Pandemic dental office closures linked to increased burden on ERs from kids with dental issues

 

A lack of access to dentists during the COVID-19 pandemic coincided with a surge in hospital visits for dental conditions among Medicaid-insured children

Peer-Reviewed Publication

New York University

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Dental office closures early in the COVID-19 pandemic were associated with a 62-percent increase in the share of emergency department visits from toothaches, abscesses, and other painful dental issues among children covered by Medicaid, according to a new study led by researchers at NYU College of Dentistry.

The findings, published in the Journal of the American College of Emergency Physicians Open, suggest that families with young kids have difficulty accessing dental care during public health crises, which may further stress overburdened hospitals.

In March 2020, as COVID-19 cases grew exponentially in New York and around the country, public health measures to stop the virus’s spread prompted the closure of dental offices. While dentists could see patients for emergency appointments, all other routine dental care was postponed.

At the same time, hospitals were filling up with critically ill patients. NYU researchers wanted to understand whether patients with urgent dental issues were also ending up in emergency rooms.

“Emergency departments are not well equipped to treat dental conditions, as they are typically limited to relieving pain and referring patients to dentists to address the underlying issues,” said Shulamite Huang, a health economist and assistant professor of epidemiology and health promotion at NYU College of Dentistry. “As a result, visiting an emergency department for tooth pain can be a waste of health care system resources—resources that are in short supply during times of crisis, including the peak of the COVID-19 pandemic.”

Huang and her colleagues examined Medicaid claims data for children under the age of 19 across New York State to determine if there were any differences in emergency department visits for dental concerns before the pandemic (in 2018 and 2019) versus 2020. They focused on issues including cavities, infections, and abscesses, and excluded injuries such as cracked or knocked-out teeth.

The researchers found that denta practice closures from March through May 2020 led to a 62- percent increase in the share of children’s emergency room visits from non-traumatic dental issues over 2019 levels (from 3.7 percent of ER visits focusing on dental issues in 2019 to 6 percent in 2020). This surge in visits was the most pronounced among young children up to age 9, who were seen in emergency departments for dental issues twice as often during this period compared to the previous year.

Notably, the increase in emergency department visits was sustained even after many dentists reopened their offices in May 2020, although to a lesser degree.

“The sizable changes in the emergency department dental care of very young children suggests that this population was likely to fall through holes in the dental safety net,” said Huang. “Although dentists were allowed to treat dental emergencies, Medicaid-insured children may have had difficulty accessing care during the initial phase of the COVID-19 pandemic.”

The authors cite several possible reasons for this, including parents having difficulty determining whether kids in pain are experiencing a true emergency. In addition, very young children covered by Medicaid may not have established care with a dentist before the pandemic, as finding a dentist that accepts Medicaid and treats young children can be a challenge.

In preparation for future pandemics or other crises that stress US hospitals, the researchers encourage health systems to consider options for emergency dental care that can divert patients from the emergency department, including offering limited hospital-based dental services or incorporating urgent dental care clinics within hospitals. In addition, ensuring that children covered by Medicaid have access to a dentist in their community may both prevent painful dental issues and provide them with emergency dental care when needed.

Additional study authors include Scarlett Wang of the NYU Wagner Graduate School of Public Service and Heather Gold of NYU Grossman School of Medicine. This research was supported by the National Institute of Dental and Craniofacial Research (K25 DE028584 and K25 DE028584-02S1). 

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Journal

Journal of the American College of Emergency Physicians Open

DOI

10.1016/j.acepjo.2025.100094 

Hard evidence of soft teeth: the oral symptoms of hypophosphatasia

Researchers from Osaka University highlight the various dental symptoms of hypophosphatasia, a skeletal disease, in an attempt to improve its diagnosis and treatment

Peer-Reviewed Publication

Osaka University

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image: 

Intraoral photographs of the case of a boy aged 4 years with mild type HPP.

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Credit: Osaka University Dental Hospital

Osaka, Japan – Hypophosphatasia is a relatively common skeletal disease that primarily affects bone and tooth strength. In the third national dental survey of hypophosphatasia in Japan, recently published in Scientific Reports, researchers analyzed the dental issues faced by Japanese patients in their largest survey to date. Their findings provide valuable information for dentists and medical doctors who treat this often misunderstood disease.

