STUDY OBJECTIVES:Opioid medications are routinely used for short-term pain management after surgery. However, data on the effects of postsurgical opioid use on sleep is limited. The goal of this pilot study was to examine differences in objective sleep metrics between those on opioid versus non-opioid therapy for pain management in the immediate postsurgical period using participants in the pilot study from the Opioid Analgesic Reduction Study (OARS) and to determine if sex modifies the association. METHODS:The OARS study is a randomized, multisite study designed for people undergoing surgical removal of impacted third molars. Adult participants were stratified by sex and randomized to a treatment group. Participants wore an actigraph monitor for three days post-surgery. Actigraph-derived outcomes included total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Subjective survey data, including the Brief Pain Inventory (BPI) and Pain and Sleep Questionnaire (PSQ-3), were collected. RESULTS:Data from 41 of the 50 pilot study participants who had full actigraphy data was included. The opioid group (n = 19) experienced more WASO on nights 1 and 3 than the nonopioid group (n = 22). The difference between the nonopioid and opioid groups was -22.3 min [90%CI:-42.8,-1.9] and -21.5 min [90%CI -41.9,-1.0], respectively. The noted difference was driven by men in the opioid group. In contrast, differences between treatment groups with regards to subjective surveys was driven by women. Women in the opioid group had worse mean PSQ-3 scores (p = 0.09): mean difference = -1.3 [90%CI:-2.4,-0.2] and -1.3 [90%CI:-2.3,-0.3] after nights 1 and 2, respectively. CONCLUSION:Postsurgical opioid therapy is associated with worse objective and subjective sleep compared to non-opioid therapy. The associations are modified by sex.

Background. Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted. Methods. To determine whether combination nonopioid analgesics are at least as good as opioid analgesics, a multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial was conducted, which examined patient-centered outcomes after impacted mandibular third- molar extraction surgery. Participants were randomized to receive 5 mg of hydrocodone with 300 mg of acetaminophen (opioid) or 400 mg of ibuprofen and 500 mg of acetaminophen (nonopioid). After an initial dose, analgesic was taken every 4 through 6 hours as needed for pain. Results. In this randomized multisite clinical trial (n = 1,815 adults), those not taking opioids experienced significantly less pain (numeric rating scale ranging from 0 [no pain] through 10 [worst pain imaginable]) for first day and night (mean difference, -0.70; 95% CI, -0.94 to -0.45; P < .001) and second day and night (mean difference, -0.28; 95% CI, -0.52 to -0.04; P = .015), and experienced no more pain than participants taking opioids over the entire postoperative period (mean difference, -0.20; 98.75% CI, -0.45 to 0.05; P = .172). Participants not taking opioids had higher overall satisfaction at the postoperative visit (85.3% extremely satisfied or satisfied vs 78.9%; 95% CI, 1.21 to 1.98; P = .006). Conclusions. The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen. At no time did hydrocodone outperform the nonopioid.

This prespecified subgroup analysis of a randomized clinical trial investigates noninferiority for pain relief, treatment effects, and patient satisfaction for nonopioids vs opioids in male and female patients after impacted mandibular third molar extraction.

Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted.

Background During the COVID-19 pandemic, there was a substantial interruption of care, with patients and workers fearful to return to the dental office. As dental practice creates a highly aerosolized environment, the potential for spread of airborne illness is magnified. As a means to increase safety and mitigate risk, pre-visit testing for SARS-CoV-2 has the potential to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the logistics and impact of two different testing mechanisms (laboratory-based PCR viral testing and point-of-care antigen testing) in dental offices. Methods Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab-based PCR methods to detect SARS-CoV-2 infection. Analysis was limited to descriptive measures, with median and interquartile ranges reported for Likert scale responses and mean and standard deviation for continuous variables. Results Of the total 72 enrolled, 28 DHCWs and 41 patients completed the protocol. Two patients (4.9%) tested positive prior to their visit, while 2 DHCWs (12.5%) tested positive for SARS-CoV-2 infection at the start of the study. DHCWs and patients shared similar degree of concern (69% and 63%, respectively) for contracting COVID-19 from patients, while patients feared contracting COVID-19 from DHCWs less (49%). Descriptive statistics calculations revealed that saliva, tongue epithelial cells, and nasal swabs were the most desirable specimen collection method; both testing (LAB and POC) protocols took similar amounts of total time to complete; and DHCWs and patients reported feeling more comfortable when both groups were tested. Conclusions While a larger-scale, network study is necessary for generalizability of results, this feasibility study suggests that SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients. As new virulent infectious diseases emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients. Trial registration ClinicalTrials.gov: NCT05123742.

