Procedimentos odontopediátricos realizados pelo Sistema Único de Saúde no Rio Grande do Sul, antes e durante a pandemia de covid-19: diferença entre os anos de 2018 e 2021 / Procedimientos de odontopediatría realizados en el Sistema Único de Salud del estado de Rio Grande do Sul antes y durante la pandemia de COVID-19: diferencia entre los años 2018 y 2021 / Pediatric dentistry procedures performed within the Brazilian National Health System in the state of Rio Grande do Sul before and during the COVID-19 pandemic: difference between the years 2018 and 2021

Objective: to analyze the difference in the number of primary teeth dental procedures performed within the Brazilian National Health System (SUS) in the state of Rio Grande do Sul, before and during the COVID-19 pandemic. Methods: this was a descriptive ecological study, using secondary data from the SUS Outpatient Information System (SIA-SUS), from 2018 to 2021, in the state and in its seven health macro-regions; we calculated the relative and absolute frequencies and the percentage difference of the dental procedures performed. Results: 94,443 and 36,151 dental procedures were recorded before and during the pandemic, respectively, corresponding to a 61.7% reduction; relevant percentage reductions were found in restorative procedures, which reached 20% in the southern region of the state; an increase in the percentage of exodontic and endodontic procedures was found. Conclusion: the results suggest that the COVID-19 pandemic had negative repercussions on the performance of primary teeth dental procedures in Rio Grande do Sul.

Objetivo: analizar la diferencia en el número de procedimientos odontológicos en dentición temporal realizados en el Sistema Único de Salud del estado de Rio Grande do Sul, antes y durante la pandemia de COVID-19. Métodos: estudio ecológico descriptivo, utilizando datos secundarios del Sistema de Información Ambulatorio del SUS (SIA-SUS), de 2018 a 2021, en el estado y en las siete macrorregiones de salud. Se calcularon las frecuencias relativas, absolutas y la diferencia porcentual de los procedimientos odontológicos realizados. Resultados: se registraron 94.443 y 36.151 procedimientos odontológicos antes y durante la pandemia, respectivamente, lo que corresponde a una reducción del 61,7%. Se observaron reducciones porcentuales relevantes en los procedimientos restaurativos, que alcanzaron 20 puntos porcentuales en la región sur del estado. Se observó un aumento en el porcentaje de procedimientos de exodoncia y endodoncia. Conclusión: los resultados sugieren que la pandemia de COVID-19 tuvo repercusiones negativas en la realización de procedimientos odontológicos en dentición temporal en el estado.

Objetivo: analisar a diferença no número de procedimentos odontológicos na dentição decídua, realizados pelo Sistema Único de Saúde (SUS) no estado do Rio Grande do Sul, Brasil, antes e durante a pandemia de covid-19. Métodos: estudo ecológico descritivo, utilizando-se dados secundários do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), de 2018 a 2021, no estado e em suas sete macrorregiões de saúde; foram calculadas as frequências relativas e absolutas, e a diferença percentual dos procedimentos odontológicos realizados. Resultados: foram registrados 94.443 e 36.151 procedimentos odontológicos antes e durante a pandemia, respectivamente, correspondendo a uma redução de 61,7%; reduções percentuais relevantes foram observadas nos procedimentos restauradores, atingindo 20 pontos percentuais na região Sul do estado; observou-se aumento no percentual de procedimentos exodônticos e endodônticos. Conclusão: os resultados sugerem que a pandemia de covid-19 teve repercussões negativas sobre a realização dos procedimentos odontológicos na dentição decídua, no estado.

An Evaluation of Knowledge, Awareness, Attitudes, and Behaviors Regarding COVID-19 Among Parents of Pediatric Dental Patients.