People with hypophosphatasia have variants in the gene responsible for making tissue-nonspecific alkaline phosphatase, which is important for bone mineralization. Although this generally leads to weakened bones, issues with teeth are also common. Less severe forms of hypophosphatasia are often diagnosed when the first teeth fall out earlier than expected, before 4 years of age. Dentists are therefore a major care provider for children with this disease—but they aren’t always familiar with its symptoms.

To explore the dental issues in patients with hypophosphatasia, researchers from Osaka University have conducted nationwide surveys of dental clinics every 5 years since 2013. In the most recent survey, they collected data from 103 cases from 30 clinics. This represents a big jump in numbers from the last two surveys (with 19 and 52 cases), allowing the researchers to conduct an in-depth analysis of the dental issues faced by Japanese patients.

“We had enough cases that we could break them down into two groups—those whose symptoms involved the teeth only, known as odonto-type disease, and those who had other symptoms, which we termed non-odonto-type disease,” explains Rena Okawa, lead author of the study. “We were surprised to see big differences in oral manifestations between the two groups.”

Specifically, the patients with odonto-type hypophosphatasia were more likely to lose their first teeth early, whereas those with non-odonto-type disease were more likely to have tooth misalignment and tooth hypomineralization (where the enamel on the outside of the teeth softens). Non-odonto-type disease was also linked to poor oral habits, such as finger sucking and tongue thrusting, and problems with swallowing.

“The trends that we observed in this study will be helpful for dentists who might come across patients with hypophosphatasia in their clinics,” says Kazuhiko Nakano, senior author. “Improved knowledge of the various ways this disease presents will lead to better diagnostic rates and earlier treatments for affected patients.”

Given that there is now an enzyme replacement therapy available to treat hypophosphatasia, its early diagnosis is particularly important for preventing problems with adult teeth later in life. The researchers hope that their findings will allow dentists to identify suspected cases of hypophosphatasia early and recommend appropriate multidisciplinary treatments.

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The article, “Japanese nationwide dental survey of hypophosphatasia reveals novel oral manifestations,” was published in Scientific Reports at DOI: https://doi.org/10.1038/s41598-025-91043-7

Dental implants still functional after forty years

 

Peer-Reviewed Publication

University of Gothenburg

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image: 

Sargon Barkarmo and Jan Kowar, Sahlgrenska Academy at the University of Gothenburg.

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Credit: Photo by Elin Lindström

Dental implants used to replace single teeth continue to function well after several decades, according to a study from the University of Gothenburg, Sweden. After nearly forty years, all examined implants were still in place and fully functional. 

The study is the longest follow-up study of single dental implants in the world and is based on a follow-up of a small group of patients who received single implants to replace missing teeth between 1982 and 1985.

The implants are a result of research conducted by Professor Per-Ingvar Brånemark at the University of Gothenburg. His discovery of how bone integrates with titanium implants has enabled millions of patients to replace lost teeth with a reliable and long-lasting solution. 

Stable implants 

Of the 16 patients who received implants during the study period, 13 participated in the follow-up, conducted at the Brånemark Clinic, Public Dental Service Västra Götaland. These 13 patients had a total of 18 implants. 

"It is impressive that the single implants function so well after such a long time. Even though the study included a small number of patients, the results show that the implants remain in place and that the bone loss around them is virtually unchanged after forty years. This confirms that the foundation Brånemark established still holds," says Sargon Barkarmo, prosthodontist and senior lecturer at the University of Gothenburg. 

A dental implant is an artificial tooth root made of titanium that is surgically placed into the jawbone, where it integrates and becomes stable. A crown is then attached to the implant, providing both functionality and aesthetics. 

The crowns placed on the implants had a shorter lifespan than the implants themselves. At the forty-year follow-up, only about 60 percent of the original crowns remained, with many having been replaced one or more times. 

"The study shows that the crowns were mostly replaced for aesthetic reasons rather than technical failures. In the future, implant treatments could be further improved with the development of new crown materials," says Jan Kowar,  prosthodontist and senior lecturer at the University of Gothenburg, and co-author of the study. 

Implants and healing 

The researchers point out that older implant systems, which have been shown to be highly effective, are unfortunately no longer available on the market. This is due to the continuous introduction of new systems that quickly replace older ones, despite their proven long-term success. 

