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Introduction: Dental examination and stabilization are performed prior to allogeneic hematopoietic cell transplantation to decrease infection risk during neutropenia. Burden of dental disease and treatment need is not well characterized in this population. Objectives: This report describes the dental status of a cohort of patients within the Chronic Graft‐versus‐Host Disease Consortium and treatment rendered prior to transplant. Methods: The cohort included 486 subjects (Fred Hutchinson: n = 245; Dana‐Farber: n = 241). Both centers have institutional‐based dental clearance programs. Data were retrospectively abstracted from medical records by calibrated oral health specialists. Results: The median age at transplant was 55.9 years, 62.1% were male, and 88% were white. Thirteen patients were edentulous (2.7%). The mean teeth among dentate patients before clearance was 26.0 (SD, 4.6). Dental findings included untreated caries (31.2%), restorations (91.6%), endodontically treated teeth (48.1%), and dental implants (5.7%). Pretransplant procedures during clearance included endodontic therapy (3.6%; mean = 0.1 teeth), restorations (25.1%; mean = 0.7), dental prophylaxis (59.2%), scaling/root planing (5.1%), and extraction (13.2%; mean = 0.3). The mean teeth after clearance was 25.6 (SD, 5.0). Conclusions: Retrospective analysis of pre‐AlloHCT dental data in subjects at two large transplant centers identified low levels of dental need. Findings suggest high access to care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to determine whether visiting only a pediatric dentist (as opposed to visiting only a general dentist) was associated with the provision of preventive dental services for a U.S.-based pediatric population (those 18 years and younger). Methods: This study analyzed pooled Medical Expenditure Panel Survey data from 2018 and 2019 to compare the use of certain preventive dental services (i.e., examination, radiographs, prophylaxis, dental sealant, and fluoride treatment) among those who reported visiting a pediatric dentist versus those who visited a general dentist. Survey procedures were used in Stata 14.0 to perform multivariable logistic regression analyses. Results: Controlling for demographic and insurance variables, children who visited only pediatric dentists had statistically significantly greater odds of receiving radiographs (adjusted odds ratio [AOR] equals 1.22; 95 percent confidence interval [95% CI] equals 1.01 to 1.48; P=0.04), fluoride treatment (AOR equals 1.57; 95% CI equals 1.30 to 1.90; P≤0.001), and sealants (AOR equals 1.63; 95% CI equals 1.24 to 2.16; P=0.001) compared to children who visited only general dentists. There was no statistically significant difference in the provision of periodic examinations and prophylaxis services. Conclusion: Based on the nationally representative data evaluated, pediatric dentists are more likely to provide more optimal preventive services than general dentists (i.e., radiographs, fluoride treatments, and sealants) to children in the United States. [ABSTRACT FROM AUTHOR]

Dentists are an overlooked group of prescribers but are responsible for up to 10% of antibiotic prescriptions written in the United States annually, most of which are for prophylaxis. Dental prophylaxis in orthopedic patients has been an area of confusion, with discordance among societal guidelines. In 2020, an antimicrobial stewardship (AS) group spearheaded a collaborative effort among dental, orthopedic surgery, and infectious diseases specialties to develop a protocol for the use of dental antibiotic prophylaxis for patients with total joint replacements (TJRs) based on the most current American Dental Association-American Academy of Orthopaedic Surgeons statement. This study aimed to assess antibiotic prescribing for dental prophylaxis before and after an AS intervention. This study is an interventional, pre-post review of dental encounters with patients with a history of TJR before (October 2019 to July 2021) and after (August 2021 to April 2023) the intervention. Charts were reviewed to determine the frequency and appropriateness of dental procedure prophylactic antibiotics. A total of 1587 encounters from October 2019 to April 2023 were identified. Notably, 179 encounters in the pre- and 183 encounters in the postgroup were analyzed, 31 encounters (17%) in the pregroup versus 33 (18%) in the postgroup had a prophylactic antibiotic associated with it (P > 0.05), 26 of 31 antibiotics (84%) in the pregroup were prescribed for prosthetic joint infection prophylaxis compared with 18 of 33 (55%) in the postgroup (P > 0.05), and 151 of 179 encounters (84.3%) were guideline adherent in the preintervention group compared with 160 of 183 encounters (87.4%) in the postintervention group (P > 0.05). This study observed a shift in the distribution of antibiotic indications and a decreased rate of inappropriate prophylactic prescriptions in dental patients with a history of TJR after an AS-led, collaborative intervention. Although the overall rate of prophylactic antibiotic prescribing remained the same and the changes did not reach statistical significance, lessons learned through this process can help inform future interventions in our institution and for others. [ABSTRACT FROM AUTHOR]

This study examined the utilization of antimicrobials in canines and felines receiving dental treatments in veterinary clinics in the United States, retrospectively. A total of 818,150 animals (713,901 procedures in dogs and 104,249 procedures in cats) underwent dental procedures under general anesthesia in 2020. These included dental prophylaxis and extractions. Patient demographic data, antimicrobial treatment, treatment duration, dose, periodontal disease score, whether tooth extractions were performed and how many extractions were performed was recorded. Our results showed that local or systemic antimicrobials were used in 116,723/713,901 (16.4%) procedures in dogs and 14,264/104,249 (14%) procedures in cats. Age, weight, extraction of one or more teeth and diagnosis of periodontal disease (any stage) were associated with increased likelihood of antimicrobial administration using univariable analysis (all P<0.001) and in the multivariable model. Clindamycin, amoxicillin-clavulanate and amoxicillin were the most common oral antimicrobials used in dogs and cats. Drugs classified as highest priority clinically important antibiotics (HPCIA) were administered to 30,960/116,723 (26.5%) of dogs and 7,469/14,264 (52%) of treated cats. The results obtained can inform interventions to optimize patient care and promote prudent use of antimicrobials during dental procedures in canine and feline patients. [ABSTRACT FROM AUTHOR]

