Effect of motivational interviewing on preventive strategies for children receiving full-mouth dental rehabilitation under general anesthesia: A randomized controlled trial.

BACKGROUND: Motivational interviewing (MI) is an approach to increase parental compliance to follow up and recall of their children. It has proven to be successful in motivating parents to adopt and maintain preventive child oral health behaviors. AIM: To assess the effectiveness of motivational interviewing on prevention strategies for parents of children who have received full-mouth dental rehabilitation under general anesthesia (GA). DESIGN: This is a parallel-arm randomized controlled trial. Parents in the treatment arm were randomized and received a combination of motivational interviewing, individualized goal setting, visual aids, and verbal education post-GA. Those in the control arm received the same information by verbal and written education. Both groups were evaluated at 2-week follow-up and 3-month recall. Differences in attendance, oral health knowledge, readiness to change, and parental self-efficacy (PSE) were compared between groups and at return visits. RESULTS: Of 74 parents of children randomly allocated in this study, 22 (61%) and 13 (38%) from the intervention group, and 21 (55%) and 16 (46%) from the control group attended the 2-week, and 3-month follow-up, respectively. The average PSE for participants in the intervention group was significantly higher than that of the control group at the follow-up visit (p = .0050). CONCLUSION: Readiness to change dietary habits and average PSE for parents in the intervention group were significantly higher than that of the control group after receiving the modified preventive strategy.

Updated consensus guidelines on the management of Phelan-McDermid syndrome.

Phelan-McDermid syndrome (PMS) is a genetic condition caused by SHANK3 haploinsufficiency and characterized by a wide range of neurodevelopmental and systemic manifestations. The first practice parameters for assessment and monitoring in individuals with PMS were published in 2014; recently, knowledge about PMS has grown significantly based on data from longitudinal phenotyping studies and large-scale genotype-phenotype investigations. The objective of these updated clinical management guidelines was to: (1) reflect the latest in knowledge in PMS and (2) provide guidance for clinicians, researchers, and the general community. A taskforce was established with clinical experts in PMS and representatives from the parent community. Experts joined subgroups based on their areas of specialty, including genetics, neurology, neurodevelopment, gastroenterology, primary care, physiatry, nephrology, endocrinology, cardiology, gynecology, and dentistry. Taskforce members convened regularly between 2021 and 2022 and produced specialty-specific guidelines based on iterative feedback and discussion. Taskforce leaders then established consensus within their respective specialty group and harmonized the guidelines. The knowledge gained over the past decade allows for improved guidelines to assess and monitor individuals with PMS. Since there is limited evidence specific to PMS, intervention mostly follows general guidelines for treating individuals with developmental disorders. Significant evidence has been amassed to guide the management of comorbid neuropsychiatric conditions in PMS, albeit mainly from caregiver report and the experience of clinical experts. These updated consensus guidelines on the management of PMS represent an advance for the field and will improve care in the community. Several areas for future research are also highlighted and will contribute to subsequent updates with more refined and specific recommendations as new knowledge accumulates.

Safety protocols at the American Board of Pediatric Dentistry Oral Clinical Examination during COVID-19.

BACKGROUND: There are continued concerns about holding large group gatherings with the ongoing COVID-19 pandemic. The American Board of Pediatric Dentistry (ABPD) made the decision to cancel the Oral Clinical Examination (OCE) in 2020 with a goal to host the exam in 2021. This cancellation postponed the board certification of over 400 pediatric dentists. There is limited published data on safety protocols for in-person examinations. AIM: To determine if safety protocols utilized in the administration of the 2021 ABPD Oral Clinical Examination (OCE) were reassuring to candidates and examiners, and effective at addressing prevention of COVID-19 infection. DESIGN: An electronic survey was emailed to candidates and examiners following completion of the board examination process. The candidate survey had 784 and the examiner survey had 108 eligible participants. Eight questions overlapped between the two surveys. Descriptive statistics were utilized. p-values < 0.05 were considered significant. RESULTS: Three hundred ninety-four candidates (response rate = 50.3%) and 97 examiners (response rate = 89.8%) completed their respective surveys. The majority of candidates (86.8%) and examiners (94.8%) felt safe participating the OCE, and found COVID-19 protocols reassuring, 69.3% and 89.7%. CONCLUSIONS: Participants agreed that safety protocols enacted by the ABPD kept everyone safe and led to a successful and safely conducted high-stakes oral clinical examination during the COVID-19 pandemic.

Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study.

BACKGROUND: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination. METHODS: Adult participants ≥30 years (n = 9374) of the 2013-2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression estimated odds ratios (OR) and 95% confidence intervals (CIs) of ever and past year oral cancer examination adjusted for age, gender, race/ethnicity, education, income, and time since last dental visit. RESULTS: One third (33%) reported ever been examined for oral cancer, 66% of whom reported an examination in the past year. Adjusted OR (95% CI) of past year examination comparing current and former smokers to non-smokers were 0.51 (0.29, 0.88) and 0.74 (0.53, 1.04) respectively. Similarly, current and former alcohol drinkers relative to abstainers were less likely to report a past year oral cancer examination, OR (95% CI) = 0.84 (0.53, 1.30) and 0.50 (0.30, 0.83) respectively. CONCLUSION: This study showed that smokers and alcohol users were less likely than abstainers to self-report a past year oral cancer examination. Access to affordable and targeted oral cancer examination within the dental care setting might ensure that these high-risk individuals get timely examinations and earlier diagnosis that might improve prognosis and survival.

Pediatric dentists' perspective of general dentists' role in treating children aged 0-3 years.

This study examined pediatric dentists' perspectives on the types of dental services general dentists provide to children who are 0-3 years old. A web-based survey was sent to 5185 pediatric dentists and 769 (14.8%) responded. Among the respondents, 58% agreed with general dentists' providing an age 1 dental visit. Only 24% agreed with general dentists' performing complex behavior management techniques, such as sedation, to patients aged 0-3 years. Those respondents who taught pediatric dentistry full time were more likely to agree with general dentists' providing an age 1 dental visit (P = 0.0088). Those who reported that their own dental school had adequately prepared them for this type of age 1 visit were also more in agreement (P < 0.0001). The results of this study promote better understanding of pediatric dentists' perceptions of the level of collaboration between general dentists and pediatric dentists; the types of oral health services general dentists can provide for children aged 0-3 years; and the anticipated level of competency of entry-level general dentists.

The Impact of Dental Operatory Color on Anxiety in Committed Youth.

Purpose: To examine the impact of dental operatory room color on the level of anxiety in committed youth at a juvenile correctional center. Methods: A randomized controlled trial was conducted at a juvenile correctional center using an approved continuous quality assurance survey. The dental assistant collected self-reported anxiety scores from 164 individuals alternating between two dental operatory rooms. One dental operatory room was painted with color while the other dental operatory room was unaltered (white). Repeated measures linear models were used to test for associations between visit type, visit number and operatory. Results: For 65 percent of visits, little to no anxiety was reported. Among the remaining visits, anxiety scores were on average 1.13 points higher across all appointment types in the non-colorful operatory room but were not statistically significant (P=0.1373, 95 percent confidence interval [95% CI] = -0.37 to 2.63). Anxiety scores were, on average, 1.7 points higher in the non-colorful room when selected for more anxiety- inducing restorative or emergency appointments (P=0.4371, 95% CI = -1.37 to -4.82), which indicated some clinical significance but was not statistically significant. Conclusion: The color of a dental operatory room did not have a statistically significant effect on lowering the level of anxiety in incarcerated youth but may have a clinically significant effect that should be further researched.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children.

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine's recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Oral Health Knowledge, Barriers to Dental Care, and Awareness of a Medicaid Pregnancy Dental Coverage Among Reproductive-Age Women.

