Contemporary predoctoral paediatric behaviour guidance education in the United States and Canada.

PURPOSE: To determine the contemporary educational experiences of predoctoral dental students in the United States and Canada regarding behaviour guidance (BG) of the child patient and assess trends from a previous study in 2004. METHODS: Data were collected from 32 predoctoral paediatric dentistry programme directors in the United States and Canada via a web-based survey. RESULTS: The didactic curriculum hours devoted to the teaching of BG techniques in 2019 are similar to 2004. A majority (60.7%) of programmes do not have a formal assessment of competency with BG techniques. Lectures (n = 28), clinical experience (n = 28) and observation (n = 26) were the most common techniques implemented to teach BG techniques, and tell-show-do (100%), non-verbal communication (82.1%), positive reinforcement (89.3%) and distraction (82.1%) were the techniques that more than 75% of dental students most commonly have hands-on experience with during their dental education. In 2019, students tended to have more hands-on experience with nitrous oxide/oxygen inhalation and less hands-on experience with aversive techniques and sedation. CONCLUSIONS: The majority of dental schools do not have a formal competency in BG of the child patient. Compared with 2004, nitrous oxide/oxygen is used more by dental students and there is less predoctoral education in aversive BG techniques.

Mineral Trioxide Aggregate and Diluted Formocresol Pulpotomy: Prospective and Retrospective Study Outcomes.

Mineral Trioxide Aggregate (MTA) has been used in many endodontic procedures with success. We hypothesized that MTA as a pulpotomy medicament elicits outcomes no different than that of the diluted formocresol (DFC). PURPOSE: The purpose of this study was to compare the outcomes of grey MTA and DFC in primary molar pulpotomies at a teaching institution and a pediatric dental practice. METHODS: At the teaching institution, 206 primary molars of 122 children were enrolled. At 48-months, 20 teeth treated with MTA and 25 teeth treated with DFC, were available for evaluation. At the private practice, dental records of 245 primary molars of 68 patients were available for evaluation. RESULTS: At 48 months, the results from both sites showed a radiographic success rate of 80 percent for DFC and 95 percent for MTA. The odds of radiographic failure were not affected by study sites. The Cox-regression analysis revealed that patient's age at the time of pulpotomy impacted the "hazard of exfoliation." Each year following the completion of DFC or MTA pulpotomy, there is a 4.6-times-more-likely chance for early exfoliation of the pulpotomized tooth. CONCLUSION: Grey MTA is an acceptable alternative for primary molar pulpotomies.

Antibiotics and Local Anesthetics: Drug Considerations for the Child Patient.

A primary concern of dental care for the child patient is patient safety. Antibiotics and local anesthetics are very commonly used in dental care, making it critical that providers take into account the special considerations when these drugs are used with the child patient. Considerations in medication selection, indications for use, appropriate and safe dosing, suitable prescribing and administration, and potential deleterious effects are discussed. An overview is provided to ensure proper use of antibiotics and local anesthetics for the pediatric patient.

The antimicrobial potential of stevia in an in vitro microbial caries model.

PURPOSE: To determine the effect of stevia on caries development when incorporated into a cariogenic diet in a controlled microbial caries model. METHODS: 56 bovine tooth specimens (4 x 4 mm) were divided into four groups, each secured in a caries-forming vessel. All vessels were placed on an electric stirrer inside a 37°C incubator. The specimens were inoculated with Streptococcus mutans, and exposed for 4 days to circulating cycles of tryptic soy broth supplemented with 5% sucrose-TSBS (three x/day), and a mineral wash solution. Between TSBS cycles (three x/day), each group received one of four experimental solutions: phosphate buffer (PBS-negative control), 0.5% stevia solution, 5% stevia solution, or 5% xylitol solution. Development of caries lesions was analyzed using enamel surface hardness. Difference in Vickers Hardness between pre and post-treatment was calculated to determine caries development. Plaque was dislodged from six specimens per group, and the CFU/ml calculated. Data were analyzed using ANOVA at 95% confidence level, and individual group differences calculated using Tukey's test. RESULTS: 5% xylitol resulted in significantly less plaque at the end of the study compared to PBS and 5% stevia, but not significantly different than 0.5% stevia. 5% stevia had significantly softer lesions than the other groups, while there was no significant difference in hardness scores between 5% xylitol, 0.5% stevia and PBS.

Etiology, Classification and Management of Ectopic Eruption of Permanent First Molars.

