PURPOSE:To investigate the association of ageism, empathy, and other possible explanatory factors among dental students in southern Brazil. METHODS:An online questionnaire and in-person visits were used for collecting sociodemographic data, dental training experiences, and attitudes toward aging, and employing the validated Brazilian versions of the Ageism Scale for Dental Students (ASDS-Braz) and Jefferson Scale of Empathy (JSE). Confirmatory factor analysis (CFA) was used to validate the JSE and ASDS-Braz, and structural equation modeling (SEM) was then employed to explore the relationships between total ageism score, total empathy score, and other factors. RESULTS:CFA for ASDS-Braz and JSE and the SEM showed marginal root mean square error of approximation (RMSEA) values and displayed expected loading directions. Among 626 predoctoral dental students (91.5% response rate), SEM revealed significant associations between the university attended and total empathy score with total ageism score, and sex with total empathy score. CONCLUSION:Among southern Brazilian dental students, university attended and overall empathy levels are strongly linked to the total ageism score. At the same time, gender shows a significant correlation with the overall empathy score.

OBJECTIVE:This study investigated associations between physical activity (PA) during late adolescence and emerging adulthood and bone strength in emerging adulthood by utilizing advanced finite element analysis of computed tomography (CT/FEA) technology beyond the traditional dual-energy X-ray absorptiometry (DXA) method. METHODS:This study included 266 participants (152 females) from the Iowa Bone Development Study. PA volume (average acceleration) and intensity (intensity gradient) metrics were calculated from ActiGraph accelerometer data collected at ages 17, 19, 21, and 23 years. Compressive modulus and compressive stiffness of the tibia were estimated at age 23 via CT/FEA of the tibia. Sex-specific linear regression models were used to evaluate associations between PA metrics and bone outcomes, adjusting for age, height, weight, musculoskeletal fitness, and calcium intake. RESULTS:Intensity gradient averaged over 17-23 years of age was positively associated with compressive stiffness at age 23 years in both females and males (p < 0.01). Intensity gradient was positively associated with compressive modulus in females (p < 0.01), but not in males. No significant associations were found between average acceleration and either compressive stiffness or modulus in either sex (p > 0.05). CONCLUSIONS:Using a state-of-the-art CT/FEA method, this study suggests that high-intensity PA during late adolescence and emerging adulthood improves bone strength.

STATEMENT OF PROBLEM:Removable partial dentures (RPDs) provide an important treatment option for replacing missing teeth, particularly for vulnerable populations. However, RPDs have been associated with damage to the remaining dentition, which can lead to treatment failure. PURPOSE:The purpose of this retrospective clinical study was to investigate the failure rates of RPD treatments among patients at a state-sponsored dental school and identify factors contributing to these failures. MATERIAL AND METHODS:A retrospective analysis was conducted using electronic health records (EHRs) from 4941 individuals for a total of 7529 patient-arches. The outcome of RPD treatment was defined as failure when any major procedure was performed on any tooth adjacent to a treated edentulous span. The time to event was measured from the date of RPD placement to the first recorded failure or the last follow-up visit (censored). A multivariable Cox proportional hazards model was employed to assess the hazard ratios for the variables of interest (α=.05). RESULTS:The average age of the cohort was 59 years, 52% female, and the mean follow-up period was 35 months. Among the arches that experienced failure (24.2%), the average time to failure was 33 months. In the multivariable model, statistically significant associations with RPD failure were found for several variables: Kennedy classification without distal extension (HR=1.23, P<.001), older age (HR=1.01, P<.001), male sex (HR=1.17, P=.008), maxillary arch (HR=1.60, P<.001), lack of insurance (HR=0.78, P<.001), cast metal framework (HR=0.55, P<.001), tobacco use (HR=1.21, P=.002), and dental fear (HR=1.26, P=.003). CONCLUSIONS:While the associations were not particularly strong, dental school patients who smoked, experienced dental anxiety, or received maxillary RPDs or RPDs without a cast metal framework demonstrated an elevated risk of requiring major treatment to the abutment teeth, leading to the failure of the RPD treatment.

