Comparisons between referred and non-referred patients to a university paediatric dental clinic.

BACKGROUND: Referrals of paediatric patients to a university clinic have been increasing over the last several years. AIM: To evaluate characteristics of referred and non-referred patients at the University of Iowa's Pediatric Dental Clinic (UIPDC). DESIGN: A retrospective chart review included dental records of 340 referred and 383 non-referred patients from July 1, 2015, to May 31, 2016 (n = 723). Age, distance to the clinic, size of the patient's community, insurance, number of teeth with decay, treatment needs, educational level of the provider, and presence of patient special health care needs were obtained. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed to analyze the outcomes (alpha = .05). RESULTS: Referred patients were more likely to live >60 miles away, live in a community of >75 000 people, have special health care needs, have caries/greater number of teeth with decay, need endodontic treatment, and were less likely to remain patients at the clinic (p < .0001). Referred patients were also more likely to need extractions (p = .0104), but less likely to need space maintenance/comprehensive orthodontic treatment (p = .0002). CONCLUSION: There was a difference in the complexity of patient treatment needs between referred and non-referred patients.

Sodium hypochlorite pulpotomies in primary teeth: a retrospective assessment.

PURPOSE: In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies. METHODS: A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature. RESULTS: One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time. CONCLUSIONS: Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes--a longitudinal study.

OBJECTIVES: The "optimal" intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight (mg F/kg bw) but is based on limited scientific evidence. The purpose of this paper is to present longitudinal fluoride intake data for children free of dental fluorosis in the early-erupting permanent dentition and free of dental caries in both the primary and early-erupting permanent teeth as an estimate of optimal fluoride intake. METHODS: Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks; 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 months; and then at 6-month intervals thereafter. Estimates of total fluoride intake at each time point were made by summing amounts from water, dentifrice, and supplements, as well as other foods and beverages made with, or containing, water. Caries data were obtained from examinations of children at ages 5 and 9 years, whereas fluorosis data were obtained from examinations of children only at age 9 years. RESULTS: The estimated mean daily fluoride intake for those children with no caries history and no fluorosis at age 9 years was at, or below, 0.05 mg F/kg bw for nearly all time points through the first 48 months of life, and this level declined thereafter. Children with caries had generally slightly less intakes, whereas those with fluorosis generally had slightly higher intakes. CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an "optimal" fluoride intake is problematic.

Four-year cost-utility analyses of sealed and nonsealed first permanent molars in Iowa Medicaid-enrolled children.

OBJECTIVES: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective. METHODS: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday. RESULTS: For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility= 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars. CONCLUSIONS: Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.

Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors.

OBJECTIVES: Several studies have focused on the timing of fluoride intake relative to the development of dental fluorosis. This study reports the relationships of fluoride intake during the first 48 months of life with fluorosis on early-erupting permanent teeth. METHODS: Subjects were followed from birth to 48 months with questionnaires every 3-4 months. Questionnaires gathered data on intakes from water, diet, supplements, and dentifrice to estimate total fluoride intake. Early-erupting permanent teeth of 579 subjects were assessed for fluorosis using the Fluorosis Risk Index (FRI) at approximately age 9. Fluorosis cases were defined as having FRI definitive or severe fluorosis on both maxillary central incisors. Individuals with FRI questionable fluorosis were excluded. The importance of fluoride intake during different time periods was assessed using t-tests and logistic regression. RESULTS: One hundred and thirty-nine (24%) subjects had fluorosis on both maxillary central incisors. Mean fluoride intake per unit body weight (bw) ranged from 0.040 to 0.057 mg/kg bw, with higher intake during earlier time periods and relative stability after 16 months. In bivariate analyses, fluoride intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central incisors, with the first year most important (P < 0.01), followed by the second (P < 0.01), third (P < 0.01), and fourth year (P = 0.03). Multivariable logistic regression analyses showed that, after controlling only for the first year, the later years individually were still statistically significant. When all four time periods were in the model, the first (P < 0.01) and second years (P = 0.04) were still significant, but the third (P = 0.32) and fourth (P = 0.82) were not. CONCLUSIONS: The first two years of life were most important to fluorosis development in permanent maxillary central incisors; however, this study also suggests the importance of other individual years.

