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Background. A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin. Methods. Eighty-two dentists participated. In phase 1 of the study, dentists identified approximately 20 SOCLs, obtained patient consent, and recorded information about the lesion, treatment or treatments, and depth, if opened. Dentists were then randomly assigned into 1 of 3 groups: no device, DIAGNOdent (KaVo), and Spectra (Air Techniques). In phase 2, dentists enrolled approximately 20 additional patients and recorded the same phase 1 information while using the assigned device to help make their treatment decisions. A mixed-model logistic regression was used to determine any differences after randomization in the proportion of lesions opened and, if opened, the proportion of lesions that penetrated into dentin. Results. A total of 1,500 SOCLs were enrolled in each phase. No statistically significant difference was found in the change in proportion of lesions receiving invasive treatment from phase 1 to phase 2 across the 3 groups (P = .33) or in the change in proportion of percentage of opened lesions that extended into dentin (P = .31). Conclusion. Caries-detecting devices in the study did not change substantially dentists' decisions to intervene or the accuracy of the intervention decision in predicting lesion penetration into dentin. Practical Implications. The caries-detecting devices tested may not improve dentists' clinical decision making for SOCLs. [ABSTRACT FROM AUTHOR]

Background. A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically. Methods. Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ² test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster. Results. The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07). Conclusions. Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives. Practical Implications. Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention. [ABSTRACT FROM AUTHOR]

Background. A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions. Methods. Fifty-three clinicians from The National Dental Practice- Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. Results. At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion’s being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinicians deciding at some point after follow-up to seal the lesion or treat it invasively. Conclusions. Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. Practical Implications. Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions. [ABSTRACT FROM AUTHOR]

Background. Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographie evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study. Methods. A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices. Results. Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively). Conclusions. To the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions. Clinical Implications. QOC is common in routine practice and warrants further investigation regarding how best to manage it. [ABSTRACT FROM AUTHOR]

Background. Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographie evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study. Methods. A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices. Results. Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively). Conclusions. To the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions. Clinical Implications. QOC is common in routine practice and warrants further investigation regarding how best to manage it. [ABSTRACT FROM AUTHOR]

The article focuses on the study that examines the materials used by dentists in The Dental Practice-Based Research Network (DPBRN) in putting the first restoration on permanent posterior tooth surfaces. A cross-sectional study was conducted by DPBRN practitioner-investigators and informed consent was sought to patients. The study indicates that amalgam was more often used by practitioner-investigators than direct resin-based composite (RBC) for posterior carious lesions.

To quantify the associations between measures of oral health-related quality of life (OHRQoL) and life-space mobility (LSM) in community-dwelling older adults. Cross-sectional study using a 54-item OHRQoL questionnaire. Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community-dwelling adults aged 65 and older. Participants completed an in-home interview about their OHRQoL and LSM. Life-space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self-rated oral health. OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well-being have a significant effect on mobility and the social participation of older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate whether underweight, normal-weight, overweight, and obese older adults differ in aspects of their oral health–related quality of life (OHRQoL). DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: The 291 subjects were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility. Participants ranged in age from 65 to 90 (60.5% women, 50.5% non-Hispanic white, and 50.5% rural). MEASUREMENTS: Participants completed an in-home interview about their OHRQoL using a 54-item questionnaire and were classified into four categories of body mass index (BMI) (<20.0 (underweight), 20.0–24.9 (normal), 25.0–29.9 (overweight), and ≥30.0 (obese)). Multivariate analyses were used to examine associations between BMI and OHRQoL, adjusting for age, race, sex, depression, education, perceived income, comorbidity score, life-space mobility, and physical activity level. RESULTS: The results suggested that a parabolic effect existed, with strongest associations occurring in the underweight and obese categories. With the normal BMI group as the reference group, obese participants were more likely to avoid eating foods they would like to eat, overweight participants were less likely to cook foods differently and reported better chewing ability, and underweight persons were more likely to limit foods they eat because of mouth dryness. CONCLUSION: Objective measures may not accurately reflect peoples' perceptions; therefore, OHRQoL determined according to response to subjective questions is important to properly assess a patient's overall health status. Older adults who are under- or overweight should be evaluated for oral health conditions that may affect their nutritional status. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health–related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than $16,000/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the relationship between: (1) children's caries score (dmft, DMFT) at the time of sealant placement; and (2) "success" (measured as being caries-free) of that tooth at follow-up visits. Methods: An existing database of over 38,000 sealants (10,038 children) placed between 1997 and 2002 by the Jefferson County Health Department's Community Based Sealant Program, Birmingham, Ala, was used in the analysis. Only children returning for follow-up visits after the initial placement of the sealants were included in this study, resulting in 6,452 sealants (2,097 children). Logistic regression analysis was performed to determine the differences in sealant success between children with a dmft score of 0 vs a dmft score of >0 at baseline, and a DMFT score of 0 vs a DMFT score of >0 at baseline. Results: In the permanent and primary dentitions, those who had no caries at the time of sealant placement (dmft/DMFT=0) had a significantly higher success of sealants during years 1 to 5 compared to those with a caries score of greater than 0 (dmft/DMFT>0; P<.023, P<.002, respectively). Conclusion: Children with previous caries experience may be at a higher risk for sealant "failure" (measured as caries on a tooth surface previously sealed) after 1 year and, therefore, may require more diligent sealant maintenance. [ABSTRACT FROM AUTHOR]

Background. Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network"). Methods. Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent ("1") or inconsistent ("0") with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence. Results. The authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent). Conclusion. Dentists reported a medium-range concordance between practice and published evidence. Practical implications. Efforts to bring research findings into routine practice are needed. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to: (1) evaluate the retention rates of occlusal sealants in children in an urban school-based sealant program run by a County Health Department in Alabama; and (2) assess the clinical benefits of this sealant program by comparing caries experience of a group of participants and nonparticipants. Methods: The records of 2,097 children (mean age=8.1±1.6 years) who received sealants and had at least 1 follow-up examination were analyzed to determine the outcome of sealed and nonsealed surfaces of permanent first molars (PFM). Additionally, 103 fifth-grade students who did and did not participate in the sealant program (P=participants; NP=nonparticipants) were examined by a masked examiner who recorded their PFM condition. Results: Sealants placed by the County Health Department had a retention rate of 71% over an average of 1.6±0.7 years (range=0.5-4.4 years). The patient's age at the initial visit appeared to be the only factor that influenced retention. On average, participants had at least 1 PFM that remained caries-free, compared to nonparticipants (permanent decayed, missing, and filled teeth [DMFT] in NP=1.5±1.4, P=0.5±0.8; <.016). Conclusions: Retention rates for occlusal sealants in this public health program were similar to those reported in previous clinical studies. Furthermore, children who had sealants had significant protection from occlusal decay up to grade 5. [ABSTRACT FROM AUTHOR]

General dentists (GDs) have the opportunity to examine their patients for oral premalignancy/malignancy. We estimated the annualized per dentist number of oral lesions suspicious for premalignancy/malignancy discovered by United States (U.S.) general dentists and the annualized per dentist number of histologically-confirmed cancers subsequently diagnosed. Eligible participants were licensed, clinically-active U.S. GDs who were members of the U.S. National Dental Practice-Based Research Network. An a priori sample size of 900 was determined; 2000 GDs were invited to participate; 1,073 completed the study. Self-reported, cross-sectional data were obtained via an online questionnaire during 4/12/2017-8/31/2017 and analyzed. The reported numbers of suspicious oral lesions and histologically-confirmed oral cancer cases diagnosed over the previous six months were quantified. Potential outcome predictors were evaluated as covariates in multivariable analyses. Crude and adjusted statistics were produced by regressing each outcome on each independent variable while assuming a Poisson distribution, log link and utilizing robust standard errors. Eighty-seven percent of dentists reported discovering 1+ lesion suspicious for oral premalignancy/malignancy during the preceding six months. The mean number of suspicious lesions/dentist/year was 9.5; adjusted mean: 9.6. Fifteen percent of participants reported discovering 1+ lesion confirmed as cancer during the same period, 213 confirmed cancer cases/6 months or 426/year. Crude and adjusted mean numbers of histologically-confirmed oral cancers were both 0.4 cancers/dentist/year. Our findings suggest that many U.S. general dentists are actively identifying oral lesions suspicious for premalignancy/malignancy, thereby aiding in the discovery of oral malignancies and representing an important component in the frontline against cancer. [ABSTRACT FROM AUTHOR]

Objectives To better understand the effectiveness of xylitol in caries prevention in adults and to attempt improved clinical trial efficiency. Methods As part of the Xylitol for Adult Caries Trial (X- ACT), non cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 g/day of xylitol, consumed by dissolving in the mouth five 1 g lozenges spaced across each day, compared with a sucralose placebo. For this analysis, seeking trial efficiency, 538 subjects aged 21-80, with complete data for four dental examinations, were selected from the 691 randomized into the 3-year trial, conducted at three sites. Acceptable inter- and intra-examiner reliability before and during the trial was quantified using the kappa statistic. Results The mean annualized noncavitated plus cavitated lesion transition scores in coronal and root surfaces, from sound to carious favoured xylitol over placebo, during the three cumulative periods of 12, 24, and 33 months, but these clinically and statistically nonsignificant differences declined in magnitude over time. Restricting the present assessment to those subjects with a higher baseline lifetime caries experience showed possible but inconsistent benefit. Conclusions There was no clear and clinically relevant preventive effect of xylitol on caries in adults with adequate fluoride exposure when non cavitated plus cavitated lesions were assessed. This conformed to the X- ACT trial result assessing cavitated lesions. Including non cavitated lesion assessment in this full-scale, placebo-controlled, multisite, randomized, double-blinded clinical trial in adults experiencing dental caries did not achieve added trial efficiency or demonstrate practical benefit of xylitol. Trial Registration: ClinicalTrials.Gov NCT00393055. [ABSTRACT FROM AUTHOR]

Objective: Following a successful 2005-2012 phase with three regional practice-based research networks (PBRNs), a single, unified national network called ''The National Dental PBRN'' was created in 2012 in the United States to improve oral health by conducting practice-based research and serving dental professionals through education and collegiality. Methods: Central administration is based in Alabama. Regional centres are based in Alabama, Florida, Minnesota, Oregon, New York and Texas, with a Coordinating Centre in Maryland. Ideas for studies are prioritized by the Executive Committee, comprised mostly of full-time clinicians. Results: To date, 2763 persons have enrolled, from all six network regions; enrollment continues to expand. They represent a broad range of practitioners, practice types, and patient populations. Practitioners are actively improving every step of the research process, from idea generation, to study development, field testing, data collection, and presentation and publication. Conclusions: Practitioners from diverse settings are partnering with fellow practitioners and academics to improve clinical practice and meet the needs of clinicians and their patients. Clinical significance: This ''nation's network'' aims to serve as a precious national resource to improve the scientific basis for clinical decision-making and foster movement of the latest evidence into routine practice. [ABSTRACT FROM AUTHOR]

Background. The Dental Practice-Based Research Network (DPBRN) provided a means to investigate whether certain procedures were performed routinely. The authors conducted a study to quantify rubber dam use during root canal treatment (RCT) among general dentists and to test the hypothesis that certain dentist or practice characteristics were associated with rubber dam use. Methods. DPBRN practitioner-investigators (P-Is) answered a questionnaire that included items about rubber dam use and other forms of isolation during RCT. DPBRN enrollment questionnaire data provided information regarding practitioner and practice characteristics. Results. A total of 729 (74 percent) of 991 P-Is responded; 524 were general dentists who reported providing at least some RCTs and reported the percentage of RCTs for which they used a rubber dam. Of these 524 P-Is, 44 percent used a rubber dam for all RCTs, 24 percent used it for 51 to 99 percent of RCTs, 17 percent used it for 1 to 50 percent of RCTs, and 15 percent never used it during RCT. Usage varied significantly by geographic region and practice type. The use of cotton rolls and other forms of isolation also was reported. Conclusions. Similar to other reports in the literature, not all DPBRN general dentists used a rubber dam during RCT. Clinical Implications. Because the clinical reference standard is to use a rubber dam during RCT, increasing its use may be important. [ABSTRACT FROM AUTHOR]

Background. The Dental Practice-Based Research Network (DPBRN) provided a means to investigate whether certain procedures were performed routinely. The authors conducted a study to quantify rubber dam use during root canal treatment (RCT) among general dentists and to test the hypothesis that certain dentist or practice characteristics were associated with rubber dam use. Methods. DPBRN practitioner-investigators (P-Is) answered a questionnaire that included items about rubber dam use and other forms of isolation during RCT. DPBRN enrollment questionnaire data provided information regarding practitioner and practice characteristics. Results. A total of 729 (74 percent) of 991 P-Is responded; 524 were general dentists who reported providing at least some RCTs and reported the percentage of RCTs for which they used a rubber dam. Of these 524 P-Is, 44 percent used a rubber dam for all RCTs, 24 percent used it for 51 to 99 percent of RCTs, 17 percent used it for 1 to 50 percent of RCTs, and 15 percent never used it during RCT. Usage varied significantly by geographic region and practice type. The use of cotton rolls and other forms of isolation also was reported. Conclusions. Similar to other reports in the literature, not all DPBRN general dentists used a rubber dam during RCT. Clinical Implications. Because the clinical reference standard is to use a rubber dam during RCT, increasing its use may be important. [ABSTRACT FROM AUTHOR]

Background. Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries. Methods. The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months. Results. Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect. Conclusions. Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries. Clinical Implications. These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly. [ABSTRACT FROM AUTHOR]

Background. Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries. Methods. The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial. Participants (n = 691) aged 21 through 80 years consumed five 1.0-gram xylitol or placebo lozenges daily for 33 months. They underwent clinical examinations at baseline and at 12, 24 and 33 months. Results. Xylitol lozenges reduced the caries increment 10 percent. This reduction, which represented less than one-third of a surface per year, was not statistically significant. There was no indication of a dose-response effect. Conclusions. Daily use of xylitol lozenges did not result in a statistically or clinically significant reduction in 33-month caries increment among adults at an elevated risk of developing caries. Clinical Implications. These results suggest that xylitol used as a supplement in adults does not reduce their caries experience significantly. [ABSTRACT FROM AUTHOR]