Fear of medical liability is a major driver for broad administration of perioperative prophylactic anticoagulation, despite the persistently low rates of clinically symptomatic venous thromboembolism events (VTE) postoperatively. This study was undertaken to evaluate the medicolegal landscape of perioperative VTE and its pharmaceutical prophylaxis. The Westlaw legal database was retrospectively searched for verdicts in medical professional liability cases in the United States between 2009 and 2020. One search strategy focused on perioperative VTE, and a second on claims of hemorrhagic complications in patients receiving perioperative anticoagulation. The search for VTE revealed 129 cases, and the search for hemorrhagic complications identified 24 cases. Almost half of the VTE cases were brought following orthopedic surgery (49%), and 29% following general surgery. The most common claims were failure to diagnose and treat during hospital stay or after discharge (74%), and failure to prescribe/administer anticoagulation (46%). Verdict for the health care professional (i.e., the defendant) was reached in 75% of cases. The median payout for patient verdicts was 1,213,644 USD (interquartile range 1,014,100; 150,000-7,700,000). Of hemorrhagic complication cases, 42% occurred in patients receiving VTE prophylaxis. In these cases, 82% resulted in a defendant verdict. Reasons for in-court medical professional liability claims involving perioperative VTE were mainly failure to diagnose VTE and rescue patients from complications postoperatively. The high rate of defendant verdicts supports the notion that decisions on VTE prophylaxis should not be influenced by fear of liability. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to analyze factors associated with oral health‐related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults. Methods: The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003–2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP‐ADD) and as prevalence of negative impacts (OHIP‐SC). Multiple logistic regression models used dichotomous outcome variables OHIP‐ADD and OHIP‐SC. The cut‐off values for poor OHRQoL were heuristically defined as OHIP‐ADD ≥6 and as OHIP‐SC > 0. Results: Poor OHRQoL was significantly (p < 0.0001) predicted by T2DM (ORSC‐controlled = 1.43, ORSC‐uncontrolled = 1.73), obesity (ORSC = 1.24), untreated dental caries (ORSC = 1.79), periodontal disease (ORADD = 1.07), evaluated unmet denture need (ORSC = 1.72), low income (ORADD = 1.22), smoking (ORSC‐former‐smoker = 1.04, ORSC‐current‐smoker = 1.99), African‐American (ORSC = 1.19), and female (ORSC = 1.66) in both logistic regression models. In contrast, protective factors significantly (p < 0.0001) associated with poor OHRQoL were private dental insurance (ORSC = 0.81), college education (ORSC = 0.85), and annual dental prophylaxis (ORSC = 0.83), after adjustment for covariates. Conclusions: This study showed that private insurance coverage and annual prophylaxis are associated with better average OHRQoL among individuals with T2DM. Improved OHRQoL may be associated with glycaemia control, decreased BMI, and smoking cessation. The highest odds for poor OHRQoL were found among US adults with T2DM with uncontrolled HbA1c, untreated dental caries, and current smoking. [ABSTRACT FROM AUTHOR]

It is well established that adverse childhood experiences (ACEs) negatively impact physical and mental health. There is a paucity of research examining the impact of ACEs on oral health. Therefore, the aim of this study was to better understand how ACEs may impact oral health utilizing a nationally representative sample of females. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) were utilized. The sample comprised 36,249 females. Chi-square tests were used to examine associations between multiple forms of ACEs and oral health, mental health, smoking, and health-related quality of life. Logistic regression models were generated for the outcomes of interest: last dental cleaning, significant tooth loss, smoking, and health-related quality of life. Post-hoc analyses were conducted to examine whether smoking and dental cleaning moderated the relationship between ACEs and significant tooth loss. All ACE categories were significantly associated with poor health-related quality of life, being a current or former smoker, last dental cleaning >1 year, and significant tooth loss even after adjusting for demographic variables. Last dental cleaning and being a current or former smoker moderated the relationship between ACEs and significant tooth loss. This study affirms other findings that women with a history of ACEs were more likely to engage in health-risk behaviors, specifically cigarette smoking, which has been strongly associated with ACEs. These findings underscore the importance of including oral health in future studies given it has implications for disease development. Furthermore, dental visits may provide a window of opportunity for trauma-informed care. [ABSTRACT FROM AUTHOR]

Objectives: Rurality is associated with reduced dental access and worse oral health outcomes. It is unknown whether there is variation in dental services received by rural adults who visit a dentist. Methods: This was a retrospective analysis of claims data from a large private insurer. All individuals who had at least one dental visit in 2018 were included. Patient demographics, whether or not a patient's ZIP code was rural as defined by the Federal Office of Rural Health Policy, as well as ZIP code demographics were collected. Differences in the frequency of dental services received were evaluated using χ2 tests. Multilevel logistic regressions were used to evaluate the individual and ZIP code‐level correlates of receiving a preventive dental procedure, a tooth extraction, or a denture‐related dental procedure. Results: Rates of preventive, oral and maxillofacial surgery, and denture‐related procedures were higher among rural adults. Accounting for individual age and gender, and ZIP code average income and dentist density, rural dwellers were more likely to receive a preventive procedure [odds ratio (OR) 1.15, P < 0.0001] or tooth extraction (OR 1.08, P < 0.0001), and less likely to have a denture‐related procedure (OR 0.94, P = 0.015) compared to nonrural dwellers. Female gender was the strongest predictor of receiving a preventive procedure (OR 1.30, P < 0.0001). Conclusions: Even among privately insured individuals with known access to dental care, rurality was associated with significant differences in the frequency of various dental procedures. Rural dental patients may have higher needs for oral surgical procedures, even when they have access to preventive care. [ABSTRACT FROM AUTHOR]

