Fluoride in the diet of 2-years-old children.

OBJECTIVES: This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for 2-years-old children utilizing market basket information for the US Midwest region. METHODS: Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey-What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. RESULTS: Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 µgF/g food for some processed meats, fish and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412±114 µgF/d. The estimated average ingestion for a 2-years-old weighing 12.24 kg was 0.034±0.009 mg/kg/d. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 µgF/d or 0.020 mg/kg/d, while a diet with foods and beverages in the 95th percentile would result in a total intake of 622 µgF/d or 0.051 mg/kg/d. CONCLUSIONS: The fluoride concentrations of foods and beverages vary widely, and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/d. Fluoride intake calculated in this study was higher than historically reported dietary levels.

Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia.

The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA) or office-based general anesthesia (OBGA) in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029). Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

Factors influencing behavior guidance: a survey of practicing pediatric dentists.

PURPOSE: The purpose of this study was to identify factors influencing behavior guidance technique utilization among practicing pediatric dentists and explore potential barriers to the incorporation of previously unused techniques. METHODS: The data for this study were obtained from a web-based survey containing 15 multiple choice questions concerning the practitioners' past, current, and anticipated future behavior guidance technique utilization. RESULTS: Most respondents received hands-on training in 10 of the American Academy of Pediatric Dentistry behavior guidance techniques. The type of training was associated with the practitioners' level of comfort using a given technique upon graduation and with the current frequency of technique utilization. Residency type impacted hands-on behavior guidance training, with 39 percent of respondents reporting no intravenous sedation training. The type of practice was associated with the frequency of behavior guidance technique utilization, as was graduation decade. Currently practicing dentists cited legal concerns, parental acceptance to change, and limited resources as perceived obstacles in the incorporation of new techniques. CONCLUSIONS: Behavior guidance technique selection and utilization among practicing pediatric dentists was influenced by multiple factors, including advanced education training, residency type, graduation decade, and practice type. Obstacles to the incorporation of previously unused techniques appear to be multifactorial.

Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages.

BACKGROUND. With Dental Caries being the most common disease amongst children in the world today, there is a need to fully understand risk factors that may be related to caries prevalence and how they could be best addressed. AIM. The aim of this study was to evaluate soda, juice, sugared-beverage intake, brushing habits, and community water source availability as they relate to the prevalence of both noncavitated and cavitated caries lesions in small rural villages in Mexico. DESIGN. The International Caries Detection and Assessment System (ICDAS) was used in children from small, isolated, villages in Mexico. Risk factors were assessed via questionnaires. RESULTS. Caries prevalence in the villages was very high, ranging from 94.7% to 100% of the children studied. The mean number of surfaces with lesions per child (D1MFS + d1mfs) having scores ≥1 (noncavitated and cavitated) ranged from 15.4 ± 11.1 to 26.6 ± 15.2. Many of the children reported drinking beverages containing sugar. CONCLUSIONS. Drinking sugared beverages, poor oral hygiene habits, and lack of access to tap water were identified as risk factor for caries in this sample of residents of rural Mexico.

Fluoride content of water used to reconstitute infant formula.

OBJECTIVE: To assess the fluoride content of water used to reconstitute infant formula by a Latino population living in the Indianapolis, Indiana, area. BACKGROUND: Negligible as well as excessive fluoride can be detrimental to oral health. Estimates of fluoride intake and exposure for individuals may aid in the determination of their risk for developing dental fluorosis or caries. METHODS: Interviews were conducted to determine brands of bottled water used to reconstitute infant formula. Identified brands were analyzed for fluoride concentration. RESULTS: Of the 458 samples tested (from 20 brands), fluoride concentration ranged from 0.006 to 0.740 µg/mL. All brands but one had fluoride concentration less than 0.7 µg/mL, with 16 brands having less than 0.22 µg/mL. Most bottled waters analyzed in the study comply with the American Dental Association recommendation to prevent fluorosis. Comparisons made demonstrated that only waters targeted for infants and that are fluoridated do not comply with recent American Dental Association recommendations.

