Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials.

AIMS: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry. BACKGROUND: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols. REVIEW RESULTS: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials. CONCLUSION: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice. CLINICAL SIGNIFICANCE: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al. Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Relación entre el perfil epidemiológico y nivel socioeconómico de la población que demanda atención en la Cátedra de Odontología Integral Niños / Relationship between the epidemiological profile and socioeconomic level of the population requiring care at the Children´s Comprehensive Dentistry Chair

Se identificó el perfil epidemiológico y se caracterizó la situación de la población en base al Nivel Socio-Económico (NSE) asociado al estado dentario y se es-tablecieron las zonas geográficas de pacientes que asistieron a la Cátedra Odontología Integral Niños (COIN) de FOUBA durante el año 2019. La muestra total se conformó con 541 niños de 9,2±3,3 años; masculi-nos 51,0%. La segmentación de los estratos sociales dio como resultado que del total de pacientes, el 33,3% perteneció a Clase Baja D2/E, el 39,2% a Clase Baja Superior D1, el 22,4% a Clase Media Baja C3, el 4% a Clase Media Alta C2 y el 1,1% a Clase Alta ABC1. La mayor demanda de atención provino de las dos clases más bajas de la pirámide social, aunque se trata de un servicio arancelado. Los indicadores del estado den-tario ceod, ceos, CPOD y CPOS, indicaron que los niños de menor posición socioeconómica presentaron los índices más altos. La mayor concurrencia provino de la Ciudad Autónoma de Buenos Aires (52%), respecto a los pacientes concurrentes del Gran Buenos Aires (37%), el 80% provino de la zona Oeste y Sur (AU)

The epidemiological profile was identified, and the situation of the population was characterized based on Socio-Economic Status (SES) associated with their dental state. Geographical areas of patients who attended the FOUBA Children's Comprehensive Dentistry Chair during 2019 were established. The total sample consisted of 541 children aged 9.2±3.3 years; males 51.0%. The segmentation of the social strata resulted in 33.3% belonging to Low-Class D2/E, 39.2% to Upper Lower-Class D1, 22.4% to Lower Middle-Class C3, 4% to Upper Middle-Class C2, and 1.1% to Upper-Class ABC1. The largest demand for care came from the two lowest classes of the social pyramid, even though it is a fee-based service. The indicators of dental status dmft, dmfs, DMFT and DMFS, showed that children coming from the lowest socio-economic position presented the highest rate of occurrence. The highest attendance came from the City of Buenos Aires (52%), compared to patients from Buenos Aires suburbs (37%), of which 80% were from the Western and Southern suburbs (AU)

Evaluación clínica de acondicionamiento dentinario y presentaciones de ionómeros fotoactivados en odontopediatría / Clinical evaluation of dentin conditioning and different presentations of light cured glass ionomer in primary dentition

Objetivo: Comparar clínicamente el comportamiento, el tiempo operatorio requerido, el costo y la dificultad de diferentes técnicas de restauración en piezas primarias, empleando ionómero vítreo fotoactivado (IVF) polvo/líquido, con y sin uso de acondicionamiento dentinario, y en cápsulas, con acondicionamiento. Materiales y métodos: El diseño de este estudio fue experimental y comparativo. Se realizaron, en 18 pacientes de 7±2 años, 33 restauraciones con IVF de una o más piezas primarias vitales con lesiones amelodentinarias en 1 o 2 superficies. Según su día de concurrencia a la Cátedra de Odontología Integral Niños, se empleó: A) IVF polvo/líquido, con acondicionamiento (3M™ VitremerTM); B) IVF polvo/líquido, sin acondicionamiento (3M™ VitremerTM); y C) IVF en cápsulas, con acondicionamiento (Riva Light Cure). Las restauraciones fueron evaluadas clínicamente al inicio y a los 12 meses según los siguientes criterios: pérdida total, pérdida total con caries, requerimiento de reemplazo por pérdida parcial, requerimiento de reemplazo por caries, aceptable con deterioro, en condiciones. El grado de dificultad se analizó utilizando una planilla diseñada para tal fin. El tiempo operatorio requerido se midió sin considerar el tiempo de inserción. Resultados: El tiempo operatorio requerido fue de 2 minutos, 15 segundos en A; 1 minuto, 25 segundos en B; y 1 minuto, 10 segundos en C, sin considerar el tiempo de inserción. El costo fue 61,11% mayor para C. La dificultad fue de 3,2±0,6 para A y B, y de 1,5±0,7 para C (ANOVA; P<0,001). El comportamiento clínico no registró diferencias significativas entre los grupos (Fisher; P=0,339). Conclusión: Los ionómeros de restauración fotoactivados encapsulados utilizados en este estudio presentaron menor dificultad de manipulación, mayor costo y similar comportamiento clínico a un año que las presentaciones polvo-líquido, con o sin uso de acondicionamiento previo en piezas primarias (AU)

