A community survey on maternal perception about the initiation of dental home for infants in Lagos, Nigeria.

INTRODUCTION: because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation after disease development, early preventive dental visits are widely encouraged by dental professional and academic stakeholders. Aim: this study aimed to determine the perceptions and practices of mothers with regards to the establishment of dental home at four local government areas (LGAs) in Lagos, Nigeria. METHODS: was a community-based descriptive household survey conducted amongst mothers in Alimosho, Ikorodu, Surulere and Epe LGAs of Lagos State. Socio-demographic data, information about the importance of primary teeth, knowledge about dental home as well as their child´s age at first dental visit and reasons for attending was obtained with a validated, structured interviewer administered questionnaire. Descriptive statistics, Chi-square and multivariable regression analysis were conducted, and the level of significance was set at P<0.05. RESULTS: the highest proportion of the mothers were aged between 26-30 years (27.4%; mean age: 34.58±7.8 years) and had a tertiary level of education (n=206, 59.9%); most respondents (n=80, 51.4%) did not know the age a child should be taken to the dental clinic for the first time and had not taken their child for any dental visit (n=229, 65.4%). Out of those who had previously taken their child for dental visits, the greater proportion (n=115, 95.0%) took the child when he/she was older than one year of age. Overall, only 126 (36.0%) respondents had a good perception about oral health and the need for a dental home while 224 (64.0%) respondents had poor knowledge. Logistic regression analysis of predictor variables that showed mothers with a tertiary level of education (OR=0.108; CI=0.0023-0.495) and those with 2-3 children (OR=0.482; CI=0.253-0.920) had significant lower odds of poor perception about the importance of a dental home. CONCLUSION: maternal knowledge and practices with regards to dental home were poor and inadequate. It is necessary to create more awareness among parents/caregivers, especially through antenatal and immunization clinics to establish the concept of dental home.

Does Preventive Care Reduce Severe Pediatric Dental Caries?

INTRODUCTION: Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS: We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS: Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION: Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.

Odontogenic Infection and dental Pain negatively impact Schoolchildren's Quality of Life.

The aim of this study is to assess the prevalence of odontogenic infection in low-income Brazilian schoolchildren and evaluate its association with the subjective variables of oral health-related quality of life and dental pain. In this cross-sectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ8-10) and self-reports of dental pain were collected. Data were statistically analyzed using MannWhitney or Kruskal-Wallis test with a post-test by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional well-being (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among low-income Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's self-perception of quality of life.

O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPO-D/ceo-d e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ8-10) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizando-se o teste Mann-Whitney ou Kruskal-Wallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bem-estar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a auto-percepção de qualidade de vida das crianças.

Odontogenic Infection and dental Pain negatively impact Schoolchildrens Quality of Life / Infecção odontogênica e odontalgia impactam negativamente a qualidade de vida de crianças escolares

ABSTRACT The aim of this study is to assess the prevalence of odontogenic infection in lowincome Brazilian schoolchildren and evaluate its association with the subjective variables of oral healthrelated quality of life and dental pain. In this crosssectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ810) and selfreports of dental pain were collected. Data were statistically analyzed using MannWhitney or KruskalWallis test with a posttest by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional wellbeing (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among lowincome Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's selfperception of quality of life.

RESUMO O objetivo deste estudo foi avaliar a prevalência de infecção odontogênica em crianças escolares brasileiras de baixa renda e analisar a sua associação com as variáveis subjetivas da autopercepção de qualidade de vida relacionada à saúde bucal e dor dentária. Neste estudo transversal, 230 crianças escolares com 8 a 10 anos de idade realizaram exame clínico bucal no qual os índices CPOD/ ceod e PUFA/pufa foram mensurados. Com isso, as crianças responderam individualmente ao Child Perceptions Questionnaire (CPQ810) e relatos de dor dentária foram coletados. Os dados foram estatisticamente analisados utilizandose o teste MannWhitney ou KruskalWallis, com posterior teste da correlação de Dunn e Pearson. Dentre as crianças examinadas, 42,6% apresentavam infecção odontogênica e 80% reportou experiência de dor dentária. A idade (p=0,034) e experiência de dor dentária (p<0,002) das crianças foram associadas à infecção odontogênica, bem como o seu bemestar emocional (p=0,008) e social (p=0,009) e impacto geral na qualidade de vida (p=0,019). Além disso, a intensidade (p<0,001), frequência (p<0,001) e duração (p<0,001) da odontalgia foram correlacionadas com o impacto geral na qualidade de vida da criança. A prevalência de infecção odontogênica permanece elevada em crianças escolares brasileiras. Infecção pediátrica e sua dor relacionada induzem não apenas diversas desordens biológicas, mas também afetam negativamente a autopercepção de qualidade de vida das crianças.