Associations between dental fluorosis of the permanent and primary dentitions.

OBJECTIVES: Relatively little is known about associations between primary and permanent tooth fluorosis. In this study, associations between dental fluorosis of the permanent and primary dentitions were assessed. METHODS: Subjects (n = 601) are in the Iowa Fluoride Study, which included fluorosis examinations of the primary and early-erupting permanent dentitions by trained dentist examiners. Relative risks, correlations, and logistic regression assessed associations between permanent tooth fluorosis and primary molar fluorosis. RESULTS: Ten percent had primary molar fluorosis at age 5; 36% had definitive (mostly mild), 28% questionable, and 36% no permanent incisor fluorosis at age 9. Those with primary molar fluorosis were significantly more likely to have definitive permanent incisor fluorosis (76% vs. 32%), and permanent molar fluorosis (59% vs. 16%). The strong association between primary and permanent tooth fluorosis is independent of level of fluoride intake. CONCLUSIONS: Detection of primary tooth fluorosis in pre-school children should alert clinicians and parents to the high likelihood of subsequent fluorosis in the permanent dentition.

Longitudinal study of non-cavitated carious lesion progression in the primary dentition.

OBJECTIVES: This study reports changes in non-cavitated tooth surface diagnoses after a 4-year period. METHODS: Dental examinations were conducted for Iowa Fluoride Study cohort children who had non-cavitated lesions in the primary dentition and were also examined an average of 4 years later in the mixed dentition. Comparison of fluoride exposures, socioeconomic factors, and beverage consumption patterns were made between children who had lesions progress and those who did not. RESULTS: Of 129 non-cavitated pit and fissure lesions in the first exams, 40 (31%) progressed to either frank decay or filled status, while among 132 noncavitated smooth surface lesions, 7 (5%) were filled and none had frank decay in the second exam. No fluoride, socioeconomic status or beverage variables were significantly associated with lesion progression. CONCLUSIONS: Non-cavitated smooth surface lesions rarely progressed in this age group, but nearly one-third of pit and fissure lesions progressed.

Survey of Iowa general dentists regarding the age 1 dental visit.

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.

Oral health behaviors of children in low and high socioeconomic status families.

PURPOSE: This prospective longitudinal study compared the patterns of oral health behaviors between low and high socioeconomic status (SES) families participating in the Iowa Fluoride Study for a period of 9 years. METHODS: Information on oral health behaviors, including consumption of juices/juice drinks, soda pop, and powder-based drinks, dental visits, and tooth-brushing frequency, was collected longitudinally at periodic intervals from 6 to 108 months of age. Dental exams were conducted at 5 and 9 years of age. Classification of low socioeconomic status (SES; n=70) and high-SES (n= 128) children was based on baseline family income and mothers' education levels, with middle SES excluded. RESULTS: Low SES children consistently had significantly greater consumption of soda pop and powder-based beverages. There were, however, virtually no differences at any time point between groups in: (1) tooth-brushing frequency; (2) use of dentifrice; or (3) fluoride concentration in drinking water. Furthermore, the mean number of decayed and filled surfaces was significantly higher in the low-SES group. CONCLUSIONS: Results suggest that beverage consumption patterns are a key difference between high- and low-socioeconomic status families and could in part explain differences in caries experience between subjects of different SES. Modification of the pattern of soda pop and powder-based beverage consumption in the low-SES groups might reduce their caries experience.

Child temperament and risk factors for early childhood caries.

