Exploring the genomic basis of early childhood caries: a pilot study.

OBJECTIVE: A genetic component in early childhood caries (ECC) is theorized, but no genome-wide investigations of ECC have been conducted. This pilot study is part of a long-term research program aimed to: (1) determine the proportion of ECC variance attributable to the human genome and (2) identify ECC-associated genetic loci. METHODS: The study's community-based sample comprised 212 children (mean age=39 months; range = 30-52 months; males = 55%; Hispanic/Latino = 35%, African-American = 32%; American Academy of Pediatric Dentistry definition of ECC prevalence = 38%). Approximately 2.4 million single nucleotide polymorphisms (SNPs) were genotyped using DNA purified from saliva. A P < 5 × 10-8 criterion was used for genome-wide significance. SNPs with P < 5 × 10-5 were followed-up in three independent cohorts of 921 preschool-age children with similar ECC prevalence. RESULTS: SNPs with minor allele frequency ≥5% explained 52% (standard error = 54%) of ECC variance (one-sided P = 0.03). Unsurprisingly, given the pilot's small sample size, no genome-wide significant associations were found. An intergenic locus on 4q32 (rs4690994) displayed the strongest association with ECC [P = 2.3 × 10-6 ; odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.1-5.9]. Thirteen loci with suggestive associations were followed-up - none showed evidence of association in the replication samples. CONCLUSION: This study's findings support a heritable component of ECC and demonstrate the feasibility of conducting genomics studies among preschool-age children.

Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia.

PURPOSE: The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. STUDY DESIGN: Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. RESULTS: There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. CONCLUSION: DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting.

OBJECTIVE: There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children. STUDY DESIGN: A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4-12. RESULTS: Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference. CONCLUSIONS: Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

Knowledge and practice of eating disorders among a group of adolescent dental patients.

OBJECTIVES: The objectives are to ascertain how much is known about the eating disorders of bulimia and anorexia nervosa in a group of female adolescents, to determine if they had practiced behaviors consistent with these eating disorders, and to determine if there was a disconnect with actual and perceived healthy weight status. STUDY DESIGN: 126 research subjects completed a survey instrument. Embedded in the eighteen question survey were the five "SCOFF" questions, to determine if an eating disorder may exist. The BMI percentile was obtained for all participants. RESULTS: 18.3% of the research sample may have an eating disorder as predicted by the SCOFF questions. Of those with a suspected eating disorder, only 38% could correctly identify the best description of bulimia nervosa and 50% for anorexia nervosa. The BMI percentiles were higher in the group suspected of having an eating disorder CONCLUSIONS: Young adolescent females are at risk for eating disorders. Educational interventions should be directed at this young age group. If the at-risk individuals knew more about the consequences of these disorders, they may be less likely to practice the behaviors.

Barriers to oral health care for transgender and gender nonbinary populations.

BACKGROUND: Despite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people's experiences and expectations with regard to oral health care remain understudied. The authors examined gender identity-related factors influencing experiences in the dental setting, aspects of subjective oral health, and avoidance of oral health care. METHODS: One-hundred eighteen TGNB people aged 13 through 70 years completed a 32-item questionnaire designed for this study. Data analysis relied on descriptive methods and bivariate comparisons using a conventional P < .05 statistical significance criterion. Qualitative description analysis was used to identify emerging themes from responses to an open-ended question. RESULTS: One-third of participants reported misgendering (that is, had been addressed by their incorrect name and pronouns in the dental setting). Although refusal of oral health care was rare in this sample of TGNB participants, more than one-half felt that their usual source of oral health care was not equipped to provide gender-appropriate care. Participants' avoidance due to gender identity was significantly associated with measures of self-reported suboptimal oral health. Common themes related to participants' oral health care experiences included gender insensitivity, awkward interactions, avoidance of care, and lack of gender-affirming providers. CONCLUSIONS: Discrepancies between TGNB patients' expectations and actual experiences suggest that their needs are often unmet in the dental setting, possibly contributing to gender identity-associated dental avoidance and oral health disparities. PRACTICAL IMPLICATIONS: Although these results need to be verified in larger and more diverse samples, they provide actionable information for improvement to this population's oral health and management.

Child Nutrition Patterns Are Associated with Primary Dentition Dental Caries.

