Longitudinal Follow-up Comparing Future Care of Primary Teeth Treated with Silver Diammine Fluoride: A Private Dental Claims Review.

Purpose: The purpose of this study was to longitudinally evaluate follow-up treatment on primary teeth initially treated with silver diammine fluoride (SDF). Methods: This retrospective cohort evaluated private insurance (not Medicaid) claims data from 2018 to 2019 for children no older than 12 years with at least one primary tooth initially treated with SDF. Additional treatment per tooth was recorded over a follow-up of at least 24 months. Results: The mean and standard deviation (±SD) age of 46,884 patients was 5.7±2.3 and for SDF-treated teeth per patient was 2.6±2.1. Forty percent (95 percent confidence interval [95% CI] equals 39 to 40.7 percent) of teeth initially treated with SDF received additional treatment. The odds of SDF-treated teeth receiving future treatment significantly decreased with patient age by 22 percent per year (odds ratio equals 0.78; 95% CI equals 0.077 to 0.79; P<0.001). Pediatric dentists had only slightly lower odds than general dentists for providing additional treatment (0.91, P<0.001). Posterior teeth and teeth expected to exfoliate in two or more years had significantly higher odds of receiving additional treatment (2.47 and 1.27, respectively, P<0.001). Conclusions: Beginning at age four, patient age at placement of silver diammine fluoride was inversely proportional to future treatment provided. Posterior teeth and teeth expected to exfoliate in two or more years were more likely to receive additional treatment.

Association Between Social Determinants of Health and Receiving Timely Dental Treatment With General Anesthesia.

Purpose: To describe social determinants of health (SDOH) in a group of children with special health care needs (CSHCN) planned for dental procedures with general anesthesia (GA) at a pediatric hospital and explore associations between SDOH and completing this treatment in the recommended timeframe. Methods: SDOH were recorded for all patients planned for dental treatment with GA in 2019. Outcomes were treatment completed in the recommended timeframe or treatment not completed within two years of planning. Results: Dental surgery plans were made for 390 CSHCN: 190 were completed in the recommended timeframe, and 119 were not completed within two years. The SDOH associated with completing/not completing surgery were parents (guardian/caregiver)/household, and documentation of social work involvement with the family. Patients receiving optimally timed surgery more frequently had two parents/one household and/or an active social work plan on the record. Those not receiving surgery frequently had two parents/two households, single parents, and/or had no social work plan. Ethnicity, payer, and the need for an interpreter were not associated with receiving timely surgery. Conclusions: Multiple studies have found that social determinants of health contribute to disparate health outcomes. In this study, children with two parents in one household appear to be advantaged in receiving care in the recommended timeframe. Families with SDOH challenges who had a social work plan were frequently able to overcome SDOH barriers and receive dental treatment with general anesthesia in the timeframe recommended.

Provision of Pediatric Dental Services by Pediatric Dentists Versus General Dentists: Secondary Dental Analysis of Medical Expenditure Panel Surveys.

Purpose: The purpose of the study was to determine whether visiting only a pediatric dentist (as opposed to visiting only a general dentist) was associated with the provision of preventive dental services for a U.S.-based pediatric population (those 18 years and younger). Methods: This study analyzed pooled Medical Expenditure Panel Survey data from 2018 and 2019 to compare the use of certain preventive dental services (i.e., examination, radiographs, prophylaxis, dental sealant, and fluoride treatment) among those who reported visiting a pediatric dentist versus those who visited a general dentist. Survey procedures were used in Stata 14.0 to perform multivariable logistic regression analyses. Results: Controlling for demographic and insurance variables, children who visited only pediatric dentists had statistically significantly greater odds of receiving radiographs (adjusted odds ratio [AOR] equals 1.22; 95 percent confidence interval [95% CI] equals 1.01 to 1.48; P=0.04), fluoride treatment (AOR equals 1.57; 95% CI equals 1.30 to 1.90; P≤0.001), and sealants (AOR equals 1.63; 95% CI equals 1.24 to 2.16; P=0.001) compared to children who visited only general dentists. There was no statistically significant difference in the provision of periodic examinations and prophylaxis services. Conclusion: Based on the nationally representative data evaluated, pediatric dentists are more likely to provide more optimal preventive services than general dentists (i.e., radiographs, fluoride treatments, and sealants) to children in the United States.

Alternative Augmentative Communication in paediatric dentistry: a mighty tool to amplify mother tongue's power.