Children infected with COVID-19 have a critical part in community-based viral transmission. This study aimed to evaluate knowledge, awareness, attitudes, and behaviors of parents of pediatric dental patients on COVID-19 and to present required actions to prevent its spreading. A total of 524 parents took part in this cross-sectional study. A self-administered questionnaire was prepared for determining sociodemographic characteristics and socioeconomic status of parents, along with their COVID-19-related knowledge, awareness, attitudes, and behaviors. In total, 90.6% of parents were unaware that disease may show no symptoms; 61.1% and 32.6% did not know roles of "close contact with asymptomatic patients" and "dentistry practices" in transmission, respectively; 30.2% thought it could be transmitted to their children at dental clinics, and only 16.4% stated their children as carriers. Parents need to be informed on COVID-19 transmission through contact with asymptomatic individuals, risks associated with dentistry practices, and role of children in transmission.

Application of the Theory of Planned Behavior to Predict Dental Attendance and Caries Experience among Children of Newcomers.

Background: This study aimed to explore the predictors of regular dental attendance behavior and caries experience among children of newcomers to Canada using the Theory of Planned Behavior (TPB). Methods: A total of 274 newcomer parents with a child aged 1 to 12 years old who had lived in Canada for 10 years or less participated in this cross-sectional study. Children underwent a dental examination to measure their deft/DEFT, and parents completed a self-administered questionnaire. Parental attitudes, subjective norms, perceived behavioral control (PBC), and intention were examined using Structural Equation Modeling (SEM) as predictors of dental attendance behavior and caries experience using the TPB model. Results: Out of all the components of the model, attitude and PBC significantly predicted the intention (p < 0.05) while the subjective norm had no statistical effects on the loading of the model (p > 0.05). Intention significantly predicted behavior, but behavior could not predict caries experience. Although 51.6% of the variance of intention was predicted by this model, only 0.2% of the variance for dental attendance behavior was explained. Conclusions: The theory of planned behavior was successful in predicting dental attendance intention and behavior for children among newcomers, but this behavior could not predict caries experience in children.

Evaluating the Quality of Multiple Choice Question in Paediatric Dentistry Postgraduate Examinations.

OBJECTIVES: This study aimed to evaluate the quality of multiple choice question (MCQ) items in two postgraduate paediatric dentistry (PD) examinations by determining item writing flaws (IWFs), difficulty index (DI) and cognitive level. METHODS: This study was conducted at Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Virtual platform-based summative versions of the general paediatric medicine (GPM) and prevention of oral diseases (POD) examinations administered during the second semester of the 2017-2018 academic year were used. Two PD faculty members independently reviewed each question to assess IWFs, DI and cognitive level. RESULTS: A total of 185 single best answer MCQs with 4-5 options were analysed. Most of the questions (81%) required information recall, with the remainder (19%) requiring higher levels of thinking and data explanation. The most common errors among IWFs were the use of "except" or "not" in the lead-in, tricky or unfocussed stems and opportunities for students to use convergence strategies. There were more IWFs in the GPM than the POD examination, but this was not statistically significant (P = 0.105). The MCQs in the GPM and POD examination were considered easy since the mean DIs (89.1% ± 8.9% and 76.5% ± 7.9%, respectively) were more than 70%. CONCLUSION: Training is an essential element of adequate MCQ writing. A general comprehensive review of all programme's MCQs is needed to emphasise the importance of avoiding IWFs. A faculty development programme is recommended to improve question-writing skills in order to align examinations with programme learning outcomes and enhance the ability to measure student competency through questions requiring higher level thinking.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Utilization of Stainless Steel Crowns by Pediatric and General Dentists.

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors.

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.

Antibiotic Prescribing Patterns Among Dental Professionals In Massachusetts.

Purpose: The purposes of this study were to investigate prescribing patterns of antibiotics for the management of common pediatric oral infections, and to and identify the independent predictors of antibiotic preference across different groups of dental practitioners in Massachusetts, USA. Methods: A cross-sectional survey assessed antibiotic prescribing practices of general dentists, pediatric dentists, endodontists, and oral surgeons based on a series of clinical scenarios where antibiotic coverage may be warranted. Results: The appropriate therapeutic management of patients with facial cellulitis occurred across all clinical groups. Endodontists were least likely to prescribe antibiotics for patients with irreversible pulpitis, and those with pulpal necrosis with associated parulis. Seventy-four percent of respondents prescribed antibiotics for patients suffering from pericoronitis and trismus. Conclusion: With the exception of the management of facial cellulitis, adherence to published guidelines for the prescription of antibiotics is low. Specifically, antibiotics are being prescribed too often for patients with tooth pain or localized abscesses and infrequently when the systemic spread of infection is less obvious, such as with trismus but no fever. Universally promulgated guidelines formulated by professional bodies may lead to improved adherence and a reduction in negative outcomes resulting from the overprescription of antibiotics.

