences in diet and physical activity behaviors in ethnic minority New York City children. METHODS Cross-sectional data from a community-based study of 486 6- to 8-year-old children were used. Race/ethnicity was derived using a caregiver's report of child's race and Hispanic ancestry. Dietary intake was obtained by 24-hour diet recalls using the Nutrition Data System for Research. Physical activity was assessed with pedometers and caregiver interviews. We compared diet and activity measures across racial/ethnic subgroups using chi-square and analysis of variance tests. Multivariate analyses adjusted for age, gender, body mass index, and caregiver education (with breastfeeding history and total energy intake included in diet models). RESULTS Participants (N = 486) were categorized as Mexican (29.4%), Dominican (8.4%), Puerto Rican (20.6%), other/mixed Hispanic (14.0%), or non-Hispanic black (27.6%). Obesity rates were lower in non-Hispanic blacks (18%) than in Hispanics (31%). Mexicans had the lowest obesity rates among Hispanic subgroups (25%), and Dominicans had the highest (39%). There were differences in mean daily servings of food groups, with Mexicans having healthier diets and Puerto Ricans and non-Hispanic Blacks having less healthy diets. Sedentary time was lower in Mexicans than in other groups in adjusted models. Examination of additional models, including home language, did not show significant differences in the estimates. CONCLUSION Diet and activity behaviors varied across racial/ethnic subgroups. Specifically, Mexican children had healthier diets, the least amount of sedentary time, and the lowest rates of obesity among the Hispanic subgroups examined. Targeted interventions in ethnic subgroups may be warranted to address specific behaviors.
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Affiliation(s)
- N Vangeepuram
- Departments of Preventive Medicine and Pediatrics (Division of General Pediatrics), Mount Sinai School of Medicine, New York, New York
| | - N Mervish
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York
| | - MP Galvez
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York
| | - B Brenner
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York
| | - MS Wolff
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York
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Takulla NF, Wolff MS, Schenkel AB. Caries management by risk assessment. N Y State Dent J 2012; 78:41-45. [PMID: 23488324] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
New York University College of Dentistry utilizes a protocol for caries management by risk assessment. It includes guidelines for determining several indicators and factors that are used to identify whether a patient is at high, moderate or low risk for dental caries. This case report presents an assessment of a patient with high caries risk and the system used to treat the disease process and lower the patient's risk for future lesions.
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Vangeepuram N, Galvez MP, Teitelbaum SL, Brenner B, Wolff MS. The association between parental perception of neighborhood safety and asthma diagnosis in ethnic minority urban children. J Urban Health 2012; 89:758-68. [PMID: 22669642 PMCID: PMC3462829 DOI: 10.1007/s11524-012-9679-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Low-income populations, minorities, and children living in inner cities have high rates of asthma. Recent studies have emphasized the role of psychosocial stress in development of asthma. Residence in unsafe neighborhoods is one potential source of increased stress. The study objective was to examine the association between parental perception of neighborhood safety and asthma diagnosis among inner city, minority children. Cross-sectional data from a community-based study of 6-8-year-old New York City children were used. Asthma was defined as parental report of physician-diagnosed asthma and at least one asthma-related symptom. Parental perceptions of neighborhood safety were assessed with a questionnaire. Associations between perceived neighborhood safety and asthma were examined using chi-squared tests. Multivariate logistic regression analyses were then performed. Five hundred four children were included with 79% female, 26.5% non-Hispanic Black, and 73.5% Hispanic. Asthma was present in 23.8% of children. There was an inverse association between feeling safe walking in the neighborhood and asthma with 45.7% of parents of asthmatic children reporting they felt safe compared to 60.9% of parents of non-asthmatic children (p = 0.006). Fewer parents of asthmatic children than of non-asthmatic children reported that their neighborhood was safe from crime (21.7% versus 33.9%, p = 0.018). In multivariate analyses adjusting for race/ethnicity, age, gender, socioeconomic status, number of smokers in the home and breastfeeding history, parents reporting feeling unsafe walking in the neighborhood were more likely to have a child diagnosed with asthma (OR = 1.89, 95%CI 1.13-3.14). Psychosocial stressors such as living in unsafe neighborhoods may be associated with asthma diagnosis in urban ethnic minority children. Addressing the increased asthma burden in certain communities may require interventions to decrease urban stressors.