AIM: The role of a child's mother tongue in shaping his/her identity and emotional development is crucial. In the context of paediatric dentistry, this principle should always be reminded. The child's right to effective communication, even when a language barrier exists, is a fundamental principle, as recently stated in the 'Rights from the Start' rights fact sheet. Preserving a child's native language in the dental setting, especially in the context of an increasingly diverse society with a significant number of refugee children, is essential. Augmentative and Alternative Communication (AAC) strategies can assist in bridging language gaps and improving treatment outcomes, blending with the traditional approaches used in paediatric dentistry. The article promotes flexibility, innovation, and empathy in paediatric dentistry to provide optimal care and ensure that every child's rights are respected. CONCLUSION: • The relationship with one's mother language plays a central role in children's growth and in the relationship they can develop with the world, "motherised" by the words of the caregiver. • The interaction between immigrant children from different linguistic and cultural backgrounds and dentists providing their care requires the integration of traditional paediatric dental techniques with AAC strategies that can compensate for deficient oral communication. • Dentists treating immigrant children should follow the suggestions proposed in this article to establish the best and most tailored paediatric setting for the child's specific needs.

Assessing modalities used to alleviate postoperative pain in children receiving dental treatment under general anaesthesia: a systematic review.

Postoperative pain is generally a novel experience among paediatric patients. Topical anaesthetics, distraction procedures, and buffering of anaesthetic solutions have been used in reducing the postoperative pain. In this review, the authors assessed various modalities used to alleviate postoperative pain in children's dental treatment under general anaesthesia. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol were strictly adhered to in this systematic review. Specific keywords including postoperative pain, general anaesthesia, children, and dental extraction were used in the search for relevant randomized control trial studies in Web of Science, Scopus and PubMed, and included articles published until June 2021. From a total of 191 abstracts, 21 were reviewed. From the six studies with the usage of non-steroidal anti-inflammatory drugs (NSAIDs) alone or in combination with paracetamol, four observed that the preoperative use of NSAIDs alone or in combination was better than paracetamol alone, one discovered preoperative intravenous paracetamol was better than postoperative intravenous paracetamol, and the remaining study found no difference among various groups. Of two studies comparing the usage of non-steroidal anti-inflammatory drugs with opioid analgesics, one stated intravenous fentanyl in combination was better, while the other study found no difference among groups. The results obtained in this review can be utilized by physicians to control postoperative pain in children undergoing dental treatment under general anaesthesia.

Factors influencing parental acceptance toward the use of passive immobilisation as behaviour guidance in children during dental treatment: a scoping review.

Exploring parental opinions regarding the use of passive immobilisation during dental treatment is critical when identifying behaviour guidance application priorities. Instead of being dismissed as an inappropriate and less favourable option, this article aims to systematically evaluate factors affecting parental acceptance toward the use of passive immobilisation as behaviour guidance among children during dental treatment in various populations and regions. This research follows Arksey and O'Malley framework and updated by Joanna Briggs Institute Framework for Scoping Reviews methodology to summarise 40 research papers from 1984 to 2022 in PubMed, Web of Science, Science Direct, EBSCO Host, Scopus, grey literature and Google search outlining the research trend of parental acceptance toward passive immobilisation as behaviour guidance. Factors influencing parental acceptance toward the use of passive immobilisation were classified into parental socio-economic and demographic characteristics, exposure method of the devices to the parents, type of dental procedures, and children's cooperation and cognitive level. In conclusion, the current explorative review of the parental perspective toward passive immobilisation proposed a recommendation and facilitate the dentist to consider this technique as an alternative option for behaviour guidance in paediatric dentistry.

Role of artificial intelligence in behavior management of pediatric dental patients-a mini review.

The influence of behavioral science on various organizations has been experiencing remarkable growth worldwide. With the integration of recent technological advancements, behavioral science's impact has expanded into diverse fields such as finance and policy. The term "artificial intelligence" (AI) has become increasingly prevalent, but it is essential to provide clarity before proceeding. AI pertains to the theory and creation of systems capable of executing tasks that typically necessitate human intelligence. Integrating artificial intelligence (AI) in pediatric dentistry has emerged as a promising avenue to enhance patient care, improve diagnostic accuracy, streamline treatment planning, and augment patient engagement. AI-driven tools such as image analysis, natural language processing, and machine learning algorithms assist in early caries detection, orthodontic treatment planning, behavior management, and personalized oral hygiene education for pediatric patients. This paper presents an overview of AI's applications in pediatric dentistry, particularly behavior management, highlighting its potential to revolutionize traditional pediatric dental practices.

Change in oral health-related behaviours of children before and after dental treatments under general anaesthesia.