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment.

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants' ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4-6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5-6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents' reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p <0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35-14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21-21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

Food Insecurity and Health Care Use.

BACKGROUND AND OBJECTIVES: Fifteen percent of US children live in households with inadequate food. Children who are food insecure often experience worse physical, emotional, and developmental health outcomes. Authors of previous studies have not examined the quality and cost implications of food insecurity in children. METHODS: This is a retrospective study of 7959 nationally representative US children (aged 1-17 years) in the 2016 Medical Expenditure Panel Survey. Households with food insecurity were identified by ≥3 positive responses to the 30-day, 10-item US Food Security Survey. Main outcomes were annual health expenditures and quality of care indicators: emergency department (ED) and inpatient use, primary care and specialist visits, routine medical and dental care, patient experience measures, and school absenteeism. Logistic and 2-part regression models were constructed to estimate outcomes conditional on sociodemographic and medical covariates. RESULTS: Children in households with food insecurity were more often publicly insured and had special needs compared with all other children. In multivariable logistic regression, household food insecurity was associated with significantly higher adjusted odds of an ED (adjusted odds ratio [aOR] = 1.37) or primary care treatment visit (aOR = 1.24) during the year. Household food insecurity was associated with significantly higher school absenteeism (aOR = 1.74) and lower access to care for routine (aOR = 0.55) or illness (aOR = 0.57) care. There were no differences in annual health expenditures, hospitalizations, or receipt of routine medical or dental care. CONCLUSIONS: Household food insecurity is associated with higher ED use and school absenteeism and lower access to care; however, it was not associated with higher annual health expenditures in children.

Psychometric properties of the Child Oral-care Performance Assessment Scale.

OBJECTIVES: This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS). METHODS: Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models. RESULTS: Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97). CONCLUSION: There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.

Access to oral health in early childhood in the city of Porto Alegre, Brazil. / Acesso à saúde bucal na primeira infância no município de Porto Alegre, Brasil.

The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.

O objetivo foi avaliar o acesso e fatores associados à consulta odontológica em crianças de até 5 anos no município de Porto Alegre, Brasil. Estudo transversal realizado em 10 Unidades Básicas de Saúde, através de questionário e exame clínico em 560 crianças. Foram avaliadas variáveis clínicas (placa visível, sangramento gengival e ceo-s), sociodemográficas, e de acesso à consulta. Regressão de Poisson foi utilizada para cálculo de Razões de Prevalência (RP), com intervalo de confiança de 95%. Os resultados mostraram que 68,2% das crianças nunca haviam ido ao dentista. O principal motivo relatado para a não realização de consulta odontológica foi não ter sentido necessidade (48,7%) e dificuldade de acesso ao posto de saúde (15,8%). A procura pelo dentista teve como propósito a prevenção/revisão (55,8%) e os locais mais procurados para consultas foi o consultório particular (43,9%) e o posto de saúde (39,5%). O modelo multivariado final mostrou que a idade da criança (IC95%, RP = 1,03 (1,02-1,05)), a renda familiar (RP = 1,05; (1,01-1,08)) e a mãe ter concluído o ensino médio (RP = 1,69 (1,15-2,56)) estiveram associados com a procura por consulta odontológica. Assim, torna-se fundamental reconhecer a importância do contexto familiar durante os primeiros anos de vida.

Acesso à saúde bucal na primeira infância no município de Porto Alegre, Brasil / Access to oral health in early childhood in the city of Porto Alegre, Brazil

Resumo O objetivo foi avaliar o acesso e fatores associados à consulta odontológica em crianças de até 5 anos no município de Porto Alegre, Brasil. Estudo transversal realizado em 10 Unidades Básicas de Saúde, através de questionário e exame clínico em 560 crianças. Foram avaliadas variáveis clínicas (placa visível, sangramento gengival e ceo-s), sociodemográficas, e de acesso à consulta. Regressão de Poisson foi utilizada para cálculo de Razões de Prevalência (RP), com intervalo de confiança de 95%. Os resultados mostraram que 68,2% das crianças nunca haviam ido ao dentista. O principal motivo relatado para a não realização de consulta odontológica foi não ter sentido necessidade (48,7%) e dificuldade de acesso ao posto de saúde (15,8%). A procura pelo dentista teve como propósito a prevenção/revisão (55,8%) e os locais mais procurados para consultas foi o consultório particular (43,9%) e o posto de saúde (39,5%). O modelo multivariado final mostrou que a idade da criança (IC95%, RP = 1,03 (1,02-1,05)), a renda familiar (RP = 1,05; (1,01-1,08)) e a mãe ter concluído o ensino médio (RP = 1,69 (1,15-2,56)) estiveram associados com a procura por consulta odontológica. Assim, torna-se fundamental reconhecer a importância do contexto familiar durante os primeiros anos de vida.

