Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children.

OBJECTIVES: The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. METHODS: This national cross-sectional study used pooled 2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. RESULTS: Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). CONCLUSIONS FOR PRACTICE: Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

Body mass index, oral health status and OHRQoL among special health care needs children and parenting stress: a case-control study in Southern Saudi Arabia.

The appropriateness for determining Oral Health Related Quality of Life (OHRQoL) of special children by their caregivers must be thoroughly assessed. The present study was conducted to assess the Oral health related quality of life of children with disability and the stress levels of their parents. Moreover, the study also evaluated the plaque, DMFT (Decayed, missing, filled teeth) and BMI (Body Mass Index) of disabled children (cases) and healthy children (controls). The present case-control study was carried out on 150 parents of disabled children and 30 parents of healthy children (control group) at King Khalid University, Abha, KSA. The Arabic version of the 36-item parenting stress index-short format (PSI-SF) instrument was used for the assessment of parental stress, and the WHOQOL-BREF (World Health Organization Quality of Life Brief Version) Arabic version questionnaire was used for the assessment of quality of life of children. The parents or the caregivers who would be mainly occupied in assisting and rendering care to their children with different disabilities (certified by a pediatrician, aged between 4-14 years), were included in the study. Data were analyzed using statistical software. The total mean value score of the PSI scale of parents of cases was statistically found to be significantly higher compared to the mean scores among parents of controls (p = 0.004). The correlation between BMI and plaque & BMI and DMFT+df of cases indicated no statistically significant correlation while a statistically significant correlation between plaque and DMFT+df values in cases was observed. The mean score of the social relationship domain was statistically significantly different across the four levels of parents' educational status. The severity of dental caries, plaque accumulation and education-level of caregivers had a significant impact on the OHRQoL, however, BMI did not show a significant relation with DMFT and plaque scores. The parenting stress was found to be statistically higher among the parents of cases compared to the parents of controls.

Caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers.

INTRODUCTION: Dental caries continues to be a public healthcare problem due to its high prevalence and morbidity. It was proposed to evaluate caries indicators in relation to healthcare access and hygienic-dietary habits in Spanish preschoolers. MATERIALS AND METHODS: A cross-sectional study was carried out on a random sample consisting of 343 patients ranging from 3 to 5 years of age in the primary care setting, the main measurements were: dental care access, hygienic-dietary habits, and caries registration according to WHO criteria. RESULTS: The prevalence of caries was 35.3% and mean ± standard deviation (SD) dft was 1.51 ± 2.93. Preschoolers who had ever visited the dentist had a higher dft occurrence than those who had never attended the dentist. The lower prevalence of caries was significantly associated with the frequency of two daily brushings versus non-daily brushing (p = 0.007; 25.3% vs. 47.1%) and was 10.7% lower in patients who had the habit of night brushing (p = 0.041). The consumption of sugary liquids between meals implied a higher dft index. CONCLUSIONS: The high prevalence of early childhood caries and the dental care access associated with poor oral health suggest the need to implement a multidisciplinary oral healthcare program that involves both healthcare and dental healthcare professionals in Primary Health Care Units without forgetting the participation of the community and local administrations.

Retention procedures for stabilising tooth position after treatment with orthodontic braces.

