Age and gender differences in the use of behavior management techniques by pediatric dentists.

PURPOSE: This study evaluated differences in the use of behavior management techniques among older and younger male and female pediatric dentists. METHODS: We surveyed all active members of the American Academy of Pediatric Dentistry residing in the U.S. and Canada. Responses were received from 2467 (59%). The survey contained items on age, gender, and use of behavior management techniques. RESULTS: Males respondents outnumbered females 2:1. Age categories were dichotomized as < 46 and > or = 46 years. Females constituted 53% of the younger group and 14% of the older group. Four gender/age categories were used. A minority indicated that they used hand-over-mouth and active immobilization of sedated patients. No significant differences by groups were seen for use of most basic behavior management techniques. Significant differences by gender/age distribution were seen for the use of non-verbal communication and advanced techniques. Most differences in anticipated changes in technique use were age-related. Most favored parental presence in the operatory, though older males were significantly less likely to allow parental presence for some procedures. CONCLUSIONS: Some statistically significant differences in the use of behavior management techniques exist between older and younger male and female pediatric dentists. Overall, however, the 4 gender/age groups report similar frequencies of use of the techniques surveyed in this study.

Evidence-based use of fluoride in contemporary pediatric dental practice.

Fluoride is an important and effective means of reducing the caries incidence in children. Multiple fluoride products are available to dentists for use with their patients at risk for dental caries. The purposes of this paper are to: (1) review clinically salient evidence, primarily systematic reviews and meta-analyses, for the effectiveness of fluoride options and, where possible, combinations of fluoride exposures; and (2) make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources. The available data suggest that therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Current best practice includes recommending twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish. The addition of other fluoride regimens should be based on periodic caries risk assessments, recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns.

Pacifier use in children: a review of recent literature.

Pediatric dentists are generally well aware of the oral implications of nonnutritive sucking (NNS). NNS via digit or pacifier can effect changes in the occlusion, including openbite, excessive overjet, and possibly posterior crossbite. Skeletal changes have also been attributed to NNS. There is some evidence that pacifiers may do less harm to the dentition, particularly because pacifier habits are often spontaneously shed at about 2 to 4 years of age. Digit habits are more likely to persist into the school-age years and can require appliance therapy for discontinuation. Thus, some authorities suggest that pacifiers be recommended for infants who engage in NNS. While pediatric dentists understand the oral and perioral effects of pacifiers, they may be less well versed in other aspects of pacifier use that have been reported in the medical, nursing, chemical, and psychological literature. This paper provides reviews of literature concerning the role of pacifier NNS in 4 areas: (1) sudden infant death syndrome; (2) breast-feeding; (3) otitis media and other infections; and (4) safety. Knowledge of current literature in these areas may assist pediatric dentists with their decisions of whether to recommend or discourage pacifier use in infants.

Behavior management conference panel I report--Rationale for behavior management techniques in pediatric dentistry.

Panel I comprised of pediatric dentists, an attorney, child psychologists, parents, a specialist in early childhood education, and a pediatrician. The purpose of this panel was to discuss: (1) 8 questions that dealt with the appropriateness and effectiveness of current behavior management techniques; (2) the scientific support for those techniques; and (3) the role of the pediatric dentist in managing the difficult child. Issues of cultural diversity, access to care, and parental attitudes toward behavior management were also explored. Nonpediatric dentist members of the panel offered insights into how other health care professionals view the behavior management techniques used by pediatric dentists. The panel sought input from the conference attendees as part of its deliberations. The major recommendations of the panel included: (1) re-evaluate the definitions of child behavior in the dental setting, including definitions of appropriate behavior; (2) develop training in effective communication with parents for pediatric dentists and their staffs; (3) seek further information on the impact that changing parental attitudes towards behavior management techniques may have on the quality and accessibility of treatment; and (4) conduct research in specific areas of behavior management, particularly in communicative techniques.

Survey of behavior management teaching in predoctoral pediatric dentistry programs.

PURPOSE: The purpose of this study was to survey directors of predoctoral pediatric dentistry programs regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all 56 dental schools in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 48 schools. Two schools declined to respond because they had not yet accepted or graduated students. The final response rate was 89%. The mean (+/-SD) percentage of total didactic time devoted to behavior management was 12% (+/-6). Communicative techniques were taught as "acceptable" by 96% to 100% of programs, with the exception of the hand-over-mouth exercise (HOME). HOME was taught as "unacceptable" by 62% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 69% to 85% of programs. Sixty-seven percent to 98% of programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that they were likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Predoctoral programs teach as acceptable communicative and pharmacologic management techniques, with the exception of HOME. Predoctoral program directors report they are not likely to increase the amount of curricular time devoted to behavior management in the near future.

A survey of members of the American Academy of Pediatric Dentistry on their use of behavior management techniques.

