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Including dental health providers in human papillomavirus (HPV) vaccination could reduce rising rates in HPV-associated oropharyngeal cancer (HPV-OPC). This study assessed Utah dentists’ perspectives on providing HPV vaccination education and services in the dental setting. A cross-sectional, 70-item self-administered survey was conducted among a convenience sample of N = 203 practicing Utah dentists. Statistical analyses included Chi Square tests of independence, scaled scores and Cronbach’s alpha coefficients. Majority of Utah dentists surveyed perceived that discussing the link between HPV and OPC and recommending the HPV vaccine is within their scope of practice, but not administration of the HPV vaccine. Dentists with >10 minutes of patient education per week were less likely to be concerned about the cultural, social norms or religious ideology of discussing HPV with their patients (p = .024). Rural dentists were more concerned about the safety and liability of the HPV vaccine (p = .011). Good internal consistency was observed survey items regarding barriers and willing to engage in HPV vaccination practices. Dental providers were interested in HPV training and patient education brochures as strategies, but less interested in administering the HPV vaccine. Dental associations support dentists’ engagement in HPV education and HPV-OPC prevention. This is the first study in Utah to examine dentists’ perspectives on HPV vaccination. Findings have implications for program planning, intervention development, and future research.

Background: The global incidence of oropharyngeal cancer is increasing. Dental professionals play a key role in the detection of oral and OPC lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are not fully defined. With sufficient knowledge and adequate training on how to educate patients about HPV vaccination, dental providers have the potential to lead HPV-OPC prevention. HPV knowledge and awareness has been reported to be low among dental student, oral health student, and oral health professional populations. Few if any of these studies have assessed the construct validity of instruments used to assess HPV knowledge and awareness among dental and oral health students and professionals. Methods: This study aimed to evaluate the applicability of a Latin American Spanish translation of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC originally developed for English-speaking populations. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4. Results: Data from a total of 122 students, a majority of the which were female (58%), aged 18 to 29 years old (93%), and Hispanic/Latino(a)/Spanish (87%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach’s alpha was 0.83, 0.77, and 0.85 respectively. The Barriers subscale had a Cronbach’s alpha of 0.92, showing a high internal consistency. The Clinical Procedures subscale focused on factors surrounding dental students’ hypothetical clinical practice procedures and had a Cronbach’s alpha of 0.80. The Scope of Practice scale had a Cronbach’s alpha of 0.73. Conclusions: Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students’ knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America.

Background The global incidence of oropharyngeal cancer (OPC) is increasing. Dental professionals play a key role in the detection of oral lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are underdeveloped and HPV knowledge and awareness has been reported to be low among dental students and professionals. The present study adapted and performed pretesting of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC for Latin American Spanish-speaking populations. Methods A previously developed questionnaire for English-speaking dental students was translated to Spanish. The questionnaire was administered to first year dental students at two Latin American universities with dental programs. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4. Results Data from a total of 114 students, a majority of the which were female (61%), and Hispanic/Latino(a)/Spanish (91%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach’s alpha was 0.83, 0.75, and 0.86 respectively. The Barriers subscale had a Cronbach’s alpha of 0.93, showing excellent internal consistency. The Clinical Procedures subscale, focused on factors surrounding dental students’ hypothetical clinical practice procedures, had a Cronbach’s alpha of 0.86. The Scope of Practice scale had a Cronbach’s alpha of 0.93. Conclusions Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students’ knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America.

Human papillomavirus related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), fourth year dental (DS4) students’ knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the United States were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n=380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the United States, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.

Background Using data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre- and posttreatment assessments of high-severity and chronic substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes. Methods After 1 through 2 months of treatment at a SUD treatment facility, 158 male self-selected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility–influenced outcomes were determined with multivariate analyses. Results The dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval [CI]) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes. Conclusions and Practical Implications Improvement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.

