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    Implementing a dental and pharmacy interprofessional telehealth simulation between two universities
    (Wiley, 2023-12) Zahl, David A.; Zeitlin, Deborah; Devine, Trish; Romito, Laura M.; Comprehensive Care and Allied Professions, School of Dentistry
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    Effect of Rapid High-Intensity Light-Curing on Increasing Transdentinal Temperature and Cell Viability: An In Vitro Study
    (MDPI, 2024-05-22) Miranda, Samille Biasi; Lins, Rodrigo Barros Esteves; Santi, Marina Rodrigues; Denucci, Giovanna Corrêa; Silva, Cleyton Cézar Souto; da Silva, Silvana de Fátima Ferreira; Marques, Daniela de Araújo Viana; Montes, Marcos Antônio Japiassú Resende; Comprehensive Care and Allied Professions, School of Dentistry
    Background: This study investigated effects of rapid high-intensity light-curing (3 s) on increasing transdentinal temperature and cell viability. Methods: A total of 40 dentin discs (0.5 mm) obtained from human molars were prepared, included in artificial pulp chambers (4.5 × 5 mm), and subjected to four light-curing protocols (n = 5), with a Valo Grand light curing unit: (i) 10 s protocol with a moderate intensity of 1000 mW/cm2 (Valo-10 s); (ii) 3 s protocol with a high intensity of 3200 mW/cm2 (Valo-3 s); (iii) adhesive system + Filtek Bulk-Fill Flow bulk-fill composite resin in 10 s (FBF-10 s); (iv) adhesive system + Tetric PowerFlow bulk-fill composite resin in 3 s (TPF-3 s). Transdentinal temperature changes were recorded with a type K thermocouple. Cell viability was assessed using the MTT assay. Data were analyzed using one-way ANOVA and Tukey tests for comparison between experimental groups (p < 0.05). Results: The 3 s high-intensity light-curing protocol generated a higher temperature than the 10 s moderate-intensity standard (p < 0.001). The Valo-10 s and Valo-3 s groups demonstrated greater cell viability than the FBF-10s and TPF-3 s groups and statistical differences were observed between the Valo-3 s and FBF-10 s groups (p = 0.023) and Valo-3 s and TPF-3 s (p = 0.025), with a potential cytotoxic effect for the FBF-10 s and TPF-3 s groups. Conclusions: The 3 s rapid high-intensity light-curing protocol of bulk-fill composite resins caused a temperature increase greater than 10 s and showed cell viability similar to and comparable to the standard protocol.
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    Non-Carious Cervical Lesions: A Bibliometric Analysis and Future Research Trends
    (Elsevier, 2024-07-11) Denucci, Giovanna; Stone, Sean; Hara, Anderson
    Objective: The present bibliometric review analyzed the literature on non-carious cervical lesions (NCCLs) to explore the current state and propose future research topics. Data: An electronic search was performed, only full scientific papers published in English were included. Sources: A search was conducted of all databases in the Web of Science (WOS) platform for available publications on the topic of NCCLs. Study Selection: 959 publications were retrieved, and the following data were extracted and analyzed: number of publications, study topics, keywords, study type, authors, affiliations, countries, funding agencies, journals and citations. Articles on NCCLs have been increasing in count, ever since they were first mentioned in the literature. Therapy alternatives account for 628 with few on prevention, and the majority were clinical. Brazil has published the most on NCCLs as well as has the highest number of authors and the most funded articles. The three journals that published the most on the topic were Operative Dentistry, Journal of Dentistry and Clinical Oral Investigations. Conclusion: The findings of this study provide a full picture of the current literature on NCCLs, research trends, knowledge gaps, and areas requiring further investigation. Clinical Significance: By highlighting evolving treatment strategies and potential gaps in prevention, researchers can contribute to the advancement of clinical practice. This can improve patient care and outcomes in the management of NCCLs, while also providing valuable insights for policymakers to prioritize research funding and policy initiatives.
