Journal of the American Dental Association最新文献

{"title":"Oncogenic role of human papillomavirus in oral and oropharyngeal cancers: Molecular insights and clinical implications for dental practice.","authors":"Chintan Desai, Bharani Kumar Bhattu, Radhika Narayan, Kaushal Chaudhari, Abhi Thakkar","doi":"10.1016/j.adaj.2026.07.009","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.07.009","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has emerged as a distinct and rising subset of head and neck malignancy, yet awareness among dental care practitioners remains limited. The authors synthesized the molecular biology of HPV-driven oral and oropharyngeal carcinogenesis, the diagnostic frameworks, and the evidence base for an expanded dental care practitioner role in detection, counseling, and prevention.</p><p><strong>Types of studies reviewed: </strong>A structured literature search of PubMed-indexed English-language articles through March 2026 was conducted using search terms including HPV, oropharyngeal cancer, oral squamous cell carcinoma, p16 immunohistochemistry, HPV vaccination, and dental practice. Original research, systematic reviews, clinical guidelines, and population-level surveillance data were selected, with an emphasis on studies reporting clinical, diagnostic, or prevention outcomes applicable to dental settings. The authors did not include single case reports or small case series, and they excluded conference abstracts, editorials, and articles not available in the English language.</p><p><strong>Results: </strong>HPV type 16 drives from 70% through 90% of HPV-positive OPSCCs through E6-mediated p53 degradation and E7-mediated retinoblastoma protein inactivation. HPV-positive OPSCC carries a better prognosis than HPV-negative disease but lacks a clinically identifiable premalignant phase and typically manifests at an advanced locoregional stage. P16 immunohistochemistry has reduced specificity in the oral cavity and tobacco-predominant populations. Prophylactic HPV vaccination had an 88% reduction in vaccine-type oral HPV prevalence among vaccinated young adults.</p><p><strong>Conclusions and practical implications: </strong>Dental care practitioners can contribute meaningfully to earlier detection through systematic clinical examination, cervical lymph node palpation, timely specialist referral, patient counseling on HPV transmission, and vaccination advocacy.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal enuresis and maxillary expansion: A narrative review.","authors":"Sanjivan Kandasamy, Andrew J Kirsch","doi":"10.1016/j.adaj.2026.07.008","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.07.008","url":null,"abstract":"<p><strong>Background: </strong>Nocturnal enuresis (NE) may occur in children experiencing poor sleep secondary to an underlying sleep disorder such as obstructive sleep apnea. A causal link between an underlying sleep disorder and NE has been suggested. Maxillary expansion has been proposed to improve nasal airway patency and airflow, with the aim of reducing or resolving NE in affected children.</p><p><strong>Types of studies reviewed: </strong>The authors examined the historical and contemporary approaches to managing NE with maxillary expansion. The source material for this review came mainly from literature searches using PubMed as the primary database; various search terms combined with Boolean operators (AND/OR) were used as well as Medical Subject Heading terms, when applicable. Three systematic reviews on this topic were identified, although only 2 included a single randomized placebo-controlled trial. The single randomized controlled trial used a placebo control with a sham maxillary expander in place. The remaining available evidence came from clinical studies. Overall, sufficient evidence was available for critical appraisal.</p><p><strong>Results: </strong>Based on the literature, the pathophysiology of NE, and the medical standards for diagnosing and managing this condition, it is clear that maxillary expansion is not an evidence-based treatment for NE.</p><p><strong>Conclusions and practical implications: </strong>There is no evidence to support routine maxillary expansion for children with NE. Expanding in the absence of a transverse discrepancy is unsubstantiated in the literature. Dental care professionals should be well informed about the evidence-based approaches for the diagnosis and management of NE, guiding families to access the right care from the relevant health care professionals such as pediatricians or pediatric urologists.