Background. Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children's preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics. Methods. Data for this observational, cross-sectional study came from the 2016 National Survey of Children's Health. Children aged 2 through 17 years were included (n = 46,100). Caregiverreported measures were preventive dental visits, prophylaxis, toothbrushing or oral health care instructions, fluoride, sealants, fair or poor condition of the teeth, and problems with carious teeth or caries. Univariate, bivariate, and multivariable logistic regression analyses were conducted. Results. As reported by parents or caregivers, 8 in 10 children had a preventive dental visit in the past year but lower rates of specific services: 75% prophylaxis, 46% fluoride, 44% instructions, and 21% sealants. In addition, 12% had carious teeth or caries and 6% had fair or poor condition of the teeth. In adjusted analyses, young children (aged 2-5 years), children with no health insurance, and those from lower-income and lower-educated households had decreased likelihood of a preventive dental visit as well as specific preventive services. Children with preventive health care visits and a personal physician or nurse had increased likelihood of receiving preventive oral health care. Conclusions. Preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage use of specific preventive services. Practical Implications. Dentists should work with caregivers and primary care providers to promote preventive oral health care, especially among young children and those from lower socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

The article discusses the competencies required for the graduate dental hygiene education approved by the American Dental Education Association House of Delegates. Topics discussed include focus on recognizing the impact of health status with integration of diversity, social and cultural sensitivity, need for identification of health care policies, interprofessional collaboration and advocacy, and focus on development of health promotion and disease prevention strategies.

Objective: To determine whether higher reimbursement for children's preventive dentistry correlates with greater utilization of preventive dental care.Methods: A cross-sectional analysis of National Survey of Children's Health 2011/2012 was conducted, combined with state Medicaid reimbursement rates for preventive dentistry. Analyses included prevalence, unadjusted odds ratios, and multivariable logistic regression for receipt of preventive dental services.Results: Of all surveyed American children 1-17 years, almost 20 percent had not received preventive dental care in prior year; this percentage is even higher in those with public insurance. Each $10 increase in state reimbursement was associated with a 17 percent decrease in odds of children not receiving preventive services.Conclusions: Higher state reimbursement for preventive services may increase children's receipt of preventive dental care. [ABSTRACT FROM AUTHOR]

Rationale/background: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. Currently, the only antibiotic prophylaxis guidelines for patients with ESRD undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first and second parts of this study found no consistent protocols amongst U.S. dental schools and U.S. GPRs and AEGDs, respectively. The goal of the third part of the project was to determine the current protocol being used to treat ESRD patients at U.S. nephrology fellowship programs.Methods and Materials: An 18 multiple-choice question survey was e-mailed to 130 directors of nephrology fellowships within the U.S. regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease.Results: Note that, 34.6% of respondents reported having an established renal treatment protocol. For programs with a protocol, 69% of programs reported following AHA guidelines.Conclusion: There is a lack of consistent, established protocols amongst U.S. nephrology fellowships. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed. [ABSTRACT FROM AUTHOR]

The article offers guidelines from the American Academy of Pediatric Dentistry (AAPD) regarding the periodicity of examination, preventive dental services, anticipatory guidance/counseling and oral treatments for infants, children and adolescents. Topics discussed include methodology and research on the topic, guidelines for examination and insights on fluoride supplementation.

Objectives: As trials were assessing the safety and efficacy of daily oral antiretroviral preexposure prophylaxis (PrEP) for the prevention of HIV infection, there was a clear need to understand the evolution of knowledge of, and attitudes toward, PrEP among primary care clinicians. Methods: Physicians and nurse practitioners were surveyed in 2009 (n = 1500), 2010 (n = 1504), 2012 (n = 1503), 2013 (n = 1507), 2014 (n = 1508) and 2015 (n = 1501) to assess their awareness of PrEP, willingness to prescribe PrEP, and whether they support use of public funds to pay for PrEP. Pharmacists (n = 251) were surveyed about PrEP in 2012 only. Descriptive statistics were computed for physician demographics and PrEP-related questions. Prevalence ratios for willingness to prescribe PrEP were computed using Poisson regression analysis. Results: Awareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 66%). Following a description of PrEP with an estimated effectiveness of 75%, across 6 of the study years 91% of clinicians indicated a willingness to prescribe PrEP to at least one group at high risk of HIV acquisition. A smaller majority of clinicians indicated support for public funding of PrEP in 2009: 59%, 2010: 53%, and 2013: 63%. Conclusions: In surveys conducted before and after the release of PrEP trial results, primary care clinicians were largely unaware of PrEP. They indicated high levels of willingness to prescribe it for patients at high risk of HIV acquisition and expressed interest in education about how to deliver this new clinical HIV prevention method. It will be important to continue monitoring clinician knowledge, attitudes, and practices as the use of PrEP increases in the US. [ABSTRACT FROM AUTHOR]

