Apexification Outcomes in the United States: A Retrospective Cohort Study
INTRODUCTION/BACKGROUND:This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the tooth-level. METHODS:Dental insurance claims data from New York State (2006-2019) and Massachusetts (2013-2018) were used in an observational, retrospective cohort study to evaluate the provision and treatment outcomes of apexification. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Cox proportional hazard regression was used to evaluate the hazard of adverse event occurrence by age, gender, tooth type, placement of permanent restoration, and dental provider type. A sensitivity analysis evaluated potential bias in the survival estimates and adjusted hazard ratios (aHRs) due to differential loss to follow-up. Robust standard errors were used to account for potential dependence between teeth within an individual. RESULTS:The analytic cohort of 575 individuals included 632 teeth, with an average follow-up time of 64 months. The survival rates of apexification procedures were 95% at 1 year; 93% at 2 years; 90% at 3 years; and 86% at 5 years. Tooth retention following apexification was 98% at 1 year; 96% at 2 years; 95% at 3 years; and 90% at 5 years. Tooth type and subsequent placement of a permanent restoration were significant predictors of survival after apexification. CONCLUSIONS:The procedural and tooth survival outcomes of apexification were high and comparable to studies that analyzed clinical data on tooth survival following apexification.
A decade of grassroots pathway programming: Saturday Academy at New York University College of Dentistry
BACKGROUND:Successful pathway programs require early and sustained support of student participants. PURPOSE/OBJECTIVE:We present the history and outcomes of a successful decade of continuous, grassroots, pathway programming at an individual dental institution. METHODS:Programmatic data were used to evaluate information on program participant demographics, academic pursuits, and career interests. Descriptive analyses were used to report on program enrollment as well as alumni academic and career outcomes. RESULTS:Between the years of 2013 and 2022, 346 high-school students participated in Saturday Academy at NYU Dentistry. Of the 240 college-aged and older program alumni, 72% (n = 172) have shared their academic and career plans after high-school. At the time of publication, 78% (134/172) of alumni that have maintained contact with Saturday Academy and have expressed interest in pursuing a career in the health professions. Of the 172 alumni, 14% (n = 24) have enrolled in or graduated from a health professional program (dental hygiene, nursing, accelerated dental or medical program, dental or medical school, or other health professional program). Of these alumni (24/172), half (n = 12) have pursued education in the dental professions, specifically. CONCLUSION/CONCLUSIONS:Saturday Academy at NYU Dentistry is an example of a sustainable and impactful pathway program in dental education and its outcomes support the merit of calls for increased institutional commitment and support of similar initiatives.
Stress and Oral Health-Related Quality of Life Among a Sample of College-Educated Black Men
This study assessed if higher levels of self-reported stress were associated with selfreported oral health-related quality of life (OHRQoL) among a sample of college-educated Black men. Using a community-based participatory approach, a questionnaire was developed and distributed using two validated instruments, the Holmes-Rahe Stress Inventory and the Oral Health Impact Profile-14. Eighty men completed the questionnaire, with 58.8% reporting Holmes-Rahe scores above 150 (mean=209, SD=175.2). The highest OHIP-14 mean ratings on a scale of 0 to 3 were for feeling self-conscious (mean=.67), painful aching (mean=.55), feeling embarrassed (mean=.49), and eating discomfort (mean=0.48). Among participants with Holmes-Rahe Stress Inventory scores above 150, mean OHRQoL levels were significantly higher for domains of painful aching (p=.007), eating discomfort (p=.038), feeling self-conscious (.006), and experiencing tense feelings (.049). Higher stress levels may be associated with college-educated Black men"™s experiences of oral health-related physical pain and psychological discomfort.
A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts
BACKGROUND:Despite substantial increases in dental benefits and improvements in the use of dental services among children and adolescents in the United States, oral health disparities according to dental insurance payer type persist. METHODS:The authors used an all-payer claims (2013-2017) database to perform a comparative analysis of the provision and treatment outcomes of an endodontic procedure (root canal therapy) in the permanent teeth of a pediatric population aged 6 through 18 years, according to dental insurance payer type. Statistical analyses, including logistic regression, Cox proportional hazards regression, and the Kaplan-Meier method, were performed at person and tooth levels. RESULTS:Compared with privately insured children and adolescents, public-payer children and adolescent beneficiaries were more likely to have had root canal therapy (adjusted odds ratio, 1.91; 95% CI, 1.73 to 2.11) and had poorer treatment outcomes associated with the procedure (adjusted hazard ratio, 2.19; 95% CI, 1.53 to 3.14; P < .0001) during the study period. Those enrolled in private insurance were more likely to receive treatment from an endodontist (specialist in providing root canal therapy) (P < .0001). Amounts allowed and paid by the insurer were significantly higher for private payers (P < .001). CONCLUSIONS:There were significant differences in the provision and outcomes of endodontic treatment between privately and publicly insured children and adolescents. PRACTICAL IMPLICATIONS:Despite ostensibly equal access to care, differences in the provision of oral health care exist between privately and publicly insured patients. These differences may be contributing to persisting oral health disparities.
Apexification Outcomes in the United States: A Retrospective Cohort Study
Introduction: This epidemiological analysis used procedure codes from dental insurance claims data to identify apexification cases and evaluate survival at the tooth-level. Methods: Dental insurance claims data from New York State (2006"“2019) and Massachusetts (2013"“2018) were used in an observational, retrospective cohort study to evaluate the provision and treatment outcomes of apexification. Statistical analyses included Kaplan"“Meier survival estimates and Cox proportional hazards regression. Cox proportional hazard regression was used to evaluate the hazard of adverse event occurrence by age, gender, tooth type, placement of permanent restoration, and dental provider type. A sensitivity analysis evaluated potential bias in the survival estimates and adjusted hazard ratios (aHRs) due to differential loss to follow-up. Robust standard errors were used to account for potential dependence between teeth within an individual. Results: The analytic cohort of 575 individuals included 632 teeth, with an average follow-up time of 64 months. The survival rates of apexification procedures were 95% at 1 year; 93% at 2 years; 90% at 3 years; and 86% at 5 years. Tooth retention following apexification was 98% at 1 year; 96% at 2 years; 95% at 3 years; and 90% at 5 years. Tooth type and subsequent placement of a permanent restoration were significant predictors of survival after apexification. Conclusions: The procedural and tooth survival outcomes of apexification were high and comparable to studies that analyzed clinical data on tooth survival following apexification.
Epidemiological Evaluation of the Outcomes of Initial Root Canal Therapy in Permanent Teeth of a Publicly Insured Pediatric Population
BACKGROUND:Previously published epidemiological outcome studies of root canal therapy (NSRCT) in the Unites States utilize data only from a single, private dental insurer for adult populations. AIM/OBJECTIVE:This study aimed to investigate outcomes of initial NSRCT, performed on permanent teeth, in a publicly insured pediatric population. DESIGN/METHODS:New York State Medicaid administrative claims were used to follow 77,741 endodontic procedures in 51,545 patients aged 6-18, from the time of initial NSRCT until occurrence of an untoward event (retreatment, apicoectomy, extraction). Initial treatment and untoward events were identified by Current Dental Terminology codes. Kaplan-Meier survival estimates were calculated at 1, 3, and 5 years. Hazard ratios for time to permanent restoration and restoration type were calculated using Cox proportional hazard models. RESULTS:Median follow-up time was 44 months [range:12-158 months]. Procedural, NSRCT, survival was 98% at 1 year, 93% at 3 years, and 88% at 5 years. Extraction was the most common untoward event. Teeth permanently restored with cuspal coverage had the most favorable treatment outcomes. CONCLUSIONS:Overall, 89% of teeth were retained and remained functional over a minimum follow-up time of 5 years. These results elucidate expected outcomes of NSRCT in permanent teeth for pediatric patients with public-payer dental benefits.
Exploring Public Perceptions of Dental Care Affordability in the United States: Mixed Method Analysis via Twitter
BACKGROUND:Dental care expenses are reported to present higher financial barriers than any other type of health care service in the United States. Social media platforms such as Twitter have become a source of public health communication and surveillance. Previous studies have demonstrated the usefulness of Twitter in exploring public opinion on aspects of dental care. To date, no studies have leveraged Twitter to examine public sentiments regarding dental care affordability in the United States. OBJECTIVE:The aim of this study is to understand public perceptions of dental care affordability in the United States on the social media site, Twitter. METHODS:Tweets posted between September 1, 2017, and September 30, 2021, were collected using the Snscrape application. Query terms were selected a priori to represent dentistry and financial aspects associated with dental treatment. Data were analyzed qualitatively using both deductive and inductive approaches. In total, 8% (440/5500) of all included tweets were coded to identify prominent themes and subthemes. The entire sample of included tweets were then independently coded into thematic categories. Quantitative data analyses included geographic distribution of tweets by state, volume analysis of tweets over time, and distribution of tweets by content theme. RESULTS:A final sample of 5314 tweets were included in the study. Thematic analysis identified the following prominent themes: (1) general sentiments (1614 tweets, 30.4%); (2) delaying or forgoing dental care (1190 tweets, 22.4%); (3) payment strategies (1019 tweets, 19.2%); (4) insurance (767 tweets, 14.4%); and (5) policy statements (724 tweets, 13.6%). Geographic distributions of the tweets established California, Texas, Florida, and New York as the states with the most tweets. Qualitative analysis revealed barriers faced by individuals to accessing dental care, strategies taken to cope with dental pain, and public perceptions on aspects of dental care policy. The volume and thematic trends of the tweets corresponded to relevant societal events, including the COVID-19 pandemic and debates on health care policy resulting from the election of President Joseph R. Biden. CONCLUSIONS:The findings illustrate the real-time sentiment of social media users toward the cost of dental treatment and suggest shortcomings in funding that may be representative of greater systemic failures in the provision of dental care. Thus, this study provides insights for policy makers and dental professionals who strive to increase access to dental care.
Junior faculty perspectives on the academic environment: A call for development and onboarding
BACKGROUND:One challenge in dental education is new faculty members can be hired with limited teaching experience or understanding of pedagogy. Recent publications document increasing initiatives of faculty development in US and Canadian dental schools. This study evaluates full-time faculty perspectives of their develop and academic environment. METHODS:A 33-item questionnaire distributed to senior administrators and forwarded to faculty, collected data on demographics and satisfaction, utilizing a 5-item Likert scale, multiple choice, and binary yes/no questions. Responses were descriptively and statistically analyzed utilizing an analysis of variance, chi-square, and two-sample t-test. RESULTS:There were 183 faculty respondents (37.7% male/62.3% female), age ranges were 20-29 (2.2%), 30-39 (53.5%), and 41-49(44.3). Respondents reported race/ethnicity: Caucasian (60.7%), Asian (19.1%), Hispanic (12.6%), Black/African American (5.5%), two or more races (2.2%), and Native American 0%. Length of employment was significantly associated with primary responsibility (pÂ =Â 0.0023), recent publications (pÂ <Â 0.0011), and short-term intent to remain in academia (pÂ =Â 0.046). There was a statistically significant difference between age and satisfaction with professional development (pÂ =Â 0.0411), achieving career objectives (pÂ =Â 0.0151), well-being (pÂ =Â 0.0492), access to resources for scholarly interests (pÂ =Â 0.0114), communication (pÂ =Â 0.0058), and assessment training (pÂ =Â 0.0249). Non-Caucasian faculty reported greater dissatisfaction with being treated respectfully (pÂ =Â 0.0302), departmental commitment to diversity and inclusion (pÂ =Â 0.0075), and departmental cooperation/teamwork (pÂ =Â 0.0323). CONCLUSIONS:A significant number of junior faculty have interest in academic dental careers. Institutions should invest in improving onboarding and professional development. Improve the early experiences of faculty, and foster diversity and inclusion and faculty well-being.
Outcomes of Primary Root Canal Therapy: An updated Systematic Review of Longitudinal Clinical Studies Published between 2003 and 2020
BACKGROUND:A comprehensive effort to evaluate outcomes of primary root canal treatment (RCT) between 1966 and 2002 was published by Ng et al. (2007, 2008). Changes in endodontic materials and treatment methods warrants an updated analysis of outcomes. OBJECTIVES/OBJECTIVE:This study aimed to 1) quantify the success rates of primary RCT published between 2003 and 2020; and 2) investigate the influence of some characteristics known/ suspected to be associated with treatment outcomes. METHODS:An electronic search was performed in the following databases (01-01-2003 to 12-31-2020): Pubmed, Embase, CINHAL, Cochrane and Web of Science. Included study designs were longitudinal clinical studies (randomized control trials, cohort studies, retrospective observational studies). Studies with at least twelve-months of post-operative review and success rates based on clinical and radiographic criteria were analyzed. The terms 'strict' (complete resolution of periapical lesion) or 'loose' (reduction in size of existing periapical lesion) were used to describe the outcome criteria. Weighted, pooled success rates were calculated. Random effects meta-regression models were used to investigate potential sources of statistical heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate for quality assessment of the included studies. RESULTS:Forty-two studies were included in the review. Meta-analyses showed that the weighted pooled success rates were estimated to be 92.6% (95% CI: 90.5-94.8%) under 'loose criteria' and 82.0% (95% CI: 79.3-84.8%) under 'strict' criteria. The most significant areas of study heterogeneity were year of publication and qualification of operator. The majority (64.29%) of studies were considered to be of low quality of evidence. DISCUSSION/CONCLUSIONS:Biological factors continue to have the most significant impact on RCT outcomes. The technological method of instrumentation had no significant effect. The quality of evidence, was based primarily on study design and only randomized control trials were considered to be "high" quality of evidence. CONCLUSIONS:The reported success rates show improvement over time. Weighted success rates for studies with a minimum of four-year follow-up had better outcomes, compared to those with less than four years, when 'strict criteria' were used.
Exploring predoctoral dental student use of YouTube as a learning tool for clinical endodontic procedures
PURPOSE/OBJECTIVES/OBJECTIVE:The goal of the present study was to examine perceived barriers to achieving clinical competence in endodontics and explain how YouTube is used to supplement formal education in this discipline. METHODS:Postgraduate endodontic students conducted focus groups with fourth-year dental students at NYU College of Dentistry. The discussion was facilitated by a semistructured interview guide. Open-ended questions about participants' perceived barriers to clinical competency in endodontics, experiences using YouTube to learn about clinical endodontics, and preferences for video format learning were asked. Demographic information was gathered. Thematic analysis of data was conducted and data collection was terminated once saturation was achieved. RESULTS:Thirty fourth-year dental students were enrolled in the study. The majority, 96.7%, reported using YouTube as a learning tool for dental procedures and 83.3% to learn about endodontics, specifically. The following domains were explored during data analysis: barriers to clinical competency, YouTube uses/experiences, and content preferences. The following themes within barriers to clinical competency were identified: psychological, educational, and clinical. Within the YouTube domain, the following themes were examined: goals of use, timing and frequency of use, search strategies, benefit/ shortcomings of YouTube, and validity of content. Students primarily used YouTube to enhance confidence and understand procedural flow. CONCLUSION/CONCLUSIONS:YouTube videos were primarily used to help students overcome perceived educational and psychological barriers that resulted in gaps in confidence and knowledge of performing endodontic procedures. Dental students placed high value on easily accessible video content of limited duration, where clinical procedures were performed on live patients.