Comparisons between referred and non-referred patients to a university paediatric dental clinic.

BACKGROUND: Referrals of paediatric patients to a university clinic have been increasing over the last several years. AIM: To evaluate characteristics of referred and non-referred patients at the University of Iowa's Pediatric Dental Clinic (UIPDC). DESIGN: A retrospective chart review included dental records of 340 referred and 383 non-referred patients from July 1, 2015, to May 31, 2016 (n = 723). Age, distance to the clinic, size of the patient's community, insurance, number of teeth with decay, treatment needs, educational level of the provider, and presence of patient special health care needs were obtained. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed to analyze the outcomes (alpha = .05). RESULTS: Referred patients were more likely to live >60 miles away, live in a community of >75 000 people, have special health care needs, have caries/greater number of teeth with decay, need endodontic treatment, and were less likely to remain patients at the clinic (p < .0001). Referred patients were also more likely to need extractions (p = .0104), but less likely to need space maintenance/comprehensive orthodontic treatment (p = .0002). CONCLUSION: There was a difference in the complexity of patient treatment needs between referred and non-referred patients.

Generalized permanent dentition fluorosis severity becomes less evident over time among a birth cohort.

Objectives: There are relatively few cohort studies which have examined changes in fluorosis appearance over time, and none of these have assessed changes in generalized fluorosis. In this analysis, we quantified and assessed changes in multiple measures of generalized fluorosis severity through childhood, adolescence, and young adulthood. Methods: Participants were from the Iowa Fluoride Study, a birth cohort recruited from 1992 to 1995. Permanent dentition fluorosis exams were carried out at ages 9, 13, 17, and 23 years using the Fluorosis Risk Index (FRI). Generalized fluorosis was assessed using mean FRI scores at the tooth- and person-level as well as a five-category measure of generalized fluorosis. Generalized fluorosis prevalence and severity was summarized at each time point and differences in adjacent time points were assessed using gamma statistics, signed-rank tests, and plotting changes in generalized fluorosis between adjacent time points. Results: We observed a statistically significant decline in the percentage of non-zero mean FRI scores at later exam ages at both the person- and tooth-levels. Based on our five-category generalized fluorosis measure, there were 34.0%-54.1% of participants with generalized fluorosis at baseline for each tooth group, and these percentages declined to 8.9%-27.2% at the age 23-year exam. Conclusions: We observed a statistically significant decline in generalized fluorosis severity scores and overall prevalence at later exam ages across all three measures of generalized fluorosis severity. This trend should be accounted for when estimating the prevalence of fluorosis in a population using fluorosis severity data collected in children and adolescents.

Role of mutans streptococci, acid tolerant bacteria and oral Candida species in predicting the onset of early childhood caries.

Aim: Early childhood caries is the most common chronic infectious disease in children in the United States. This study, which is part of a larger, longitudinal study exploring oral microbiological components of caries development in children, reports on the impact of total mutans streptococci (MS), total acid tolerant bacteria and Candida species on the development of dental caries in a subset of these children. Of particular interest was the relationship between caries development and co-colonization of mutans streptococci and Candida species. Methods: Children between the ages of 12 and 47 months displaying no evidence of dental caries were recruited for a longitudinal study (n = 130). Twelve age- and gender-matched pairs were selected. In each pair, one child developed caries during the study, and one did not. Whole mouth plaque samples were collected by swab at baseline and every 6 months thereafter for a duration of 18 months and spiral plated for microbial counts (CFU/ml). Cut-offs based on percent of total cultivable flora were designated for all microbial measures. A scoring system designated the Plaque Microbial Index (PMI) was developed for use in statistical analyses to assess potential predictive factors for caries risk assessment. Results: Children who developed caries were significantly more likely to harbor higher percentages of acid tolerant bacteria (p = 0.003), MS (p < 0.001) and have Candida species present (p < 0.001) at ≥1 visit leading up to caries onset. Mean PMI scores derived from the aforementioned microbial measures, were higher for caries active children than caries free children (p = 0.000147). Co-colonization of MS and Candida species was significantly associated with caries development (p < 0.001) and detection of both at the same visit had a 100% positive predictive value and 60% negative predictive value for caries development. Conclusion: In children who developed caries, there was a statistically significant association with the percent of total flora that was acid tolerant, the percent of MS, the presence of Candida and co-colonization of MS and Candida species. Combining these microbial measures into PMI scores further delineated children who developed caries from those who remained caries-free. These microbiological measures show potential as predictive factors and risk assessment tools for caries development.

