Notes

A Meta-analytic Review: Emotional Management of Subthreshold Major depression in kids and also Young people.
The rise of direct-to-consumer (DTC) orthodontics has caused significant controversy among dentists and orthodontists. However, little is known about the actual harms or benefits experienced by users of at-home teeth aligners.

The authors designed a 24-item online survey to assess users' experiences with at-home aligners. The authors recruited users for 6 months (March-August 2019) on social media platforms (Instagram, Twitter) and online forums related to DTC orthodontics. A total of 470 responses were analyzed.

The typical respondent was a white, female millennial (23-38 years old in 2019) who purchased aligners to correct crowding. More than one-half of respondents consulted with a dentist before purchasing aligners. In those interactions, the dentist most often recommended an in-office treatment. Although most respondents (87.5%) were satisfied with DTC treatment, 6.6% had to visit their dentist due to the severity of adverse effects.

Although many respondents would have preferred traditional treatment from a dentist or orthodontist, they opted for DTC aligners because of cost and convenience.

Rather than warning patients wholesale against at-home aligners, it might be more productive for dentists to have frank discussions with them about the risks and benefits. In parallel to pushing for increased accountability, it might be prudent to consider new ways of coexisting in this altered landscape, such as offering professional oversight of DTC treatments.
Rather than warning patients wholesale against at-home aligners, it might be more productive for dentists to have frank discussions with them about the risks and benefits. In parallel to pushing for increased accountability, it might be prudent to consider new ways of coexisting in this altered landscape, such as offering professional oversight of DTC treatments.
The best treatment option for large caries in permanent posterior teeth is still a matter of uncertainty in dental literature. The authors conducted a network meta-analysis to address the challenges related to rehabilitation of these teeth.

The authors selected prospective and retrospective studies that compared at least 2 different treatment alternatives for permanent teeth with a minimum of 5 years of follow-up. The authors searched databases from MEDLINE, Scopus, Cochrane Library, and Web of Science in October 2019 without language or year of publication restrictions.

From 11,263 studies identified, 43 studies fulfilled the eligibility criteria and were included in the final review. Only 13 studies were randomized controlled trials and were classified as low risk of bias. Gold (annual failure rate of 0.29%) and metal ceramic (annual failure rate of 0.52%) crowns performed better for indirect restorations and direct resin composite performed better for direct restorations (annual failure rate of 2.19%). The most substantial comparisons were between feldspathic and glass ceramics, followed by direct resin composite and amalgam; there were no statistically significant differences between these interventions. Results of the pairwise meta-analysis showed mainly glass ionomer as significantly more prone to failure than amalgam and direct composite resin.

Reference standard direct and indirect materials except for glass ionomer can be used for restorations of large posterior caries.
Reference standard direct and indirect materials except for glass ionomer can be used for restorations of large posterior caries.
Medicaid programs may have a salient financial incentive to provide adult coverage for cost-effective preventive dental procedures because they face responsibility for catastrophic costs of dental disease. buy Galunisertib Whether there is sufficient evidence to support adult Medicaid coverage of preventive dental services is unclear.

Using an optimal insurance model, the author examines what evidence there is to support coverage of cost-effective preventive dental services in Medicaid and what evidence gaps remain.

There is insufficient evidence to support adult Medicaid coverage for preventive dental procedures.

More research is needed to identify preventive dental procedures that are cost-effective from a Medicaid perspective, quantify the impact dental prevention has on dental-related health care costs and overall health care costs, and quantify the impact patient-side and provider-side financial incentives have on take-up of specific preventive dental treatments.

Although Medicaid programs may have an interest in preventing catastrophic costs of dental disease (that is, dental-related emergency department visits), there is insufficient evidence for Medicaid programs to provide coverage for preventive dental procedures.
Although Medicaid programs may have an interest in preventing catastrophic costs of dental disease (that is, dental-related emergency department visits), there is insufficient evidence for Medicaid programs to provide coverage for preventive dental procedures.
The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.

Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N= 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.

A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a s of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients' oral health needs.
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