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.

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.

Job Satisfaction and Relocation Desire among Pediatric Dentists in Puerto Rico.

OBJECTIVE: To determine the levels of satisfaction, license status, and desire to relocate of pediatric dentists in Puerto Rico. METHODS: Pediatric dentists in Puerto Rico were surveyed via telephone interviews. Data were collected through a 34-item questionnaire that explored satisfaction as related to income, continuing education, professional goals, and participation in the Mi Salud program. Frequencies, chi-square analysis, and Fisher's exact 2-tailed t-test were utilized to determine the relationships between satisfaction and the demographics of the pediatric dentists. RESULTS: Sixty pediatric dentists participated in our survey-77% of the total number of pediatric dentists practicing in Puerto Rico. Overall, 65% of the participating pediatric dentists expressed dissatisfaction. Male pediatric dentists were more dissatisfied than their female colleagues were. Most pediatric dentists participating in Mi Salud expressed dissatisfaction. When asked about whether or not they had considered migrating to the mainland, those who were dissatisfied were more likely to have considered that idea than were those who were satisfied. Overall, 57% of the pediatric dentists comprising our sample had considered relocating to the continental United States. CONCLUSION: In general, the pediatric dentists who participated in our study expressed dissatisfaction in most areas except when asked about their ability to reach professional goals. Determining the levels of satisfaction of health care providers is important in the maintaining of an adequate workforce. As current levels of dissatisfaction are high, it is important to determine what variables are related to satisfaction so that corrective measures can be taken to ensure that retention rates improve, thereby maintaining an adequate pediatric dental workforce.

Minimal intervention dentistry procedures: a ten year retrospective study.

UNLABELLED: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals. OBJECTIVE: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID. STUDY DESIGN: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests. RESULTS: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002). CONCLUSIONS: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Outpatient dental procedures carried out by Pediatric Dentists within Brazil's public healthcare system.

Brazil's public healthcare system (SUS) offers specialized oral health services to Brazilians, but the productivity of specialists, such as Pediatric Dentists, has not been characterized. Therefore, the objective of this study was to characterize the outpatient dental procedures (ODPs) carried out by Pediatric Dentists within the SUS. An epidemiological study with an ecological, longitudinal, retrospective, and quantitative approach was conducted. The ODPs carried out by Pediatric Dentists within the SUS were characterized based on type of procedure, complexity level, and circumstance (urgent or elective). Data were analyzed using a descriptive and analytical approach, considering a significance level of 5%, as well as the impact of the COVID-19 pandemic (the 2020-2022 years were not included in secondary analyses). In the last 15 years, 29,234,972 ODPs were carried out by Pediatric Dentists within the SUS. Clinical procedures were the majority (55.4%), significantly more frequent than all other types of procedures (all p <0.05). Among these, restorative and periodontal procedures were the most common (30.7% and 21.0%, respectively). From 2008 to 2019, excluding COVID-19 pandemic years, the trend over the last 15 years was constant for all types of procedures (all p >0.05). In addition, low complexity ODPs were the majority (90.1%), significantly more frequent than medium (9.7%) and high complexity procedures (0.1%) (both p <0.05). At last, most ODPs were not characterized by circumstance in the outpatient production reports (96.9%). Therefore, it was possible to conclude that Pediatric Dentists carried out diverse ODPs within the SUS over the past 15 years, although there was a dominant pattern of type and complexity.

Impact of COVID-19 on pediatric dental care in two epicenters: Italy and Brazil.

The study aimed to compare the adherence of Brazilian and Italian pediatric dentists to the biosafety measures and operative protocols recommended by the health authorities during COVID-19 pandemic and to classify the participants according to their risk of infection. An online questionnaire with 34 questions about sociodemographic and occupational data, dental practice organization, biological risk management, and clinical operative protocols was sent to Brazilian and Italian pediatric dentists using a convenience sampling strategy. Chi-square test and multivariate analysis (two-step cluster) were performed (α = 5%). Of 641 respondents (377 Brazilians and 264 Italians), most were female (94% and 70%, respectively), aged 20-39 years (63%), with over 10 years of professional experience (58% and 49%, respectively). Based on adherence to recommended biosafety measures, participants were classified as "safer" (n = 219) or "less safe" (n = 422). Adherence to recommended protocols by the majority of participants resulted in low contagion rates (Brazilians = 5%; Italians = 12.5%). Participants with extensive professional experience in the dental setting exhibited a greater tendency to implement multiple adaptations (three or more) in their practice. Most participants (Brazilians = 92%; Italians = 80.7%) adopted the recommended minimal intervention dentistry approaches, with the use of fissure sealants and the use of non-rotary instruments for caries removal the most frequently techniques used among Brazilians (36%) and Italians (66%), respectively. Two different profiles of pediatric dentists were identified based on the biosafety protocols adopted during the pandemic. In addition, changes were implemented in the dental care provided to children, with focus on the minimal intervention dentistry.