PURPOSE: The objective of this study was to survey members of the American Academy of Pediatric Dentistry (AAPD) regarding their use of behavior management techniques. METHODS: Surveys were mailed to 4,180 members, with a follow-up mailing to nonrespondents 2 months later. The survey contained items on demographic variables and use (current, past, and future) of communicative and pharmacologic techniques. Information was also obtained on informed consent, parental presence in the operatory, and parenting styles. RESULTS: Survey response was 66%. Communicative techniques are widely used, with the exception of the hand-over-mouth exercise (HOME). Immobilization for sedated and nonsedated children and pharmacologic techniques are used by a majority or near majority of respondents. Little change was reported in technique use over time, except that 50% of respondents indicated they use HOME less now than 5 years ago, and 24% plan to use it less over the next 2 to 3 years. Parental presence in the operatory appeared to be a common practice for some procedures and for children with special health care needs. The majority of respondents believed that parenting styles had changed in ways that adversely impacted children's behavior in the dental setting. CONCLUSIONS: Most practitioners have not changed their use of behavior management techniques in recent years, nor do they plan to change their use of them in the near future. HOME was the exception to these trends.

Survey of behavior management teaching in pediatric dentistry advanced education programs.

PURPOSE: The purpose of this study was to survey pediatric dentistry advanced education program directors regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all (65) advanced education programs in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 54 programs. Two programs declined to respond because they had not yet accepted or certified residents. The final response rate was 86%. The mean percentage (+/- SD) of total didactic time devoted to behavior management was 13% (+/-9.5). Communicative techniques were taught as "acceptable" by 98% of programs, with the exception of the hand-over-mouth exercise (HOME), which was taught as "unacceptable" by 54% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 76% to 98% of programs. All programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that it is likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Most programs do not teach HOME as an acceptable behavior management technique. The amount of curricular time devoted to behavior management is not likely to change appreciably in the near future.

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

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

The role of sealants in caries prevention programs.

Pit-and-fissure sealants have been employed as an element in dental prevention programs for more than 30 years. The technique for sealant placement has evolved over time to become somewhat more invasive today. However, a meticulous technique is still required for success. Practitioners recently estimated that their one- and three-year sealant success rates were 89 percent and 78 percent, respectively. Grand medians for sealant success rates after one year in clinical trials have been reported to be as high as 83 percent for effectiveness and 92 percent for complete retention. Seven-year rates were 55 percent and 66 percent, respectively. Several changes in caries epidemiology have had an impact on the use of sealants. These changes include: * Declines in overall caries rates in U.S. schoolchildren during the latter decades of the 20th century; * A relative increase in the percentage of the population DMFS constituted by occlusal caries; and * A general slowing in the rate of lesion progression. Dentists' abilities to diagnose occlusal surface status also affect the decision to seal. Sealant cost-effectiveness can be improved by: * Targeting at-risk populations; * Using sealants on incipient lesions and minimally defective restorations; and * Training more dental auxiliaries to place sealants under a dentists' supervision. Concerns about sealing over decay and the estrogenicity of sealant components are addressed. Sealant guidelines, as promulgated by the Workshop on Guidelines for Sealant Use, are reviewed; and conclusions are presented about the role of sealants in prevention programs.

The role of caries prevention protocol in pediatric dentistry specialty programs.

Advanced specialty education programs in pediatric dentistry are often overwhelmed with patients who need restorative and surgical care, often on an emergency basis. Still, the Commission on Dental Accreditation Standards for Advanced Specialty Education Programs requires that residents receive didactic and clinical training in the prevention of dental caries. This paper contains several recommendations for strengthening the training of pediatric dental residents in caries risk assessment and prevention, including the suggestion that pediatric dental training programs become "dental homes" for their patients.

Gender shifts and effects on behavior guidance.

UNLABELLED: Women's presence in pediatric dentistry has dramatically increased over the past several decades. Women now comprise almost 50 percent of AAPD membership and almost 75 percent of new members. PURPOSE: The purpose of this investigation was to determine differences between male and female pediatric dentists relative to practice patterns and use of behavior guidance techniques (BGTs). METHODS: A web-based survey was sent to 511 pediatric dentists who had been recruited by the AAPD to participate in a series of surveys related to pediatric dentistry. RESULTS: Fifty-nine percent of dentists responded. Fifty-two percent of the respondents were male and 48 percent were female. Female respondents were significantly younger than male respondents. Males were more likely to own a practice and hold leadership positions in dentistry while females were more likely to work as faculty, staff dentists, or part-time in private practice. No significant differences were noted between the genders relative to the use of BGTs, though females tended to involve parents more and were more likely to report the use of protective stabilization in selected situations. Both genders reported that parenthood had an effect on their behavior guidance styles.