Rahma Mungia

Interaction of age and specific saliva component output on caries

Background and aims: The purpose of this study was to explore the relationship between individual salivary components, dental caries and age, utilizing the data from the Oral Health: San Antonio Longitudinal Study of Aging (OH:SALSA). Methods: The study population comprised a well-defined stratified sample of 811 dentate men and women. Subjects were divided into four age groups from 35 to 75+ years old. Unstimulated and stimulated submandibular/sublingual saliva flow rates, unstimulated and stimulated parotid saliva flow rates, total protein, 6 individual proteins and 4 inorganic constituents were measured. Specific salivary components were lactoferrin, secretory IgA, albumin, lysozyme, mucin, cystatin, K+, Ca+2, Na+ and Cl−. Caries measurements were the DMFT Index for crowns and for roots, Tooth Health Index for crowns and roots, Tooth caries, Root caries and Tooth restoration. The data on saliva components were square root transformed for linearity prior to analysis. Analysis was carried out in two stages. Partial correlation was performed, in order to identify significant relationships between specific salivary components and caries measurements, controlling for age group. In the second stage, using caries measurement as the dependant variable, the effects of age, flow rate and specific salivary component output (product of flow rate and concentration) were examined. Results: Significant associations were found between caries, age and specific individual submandibular/sublingual salivary proteins (lactoferrin, albumin, lysozyme, mucin and cystatin) and specific inorganic constituents (K+, Ca+2, Na+ and Cl− ). Conclusions: Changes in submandibular/sublingual salivary component output during aging are correlated with high caries prevalence. These changes in saliva components over age may represent caries risk indicators.

Generating National Dental PBRN Research Ideas Through the ToP Consensus Method Workshop

Purpose: The purpose of this article is to illustrate the research idea generation process employed by the Southwest Region of the National Dental Practice-Based Research Network (PBRN; www.NationalDentalPBRN.org) based on the Technology of Participation (ToP) Consensus Method Workshop. This method encourages a high level of participation in the decision-making process through individual, small group, and large group discussions. This approach to idea generation has predominately been used by nonprofit organizations and community groups both nationally and internationally, but offers great potential to study concept development for PBRNs.Method: Five independent workshops were designed over a 12-month period. Workshops were held at three academic institutions, one National Dental PBRN meeting, and one as part of a continuing education program. The sessions were directed at general dentists, dental hygienists, and dental researchers to identify research ideas appropriate for examination through the PBRN mechanism.Result: Five groups ranging in size from 11 to 53 (197 participants total) participated in the consensus workshops and generated 205 research ideas. Ideas across the five sessions were collated into novel and common categories of interest, and identified key participants interested in developing research concepts. Participant reaction to the sessions was positive based on evaluation comments and personal interactions.Implications: Practitioners effectively generated research ideas based on their current needs and daily clinical experience. The experiences presented in this article suggest continued use of the ToP consensus workshop methods within the PBRNs may help bridge the gap between research and practice.

Connecting and Collaborating: Developing National Dental PBRN Study Concepts Through POD Engagement.

Purpose. This article illustrates the process by which the Southwest Region of the National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) fosters collaboration among practitioners and researchers in study concept development through protocol development groups (PODs). The Southwest Region begins this process by engaging PODs, which comprise dentists, hygienists, and/or academic faculty who share research interests related to improving dental care. Method. The PODs use the Tuckman four-stage model of group development (forming, storming, norming, and performing) to develop study concepts. This well-structured model encourages engagement among group members and enables quality discussion through organized sessions. This model provides milestones for the group’s progression and for the members’ interactions. The Southwest Region Directors play a crucial role in guiding and directing the development of PODs by aligning the members’ research interests with the goals of the National Network. Results. POD engagement using Tuckman’s stages has been successful in developing study concepts for submission to the National Network. Between 2012 and 2014, the Southwest Region has developed 14 PODs from 275 research ideas. Five of these study concepts have been submitted to the National Network for approval, including the Novel Tobacco Products POD, which showcases the applicability of Tuckman’s model. Conclusion. Overall, the POD concept is a collaborative effort that brings together practitioners and academicians through shared research interests and capitalizes on participants’ expertise and experiences. The Southwest Region will continue to develop PODs to foster new ideas for future studies in the Network.

Associations of Types of Pain with Crack-Level, Tooth-Level and Patient-Level Characteristics in Posterior Teeth with Visible Cracks: Findings from the National Dental Practice-Based Research Network

OBJECTIVES The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < .05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.

Patient-Centered Dentinal Hypersensitivity Treatment Outcomes: Results from the National Dental PBRN:

Dentinal hypersensitivity (DH) can have a significant impact on oral health and functioning, and it is a clinical symptom commonly managed by dentists during routine clinical practice. DH symptoms are typically elicited by otherwise innocuous, nonpainful stimuli applied to exposed dentin (e.g., tactile stimuli, warming or cooling temperatures or air puffs). Treatment approaches have sought to directly target the dentinal pulp tissues or close dentinal tubules via dental office care and treatment services (fluoride varnishes, glutaraldehydes, bonding agents, sealants, oxalates, or lasers) or home care services (toothpastes or dentifrices containing fluoride or potassium nitrate compounds). The purpose of this prospective multicenter cohort study was to assess how community-based dentists from the National Dental Practice-Based Research Network (National Dental PBRN) manage DH and whether the effectiveness of DH treatments can be assessed in those settings. A total of 171 dentists recruited 1862 subjects with DH from their existing patients. Dentists then recommended and provided DH treatment as appropriate. Treatment choice was at the discretion of the dentists. Patients rated their DH pain at baseline and 1, 4, and 8 wk during the course of their treatments. They used pain intensity and unpleasantness visual analog scales and 4 labeled magnitude scales and rated their satisfaction with treatment after 8 wk. Patients were provided reminders postbaseline via email, texting, or voice mail. These patient-centered outcomes served as the principal measures for the assessment of treatment because treatments sought to alleviate DH symptoms. The patients with DH who reported pain reduction from dentist-provided treatments (glutaraldehyde/HEMA [hydroxyethyl methacrylate] compounds, oxalates, and bonding agents), dentists’ advice and counseling regarding oral habits and diet, and patient-applied fluoride toothpaste reported a concomitant positive rating of satisfaction with DH treatments. The results from this study support the feasibility of engaging network practices to assess the effectiveness of clinical DH treatments. Knowledge Transfer Statement: National Dental PBRN dentists provide a range of procedures to treat dentinal hypersensitivity. In this large nonrandomized study designed to assess clinical care and to capture patient-reported outcomes, about 60% of patients reported improvement in pain. This study demonstrated the feasibility of engaging network dentists and their patients to assess treatment effectiveness. Future studies will explore the feasibility of imposing randomization and measuring patient compliance with treatment in the manner that this treatment is provided.