Objectives: The Centers for Disease Control and Prevention defines HIV prevention as a core family planning service. The HIV community identified family planning visits as key encounters for women to access preexposure prophylaxis (PrEP) for HIV prevention. No studies explore US family planning providers' knowledge of and attitudes towards PrEP. We conducted a national survey of clinicians to understand barriers and facilitators to PrEP implementation in family planning.Study Design: Family planning providers recruited via website postings, national meetings, and email completed an anonymous survey in 2015. Descriptive statistics were performed.Results: Among 604 respondents, 495 were eligible for analysis and 342 were potential PrEP prescribers (physicians, nurse practitioners, midwives or physicians assistants). Among potential prescribers, 38% correctly defined PrEP [95% confidence interval (CI): 32.5-42.8], 37% correctly stated the efficacy of PrEP (95% CI: 32.0-42.4), and 36% chose the correct HIV test after a recent exposure (95% CI: 30.6-40.8). Characteristics of those who answered knowledge questions correctly included age less than 35 years, practicing in the Northeast or West, routinely offering HIV testing, providing rectal sexually transmitted infection screening or having seen any PrEP guidelines. Even among providers in the Northeast and West, the proportion of respondents answering questions correctly was less than 50%. Thirty-six percent of respondents had seen any PrEP guidelines. Providers identified lack of training as the main barrier to PrEP implementation; 87% wanted PrEP education.Conclusions: To offer comprehensive HIV prevention services, family planning providers urgently need training on PrEP and HIV testing.Implications: US family planning providers have limited knowledge about HIV PrEP and HIV testing, and report lack of provider training as the main barrier to PrEP provision. Provider education is needed to ensure that family planning clients access comprehensive HIV prevention methods. [ABSTRACT FROM AUTHOR]

Introduction: Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities.Methods: Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015.Results: In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively).Conclusions: Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care. [ABSTRACT FROM AUTHOR]

The aim of this study was to define the extent to which leadership and leadership skills are taught in dental hygiene degree completion programs by comparing stand-alone leadership courses/hybrid programs with programs that infuse leadership skills throughout the curricula. The study involved a mixed-methods approach using qualitative and quantitative data. Semi-structured interviews were conducted with program directors and faculty members who teach a stand-alone leadership course, a hybrid program, or leadership-infused courses in these programs. A quantitative comparison of course syllabi determined differences in the extent of leadership content and experiences between stand-alone leadership courses and leadership-infused curricula. Of the 53 U.S. dental hygiene programs that offer degree completion programs, 49 met the inclusion criteria, and 19 programs provided course syllabi. Of the program directors and faculty members who teach a stand-alone leadership course or leadership-infused curriculum, 16 participated in the interview portion of the study. The results suggested that competencies related to leadership were not clearly defined or measurable in current teaching. Reported barriers to incorporating a stand-alone leadership course included overcrowded curricula, limited qualified faculty, and lack of resources. The findings of this study provide a synopsis of leadership content and gaps in leadership education for degree completion programs. Suggested changes included defining a need for leadership competencies and providing additional resources to educators such as courses provided by the American Dental Education Association and the American Dental Hygienists' Association. [ABSTRACT FROM AUTHOR]

Many reviews support fluoride varnish (FV) as a caries-inhibitory agent. Evidence from 6 Cochrane systematic reviews involving 200 trials and more than 80,000 participants further confirms the effectiveness of FV, applied professionally 2-4 times a year, for preventing dental caries in both primary and permanent teeth. The relative benefit of FV application seems to occur irrespective of baseline caries risk, baseline caries severity, background exposure to fluorides, use of fluoride toothpaste and application features such as prior prophylaxis, concentration of fluoride or frequency of application. While the efficacy of FV is acknowledged in clinical practice guidelines globally, the implementation of this recommendation may still be an issue. Factors that may facilitate FV application in the USA include Medicaid eligibility, relationships with dentists/community centers and strong cooperation and communication between physicians and support staff. Barriers include insufficient time to integrate oral health services into well-child visits, difficulty in applying FV (lack of skills/training) and resistance among colleagues and staff. Research in the UK/Scotland also suggests encouraging clinicians in their motivation to perform this treatment and addressing professional and parental concerns relating to possible negative consequences may be influential. Further research targeting cost-effectiveness and how FV in routine care may fit in with political agendas relating to, for example, inequalities in health care provision and access will also play a key part in stakeholder decisions to put resources into this issue. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted to determine the frequency and type of adverse events (AEs) associated with ultrasonic scaler reported to the Food and Drug Administration manufacturer and user facility device experience (MAUDE) database.Materials and Methods: The authors reviewed the ultrasonic scaler units (USU) related AEs reported to MAUDE from October 1, 1995, to September 31, 2015. Analyses of details collected are presented.Results: MAUDE received a total of 667 unique USU-related AE reports. Of 667 cases, MAUDE classified 628 instances (94.2%) as malfunction 27 (4%) as injurious, 10 (1.5%) as others, and 2 (0.3%) claiming the use of USU as cause of death. Of the 667 cases, 511 (76.6%) were used for endodontic application, and 147 (22%) as scaler applications. In 512 (76.8%) instances, there was separation of the tips, posing danger to patients or users, and 112 (16.8%) instances of overheating, 12 (1.8%) instances of breakage, and electrical issues in 8 (1.2%) instances. These AE resulted in 19 instances of thermal injury, 2 suspicious deaths, and hearing loss in 3 cases. In 4 cases, patient swallowed broken parts requiring additional medical care.Conclusions: Use of USU, a Class 2 device without exemption, carries a degree of risk to patient's safety, if not properly used. As of today, MAUDE data is the only reliable source of AE until another database or such study is carried out. Certain AE that has been largely anecdotal, such as hearing loss has been reported in this study. The findings from study reiterate that more in-depth analysis of AE of USU is needed. Until then operator needs to take all precautions to avoid AE when using USU. [ABSTRACT FROM AUTHOR]

