Investigation of adult stainless steel crown longevity as an interim restoration in pediatric patients.

BACKGROUND: Preformed metal crowns, also known as stainless steel crowns (SSC), are utilized for providing full coverage to young permanent teeth and have been used extensively as restorations of primary teeth for approximately 65 years. AIM: Evaluate permanent tooth SSC longevity as an interim restoration for teeth requiring full coverage restoration in pediatric patients. DESIGN: Retrospective chart review from 2006 through 2014 in a hospital-based dental clinic for permanent tooth pre-fabricated crown longevity. One hundred and fifty-five SSCs were evaluated with regard to: age of patient at restoration placement, diagnoses, and duration of crown service. Duration service was further categorized as successful or failed. RESULTS: Of 155 SSCs, 137 were considered successfully functioning. Total failures were 18. The overall combined success rate for the study group was observed to be 88% with an average service period of 45.18 months. Significant success was noted in patients less than 9 years of age, and significant failure was observed in patients 12 years and older. CONCLUSIONS: Stainless steel crowns are a viable option for interim restoration needs, with an 88% overall success rate during an average service period of 45.18 months.

Accuracy of Parent-Reported Allergies and Medications in Pediatric Dentistry.

Purpose: To measure the accuracy of parent-reported allergies and medication usage by comparing parental reports during dental con- sultations to medical reports from their child's primary care physician. Methods: A retrospective chart review was performed for 862 eligible patients 17 years and younger seen in the Department of Pediatric Dentistry at Franciscan Children's, Boston, Mass., USA, and who were required to obtain medical clearance prior to initiating dental treatment with sedation or general anesthesia. Allergies were categorized into three groups: food, environmental, and drug allergies. Allergies in each category reported by the parents were compared to the physician-reported allergies to assess for accuracy. Medications reported by the parents were also compared to the total number of medications reported by the physician and categorized as a full, partial, or non-match. Results: The sensitivity of parental identification for drug, food, and environmental allergies was 50.9 percent, 48.1 percent, and 18.8 percent, respectively. Of the 245 patients taking prescription medications, 53.1 percent of parents were unable to identify any of their child's medications, 22.9 percent of parents were partially able to identify their child's medications, and only 24.1 percent of parents were able to identify their child's medications fully. Among parents of children who take one or more medications as reported by their physician, the average reporting accuracy was 34.7 percent. Conclusion: Utilizing interprofessional collaboration is warranted in identifying accurate reports of patient allergies and medication usage in the pediatric population to prevent adverse reactions and improve the overall quality of dental care.

Considerations for Transgender Patients Requiring Dental Rehabilitation.

Transgender youth are at risk for poorer oral health and may have a more difficult time accessing health care. Pediatric dentists should be aware of risk factors that impact care in the dental office and operating room settings. Medical care avoidance is common and can be reinforced when patients feel unsupported or misunderstood when receiving care. Intentional or unintentional environmental indignities, which communicate negative attitudes toward transgender patients, may occur from unknowing providers. Identified here are best practices and opportunities for improvement when providing care for these patients. Dental care for the transgender patient requires a welcoming and inclusive environment that encourages continuous comprehensive care for these individuals.

Chilling Effects on Immigrants' Health Insurance Coverage After the 2016 Presidential Election.

BACKGROUND: Depressed enrollment in public benefits among immigrants and their families may occur due to concerns about deportation and obstacles to permanent residency status related to immigration policies. METHODS: Using data from the American Community Survey (ACS) from 2014 to 2019, we conducted an interrupted time series analysis to estimate Medicaid enrollment, private insurance enrollment, and uninsured rates among low-income non-citizen adults and their children, compared to U.S. citizens before and after the Trump administration entered office in January 2017. RESULTS: Compared to U.S. citizen adults, Medicaid enrollment among non-citizen adults decreased and the uninsured rate increased (1.5 percentage points per year, p < 0.05) from 2017 to 2019. Decreases in coverage starting in 2017 were larger among both children with at least one non-citizen parent and non-citizen children. DISCUSSION: These findings suggest that the Trump administration immigration policy climate is associated with decreased health insurance enrollment among this population.

Comparison of Contributing Risk Factors for Primary Tooth Caries in Down Syndrome and Non-Special Health Needs Children.