Objectives: Oral health is an integral part of women's health, yet many women face barriers and go without necessary dental care. The objectives of this study were to (1) examine and compare pregnancy-related oral health knowledge and barriers to dental care access during pregnancy among women with private and public insurance and (2) estimate awareness of available Medicaid pregnancy dental benefit among Medicaid-enrolled women and explore associated factors. Methods: A cross-sectional survey was administered to a convenience sample of 21- to 45-year-old women (n = 187) visiting a large urban academic health center in Virginia. Data on pregnancy-related oral health knowledge, barriers to dental care access, Medicaid dental benefit awareness, health insurance, socio-demographics, health information source, and last dental visit were collected. Chi-square tests, t-tests, and multivariable regression were used to examine associations at p ≤ 0.05. Results: More than half of the women reported private insurance (52.4%), 40.3% reported Medicaid, and 8.3% reported being uninsured. Medicaid-enrolled women reported a lower prevalence of a routine dental checkup in the past year (44% vs. 71%, p = 0.002), lower knowledge scores (2.9 vs. 3.6, p < 0.001), and more barriers to accessing dental care during pregnancy compared with privately insured women. One in every three Medicaid-enrolled women (34%) was unaware of the Medicaid pregnancy dental benefit. Benefit awareness was associated with the receipt of health information from a health care source (p = 0.030) and a high oral health knowledge score (p = 0.018). Conclusions: There was a significant gap in dental care use and knowledge between Medicaid-enrolled and private-insured women in our study sample. Targeted programs should be developed to educate women about the importance of oral health and share information about available Medicaid dental coverage to reduce barriers to dental care during pregnancy.

The impact of dental Medicaid reform on dental care provider activity and market penetration of dental support organizations.

BACKGROUND: Medicaid state dental programs have experienced changes related to provider practice settings with the increased growth of dental support organizations (DSOs). The authors conducted this study to assess the impact of state Medicaid reform on the dental practice environment by examining provider activity and practice setting. METHODS: This was a retrospective cohort study of more than 13 million dental claims in the Virginia Medicaid program. It included children and dental care providers in the Virginia dental Medicaid program at some time during a 9-year period (fiscal years 2003-2011). The independent variable was the provider practice setting: private practice, DSO, and safety-net practice. The outcomes included annual measures of claims, patients, and payments per provider. The outcomes were examined over 3 phases of the study period: prereform (2003-2005), implementation phase (2006-2008), and postreform maturation (2009-2011). RESULTS: Provider activity increased after dental program reform, with private-practice providers delivering most of the dental care in the Medicaid program. There was a significant penetration of DSO providers in number of providers, claims per provider, and patients per provider (P < .001). Regression results found that providers in DSO settings had an increased number of patients and claims compared with private-practice providers. CONCLUSIONS: Medicaid reform has resulted in a significant increase in provider participation and growth of DSO-affiliated providers. PRACTICAL IMPLICATIONS: Areas of the state with more dense population had a higher penetrance of dentists practicing in DSO settings providing dental services to children enrolled in Medicaid.

A descriptive pilot study of the immediate impacts of COVID-19 on dental and dental hygiene students' readiness and wellness.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has impacted dental students training across the U.S. academic dental institutions by moving classroom instruction to an online modality, limiting patient care, canceling external rotations, and rescheduling of licensure examinations. OBJECTIVE: The aim of this study was to assess the immediate impacts of COVID-19 on students' readiness to enter clinical practice or residency and its association with well-being (anxiety, perceived stress, coping and social support, and resilience). METHODS: An online REDCap survey was distributed to 407 D1-D4 year dental students and 29 DH3-DH4 year dental hygiene students enrolled at a U.S. dental school. The survey consisted of readiness and wellness measures as well as socio-demographic variables. RESULTS: Overall response rate was 58% (N = 252) ranging from 40% among D4 students to 72% among D1 students. About half (55%) of the respondents were White, a third (34%) Asians and 5% were African Americans. Ninety-two percent were non-Hispanics while 62% were female. Overall mean (SD) anxiety score was 6.5 (5.3) and 26% of respondents reported moderate or severe levels of anxiety. Anxiety score differed significantly by gender with females reporting higher anxiety levels, mean (SD) = 7.3 (5.5) versus 5.2 (4.7) for males; P = 0.002). Furthermore, mean anxiety score differed significantly among the dental school classes, ranging from 5.5 (5.3) among D2 students to 11.8 (6.2) in DH4 students (P = 0.02). CONCLUSION: Academic dental institutions need to be responsive to the heightened anxiety and uncertainly levels of students and provide responsive training and support to mitigate its effects.

