PURPOSE/ OBJECTIVES:The aim of this study was to evaluate the impact of race-blind admissions policies on the recruitment and enrollment of a single, university-based, pathway program. METHODS:Programmatic data were used to conduct a retrospective cohort study of applicants to the pathway program, Saturday Academy at New York University College of Dentistry, during the period of race-conscious admissions practices (2023) and after the implementation of race-blind admissions policies (2024). Chi-squared, Fisher's exact, and Z-tests were used to compare demographic characteristics reported by program applicants and enrollees. RESULTS:No statistically significant differences were observed in the demographics of the applicant pool between 2023 and 2024, as it related to gender, ethnicity, race, use of federal/ state assistance programs, or first-generation college status. No statistically significant differences could be observed between Saturday Academy enrollees in 2023 and 2024 as it related to gender and use of federal/ state assistance programs. There was a 46.2% (p = 0.002) decrease in the proportion of Hispanic students and a 74.4% (p = 0.001) decrease in the proportion of Black students admitted to the program in 2024. Also in 2024, there was a 119.8% (p = 0.004) increase in the proportion of Asian American students admitted, and the proportion of students who self-identified as first-generation college students increased 27% (p = 0.03). CONCLUSION:The effective federal ban on race-conscious admissions practices is likely to compromise the ability of pathway programs to significantly contribute to the development of a healthcare workforce that is representative of the demographics of the US population.

INTRODUCTION:The aims of this study were to evaluate the decision to extract or treat a tooth with initial root canal therapy (RCT) made by general dentists practicing in the United States; and evaluate the effect of clinical and nonclinical factors on decision-making. METHODS:Authors conducted a cross-sectional survey study. Participants read a vignette presenting a questionably restorable tooth for consideration and provided their clinical recommendations. The primary treatment decision was analyzed as a binary variable: tooth extraction or RCT. Other questions about clinical decision-making used the Likert-scale for capturing responses. Clinician-related variables were evaluated as follows: age, gender, years of experience, primary practice setting, and participation with payment systems. Kruskal-Wallis tests were used to compare the treatment decision with Likert-scale responses for clinical decision-making. A logistic regression model investigated the effect of clinician factors on the treatment decision. RESULTS:One hundred thirteen eligible dentists completed the survey. For the presented case, a maxillary first molar, 54% of general dentists recommended initial RCT, and 46% recommended extraction. 37.2% of dentists responded that the patient's tooth was somewhat or very likely restorable. None of the evaluated clinician factors were statistically significant in predicting the treatment decision. Borderline significance (P = .05) was noted for general dentists primarily practicing in academic settings; they had 3.57 times the odds of recommending tooth extraction than dentists primarily in private practice (P = .05). CONCLUSIONS:This study found that general dentists' decision to either save a tooth with initial root canal therapy or extract was primarily associated with perceived tooth restorability.

Objectives:This study aims to examine the impact of the COVID-19 public health emergency on state-level dental service utilization, focusing on endodontic care; and to understand how benefit design and coverage influence healthcare disparities in oral health. Methods:The data comes from the 2019-2021 Centers for Medicare & Medicaid Services (CMS) unredacted Transformed Medicaid Statistical Information System (T-MSIS). State-level coverage was collected from state Medicaid program provider manuals. We analyzed service utilization rates overall and by demographic factors such as age, sex, and race/ethnicity. Chi-square tests were used to test for significant differences in the rates across the years and within each group. Clustered-robust standard error models were used to predict the odds of receiving an endodontic service. Results:The COVID-19 pandemic significantly disrupted dental service utilization across the United States, with a marked decrease in preventive and routine dental care. Utilization of endodontic services experienced less of a decline during the pandemic and a significant increase post-pandemic, compared to other dental services. States with more comprehensive Medicaid dental benefits design had significantly higher rates of endodontic service utilization for children and adults. Among children, increased age, female gender, and non-Hispanic Black race/ ethnicity were significantly associated with lower levels of endodontic service utilization. Among adults, rural residence designation was significantly associated with lower levels of endodontic service utilization. Conclusion:The study highlights the critical role of benefit design in ensuring dental service utilization, particularly during public health emergencies. Oral health stakeholders must recognize the potential long-term consequences of delayed dental care and remain innovative in providing care under limited circumstances.

