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Tooth extractions account for most opioid prescriptions from dentists, but specific characteristics that influence likelihood are less established. Improving understanding can facilitate development of tailored interventions to reduce unnecessary opioid prescribing. The authors performed a retrospective review of patients 12 years and older undergoing tooth extraction at the College of Dentistry at the University of Kentucky from 2013 through 2020. The primary end point was issuance of an opioid prescription related to the encounter. In 44,387 eligible records analyzed, 10,628 (23.9%) patients received an opioid prescription. Results of multivariable logistic regression found that the factors associated with an opioid prescription included receipt of a nonopioid analgesic prescription (adjusted odds ratio [aOR], 11.36; 95% CI, 10.37 to 12.44), receipt of an antibiotic prescription (aOR, 8.29; 95% CI, 7.57 to 9.08), procedural sedation (aOR, 2.11; 95% CI, 1.93 to 2.31), surgical extraction (aOR, 1.96; 95% CI, 1.84 to 2.10), and third molar extractions (1 tooth: aOR, 1.14; 95% CI 1.04 to 1.25; 2 teeth: aOR, 2.09; 95% CI, 2.87 to 2.34; 3 teeth: aOR, 2.73; 95% CI, 2.36 to 3.15; 4 teeth: aOR, 3.45; 95% CI, 3.10 to 3.83). Factors that decreased risk included having an appointment in 2018 or later (aOR, 0.31; 95% CI, 0.29 to 0.33), in a student (aOR, 0.57; 95% CI, 0.51 to 0.65) or resident (aOR, 0.33; 95% CI, 0.31 to 0.36) clinic, and on any day other than Friday (Monday: aOR, 0.83; 95% CI, 0.76 to 0.91; Tuesday: aOR, 0.90; 95% CI, 0.83 to 0.99; Wednesday: aOR, 0.89; 95% CI, 0.81 to 0.97; Thursday: aOR, 0.88; 95% CI 0.81 to 0.97). Opioid prescriptions after tooth extraction were common in patients undergoing more extensive procedures. Provider perceptions, habits, and several clinical factors appeared to influence prescribing patterns. The decision to prescribe an opioid appears to be associated with habits and factors perceived to modulate postoperative pain, which may serve as targets for opioid reduction strategies. [ABSTRACT FROM AUTHOR]

Objectives: To detail how the scope of practice of dentistry was expanded in Kentucky allowing dentists to be rapidly mobilize and join a mass vaccination campaign and administer COVID‐19 vaccines to the community. Methods: The processes involving policy change, an emergency administrative regulation, provider training and community action are detailed. Results: In just 21 days from state authorization, dentists from the University of Kentucky organized and trained clinicians to join a mass vaccination effort and provided over 1200 COVID‐19 vaccines to the community. Conclusions: As essential healthcare workers, Kentucky dentists joined the fight against the COVID‐19 pandemic by participating in a mass vaccination campaign. This communication provides guidance to states, academic institutions, and dentists who are currently in the process of achieving this regulatory change and taking community action. It also provides insights to the benefits of expanding the scope of practice to include vaccination as part of dental services. [ABSTRACT FROM AUTHOR]

Background: Leptin and adiponectin, two adipokines involved in glucose and lipid metabolism, have been linked to regulation of growth in early infancy, energy balance, and metabolic disorders in childhood. The aim of this study was to determine if concentrations of leptin and adiponectin could be measured reliably in infants' saliva, to evaluate the degree of agreement with infant serum levels, and to explore their association with infant feeding status. Methods: A total of 34 infants were recruited after birth and followed for 20 weeks. After log-transformation of the values, a Bland-Altman graphical approach was used to summarize the direction of the difference between the serum and saliva values. Repeated measures mixed modeling was used to evaluate differences over time in these outcomes by feeding status. Results: Mean concentration of salivary leptin and adiponectin in infants was 3.7 (SD =.8) ng/mL and 2.9 (SD = 0.7) ng/mL, respectively. The degree of agreement between serum and saliva for log-transformed leptin and adiponectin values were relatively robust, albeit with a non-zero bias between the two methods, given that serum values were greater than corresponding saliva values for both adipokines in all infants. Each of the four repeated measures mixed models (one for each adipokine measure) had a significant main effect; however, the interaction between time and feeding status was not significant in any of the models. Conclusion: This study demonstrated that leptin and adiponectin can be measured in infant saliva, but in some cases leptin concentrations may be more difficult to detect. [ABSTRACT FROM AUTHOR]

