Biodentine as a pulpotomy medicament for primary molars: a retrospective chart review.

This retrospective chart review study investigates the long-term clinical outcome of Biodentine® (Tricalcium silicate) as a medicament for pulpotomy in primary molars. Data in this retrospective study was collected from the dental records of all patients that had at least one primary molar receive pulpotomy treatment (CDT code: D3221) between 01 July 2012 and 01 July 2015. This data includes child's age, medical history, dental history, dental radiographs, pulpotomy procedure details and follow-up clinical notes. Kaplan-Meier Estimate was used to measure the fraction of successful pulpotomy procedures for up to 24 months. A total of 1758 pulpotomy procedures were performed on 1032 patients in our institute in the three-year period and 21.4% of them (N = 376) had follow-up dental records that qualified for the study. Eleven teeth out of 376 teeth were excluded from the statistical analysis due to loss of/broken stainless steel crowns (3.1%). Seventeen pulpotomy failures were identified out of the remaining 365 procedures. The survival probablity of using Biodentine® as a pulpotomy medicament is 96.3% for 18-month follow-up and 95.4% for 24-month follow-up. Biodentine®, a tricalcium silicate formulation, used as a pulpotomy medicament demonstrates a high clinical success rate (95.4%) over a 24-month peroid in primary molars.

How Can Dentists Effectively Manage Behavior, Sedation, and General Anesthesia in Pediatric Patients?

The problem of treating and healing such patients is complex. Considerations encompass the safety and comfort of the child, the amount and difficulty of treatment needed, the level of the patient's anxiety and whether or not the patient is cooperative, the parent or guardian's attitude and level of trust, and whether or not the patient is physically resistant and, if so, the level of resistance. Other considerations are medicolegal implications, financial implications of treatment, insurance considerations, the dentist's and staff's training and experience, and the availability of sedation or general anesthesia.

Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.

OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS: In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.

Agreement between photographic and clinical examinations in detecting developmental defects of enamel in infants.

OBJECTIVES: This study assesses the reliability of photographic method with clinical examinations in detecting developmental defects of enamel (DDE) in the anterior primary teeth of infants. METHODS: The study sample was a part of an ongoing longitudinal study to assess risk factors for early childhood caries, and consisted of 138 and 238 infants who had scheduled follow-up visits at approximately 8 and 18-20 months corrected age, respectively. The modified DDE Index was used to record enamel defects (opacity, hypoplasia, and all types of defects) on anterior primary teeth by trained dentist examiners. Photographs of the teeth were taken using a digital camera. Statistical analysis included Cohen's Kappa for reliability, and McNemar test and paired t-test for comparison between photographic and clinical examinations. RESULTS: The level of agreement between clinical and photographic methods was fair to moderate with Kappa values ranging from 0.252 to 0.514. The photographic examination detected significantly more DDE than the clinical examination regardless of age group and type of DDE. The intra- and inter-examiner reliability of the photographic method was excellent with Kappa values ranging from 0.638 to 0.927. CONCLUSIONS: Within the limitation of this study, the photographic method can be a sound approach for verifying the diagnosis of DDE.

The 2001 Kentucky Childrens Oral Health Survey: findings for children ages 24 to 59 months and their caregivers.

PURPOSE: This study was performed to provide a 2001 benchmark of oral health status of children in Kentucky with a comparison to the most recent state (1987) and national surveys. METHODS: Using Basic Screening Survey protocols for visual screenings, a sample of 572 children ages 24 to 59 months was screened in health department clinics and physicians' and pediatric dentists' offices across Kentucky after caregivers completed a questionnaire. Screeners were provided modified Association of State and Territorial Dental Directors training materials. Analyses on the sample and population estimates were done with SAS and SUDAAN software. This weighted population estimate analysis is based on the assumption that sampled children at participating sites are representative of other children at that site, as well as children at refusing sites. RESULTS: Sample data and adjusted population estimates closely approximated each other. Population estimates indicated that 43% had untreated caries, 47% had caries experience (early childhood caries), and 31% had severe early childhood caries. Thirty-seven percent of the children needed early care, 9% needed urgent care, 39% had never been to the dentist, 44% had a history of "bad bottle behaviors," and 35% of the parents had not been to the dentist within the last year. CONCLUSIONS: Dental caries is a major health and early childhood development problem in high-risk preschool children in Kentucky.