Objectives To achieve a comprehensive understanding about the global burden of oral diseases in HIV-infected children and to identify research needs. Materials and methods A literature search was conducted in PubMed (2009–2014) to address five questions: (i) prevalence of oral diseases in HIV-infected compared with uninfected children, (ii) impact of oral diseases on quality of life, (iii) effect of antiretroviral exposure in utero on craniofacial and dental development, (iv) important co-infections and antiretroviral complications, and (v) value of atraumatic restorative treatment. Results Studies showed a high prevalence of dental caries in HIV-infected children but the relationship between HIV infection and dental caries remains unclear. Also quality of life needs further investigation supported by better study designs and improvement of the instruments used. Up-to-date evidence suggested long-term harms associated with in utero antiretroviral exposure were minor but would require long-term follow-up through National Registries. The reviews also revealed the wide spectrum of metabolic disease due to antiretroviral therapy and co-infections such as tuberculosis. Finally, atraumatic restorative technique appears to be a simple and safe technique to treat dental caries but outcomes need further evaluation. Conclusions The impact of antiretroviral therapy in HIV-infected children has raised novel challenging questions in the field of oral health warranting future research.

This was the first study to develop and pilot test an assessment tool for the examination of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) knowledge, perceptions, and clinical practices of oral health students. An interdisciplinary team developed the tool using surveys that examined this topic in other populations. The tool was then pilot tested at two different dental programs. Results from the pilot informed revisions to the final version of the tool. Of the 46 student participants, 18 were first-year dental hygiene and 28 were first-year dental students. The majority of participants were female (N = 29, 63%) and ages 18 to 29 years old (N = 41, 89%). Four scales used in the questionnaire were analyzed for reliability. Of these, the HPV and HPV-OPC knowledge and the HPV vaccination knowledge scales had Cronbach alphas of 0.71 and 0.79, respectively. Questions assessing HPV and the role of dental professionals had a correlation coefficient of 0.71. Questions assessing willingness to administer vaccines in the dental office had a correlation coefficient of 0.85. Assessing oral health students' HPV-OPC knowledge, perceptions, and clinical practices are important for future assessment of possible HPV-OPC cases. Dental professionals may be optimally positioned to provide HPV patient education. The tool developed and pilot tested in this study can help schools assess their students' knowledge and guide their dental curriculum to address deficiencies. Since this topic has not been effectively examined with dental health students, the results could help improve dental education and dental care.

The purpose of this study was to test the bond strength and analyze the morphology of the dentin-adhesive interface of two etch and rinse and two self-etch adhesive systems with two kinds of artificial saliva (with and without 450 mg/L mucin) contamination under different conditions of decontaminating the interface. Bonded specimens were sectioned perpendicularly to the bonded surface in 1-mm thick slabs. These 1-mm thick slabs were remounted in acrylic blocks and sectioned in sticks perpendicular to the bonding interfaces with a 1-mm2 area. Nine specimens from each condition were tested after 24 h on a testing machine (Instron) at a speed of 0.5 mm/min for a total of 360 specimens. Mean and standard deviations of bond strength (MPa) were calculated. ANOVA showed significant differences as well as Fisher’s PLSD intervals (p < 0.05). The following values are the results for different groups: Control group 34–60 MPa, saliva without mucin 0–52 MPa, and saliva with mucin 0–57 MPa. Failure sites were mixed and adhesive failure was common for the low bond strength results. P&BNT with ideal conditions and following the manufacturer’s instructions (control) had the highest bond strengths and the dentin-adhesive interface exhibited an ideal morphology of etch-and-rinse system. SEM gave complementary visual evidence of the effect in the dentin/adhesive interface structure with some contaminated conditions compared with their respective control groups. This in vitro artificial saliva model with and without mucin showed that an organic component of saliva could increase or decrease the bond strength depending on the specific bonding agent and decontamination procedure.