Aims: To describe correlations and agreement between salivary and serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), interleukin (IL)-6, and IL-10 and determine which biomarkers predict worse functional class in patients with heart failure (HF). Methods: Serum and saliva were collected from 75 hospitalized patients with HF (57 ± 12 years, 43% female, New York Heart Association [NYHA] Classes I [4%], II [43%], and III [53%]). Oral inflammation was rated as good, fair, or poor. Spearman’s ρ and Bland–Altman were used to determine correlations and agreement of the salivary and serum forms of each biomarker. Logistic regressions were used to determine which biomarkers predicted worse NYHA functional class, controlling for depression, body mass index, smoking, and oral inflammation. Results: Median biomarker concentrations were as follows: BNP (serum 361 pg/ml, saliva 9 pg/ml), CRP (serum 13 ng/ml, saliva 25.6 ng/ml), IL-6 (serum 19.3 pg/ml, saliva 10.5 pg/ml), and IL-10 (serum 64.1 pg/ml, saliva 4.7 pg/ml). There was a moderate-to-strong correlation for serum–salivary CRP, weak correlation for serum–salivary IL-6, and no correlations for serum–salivary BNP and IL-10. The Bland–Altman test showed good salivary–serum agreement for all biomarkers, but as serum concentrations rose, salivary measures underestimated serum levels. Visible oral inflammation was the only predictor of worse NYHA class. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that rheumatoid arthritis (RA) influenced levels of salivary biomarkers of periodontal disease. Methods: Medical assessments, periodontal examinations and pain ratings were obtained from 35 RA, 35 chronic periodontitis and 35 age- and gender-matched healthy controls in a cross-sectional, case-controlled study. Unstimulated whole saliva samples were analysed for interleukin-1β (IL-1β), matrix metalloproteinase-8 (MMP-8) and tumour necrosis factor-a (TNF-α) concentrations. Results: The arthritis and healthy groups had significantly less oral disease than the periodontitis group (P<0.0001), with the arthritis group having significantly more sites bleeding on probing (BOP) than matched controls (P=0.012). Salivary levels of MMP-8 and IL-1β were significantly elevated in the periodontal disease group (P<0.002), and IL-1β was the only biomarker with significantly higher levels in the arthritis group compared with controls (P=0.002). Arthritis patients receiving anti-TNF-α antibody therapy had significantly lower IL-1β and TNF-α levels compared with arthritis patients not on anti-TNF-α therapy (P=0.016, 0.024) and healthy controls (P<0.001, P=0.011), respectively. Conclusion: RA patients have higher levels of periodontal inflammation than healthy controls, i.e., an increased BOP. Systemic inflammation appears to influence levels of select salivary biomarkers of periodontal disease, and anti-TNF-α antibody-based disease-modifying therapy significantly lowers salivary IL-1β and TNF-α levels in RA. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal cancer has a low 5-year survival rate in the United States, indicating that much remains to be learned about risk and survival factors. The purpose of this research was to identify factors that contribute to risk of and survival from this disease in a region associated with high tobacco use., Methods: A retrospective chart review of 221 subjects with diagnosis of head and neck cancer at a regional University Medical Center during a 10-year period (1986 to 1995) was performed to identify relationships between risk and survival factors of oropharyngeal squamous cell carcinoma (OSCC). Data from 92 records met the inclusion criteria and were analyzed with the chi(2) test of association, the Fisher exact test, and the log-rank test for comparison of survival distributions. The software used was SAS for Windows, release 8.2., Results: Most study subjects were white men between the ages of 50 and 75 years who chronically used tobacco and alcohol. The overall median survival period of the group was 18.1 months. The percentage of subjects surviving to 3 years was 35.6%. Disparities were identified in risk and survival by sex, race, age, dwelling, anatomic site, and exposure to carcinogenic substances. In particular, the disease more adversely affected minorities and those who chronically used tobacco or alcohol., Conclusions: Our results show that, in the examined regional population, a high prevalence of tobacco use correlated with alcohol use and a lower rate of survival from OSCC than the national rate. Also, risk of and survival from OSCC are affected by demographic, geographic, and behavioral factors. This information is useful for the design and implementation of more effective preventive and intervention strategies.