BACKGROUND: Without a phase of retention after successful orthodontic treatment, teeth tend to 'relapse', that is, to return to their initial position. Retention is achieved by fitting fixed or removable retainers to provide stability to the teeth while avoiding damage to teeth and gums. Removable retainers can be worn full- or part-time. Retainers vary in shape, material, and the way they are made. Adjunctive procedures are sometimes used to try to improve retention, for example, reshaping teeth where they contact ('interproximal reduction'), or cutting fibres around teeth ('percision'). This review is an update of one originally published in 2004 and last updated in 2016. OBJECTIVES: To evaluate the effects of different retainers and retention strategies used to stabilise tooth position after orthodontic braces. SEARCH METHODS: An information specialist searched Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase and OpenGrey up to 27 April 2022 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: Randomised controlled trials (RCTs) involving children and adults who had retainers fitted or adjunctive procedures undertaken to prevent relapse following orthodontic treatment with braces. We excluded studies with aligners. DATA COLLECTION AND ANALYSIS: Two review authors independently screened eligible studies, assessed risk of bias and extracted data. Outcomes were stability or relapse of tooth position, retainer failure (i.e. broken, detached, worn out, ill-fitting or lost), adverse effects on teeth and gums (i.e. plaque, gingival and bleeding indices), and participant satisfaction. We calculated mean differences (MD) for continuous data, risk ratios (RR) or risk differences (RD) for dichotomous data, and hazard ratios (HR) for survival data, all with 95% confidence intervals (CI). We conducted meta-analyses when similar studies reported outcomes at the same time point; otherwise results were reported as mean ranges. We prioritised reporting of Little's Irregularity Index (crookedness of anterior teeth) to measure relapse, judging the minimum important difference to be 1 mm. MAIN RESULTS: We included 47 studies, with 4377 participants. The studies evaluated: removable versus fixed retainers (8 studies); different types of fixed retainers (22 studies) or bonding materials (3 studies); and different types of removable retainers (16 studies). Four studies evaluated more than one comparison. We judged 28 studies to have high risk of bias, 11 to have low risk, and eight studies as unclear.  We focused on 12-month follow-up.  The evidence is low or very low certainty. Most comparisons and outcomes were evaluated in only one study at high risk of bias, and most studies measured outcomes after less than a year. Removable versus fixed retainers Removable (part-time) versus fixed   One study reported that participants wearing clear plastic retainers part-time in the lower arch had more relapse than participants with multistrand fixed retainers, but the amount was not clinically significant (Little's Irregularity Index (LII) MD 0.92 mm, 95% CI 0.23 to 1.61; 56 participants). Removable retainers were more likely to cause discomfort (RR 12.22; 95% CI 1.69 to 88.52; 57 participants), but were associated with less retainer failure (RR 0.44, 95% CI 0.20 to 0.98; 57 participants) and better periodontal health (Gingival Index (GI) MD -0.34, 95% CI -0.66 to -0.02; 59 participants). Removable (full-time) versus fixed   One study reported that removable clear plastic retainers worn full-time in the lower arch did not provide any clinically significant benefit for tooth stability over fixed retainers (LII MD 0.60 mm, 95% CI 0.17 to 1.03; 84 participants). Participants with clear plastic retainers had better periodontal health (gingival bleeding RR 0.53, 95% CI 0.31 to 0.88; 84 participants), but higher risk of retainer failure (RR 3.42, 95% CI 1.38 to 8.47; 77 participants). The study found no difference between retainers for caries.  Different types of fixed retainers Computer-aided design/computer-aided manufacturing (CAD/CAM) nitinol versus conventional/analogue multistrand One study reported that CAD/CAM nitinol fixed retainers were better for tooth stability, but the difference was not clinically significant (LII MD -0.46 mm, 95% CI -0.72 to -0.21; 66 participants). There was no evidence of a difference between retainers for periodontal health (GI MD 0.00, 95% CI -0.16 to 0.16; 2 studies, 107 participants), or retainer survival (RR 1.29, 95% CI 0.67 to 2.49; 1 study, 41 participants). Fibre-reinforced composite versus conventional multistrand/spiral wire  One study reported that fibre-reinforced composite fixed retainers provided better stability than multistrand retainers, but this was not of a clinically significant amount (LII MD -0.70 mm, 95% CI -1.17 to -0.23; 52 participants). The fibre-reinforced retainers had better patient satisfaction with aesthetics (MD 1.49 cm on a visual analogue scale, 95% CI 0.76 to 2.22; 1 study, 32 participants), and similar retainer survival rates (RR 1.01, 95% CI 0.84 to 1.21; 7 studies; 1337 participants) at 12 months. However, failures occurred earlier (MD -1.48 months, 95% CI -1.88 to -1.08; 2 studies, 103 participants; 24-month follow-up) and more gingival inflammation at six months, though bleeding on probing (BoP) was similar (GI MD 0.59, 95% CI 0.13 to 1.05; BoP MD 0.33, 95% CI -0.13 to 0.79; 1 study, 40 participants). Different types of removable retainers Clear plastic versus Hawley When worn in the lower arch for six months full-time and six months part-time, clear plastic provided similar stability to Hawley retainers (LII MD 0.01 mm, 95% CI -0.65 to 0.67; 1 study, 30 participants). Hawley retainers had lower risk of failure (RR 0.60, 95% CI 0.43 to 0.83; 1 study, 111 participants), but were less comfortable at six months (VAS MD -1.86 cm, 95% CI -2.19 to -1.53; 1 study, 86 participants). Part-time versus full-time wear of Hawley There was no evidence of a difference in stability between part-time and full-time use of Hawley retainers (MD 0.20 mm, 95% CI -0.28 to 0.68; 1 study, 52 participants). AUTHORS' CONCLUSIONS: The evidence is low to very low certainty, so we cannot draw firm conclusions about any one approach to retention over another. More high-quality studies are needed that measure tooth stability over at least two years, and measure how long retainers last, patient satisfaction and negative side effects from wearing retainers, such as tooth decay and gum disease.