Ectopic eruption of a permanent tooth involves abnormal resorption of a portion or all of the adjacent primary tooth. Among the most commonly ectopically erupted teeth are the permanent first molars. Ectopically erupting molars may require intervention to allow for full eruption, or they may spontaneously self-correct and erupt into occlusion. Decisions regarding the necessity of intervention, its ideal timing, and intervention type are multifactorial. Treatment options for the ectopically erupting permanent first molar include the elastomeric separator, brass wire, pre-fabricated clip separator, custom made appliances (Humphrey appliance, Halterman appliance), or extraction of the primary molar. Early intervention when indicated can ensure proper full eruption of the permanent first molar and prevent mesial angulation, arch perimeter loss, tooth impaction and ankylosis. Two cases are described that manage ectopic eruption of the permanent first molar.

Periodontal Considerations for the Child and Adolescent. A Literature Review.

The primary etiology of periodontal disease is bacterial plaque and its byproducts in a susceptible host. Although the prevalence of plaque-induced periodontal disease is relatively low for the child and adolescent, destructive periodontal disease may be a manifestation of an underlying systemic disease. In some cases, childhood periodontal destruction may be the first sign of systemic disease, making appropriate recognition and determination of etiology critical in this population. Therefore, this literature review discusses the periodontal considerations for the child and adolescent patient, aiming to offer a guide for differential diagnosis and oral management of periodontal disease in the young population.

Michigan Dentists' Attitudes toward Medicaid and an Alternative Public Dental Insurance System for Children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentists' attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an email address registered with the Michigan Dental Association (n=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Avulsion of the immature permanent tooth: case report and review.

Traumatic dental injuries are common among children in the mixed dentition. A case is described outlining treatment of avulsion of immature maxillary and mandibular incisors in an 8-year-old child. Resources to aid the dentist to easily locate the most recent evidence-based treatment recommendations are described.

Parents of Children With Versus Without Special Health Care Needs and Oral Health Promotion: Challenges and Best Practices.

Purpose: Oral health care is a leading unmet health care need of children with special health care needs (CSHCNs). The purposes of this study were to: (1) compare the responses of parents (parents, caregivers) of children with versus without special health care needs (SHCNs) concerning their child's functioning, oral health-related knowledge, attitudes, and behavior; and (2) assess which information parents received/wanted to receive from dentists. Methods: A total of 122 parents of CSHCNs and 115 parents of children without SHCNs responded to the surveys. Results: Parents of CSHCNs reported that their children had lower functioning (per a four-point scale, with zero indicating worst functioning; means without SHCNs/CSHCNs equal 1.98/2.70; P<0.001) and nonverbal interactions (2.24/2.77; P<0.001), flossed and used mouth rinse less frequently (per a fivepoint scale, with one indicating never: 2.23/2.70; P=0.002; 1.82/2.27; P=0.004) than parents of children without SHCNs. They reported more oral care-related challenges (43.4 percent versus 21.7 percent; P<0.001), were less comfortable helping with oral care (per a five-point answer scale, with five indicating very comfortable: 3.92/4.48; P<0.001) and less interested in receiving information (3.13/3.71; P<0.001) than parents of children without SHCNs. Conclusions: Parents of children with or without special health care needs do not differ in their knowledge and attitudes. However, parents of CSHCNs are less comfortable in helping with oral care and less interested in receiving information than parents of children without SHCNs. Understanding the obstacles parents of CSHCNs face when providing oral care for their children can help dentists better support their oral health-related efforts.

Impact of Reduced Operating Room Access on Dental Departments in Children's Hospitals.

Purpose: Access to hospital operating rooms (HORs) for pediatric dental patients worsened with the COVID-19 pandemic. The purpose of this study was to assess the impact of hospital operating room denials for dental patients on service and teaching missions in selected US children's hospitals (CHs). Methods: A 12-question online survey was sent to administrative heads of 34 CH dental departments. Results: Twenty-two surveys were completed. All respondent CHs were engaged in pediatric dentistry training. The majority (68 percent) reported that access to HORs worsened since 2017, resulting in longer wait times for hospital dental service cases (82 percent), decreased ability to achieve and maintain oral health for special needs patients (64 percent), more caries-related emergency department visits (50 percent), and delays in medical surgery for children needing dental clearance (45 percent). A quarter (27 percent) reported HOR availability somewhat affected resident training. Conclusion: Lack of access to hospital operating rooms in training hospitals had a negative impact on the quality and timeliness of care and the quality of training.

Rubber dam isolation in pediatric patients: a review.

The rubber dam has been available to the dental profession for over 145 years and can serve as an invaluable tool to dental practitioners. Here we review the rubber dam and its application on children including advantages and disadvantages associated with its use and alternative isolation methods.

Aspiration of an exfoliated primary molar in a child with cerebral palsy: A case report.