Family oral health education.

This article focuses on the family's role in the oral health status of children and the impact parents can have on the prevention of early childhood caries. Parents play a vital role in filtering the interaction between children and their environment through the feeding habits, oral hygiene care, and other preventive practices and services they make available to their children. Predisposing, enabling, and reinforcing factors affect parents' ability to instill healthy oral habits into a child's daily routine.

Prenatal smoking and the risk of early childhood caries: A prospective cohort study.

INTRODUCTION: Dental caries is a chronic complex disease of multifactorial etiology that affects a quarter of U.S. children. This study evaluated the association between prenatal smoking and offspring caries experience and used a negative control exposure analysis to assess if the association is causal. METHODS: Data from 1429 mother-offspring participants of the 1991/92 Avon Longitudinal Study of Parents and Children conducted in Bristol, England were analyzed. Prenatal smoking (yes v. no) and quantity smoked (none,

Utilization of and Dental Students' Perceived Benefits of an Urgent Care Clinic in a Dental School.

The aims of this study were to describe patient utilization of an urgent care clinic (UCC) in a dental school for one year and to assess dental students' perceptions of the benefits of training in this clinic. Aggregate clinic data from July 3, 2017, through July 6, 2018, were used to determine number of patients, number of new patients, number of new patients who elected to transfer their primary dental care to the university, number who were seen for a follow-up, and service/clinic to which each patient was referred. Student evaluations were used to determine the benefits students perceived in their training in the UCC. Results showed that 1,674 patients were seen in the UCC during the study period. Of these, 67% were new patients, and 53% of these new patients opted to transfer their primary dental care to the university. An average of 7.03 patients were treated per day, and 2.48 new patients per day were generated for the predoctoral student clinic. The most common referrals were to oral surgery (37%), endodontics (30%), and the predoctoral dental clinic (28%). Among these patients, 39% scheduled follow-up appointments, and the attendance rate was 69%. About 80% of eligible students (40/50) completed the questionnaire, and many provided optional comments. Over 80% of the responding students responded favorably regarding the learning experiences and assessments during the UCC rotation. This study found that establishment of the UCC increased the pool of patients and provided students the necessary experiences in triaging and treating dental emergencies.

Accuracy of Maternal Reports of Young Children's Dental Disease Status: Avon Longitudinal Study of Parents and Children.

Background: Parental reports of their children's health status is integral to pediatric medical and dental care. Therefore, understanding the accuracy of such reports is vital. Our objectives were to (1) assess the correlation between maternal reports of their children's indicators of caries experience (subjective assessment) and actual caries status determined by oral examination (objective assessment), and (2) identify potential modifiers of this correlation. Methods: Longitudinal data from the Avon longitudinal study of parents and children (n = 1429) was used to assess the correlation between maternal reports of the number of missing and filled teeth of children aged 38 months, 54 months, and 5.5 years and clinical oral examinations of decayed, missing and filled teeth conducted when the same children were 31, 43 months, and five years of age. Homogeneity chi-square tests assessed differences in correlations according to sociodemographic factors. Results: Overall, we found a statistically significant correlation that was weak to moderate in magnitude. Maternal reports of missing teeth at 38 months was significantly correlated with decayed teeth, 0.27 (p < 0.001); missing teeth, 0.23 (p < 0.001), and the decayed, missing and filled (dmft) index, 0.35 (p < 0.001) based on oral examination at 31 months. A maternal report of filled teeth at 54 months was significantly correlated with decayed teeth, 0.30 (p < 0.001); filled teeth 0.30 (p < 0.001), and dmft 0.40 (p < 0.001) at 43 months. Mothers tended to underestimate the extent of missing and filled teeth in their children irrespective of the child's age, but the extent of underestimation was greater among younger children. Maternal age, education level, and whether the child had ever visited a dentist were significant modifiers of subjective and objective caries assessments. Conclusions: From a clinical and dental public health perspective, our findings of a weak to moderate correlation of maternal assessments of their children's caries experience may be concerning when reporting the burden of dental diseases in large population studies or for surveillance purposes that rely on self-reported measures and must therefore be utilized with caution because of the potential to result in underestimated disease burden.

