JDR Clinical & Translational Research最新文献

{"title":"Evaluating Trust in the Patient-Dentist Relationship: A Mixed-Method Study.","authors":"T Tiwari, N N Maliq, N Rai, J Holtzmann, L Yates, V Diep, E P Tranby, J Frantsve-Hawley","doi":"10.1177/23800844221087592","DOIUrl":"https://doi.org/10.1177/23800844221087592","url":null,"abstract":"Background: The objective of this article was to understand the trust of study participants in dental providers and trust-building practices used by dentists to establish and maintain trust with their patients. Methods: This study used a concurrent cross-sectional mixed-methods design to measure the participants’ trust in their dental providers. An 11-item Dental Trust Scale (DTS) questionnaire was administered to 150 White, Black, and Hispanic study participants. In addition, the research team conducted semistructured interviews with 7 dentists in order to understand their perspectives related to patient trust. The internal consistency of the DTS was tested using Cronbach’s α. Univariate and multivariable logistic regression models were run to test the association between the DTS mean score and individual participant factors. Qualitative information from interviews was analyzed using a thematic analysis approach. Results: The overall mean score of dental trust for the entire sample was 3.4. The DTS had good internal consistency (α = 0.93). Overall, dental trust was significantly higher in participants who had a regular dentist (F = 8.74, P = 0.003). The qualitative data were grouped under these key thematic categories: the importance of trust, building trust, and trust in treatment planning. Qualitative analysis also showed that the 2 main trust-building tools used by dentists were communication and understanding the patient’s lifestyle or social determinants of health. Knowledge Transfer Statement: This study provides insight into the dentist–patient relationship. It increases our understanding of levels of dental trust among patients and examines methods used by the dentist to build trust. The outcomes of this study can be considered by dentists in their everyday practice as they seek to build trust with their patients.","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"287-298"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9705290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental Caries Postradiotherapy in Head and Neck Cancer.","authors":"M T Brennan,&nbsp;N S Treister,&nbsp;T P Sollecito,&nbsp;B L Schmidt,&nbsp;L L Patton,&nbsp;A Lin,&nbsp;L S Elting,&nbsp;E S Helgeson,&nbsp;R V Lalla","doi":"10.1177/23800844221086563","DOIUrl":"https://doi.org/10.1177/23800844221086563","url":null,"abstract":"<p><strong>Background: </strong>Treatment for head and neck cancer (HNC) such as radiotherapy (RT) can lead to numerous acute and chronic head and neck sequelae, including dental caries. The goal of the present study was to measure 2-y changes in dental caries after radiotherapy in patients with HNC and test risk factors for caries increment.</p><p><strong>Methods: </strong>Cancer and dental disease characteristics, demographics, and oral health practices were documented before and 6, 12, 18, and 24 mo after the start of RT for 572 adult patients with HNC. Patients were eligible if they were age 18 y or older, diagnosed with HNC, and planned to receive RT for treatment of HNC. Caries prevalence was measured as decayed, missing, and filled surfaces (DMFS). The association between change in DMFS and risk factors was evaluated using linear mixed models.</p><p><strong>Results: </strong>On average, DMFS increased from baseline to each follow-up visit: 6 mo, +1.11; 12 mo, +2.47; 18 mo, +3.43; and 24 mo, +4.29 (<u>P</u> < 0.0001). The increase in DMFS during follow-up was significantly smaller for the following patient characteristics: compliant with daily fluoride use (<u>P</u> = 0.0004) and daily oral hygiene (brushing twice daily and flossing daily; <u>P</u> = 0.015), dental insurance (<u>P</u> = 0.004), and greater than high school education (<u>P</u> = 0.001). DMFS change was not significantly associated with average or maximum RT dose to the parotids (<u>P</u> > 0.6) or salivary flow (<u>P</u> > 0.1). In the subset of patients who had salivary hypofunction at baseline (<u>n</u> = 164), lower salivary flow at follow-up visits was associated with increased DMFS.</p><p><strong>Conclusion: </strong>Increased caries is a complication soon after RT in HNC. Fluoride, oral hygiene, dental insurance, and education level had the strongest association with caries increment after radiotherapy to the head and neck region. Thus, intensive oral hygiene measures, including fluoride and greater accessibility of dental care, may contribute to reducing the caries burden after RT in HNC.</p><p><strong>Knowledge transfer statement: </strong>The results of this study can be used by clinicians when deciding how to minimize oral complications related to cancer therapy for patients with head and neck cancer. Identification of modifiable factors (e.g., oral hygiene and prescription fluoride compliance) associated with increased caries risk can minimize radiation caries burden.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"234-243"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286183/pdf/10.1177_23800844221086563.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9702770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial.","authors":"Y Anopa,&nbsp;L M D Macpherson,&nbsp;A D McMahon,&nbsp;W Wright,&nbsp;D I Conway,&nbsp;E McIntosh","doi":"10.1177/23800844221090444","DOIUrl":"https://doi.org/10.1177/23800844221090444","url":null,"abstract":"<p><strong>Introduction: </strong>An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV.</p><p><strong>Methods: </strong>The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated.</p><p><strong>Results: </strong>Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, <u>n</u> = 265 (50%) in the FV arm and <u>n</u> = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 (<u>P</u> = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 (<u>P</u> = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%.</p><p><strong>Conclusion: </strong>The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness.</p><p><strong>Knowledge transfer statement: </strong>The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"207-214"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9701470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Caries Prevention in Children to Adults with Cancer: New Evidence and Ideas.","authors":"J S Feine","doi":"10.1177/23800844231177991","DOIUrl":"https://doi.org/10.1177/23800844231177991","url":null,"abstract":"Many of the original research reports in this issue of the JDR CTR consider the oral and general health concerns of younger populations in a variety of ways. It is commonly accepted that preventing the initial development of caries in young children will result in improved oral health for the population over their lifetimes. The literature is replete with reports on technologies aimed to prevent and treat this common disease (Cheng et al. 2022; Luiz et al. 2023). Three reports examine sugar intake in children and its impact on dental caries. Ha et al. (2022) used data on the 5to 14-y-old overweight and obese population in the Australian National Child Oral Health Survey (2012 to 2014) to determine the effect of drinking sugar-sweetened beverages (SSBs) on decayed, missing, or filled primary teeth, taking into consideration the levels of fluoridation in their home water systems. Their findings emphasize the significant effect that SSBs have on the incidence/ prevalence of dental caries, as well as the modifying influence of community water fluoride. This study also showed that SSBs contribute to overweight/ obesity, particularly in low-income populations. While policy makers and politicians may not be inspired to protect the public from SSBs regarding tooth decay, the fact that SSBs are shown to contribute to the epidemic of overweight/obesity and its cost to society may inspire governments to react appropriately. Melough et al. (2022) used data from the National Health and Nutrition Examination Survey (2013 to 2014 and 2015 to 2016) to understand the associations between all free sugars in the diet and dental caries, as well as how much exposure to community water fluoride mitigates cariogenic activity in children and adolescents aged 1 to 19 y. The authors found that SSBs had the most pronounced association with caries and that the higher the concentration of fluoride in the water, the greater the reduction of caries. Based on these 2 reports, it appears that SSBs have a strong association with the development of dental caries and that community water fluoridation reduces this association. Bhoopathi et al. (2022) also studied an obese population; however, they focused on an adolescent population with developmental disabilities and obesity, using data from the National Survey of Children’s Health (waves 2016 through 2019) with almost 70,000 adolescents aged 10 to 17 y; this population was categorized as developmentally disabled and/or obese and not developmentally disabled or obese. The authors found that adolescents with developmental disabilities and obesity, as compared with healthy adolescents with no disabilities or obesity, were significantly at higher odds of experiencing toothache, decayed teeth, bleeding gums, and difficulty eating or swallowing. It would be interesting to know whether the intake of SSBs is greater in developmentally disabled adolescents. Two additional reports on children assess the effect oral health prevention program","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"204-206"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9707154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned from the Preimplementation Phase of an Oral Health Care Project.","authors":"J Murray,&nbsp;S C Hunter,&nbsp;Z Splawinski,&nbsp;T Conroy","doi":"10.1177/23800844221083966","DOIUrl":"https://doi.org/10.1177/23800844221083966","url":null,"abstract":"<p><strong>Knowledge transfer statement: </strong>This commentary highlights that effective implementation of best-practice oral health care in acute geriatric units is built on the time and relationship building invested in the preimplementation phase.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"299-301"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9693238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children.","authors":"D H Ha,&nbsp;A Arora,&nbsp;J Harford,&nbsp;L Luzzi,&nbsp;S Chrisopoulos,&nbsp;L G Do","doi":"10.1177/23800844221091701","DOIUrl":"https://doi.org/10.1177/23800844221091701","url":null,"abstract":"<p><strong>Knowledge transfer statement: </strong>The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"224-233"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Electronic Dental Records to Assess Osteoradionecrosis Risk in Irradiated Head and Neck Cancer.","authors":"P Saenthaveesuk,&nbsp;S Kiat-Amnuay,&nbsp;M F Walji","doi":"10.1177/23800844221089549","DOIUrl":"https://doi.org/10.1177/23800844221089549","url":null,"abstract":"<p><strong>Objective: </strong>Over the last 2 decades, investigations have demonstrated a decreased trend in the likelihood of osteoradionecrosis of the jaw (ORNJ) after extraction. The aim of this study was to explore the potential risk factors for ORNJ in irradiated head and neck cancer by using patients' electronic dental records (EDRs).