Evidence-based care pathways for management of early childhood caries.

The purpose of this article is to provide general dentists with simple care pathways for evidence-based early childhood caries chronic disease management (ECC-CDM). Early childhood caries, defined as the presence of dental caries in children younger than 6 years old, is a chronic disease that has been traditionally managed with conventional restorative care. There are limits to the long-term success of restorative care alone, and the care pathways in the ECC-CDM model include additional treatment modalities such as fluoride varnish, silver diamine fluoride, interim therapeutic restorations, and sealants. The ECC-CDM model also pairs customized, patient-specific strategies to these treatment options. These strategies include the use of active surveillance, counseling on prevention, recall strategies to prevent disease relapse, and the option to defer restorative care. General dentists can use the care pathways in the ECC-CDM model to manage caries progression in a way that best addresses the individual needs of children.

Perceptions on pregnancy and parenthood among program directors in pediatric dentistry.

PURPOSE: This cross-sectional study assessed the perceptions of pediatric dental residency program directors (PDs) regarding policies and attitudes on pregnancy and parenthood during residency training. METHODS: A 28-item electronic survey was administered to PDs of pediatric dental residencies in the United States. Statistical tests were performed. Variables were reported as counts (percentages) and compared using Fischer's exact test and chi-squared tests at a significance level of 0.05. RESULTS: Forty-two of the 97 PDs completed the survey for 43% response rate. Almost all programs had a formal maternal leave policy, but perceptions and policies varied regarding the effects of both pregnancy and parenthood on residents during training. Chi-square results compared if parenthood had a negative impact on the well-being a female trainee versus a male trainee had a p-value < .05. CONCLUSIONS: There appeared to be a lack of national uniformity regarding program policies on parental leave. Most PDs perceived having a child during residency had at least one negative effect on their female residents. Finally, PDs were likely to perceive parenthood to adversely impact the well-being and work of female trainees more so than their male counterparts.

Oral Health in the Down Syndrome Population: Parental Perceptions on Dental Care in the United States.

Purpose: To assess the oral health status of children with Down syndrome (DS) in the United States and evaluate the oral health needs of families with DS. Methods: Among 320 parents who consented to participate, 260 (81.2 percent) surveys were completed. A survey was distributed through the National Down Syndrome Society to parents of children with DS up to age 21 years, which asked questions about children's general and oral health. Results: Parents who reported that their children had difficulty rinsing and spitting were more likely to report their child's overall general health as poor (P<0.05). Parents' frequency of daily toothbrushing was similar to their children's toothbrushing habits (P<0.05). Conclusions: Dysphagia for children with Down syndrome may negatively impact oral health in addition to general health. Encouraging parental involvement in oral care for children with DS may lower their risk for oral disease. Continued support is needed to ensure dental school education includes training for the treatment and management of patients with DS.

Caregivers' Perspectives on Transitioning Dental Care for Adolescents with Special Healthcare Needs-A Cross-Sectional Study.

Introduction: Few studies have investigated the concerns of caregivers of adolescents with special health-care needs (ASHCN) regarding the barriers and challenges of transitioning from a pediatric to an adult-based dental home. The purpose of this study was to assess these perceptions. Methods: A 23-question survey was administered to guardians of ASHCN who presented to the pediatric dental clinic at the University of Maryland. Question types were either multiple choice, Likert scale responses, or open-ended. A descriptive analysis and Fisher's exact test were performed. Keywords were evaluated from the open-ended answers. Results: Twenty-seven caregivers completed the survey over a six-month period. Sixty-six percent of caregivers were aware that dental needs change as child ages and thought that transitioning was a logical next step, 78% had concerns about transitional care, and 70% did not have the desire to transition. Fisher's exact analysis comparing awareness of transition versus the desire to transition was p < 0.10. Conclusion: Most caregivers were aware of the changing dental needs of ASHCN and believed transitioning was a logical step. Many caregivers lacked readiness and perceived multiple barriers to transitioning. Awareness of the need to transition from pediatric to adult-based dental homes was not correlated with the readiness to transition.

Pediatric Dental Residency Program Directors' Perspectives on and Use of Social Media for Resident Selection and Education.

Residency programs are increasingly using social media for a variety of purposes. The aim of this study was to assess the views of U.S. pediatric dental residency program directors on their programs' participation in social media and use of social media in resident selection and education. This cross-sectional study used an electronic survey sent to all 89 U.S. program directors in 2018 to assess the use of social media and obtain demographic information. Forty-six surveys were completed, for a 52% response rate. Regarding resident selection, 76% of the responding directors said their programs did not conduct any online assessment of residency candidates, although 51% responded that social media postings could influence their decisions. For resident education, 78% said their programs did not provide training in challenges posed to evidence-based dentistry by social media, yet 89% expressed concern about the influence of expert opinions via social media on clinical decision making. Regarding participation in social media, 50% of respondents said their programs used social media to promote the program. These results point to a need for further evaluation of possible knowledge and behavior gaps among residency program directors and for development of formal social media assessment and education models for use in pediatric dentistry and other residency programs.

The Transition of Patients with Special Health Care Needs From Pediatric to Adult-Based Dental Care: A Scoping Review.

Purpose: The purpose of this study was to explore the breadth and extent of evidence regarding the transition of health care from pediatric to adult-based care for patients with special health care needs (SHCN), including evidence-based protocols to guide future research for the care of these patients. Methods: A scoping review protocol was used. A comprehensive literature search was completed for the relevant keywords and in multiple databases. Additional literature was identified from references within these articles. The inclusion criteria included both medical and dental literature to capture all pertinent information. Resulting article abstracts were screened and a full article review was performed to determine final inclusion. Results: Twenty-four articles were included. There is more medical literature for transition care for patients with chronic medical conditions than for oral health care. While there have been policy statements and guidelines published, these are not supported by high-quality evidence. There are no evidence-based protocols to guide this process. Conclusions: There is limited information within the current literature to guide the transition process for patients with special health care needs from pediatric to adult-based dental care. This is an area of study that can be explored in more depth to help improve dental management and care for patients with SHCN.

Acceptance of Preventive Dental Services for Children at a Retail-Based Clinic: A Pilot Study.

Purpose: Low-income children with high caries risk are disproportionately affected by poor access to dental care. Retail-based clinics (RBCs) can provide accessible ancillary oral health care. The purposes of this study were: (1) to measure caregivers' acceptance rate of an oral health screening, fluoride varnish (FV) application, and caries risk assessment offered to children on a walk-in basis in an RBC; and (2) to categorize the caries risk and demographics among the participants.
Methods: Screenings and FV applications were provided to children younger than 18 years at a Walgreens Health Care Clinic in Baltimore, Md., USA, from October 2016 to October 2017. The acceptance rate and caries risk using the American Dental Association caries risk assessment form were documented. Descriptive statistics and Fisher's exact test were used to analyze the data.
Results: Eighty-five children and their caretakers were approached and 32 (38 percent) agreed to participate. Most children had high caries risk (84.3 percent) and a dental home (81.2 percent), but only 50 percent reported visiting their dentist in the last year.
Conclusion: Our results demonstrate modest acceptance of FV application for children on a convenience basis. This population had predominantly high caries risk, with poor adherence to follow-up with their dental home. Retail-based dental care should not replace the dental home but could support it by increasing access to preventive dental care in children. (J Dent Child 2019;86(1):40-6)
Received July 2, 2018; Last Revision August 13, 2018; Accepted August 13, 2018.