Patterns and correlates of tobacco control behavior among American Association of Pediatric Dentistry members: a cross-sectional national study.

BMC Oral Health. 2007 Oct 11;7(1):13

Authors: Gansky SA, Ryan JL, Ellison JA, Isong U, Miller AJ, Walsh MM

ABSTRACT: BACKGROUND: To determine the tobacco-related knowledge, attitudes, and practice behaviors among US pediatric dentists. METHOD: A survey was conducted in 1998 among a national, random sample of 1500 American Academy of Pediatric Dentistry members. Chi-square tests and logistic regression with odds ratios (ORs) and 95% confidence intervals assessed factors related to pediatric dentists tobacco control behaviors. RESULTS: Response was 65% for the survey. Only 12% of respondents had prior tobacco prevention/cessation training. Of those untrained, 70% were willing to be trained. Less than two-thirds correctly answered any of four tobacco-related knowledge items. Over one-half agreed pediatric dentists should engage in tobacco control behaviors, but identified patient resistance as a barrier. About 24% of respondents reported always/often asking their adolescent patients about tobacco use; 73% reported always/often advising known tobacco users to quit; and 37% of respondents always/often assisting with stopping tobacco use. Feeling prepared to perform tobacco control behaviors (ORs=1.9-2.8), a more positive attitude score (4 points) from 11 tobacco-related items (ORs=1.5-1.8), and a higher statewide tobacco use prevalence significantly predicted performance of tobacco control behaviors. CONCLUSIONS: Findings suggest that training programs on tobacco use and dependence treatment in the pediatric dental setting may be needed to promote tobacco control behaviors for adolescent patients.

PMID: 17931425 [PubMed - as supplied by publisher]

Illinois dental anesthesia and sedation survey for 2006.

Anesth Prog. 2007;54(2):52-8

Authors: Flick WG, Katsnelson A, Alstrom H

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.

PMID: 17579504 [PubMed - indexed for MEDLINE]

[Clinical effect of pit and fissure sealant used in combination with self-etching adhesive on permanent teeth]

Shanghai Kou Qiang Yi Xue. 2006 Dec;15(6):571-4

Authors: Peng SM, Zhao W, Lin JC, Ling JQ

PURPOSE: To determine the role of pit and fissure sealant used in combination with self-etching adhesive in retention of the sealants and caries decrease of the permanent teeth. METHODS: Sixty two children aged 6-14 years old were chosen from the outpatients in the Department of Pediatric Dentistry, the first or the second permanent molars (n= 156) were sealed with two kinds of sealant. The tooth in one side was sealed with sealant (Concise, 3M-ESPE) and self-etching system (Adper and Prompt, 3M-ESPE) while the tooth in the other side was sealed with sealant (Concise, 3M-ESPE) and phosphate acid system. All the patients were followed up and reexamined 3, 6 and 12 months after treatment. Statistical analysis was carried out with SPSS 12.0 (SPSS Inc., Chicago, IL, USA) software package for Chi-square test and t test. RESULTS: The operating time using self-etching system was (122 +/- 13)s, shorter than (219 +/- 13)s using phosphate acid system (P < 0.05). The self-etching system used only one step to finish etching, adhesion and treatment of tooth surface, saving the steps of rinsing and drying. The retention rates of pit and fissure sealant in self-etching system and phosphate acid system were 97.4% and 96.2% respectively at the third month, 94.9% and 92.3% at the sixth month, 91.0% and 88.4% at the end of one year after treatment. The prevalence rate of caries in both groups had no significant difference (P>0.05); No caries in both groups were found in the first three months; In patients using self-etching system, caries decreased by 100% at the sixth month and by 50% at the end of one year. CONCLUSION: Adper Prompt self-etching adhesive, with an advantage of simple operation and shorter operation period, is effective in bonding sealant to the enamel. The retention rates of pit and fissure sealant were not different between the two groups.

PMID: 17533704 [PubMed - in process]

Teaching learners to care for children with special needs.

Fam Med. 2007 May;39(5):310; author reply 310-1

Authors: Silk H

PMID: 17476599 [PubMed - indexed for MEDLINE]

Treatment of space loss caused by submerged maxillary second primary molar.

J Indian Soc Pedod Prev Dent. 2007 Mar;25(1):36-8

Authors: Karacay S, Guven G, Basak F

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.

PMID: 17456966 [PubMed - indexed for MEDLINE]

Antimicrobial analysis of different root canal filling pastes used in pediatric dentistry by two experimental methods.

Braz Dent J. 2006;17(4):317-22

Authors: Amorim Lde F, Toledo OA, Estrela CR, Decurcio Dde A, Estrela C

The objective of this study was to compare, by two experimental methods, the antimicrobial efficacy of different root canal filling pastes used in pediatric dentistry. The tested materials were: Guedes-Pinto paste (GPP), zinc oxide-eugenol paste (OZEP), calcium hydroxide paste (CHP), chloramphenicol + tetracycline + zinc oxide and eugenol paste (CTZP) and Vitapex. Fiven microbial strains (S. aureus, E. faecalis, P. aeruginosa, B. subtilis and C. albicans) obtained from the American Type Culture Collection were inoculated in Brain Heart Infusion (BHI) and incubated at 37 degrees C for 24 h. For the direct exposure test (DET), 72 paper points were contaminated with the standard microbial suspensions and exposed to the root canal filling pastes for 1, 24, 48 and 72 h. The points were immersed in Letheen Broth (LB), followed by incubation at 37 degrees C for 48 h. An inoculum of 0.1 mL obtained from LB was then transferred to 7 mL of BHI, under identical incubations conditions and the microbial growth was evaluated. The pastes showed activity between 1 and 24 h, depending on the material. For the agar diffusion test (ADT), 30 Petri plates with 20 mL of BHI agar were inoculated with 0.1 mL of the microbial suspension, using sterile swabs that were spread on the medium. Three cavities were made in each agar plate (total = 90) and completely filled with one of the filling root canal pastes. The plates were pre-incubated for 1 h at room temperature and then incubated at 37 degrees C for 24 to 48 h. The inhibition zone around each well was recorded in mm. The complete antimicrobial effect in the direct exposure test was observed after 24 h on all microbial indicators. All root canal filling materials induced the formation of inhibition zones, except for Vitapex (range, 6.0-39.0 mm).

