Role of mutans streptococci, acid tolerant bacteria and oral Candida species in predicting the onset of early childhood caries.

Aim: Early childhood caries is the most common chronic infectious disease in children in the United States. This study, which is part of a larger, longitudinal study exploring oral microbiological components of caries development in children, reports on the impact of total mutans streptococci (MS), total acid tolerant bacteria and Candida species on the development of dental caries in a subset of these children. Of particular interest was the relationship between caries development and co-colonization of mutans streptococci and Candida species. Methods: Children between the ages of 12 and 47 months displaying no evidence of dental caries were recruited for a longitudinal study (n = 130). Twelve age- and gender-matched pairs were selected. In each pair, one child developed caries during the study, and one did not. Whole mouth plaque samples were collected by swab at baseline and every 6 months thereafter for a duration of 18 months and spiral plated for microbial counts (CFU/ml). Cut-offs based on percent of total cultivable flora were designated for all microbial measures. A scoring system designated the Plaque Microbial Index (PMI) was developed for use in statistical analyses to assess potential predictive factors for caries risk assessment. Results: Children who developed caries were significantly more likely to harbor higher percentages of acid tolerant bacteria (p = 0.003), MS (p < 0.001) and have Candida species present (p < 0.001) at ≥1 visit leading up to caries onset. Mean PMI scores derived from the aforementioned microbial measures, were higher for caries active children than caries free children (p = 0.000147). Co-colonization of MS and Candida species was significantly associated with caries development (p < 0.001) and detection of both at the same visit had a 100% positive predictive value and 60% negative predictive value for caries development. Conclusion: In children who developed caries, there was a statistically significant association with the percent of total flora that was acid tolerant, the percent of MS, the presence of Candida and co-colonization of MS and Candida species. Combining these microbial measures into PMI scores further delineated children who developed caries from those who remained caries-free. These microbiological measures show potential as predictive factors and risk assessment tools for caries development.

Comparison of Failed and Kept General Anesthesia Appointments in a Pediatric Dental Clinic.

Purpose: To evaluate reasons pediatric dental patients missed appointments associated with general anesthesia (GA) or monitored anesthesia care (MAC).
Methods: Data were collected using a retrospective review of 518 charts of patients with appointments at a university pediatric dental clinic between January 1, 2018 and April 30, 2019. The information obtained included patient demographics and reasons for failing appointments. Statistical analyses included descriptive and bivariate analyses (alpha=0.05).
Results: A total of 518 patients were included in the study. There were 86 failed appointments (age=7.6±5.8 [standard deviation; {SD}] years; 64 percent males) and 432 kept appointments (age=8.4±7.0 [SD] years; 61.6 percent males), were included in the study. Among those patients who failed appointments, 82.6 percent had public aid (Medicaid) coverage and 47.7 percent had special health care needs (SHCN). For those who kept appointments, 80.8 percent had Medicaid coverage and 55.8 percent had SHCN. The most common reason for failed appointments was "child illness." Patients seen for emergency care between consultation and the surgery visit were more likely to fail appointments than those who were not seen for emergency care (33.3 percent versus 12.7 percent; P =0.001). Additionally, the mean/median days, respectively, between consultation and surgery for patients who missed appointments were significantly higher than for patients who kept appointments (107.5/91 days versus 75.6/58 days; P <0.001).
Conclusion: Significant differences were found between patients who failed their appointments and those who kept them.

Simulation-Based Medical Emergencies Education for Dental Students: A Three-Year Evaluation.

This aim of this study was to develop and evaluate a simulation program for dental students to supplement a lecture-based medical emergencies course. Students' self-reported knowledge, experience, confidence, and ability regarding medical emergencies were assessed as program outcomes. For three years (in 2014, 2015, and 2016), all second-year students (N=333) at one U.S. dental school were randomly assigned to groups of 15 and participated in 15 simulated clinical scenarios. All students completed a 21-item pre-post survey and rated their knowledge, experience, and confidence using simulated emergencies. Following the intervention, students' ability to complete critical actions was also peer-assessed using a ten-item checklist. Four open-ended questions were included on the post-intervention survey for acquisition of additional data. For all years, students' self-reported measurements significantly improved with high practical impact (p≤0.001, g=|0.62, 3.93|), with the exception of calling 911 (knowledge). Peer-rated performance indicated the students were deficient (<75% success) in the following: inhaler use, dose of local anesthetic, dose of epinephrine, and EpiPen use. Content analysis of students' comments pointed to areas that need improvement but found high satisfaction with the program. These findings indicate that this program improved students' knowledge, experience, and confidence using simulated medical emergencies.