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PubMed2003

ADA members weigh in on perceptions of the ADA and association priorities.

BACKGROUND: The American Dental Association conducted the 2000 Membership Needs and Opinions Survey to evaluate the professional needs and personal perceptions of ADA members on selected topics. METHODS: A questionnaire was sent to a sample of 6,310 ADA members in January 2000 with follow-up mailings in February, March and April 2000. Data collection was completed in July 2000. The survey included questions on critical professional issues, perceptions of the American Dental Association and its priorities. A total of 3,558 surveys were received for an adjusted response rate of 59.5 percent. Only professionally active dentists who were ADA members were included in the sampling frame. RESULTS: Members evaluated statements about the American Dental Association, revealing their perceptions of the ADA on key issues. Findings showed strong support for the ADA Seal program, agreement that the ADA enhances the integrity and ethics of the profession and that the ADA is the premier professional association for dentists. Findings also provided information regarding the relative importance of ADA priorities by allocating "dues dollars" in $5 increments. The highest priorities were "providing continuing education to dentists," "lobbying members of Congress and federal regulatory agencies" and "influencing national public health policy." CONCLUSIONS: ADA members, both new and established dentists, had positive perceptions of the Association and its programs. Although there was general agreement between these groups concerning ADA priorities, there was a substantial difference between some subgroups (especially graduate students and federally employed dentists) and the overall membership on the issue of changes in the licensure process to facilitate dentists' freedom of movement. PRACTICE IMPLICATIONS: The Association should continue to take into account the membership's perceptions of the ADA and its priorities, as well as note issues of special interest to selected membership subgroups, in the planning and implementation of Association activities.

American Dental Association↗
PubMed2000

ADA guidelines for the acceptance of tooth-whitening products.

Since the introduction of at-home tooth whitening using peroxide-containing agents in 1989, the procedure has been well-received by the public and is becoming one of the most popular cosmetic dental procedures today. To ensure the safety and efficacy of this treatment, the Guidelines for the Acceptance of this category of products by the American Dental Association were developed. This article provides background on the American Dental Association (ADA) Seal of Acceptance Program. It also offers an overview of the ADA Acceptance Program Guidelines for Home-Use Tooth Whitening Products as well as the process through which the document was developed.

American Dental Association↗
PubMed2004

The use of CDA best management practices and amalgam separators to improve the management of dental wastewater.

Concerns over the persistence and effects of mercury in the environment, particularly in wastewater, have increased significantly over the past decade. Because mercury is a component of dental amalgam, comprising about 50 percent of amalgam among other metals, in recent years the concern has affected dental practices and even educational curricula in the dental schools. While numbers vary widely from area to area, on average, it is estimated dentistry contributes less than 1 percent of the mercury generated from human activity to the environment. Despite dentistry's low contribution to the environmental mercury load, organized dentistry's position is that dentistry's role as a public health profession includes environmental stewardship, as well as patient safety, and that dental professionals must act responsibly by taking steps to prevent amalgam waste or any potentially harmful materials from entering the environment, no matter how small the amount. In support of this belief, both the California Dental Association and the American Dental Association have developed recommendations for best practice that dental offices should follow when handling dental amalgam waste. Many dental schools and auxiliary programs have shown their commitment to minimizing detrimental effects to the environment, evidenced by the fact that most, if not all, have incorporated safe work practices including mercury hygiene procedures as part of clinical coursework. Some local jurisdictions hardest hit by the effects of mercury in wastewater have gone even further to recommend, or even require, the installation of amalgam separators in dental offices. This article will describe the history of BMPs and amalgam separators usage in California, and examine the practical aspects of their usage in reducing the discharge of dental amalgam into waste streams.

California↗
PubMed2003

Antibiotic prophylaxis for dental patients with total joint replacements.

BACKGROUND AND OVERVIEW: In 1997, the American Dental Association and the American Academy of Orthopaedic Surgeons convened an expert panel of dentists, orthopaedic surgeons and infectious disease specialists and published their first Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints. This represented the first time that national health organizations had gone on record on this topic. This 2003 advisory statement is the first periodic update of the 1997 statement. In addition, the organizations have created a new patient handout (included at the end of the statement) that dentists may share with their patients. The 1997 Advisory Statement has been well-used by dentists and orthopaedic surgeons. Following their standard protocols for periodic review of existing advisory statements, the ADA and AAOS and their expert consultants recently reviewed the 1997 statement. CONCLUSIONS AND CLINICAL IMPLICATIONS: The 2003 statement includes some modifications of the classification of patients at potential risk and of the incidence stratification of bacteremic dental procedures, but no changes in terms of suggested antibiotics and antibiotic regimens. The statement concludes that antibiotic prophylaxis is not indicated for dental patients with pins, plates or screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection.