Comorbidities in Children with Autism Spectrum Disorder Undergoing Oral Rehabilitation Under General Anesthesia.

Purpose:To investigate the oral health needs and comorbidities among patients with autism spectrum disorder (ASD) undergoing oral rehabilitation under general anesthesia (GA) at a university hospital.
Methods: Records of patients with ASD who underwent oral rehabilitation under GA between January 2016 and May 2019 were reviewed to identify comorbid conditions and oral health needs. Statistical analysis consisted of descriptive and bivariate analyses (alpha = 0.05).
Results:A total of 160 patients from three to 18 years of age fulfilled the inclusion criteria. Seventy-eight percent were male and 69 percent had public insurance. Be- havioral issues, such as anxiety, aggression and nonverbal status, were observed more frequently than reported in the ASD literature. Dental caries, poor oral hygiene and gingivitis were the most common dental conditions observed. Radiographs, sealants, stainless steel crowns and extractions were the most common treatments rendered. Bivariate analysis revealed that subjects who had eight to 15 comorbidities were likely to be older.
Conclusions: Patients with ASD have many dental needs and may have comorbid medical conditions that directly affect the safe delivery of GA and dental treatments. As patients with ASD age, the number of comorbidities increases.

Transitioning Adolescent Patients with Special Health Care Needs from Pediatric to Adult Dental Care.

Health care transition from adolescence into adulthood is a complex process that often lacks care coordination, planning, and collaboration among the parties involved. Dental transition is significantly more challenging for adolescents with special health care needs. Shortage of qualified general dentists willing to treat these individuals and low dental reimbursement by public insurance programs are significant barriers to successful transition. Adequate training to increase dental workforce, insurance benefits, protocol development, and research are needed to ensure successful transition for this population. Meanwhile, it is important to target individuals less likely to access adequate oral health care and achieve satisfactory transition.

Management of Head Lice in Dental Offices: A Call for Updated Policies.

Purpose: To compare knowledge, policy, and management regarding patients with suspected head lice between general dentists (GPs) working at Federally Qualified Health Centers (FQHCs) and pediatric dentists (PDs).
Methods: A 14-item survey was emailed to 340 active dentists in Iowa, Missouri, and Kansas. Statistical analysis consisted of bivariate and multiple logistical regression analysis (alpha = 0.05).
Results: The response rate was 20.0 percent, comprising 27 GPs, 39 PDs, and one other specialist. Among the respondents, 23.9 percent were familiar with the American Academy of Pediatrics guidelines on head lice and 27.0 percent had a policy about patients with head lice in their practice. PDs were more likely to be familiar with the AAP guidelines on head lice (P =0.001), have received training on head lice (P =0.032), and feel comfortable identifying head lice in patients (P =0.015). PDs were also more likely to proceed with dental treatment if suspecting a patient had active head lice (odds ratio 4.27; 95 percent confidence interval = 1.19 to 84.59; P =0.002).
Conclusion: PDs are more willing to treat patients with suspected head lice and to personally discuss the topic with parents. Neither group universally followed current guidelines in working with children with head lice.

Clinical Versus Radiographic Caries Diagnosis in Primary Tooth Approximal Surfaces.

