Dental Caries: Early Intervention and the Role of the Pediatrician.

Despite improvements in oral morbidity levels and access to care among the pediatric population, there are still major disparities in the United States. Results of national surveys have documented a decrease in the number of children receiving either a dental examination or a cleaning. This finding is particularly concerning for toddlers and infants, as early preventive dental visits and the establishment of a dental home is cost-effective and leads to enhanced oral health outcomes over the life span. Many infants and toddlers do not visit a dentist, suggesting that the recommendations of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to establish a dental home are not appropriately adopted.

Dental providers' familiarity with and attitudes about alternative payment models in value-based care.

The objective of this study was to examine dental providers' familiarity with and attitudes toward alternative payment models (APMs) in a value-based care (VBC) delivery model. The authors analyzed responses to questions pertaining to VBC and APMs from a survey conducted between March and April 2021. Responses were stratified by age, race, practice location, practice type, and provider specialty using descriptive and inferential analysis, including Pearson chi-square or Fisher exact test. Analyses were performed using statistical software, with P < 0.05 indicating statistical significance. The sample consisted of 378 dental providers (women, n = 211). The majority (n = 321) worked in private practice; 170 were general dentists and 41 were pediatric dentists. Public health practitioners were more likely than private practitioners to report being familiar with VBC strategies and APMs (P < 0.003). Older providers were less interested than younger providers in participating in risk-sharing agreements (P < 0.049), while those practicing in urban locations were more likely to consider participating in partial (P < 0.001) and full capitation models (P < 0.014). Hispanic dentists and public health practitioners were more likely (P < 0.025 and P < 0.015, respectively) than other respondents to report that VBC arrangements would lead to more equitable outcomes. While some dental providers understood APMs and reported using them, survey respondents in general were unfamiliar with both VBC and APMs.

Enhancing the pediatric dentistry skills and knowledge of general dentists.

The purpose of this study was to evaluate the outcomes of a training initiative aimed at enhancing general dentists' knowledge and clinical skills in pediatric dentistry. Data were gathered from participants in 2-day didactic and preclinical training courses offered at Nicklaus Children's Hospital from December 2015 through December 2016. Clinical knowledge was measured with a 30-item questionnaire, and self-efficacy was measured with standardized instruments. The participants' satisfaction with the course was measured at the end of the program. Data on patterns of treatment were collected pretraining and 3 months posttraining via a follow-up survey. During the study period, 38 general dentists participated in the training program and reported statistically significant increases in knowledge and cognitive skills (P < 0.05). All of the respondents to the follow-up survey reported an increase in the number of children treated and scope of services provided, and all respondents expressed satisfaction with the course (response rate = 34.2%). Training initiatives seeking to enhance the clinical skills and knowledge of general dentists may be an effective tool for modifying patterns of treatment, increasing access to care for children, and maximizing the capacity of the safety net system.

Passive Observer Instruction on Parental Satisfaction in a Dental Setting.

PURPOSE: To assess the effect of a single pre-operative instruction given to parents to be a passive observer on satisfaction with their child's dental visit. STUDY DESIGN: Parents of 105 healthy three to nine year-old patients presenting for their first restorative appointment were randomly assigned to the test or control group. The former received an oral instruction at the beginning of the appointment from the treating dentist to be a passive observer while the latter received a mock instruction. The dentist assessed whether the parent remained a passive observer during the visit. Parents completed a survey assessing satisfaction with their child's dental visit. RESULTS: More parents were rated as passive in the test group than in the control group, 67.3% vs. 32.1%, (P<0.01). However, no statistically significant difference was found in parental satisfaction between the test and the control group. CONCLUSION: Asking parents to act as passive observers may help preserve the advantages of parental presence in the operatory while eliminating many of the disadvantages. A single preoperative instruction given orally by the treating dentist to be a passive observer was effective and did not lead to a reduction in parental satisfaction.

Dental-Related Use of Hospital Emergency Departments by Hispanics and Non-Hispanics in Florida.