PURPOSE/OBJECTIVES:The aim of this study was to assess predoctoral dental students' satisfaction with faculty-created educational content, aimed at reducing perceived barriers to achieving clinical competency in endodontics. METHODS:This mixed-methods study was conducted with third (D3)- and fourth (D4)-year dental students at New York University College of Dentistry. Focus groups were held to collect qualitative data after initial drafts of clinical instructional videos were made. Surveys were then sent to four randomized groups of D3 and D4 students to collect quantitative data regarding satisfaction with final versions of the instructional videos. RESULTS:Qualitative data indicated that D3 and D4 students valued different things when evaluating the instructional videos. D3 students were likely to express positive feedback about background information and the explanation of fundamental concepts. Alternatively, D4 students were more likely to express positive feedback about the enhanced visualization that filming through the clinical operating microscopes afforded. Both groups were adept at pointing out inconsistencies between the presented video content and their formal, didactic curriculum. Quantitative data indicated that all respondents (100%) would be willing to watch these videos if they were integrated into their dental school curriculum. Student respondents indicated relatively equal preferences between having the videos published on YouTube/social media (51%) or on an NYU-affiliated platform (49%). CONCLUSION:Students expressed satisfaction with faculty-created educational videos, with D3 and D4 students valuing different aspects of the content. Partnering with dental students helps ensure that created content is reflective of students' curriculum and responsive to their preferred learning styles.

INTRODUCTION:Medicaid is the largest source of health coverage in the United States and provides dental benefits to eligible low-income families. Federal policies establish minimum dental service requirements for children, while states have flexibility regarding the coverage of dental services for adults in any capacity. The objective of this study was to evaluate endodontic procedure coverage, reimbursement, and dentist participation for Medicaid beneficiaries. METHODS:This retrospective, cross-sectional study evaluated child and adult dental Medicaid benefits in 2021. For children, 18 endodontic procedure codes were evaluated; 16 were evaluated for adults. Mapping was used to depict state-level coverage of procedures. Logistic regression analyses were conducted to evaluate the odds of procedural coverage. RESULTS:For children and adults, initial root canal therapy was the most routinely covered endodontic procedure category; and molar teeth were the least likely tooth type to be covered. States were more likely to have established payment policies for vital pulp therapy procedures for children than for adults. For children and adults, geographic region was significantly associated with Medicaid coverage of endodontic procedures. Endodontic procedure reimbursement rates ranged from $7.00 to $1113.87 (median, $251.00). Overall, adult procedures tended to have lower reimbursement rates than child procedures at the category level but had a higher overall median reimbursement rate. Median endodontist participation for child dental services was 24%. CONCLUSIONS:Gaps in endodontic coverage exist for Medicaid beneficiaries. Endodontic treatments for molar teeth, vital pulp therapy, and regenerative endodontic procedures are the least consistently covered.

INTRODUCTION:The purpose of this study was to evaluate long-term outcomes of nonsurgical retreatment (NS-ReTx) procedures performed by a single endodontist in private practice. METHODS:This retrospective cohort study evaluated NS-ReTx procedures performed between the years 1986 and 2019, meeting the following inclusion criteria: minimum of 1-year follow-up and preoperative, postoperative, and follow-up radiographs available for analysis. Procedures were evaluated clinically and radiographically, and treatment outcomes were reported. A subset of cases included cone-beam computed tomography (CBCT) images and CBCT-assessed periapical healing was reported for these cases. The effect of clinical factors on radiographic healing was assessed using a Cox proportional hazard regression model. The Kaplan-Meier method estimated the probability of tooth survival at each year of follow-up. RESULTS:A total of 241 NS-ReTx procedures from 202 patients met the inclusion criteria. The median patient age at time of NS-ReTx was 54 years. Molars were the most frequently treated tooth type, 57.68%. Radiographic healing at the median follow-up time, 9.14 years (n = 231) was 64.07% healed (148 of 231), 7.36% healing (17 of 231), and 28.57% unhealed (66 of 231). An additional 10 teeth were extracted before any radiographic follow-up. CBCT-assessed periapical healing ("strict" criteria) was 65.63% over a median follow-up time of 9.18 years. Tooth survival following NS-ReTx was 93.3% at 5 years and 85.3% at 10 years. CONCLUSIONS:The study demonstrates that radiographic periapical healing and treatment success improve over time and that tooth survival following NS-ReTx is favorable long-term.

In the United States (U.S.), 23% of adults aged 18 or older were reported to have a mental health, behavioral, or emotional disorder in 2022 [1]. The prevalence is even higher for young adults in the age range that encompass the typical dental student (18–25), reaching 36% [1]. Navigating through health professional education is challenging, resulting in elevated levels of stress, depression, and anxiety among health professional students [2]. Research indicates that dental students in the U.S. have mental health disorders at rates comparable to or higher than those of medical students, and notably higher than the general population [2-4]. Efforts to address mental health concerns in dental education have been studied more internationally than in the U.S [5]. The purpose of this perspective paper is to serve as a call to action to address mental health concerns among dental students and increase awareness of evidence-based interventions that may be utilized to support the mental health of students in U.S. dental schools. The prevalence of depressive symptoms among U.S. dental students has been associated with several demographic characteristics: self-reported racial/ethnic minority status [6] and first-generation college status [4]. Other demographic characteristics, such as gender and year in dental school, have inconsistently reported associations with the prevalence of depressive symptoms [2–4, 7]. Students who are underrepresented in health professional education, such as racial/ethnic minorities and first-generation college students, were more likely to have depressive symptoms [3, 5]. This could be a reflection of institutionally related challenges, such as lack of representation in dental faculty or discrimination [8]. Beyond demographic characteristics, intrinsic and environmental-related factors contributing to stress during dental education include academic pressure, perfectionism, low self-esteem, financial insecurity, and prevalence of pain/injury [3, 5]. Particularly relevant to dental students is the prevalence of pain/injury, which has been associated with depressive symptoms in this population [5]. In addition to the general deleterious impact of pain on mental health, physical pain and injury experienced by dental students may cause stress about long-term career viability and financial security due to the physical demands of practicing clinical dentistry [5]. The COVID-19 pandemic heightened awareness of mental health issues globally, including within dental education [7]. The pandemic introduced novel stressors to dental education: social isolation, worries about personal health, worries about health of family members, and a need to adapt to new educational methodologies. These pandemic-related stressors exacerbated existing mental health concerns [7]. Findings of the 2022 American Dental Education Association Climate Study found that less than 60% of members of U.S. dental schools agreed or strongly agreed that they were satisfied with the climate at their dental school [9]. Further, the well-being of students enrolled in U.S. dental schools was lower than that of administrators, faculty, and staff [9]. These recent findings indicate a need for increased sensitivity, and resources to support initiatives directed at improving mental health concerns among U.S. dental students. Areas of intervention and support for mental health include primary prevention, secondary prevention, and tertiary prevention [5]. The strategies that have been studied in dental schools, specifically, are summarized in Table 1 [5]. Each level of prevention addresses mental health challenges differently, aiming to create a comprehensive support framework for students. Primary prevention involves creating environments that reduce stressors in the academic setting. Unfortunately, primary prevention strategies are limited in dental education, with few initiatives targeting the root causes of stress. Globally, a systematic review revealed a lack of studies focused on primary prevention in dental education, underscoring the need for further efforts in this area [5]. Secondary prevention encompasses psychoeducational interventions and stress-management training [5]. Programs aimed at decreasing imposter syndrome, stress, and anxiety are commonly implemented, helping students develop coping skills essential for academic and personal development [4]. Additionally, resiliency training has gained popularity, with evidence showing it can reduce burnout in healthcare students [5, 10]. Tertiary prevention typically involves counseling services for students experiencing acute mental health issues [4]. In the U.S., counseling services are often embedded in dental schools to provide accessible support tailored to the unique stressors faced by dental students [5, 10]. Training to decrease imposter syndrome [5] Training to decrease stress and anxiety [5] Resiliency assessment and training [10] Of the services and interventions (secondary and tertiary) that have been systematically evaluated in dental education, tertiary-level services appear to have the most significant impact on dental students. This is consistent with evidence from other areas of the health sector, which suggests that secondary prevention efforts have small but statistically significant effects on reducing stress levels and burnout in healthcare professionals [5]. Thus, efforts to promote the utilization of tertiary-level interventions, such as professional counseling services, by students are essential. Anecdotal evidence suggests that dental schools are making efforts to provide tertiary-level services and interventions to improve the mental health of students. The model of "embedding" counseling services within the dental school was validated by reports that counselors working specifically with dental students had greater understanding of the nuances of the dental school environment [5]. This "embedded" model facilitated the use of counseling services [5]. In a U.S. context, the demographics of dental students who utilized counseling services embedded within a dental school setting predominately identified as white, heterosexual, women. Only a small percentage