ANTECEDENTES: Sin una fase de retención tras un tratamiento de ortodoncia exitoso, los dientes tienden a "recaer", es decir, a volver a su posición inicial. La retención se consigue colocando retenedores fijos o removibles para proporcionar estabilidad a los dientes y evitar al mismo tiempo daños en dientes y encías. Los retenedores removibles pueden llevarse a tiempo completo o parcial. Los retenedores varían en la forma, el material y el modo de fabricación. A veces se utilizan procedimientos complementarios para intentar mejorar la retención, por ejemplo, remodelando los dientes en la zona de contacto ("reducción interproximal") o cortando fibras alrededor de los dientes ("pericisión"). Esta revisión es una actualización de una publicada originalmente en 2004 y actualizada por última vez en 2016. OBJETIVOS: Evaluar los efectos de los diferentes retenedores y estrategias de retención utilizados para estabilizar la posición de los dientes después del tratamiento con aparatos de ortodoncia. MÉTODOS DE BÚSQUEDA: Un documentalista realizó búsquedas en el Registro de ensayos del Grupo Cochrane de Salud oral (Cochrane Oral Health), en CENTRAL, MEDLINE, Embase y OpenGrey hasta el 27 de abril de 2022 y utilizó métodos de búsqueda adicionales para identificar estudios publicados, no publicados y en curso. CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorizados (ECA) con niños y adultos a los que se les colocaron retenedores o se les realizaron procedimientos complementarios para prevenir la recaída tras el tratamiento con aparatos de ortodoncia. Se excluyeron los estudios con alineadores. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión realizaron de forma independiente la revisión de los estudios elegibles, evaluaron el riesgo de sesgo y extrajeron los datos. Los desenlaces fueron la estabilidad o recaída de la posición dental, el fracaso del retenedor (es decir, roto, desprendido, desgastado, mal ajustado o perdido), los efectos adversos en dientes y encías (es decir, índices de placa, gingivales y de sangrado) y la satisfacción de los participantes. Se calcularon las diferencias de medias (DM) para los datos continuos, las razones de riesgos (RR) o las diferencias de riesgos (DR) para los datos dicotómicos, y los cociente de riesgos instantáneos (CRI) para los datos de supervivencia, todos ellos con intervalos de confianza (IC) del 95%. Se realizaron metanálisis cuando estudios similares informaron desenlaces en el mismo punto temporal; de lo contrario, los resultados se informaron como rangos medios. Se dio prioridad a la notificación del Little's Irregularity Index (torcedura de los dientes anteriores) para medir la recaída, considerando que la diferencia mínima importante era de 1 mm. RESULTADOS PRINCIPALES: Se incluyeron 47 estudios con 4377 participantes. Los estudios evaluaron: retenedores removibles versus fijos (ocho estudios); diferentes tipos de retenedores fijos (22 estudios) o materiales adhesivos (tres estudios); y diferentes tipos de retenedores removibles (16 estudios). Cuatro estudios evaluaron más de una comparación. Se consideró que 28 estudios tenían un alto riesgo de sesgo, 11 un riesgo bajo y en ocho estudios fue incierto. El centro de atención de esta revisión fue el seguimiento a los 12 meses. La evidencia es de certeza baja a muy baja. La mayoría de las comparaciones y los desenlaces se evaluaron en un solo estudio con alto riesgo de sesgo, y la mayoría de los estudios midieron los desenlaces después de menos de un año. Retenedores removibles versus fijos Removible (a tiempo parcial) versus fijo Un estudio informó que los participantes que llevaban retenedores de plástico transparente a tiempo parcial en la arcada inferior presentaron más recaídas que los participantes con retenedores fijos de múltiples barras, pero la cantidad no fue clínicamente significativa (Little's Irregularity Index [IIL] DM 0,92 mm; IC del 95%: 0,23 a 1,61; 56 participantes). Los retenedores removibles tuvieron más