ObjectiveTo investigate the behavioral outcomes of children with clefts and the psychosocial impact and mental health experiences of their caregivers regarding unintended outcomes of genomic sequencing, that is, secondary genetic findings (SFs).DesignConvergent parallel mixed methods.SettingThe cleft and immunization clinics at the Lagos University Teaching, Hospital, Nigeria.ParticipantsIn total, 127 cases and 158 control caregiver child dyads (quantitative) and 22 caregivers of children with clefts (qualitative).Main Outcome MeasuresStandardized questionnaires were used to assess caregiver-reported mental health, quality of life (QoL), and their children's behavioral difficulties. In 2 focus groups, participants shared their perspectives on genomic testing outcomes, including SFs, mental health, and expectations in the context of clefts.ResultsCompared to the control group, caregivers of children with clefts reported poorer mental health, lower QoL and more behavioral difficulties in their children. Also, they believed that introducing genomic testing outcomes, including SFs, may exacerbate existing burdens. Following qualitative data analyses, 5 themes emerged-genetics knowledge/awareness, stressors, cognitive appraisals, coping/support strategies, and negative impact/positive gains. Both qualitative and quantitative results showed that caring for children with clefts required significant financial resources placing substantial stress on caregivers.ConclusionsThese findings highlight the importance of addressing caregivers' psychosocial needs and the need for proactive measures to prepare for the return of genomic sequencing outcomes to patients and research participants, particularly in resource-limited settings like Africa, where such support may be lacking.

Purpose: This study aimed to investigate the predictors of survival of non-occlusal non-incisal glass-ionomer restorations as a surrogate for root surface restorations among older adults. Methods: In a retrospective cohort analysis using the University of Iowa College of Dentistry electronic dental records, we included 721 patients aged 65+whoreceived 2+surface non-occlusal non-incisal glass ionomer restorations placed from January 2005 - December 2011. Restorations were followed until September2017 or until they were deemed to have failed. Results: At baseline, participants' mean age was 77.6 +/- 8.2 years, and 45.8%were females. Most patients were self-pay (65.2%). Most restorations were placed by residents and dental students (82.7%) and included only two surfaces (95.6%).About half (49.1%) failed during follow-up, with a median survival time of3.7 years. The time ratio for lower incisors compared to other teeth was 0.6(p=.006), for three-and-four-surface restorations compared to two was 0.7(p=.007), for faculty as providers compared to residents and students was 1.4(p=.039), and for the Geriatric & Special Needs Clinic compared to others was 0.8 (p=.013). Time ratios less than one indicate association with shorter durations for restorations, and time ratios greater than one indicate association with longer durations for restorations. Conclusion: Tooth type, number of restored surfaces, provider type, and clinic were all significant factors associated with survival of these restorations.

Data collection is a fundamental process in any scientific investigation. This article outlines best practices for three general elements of the data-collection process: (1) determining the specific aim, (2) design, and (3) documentation. We discuss these elements in the style of a tutorial, using extended examples specific to dental research. Each section of the tutorial concludes with a bullet-point summary for ease of reference to the readers. The supplemental material for this article includes templates designed to assist dental researchers in initiating the data-collection process in their respective research efforts, and selected references are organized by topic. Although written for an audience of clinical scientists in dentistry, the principles outlined here could be generalized to other health science research contexts.

Fuchs endothelial corneal dystrophy (FECD), the leading indication for corneal transplantation in the U.S., causes loss of corneal endothelial cells (CECs) and corneal edema leading to vision loss. FECD pathogenesis is linked to impaired response to oxidative stress and environmental ultraviolet A (UVA) exposure. Although UVA is known to cause nonapoptotic oxidative cell death resulting from iron-mediated lipid peroxidation, ferroptosis has not been characterized in FECD. We investigated the roles of genetic background and UVA exposure in causing CEC degeneration in FECD. Using ungenotyped FECD patient surgical samples, we found increased levels of cytosolic ferrous iron (Fe2+) and lipid peroxidation in end-stage diseased tissues compared with healthy controls. Using primary and immortalized cell cultures modeling the TCF4 intronic trinucleotide repeat expansion genotype, we found altered gene and protein expression involved in ferroptosis compared to controls including elevated levels of Fe2+, basal lipid peroxidation, and the ferroptosis-specific marker transferrin receptor 1. Increased cytosolic Fe2+ levels were detected after physiologically relevant doses of UVA exposure, indicating a role for ferroptosis in FECD disease progression. Cultured cells were more prone to ferroptosis induced by RSL3 and UVA than controls, indicating ferroptosis susceptibility is increased by both FECD genetic background and UVA. Finally, cell death was preventable after RSL3 induced ferroptosis using solubilized ubiquinol, indicating a role for anti-ferroptosis therapies in FECD. This investigation demonstrates that genetic background and UVA exposure contribute to iron-mediated lipid peroxidation and cell death in FECD, and provides the basis for future investigations of ferroptosis-mediated disease progression in FECD.

