Purpose Non-surgical periodontal therapy (NSPT) is considered to be fundamental in the treatment of periodontal disease. Advanced area specific instruments were designed to increase the clinician's ability to effectively access root furcation areas during NSPT. The purpose of this study was to explore clinical dental hygienists' familiarity, utilization, and perceived efficacy of advanced instruments in root furcation areas during NSPT.Methods A randomized sample (n=3,500) of licensed dental hygienists in Michigan was invited to participate in a paper-based, mail survey. The 10-item instrument consisted of demographic, multiple choice, Likert scale, and open-ended questions. Descriptive and inferential statistics were used to analyze the data.Results A total of 1,156 surveys were returned; 858 met the inclusion criteria for a response rate of 24.5%. Respondents who graduated between 2010-2020 than those who graduated between 1990-1999 were more likely to utilize advanced instruments and those who graduated in 1989 or earlier (16.0% and 19.9% respectively). Respondents familiar with advanced instruments were more likely to use them in furcation areas during NSPT than those less familiar with the instruments (95% CI [18.1, 29.6], p<0.001). Respondents who perceived advanced instruments to be effective in furcation areas were more likely to utilize them (95% CI [1.0, 8.0], p<0.05) during NSPT. Most respondents indicated that they became familiar with advanced instruments during their dental hygiene education or through continuing education courses.Conclusion Familiarity with advanced instruments and perceived efficacy of these instruments for accessing root furcations increased the likelihood of clinical dental hygienists utilizing them during NSPT. Dental hygiene education and continuing education programs should continue to provide opportunities for students and practicing clinicians to learn NSPT instrumentation techniques utilizing advanced instruments designed for furcation access.

Background. In the absence of a full spectrum of evidence-based guidelines for the appropriate use of antimicrobial agents, dentists, including periodontists, remain a highly frequent antibiotic pre-scribing group. With the goal of understanding antibiotic prescribing practices, the authors surveyed a convenience sample of dental practitioners and periodontists to identify differences between the 2 cohorts and assess the factors that affect prescribing practices. Methods. An institutional review board-approved 15-item survey was developed to capture antibiotic prescribing practices addressing the main research question, factors affecting systemic antibiotic prescription patterns, and prescription timing. The authors collaborated with the American Dental Association (ADA) and the American Academy of Periodontology (AAP) for survey dissemination. Responses were summarized using descriptive statistics. Multivariable models were developed to identify antibiotic prescription predictors. Results. Overall, 32.4% of the participants prescribed systemic antibiotics with scaling and root planing. When comparing the 2 groups, the authors found that 46.4% and 18.7% of the AAP and ADA members, respectively, prescribed systemic antibiotics with scaling and root planing (P = .0001). The authors found a significant difference between the AAP and ADA groups in prescription timing (P = .01). The multivariable model revealed that practitioner sex (P = .03), AAP membership (P = .0001), and years of practitioner experience (P = .04) predicted antibiotic prescription practices. The geographic location, practice setting, and occupation type did not predict antibiotic prescription patterns. Conclusion. The authors found a lack of clarity related to prescription timing, factors determining prescription patterns, and selection of patient population who would benefit more from antibiotics. Practical Implications. This study confirmed a lack of clarity related to antibiotic prescription patterns in combination with nonsurgical periodontal treatment.

INTRODUCTION:The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes.OBJECTIVE:This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist.METHODS:In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined.RESULTS:The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting.CONCLUSION:The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting.KNOWLEDGE TRANSFER STATEMENT:The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients' health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.

The advent of the COVID-19 pandemic in the final months of 2019 prompted an extraordinary response on the part of the scientific community, with fundamental research on the biology of the virus and the human immune response, and development of testing, therapeutics, and vaccines occurring on an unprecedentedly short timescale. Within a year after the worldwide outbreak of the disease, more than 40 vaccine candidates had emerged, with 21 candidates in phase 3 trials or already being used on an emergency basis. Many of these vaccines have involved innovative platforms. In this concise review, the authors will summarize the characteristics and performance of the leading vaccines and discuss considerations of virus mutations and asymptomatic spread that may affect the ability of the worldwide community to use these vaccines as a means to defeat the pandemic and restore pre-COVID-19 normality.