Background: People who travel to areas with high rabies endemicity and have animal contact are at increased risk for rabies exposure. We examined characteristics of international travelers queried regarding rabies vaccination during pretravel consultations at Global TravEpiNet (GTEN) practices during 2009-2010. Material and Methods: We performed bivariate and multivariable analyses of data collected from 18 GTEN clinics. Travel destinations were classified by strength level of rabies vaccination recommendation. Results: Of 13,235 travelers, 226 (2%) reported previous rabies vaccination, and 406 (3%) received rabies vaccine at the consultation. Common travel purposes for these 406 travelers were leisure (26%), research/education (17%), and nonmedical service work (14%). Excluding the 226 who were previously vaccinated, 8070 (62%) of 13,009 travelers intended to visit one or more countries with a strong recommendation for rabies vaccination; 1675 (21%) of these 8070 intended to travel for 1 month or more. Among these 1675 travelers, 145 (9%) were vaccinated, 498 (30%) declined vaccination, 832 (50%) had itineraries that clinicians determined did not indicate vaccination, and 200 (12%) remained unvaccinated for other reasons. In both bivariate and multivariate analyses, travelers with trip durations >6 months versus 1-3 months (adjusted odds ratio [OR]=4.9 [95% confidence interval [CI] 2.1, 11.4]) and those traveling for 'research/education' or to 'provide medical care' (adjusted OR=5.1 [95% CI 1.9, 13.7] and 9.5 [95% CI 2.2, 40.8], respectively), compared with leisure travelers, were more likely to receive rabies vaccination. Conclusions: Few travelers at GTEN clinics received rabies vaccine, although many planned trips 1 month long or more to a strong-recommendation country. Clinicians often determined that vaccine was not indicated, and travelers often declined vaccine when it was offered. The decision to vaccinate should take into account the strength of the vaccine recommendation at the destination country, duration of stay, availability of postexposure prophylaxis, potential for exposure to animals, and likelihood of recurrent travel to high-risk destinations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, there is no standard of care for prophylactic antibiotics (PABX) at the time of placement of fully implanted central venous access ports (CVAPs). A survey of fellows of the American College of Surgeons was undertaken to determine the current practice pattern of PABX in CVAP placement. METHODS: A survey was mailed to 5,000 fellows of the American College of Surgeons. RESULTS: The response rate was 21.7%, with 73.1% of respondents nonacademic surgeons. PABX were given by 88.2% of the respondents. Of those who did not use PABX, the primary reasons were "not justified'' or "not standard of care.'' General comments regarding reasons for use of PABX in-cluded "medicolegal," "required by hospital,'' and "liability." CONCLUSIONS: In this survey, the overwhelming majority of responding American College of Sur-geons fellows indicated that they use preoperative antibiotic prophylaxis for CVAP placement, despite there being no accepted standard of care or definitive evidence regarding PABX use for fully implanted CVAPs. [ABSTRACT FROM AUTHOR]

Background. The 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis (IE) called for a major reduction in the number of patients recommended for antibiotic prophylaxis (AP) and redefined the dental procedures considered to put these patients at risk of acquiring the infection. The purpose of the authors' study was to determine the acceptance of these changes among and the impact of the changes on dentists and their patients. Methods. The authors sent a survey to a random sample of 5,500 dentists in the United States. Results. Ninety-five percent of the 878 respondents indicated that they saw patients who receive AP. More than 75 percent were either satisfied or very satisfied with the AHA guidelines, and the respondents indicated that they believed almost three- quarters of their patients also were pleased. Seventy percent of dentists, however, had patients who took antibiotics before a dental procedure even though the guidelines no longer recommend it. Conclusions. Acceptance of the 2007 guidelines appears to be high, but controversy remains. Additional scientific data are needed to resolve these issues. Practical Implications. The 2007 AHA guidelines have greatly simplified the identification of patients who need AP for dental procedures, given that, in general, far fewer people with cardiac abnormalities are considered to be at risk as a result of invasive procedures. Some physicians, however, continue to prescribe antibiotics for some patients whom the AHA no longer considers to need them. Patients also may choose to continue this practice themselves. There is ongoing controversy surrounding this common clinical question in dental practice, and the next guidelines from the AHA may change on the basis of data from future clinical studies. [ABSTRACT FROM AUTHOR]