PMID: 17262146 [PubMed - indexed for MEDLINE]

Interdisciplinary approach to endodontic therapy for uncooperative children in a dental school environment.

J Dent Educ. 2006 Dec;70(12):1362-5

Authors: Soares F, Britto LR, Vertucci FJ, Guelmann M

The aim of this study was to describe an interdisciplinary approach for endodontic therapy of behavior-challenging children and to report the efficacy of sedation techniques for these procedures. Sedation records of thirty-two patients who received root canal treatment were reviewed. Age at treatment in months, gender, year of treatment, tooth type, status of root maturation (open or closed apex), etiological factor(s), sedation protocol, and outcome were the variables analyzed. The collected information was entered into a computerized flowchart and the data analyzed using descriptive statistics. Midazolam in combination with meperidine or hydroxyzine were the most common protocols used (46 percent and 40 percent of the cases, respectively). Only two (6 percent) treatments were aborted due to uncontrolled behavior during sedation. We conclude that cooperation between pediatric dentists and endodontists is fundamental to achieving success when providing root canal treatment for uncooperative child patients.

PMID: 17170328 [PubMed - indexed for MEDLINE]

Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update.

Pediatrics. 2006 Dec;118(6):2587-602

Authors: , , Cot&#xE9; CJ, Wilson S,

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age- and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.

PMID: 17142550 [PubMed - indexed for MEDLINE]

The transmission of BANA-positive periodontal bacterial species from caregivers to children.

J Am Dent Assoc. 2006 Nov;137(11):1539-46

Authors: Lee Y, Tchaou WS, Welch KB, Loesche WJ

BACKGROUND: The purpose of the authors' study was to use the N-benzoyl-DL-arginine-2-naphthy-lamide (BANA) test (BANAMet LLC, Ann Arbor, Mich.) to obtain information regarding the prevalence of an enzyme unique to certain periodontal pathogens in plaque samples of children, as well as the potential transmission of these pathogens from caregivers to children. METHODS: The authors tested 218 subjects (3 to 10 years old) and 195 care-givers at four pediatric dentistry clinics in Taipei, Taiwan. RESULTS: Forty-four percent of the children had at least one plaque sample that tested positive and/or weakly positive. Positive results were more frequent in the mixed dentition, as well as in children with gingivitis (P < .001). A logistic regression model showed that if the BANA test results for the care-giver were positive, the odds of the child's also having positive test results were 55 times greater (P < .001; confidence interval [CI] = 14 to 224) than those for a child whose caregiver had negative BANA test results. Other predictors were the presence of a mixed dentition (P < .001; odds ratio [OR] = 11; CI = 3.5 to 33.5) and the children's papillary bleeding scores (P < .001, OR = 3.1, CI = 2.0 to 4.7). CONCLUSION: The BANA test results were positive for almost one-half of the children. A positive reaction was associated with gingivitis, a mixed dentition, a BANA-positive caregiver or a caregiver with a history of periodontal disease in the family. CLINICAL IMPLICATIONS: The authors propose an anaerobic periodontal infection risk model in which children with a mixed dentition who have gingivitis and a caregiver with a history of periodontal disease would undergo the BANA test.

PMID: 17082280 [PubMed - indexed for MEDLINE]

Will paediatric dentists please stand up?

J Indian Soc Pedod Prev Dent. 2006 Sep;24(3):115

Authors: Bedi R

PMID: 17065776 [PubMed - indexed for MEDLINE]

Fluoride knowledge and prescription practices among dentists.

J Dent Educ. 2006 Sep;70(9):956-64

Authors: Narendran S, Chan JT, Turner SD, Keene HJ

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

PMID: 16954417 [PubMed - indexed for MEDLINE]

[The characteristics of uncooperative children's temperament during dental treatment]

Shanghai Kou Qiang Yi Xue. 2006 Jun;15(3):279-81

Authors: Su JM, Ye XW, Ruan WH, Wu ZF, Huang XJ

PURPOSE: To compare the temperament of uncooperative and cooperative children during dental treatment, and find out the characteristics of the uncooperative children's temperament. METHODS: Fifty-two cooperative children (aged from 3 to 7 years) and thirty-five uncooperative children (aged from 3 to 7 years) during dental treatment were included in the investigation. Their parents were asked to answer the Chinese Preschool Children's Temperament Scale (CPTS). The two independent sample's Mann-whitney test and Student's t test were performed to find the difference of the type of temperament and the temperamental dimension between the two groups. RESULTS: (1) There was a statistically significant difference (P<0.05) in the type of temperament between the uncooperative group and the cooperative group. In the uncooperative group, the number of difficult temperament children was significantly larger than that in the uncooperative group. (2) The scores of adaptability and quality of mood were significantly higher in the uncooperative group than that in the cooperative group. CONCLUSIONS: Children's cooperation in pediatric dentistry was correlated to their temperament. The tendencies of negative mood and slow adaptation and difficult temperament should be considered patients at risk of uncooperation in pediatric dentistry.

PMID: 16862362 [PubMed - in process]

Pediatricians' views about oral health care.

Indian J Pediatr. 2006 Jun;73(6):535-6

Authors: Bhat SS, Sargod SS, Kiran Kumar BS

Pediatricians and family practitioners have the responsibility of providing the crucial primary care for the children. They are considered to be in a unique position to contribute to the dental health of their young patients. In view of this a study was conducted in Mangalore city (India) to assess pediatricians' views about oral health care and their advice regarding oral hygiene maintenance. Fifty pediatricians were personally interviewed with a questionnaire. All pediatricians acknowledged their role in oral hygiene maintenance of their patients. This study showed that there is a need for more communication between the two pediatric specialties of medicine and dentistry so as to deliver better child health care.