Aim: To assess the clinical performance, operative time required, cost and technical difficulties of different restorative techniques in primary teeth, using light cured glass ionomers (LCG), powder/liquid, with and without dentin conditioning and light cured glass ionomer in capsules with conditioning. Materials and methods: The design of this study was experimental and comparative. 33 restorations with LCG were performed in 18 patients, 7 ± 2-years-old, in one or more vital primary teeth with carious lesions involving one or more tooth surfaces. Patients were assigned to one of the three groups according to the day of the week in which they attended to the Pediatric Department of the Dental School: A) LCG powder/liquid, with conditioning (3M™ VitremerTM); B) LCG powder/liquid without conditioning (3M™ VitremerTM); and C) LCG in capsules with conditioning (Riva Light Cure). The restorations were clinically evaluated at baseline and after 12 months according to the following criteria: complete loss of the restoration, complete loss with caries, need of replacement because of partial loss, need of replacement because of caries, good condition with some wear and good condition. Technical difficulties were analyzed using a data sheet designed for that purpose. The operative time required was evaluated without considering the insertion time. Results: Time operative time required was 2 minutes 15 seconds in A, 1 minute 25 seconds in B and 1 minute 10 seconds in C. Cost was 61.11% higher for C. Difficulty was 3.2±0.6 for A and B and 1.5±0.7 for C (ANOVA; P<0.001). No significant differences were observed among the three groups in relation to the clinical performance (Fisher; P=0.339). Conclusions: In these 12 months, study in primary teeth, the light cured glass ionomers used dispensed in capsules showed to be the easiest to handle, had higher cost and similar clinical performance than the powder liquid presentations with and without dentin conditioner (AU)

Prevalence of Dental Fear among 6-15 Years Old School Children.

INTRODUCTION: Odontophobia or dental fear is a "unique phobia with special psychosomatic components that impact on the dental health of the odontophobia persons". It is well documented that dental fear has a significant impact on dental care utilization behaviors. The objective of this study was to find out the level of dental fear among school children studying in government schools of Dharan, Nepal. METHODS: A descriptive cross-sectional study was conducted from March to August 2017 among 215 school going children of Dharan of age group 6 to 15 years. Ethical approval was obtained. Children studying in six different government schools of Dharan were selected using two stage cluster sampling method. The Children's Fear Survey Schedule-Dental Subscale was used to measure dental fear among the study group. Data were entered in Microsoft Excel Sheet 2007 and analyzed in Statistical Package of Social Sciences 11.5. RESULTS: This study showed that among the total study population, 96 (44.7%) had high fear, 62 (28.8%) had moderate fear and 57 (26.5%) had low dental fear. Among males, 29 (34.5%) had high fear whereas more than half of the female respondents had high fear. CONCLUSIONS: The present study showed that most of the school going children had high fear of dental treatment. So, school health programs should be planned to make the children familiar to dentistry and proper treatment modalities should be provided to make the child comfortable to seek dental care.

A dental workforce strategy to make Australian public dental services more efficient.

BACKGROUND: Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS: Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS: The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION: An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.

Assessing the Feasibility of Oral Health Interventions Delivered by Social Workers to Children and Families in the Foster Care System.