probabilidades de causar molestias (RR 12,22; IC del 95%: 1,69 a 88,52; 57 participantes), pero se asociaron con menos fracaso del retenedor (RR 0,44; IC del 95%: 0,20 a 0,98; 57 participantes) y mejor salud periodontal (Gingival Index [IG] DM ­0,34; IC del 95%: ­0,66 a ­0,02; 59 participantes). Removible (a tiempo completo) versus fijo Un estudio informó que los retenedores removibles de plástico transparente utilizados a tiempo completo en la arcada inferior no proporcionaron efectos beneficiosos clínicamente significativos en la estabilidad dental en comparación con los retenedores fijos (LII DM 0,60 mm; IC del 95%: 0,17 a 1,03; 84 participantes). Los participantes con retenedores de plástico transparente tenían mejor salud periodontal (sangrado gingival RR 0,53; IC del 95%: 0,31 a 0,88; 84 participantes), pero mayor riesgo de fracaso del retenedor (RR 3,42; IC del 95%: 1,38 a 8,47; 77 participantes). El estudio no encontró diferencias entre los retenedores en las caries. Diferentes tipos de retenedores fijos De nitinol con diseño asistido por ordenador/fabricación asistida por ordenador (DAO/FAO) versus de múltiples barras convencional/analógico Un estudio informó que los retenedores fijos de nitinol con DAO/FAO fueron mejores para la estabilidad dental, pero la diferencia no fue clínicamente significativa (LII DM ­0,46 mm; IC del 95%: ­0,72 a ­0,21; 66 participantes). No hubo evidencia de una diferencia entre los retenedores en la salud periodontal (GI MD 0,00; IC del 95%: ­0,16 a 0,16; dos estudios, 107 participantes) ni en la supervivencia del retenedor (RR 1,29; IC del 95%: 0,67 a 2,49; un estudio, 41 participantes). Composite reforzado con fibra versus alambre de múltiples barras/en espiral convencional Un estudio informó que los retenedores fijos de composite reforzado con fibra proporcionaron una mayor estabilidad que los retenedores de múltiples barras, pero no fue clínicamente significativa (LII DM ­0,70 mm; IC del 95%: ­1,17 a ­0,23; 52 participantes). Los retenedores reforzados con fibra tuvieron una mejor satisfacción del paciente con respecto a la estética (DM 1,49 cm en una escala visual analógica; IC del 95%: 0,76 a 2,22; un estudio, 32 participantes) y tasas similares de supervivencia del retenedor (RR 1,01, IC del 95%: 0,84 a 1,21; siete estudios; 1337 participantes) a los 12 meses. Sin embargo, los fracasos se produjeron antes (DM ­1,48 meses; IC del 95%: ­1,88 a ­1,08; dos estudios, 103 participantes; seguimiento de 24 meses) y más inflamación gingival a los seis meses, aunque el sangrado al sondaje (SS) fue similar (GI DM 0,59; IC del 95%: 0,13 a 1,05; SS DM 0,33; IC del 95%: ­0,13 a 0,79; un estudio, 40 participantes). Diferentes tipos de retenedores removibles Plástico transparente versus Hawley Cuando se llevó en la arcada inferior durante seis meses a tiempo completo y seis meses a tiempo parcial, el plástico transparente proporcionó una estabilidad similar a los retenedores Hawley (LII DM 0,01 mm; IC del 95%: ­0,65 a 0,67; un estudio, 30 participantes). Los retenedores Hawley tuvieron un menor riesgo de fracaso (RR 0,60; IC del 95%: 0,43 a 0,83; un estudio, 111 participantes), pero resultaron menos cómodos a los seis meses (EVA DM ­1,86 cm; IC del 95%: ­2,19 a ­1,53; un estudio, 86 participantes). Hawley a tiempo parcial versus a tiempo completo No hubo evidencia de una diferencia en la estabilidad entre el uso a tiempo parcial y a tiempo completo de los retenedores Hawley (DM 0,20 mm; IC del 95%: ­0,28 a 0,68; un estudio, 52 participantes). CONCLUSIONES DE LOS AUTORES: La evidencia es de certeza baja a muy baja, por lo que no fue posible establecer conclusiones firmes sobre un método de retención en detrimento de otro. Se necesitan más estudios de alta calidad que midan la estabilidad de los dientes durante al menos dos años, así como la duración de los retenedores, la satisfacción de los pacientes y los efectos secundarios negativos del uso de retenedores, como caries y enfermedades de las encías.

Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: US Preventive Services Task Force Recommendation Statement.

Importance: Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years. Population: Asymptomatic children and adolescents aged 5 to 17 years. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. Recommendations: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).

OPERATIONALIZING ORAL HEALTH OUTCOME MEASURES TO IMPROVE THE ORAL HEALTH OF PERSONS WITH INTELLECTUAL DISABILITIES.

Individuals with intellectual disability (ID) face significant challenges in preventing oral diseases. They also lack access to high-quality oral health care in professional settings. To understand the effects of oral conditions on their lives and health, it is necessary to assess their oral health outcome measures. For those with mild ID, who possess adequate linguistic and cognitive abilities, accessibility features should be incorporated in the dental patient reported outcome (dPRO) measures. But many other individuals often lack the linguistic and cognitive ability to self-report through dPRO measures. While self-reported measures are preferable, requiring dPROs in this population would result in a high amount of missing data and the inability to assess interventions for improving their dental health. Thus, there is a need to use proxy-reported outcome (ProxRO) measures, observer reported outcome (ObsRO) measures, and clinician reported outcome (ClinRO) measures among those with ID. This is also a common approach taken by other specialties that work closely with those with ID, where the measures for activities of daily living and adaptive behavior measures use reporting by caregivers. ProxRO measures in dentistry that were created for infants and young children provide a structure for appropriate adaptations and the creation of relevant outcome measures. Including input from the intensely multidisciplinary teams that provide supports for those with ID is key to creating high-quality measures and oral health interventions for those with ID.

The transitional care pathway following traumatic dental injuries: Patient perspectives.

BACKGROUND AND AIM: The nature of complex traumatic dental injuries (TDIs) often means that management continues through paediatric to adult dental services. Evidence suggests that failure in transitional care can have detrimental impacts on health. There is limited evidence regarding patients' experiences of transitional care pathways (TCPs) in dentistry. The aim of this study was to investigate the views and experiences of the TCP from paediatric to adult care for individuals who have experienced TDIs. MATERIALS AND METHODS: Semi-structured interviews were undertaken. Ethical approval was granted by the Health Research Authority and sponsored by the University of Liverpool. Inclusion criteria included individuals aged 16 to 21 years old who had received care in both paediatric and adult restorative dentistry departments at Liverpool University Dental Hospital following a TDI. Five purposively sampled patients were interviewed. Thematic analysis was undertaken using NVivo. RESULTS: Thematic analysis identified 5 main themes with regard to transitional care experience: patient-clinician communication, impact of dental trauma, feelings of uncertainty, patient personal development and transitional care planning. Feelings of uncertainty with regard to the long-term prognosis of traumatized teeth were highlighted. Clear communication and involvement of young people in decision-making was identified as a vital factor to facilitate a successful TCP experience. CONCLUSION: The involvement of young people in decision-making is essential for a successful TCP. Consideration should be given to development of TCP guidance, to allow for the provision of timely and consistent information regarding the process. Despite this, there needs to be adaptivity within the TCP to create a successful TCP for every young person.

Dental fear in school children and young adults attending public dental health care: prevalence and relationship to gender, oral disease and dental treatment; trends over 40 years.

PURPOSE: To study prevalence of dental fear and the relationship to gender, oral disease and dental treatment between 1973 and 2013 in school children and young adults attending public dental health care. METHODS: Every ten years from 1973 to 2013 random samples of about 100 individuals in each of the age groups 10, 15 and 20 years took part in a repeated cross-sectional study based on clinical parameters and a questionnaire. Dental fear was estimated by the question: "What do you feel at the prospect of an appointment with a dentist?". 75-99% of the samples answered the question. Agreement to at least one of the alternative answers: ill at ease, frightened and sick defined dental fear. Frightened and/or sick indicated severe dental fear. The prevalence of caries, gingivitis and number of filled tooth surfaces were calculated. Chi-square tests were used to show differences in proportions between groups and linear regression to show trends over time. RESULTS: Prevalence of dental fear declined in all age groups over time. In the 20-year olds dental fear was found in 29% of the sample and severe dental fear in 12% of girls and 5% of boys in 2013. Individuals with dental fear had higher mean caries prevalence and number of filled tooth surfaces compared with individuals without dental fear. CONCLUSIONS: This 40-year time trend study showed a reduction in dental fear prevalence in school children and young adults offered regular public dental health care based on prevention and a psychological approach. The prevalence of dental fear was still high in 2013 despite a significant decline in caries during the study period. Further improvements in the psychological approach when treating children are thus needed.

Efficacy of tooth brushing via a three-dimensional motion tracking system for dental plaque control in school children: a randomized controlled clinical trial.