Purpose: Diet is a well-established, modifiable factor influencing dental caries risk. However, evidence regarding its association with distinct clinical patterns of dental caries is lacking. The purpose of this study was to identify the association of child nutrition patterns with two distinct clinical presentations (subtypes) of childhood dental caries. Methods: The study sample comprised 120 children who were patients of a private pediatric dental practice: 30 ages one to three years (mean equals 2.2 years) with anterior carious lesions; 30 ages four to 12 years (mean equals six years) with posterior-only carious lesions; and 60 age-, gender-, and payment method-matched caries-free controls. Participants underwent dental examinations, and their guardians completed a 17-item nutrition frequency questionnaire. A latent profile analysis was used to define distinct dietary patterns and, subsequently, test their association with dental caries subtypes. Results: Dietary patterns were differentiated by consumption frequencies of water and cariogenic solid, soft, and liquid food items; a diet cluster characterized by frequent consumption of fruit juice, cereal bars, and daily vitamins was more common (P<0.05) among one- to three-year-old patients with anterior carious lesions compared to matched caries-free controls. Conclusions: These results affirm the key role of dietary patterns in childhood oral health and demonstrate the influence of fermentable carbohydrates on specific clinical subtypes of caries.

Socio-ecological factors associated with returning for post-operative care after dental treatment under general anesthesia.

PURPOSE: The aim of this study was to determine if specific variables in a theorized socio-ecological model are associated with returning for post-operative care after dental treatment under general anesthesia. METHODS: A 26 item cross-sectional survey assessing socio-ecological variables of 100 families of patients receiving dental treatment under general anesthesia was conducted. Chi-square tests and logistic regressions were used to investigate associations between returning for post-operative care with child, family, clinic and environmental variables described in the proposed socio-ecological model. RESULTS: Forty-seven percent of patients returned for post-operative care. Children without a dental home had lower odds of returning than children referred from a continuous source of care. Children with an ASA II/III classification had lower odds of returning for post-operative care than children who were ASA I. CONCLUSIONS: One child level and one environmental level variable in the theorized socio-ecological model had an impact on whether patients returned for post-operative care after dental treatment under general anesthesia. Further investigation of socio-ecological variables influencing dental health behaviors is needed.

Evaluation of knowledge, attitudes, and self-reported behaviors among 3-5 year old school children using an oral health and nutrition intervention.

METHODS: Ninety 3-5 year old children, 43 in the control group and 47 in the intervention group, participated in the study. An age and developmental appropriate prop-based oral health and nutrition intervention program was used. Subjects in the intervention group received a pre-test, an 8-10 minute prop-supported intervention, followed by an immediate post-test. The same test was repeated two weeks later The control group received a pre-test and post-test two weeks later but no intervention. RESULTS: Intervention improved scores in the immediate post-test but these improvements were not sustained two weeks later The only positive relationship found for the entire group between pre-and two week post-test scores was for oral health knowledge. There were no significant findings when adjusted for race, intervention type or group. CONCLUSIONS: Changing oral health and nutrition knowledge, attitude and behavior may require intense and repetitive interventions to have a significant effect in this age cohort.

Versatility of polymethacrylate monoliths for chromatographic purification of biomolecules.

Polymethacrylate monoliths, specifically poly(glycidyl methacrylate-co-ethylene dimethacrylate) or poly(GMA-co-EDMA) monoliths, are a new generation of chromatographic supports and are significantly different from conventional particle-based adsorbents, membranes, and other monolithic supports for biomolecule purification. Similar to other monoliths, polymethacrylate monoliths possess large pores which allow convective flow of mobile phase and result in high flow rates at reduced pressure drop, unlike particulate supports. The simplicity of the adsorbent synthesis, pH resistance, and the ease and flexibility of tailoring their pore size to that of the target biomolecule are the key properties which differentiate polymethacrylate monoliths from other monoliths. Polymethacrylate monoliths are endowed with reactive epoxy groups for easy functionalization (with anion-exchange, hydrophobic, and affinity ligands) and high ligand retention. In this review, the structure and performance of polymethacrylate monoliths for chromatographic purification of biomolecules are evaluated and compared to those of other supports. The development and use of polymethacrylate monoliths for research applications have grown rapidly in recent times and have enabled the achievement of high through-put biomolecule purification on semi-preparative and preparative scales.