Background: Myelosuppressive chemotherapy can lead to dose-limiting febrile neutropenia. Prophylactic use of recombinant human G-CSF such as daily filgrastim and once-per-cycle pegfilgrastim may reduce the incidence of febrile neutropenia. This comparative study examined the effect of pegfilgrastim versus daily filgrastim on the risk of hospitalization. Methods: This retrospective United States claims analysis utilized 2004-2009 data for filgrastim- and pegfilgrastim-treated patients receiving chemotherapy for non-Hodgkin's lymphoma (NHL) or breast, lung, ovarian, or colorectal cancers. Cycles in which pegfilgrastim or filgrastim was administered within 5 days from initiation of chemotherapy (considered to represent prophylaxis) were pooled for analysis. Neutropenia-related hospitalization and other healthcare encounters were defined with a "narrow" criterion for claims with an ICD-9 code for neutropenia and with a "broad" criterion for claims with an ICD-9 code for neutropenia, fever, or infection. Odds ratios (OR) for hospitalization and 95% confidence intervals (CI) were estimated by generalized estimating equation (GEE) models and adjusted for patient, tumor, and treatment characteristics. Per-cycle healthcare utilization and costs were examined for cycles with pegfilgrastim or filgrastim prophylaxis. Results: We identified 3,535 patients receiving G-CSF prophylaxis, representing 12,056 chemotherapy cycles (11,683 pegfilgrastim, 373 filgrastim). The mean duration of filgrastim prophylaxis in the sample was 4.8 days. The mean duration of pegfilgrastim prophylaxis in the sample was 1.0 day, consistent with the recommended dosage of pegfilgrastim - a single injection once per chemotherapy cycle. Cycles with prophylactic pegfilgrastim were associated with a decreased risk of neutropenia-related hospitalization (narrow definition: OR = 0.43, 95% CI: 0.16-1.13; broad definition: OR = 0.38, 95% CI: 0.24-0.59) and all-cause hospitalization (OR = 0.50, 95% CI: 0.35-0.72) versus cycles with prophylactic filgrastim. For neutropenia-related utilization by setting of care, there were more ambulatory visits and hospitalizations per cycle associated with filgrastim prophylaxis than with pegfilgrastim prophylaxis. Mean per-cycle neutropenia-related costs were also higher with prophylactic filgrastim than with prophylactic pegfilgrastim. Conclusions: In this comparative effectiveness study, pegfilgrastim prophylaxis was associated with a reduced risk of neutropenia-related or all-cause hospitalization relative to filgrastim prophylaxis. [ABSTRACT FROM AUTHOR]

Background: The current radiation threat from the Fukushima power plant accident has prompted rethinking of the contingency plan for prophylaxis and treatment of the acute radiation syndrome (ARS). The well-documented effect of the growth factors (granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF]) in acute radiation injury has become standard treatment for ARS in the United States, based on the fact that growth factors increase number and functions of both macrophages and granulocytes. Methods: Review of the current literature. Results: The lungs have their own host defense system, based on alveolar macrophages. After radiation exposure to the lungs, resting macrophages can no longer be transformed, not even during systemic administration of growth factors because G-CSF/GM-CSF does not penetrate the alveoli. Under normal circumstances, locally-produced GM-CSF receptors transform resting macrophages into fully immunocompetent dendritic cells in the sealed-off pulmonary compartment. However, GM-CSF is not expressed in radiation injured tissue due to defervescence of the macrophages. In order to maintain the macrophage's important role in host defense after radiation exposure, it is hypothesized that it is necessary to administer the drug exogenously in order to uphold the barrier against exogenous and endogenous infections and possibly prevent the potentially lethal systemic infection, which is the main cause of death in ARS. Recommendation: Preemptive treatment should be initiated after suspected exposure of a radiation dose of at least -2 Gy by prompt dosing of 250-400 μg GM-CSF/m2 or 5 μg/kg G-CSF administered systemically and concomitant inhalation of GM-CSF ~ 300 mcg per day for at least 14-21 days. Conclusion: The present United States standard for prevention and treatment of ARS standard intervention should consequently be modified into the combined systemic administration of growth factors and inhaled GM-CSF to ensure the sustained systemic and pulmonary host defense and thus prevent pulmonary dysfunction. [ABSTRACT FROM AUTHOR]

The article discusses the results of a survey regarding the oral health of the U.S. Army recruits. The survey was conducted from December 2007 to November 2008 with a sample of 1,928 Army recruits. Results showed that 84.3% of the recruits need oral prophylaxis and 39.6% recruits need oral surgery. It mentions that of the total recruits examined, 60.5% perceived a need for dental care but do not do so because of the expense.

The article presents guidelines from the American Academy of Pediatric Dentistry concerning clinical decision making for preventative dental care. It comments on the use of risk assessment for dental caries and states children have a higher likelihood of developing caries if they acquire the bacteria mutans streptococci at an early age. It talks about the use of topical fluoride treatment and prophylaxis in treating and preventing periodontitis. It mentions the use of dental radiography and of the U.S. Food and Drug Administration and American Dental Association guidelines which are meant to assist dentists in determining when specific radiographs are needed. It also comments on the use of dental sealants to reduce the risk of pit and fissure caries and on third molar development.

The article focuses on the recognition and prevention of invasive candidiasis infections in the intensive care unit (ICU) in the U.S. It mentions the diagnosis of invasive candidiasis including rapid species identification and improvements in antigen testing. It notes the introduction of several prediction rules which helped clinicians in the use of prophylaxis or preemptive antifungal therapy in high-risk patients.

Background. The aim of this study was to determine the development of drug resistance among pregnant women receiving a protease inhibitor-based antiretroviral prophylaxis for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV). Methods. HIV-infected pregnant women without maternal indication for antiretroviral therapy were enrolled prospectively. Genotypic resistance testing was performed prior to initiation of antiretroviral prophylaxis and was repeated 4-8 weeks after cessation of antiretroviral therapy at the time of delivery. Results. Forty pregnant women with HIV infection (Centers for Disease Control and Prevention stage A1 or A2) were included. All women received an antiretroviral regimen including either fixed-dose lopinavir/ritonavir (n=33) or ritonavir-boosted saquinavir (n=7) and a backbone consisting of 2 nucleoside reverse-transcriptase inhibitors. The mean duration of antiretroviral treatment was 8.4 weeks (range, 5-22 weeks). Primary resistance mutations were found in 2 patients (nonnucleoside reverse-transcriptase inhibitor resistance, K103N; protease inhibitor resistance, G48V). Postpartum genotypic resistance revealed no new relevant resistance mutations. Conclusions. In our study no clinically significant resistance mutations developed in pregnant women receiving a short-term protease inhibitor-based antiretroviral regimen for prophylaxis of mother-to-child transmission of HIV. Future therapeutic options are therefore preserved. [ABSTRACT FROM AUTHOR]

The article discusses the use of postexposure prophylaxis against human immunodeficiency virus (HIV) infection in the U.S. as of October 2009. It says that a 24-year-old man reported that he had receptive anal intercourse with an anonymous male partner 36 hours before he went into an outpatient clinic. According to the author, the history of the use of postexposure prophylaxis as a treatment for this chronic infection can be traced back to the early parts of the 1990s, which was the time when antiviral treatment was limited. Details of assessing the need for postexposure prophylaxis and the prevalence of HIV infection in the country are also discussed.