OBJECTIVES: To examine differences between Hispanics and non-Hispanics in Florida in the dental-related use of hospital emergency departments (EDs). METHODS: We used ambulatory ED discharge records from 2013 to 2015 to compute rates of ED visits for dental complaints per 10 000 population, by region, age, gender, and the percentage distribution visits by primary payer, day of the week, and hour of arrival. RESULTS: There were 64 100 ED visits for dental complaints by Hispanics and 425 162 by non-Hispanics. Medicaid was the most common primary payer for Hispanics (42.2%) and for non-Hispanics (38.1%). Rates of ED utilization for dental problems per 10 000 population were 45.5 for Hispanics and 95.2 for non-Hispanics. CONCLUSIONS: Rates of ED utilization for dental problems were different between Hispanics and non-Hispanics. Public Health Implications. Effective interventions need to be developed in the context of a social-ecological model to better understand factors such as health, economics, and education, among others. Understanding and intervening with the individual, communities, and policy could help to modify behaviors and improve access to dental care.

A Retrospective Study of the 3-Year Survival Rate of Resin-Modified Glass-Ionomer Cement Class II Restorations in Primary Molars.

OBJECTIVE: To determine the three-year survival rate of Class II resin-modified glass-ionomer cement (RMGIC), Vitremer, restorations in primary molars and to compare these results with measurements of survival of Class II restorations of standard restorative materials. STUDY DESIGN: Data on Class II restorations placed in primary molars during a six-year period were collected through a chart review and radiographic evaluation in the office of a board-certified pediatric dentist. A radiograph showing that the restoration was intact was required at least 3 years after placement to qualify as successful. If no radiograph existed, the restoration was excluded. If the restoration was not found to be intact radiographically or was charted as having been replaced before three years it was recorded as a failure. The results of this study were then compared to other standard restorative materials using normalized annual failure rates. RESULTS: Of the 1,231 Class II resinmodified glass-ionomer cement restorations placed over six years 427 met the inclusion criteria. There was a 97.42% survival rate for a 3-year period equivalent to an annual failure rate of 0.86%. CONCLUSIONS: A novel approach comparing materials showed that in this study Vitremer compared very favorably to previously published success rates of other standard restorative materials (amalgam, composite, stainless steel crown, compomer) and other RMGIC studies.

Job Satisfaction and Relocation Desire among Pediatric Dentists in Puerto Rico.

OBJECTIVE: To determine the levels of satisfaction, license status, and desire to relocate of pediatric dentists in Puerto Rico. METHODS: Pediatric dentists in Puerto Rico were surveyed via telephone interviews. Data were collected through a 34-item questionnaire that explored satisfaction as related to income, continuing education, professional goals, and participation in the Mi Salud program. Frequencies, chi-square analysis, and Fisher's exact 2-tailed t-test were utilized to determine the relationships between satisfaction and the demographics of the pediatric dentists. RESULTS: Sixty pediatric dentists participated in our survey-77% of the total number of pediatric dentists practicing in Puerto Rico. Overall, 65% of the participating pediatric dentists expressed dissatisfaction. Male pediatric dentists were more dissatisfied than their female colleagues were. Most pediatric dentists participating in Mi Salud expressed dissatisfaction. When asked about whether or not they had considered migrating to the mainland, those who were dissatisfied were more likely to have considered that idea than were those who were satisfied. Overall, 57% of the pediatric dentists comprising our sample had considered relocating to the continental United States. CONCLUSION: In general, the pediatric dentists who participated in our study expressed dissatisfaction in most areas except when asked about their ability to reach professional goals. Determining the levels of satisfaction of health care providers is important in the maintaining of an adequate workforce. As current levels of dissatisfaction are high, it is important to determine what variables are related to satisfaction so that corrective measures can be taken to ensure that retention rates improve, thereby maintaining an adequate pediatric dental workforce.

A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders?

