Do early dental visits reduce treatment and treatment costs for children?

PURPOSE: The purpose of this paper was to determine if number and cost of dental treatments in high caries-risk children differs in children with early dental intervention compared to children with later intervention. METHODS: Billing data from children age zero to seven years old, whose first dental visit was between January 1, 2004 and December 31, 2004, were collected from 20 corporate treatment centers serving children from lower socioeconomic status backgrounds. Data included age at first visit, dental treatment codes, and associated costs for eight years after the first dental visit. Treatment included restorations, crowns, pulpotomies, and extractions. First visit age was categorized into early starters (younger than four years old) and late starters (four years of age or older). Linear regression with cluster adjustment for clinic determined a difference in costs and dental treatments by early and late starters. RESULTS: Of 42,532 subjects, 17,040 (40 percent) were early starters and 25,492 (60 percent) were late starters. There were 3.58 more dental procedures performed on late starters, over eight years of follow-up, than on early starters (P<.001). Late starters spent $360 more over eight years of follow-up than early starters (P<.001). CONCLUSION: In this study, number of procedures performed were fewer and cost of treatment less for children seen earlier versus later.

Utility of bispectral index monitoring during deep sedation in pediatric dental patients.

OBJECTIVE: The aim of this study was to compare the total medicament doses and recovery profiles of patients for whom Bispectral Analysis (BIS) monitor was used to monitor sedation. STUDY DESIGN: Thirty-four uncooperative paediatric patients aged 3-6 years who attended to the Department of Pediatric Dentistry for dental treatment were enrolled in the study. Patients were randomly divided into 2 groups of 17 patients each. Physiological variables including oxygen saturation, blood pressure and heart rate were recorded. In one group (BIS-monitored group), drugs were administered to maintain patients' BIS values between 60-70, while the other group (Non-BIS-monitored Group) was not monitored using BIS. Data was evaluated by Chi-square, Mann Whitney U, Independent Samples t, Paired Samples t and Wilcoxon signed tests, with a p-value of <0.05 considered to be statistically significant. RESULTS: There was no significant difference in total anesthetic doses, incidence of adverse events or recovery profiles of patients between non- BIS-monitored and BIS-monitored groups (p ≥ 0.05). However, distinct correlation was determined among mean values of UMSS and BIS values (p<0.05). CONCLUSION: BIS represents no advantage over the current commonly accepted methods for monitoring sedation depth in children.

Perfil epidemiológico de caries dental en ocho delegaciones políticas del Distrito Federal, México / Epidemiological profile of dental caries in eight political delegations of the Federal District

En diferentes estudios se reconoce la distribución desigual de los perfiles epidemiológicos de caries dental en diferentes grupos sociales. En ellos se reconoce el papel determinante de los aspectos socioeconómicos, dentro de ellos la ocupación, instrucción ingresos entre otros. Objetivo: identificar la prevalencia de caries dental en la población escolar de seis a doce años de ocho escuelas primarias ubicadas en diferentes Delegaciones Políticas del Distrito Federal y la relación que existe con la ocupación, instrucción e ingresos de los padres. Método: estudio descriptivo, transversal y observacional. Muestra, por conveniencia, tomando a 25 escolares por cada edad de seis a doce años, 175 escolares en promedio, por escuela primaria de ocho de las siguientes Delegaciones Políticas del distrito Federal México: Benito Juárez, Cuauhtémoc, Miguel Hidalgo, Iztapalapa, Milpa alta, Tláhuac, Xochimilco, Alvaro Obregón. El estudio se realizó en el año 2009. Resultados: El promedio de caries dental global en la Benito Juárez fue de 1.5, en la Cuauhtémoc de 1.6, en la Miguel Hidalgo de 2.2, en Iztapalapa de 3.0, Milpa Alta de 3.6, Tláhuac de 3.3, Xochimilco 3.2 y Alvaro Obregón de 2.8. Conclusiones: existe diferencias estadísticas de acuerdo a la prueba Testa Between-Subjects effects del promedio de dientes cariados, perdido y obturados, CPOD, de las ocho escuelas primarias que participaron en este estudio, F igual 2.717, p igual 0.000

Who accompanies children to a dental hospital appointment?