of racial/ethnic minority of students with depressive symptoms accessed professional help, despite the availability of these services being widely known [4, 5]. This finding suggests that there may barriers to the use of these services for populations of students that are underrepresented in dental schools. Documented barriers to the use of professional mental health services include the following: lack of time, a barrier expressed more predominately by dental students than other health professional students; fear of documentation; fear of unwanted intervention; fear of lack of confidentiality and stigma [4]. Consistent with the reported barriers associated with fear, in a U.S. context, students reported an increased willingness to access counseling services after the office was relocated to a more confidential setting within the dental school [5]. The absence of documented primary-level interventions aimed at mitigating sources of stress that are inherent to the dental school environment are notable. The absence of these interventions likely limits the ability of dental institutions to significantly address the mental health of students. Unless attempts are made to address sources of stress in the dental school environment and reduce stigma around seeking help for mental health disorders, stand-alone secondary and tertiary interventions are unlikely to be effective long-term [5]. From our perspective, the mental health of dental students is a critical issue that must be addressed. There is ample evidence that mental health disorders are widespread among university-aged students, even prior to their matriculation to dental school [1]. After enrolling in dental school, there is evidence that existing mental health disorders may be exacerbated and the prevalence of these disorders will increase [3, 5, 6]. Given these insights, it is crucial for educational institutions to support students' mental health through primary-, secondary-, and tertiary-level prevention efforts. Our recommendations are summarized in Table 2. If left unaddressed, mental health disorders among dental students will continue into practice as health professionals. Mental health disorders in health professionals have been associated with higher rates of burnout, a concern for workforce sustainability [5]. Ultimately, mental health disorders in health professionals can also lead to a lower quality of care for patients [5]. The prevalence of mental health disorders among dental students represents a significant concern, with far-reaching implications for both academic success and the delivery of patient care. The challenges within dental education are multifaceted, encompassing academic pressures, physical demands, financial constraints, and internalized expectations of perfectionism. These pre-existing challenges were compounded by the unprecedented impact of the COVID-19 pandemic. The COVID-19 pandemic may have introduced new challenges for contemporary dental students, such as social isolation. Notably, these stressors often intersect with students' demographic characteristics, such as race/ethnicity, sexual orientation, first-generation college status, and socioeconomic status. These intersections can compound mental health struggles, creating a nuanced and complex picture. The primary-level stressors contributing to mental health disorders among dental students are both environmental and intrinsic. Heavy academic workloads, physical demands, financial strain, and social isolation emerge as significant environmental stressors. Meanwhile, intrinsic factors such as perfectionism, performance pressure, and feelings of inadequacy also contribute to the complex landscape of mental health challenges in dental education. To effectively support student mental health, dental institutions must go beyond supporting individual coping mechanisms, by promoting broader cultural changes within the academic environment. This holistic approach is crucial to addressing both individual and systemic challenges. Recommendations put forth in the literature advocate for multifaceted strategies encompassing various aspects of student life. These strategies include initiatives aimed at supporting incoming students with pre-existing mental health concerns, interventions embedded within the curriculum to reduce stress, and the creation of a supportive environment through counseling services and community-building programs. While some progress has been made, many mental health interventions, such as counseling services and stress-management training, do not address root causes within the academic structure. Innovative approaches are needed, such as technology-driven mental health applications, enhanced peer support networks, and partnerships with mental health organizations. These strategies have the potential to combat the stigma surrounding mental health and build a more robust support system. Embedding mental health support structures within the educational framework, alongside promoting a culture of support among faculty, staff, and students, is essential. Our recommendations emphasize a comprehensive approach that aims to proactively identify and support at-risk students. Furthermore, these recommendations highlight the significance of comprehensive medical coverage and de-stigmatized approaches for students facing academic challenges related to mental health. In conclusion, the mental health of dental students cannot be overlooked. As future healthcare providers, these students' well-being impacts not only their success in school but also the broader healthcare system. A commitment to mental health in dental education—through a mix of individual support, environmental adjustments, and community engagement—will lay the foundation for a more resilient, inclusive, and compassionate dental profession. By investing in comprehensive support structures, dental institutions can help bridge the gap between academic rigor and mental health resilience, empowering students to thrive personally and professionally. The authors of this study participated in the American Dental Education (ADEA) Leadership Institute, 2023–2024 The authors declare no conflicts of interest.