PURPOSE/OBJECTIVES:Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care.METHODS:A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data.RESULTS:The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment.CONCLUSION(S):We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.

Journal of Dental EducationVolume 85, Issue 4 p. 445-446 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 85 Number 4/April 2021 First published: 16 April 2021 https://doi.org/10.1002/jdd.12204AboutPDF 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. Volume85, Issue4April 2021Pages 445-446 RelatedInformation

Background The long-term outcomes of acellular dermal matrix (ADM) for the treatment of isolated gingival recessions has not yet been evaluated. Thus, the aim of this study was to observe the root coverage outcomes of coronally advanced flap with ADM over time, and compare them with their adjacent untreated sites. Methods Twelve patients (from 20) were available at the 9-year recall. Clinical parameters (recession depth, mean root coverage [mRC], keratinized tissue width [KTW], and gingival thickness) were evaluated and compared with the 1-year results, and the ADM-adjacent untreated sites (on mesial and distal) via mixed-modeling regression analyses. Results From 1 to 9 years, the ADM-treated isolated recessions showed a relapse from 77% to 62% mRC (P <0.05). A similar pattern toward apical shift of the gingival margin was noticed for the ADM-adjacent untreated sites without baseline recession. However, ADM-adjacent untreated sites which had presented with recession at baseline but were not treated showed a significantly more apical shift of the gingival margin (almost two-fold). A significant increase in KTW was noted for all sites. Baseline KTW >= 2 mm was a significant predictor for the stability of the gingival margin at the ADM-treated, and the ADM-adjacent sites with baseline recession. Conclusions ADM-treated sites displayed recession relapse from 1 to 9 years. The untreated adjacent sites with a recession at baseline, showed a higher apical displacement of the gingival margin compared with the ADM-treated sites, and ADM-adjacent sites without a recession at baseline.

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

BACKGROUND:In 1974, the American Dental Association first considered recommending that dental offices measure blood pressure (BP) routinely, and it has been further encouraged since 2006. Investigators in several dental publications have recommended cancellation of dental procedures based solely on BP greater than 180/110 millimeters of mercury for urgent oral health care and greater than 160/100 mm Hg for elective oral health care, in the absence of prior medical consultation.METHODS:The authors reviewed the evidence for cancellation of any dental or surgical procedures by using an Ovid MEDLINE search for the terms dental, elevated blood pressure, and hypertension. In addition, the authors searched resources at ebd.ada.org using the same criteria. The authors collaborated to develop recommendations in view of 2017 guidelines on this subject.RESULTS:To the authors' knowledge, there are no professionally accepted criteria or study evidence indicating a specific BP elevation at which to prohibit oral health care. Researchers of a 2015 review on management of comorbidities in ambulatory anesthesia failed to find increased morbidity from hypertension in the outpatient setting.CONCLUSIONS:To the authors' knowledge, there are no prospective study investigators that have addressed whether or when to cancel dental procedures due to office-measured elevated BP. The authors recommend using current anesthesiology guidelines based on functional status and past BP measurements to prevent unnecessary cancellations.PRACTICAL IMPLICATIONS:It is seldom necessary to cancel dental procedures on the basis of BP measured before a planned procedure for patients under a physician's care.