Knowledge, perceptions, and clinical experiences on molar incisor hypomineralization among dental care providers in Hong Kong.

BACKGROUND: Molar incisor hypomineralization (MIH) is an alarming problem with considerable challenges in management. This study aimed to evaluate and compare the knowledge, perceptions, and clinical experiences of molar incisor hypomineralization (MIH) between general dental practitioners (GDPs) and paediatric dentists (PDs) in Hong Kong. METHODS: A cross-sectional survey of 557 randomly selected GDPs (approximately 25% of all registered dentists) and all registered PDs (n = 31) were invited. They were asked to complete a 4-section questionnaire adapted and modified from a study by Gambetta-Tessini and co-workers on sociodemographic profiles, knowledge, experience, and perceptions regarding MIH. Data were analyzed with chi-square, Fisher's exact, and multiple factor ANCOVA tests. RESULTS: The overall response rate was 43.37% (255/588). Majority (74.1%) of the respondents encountered MIH in their practices. A significantly higher mean knowledge score (46.33 ± 7.1) was observed among PDs than GDPs (43.09 ± 7.0) (P < 0.01) and among PDs who are 40 years old or younger (P < 0.001). Differences in treatment of MIH were also observed between PDs and GDPs (P < 0.05). Paediatric dentists were more confident in diagnosing and treating MIH (P < 0.001). Most respondents (87.8%) expressed a need for continuing education on MIH. CONCLUSION: Continuing education on MIH is needed to assure that the highest quality of evidence-based care is given to patients with MIH. Dissemination of latest best evidence on MIH, especially to GDPs, will assure that the condition is accurately diagnosed and well managed.

Pediatric Dentistry Academic Workforce Survey.

Purpose: The purposes of this paper were to: (1) assess the current status of the pediatric dentistry academic workforce; (2) compare current findings with a similar survey completed in 2006; and (3) explore factors influencing the faculty workforce in pediatric dentistry. Methods: In 2016, 144 pediatric dentistry faculty members completed a web-based survey regarding workforce issues. Questions were asked regarding: (1) faculty demographics; (2) academic job history; (3) academic career longevity and possible change motivators; and (4) private practice participation. Results: A slight increase in the number of female pediatric dentistry educators was noted, since 2006. The precipitous drop in pediatric dentistry educators within the first five years of their academic careers, noted in 2006, seems to have improved somewhat, with more respondents indicating that they had been in their academic careers between five and 10 years than previously. However, a concerning number of faculty vacancies remain unfilled. Conclusions: Survey results indicate that pediatric dentistry's academic workforce challenges are consistent with the well-documented national shortage of dental faculty members. The most notable changes since the 2006 survey are the slight increase in female faculty members and a possible trend toward slightly younger faculty members and slightly longer faculty retention.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

Do Standard Bibliometric Measures Correlate with Academic Rank of Full-Time Pediatric Dentistry Faculty Members?

The aim of this cross-sectional study was to assess the relationship between quantitative measures of research productivity and academic rank for full-time pediatric dentistry faculty members in accredited U.S. and Canadian residency programs. For each pediatric dentist in the study group, academic rank and bibliometric factors derived from publicly available databases were recorded. Academic ranks were lecturer/instructor, assistant professor, associate professor, and professor. Bibliometric factors were mean total number of publications, mean total number of citations, maximum number of citations for a single work, and h-index (a measure of the impact of publications, determined by total number of publications h that had at least h citations each). The study sample was comprised of 267 pediatric dentists: 4% were lecturers/instructors, 44% were assistant professors, 30% were associate professors, and 22% were professors. The mean number of publications for the sample was 15.4±27.8. The mean number of citations was 218.4±482.0. The mean h-index was 4.9±6.6. The h-index was strongly correlated with academic rank (r=0.60, p=0.001). For this sample, an h-index of ≥3 was identified as a threshold for promotion to associate professor, and an h-index of ≥6 was identified as a threshold for promotion to professor. The h-index was strongly correlated with the academic rank of these pediatric dental faculty members, suggesting that this index may be considered a measure for promotion, along with a faculty member's quality and quantity of research, teaching, service, and clinical activities.