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    Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations—Adults and children
    (Public Library of Science, 2022-06-24) Cagetti, Maria Grazia; Bontà, Giuliana; Lara, Juan Sebastian; Campus, Guglielmo; Comprehensive Care and Allied Professions, School of Dentistry
    This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups' data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: "low risk" = 61-100% or 81-100% chance to avoid caries, "moderate risk" = 41-60% or 21-80% and "high risk" = 0-40% or 0-20%, named model 1 and 2; b) four risk categories with two different thresholds as: "low risk" = 61-100% or 76-100%, "moderate/low risk" = 41-60% or 51-75%; "moderate/high risk" = 21-40% or 26-50% and "high risk" = 0-20% or 0-25%, model 3 and 4; c) five risk categories as: "very low risk" = 81-100%; "low risk" = 61-80% "moderate risk" = 41-60%; "high risk" = 21-40% and "very high risk" = 0-20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen's kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen's Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen's Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children's samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups' convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.
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    Urinary fluoride levels and metal co-exposures among pregnant women in Los Angeles, California
    (BMC, 2023-10-26) Malin, Ashley J.; Hu, Howard; Martínez‑Mier, E. Angeles; Eckel, Sandrah P.; Farzan, Shohreh F.; Howe, Caitlin G.; Funk, William; Meeker, John D.; Habre, Rima; Bastain, Theresa M.; Breton, Carrie V.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Background: Fluoride is ubiquitous in the United States (US); however, data on biomarkers and patterns of fluoride exposure among US pregnant women are scarce. We examined specific gravity adjusted maternal urinary fluoride (MUFsg) in relation to sociodemographic variables and metal co-exposures among pregnant women in Los Angeles, California. Methods: Participants were from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort. There were 293 and 490 women with MUFsg measured during first and third trimesters, respectively. An intra-class correlation coefficient examined consistency of MUFsg between trimesters. Kruskal-Wallis and Mann-Whitney U tests examined associations of MUFsg with sociodemographic variables. Covariate adjusted linear regression examined associations of MUFsg with blood metals and specific gravity adjusted urine metals among a subsample of participants within and between trimesters. A False Discovery Rate (FDR) correction accounted for multiple comparisons. Results: Median (IQR) MUFsg was 0.65 (0.5) mg/L and 0.8 (0.59) mg/L, during trimesters one and three respectively. During both trimesters, MUFsg was higher among older participants, those with higher income, and White, non-Hispanic participants than Hispanic participants. MUFsg was also higher for White, non-Hispanic participants than for Black, non-Hispanic participants in trimester three, and for those with graduate training in trimester one. MUFsg was negatively associated with blood mercury in trimester one and positively associated with blood lead in trimester three. MUFsg was positively associated with various urinary metals, including antimony, barium, cadmium, cobalt, copper, lead, nickel, tin, and zinc in trimesters one and/or three. Conclusions: MUFsg levels observed were comparable to those found in pregnant women in Mexico and Canada that have been associated with poorer neurodevelopmental outcomes. Lower urinary fluoride levels among Hispanic and non-Hispanic Black participants in MADRES compared to non-Hispanic White participants may reflect lower tap water consumption or lower fluoride exposure from other sources. Additional research is needed to examine whether MUFsg levels observed among pregnant women in the US are associated with neurodevelopmental outcomes.
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    The Association of Dietary Fluoride Intake and Diet Variables with Dental Caries in Adolescents from the ELEMENT Cohort Study
    (Karger, 2021) Cantoral, Alejandra; Muñoz-Rocha, Teresa V.; Luna-Villa, Lynda; Mantilla-Rodriguez, Andres; Ureña-Cirett, José L.; Castiblanco, Gina A.; Solano, Maritsa; Howard, Hu H.; Peterson, Karen E.; Téllez-Rojo, Martha M.; Martínez-Mier, Esperanza A.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    To examine the association of dietary fluoride intake, total carbohydrate consumption and other key dietary variables with dental caries experience among adolescents, a cross-sectional analysis was conducted in a sample of 402 participants from the Early Life Exposures in Mexico to Environmental Toxicants cohort. The presence and severity of dental caries were assessed using the Caries Detection and Assessment System (ICDAS) to calculate the number of Decayed, Missing, and Filled Teeth or Surfaces (D1MFT/D4MFT). Dietary intake of fluoride, energy, carbohydrates and food groups was estimated using a validated Food Frequency Questionnaire (FFQ). Multivariate zero-inflated negative binomial regression models and negative binomial regression models were run to estimate the association of fluoride intake (mg/d) and total carbohydrate intake (g/d) with the D1MFT/D4MFT index. We found that 80% of adolescents experienced dental caries (D1MFT>0), with 30% presenting cavitated lesions (D4MFT>0). Mean scores for D1MFT and D4MFT were 6.2 (SD 5.3) and 0.67 (SD 1.3), respectively. The median intake of fluoride estimated by the FFQ was 0.015 mg/d, this intake was statistically higher in those participants with a D4MFT=0 than those with a D4MFT>0 (0.90 vs 0.82 mg/d; 0.016 mg/Kg/d vs 0.014 mg/Kg/d, p<0.05). For D1MFT, D1MFS, D4MFT and D4MFS scores, there was a statistically significant reduction in the number of lesions with higher fluoride consumption (mg/d) from foods and beverages. The reported frequency of consumption of sugary foods in a whole day was statistically higher in those with D1MFT>0 than those with D1MFT=0 (p<0.05). Total carbohydrate intake (g/d) was positively associated with dental caries experience. We conclude that higher fluoride intake through foods and beverages was associated with lower dental caries experience among adolescents; this effect was seen even when the dietary intake of fluoride was 0.015mg/kg/d, which is lower than the average intake recommendation. In contrast, a higher amount of total carbohydrate intake and the frequency of intake of sugary foods were associated with higher dental caries experience, with no apparent threshold for the effects.