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary adjunct tests to determine the need for biopsy for early detection of oral squamous cell carcinoma and potentially malignant disorders: An evidence summary of a living systematic review, Version 2026 1.0.","authors":"Carolina Martins-Pfeifer, Ankita Shashikant Bhosale, Olivia Urquhart, Francisca Verdugo-Paiva, Grace H Lee, Kelly K O'Brien, Ana María Rojas-Gómez, Michael Glick, Mark W Lingen, Anil K Chaturvedi, Alonso Carrasco-Labra","doi":"10.1016/j.adaj.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.08.007","url":null,"abstract":"<p><strong>Background: </strong>Salivary adjunct tests could play a role in the oral cancer diagnostic pathway before a biopsy-confirmed definitive diagnosis. The authors aimed to assess the diagnostic impact and diagnostic test accuracy of salivary adjunct tests for detecting oral potentially malignant disorders and oral squamous cell carcinoma.</p><p><strong>Types of studies reviewed: </strong>The authors enhanced and updated the systematic searches from systematic reviews across several databases (MEDical Literature Analysis and Retrieval System Online (MEDLINE), Epistemonikos, Embase, Cochrane Central Register of Controlled Trials) through April 27, 2026. Independent paired reviewers screened and extracted data on diagnostic impact and test accuracy studies in duplicate. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.</p><p><strong>Results: </strong>The authors identified 1 diagnostic test accuracy study but no diagnostic impact studies in people with mucosal abnormalities and those without mucosal abnormalities. The identified study analyzed 4 biomarkers collected from saliva (interleukin-6, interleukin-8, tumor necrosis factor-α, matrix metalloproteinase-9). The reported sensitivity was 0.88, and the specificity was 0.80 (with very low certainty). Likelihood ratios, 95% CIs, and number of true-positive results, false-positive results, true-negative results, and false-negative results were not reported. The reported sensitivity and specificity could not be independently verified without crude data. The positivity threshold for the index test was unclear.</p><p><strong>Conclusions and practical implications: </strong>There is a lack of diagnostic test accuracy studies that evaluate salivary adjunct tests in a single cohort of patients with a suspected target condition that report accuracy estimates and person-important outcomes. The available evidence is limited, incompletely reported, and neither reproducible nor applicable, making it unsuitable for informing clinical decision making.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living evidence-informed guideline on the early detection of oral squamous cell carcinoma and potentially malignant disorders: Salivary adjunct tests to determine the need for biopsy, Version 2026 1.0.","authors":"Francisca Verdugo-Paiva, Olivia Urquhart, Ankita Shashikant Bhosale, Carolina Martins-Pfeifer, Alonso Carrasco-Labra, Julia Pimentel, A Ross Kerr, Marco Magalhaes, Carol Anne Murdoch-Kinch, JoAnn Gurenlian, Anil K Chaturvedi, Eva Grayzel, Alexander T Pearson, James C Melville, Anita S H Patel, Alessandro Villa, Michael Glick, Mark W Lingen","doi":"10.1016/j.adaj.2026.07.028","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.07.028","url":null,"abstract":"<p><strong>Background: </strong>Major breakthroughs in the clinical application of liquid biopsies, such as the use of salivary samples to detect biomarkers for the early detection of diseases and conditions, are on the horizon. Historically, late detection of oral cancer has contributed to high morbidity and mortality, making scientific advancements in this field particularly impactful. This guideline evaluates and provides recommendations for commercially available salivary adjunct tests in the United States designed specifically for screening adults without mucosal abnormalities and for determining the need for biopsy among adults with mucosal abnormalities of the oral cavity or lip.</p><p><strong>Types of studies reviewed: </strong>The researchers used living systematic review methodology to identify evidence on the benefits and harms of salivary adjunct tests. They also conducted a scoping review of patient and clinician values and preferences regarding the use of these adjuncts and evaluated data on other contextual factors, including costs, equity, acceptability, and feasibility of these tests. The guideline panel formulated a recommendation after applying the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework.</p><p><strong>Results: </strong>The panel issued 2 research-only recommendations, limiting the use of salivary adjunct tests for early oral cancer detection to research settings: 1 for adults with oral mucosal or lip abnormalities, and 1 for adults without mucosal abnormalities. Three good practice statements were also formulated: 2 recommending the performance of clinical oral examinations for all adult patients, and 1 recommending biopsy or referral for adult patients with persistent oral mucosal abnormalities.