The article discusses the revised guidelines for the application of antibiotic prophylaxis to prevent infective endocarditis. The effectiveness of antibiotic prophylaxis in preventing the incidence of bacteremia is tackled. The preference for an evidence-based approach to antibiotic prophylaxis is also tackled. The guidelines from the American Heart Association (AHA), the National Institute for Health and Clinical Excellence (NICE) and the British Society for Antimicrobial Chemotherapy (BSAC) are compared.

RSV can cause respiratory illness after SOT, yet preventive recommendations are lacking for this population. To ascertain current preventive practices against RSV disease in pediatric SOT candidates and recipients, a survey was developed. The survey was mailed to 108 SOT programs in the United States (liver, 42; heart, 28; lung, 11; intestinal, 25; and heart-lung, 2). Results were tabulated and analyzed using standard methods. Sixty-two percent (67/108) of surveys were completed. Forty-nine percent (33/67) of programs reported using RSV prophylaxis; palivizumab was used at 97% (32/33) of centers with 26 giving palivizumab to candidates and 27 to recipients. Prophylaxis was provided to infants aged 0–12 months by 27/29 (93%) of responding centers; 23/29 of centers extended its use to infants aged 0–24 months. Three centers gave prophylaxis to children between ages two and four yr and two centers for those over four yr. RSV prophylactic strategies, and in particular the use of palivizumab, are employed by almost 50% of responding pediatric SOT centers. Strategies varied at centers based on age and organ type. Data on RSV hospitalization and outcome are needed to refine approaches to RSV immunoprophylaxis in these high-risk patients. [ABSTRACT FROM AUTHOR]

Postexposure prophylaxis after sexual exposure to human immunodeficiency virus (HIV) is recommended by state and national agencies. A cross-sectional survey of 117 Los Angeles County sites found that 17 sites (14.5%) offer postexposure prophylaxis. Ten sites (8.5%) offer postexposure prophylaxis to patients who are uninsured. General availability of postexposure prophylaxis should be a public health priority. [ABSTRACT FROM AUTHOR]

The relationship between periodontal disease and systemic disease has gained much attention in recent years in the dental profession and from national health care agencies. Two third-party providers are now modifying their dental reimbursements for patients who have periodontal disease and are pregnant or have cardiovascular disease. However, there are few reports in the dental or dental hygiene literature about how students are taught this information and how it is incorporated into the didactic and clinical aspects of the curriculum. A thirty-item survey and cover letter on these subjects were emailed to the directors of the 286 accredited dental hygiene programs in the United States in 2007. The response rate was 63 percent. According to these responses, the three most emphasized topics regarding oral-systemic disease are diabetes, tobacco use, and cardiovascular disease. Most programs (90 percent) use journal articles for instructional content, and 87 percent use the American Academy of Periodontology website for reference. Only 4 percent have content taught jointly with nursing, medical, or allied health students. The majority of directors (87 percent) indicated they could use more evidence-based educational materials to help teach the concepts to students. Only 9 percent of survey respondents thought that nurses and physicians are knowledgeable about the relationship of oral health to systemic disease. The findings indicate that dental hygiene program directors are confident about the education on oral-systemic content provided to their dental hygiene students, but would like additional evidence-based materials to help their students learn this topic. [ABSTRACT FROM AUTHOR]

Background: This study assessed predictive values of self-reported periodontal need to identify periodontal conditions using clinical examinations as the gold standard. Methods: We identified 12,370 adults ≥18 years of age in the third National Health and Nutrition Examination Survey. Self-reported periodontal need was based on participants responding that gum treatment and/or cleaning was needed when asked: "What type of dental care do you need now?" Two periodontal conditions were at least two sites with pockets (pockets ≥3 mm or pockets ≥4 mm) and at least two sites with calculus. Main outcomes were: 1) positive predictive value (PPVClean): proportion of those who self-reported the need for cleaning who had calculus; and PPVGum: proportion who self-reported the need for gum treatment who had pockets; 2) negative predictive value (NPVClean): proportion of those who self-reported no need for cleaning who did not have calculus; and NPVGum: proportion who self-reported no need for gum treatment who did not have pockets; 3) association between predictive values and sociodemographic and behavioral characteristics; and 4) proportion of individuals with specific sociodemographic and behavioral characteristics whose self-reported periodontal need predicted periodontal conditions. Results: The prevalence of periodontal conditions influenced predictive values. Calculus prevalence=85%: corresponding PPVClean= 88% and NPVClean= 16%. Prevalence of pockets ≥3 mm = 47%: corresponding PPVGum = 62% and NPVGum= 54%. Prevalence of pockets ≥4 mm = 11%: corresponding PPVGum = 25% and NPVGum = 90%. Ninety percent of 30- to 44-year-old minority female smokers who did not visit the dentist in the past year and reported the need for gum treatment had pockets ≥3 mm (PPVGum = 90%). Conclusions: Self-reported periodontal need (cleaning/gum treatment) predicted the presence of the prevalent conditions (calculus/ pockets ≥3 mm). Not reporting a need for periodontal treatment predicted the absence of the less common condition (pockets ≥4 mm) but not the more prevalent condition (calculus). [ABSTRACT FROM AUTHOR]