COVID-19 poses a threat to health and well-being. Objectives: 1) To compare the impact of COVID-19 on the life experiences of essential workers attending a COVID-19 antibody testing clinic at a dental school. 2) To compare responses of dental, non–dental health care, and non–health care essential workers. 3) To assess acceptability/satisfaction of testing done in a dental setting. Method: A total of 984 participants completed a self-administered online questionnaire. Results: Over 90% were healthy (i.e., not in a high-risk health-related group for COVID-19), did not have COVID-19 symptoms within 30 d, and always/frequently engaged in preventive measures. Fifty-eight percent thought that they had a 0% to 25% chance of having immunity/antibodies to COVID-19. Non–dental health care workers thought that their chance was significantly higher (P < 0.05) than others. Over 70% were sometimes, frequently, or always worried about their friends and loved ones getting COVID-19 and of resulting financial problems. Dental workers were significantly less afraid than non–dental health care and non–health care providers. For all groups, more than half of the respondents stated that the pandemic had a negative (somewhat worse or worse) impact on daily life (59%), interactions with others (65%), stress levels (66%), and enjoyment of life (56%). There were significant differences among all 3 groups regarding the percentage of individuals with a negative impact on job security (dental, 47%; non–dental health care, 34%; non–health care, 31%). However, more than half of the respondents stated that the pandemic had a positive impact (same, somewhat better, or much better) on caring about one another, self-care, and exercise. Knowing the results of an antibody test would decrease the level of stress and anxiety in 67% of respondents. Over 80% found a COVID-19 test received in a dental setting acceptable, were “definitely” satisfied, and would “definitely” recommend it to a friend, family, or coworker. Conclusions: These findings support that dental workers are as vulnerable as other essential workers to threats and psychological impacts of COVID-19. They also support the acceptability and satisfaction of testing for a pandemic done in a dental setting. Knowledge Transfer Statement: The results of this study highlight the impact that pandemics such as COVID-19 can have on life experiences of essential workers, including dentists. It also highlights a role that dentistry can play within the broader health care system, during and beyond the current pandemic, to help with surveillance efforts of community health. Testing may also help alleviate stress and anxiety associated with these pandemics.

Subjects or Study Selection The authors searched PubMed, Embase, Web of Science, and Scopus databases for randomly controlled clinical trials, cohort studies, case-control studies, and case series of subjects with dental implants who smoked, who also reported implant failures and the number of cigarettes they smoked. Two authors graded the quality of the studies using the nine-point Newcastle-Ottawa scale, and they retained studies that scored greater than 6 points. The initial search identified 5035 studies, 23 of which met the criteria for inclusion in the meta-analysis, with 1 clinical trial, 6 prospective studies, and 16 retrospective studies, and a total of 31,129 implants. Although not reported in the study, the number of subjects (10,902) was calculated from the online supplemental Table S2A; however, the actual number of subjects was higher because one study in the table did not report the number of subjects. Key Study Factor Systematic review and meta-analysis of 23 studies comparing the effects of smoking on failure rates of dental implants were conducted; all studies had to include the level of smoking expressed as numbers of cigarettes smoked, and at least 2 categories, such as light versus heavy smoking. Main Outcome Measure The main outcome measure was a statistically significant increase (P < .05) in the relative risk of implant failure with increased numbers of cigarettes smoked. Because studies categorized cigarette smoking levels differently, separate meta analyses were performed for groups of studies based on how they categorized smoking. The groups were as follows: 1) none, 10, or 15, or 20, or 10, 10-20, or 20 cigarettes. They also performed separate meta analyses based on implant-related and patient-related data (each implant was considered as a separate subject). Finally, separate subgroup meta-analyses were performed based on implant surface type (rough vs. smooth) and based on implants placed in grafted sinuses. Main Results Subjects who smoked 20 cigarettes per day, compared with nonsmokers, had a relative risk of 2.48 (CI, 1.46-4.22, P = .001) for implant failure on an implant-level basis and 4.0 (CI, 2.72-5.89, P < .001) on a subject-level basis. High heterogenicity (I-2 = 72%) was reported for the implant-related findings but was low (I-2 = 7.9%) for the patientrelated findings. Statistically significantly higher relative risks were also found for subjects who smoked any number of cigarettes compared with none; however, the effect sizes were lower and less consistent. Comparisons between levels of smoking that excluded nonsmokers were inconsistent. Funnel plot inspections and Egger's tests for all meta-analyses performed detected no evidence of publication bias. Conclusions The authors concluded that the risks of implant failure increased as the number of cigarettes smoked increased and that smoking more than a pack of cigarettes per day can be considered a risk for implant failure.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION:Management of anticoagulated patients in implant therapy: a clinical comparative study. Clemm R, Neukam FW, Rusche B, Bauersachs A, Musazada S, Schmitt CM. Clin Oral Implants Res 2016;27(10):1274-82. SOURCE OF FUNDING:Information not available TYPE OF STUDY/DESIGN: Cohort study.