</p><p><strong>Practical implications: </strong>All adult patients should receive a clinical oral examination. When a mucosal abnormality is identified, biopsy remains the reference standard for establishing a definitive diagnosis. Salivary diagnostic adjuncts, whether used to screen asymptomatic adults or to determine the need for biopsy in adults with mucosal abnormalities, should not be used in regular clinical practice or as a public health screening measure outside of a research setting. Further research is needed to establish the potential role of salivary adjunct tests in clinical practice.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to and facilitators of general dentists performing intraoral biopsies.","authors":"Angela Ritchie, David Ajayi, Heather L Taylor","doi":"10.1016/j.adaj.2026.07.001","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.07.001","url":null,"abstract":"<p><strong>Background: </strong>Early detection of oral potentially malignant disorders and oral cancer relies heavily on biopsy for definitive diagnosis. Yet biopsies remain underused in general dentist practices. To better understand these practice behaviors, the authors examined whether general dentists perform intraoral biopsies and what they perceived to be barriers to and facilitators of their biopsy-related behaviors in practice.</p><p><strong>Methods: </strong>A cross-sectional online survey was distributed to licensed members of the Indiana Dental Association. The survey was used to assess demographic characteristics, training, practice characteristics, attitudes, and self-reported barriers and facilitators related to oral biopsies. Data specific to general dentists were descriptively analyzed.</p><p><strong>Results: </strong>Of 477 respondents (17.8% response rate), 377 self-identified as general dentists. Although 83.5% agreed that performing biopsies falls within their professional scope, 67.3% reported never having performed a biopsy and 76.3% routinely referred biopsy cases to specialists. Only 18.2% felt well prepared by dental school to perform biopsies, and 22.4% felt well prepared by continuing education. Overall, 82.2% reported a lack of training or confidence as a barrier to performing biopsies. Most general dentists selected hands-on training or workshops (85.4%), and clear biopsy indication guidelines as potential facilitators of performing more biopsies.</p><p><strong>Conclusions: </strong>Despite broad acknowledgment that oral biopsy is within their scope, most general dentists do not perform biopsies, citing inadequate training and logistical barriers. Addressing these gaps through enhanced predoctoral and continuing education, standardized biopsy guidelines, and supportive practice infrastructure may strengthen general dentists' capacity to perform biopsies more frequently.</p><p><strong>Practical implications: </strong>The capacity for the dental workforce to detect oral malignancies and cancers early may be inhibited by means of how infrequently general dentists perform intraoral biopsies, if at all, in their practices.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safeguarding academic integrity in the age of generative artificial intelligence across dental research, publishing, and clinical practice: Are we prepared to uphold ethics while embracing innovation?","authors":"Fotini V Anagnostopoulos-King","doi":"10.1016/j.adaj.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.07.016","url":null,"abstract":"","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lip Filler-Related Nodules.","authors":"Poramate Pitak-Arnnop","doi":"10.1016/j.adaj.2026.08.026","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.08.026","url":null,"abstract":"","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' Response.","authors":"Zahra Bagheri, Hyongsup Kimm","doi":"10.1016/j.adaj.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.09.006","url":null,"abstract":"","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the multidimensional implications of oral health in chronic kidney disease: A systematic review.","authors":"Sandra Moreira Rua Ventura, Pedro Manuel Vasconcelos Mesquita","doi":"10.1016/j.adaj.2026.06.004","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.06.004","url":null,"abstract":"<p><strong>Background: </strong>The authors of this systematic review aimed to synthesize the evidence on the multidimensional oral health outcomes associated with chronic kidney disease (CKD), including oral health status, oral manifestations, oral health-related quality of life, underlying biological mechanisms, and access to oral health care.