Multidisciplinary trauma management: a case report.

This case report documents the dental management of two permanent maxillary central incisors with a severe intrusive labial luxation injury in conjunction with one complicated and one uncomplicated crown fracture. Additionally, there was a fracture of the labial cortical plate which remained attached to the overlying soft tissue. The two affected teeth and fractured labial plate of bone were surgically repositioned and splinted. Endodontic therapy was completed on the two incisors and the two crown fragments, which had been maintained wet, were re-attached. The report describes a multidisciplinary approach to trauma management and case progress over a 20-month period.

Medical diagnoses of pediatric dental patients treated under general anesthesia: a 19 year review.

OBJECTIVE: The objective of this study was to examine the records of pediatric dental patients treated under general anesthesia to determine if there had been any significant change in preoperative diagnoses between 1990-99 and 2000-08. STUDY DESIGN: The records of 3298 pediatric dental patients treated in the operating room under general anesthesia at the University of North Carolina (UNC) Children's Hospital were examined and medical diagnoses recorded. The number of cases treated by calendar year was obtained. RESULTS: The results of this study did not find any significant differences in percentage frequency of medical diagnoses between the years of 1990-99 and 2000-08. There has been a steady increase in the number of cases treated under general anesthesia over the period of the study. CONCLUSIONS: 1. Dental care under general anesthesia remains an important treatment option. 2. The medical diagnoses of children provided dental treatment under general anesthesia has not changed significantly over the past nineteen years at the UNC Children's Hospital. 3. The demand to provide dental care for children under general anesthesia has continued to increase.

Impact of an oral health education intervention among a group of patients with eating disorders (anorexia nervosa and bulimia nervosa).

BACKGROUND: It is recognized that eating disorders are serious psychosocial illnesses that affect many adolescents and adults. A pre and post survey study was developed to assess demographics, oral health knowledge and self-image of patients with eating disorders participating in a hospital-based eating disorder clinic using an original oral health education program. The program's aim is to change the self-image and oral health practices of patients with anorexia-binge eating/purging (AN-BP) and bulimia nervosa (BN) disorders. METHODS: A pre-survey was completed by each study participant prior to attending the three educational sessions over a six-week period. A post survey questionnaire was completed after participation in all the educational presentations. Forty-six patients attended all three educational sessions and completed the pre and post-questionnaires. RESULTS: Most patients knew in advance that AN-BP and BN behavior can cause erosion of the teeth but only 30% knew the most likely location for the erosion to occur. But, following completion of the educational interventions, 73% answered the location correctly. Patients who reported going to the dentist regularly were significantly more likely to respond that their teeth/mouth had a positive effect on how they looked to themselves and to others, their general health, and their general happiness. Positive responses to the effect of the teeth/mouth on kissing and romantic relationships were also significantly higher for those who go to the dentist regularly compared to those who do not. CONCLUSIONS: There is a need to further understand AN-BP and BP patients' oral health knowledge and self-image perceptions as it relates to their smile (teeth, mouth) to assist in developing a standardized oral health program for eating disorder centers to implement into their daily curricula. A dental team member in an interdisciplinary eating disorder treatment team is important. Including an oral health education program improves patients' oral hygiene and oral health knowledge, as well as provides a supportive environment to empower the patients to take control of their overall oral health. TRIAL REGISTRATION: This study was retrospectively registered on April 18, 2019 in ClinicalTrials.gov, Identifier: NCT03921632.

Dental health of children: where we are today and remaining challenges.

Dental caries remains the most common disease in man and presents a tremendous health-affecting challenge and fiscal burden to both developed and underdeveloped countries. Changing demographics including increased number of ethnic minorities, cultural practices and diet, the number of children living in poverty or near poverty, and the special needs of medically compromised children have made solutions more complex and evasive. Systemic and topical fluoride contacts remain the most cost-effective public health response to preventing caries among children. The time-honored impact of reducing sugars and carbohydrates in the diet and improving oral hygiene practices also remain essential. New technology has the potential of offering remineralization strategies. The dental profession is challenged to be proactive in identifying alternatives and implementing new and creative ways to embrace underserved children and improve their access to care including trauma prevention. The impact on families and society, including financial and general well-being, due to poor oral health is significant. Lower income families absorb disproportionately the effect of dental diseases due to lack of education, food availability and selection, and access to early preventive care.