PMID: 16816520 [PubMed - indexed for MEDLINE]

The efficacy of noncontingent escape for decreasing children's disruptive behavior during restorative dental treatment.

J Appl Behav Anal. 2006;39(2):161-71

Authors: O'Callaghan PM, Allen KD, Powell S, Salama F

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff s use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.

PMID: 16813038 [PubMed - indexed for MEDLINE]

General dentists' referrals of 3- to 5-year-old children to pediatric dentists.

J Am Dent Assoc. 2006 May;137(5):653-60

Authors: McQuistan MR, Kuthy RA, Daminano PC, Ward MM

BACKGROUND: Little is known about general dentists' referral patterns. The authors explored the practice, dentist and patient characteristics associated with general dentists' likelihood of referring children aged 3 to 5 years to pediatric dentists. METHODS: The authors sent all Iowa general dentists (N = 1,089) a 25-item questionnaire regarding the referral of children in their practices. The authors merged the resulting information with an existing database (Iowa Dentist Tracking System) to create the dataset. A total of 65.4 percent of the dentists (712) participated. RESULTS: Logistic regression analysis demonstrated that an increase in the percentage of children in the practice decreased the likelihood of the dentist's referring the children (odds ratio [OR] = 0.93, 95 percent confidence interval [CI] = 0.90 to 0.96). Practices with more than 5 percent of patients with public insurance were more likely to refer children (OR = 1.96, 95 percent CI = 1.26 to 3.06), as were dentists with additional training beyond dental school (OR = 1.69, 95 percent CI = 1.06 to 2.69). CONCLUSION: These data indicate that both practice and dentist characteristics are associated with the likelihood of making referals; however, there needs to be further study on general dentists' referral decisions. PRACTICE IMPLICATIONS: As the characteristics of the dental work force evolve, there is a need to study referral patterns and the influence they have on work force policy, patient accessibility and educational curriculum.

PMID: 16739546 [PubMed - indexed for MEDLINE]

Dental and medical students' knowledge and opinions of infant oral health.

J Dent Educ. 2006 May;70(5):511-7

Authors: Chung MH, Kaste LM, Koerber A, Fadavi S, Punwani I

Primary care providers' involvement with and perceptions of the epidemic of early childhood caries could be related to attitudes and knowledge of the disease as well as to differences in discipline-based recommendations. A cross-sectional survey of demographics, opinions on infant oral health care visits and importance of infant oral health care, knowledge of tooth eruption, and knowledge of health care guidelines of the American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) was administered by several methods to first- and fourth-year dental and medical students at two University of Illinois campuses. Some expected variations were found among dental and medical students pertaining to perceptions and knowledge of infant oral health. Higher proportions of dental students responded correctly or considered the issues very important. However, Rockford medicine students were more likely to know when children should be weaned, yet less likely to agree with recommendations for time of first dental visit. Furthermore, fourth-year dental students were less likely than first-year dental students to give the recommended answer for age of first dental visit. Variances of opinions and basic knowledge of infant oral health of dental and medical students showed inconsistencies with desired outcomes of educational and clinical experiences. Further research is needed to understand the role of experience and other factors to effectively educate primary care providers in this area.

PMID: 16687635 [PubMed - indexed for MEDLINE]

Collaboration Between Dietetics and Dentistry: Dietetic Internship in Pediatric Dentistry.

Top Clin Nutr. 2005;20(3):259-268

Authors: More FG, Sasson LM, Godfrey EM, Sehl RB

The American Dietetic Association and the American Dental Association share a common interest in improving the health and quality of life of the population. Dental visits present an opportunity to identify nutrition-related issues for both the pediatric and adult population. Traditionally, dental and nutrition students have had little opportunity to learn and work together since little time was spent on nutrition in the dental curriculum. The purpose of this article is to describe the development of a new collaborative training experience for dietetic interns and pediatric dentistry residents. The oral health rotation for dietetic interns also has several objectives, including experience interacting with a culturally diverse population and participating in community nutrition education (Head Start). In its first 18 months, the collaborative program has been viewed as a success by the pediatric dentistry faculty and residents and the nutrition faculty and interns.

PMID: 16639470 [PubMed - as supplied by publisher]

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

J Am Dent Assoc. 2006 Apr;137(4):502-13

Authors: Dionne RA, Yagiela JA, Cot&#xE9; CJ, Donaldson M, Edwards M, Greenblatt DJ, Haas D, Malviya S, Milgrom P, Moore PA, Shampaine G, Silverman M, Williams RL, Wilson S

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.

PMID: 16637480 [PubMed - indexed for MEDLINE]

Predoctoral dental student evaluation of American Academy of Pediatric Dentistry's Caries-Risk Assessment Tool.

J Dent Educ. 2006 Mar;70(3):292-5

Authors: Nainar SM, Straffon LH

The purpose of this study was to determine predoctoral dental student evaluation of the American Academy of Pediatric Dentistry's Caries-Risk Assessment Tool (CAT) for children. Dental students were introduced to the CAT instrument as part of their didactic pediatric dentistry curriculum. These students were later encouraged to use the CAT instrument for determining caries risk in their pediatric patients. Following a two-year exposure to the CAT instrument, dental students completed an anonymous seven-item evaluation of the instrument at the end of their primary clinical experience in pediatric dentistry. The students were asked to score each item on a five-point scale ranging from strongly agree (#5) to neutral (#3) to strongly disagree (#1). Ninety-seven percent of eligible students completed the CAT evaluation questionnaire. Most students agreed that the CAT instrument was easy to understand (86 percent), simple to apply (76 percent), useful for prescribing radiographs (76 percent), and useful for determining preventive procedures (84 percent). Eighty percent of them indicated that they were likely to use the CAT instrument in their clinical practice. In conclusion, student acceptance of the CAT instrument indicates that it may educate predoctoral dental students regarding caries risk assessment in children.