Purpose: The purpose of this study was to compare approximal carious lesions in dentin diagnosed by clinical examination with those diagnosed radiographically in high caries-risk children. Methods: Eighty-four Amish two- to 11-year-olds were evaluated clinically by calibrated examiners using standard epidemiological criteria and radiographically using standard criteria as part of baseline examinations for a two-year pilot clinical trial. Approximal carious surfaces diagnosed by clinical examination were compared to those diagnosed radiographically to determine the number of lesions misdiagnosed by clinical examination alone. Comparisons between the number of lesions detected by clinical exam and radiographic exam were made using McNemar's test. Results: Among 124 anterior approximal tooth surfaces, clinical examination alone identified 61 lesions (49.2 percent), while radiograph examination identified 72 lesions (58.1 percent); thus, nine percent of lesions were misdiagnosed by clinical examination alone. For the 412 posterior approximal tooth surfaces included in the study, 101 lesions (24.5 percent) were identified by clinical examination, whereas 229 lesions (55.6 percent) were identified via radiographic examination. Thus, 128 (31.1 percent) were misdiagnosed by clinical examination alone. Conclusions: Clinical examinations without radiographs significantly underestimate caries prevalence. Therefore, the use of radiographs should be encouraged in epidemiological studies and clinical trials.

Multidisciplinary care for a patient with syndromic craniosynostosis: A case report with 20 years of special care.

AIM: The functional and structural complexities accompanying syndromic craniosynostosis make dental care for these patients particularly challenging. We report a case of long-term care for a syndromic craniosynostosis patient. The objective of this report is to introduce special care guidance and clinical recommendation, so that oral health care providers, as key members of a multidisciplinary care team, can provide optimal diagnosis, treatment, and management for the patient with syndromic craniosynostosis. CASE REPORT: The patient of this case report had a medical history of syndromic craniosynostosis involving multiple comorbidities. Over the past 20 years, a multidisciplinary care team has successfully treated the patient. Dental and medical procedures that the patient has received include cranial surgeries, prophylactic dental care, caries control, growth hormone therapy, comprehensive orthodontic treatment in conjunction with orthognathic surgeries, and plastic surgery. CONCLUSION: Oral health care providers can play essential roles in multidisciplinary care for patients with craniosynostosis by understanding the patients' unique oral health conditions and dentofacial deformities. To provide optimal oral health care in a multidisciplinary team, clear communication between the members of the care team is crucial.

A Preexperimental Study to Assess the Impact of an Interdisciplinary Educational Intervention on Nurses' Knowledge of Perinatal and Infant Oral Health Care.

OBJECTIVE: The objective of this study was to assess the impact of an interdisciplinary educational intervention on the knowledge of nursing practitioners regarding perinatal and infant oral health (PIOH) care. MATERIALS AND METHODS: This was a preexperimental study conducted among nursing practitioners in Lagos, Nigeria. Participants received hands-on training and didactic lectures, which included dental caries etiology and risk factors; oral hygiene and dietary education; teething and its management; dental trauma and its prevention; nonnutritive habits; screening, referrals, and counseling; and fluoride varnish application. Knowledge of the trainees was assessed using pre- and posttest questionnaires. Level of statistical significance was set at P < 0.05. RESULTS: Overall, 110 nurses participated in the study with a mean age of 40.9 ± 10.8 years; 106 (96.4%) were females. Approximately 88% of the participants had not received formal training on PIOH. The baseline mean scores of the participants' knowledge on oral hygiene, teething, trauma, caries, and oral habits were 4.31 ± 1.9, 9.84 ± 2.6, 2.59 ± 1.7, 4.24 ± 1.8, and 1.45 ± 0.6, respectively; this increased significantly (P < 0.001) following the educational intervention with posttest mean scores as 7.58 ± 0.8, 11.79 ± 1.3, 4.34 ± 1.9, 6.19 ± 1.8, and 1.82 ± 0.4 and six-month evaluation scores as 6.21 ± 1.8,7 10.27 ± 3.1, 4.39 ± 1.5, 5.91 ± 1.8, and 1.79 ± 0.5, respectively. Overall posttest (31.4 ± 4.2) and six-month (28.6 ± 6.2) knowledge scores were significantly higher than the pretest values (22.4 ± 4.8, P < 0.001). At the six-month post-intervention survey, 84% of the nurses reported inclusion of PIOH education in their routine general health education sessions. CONCLUSION: There was a positive impact of the educational intervention as evidenced by an increase in the knowledge of the nurses on PIOH care and the inclusion of PIOH education in their general health education. A slight decline between posttest and six-month evaluation scores indicates a need for continuous education and evaluation.

