Impact of the COVID-19 pandemic on oral health care use in the United States through December 2021.

BACKGROUND: The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data. METHODS: Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years). RESULTS: For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P < .05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters. CONCLUSIONS: The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year. PRACTICAL IMPLICATIONS: Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic.

Vector-borne pathogens in dogs from Guatemala, Central America.

Vector-borne pathogens (VBPs) of dogs have been extensively studied worldwide, though scientific information for some countries, as is the case for Guatemala, is almost nonexistent. From 2012 to 2015, 975 dogs residing in different departments of Guatemala were sampled and screened using a rapid ELISA for detecting antigen of Dirofilaria immitis and antibodies against Anaplasma spp., Ehrlichia spp. and Borrelia burgdorferi. Out of 975 samples analyzed, 46.4% (n = 452) scored positive for at least one pathogen, with D. immitis being the most prevalent (29.7%), followed by Ehrlichia spp. (11.5%) and Anaplasma spp. (5.1%). None of the dogs were positive to B. burgdorferi. Co-infections were observed in 18.1% (n = 176) of dogs, with the simultaneous detection of D. immitis and Ehrlichia spp. being most common. The frequency of VBPs was higher in the department of Santa Rosa (southeast coast of Guatemala), which has a tropical savanna climate. In this region, 59.7% of the dogs surveyed were infected with D. immitis. Our results suggest that the prevalence of VBPs in dogs in Guatemala may be affected by the climate, with dogs living in the southeast coast being at higher risk, as compared to other regions studied. Increased awareness regarding the risk of VBPs in dogs in Guatemala is advocated and the adoption of preventive strategies should be encouraged.

Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review.

STATEMENT OF PROBLEM: Dentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)? PURPOSE: The purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement. MATERIAL AND METHODS: Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations. RESULTS: The 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs. CONCLUSIONS: Lack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.

Risk-based recall intervals recommended.

This summary of clinical guideline 19 from NICE includes recommendations for patients of all ages (both dentate and edentulous patients) and covers primary care received from NHS dental staff (dentists, independent contractors contracting within the NHS, dental hygienists and therapists) practising in England and Wales. The guideline takes into account the potential of the patient and the dental team to improve or maintain the quality of life and to reduce morbidity associated with oral and dental disease. The guideline does not cover intervals between dental examinations that are not routine dental recalls; that is, intervals between examinations related to ongoing courses of treatment, or part of current dental interventions, nor does it cover emergency dental interventions, or intervals between episodes of specialist care.

Insufficient evidence to understand effect of routine scaling and polishing.

DATA SOURCES: Relevant studies were sourced using the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline and Embase. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. STUDY SELECTION: Trials were selected if they were randomised, included anyone with an erupted permanent dentition, and where subjects were judged to have received a routine scale and polish as defined in this review. Outcomes assessed included tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes. DATA EXTRACTION AND SYNTHESIS: Trial details were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both the standardised mean differences and weighted mean differences were calculated, as appropriate, using random-effects models. RESULTS: Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, which involved people attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each timepoint during the 1-year trial. The other study, of adolescents in a developing country who had high existing levels of and calculus who had not received any dental treatment for at least 5 years, reported statistically significant improvements in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish procedures provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing carried out at more frequent intervals, that is, at 2 weeks versus 6 months; 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); and at 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry. CONCLUSIONS: The research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High-quality clinical trials are required to address the basic questions posed in this review. Scaling and/or polishing of the crown and root surfaces of the teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.