The study concludes that implants placed using well-planned surgical techniques and given sufficient healing time have an excellent long-term prognosis. Sargon Barkarmo again: 

"Today, methods that accelerate treatment and healing are commonly used. These approaches also need long-term follow-ups and careful evaluation to ensure equally good results over time," he says. 

The study results have been published in the scientific journal Clinical Implant Dentistry and Related Research.

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Journal

Clinical Implant Dentistry and Related Research

DOI

10.1111/cid.13443 

Do starchy carbs cause cavities?

 It’s common knowledge that sugar causes cavities, but new Cornell University research provides evidence that – depending on your genetic makeup – starches could also be a contributing factor.

The study, published in Microorganisms, explores the response of the oral microbiome to starch, finding that the number of copies of a particular gene, AMY1, in combination with starch, alters the complex composition of bacteria that play a role in oral health.

“Most people have been warned that if you eat a bunch of sugar, make sure you brush your teeth,” said Angela Poole, senior author and assistant professor of molecular nutrition. “The takeaway finding here is that depending on your AMY1 copy number, you may want to be just as vigilant about brushing your teeth after eating those digestible starches.”

AMY1 codes for the salivary amylase enzyme, which helps break down starch in the mouth. Previous studies have associated AMY1 with cavities and periodontal disease. Poole, in prior studies, found that a high AMY1 copy number is associated with higher levels of the species Porphyromonas endodontalis, which is strongly associated with periodontitis and gum disease.

But how the salivary amylase enzyme interacts with its main substrate, starch, to alter the oral microbiome and increase disease risk was unclear.

“That’s what we wanted to know in this experiment,” Poole said. “What’s going on in the mouth if someone eats starch, and is the answer different if their copy number is high or if it’s low? What we found was that there are other bacteria involved in these processes and that the changes depended on AMY1.”

The researchers also found evidence that the oral microbiome has co-evolved in response to increasing copies of AMY1, which is found in higher numbers in populations where there’s a long history of agriculture and starch consumption. In the pool of 31 samples, taken in Ithaca, N.Y., the AMY1 number ranged from two to 20 copies.

“The populations that historically had greater access to starch tend to have more copies,” Poole said, “which makes sense from a practical standpoint, because it would have given you a survival advantage when food is scarce, to be able to break down those starches more efficiently.”

In saliva samples with a high AMY1 copy number, the researchers saw increased populations of bacteria, like Streptococcus, that feed off the starch’s sugars.

“If someone has a high copy number, they break down starch efficiently, and bacteria that like those sugars are going to grow more in that person’s mouth,” Poole said. “So you can have species behave differently based on the different substrates. It’s pretty incredible – how we adapt and these microbes turn around and adapt, too.”

 

Revolutionizing dental surgery with AI

 

Researchers in engineering are exploring smart dental implant surgery planning for personalized care with predictable outcomes

Grant and Award Announcement

Texas A&M University

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Texas A&M University researchers Dr. Yuxiao Zhou, assistant professor in the J. Mike Walker ’66 Department of Mechanical Engineering, and Dr. Jaesung Lee, assistant professor in the Wm Michael Barnes ’64 Department of Industrial and Systems Engineering, have been awarded the 2024 Seed Program for AI, Computing, and Data Science award. 

Their project, “Toward Smart Orthopedic Surgery Planning by using Physics-Informed Machine Learning,” was selected as one of the top ten proposals in a competitive cycle featuring 39 submissions from researchers across three institutions.

Dental implant surgeries are critical for enhancing the quality of life, particularly among the aging population. However, their success depends on achieving optimal mechanical stress levels in the surrounding bone during chewing to prevent bone loss from insufficient loading and avoid bone fracture due to excessive loading. 

Implant success is complicated by challenges such as delayed bone healing and age-related bone loss in older individuals and varying bone stiffness. Current methods for measuring bone stiffness are often invasive, computationally costly, or lack accuracy, creating a need for innovative and practical patient-specific solutions.

To address this, Dr. Zhou and Dr. Lee are developing a hybrid biomechanical physics-informed machine learning model. Their approach combines experimentally measured bone deformation data with governing physics and a robust machine learning framework, enabling precise, personalized predictions of mechanical stress in the bone. This innovation provides an efficient tool for patient-specific dental surgery planning, optimizing bone healing and ensuring long-term implant success.

“Our model will revolutionize surgical planning by delivering personalized, computationally efficient treatment plans with predictable outcomes,” said Dr. Zhou.