This study evaluated the behavioural changes pertaining to children's oral health before and after the dental general anaesthesia (DGA), with particular focus on the factors associated with these changes. The records were collected for the children who received DGA from July 2015 to November 2016, and relevant questionnaires were obtained from their parents/guardians for the information prior to and after the DGA. The questionnaire included Early Childhood Oral Health Impact Scale (ECOHIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) to investigate the changes in Oral Health-related Quality of Life (OHRQoL) and dental fear. The DGA impact on children's oral hygiene habits and oral health-related behaviours was assessed by analysing the data. The chi-square test and Mann-Whitney test were employed to evaluate the differences. Total of 141 patients (89 before DGA and 77 after DGA, 25 being common) participated in this study. There were 60 children below 5 years and 29 over 5 years before DGA, while 41 children below 5 years and 36 over 5 years after DGA. Most parents/guardians were educated above undergraduate level (59.6% before DGA, 55.8% after DGA). More children lived with grandparents (61.8% before DGA, 54.5% after DGA) than only with parents (20.2% before DGA, 26.0% after DGA). In total, 73.0% (65/89) children before DGA brushed teeth more than twice a day. This proportion increased to 90.9% after DGA (70/77, p = 0.03). The eating difficulty decreased after DGA according to ECOHIS (p = 0.01). CFSS-DS score also decreased after DGA (p < 0.05). After DGA, children's oral hygiene habits and oral health-related quality of life (OHRQoL) improved, children fear for dental treatment decreased, and parents became more attentive towards children oral health.

Supporting post-pandemic recovery: a qualitative study of the capabilities, opportunities and motivations to deliver oral health behaviour change messages to parents of young children in community settings.

BACKGROUND: The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children's oral health, and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase, and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in early years educational and care settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours. METHODS: Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis. RESULTS: The data were a good fit with the COM-B model, and further themes were developed within each construct, representing insights from the data. CONCLUSION: Early years practitioners can reach vulnerable children who are not usually brought to see a dentist, and have the capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.

Accuracy of Parent-Reported Allergies and Medications in Pediatric Dentistry.

Purpose: To measure the accuracy of parent-reported allergies and medication usage by comparing parental reports during dental con- sultations to medical reports from their child's primary care physician. Methods: A retrospective chart review was performed for 862 eligible patients 17 years and younger seen in the Department of Pediatric Dentistry at Franciscan Children's, Boston, Mass., USA, and who were required to obtain medical clearance prior to initiating dental treatment with sedation or general anesthesia. Allergies were categorized into three groups: food, environmental, and drug allergies. Allergies in each category reported by the parents were compared to the physician-reported allergies to assess for accuracy. Medications reported by the parents were also compared to the total number of medications reported by the physician and categorized as a full, partial, or non-match. Results: The sensitivity of parental identification for drug, food, and environmental allergies was 50.9 percent, 48.1 percent, and 18.8 percent, respectively. Of the 245 patients taking prescription medications, 53.1 percent of parents were unable to identify any of their child's medications, 22.9 percent of parents were partially able to identify their child's medications, and only 24.1 percent of parents were able to identify their child's medications fully. Among parents of children who take one or more medications as reported by their physician, the average reporting accuracy was 34.7 percent. Conclusion: Utilizing interprofessional collaboration is warranted in identifying accurate reports of patient allergies and medication usage in the pediatric population to prevent adverse reactions and improve the overall quality of dental care.

Parental use and acceptance of an accessible, commercially available intraoral camera for teledentistry in their children.

PURPOSE: The potential of combining teledentistry and engaging parents as underutilised resources to monitor paediatric dental health was emphasised during the COVID-19 pandemic and remains underexplored. This study aims to assess parental acceptance and use of a commercially available intraoral camera (IOC) for effective remote monitoring. METHODS: 47 child-parent dyads, where the parent was the main caregiver and the child was treated under general anaesthesia for early childhood caries, were recruited. Caregivers were trained to image their child's teeth on a commercially available IOC. Subsequently, submitted images were reviewed asynchronously by dentists for image quality, presence of dislodged fillings, abscesses, cavitation, and oral hygiene. Post-surgery monitoring was performed using teledentistry at 1 and 2 months and in-person at 4 months. A modified Telehealth Usability Questionnaire (TUQ) was used to record caregiver acceptance for study procedures. RESULTS: A mean TUQ of 6.09 out of 7 was scored by caregivers. Caregiver-reported issues were limited to problems with technique and child uncooperativeness. The number of clear images during the second teledentistry review was improved compared to the first (p = 0.007). 68% of children liked having images of their teeth taken. CONCLUSION: This study supports the feasibility of using an IOC as a clinically appropriate avenue for teledentistry with a high level of caregiver-child acceptance.