Purpose: The purpose of this study was to evaluate the feasibility of social worker-delivered oral health interventions for preschoolers in foster care. Methods: We interviewed social workers in Washington state (N equals 20). Interview data were coded into three domains: (1) oral health predictors and outcomes; (2) dental care access; and (3) intervention feasibility. Results: The mean age of participants was 39.8±10.5 years, and 65 percent worked in the public sector. Participants believed preschoolers in foster care are at risk for poor oral health, secondary to neglect and suboptimal behaviors. Many children enter foster care not having seen a dentist because of financial barriers and difficulties finding dentists who accept Medicaid. Barriers to care persist after entering foster care. Social workers considered themselves ideal interventionists to lead brief oral health programs during home visits. To enhance feasibility, social workers would require education and training. Conclusion: Future research should explore interventions that could be implemented by social workers to improve the oral health of foster children.

A study of the dental treatment needs of special patients: cerebral paralysis and Down syndrome.

AIM: The aim of the present study was to compare the dental characteristics and the oral health care needs of patients with Cerebral Paralysis (CP) and Down Syndrome (DS). MATERIALS AND METHODS: The selected sample consisted of 28 patients of both sexes between 10 and 20 years of age. STUDY DESIGN: observational, descriptive and cross-sectional study. STATISTICS: The statistical analysis was carried out with the SPSS 19.0 program for Windows. The frequency distribution and contingency tables were analysed, as was interobserver concordance. non mi è chiaro cosa intendono qui. RESULTS: Fifty percent of the patients with CP presented dental traumas, compared to 15% of the patients with DS. Dental prophylaxis was the most prevalent treatment in both groups (77% in CP compared to 86.7% in DS). The most frequent habit was oral breathing, which was found in 69.2% of the patients with CP and 80% of those with DS. CONCLUSIONS: Patients with CP and DS require early dental care in order to prevent and limit the severity of the pathologies observed.

A protocol for early childhood caries diagnosis and risk assessment.

The global Early Childhood Caries (ECC) burden is of concern to the World Health Organisation (WHO), but the quantification of this burden and risk is unclear, partly due to difficulties in accessing young children for population surveys and partly due to diagnostic criteria for ECC experience. The WHO criterion for caries diagnosis is the late stage event of dentine cavitation. Earlier stages of the caries lesion are clinically detectable and should be registered earlier in the life of children and arrested/remineralized before lesions progress to the cavitation stage. A protocol for ECC diagnosis is proposed to guide those engaged in clinical dentistry in their characterization of the ECC lesion. As management of early lesions is a critical step to reduce risk of their progression to later stage lesions, a practical method for assessing ECC risk is proposed also. Risk assessment is very important because it determines (a) urgency for interventions aimed to arrest lesion progression; (b) the frequency of such interventions and (c) the need to enhance the primary prevention of ECC. The guidelines are set out separately for ECC diagnosis for ongoing clinical care and for epidemiologic purposes. Similarly, guidelines are set out for ECC risk assessment and ongoing monitoring.

Cost savings from a teledentistry model for school dental screening: an Australian health system perspective.

Objective The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children. Methods A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7million children) aged 5-14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars. Results The total estimated cost of the teledentistry model was $50million. The fixed cost of teledentistry was $1million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49million. The estimated staff salary saved with the teledentistry model was $56million, and the estimated travel allowance and supply expenses avoided were $16million and $14million respectively; an annual reduction of $85million in total. Conclusions The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas. What is known about the topic? Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great potential to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach. What does this paper add? The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs. What are the implications for practitioners? The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.

Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs.

BACKGROUND: This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth. TYPES OF STUDIES REVIEWED: The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence- to-decision framework was employed to formulate a recommendation. RESULTS: The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended practices are based upon the best available evidence to-date. A 38 percent SDF protocol is included in Appendix II.

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay.

BACKGROUND: Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown. OBJECTIVE: To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability. DESIGN: A randomised controlled allocation-blinded clinical trial with two parallel arms. SETTING: A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales. PARTICIPANTS: In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV. INTERVENTIONS: Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years. MAIN OUTCOME MEASURES: The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D4-6MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions. RESULTS: At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported. LIMITATIONS: There are no important limitations to this study. CONCLUSIONS: In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive. FUTURE WORK: The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation. TRIAL REGISTRATION: EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.