INTRODUCTION:Older adults living in long-term care facilities (LTCFs) often have poor oral health and difficulty accessing dental services. The aim was to implement a virtual dental home (VDH) program for residents in two LTCFs utilizing asynchronous teledentistry techniques and mobile dental equipment. METHODS:This pilot project was a 6-month longitudinal cohort study in two LTCFs. Dental hygienists and dentists from a local community health care center utilized asynchronous teledentistry to provide diagnostic and preventive dental services onsite and to establish a dental home for additional comprehensive care services. Data were collected, including resident's demographics, oral health status, and dental services received. Descriptive data analyses, Wilcoxon signed rank, and McNemar tests were conducted. RESULTS:Thirty-four residents completed in-person baseline oral exams and 16 residents completed the recall exams. Ninety-two percent (n = 23) of dentate residents (n = 25) had untreated caries and 64% (n = 16) of dentate residents had at least one sextant of severe gingival inflammation. The median number of teeth with active untreated caries (p = .01) significantly decreased and arrested caries (p = .02) significantly increased from baseline. CONCLUSION:Iowa's VDH pilot project was successful in establishing a dental home using asynchronous teledentistry for residents in two LTCFs and providing resident access to preventive and disease control dental services.

Objectives This study investigates longevity of glass ionomer restorations in an older adult population. Methods This was a retrospective study based on clinical records. Patient records for 3,665 restorations in 1,777 adults 65 or older who had received a restoration between 12th July 2016 and 20th October 2022 were extracted from the electronic dental records system of the University of Iowa College of Dentistry and Dental Clinics. The data were analyzed to determine the influence of patient factors and restorative material on restoration longevity. Single variable and multiple variable survival models were created. Results Many variables that showed a statistically significant influence on restoration longevity in the single variable survival models and did not show such an influence in the multivariable model, indicating the effect of these variables is explained when other factors are controlled for. In particular, patient age at the time of restoration showed no significant influence in the multivariable model, and no medical factor had a statistically significant influence. The restorative material did show a significant influence in the multivariable model; using the resin-modified glass ionomer restorative (Fuji II LC) as a reference, the conventional glass ionomer restorative (Fuji IX) had a hazard ratio of 2.0 (p = 0.011), and the coated-conventional glass ionomer restorative (Equia) had a hazard ratio of 2.8 (p < 0.001). Significance Resin-modified glass ionomer restorations may have superior longevity for older adults than conventional and coated-conventional glass ionomer restorations.

Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa. An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis. Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532). Controlling for other variables in the linear model, healthcare students’ view of their faculty’s empathy toward patients and students’ self-reported empathy levels were significantly associated with students’ JSPE-HPS scores.

In dental research, it is particularly common for studies to collect data that are fundamentally correlated. Some common dental situations in which correlation arises include patients being observed across multiple teeth and/or across multiple time points, such as before and after treatment, or groups of patients being clustered (ie, familial units). For a number of traditional statistical tests and modeling techniques, the assumption of independence between observations is imperative in order to receive valid results and make accurate conclusions. This article describes how ignoring inherent correlations in data can lead to erroneous results when using traditional methods as well as the types of modeling techniques that are available to handle correlated data. Furthermore, two simulation studies are performed to further illustrate and prove the advantages of adequately handling correlated data in statistical analyses. Int J Oral Maxillofac Implants 2023;38:417-421. doi: 10.11607/jomi.10285.

It is important for dental researchers to have a general idea of the different types of data that can be collected from a study and the available statistical tools that can be used with such data. By knowing about what is available, researchers will have an informed idea of the types of studies that should be conducted, the data that should be collected, and the proper statistical methods for analyzing collected data. In the first part of this general overview of statistical methods, we walked through the various types of data that traditional statistical techniques, such as t tests and linear regression, can handle. In this second part, we explore more complex types of data that traditional statistical techniques are unable to handle. Specifically, we discuss longitudinal and time-to-event data because both occur frequently in dental studies and require special modeling techniques in order to analyze correctly. Using two different simulated dental datasets, the proper application of techniques such as repeated measures ANOVA, linear mixed modeling, generalized estimating equations, log-rank test, and Cox proportional hazards models are discussed and illustrated in depth.