The project also highlights interdisciplinary collaboration, leveraging Dr. Lee’s expertise in machine learning for healthcare systems to address a long-standing clinical challenge. The success of this work has the potential to extend beyond dental implants, offering advancements for other surgical applications in healthcare.

This award highlights Texas A&M’s commitment to research in AI, computing, and data science that drive solutions with real-world impacts.

By Maddy Busby, Texas A&M Engineering

Regular dental flossing may lower risk of stroke from blood clots, irregular heartbeats

 

Research Highlights:

• People who regularly floss their teeth (one or more times per week) may lower their risk of stroke caused by a blood clot traveling from the heart and a stroke associated with an irregular heartbeat such as atrial fibrillation (AFib).
• The benefits of regular flossing may be independent of tooth brushing and other oral hygiene behaviors.
• Researchers suggest that flossing is a healthy habit that is affordable, easy to adopt and accessible everywhere.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

Flossing your teeth at least once a week may be linked to a lower risk of stroke caused by a blood clot blocking brain blood flow and irregular heartbeats, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“A recent global health report revealed that oral diseases — such as untreated tooth decay and gum disease — affected 3.5 billion people in 2022, making them the most widespread health conditions,” said study lead author Souvik Sen, M.D., M. S., M.P.H, chair of the Department of Neurology, Prisma Health Richland Hospital and the University of South Carolina School of Medicine in Columbia, South Carolina. “We aimed to determine which oral hygiene behavior — dental flossing, brushing or regular dentist visits — has the greatest impact on stroke prevention.”

The Atherosclerosis Risk in Communities (ARIC) study, one of the first large-scale investigations of this kind in the U.S., assessed the home use of dental floss through a structured questionnaire of more than 6,000 people. Among those who reported flossing, 4,092 had not experienced a stroke, and 4,050 had not been diagnosed with an irregular heartbeat known as atrial fibrillation (AFib).

Participants were asked about their status regarding high blood pressure, diabetes, high cholesterol, smoking, body mass index, education, regular brushing and dentist visits. During the 25 years of follow-up, 434 participants were identified as having strokes, of which 147 were larger artery brain clots, 97 were heart-driven clots and 95 were hardening of the smaller arteries. Additionally, 1,291 participants were noted to have experienced AFib.

The analysis found:

• Flossing was associated with a 22% lower risk of ischemic stroke, 44% lower risk of cardioembolic stroke (blood clots traveling from the heart) and 12% lower risk of AFib.
• The associated lower risk was independent of regular brushing and routine dental visits or other oral hygiene behaviors.
• Increasing the frequency of flossing had a greater chance of stroke risk reduction.
• Flossing was also associated with a lower chance of cavities and periodontal disease.

Researchers were surprised by the reduction of irregular heartbeats, or AFib. AFib is the most common form of irregular heartbeat. It can lead to stroke, heart failure or other cardiovascular complications. More than 12 million people are projected to have AFib in the United States by 2030, according to the American Heart Association’s 2025 Heart Disease and Stroke Statistics.

“Oral health behaviors are linked to inflammation and artery hardening. Flossing may reduce stroke risk by lowering oral infections and inflammation and encouraging other healthy habits,” Sen said. “Many people have expressed that dental care is costly. Flossing is a healthy habit that is easy to adopt, affordable and accessible everywhere.”

Study limitations include that data were based on answers to a questionnaire, and the 25-year follow-up appears to have focused on stroke and heart outcomes only. There was no follow-up concerning flossing or other oral behaviors over the years, Sen said.

“This study offers more insights into the specific dental health behaviors that may be linked to stroke risks and potential risk reduction. With further research, dental health practices could possibly be incorporated into the "Life's Essential 8" risk factors, which include diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose and blood lipids,” said Daniel T. Lackland, Dr.P.H., FAHA, American Heart Association EPI and Stroke Council member and professor of epidemiology and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston. Lackland was not involved in this study.

Study background, and details:

• The study began in 1987 and is ongoing.
• Of the 6,258 participants, 82% were self-reported white adults and 18% Black adults. Their average age was 62 years and 55% were women.
• Potential participants were excluded if they had total tooth loss, dental implants, heart disease, organ transplant, artificial joints, implanted heart valve or stent or major surgery.

Co-authors, disclosures and funding sources are listed in the manuscript.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.