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Affiliation(s)
- N Vangeepuram
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Baldassarri M, Stappert CFJ, Wolff MS, Thompson VP, Zhang Y. Residual stresses in porcelain-veneered zirconia prostheses. Dent Mater 2012; 28:873-9. [PMID: 22578663 DOI: 10.1016/j.dental.2012.04.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Compressive stress has been intentionally introduced into the overlay porcelain of zirconia-ceramic prostheses to prevent veneer fracture. However, recent theoretical analysis has predicted that the residual stresses in the porcelain may be also tensile in nature. This study aims to determine the type and magnitude of the residual stresses in the porcelain veneers of full-contour fixed-dental prostheses (FDPs) with an anatomic zirconia coping design and in control porcelain with the zirconia removed using a well-established Vickers indentation method. METHODS Six 3-unit zirconia FDPs were manufactured (NobelBiocare, Gothenburg, Sweden). Porcelain was hand-veneered using a slow cooling rate. Each FDP was sectioned parallel to the occlusal plane for Vickers indentations (n = 143; load = 9.8 N; dwell time = 5s). Tests were performed in the veneer of porcelain-zirconia specimens (bilayers, n=4) and porcelain specimens without zirconia cores (monolayers, n = 2). RESULTS The average crack lengths and standard deviation, in the transverse and radial directions (i.e. parallel and perpendicular to the veneer/core interface, respectively), were 67 ± 12 μm and 52 ± 8 μm for the bilayers and 64 ± 8 μm and 64 ± 7 μm for the monolayers. These results indicated a major hoop compressive stress (~40-50 MPa) and a moderate radial tensile stress (~10 MPa) in the bulk of the porcelain veneer. SIGNIFICANCE Vickers indentation is a powerful method to determine the residual stresses in veneered zirconia systems. Our findings revealed the presence of a radial tensile stress in the overlay porcelain, which may contribute to the large clinical chip fractures observed in these prostheses.
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Affiliation(s)
- Marta Baldassarri
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, United States
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Canares G, Salgado T, Pines MS, Wolff MS. Effect of an 8.0% arginine and calcium carbonate desensitizing toothpaste on shear dentin bond strength. J Clin Dent 2012; 23:68-70. [PMID: 22779220] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The objective of this study was to determine the effect of an 8.0% arginine and calcium carbonate desensitizing toothpaste (Colgate Sensitive Pro-Relief) on shear bond strength of composites to bovine incisor dentin. METHODS Bovine incisors were sectioned and prepared into 27 dentin specimens. The experimental group had 13 specimens treated for 10 sessions of two-minute brushing with an 8.0% arginine and calcium carbonate desensitizing toothpaste, followed by a 30-second agitated water wash. The control group had 14 specimens treated with flour of pumice only. Each specimen was dried, etched with 35% phosphoric acid for 15 seconds, and washed clean. A bonding agent was applied and polymerized. A 2.38 mm diameter column of Filtek Supreme A2 was bonded to the surface and polymerized as per manufacturer's instructions. Specimens were stored in water for at least 48 hours, subjected to a shear force at a crosshead speed of 0.5 mm/minute on an Instron mechanical testing device, and force at failure was recorded. A one-sided t-test was used to evaluate significant differences among the groups as measured by mean shear strength. RESULTS Mean shear force was 19.6 +/- 9.4 (SD) for the experimental group and 15.4 +/- 6.0 for the control group with p = 0.0291. CONCLUSION No significant differences were found for bond strength to dentin treated with an 8.0% arginine and calcium carbonate desensitizing toothpaste or pumice. Dentists can still achieve optimal dentin bonding results if a patient is using Colgate Sensitive Pro-Relief to manage dentin hypersensitivity.
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Affiliation(s)
- G Canares
- New York University College of Dentistry New York, NY, USA
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Young D, Ricks CS, Featherstone JDB, Fontana M, Fournier SM, Geiermann SP, Hurlbutt M, Kutsch VK, Loftus R, Luther JR, Nový BB, Wolff MS, Wong A. Changing the face and practice of dentistry: a 10-year plan. J Calif Dent Assoc 2011; 39:746-751. [PMID: 22132587] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Jan. 7 through 9, 2011, the California Dental Association Foundation hosted a symposium on caries management by risk assessment in which a diverse range of stakeholders from across the nation gathered to discuss current and future status of CAMBRA. The consensus of the group was to develop a national strategic plan for CAMBRA implementation which will chart the course to improve the standard in caries disease management within the next decade. This paper represents the initial start of this living document.