PURPOSE: The purpose of this study was to determine if a relationship existed between a mother's perception of her child's temperament and the child's risk factors for early childhood caries (ECC). METHODS: Data was collected from 629 records of children ages 0 to 4 who were patients of the University of Iowa's Infant Oral Health Program. Data included: (1) maternal report of child's temperament; (2) knowledge of ECC; (3) dietary and oral hygiene habits; and (4) clinical evidence of cavitated and noncavitated lesions and visible plaque on maxillary incisors. Chi-square tests and logistic regression models were used to analyze the data. RESULTS: Bivariate analyses showed that children reported as "easy" were more likely to: (1) be younger (P=.001); (2) be breast-fed to sleep (P=.046); (3) be breast-fed throughout the night (P=.012); and (4) have their teeth brushed twice daily (P=.006). Children reported as "difficult" were more likely to: (1) be bottle-fed to sleep (P=.002); and (2) have noncavitated lesions (P=.044). Final logistic regression analysis indicated that children perceived as "easy" were more likely to breast-fed throughout the night (odds ratio [OR]= 1.77; P=.016), while those perceived as "difficult" were more likely to be bottle-fed to sleep (OR=1.74; P=.016). CONCLUSIONS: Maternal reported child temperament may be related to important early childhood caries risk factors.

Emergency department visits and revisits for nontraumatic dental conditions in Iowa.

OBJECTIVES: To examine the characteristics associated with emergency department (ED) utilization in Iowa for nontraumatic dental conditions (NTDCs), and those associated with having multiple visits to the ED for NTDCs before the Medicaid expansion program in Iowa. METHODS: State Emergency Department Database for Iowa was used for 2012, which comprised of all outpatient ED visits in the state. Logistic regression was used for bivariate and multivariable analyses to model the odds of visiting the ED for NTDCs, relative to other conditions, and odds of visiting the ED multiple times relative to a single time in 2012 for NTDCs. The hospital charges associated with the NTDC ED visits were also examined. RESULTS: ED visits for NTDCs comprised 1.41% of all ED visits in Iowa during 2012 with a mean charge of $557. Of the patients presenting for NTDCs in 2012, 17% presented multiples times. Young adults, Medicaid enrollees or uninsured, and those residing in metropolitan areas had greater odds of presenting to the EDs for NTDCs compared with other conditions, and presenting multiple times to EDs for NTDCs. Those with more chronic conditions also had greater odds of repeatedly visiting the ED for NTDCs. CONCLUSIONS: Low-income young adults in Iowa rely on EDs for their dental needs that can have substantial costs. The Dental Wellness Plan (DWP) is intended to facilitate dental care access by providing dental coverage to low-income Iowans. This study provides baseline data that will be used to evaluate the success of DWP in improving access to dental care.

Dentists' participation and children's use of services in the Indiana dental Medicaid program and SCHIP: assessing the impact of increased fees and administrative changes.

BACKGROUND: The authors conducted a study to evaluate whether administrative changes, including higher fee schedules for dental services in the Indiana dental Medicaid program and the State Children's Health Insurance Program (SCHIP), were associated with improved dentist participation and utilization of dental services by children. METHODS: The authors evaluated dentists' participation and children's use of services for the two years before fees were increased to 100 percent of the 75th percentile of usual and customary fees, compared with two years after the increase. They obtained administrative data from the Indiana Department of Family and Social Services Administration and the Indiana Department of Public Health to determine participation rates and service use. RESULTS: The number of dentists seeing a Medicaid-enrolled child increased from 770 in fiscal year (FY) 1997 to 1,096 in FY 2000. The number of Medicaid-enrolled children with any dental visit increased from 68,717 (18 percent) to 147,878 (32 percent), with little difference between children enrolled through the Medicaid-SCHIP and traditional Medicaid programs by FY 2000. The mean number of visits per child per year and the mean number of procedures per child per year remained relatively constant. The cost per enrolled child increased from dollars 1.70 to dollars 6.70 per month, while the cost per child with a visit increased from dollars 9 to dollars 21 per month. CONCLUSION: The increase in fees and changes in administration of the Indiana dental Medicaid program were positively associated with improved dentist participation and children's use of dental services. PRACTICE IMPLICATIONS: Changes beyond increasing fees to 100 percent of the 75th percentile may be needed if Medicaid-enrolled children are to have access to dental care commensurate with their lower oral health status and greater need for services. Sustained fee increases also are important. As of 2003, no increase in dental fees had occurred in the Indiana Medicaid program since the increase in FY 1998.

Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness.

BACKGROUND: Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants. METHODS: The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars. RESULTS: Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care. CONCLUSIONS: Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations. CLINICAL IMPLICATIONS: Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition.