Oral health knowledge levels of Hispanics in Iowa.

BACKGROUND: Hispanics disproportionately experience preventable oral health conditions in the United States. This study aimed to determine the oral health knowledge (OHK) of Hispanic adults in Iowa to identify potential gaps in knowledge. METHODS: This cross-sectional study included a convenience sample of self-identifying Hispanic adults. Data pertaining to oral health literacy and demographic, cultural, and dental characteristics were collected. OHK was assessed with the Conceptual Measure of Oral Health Knowledge, and it was categorized as low or high. Bivariate analyses and multiple logistic regression models were conducted to identify the variables related to OHK (P < .05). Institutional review board approval was obtained. RESULTS: Three hundred thirty-eight participants completed the questionnaire, 68% of participants completed the questionnaire in Spanish, and 51% of all participants had low OHK. Participants were less likely to correctly answer questions pertaining to children's oral health, periodontal disease, and oral cancer. Low OHK was associated with having less than 12th grade education, lack of dental insurance, and preference for a Spanish-speaking oral health care provider. CONCLUSIONS AND PRACTICAL IMPLICATIONS: OHK appears to be low in this population. Increasing OHK may help decrease oral health disparities and improve oral health outcomes. Furthermore, it is important that oral health care providers have an understanding of barriers that can impede patients' understanding of the health care system. Specifically, minority populations, such as Hispanics, may have a harder time because of certain cultural differences that exist among this ethnic group.

The relationships between fluoride intake levels and fluorosis of late-erupting permanent teeth.

OBJECTIVES: To examine the relationships between fluoride intake levels and fluorosis of late-erupting permanent teeth. METHODS: The current study used information collected from 437 children in the longitudinal Iowa Fluoride Study. Participants' fluoride intake information was collected using questionnaires from birth to age 10 years. Estimated mean daily fluoride intake was categorized into low, moderate, and high intake tertiles for each age interval (2-5, 5-8, and 2-8 years). Bivariate analyses were performed to study the relationships between self-reported fluoride intake levels during three age intervals and dental fluorosis. RESULTS: For canines and second molars, the prevalence of mostly mild fluorosis was less than 10% in the lowest fluoride intake tertile and more than 25% in the highest intake tertile. For both first and second premolars, the prevalence in the low and high intake tertiles was approximately 10-15% and 25-40%, respectively. When estimated total daily fluoride intake was 0.04 mg/kg BW during ages 2-8 years, the predicted probability of fluorosis was 16.0%, 20.5%, 21.8%, and 15.4% for canines, 1st and 2nd and premolars and 2nd molars, respectively. We found that an incremental increase in fluoride intake during the age 5- to 8-year interval led to greater odds for development of mostly mild dental fluorosis in late-erupting teeth compared to increases in fluoride intake during other age intervals. CONCLUSIONS: Our results clearly show that dental fluorosis prevalence is closely related to fluoride intake levels and that teeth have greater susceptibility to fluoride intake during certain age intervals.

Longitudinal Study Assessing Factors Associated with Mutans Streptococci Acquisition in Infants and Toddlers.