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Affiliation(s)
- Douglas Young
- Department of Dental Practice, Arthur A. Dugoni School of Dentistry, San Francisco, Calif 94115, USA
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Abstract
Understanding the nature of the caries lesion, disease activity, and the patient's caries risk are all used in determining the nature of dental care to be delivered. An examination should include a health and social history and clinical examination using appropriate technologies. This allows proper assessment and suggests a logical management intervention. Minimally invasive dentistry is a concept based on an assessment of a patient's caries risk and the application of the current therapies to prevent, control, and treat the disease. The history of the dental examination and the variety of current technologies are discussed.
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Affiliation(s)
- Glenn K Rochlen
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010, USA
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Calamia JR, Levine JB, Lipp M, Cisneros G, Wolff MS. Smile design and treatment planning with the help of a comprehensive esthetic evaluation form. Dent Clin North Am 2011; 55:187-vii. [PMID: 21473988 DOI: 10.1016/j.cden.2011.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 05/30/2023]
Abstract
Even if a clinician possesses basic knowledge in esthetic dentistry and clinical skills, many cases presenting in modern dental practices simply cannot be restored to both the clinician's and the patient's expectations without incorporating the perspectives and assistance of several dental disciplines. Besides listening carefully to chief complaints, clinicians must also be able to evaluate the patient's physical, biologic, and esthetic needs. This article demonstrates the use of a smile evaluation form designed at New York University that assists in developing esthetic treatment plans that might incorporate any and all dental specialties in a simple and organized fashion.
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Affiliation(s)
- John R Calamia
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA.
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Shelley D, Anno J, Tseng TY, Calip G, Wedeles J, Lloyd M, Wolff MS. Implementing Tobacco Use Treatment Guidelines in Public Health Dental Clinics in New York City. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.4.tb05076.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Donna Shelley
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
| | | | - Tuo-Yen Tseng
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
| | - Greg Calip
- Fred Hutchinson Cancer Research Center; University of Washington
| | - John Wedeles
- Department of Prevention and Community Health; George Washington University School of Public Health and Health Services
| | | | - Mark S. Wolff
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
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Shelley D, Anno J, Tseng TY, Calip G, Wedeles J, Lloyd M, Wolff MS. Implementing tobacco use treatment guidelines in public health dental clinics in New York City. J Dent Educ 2011; 75:527-533. [PMID: 21460273] [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: 05/30/2023]
Abstract
In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.
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Affiliation(s)
- Donna Shelley
- New York University College of Dentistry, 380 Second Ave., New York, NY 10010, USA.
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Affiliation(s)
- John R Calamia
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA.
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Affiliation(s)
- Douglas A Young
- Department of Dental Practice, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA 94115, USA.
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Abstract
Dental caries is a dietary and host-modified biofilm disease process, transmissible early in life that, if left untreated, will cause destruction of dental hard tissues. If allowed to progress, the disease will result in the development of caries lesions on tooth surfaces, which initially are noncavitated (eg, white spots), and eventually can progress to cavitation. The "medical model," where the etiologic disease-driving agents are balanced against protective factors, in combination with risk assessment, offers the possibility of patient-centered disease prevention and management before there is irreversible damage done to the teeth. This article discusses how to use evidence supporting risk assessment and management strategies for the caries process.
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Affiliation(s)
- Margherita Fontana
- Department of Preventive and Community Dentistry, Indiana University School of Dentistry, 1121 W. Michigan Street, Room DS-406, Indianapolis, IN 46202, USA.
