Faculty Bibliography

Objectives: The authors aim to evaluate a scale assessing oral health knowledge, the KROHL (Knowledge Related to Oral Health Literacy) including the inter-rater reliability for scoring open-ended questions, internal consistency of the hypothesized scales, the discriminant validity of the resulting scale and its relationship to existing measures of oral health literacy. Methods: The questionnaire was administered via face-to-face interviews to 144 volunteers recruited in the waiting areas of clinics throughout the NYU College of Dentistry. The KROHL questionnaire evaluates oral health knowledge by asking open-ended questions about the appearance, cause, treatment and prevention of caries, gum disease, oral cancer, tooth loss and malocclusion. Those 20 questions were scored to produce scale scores. Demographic information, a self-reported measure of HL and the CMOHK (Comprehensive Measure of Oral Health Knowledge) were also collected. Data were analyzed using Pearson correlation coefficients and principal components analysis, by computing Cronbach's alpha and Cohen's kappa, and by comparing group means with ANOVA. Results: Kappa indicated good to excellent agreement among raters for the full and the individual subscales of the KROHL. Cronbach's alpha indicated good consistency of the full scale score, but not the individual scales. The mean (SD) KROHL score was lower in the patient group than in the dental students (13.3 (5.9) vs. 26.1 (4.7), p < .001), and varied directly with education level within the patients. KROHL scores were unrelated to existing measures of health literacy. Conclusions: The KROHL scale is an innovative, reliable and valid tool to assess overall oral health knowledge and provide information to customize educational interventions. Further research is needed to determine the validity and reliability of the scale in multiple settings. Innovation: The innovation of the KROHL tool of assessment of oral health knowledge lies in its ability to scale depth of knowledge within the domains of identification, causes, prevention, and treatment for the most common oral conditions.

Antimicrobial resistance was recently described by the World Health Organization (WHO) as "a clear and present danger to global health." It is well documented that this resistance is significantly driven by the overuse and inappropriate use of antibiotics. Impactful change can only come from the adoption of antibiotic stewardship practices in all aspects of health care. With dentistry responsible for approximately 10% of all prescribed antibiotics in the United States, there is a potential to be acutely impactful with adequate interventions. After extensively reviewing the most current national and international literature on the topic, we identified that predoctoral dental education provides a potentially impactful opportunity to introduce and support the development of responsible antibiotic practices. To that extent, we developed a detailed framework of antibiotic stewardship competencies to promote responsible best practices among dental students.

Data sources Medline via PubMed, Scopus, Science Direct, Scielo and Google Scholar were searched without language restriction until 28 May 2020.Study selection Publications on the topic of biosafety measures before, during and after dental practice from observational studies, systematic reviews and literature reviews were included, while letters to the editor, individual opinions and books were excluded.Data extraction and synthesis The authors used a narrative review to describe the findings and grouped them into two categories: those considerations before dental care and those during dental consultation.Results The review was based on 43 publications. Of those, 23 were recent reviews, guidelines, protocols and recommendations from national and international organisations; three were COVID-related original studies and the remainder were pre-COVID publications on handpieces, surface contamination, ventilation, aerosols and airborne spread, ultrasonics, hand washing and dental pain management.Conclusions Patients should conform to COVID-19 screening protocols in order to receive dental care and follow all the procedures in place to prevent transmission while in the dental office.

The Hispanic population has one of the highest levels of untreated oral disease of any linguistic or ethnic population in the United States. Research examining the factors leading to such outcomes is limited. Since health literacy has been identified as a mediator of health disparities, it is important to identify the most appropriate tool to assess it. The Knowledge Related to Oral Health Literacy model for Spanish speakers (KROHL-S) is an inclusive framework to evaluate oral health knowledge and other modifiable factors at the individual level among the Hispanic population as related to oral health literacy. KROHL-S intends to provide concrete, practical information to help customize interpersonal interactions and educational experiences to individuals' needs and capabilities. The questionnaire that will allow the creation of the KROHL-S scale consists of orally administered open-ended questions to measure knowledge that is condition specific (caries, periodontal disease, oral cancer, tooth loss, and malocclusion) and domain that is knowledge specific (identification of condition, causes, prevention, treatment, general knowledge). Implementation of the KROHL-S framework will provide in depth information that could be shared among health care providers and the creation of patient-centred initiatives.

This protocol has been withdrawn as it is now out of date and the topic has not been identified as a priority.