BACKGROUND:With addiction rates and opioid deaths increasing, health care providers are obligated to help stem the opioid crisis. As limited studies examine the comparative effectiveness of fixed-dose combination nonopioid analgesia to opioid-containing analgesia, a comparative effectiveness study was planned and refined by conducting a pilot study.METHODS:The Opioid Analgesic Reduction Study (OARS) pilot, a stratified, randomized, multisite, double-blind clinical trial, was designed to test technology and procedures to be used in the full OARS trial. Participants engaged in the full protocol, enabling the collection of OARS outcome data. Eligible participants reporting to 1 of 5 sites for partial or full bony impacted mandibular third molar extraction were stratified by biologic sex and randomized to 1 of 2 treatment groups, OPIOID or NONOPIOID. OPIOID participants were provided 20 doses of hydrocodone 5 mg/acetaminophen 300 mg. NONOPIOID participants were provided 20 doses of ibuprofen 400 mg/acetaminophen 500 mg. OARS outcomes data, including pain experience, adverse effects, sleep quality, pain interference, overall satisfaction, and remaining opioid tablets available for diversion, were collected via surveys, electronic medication bottles, eDiary, and activity/sleep monitor.RESULTS:Fifty-three participants were randomized with 50 completing the OARS pilot protocol. Across all outcome pain domains, in all but 1 time period, NONOPIOID was better in managing pain than OPIOID (P < 0.05 level). Other outcomes suggest less pain interference, less adverse events, better sleep quality, better overall satisfaction, and fewer opioid-containing tablets available for diversion.DISCUSSION:Results suggest patients requiring impacted mandibular third molar extraction would benefit from fixed-dose combination nonopioid analgesia.KNOWLEDGE TRANSFER STATEMENT:Study results suggest fixed-dose nonopioid combination ibuprofen 400 mg/acetaminophen 500 mg is superior to opioid-containing analgesic (hydrocodone 5 mg/acetaminophen 500 mg). This knowledge should inform surgeons and patients in the selection of postsurgical analgesia.

Abstract Introduction: The New Jersey Kids Study (NJKS) is a transdisciplinary statewide initiative to understand influences on child health, development, and disease. We conducted a mixed-methods study of project planning teams to investigate team effectiveness and relationships between team dynamics and quality of deliverables. Methods: Ten theme-based working groups (WGs) (e.g., Neurodevelopment, Nutrition) informed protocol development and submitted final reports. WG members (n = 79, 75%) completed questionnaires including de-identified demographic and professional information and a modified TeamSTEPPS Team Assessment Questionnaire (TAQ). Reviewers independently evaluated final reports using a standardized tool. We analyzed questionnaire results and final report assessments using linear regression and performed constant comparative qualitative analysis to identify central themes. Results: WG-level factors associated with greater team effectiveness included proportion of full professors (β = 31.24, 95% CI 27.65–34.82), team size (β = 0.81, 95% CI 0.70–0.92), and percent dedicated research effort (β = 0.11, 95% CI 0.09–0.13); age distribution (β = −2.67, 95% CI –3.00 to –2.38) and diversity of school affiliations (β = –33.32, 95% CI –36.84 to –29.80) were inversely associated with team effectiveness. No factors were associated with final report assessments. Perceptions of overall initiative leadership were associated with expressed enthusiasm for future NJKS participation. Qualitative analyses of final reports yielded four themes related to team science practices: organization and process, collaboration, task delegation, and decision-making patterns. Conclusions: We identified several correlates of team effectiveness in a team science initiative's early planning phase. Extra effort may be needed to bridge differences in team members' backgrounds to enhance the effectiveness of diverse teams. This work also highlights leadership as an important component in future investigator engagement.

