Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients.

OBJECTIVE: This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods. METHODS: Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88). RESULTS: The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence. CONCLUSION: Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.

A Predictive Model for Primary Care Providers to Identify Children at Greatest Risk for Early Childhood Caries.

Purpose: The purpose of this study was to create an early childhood caries (ECC) risk-screening tool that fits into the primary care provider (PCP) well-child workflow. Methods: Integrated health records were employed to develop a predictive model for infants/toddlers at ECC risk; 2,009 patients with 12-, 15-, or 18-month well-child visits and at least one dental visit were used to develop a predictive model for ECC risk at the first dental visit. Independent model validation used 880 18- to 48-month-olds at their first dental appointment after at least one well-child visit. Results: Age at the first dental visit strongly predicted caries risk (odds ratio for one-year increase in age equals 2.11; 95 percent confidence interval equals 1.80 to 2.47). Three factors predicted high-caries risk: breast feeding status, preferred language not English, and no-show rates for pediatric clinic visits greater than 20 percent. All three non-age risk factors in well-child exams prior to 18 months predicted 42 percent probability of having caries if present for the first dental visit at 18 months. If that child was not seen until four years of age for the first dental visit, the probability of high caries risk increased to 83 percent. Model performance for independent validation was very close to expected performance. Conclusions: Existing clinical documentation plus a validated predictive model enables an effective caries risk assessment within well-child visits.

Dental Local Anesthesia-Related Pediatric Cases Reported to U.S. Poison Control Centers.

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No cases of permanent damage or fatal outcomes were found. Seizure activity following the administration of local anesthetic was the most common event, suggesting intravascular administration or a toxic dose.

Ohio dentists' awareness and incorporation of the dental home concept.

BACKGROUND: The authors measured the awareness of the dental home concept among pediatric dentists (PDs) and general practice dentists (GPs) in Ohio and determined whether they included dental home characteristics for children 5 years and younger into their practices. METHODS: The authors sent a pretested 20-question survey to all Ohio PDs and to a random sample of approximately 20 percent of GPs in Ohio. The authors designed the survey to elicit information about dental home awareness and the extent to which dental home characteristics were incorporated into dental practices. RESULTS: More than 90 percent of both GPs and PDs incorporated or intended to incorporate into their dental practices the specific dental home characteristics mentioned in 20 of 41 items related to dental home characteristics. Of the respondents who did not already incorporate dental home characteristics into their practices, however, most did not intend to do so. Less than 50 percent of respondents in both groups responded positively to some items in the culturally effective group, and GPs were less likely than were PDs to provide a range of behavior management services and to provide treatment for patients with complex medical and dental treatment needs. PDs were more likely than were GPs to accept Ohio Medicaid (64 versus 33 percent). PDs were more likely than were GPs (78 versus 18 percent) to be familiar with the term "dental home." More recent dental school graduates were more familiar with the term. CONCLUSIONS: Most Ohio PDs' and GPs' practices included characteristics found in the definition of dental home, despite a general lack of concept awareness on the part of GPs. Research is needed to provide an evidence base for the dental home. Practical Implications. Once an evidence base is developed for the important aspects of the dental home and the definition is revised, efforts should be made to incorporate these aspects more broadly into dental practice.

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs.

PURPOSE: The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN). METHODS: A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts. RESULTS: Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792. CONCLUSIONS: The current US dental care system has extremely limited capacity to care for children with special health care needs.

Characteristics of dental clinics in US children's hospitals.

PURPOSE: This study's purpose was to describe the workforce, patient, and service characteristics of dental clinics affiliated with US children's hospitals belonging to the National Association of Children's Hospital and Related Institutions (NACHRI). METHODS: A 2-stage survey mechanism using ad hoc questionnaires sought responses from hospital administrators and dental clinic administrators. Questionnaires asked about: (1) clinic purpose; (2) workforce; (3) patient population; (4) dental services provided; (5) community professional relations; and (5) relationships with medical services. RESULTS: Of the 222 NACHRI-affiliated hospitals, 87 reported comprehensive dental clinics (CDCs) and 64 (74%) of CDCs provided data. Provision of tertiary medical services was significantly related to presence of a CDC. Most CDCs were clustered east of the Mississippi River. Size, workload, and patient characteristics were variable across CDCs. Most were not profitable. Medical diagnosis was the primary criterion for eligibility, with all but 1 clinic treating special needs children. Most clinics (74%) had dental residencies. Over 75% reported providing dental care prior to major medical care (cardiac, oncology, transplantation), but follow-up care was variable. CONCLUSIONS: Many children's hospitals reported comprehensive dental clinics, but the characteristics were highly variable, suggesting this element of the pediatric oral health care safety net may be fragile.

Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the american academy of pediatric dentistry.

PURPOSE: The purpose of this study was to survey the alternative behavior management techniques that might be utilized by pediatric dentists in place of hand over mouth exercise (HOME) after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry (AAPD). METHODS: A questionnaire was electronically mailed to 2,600 AAPD members. The survey included items related to HOME alternatives after the elimination, concerns with its use, and if the elimination had affected access to care for children. RESULTS: Seven hundred four respondents (30%) completed the survey. Voice control was the first alternative, and minimum/moderate sedation was the second most common. Three hundred fifty respondents (50%) believed that HOME is an acceptable behavior management technique, and 290 (41%) believed it should be continued to be recognized by the AAPD. Only 7% believed that HOME elimination affected access to care for some children. CONCLUSION: Advanced behavior management techniques will be utilized more by pediatric dentists after the elimination of the hand over mouth exercise from the American Academy of Pediatric Dentistry's clinical guidelines.