Gender inequities in dental research publications: Findings from 20 years

This study described trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20- year period. Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1,000 articles each were retrieved: a random sample and another sample of top-cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, an online software platform was used (https://genderize.io). Descriptive analyses identified the proportion of female first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years.

Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top cited sample. Women led 28.4% and 20.3% of articles in the random and top cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top cited sample (from 15.0% in 1996-2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996-2000 to 33.2% in 2011). Clear gender disparities in dental research publications in the last 20 years were identified in both general and top cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. The authors call for actions to be taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity.

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Study examines the influence of dietary free sugar intake on dental caries

Free sugar consumption was measured in children enrolled in the Barwon Infant Study at age 18-months and 4-years. The exposure, free sugar intake was quantified as continuous and binary variables indicating less than 5% of total energy intake (TEI) at 18-months and 4-years of age. The prevalence of dental caries was obtained from dental records. Multiple logistic regression estimated the effect of the exposure variables on the presence of dental caries at 4-6 years of age, adjusting for potential confounders.

Of the original birth cohort, dietary data (N=863) and dental caries data (N=368) were available. 70.4% and 36.7% participants consumed less than 5% TEI from free sugars at 18-months and 4-years, respectively. Dental caries affected 46.7% of children. In fully adjusted models, free sugar at 18-months (OR 1.74; 95% CI 1.06, 2.86 per 5% of TEI) and at 4-years of age (OR 1.43; 95% CI 0.90, 2.28, per 5% of TEI) increased dental caries risk at 4-6 years. The estimated effect of consuming less than 5% free sugars of TEI at 18-months and 4-years of age on dental caries prevalence at 4-6 years was an OR 0.71, 95% CI 0.42, 1.19 and OR: 0.61; 95% CI 0.38, 0.97 respectively. The estimated effect of lowering free sugars to less than 5% of TEI at both timepoints compared to exceeding 5% TEI at one or both timepoints, on dental caries risk at 4-6 years was an OR 0.55; 95% CI 0.33, 0.93.

The authors concluded that between 18-months and 4-years, free sugar consumption increased markedly with two thirds of children exceeding 5% of TEI at 4-years of age. Early free sugar intake increases the risk of dental caries at 4-6-years of age.

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Acids in sugar-free beverages could erode tooth enamel,

  New research finds acids in sugar-free beverages could erode tooth enamel, as a recipe mixing flavored sparkling water with balsamic vinegar to create a so-called “healthier” alternative to soda takes TikTok by storm.

The research, published online in the open access journal JADA Foundational Science, adds to our understanding about the importance of limiting consumption of acidic beverages. The TikTok video of adding balsamic vinegar (an acid) to flavored sparkling water (an acidic beverage) recently received more than 6.3 million views. 

“I love balsamic vinegar, but I enjoy it more on my salad than in my drinking glass. It’s much kinder to the teeth than bathing them in a beverage blend of two acids,” says Dr. Edmond Hewlett, a spokesperson for the American Dental Association. “The more acidic the drink, the greater the risk of tooth erosion with frequent consumption.”

Acidic foods and beverages can wear away the enamel that protects teeth, a process known as tooth erosion. Tooth erosion is permanent and may open the door for bacteria to cause cavities or infection. It can also make teeth appear discolored, as white enamel is worn away to expose the yellow layer below called dentin.

Research and results

In the study, researchers wanted to see whether non-carbonated bottled water, flavored sparkling water and plain sparkling water might cause dental erosion. Recently extracted human teeth were soaked in 7 different sugar-free beverages (and one soda with sugar for comparison) to see which, if any, beverages caused erosion. Teeth were exposed for twenty-four hours, which the researchers considered to replicate a year’s worth of exposure to these beverages.

When measuring the results of soda with sugar versus sugar-free soda, they found acids in both caused dental enamel to erode. Sweetener type was less of a factor, as it was the acid in the beverage that eroded the enamel.

Researchers also observed erosion in flavored sparkling waters, though it was less than that observed for sugar containing and sugar-free soda. The only beverages in the study that did not erode enamel were non-carbonated, non-flavored bottled waters.

Consuming acidic foods and beverages

While the TikTok recipe was not included in the study, it is similar to the other sugar-free, acidic beverages tested.

“People find carbonated beverages refreshing, especially this time of year. Enjoy them in moderation and preferably with meals,” Dr. Hewlett says. “But if you’re looking for a glass of something that is actually good for your dental health, regular water, including fluoridated tap water, or milk are always good options.”