PMID: 16522758 [PubMed - indexed for MEDLINE]

Short forms of the Child Perceptions Questionnaire for 11-14-year-old children (CPQ11-14): development and initial evaluation.

Health Qual Life Outcomes. 2006;4:4

Authors: Jokovic A, Locker D, Guyatt G

BACKGROUND: The Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14) is a 37-item measure of oral-health-related quality of life (OHRQoL) encompassing four domains: oral symptoms, functional limitations, emotional and social well-being. To facilitate its use in clinical settings and population-based health surveys, it was shortened to 16 and 8 items. Item impact and stepwise regression methods were used to produce each version. This paper describes the developmental process, compares the discriminative properties of the resulting four short-forms and evaluates their precision relative to the original CPQ11-14. METHODS: The item impact method used data from the CPQ11-14 item reduction study to select the questions with the highest impact scores in each domain. The regression method, where the dependent variable was the overall CPQ11-14 score and the independent variables its individual questions, was applied to the data collected in the validity study for the CPQ11-14. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability and test-retest reliability) of all 4 short-forms were evaluated using the data from the validity and reliability studies for the CPQ11-14. RESULTS: All short forms detected substantial variability in children's OHRQoL. The mean scores on the two 16-item questionnaires were almost identical, while on the two 8-item questionnaires they differed by only one score point. The mean scores standardized to 0-100 were higher on the short forms than the original CPQ11-14 (p < 0.001). There were strong significant correlations between all short-form scores and CPQ11-14 scores (0.87-0.98; p < 0.001). Hypotheses concerning construct validity were confirmed: the short-forms' scores were highest in the oro-facial, lower in the orthodontic and lowest in the paediatric dentistry group; all short-form questionnaires were positively correlated with the ratings of oral health and overall well-being, with the correlation coefficient being higher for the latter. The relative validity coefficients were 0.85 to 1.18. Cronbach's alpha and intraclass correlation coefficients ranged 0.71-0.83 and 0.71-0.77, respectively. CONCLUSION: All short forms demonstrated excellent criterion validity and good construct validity. The reliability coefficients exceeded standards for group-level comparisons. However, these are preliminary findings based on the convenience sampling and further testing in replicated studies involving clinical and general samples of children in various settings is necessary to establish measurement sensitivity and discriminative properties of these questionnaires.

PMID: 16423298 [PubMed - indexed for MEDLINE]

Ohio dental care providers' treatment of young children, 2002.

J Am Dent Assoc. 2005 Nov;136(11):1583-91

Authors: Siegal MD, Marx ML

BACKGROUND: Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children. METHODS: Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character. RESULTS: Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. CONCLUSIONS: Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them. PRACTICE IMPLICATIONS: New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.

PMID: 16329425 [PubMed - indexed for MEDLINE]

Application of the total etching technique or self-etching primers on primary teeth after air abrasion.

Braz Oral Res. 2005 Jul-Sep;19(3):198-202

Authors: Leite FR, Capote TS, Zuanon AC

Since the use of air abrasion has grown in pediatric dentistry, the aim of this study was to evaluate, by means of shear bond strength testing, the need to use the total etching technique or self-etching primers on dentin of primary teeth after air abrasion. Twenty-five exfoliated primary molars had their occlusal dentin exposed by trimming and polishing. Specimens were treated by: Air abrasion + Scotchbond MultiPurpose adhesive (G1); 37% phosphoric acid + Scotchbond MP adhesive (G2); Clearfil SE (G3); Air abrasion + 37% phosphoric acid + Scotchbond MP adhesive (G4); Air abrasion + Clearfil SE (G5). On the treated surface, a cylinder of 2 mm by 6 mm was made using a composite resin (Z100). Duncan's test showed that: (G2 = G3 = G5) > (G1 = G4). The use of a self-etching primer on air abraded dentin is recommended to obtain higher bond strengths.

PMID: 16308608 [PubMed - indexed for MEDLINE]

Specialty and sex as predictors of depression in dentists.

J Am Dent Assoc. 2005 Oct;136(10):1388-95

Authors: Mathias S, Koerber A, Fadavi S, Punwani I

BACKGROUND: Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists. METHODS: The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week. RESULTS: The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment. CONCLUSIONS: The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment. CLINICAL IMPLICATIONS: Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.

PMID: 16255463 [PubMed - indexed for MEDLINE]

Use of SMS text messaging to improve outpatient attendance.

Med J Aust. 2005 Oct 3;183(7):366-8

Authors: Downer SR, Meara JG, Da Costa AC

OBJECTIVE: To evaluate the effect of appointment reminders sent as short message service (SMS) text messages to patients' mobile telephones on attendance at outpatient clinics. DESIGN: Cohort study with historical control. SETTING: Royal Children's Hospital, Melbourne, Victoria. PATIENTS: Patients who gave a mobile telephone contact number and were scheduled to attend any of five outpatient clinics (dermatology, gastroenterology, general medicine, paediatric dentistry and plastic surgery) in September (trial group) or August (control group), 2004. MAIN OUTCOME MEASURES: Failure to attend (FTA) rate compared between the group sent a reminder and those who were not. RESULTS: 2151 patients were scheduled to attend a clinic in September; 1382 of these (64.2%) gave a mobile telephone contact number and were sent an SMS reminder (trial group). Corresponding numbers in the control group were 2276 scheduled to attend and 1482 (65.1%) who gave a mobile telephone number. The FTA rate for individual clinics was 12%-16% for the trial group, and 19%-39% for the control group. Overall FTA rate was significantly lower in the trial group than in the control group (14.2% v 23.4%; P < 0.001). CONCLUSIONS: The observed reduction in failure to attend rate was in line with that found using traditional reminder methods. The ease with which large numbers of messages can be customised and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance.

PMID: 16201955 [PubMed - indexed for MEDLINE]

TRICARE; changes included in the National Defense Authorization Act for fiscal year 2005; TRICARE Dental Program. Interim final rule.