PURPOSE: Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors. METHODS: Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type. RESULTS: Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer. CONCLUSIONS: Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Overview of the evidence for clinical interventions in pediatric dentistry.

PURPOSE: The purpose of this report was to describe the quantity of published literature and types of studies supporting the use of 4 pediatric dentistry procedures: (1) ferric sulfate pulpotomy; (2) stainless steel crowns; (3) space maintainers; and (4) atraumatic restorative technique (ART). METHODS: When available, titles and abstracts of reports written in English and published over a 36-year period (1966-2002) concerning these procedures were retrieved from MEDLINE. They were classified using a modified classification scheme that, in addition to the study designs, also considered the 4 dimensions of measuring dental outcomes. RESULTS: The quantity of available literature concerning each dental procedure varied considerably. Even though many reports were published on treatments, only a small proportion of the published literature for each procedure was found to evaluate outcomes, regardless of outcome dimension. Besides outcomes evaluations, studies on techniques, material properties, and review articles comprised a large proportion of the literature. Clinical dimension of outcomes was most commonly studied. Case series and case reports were the most frequently used study designs to report outcomes. CONCLUSIONS: The outcomes-related literature to support some of the commonly performed treatments is limited both in quantity and study types. More reports are needed to develop the evidence base to support the commonly performed procedures in pediatric dental practice. Additional analyses reporting of the literature are also needed to assess internal and external validity of the studies.

Potential utilization of expanded function dental auxiliaries to place restoratives.

OBJECTIVES: The Affordable Care Act is predicted to increase dental benefits coverage for millions of Americans. Utilization of expanded function dental auxiliaries (EFDAs) can contribute to increased workforce capacity. Iowa currently allows EFDAs to perform certain nonrestorative procedures. This study investigated dentists' willingness to use auxiliaries for restorative procedures in order inform recent discussions about expanding scope of practice for EFDAs to include such procedures. METHODS: This study examined responses from 677 primary care dentists who responded to the 2013 Survey of Iowa Dentists (response rate = 59 percent). The authors performed univariate and bivariate analyses (χ(2) and t-tests) to examine characteristics of dentists who indicated willingness to utilize an auxiliary for newly proposed restorative functions. RESULTS: Thirty-seven percent of respondents indicated they would delegate at least one of the newly proposed restorative functions to an auxiliary. Pediatric dentists were significantly more likely to be willing to delegate (P = 0.042). Placing stainless steel crowns was most acceptable (31.9 percent of respondents), followed by amalgam restorations (22.3 percent), and composites (18.6 percent). CONCLUSIONS: Many dentists are willing to delegate reversible restorative procedures. Increasing scope of practice for auxiliaries may increase capacity of the existing dental workforce and improve access for newly insured populations. Expanding scope of practice for dental auxiliaries offers a viable mechanism to rapidly increase states' dental capacity in response to rising demands for dental care, including newly insured Medicaid populations.

Primary tooth fluorosis and fluoride intake during the first year of life.

OBJECTIVES: Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis. METHODS: As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4-7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data. RESULTS: Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant. CONCLUSIONS: Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.

Twelve-month sealant retention in a school-based program using a self-etching primer/adhesive.

OBJECTIVES: Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program. METHODS: Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively. RESULTS: Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop. CONCLUSIONS: In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.

Dental caries in the primary dentition: assessing prevalence of cavitated and noncavitated lesions.

BACKGROUND: Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later caries experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. METHODS: As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2-3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n = 67) of these children. RESULTS: Interexaminer agreement for any d1 and any d2-3 lesions at the person level was 100 percent. At the tooth level for d1d2-3f, there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa = .24. For d2-3 it was 99.4 percent agreement and kappa = .81. Prevalence of untreated d2-3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2-3 or filled surfaces, while over 63 percent had no d1, d2-3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2-3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. CONCLUSION: Despite some concern with reliability of diagnosing d1 lesions, it appears that the d1d2-3 criteria are informative and useful in assessing the primary dentition.

The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994.

BACKGROUND: As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children. METHODS: The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years. RESULTS: The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth. CONCLUSION: Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children. PRACTICE IMPLICATIONS: Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.