Foreign body aspiration is a concern in children which may occur with anything introduced to the oral cavity and can result in significant morbidity and mortality. Food and foreign objects are the most commonly aspirated objects in young children. Aspiration of a normally exfoliated primary tooth is thought to be extremely rare, if not unheard-of. The purpose of this case report is to describe the events occurring to a 10-year-old child with a cerebral palsy presenting with signs and symptoms of respiratory distress due to aspiration of a naturally exfoliated primary molar. Recommendations are provided for delivery of appropriate anticipatory guidance, management of exfoliating primary teeth, and safe clinical practice.

Safety Training in US Pediatric Dentistry Advanced Education Programs: A Survey of Program Directors.

Purpose: Incorporation of patient safety and quality improvement into the educational framework of all health care trainees, including those in dentistry, is growing. The purpose of this study was to characterize the current state of patient safety training and education in US pediatric dentistry residency programs. Methods: A 19-item web-based survey was emailed to all US pediatric dentistry residency program directors in 2021. The survey collected information regarding program background, safety education, safety protocol and experience, attitudes toward safety, and potential support for safety education. Data were analyzed using descriptive statistics and Fisher's exact test. Results: Seventy-two directors (76 percent response rate) completed the survey. The majority felt safety education was somewhat (11 percent, N equals six) or extremely important (68 percent, N equals 49) for residents. Only six percent (N equals four) reported residents entered their program with an adequate understanding of safety science. Most (74 percent, N equals 53) taught safety science through both didactic seminars and clinical experience. Timeouts under general anesthesia (78 percent, N equals 56) and emergency simulations (72 percent, N equals 52) were more common modes of clinical safety training. Overall, a limited number of program directors had familiarity with many safety tools used to prevent adverse events. Program directors' experience with adverse events was not associated with opinions regarding the importance of safety education. The majority expressed interest in AAPD supporting safety education. Conclusions: Although program directors feel safety education is important, programs do not sufficiently address safety education and look for support to help integrate safety measures into education.

Guiding the behavior of children in the dental setting. Opportunities for success.

Through use of communication-based strategies, effective local anesthesia, and judicious use of nitrous oxide, the vast majority of children can be cooperative at the dentist's office. Proper communication with children helps to ensure that dental care is completed in a compassionate, safe manner, helping to make children's dentistry a very rewarding part of a dental practice.

Oral Health Advocacy Education Impacts Future Engagement: Exploration at a Midwestern US Dental School.

Purpose: With the emergence of COVID-19, and the potential inclusion of dental benefits in Medicare, it is critical that dentists are able to engage in legislative advocacy to support public oral health. Dental education has an opportunity to teach advocacy skills to future dentists, although advocacy training in predoctoral dental education has been largely ignored. The purpose of this study was to evaluate fourth-year dental student's attitudes toward advocacy, identify the type and extent of advocacy experiences during dental school, and assess their future intentions to engage in advocacy. Methods: An electronic questionnaire was administered to fourth-year dental students enrolled in their final semester at Ohio State University. Results: Forty-seven students completed the survey (43% response rate). Most (84%) respondents agreed that advocacy training should be a required experience in accreditation standards for predoctoral dental education. Over half (58%) reported seldom or no exposure to legislative and regulatory processes in oral health policy development in the curriculum. Students who participated in grassroots advocacy efforts while in dental school were more likely to contact legislators regarding dental issues (p = 0.005) or public insurance (p = 0.037), and participate in future lobbying efforts (p = 0.019). Students who contributed to PAC while in dental school were more likely to express intentions to contribute in future (p = 0.005). Conclusions: There is limited exposure to legislative advocacy in predoctoral dental education. Dental students with advocacy experience are more likely to report intentions to participate in advocacy as dentists. Dental education has a critical role in preparing future dentist-advocates.

Restorations Versus Stainless Steel Crowns in Primary Molars: A Retrospective Split-Mouth Study.

Purpose: The purpose of this study was to evaluate the treatment outcomes of multisurface caries in primary molars treated with intracoronal restorations versus stainless steel crowns (SSCs) through a retrospective split-mouth study. Methods: Dental records were screened for patients who had treatment of one primary molar with a multisurface restoration and one primary molar with an SSC. Teeth were followed until a loss to follow-up, exfoliation, or failure. Results: A total of 988 primary molars were evaluated, with a mean follow-up time of 22 months. The survival probabilities for: SSCs were 95.5 percent at one year of service and 92.8 percent at two years of service; and for intracoronal restorations were 92.0 percent at one year of service and 80.0 percent at two years of service. Overall survival analysis showed SSCs to be significantly more successful than restorations (P<0.001), particularly in children treated at ages four years and younger (P<0.001). No statistically significant difference (P=0.10) was found for children treated at ages five years and older. Conclusions: Stainless steel crowns have a higher survival probability versus restorations for multisurface caries. In children ages four years and younger, more aggressive treatment of multi-surface caries with SSCs should be considered, as conservative treatment leads to an increased need for retreatment.