BACKGROUND: School children are in a developmental period in which permanent teeth replace primary dentition. It is also a period with a high incidence of gingivitis and caries, which can be improved with adequate tooth brushing. Advances in information technology have led to the development of smart health devices that assist in tooth brushing. We compared the effectiveness of computer-assisted toothbrushing using a toothbrushing instruction (TBI) method called the smart toothbrush and smart mirror (STM) system with that of conventional TBI (verbal instructions) for plaque control in school children. METHODS: This randomized controlled clinical trial analyzed and compared the reduction of the modified Quigley-Hein plaque index between the two methods in 42 school children. The participants were randomly assigned to the STM system group (n = 21) or conventional-TBI group (n = 21). The plaque indices were evaluated at baseline, immediately after TBI (day 0), and 1 week and 1 month after TBI. RESULTS: The STM system and conventional TBI led to an average reduction of 40.50% and 40.57%, respectively, in whole mouth plaque. Reductions in the plaque indices within each tested time period were observed in both groups (P < 0.001), and the mean plaque reduction did not differ between the two groups (P = 0.44). CONCLUSIONS: The present study tested a computer assisted system for TBI, more studies are needed to confirm its usefulness in different objectives. Clinical relevance The computer-assisted STM system may be an alternative of TBI for children. Trial registration ClinicalTrials.gov (NCT04627324) Registered 13/11/2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04627324 .

Ultra-processed foods and early childhood caries in 0-3-year-olds enrolled at Primary Healthcare Centers in Southern Brazil.

OBJECTIVE: To investigate the relationship between ultra-processed food consumption and early childhood caries. DESIGN: Cross-sectional analysis of baseline data from a cluster randomised controlled study. Outcomes included the prevalence of children with non-cavitated and cavitated caries. The main exposure was the total daily consumption of ultra-processed foods (up to three times and four times or more), assessed through a FFQ. Potential confounders were socio-demographic characteristics of the child and caregiver/family, child breast-feeding, oral hygiene and use of dental services. Poisson regression using robust variance adjustment was used to estimate prevalence ratios (PR) and their respective 95 % CI. SETTING: Primary Healthcare Centers in an urban area of Pelotas, Southern Brazil. PARTICIPANTS: Children aged 0-3 years (n 309). RESULTS: Consumption of ultra-processed foods four times or more a day was found in 67·6 % of children; 24·4 and 12·0 % presented non-cavitated and cavitated caries, respectively. After adjustment, children who consumed ultra-processed foods four times or more a day were more likely to present both non-cavitated caries (PR 2·25, 95 % CI 1·19, 4·27, P = 0·013) and cavitated caries (PR 3·48, 95 % CI 1·18, 10·30, P = 0·024) compared with those who have consumed them up to three times a day. CONCLUSIONS: Consumption of ultra-processed foods is associated with early childhood caries. Interventions aiming at reducing ultra-processed food consumption should be implemented to improve children's oral health.

Trends in rates and inequalities in paediatric admissions for Ambulatory Care Sensitive Conditions in Victoria, Australia (2003 to 2013).

AIM: To examine 10-year trends and inequalities in paediatric admission rates for acute and chronic Ambulatory Care Sensitive Conditions (ACSCs) in Victoria, Australia. METHODS: Secondary data analysis of the Victorian Admitted Episodes Dataset of children aged 0-17 years and 11 months admitted with a principal diagnosis of acute ACSCs: gastroenteritis/dehydration, dental conditions and urinary tract infections (UTIs) or chronic ACSCs: asthma and diabetic ketoacidosis, from 2003 to 2013. Main outcome measure was trends in paediatric hospital admission rates for ACSCs (per 1000 population). RESULTS: Over the 10 years, hospital admission rates remained consistently high for asthma and dental conditions. Children from socioeconomically disadvantaged areas were more likely to be admitted for all acute conditions over time. Dental conditions were the only ACSC associated with increased rates of admissions in regional areas. CONCLUSIONS: Inequalities in paediatric hospital admissions exist for acute conditions and have not changed from 2003 to 2013; disadvantaged Victorian children were more likely to be admitted to hospital at each time point. More equitable access to medical and dental care is needed. Primary care (medical and dental) should be a critical platform to address socio-economic differences and effectively prevent avoidable hospital admissions in children.

10-year follow-up study on attendance pattern after dental treatment in primary oral health care clinic for fearful patients.