</p><p><strong>Types of studies reviewed: </strong>A total of 46 English-language studies published over the past decade were included, comprising randomized controlled trials, nonrandomized interventional studies, and observational designs (eg, cohort, case-control, and cross-sectional studies). Studies were selected according to predefined population, exposure, comparator, and outcomes criteria. Risk of bias and methodological quality were assessed independently, and findings were synthesized qualitatively due to heterogeneity. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.</p><p><strong>Results: </strong>Patients with CKD exhibited poorer oral health outcomes than healthy controls across multiple domains. These included reduced oral health-related quality of life (standardized mean difference, 0.45), high prevalence of oral mucosal lesions (81.8%), higher salivary pH (standardized mean difference, 1.74), and substantial tooth loss (mean, 15 teeth). Proposed mechanisms include systemic inflammation, altered mineral metabolism, kidney osteodystrophy, salivary changes, and oral microbiome dysbiosis.</p><p><strong>Conclusions and practical implications: </strong>Routine use of the 14-item Oral Health Impact Profile can help clinicians identify oral health-related quality of life issues in patients with CKD, guide early detection and prevention of oral complications, and support integration of oral health care with overall medical management, including monitoring kidney function tests to identify patients at higher risk. In the future, researchers should focus on underrepresented groups, particularly patients with mild to moderate CKD, and use robust study designs to clarify longitudinal outcomes and the complex interactions between CKD and oral health. The protocol used in this systematic review was registered in the International Prospective Register of Systematic Reviews database (registration CRD42024618866).</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoridation and the risk of multiple amalgam or composite resin restorations for privately insured Massachusetts children: A retrospective cohort study.","authors":"Sam A Merabi, Pam Factor-Litvak, Eric P Tranby, Ivy Mushamiri","doi":"10.1016/j.adaj.2026.05.027","DOIUrl":"https://doi.org/10.1016/j.adaj.2026.05.027","url":null,"abstract":"<p><strong>Background: </strong>Community water fluoridation (CWF) is widely associated with reduced childhood caries. The authors examined whether CWF reduces amalgam or composite resin restoration risk among privately insured children in Massachusetts.</p><p><strong>Methods: </strong>In this retrospective cohort study, the authors analyzed dental insurance claims (2016-2019) linked to municipal fluoridation and Internal Revenue Service data among 35,610 privately insured children aged 1 through 16 years. Linear regression estimated adjusted mean differences in amalgam or composite resin restorations to examinations ratios and Poisson regression with log-link estimated adjusted risk ratios for multiple amalgam or composite resin restorations. Age stratification included teenagers entering the study (n = 9,215). Models adjusted for age, sex, income, topical fluoride, and sealants.</p><p><strong>Results: </strong>In adjusted models, the CWF cohort had a lower amalgam or composite resin restorations to examinations ratio (-0.034; 95% CI, -0.057 to -0.011; P = .004). A lower ratio was observed among adolescents 13 years and older at study entry (-0.092; 95% CI, -0.155 to -0.030; P = .004). Results of secondary threshold analyses showed generally larger relative risk reductions with higher treatment thresholds reaching an overall 19.0% reduced risk for more than 8 amalgam or composite resin restorations (estimate, -0.211; 95% CI, -0.360 to -0.062; P = .005). Similarly, a 26.9% reduced risk was observed for more than 7 amalgam or composite resin restorations among adolescents 13 years and older at study entry (estimate, -0.312; 95% CI, -0.511 to -0.115; P = .002).</p><p><strong>Conclusions: </strong>The results of this study showed that privately insured children exposed to CWF had a lower risk of undergoing restorative dental treatment, with greater protection generally observed at higher treatment counts. These findings support the extension of CWF's preventive public health benefits to privately insured children.</p><p><strong>Practical implications: </strong>Results showed CWF remains relevant for reducing dental treatment needs and may inform municipal fluoridation decisions.</p>","PeriodicalId":17197,"journal":{"name":"Journal of the American Dental Association","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}