Background The Opioid Analgesic Reduction Study is a double-blind, prospective, clinical trial investigating analgesic effectiveness in the management of acute post-surgical pain after impacted third molar extraction across five clinical sites. Specifically, Opioid Analgesic Reduction Study examines a commonly prescribed opioid combination (hydrocodone/acetaminophen) against a non-opioid combination (ibuprofen/acetaminophen). The Opioid Analgesic Reduction Study employs a novel, electronic infrastructure, leveraging the functionality of its data management system, Research Electronic Data Capture, to not only serve as its data reservoir but also provide the framework for its quality management program. Methods Within the Opioid Analgesic Reduction Study, Research Electronic Data Capture is expanded into a multi-function management tool, serving as the hub for its clinical data management, project management and credentialing, materials management, and quality management. Research Electronic Data Capture effectively captures data, displays/tracks study progress, triggers follow-up, and supports quality management processes. Results At 72% study completion, over 12,000 subject data forms have been executed in Research Electronic Data Capture with minimal missing (0.15%) or incomplete or erroneous forms (0.06%). Five hundred, twenty-three queries were initiated to request clarifications and/or address missing data and data discrepancies. Conclusion Research Electronic Data Capture is an effective digital health technology that can be maximized to contribute to the success of a clinical trial. The Research Electronic Data Capture infrastructure and enhanced functionality used in Opioid Analgesic Reduction Study provides the framework and the logic that ensures complete, accurate, data while guiding an effective, efficient workflow that can be followed by team members across sites. This enhanced data reliability and comprehensive quality management processes allow for better preparedness and readiness for clinical monitoring and regulatory reporting.

Professionals, including physicians, dentists, and lawyers, have earned a special place in society. They are characterized by a high level of education, devotion to selflessness and service, responsibility for self-governance, and adherence to a code of professional conduct.1 Dentists are governed by the American Dental Association's Principles of Ethics and Code of Professional Conduct, which incorporates 5 fundamental principles to form its foundation: Patient Autonomy ("self-governance"), Nonmaleficence ("do no harm"), Beneficence ("do good"), Justice ("fairness"), and Veracity ("truthfulness").

Objectives: To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs). Methods: A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping). Results: SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01). Conclusions: Understanding DHCWs’ perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings. Knowledge Transfer Statement: Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Background Dental practice has been greatly affected by the COVID-19 pandemic. As SARS-CoV-2 infection is transmitted by respiratory fluids, dental practice techniques, which include aerosol-generating procedures, can increase the risk of transmission causing heightened safety concerns for both dental health care workers (DHCWs) and patients. These concerns have resulted in the reduction in patient volume and the available workforce within dental practices across the United States. Standardized methods for COVID-19 triage and testing may lead to increased safety and perceptions of safety for DHCWs and their patients and promote willingness to provide and access oral health care services. Objective This study is designed to develop procedures that test the feasibility of enhanced COVID-19 triage and testing in dental offices. It will provide preliminary data to support a larger network-wide study grant application aimed at developing protocols to address safety concerns of patients and DHCWs in a peri–COVID-19 pandemic era. Methods The feasibility study is being conducted in 4 private dental practices, each of which has a dentist member of the National Dental Practice–Based Research Network. Participants include the DHCWs and patients of the dental practice. Study procedures include completion of COVID-19 triage, completion of COVID-19 testing (point-of-care [POC] or laboratory-based [LAB] SARS-CoV-2 viral, antigen, and antibody tests based on office designation), and administration of perception and attitude surveys for participating DCHWs and patients of the dental practice over a defined study period. The office designation and the participant’s role in the practice determines which testing protocol is executed within the office. There are 4 study groups following 4 distinct protocols: (1) POC DHCWs, (2) POC patients, (3) LAB DHCWs, and (4) LAB patients. Results Data collection began in December of 2021 and concluded in March 2022. Study results are expected to be published in fall 2022. Conclusions The results of this feasibility study will help identify the viability and functionality of COVID-19 triage and testing in dental practices and inform a larger network-wide study grant application that develops protocols that address safety concerns of patients and DHCWs in a COVID-19 environment. Trial Registration ClinicalTrials.gov NTC05123742; https://clinicaltrials.gov/ct2/show/NCT05123742?term=NCT05123742 International Registered Report Identifier (IRRID) DERR1-10.2196/38386