The article presents information on a study that was conducted to examine reasons behind substantial morbidity among HIV-infected persons despite availability of effective prophylaxis, Pneumocystis jiroveci pneumonia (PCP) in the U.S. A total of 483 episodes of PCP were diagnosed during 7315 person-years. Incidence was lowest among persons prescribed both antiretroviral therapy (ART) and PCP prophylaxis, while persons not prescribed prophylaxis had higher PCP incidence.

The objective of the study was to investigate various aspects of evidence-based dental prophylaxis education in postdoctoral pediatric dentistry training programs in the United States. An anonymous nationwide postal survey of fifty-two postdoctoral pediatric dentistry program directors was conducted in September 2001. The survey had a response rate of 75 percent with all geographic regions of the nation represented and with a preponderance of university-based programs (62 percent). Most of the training programs (74 percent) routinely recommended dental prophylaxis for all recall patients. The proportion of programs that recommended dental prophylaxis for the following indications were: plaque, stain and/or calculus removal--97 percent; caries prevention--59 percent; prior to topical fluoride application--67 percent; prior to sealant application--62 percent; and for behavioral modification--77 percent. Most training programs (77 percent) defined dental prophylaxis as both rubber cup pumice prophylaxis and toothbrush prophylaxis. However, only one-half of the training programs (51 percent) had modified their teaching to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis. In conclusion, only one half of postdoctoral pediatric dentistry training programs in the United States teach evidence-based practice of dental prophylaxis for recall patients. [ABSTRACT FROM AUTHOR]

There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice. [ABSTRACT FROM AUTHOR]

Examines the use of systematic antimicrobial prophylaxis for patients and the risk for endocarditis in dental practice in the U.S. Colonization of different organisms in the human oral cavity; Vegetation of fibrin thrombus on the damaged heart valve; Revision of guidelines by the American Heart Association.

Focuses on the prevalence of prophylaxis on HIV-infected persons in the United States. Impact of highly antiretroviral therapy (HAART) on the incidence of opportunistic infections (OI) among HIV-infected patients; Association of HAART in AIDS-related mortality and days of hospitalization; Incidence of OI during immunization.

The article presents guidelines from the American Academy of Pediatric Dentistry (AAPD) on the education of caregivers and other interested third parties on the indications for and benefits of a dental prophylaxis in conjunction with a periodical oral health assessment. Indications for a dental prophylaxis include the removal of plaque, stain and calculus and the introduction of the child to dental procedures.

Provides information on a survey of topical medicine experts on whether contacts of patients with rabies be advised to seek postexposure prophylaxis. Situation in which the U.S. Centers for Disease Control and Prevention recommend the immunization for contacts of patients with rabies; Factor that contributes to the generous use of rabies vaccine and rabies immunoglobulin; Fatality due to rabies; Presence of rabies virus in human fluids and tissues.

OBJECTIVE: The primary objective of this study was to determine the prevalence of appropriate use of antibiotics before a dental procedure.
DESIGN: Retrospective cohort study.
SETTING: Veterans Healthcare Systems.
PARTICIPANTS: Veterans who filled outpatient prescriptions for antimicrobial dental prophylaxis at the Veterans Administration Western New York Healthcare System from December 1, 2017, through October 1, 2019.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES : Use of antibiotic dental prophylaxis was deemed appropriate if in accordance with guideline recommendations. Descriptive statistics were used to summarize data.
RESULTS: A total of 130 veterans receiving antibiotics for dental prophylaxis were included in this evaluation. Of those who were included, only 16.9% received appropriate antibiotic dental prophylaxis. Patients with a prosthetic joint were significantly more likely to be inappropriately prescribed antibiotics for dental prophylaxis. Approximately 87% of patients who were inappropriately prescribed antibiotic prophylaxis had prosthetic joints ( P < .0001).
CONCLUSION : Most antibiotics for dental prophylaxis are prescribed inappropriately. The large amount of inappropriately used antibiotics in this study highlights the need for dental stewardship in our veteran population. Antibiotics for dental prophylaxis therefore represent an important stewardship target in the outpatient setting. This may be an ideal opportunity for senior care pharmacists to intervene upon.

Total joint arthroplasty frequently is performed in the United States to treat degenerative hip and knee arthritis. Despite the routine nature of this procedure, recommendations about dental prophylaxis in patients with prosthetic joints have varied considerably over the past decade. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) published appropriate use criteria for dental prophylaxis in patients with orthopedic implants. Despite these recommendations, discrepancies in prescribing practices persist, and controversy surrounding this topic remains prevalent in the medical literature. This article reviews the AAOS appropriate use criteria and discusses the ongoing controversy about the use of dental prophylaxis in patients with orthopedic implants.

The article focuses on the revised guidelines of the American Heart Association (AHA) for the prevention of bacterial endocarditis. It notes that the guidelines have been modified to more clearly define when prophylaxis should be recommended, improve the compliance of practitioners and patients, reduce cost and approach a more universal set of recommendations. It cites that the problem of repetitive antibiotic exposures in patients who require a series of dental procedures has also been addressed in the guidelines.