The American Dental Association offers these tips to reduce tooth erosion from acidic food and beverages:

• Use a straw, sip and swallow – do not swish or hold it in your mouth longer than you need to.

• Wait an hour before brushing to give saliva a chance to naturally wash away acids and re-harden enamel.
• Rinse with water, drink milk or enjoy a snack of cheese right afterward. Dairy and other calcium-rich foods can help neutralize acids.
• Keep saliva flowing to keep acids under control and protect your teeth. You can do so by chewing sugarless gum. 
• Look for dental health products like enamel erosion control toothpaste and sugarless gum with the ADA Seal of Acceptance, which indicates the product has been rigorously and independently evaluated by dental experts.  
• Practice good oral health every day: Brush twice a day with fluoride toothpaste, clean between your teeth daily with floss or another interdental cleaner, eat a healthy diet that limits sugary foods and beverages, and visit a dentist regularly.

Visit MouthHealthy.org for more information on how food and beverage choices can impact teeth.
 

Linking medical and dental records in health information exchanges could improve dental patient safety, preventive care, and treatment outcomes

 

– Dental professionals require access to each patient’s complete electronic health record – including laboratory test results and current prescriptions – so they can provide the best care possible; care that is safe for the patient, promotes preventive management and improves dental treatment outcomes.

This unprecedented access would aid all types of dental professionals, including general dentists, oral surgeons, periodontists, prosthodontists, endodontists, hygienists and others. A new multi-study project from the Regenstrief Institute and Indiana University School of Dentistry has determined that information from patients’ medical records is generally not available to oral health practitioners in either an easy-to-use or timely manner.

The dental informatics researchers confirmed that requested medical information typically is faxed from a medical facility to the dental office. Faxes, sometimes unreadable when received, often are scanned into the patient’s dental record. The researchers found that, typically, the faxed information arrived in 7 to 10 days, although in the study, 30 percent took even longer.

“Oral health practitioners may need to confirm a list of medical considerations; for example, that there is no contraindication to a patient sitting in a chair for a lengthy procedure or whether a patient is taking any medication that could put them at risk for excessive bleeding during a tooth extraction or other procedure,” said senior author and study leader Thankam P. Thyvalikakath, DMD, MDS, PhD, director of the Regenstrief and IU School of Dentistry Dental Informatics program. “In this day and age of electronic data transmissions in banking, shopping and other commercial fields, should health professionals still be relying on inefficient, paper-based methods for sharing patient information?”

Demand for advanced dental care is increasing due to people living longer with chronic diseases like HIV and the growing number of older adults with natural teeth. For these patients, information from their medical file may be especially critical to appropriate dental treatment.

The researcher-clinicians found that the medical information most frequently requested by a dental office to finalize treatment decisions and procedure timing were patient diabetes status and history of blood sugar levels. Knowing this information helps oral health professionals rule out any contraindication to undergo dental treatments, determine outcomes of a surgical procedure or assess options for implant placement and calculate risk for gum disease. For example, if blood sugar numbers are high, there is a greater probability that an implant may fail.

“Retrospective Study of the Reasons and Time Involved for Dental Providers’ Medical Consults” is published in the peer-reviewed journal Frontiers in Digital Health. Authors, in addition to Dr. Thyvalikakath, who is the senior and the corresponding author, are Shuning Li, PhD, IU School of Dentistry; Karmen S. Williams, MBA, DrPH, Regenstrief Institute and IU Richard M. Fairbanks School of Public Health, IU School of Dentistry and City University of New York; Jayanth Kuman Medam, BDS, M.S., IU School of Dentistry and ELLKAY LLC; Jay S. Patel, BDS, MS, PhD, IU School of Dentistry and Temple University and Theresa Gonzalez, DDS, IU School of Dentistry.

The study was funded by IU School of Dentistry and the National Library of Medicine.

Related study reports few dental-medical record integrations exist

In a related study, published earlier this year, Dr. Thyvalikakath and colleagues report that, with the exception of large healthcare organizations that provide both dental and medical care to patients, for example safety net health systems, few integrated medical-dental records exist. In “How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements,” also published in Frontiers in Digital Health, the researcher-clinicians present a health information exchange (HIE) approach they designed to address the need of dental professionals to access a patient’s medical record expeditiously. They note this approach can be adopted by electronic health record (EHR) and electronic dental record (EDR) vendors to develop a connection between dental systems and HIEs.