The COVID-19 pandemic underscores the need to address potential risk of transmission of infectious diseases among dental health care workers (DHCWs) and patients. As with the emergence of other novel pathogens, infection control protocols have changed dramatically1 over the past 2 years. Before the 1980s, dentists rarely wore eye protection, masks, or gloves. Our experience with HIV changed that. Today, our protocols include enhanced personal protective equipment, environmental disinfection, and ventilation upgrades.

Background : Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription a patient’s risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the United States, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient’s risk for addiction. Methods : A double blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision making tool, pain management, extraction difficulty and number of tablets taken is being collected enabling an experimental decision making tool to be developed. Discussion : The proposed methods address the short comings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 hours. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, either related to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management. Trial registration : ClinicalTrials.gov NCT04452344. Registered on June 20, 2020

Dental practice has been greatly affected by the COVID-19 pandemic. As SARS-COV-2 infection is transmitted by respiratory fluids, dental practice techniques, which include aerosol-generating procedures, can increase the risk of transmission causing heightened safety concerns for both dental health care workers (DHCWs) and patients. These concerns have resulted in the reduction in patient volume and the available workforce within dental practices across the United States. Standardized methods for COVID-19 triage and testing may lead to increased safety and perceptions of safety for DHCWs and their patients and promote willingness to provide and access oral healthcare services. This study is designed to develop procedures that test the feasibility of enhanced COVID-19 triage and testing in dental offices. It will provide preliminary data to support a larger network-wide study grant application aimed at developing protocols to address safety concerns of patients and DHCWs in a peri-COVID-19 pandemic era. The feasibility study is being conducted in four private dental practices, each of which has a dentist member of the National Dental Practice-Based Research Network. Participants include the DHCWs and patients of the dental practice. Study procedures include completion of COVID-19 triage, completion of COVID-19 testing [Point-of-Care (POC) or laboratory based (LAB) Laboratory (LAB) SARS-CoV-2 viral, antigen and/or antibody tests based on office designation] and administration of perception and attitude surveys for participating DCHWs and patients of the dental practice over a defined study period. The office designation and participant’s role in the practice determines which testing protocol is executed within the office. There are four study groups following four distinct protocols: (1) POC DHCWs, (2) POC Patients, (3) LAB DHCWs, and (4) LAB Patients. This work has been peer reviewed and funded by the National Institute of Dental and Craniofacial Research (NIDCR), an institute within the National Institute of Health (NIH). Study protocols commenced in December of 2021 and are expected to end in March 2022 with data analysis to follow. The results of this feasibility study will help identify viability and functionality of COVID-19 triage and testing in dental practices and inform a larger network-wide study grant application that develops protocols that address safety concerns of patients and Dental Health Care Workers (DHCWs) in a COVID-19 environment. The ClinicalTrials.gov registration is NTC05123742.

The COVID-19 pandemic has created a new and demanding work environment for health professionals. This article will focus on the biological issues related to infection and disease, tests developed based on these biological principles, the ways in which these tests are evaluated, and how they can be used to protect both patients, dental professionals, and office affiliates. The article will describe types of COVID-19 testing that may be performed in dental offices, the issue of testing and anxiety, regulations regarding testing that are relevant to dentists, rules for delivery and reimbursement, and strategies for proceeding as a health professional in the current challenging environment. The authors conclude that the devastating effects of the pandemic on public health has facilitated a new role for dentists as public health professionals, with the opportunity for the dental profession to actively expand its participation in improving the health of the public moving forward. Testing will continue as a means of relieving anxiety for the public.