BACKGROUND: Dental fear may lead to avoidance of regular dental treatment. The scope of this long-term practe-based study was to monitor the dental attendance of patients who received chair-side dental and fear treatment. METHODS: In 2000-2006, patients in the City of Oulu, Finland, received treatment for dental fear in the Clinic for Fearful Dental Patients (CFDP) from primary health care dentists trained on this subject. Of the originally treated patients (n = 163), 152 (93%) with sufficient information in dental records made up the study population. Information on their age and sex was available. The number of dental examinations, emergency visits and missed appointments was collected covering the follow-up period of 10 years 2006-2016. For analyses, data were dichotomized according to age at baseline and preliminary outcome baseline condition of dental fear treatment evaluated in 2006. To investigate association further, Poisson regression as well as binary logistic regression models were conducted. As register keeper, the City of Oulu gave permission for this retrospective data-based study. RESULTS: Patients receiving dental fear treatment at younger age (2-10 y) had significantly more dental examinations than those treated at > 10 years. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. Sex was not a significant factor in later dental attendance. There was an association between few dental examinations and dental emergency care need with unsuccessful baseline outcome of dental fear treatment. CONCLUSIONS: Successful dental fear treatment especially at an early age is beneficial for future dental attendance measured by the number of examinations and consequently, less need for emergency care than in the opposite case. Successful fear treatment has positive impact on later dental care and regular dental attendance.

ESTABLISHING A QUALITY IMPROVEMENT CULTURE WITHIN A LARGE INTEGRATED MEDICAL-DENTAL HEALTH SYSTEM WITH A POPULATION BASED FOCUS.

OBJECTIVES: Quality improvement strategies have been an integral part of healthcare to attain improved care delivery and effective health outcomes. The dental quality initiative improvement (DQII) presented in this manuscript represents a case study of successful implementation of a quality improvement culture within a large integrated-medical-dental health system serving a largely rural population. METHODS: The key elements of DQII included steering committee establishment, definition or dental quality measures and development/implementation of a dental quality analytics dashboard (DQAD) that provides relevant data on dental quality measures. Qualitative metrics were applied to look at the improvement in performance for the various measures relative to quality benchmarks. RESULTS: DQII facilitated improved oversight of care continuity and provider performance surrounding quality measures at granular and/or institutional level. Improvement associated with care delivery performance relative to benchmarks was observed. CONCLUSIONS: DQII further advanced the quality improvement culture prevalent in our learning healthcare environment with its focus on value-based care delivery. DQII initiative and establishment of DQAD provided ability to track performance in operational care delivery for dental providers in a clinical setting in real time.

Development of a core outcome set for use in routine orthodontic clinical trials.

INTRODUCTION: A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups. METHODS: A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16 years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set. RESULTS: After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures. CONCLUSIONS: A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.

A music- and game-based oral health education for visually impaired school children; multilevel analysis of a cluster randomized controlled trial.

BACKGROUND: Visually impaired children encounter some challenges for their oral health. We aimed to compare the effectiveness of oral health education using Audio Tactile Performance (ATP) technique alone, ATP combined with oral health education for mothers, and ATP along with art package on the oral health status of visually impaired children. MATERIALS AND METHODS: This cluster, randomized trial, included visually impaired children from preschool to 10th grade (32 classes, n = 200), in Tehran, Iran, in 2018-2019. A questionnaire was filled out through face to face interviews at baseline regarding age, gender, status of visual impairment, and place of residence. The Simplified Oral Hygiene Index (OHI-S) and Bleeding on Probing (BOP) were examined afterward. Classes were randomly assigned to three groups through simple randomization: 1. Art group (ATP, game-based, and music-based education (11 classes, n = 66); 2. Mothers group (children received ATP and their mothers received education by telephone (10 classes, n = 73); and 3. Control group (children received ATP (11 classes, n = 61). Children received reinforcement after 1 and 2 weeks. Follow-up oral examinations were performed after 1 and 2 months by a blind calibrated examiner. Descriptive statistics were performed using Chi-Square, and ANOVA tests by SPSS (version 22). In analytic statistics, two-level mixed-effects models for BOP and OHI-S were fitted using the Statistical Analysis Software (SAS) version 9.4. Both models fitted with the grouping variable and time (baseline, 1, and 2 months after interventions) as the fixed effects. RESULTS: The mean age (SD) of the children was 12.29 (3.45) years (range: 6-17). Male children (67%) more than female children (33%) participated in the study. Also, 35.5% were blind, and 12% resided at the dormitory. The art and mothers groups had no statistically significant difference compared with the control group, in terms of OHI-S (P = 0.92, and 0.39, respectively) and BOP (OR = 0.64, and 0.66, respectively). The time effect was statistically significant in both BOP and OHI-S models (P < 0.0001). CONCLUSIONS: ATP technique is an effective method to improve the oral health status of visually impaired school children. Oral health promotion programs can be done using this method to tackle oral hygiene problems in visually impaired children. TRIAL REGISTRATION: (https://www.irct.ir/trial/34676: Nov 29th, 2018).