An Analysis of Pediatric Dentistry Residents' Productivity in the Operating Room.

PURPOSE: To analyze productivity of pediatric dental residents (PDRs) in the operating room (OR) and to determine predictors of case length. METHODS: Service-mix for OR cases completed between 2010 and 2013 were converted to relative value units (RVUs). Additional information, including patients' age, gender, American Society of Anesthesiologists (ASA) status, number of teeth, and operation time was retrieved. Analysis entailed descriptive, correlational, and multivariable techniques. RESULTS: Eight PDRs completed 893 OR cases. First-year residents (FYRs) completed more complex cases than second-year residents (SYRs), as determined by total RVUs and number of teeth. However, SYRs were more productive, as determined by RVUs per minute. Productivity for all PDRs increased on average by 33 percent during the program, with an average of 0.39 versus 0.59 RVUs per minute during the first versus the last quarters. Case complexity - measured in total RVUs per case - was associated with number of teeth and operation time, while patients' age and ASA status were not significantly associated with case complexity in the final regression model. CONCLUSIONS: Clinical productivity of PDRs increased over the two-year period, with a wide variation demonstrating a differential learning curve on different individuals. A significant association between case complexity, number of teeth, and operation time was found.

Referral patterns of special needs patients at the Royal Dental Hospital of Melbourne, Victoria, Australia.

BACKGROUND: Special Needs Dentistry (SND) has been recognized as a dental specialty in Australia since 2003 but there have been no studies addressing the profile of patients for specialist care. The purpose of this study is to identify, via referrals received, the profile of patients and quality of referrals at the largest public SND unit in Victoria, Australia. METHODS: All referrals received over a 6-month period (1 January-30 June 2013) by the integrated SND unit (ISNU) were reviewed prior to allocation to the outpatient clinic (OP), domiciliary (DOM) or general anaesthetic (GA) services. RESULTS: Six-hundred and eighty-eight referrals were received with the majority for the OP clinic (68.3%), followed by DOM (22.4%) and GA services (9.3%) (χ2  = 360.2, P < 0.001). A referral may have specified more than one special needs condition with the most common category being those who were medically compromised (81.7%). The reasons for referral included lack of compliance (27.2%), further management due to multiple medical conditions or GA services required (9.9%), or for multiple other reasons (62.9%). CONCLUSIONS: A diverse pattern of SND patients was referred to the ISNU with a majority of referrals having no specific referral reason cited, suggesting poor quality of referrals.

General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis.

BACKGROUND: There is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists' (GDs), pediatric dentists' (PDs), and endodontists' (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs. METHODS: A total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey. RESULTS: Most EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions. CONCLUSIONS: Most respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs. PRACTICAL IMPLICATIONS: Efforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs.

Awareness and prevention of patient gag reflex among pedodontists in India: A web-based survey.

AIM: The aim of this study is to devise a reliable and valid web-based survey to predict the awareness level and prevention of patient's gag reflex among Indian pedodontists. MATERIALS AND METHODS: An 11-question predictive gagging survey was created, refined, and tested on 377 pedodontists. The questions focused on age group, common procedure associated with gag reflex and the most common technique adapted by dentists in their clinics to prevent gag. RESULTS: There was no statistically significant difference in gagging reflex among age groups with 53.5% of patients reported anxiety and fear as a main cause of gag; behavioral modification technique was considered as the most reliable method for gagging prevention in 68.5% of patients and there was no statistically significant difference in gagging severity index among patients irrespective of age, causes, and methods used to prevent it. CONCLUSION: The web-based gagging survey established that level of awareness regarding management of patient's gag is significantly low among pedodontists in India and hence is a major hindrance in the clinical practice.

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.