[Children stomatology outpatient treatment requirements analysis and countermeasures].

OBJECTIVE: To assess dental treatment needs and oral health status among children under 18-year-old in Beijing and to examine how these are affected by age, gender. METHODS: In the retrospective study, 3 148 children aged 0.8-18.0 years were selected from patients who first visit the Department of Paediatric Dentistry, Peking University School and Hospital of Stomatology, from May 2010 to January 2011. The treatment needs were evaluated and analysed. RESULTS: Mean age of the group was 6.23 ± 3.46, median was 5.0, and 52.4% (1 649/3 148) were boys. The percentages of treatment need for caries, pulptis and periapical periodontitis, teeth developmental abnormality, dental injury space management, periodontal disease, non carious disease and others were 35.1%(1 105/3 148), 32.2%(1 013/3 148), 11.5% (363/3 148) and 6.7%(212/3 148), 2.0%(62/3 148), 1.3%(41/3 148), 0.1% (2/3 148) and 2.2%(69/3 148) respectively. 3.6% (112/3 148) children suffered toothache and need an emergency dental treatment. In 1 602 children under 6-year-old, 55.2% (884/1 602) were diagnosed as severe early childhood caries. Only 8.9% (281/3 148) children were found to need no treatment, who just asked a regular dental examine. CONCLUSION: Systematic implementation of preventive oral care and community-oriented health programmers for children, especially preschool-aged children, are urgently needed in China.

A cross-sectional survey investigating care of the primary dentition by paediatric dental specialists in Japan and the UK.

OBJECTIVE: The aim of this study was to compare treatment decisions in primary dentistry between Japanese and UK-based paediatric dental specialists. METHODS: Four clinical scenarios involving a 6-year-old boy were used to ascertain the clinical opinions of participants. The scenarios presented: (i) a single distal cavity, vital and without pain; (ii) a distal occlusal cavity, vital and without pain; (iii) a large distal occlusal cavity, non-vital and without pain, and (iv) a large distal occlusal cavity, non-vital and painful. Participants were 104 Japanese and 115 UK-based paediatric dental specialists. RESULTS: In the first scenario, some UK specialists showed a preference for vital pulpotomy with a stainless steel crown (10.3% compared with 0.9% in Japan). In the second scenario, Japanese participants were more likely than UK participants to offer traditional restorative care (73.6% vs. 24.1%). In the third scenario, 54.7% of Japanese specialists chose to open the pulp chamber, whereas 51.8% of UK specialists selected non-vital pulpotomy with stainless steel crown. In the final scenario, 74.0% of Japanese specialists chose to open the pulp chamber, whereas 51.8% of UK specialists chose not to offer any treatment other than extraction. CONCLUSIONS: Japanese and UK specialists in paediatric dental care choose different interventions for the same clinical problems.

Reliability of panoramic radiographs for identifying supernumerary teeth in children.

OBJECTIVES. To evaluate the reliability of panoramic radiographs (PRs) for identifying supernumerary teeth (ST) and to determine whether the level of dental training of the observer influenced the identification of ST. METHODS. Seventy-five PRs were randomly selected from the patient records and 18 examiners independently rated 25 radiographs each, for specific risk factors as well as for a measure of adequacy. Subsequently, the results were paired with those of the other examiners who assessed the same set of PRs. Descriptive statistics were computed using Fisher's exact test, and kappa statistics were used to assess the inter- and intra-observer reliability. RESULTS. Four hundred and fifty PRs were available for analysis. The overall sensitivity and specificity figures were 50% and 98.3%, whereas the positive and negative predictive values were 90.6% and 83.6%, respectively. The sensitivity figures for Junior House Dental Officers and Postgraduate Paediatric Dental Trainees were 39.2% and 60.8%, whereas the specificity figures were 99.4% and 95% with slight inter-examiner and moderate intra-examiner reliability. CONCLUSIONS. Panoramic radiographs are unreliable for identifying ST, and higher level of dental training is essential for identifying ST.

The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

Access to dental care and the capacity of the California dental care system.

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

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.

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.

Contribution of dentist anesthesiologists to dental anesthesiology research.