Risk indicators of early childhood caries (ECC) in children with high treatment needs.

Early childhood caries (ECC) represents a major health and economic problem worldwide. Its consequences such as early pain experience may affect the immediate and long-term quality of life of the child. In very young and uncooperative children the therapy of ECC is often viable only under general anesthesia. After treatment these affected children have a higher risk for future caries either soon thereafter, or later in life. The aim of the present study was to determine risk indicators and their correlation among children with high caries prevalence and high treatment needs, in order to facilitate the development of targeted prophylaxis programs that would reduce future occurrences of ECC or at least positively influence the outcome. For this purpose, between 2010 and 2014 the parents of these children (n=82) were interviewed in the University Children’s Hospital in Basel (UKBB) prior to the children's treatment under general anesthesia. The standardized questionnaire included questions regarding the age of the child, the mother's country of origin, the oral hygiene, and the drinking habits of the child. The analysis shows that the high mean dmft/ dmfs values (dmft: 9.49 and dmfs: 26.35) correlated significantly with the geographic origin of the mother (p<0.05), the beginning of tooth brushing (p<0.05), lack of supervised tooth brushing (p<0.01), and nighttime consumption of sugar-sweetened beverages (p<0.05). In contrast, the duration of breastfeeding and prolonged use of a baby bottle (about 2.5 years) did not have a clear impact on high caries prevalence.

Expanding Where Dental Therapists Can Practice Could Increase Americans' Access To Cost-Efficient Care.

Since 1923, more than fifty countries have improved access to dental care by allowing midlevel providers-frequently called dental therapists-to offer preventive and restorative treatment, primarily in the public sector. A growing body of research has found that dental therapists provide high-quality, cost-effective care and improve access to care for underserved populations. This article explores the evolution of the dental therapy movement in the United States, where multiple barriers to oral health care have created persistent unmet needs. We examine developments since the 1940s that have led to the authorization of dental therapists in parts of Alaska and the states of Minnesota, Maine, and Vermont; and the approval of national accreditation standards for dental therapy training programs by dental educators. We also show how dental therapists might fit within a health care system that is being transformed.

Impact of a dental care program on the quality of life of children with and without caries.

The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.

Evaluation of dental therapists undertaking dental examinations in a school setting in Scotland.

OBJECTIVE: To measure agreement between dental therapists and the Scottish gold-standard dentist undertaking National Dental Inspection Programme (NDIP) examinations. METHODS: A study of interexaminer agreement between 19 dental therapists and the national gold-standard dentist was carried out. Pre-calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry (BASCD). Twenty-three 5-year-old children (Primary 1) and 17 11-year-old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3 mft and D3 MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3 t/D3 T and ft/FT. Calibration data on P1 and P7 children from 2009-2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. RESULTS: The mean kappa score was 0.84 (SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold-standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold-standard dentist, where the mean kappa value was 0.68 (SD 0.22) with a range of 0.35-1.00. The mean sensitivity score was 0.98 (SD 0.04) (range 0.88-1.0) and mean specificity score was 0.90 (SD 0.06) (range 0.78-0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. CONCLUSION: We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme.

Potentially preventable dental care in operating rooms for children enrolled in Medicaid.

BACKGROUND: In this study, the authors examined the prevalence and cost of care for children enrolled in Medicaid for potentially preventable dental conditions who receive surgical care in hospital operating rooms (ORs) or ambulatory surgery centers (ASCs). METHODS: The authors analyzed Medicaid data from 8 states to find cases in which children aged 1 to 20 years received surgical care in ORs or ASCs in 2010 and 2011 for potentially preventable diagnoses, as defined with diagnostic codes. RESULTS: For 6 states with complete data, there were 26,373 cases in 2011 in which children received OR or ASC surgical care for potentially preventable conditions. These cases represent approximately 0.5% of all children enrolled in Medicaid in these states and approximately 1% of children enrolled in Medicaid who received any dental care. There were $68 million in total Medicaid payments for these cases, with an average of $2,581 per case. Diagnostic codes indicated that 98% of cases were related to treatment of dental caries. More than two-thirds of the cases (71%) were children aged 1 to 5 years. CONCLUSIONS: Extrapolation to the United States suggests that approximately $450 million in additional expenditures occurred in 2011 because of OR or ASC surgical care for potentially preventable pediatric dental conditions, primarily related to early childhood caries. PRACTICAL IMPLICATIONS: Strategies to improve prevention of early childhood caries, including community- and family-based education, and to increase access to timely and early dental care for low-income children could reduce the burdens and costs of these dental problems.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: I. Material Choice.