Background Clinical approaches for pediatric patients requiring endodontic treatment have been associated with specialty type.Aim The purpose of this study was to elucidate the nuanced clinical decision-making process for endodontic treatment of pediatric patients' permanent teeth.Design A qualitative design was used to explore the experiences and decision-making of general dentists, pediatric dentists, and endodontists. Clinicians practicing in the United States were recruited to interview using purposive sampling methods. A framework, thematic analytic approach was used to evaluate the data.Results In total, 26 dentists participated in the study: 7 general dentists, 11 pediatric dentists, 6 endodontists, and 2 dual-trained specialists. Overall, clinicians reported that caries on permanent first molars were the most common reason that pediatric patients required endodontic treatment. Access to care was influenced by practitioner clinical training and knowledge; patient behavior; and financial considerations. Treatment planning was influenced by parents, referrals, and clinical philosophy.Conclusions The findings explain how clinician decision-making and system-level factors influence access to care for pediatric patients in need of endodontic treatment and propagate oral health disparities. Barriers to accessing care were most limiting for children and adolescents from low-income households and were likely to result in premature tooth loss.

BACKGROUND:Evidence suggests that pediatric patients requiring endodontic treatment in the permanent dentition are often a "missed population". AIM:This study surveyed pediatric dentists and endodontists about the frequency with which they encounter pediatric patients requiring endodontic treatment, their training, practice patterns, and decision-making considerations for the treatment of immature permanent teeth. DESIGN:Surveys were distributed to endodontists (n = 2457) and pediatric dentists (n = 3974) in the United States. Data were analyzed using descriptive statistics and X2 analysis. The level of significance was set at 0.05. RESULTS:The response rate was 13.1% (n = 840). The frequency of clinicians encountering pediatric patients requiring endodontic treatment for permanent teeth did not differ significantly by specialty. Pediatric dentists and endodontists reported statistically significant differences in their practice patterns related to the performance of vital pulp therapy (p < 0.001) and procedures for necrotic immature permanent teeth (p < 0.001). Among specialists, apexification was more frequently performed than regenerative endodontic procedures (REPs) (p < 0.001). When asked to consider clinical and patient factors related to the treatment of necrotic immature permanent teeth, pediatric dentists most frequently responded that they were "unsure" of their preferred treatment. CONCLUSION:Standardized clinical knowledge and management of immature permanent teeth between specialties may improve interdisciplinary care for pediatric patients.

Introduction: This study aimed to investigate access to care and financial considerations associated with the endodontic treatment of immature permanent teeth. Methods: Surveys were distributed to endodontists (n n = 2,457) and pediatric dentists (n n = 3,974) in the United States. Data were analyzed using X-2 analysis and logistic regression. The level of significance was set to 0.05. Results: The response rate was 13% (n n = 840). Respondent specialist groups were similar by age and years since specialty residency completion, but significantly different with regard to primary practice setting (eg private practice, Federally Qualified Health Center, hospital), (P P = .001). The majority (91%) of respondents reported participation with dental insurance. Pediatric dentists (69%) were significantly more likely than endodontists (17%) to participate with public-payer dental insurance (P P < .001). The majority of respondents (82%) indicated that patients reported economic factors (time or money) as a barrier to accessing endodontic treatment. Pediatric dentists were significantly more likely to consider economic factors when planning for treatment (P P < .001). Pediatric dentists were more likely than endodontists to have the opinion that endodontic procedures for treatment of necrotic immature permanent teeth should cost less than root canal therapy (apexification, P < .001; regenerative endodontic procedures, P = .002). Pediatric dentists (33%) reported encountering barriers when attempting to refer their patients to an endodontist. Inability to find an endodontist that participates with dental insurance was the most frequently cited barrier. Conclusions: Limited clinician participation with dental insurance and gaps in insurance coverage for endodontic procedures appear to contribute to access to care barriers for pediatric patients.