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Golub LM, Lee HM, Stoner JA, Sorsa T, Reinhardt RA, Wolff MS, Ryan ME, Nummikoski PV, Payne JB. Subantimicrobial-dose doxycycline modulates gingival crevicular fluid biomarkers of periodontitis in postmenopausal osteopenic women. J Periodontol 2008; 79:1409-18. [PMID: 18672990 DOI: 10.1902/jop.2008.070623] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We recently demonstrated that a 2-year subantimicrobial-dose doxycycline (SDD) regimen (double-masked, placebo-controlled clinical trial) in postmenopausal (PM) women exhibiting mild systemic bone loss (osteopenia) and local bone loss (periodontitis) reduced the progression of periodontal attachment loss (intent-to-treat analysis) and the severity of gingival inflammation and alveolar bone loss (subgroups) without producing antibiotic side effects. We now describe SDD effects on biomarkers of collagen degradation and bone resorption in the gingival crevicular fluid (GCF) of the same vulnerable subjects. METHODS GCF was collected from SDD- and placebo-treated PM subjects (n=64 each) at the baseline and 1- and 2-year appointments; the volume was determined; and the samples were analyzed for collagenase activity (using a synthetic peptide as substrate), relative levels of three genetically distinct collagenases (Western blot), a type-1 collagen breakdown product/bone resorption marker (a carboxyterminal telopeptide cross-link fragment of type I collagen [ICTP]; radioimmunoassay), and interleukin-1beta (enzyme-linked immunosorbent assay). Statistical analyses were performed using generalized estimating equations; primary analyses were intent-to-treat. RESULTS Collagenase activity was significantly reduced by SDD treatment relative to placebo based on intent-to-treat (P=0.01). ICTP showed a similar pattern of change during SDD treatment, and GCF collagenase activity and ICTP were positively correlated at all time periods (P<0.001). Matrix metalloproteinase (MMP)-8 accounted for approximately 80% of total collagenase in GCF, with much less MMP-1 and -13, and SDD reduced the odds of elevated MMP-8 by 60% compared to placebo (P=0.006). CONCLUSION These observations support the therapeutic potential of long-term SDD therapy to reduce periodontal collagen breakdown and alveolar bone resorption in PM women; effects on serum biomarkers of systemic bone loss in these subjects are being analyzed.
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Affiliation(s)
- Lorne M Golub
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
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Xu L, Yu Z, Lee HM, Wolff MS, Golub LM, Sorsa T, Kuula H. Characteristics of collagenase-2 from gingival crevicular fluid and peri-implant sulcular fluid in periodontitis and peri-implantitis patients: pilot study. Acta Odontol Scand 2008; 66:219-24. [PMID: 18615324 DOI: 10.1080/00016350802183393] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare collagenase activity and collagenolytic matrix metalloproteinase (MMP) levels in gingival crevicular fluid (GCF) and in peri-implant sulcular fluid (PISF) in gingivitis (G), chronic periodontitis (CP), and peri-implantitis (PI) human subjects. MATERIAL AND METHODS GCF and PISF were collected on filter paper strips, volume was determined, and samples were extracted in buffer containing general proteinase but not MMP inhibitors. Collagenase activity was measured using a DNP-synthetic octapeptide, and molecular and activation forms of collagenase-2 by Western immunoblotting. RESULTS GCF from CP and G sites exhibited elevated collagenase activity and flow, but collagenase concentrations expressed per microl were not significantly different between the healthy and G sites. Minimal fluid was obtained from healthy PISF, and collagenase concentration was the same or lower than in healthy GCF. Although PISF flow was 34% lower than GCF flow in CP subjects, collagenase concentration in CP and in PI sites was 78% and 971% greater, respectively, than in the appropriate healthy sites. Western immunoblot revealed MMP-8 in both PISF and GCF; fibroblast-type MMP-8 was not detected in healthy GCF and PISF. Immunoreactivity level and inactive and activated forms of PMN-type MMP-8 in GCF and PISF increased with the severity of periodontitis and peri-implantitis. Enhanced levels of fibroblast-type MMP-8 in active form were detected only in severe CP GCF and PI PISF. CONCLUSIONS Peri-implantitis PISF contained higher collagenase-2 levels and activity than GCF from similar deep CP sites. GCF and PISF from severe CP and PI exhibited the highest activation of MMP-8 isoenzymes species (PMN and fibroblast-type).
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Estafan D, Klodnitskaya L, Wolff MS. Treatment planning in esthetic dentistry requires careful listening to the patient. Gen Dent 2008; 56:290-292. [PMID: 19288840] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Creating an esthetic result that is pleasing to both the patient and the dentist requires careful consideration of patient concerns and treatment goals. This article presents a case involving a patient with many esthetic concerns. Following in-depth examination of the patient and consultations, an esthetic treatment plan involving the placement of laminate veneers was developed and executed. After the first set of laminate veneers was placed, some concerns led to an alteration in the proposed treatment plan. Each step of the treatment plan must be assessed before the next step is performed to guarantee a result that is both functional and esthetically pleasing.
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Affiliation(s)
- Denise Estafan
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York City, NY, USA
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Spielman AI, Wolff MS. Overcoming barriers to implementing evidence-based dentistry. J Dent Educ 2008; 72:263-264. [PMID: 18316529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- Andrew I. Spielman
- New York University College of Dentistry; Office of Academic Affairs; 10010 NY New York 345 E. 24th Street, 10th Floor
| | - Mark S. Wolff
- New York University College of Dentistry; Office of Academic Affairs; 10010 NY New York 345 E. 24th Street, 10th Floor
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