One of the most important parts of any research project is the statistical analysis through which results are described and deemed significant or otherwise. Given this role of statistical analyses, it is imperative to understand what statistical tests are available and, most importantly, when they are appropriate. This is because choosing an improper statistical test can lead to inaccurate results and meaningless conclusions. We have written this data analysis guide to assist dental researchers with carrying out a proper analysis plan in consultation with a statistician. In this first part, we detail common types of outcome and predictor variables and include some common tests that can be used for each scenario. Using different simulated datasets, we also provide examples of common data visualization techniques and how a proper statistical test can be applied. We hope this guide provides some general background knowledge on common statistical techniques and allows for easier and more effective conversations with your statistician.

AbstractPurpose/AimTo investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care.Materials and MethodsDe‐identified data was collected from electronic health records of 18‐year‐old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care.ResultsSample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits.ConclusionsOnly one in every three adults with autism had at least one preventive dental visit per year.

OBJECTIVES:Some non-cavitated caries lesions (D1 ), the initial stage of caries, progress to cavitation. This article reports participant-level and surface-level D1 prevalence and changes in status of D1 lesions through different periods from age 9 to 23. METHODS:The Iowa Fluoride Study (IFS) participants were followed longitudinally; all permanent tooth surfaces were examined clinically for caries at ages 9, 13, 17, and 23 using standardized criteria for sound (S), questionable (D0 ), non-cavitated (D1 ), cavitated (D2+ ), filled (F), or missing due to decay (M). D1 lesions at the beginning of each interval were reassessed at each follow-up age to determine transitions (to the 5 categories or no transition). RESULTS:The sample had relatively high socioeconomic status (SES), with about 52%-55% high SES, 32-35% middle SES, and 12-13% low SES. Person-level prevalences of D1 lesions were 23%, 38%, 60%, and 45% at ages 9, 13, 17, and 23, respectively. Surface-level prevalences were less than 1% at ages 9 and 13, 3% at 17, and 2% at 23. Thirteen percent of D1 s at age 9 progressed at 13, 18% progressed from 13 to 17, and 11% progressed from 17 to 23. The percentages regressing (to sound or D0 ) were 72%, 54%, and 72%, respectively. CONCLUSION:Non-cavitated lesions were more prevalent at age 17 than at ages 9, 13, and 23. The high rates of regression compared to progression or no change suggest that many non-cavitated lesions do not progress to cavitated lesions and could be reversed; therefore, surgical intervention should not be the treatment of choice for incipient lesions.

Individuals with orofacial clefting (OFC) have a higher prevalence of tooth agenesis (TA) overall. Neither the precise etiology of TA, nor whether TA occurs in patterns that differ by gender or cleft type is yet known. This meta-analysis aims to identify the spectrum of tooth agenesis patterns in subjects with non-syndromic OFC and controls using the Tooth Agenesis Code (TAC) program. An indexed search of databases (PubMed, EMBASE, and CINAHL) along with cross-referencing and hand searches were completed from May to June 2019 and re-run in February 2022. Additionally, unpublished TAC data from 914 individuals with OFC and 932 controls were included. TAC pattern frequencies per study were analyzed using a random effects meta-analysis model. A thorough review of 45 records retrieved resulted in 4 articles meeting eligibility criteria, comprising 2182 subjects with OFC and 3171 controls. No TA (0.0.0.0) was seen in 51% of OFC cases and 97% of controls. TAC patterns 0.2.0.0, 2.0.0.0, and 2.2.0.0 indicating uni- or bi-lateral missing upper laterals, and 16.0.0.0 indicating missing upper right second premolar, were more common in subjects with OFC. Subjects with OFC have unique TA patterns and defining these patterns will help increase our understanding of the complex etiology underlying TA.

