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What is the societal economic cost of poor oral health among older adults in the United States? A scoping review

Huang, Shulamite S; Veitz-Keenan, Analia; McGowan, Richard; Niederman, Richard
OBJECTIVE:To assess the state of the literature in the United States quantifying the societal economic cost of poor oral health among older adults. BACKGROUND:Proponents of a Medicare dental benefit have argued that addressing the growing need for dental care among the US older adult population will decrease costs from systemic disease and other economic costs due to oral disease. However, it is unclear what the current economic burden of poor oral health among older adults is in the United States. METHODS:We conducted a scoping review examining the cost of poor oral health among older adults and identified cost components that were included in relevant studies. RESULTS:Other than oral cancer, no studies were found examining the economic costs of poor oral health among older adults (untreated tooth decay, gum disease, tooth loss and chronic disease/s). Only two studies examining the costs of oral cancer were found, but these studies did not assess the full economic cost of oral cancer from patient, insurer and societal perspectives. CONCLUSIONS:Future work is needed to assess the full economic burden of poor oral health among older adults in the United States, and should leverage novel linkages between medical claims data, dental claims data and oral health outcomes data.
PMID: 33719086
ISSN: 1741-2358
CID: 4817392

Direct composite resin fillings versus amalgam fillings for permanent posterior teeth

Worthington, Helen V; Khangura, Sara; Seal, Kelsey; Mierzwinski-Urban, Monika; Veitz-Keenan, Analia; Sahrmann, Philipp; Schmidlin, Patrick Roger; Davis, Dell; Iheozor-Ejiofor, Zipporah; Rasines Alcaraz, María Graciela
BACKGROUND:Traditionally, amalgam has been used for filling cavities in posterior teeth, and it continues to be the restorative material of choice in some low- and middle-income countries due to its effectiveness and relatively low cost. However, there are concerns over the use of amalgam restorations (fillings) with regard to mercury release in the body and the environmental impact of mercury disposal. Dental composite resin materials are an aesthetic alternative to amalgam, and their mechanical properties have developed sufficiently to make them suitable for restoring posterior teeth. Nevertheless, composite resin materials may have potential for toxicity to human health and the environment. The United Nations Environment Programme has established the Minamata Convention on Mercury, which is an international treaty that aims "to protect the [sic] human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds". It entered into force in August 2017, and as of February 2021 had been ratified by 127 governments. Ratification involves committing to the adoption of at least two of nine proposed measures to phase down the use of mercury, including amalgam in dentistry. In light of this, we have updated a review originally published in 2014, expanding the scope of the review by undertaking an additional search for harms outcomes. Our review synthesises the results of studies that evaluate the long-term effectiveness and safety of amalgam versus composite resin restorations, and evaluates the level of certainty we can have in that evidence. OBJECTIVES:To examine the effects (i.e. efficacy and safety) of direct composite resin fillings versus amalgam fillings. SEARCH METHODS:An information specialist searched five bibliographic databases up to 16 February 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: To assess efficacy, we included randomised controlled trials (RCTs) comparing dental composite resin with amalgam restorations in permanent posterior teeth that assessed restoration failure or survival at follow-up of at least three years. To assess safety, we sought non-randomised studies in addition to RCTs that directly compared composite resin and amalgam restorative materials and measured toxicity, sensitivity, allergy, or injury. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. MAIN RESULTS:We included a total of eight studies in this updated review, all of which were RCTs. Two studies used a parallel-group design, and six used a split-mouth design. We judged all of the included studies to be at high risk of bias due to lack of blinding and issues related to unit of analysis. We identified one new trial since the previous version of this review (2014), as well as eight additional papers that assessed safety, all of which related to the two parallel-group studies that were already included in the review. For our primary meta-analyses, we combined data from the two parallel-group trials, which involved 1645 composite restorations and 1365 amalgam restorations in 921 children. We found low-certainty evidence that composite resin restorations had almost double the risk of failure compared to amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35; P < 0.001), and were at much higher risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74; P < 0.001). We found low-certainty evidence that composite resin restorations were not more likely to result in restoration fracture (RR 0.87, 95% CI 0.46 to 1.64; P = 0.66). Six trials used a split-mouth design. We considered these studies separately, as their reliability was compromised due to poor reporting, unit of analysis errors, and variability in methods and findings. Subgroup analysis showed that the findings were consistent with the results of the parallel-group studies. Three trials investigated possible harms of dental restorations. Higher urinary mercury levels were reported amongst children with amalgam restorations in two trials, but the levels were lower than what is known to be toxic. Some differences between amalgam and composite resin groups were observed on certain measures of renal, neuropsychological, and psychosocial function, physical development, and postoperative sensitivity; however, no consistent or clinically important harms were found. We considered that the vast number of comparisons made false-positive results likely. There was no evidence of differences between the amalgam and composite resin groups in neurological symptoms, immune function, and urinary porphyrin excretion. The evidence is of very low certainty, with most harms outcomes reported in only one trial. AUTHORS' CONCLUSIONS:Low-certainty evidence suggests that composite resin restorations may have almost double the failure rate of amalgam restorations. The risk of restoration fracture does not seem to be higher with composite resin restorations, but there is a much higher risk of developing secondary caries. Very low-certainty evidence suggests that there may be no clinically important differences in the safety profile of amalgam compared with composite resin dental restorations. This review supports the utility of amalgam restorations, and the results may be particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Of note, however, is that composite resin materials have undergone important improvements in the years since the trials informing the primary analyses for this review were conducted. The global phase-down of dental amalgam via the Minamata Convention on Mercury is an important consideration when deciding between amalgam and composite resin dental materials. The choice of which dental material to use will depend on shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols.
PMID: 34387873
ISSN: 1469-493x
CID: 5010882

Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials

Khouly, Ismael; Braun, Rosalie Salus; Ordway, Michelle; Alrajhi, Mashal; Fatima, Sana; Kiran, Bhupesh; Veitz-Keenan, Analia
PURPOSE/OBJECTIVE:To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery. MATERIALS AND METHODS/METHODS:A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data. RESULTS:Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials. CONCLUSION/CONCLUSIONS:Within the limitations of this review, POP following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery. CLINICAL RELEVANCE/CONCLUSIONS:Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician's analgesic prescription should be directed by a patient's medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects. TRIAL REGISTRATION/BACKGROUND:CRD42018099324.
PMID: 33839939
ISSN: 1436-3771
CID: 4845582

Adopting an interdisciplinary clinical approach with older adults with Zoom

Chapter by: Fink, Nancy; Kaye, Jillian; Veitz-Keenan, Analia; Levine, Marci; Solvakovsky, Silvia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. ?-?
ISBN:
CID: 4819932

Adapting curriculum to the Integrated National Board Dental Examination

Chapter by: Levine, Marci; Veitz-Keenan, Analia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. ?-?
ISBN:
CID: 4819972

Adapting curriculum to the Integrated National Dental Board Examination

Chapter by: Levine, Marci; Veitz-Keenan, Analia
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2021
pp. -
ISBN:
CID: 4816362

Adhesive restorations for the treatment of dental non-carious cervical lesions [Intervention Protocol]

Veitz-Keenan, Analia; Spivakovsky, Silvia; Lo, Danny; Furnari, Winnie; ElSayed, Hend
This protocol has been withdrawn as it is now out of date and the topic has not been identified as a priority.
SCOPUS:85076700679
ISSN: 1469-493x
CID: 4248602

One phase or two phase orthodontic treatment for Class II division 1 malocclusion ?

Veitz-Keenan, Analia; Liu, Nicole
Data sources Numerous online databases were searched including:, the Cochrane Central Register of Controlled Trials, the Cochrane Library, MEDLINE Ovid and Embase Ovid). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials. No restrictions were placed on the language or date of publication when searching the electronic databases.Study selection The review included only randomised clinical trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. The review selected studies that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces/headgear versus late (one-phase) treatment in adolescents with any type of orthodontic braces or head-braces/headgear, and studies that compared any type of orthodontic braces or head-braces/headgear versus no treatment or another type of orthodontic brace/treatment or appliance (where treatment started at a similar age in the intervention groups). The review excluded studies involving participants with craniofacial deformities/syndromes or a cleft lip or palate, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion.Data extraction and synthesis The review authors screened the search results, extracted data and assessed risk of bias independently, and used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes (incisal trauma), and mean differences (MDs) and 95% CIs for continuous outcomes (overjet and ANB angle).Results Twenty-seven studies were included and analysed in the review. Out of the 27 trials , three trials (343 patients - low /moderate quality evidence ) compared early/ two stage orthodontic treatment with functional appliances versus late two phases orthodontic treatment assessing all changes in overjet, cephalometric changes (antero-posterior relationship of the mandible to the maxilla or ANB angle) and incisal trauma in the upper anterior teeth.Firstly the results showed a reduction in the overjet and ANB angle after phase one of early treatment in patients using functional appliances, before the other group had received any treatment; the results changed when both groups underwent treatment, resulting in a non-statistical difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; or ANB (MD -0.02, 95% CI -0.47 to 0.43).Incidence of new incisal trauma: the results favoured initial or early treatment with functional appliances. The odds of incisal trauma using early functional appliances were reduced compared to late treatment: OR 0.56 (95% CI 0.33 to 0.95). The incidence of front teeth trauma was 30% in the participants of the late treatment group/ one phase compared to 19% in the participants who received the early/two phase orthodontic treatment ( 332 patients - moderate quality evidence).Headgear versus late treatment: early (two-phase) treatment with headgear reduced roughly half the incidence of new front teeth trauma (OR 0.45, 95% CI 0.25 to 0.80) compared to the late treatment group . The use of headgear reduced overjet and ANB, however, when both groups finalised the treatment, there was no statistically significant difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; or ANB (MD -0.27°, 95% CI -0.80 to 0.26) (low quality evidence).Fixed functional appliances versus no treatment (low quality evidence): the analysis of seven trials that compared late treatment with functional appliances versus no treatment concluded that there was a reduction in final overjet with fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28 ).There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53, 95% CI -1.27 to -0.22 ).Removable functional appliances to reduce ANB compared to no treatment: the results ( low quality evidence) showing a MD of -2.37° (95% CI -3.01 to -1.74 ), favouring the functional appliances.Twin block appliance versus other appliances in adolescents: six studies found no difference in changes in overjet (0.08 mm, 95% CI -0.60 to 0.76) . The reduction in ANB favoured treatment with a twin block (-0.56°, 95% CI -0.96 to -0.16).Removable functional appliances versus fixed appliances: the data combination of three trials concluded that there is a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33), and a reduction in ANB in favour of removable appliances (-1.04° , 95% CI -1.60 to -0.49).Conclusions Evidence classified as low to moderate quality suggests that providing early orthodontic treatment/two stages for children with prominent upper front teeth is more effective for reducing the incidence of upper front teeth trauma ( incisal trauma) than providing one course of orthodontic treatment in adolescence. However, it appears that there is no other benefit of providing early treatment when compared to late treatment. Low-quality evidence proposes that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.
PMID: 31562403
ISSN: 1476-5446
CID: 4105802