</p><p><strong>Methods: </strong>Patients diagnosed with head and neck cancer who had irradiation between January 2010 and December 2020 were included in this retrospective cohort analysis. Patient charts showing evidence of \"head and neck cancer,\" \"oral cancer,\" \"radiotherapy,\" \"radiation,\" and \"oral complication\" were identified by an informatics analyst querying the EDR. Subsequently, the charts were manually reviewed, and data quality was assessed on 3 dimensions: completeness, accuracy, and consistency. The patient, tumor, systemic condition/drug, oral condition, treatment/trauma, and radiation were all categorized as potential risk factors.</p><p><strong>Results: </strong>A total of 359 patients were included. With the exception of radiation-related factors, we found that the data quality was generally sufficient to support the research. Multivariate logistic regression analysis demonstrated that the following factors were significant in predicting the occurrence of ORNJ development in irradiated head and neck cancer: smoking (odds ratio [OR], 9.0; 95% CI, 1.9 to 43.0; <u>P</u> = 0.006), steroid use (OR, 6.4; 95% CI, 1.3 to 30.8; <u>P</u> = 0.021), oral health status (OR, 23.7; 95% CI, 2.7 to 211.0; <u>P</u> = 0.005), and postirradiation extraction (OR, 3.8; 95% CI, 1.0 to 14.4; <u>P</u> = 0.050).</p><p><strong>Conclusions: </strong>A 10-y retrospective analysis of data from an EDR revealed that smoking, steroid use, poor oral status, and postirradiation extraction are all factors linked to an increased risk of developing ORNJ. The quality of EDR data may be systematically assessed by determining the completeness, accuracy, and consistency of the underlying data. Radiation-related factors in particular were poorly documented, highlighting the need for collecting or incorporating this information into the EDR.</p><p><strong>Knowledge transfer statement: </strong>EDRs can be used to identify risk factors for developing ORNJ in irradiated head and neck cancer and can help clinicians with selecting treatments by incorporating risk and complication considerations.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"244-256"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9705296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficulty with Oral Health Complications in Adolescents with Developmental Disability and Obesity.","authors":"V Bhoopathi,&nbsp;C Wells,&nbsp;F Ramos-Gomez,&nbsp;K A Atchison","doi":"10.1177/23800844221090447","DOIUrl":"https://doi.org/10.1177/23800844221090447","url":null,"abstract":"<p><strong>Introduction: </strong>Developmental disabilities (DDs), obesity, and dental caries are highly prevalent health conditions among adolescents. Evidence indicates that a significant proportion of adolescents with DDs are obese, and those with obesity and dental caries share common risk factors.</p><p><strong>Objective: </strong>In this first-ever US-based cross-sectional national study, we assessed the likelihood of adolescents with DDs and obesity experiencing chronic difficulty with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition among adolescents with DDs and obesity compared to adolescents with no DDs or obesity.</p><p><strong>Methods: </strong>For this secondary data analysis study, we used data of 68,942 adolescents aged 10 to 17 y from the 2016 through 2019 National Survey of Children's Health. Weighted descriptive and bivariate analyses were conducted. Four multiple logistic regression models predicting chronic difficulty in the past 12 mo with decayed teeth, toothaches, bleeding gums, and eating and swallowing due to a health condition were conducted, controlling for other variables.</p><p><strong>Results: </strong>The adjusted odds ratio (aOR) of experiencing chronic difficulty in the past 12 mo for adolescents with no DDs or obesity was significantly lower for decayed teeth (aOR, 0.64; 95% confidence interval [CI], 0.51-0.80; <u>P</u> < 0.0001), toothaches (aOR, 0.43; 95% CI, 0.30-0.60; <u>P</u> < 0.0001), bleeding gums (aOR, 0.48; 95% CI, 0.33-0.70; <u>P</u> < 0.0001), and eating or swallowing due to a health condition (aOR, 0.34; 95% CI, 0.20-0.57; <u>P</u> < 0.0001) compared to adolescents with both DDs and obesity.</p><p><strong>Conclusions: </strong>Results from this study indicate that DD adolescents with obesity have more/greater impending oral health needs than adolescents with no DDs or obesity.</p><p><strong>Knowledge transfer statement: </strong>Results of this study highlight the high oral health needs and the chronic difficulty adolescents with developmental disabilities and obesity experience compared to adolescents without developmental disabilities and obesity. Targeted oral health policies and interventions that will promote oral health among this high-risk group are recommended.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"276-286"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/0e/10.1177_23800844221090447.PMC10285424.