Objectives: This study aimed to assess the oral health status of adults in the rural Kithoka community of Meru, Kenya. Methods: A cross-sectional study of 102 adults, aged 20-90, that consisted of an oral health survey and dental examination was performed. Clinical data on caries history was collected using the DMFT index. Data on gingival recession, gingival inflammation, and fluorosis were also collected. Results: Fifty-two percent of the population studied was female and 48% were male. Having no access to professional dental services was reported by 31% of the population. Seventy-eight percent of the population reported owning a toothbrush, while 83% of those individuals brushed daily. The average DMFT of the population was 3.9. Total DMFT comprised 58% decayed, 41.7% missing, and only 0.3% filled teeth. Eighty-one percent reported history of oral pain and 48% reported having oral pain at the time of the survey. Ten percent of the population presented with no gingival inflammation, 75% had mild-moderate inflammation, and 15% had severe inflammation; reminiscent of the natural history of periodontal disease percentages reported for untreated populations. Forty-six percent presented with varying degrees of gingival recession. Fluorosis prevalence was 22%. Conclusion: A high level of untreated dental caries, gingival inflammation, and oral pain was found in the adult population of this community. The poor dental health status of this community is further perpetuated by limited access to care, suggesting that there is a need for increased oral care and implementation of cost-effective preventive strategies in this community.

AIM:This study was conducted to determine periodontal changes in postmenopausal breast cancer (BCa) survivors using aromatase inhibitors (AI) as compared to postmenopausal women without BCa.METHODS:An 18-month prospective examination of periodontal health in postmenopausal women (29 receiving AI therapy; 29 women without BCa) was conducted at University of Michigan. Comprehensive periodontal examinations including alveolar bone height (ABH) were conducted at baseline, 6, 12, and 18 months. Bisphosphonate, vitamin D, and calcium supplementation were collected via chart review. Linear mixed models were utilized to investigate the relationship between AI and periodontal measures.RESULTS:Aromatase inhibitor users had significantly deeper probing depths, more dental plaque and clinical attachment loss as compared to controls at the 6, 12, and 18 month study visits (p < 0.05). ABH loss was seen over time within the AI group. The linear mixed model showed a significant effect of time as well as an interaction between aromatase inhibitor use and calcium supplement status. AI users taking calcium experienced less ABH loss over the study than AI users not taking calcium (p = 0.005).CONCLUSION:Aromatase inhibitor therapy has a negative impact on the periodontal health of postmenopausal BCa patients. Calcium supplementation appears to mitigate ABH loss in women on AI.

Periodontitis is an inflammatory condition of the periodontium that leads to destruction of the supporting structures of the tooth, including loss of attachment and alveolar bone. A clinician's first line of treatment for periodontitis is traditionally mechanical periodontal therapy, including oral hygiene instructions together with scaling and root planing. How- ever, it has been shown that mechanical therapy may not always be effective in halting disease. Adjunctive chemotherapeutics, such as systemic antibiotics or host-modulating agents, may improve the treatment outcome of periodontitis. Using relevant terms such as “adjunctive antibiotics” and “systemic chemotherapeutics” in a manual search of the PubMed database, the authors have prepared a narrative review of the chemotherapeutics currently used in the field. Results of the search and review show that adjunctive antibiotics may be useful in cases of aggressive periodontitis, refractory periodontitis, and in some patients who are immunocompromised, such as heavy smokers or poorly controlled diabetics. Host-modulating agents are generally recommended only as the last resort and are limited to the use of submicrobial dose doxycycline. Microbial testing may be indicated, particularly in aggressive periodontitis cases or refractory cases. Using these results, a decision tree is provided for clinicians to determine when adjunctive chemotherapeutics may be indicated.

The prevalence of gingival recession has been estimated at around 22.5% in people aged older than 29 years. Classic treatment approaches include the use of connective tissue grafts in combination with coronally advanced flaps (CAFs). To reduce morbidity and the need for a secondary surgical site, allograft materials are currently being used. Nevertheless, long-term randomized studies testing the efficacy of these materials are lacking. Hence, the aim of the present randomized controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze-dried (FDADM) and solvent-dehydrated ADM (SDADM). At 12 months, both groups showed significant improvement in attachment level, recession depth, and recession width. A mean improvement in attachment level of 2.0 ± 1.08 mm for FDADM and 2.0 ± 0.70 mm for both SDADM was achieved (P = .002). Root coverage after 12 months was 80.66 ± 22.90% for FDADM and 80.97 ± 18.08% for SDADM. Hence, it was concluded that both FDADM and SDADM grafting materials can successfully achieve root coverage in Miller Class I and II recession defects for up to 12 months when used in combination with CAFs.