BACKGROUND: Oral health is an integral component of general health and well-being. While edentulism has been examined in relation to socioeconomic status, rural residency, chronic disease and mental health, no study that we know of has examined edentulism and these factors together. The objective of this study was to determine whether depression and rural residency were significantly associated with partial and full edentulism in US adults after controlling for potential confounders. METHODS: 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify factors associated with increased odds of partial or full edentulism. This year of BRFSS data was chosen for analysis because in this year the standardized and validated Personal Health Questionnaire-8 (PHQ-8) was used to measure current depression. This measure was part of the optional questions BRFSS asks, and in 2006 33 states and/or territories included them in their annual surveillance data collection. Bivariate and logistic regression analyses were performed on weighted BRFSS data. RESULTS: Logistic regression analysis using either full or partial edentulism as the dependent variable yielded that rural residency or living in a rural locale, low and/or middle socioeconomic status (SES), depression as measured by the PHQ-8, and African American race/ethnicity were all independent risk factors when controlling for these and a number of additional covariates. CONCLUSIONS: This study adds to the epidemiological literature by assessing partial and full edentulism in the US utilizing data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS). Examining data collected through a large national surveillance system such as BRFSS allows for an analysis that incorporates an array of covariates not available from clinically-based data alone. This study demonstrated that current depression and rural residency are important factors related to partial and full edentulism after controlling for potential confounders.

Pediatric dentistry workforce in Puerto Rico: results of a 2011 survey.

OBJECTIVE: Determine the socio-demographic and educational characteristics of and develop a profile of practice for Pediatric Dentists (PDs) in Puerto Rico. METHODS: A 34-item questionnaire assessing 3 dimensions: socio-demographic and education, practice profile, and level of satisfaction/desire to relocate, was developed and pre-tested for comprehensiveness, validity, and reliability. Data were collected through telephone interviews by a calibrated interviewer, entered and tabulated using Excel (Microsoft Office 2010) and exported to SPSS v. 17 (SPSS Inc., Chicago, IL). Descriptive statistical analyses were conducted. RESULTS: Eighty percent (80%) of all of the licensed PDs in PR participated in our study. The typical PD in PR has been in practice for 19 years, is 48 years old, and spends 31 hours/week providing clinical care. Female PDs, who comprise 70% of the PD workforce, devote more time to clinical and managerial activities than do their male counterparts. Seventy-three percent (73%) of the current PD workforce will be retiring within the next 20 years and 70% are solo-practitioners. Most PDs (65%) participate in the government-subsidized dental insurance program "Mi Salud," which represents as much as 48% of their income. PDs beginning or ending their careers were more likely to be participating providers for "Mi Salud" than were those in mid-career. CONCLUSION: In evaluating the adequacy of the pediatric dentistry workforce in Puerto Rico, the socio-demographic information of the PDs and the characteristics of their practices must be taken into account. These variables must be examined in relation to epidemiological indicators as well as environmental factors, including the comprehensiveness of dental benefits and the adequacy of reimbursement levels by third-party payers, which when inadequate may lead to decreased access to care.

Motivational Interviewing to Improve Pediatric Dental Recall Attendance after General Anesthesia.

Purpose: To determine the effect of motivational interviewing (MI) to improve recall attendance after dental treatment under general anesthesia (GA).
Methods: The sample consisted of parents of randomly selected pediatric patients who had oral rehabilitation under GA at a children's hospital. An 18-item questionnaire that included demographics, education, language, country of birth and age was administered prior to the GA appointment. A five-minute MI phone call three months after the procedure and a second MI phone call after the first recall was conducted by a standardized interviewer. The primary outcomes were attendance at the six- and 12-month recall visits. Data were compared to a historical control group of participants who did not receive the MI phone call during the same date range.
Results: Of 100 patients, 72 participated in the first phone call and 51 participated in the second phone call. All children had public insurance. The estimated odds of a six-month recall visit for parents receiving a single motivational interview was 2.52 times (95 percent confidence interval [95% CI]=1.43 to 4.44, P =0.001) higher compared to the control. The estimated odds of a 12-month recall visit for parents receiving two motivational interviews was 2.40 times greater (95% CI=1.27 to 4.54, P =0.006) compared to the historical control.
Conclusion: A brief intervention using MI led to an improvement in attendance at both the six- and 12-month recall visits.

Effects of reinforcement during the intertrial interval on temporal discrimination: Location version with rats.