Background Dentists prescribe 10% of outpatient antibiotics, yet aside from guidelines for infective endocarditis prophylaxis and against prosthetic joint infection prophylaxis, little is known about appropriate antibiotic use in dentistry. We aimed to describe antibiotic prescribing in dentistry to identify targets for improving prescribing. Methods We performed a cross-sectional study of patients receiving antibiotics between October 1, 2014 and September 30, 2016 at one of three University of Utah (UU) Dentistry clinics. Antibiotic prescriptions entered through the dental practice management software (Dentrix) were pulled from the UU data warehouse and linked with medical records. We assessed antibiotic prescribing rates, most commonly prescribed agents, frequency of documented β-lactam allergies, and duration of therapy. Prescriptions were categorized as for prophylaxis based on administration directions or antibiotics administered as one-time doses in the clinic. Finally, we measured the frequency of cardiac indications for preprocedure antibiotic prophylaxis and indicators that may be drivers of unnecessary antibiotic use (e.g., prosthetic joint). Results A total of 1,718 antibiotic prescriptions occurred in the study period, with a prescribing rate of 48/1,000 dental visits. Penicillins were the most commonly prescribed class [81% (1,399/1,718)]. Six percent (96/1,718) of prescriptions were consistent with infection prophylaxis. Thirty percent (29/96) of those receiving prophylaxis had a cardiac indication for dental prophylaxis, and 23% (22/96) had prosthetic joints. Mean nonprophylactic antibiotic duration was 8 days (standard deviation 3.9 days). Ten percent (180/1,718) of prescriptions were in patients with a documented β-lactam allergy. The majority of these patients [62% (111/180)] received clindamycin. Conclusion The majority of prescriptions evaluated were not consistent with preprocedure prophylaxis. Prophylaxis was frequently prescribed in patients without prophylactic indications. While improving prophylactic use of antibiotics for dental procedures is an important antibiotic stewardship target, a better understanding of the use of treatment courses could have more significant implications for dental antibiotic stewardship efforts. Disclosures All authors: No reported disclosures.

The purpose of this study was to determine the effects of contamination with smoker's and non-smoker's saliva on the bond strength of resin composite to superficial dentin using different adhesive systems. The interfacial structure between the resin and dentin was evaluated for each treatment using environmental scanning electron microscopy (ESEM). Freshly extracted human molars were ground with 600-grit SiC paper to expose the superficial dentin. Adhesives [One-Up-Bond-F-Plus (OUFP) and Adper-Prompt-L-Pop (APLP)] and resin composite (TPHSpectrum) were bonded to the dentin (n = 8/group, 180 total specimens) under five surface conditions: control (adhesive applied following manufacturers' instructions); saliva, then 5-s air dry, then adhesive; adhesive, saliva, 5-s air dry; adhesive, saliva, 5-s water rinse, 5-s air dry (ASW group); and adhesive, saliva, 5-s water rinse, 5-s air dry, reapply adhesive (ASWA group). After storage in water at 37 degrees C for 24 h, the specimens were debonded under tension at a speed of 0.5 mm/min. ESEM photomicrographs of the dentin/adhesive interfaces were taken. Mean bond strength ranged from 8.1 to 24.1 MPa. Fisher's protected least significant difference (P = 0.05) intervals for critical adhesive, saliva, and surface condition differences were 1.3, 1.3, and 2.1 MPa, respectively. There were no significant differences in bond strength to dentin between contamination by smoker's and nonsmoker's saliva, but bond strengths were significantly different between adhesive systems, with OUFP twice as strong as APLP under almost all conditions. After adhesive application and contamination with either smoker's or nonsmoker's saliva followed by washing and reapplication of the adhesive (ASWA group), the bond strength of both adhesive systems was the same as that of the control group.

To determine the bond strength, nanoleakage and interfacial morphology of four self-etch adhesives bonded to superficial dentin.Microtensile (MT) (n= 15) and single plane shear (SP) (n= 8) bond tests were performed using human dentin polished through 320-grit SiC paper. Clearfil Protect Bond (PB), Clearfil S3 Bond (S3), Prompt L-Pop (PLP) and G-Bond (GB) were used according to their manufacturers' instructions. Composite was applied as cylinders with a thickness of 4 mm with a 1 mm diameter and stored in water at 370C for 24 hours. Specimens were debonded with a testing machine at a cross-head speed of 1 mm/minute. Means and standard deviations of bond strength were calculated. Data were analyzed using ANOVA. Fisher's PLSD intervals were calculated at the 0.05 level of significance. Failure modes were determined at x100. The hybrid layer was revealed by treatment with 5N HC1/5% NaOCl or fractured perpendicular to the interface and sputter coated with gold. Specimens were viewed at x1,000, x2,500, and x5,000 in a field emission SEM at 15 kV. Teeth (n=2) sectioned into 0.9 mm-thick slabs were immersed in ammoniacal silver nitrate solution for 24 hours, rinsed and immersed in photo-developing solution for 8 hours. Specimens were sectioned (90 nm-thick) and observed under TEM.Means ranged from 25.0 to 73.1 MPa for MT and from 15.5 to 56.4 MPa for SP. MT values were greater than SP, but were highly correlated (R2 = 0.99, P= 0.003) and provided the same order for the systems studied. Fisher's PLSD intervals (P0.05) for bond strength techniques and adhesives results were 1.7 and 2.3 MPa, respectively. Failures sites were mixed. TEM showed that hybrid layers were -0.5 pm for PB, GB and S3 and approximately 5 microm for PLP. SEM showed morphologic differences among adhesives. Silver nitrate deposits were observed within the interfaces for all adhesive systems.

Objectives : We investigated the influence of dentin tubule direction and identifiable zone of carious dentin on the microstructure and the thickness of the hybrid-like layer (HL) formed by self-etch and etch-rinse adhesive systems. Methods : An etch-rinse and a self-etching adhesive were bonded to dentin carious zones divided into groups with parallel or perpendicular orientation relative to the dentin tubules at the resin-carious dentin interface (N = 5/variable). Bonds were prepared to each of the four zones of carious dentin apparent after staining with Caries Detector: pink, light pink, transparent and apparently normal; six non-carious third molars were controls. The microstructure and thickness of the HL were determined by SEM and compared using three-way ANOVA and Tukey's multiple comparisons (p Results : Etch-rinse controls gave thicker HLs than self-etching systems; orientation did not affect thickness for the self-etch system. Perpendicular orientations gave thicker HLs than parallel for the pink zone bonded with the etch-rinse system. For both adhesives, HL thickness in the pink zone was significantly greater than in light pink for the perpendicular group, but no significant differences were found among other variables. HL microstructure was more granular and rougher for the etch-rinse than for the self-etching system. Pores and cracks were obvious in the more demineralized zones. Resin tags were shorter and irregular in the transparent zone and often were completely absent in the outer demineralized zones (pink, light pink). Significance : Microstructure of bonded interfaces varies markedly depending on adhesive system, tubule orientation and carious zone.

To determine the effect of filler addition on two total-etch, single component bonding systems on the bond strength, displacement at debonding, stiffness of debonding and energy absorbed to debonding of resin composites to human dentin.Two dentin bonding systems with no-filler (OS and SB) and filler-added (OSP and SBP) versions were studied. The dentin surfaces of human teeth were exposed with 600-grit SiC. TPH Spectrum A2 was used to bond to the dentin surfaces in the form of a truncated cone, 3 mm in diameter at the bonding surfaces and 5 mm in diameter at the base. Bonded specimens were stored in distilled water at 37 degrees C for 24 hours. They were then debonded in tension with a universal testing machine at a cross-head speed of 0.5 mm/minute. Displacement at debonding, stiffness and energy to debonding were calculated based on the stress-displacement curve.Bond strength, displacement at debonding and energy to debonding (measured and elastic) were influenced by the brand of the adhesive (OS/OSP vs. SB/SBP), but were not influenced by the filler addition based on two-way analysis of variance. Bond strength was in the range of 24.4-30.1 MPa, and there were significant differences between the bond strengths of OS and SB. Displacement and energy to debonding (measured and elastic) were different between the adhesives. Bond strength, bond stiffness and energy to debonding (measured) showed significant correlations.