Serum cotinine, vitamin D exposure levels and dental caries experience in U.S. adolescents.

INTRODUCTION: Epidemiologic studies of risk and protective factors for poor oral health have mostly been among children and adults, seldom focusing on adolescents. The aims of this study were to examine whether serum cotinine, a marker of tobacco exposure, and serum vitamin D are independently associated with dental caries experience among adolescents. METHODS: Cross-sectional data from 2579 adolescent participants in the 2005-2008 National Health and Nutritional Examination Survey were analysed. The exposures, cotinine and vitamin D, were measured in serum while dental caries experience was determined by screening examination, and a case defined as having ≥1 decayed or filled teeth. Survey-adjusted logistic regression estimated prevalence odds ratios (POR) and 95% confidence intervals (CI) between the respective exposures and outcome. RESULTS: The overall median (IQR) serum cotinine level was 0.15 ng/mL (0.04, 1.80) while the mean (SE) serum vitamin D concentration was 68.2 nmol/L (1.36). In contrast to participants with serum cotinine ≤3 ng/L, those with levels >3 ng/L had covariate-adjusted estimate of 1.69 (1.16, 2.47) for caries experience. Each additional mean (ng/L) serum cotinine level was associated with an 8% (95% CI = 1.01, 1.16) greater adjusted prevalence odds of having caries experience. In contrast to participants with vitamin D ≥ 50 nmol/L, those with levels of30- < 50 nmol/L and <30 nmol/L had non-statistically significant adjusted estimates of 1.02 (0.72, 1.44) and 1.23 (0.70, 2.16) respectively for caries experience. CONCLUSIONS: Serum cotinine is associated with dental caries experience among adolescents and while deficient (<30 nmol/L) levels of vitamin D appear to be associated with greater prevalence odds of caries experience, this association is inconclusive.

Factors Associated with Preventive Dental Visits Before and During Pregnancy.

Objective: Poor prenatal oral health has implications for maternal, fetal, and infant health. Studies have shown an association between periodontal disease and adverse pregnancy outcomes, such as preterm delivery, low birth weight, and pre-eclampsia. The objective of this study was to identify the factors associated with preventive dental visits before and during pregnancy and examine the relationship of dental insurance with those visits among Virginia women. Methods: The Virginia Pregnancy Risk Assessment Monitoring System (2012-2014) cross-sectional data were used to explore the use of dental cleaning visit among women. The bivariate and multivariate analyses included sociodemographic variables, health risk factors, chronic conditions, oral health knowledge, and oral health promotion variables. All estimates were weighted; p < 0.05 was considered statistically significant. Results: A total of 1,344 weighted respondents represented ∼293,608 women in Virginia. Overall, 56% of women reported a before pregnancy dental cleaning visit, and 47% of women reported a during pregnancy dental cleaning visit. Nearly 60% of women were non-Hispanic white, 78% were between 20 and 34 years of age, and 67% reported having dental insurance. Dental insurance (odds ratio [OR] = 3.5; 95% confidence interval [95% CI] = 2.17-5.67) and oral health knowledge (OR = 2.8; 95% CI = 1.42-5.48) were associated with before pregnancy dental visit. During pregnancy dental visit was strongly associated with dental insurance (OR = 5.8; 95% CI = 2.80-11.97), before pregnancy dental visit (OR = 20.72, 95% CI = 11.14-38.54), and oral health promotion by health provider (OR = 12.37, 95% CI = 7.31-20.93). Conclusions: Overall, the use of a preventive dental visit before and during pregnancy was low among Virginia women. Improving the use of routine dental visits before pregnancy, increasing access to dental insurance, and engaging health care providers to promote oral health can impact the use of dental care during pregnancy.

Effects of enrollment in medicaid versus the state children's health insurance program on kindergarten children's untreated dental caries.