PURPOSE: To assess the role of sociodemographic, dietary, and clinical factors in early mutans streptococci (MS) colonization in children aged 6 to 24 months who were followed for 18 months. MATERIALS AND METHODS: Ninety-four children (mean age: 11.5 ± 4.99 months at baseline) were enrolled in the study from the Women, Infants and Children Supplemental Nutrition Program during 2003-2004. Salivary MS levels of the children were determined at baseline and at 18 months using a semi-quantitative method. Detailed information about the children's beverage consumption pattern, dietary behavior, and clinical information about oral health status was collected at baseline, 9 months, and 18 months. None of the children included in this study had detectable levels of MS at baseline. RESULTS: Of the 94 children at baseline, 36 (38%) had acquired MS by the 18-month follow-up. The presence of >5 teeth [OR = 3.55 (1.46-9.04); p = 0.0062] was a significant risk factor for MS acquisition among the baseline variables. At 9 months, sports drinks consumption [OR = 5.56 (1.39-26.26); p = 0.0143] and presence of caries [OR = 9.36 (2.55-40.90); p < 0.0001] were significantly associated with MS colonization at 18 months. Higher maternal education [OR = 0.3 (0.07-1.36); p = 0.0351] was a protective factor at all the time points. CONCLUSION: Sugared beverage consumption, tooth-related factors, and lower maternal education can predict MS acquisition in young children.

Dental caries clusters among adolescents.

OBJECTIVES: There have been very few longitudinal studies of dental caries in adolescents, and little study of the caries risk factors in this age group. The purpose of this study was to describe different caries trajectories and associated risk factors among members of the Iowa Fluoride Study (IFS) cohort. METHODS: The IFS recruited a birth cohort from 1992 to 1995, and has gathered dietary, fluoride and behavioural data at least twice yearly since recruitment. Examinations for dental caries were completed when participants were ages 5, 9, 13 and 17 years. For this study, only participants with decayed and filled surface (DFS) caries data at ages 9, 13 and 17 were included (N=396). The individual DFS counts at age 13 and the DFS increment from 13 to 17 were used to identify distinct caries trajectories using Ward's hierarchical clustering algorithm. A number of multinomial logistic regression models were developed to predict trajectory membership, using longitudinal dietary, fluoride and demographic/behavioural data from 9 to 17 years. Model selection was based on the akaike information criterion (AIC). RESULTS: Several different trajectory schemes were considered, and a three-trajectory scheme-no DFS at age 17 (n=142), low DFS (n=145) and high DFS (n=109)-was chosen to balance sample sizes and interpretability. The model selection process resulted in use of an arithmetic average for dietary variables across the period from 9 to 17 years. The multinomial logistic regression model with the best fit included the variables maternal education level, 100% juice consumption, brushing frequency and sex. Other favoured models also included water and milk consumption and home water fluoride concentration. The high caries cluster was most consistently associated with lower maternal education level, lower 100% juice consumption, lower brushing frequency and being female. CONCLUSIONS: The use of a clustering algorithm and use of Akaike's Information Criterion (AIC) to determine the best representation of the data were useful means in presenting longitudinal caries data. Findings suggest that high caries incidence in adolescence is associated with lower maternal educational level, less frequent tooth brushing, lower 100% juice consumption and being female.

Bedsharing and Oral Health-related Feeding Behaviors Among Zero- to Three-year-old Children.

PURPOSE: The purpose of this study was to investigate the association between bedsharing and oral health-related feeding behaviors among zero- to three-year-old children. METHODS: Data were collected from records of children attending the University of Iowa's Infant Oral Health Program (1998 to 2009), including maternal demographics, children's nighttime dietary practices, bedsharing habits, methods to help children sleep, and clinical evidence of plaque and caries. Statistical analyses utilized bivariate and logistic regression analyses. RESULTS: Mother-child dyads (n equals 629) who either bedshared every night (n equals 273) or did not bedshare (n equals 356) were included. Of the 629 children (mean±standard deviation [SD] age equals 21.6±12.1 months), 51 percent were male, 50 percent were nonwhite, and 72 percent lived with both parents. Logistic regression analysis revealed that children who bedshared were more likely to be healthy (OR equals 6.78; P=.008), older (OR equals 1.56; P=.007), nonwhite (OR equals 2.96; P<.001), live with a single mother (OR equals 3.41; P<.001), breastfed throughout the night (OR equals 4.33; P<.001), and bottle-fed and breastfed to help them sleep (OR equals 2.34; P=.03; OR equals 3.27; P=.03, respectively). Moreover, these children were more likely to be in the high caries-risk category (OR equals 2.19; P=.01). CONCLUSIONS: Bedsharing was significantly associated with the child's health status, age, race, nighttime feeding habits, and high caries-risk and with whom the child lived. Caries preventive measures should be targeted to mother-child dyads who bedshare.