Fed Regist. 2005 Sep 21;70(182):55251-2

Authors:

The Department is publishing this interim final rule to implement sections 711 and 715 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA-05), Public Law 108-375. Specifically, that legislation makes young dependents of deceased Service members eligible for enrollment in the TRICARE Dental Program when the child was not previously enrolled because of age, and authorizes post-graduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association to provide dental treatment to dependents who are 12 years of age or younger and who are covered by a dental plan established under 10 U.S.C. 1076a. This rule also corrects certain references in 32 CFR 199.13. The rule is being published as an interim final rule with comment period in order to comply with statutory effective dates. Public comments are invited and will be considered for possible revisions to the final rule.

PMID: 16175671 [PubMed - indexed for MEDLINE]

The ABCDs of treating the most prevalent childhood disease.

Am J Public Health. 2005 Aug;95(8):1322-4

Authors: Donahue GJ, Waddell N, Plough AL, Del Aguila MA, Garland TE

Dental caries is a potentially preventable infectious disease that, untreated, can cause significant morbidity requiring costly treatment. The Access to Baby and Child Dentistry (ABCD) program increases access to prevention and early treatment for Medicaid-eligible children aged younger than 6 years in Washington State.The program is a partnership of Washington Dental Service Foundation, the University of Washington School of Pediatric Dentistry, the state Medical Assistance Administration, and local stakeholders. Through training in pediatric dental techniques and enhanced reimbursement, ABCD equips and encourages dentists to serve young Medicaid patients. Family counseling increases oral care compliance and reduces no-show rates. Program evaluation demonstrates changing attitudes and behavior among participating families and dentists, with more young, low-income Washington children receiving oral health care.

PMID: 16043665 [PubMed - indexed for MEDLINE]

Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist.

Am J Public Health. 2005 Aug;95(8):1325-9

Authors: Nash DA, Nagel RJ

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children.We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children.Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue-one of social justice.

PMID: 16006412 [PubMed - indexed for MEDLINE]

Estimated impact of competing policy recommendations for age of first dental visit.

Pediatrics. 2005 Apr;115(4):906-14

Authors: Jones K, Tomar SL

OBJECTIVE: To compare levels of dental utilization and untreated dental decay among children aged 1 to 3 years that are likely to occur under 2 potential guidance policies: (1) pediatricians refer all toddlers to dentists for screening (consistent with American Academy of Pediatric Dentistry and the American Dental Association recommendations; DENT), and (2) pediatricians receive training in caries risk assessment, screen toddlers, and refer at-risk children to dentists (consistent with American Academy of Pediatrics recommendations; PED). METHODS: Using decision analysis, we estimated the impact of PED and DENT assuming alternately unlimited dental capacity for Medicaid-insured patients and fixed Medicaid dental capacity. Results With unlimited capacity, if DENT were implemented, then dental utilization is estimated to increase from 27% under the status quo to 65% and untreated decay to decrease from a mean of 0.60 surfaces to 0.52 surfaces per child. If PED were implemented, then dental utilization and untreated decay would decrease from status quo levels to an estimated 11% and 0.47 surfaces, respectively, assuming that diagnostic sensitivity and specificity both equaled 1; they would decrease to 13% and 0.53 surfaces, respectively, if sensitivity equaled 0.76 and specificity equaled 0.95. With fixed capacity, under DENT, untreated decay is estimated to increase to 0.63 surfaces because low-risk private-pay patients would crowd out at-risk Medicaid-insured children, whereas under PED, untreated decay would still be less than under the status quo. CONCLUSIONS: Implementing PED will decrease untreated decay under most plausible scenarios, whereas switching to DENT will increase the burden of disease if Medicaid dental capacity is limited.

PMID: 15805363 [PubMed - indexed for MEDLINE]

Family medicine residency directors' knowledge and attitudes about pediatric oral health education for residents.

J Dent Educ. 2005 Apr;69(4):446-52

Authors: Gonsalves WC, Skelton J, Heaton L, Smith T, Feretti G, Hardison JD

The Surgeon General's report on oral health called for improved education about oral health, a renewed understanding of relationships between oral and overall health, and an interdisciplinary approach to oral health involving primary care providers. This study examined the following: 1) family medicine residency directors' knowledge of preventive dental care, 2) status of an oral heath curriculum in family medicine residencies, and 3) the likelihood of initiating an oral health curriculum. We conducted a fifty-item survey of family medicine program directors emphasizing pediatric oral health assessed demographics, knowledge of preventive procedures, existing oral health curriculum, composition, and time commitment for an oral health curriculum. Directors returned 208 (45 percent) surveys. Approximately 95 percent agreed that oral health knowledge should be a component of residency training. Most programs are teaching anticipatory guidance. The mean time program directors felt should be given to an oral health curriculum was four hours. Program directors lack knowledge of preventive dental procedures and oral health care recommendations. Oral health care knowledge is felt to be an important component of residency training. Program directors need faculty development for a successful delivery of an oral health curriculum.

PMID: 15800258 [PubMed - indexed for MEDLINE]

Creating learner-centered classrooms: use of an audience response system in pediatric dentistry education.

J Dent Educ. 2005 Mar;69(3):378-81

Authors: Johnson JT

Research suggests that the exclusive use of lecture in the classroom hinders student learning. The advent of compact electronic wireless audience response systems has allowed for increased student participation in the classroom. Such technology is utilized in medical education. This article describes the use of an audience response system in a "quiz bowl" format to facilitate and improve the comprehension of student dentists in core concepts in pulp therapy for the pediatric patient.

PMID: 15749949 [PubMed - indexed for MEDLINE]

Increasing general dentists' provision of care to child patients through changes in the undergraduate pediatric dentistry program.

J Dent Educ. 2005 Mar;69(3):371-7

Authors: Lekic PC, Sanche N, Odlum O, deVries J, Wiltshire WA

Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998-99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded, fifteen from each of the three surveyed classes. Dentists who graduated after the changes to the program (2000, 2002) reported that they performed a greater number of complex pediatric dentistry procedures and treated more toddler and preschool children than the group that graduated before the changes (1993). Referrals to pediatric dentistry specialists were higher in the 1993 group than in the 2000 and 2002 groups. In conclusion, an adequate pool of pediatric patients is critical to provide dental students with sufficient learning experiences. The dentists who graduated from the program after the changes were implemented are providing more comprehensive treatment to younger children.