Abstract The goal was to assess the access and factors connected to dental visits in children up to age five in the city of Porto Alegre, Brazil. The cross-sectional study was conducted in 10 Basic Health Units through a questionnaire and clinical examination on 560 children. Clinical (visible plaque, gingival bleeding and defs), socio-demographic, and visit access variables were assessed. Poisson Regression was used to calculate the Prevalence Ratios (PR), with a 95% confidence interval. Results showed that 68.2% of children had never gone to a dentist. The main reason reported for not visiting a dentist was not feeling the need (48.7%) and difficult access to a health clinic (15.8%). The purpose of going to the dentist was for prevention/revision (55.8%), and the most sought-after places for visits were the private office (43.9%) and health clinic (39.5%). The final multivariate model showed that age of the child (95%CI, PR = 1.03 (1.02-1.05)), household income (PR = 1.05; (1.01-1.08)), and the mother having completed high school (PR = 1.69 (1.15-2.56)) were associated with seeking dental consultation. Thus, it is crucial to recognize the importance of the family setting during the first years of life.

The Prevalence and Factors Associated with Sibling-Recurrent Dental Treatment Under General Anesthesia at an Academic Institution.

Purpose: The purpose of this study was to assess the prevalence of and factors that contribute to sibling-recurrent dental general anesthesia (DGA) at the Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, Va., USA. Methods: Subjects were recruited from July 25, 2017 to March 15, 2018. The guardian of patients with siblings who attended a university pediatric dental clinic were provided a questionnaire to assess the prevalence and factors associated with recurrent DGA. A provider survey was completed to ensure inclusion/exclusion criteria were met. Results: A total of 40 families with a child presenting for general anesthesia (GA) and who had at least one sibling were included in the study. Of these, 45 percent had sibling-recurrent GA treatment; 20 percent of patients had one sibling; and 25 percent had two or more sibling-recurrent DGA (P<.05). Additionally, 13 percent of the children currently presenting for GA had already been treated under GA, and 15 percent of the siblings previously treated with GA had recurrent caries after GA. Conclusions: Sibling-recurrent general anesthesia is high at Virginia Commonwealth University's Pediatric Dentistry Clinic. This increased prevalence could be due to parental acceptance and positive experiences with DGA. Dental providers should be proactive with prevention of recurrent DGA.

The child's first dental visit. Age, reasons, oral health status and dental treatment needs among children in Southern Poland.

AIM: The aim of this study was to determine the age at and the reasons for the child's first dental visit, and to assess the oral health status and treatment needs in the analysed group of paediatric patients. MATERIALS AND METHODS: The study involved 320 children (154 girls and 166 boys) aged between 0.7 months and 13.5 years, visiting the dentist for the first time. All parents/legal guardians of the study participants gave written informed consent for participation in the study. Data on the child's age and reason for the dental visit were collected from interviews with parents. The state of oral health and dental treatment needs were assessed based on clinical examination, according to recommendations of the World Health Organization. STATISTICAL ANALYSIS: collected data were entered into an Excel spreadsheet and analysed using IBM SPSS software (version 24). Research hypotheses were verified using the Chi-square independence test at the level of statistical significance p<0.05. RESULTS: The mean age of children at their first dental visit was 3.79 years (+/- 1.82 years). The most common reasons (60%) for the first dental visit were pain followed by dental caries (33.1%) and the presence of decayed teeth (26.9%). The frequency of caries in the population was 75.9%, which means that only one out of four examined children was free from dental caries. Only 23.1% of patients did not require dental treatment and as many as 76.9% of the studied population needed dental treatment. CONCLUSION: Polish children make their first dental visit too late (usually at the age of 4 years) in relation to medical recommendations (between 6 and 12 months of life). The predominant reason for the child's first dental visit is caries and its complications. The results of this study indicate the bad oral health of Polish children making their first dental visit and low health awareness of parents and guardians.

Family Health Strategy associated with increased dental visitation among preschool children in Brazil.