Different studies on temporal control of behavior have focused on making modifications to experimental tasks by introducing disruptors to know how these manipulations modify temporal control. The aim of this study was to produce changes in temporal discrimination in a temporal bisection task by using a disruptor associated with motivation, which consisted in delivering reinforcement during the intertrial interval (RITI). Four Wistar rats and a pair of duration 2s-8s were used. There were two types of sessions: baseline generalization, where the disruptor was not applied, and RITI generalization, where the disruptive manipulation was applied. The analysis of results consisted of comparing psychophysical parameters, Signal Detection Theory indices, and latencies to start trials of baseline sessions and disruption sessions. The results showed a change in the point of subjective equality, a change in the psychophysical function, an increasing trend in the latencies to start trials on RITI disruption, and no change in the Signal Detection Theory indices. The results highlight the importance of incorporating motivational explanations to theories of temporal control in non-human organisms.

[Inhibitory activity of the ethanolic extract of Cyperus Rotundus from the Cajamarca region (Contumazá province) in a standardize strain of Streptococcus mutans (ATCC ® 25175 TM )]. / Actividad inhibitoria del extracto etanólico del Cyperus Rotundus procedente de la región de Cajamarca (provincia de Contumazá) en una cepa estandarizada de Streptococcus mutans (ATCC ® 25175 TM ).

Objective: The purpose of this study was to determine in vitro the inhibitory activity of the ethanolic extract of Cyperus rotundus (Cajamarca - Contumazá) against a standardize strain of Streptococcus mutans (ATCC®25175™). Materials and methods: This study was an experimental in vitro study, which consisted of determining the inhibitory effect of three concentrations of the ethanolic extract of Cyperus rotundus: 250 mg/ml, 500 mg/ml, and 1000 mg/ml against a strains of Streptococcus mutans (ATCC®25175™). Ten tests were performed for each concentration, having 0.12% chlorhexidine as a positive control for Streptococcus mutans plates and 10% DMSO as a negative control. To evaluate the inhibitory effect, the disk diffusion method or Kirby-Bauer test was used, reading the results at 48 hours after initial sowing. Results: None of the three concentrations of the ethanolic extract of Cyperus rotundus demosntrated inhibitory effects on the Streptococcus mutans strain; however, the positive control, chlorhexidine, clearly showed inhibition halos of 14.43 mm ± 1.23 mm after 48 hours of incubation. Conclusions: The ethanolic extract of Cyperus rotundus did not inhibit the growth of Streptococcus mutans. It is recommended to deepen the chemical analysis of the components of this plant and explore other extraction methods to verify its bacteriostatic action versus other oral and non-oral microorganisms.

Assessing the Current Research Infrastructure of Pediatric Dentistry Residency Programs: An Update for 2020.

Purpose: To assess the research infrastructure of pediatric dentistry residency programs in the United States and to determine the variables associated with increased scholarly activity. Methods: A 21-item questionnaire assessing program characteristics, research infrastructure, publication output and grants secured, barriers to scholarly activity, and satisfaction with current research infrastructure was developed and administered to program directors from March through June 2020. Results: Of 94 programs, 43 (46 percent) responded; 22 (51 percent) were hospital-based (H), 15 (35 percent) combined hospital-university-based (C), and six (14 percent) university-based (U). Most programs (77 percent) offered protected time to residents with varying time allocation (P<0.001). Forty-four percent of programs did not offer any protected time for faculty (P=0.001). Median number of faculty publications, resident publications, and grants were highest for U (16, five, and five, respectively) and lowest for H (zero, zero, and zero) (P<0.001; P=0.03; P<0.001). Number of total full-time faculty, full-time board-certified faculty, and full-time faculty with advanced degrees were associated with increased publications and grants secured. Interference with revenue-generating clinical time was the largest barrier to publication. Conclusion: Although university-based programs exhibit the infrastructure most conducive to scholarly activity, these findings suggest pediatric dentistry residency programs may lack resources and infrastructure to generate high quality research.

The dental workforce in Kentucky: current status and future needs.