Pediatrician's role in children's oral health: an Indiana survey.

OBJECTIVES: To evaluate Indiana pediatricians' current practices related to oral health, knowledge of oral health prevention, and opinions on anticipatory guidance integration into their practices. BACKGROUND: The American Academy of Pediatrics (AAP) May 2003 policy statement on oral health risk assessment timing and establishment of a dental home has provided pediatricians with guidelines to assess patients' oral health and caries risk status. METHODS: A survey of 31 questions was distributed via mail to all active Indiana pediatricians (300) registered in the Indiana State Medical Association to evaluate current practices relating to oral health prevention and guidance. RESULTS: Of the 300 distributed surveys, 138 were returned (46%). The authors found that 15% of pediatricians recognize the AAP-recommended age for a dental home as 12 months and practice this recommendation. Among the respondents, 7% believe application of fluoride should be part of a well-child visit. The majority (89%) of respondents reported interest in obtaining further knowledge on oral health.

Effect on behavior of dental treatment rendered under conscious sedation and general anesthesia in pediatric patients.

PURPOSE: The purpose of this study was to determine if there were differences in the amount of time it took to exhibit positive behavior following dental treatment under general anesthesia (GA) vs conscious sedation (CS). METHODS: This retrospective study examined charts of a pediatric dental office between 1999 to 2003. Patients presenting before 36 months old for an initial exam who were diagnosed with early childhood caries were included in the study. Following the initial exam, the patients were treated under GA or CS. These patients were followed to determine their behavior at the 6-, 12-, and 18-month recoil appointments. RESULTS: Thirty-nine patients who received treatment under GA were identified and 41 were treated under CS. The former were 3.9 times (P < .01) (P = .0057) more likely to exhibit positive behavior at the 6-month recall appointment. Although not statistically significant, a trend toward positive behavior was exhibited at the 12- and 18-month appointments. CONCLUSION: Clinicians should consider future behavior, in addition to caries, when determining treatment modalities for children presenting to their office with dental caries.

Dental caries experience and association to risk indicators of remote rural populations.

BACKGROUND: Dental caries continues to be the most common infectious disease of childhood; however, it is no longer pandemic, but endemic in specific sectors of populations. Therefore, it is important to identify and target patients at risk of developing caries in order to develop specific preventive measures. AIM: This study aims to test dental caries risk indicators for significant associations with caries severity. DESIGN: Five separate, small, isolated rural villages in Mexico with varying degrees of caries prevalence were selected for this observational study. A total of 248 children were examined. Risk indicators were assessed via questionnaire and water and salt fluoride analysis. Caries severity was measured by the International Caries Detection and Assessment System (ICDAS-I). RESULTS: Prevalence of caries ranged from 95% to 100% for the five villages. Mean total DMFS (decayed, missing, or filled surfaces-permanent teeth) and dmfs (decayed, missing, or filled surfaces-primary teeth) scores ranged from 2.5 to 5.0 and from 11.3 to 16.9, respectively. Multivariable models showed age and drinking soda between meals to be significantly associated with DMFS, and drinking juice and being female were significantly associated with dmfs. CONCLUSION: DMFS and dmfs were high in each village, significantly different between villages, and associated with specific risk indicators.

The effect of glove contamination on the bond strength of resin to enamel.

Over the past twenty years infection control protocol has evolved and use of gloves is now mandatory. Practitioners have become aware of potential interactions between the latex gloves and many of the dental material used as well as the potential for contamination from the gloves. The purpose of this study was to evaluate the shear bond strength of bonded restorations to enamel of uncontaminated and contaminated resin adhesive with powder free and powdered latex gloves. The results of the study demonstrated that the resin bonding agent that was in contact with either powdered or non- powdered latex gloves did not have a significant effect on the shear bond strength of the bonded restoration.