Payment Methods and Demographics Influence Patterns of Dental Service Utilization.

OBJECTIVE: To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM). DESIGN: This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis. SETTING: Nine dental clinic sites across the state of North Carolina. PARTICIPANTS: In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study. MAIN OUTCOME MEASURES: In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method. RESULTS: Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants. CONCLUSIONS: Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.

Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery?

PURPOSE: Because of increased attention focused on administering dexamethasone to treat third molar surgical complications, this study investigated the efficacy of single-dose dexamethasone in managing postoperative complications after impacted third molar surgery. Pain intensity and analgesic intake, patients' discomfort, limitation of oral function, and limitation of daily activities were assessed. MATERIALS AND METHODS: This triple-blinded split-mouth randomized controlled clinical trial included patients 18 to 30 years old who underwent randomized bilateral extractions of impacted mandibular third molars during 2 consecutive sessions. Each patient was given a single-dose intramuscular injection of dexamethasone (0.1 mg/kg) preoperatively in 1 session and a placebo in the other session. Data were collected daily for 7 postoperative days, and 14 patient-centered outcomes were interpreted. A 2-tailed P value less than .05 was considered significant. RESULTS: All 32 patients (100%) enrolled completed the study. When administered dexamethasone, patients reported less pain (P ≤ .007), took fewer analgesics (P ≤ .002), reported less swelling (P ≤ .007), had less difficulty in eating (P ≤ .024), had less difficulty in enjoying food (P ≤ .005), had less difficulty in speech (P = .043), had less trismus (P = .005), were absent less from school or work (P ≤ .016), and had less disruption of daily activity (P ≤ .042). The differences between the 2 conditions in bleeding, malaise, and sleep disturbance were not significant (P > .05). CONCLUSION: Prophylactic dexamethasone administered intramuscularly before third molar surgery should be recommended as a safe and effective strategy for decreasing pain and discomfort and enhancing oral functions and daily activities, unless contraindicated.

A Cohort Study of the Patterns of Third Molar Impaction in Panoramic Radiographs in Saudi Population.

OBJECTIVES: To evaluate the epidemiological patterns of third molar impaction in a cohort of patients living in the north of Saudi Arabia. MATERIALS AND METHODS: A retrospective cohort study comprised of analysing 2550 Orthopantomograms (OPGs) belonging to patients who attended Aljouf University College of Dentistry between September 2013 and December 2015. OPGs were examined to determine the frequency of third molar impaction, their levels of eruption and angulations. Mixed effects logistic regression analysis was performed to calculate adjusted odds ratios. Data were weighted by age and sex based on population regional estimates. RESULTS: 1551 patients (60.8%) with a mean age of 33.5 years-old (95%CI: 32.9 to 34) demonstrated 2650 impacted third molars. Third molars were more likely present in patients aged from 20 to 39 years-old (p<0.001); and in mandible more than maxilla (p<0.001). It showed highest vertical impaction and higher impaction rate in mandible than maxilla. Level A impaction was the most common among other levels by 1365 (53.5%). Vertical impaction was the most common pattern (1354 patients; 53.1%). Mesioangular impaction ranked second in mandible, while distoangular impaction ranked second in maxilla. There was no statistically significant difference between males and females concerning impaction frequency, depth levels and angulations. CONCLUSION: Impacted third molars is still a public health concern among youth and young adults. Vertically impacted mandibular third molars with their occlusal plane at the same level as the occlusal plane of adjacent tooth is the most prevalent pattern of third molar impaction in the northern region of Saudi Arabia.

Incidence, Risk Factors, and Complications of Schneiderian Membrane Perforation in Sinus Lift Surgery: A Meta-Analysis.

OBJECTIVES: To evaluate the incidence of Schneiderian membrane perforation occurring during sinus lift surgery, and to investigate possible risk factors and associated complications. MATERIALS AND METHODS: A systematic search for papers published between 1975 and 2015 was performed in MEDLINE, EMBASE, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses. The quality assessment of each study was performed using the GRADE system. All extracted data were synthesized using either fixed or random effect models as indicated. RESULTS: Out of 1652 sinus lift surgeries reported in 12 studies, 388 membrane perforations occurred. The weighted incidence rate of perforation was 23.5% ranging from 3.6% to 41.8%. Both reduced membrane thickness and sinus septa increased the risk of perforation. The difference in the weighted implant survival rates between perforated and nonperforated side was not significant (P = 0.24). The use of piezoelectric instrumentation appears to reduce the perforation risk. CONCLUSIONS: With an incidence ratio of 1:4, membrane perforation is a common surgical complication during sinus lift surgery. We should keep in mind that appropriately handled and treated membrane perforation tends to show comparable implant survival when compared with intact membrane.