PMID: 15749948 [PubMed - indexed for MEDLINE]

Survey of dental prophylaxes rendered by pediatric dentists in New England.

J Contemp Dent Pract. 2004 Nov 15;5(4):14-22

Authors: Nainar SM, Redford-Badwal DA

BACKGROUND: The objective of this anonymous postal survey was to assess the provision of dental prophylaxis by pediatric dentists in New England. METHODS: The questionnaire survey was sent by first class mail in September, 2001 to all 217 American Academy of Pediatric Dentistry (AAPD) members in active private practice in the six New England States of Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. A self-addressed, stamped envelope was provided to facilitate the returned response. RESULTS: The survey had a response rate of 70%. Most practitioners (93%) routinely recommended dental prophylaxis for their recall patients. The proportion of practitioners who considered the following indications for recommending dental prophylaxis was: plaque, stain, and/or calculus removal - 99%; caries prevention - 75%; prior to topical fluoride application - 82%; prior to sealant application - 58%; and for behavioral modification - 68%. Almost two thirds of the practitioners (62%) defined dental prophylaxis as referring to both rubber cup pumice prophylaxis as well as to toothbrush prophylaxis. However, only one in four practitioners (26%) had modified her/his clinical practice to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis. CONCLUSION: Pediatric dentists in New England routinely provide dental prophylaxis to their recall patients.

PMID: 15558086 [PubMed - indexed for MEDLINE]

A snapshot of the U.S. postdoctoral pediatric dentistry faculty workforce, 2002.

J Dent Educ. 2004 Aug;68(8):823-8

Authors: Casamassimo PS, Feigal R, Adair SM, Berg J, Stewart R

This study characterizes the faculty shortage in U.S. postdoctoral pediatric dentistry (PD) education. The objectives of the study were to determine: 1) the changes in PD faculty numbers and teaching loads between 1995 and 2002 for postdoctoral PD education, 2) current faculty age and training, and 3) distribution of faculty by age. A questionnaire was sent in 2002 to fifty-four programs, of which forty-six responded (85 percent). Dental school and residency mean class sizes increased in the seven-year study period from 82.8 to 91.8 and from 6.0 to 8.5, respectively. Full- and part-time mean faculty positions increased as did vacancies, the latter growing from 15 to 38.9 and changing during the period from 5 to 10.8 percent of available positions. About one-third of programs used general dentists to teach PD, while programs using foreign-trained educators grew from 4 to 13 percent. Twenty-nine percent of full-time and 27 percent of part-time faculty are fifty-five years or older, and young entry-level faculty, age twenty-five to twenty-nine, represent only 2 percent and 5 percent of full- and part-time faculty respectively. Faculty vacancies have increased along with numbers of students and residents, and the largest segment of PD faculty is within a decade of retirement age.

PMID: 15286104 [PubMed - indexed for MEDLINE]

Dental hygienists and dental therapists.

J Dent Educ. 2004 Apr;68(4):413

Authors: Wyche CJ

PMID: 15112917 [PubMed - indexed for MEDLINE]

If only we all cared.

J Dent Educ. 2004 Mar;68(3):304-5

Authors: Fenton SJ

PMID: 15038630 [PubMed - indexed for MEDLINE]

[The new start,the new pursuit]

Shanghai Kou Qiang Yi Xue. 2004 Feb;13(1):1

Authors: Zhang ZY

Shanghai Journal of Stomatology(Shanghai Kou Qiang Yi Xue,ISSN 1006-7248),a peer reviewed national journal on oral medicine, oral and maxillofacial surgery, prosthodontics, pediatric dentistry, preventive dentistry, oral pathology, oral radiology, etc, was recently accepted and included in index Medicus and MEDLINE. This is an exciting and encouraging event both for the Editorial Board and authors. The journal will do its best to improve the academic and printing quality in accordance with the demands of MEDLINE and international conventions. The Editorial Board was re-founded last year with addition of internationally renowned experts on stomatology. Every submitted manuscript was evaluated by a minimum of 2 expert reviewers. Almost all of the manuscripts were returned to the corresponding authors with recommendations for revision and correction. In addition, statistics will be addressed for each manuscript to ensure the scientific credibility and repeatability. To help the authors to understand and apply statistics soundly, a series of tutorials on statistics will be published in the 6 issues of this year. All the English information is revised and processed by our invited experts. What we should do next is to increase the impact factor of the journal and shorten the publication periods(currently 9 to 12 months)as much as possible. what we wish is that the impact of this journal will be magnified through the joint efforts from our reviewers, editors and authors worldwide in the future.

PMID: 15031748 [PubMed - indexed for MEDLINE]

A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation.

Pesqui Odontol Bras. 2003 Jul-Sep;17(3):206-11

Authors: Lima AR, da Costa LR, da Costa PS

The effectiveness of oral midazolam in pediatric dentistry is controversial. This randomized, controlled, crossover, double blind clinical trial was conducted in order to study the effect of midazolam, used either alone or in association with hydroxyzine, during child dental treatment. Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old. In each appointment children were randomly assigned to groups: P - placebo, M - midazolam (1.0 mg/kg), or MH - midazolam (0.75 mg/kg) plus hydroxyzine (2.0 mg/kg). Vital signs (blood pressure, breathing rate, pulse and oxygen saturation) and behavior parameters (consciousness, crying, movement, overall behavior) were evaluated every 15 minutes. Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group. Normal values of vital signs were usually registered. Heart rate increased in groups P and M as the session went on. Group M presented less crying and movement at the first 15 minutes of treatment. Group MH caused more drowsiness at the beginning of the session. Overall behavior was better in group M than in groups P or MH. Group M produced effective sedation in 77% of the cases, and group MH did so in 30.8%. It was concluded that midazolam was effective and safe, and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation.

