Access to restorative oral health care for children living in Illinois with Medicaid vs private dental insurance: An audit study.

BACKGROUND: Public dental insurance programs for children aim to provide access to care, but barriers remain that preclude care delivery. Understanding these barriers is an important health policy concern. METHODS: A telephone audit sought to ascertain availability of oral health care for children in dental offices eligible to bill Medicaid. Female callers posing as mothers called eligible offices requesting appointments. In this cross-over design, offices were randomized to public or private insurance for initial calls and then to the other condition after a washout period. RESULTS: Using mixed models, privately insured patients had 5.9 times (95% CI, 4.55 to 7.69) greater odds of obtaining an appointment than Medicaid patients. Compared with patients in Cook County, suburban patients had slightly better odds, whereas nonurban patients in larger and smaller rural counties had lower odds of success. CONCLUSIONS: Medicaid compares poorly with private insurance for providing access to pediatric oral health care. Regardless of insurance conditions, access is poor in less urban environments compared with metropolitan communities. PRACTICAL IMPLICATIONS: Even Medicaid-enrolled dental practices limit the care they extend to insured children. Providing Medicaid by itself cannot overcome large oral health care access disparities, which are greatest in rural communities.

Premixed Mineral Trioxide Aggregate Setting Reaction in Primary Molar Pulpotomies.

Purpose: To assess the setting of premixed mineral trioxide aggregate (NuSmile NeoPUTTY) when used as a pulpotomy agent in primary molars, restored in a single visit, and to compare the effect of overlying materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC) and stainless steel crowns (SSC), on the microhardness of the NeoPUTTY.
Methods: Forty-eight extracted primary molars were prepared with the standard pulpotomy technique. Approximately three mm of NeoPUTTY were placed on the pulpal floor of each tooth. The teeth were divided into four groups according to restorative material: (1) control group-none; (2) RMGIC; (3) ZOE; and (4) ZOE and SSC. Groups 2, 3 and 4 specimens were placed in artificially simulated oral cavity conditions. After 24 hours, all teeth were sectioned mesiodistally and polished. Microhardness was then measured in Knoop scales (HK) at one mm, two mm and three mm away from the NeoPUTTY-overlying material interface following the application of a 25-gf load force for 30 seconds at each site. One-way analysis of variance was used to compare the NeoPUTTY microhardness values between groups at each depth as well as between the three different depths within each group (P <0.05).
Results: No statistically significant differences in mean HK values (57.9 to 62.3 range) were found between groups at each depth, or between depths within each group (Group 1,P =0.328; Group 2, P =0.74; Group 3, P =0.293; Group 4, P =0.788).
Conclusion: The setting reaction of NeoPUTTY, as a function of microhardness, was not affected by the presence or type of overlying material used in a single-visit pulpotomy. This in vitro study found no evidence against the immediate restoration of primary molar pulpotomies done with NeoPUTTY.

Dental Management in Juvenile Idiopathic Arthritis.

Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. It can involve the temporomandibular joint (TMJ) at onset; however, this is frequently overlooked until later stages when pain and dysfunction occur. The purpose of this paper is to discuss the case of a 14-year-old female with malocclusion and TMJ pain who presented for orthodontic treatment. The orthodontist referred her to the orofacial pain specialist to rule out TMJ dysfunction before starting care. After a comprehensive evaluation, the patient was diagnosed with JIA. Dentists can play a key role in the initial detection of systemic diseases causing TMJ pathology. This case report outlines the main orofacial signs and symptoms a dentist needs to be familiar with for the prompt identification of JIA, further reiterating the importance of an early diagnosis for a better prognosis and quality of life of a young patient with JIA.

COVID-2019 fundamentals.

BACKGROUND: A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified at the end of 2019. The disease caused by SARS-CoV-2 was named COVID-19. The main purpose of this review was to provide an overview of SARS-CoV-2. METHODS: The authors searched the MEDLINE database for clinical studies related to virus characteristics, pathogenesis, diagnosis, transmission mechanisms, and treatment options. RESULTS: As of January 27, 2021, the number of infected people and deaths associated with COVID-19 worldwide were approximately 100 million and 2 million, respectively. The manifestations of COVID-19 are variable, and the severity is affected by age and preexisting medical conditions. Children and adolescents are usually asymptomatic or have mild symptoms. Older adults, in comparison, may experience severe illness and have disproportionally elevated mortality. Among those who survive, some may experience enduring deficits. The viral load is particularly elevated in saliva and oropharynx, which constitute potential sources of infection. The diagnosis of the disease may be confounded by factors related to the replicating cycle of the virus, viral load, and sensitivity of the diagnostic method used. As of January 2021, COVID-19 has no cure but can be prevented. Its treatment is based on supportive care along with antiviral medications and monoclonal antibodies. In severe cases with multiorgan involvement, mechanical ventilation, dialysis, and hemodynamic support may be necessary. CONCLUSIONS: COVID-19 is a transmittable disease with a variable course. A substantial number of patients, particularly children, remain asymptomatic. Important advances have been made in the development of new treatments. However, the mortality in vulnerable populations remains elevated. PRACTICAL IMPLICATIONS: The elevated viral load in the oral cavity and pharynx suggests that oral health care professionals could get infected through occupational exposure. Providers should understand the variables that influence the yield of diagnostic studies because false-negative results can occur.