Antibiotic Prophylaxis↗
PubMed2006

Blood pressure assessment practices of dental hygienists.

An estimated 50 million Americans have high blood pressure (HBP), with 30% of them unaware of their condition. Both the American Dental Association (ADA) and the American Dental Hygienists' Association (ADHA) have advocated including recording blood pressure during the dental appointment. Recording blood pressure is also a standard procedure in patient care. This study surveyed 236 dental hygienists attending a continuing education program to document their blood pressure assessment practices. The majority (55%) of participants indicated they rarely or never record blood pressure. The primary reason cited by 51% of the participants was a lack of time in the appointment. Based on these findings, a recommendation was made for dental offices to modify their patient check-in procedures to include recording blood pressure.

Blood Pressure Determination↗
PubMed2000

Antibiotic prophylaxis in dentistry: a review and practice recommendations.

BACKGROUND: The American Heart Association, or AHA, and the American Dental Association recently changed their recommended protocols for antibiotic prophylaxis against bacterial endocarditis. A new recommendation also has been issued by the ADA and the American Academy of Orthopaedic Surgeons, or AAOS, against routine antibiotic prophylaxis in patients with prosthetic joint replacements. These changes reflect increasing scientific evidence and professional experience in opposition to widespread use of antibiotic prophylaxis in these specific situations and others faced in dentistry. METHODS: The authors reviewed the medical and dental literature for scientific evidence regarding the use of antibiotics to prevent local and systemic infections associated with dental treatment. Situations commonly considered by dentists for potential use of prophylactic antibiotics were reviewed to determine current evidence with regard to use of antimicrobial agents. This included prevention of distant spread of oral organisms to susceptible sites elsewhere in the body and the reduction of local infections associated with oral procedures. RESULTS: There are relatively few situations in which antibiotic prophylaxis is indicated. Aside from the clearly defined instances of endocarditis and late prosthetic joint infections, there is no consensus among experts on the need for prophylaxis. There is wide variation in recommended protocols, but little scientific basis for the recommendations. The emerging trend seems to be to avoid the prophylactic use of antibiotics in conjunction with dental treatment unless there is a clear indication. CONCLUSIONS: Aside from the specific situations described, there is little or no scientific basis for the use of antibiotic prophylaxis in dentistry. The risk of inappropriate used of antibiotics and widespread antibiotic resistance appear to be far more important than any possible perceived benefit. CLINICAL IMPLICATIONS: Dentists are wise to use antibiotic prophylaxis in only those specific situations in which there is a valid scientific basis for it. Whenever possible, dentists should follow the standard protocols recommended by the ADA, AHA or AAOS.

American Dental Association↗
PubMed1995

How much fluoride is too much? The new guidelines.

Prescribing fluoride supplements isn't always a simple matter. Fluoride in drinking water, other beverages, and toothpaste can push intake above therapeutic levels and cause fluorosis. New guidelines from the American Dental Association and American Academy of Pediatrics help you decide when and how much supplementation your patients need.

Adolescent↗
PubMed2006

Balancing efficacy and safety in the use of oral sedation in dental outpatients.

BACKGROUND: Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations. OVERVIEW: There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety. Mortality and serious morbidity, however, have been reported with oral conscious sedation, especially in young children. Most serious adverse events are related to potentially avoidable respiratory complications. CONCLUSIONS: Clinical trials are needed to evaluate oral sedative drugs and combinations, as well as to develop discharge criteria with objective quantifiable measures of home readiness. Courses devoted to airway management should be developed for dentists who provide conscious sedation services. State regulation of enteral administration of sedatives to achieve conscious sedation is needed to ensure safety. PRACTICE IMPLICATIONS: Safety in outpatient sedation is of paramount concern, with enteral administration of benzodiazepines appearing safe but poorly documented in the office setting. Conscious sedation by the enteral route, including incremental triazolam, necessitates careful patient evaluation, monitoring, documentation, facilities, equipment and personnel as described in American Dental Association and American Academy of Pediatric Dentistry guidelines.

Adult↗
PubMed1988

The use of animal models in research on dental implants.

The use of animal models in the study of dental implants has contributed greatly to our present understanding of the many different devices in use today. Animal testing plays a major role in assessing the safety and efficacy of dental implants. Standardized tests for determination of the toxicity and general biocompatibility responses of dental implants have been developed by the American Dental Association, the American National Standards Institute, and the Fédération Dentaire Internationale. To date, animal testing has shown the nature of soft tissue attachment to implants and the types of interfacial tissues within bone sites. There have been increased studies correlating animal tests with in vitro analysis and human studies. Additional development of testing remains to be accomplished to show the effects of function on host tissue and the long-term safety of dental implants.