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    Characterizing clinical findings of Sjögren's Disease patients in community practices using matched electronic dental-health record data
    (Public Library of Science, 2023-07-31) Felix Gomez, Grace Gomez; Hugenberg, Steven T.; Zunt, Susan; Patel, Jay S.; Wang, Mei; Rajapuri, Anushri Singh; Lembcke, Lauren R.; Rajendran, Divya; Smith, Jonas C.; Cheriyan, Biju; Boyd, LaKeisha J.; Eckert, George J.; Grannis, Shaun J.; Srinivasan, Mythily; Zero, Domenick T.; Thyvalikakath, Thankam P.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Established classifications exist to confirm Sjögren's Disease (SD) (previously referred as Sjögren's Syndrome) and recruit patients for research. However, no established classification exists for diagnosis in clinical settings causing delayed diagnosis. SD patients experience a huge dental disease burden impairing their quality of life. This study established criteria to characterize Indiana University School of Dentistry (IUSD) patients' SD based on symptoms and signs in the electronic health record (EHR) data available through the state-wide Indiana health information exchange (IHIE). Association between SD diagnosis, and comorbidities including other autoimmune conditions, and documentation of SD diagnosis in electronic dental record (EDR) were also determined. The IUSD patients' EDR were linked with their EHR data in the IHIE and queried for SD diagnostic ICD9/10 codes. The resulting cohorts' EHR clinical findings were characterized and classified using diagnostic criteria based on clinical experts' recommendations. Descriptive statistics were performed, and Chi-square tests determined the association between the different SD presentations and comorbidities including other autoimmune conditions. Eighty-three percent of IUSD patients had an EHR of which 377 patients had a SD diagnosis. They were characterized as positive (24%), uncertain (20%) and negative (56%) based on EHR clinical findings. Dry eyes and mouth were reported for 51% and positive Anti-Ro/SSA antibodies and anti-nuclear antibody (ANA) for 17% of this study cohort. One comorbidity was present in 98% and other autoimmune condition/s were present in 53% respectively. Significant differences were observed between the three SD clinical characteristics/classifications and certain medical and autoimmune conditions (p<0.05). Sixty-nine percent of patients' EDR did not mention SD, highlighting the huge gap in reporting SD during dental care. This study of SD patients diagnosed in community practices characterized three different SD clinical presentations, which can be used to generate SD study cohorts for longitudinal studies using EHR data. The results emphasize the heterogenous SD clinical presentations and the need for further research to diagnose SD early in community practice settings where most people seek care.
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    Exploratory Analysis of Objective Outcome Measures for the Clinical Assessment of Erosive Tooth Wear
    (MDPI, 2023-08-02) Romero, Maria Jacinta Rosario H.; Ungar, Peter S.; Fried, Daniel; Lippert, Frank; Zero, Domenick T.; Zunt, Susan; Eckert, George J.; Gutierrez Gossweiler, Ana; Elkington-Stauss, Dylan Jacob; Tamayo-Cabeza, Guillermo; Kelly, Adam B.; Bartels, Troy; Kita, Camille; Wewers, Elizabeth; Hara, Anderson T.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p < 0.001), BEWE scores, Sa, and Str increased (p < 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p < 0.001) and moderately with BEWELingual (r = 0.42, p < 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = −0.15–0.16, p < 0.001) and did not correlate with Δenamel thickness (r = 0.02–0.09, p > 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness.