BACKGROUNDFrom the earliest days of the COVID-19 pandemic, dental practitioners, organizations, educators, insurers, and manufacturers were concerned about the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a panoply of issues, including transmission modes; personal protective equipment (PPE) supplies; aerosolization; office disinfection; patient confidence; and screening and testing protocols to determine the viral status of patients, clinicians, and staff members.The shared goals of dental clinicians were to treat patients as safely as possible through optimal use of PPE with disinfection and aerosol mitigation protocols to minimize the risk of viral transmission in the dental office or school clinic.Since initial state and federal pandemic efforts focused on treating the sickest patients, hospital capacity, mass testing, and the global PPE supply, a group of dental schools recognized that dental practices would benefit greatly from the ability to evaluate the viral status of their patients using officebased, point-of-care (POC) tests, ideally using sputum, saliva, and/or finger stick blood samples.Since private dental offices and most dental schools lack the analytic instrumentation and the Clinical Laboratory Improvement Amendment (CLIA) certifications to conduct the types of polymerase chain reaction (PCR) viral tests prevalent in

The aim of this study was to improve understanding of predictors of student success in dental school. A total of 178 student records from the Classes of 2015 and 2016 at a U.S. dental school were reviewed for this retrospective study. The records assessed included admissions files with such elements as scores on the Dental Admission Test (DAT), participation in a pipeline program, and undergraduate transcripts; academic records from the first term of dental school (class rank, course remediation, and withdrawal/dismissal from dental school); and National Board Dental Examination (NBDE) Part I results. The results showed that the DAT Perceptual Ability Test was positively related to performance in the first term of dental school (p=0.030). The DAT Academic Average (p<0.0001) and participation in a pipeline program (p=0.006) were found to be predictors of performance in the lower 25% of the class by end of first term rank. Taking organic chemistry in a summer term during undergraduate study was identified as a predictor variable for dismissal, withdrawal, or entry into a decompressed curriculum (p=0.025). Although this analysis found that traditional predictors of academic success in dental school were associated with strong academic performance in the study sample, it also provided a more complex assessment of factors that may be associated with students who struggle in the first year. As the vast majority of students in this sample successfully completed dental school, the results were not sought to inform admissions criteria, but rather to help academic and student affairs officers identify at-risk students in order to offer timely intervention.

The aim of this study was to determine if there was a relationship between students’ academic history and their performance in the first year of dental school, with a focus on academic load in undergraduate education. A total of 174 student records from the Rutgers School of Dental Medicine Classes of 2011 to 2018 were analyzed. These records included students at the top and bottom of each class at the end of their first term of study. Outcomes were broad measures of student success: student continued in curriculum, student withdrew/was dismissed, or student remediated at least one course. In the comparison of the top and bottom ten students across the classes, the following variables were found to be significant: Barron's score of undergraduate institution, undergraduate science GPA, number of failures or withdrawals from science courses during undergraduate education, DAT scores, and underrepresented minority status. The results of this study are not meant to inform the admissions process, but to highlight opportunities for enhancing student services via early identification of students who may benefit from additional academic support while in dental school.

Journal of Dental EducationVolume 81, Issue 7 p. 772-774 Article Address by Chair-elect of the ADEA Board of Directors Leon Assael DMD, CMM, Leon Assael DMD, CMMSearch for more papers by this author Leon Assael DMD, CMM, Leon Assael DMD, CMMSearch for more papers by this author First published: 01 July 2017 https://doi.org/10.1002/j.0022-0337.2017.81.7.tb06285.x This address by the 2016–17 Chair-elect of the ADEA Board of Directors was presented to the ADEA House of Delegates at the 94th ADEA Annual Session & Exhibition in Long Beach, California. Dr. Assael is Professor and Dean Emeritus of the University of Minnesota School of Dentistry. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume81, Issue7July 2017Pages 772-774 RelatedInformation