Animals↗
PubMedDate not supplied

Current dental concepts in antibiotic prophylaxis for total joint replacement patients.

The subject of antibiotic prophylaxis has evoked controversy and much debate over the validity of such practice. In July 1997, the American Dental Association and American Academy of Orthopedic Surgeons issued an advisory statement concerning the use of antibiotic prophylaxis for patients with total joint replacements. A historical perspective of the subject is presented, with a review of the recommendation for total joint replacement antibiotic prophylaxis, a discussion of the new decision-making responsibility for the dentist, and medicolegal ramifications of this change.

Adult↗
PubMed1999

Ethics for orthodontists.

When treating children, important ethical issues may arise relating to the best interests of the child and decision making for minors. The case of a child with a cleft lip and palate whose parents failed to bring her in for medically indicated orthodontic care is presented. Ethical features of the case are discussed, including the need to benefit the patient, avoid harm, and respect the preferences of the parents. Ethical codes of the American Dental Association and American Medical Association are referenced. Ethical dilemmas include the conflict between the orthodontist's obligation to the child and the need to respect parental autonomy. Parental autonomy is respected up until the point at which significant harm to a child may result. The orthodontist's primary ethical responsibility is to the child, not the parents. The orthodontist providing medically indicated care should involve the craniofacial team or hospital social worker when parental decision making is in question.

Child↗
PubMed1993

The relative anticaries effectiveness of sodium monofluorophosphate and sodium fluoride as contained in currently available dentifrice formulations.

A 36-month double-blind clinical caries study was conducted to determine the comparative anticaries efficacy of sodium monofluorophosphate (MFP) and sodium fluoride (NaF) as incorporated in dentifrice formulations. The test dentifrices which were utilized are commercially available in the United States and all have been granted the American Dental Association Seal of Acceptance for anticaries efficacy. The study was conducted in accordance with the 1988 Guidelines of the American Dental Association Council on Dental Therapeutics. The two formulations used in the NaF versus MFP comparison were Colgate Winterfresh Gel with 0.76% sodium monofluorophosphate in a silica base and Crest Regular Flavor Toothpaste with 0.24% sodium fluoride in a silica base. A third commercially-available NaF dentifrice, Colgate Junior Toothpaste with 0.243% sodium fluoride in a silica base, was included in the study for further comparison. Schoolchildren residing in Maine, U.S.A. received a baseline caries clinical examination and then were randomly assigned to the twice-daily use of one of the three dentifrices which were purchased in the marketplace and repackaged in plain white tubes. Caries clinical examinations were subsequently conducted after 2 and 3 years' use of the dentifrices. A total of 2,222 children participated in both the 2 and 3-year caries clinical examinations. The 36-month DFS (decayed and filled surfaces) and the DFT (decayed and filled teeth) mean caries increments for the three dentifrice groups were virtually identical. The children using the MFP formulation experienced a DFS of 1.50 and a DFT of 1.08; those using the Crest NaF formulation experienced a DFS of 1.48 and a DFT of 1.07; subjects in the third group (Colgate Junior Toothpaste, 0.243% NaF) had a DFS of 1.49 and DFT of 1.06. The statistical evaluation of the data consisted of the calculation of 90% confidence bounds for the ratio of (true) mean increments, in accordance with the 1988 American Dental Association Guidelines. Expressed in the language of the Guidelines, the analyses indicated that, (1) the anticaries efficacy provided by the MFP formulation, (Colgate Winterfresh Gel with 0.76% MFP) is "as good as" that provided by the NaF formulation, (Crest Regular Flavor Toothpaste, with 0.243% NaF), and (2) the anticaries efficacy provided by the one NaF formulation (Colgate Junior Toothpaste, with 0.243% NaF) is "as good as" that provided by the other, (Crest Regular Flavor Toothpaste, with 0.243% NaF).

American Dental Association↗
PubMed1997

Prevention of bacterial endocarditis: recommendations by the American Heart Association.

OBJECTIVE: To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. PARTICIPANTS: An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the infectious Diseases Society of America, the American Academy of Pediatrics and the American Society for Gastrointestinal Endoscopy. EVIDENCE: The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using root words endocarditis, bacteremia and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the U.S. Preventive Services Task Force categories of evidence. CONSENSUS PROCESS: The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. CONCLUSIONS: Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate- and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered.

Algorithms↗