BACKGROUND: Early-life dental service utilization could improve child dental health. AIM: Identify contextual, socioeconomic, and child characteristics associated with dental visitation by age 3 years. DESIGN: Within a Brazilian birth cohort (N = 435), multivariable regression models were fitted to identify independent predictors of having made a dental visit at age 3 years. Contextual variables considered included health center type (Traditional vs. Family Health Strategy, which perform home visits) and composition of oral health teams at the heath center where mothers accessed prenatal care. RESULTS: Dental visitation was positively associated with Family Health Strategy health centers (36% vs. 23%) and with higher maternal education and family social class. Visitation was lowest among families served by a health center without a dentist, but number of dentists and oral health team composition were not associated with visitation among facilities with ≥1 dentists. Dental visitation was not statistically significantly associated with caries experience but was higher if parents reported worse oral health-related quality of life. The vast majority of dental decay remained untreated. CONCLUSIONS: Dental visits were underutilized, and socioeconomic inequalities were evident. Dental visitation was more common when mothers received prenatal care at Family Health Strategy health centers, suggesting a possible oral health benefit.

Oral Health Disparities in Children: A Canary in the Coalmine?

Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.

Impact of oral health literacy on self-reported missing data in epidemiological research.

OBJECTIVES: To investigate whether oral health literacy (OHL) impacts missing data obtained through self-reporting in oral health epidemiological research. METHODS: A cross-sectional study was conducted with parents (n = 344) of 4- to 5-year-old children randomly selected from public schools within the city of Curitiba, Brazil. Parental OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30). Parents answered a set of questionnaires comprising 88 items concerning sociodemographic and economic data, children's access to dental services, oral hygiene behaviour, diet and mealtime behaviour. The total number of unanswered items (TUI) and the number of unanswered items in each type of question (open-ended, dichotomous, multiple choice with up to 4 options and with 5-9 options) for each participant was compared across different levels of OHL (chi-squared, Mann-Whitney, Kruskal-Wallis and Spearman's correlation test). Multiple Poisson regression was used to estimate rate ratios (RR) of TUI between OHL scores and their respective 95% confidence interval (95% CI). RESULTS: Approximately one-third of studied parents (37%) exhibited low OHL (BREALD-30 ≤ 21). The prevalence of missing data in at least one item was 85.5%. Low OHL was associated with failing to respond open-ended items (P = 0.003) and multiple-choice items with up to 4 (P = 0.003) and between 5 and 9 options (P = 0.030). There was a negative correlation between OHL scores and TUI (r = -0.195; P < 0.001), as well as with the number of unanswered items in all types of questions (P < 0.01), except dichotomous questions. Parents with lower OHL were more likely to show higher values of TUI (RR 0.95: 0.93-0.98), when adjusted by income and education. CONCLUSIONS: Participants with lower OHL were significantly more likely to fail to complete research questionnaires. The impact of OHL on missing data was greater with more complex types of items.

Prevalence and disparities in the first dental visit of preschool children aged 12-18 months in southern Brazil / Prevalência e disparidades na primeira visita odontológica de pré-escolares de 12 a 18 meses no sul do Brasil

Objective: this study aimed to assess the use of dentalservices in a southern Brazilian city by children aged12-18 months and to verify the relationship betweensocioeconomic and demographic variables, as well asmaternal use of dental services, and presence of dentalcaries in the children. It also aimed to describe theprevalence of use of dental services by variables of disparity.Subjects and method: this cross-sectional studywas performed on the National Children's VaccinationDay in 12 public health care centers in Pelotas, RS, Brazil.The data on demographic and socioeconomic status(children's sex, number of children, family income, andmaternal education), pattern of maternal use of dentalservices, and children's first dental visit were collectedusing a semi-structured interview answered by themothers. Clinical examination was performed to assessdental caries in the children. Chi-square and Fisher'sexact tests were performed to analyze the associationsand an equiplot graph investigated disparities in the prevalenceof the first dental visit of preschoolers. Results:most children had never been to the dentist (93.4%).The bivariate analysis showed that children who hadnever been to the dentist belonged to families with lowerincome, and their mothers presented low level ofeducation and did not use dental services. Conclusion:most children aged 12-18 months had never been to thedentist and there is a socioeconomic disparity in the useof dental services by preschool children. (AU)