OBJECTIVES: We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children's Health Insurance Program [SCHIP]) on untreated dental caries in children. METHODS: Dental health outcomes were obtained through a calibrated oral screening of kindergarten children (enrolled in the 2000-2001 school year). We obtained eligibility and claims data for children enrolled in Medicaid and SCHIP who were eligible for dental services during 1999 to 2000. We developed logistic regression models to compare children's likelihood and extent of untreated dental caries according to enrollment. RESULTS: Children enrolled in Medicaid or SCHIP were 1.7 times (95% confidence interval [CI] = 1.65, 1.77) more likely to have untreated dental caries than were nonenrolled children. SCHIP-enrolled children were significantly less likely to have untreated dental caries than were Medicaid-enrolled children (odds ratio [OR]=0.74; 95% CI=0.67, 0.82). According to a 2-part regression model, children enrolled in Medicaid or SCHIP have 17% more untreated dental caries than do nonenrolled children, whereas those in SCHIP had 16% fewer untreated dental caries than did those in Medicaid. CONCLUSIONS: Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid.

Articaine use in children among dental practitioners.

PURPOSE: The purpose of this study was to examine local anesthetic selection and dentists' use of articaine in children. METHODS: Using a cross-sectional survey design, a questionnaire regarding the use of local anesthetics in children was mailed to a random sample of dentists and all pediatric dentists from North Carolina and Virginia. The 16-item questionnaire included questions regarding the preferred local anesthetic used in children. The association between dental practitioner type and anesthetic use was tested using the chi-square or Fisher's exact test. RESULTS: There was a 30% response rate. Lidocaine with epinephrine was the local anesthetic preferred overall by all practitioners. Approximately 50% of dentists surveyed reported using articaine in children. There were no significant differences in the preference of articaine between provider types with the exception of older, 7- to 10-year-old patients, where general dentists preferred articaine significantly more than pediatric dentists (28% vs 16%). CONCLUSIONS: While lidocaine with epinephrine was still the preferred local anesthetic for use in children, the use of articaine in children was prevalent among both general and pediatric dentists. The use of articaine became more prevalent as the patient's age increased.

Infant oral health care: a survey of general dentists, pediatric dentists, and pediatricians in Virginia.

PURPOSE: This study's purpose was to examine the current knowledge, attitudes, and experiences related to infant oral health for dental and medical providers in Virginia. METHODS: A survey of infant oral health care was sent to: (a) 300 randomly selected general dentists; (b) 300 randomly selected pediatricians; and (c) all pediatric dentists in Virginia. Survey respondents were tabulated, and percent frequency distributions for responses to each item were computed. RESULTS: The surveys return rate was 48%. A total of 100% of pediatric dentists treated infants and were more likely to recommend that children be seen by age 1 (P < .001). All pediatricians treated infants as well, while only 5% referred for the first dental visit by 1 year of age. Forty-five percent of general dentists surveyed treated infants, and only 12% referred for the first dental visit by 1 year of age. The logistic regression results indicated that there were differences between practitioner type regarding the recommended age of the first dental visit and years in practice. CONCLUSIONS: The majority of pediatricians and general dentists are not advising patients to see the dentist by 1 year of age. There is a need for increased infant oral health care education in the medical and dental communities.

Impact of Community-Based Clinical Training on Dental Students' Confidence in Treating Pediatric Patients.

With a significant need for more general dentists to provide care for pediatric patients, previous studies have found that community-based clinical training experience with children increased dental students' willingness to provide care to pediatric patients after graduation. The aim of our study was to determine the impact of community-based clinical training with pediatric patients on dental students' self-perceived confidence in treating pediatric patients, both overall and related to specific procedures. Of the total 105 fourth-year dental students at one U.S. dental school invited to participate in the study in academic year 2011-12, 76 completed the survey about their community-based dental education (CBDE), for a 72% response rate. Over half of the respondents (55%) reported feeling more confident in treating pediatric patients after their rotations. The increase in confidence was not associated with demographics. The placement of sealants (p=0.0022) and experience in giving local anesthesia (p=0.0008) were the two procedures most strongly associated with the increase in confidence. Also, these students received more experience in pulp therapy, extractions, and treating children up to three years of age during their community-based rotations than in the school-based clinic. In this study, greater exposure to pediatric dental clinical experiences during CBDE increased the students' confidence in treating pediatric patients. These results suggest that community-based experiences are useful in supplementing the school-based pediatric clinical experience, including increasing entry-level dentists' confidence in treating pediatric patients.