AIM: To determine who accompanies paediatric dental patients to their appointments, in a teaching hospital setting. STUDY DESIGN: Data were recorded prospectively for children attending the Paediatric Dentistry clinic of the Charles Clifford Dental Hospital, Sheffield, England, over 4 months which included two school holiday periods. The data were recorded on a standardised data collection sheet, which included age and gender of the patient; number/s of accompanying adults and children and their relationship to the patient; the appointment session and appointment type. RESULTS: A total of 394 paediatric dental visits were recorded. Patients were of a mean age of 10 (range 1-17 years). Most visits were for treatment (44.7%) and review (39.8%), with a much smaller proportion being new patient assessments (8.9%) and emergency appointments (6.6%). The numbers of afternoon and morning sessions recorded were approximately similar and 35% of the visits were recorded in a school holiday day. The majority of patients attended with at least one parent (91.6%). A parent was most likely to attend a new patient assessment (97.1%) or review visit (94.3%). Parental presence was less likely for treatment (89%) and least likely for emergency visits (84%). Most patients attended with their mother (62.1%). Patients were less frequently accompanied by parents (13.1%), their father (12.1%) and one or both grandparents (4.3%). Smaller proportions were accompanied by older siblings, a step parent, other relatives or foster carers. Two patients attended unaccompanied. The time of day, or whether it was a school holiday period or not, did not influence parental presence or the numbers of adults accompanying patients. However the additional presence of other children (non patients) was more likely on morning sessions and during school holidays. STATISTICS: One way analysis of variance (ANOVA), an independent sample t-test or chi-squared tests were undertaken as appropriate to determine whether there were any significant differences in parental or child accompaniment according to the patient's age; gender; type of appointment or time of appointment. Significance levels were set at p<0.05. CONCLUSIONS: It was of concern that a parent was least likely to accompany a child for an emergency visit when a history and consent may assume the greatest importance.

Referring children to a Special Dental Care Centre in the Netherlands: parents' experiences and expectations.

AIM: The aim of the present study was to assess the relation between treatment at the family dentist versus referral and different aspects of treatment at a Special Dental Care Centre (SDCC), including the choice to return to their family dentist or not. The same study was performed for a group of patients recently referred to and still treated at a Special Dental Care Centre ( SDCC). METHODS: A questionnaire was sent to the parents of 852 children for whom complete dental records were available. Treatment was completed for 111 children (study 1) and 170 children were recently referred and had just started treatment (study 2). RESULTS/STATISTIC: In total 281 questionnaires were returned and filled out. Parents of children who returned to their general dental practitioner (GDP) were more satisfied with their GDP treatment than parents of children who did not return to their GDP (study 1: Z=- 3.65, p<0.001; study 2: Z=-2.86, p=0.004). CONCLUSION: The decision to return to the family dentist or not after treatment at a SDCC centre was based on their satisfaction with their treatment.

Dental services, costs, and factors associated with hospitalization for Medicaid-eligible children, Louisiana 1996-97.

OBJECTIVE: This study compared types and costs of dental services rendered to children who had received care in a hospital operating room (H) with children who had not (NH). METHODS: The study population consisted of all children aged 1-5 years who received a dental service reimbursed by the Louisiana Medicaid EPSDT program from October 1996 through September 1997. Claim files were provided by the Louisiana Bureau of Health Services Financing. A treatment intensity index [TII = 3 x (# extractions) + 2 x (# pulpotomies + # crowns) + # simple restorations] was calculated for H children (n = 2, 142) and NH children (n = 38,423). Using logistic regression, a dichotomous hospitalization variable (H vs NH) was regressed against treatment intensity and selected personal and parish (county) characteristics for each of the five age groups. Total and average reimbursement per child were calculated for both groups of children, by age. RESULTS: The mean treatment intensity scores for H and NH children were 24.02 (SD = 11.82) and 2.16 (SD = 4.78), respectively. For all age groups, children with treatment intensity scores greater than 8 were at least 132 times more likely to be hospitalized than were children with scores less than or equal to 8. The mean cost for care provided to H children was $1,508 compared with $104 for NH. Total costs for dental care rendered to H children (5% of the study population) were $3,229,851 (45% of total dental costs for the study population). CONCLUSION: Reducing severe caries through early interventions could provide substantial cost savings.

Child behavior in a private pediatric dental practice associated with types of visits, age and socio-economic factors.

The purpose of this study was to describe child patient behavior patterns seen in a private pediatric dental practice. Patient behavior for every individual visit was recorded over a span of 3 consecutive months using the Sarnat Behavior Scale as the descriptive measurement device. Behavior during 5 categories of procedures was recorded: new patient examination/introduction to the office, periodic recare, restorative dentistry, orthodontic adjustment and quick check observation. Socio-demographic variables such as age, sex, method of payment as an indicator of socio-economic status, prior dental experience and referral source were also recorded. The results of this study showed: 1. the younger the child and the more threatening the procedure, the more often negative behavior was noted, 2. patients whose dental treatment was paid for by Medicaid and who are likely to be in a lower socio-economic strata, often exhibited more negative behavior than the fee-for service counterparts, 3. in general, there was no difference in the behavior between males and females, although males age 8 to 12 had a higher incidence of negative behavior than females when undergoing restorative dental procedures. There are trends between age, type of procedure, source of patient referral, method of payment and familiarity with the office, that may be able to used as behavioral predictors in a private pediatric dental office.

Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital.

This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.