Background The scope and regulation of expanded function dental assistants (EFDAs) vary according to state. The authors explored predictors of EFDA workforce participation rates and quantified EFDA regulation, delegation patterns, and perception nationally. Methods The authors applied a cross-sectional design using secondary data collection and 2 online surveys to dentists (n = 558) and dental assistants (n = 1,016). Licensed dentists and dental assistants working in a dental practice in the United States were eligible to participate. Results In states with registered EFDAs, nearly one-half (46.9%) had low EFDA rates. More established EFDA levels were associated with higher EFDA rates. Dentists delegated preventive functions to dental assistants frequently, but only 32.9% delegated direct restorations. Delegation depended on both environmental and personal factors. Dentists were approximately twice as likely to delegate direct restorations if they felt it saved them time, nearly 12 times more likely to delegate in states with function-specific certificates (compared with states without EFDA registration), and more than 4 times more likely to delegate in public health settings than in dental support organizations. Overall, both regulations and workplace environment strongly influenced how much responsibility dentists gave to dental assistants. Conclusions EFDAs represent a valuable, yet underdeveloped, component of the dental workforce. There are opportunities to increase EFDA rates and delegation. Although this study has limitations, the authors point to key considerations and opportunities for future workforce development and research. Practical Implications States aiming to introduce or expand EFDA roles should collaborate with associations and schools to provide EFDA training, guidance on how to fully use EFDAs, and information on the associated productivity benefits.
BACKGROUND:Sickle cell anemia (SCA) is an autosomal recessive disorder characterized by a point mutation in the β-globin chain of the hemoglobin protein, causing abnormal folding. This can lead to sickling of red blood cells, agglutination, and ultimately vascular obstruction, which rarely occurs in the cervicofacial region. CASE DESCRIPTION:This report reviews a rare case of vaso-occlusive crisis (VOC) in the cervical vertebrae and mandible, manifesting as severe mandibular pain of unknown origin in a patient with SCA. The patient experienced diffuse body pain, 3 days in duration, and most prominent in the right hemimandible. Symptoms were refractory to hydration and analgesics, requiring intensive care unit admission. Jaw pain persisted, and magnetic resonance imaging of the face was significant for enhancement in the right posterior hemimandible with surrounding soft-tissue inflammatory changes. Differential diagnoses included osteonecrosis, osteomyelitis, odontogenic infection, extramedullary hematopoiesis, and VOC. The patient lacked signs and sequelae of infection or hematopoiesis; therefore, the pain was attributed to bone infarcts secondary to VOC. The patient was placed on a multimodal analgesic regimen with resolution of symptoms and was discharged in stable condition. PRACTICAL IMPLICATIONS:This case illustrates an unusual manifestation of severe jaw pain of unknown origin that was determined to be caused by VOC of the mandible. This highlights the need for dentists to understand SCA pathophysiology and their integral role in the diagnosis of atypical facial pain in patients with SCA. Dentists may be the first to recognize manifestations of SCA, emphasizing their role in patient education and interdisciplinary care.
BACKGROUND:Although edentulism prompts a continued need for professional care, related use and expenditures are not well characterized. The authors evaluated associations between dentition status and dental care visits and incremental expenditures among US adults. METHODS:Using 2016-2018 Medical Expenditure Panel Survey data and 2015-2017 National Health Interview Survey results, the authors categorized dental care visits as occurring within 12 months and dentition as edentate or dentate. Using Poisson regression, the authors estimated the association between dentition and visits, controlling for sociodemographic covariates. Using a 2-part model, they determined incremental expenditures adjusted to 2023 health care rates. RESULTS:The sample of 66,639 adults represented 236 million people in the United States, 6.3% of whom were edentate. Lack of dental care visits in the previous 12 months was higher among edentate adults (81.2%) compared with dentate adults (55.2%). After controlling for covariates, edentate adults had significantly lower visit prevalence (20.1%) than dentate adults (44.5%; adjusted prevalence ratio, 0.45; 95% CI, 0.41 to 0.49). The adjusted mean expenditure was $359.70 for dentate adults and $276.00 for edentate adults. Edentate adults incurred $83.70 less per capita in adjusted incremental expenditures (P < .002). CONCLUSIONS:Edentulism is associated with significantly fewer visits and lower expenditures despite the need linked to the natural aging of dental tissues. PRACTICAL IMPLICATIONS:The study results revealed a paradox; people with the highest potential oral health care needs are the least likely to access care. This differential access to oral health care could be due to socially framed circumstances, and integrating oral health care with primary and geriatric care can help address this in the most affected population groups.
BACKGROUND:Although the health implications of social frailty have drawn great interest, research on its relationship with oral health is scarce. The authors examined the relationship between social frailty and oral health-related quality of life (OHRQoL) and the mediating role of cognitive function. METHODS:The authors analyzed 5,227 middle-aged and older adults. Social frailty was measured using 5 domains and grouped as non-social frailty, pre-social frailty, and social frailty. Cognitive function and OHRQoL were measured using the Mini-Mental State Examination and the Geriatric Oral Health Assessment Index, respectively. Linear regression was used to analyze the association between social frailty and OHRQoL, and the mediating role of cognitive function was estimated using the mediation analysis, expressed as natural indirect effects. RESULTS:At baseline, 64.7%, 21.8%, and 13.5% of the participants had non-social frailty, pre-social frailty, and social frailty, respectively. Compared with non-social frailty, both pre-social frailty (β = -0.87; 95% CI, -1.54 to -0.32) and social frailty (β = -0.92; 95% CI, -1.66 to -0.03) were associated with poorer subsequent OHRQoL. The natural indirect effects of the mediating role of cognitive function was -0.11 (95% CI, -0.20 to -0.08) for pre-social frailty and -0.22 (95% CI, -0.37 to -0.16) for social frailty, accounting for 13.1% and 23.5% of the total associations, respectively. CONCLUSIONS:Social frailty was negatively associated with subsequent OHRQoL among middle-aged and older adults. Poor cognitive function may partially explain this association. PRACTICAL IMPLICATIONS:Comprehensive interventions aimed at enhancing social engagement and cognitive function may be essential for the improvement of oral health outcomes.