PURPOSE: The purpose of this study was to assess the preferences of pediatric dentists in Canada and the United States about clinical decision-making related to the placement of direct restorative materials. METHODS: A cross-sectional web-based survey was used to collect the preference of all active pediatric members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth in healthy, developmentally delayed (DD), and medically compromised (MC) children. Bivariate and multivariate analyses were performed to determine the association between the predictor variables and all materials at two-tailed P<0.05. RESULTS: A response rate of 19.3 percent (n equals 762) was achieved. For DD patients, stainless steel crowns were the most preferred material for primary teeth, and a similar frequency of amalgam and composite were preferred for permanent teeth. Amalgam usage was increasingly preferred in the DD population versus healthy and MC patients. CONCLUSIONS: Composite resin was the most preferred restoration for Class I, II, and V restorations in primary and permanent teeth in healthy and medically compromised individuals. In DD individuals, stainless steel crowns and amalgam were preferred more frequently.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: II. Rubber Dam Isolation.

PURPOSE: The purpose of this study was to assess usage, indications, and contraindications for rubber dam isolation (RDI) by pediatric dentists in Canada and the United States. METHODS: A cross-sectional, web-based, self-administered survey was utilized to collect the opinions of all active pediatric dentist members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain on the RDI utilization and its perceived indications and contraindications. Bivariate and multivariate analyses for RDI usage and its predictor were performed at two-tailed P<0.05. RESULTS: A response rate of 19.3 percent was obtained. Most participants (72.5 percent) reported using RDI "all the time." The material with the lowest usage of RDI was composite (82 percent) in the primary dentition and stainless steel crown (80.7 percent) in the permanent dentition. The three top-noted reasons for not using RDI included decreased trauma to the patient (66.2 percent), being able to prevent soft tissue from interfering without using RDI (55.9 percent), and decreased time for appointments (45.6 percent). CONCLUSION: Rubber dam isolation was valued by the majority of pediatric dentists when restoring primary and permanent dentition for all materials.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: III. Preferred Level of Participation in Decision-making.

PURPOSE: The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making. METHODS: A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain to elicit participants' preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05). RESULTS: Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [CI] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent CI equals 1.11 to 11.77). CONCLUSION: The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision-making.

Impact of a dental care program on the quality of life of children with and without caries

Abstract: The aim of the present study was to evaluate the long-term effects of the caries treatment provided by a dental care program on changes in schoolchildren's OHRQoL. A one-year follow-up was conducted with a sample of 372 children aged 8 to 10 years which were clinically examined and divided into two matched groups according to their caries experience: dental treatment group (DTG) and group without caries (GWC). Both groups were assessed three times (at baseline, at 4 weeks, and at 1 year) using the Child Perceptions Questionnaire (CPQ8-10). The normality test was performed for the statistical analyses; the Friedman test was used for the dependent variables (longitudinal assessment repeated three times for the same group); and the Mann-Whitney test was used for the independent variables (test and control groups in each time period). There was improvement in all domains and in overall CPQ8-10 (p < 0.0001) in the DTG over time, but no significant changes (p > 0.05) were observed at baseline for overall CPQ8-10 and for the emotional well-being domain in the GWC. The comparison between groups demonstrated that OHRQoL was persistently better for the GWC (p < 0.05) over time. In conclusion, dental caries treatment has a long-term positive impact on schoolchildren's OHRQoL, highlighting the importance of health policies that promote access to dental care for this population.