Naoki Kakudate

Restorative Treatment Thresholds for Proximal Caries in Dental PBRN

This study was conducted to assess caries treatment thresholds among Japanese dentists and to identify characteristics associated with their decision to intervene surgically in proximal caries lesions within the enamel. Participants (n = 189) were shown radiographic images depicting interproximal caries and asked to indicate the lesion depth at which they would surgically intervene in both high- and low-caries-risk scenarios. Differences in treatment thresholds were then assessed via chi-square tests, and associations between the decision to intervene and dentist, practice, and patient characteristics were analyzed via logistic regression. The proportion of dentists who indicated surgical intervention into enamel was significantly higher in the high-caries-risk scenario (73.8%, N = 138) than in the low-caries-risk scenario (46.5%, N = 87) (p < 0.001). In multivariate analyses for a high-caries-risk scenario, gender of dentist, city population, type of practice, conducting caries-risk assessment, and administering diet counseling were significant factors associated with surgical enamel intervention. However, for a low-caries-risk scenario, city population, type of practice, and use of a dental explorer were the factors significantly associated with surgical enamel intervention. These findings demonstrate that restorative treatment thresholds for interproximal primary caries differ by caries risk. Most participants would restore lesions within the enamel for high-caries-risk individuals (Clinicaltrials.gov registration number NCT01680848).

Application of self‐efficacy theory in dental clinical practice

In clinical practice, self-efficacy refers to how certain a patient feels about his or her ability to take the necessary action to improve the indicators and maintenance of health. It is assumed that the prognosis for patient behaviour can be improved by assessing the proficiency of their self-efficacy through providing psychoeducational instructions adapted for individual patients, and promoting behavioural change for self-care. Therefore, accurate assessment of self-efficacy is an important key in daily clinical preventive care. The previous research showed that the self-efficacy scale scores predicted patient behaviour in periodontal patients and mothers behaviour in paediatric dental practice. Self-efficacy belief is constructed from four principal sources of information: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states. Thus, self-efficacy can be enhanced by the intervention exploiting these sources. The previous studies revealed that behavioural interventions to enhance self-efficacy improved oral-care behaviour of patients. Therefore, assessment and enhancement of oral-care specific self-efficacy is important to promote behaviour modification in clinical dental practice. However, more researches are needed to evaluate the suitability of the intervention method.

Association between self‐efficacy and loss to follow‐up in long‐term periodontal treatment

AIM To examine whether or not oral health care-specific self-efficacy can predict loss to follow-up for long-term periodontal treatment. METHODS Our prospective cohort study enrolled 144 patients with chronic periodontitis. Patient self-efficacy was assessed on the initial visit using the self-efficacy scale for self-care (SESS). Participants were then followed for 30 months from the onset of periodontal treatment. The loss to follow-up is the main outcome variable. Multiple logistic regression analysis was conducted to examine the association between self-efficacy for self-care and loss to follow-up for periodontal treatment. Gender, age, number of teeth, probing depth, plaque control record (PCR) value, PCR improvement rate, general self-efficacy scale score, and SESS score were used as the independent variables, and loss to follow-up as a dependent variable. RESULTS A total of 67 patients were lost to follow-up over the course of the study. Compared with the high-scoring SESS group (60-75), the odds ratio of loss to follow-up for the middle- (54-59) and low-scoring groups (15-53) were 1.05 [95% confidence interval (CI): 0.36-3.07] and 4.56 (95% CI: 1.11-18.74), respectively. CONCLUSION Assessment of oral health care-specific self-efficacy may be useful in predicting loss to follow-up in long-term periodontal treatment.

Contribution of out-of-hospital factors to a reduction in cardiac arrest mortality after witnessed ventricular fibrillation or tachycardia

BACKGROUND Mortality rates in Osaka for cardiac arrest after witnessed ventricular tachycardia (VT) or ventricular fibrillation (VF) have decreased dramatically. We sought to estimate the contribution of changes in out-of-hospital care to this decrease. METHODS We applied a previously validated statistical model, IMPACT, to data obtained from the Utstein Osaka Project, which registers all cardiopulmonary arrests in Osaka. The outcome was death within the first month after the arrest. Sensitivity analysis was conducted by simulating an increase in the use of public access defibrillators (PADs). RESULTS From 1999 through 2008, age- and sex-adjusted standardized 1-month mortality fell from 88.6% to 57.1%. There were 105 fewer deaths than expected in 2008 (295 deaths). The IMPACT model explained 62.5% of the decrease (67 deaths) in the 1-month mortality. The main contributors to the decrease in mortality were an increase in the use of biphasic waveform defibrillators, and a shortened time to first shock. These were partly offset by an increase in the administration of epinephrine by emergency medical services personnel. According to the simulation, an increase in PAD use from 1.9% to 34.4% would reduce mortality from the observed 57.1% to 49.5%. CONCLUSIONS Modeling suggests that improvement in out-of-hospital care accounted for approximately 60% of the decline in deaths following witnessed VT or VF arrests in Osaka between 1999 and 2008. Increased usage of PADs could further improve these outcomes.

Dentists’ Dietary Perception and Practice Patterns in a Dental Practice-Based Research Network

Background Dental caries are largely preventable, and epidemiological evidence for a relationship between diet and oral health is abundant. To date, however, dentists’ perceptions about the role of diet and dentists’ practice patterns regarding diet counseling have not been clarified. Objective The purposes of this study were to: (1) examine discordance between dentists’ perception of the importance of diet in caries treatment planning and their actual provision of diet counseling to patients, and (2) identify dentists’ characteristics associated with their provision of diet counseling. Design The study used a cross-sectional study design consisting of a questionnaire survey in Japan. Participants The study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which aims to allow dentists to investigate research questions and share experiences and expertise (n = 282). Measurement Dentists were asked about their perceptions on the importance of diet and their practice patterns regarding diet counseling, as well as patient, practice, and dentist background data. Results The majority of participants (n = 116, 63%) recognized that diet is “more important” to oral health. However, among participants who think diet is “more important” (n = 116), only 48% (n = 56) provide diet counseling to more than 20% of their patients. Multiple logistic regression analysis suggested that several variables were associated with providing diet counseling; dentist gender, practice busyness, percentage of patients interested in caries prevention, caries risk assessment, and percentage of patients who receive blood pressure screening. Conclusions Some discordance exists between dentists’ perception of the importance of diet in caries treatment planning and their actual practice pattern regarding diet counseling to patients. Reducing this discordance may require additional dentist education, including nutritional and systemic disease concepts; patient education to increase perception of the importance of caries prevention; or removing barriers to practices’ implementation of counseling. Trial Registration ClinicalTrials.gov NCT01680848

Development of the outcome expectancy scale for self-care among periodontal disease patients.

RATIONALE The theory of self-efficacy states that specific efficacy expectations affect behaviour. Two types of efficacy expectations are described within the theory. Self-efficacy expectations are the beliefs in the capacity to perform a specific behaviour. Outcome expectations are the beliefs that carrying out a specific behaviour will lead to a desired outcome. OBJECTIVE To develop and examine the reliability and validity of an outcome expectancy scale for self-care (OESS) among periodontal disease patients. METHODS A 34-item scale was tested on 101 patients at a dental clinic. Accuracy was improved by item analysis, and internal consistency and test-retest stability were investigated. Concurrent validity was tested by examining associations of the OESS score with the self-efficacy scale for self-care (SESS) score and plaque index score. Construct validity was examined by comparing OESS scores between periodontal patients at initial visit (group 1) and those continuing maintenance care (group 2). RESULTS Item analysis identified 13 items for the OESS. Factor analysis extracted three factors: social-, oral- and self-evaluative outcome expectancy. Cronbachs alpha coefficient for the OESS was 0.90. A significant association was observed between test and retest scores, and between the OESS and SESS and plaque index scores. Further, group 2 had a significantly higher mean OESS score than group 1. CONCLUSION We developed a 13-item OESS with high reliability and validity which may be used to assess outcome expectancy for self-care. A patients psychological condition with regard to behaviour and affective status can be accurately evaluated using the OESS with SESS.

A novel Internet-based blended learning programme providing core competency in clinical research.

RATIONALE, AIMS AND OBJECTIVES We developed a novel Internet-based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. METHOD This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet-based feedback system and an end-of-course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end-of-course examination. RESULTS Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end-of-course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end-of-course scores among medical doctors, pharmacists, registered nurses and other occupations. CONCLUSIONS We developed an Internet-based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation.

Interpersonal psychosocial factors associated with underreported dietary energy intake in hemodialysis patients.

OBJECTIVE To examine the association between degree of underreporting energy intake and psychosocial (including interpersonal and personal) factors among hemodialysis patients in Japan. DESIGN We conducted a cross-sectional study. Predictors of difference were identified using multiple linear regression analysis. SETTING Study was conducted at a public hospital and a dialysis clinic in a single district in northeast Honshu, Japan. SUBJECTS Participants were hemodialysis outpatients. Patients aged more than 20 years and undergoing treatment for end-stage renal disease for at least 6 months were included. Exclusion criteria were diagnosis of depression, a mental disease, or dementia. MAIN OUTCOME The outcome measure was the difference in reported energy intake defined by the differences between a brief administered dietary history questionnaire and diet record stratified by standardized weight. RESULTS Seventy patients undergoing hemodialysis participated (44 men [62.9%] and 26 women [37.1%]). Of these, 54.3% underreported energy intake (by >10%). Sex (male) and employment status (employed) were statistically associated with energy intake underreporting. A lower score of dialysis staff encouragement was associated with greater energy intake underreporting (β coefficient = 3.89 kcal/standardized weight, 95% confidence interval: 0.89 to 6.90; P = .012). CONCLUSION Degree of underreporting energy intake is significantly associated with interpersonal psychosocial factors among hemodialysis patients in Japan. The interpersonal relationship with encouragement by the dialysis staff is important in improving the accuracy of reporting energy intake among dialysis patients.