Timing of fluoride intake and dental fluorosis on late-erupting permanent teeth.

OBJECTIVE: Very few studies have examined the relationship between timing of fluoride intake and development of dental fluorosis on late-erupting permanent teeth using period-specific fluoride intake information. This study examined this relationship using longitudinal fluoride intake information from the Iowa Fluoride Study. METHODS: Participants' fluoride exposure and intake (birth to 10 years of age) from water, beverages, selected food products, dietary fluoride supplements, and fluoride toothpaste was collected using questionnaires sent to parents at 3- and 4- month intervals from birth to 48 months of age and every 6 months thereafter. Three trained and calibrated examiners used the Fluorosis Risk Index (FRI) categories to assess 16 late-erupting teeth among 465 study participants. A tooth was defined as having definitive fluorosis if any of the zones on that tooth had an FRI score of 2 or 3. Participants with questionable fluorosis were excluded from analyses. Descriptive and logistic regression analyses were performed to assess the importance of fluoride intake during different time periods. RESULTS: Most dental fluorosis in the study population was mild, with only four subjects (1%) having severe fluorosis (FRI Score 3). The overall prevalence of dental fluorosis was 27.8%. Logistic regression analyses showed that fluoride intake from each of the individual years from age 2 to 8 plays an important role in determining the risk of dental fluorosis for most late-erupting permanent teeth. The strongest association for fluorosis on the late-erupting permanent teeth was with fluoride intake during the sixth year of life. CONCLUSION: Late-erupting teeth may be susceptible to fluorosis for an extended period from about age 2 to 8. Although not as visually prominent as the maxillary central incisors, some of the late-erupting teeth are esthetically important and this should be taken into consideration when making recommendations about dosing of fluoride intake.

Examination criteria and calibration procedures for prevention trials of the Early Childhood Caries Collaborating Centers.

OBJECTIVES: To summarize diagnostic criteria and examiner training and calibration of the National Institute of Dental and Craniofacial Research-funded Early Childhood Caries Collaborating Centers (EC4) and report examiner calibration results from 2010 to 2014. The EC4 at Boston University, University of Colorado, and University of California San Francisco are performing randomized controlled early childhood caries (ECC) prevention trials with caries as the main outcome measure. METHODS: The EC4 with University of Iowa consultants developed standardized tooth and tooth surface status examination criteria for use in field conditions, examiner training materials, and examiner calibration and re-calibration methodologies. Calibration and re-calibration were performed with 1- to 5-year-old children in the San Francisco Mission District in which assessments from each examiner to be calibrated were compared with those from a single gold standard examiner from 2010 to 2014. Cohen's kappa statistic was used to determine inter-examiner agreement. RESULTS: A total of seven examiners were successfully (re)calibrated during that period, examining a total of 231 children. Overall unweighted Cohen's kappas for 10 surface conditions exceeded the criterion of 0.70. However, separate agreement for assessment of noncavitated lesions, as in other studies, was lower. CONCLUSIONS: An experienced multidisciplinary and multi-institutional team was able to develop criteria and training materials to anticipate situations and field conditions the main trials would encounter. Examiners were successfully trained and (re)calibrated.

Group home caregivers' comfort levels regarding physical resistance during oral hygiene care.