Silver Diamine Fluoride and Progression of Incipient Approximal Caries in Permanent Teeth: A Retrospective Study.

Purpose: The purpose of this study was to evaluate the progression of incipient approximal caries lesions in permanent teeth of children and adolescents with and without silver diamine fluoride (SDF) application. Methods: A retrospective analysis of dental records and radiographs was performed. Baseline and follow-up bitewing radiographs were evaluated and scored using International Caries Classification and Management System (ICCMS) criteria to assess lesion progression. Results: A total of 131 lesions from 68 subjects (mean age equals 9.6 years) were evaluated radiographically and followed for up to 41 months (mean time equals 13.61±6.8 months); 23.6 percent of lesions in the SDF group progressed compared to 38.1 percent in the control group (P<0.001). On average, lesions in the control group increased more per month compared to the study group (P<0.001). The odds of lesion progression in the control group were 2.76 times the odds of progression in the study group. There was a statistically significant difference in lesion progression based on application method; lesions where SDF was applied with Superfloss progressed more per month, on average, versus microbrush application. Conclusions: Silver diamine fluoride may be an effective therapy to slow caries progression of incipient approximal lesions in permanent teeth in high caries-risk populations. Future studies are needed to detect differences in application methods.

Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars.

PURPOSE: The purpose of this multisite, multioperator, prospective, randomized, controlled clinical trial was to evaluate the 6-month outcomes of diluted formocresol (DFC) compared to gray mineral trioxide aggregate (GMTA) as pulpotomy medicament. METHODS: Determined by a power analysis, 252 molars of 152 children were recruited. The teeth were randomly assigned to receive GMTA or DFC. At the 6-month follow-up, 118 children with 203 treated teeth were evaluated. RESULTS: Four blinded and calibrated evaluators scored each radiograph for pathologies. Clinical success was similar for DFC (97%) and GMTA (100%), (P<.09). Radiographic success differed significantly (P<.04) for DFC (86%) and GMTA (95%). Pulp canal obliteration was radiographically observed in 25% of the DFC group and in 37% of the GMTA group (P=.07). Dentin bridging was observed in 22% of the GMTA group but was not found in the DFC group (P<.01). CONCLUSION: Teeth treated with GMTA showed more favorable radiographic outcomes than DFC at 6 months post-treatment.

General dentistry's role in the care for children with special needs: a review.

Children with special health care needs include those with behavioral issues, developmental disorders, cognitive disorders, congenital or genetic disorders, or systemic disease. These conditions may place them at increased risk for oral diseases, making it important to establish preventive oral health strategies at an early age. These children should have an established dental home, through which preventive care can be initiated and maintained, by 12 months of age. Dentists can establish prevention-based care from a young age by understanding the child's condition and how that condition influences the delivery of oral health care. This article outlines common conditions among children with special needs, focuses on their influence on dental health, and describes how these conditions influence preventive, operative, surgical, and behavior management strategies. The goal is to provide an overview that will help guide practicing dentists to understand their role in the care of children with special health care needs.

Contemporary appraisal of factors influencing pediatric dental program directors' selection of residents.

PURPOSE: With the increasing number of applicants and changes to information available in applications, pediatric dentistry program directors must adapt the resident selection process. The evaluation approach was significantly impacted when the National Board Dental Examination (NBDE) changed to a pass/fail grading system. The purposes of this are study to examine what criteria pediatric dentistry program directors now use to select residents, and to evaluate current criteria against those used in the past. METHODS: A 30-item survey was structured similar to a previous questionnaire used in 2005. An invitation to participate was sent via email to all pediatric dentistry program directors for the 82 Commission on Dental Accreditation (CODA)-accredited programs located in the United States and Canada. Anonymous responses were analyzed. RESULTS: There were 58 responses (70.7% response rate). The overall most important factors were clinical grades, dental school class rank, dental school grade point average (GPA), and applicant's essay. The least important factors were the applicant being a graduate of the program's dental school, Advanced Dental Admission Test (ADAT) score, and applicant's fluency in a second language. The factor that had the most significant increase in importance from 2005 is the applicant's essay, followed by dental school reputation and the dental school's pediatric program reputation. CONCLUSIONS: The most important factors to program directors are clinical grades, dental school class rank, dental school GPA, and applicant's essay. The applicant's essay has increased in importance since 2005.