Children's experiences during their first dental visit: A qualitative study.

BACKGROUND: While the child's first dental visit can shape his/her attitude towards further treatments, little consideration has been given to exploring this experience from the child's perspective. Therefore, the aim of the study was to delineate the experiences of the first dental visit of children based on self-written stories in their own words. METHODS: Qualitative study conducted as part of the oral health promoting school program in Isfahan city, Iran. Data collection was based on the responses to a question included in the programme's printed educational content. Schoolchildren were asked to explain about their experiences of their first dental visit in a story. Two researchers read the stories separately and identified concepts and themes. In a discussion panel gained consensus about the main themes. Then the researchers integrated and grouped together similar themes to new categories. Categories originating in the data provided insights into and explanations of factors that might influence the schoolchildren's experience in the dental office. Sampling continued until saturation, when no new codes appeared in the data. The childrens' stories were imported in the MAXQD software and analyzed to retrieve the main categories and themes. RESULTS: Factors that influenced experiences appeared to be idiosyncratic, but could be classified into three categories: the person accompanying the child, child and dentist-related factors. Two sub-categories of the person accompanying the child were the role of person in their treatment and the types of persons accompanying them. Dentist-related factors included three more sub-themes of applied behavioral management techniques, their role in oral health education, and organization of the office environment. The three sub-themes of children's related factors were experiencing fear, remembering the details of their experience, and type of care received. CONCLUSION: Although the method was limited to the qualitative written stories of children and there was no opportunity to explore more and consider the detailed opinions by face-to-face interviews, some noticeable elements were mentioned by children. The person accompanying the child, child and dentist-related factors were three main categories obtained from the data.

The Effect of Temperament on Outcomes of Opioid and Non-Opioid Pediatric Dental Sedation.

Purpose: To assess oral sedation success using midazolam and hydroxyzine with and without meperidine, and to assess the relationship between child temperament and sedation outcomes. Methods: This study recruited children between the ages of 36 and 95 months who were randomly assigned to receive dental treatment with an oral sedation regimen of midazolam (0.5 mg/kg) and hydroxyzine (1.0 mg/kg) with or without meperidine (1.5 mg/kg). Data were collected from the treatment log and electronic health records. Parents completed the Child Behavior Questionnaire Short Form (CBQ-SF) to assess temperament. Results: The study included 37 participants. The overall treatment success rate was 54 percent. There were no significant differences in sedation outcome with age, sex, insurance status, sedation regimen, isolation method or duration of procedure. Children with high pre-operative Frankl behavioral ratings were more likely to have a successful sedation outcome (P <0.01). Children who displayed high soothability experienced higher rates of success (P =0.04), which was more pronounced in the non-opioid group (P <0.01). Conclusion: The study showed low rates of success for a relatively small sample size. There was no difference in sedation success between the opioid group and non-opioid group. However, pre-procedure behavior and temperament characteristic of sooth- ability may warrant more exploration as predictors of sedation success.

A scoping review of guidelines on caries management for children and young people to inform UK undergraduate core curriculum development.

BACKGROUND: Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry. METHODS: A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching. RESULTS: This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For "early lesions" in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants. CONCLUSIONS: This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

Dog-Assisted Therapy (DAT) for the management of anxiety during paediatric dental care. A scoping review.

AIM: Distraction techniques in paediatric dentistry can be effective in decreasing the child's attention span from an unpleasant or stressful procedure. Distraction is achieved through imagination, audio, and/or visual stimuli. It has been shown that the accompaniment and participation of animals or pets, specifically dogs (Dog-Assisted Therapy or DAT), during medical, oral, and therapeutic activities can improve the physical and mental health of patients, especially children. However, there is limited information available regarding the impact of incorporating a certified therapy dog into the paediatric dental environment as a distraction strategy to alleviate anxiety levels during dental procedures. METHODS: This scoping review aimed to identify and review published articles concerning the use of DAT in paediatric dentistry. The article discusses indications, benefits, and potential risks to human health and safety in clinical settings. Eligible sources encompass clinical trials, observational studies, and narrative reviews written in either English or Spanish and published over the last two decades, sourced from four electronic databases. Ultimately, seven pertinent studies were included in the review. CONCLUSION: DAT presents itself as a promising alternative in managing anxiety and stress among children during dental visits. The integration of a therapy dog and its handler into the paediatric oral care team should be thoughtfully considered by clinicians as a means to enhance the comfort and compliance of apprehensive patients.