BACKGROUND:Historical reports of unpredictable outcomes associated with vital pulpal therapies, particularly direct pulp capping (DPC), have contributed to clinicians' skepticism of the procedure. Contemporary reports highlight more predictable outcomes of vital pulpal therapies, inclusive of DPC. There is a dearth of reported patient-centered outcomes of these procedures. METHODS:Insurance claims were used in an observational, retrospective cohort study to evaluate outcomes of DPC performed on permanent teeth. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Log-rank tests were used to evaluate unadjusted differences in survival. Cox proportional hazard regression was used to evaluate the adjusted hazard of adverse event occurrence. RESULTS:The analytic cohort included 4,136 teeth from 3,716 patients. DPC procedures were identified in public-payer (85.5%) and private-payer (13.4%) insurance claims databases. After DPC, procedure survival rate was 83% and tooth survival rate was 93% during a mean follow-up time of 52 months. Molar tooth type, same-day permanent restoration placement, and amalgam restoration type were significant positive predictors of procedure (DPC) survival. Age was not a statistically significant predictor of procedure survival after controlling for tooth type, gender, time to restoration, and restoration type. Nonmolar tooth type and younger age were significant positive predictors of tooth survival after DPC. Failures were most likely to occur within the first year. CONCLUSIONS:DPC has favorable patient-centered outcomes and contributes to long-term tooth survival. PRACTICAL IMPLICATIONS:The favorable patient-centered outcomes of DPC bolster calls to consider cost-effectiveness and access to care for endodontic procedures.

BACKGROUND:Dental schools aim to train and support a diverse dentist workforce. Among all faculty, full-time and part-time faculty who identify as members of historically underrepresented groups are 13.9% and 8.4%, respectively. The recruitment and retention of faculty is a known challenge, with growing faculty vacancies at dental schools. This study explored dental student perceptions of academic careers, specifically focusing on Black and Hispanic predoctoral students.METHODS:From August to November 2022, we conducted focus group with second-, third-, and fourth-year predoctoral dental students who identified as Black or Hispanic using a semi-structured interview guide that was developed for this study. Data were analyzed using inductive thematic analysis.RESULTS:Four themes emerged: (1) students perceived academic dental dentistry as inclusive but not diverse spaces for Black and Hispanic people; (2) academic dental careers were perceived as secondary careers; (3) academic dental careers were perceived as a career option with a lack of autonomy and less income, compared to clinical practice in other settings; (4) students expressed a lack of knowledge about pathways to academic dental careers. Despite these challenges, students expressed interest in academic dental careers and noted being inspired by younger faculty members.CONCLUSION:Dental schools must do more to encourage dental students to consider careers in academic dentistry. Pathway programs, mentoring, and the presentation of academic careers as a viable career option for students by faculty should be further emphasized practices. Increasing the diversity of faculty members is also key. Students cannot be who they cannot see.

BACKGROUND:Successful pathway programs require early and sustained support of student participants.PURPOSE:We present the history and outcomes of a successful decade of continuous, grassroots, pathway programming at an individual dental institution.METHODS:Programmatic data were used to evaluate information on program participant demographics, academic pursuits, and career interests. Descriptive analyses were used to report on program enrollment as well as alumni academic and career outcomes.RESULTS:Between the years of 2013 and 2022, 346 high-school students participated in Saturday Academy at NYU Dentistry. Of the 240 college-aged and older program alumni, 72% (n = 172) have shared their academic and career plans after high-school. At the time of publication, 78% (134/172) of alumni that have maintained contact with Saturday Academy and have expressed interest in pursuing a career in the health professions. Of the 172 alumni, 14% (n = 24) have enrolled in or graduated from a health professional program (dental hygiene, nursing, accelerated dental or medical program, dental or medical school, or other health professional program). Of these alumni (24/172), half (n = 12) have pursued education in the dental professions, specifically.CONCLUSION:Saturday Academy at NYU Dentistry is an example of a sustainable and impactful pathway program in dental education and its outcomes support the merit of calls for increased institutional commitment and support of similar initiatives.

