Clinical evaluation of a modified silver fluoride application technique designed to facilitate lesion assessment in outreach programs.

BACKGROUND: An advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment. METHODS: A total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs. RESULTS: The retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively. CONCLUSION: The retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.

Factors affecting missed appointment rates for pediatric patients insured by medicaid in a traditional hospital-based resident clinic and hospital-owned practice settings.

Missed appointment rates (MAR) of pediatric patients insured by Medicaid and seen in a traditional hospital-based continuity (teaching) clinic were compared to the rates for the same patients after their care had been transitioned to a community practice. The hypothesis is that when rewarded with shorter waiting times, a less chaotic environment, and more pediatrician continuity, the MAR for patients insured by Medicaid would be lower in the practice setting than it had been in continuity clinic. The MAR decreased from 33% in the continuity clinic in 1999 to 18% in the community practice in 2001 (p<0.01). It was also hypothesized that the MAR for patients insured by Medicaid would be higher in practices with a higher percentage of Medicaid appointments. Among 15 hospital-owned pediatric practices, the MAR for patients insured by Medicaid was positively correlated with the percentage of total appointments that were made by patients insured by Medicaid (correlation coefficient 0.706 [p<0.01]).