In order to determine if dentist anesthesiologists (DAs) actively contribute to research in the field of anesthesiology, and thus contribute new knowledge to the field, an extensive literature search was accomplished. DAs make up only 1.5% of dentists who actively contribute to anesthesia research but account for 10% of publications. To determine if the impact of DA research was similar to the American Dental Association (ADA) recognized specialties, h-indices of noted researchers in other specialties were compared to the h-indices of noted DA researchers. The results show that the impact of top DA researchers in dental anesthesiology is similar to the impact of top dental specialty researchers, despite lack of academic departments in dental schools where a large percentage of dental research is completed. Dentist anesthesiologists actively contribute to the research in anesthesiology for dentistry and thus, actively contribute to new knowledge in the field.

Clinical decision on pit and fissure sealing according to the occlusal morphology. A descriptive study.

BACKGROUND: The objective of this descriptive study was to evaluate the clinical decision on sealing pits and fissures according to the occlusal morphology in patients with low individual caries risk (ICR). MATERIALS AND METHODS: A total of 222 dentists, 86 affiliated to the French Society of Paediatric Odontology (SFOP) and 136 general practice dentists (GPs), answered the same questionnaire with illustrations of 4 occlusal surfaces of permanent molars: they indicated firstly if these were at risk and secondly the corresponding decision regarding sealing. This questionnaire assessed the decision on widening pits and fissures before sealing and the type of sealant material used. Multivariate logistic regression analyses were performed to identify the factors associated with the clinical decision to widen pits and fissures. RESULTS: Sealing of at-risk teeth was indicated by 89% of dentists, whereas sealing of not at-risk occlusal surfaces was recommended by 46%. SFOP dentists were more prone to recommend pit and fissures sealants. The multivariate analyses demonstrated that only the type of material was associated with the clinical decision to widen pits and fissures. Forty eight percent of dentists choose the same material in all clinical situations. CONCLUSION: The wide variations in sealant use and placement technique implies there is no apparent consensus among GP and SFOP dentists. Although the criteria are similar in numerous scientific societies, not all dentists are acting upon these recommendations.

An access to care study for the pre-surgical nasoalveolar molding and other treatments for cleft lip and palate.

PURPOSE: This study is designed to ascertain whether a regional bias exists, as well as provide a reference to those seeking the various modalities used in pre-surgical intervention for cleft lip and palate either for their own patients or educational purposes. METHODS: A survey was constructed using Survey Monkey and distributed via e-mail to American Academy of Pediatric Dentistry members. Approximately 3689 surveys were delivered consisting of 12 questions asking whether they provide pre-surgical intervention to cleft lip and palate patients, and what type of interventions they use. RESULTS: A total of 572 members responded. Of the respondents, 480 reported they treat children affected by cleft lip and/or cleft palate. Of these, only 102 reported that they provide pre-surgical treatment. Pre-surgical nasoalveolar molding (PNAM) represented 29.2 percent of the interventions used and was most heavily concentrated in Texas. Other modalities used included the Latham appliance, lip adhesion/tacking, the passive appliance, and a category 'other' was included. Those checking 'other' most often described alveolar grafting prior to later surgical procedures than were of interest in this study. The University of Texas Health Science Center San Antonio had the largest number of respondents using the PNAM. CONCLUSIONS: A very small proportion of pediatric dentists are providing pre-surgical intervention of any kind to patients with cleft lip and palate. However, those that are providing the service are spread around the country enough to consider PNAM as the standard of care for pre-surgical infant cleft treatment.

Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

Rubber dam use: a survey of pediatric dentistry training programs and private practitioners.

PURPOSE: The benefits of the rubber dam (RD) are well known, but little data on utilization is available. This study's purpose was to evaluate the use of the rubber dam comparing survey responses of postgraduate pediatric dental residency program directors to privately practicing pediatric dentists. METHODS: This prospective, Institutional Review Board-approved, survey-based study was sent to 75 current directors of pediatric dentistry postgraduate programs and a random sample of 200 practicing pediatric dentists identified through a computer-generated process. A 22-item survey was developed, pilot tested, and attached to an e-mail sent to the study sample. Surveys were posted and managed at: "www.surveymonkey.com". RESULTS: One hundred fifteen respondents completed the survey. Fifty-six (75%) were program directors, and 59 (30%) were private practitioners. Most respondents felt that the use of RD is considered a standard of care and was emphasized during training. More than 80% stated that they use the RD either always or frequently during daily practice. The most common factors for and against the use of RD were maintaining a dry field and patient anxieties and potential for painful stimulus, respectively. CONCLUSION: This study's results suggest that the use of rubber dams: (1) is considered a standard of care in pediatric dentistry; and (2) may be modified, depending on procedural and/or patient factors.