Purpose: To evaluate decayed, missing, and filled surfaces in primary teeth (dmfs) in Down syndrome subjects (DS) compared to typically developed (TD) controls using analysis. Methods: A retrospective study of 440 matched subjects (220 DS and 220 TD) was conducted. Categorical variables were evaluated for association with dental caries, with mean dmfs as the main outcome measure. Pearson's chi-square and independent sample t-tests for unequal variances for means were employed. Results: Overall, the TD control group was found to have significantly higher mean dmfs scores than the DS group: TD Equals 17.65 (mean dmfs), 95% confidence interval (CI) equals 15.48 to 19.90; DS equals 10.30 (mean dmfs), at 95% CI equals 7.96 to 12.78, (P<0.001). However, when controlled for the variable factors African American status (P=0.11), Hispanic status (P=0.07) and income level at or below 200 percent of poverty level (P=0.24) there was no significant difference in mean dmfs. Conclusions: In the study population DS and TD exhibited dissimilar dmfs scores, while when taking into consideration social and economic factors dmfs was equivalent. Caries risk factors modulate disease experience and should be considered in all population-specific studies. Patients with multiple high-risk factors should be treated as such, regardless of DS status.

Accuracy of parent-reported health history in a dental setting.

BACKGROUND: Obtaining thorough documentation of a patient's medical history is important for dental care professionals, as oral health is connected intricately to systemic health. The purpose of this study was to assess the accuracy of parent-reported health history for pediatric patients in a dental setting. METHODS: A retrospective chart review was conducted on 863 patients 17 years and younger. Parent-reported health history was compared with subsequent physician-to-dentist consultations. The most common diagnoses were grouped on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, categories. RESULTS: The sensitivity of parent report of health conditions was highest for reporting mental and behavioral disorders (75.1%; 95% CI, 69.6% to 80.0%), followed by nervous system diseases (63.0%; 95% CI, 47.5% to 76.8%), respiratory conditions (47.9%; 95% CI, 37.6% to 58.4%), congenital conditions (46.3%; 95% CI, 30.7% to 62.6%), and cardiovascular conditions (25.0%; 95% CI, 11.4% to 43.4%) and was lowest for hematologic conditions (12.2%; 95% CI, 4.1% to 26.2%). Parents of children 6 years and older and those with private insurance had higher sensitivity for reporting mental and behavioral conditions than those with children younger than 6 years or having Medicaid (P < .0001). The specificity of parent-reported health conditions ranged from 96.0% for mental and behavioral disorders to 99.8% for hematologic conditions. CONCLUSIONS: Sensitivity varied widely, showing that parents may be unreliable in their report of children's health histories and that dentists cannot rely solely on parents when obtaining health history. PRACTICAL IMPLICATIONS: In advocating for patient safety, especially for those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records.

The patient protection and affordable care act: effects on dental care.

Health care reform has been a subject of debate long before the presidential campaign of 2008, through the presidential signing of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, and is likely to continue as a topic of discussion well into the future. The effects of this historic reform on the delivery of healthcare and on the economy are subject to speculation. While most people are at least generally aware that access to medical care will be improved in many ways, few people, including many in the dental profession, are aware that this legislation also addresses oral health disparities and access to dental care. It is the purpose of this paper to review how dental care is currently accessed in the United States and where oral health care disparities exist, to suggest approaches to alleviating these disparities and to delineate how the changes in dental policies found in the PPACA hope to address these concerns. The main arguments of organized dentistry, both those in support of and in opposition to the PPACA, are summarized.

Adjuncts to traditional local anesthesia techniques in instance of hypomineralized teeth.

Molar incisor hypomineralization (MIH) is a defect in the enamel of permanent and/or primary molars and incisors. This disorder allows for rapid breakdown of the teeth and often calls for extensive restorative procedures. Due to the chronic pulpitis condition that is often associated with hypomineralized teeth, local anesthesia complications can result. This paper is a systematic review of the literature for the purpose of investigating adjuncts to traditional local anesthesia techniques in the case of hyper-responsive, hypomineralized-involved teeth during restorative procedures.

Brief Report: Remotely Delivered Video Modeling for Improving Oral Hygiene in Children with ASD: A Pilot Study.

Children with autism have heightened risk of developing oral health problems. Interventions targeting at-home oral hygiene habits may be the most effective means of improving oral hygiene outcomes in this population. This randomized control trial examined the effectiveness of a 3-week video-modeling brushing intervention delivered to patients over the internet. Eighteen children with autism were assigned to an Intervention or Control video condition. Links to videos were delivered via email twice daily. Blind clinical examiners provided plaque index ratings at baseline, midpoint, and endpoint. Results show oral hygiene improvements in both groups, with larger effect sizes in the Intervention condition. The findings provide preliminary support for the use of internet-based interventions to improve oral hygiene for children with autism.