Objetivos: avaliar o uso do serviço odontológico em uma cidade do sul do Brasil por crianças de 12 a 18 meses de idade; verificar a relação entre variáveis socioeconômicas, demográficas, uso de serviço odontológico materno e presença de cárie dentária nas crianças; e descrever a cobertura do uso do serviço odontológico por variáveis de disparidade. Sujeitos e método: este estudo transversal foi realizado no Dia Nacional de Vacinação Infantil em doze centros de saúde pública em Pelotas, Rio Grande do Sul, Brasil. Os dados sobre status demográfico e socioeconômico (sexo da criança, número de filhos, renda familiar e educação materna), padrão de uso de serviço odontológico materno e primeira consulta odontológica infantil foram coletados por meio de uma entrevista semiestruturada com as mães. Foi realizado exame clínico para avaliação de cárie dentária nas crianças. O teste Qui-Quadrado e o teste exato de Fisher foram realizados para analisar as associações, e um gráfico equiplot investigou disparidades na cobertura da primeira visita odontológica de pré- -escolares. Resultados: a maioria das crianças nunca foi ao dentista (93,4%). A análise bivariada mostrou que as crianças que nunca foram ao dentista eram de famílias com menor renda, cujas mães tinham níveis baixos de escolaridade e não usavam o serviço de atendimento odontológico. Conclusão: a maioria das crianças de 12 a 18 meses nunca foi ao dentista. Há uma disparidade socioeconômica no uso de serviços odontológicos por crianças pré-escolares. (AU)

Disparities in Receipt of Preventive Dental Services in Children From Low-Income Families.

INTRODUCTION: Healthy People 2020 includes a goal of increasing use of preventive dental care among children from low-income families. The services used to define preventive care are evidence-based services (i.e., dental sealants and professionally applied topical fluoride) and professional dental cleaning, which lacks evidence of effectiveness in preventing caries. This study examined how increasing preventive dental care use and reducing disparities by race/ethnicity among children from low-income families varied by the services included in case definitions of preventive dental care use. METHODS: Three case definitions of past-year preventive dental care use were considered: (1) the Healthy People 2020 definition; (2) receipt of an evidence-based caries prevention service; and (3) dental cleaning only. Using pooled data from the 2001-2002 and 2013-2014 Medical Expenditure Panel Survey for each definition, this study conducted in 2017 used multivariate logistic regression to estimate changes in preventive dental care use among children from low-income families by race/ethnicity. RESULTS: Use increased for all racial/ethnic groups for all definitions. Use of preventive dental care (Healthy People 2020 definition), however, was at least two times higher than evidence-based preventive dental use for all racial/ethnic groups in both survey periods. After controlling for insurance status and parental education, the disparity between non-Hispanic black and non-Hispanic white children in use of preventive dental care that was present in 2001-2002 was not detected in 2013-2014 whereas the disparity for evidence-based preventive dental care use persisted. CONCLUSIONS: Case definitions of preventive dental care that include non-evidence-based services may overstate receipt of effective preventive dental care and reductions in certain racial/ethnic disparities.

Child, caregiver, and family factors associated with child dental utilization among Mexican migrant families in California.

OBJECTIVE: To identify associations between child, caregiver, and family-level factors and child dental utilization. RESEARCH DESIGN: Cross-sectional oral health survey. PARTICIPANTS: Caregivers and one study child (ages 0-17) from Mexican migrant families in northern San Diego county, CA (n=142). METHODS: Caregivers reported on child's dental care utilization history and related factors, including: child (age, gender, dental insurance, source of care, believed to have cavities), caregiver (marital status, income, education, acculturation level, depressive symptoms), and family cohesion. Descriptive and logistic regression models identified predisposing, enabling, and need factors associated with child dental utilization during the past year. RESULTS: Most (76%) children had visited the dentist in the past year, while 8.6% had never been. Child factors (gender, insurance), caregiver factors (education, depressive symptoms), and family cohesion were each associated with child dental utilization in the bivariate analyses. In the final adjusted model, uninsured children were less likely to have a past year dental visit compared to insured children (Odds Ratio (OR) = 0.23, 95% Confidence Interval (CI) = 0.06-0.96). Children whose caregivers visited the dentist were 4.29 times more likely to visit the dentist in the past year (CI=1.36-13.61). Higher caregiver education was positively associated with child dental utilization (OR=4.50, CI=1.50-13.55). CONCLUSION: Child age and dental insurance, and caregiver education and dental utilization history were associated with whether or not a child had a past year dental visit. Ensuring child dental coverage and caregiver access to dental care may promote regular dental utilization by children.

Trends in Pediatric Dental Care Use.

This article explores trends in 3 areas of dental services use for children less than 21 years of age. First, it examines the change in access to prevention, diagnostic, and treatment services over time among Medicaid-enrolled children and how access to care is affected by state-level factors. Second, it evaluates trends and health care costs associated with the treatment of oral health conditions in the operating room of pediatric hospitals. Third, it examines the trends in use of emergency departments for dental needs among children in the United States.

Barriers to sealant guideline implementation within a multi-site managed care dental practice.

BACKGROUND: The purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association's recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices. METHODS: We anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics. RESULTS: The response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%). CONCLUSIONS: We identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers.