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Annals of Periodontology Jul 1998Infective endocarditis (IE) is a serious disease that is associated with dental diseases and treatment. The objective of this study was to summarize the epidemiological... (Review)
Review
Infective endocarditis (IE) is a serious disease that is associated with dental diseases and treatment. The objective of this study was to summarize the epidemiological information about IE and reevaluate previous causal models in light of this evidence. The world biomedical literature was searched from 1930 to 1996 for descriptive and analytic epidemiological studies of IE. Multiple searching strategies were performed on 9 databases, including MEDLINE, CATLINE, and WORLDCAT. Results show that: 1) the incidence of IE varies between 0.70 to 6.8 per 100,000 person-years: 2) the incidence of IE increases 20 fold with advancing age: 3) over 50% of all IE cases are not associated with either an obvious procedural or infectious event 3 months prior to developing symptoms; 4) about 8% of all IE cases are associated with periodontal or dental disease without a dental procedure: 5) the time from the diagnosis of heart valve deformities to the development of IE approaches 20 years: 6) the median time from identifiable procedures to the onset of IE symptoms is about 2 to 4 weeks: 7) the risk of IE after a dental procedure is probably in the range of 1 per 3,000 to 5,000 procedures: and 8) over 80% of all IE cases are acquired in the community, and the bacteria are part of the host's endogenous flora. The synthesis of these data demonstrates that IE is a disorder with the epidemiological picture of a chronic disease such as cancer, instead of an acute infectious disease, with a long latent period and possibly several definable intermediates or stages. A new causal model is proposed that includes early bacteremias that may "prime" the endothelial surface of the heart valves over many years, and a late bacteremia over days to weeks that allows adherence and colonization of the valve, resulting in the characteristic fulminant infection.
Topics: Animals; Bacteremia; Chronic Disease; Dental Care; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Incidence; Risk Factors; Staphylococcal Infections; Streptococcal Infections; United States
PubMed: 9722702
DOI: 10.1902/annals.1998.3.1.184 -
Journal of Paediatrics and Child Health Jul 2023To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a...
AIM
To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost.
METHODS
A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures.
RESULTS
Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason.
CONCLUSIONS
Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.
Topics: Child; Humans; Retrospective Studies; Tooth Extraction; Anesthesia, General; Anesthetics, General; Heart Defects, Congenital; Dental Care; Dental Care for Children
PubMed: 37067153
DOI: 10.1111/jpc.16406 -
The Cochrane Database of Systematic... Oct 2008Infective endocarditis is a severe infection arising in the lining of the heart with a high mortality rate.Many dental procedures cause bacteraemia and it was believed... (Review)
Review
BACKGROUND
Infective endocarditis is a severe infection arising in the lining of the heart with a high mortality rate.Many dental procedures cause bacteraemia and it was believed that this may lead to bacterial endocarditis (BE) in a few people. Guidelines in many countries have recommended that prior to invasive dental procedures antibiotics are administered to people at high risk of endocarditis. However, recent guidance by the National Institute for Health and Clinical Excellence (NICE) in England and Wales has recommended that antibiotics are not required.
OBJECTIVES
To determine whether prophylactic antibiotic administration compared to no such administration or placebo before invasive dental procedures in people at increased risk of BE influences mortality, serious illness or endocarditis incidence.
SEARCH STRATEGY
The search strategy from the previous review was expanded and run on MEDLINE (1950 to June 2008) and adapted for use on the Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers, as well as the following databases: CENTRAL (The Cochrane Library 2008, Issue 2); EMBASE (1980 to June 2008); and the metaRegister of Controlled Trials (to June 2008).
SELECTION CRITERIA
Due to the low incidence of BE it was anticipated that few if any trials would be located. For this reason, cohort and case-control studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of antibiotic compared to no such administration before a dental procedure in people with an increased risk of BE. Cohort studies would need to follow those at increased risk and assess outcomes following any invasive dental procedures, grouping by whether prophylaxis was received. Included case-control studies would need to match people who had developed endocarditis (and who were known to be at increased risk before undergoing an invasive dental procedure preceding the onset of endocarditis) with those at similar risk but who had not developed endocarditis. Outcomes of interest were: mortality or serious adverse event requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who develop endocarditis.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion, then assessed quality and extracted data from the included study.
MAIN RESULTS
No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included. One case-control study met the inclusion criteria. It collected all the cases of endocarditis in The Netherlands over 2 years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxys). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes.
AUTHORS' CONCLUSIONS
There remains no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support previously published guidelines in this area. It is not clear whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Topics: Antibiotic Prophylaxis; Dental Care; Dentistry; Endocarditis, Bacterial; Humans; Penicillins
PubMed: 18843649
DOI: 10.1002/14651858.CD003813.pub3 -
Journal of Prosthodontics : Official... Feb 2019The goal of disinfection in the dental office is to prevent the spread of infection from one patient to another and maintain the safety of the dental care providers.... (Comparative Study)
Comparative Study Review
The goal of disinfection in the dental office is to prevent the spread of infection from one patient to another and maintain the safety of the dental care providers. Prevention of cross infection has significant effect on infection control. The standard procedure of rinsing impressions under tap water immediately after removal from the mouth eliminates microorganisms along with saliva and blood. A broad search on published literature was done using the keywords impression materials, disinfection method, and sterilization of dental impression from 1980 to 2016 in Medline, Google Scholar, the internet, and textbooks. This article critically analyzes the various published methods of dental impression disinfection in dentistry.
Topics: Cross Infection; Dental Care; Dental Impression Materials; Dental Impression Technique; Disinfectants; Disinfection; Humans
PubMed: 28422353
DOI: 10.1111/jopr.12597 -
Behaviour Research and Therapy 1984
Topics: Adolescent; Adult; Anxiety; Dental Care; Female; Humans; Male; Middle Aged; Pain; Set, Psychology
PubMed: 6508698
DOI: 10.1016/0005-7967(84)90049-4 -
Journal of the American Dental... Sep 2009The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and... (Comparative Study)
Comparative Study
BACKGROUND
The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures.
METHODS
The authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures. They tested the modifying effect between CSHCN and other variables on the probability of having any dental care expenditure.
RESULTS
Compared with children without SHCN, CSHCN did not differ in the probability (odds ratio = 0.91, 95 percent confidence interval [CI] = 0.76 to 1.09) or amount (beta = 30.17, 95 percent CI = -162.93 to 223.27) of total dental care expenditures. Likewise, CSHCN did not differ in their likelihood of having undergone a preventive, restorative, diagnostic or other procedure. Known determinants of dental care utilization did not modify the relationships between having SCHN and any dental care expenditure.
CONCLUSIONS
Despite the reported difficulty in CSHCN's accessing dental care, the authors found that CSHCN had dental care utilization and expenditures that were comparable with those of children without SHCN. Furthermore, the association of CSHCN status and any dental care expenditure was not modified by known determinants of dental care utilization. Future research should focus on characterizing risk for dental disease among CSHCN more accurately and identifying factors that affect dental care utilization in CSHCN, including provider and parent characteristics.
PRACTICE IMPLICATIONS
The study results highlight low rates of dental care utilization among all young children, including CSHCN. Efforts to increase dental care utilization among children are warranted and need to include broad-based provider and parent initiatives.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Dental Care for Children; Dental Care for Disabled; Educational Status; Female; Follow-Up Studies; Health Expenditures; Health Services Accessibility; Health Status; Humans; Income; Insurance, Dental; Male; Needs Assessment; Parents; Poverty; Probability; Racial Groups; United States
PubMed: 19723949
DOI: 10.14219/jada.archive.2009.0343 -
Evidence-based Dentistry Mar 2014The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health...
DATA SOURCES
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the metaRegister of Controlled Trials.
STUDY SELECTION
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) would be included where available. Due to the low incidence of bacterial endocarditis it was anticipated that few such trials would be found. Cohort and case-control studies were included where suitably matched control or comparison groups had been studied.
DATA EXTRACTION AND SYNTHESIS
Two review authors independently selected studies for inclusion then assessed risk of bias and extracted data from the included study.
RESULTS
Only one case controlled study met the inclusion criteria. It collected all the cases of endocarditis in the Netherlands over two years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines, and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxies). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days, and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes.
CONCLUSIONS
There remains no evidence that antibiotic prophylaxis is either effective or ineffective against bacterial endocarditis in people considered at risk who are about to undergo an invasive dental procedure. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.
Topics: Antibiotic Prophylaxis; Dental Care; Endocarditis, Bacterial; Humans
PubMed: 24763168
DOI: 10.1038/sj.ebd.6400983 -
Medical Principles and Practice :... 2002High-quality appropriate dental care should encompass the concepts of effectiveness and efficiency. Many dental procedures are ineffective, and some preventive measures...
High-quality appropriate dental care should encompass the concepts of effectiveness and efficiency. Many dental procedures are ineffective, and some preventive measures are inefficient. Examples of criteria that are ethically essential to use before carrying out any clinical procedure are outlined based on the concepts included in 'informed consent'. Applying the criteria rigorously will lead to minimal intervention and a more equitable distribution of appropriate dental care. Unnecessary dental care will be reduced.
Topics: Dental Care; Efficiency; Evidence-Based Medicine; Humans; Informed Consent; Treatment Outcome; United Kingdom
PubMed: 12123112
DOI: 10.1159/000057772 -
Journal of the American Dental... Jan 1994
Topics: Dental Care; Health Care Reform; Humans; United States
PubMed: 8294661
DOI: 10.14219/jada.archive.1994.0013 -
Health Affairs (Project Hope) Dec 2016Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and...
Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.
Topics: Child; Cost-Benefit Analysis; Dental Care; Dental Care for Children; Education, Dental; Health Services Accessibility; Healthcare Disparities; Humans; Quality of Health Care; United States; Vulnerable Populations
PubMed: 27920307
DOI: 10.1377/hlthaff.2016.0844