Background: The purpose of this multicenter randomly controlled clinical trial was to compare two acellular dermal matrix (ADM) materials produced by different processing techniques, freeze‐dried (FDADM) and solvent‐dehydrated (SDADM) ADM, in their ability to correct Miller Class I and II recession defects.Methods: Eighty individuals from four study centers, each with a single maxillary anterior Miller Class I or II recession defect were enrolled. Participants were randomly assigned and treated with coronally advanced flap (CAF) + FDADM (n = 42) or CAF + SDADM (n = 38). Gingival thickness, recession depth, recession width, probing depth (PD), clinical attachment level, gingival index, plaque index, patient discomfort, and wound healing index were recorded before surgery (day 0), immediately after surgery (day 1), and 2, 4, 12, 24, and 52 weeks postoperatively. The Student t test, paired t test, and Kruskal‐Wallis one‐way ANOVA were used to analyze the data.Results: When evaluating the clinical parameters after 1 year, both groups showed significant (P <0.05) improvement for most of the parameters evaluated when compared to baseline (day 0). For example, percentage of root coverage was 77.21% ± 29.10% for CAF + FDADM and 71.01% ± 32.87% for CAF + SDADM. Conversely, no significant differences were observed between the two materials for any clinical parameter tested or for patient satisfaction except PD on the mesial side of the defects (P = 0.03).Conclusions: Both FDADM and SDADM can be used successfully to correct Miller Class I or II recession defects. There were no statistically significant differences between groups for any of the clinical parameters tested.

Background: Oral health studies to address dental needs of children have been conducted in Nairobi, Kenya. However, limited data is available for the rural areas of Kenya. The aim of this study was to gather baseline oral health data on primary school children in the rural Kithoka community of Meru, Kenya. Methods: A cross sectional dental examination and oral health survey of 583 children, aged 3-18 years, were performed. Decayed, missing, and filled primary/permanent teeth (dmft/DMFT) values were recorded. Gingival recession ranking, a gingival inflammation index, and a fluorosis index were also employed. Children were surveyed regarding dental visits, toothbrush ownership, and oral pain. Results: The average dmft/DMFT score was 1.2, fluorosis prevalence was 29%, gingival disease prevalence was 75.1%, oral pain prevalence was 29%, and 72% of children had never been to a dentist. Conclusions: DMFT scores for Kenyan children were almost exclusively comprised of decayed teeth. This finding probably reflects the low dentist-to-population ratio and the scarcity of dentists practicing in Kenyan rural areas. Gingival disease and pain prevalence in these children were high, exceeding those reported in developed countries. The findings reflect the oral health preventive and treatment needs for children in this Kenyan region.

This randomized controlled clinical pilot trial compared the efficacy of 2 soft tissue grafting methods for correcting esthetic discrepancies associated with definitively restored implant crowns.Thirteen patients presenting with implants displaying recession, thin biotype, concavity defects, or a combination thereof associated with single crowned dental implants randomly received subepithelial connective tissue grafts (SCTG) in the control group (N = 7) or acellular dermal matrix (ADM) allografts in the test group (N = 6), both under coronally positioned flaps. Data regarding soft tissue, hard tissue, esthetics, and quality of life (QoL) parameters were collected over 6 months.Both groups gained tissue thickness (SCTG: 63% and ADM: 105%), reduced concavity measures (SCTG: 82% and ADM: 96%), and improved recessions (SCTG: 40% and ADM: 28%) from baseline to 6 months. Clinicians determined improvement in esthetics for both groups (P = 0.001), unlike patients who did not change their esthetic ratings. No statistical differences were noted for QoL assessment; however, ADM subjects had more eventful wound healing (P = 0.021).Within the limitations of this study, both SCTG and ADM result in increased mucosal thickness, reduction in concavity dimensions, and have a potential for recession reduction on definitively restored dental implants.