[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016]. / Éducation thérapeutique en odontologie pédiatrique : analyse des obstacles et leviers au développement de programmes en France en 2016.

OBJECTIVE: Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives. METHODS: A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry. RESULTS: The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE. CONCLUSION: More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

An assessment of the quality of reporting randomised controlled trials published in paediatric dentistry journals.

AIM: The objectives of this study are to compare the quality of reporting of randomised controlled trials (RCTs) published in 2011 and 2012 within five paediatric dentistry journals. STUDY DESIGN: RCTs published in the years 2011 and 2012 were hand-searched by one reviewer. After randomisation and blinding, these journals were independently scored by two blinded reviewers based on the CONSORT 2010 checklist. METHODS: A total of 59 articles were included for analysis and 70 criteria were scored dichotomously as '1' when reported and '0' when not reported. Descriptive statistics and one-way ANOVA tests were performed. RESULTS: The Gwets AC1 Inter rater reliability coefficient was calculated as 0.85 (95 % C.I 0.84-0.86) indicating excellent correlation between the two reviewers. Only 19 articles (32.2 %) reported more than half (35/70) of the expected criteria. Descriptive statistics showed that sections such as introduction, results and discussion were reported better than abstract, materials and methods and other information. One-way ANOVA tests showed no significant difference (p > 0.05) in the reporting of criteria across different journals and there was also no significant difference between the articles published in 2011 and 2012 (p > 0.05). CONCLUSION: The general quality of reporting of RCTs in paediatric dentistry journals was inadequate. Authors, reviewers and journal guidelines must work together towards a common goal for improving the quality of reporting of RCTs.

Methodological quality and implications for practice of systematic Cochrane reviews in pediatric oral health: a critical assessment.

BACKGROUND: To ensure evidence-based decision-making in pediatric oral health, Cochrane systematic reviews that address topics pertinent to this field are necessary. We aimed to identify all systematic reviews of paediatric dentistry and oral health by the Cochrane Oral Health Group (COHG), summarize their characteristics and assess their methodological quality. Our second objective was to assess implications for practice in the review conclusions and provide an overview of clinical implications about the usefulness of paediatric oral health interventions in practice. METHODS: We conducted a methodological survey including all paediatric dentistry reviews from the COHG. We extracted data on characteristics of included reviews, then assessed the methodological quality using a validated 11-item quality assessment tool (AMSTAR). Finally, we coded each review to indicate whether its authors concluded that an intervention should be implemented in practice, was not supported or was refuted by the evidence, or should be used only in research (inconclusive evidence). RESULTS: We selected 37 reviews; most concerned the prevention of caries. The methodological quality was high, except for the assessment of reporting bias. In 7 reviews (19%), the research showed that benefits outweighed harms; in 1, the experimental intervention was found ineffective; and in 29 (78%), evidence was insufficient to assess benefits and harms. In the 7 reviews, topical fluoride treatments (with toothpaste, gel or varnish) were found effective for permanent and deciduous teeth in children and adolescents, and sealants for occlusal tooth surfaces of permanent molars. CONCLUSIONS: Cochrane reviews of paediatric dentistry were of high quality. They provided strong evidence that topical fluoride treatments and sealants are effective for children and adolescents and thus should be implemented in practice. However, a substantial number of reviews yielded inconclusive evidence.

Bispectral Index Monitoring: validity and utility in pediatric dentistry.

Reliable and safe provision of sedation and general anesthesia is dependent on continuous vigilance of patient's sedation depth. Failure to do so may result in unintended oversedation or undersedation. It is a common practice to observe sedation depth by applying subjective sedation scales and in case of general anesthesia, practitioner is dependent on vital sign assessment. The Bispectral Index System (BIS) is a recently introduced objective, quantitative, easy to use, and free from observer bias, and clinically useful tool to assess sedation depth and it precludes the need to stimulate the patient to assess his sedation level. The present article is an attempt to orient the readers towards utility and validity of BIS for sedation and general anesthesia in pediatric dentistry. In this article, we attempt to make the readers understand the principle of BIS, its variation across sedation continuum, its validity across different age groups and for a variety of sedative drugs.

What do we really know about UK paediatric dental general anaesthesia services?

Dental general anaesthesia (DGA) is only permitted within a hospital setting where critical care facilities are available. Recently, concern has been expressed about the number of hospital admissions for the dental care of children following the publication of a high profile paper which highlighted an apparent increase in children being admitted for extractions due to caries under DGA. Coincidentally new best practice standards for paediatric DGA services have been published. An evaluation of DGA services in Yorkshire and the Humber suggested that existing monitoring was inadequate and is unlikely to represent true levels of activity and that any apparent increase may reflect the method of remuneration for services. In fact, recent changes in service structure and changes to improve quality have reduced DGA activity in some areas. In addition, the evaluation revealed that many services were not meeting standards of best practice.

A pilot improvement project in hospital-based oral healthcare: improving caries risk assessment documentation.

OBJECTIVE: To evaluate the impact of a continuous improvement project to improve completion of a caries risk assessment (CRA) and to assess its impact on delivery of dental caries prevention. DESIGN: Single centre clinical improvement project. SETTING: A paediatric dental department within a UK dental hospital over the course of 2008-2009.Subjects (materials) and methods Continuous monitoring of documentation of a CRA was instigated and results fed back to clinicians. Tools were developed to structure the process of CRA. After six months of intervention, a comparison of preventive care to a pre-intervention sample was undertaken. MAIN OUTCOME MEASURES: The main outcome measure was completion of a CRA. Comparison was also made with pre-intervention data on levels of preventive care received. RESULTS: Over the 12 month project the mean rate of CRA completion improved from 30% over the first 6 months to 73% in the second 6 months. Compared to the pre-intervention sample, all items of the caries prevention package had improved, with delivery of toothpaste strength advice (16% vs 60%, p = 0.001) and diet advice (32% vs 70%, p = 0.004) improving significantly. CONCLUSION: By targeting and improving CRA completion the quality of preventive care delivered has also significantly improved.

A service-learning project to eliminate barriers to oral care for children with special health care needs.

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.

The future of pediatric dentistry advanced education: the need for change in training standards.

This report describes the background, rationale and process for revision of training standards for advanced educational programs in pediatric dentistry in the United States.

Assessment of the quality of reporting of randomized clinical trials in paediatric dentistry journals.

INTRODUCTION: Reporting of randomized controlled trials (RCTs) should be of high quality to support the conclusions reached by the authors. Poor-quality reporting has been associated with an overestimation in intervention efficacy. Within the field of paediatric dentistry, no study has assessed the quality of reporting. OBJECTIVE: The aim of this study was to assess published RCTs in paediatric dental journals between 1985 and 2006 for: (i) whether quality of reporting allows readers to assess the validity of trials; and (ii) whether quality of reporting has improved since the introduction of the Consolidated Standards of Reporting Trials (CONSORT) guidelines. METHODS: Hand search of the main paediatric dentistry journals; inclusion criteria were: the trial was performed on children, and RCT. CONSORT guidelines were made into an operational checklist. Trials published between 1985 and 1997, and between 1998 and 2006 were compared to determine any improvement since the publication of the CONSORT guidelines. RESULTS: One hundred and seventy-three of 5635 articles met the inclusion criteria. Reporting quality was poor overall and showed heterogeneity. It had improved slightly since the publication of CONSORT. Few trials were reported adequately. CONCLUSION: The quality of reporting of clinical trials is poor, and often not adequate to allow readers to assess trial validity. Overall quality of reporting has not substantially improved since the publication of CONSORT.