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10078261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Preventive Dental Services on Subsequent Dental Treatment for Children in Medicaid.","authors":"T H Brickhouse,&nbsp;J Yu,&nbsp;A M Kumar,&nbsp;B Dahman","doi":"10.1177/23800844221096317","DOIUrl":"https://doi.org/10.1177/23800844221096317","url":null,"abstract":"Objective: The goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program. Methods: Four data sources were used (dental claims, eligibility files, American Community Survey, and Area Health Resource Files) for fiscal years 2011 to 2018. The outcomes of interest were time to first treatment services from birth. The treatment outcomes were basic restorative treatment, advanced restorative treatment, or complex treatment. The independent variable was a preventive service prior to a treatment service. Time-to-event curves were estimated and compared using a log-rank test. Propensity score–matched univariate and multivariate Cox proportional hazards frailty models with an inverse probability censoring weighting correction estimated hazard ratios (HRs) for treatment outcomes comparing use of preventive services while controlling for patient demographic, geospatial, and county-level socioeconomic status measures. Results: The analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan–Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46–2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28–1.80) and complex treatment (HR, 2.13; 95% CI, 1.68–2.61). Conclusions: In a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services. Knowledge Transfer Statement: This study examines the impact of the utilization of preventive dental services since birth and the subsequent dental treatment for children enrolled in a dental Medicaid program. This study also examines the influence of preventive care on dental complexity of treatment for these children. Findings can inform federal and state policy planning of dental Medicaid programs as well as interventions to improve referral systems for the early use of preventive dental services and the establishment of a dental home.","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"257-266"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286182/pdf/10.1177_23800844221096317.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9700047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental Extractions under General Anesthesia: New Insights from Process Mining.","authors":"F Fox,&nbsp;H Whelton,&nbsp;O A Johnson,&nbsp;V R Aggarwal","doi":"10.1177/23800844221088833","DOIUrl":"https://doi.org/10.1177/23800844221088833","url":null,"abstract":"<p><strong>Introduction: </strong>Tooth extraction under general anesthetic (GA) is a global health problem. It is expensive, high risk, and resource intensive, and its prevalence and burden should be reduced where possible. Recent innovation in data analysis techniques now makes it possible to assess the impact of GA policy decisions on public health outcomes. This article describes results from one such technique called process mining, which was applied to dental electronic health record (EHR) data. Treatment pathways preceding extractions under general anesthetic were mined to yield useful insights into waiting times, number of dental visits, treatments, and prescribing behaviors associated with this undesirable outcome.</p><p><strong>Method: </strong>Anonymized data were extracted from a dental EHR covering a population of 231,760 patients aged 0 to 16 y, treated in the Irish public health care system between 2000 and 2014. The data were profiled, assessed for quality, and preprocessed in preparation for analysis. Existing process mining methods were adapted to execute process mining in the context of assessing dental EHR data.</p><p><strong>Results: </strong>Process models of dental treatment preceding extractions under general anesthetic were generated from the EHR data using process mining tools. A total of 5,563 patients who had 26,115 GA were identified. Of these, 9% received a tooth dressing before extraction with an average lag time of 6 mo between dressing and extraction. In total, 11,867 emergency appointments were attended by the cohort with 2,668 X-rays, 4,370 prescriptions, and over 800 restorations and other treatments carried out prior to tooth extraction.</p><p><strong>Discussion and conclusions: </strong>Process models generated useful insights, identifying metrics and issues around extractions under general anesthetic and revealing the complexity of dental treatment pathways. The pathways showed high levels of emergency appointments, prescriptions, and additional tooth restorations ultimately unsuccessful in preventing extractions. Supporting earlier publications, the study suggested earlier screening, preventive initiatives, guideline development, and alternative treatments deserve consideration.</p><p><strong>Knowledge transfer statement: </strong>This study generates insights into tooth extractions under general anesthetic using process mining technologies and methods, revealing levels of extraction and associated high levels of prescriptions, emergency appointments, and restorative treatments. These insights can inform dental planners assessing policy decisions for tooth extractions under general anesthetic. The methods used can be combined with costs and patient outcomes to contribute to more effective decision-making.</p>","PeriodicalId":14783,"journal":{"name":"JDR Clinical & Translational Research","volume":"8 3","pages":"267-275"},"PeriodicalIF":3.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}