Severe acute respiratory syndrome coronavirus 2 infection in asymptomatic pediatric dental patients.

BACKGROUND: Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are typically asymptomatic but contagious. The authors investigated the positivity rate of asymptomatic SARS-CoV-2 infection in pediatric dental patients. METHODS: The authors reviewed consecutive charts of children younger than 18 years scheduled for elective dental procedures from April 1, 2020, through August 1, 2020. All patients were screened for signs and symptoms of SARS-CoV-2 infection. Asymptomatic patients scheduled for dental procedures underwent polymerase chain reaction (PCR) testing for SARS-CoV-2. Sociodemographic characteristics were abstracted, and positivity rates were calculated. Variables for patients who were SARS-CoV-2 positive and SARS-CoV-2 negative were compared using Fisher exact and Mann-Whitney U tests. RESULTS: The sample size was 921. The median age was 6 years, and 50.9% were boys. The overall SARS-CoV-2 positivity rate was 2.3%. Age, insurance status, medical history, and dental diagnosis were comparable in patients who were SARS-CoV-2 positive and SARS-CoV-2 negative. Positivity rates were statistically higher for Hispanic or Latinx patients than other groups (P = .038). CONCLUSIONS: Although the yield of testing was low, the systematic evaluation of asymptomatic pediatric dental cases via PCR resulted in the identification of SARS-CoV-2 carriers who could have been infectious. In this study, Hispanics or Latinx had a higher positivity rate than other demographic groups. PRACTICAL IMPLICATIONS: PCR testing for SARS-CoV-2 of asymptomatic patients in pediatric dentistry adds value to the use of screening questionnaires for the identification of infected people who could be contagious.

An association of premature loss of primary maxillary incisors with speech production of bilingual children.

PURPOSE: Early childhood caries is prevalent in the United States, especially among Hispanic children. One consequence may be premature loss of primary teeth, raising concern about developmental challenges. This study examined speech sound articulation errors association with premature loss of the primary maxillary incisors of bilingual children (Spanish/English). METHODS: Hispanic children were assessed with a speech sound articulation test at 7 to 10 years of age against their history of primary maxillary anterior incisor loss. The exposed group (N =25) experienced premature extraction of these incisors, and the unexposed group (N =8) had normal dental exfoliation. RESULTS: The groups were similar regarding: age at speech assessment; gender; language spoken at home; socioeconomic status; caries prevalence; mean number of decayed, missing, filled and sealed teeth. Higher values for the dental articulation errors (P=.04) were revealed among exposed vs unexposed. Exposed boys had more total speech articulation errors (P=.03), dental-related errors (P=.048), and other errors (P=.04) than the unexposed boys, although of small sample size. DISCUSSION: Bilingual children who experienced early primary tooth loss exhibited differences in speech sound production vs those who did not. Further research is warranted to determine the extent early tooth loss in bilingual children predicts speech problems.

Estado de salud bucodental de escolares residentes en localidades abastecidas con agua de consumo humano de muy alto y muy bajo contenido de fluoruros / State of oral health among schoolchildren living in towns supplied with drinking water containing very high and very low levels of fluoride

Descreve e analisa os resultados de uma pesquisa epidemiológica de corte transversal destinada a avaliar o estado de saúde buco-dental de escolares de 6-7 e 12-13 anos, residentes em Sampacho e Porteña, duas localidades da Província de Córdoba (Argentina), abastecidas com água potável contendo quantidade de F- muito diferentes. Em Sampacho, o nível de F- é de 9,05 mg/l enquanto que em Porteña a concentraçäo é de 0,19 mg/l. A proporçäo de escolares (6-7 e 12-13 anos) que näo apresentaram cárie foi significativamente maior em Sampacho do que em Porteña, enquanto, que os índices ceo-d, ceo-s, CPO-D e CPO-S resultaram consideravelmente mais altos nesta última localidade. A severidade da doença de cárie nas crianças de 12-13 anos de Sampacho esteve compreendida entre as categorias baixa e moderada (CPO-D = 2,53), enquanto que em suas similares em Porteña atingiu o grau de moderada e alta (CPO-D=4,41). Näo se registrou nenhum caso de fluorose dental em Porteña enquanto que em Sampacho houve uma alta proporçäo de crianças que apresentou fluoroses leve (6-7 anos) e leve ou intensa (12-13 anos). Os níveis salivares de cálcio, fosfatos, tiocianato, proteínas totais e lg A secretora foram muito similares nos escolares de ambas localidades, e também entre crianças com diferentes tipos de cárie e diferentes graus de gravidade de fluorose. Conclui ser necessária a aplicaçäo de medidas sanitárias urgentes (preventivas ou curativas) para reduzir ou controlar as doenças de cárie em Porteña e a fluorose dental em Sampacho