PMID: 14762496 [PubMed - indexed for MEDLINE]

General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs.

J Dent Educ. 2004 Jan;68(1):23-8

Authors: Casamassimo PS, Seale NS, Ruehs K

This study analyzed a data subset of a national survey of general dentists conducted in 2001 to determine their overall care of children with special health care needs (CSHCN). In the survey, dentists were asked to respond to questions in the following areas: did they provide care for CSHCN (children with cerebral palsy, mental retardation, and those who are medically compromised); what were their perceptions of the training they received in dental school related to CSHCN; what was their interest in additional training for CSHCN; and what factors influenced their willingness to provide care for CSHCN? Only about 10 percent see CSHCN often or very often, and only one in four respondents had hands-on experience with these patients in dental school. Postgraduate education in general practice or advanced general dentistry residency had no effect on willingness to care for CSHCN. Older dentists, those accepting Medicaid for all children, and those practicing in small communities were more likely to see CSHCN. Dentists willing to see CSHCN also were more likely to perform procedures associated with special needs and underserved child populations including pharmacologic management and stainless steel crowns. Dentists with hands-on educational experiences in dental schools with CSHCN were less likely to consider such factors as level of disability and patient behavior as obstacles to care and were more likely to desire additional education in care of CSHCN.

PMID: 14761169 [PubMed - indexed for MEDLINE]

Developing a pediatric oral health therapist to help address oral health disparities among children.

J Dent Educ. 2004 Jan;68(1):8-20; discussion 21-2

Authors: Nash DA

Oral Health in America: A Report of the Surgeon General documented the profound and significant disparities that exist in the oral health of children in the United States. Recently, the country has been issued a National Call to Action to Promote Oral Health, under the leadership of the Office of the Surgeon General. Among the significant factors contributing to the disparities problem is the access to oral health care by disadvantaged populations. There are inadequate numbers of dentists able and willing to treat children, particularly poor and minority children. In the early part of the twentieth century, New Zealand faced a significant problem with oral disease among its children and introduced a School Dental Service staffed by allied dental professionals, known as "school dental nurses," who had received two years training in caring for the teeth of children. A number of other countries have since adopted this model. This article reviews attempts to develop a comparable approach in the United States. Furthermore, it justifies and advocates the development of pediatric oral health therapists in the United States as a means of addressing the disparities problem that exists in this nation. These pediatric oral health therapists would be trained in a two-year program to provide dental care services to children. The article concludes by asserting that such action is a practical and cost-effective way for dentistry to fulfill its professional obligation to care for the oral health of all children, thus ensuring justice in oral health for America's children.

PMID: 14761168 [PubMed - indexed for MEDLINE]

Access to dental care for children in the United States: a survey of general practitioners.

J Am Dent Assoc. 2003 Dec;134(12):1630-40

Authors: Seale NS, Casamassimo PS

BACKGROUND: In response to concern that inadequate dental school training may create a barrier to access to care for children, the authors conducted a survey concerning general practitioners' practice patterns involving child patients. METHODS: The authors requested a list of 4,970 randomly chosen general practitioners from the American Dental Association Survey Center. They then sent those dentists a written survey asking whether and in what numbers they treat children; the ages and caries levels of any children they do treat; their perceptions of their educational experiences in pediatric dentistry, and their perceived needs for continuing education in pediatric dentistry. They analyzed data using chi2. RESULTS: Ninety-one percent of the general dentists surveyed treated children, but those younger than 4 years of age, with high levels of caries, and whose care is funded by Medicaid were represented in very low numbers. The types of patients treated and procedures performed by the respondents were significantly (P < or = .05) associated with the intensity of the respondents' educational experiences, except for the number and types of Medicaid patients they treated. CONCLUSIONS: These data indicate that the vast majority of general practitioners treat children in their practices, but there still are groups of children for whom access to dental care is a problem. PRACTICE IMPLICATIONS: Very young children, children with high levels of caries and Medicaid-covered children have difficulty finding dental care in the general practice community.

PMID: 14719761 [PubMed - indexed for MEDLINE]

Oral manifestations of graft versus host disease. Case report.

Med Oral. 2003 Nov-Dec;8(5):361-5

Authors: Dom&#xED;nguez Reyes A, Aznar Martín T, Barbería Leache E, Cabrera Suárez E

This study has been carried out in order to understand and increase our knowledge about the oral manifestations and the treatment required for Graft Versus Host Disease. The complication of allogeneic transplants with haematopoietic cells is revised. The clinical case report deals with a nine-year-old girl who was treated in our unit of Integrated Paediatric Dentistry after referral by her paediatrician. The symptoms of Graft Versus Host Disease are basically characterised by immunodeficiency, diarrhoea, weight loss, dermatological and hepatic alterations and oral manifestations. This group of syndromes, caused by the fact that the receptor acquires 30% to 50% of the donor's immune system, can become acute leading to a 20% to 30% mortality rate. The syndromes are chronic in 50% of cases, when sometimes the destruction of the salivary glands is the only manifestation and has a mortality rate of 5%. From the odontological point of view 80% of patients are affected, although we should make the distinction between the manifestations which are directly caused by the disease, and those caused by chemotherapy or radiotherapy. Oral manifestations (caries, mucositis, ulcers, infections, etc) should be treated as soon as possible. Positive co-operation between physicians is of vital importance.

PMID: 14595261 [PubMed - indexed for MEDLINE]

Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia.

Pesqui Odontol Bras. 2003 Apr-Jun;17(2):147-50

Authors: Costa EM, Fernandes MZ, Quinder LB, de Souza LB, Pinto LP

This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12% chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12% chlorhexidine mouth rinse (p < 0.05 by Fisher's exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy.

PMID: 14569357 [PubMed - indexed for MEDLINE]

Building the minority faculty development pipeline.