Journal of Dental EducationVolume 87, Issue 9 p. 1215-1216 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 87 Number 9/August 2023 First published: 31 August 2023 https://doi.org/10.1002/jdd.12990AboutPDF 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume87, Issue9September 2023Pages 1215-1216 RelatedInformation

INTRODUCTION:This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the tooth-level. METHODS:Dental insurance claims data from New York State (2006-2019) and Massachusetts (2013-2018) were used in an observational, retrospective cohort study to evaluate the provision and treatment outcomes of apexification. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Cox proportional hazard regression was used to evaluate the hazard of adverse event occurrence by age, gender, tooth type, placement of permanent restoration, and dental provider type. A sensitivity analysis evaluated potential bias in the survival estimates and adjusted hazard ratios (aHRs) due to differential loss to follow-up. Robust standard errors were used to account for potential dependence between teeth within an individual. RESULTS:The analytic cohort of 575 individuals included 632 teeth, with an average follow-up time of 64 months. The survival rates of apexification procedures were 95% at 1 year; 93% at 2 years; 90% at 3 years; and 86% at 5 years. Tooth retention following apexification was 98% at 1 year; 96% at 2 years; 95% at 3 years; and 90% at 5 years. Tooth type and subsequent placement of a permanent restoration were significant predictors of survival after apexification. CONCLUSIONS:The procedural and tooth survival outcomes of apexification were high and comparable to studies that analyzed clinical data on tooth survival following apexification.

This study assessed if higher levels of self-reported stress were associated with self-reported oral health-related quality of life (OHRQoL) among a sample of college-educated Black men. Using a community-based participatory approach, a questionnaire was developed and distributed using two validated instruments, the Holmes-Rahe Stress Inventory and the Oral Health Impact Profile-14. Eighty men completed the questionnaire, with 58.8% reporting Holmes-Rahe scores above 150 (mean=209, SD=175.2). The highest OHIP-14 mean ratings on a scale of 0 to 3 were for feeling self-conscious (mean=.67), painful aching (mean=.55), feeling embarrassed (mean=.49), and eating discomfort (mean=0.48). Among participants with Holmes-Rahe Stress Inventory scores above 150, mean OHRQoL levels were significantly higher for domains of painful aching (p=.007), eating discomfort (p=.038), feeling self-conscious (.006), and experiencing tense feelings (.049). Higher stress levels may be associated with college-educated Black men's experiences of oral health-related physical pain and psychological discomfort.

Journal of Dental EducationVolume 86, Issue 7 p. 769-770 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 86 Number 7/July 2022 First published: 20 July 2022 https://doi.org/10.1002/jdd.12672AboutPDF 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 No abstract is available for this article. Volume86, Issue7July 2022Pages 769-770 RelatedInformation

Abstract Background Previously published epidemiological outcome studies of nonsurgical root canal therapy (NSRCT) in the United States utilize data only from a single, private dental insurer for adult populations. Aim This study aimed to investigate the outcomes of initial NSRCT, performed on permanent teeth, in a publicly insured paediatric population. Design New York State Medicaid administrative claims were used to follow 77 741 endodontic procedures in 51 545 patients aged 6–18, from the time of initial NSRCT until the occurrence of an untoward event (retreatment, apicoectomy, and extraction). The initial treatment and untoward events were identified by Current Dental Terminology codes. The Kaplan–Meier survival estimates were calculated at 1, 3, and 5 years. Hazard ratios for time to permanent restoration and restoration type were calculated using the Cox proportional hazards model. Results The median follow‐up time was 44 months [range: 12–158 months]. Procedural, NSRCT, survival was 98% at 1 year, 93% at 3 years, and 88% at 5 years. Extraction was the most common untoward event. Teeth permanently restored with cuspal coverage had the most favorable treatment outcomes. Conclusions Overall, 89% of teeth were retained and remained functional over a minimum follow‐up time of 5 years. These results elucidate the expected outcomes of NSRCT in permanent teeth for paediatric patients with public‐payer dental benefits.