Limited Evidence Suggests Metformin Might Be Beneficial to Reduce Head and Neck Cancer Risk and Increase Overall Survival, While Any Benefit With Antiinflammatory Drugs Is Inconsistent

Veitz-Keenan, Analia; Silvestre Calle, Thamar Delia; Bergamini, Marco
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION/BACKGROUND:Protective effects of metformin, statins, and antiinflammatory drugs on head and neck cancer: A systematic review. Saka Herrán C, Jané-Salas E, Devesa AE, López-López J. Oral Oncol 2018;85:68-81. SOURCE OF FUNDING/BACKGROUND:None. TYPE OF DESIGN/UNASSIGNED:Systematic review with meta-analysis.
PMID: 31732106
ISSN: 1532-3390
CID: 4208312

Quality Appraisal of Child Oral Health-Related Quality of Life Measures: A Scoping Review

Yang, C; Crystal, Y O; Ruff, R R; Veitz-Keenan, A; McGowan, R C; Niederman, R
BACKGROUND/UNASSIGNED:Children's oral health-related quality of life (COHQoL) measures are well known and widely used. However, rigorous systematic reviews of these measures and analyses of their quality are in absence. OBJECTIVES/UNASSIGNED:To systematically review and quantitatively assess the quality of COHQoL measures through a scoping review. DATA SOURCES/UNASSIGNED:Systematic literature search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE (Excerpta Medica database), HaPI (Health and Psychosocial Instruments), and DOSS (Dentistry and Oral Sciences Source). STUDY ELIGIBILITY/UNASSIGNED:The measure's focus was COHQoL; the child age ranged from 5 to 14 years; the publication was either a research article or a systematic review and related to caries; and it was written in English or had an English abstract. Two authors independently selected the studies. Disagreements were reconciled by group discussions with a third author. APPRAISAL/UNASSIGNED:The International Society for Quality of Life Research minimum standards for patient-reported outcome measures were used for quality appraisal. SYNTHESIS/UNASSIGNED:Descriptive analysis. RESULTS/UNASSIGNED:We identified 18 measures. Their quality scores ranged from 9.5 to 15.0 on a scale of 16. The quality appeared to bear no relationship to the citation and use of these measures. However, elements of these measures might be more useful than others, depending on the age-specific use and primary quality concerns. LIMITATIONS/UNASSIGNED:Some of the information on the minimum standards of the 18 measures cannot be found in the existing literature. Measures published without English abstract were not searched. CONCLUSIONS/UNASSIGNED:The quality of these measures is suboptimal. Researchers and practitioners in this field should exercise caution when choosing and using these measures. Efforts at improving the quality of the COHQoL measures, such as refining existing ones or developing new measures, are warranted. KNOWLEDGE TRANSFER STATEMENT/UNASSIGNED:Researchers, clinician scientists, and clinicians can use the results of this study when deciding which oral health-related quality of life measure they wish to use in children.
PMID: 31238010
ISSN: 2380-0852
CID: 3962742