J Dent Educ. 2003 Sep;67(9):1034-8

Authors: Gates PE, Ganey JH, Brown MD

The shortage of faculty in dental education is well documented, but the data also show a shortage of minorities in postgraduate programs, which develop future faculty. In the last ten years, ADEA's effort to address minority issues in dental education has made some progress. In addition, examples of pipelines for minority faculty development that have shown some success include: a partnership between Harlem Hospital and Columbia University School of Dentistry and Oral Surgery in which the school dedicates one position in its postgraduate training programs to an individual participating in the Harlem Hospital General Practice Residency program; a partnership between the National Dental Association Foundation and Colgate-Palmolive Company, which provides scholarships for advanced dental education study; and the Bronx Lebanon Hospital Center Department of Dentistry, which enrolls underrepresented minorities in its General Practice Residency Program, a new Pediatric Dentistry Residency Program, and a unique program providing hands-on experience in HIV/AIDS health care policy and AIDS development management. Critical elements in the relative success of these programs are environment, selection criteria, mentoring, networking, and finance. The true measure of the outcomes is still to be seen.

PMID: 14518843 [PubMed - indexed for MEDLINE]

The reduction of broken appointment rates through an automated appointment confirmation system.

J Dent Educ. 2003 Sep;67(9):1016-22

Authors: Almog DM, Devries JA, Borrelli JA, Kopycka-Kedzierawski DT

Broken appointments continue to be an important productivity, quality assurance, and access gauge for private dental practices and academic dental centers. In November 2001, the University of Rochester Eastman Dental Center, an urban academic dental center, installed an automated confirmation system to address a high incidence of broken appointments. Following the installation of the system, the Eastman Dental Center experienced a marked decrease in the broken appointment rate. Over a twelve-month period, the center's overall broken rate declined from 23.42 percent to 19.17 percent. The general dentistry rate declined from 23.67 percent to 19.77 percent, and the pediatric dentistry rate declined from 29.42 percent to 25.25 percent.

PMID: 14518840 [PubMed - indexed for MEDLINE]

Child-management techniques. Are there differences in the way female and male pediatric dentists in Israel practice?

Braz Dent J. 2003;14(2):82-6

Authors: Peretz B, Glaicher H, Ram D

The purpose of this study was to assess differences in the management techniques used by Israeli female and male pediatric dentists. All 112 participants of the meeting of the Israeli Society of Dentistry for Children that was held in February 1999 received a questionnaire which sought information regarding age, sex, behavioral and pharmacological methods used to treat children, having a course in nitrous oxide, general anesthesia, and feelings towards pediatric patients. No differences between female and male dentists were found regarding most management techniques. The majority of dentists used tell-show-do, and gave presents at the end of the appointments. Hypnosis was the least used technique. Papoose board was more prevalent among male dentists than among female dentists. Most dentists reported having the parents present during treatment, and more male dentists used their assistance when restraint was needed. General anesthesia was significantly more prevalent among males than among females (p = 0.01). One-third of the dentists reported feeling aggression toward the pediatric patient. Although not statistically significant, more female dentists reported about feeling aggression than male dentists. Most dentists felt authority towards the pediatric patient. Our findings imply that female and male dentists use similar management techniques when treating children.

PMID: 12964649 [PubMed - indexed for MEDLINE]

Addressing disparities in children's oral health: a dental-medical partnership to train family practice residents.

J Dent Educ. 2003 Aug;67(8):886-95

Authors: Mouradian WE, Schaad DC, Kim S, Leggott PJ, Domoto PS, Maier R, Stevens NG, Koday M

Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.

PMID: 12959162 [PubMed - indexed for MEDLINE]

Orthodontic training in pediatric dental residencies.

J Dent Educ. 2003 Jun;67(6):614-21

Authors: Hilgers KK, Redford-Badwal D, Reisine S, Mathieu GP

The purpose of this study was to determine the amount and types of orthodontic training in pediatric dental residencies. A twenty-one-item survey was mailed to sixty directors of pediatric dental residencies. Follow-up surveys were sent to those who had not responded. Fifty-two surveys were returned for a response rate of 87 percent. Most programs provided forty-eight formal orthodontic course hours, one-half to one day of clinical orthodontic experience per week, and six to ten case starts for each resident. Most program directors anticipated this amount of experience would increase or stay the same in the future.Though most programs had an affiliated graduate orthodontic program, fewer than half of the programs had an orthodontist on faculty from the affiliated program (43 percent). As expected, orthodontic training varies with different program characteristics. The faculty members teaching orthodontics in pediatric dental residencies are often not from affiliated graduate orthodontic programs. Most program directors do not anticipate a decrease in the didactic or clinical components in the next five years.

PMID: 12856961 [PubMed - indexed for MEDLINE]

Stress management for dental students performing their first pediatric restorative procedure.

J Dent Educ. 2003 May;67(5):542-8

Authors: Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK

Research has demonstrated that dental students experience considerable stress during their training. Students' anxiety is likely to be especially high when they perform their first pediatric restorative procedure. The aims of this study were to provide a description of dental students' level of anxiety and typical coping strategies and to evaluate the use of a distress management intervention for reducing anxiety around their first pediatric restorative procedure. Dental students were randomly assigned to either an Anxiety Management or an Attention Control group. The management group received training on relaxation strategies (i.e., deep breathing, progressive muscle relaxation). The control group attended a lecture on the relation among stress, anxiety, and health. No significant differences were found between group levels of anxiety related to their first pediatric restorative procedure. Information is provided on students' reported level of anxiety and general coping strategies. Limitations of the current study and suggestions for future research are provided.

PMID: 12809189 [PubMed - indexed for MEDLINE]

Oral health risk assessment timing and establishment of the dental home.

Pediatrics. 2003 May;111(5 Pt 1):1113-6

Authors: Hale KJ,

Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation's children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother or another intimate care provider, through shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's predisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.

PMID: 12728101 [PubMed - indexed for MEDLINE]

Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.

J Dent Educ. 2003 Mar;67(3):338-47

Authors: Graham E, Negron R, Domoto P, Milgrom P

The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program.

PMID: 12665063 [PubMed - indexed for MEDLINE]