The purpose of this study was to investigate perceived comfort levels, behaviors, and barriers reported by group home caregivers who provide oral hygiene measures to consumers with special health care needs (SHCN) who physically resist the care. A 24-item survey was sent to 884 caregivers employed at six care facilities in Iowa. Bivariate analyses and logistic regression models were used to analyze the data (alpha = 0.05). The overall response rate was 52%. An analysis of the data indicated that caregivers who felt more comfortable providing oral hygiene for consumers who physically resisted the care experienced a higher frequency of consumers not opening their mouths (p = 0.0003), pushing the caregiver away (p = 0.0002), moving their heads uncontrollably (p = 0.0004), spitting at (p = 0.0099), hitting and/or kicking the caregiver (p = 0.0011). Furthermore, these caregivers provided weekly direct care for a greater number of consumers (p = 0.0044), received oral care training from their current facility (p = 0.0424), brushed the teeth of uncooperative consumers at least 75% of the time (p < 0.0001), and felt "somewhat comfortable to very comfortable" flossing their teeth (p < 0.0001). The caregivers' comfort level in providing oral hygiene measures to those consumers with SHCN who physically resist the care appears to be significantly associated with their training and experience working with this population.

Spill-proof beverage container usage among young WIC-enrolled children.

PURPOSE: Currently, research is lacking regarding the use of spill-proof beverage containers (SPBCs). The purpose of this study was to assess the relationship between daytime SPBCs use for sugared beverages, caries, socioeconomic status, and other covariates in high-caries risk 12- to 49-month-old children attending a Women, Infants and Children (WIC) program. METHODS: Data were analyzed using baseline information from 415 Iowa WIC-enrolled children who participated in a psychoeducational study. Mothers completed a series of detailed questionnaires regarding their SES and their child's beverage consumption. Dental examinations using d1d2.3 (noncavitated and cavitated carious lesions) criteria were completed for the children. Bivariate relationships for consumption of any sugared beverage using SPBCs were assessed and followed by multivariable modeling using logistic regression (alpha=0.05). RESULTS: Only 18 children (four percent) reported using SPBCs for any sugared beverage during the night versus 290 (70 percent) during the day. Daytime consumption of sugared beverages from SPBCs was less likely to be reported in older children (P<.001) and in African American children when compared to both Hispanics (P>.001) and Caucasians (P=.001). CONCLUSIONS: Iowa WIC children primarily consume sugared beverages using spill-proof beverage containers during the day; children who were younger and Hispanic or Caucasian were more likely to use SPBCs to consume sugared beverages.

The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis.

OBJECTIVES: The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. METHODS: A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. RESULTS: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119). CONCLUSIONS: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

Spill-proof Beverage Container Usage among Young WIC-enrolled Children.

PURPOSE: Currently, research is lacking regarding the use of spill-proof beverage containers (SPBCs). The purpose of this study was to assess the relationship between daytime SPBCs use for sugared beverages, caries, socioeconomic status, and other covariates in high-caries risk 12- to 49-month-old children attending a Women, Infants and Children (WIC) program. METHODS: Data were analyzed using baseline information from 415 Iowa WIC-enrolled children who participated in a psychoeducational study. Mothers completed a series of detailed questionnaires regarding their SES and their child's beverage consumption. Dental examinations using d1d2.3 (noncavitated and cavitated carious lesions) criteria were completed for the children. Bivariate relationships for consumption of any sugared beverage using SPBCs were assessed and followed by multivariable modeling using logistic regression (alpha=0.05). RESULTS: Only 18 children (four percent) reported using SPBCs for any sugared beverage during the night versus 290 (70 percent) during the day. Daytime consumption of sugared beverages from SPBCs was less likely to be reported in older children (P<.001) and in African American children when compared to both Hispanics (P>.001) and Caucasians (P=.001). CONCLUSIONS: Iowa WIC children primarily consume sugared beverages using spill-proof beverage containers during the day; children who were younger and Hispanic or Caucasian were more likely to use SPBCs to consume sugared beverages.