When a clinician sees a patient with a complication, they often go through a Bayesian style of logic, most likely without even knowing it. They assess whether they have seen the complication before, provide an intervention based on historical knowledge of what leads to improvement, and then later assess how the intervention is performed. This process, which is routine in clinical practice, can be mathematically extended into an alternative way of performing statistical analyses to assess clinical research. However, this process is contrary to the most common statistical methods used in dental research: frequentist statistics. Though powerful, frequentist methods come with advantages and disadvantages. Bayesian statistics are an alternative method, one that mirrors how we as researchers think and process new information. In this primer, a walkthrough of Bayesian statistics is performed by constructing priors, defining the likelihood, and using the posterior result to draw conclusions on parameters of interest. The motivating example for this walkthrough was a Bayesian analog to logistic regression, fit using a simulated dental-related dataset of 50 patients who received a dental implant-classified as either within or outside normal limits-from practitioners who did or did not receive a training course in implant placement. The results of the Bayesian and traditional frequentist logistic regression models were compared, resulting in very similar conclusions regarding which parameters seemed to be strongly associated with the outcome.

The intersection between the human oral microbiome and oral health is an emerging area of study which has gained momentum over the last decade. This momentum has motivated a search for associations between the oral microbiome and oral cancer, in hopes of identifying possible biomarkers that facilitate earlier diagnosis and improved prognosis for patients with that disease. The present study examined the relationship between the microbiome in the human oral cavity and oral squamous cell carcinoma (OSCC). We searched the literature for case-control studies which focused on the relationship between the human oral microbiome and OSCC. We aggregated three types of data from these studies: bacteriome data at the genus level, predicted functional pathway data, and gene abundance data. From these data, we noted several microbial genera which may be associated with oral cancer status, including Fusobacterium. We also identified functional pathways which merit further investigation, including RNA degradation (ko03018) and primary immunodeficiency (ko05340). In addition, our analysis of gene abundance data identified the gene K06147 (ATP-binding cassette, subfamily B, bacterial) as being over abundant in OSCC samples. Our results are generalizations which identified some currents that we believe could guide further research. Our work faced several limitations related to the heterogeneity of the available data. Wide variation in methods for sample collection, methods for controlling for known behavioral risk factors, computing platform choice, and methods for case-control design all posed confounding factors in this work. We examined the current methods of data collection, data processing, and data reporting in order to offer suggestions toward the establishment of best practices within this field. We propose that these limitations should be addressed through the implementation of standardized data analytic practices that will conform to the rigor and reproducibility standards required of publicly funded research.

BACKGROUND:Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs.METHODS:This mixed-method study included 49 English-speaking PRPC (age≥18) recruited from the University of Iowa Palliative Care Clinic. Participants first completed a structured review of oral symptoms, followed by an oral exam. A nested sample of 11 participants also completed a semi-structured, in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation.RESULTS:Participants averaged 58.4 years. Nearly 70% had terminal cancer and 25% had advanced organ failure. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). Among the 31 dentate participants, 52% had untreated decayed/broken teeth and 33.3% had oral soft tissue lesions. Ill-fitting dentures and denture sores were common among denture users. About 40% of participants reported compromised health and/or quality of life due to oral conditions; however, the perceived impacts were modest. With the exception of painful conditions, oral treatment was not a priority for most of the participants.CONCLUSION:Oral disease was highly prevalent in PRPC, yet its overall impact was modest. In the absence of painful symptoms, most participants reported limited desire to seek treatment for oral health conditions. However, given the serious impacts of untreated oral diseases, oral healthcare decision should not be based solely on self-reported symptoms or distress.

Purpose/aim: To analyze potential factors associated with levels of selected oral pathogens, as well as total aerobic bacterial species, among nursing home residents. Materials and methods: Nursing home residents were divided into three groups (G1 included people with teeth but no dentures, G2 included people with teeth and dentures, and G3 included people with no teeth and with dentures). All participants had microbiological samples collected from their oral cavity and dentures. Counts of total aerobic bacterial species, Porphyromonas gingivalis, Fusobacterium nucleatum, Actinomyces viscosus, Aggregatibacter actinomycetemcomitans, and Candida albicans were compared among groups using the Wilcoxon rank sum test. A multivariate analysis was also performed to control other available covariates. Results: Bivariate analysis revealed significant differences among the groups, and multivariate analysis showed that sex, the presence of natural teeth, denture wearing, oral hygiene indices, and systemic health conditions were associated with bacterial and Candida albicans log counts. Conclusions: Presence of natural teeth and denture wearing, as well as oral hygiene, sex and systemic health conditions were associated with bacterial and Candida albicans log counts among nursing home residents.