Recent Trends in Sinus Lift Surgery and Their Clinical Implications.

BACKGROUND: Sinus lift procedures are used to allow residual bone to accommodate functional implants in atrophic posterior maxilla. Numerous anatomical and surgical advancements in sinus lift surgery are still inspiring clinicians. PURPOSE: The purpose of this study was to describe the recent trends in sinus lift surgery focusing on implant survival, bone grafting, anatomical and surgical considerations, and their clinical implications on the practice of implant dentistry in atrophic posterior maxilla. MATERIALS AND METHODS: We performed an extensive search in MEDLINE, Embase, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses. Articles were critically reviewed to determine the level of evidence as per the Canadian Task Force on Preventive Health Care. RESULTS: Comprehensive assessment of sinus septa, sinus pathology, and bone quality and quantity using three-dimensional cone beam computed tomography radiographs is important before placing implants in posterior maxilla. With a residual bone height of less than 5 mm, the survival rate of implant decreases substantially. Lateral window approach can increase the vertical bone height to greater than 9 mm, while osteotome approach can increase this height from 3 to 9 mm. The perforation of Schneiderian membrane doubles the risk for the incidence of sinusitis or infection. The use of piezoelectric surgery allows adequate sinus lift while protecting soft tissues and minimizing patient discomfort. CONCLUSIONS: Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants. Future research directions should consider study designs grounded on longitudinal randomized controlled trials of large sample size.

Dental students' perceptions of undergraduate clinical training in oral and maxillofacial surgery in an integrated curriculum in Saudi Arabia.

PURPOSE: The aim was to understand dental students' experiences with oral and maxillofacial surgery (OMS) teaching, their confidence levels in performing routine dento-alveolar operations, and the relationship between the students' confidence level and the number of teeth extracted during the clinical practice. METHODS: The survey questionnaire was distributed to 32 students at Aljouf University College of Dentistry, Saudi Arabia during their fourth and fifth year in 2015. Respondents were asked to rate 19 items, which represent a student's confidence in performing routine surgical interventions, using a four-point Likert scale (1=very little confidence, 4=very confident). A multivariate regression was computed between average confidence and the variables: weekly hours devoted to studying oral and maxillofacial surgery, college grade point average, and the total number of teeth extracted. RESULTS: The response rate was 100%. Students revealed the highest level of confidence in giving local anesthesia (96.9%), understanding extraction indications (93.8%), and performing simple extractions (90.6%). Less confidence was shown with handling difficult extractions (50.0%), extracting molars with separation (50.0%) or extracting third molars (56.3%). The average confidence in performing surgical procedures was 2.88 (SD=0.55), ranging from 1.79 to 3.89. A given student's confidence increased with an increase in the total number of teeth extracted (P=0.003). CONCLUSION: It reveals a significant impact of undergraduate clinical training on students' confidence in performing oral and maxillofacial surgery clinical procedures: The more clinical experience the students had, the more confidence they reported.

Epidemiology of maxillofacial injuries in Ontario, Canada.