Dentist practice patterns and therapeutic confidence in the treatment of pain related to temporomandibular disorders in a dental practice-based research network

AIMS To quantify the practice patterns of Japanese dentists in the management of pain related to temporomandibular disorders (TMD) and to identify specific characteristics that are significantly associated with the decision to perform occlusal adjustment for TMD-related pain. METHODS A cross-sectional study was conducted consisting of a questionnaire survey of dentists affiliated with the Dental Practice-Based Research Network Japan (JDPBRN) (n = 148). Participants were asked how they diagnosed and treated TMD-related pain. Associations between dentist characteristics and the decision to perform occlusal adjustment were analyzed via multiple logistic regression. RESULTS A total of 113 clinicians responded to the questionnaire (76% response rate), and 81% of them (n = 89) had treated TMD during the previous year. Dentists treated an average of 1.9 ± 1.8 (mean ± SD) patients with TMD-related pain per month. Most JDPBRN dentists used similar diagnostic protocols, including questions and examinations. The most frequent treatments were splints or mouthguards (96.5%), medications (84.7%), and self-care (69.4%). Occlusal adjustment for TMD-related pain was performed by 58% of the participants. Multiple logistic regression analysis identified two factors significantly associated with the decision to perform occlusal adjustment: dentist lack of confidence in curing TMD-related acute pain (odds ratio [OR] 5.60; 95% confidence interval [CI] 1.260 to 24.861) and proportion of patients with severe TMD-related pain (OR 0.95; 95% CI 0.909 to 0.999). CONCLUSION The most common treatments for TMD-related pain were reversible treatments; however, over half of the dentists performed occlusal adjustment for TMD-related pain. The results of this study suggest that an evidence-practice gap exists for occlusal adjustment for TMD-related pain.

Abstract PR-04: Curcumin is an effective chemopreventive substance for betel quid chewer's oral precancer in Sri Lanka.

Background: Oral squamous cell carcinoma has one of the highest recorded incidences in developing countries, comprising 20-30% of all neoplasms, and it is a major cause of cancer mortality in Sri Lanka and other South and Southeast Asian countries. Epidemiological studies have demonstrated that this high incidence is related to betel quid chewing. Curcumin is derived from the spice turmeric. It has been used in these countries for a long time and has antiinflammatory, antioxidative and antineoplastic effects. Objectives: In this study, we aimed to investigate the inhibitory potential of curcumin against betel quid-induced oral precancerous lesions in Sri Lanka. Study Design and Methods: To clarify the effects of curcumin against oral precancerous lesions, we made curcumin-coated chewing gum and placebo chewing gum and used them for a chemopreventive intervention study. One hundred eighteen Sri Lankan betel quid chewers were recruited. Forty-six chewers with oral submucous fibrosis were excluded because it is not measurable lesion. After pathological diagnosis of white lesions of the oral mucosa, seventy-two participants with oral precancer (mean age 53.9; 90.2% male; ethnic 98.6% Sinhala) were recruited from 15 national hospitals in Sri Lanka and randomly divided in two groups; a curcumin group and placebo group. Using person-to-person interviews, we collected data on habits including betel quid chewing, smoking and drinking. The sizes of lesions were measured every 6 months. They were followed every month by oral and maxillofacial surgeons in each hospital. The ethical committee of Hokkaido University, Health Sciences University of Hokkaido, Japan and Peradeniya University ethical committee of Sri Lanka Dental Hospital approved this study. Results: The results of analysis of covariance and the chi-square test showed that the oral precancerous lesions of the curcumin group were significantly smaller within 6 months (p<0.05). Moreover, quitting betel quid chewing and the use of curcumin had synergistic effects on the reduction of the lesion size (p<0.05). Conclusions: While the small size of the study limits its interpretation, these findings suggest that curcumin could have chemopreventive effects on the betel quid chewers oral cancer prevalent in South and Southeast Asian countries. This abstract is also presented as Poster B18. Citation Format: Itsuo Chiba, Maiko Takeshima, Yoshihiro Abiko, Hiroshi Kobayashi, Malsantha Muthumala, Chihiro Sugiura, Makiko Onodera, Shibata Toshiyuki, Hirofumi Matsuoka, Naoki Kakudate, Shunichi Fukuhara, Toshio Takiguchi. Curcumin is an effective chemopreventive substance for betel quid chewers oral precancer in Sri Lanka. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr PR-04.