To determine the effects of contamination by ferric sulfate and aluminum chloride astringents on the bond strength of composite bonded to superficial dentin using self-etching adhesives.Freshly extracted human teeth were ground to expose superficial dentin and polished to 600 grit. One of three self-etching adhesive systems and restorative composites were bonded to the specimens, with contamination by one of three astringents and five surface conditions (no contamination, moist dentin control; contaminant, air, adhesive; contaminant, water rinse, air, adhesive; contaminant, water rinse, glycolic acid scrub, rinse, adhesive; contaminant, water rinse, chlorhexadine scrub, rinse, adhesive). Composite was bonded to the surfaces in the shape of an inverted, truncated cone (n = 5, 180 specimens total). Specimens were stored in water at 37 degrees C for 24 hours, then de-bonded in tension with a testing machine at a crosshead speed of 0.5 mm/minute. Tensile bond strengths (MPa) were calculated.Means (SD) were compared using analysis of variance. Significant differences (Fisher's PLSD) were found among all variables. SE and ABF had the highest control values, but were affected most by astringent contamination. Ferric sulfate reduced bond strengths the greatest in most cases, and aluminum chloride putty reduced bond strengths the least. Chlorhexadine rinse was most effective in restoring bond strength values.

The purpose of this study was to investigate the fracture resistance of re-attached coronal fragments of teeth using different materials and tooth preparations. Seventy-two recently extracted bovine incisors were selected. Eight incisors were maintained without any preparation as a control group. The incisal third of the other teeth was sectioned using a diamond saw. In one group (n = 32), a 2-mm bevel was prepared, whereas in the second group no preparation was made (n = 32). The specimens (beveled and non-beveled) were divided in four groups (n = 8) and re-attached with the following materials: a dual-cured resin cement RelyX ARC (RX); a chemically cured composite Bisfil 2B (B2); a light-cured composite Z250 (Z2); and a one-bottle adhesive Single Bond (SB). The bevel region was restored with adhesive and composite. All materials were used according to manufacturer's directions. A light-curing unit was used to polymerize the materials. Specimens were stored in saline solution for 72 h. De-bonding procedures were performed in a testing machine with cross-head speed of 0.6 mm min(-1). The load was applied in the incisal third. The resistance to fracture for control group was 70 (7) kg. The fracture resistance for non-beveled and beveled specimens were: SB, 3.3 (2.4) and 17.0 (4.1); RX, 11.5 (3.0) and 16.3 (3.1); Z2, 14.4 (4.2) and 20.5 (1.7); and B2, 19.5 (3.5) and 32.5 (7.4) kg. Analysis of variance (anova) and Fisher's protected least significant difference (PLSD) test disclosed significant influence for materials and cavity designs (P = 0.001). The highest failure loads were obtained with the B2 group and then with the Z2 with either bevel or non-bevel. RX produced lower failure loads than the restorative composites. The lowest failure load was obtained with SB in the non-beveled group. No technique studied was able to attain the fracture resistance of the control group and both materials and tooth preparation influenced the fracture resistance.

The purpose of this study was to test the bond strength and analyze the morphology of the dentin-adhesive interface of two etch and rinse and two self-etch adhesive systems with two kinds of artificial saliva (with and without 450 mg/L mucin) contamination under different conditions of decontaminating the interface. Bonded specimens were sectioned perpendicularly to the bonded surface in 1-mm thick slabs. These 1-mm thick slabs were remounted in acrylic blocks and sectioned in sticks perpendicular to the bonding interfaces with a 1-mm2 area. Nine specimens from each condition were tested after 24 hours on a testing machine (Instron) at a speed of 0.5 mm/min for a total of 360 specimens. Means and standard deviations of bond strength (MPa) were calculated. ANOVA showed significant differences as well as Fisher's PLSD intervals (p