PURPOSE: The aims of this study were to 1) calculate rates for maxillofacial (MF) injury-related visits in emergency departments (EDs) and hospitals in Ontario, Canada, 2) identify and rank common causes for MF injuries, 3) investigate the variation and trends in MF injuries according to gender, age, and socioeconomic status, and 4) describe the geographic distribution of MF injuries. MATERIALS AND METHODS: An 8-year retrospective study design was implemented. The Discharge Abstract Database and the National Ambulatory Care Reporting System datasets were used. After examining demographic and diagnostic information, frequencies, percentages, and rates were calculated. Color-coded maps were created using ArcGIS to display the geographic distribution of MF injuries. RESULTS: From 2004 through 2012, 1,457,990 ED visits and 41,057 hospitalizations occurred as a result of MF injury in Ontario. The mean age of patients for each ED visit was 30.6 years and for each hospitalization was 52.6 years. Rates of ED visits and hospitalizations owing to MF injury show a slight decrease during the 8-year period. MF injuries were most frequent in the evening, during the weekends, and during the summer. Falls were reported as the leading cause of MF injuries. Rural areas had higher rates of ED visits and hospitalizations. CONCLUSIONS: This study highlighted the public health impact of MF injuries, offering policy makers important epidemiologic information, which is fundamental to formulate and optimize measures aimed at protecting Canadians from injuries that are largely predictable and preventable. Future injury prevention programs should enhance the population-based approach and focus on high-risk groups such as male youth and elderly women in low-income families.

Assessing the relationship between dental appearance and the potential for discrimination in Ontario, Canada.

Poor oral health is influenced by a variety of individual and structural factors. It disproportionately impacts socially marginalized people, and has implications for how one is perceived by others. This study assesses the degree to which residents of Canada's most populated province, Ontario, recognize income-related oral health inequalities and the degree to which Ontarians blame the poor for these differences in health, thus providing an indirect assessment of the potential for prejudicial treatment of the poor for having bad teeth. Data were used from a provincially representative survey conducted in Ontario, Canada in 2010 (n=2006). The survey asked participants questions about fifteen specific conditions (e.g. dental decay, heart disease, cancer) for which inequalities have been described in Ontario, and whether participants agreed or disagreed with various statements asserting blame for differences in health between social groups. Binary logistic regression was used to determine whether assertions of blame for differences in health are related to perceptions of oral health conditions. Oral health conditions are more commonly perceived as a problem of the poor when compared to other diseases and conditions. Among those who recognize that oral conditions more commonly affect the poor, particular socioeconomic and demographic characteristics predict the blaming of the poor for these differences in health, including sex, age, education, income, and political voting intention. Social and economic gradients exist in the recognition of, and blame for, oral health conditions among the poor, suggesting a potential for discrimination amongst socially marginalized groups relative to dental appearance. Expanding and improving programs that are targeted at improving the oral and dental health of the poor may create a context that mitigates discrimination.

Emerging science in the dietary control and prevention of dental caries.

The key environmental factor involved in caries incidence is fermentable carbohydrates. Because of the high costs of caries treatment, researchers continue to explore dietary control as a promising preventive method. While dietary change has been demonstrated to reduce Streptococcus mutans, a preventive role is expected for "functional foods" and dietary habit alterations. The authors consider how recent advances in the understanding of caries pathology can reveal dietary control as a valuable method in promoting a healthy dentition.

Emerging science in the dietary control and prevention of dental caries.

The key environmental factor involved in caries incidence is fermentable carbohydrates. Because of the high costs of caries treatment, researchers continue to explore dietary control as a promising preventive method. While dietary change has been demonstrated to reduce Streptococcus mutans, a preventive role is expected for "functional foods" and dietary habit alterations. The authors consider how recent advances in the understanding of caries pathology can reveal dietary control as a valuable method in promoting a healthy dentition.

Comparison of dental caries prevalence in patients with cleft lip and/or palate and their sibling controls.

OBJECTIVE: To evaluate the prevalence of dental caries in patients with cleft lip and/or palate and their cleft-free sibling controls. METHODS: The two subject groups (patient and control) comprised 106 participants. The former group consisted of 53 patients with cleft lip and/or palate,aged 12 to 29 years, who visited the Oral and Maxillofacial Surgery Hospital at Damascus University of Syria. The control group consisted of the patients' siblings who had no clefts,and they were sex matched to the patient group. Dental caries were examined clinically and were reported using the decayed,missing, and filled permanent teeth (DMFT) index. The DMFT scores were compared between the two groups. RESULTS: The author found an overall association of dental caries with the presence of cleft lip and/or palate (odds ratio = 2.52; 95% confidence interval =1.389-4.574; p , .05). The DMFT index scores were proportionally higher inpatients with cleft lip and/or palate compared with the control group (p , .001). CONCLUSION: Subjects with cleft lip and palate are susceptible to dental caries independently of socioeconomic status.