OBJECTIVES: This study assessed the geographic distribution of dentists in Kentucky, determined socioeconomic correlates of practice location, estimated the future availability of dental providers, and made policy recommendations that could improve access to oral health care in Kentucky and other rural states. METHODS: Dentists' addresses were mapped using a geographic information system. Poisson regression modeling and geospatial analyses were conducted using SAS v9.1 (SAS Institute, Cary, NC, USA) and ArcGIS v9.2 (Environmental Systems Research Institute Inc., Redlands, CA, USA), respectively. Data on the number of dentists (n = 2,391) per county (n = 120) were used for the regression models. Explanatory variables included: per capita income, 2006 intercensal population estimates, percent adults with six or more teeth removed, percent population uninsured, physician-to-population ratios, and region type. A simulation model was used to project dentist-to-population ratios to the year 2016. RESULTS: The dental workforce analysis revealed disparities in the distribution of dentists between rural, urban, and Appalachian Kentucky counties. Dentists were more likely to be found practicing in areas with higher income and higher physician-to-population ratios. Compounding this geographic maldistribution, our projections suggest that the number of dentists per unit population will decrease over time in the near future, likely widening this disparity in rural and underserved areas. CONCLUSIONS: These results show present and widening workforce disparities in rural and socioeconomically depressed counties in Kentucky. Understanding the geographic distribution of dentists and the socioeconomic correlates of their practice locations may inform workforce development and reimbursement policies for the goal of improving access to oral health care in these areas.

Mobile dental operations: capital budgeting and long-term viability.

OBJECTIVE: The University of Kentucky College of Dentistry (UKCD) runs a large mobile dental operation. Economic conditions dictate that as the mobile units age it will be harder to find donors willing or able to provide the financial resources for asset replacement. In order to maintain current levels of access for the underserved, consideration of replacement is paramount. A financial analysis for a new mobile unit was conducted to determine self-sustainability, return on investment (ROI), and feasibility of generating a cash reserve for its replacement in 12 years. METHODS: Information on clinical income, operational and replacement costs, and capital costs was collected. A capital budgeting analysis (CBA) was conducted using the Net Present Value (NPV) methodology in four different scenarios. Depreciation funding was calculated by transferring funds from cash inflows and reinvested to offset depreciation at fixed compound interest. RESULTS: A positive ROI was obtained for two scenarios. He depreciation fund did not generate a cash reserve sufficient to replace the mobile unit. CONCLUSIONS: Mobile dental programs can play a vital role in providing access to care to underserved populations and ensuring their mission requires long-term planning. Careful financial viability and CBA based on sound assumptions are excellent decision-making tools.

Mobile dental units: leasing or buying? A dollar-cost analysis.

INTRODUCTION: The decision to acquire a mobile dental unit is based on a standard capital budgeting analysis. The next step is to determine whether to obtain the use of the mobile dental unit by borrowing and purchasing or by leasing. As a financing mechanism, leases are simply another way of borrowing money to pay for the asset. OBJECTIVE: To compare lease vs. debt as financial vehicles to acquiring a mobile dental unit. METHODS: An estimate for a new mobile unit was obtained. Lease and loan proposals from financial lenders were collected. A cost of capital rate was chosen for comparison. Cash flows associated with borrowing and leasing vs. buying were determined fortwo different scenarios: for profit (FP) vs. not-for-profit (NFP), at 5 years. A dollar-cost analysis was utilized to determine the option with the lowest capitalized value. RESULTS: There was a net advantage to buying vs. leasing for both for FP and NFP organizations. Due to tax advantages, owning and leasing were substantially less expensive for FP than for NFP. Slight decreases in the monthly lease payments would make leasing competitive to the buying approach. CONCLUSION: Exploring alternative financing vehicles may allow dental programs to expand their services through the acquisition of a mobile unit. Though programs generally own assets, it is the use of the asset which is important rather than the ownership. Dental programs can find leasing an attractive alternative by offering access to capital with cash-flow advantages.

Trends in paediatric dental caries by poverty status in the United States, 1988-1994 and 1999-2004.

BACKGROUND: Recent reports have suggested that dental caries among some young children is increasing in the United States. AIM: To describe changes in paediatric caries prevalence by poverty status in the United States. DESIGN: National Health and Nutrition Examination Survey (NHANES) data for children aged 2-11 years for 1988-1994 and 1999-2004 were used. RESULTS: Caries in the primary dentition increased among poor and non-poor boys aged 2-8 years (45-53% and 23-31%, respectively) and among non-poor boys aged 2-5 years (13-21%) from 1988-1994 to 1999-2004. Caries experience also increased on buccal-lingual, mesio-distal, and occlusal primary dental surfaces among poor children aged 2-8 years and this increase may be attributed to an increase in the number of dental surfaces restored. In the mixed dentition, caries remains relatively unchanged. Caries continues to decline in the permanent dentition for many children, but is increasing among poor non-Hispanic whites aged 6-8 years (8-22%) and poor Mexican-Americans aged 9-11 years (38-55%). CONCLUSIONS: For many older children, caries continues to decline or remain unchanged. Nevertheless, for a subgroup of younger children, caries is increasing and this increase is impacting some traditionally low-risk groups of children.