Emergency management of dental injury; preparedness among school teachers in Bhubaneswar, India.

BACKGROUND: School is the place, identified with a noticeable risk of Traumatic Dental Injuries (TDI) in children which have functional, esthetic and psychological effects. OBJECTIVES: To assess the preparedness of concerning traumatic dental injuries and their management among school teachers and also to empower the clinician to frame a set of instructions for school teachers to handle the emergencies effectively at the site of the incident. MATERIAL AND METHODS: A cross-sectional study was conducted among 330 school teachers enrolled in government and private schools of 24 randomly selected schools in Bhubaneswar city. A self-administered questionnaire was distributed to collect information on participants demographic characteristics, knowledge, attitude and practice about emergency management of Traumatic Dental Injury. Chi-square test with level of significance set at 5% was used for statistical analysis. RESULTS: Statistically significant (p<0.05) correct responses were provided by 66.7% males and 35.6% females and 100% younger age teachers. Larger population perceived that their level of knowledge was not satisfactory as they responded for inadequate and don't know options which was significant in relation to gender and age (p<0.05) but not with respect to the type of school (p>0.05). All the respondents expressed the need for a training program. CONCLUSIONS: This study highlights the instantaneous need for tailor made dental health educational and preventive programs for school teachers in order to effectively manage the Traumatic Dental Injuries.

Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments.

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.

Developmental defects of enamel in the deciduous incisors of infants born preterm: Prospective cohort.

OBJECTIVE: Developmental defects of enamel (DDE) in preterm infants still require clarification and may favour dental caries, lower food intake and greater difficulty with weight-height gain. We evaluated factors associated with DDE in preterm infants. SUBJECTS AND METHODS: In this prospective cohort study, we monitored 54 prematurely born infants from birth to 24 months of age. Trained and calibrated dentists examined the oral cavity of these children to identify and categorize DDE. Information on perinatal variables was collected from the infants' medical records and interviews with their mothers. The data were analysed using Student's t test, a chi-squared test and Pearson's product-moment correlation coefficient. RESULTS: A total of 46.3% of the 54 children presented DDE, which was observed more frequently in the left hemiarch in children born extremely (<28 weeks of gestation) or very preterm (28 to <32 weeks; RR = 2.2; 95% CI 1.3-3.6), with very low birthweight (<1,500 g; RR = 2.0; 95% CI 1.1-3.5), who were admitted to the neonatal intensive care unit (RR = 1.3; 95% CI 1.0-1.7), and who were intubated (RR = 1.6; 95% CI 1.1-2.2). CONCLUSIONS: The high incidence of incisor enamel defects, particularly on the left side, was related to higher risk prematurity and to local trauma from intubation.

Outcome Measures in UCLP: The Modified 5-Year-Olds'-Index-Development and Reliability.

OBJECTIVE: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN: Retrospective method comparison and development study. SETTING: School of Oral and Dental Science, University of Bristol. METHODS: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.

CAD-CAM-fabricated mini-implant insertion guides for the delivery of a distalization appliance in a single appointment.

This article reports on the technical aspects of using a computer-aided design-computer-aided manufacturing (CAD-CAM) insertion guide for the placement of orthodontic mini-implants used for the purpose of providing anchorage support for maxillary molar distalization. A 10-year-old girl presented with a bilateral full-step Angle Class II molar relationship in the permanent dentition, with anterior arch-length insufficiency and blocked out maxillary canine teeth. The primary treatment objective was to provide an esthetic and functional occlusal outcome, and secondarily to avoid the removal of multiple premolar teeth. The patient was initially treated with an implant-supported distalization device, and the occlusion was subsequently detailed with preadjusted fixed orthodontic appliances. The CAD-CAM procedure facilitates the safe and precise insertion of mini-implants in the anterior palate, potentially broadening the scope of use of palatal mini-implants for less experienced clinicians. The illustrated protocol allows for the insertion of mini-implants and fitting of a prefabricated appliance in a single office appointment.