Infant Oral Mutilation.

Ebinyo refers to the practice of removing primary canine tooth follicles in infants without anesthetic by African traditional healers or elders using unsterilized instruments. This report describes a case of ebinyo or infant oral mutilation (IOM) and associated sequelae in a child adopted from a remote African tribe. The intraoral examination revealed that the patient was missing his primary maxillary and mandibular canines. The maxillary anterior periapical radiograph displayed a dysmorphic ectopic unerupted maxillary right primary canine positioned mesial to the maxillary right primary first molar. Periapical films taken confirmed partial or complete absence of the patient's primary mandibular left (73) and mandibular right (83) canines, and a bitewing and periapical film confirmed the absence of the patient's primary maxillary left (63) canine. The permanent canines will be monitored for possible hypoplasia secondary to trauma to the tooth buds during extirpation of the primary canines. Research presented in this report reveals that there are serious health implications involved with the practice of ebinyo.

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists.

Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management of 18 cases (primary and permanent dentition) according to perceived urgency. Repeated-measures logistic regression was used to analyze factors influencing perception of clinical scenarios. Results: Response rates for PD and GP were 45.5% and 36.3%, respectively. Perceived urgency varied by clinical scenarios, dentition (primary vs. permanent), and practitioner (PD vs. GP) (P<.001). Practitioners with fewer years in practice or seeing fewer pediatric patients managed more cases as urgent. Traumatic injuries in primary dentition (intrusion, pulp exposure, palatal displacement, avulsion) were managed as more urgent by GP than PD (P<.001). Emergencies related to infection and permanent dentition were perceived similarly by PD and GP. Conclusions: Clinical scenarios highlighted disagreement in the management of after-hours pediatric dental emergencies between GP and PD, especially trauma in primary dentition. General practitioners tended to refer to an ED or see urgently, and PD tended to defer care. By identifying needs for improved education in dental trauma management, we can increase utilization of the dental home, avoiding use of overburdened EDs.

A Cost Analysis of Three Pharmacologic Behavior Guidance Modalities in Pediatric Dentistry.

Purpose: The aims of this study was to compare dental treatment costs for three pharmacologic behavior guidance modalities: (1) dental office-based moderate sedation (SED); (2) hospital-based general anesthesia (GA-H); and (3) dental office-based general anesthesia (GA-OFF). Methods: Data were collected for healthy two- to six-year-olds who had full-mouth rehabilitation using GA-H at the University of North Carolina Children's Hospital, Chapel Hill, N.C., USA. Patients served as their own controls to compare costs across the three modalities. Rendered treatments were quantified using relative value units (RVUs). Costs included opportunity costs and administrative data. We relied upon ordinary least squares analyses to examine the relationship between total costs and RVUs. Results: Of 200 consecutive hospital records, 65 met the inclusion criteria. The mean age was 4.4 years old (range equals two to six years old; 41 ASA I, 24 ASA II). Dental treatment using GA-H averaged 118 minutes (range equals 62 to 256 minutes), with a mean of 12 teeth (range equals six to 20) treated. GA-H costs were 4.1 times greater than GA-OFF costs (range equals 1.1 to 4.9), and 4.5 times greater than SED costs (range equals 0.9 to 7.1); GA-OFF costs were 1.1 times greater than SED costs (range equals 0.7 to 1.6). Conclusions: Treatment completed (measured in relative value units) was correlated highest with costs for dental office-based moderate sedation and least for hospital-based general anesthesia. If more than four SED appointments are needed, GA-OFF may provide cost-savings; however, at no point does GA-H offer cost-savings.

A study of military recruitment strategies for dentists: possible implications for academia.

Results of the annual American Dental Education Association surveys of dental school seniors show approximately 10 percent of graduates enter federal government services while less than 1 percent enter dental academia. To examine this difference, this study sought the perceptions of senior dental students and junior military dental officers regarding their choice of a military career in order to determine how military recruitment strategies influenced their career decisions. Official documents explaining military recruitment efforts were requested from the military services and summarized. In-depth telephone interviews were conducted to gather perception data from the students and dental officers on successful strategies. By employing several strategies, the military was able to inform potential recruits about the benefits of being a dentist in the military. The opportunity to have the military finance a student's dental education was a successful military recruitment tool. Other enticing factors included guaranteed employment upon graduation, prestige associated with serving in the military, access to postgraduate training, minimal practice management responsibilities, and opportunities to continue learning and improve clinical skills without significant financial implications. It was concluded that dental education can use the same strategies to highlight the benefits of an academic career and offer many similar incentives that may encourage students to consider a career path in dental education.