Authors of this study, in addition to Dr. Thyvalikakath, who is the senior author, are Shuning Li, PhD, IU School of Dentistry; Anushri Singh Rajapuri, BDS, M.S., Regenstrief Institute; Grace Gomez Felix Gomez, BDS, PhD, MPH, IU School of Dentistry; and Titus Schleyer, DMD, PhD, and Eneida Mendonca, M.D., PhD, Regenstrief Institute and IU School of Medicine. 

“Oral health practitioners shouldn’t have to wait, as our work shows they often currently must, for medical information to make treatment decisions. Delays in receiving medical information can require dental treatment to be postponed, sometimes to the detriment of the patient’s health and convenience,” said Dr. Thyvalikakath. “And the exchange of information process should be two-way – in addition to the medical record informing dental care, dental records can inform medical care. For example, an oral health professional’s identification of new oral ulcers or dry mouth may alert the physician to a previously unreported medical issue or present another symptom, helping in the identification of a medical syndrome. Incorporating the patient’s electronic dental record as part of the information that can be shared through an HIE makes this possible and practical.”

NIH 5-year grant to investigate HIEs and medical-dental records coordination

Dr. Thyvalikakath recently received a grant, 1RO1DE031259-01, “Development and evaluation of patient medical summary from health information exchange to improve dental care,” expected to total $2.4 million over five years, from the National Institutes of Health’s National Institute of Dental and Craniofacial Research (NIDCR) to build upon the knowledge gained in the two studies and to investigate how an HIE can improve communication and referrals between dental and medical clinicians.

“The advantage of accessing the patient’s medical history through an HIE is that not only will the data be readily and promptly available, but dental professionals will also have access to extensive information coming from multiple providers – the primary care physician, specialists, emergency departments, and from multiple healthcare systems,” said Dr. Thyvalikakath. “Incomplete patient medical history can compromise dental care and increase the risk of potential adverse events, a concern that has intensified during the pandemic with oral health professionals having to rely on the patient for many issues related to COVID-19, such as immuno-compromised status and vaccine history, to prevent disease transmission.”

With the NIDCR funding, the researchers hope to demonstrate that the electronically transmitted patient medical summaries from an HIE, in addition to being timelier, will contain a higher percentage of complete, up-to-date and legible medical information than what oral health providers now receive via fax.

The goal of the study, which will commence in the coming months, is to lay a strong foundation for interprofessional dental-medical care delivery that supports patient care and reduces dental care costs. The research team plans to design, develop and test new technological solutions that are practical for the connection of even solo- and small- group dental practices with community HIEs to access their patients’ medical data. They anticipate that their work will facilitate bidirectional communication among providers to promote patient safety and enhance both dental and medical health.

Thankam Thyvalikakath, DMD, MDS, PhD  

In addition to her role as a Regenstrief research scientist and director of the Regenstrief and IU School of Dentistry Dental Informatics program, Thankam Thyvalikakath, DMD, MDS, PhD, is the director of the dental informatics core, a professor at IU School of Dentistry and an adjunct associate professor in the IUPUI School of Informatics and Computing.

Simple blood test may allow for early detection of oral cancer

 

The current 60% five-year survival rate of individuals with oral squamous cell carcinoma (OSCC)—a type of cancer of the mouth and throat—could be greatly improved if treatments were initiated as early as possible. In a study published in Natural Sciences, researchers used a technology called conductive polymer spray ionization mass spectrometry to screen the blood for metabolic signs of OSCC. The method could accurately distinguish between individuals with and without OSCC.  

Also, two altered lipid markers that were discovered in the blood could be traced back to the cancer site for guiding surgical margin assessments. 

The method—which requires only a single drop of blood—could also distinguish between patients with early versus later stages of OSCC.  

“This study represents the fruits of research involving the United States and China, in which all the participants believed that the results would be a win for both countries and for the world as a whole, an idea that seems alas to be disappearing in these times of mutual suspicion and distrust of international collaborations,” said co–corresponding author Richard N, Zare, PhD, of Stanford University. 

The author of an accompanying Research Highlight noted that the study “is a perfect showcase for how mass spectrometry-based metabolomics workflows can be simplified to make them usable in clinical applications.” 

URL Upon Publication: https://onlinelibrary.wiley.com/doi/10.1002/ntls.20210071