Data sources The following traditional databases were searched until January 2018; Cochrane Central Register of Controlled Trials (CENTRAL); the Cochrane Library; Issue 1, MEDLINE Ovid, Embase Ovid, CINHAL Plus and the Institute of Scientific Information (ISI) Web of Science. In addition, five more databases (IndMED, KoreaMED, Panteleimon, ANZCTR and Ingenta Connect) and bibliographies. References lists were also searched until January 2018 as well as handsearching of multiple relevant journals and potential sources of unpublished studies.Study selection All included studies were randomised controlled trials comparing different agents, different dosage or different concentration of local anaesthetics in clinical procedures or simulated scenarios using parallel or cross-over design with no language or year of publication restrictions. Data extraction and synthesis Two reviewers independently selected, reviewed and extracted data using a standardised form. Risk of bias was also assessed by two authors. Quality of the evidence was evaluated by the GRADE approach. Treatment effect was presented as odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (CI) for binary data, while mean differences (MD) with 95% CI was used for continuous data. Statistical heterogeneity was calculated by the 'Q' statistic and I2. 'Summary findings' tables were created for eight comparisons. Subgroup analysis was performed based on the tissue anaesthetised.Results From the 123 studies (19,223 participants) on dental anaesthesia using commercially available formulations that met the inclusion criteria, 68 studies with 6615 participants were included for quantitative analysis. The comparison of 4% articaine, 1:100.000 adrenaline with 2% lidocaine, 1:100.000 adrenaline was reported as the main comparison and included the results of four studies with 203 participants with irreversible pulpitis during endodontic access and instrumentation. For the primary outcome of success, as measured by the absence of pain, the calculated RR of 1.60 (95% CI 1.10 to 2.32) favoured articaine with low heterogeneity. No evidence of difference was observed on pain during injection (MD 4.74 mm, 95% CI -1.98 to 11.46 mm) or following injection (MD 6.41 mm CI 95% 1.01 to 11.80 mm) based on three cross-over studies comparing the same formulations used for the evaluation of success.Conclusions The authors concluded there is no sufficient high quality evidence to determine which formulation is more effective. Four percent, 1:100,000 adrenaline was superior to lidocaine 2%, 1:100,000 epinephrine when measuring success on posterior teeth with irreversible pulpitis. Two percent lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine 0.03 IU felypressin during surgical procedures and 4% prilocaine plain during surgical and periodontal treatment.

Data sourcesMedline, Embase, Scopus and Scielo were searched until April 2017 supplemented by manual searching.Study selectionClinical trials with parallel-groups, crossover and split mouth in patients older than 18 years were included with no language restrictions. The primary outcome considered was changes in pain intensity, while the secondary outcome was changes on onset time.Data extraction and synthesisTwo authors extracted data using a standard data form. Inter-rater reliability was calculated as high. For the primary outcome all scales were converted to a 0-100 scale. For the secondary outcome all measures were normalised in minutes. Risk of bias was assessed using the Cochrane Collaboration tool. The treatment effect was calculated using mean differences and 95% confidence interval. Heterogeneity and sensitivity analysis were performed. Data were combined using a random effect model.ResultsFourteen studies were included in the review. Of those nine were included in a meta-analysis for the primary outcome pain showing no significant reduction: -7.38 (-15.67-0.91) for normal tissue (five studies) and -4.41 (-15.25-6.43) for inflamed tissue on four studies. No statistically significant results were found in the block (three studies) or the infiltration groups (seven studies). Four studies were included in a meta-analysis for onset time. Significant reduction was achieved for inferior alveolar nerve blocks: -1.26 (-1.41 to -1.10) on three studies and when used on inflamed tissue: -1.37 (-2.03 to -0.70) from one study. High degree of heterogeneity was observed in all groups.ConclusionsThe authors concluded that buffered lidocaine does not reduce pain from injection and the onset time reduction in inferior alveolar nerve blocks and in inflamed tissues while the magnitude of the reduction is not clinically relevant.

Data sourcesMEDLINE/PubMed, Scopus and ISI Web of knowledge, from date of inception up to July 2017. Hand searching of the reference lists of the included studies was performed.Study selectionRandomised (RCT) and non-randomised (n-RCT) controlled trials and controlled and comparative studies were included in patients more than 18 years old diagnosed with symptomatic oral lichen planus, histopathologically confirmed, on the use of photodynamic therapy (PDT) compared with corticosteroids, published in English.Data extraction and synthesisTwo authors independently assessed for inclusion and performed quality assessment of the included studies following the CONSORT statement followed by the overall estimation of the risk of bias. Data extraction was also done independently by two authors. The primary outcome was the effect of PDT on pain and clinical improvement.ResultsFive studies were included: three RCTs and two n-RCTs having between eight and 30 participants. Two studies used diode laser and three used light emitting diode (LED) and the duration of the radiation ranged between 30 seconds to ten minutes. Each study used a unique corticosteroid agent. Three studies used methylene blue, one toluidine blue and one 5-aminolevulinic acid as photosensitiser agent. Follow-up was between one and three months. The authors presented the results as a narrative review.ConclusionsThe limited present evidence suggests that PDT is an effective treatment option for the management of OLP by reduction in pain, burning and decrease in the size of the lesions.

Data sourcesPubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases were searched from 1980 to March 2016. Literature reviews were explored in order to retrieve any other relevant papers.Study selectionRandomised controlled studies (RCTs), prospective and before and after studies that applied botulinum toxin (BoNT-A) to the masseter and/or temporalis muscles assessing objective and subjective parameters of bruxism published in English were included.Data extraction and synthesisThree reviewers independently assessed for eligibility. Disagreement was solved by discussion and when reaching consensus between at least two. Standard data items were extracted. Quality assessment was assessed using the Cochrane Collaboration's risk of bias tool and the Critical Appraisal Skills Program (CASP) tool. Before-After Study Checklist was used for the nonrandomised studies. Results were presented as a narrative review.ResultsFive studies were included in the review, of those three were RCTs and two before and after. A total of 188 subjects were included. Regimen was unique in each study and the follow-up ranged from two to 24 weeks. The risk of bias of the RCTs was assessed as low to unclear, while the before and after studies were assessed as of moderate risk of bias.ConclusionsThe authors concluded that botulinum toxin represents a possible option for the management of sleep bruxism (SB), minimising symptoms and reducing the intensity of contractions rather than for SB itself.