BACKGROUND:This study aimed to investigate the association between unstimulated salivary endocannabinoid concentrations and caries experience in systemically healthy adults, while also evaluating key salivary parameters related to caries risk. METHODS:In this cross-sectional study, 74 adults aged 19 through 35 years were allocated into low caries risk (decayed, missing, and filled teeth [DMFT] ≤ 5) and high caries risk (DMFT ≥ 14) groups. Unstimulated salivary flow rate, salivary pH, and plaque formation rate index were assessed. Salivary concentrations of anandamide, 2-arachidonoylglycerol, palmitoylethanolamide, and oleoylethanolamide were quantified by liquid chromatography-tandem mass spectrometry. Intergroup comparisons and correlation analyses were performed using nonparametric statistical methods. RESULTS:Participants with high caries experience exhibited significantly lower salivary flow rates and pH values, alongside higher plaque formation rate index scores, than the low caries risk group (P < .001). In contrast, no significant differences were observed between groups with respect to salivary anandamide, 2-arachidonoylglycerol, palmitoylethanolamide, or oleoylethanolamide concentrations (P > .05). DMFT scores were significantly correlated with salivary parameters but showed no association with salivary endocannabinoid levels. CONCLUSIONS:Unstimulated salivary endocannabinoid concentrations were not directly associated with caries experience in adults. Accordingly, salivary endocannabinoids do not appear to constitute reliable biomarkers for caries susceptibility. PRACTICAL IMPLICATIONS:These findings indicate that conventional salivary parameters, such as flow rate, pH, and plaque accumulation, remain reliable and clinically relevant markers of caries susceptibility, whereas unstimulated salivary endocannabinoid levels do not provide additional diagnostic or prognostic value in the assessment of caries risk.
BACKGROUND:Vital pulpal therapy (VPT) failure associated with pulpal calcifications (PCs) may represent technical challenges for root canal treatment. The authors aimed to assess the PC rate after VPT using different repair materials (RMs) and to verify the association between PC and treatment success. TYPES OF STUDIES REVIEWED:Six databases were searched for studies published from inception through May 1, 2025. The PC rate using different RMs and the association between PC and VPT success were collected for qualitative and quantitative synthesis. Meta-analyses were performed to verify differences in PCs according to the RMs and to compare success rates according to the presence of PCs. Using Version 2 of the Cochrane risk of bias tool for randomized trials and the Risk of Bias in Non-Randomized Studies of Interventions, Version 2, the authors assessed the risk of bias for randomized clinical trials and nonrandomized intervention studies, respectively. The authors assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:Forty-two studies were selected for qualitative synthesis and 37 were selected for meta-analysis. PCs occurred in 8.80% of the teeth, with a 96.77% success rate in obliterated canals. PC was not associated with VPT success (odds ratio, 1.01; 95% CI, 0.43 to 2.38). No significant differences were found in PC rates of mineral trioxide aggregate compared with other RMs (odds ratio, 1.91; 95% CI, 0.84 to 4.33). Risk of bias was moderate to low in randomized clinical trials and moderate in nonrandomized intervention studies. The certainty of the evidence was high for the comparison of RMs and very low for the impact of PCs on VPT success. CONCLUSIONS AND PRACTICAL IMPLICATIONS:After VPT, the PC rate was low and comparable among RMs. PC does not influence VPT success. Therefore, VPT contraindication due to the risk of developing a failure associated with PC cannot be considered an evidence-based practice.
BACKGROUND:The human oral and gut microbiomes play critical roles in maintaining overall health. Although systemic antibiotics are frequently prescribed perioperatively in dental procedures, their impact on microbiota composition and diversity remains inadequately understood. The authors' objective was to characterize the evolution of the gut and oral microbiomes after a course of antibiotics administered for dental surgeries. The authors hypothesized that the microbiome would experience disruption but eventually recover to baseline levels and that patient-related factors would influence the extent of disruption and recovery. METHODS:Saliva and stool samples were collected from patients undergoing dental surgeries and receiving prophylactic antibiotics (n = 64) at baseline and then at 3, 10, 30, and 90 days after surgery. Microbial diversity and composition were assessed using 16S ribosomal RNA sequencing. Shotgun metagenomics sequencing was applied to a subset of samples to evaluate changes in antimicrobial resistance genes. RESULTS:Significant (P < .01) declines in alpha diversity were observed in both oral and fecal microbiomes, most notably at days 3 and 10, with near recovery at day 90. The oral microbiome exhibited greater disruption than the gut microbiome, suggesting higher susceptibility to postoperative disturbance. Patient-level factors including sex, race, gastroesophageal reflux disease, and antibiotic type influenced baseline diversity, disruption, and recovery. Results of taxonomic analyses revealed that key health-associated genera were substantially altered postsurgery. Some antimicrobial resistance genes increased in relative abundance over time, consistent with potential long-term ecological consequences of antibiotic use. CONCLUSIONS:The findings highlight the dynamic response of the human microbiome to antibiotic exposure and oral surgery and underscore the importance of antibiotic stewardship in practice. Further research on functional outcomes and host-microbiome interactions is warranted to optimize perioperative care in dentistry. PRACTICAL IMPLICATIONS:Consideration of patient factors is essential to minimize unnecessary disruption of the microbiome and mitigate the risk of developing resistance.