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    Comparing gingivitis diagnoses by bleeding on probing (BOP) exclusively versus BOP combined with visual signs using large electronic dental records
    (Springer, 2023-10-10) Patel, Jay S.; Shin, Daniel; Willis, Lisa; Zai, Ahad; Kumar, Krishna; Thyvalikakath, Thankam P.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    The major significance of the 2018 gingivitis classification criteria is utilizing a simple, objective, and reliable clinical sign, bleeding on probing score (BOP%), to diagnose gingivitis. However, studies report variations in gingivitis diagnoses with the potential to under- or over-estimating disease occurrence. This study determined the agreement between gingivitis diagnoses generated using the 2018 criteria (BOP%) versus diagnoses using BOP% and other gingival visual assessments. We conducted a retrospective study of 28,908 patients' electronic dental records (EDR) from January-2009 to December-2014, at the Indiana University School of Dentistry. Computational and natural language processing (NLP) approaches were developed to diagnose gingivitis cases from BOP% and retrieve diagnoses from clinical notes. Subsequently, we determined the agreement between BOP%-generated diagnoses and clinician-recorded diagnoses. A thirty-four percent agreement was present between BOP%-generated diagnoses and clinician-recorded diagnoses for disease status (no gingivitis/gingivitis) and a 9% agreement for the disease extent (localized/generalized gingivitis). The computational program and NLP performed excellently with 99.5% and 98% f-1 measures, respectively. Sixty-six percent of patients diagnosed with gingivitis were reclassified as having healthy gingiva based on the 2018 diagnostic classification. The results indicate potential challenges with clinicians adopting the new diagnostic criterion as they transition to using the BOP% alone and not considering the visual signs of inflammation. Periodic training and calibration could facilitate clinicians' and researchers' adoption of the 2018 diagnostic system. The informatics approaches developed could be utilized to automate diagnostic findings from EDR charting and clinical notes.
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    Longitudinal In Vitro Effects of Silver Diamine Fluoride on Early Enamel Caries Lesions
    (Academy of Operative Dentistry, 2022-05) Alcorn, Alice-Anne Thompson; Al Dehailan, Laila; Cook, Norman Blaine; Tang, Qing; Lippert, Frank; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    This laboratory study evaluated the longitudinal surface microhardness changes in early, incipient, noncavitated, white-spot, enamel caries lesions treated with silver diamine fluoride (SDF). Five intervention groups (SDF, AgNO3, KF, 5% sodium fluoride varnish (FV), deionized water (DI)) × two-time intervals after intervention (immediate & delayed pH-cycling) resulted in 10 groups (n=18). Silver nitrate (AgNO3) and potassium fluoride (KF) groups served as controls to assist in evaluating if remineralization effects were due to the silver or fluoride component in SDF. Early, incipient, noncavitated, white-spot, enamel caries lesions were created in bovine enamel, the extent of demineralization was determined using Vickers surface microhardness (VHNlesion). Intervention treatments were applied. Half the specimens from each group underwent immediate 5-day pH-cycling, and half were stored in an incubator with artificial saliva for 2 weeks before undergoing 5-day pH-cycling. After pH-cycling, lesion hardness was evaluated using VHNpost. Specimens were then exposed to a second demineralization challenge, and lesion softening was evaluated (VHNsecdem). Hardness variables were calculated: ΔVHN = VHNpost - VHNlesion; ΔVHNsecdem = VHNsecdem - VHNpost. Data were analyzed using two-way ANOVA (α=0.05). Immediately cycled, SDF had significantly (p<0.0001) greater remineralization than DI, AgNO3, and FV. All delayed cycling groups had significantly greater remineralization than FV (p<0.0001). Significantly greater remineralization was noted in delayed AgNO3 (p≤0.0001), DI (p=0.0003), and FV (p=0.0006) compared to immediately cycled. After the second demineralization challenge, FV had significantly less surface softening than AgNO3 (p=0.0002), DI (p=0.0003), KF (p=0.0225), and SDF (p=0.0388) intervention groups. No significant difference was found between the pH-cycle timings (p=0.2710). Based the present findings, FV may be better suited than SDF to treat early, incipient, noncavitated, white-spot, enamel caries lesions.