Integrating dental screening and fluoride varnish application into a pediatric residency outpatient program: clinical and financial implications.

Delivery of preventive oral health services (POHS) has been embraced by many pediatric andfamily medical practices in North Carolina (NC). The outcome of implementing a state-wide Medicaid-supported oral health prevention initiative, "Into the Mouth of Babes Varnish and Screening Program (IMB), in an academic medical residency setting is described Retrospective chart audit of encounterforms and collection of administrative records related to POHS provided by pediatric medical residents for Medicaid recipients less than 3 years of age at the University of North Carolina pediatric continuity care clinic over 31 months were examined A total of 1,081 visits and 655 patients were documented during the study period accountingfor 36.6% of all children aged 6-36 months seen in the clinic during the period of this study. Thirty-eight percentof the patients received one or more IMB follow-up visits. Twenty-nine (4.4%) children were reported to have one or more carious teeth and 94 children (14.1%) were referred to a dentist. The IMB program provides an oral screening, parent oral health counseling and application of fluoride varnish to the teeth at the medical appointment by non-dental personnel. Following a cost/revenue analysis it was concluded that a preventive oral health initiative in an academic setting provides an additional access to oral health preventative services for underserved children and contributes to the financial viability of the clinic.

Dental Emergency Practice Characteristics Among North Carolina Pediatric and General Dentists.

PURPOSE: The purpose of this study was to assess after-hours practice characteristics of pediatric dentists (PDs) and general dentists (GDs) and determine how patients-of-record obtain after-hours emergency dental care. METHODS: A 29-item survey was electronically distributed to PDs and GDs in North Carolina in September 2014. Demographics and after-hours emergency practice characteristics were assessed. Survey respondents were subsequently called after-hours to validate reported after-hours emergency protocol. Descriptive and bivariate statistics compared responses from PDs and GDs. Concordance between survey and telephone responses was analyzed. RESULTS: Eighty-six (46 percent) PDs and 1,199 (36 percent) GDs completed the survey; 86 (100 percent) and 1,015 (85 percent) met inclusion criteria, respectively. Most dentists allowed patients to reach them via pager/cell phone after-hours (82.1 percent of PDs, 72.8 percent of GDs; P=0.04). More PDs than GDs had established after-hours emergency protocols (95.3 percent versus 56.7 percent, P<0.001), practiced in a group (71.1 percent versus 40.9 percent, P<0.001), and shared call (64.0 percent versus 30.1 percent, P<0.001). Telephone and survey responses significantly differed for GDs (P<0.001) but not PDs (P=0.14). CONCLUSIONS: After-hours emergency care is an important component of a comprehensive dental home. More pediatric dentists than general dentists provided after-hours emergency dental care. Survey and telephone responses were more consistent and favorable for PDs than GDs. This highlights gaps in emergency dental practice and breakdown of the dental home.

A policy review of after-hours emergency dental care responsibilities.

OBJECTIVES: To examine professional guidelines and/or requirements of state and national dental organizations regarding the responsibility of dentists for after-hours emergency care. METHODS: Guidelines of national dental professional organizations, specialties, and all 50 state dental boards were examined for language pertaining to after-hours emergency care. Guidelines were categorized as: a) no guidelines; b) deferral to American Dental Association (ADA) guidelines; c) specific guidelines outlined. RESULTS: Most states and national guidelines were similar to the ADA: dentists are obliged to make reasonable arrangements for the emergency dental care of patients of-record and not-of-record. Oral surgery maintains the most stringent guidelines of all specialties. Results of the 50 states reviewed: no guidelines-16 states (32 percent), deferral to ADA guidelines-21 states (42 percent), and specific guidelines outlined-13 states (26 percent). CONCLUSIONS: Current after-hours emergency guidelines are nonspecific and open to interpretation. Variability between state guidelines likely contribute to unnecessary hospital emergency visits and increased healthcare costs, undermining the goal of establishing and maintaining dental homes.