Objectives This study investigated differences in the provision of root canal therapy and outcomes in a publicly insured cohort of children and adolescents. Methods New York State Medicaid administrative claims from 2006 to 2018 were analyzed. Enrollees aged 6–18 were included in the study if they had initial non-surgical root canal therapy (NSRCT), in the permanent dentition, that allowed for at least 1 year of post-treatment follow-up. Descriptive analyses, multivariable logistic regression, and multivariable Cox proportional hazard models were used to examine the association between demographic variables (gender, age, race/ethnicity, and area-based factors) and dental treatment provision and outcomes. Results Male gender was associated with having more than one initial NSRCT (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) = 1.02–1.10), as was rurality (aOR = 1.15; 95% CI = 1.06–1.24). Black/African American (AA) and Hispanic children were less likely than non-Hispanic white children to have multiple NSRCTs (aOR = 0.88; 95% CI = 0.83–0.93 and aOR = 0.78; 95% CI = 0.74–0.83). Being older or female conferred a lower hazard of an untoward event (aHR = 0.93; 95% CI = 0.92–0.94 and aHR = 0.86; 95% CI = 0.81–0.91). Compared to non-Hispanic white children, Hispanic and Black/AA children had a higher risk of untoward event (aHR = 1.31; 95% CI = 1.21–1.41 and aHR = 1.55; 95% CI = 1.43–1.67) while children of Asian descent had a lower incidence after initial NSRCT (aHR = 0.79; 95% CI = 0.71–0.88). Conclusion Race/ethnicity was the strongest demographic predictor of provision of initial non-surgical root canal therapy, subsequent placement of a permanent restoration and the occurrence of an untoward event after NSRCT in this cohort.

BACKGROUND:A comprehensive effort to evaluate outcomes of primary root canal therapy (RCT) between 1966 and 2002 was published by Ng et al. (2007, International Endodontic Journal, 40, 921; 2008, International Endodontic Journal, 41, 6). Changes in endodontic materials and treatment methods warrant an updated analysis of outcomes. OBJECTIVES:This study aimed to (1) quantify the success rates of primary RCT published between 2003 and 2020; and (2) investigate the influence of some characteristics known/suspected to be associated with treatment outcomes. METHODS:An electronic search was performed in the following databases (01-01-2003 to 12-31-2020): Pubmed, Embase, CINHAL, Cochrane and Web of Science. Included study designs were longitudinal clinical studies (randomized control trials, cohort studies, retrospective observational studies). Studies with at least twelve-months of post-operative review and success rates based on clinical and radiographic criteria were analysed. The terms 'strict' (complete resolution of periapical lesion) or 'loose' (reduction in size of existing periapical lesion) were used to describe the outcome criteria. Weighted, pooled success rates were calculated. Random effects meta-regression models were used to investigate potential sources of statistical heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate for quality assessment of the included studies. RESULTS:Forty-two studies were included in the review. Meta-analyses showed that the weighted pooled success rates were estimated to be 92.6% (95% CI: 90.5%-94.8%) under 'loose criteria' and 82.0% (95% CI: 79.3%-84.8%) under 'strict' criteria. The most significant areas of study heterogeneity were year of publication and qualification of operator. The majority (64.29%) of studies were considered to be of low quality of evidence. DISCUSSION:Biological factors continue to have the most significant impact on RCT outcomes. The technological method of instrumentation had no significant effect. The quality of evidence was based primarily on study design and only randomized control trials were considered to be 'high' quality of evidence. CONCLUSIONS:The reported success rates show improvement over time. Weighted success rates for studies with a minimum of four-years follow-up had better outcomes, compared to those with less than four years, when 'strict criteria' were used. REGISTRATION:PROSPERO database (CRD42021226311).