Evaluation of Potential Strategies to Increase Provider Participation in Florida's Dental Medicaid Program.

Purpose: To evaluate dentists' perspectives on the Medicaid program and explore hypothetical changes that could lead to increased participation. Methods: A 26-item questionnaire assessing demographics, practice profile, attitudes towards the Medicaid program and hypothetical scenarios to increase participation was administered to general and pediatric dentists. Results: A total of 165 surveys were completed; 50.6 percent of respondents indicated they were not Medicaid participating providers. Pediatric dentists were more likely than general dentists to be participating in Medicaid and willing to participate in the future, 35.5 percent vs. 23.2 percent respectively. A 68 percent increase in fees would yield the highest level of participation with 58.4 percent of participants responding they would treat at least 16 additional children per week. Pediatric versus general dentists would be more likely to participate in Medicaid with more modest raises, i.e. 30-44 percent range. Low compensation by Medicaid (weighted average of 4.77) was the greatest barrier indicated by all participants. Hispanic dentists had greater odds of participating in Medicaid than non-Hispanic dentists. Dentists who were 'employees' had a greater odds of participating in Medicaid than a 'solo owner of a practice'. Conclusion: Increased participation in Medicaid would require a combination of meaningful increases in reimbursement rates, loan forgiveness programs and tax credits.

Self-reported factors associated with dental care utilization among Hispanic migrant farmworkers in South Florida.

OBJECTIVES: To explore patterns of dental care utilization among adult Hispanic migrant farmworkers utilizing the Andersen Behavioral Model of Health Services. METHODS: In 2010, 278 Hispanic migrant workers participated in the oral health assessment. Hierarchical logistic regression modeling was used to assess the effects of multiple factors on having a past-year dental visit. Predisposing variables included age, education, and knowledge toward preventing tooth decay. Enabling factors included medical insurance, place for medical care, and social support. Need measures included oral health problems and treatment. RESULTS: Only 20.5 percent of Hispanic migrant farmworkers reported a past-year dental visit. More than one-half (52.5 percent) needed oral health treatment and nearly two-thirds (61.2 percent) stated that they perceived their mouth to be in poor condition. The final model indicated that those who reported preventing tooth decay by brushing and flossing, brushed their teeth once a day, and stated a good condition of their mouth were more likely to have had a past-year dental visit. CONCLUSIONS: Most Hispanic migrant farmworkers in south Florida have not had a past year dental visit. Similar to other ethnic minorities in the United States, migrant farmworkers experience poor oral health outcomes and have inadequate access to health-care services.

Anesthesia Onset Time and Injection Pain Between Buffered and Unbuffered Lidocaine Used as Local Anesthetic for Dental Care in Children.

Purpose: From a physiological standpoint, increasing the pH of anesthetic solution decreases the injection pain and onset time while increasing the depth of anesthesia. The purpose of this study was to compare injection pain and anesthesia onset time of alkalinized and non-alkalinized local anesthetic solutions in pediatric patients. Methods: A prospective, randomized, single-blind, split-mouth design was utilized. The control agent was nonalkalinized two percent lidocaine 1:100,000 (100k) with epinephrine, and the test agent was two percent lidocaine 1:100k with epinephrine alkalinized. The anesthetic agent (test versus control) was selected randomly. Injection pain was measured using the image result for the Wong-Baker Faces Pain Rating Scale and the Ohio State University Behavior Rating Scale. Time of onset was measured using endodontic ice and a timer after two minutes. Results: Sixty-five seven- to 11-year-olds participated in this study. There were no significant differences between the test and control groups for either onset time or injection pain observed by the clinician or reported by the patient for unbuffered versus buffered lidocaine anesthetic solutions. Conclusions: Administration of buffered anesthetics resulted in no observed differences in pain or anesthesia onset time as compared to unbuffered anesthetics. (Pediatr Dent 2019;41(5):354-7).