Evaluation of Potential Strategies to Increase Provider Participation in Florida's Dental Medicaid Program.

Purpose: To evaluate dentists' perspectives on the Medicaid program and explore hypothetical changes that could lead to increased participation. Methods: A 26-item questionnaire assessing demographics, practice profile, attitudes towards the Medicaid program and hypothetical scenarios to increase participation was administered to general and pediatric dentists. Results: A total of 165 surveys were completed; 50.6 percent of respondents indicated they were not Medicaid participating providers. Pediatric dentists were more likely than general dentists to be participating in Medicaid and willing to participate in the future, 35.5 percent vs. 23.2 percent respectively. A 68 percent increase in fees would yield the highest level of participation with 58.4 percent of participants responding they would treat at least 16 additional children per week. Pediatric versus general dentists would be more likely to participate in Medicaid with more modest raises, i.e. 30-44 percent range. Low compensation by Medicaid (weighted average of 4.77) was the greatest barrier indicated by all participants. Hispanic dentists had greater odds of participating in Medicaid than non-Hispanic dentists. Dentists who were 'employees' had a greater odds of participating in Medicaid than a 'solo owner of a practice'. Conclusion: Increased participation in Medicaid would require a combination of meaningful increases in reimbursement rates, loan forgiveness programs and tax credits.

Passive Observer Instruction on Parental Satisfaction in a Dental Setting.

PURPOSE: To assess the effect of a single pre-operative instruction given to parents to be a passive observer on satisfaction with their child's dental visit. STUDY DESIGN: Parents of 105 healthy three to nine year-old patients presenting for their first restorative appointment were randomly assigned to the test or control group. The former received an oral instruction at the beginning of the appointment from the treating dentist to be a passive observer while the latter received a mock instruction. The dentist assessed whether the parent remained a passive observer during the visit. Parents completed a survey assessing satisfaction with their child's dental visit. RESULTS: More parents were rated as passive in the test group than in the control group, 67.3% vs. 32.1%, (P<0.01). However, no statistically significant difference was found in parental satisfaction between the test and the control group. CONCLUSION: Asking parents to act as passive observers may help preserve the advantages of parental presence in the operatory while eliminating many of the disadvantages. A single preoperative instruction given orally by the treating dentist to be a passive observer was effective and did not lead to a reduction in parental satisfaction.

An Analysis of Pediatric Dentistry Residents' Productivity in the Operating Room.

PURPOSE: To analyze productivity of pediatric dental residents (PDRs) in the operating room (OR) and to determine predictors of case length. METHODS: Service-mix for OR cases completed between 2010 and 2013 were converted to relative value units (RVUs). Additional information, including patients' age, gender, American Society of Anesthesiologists (ASA) status, number of teeth, and operation time was retrieved. Analysis entailed descriptive, correlational, and multivariable techniques. RESULTS: Eight PDRs completed 893 OR cases. First-year residents (FYRs) completed more complex cases than second-year residents (SYRs), as determined by total RVUs and number of teeth. However, SYRs were more productive, as determined by RVUs per minute. Productivity for all PDRs increased on average by 33 percent during the program, with an average of 0.39 versus 0.59 RVUs per minute during the first versus the last quarters. Case complexity - measured in total RVUs per case - was associated with number of teeth and operation time, while patients' age and ASA status were not significantly associated with case complexity in the final regression model. CONCLUSIONS: Clinical productivity of PDRs increased over the two-year period, with a wide variation demonstrating a differential learning curve on different individuals. A significant association between case complexity, number of teeth, and operation time was found.

A Retrospective Study of the 3-Year Survival Rate of Resin-Modified Glass-Ionomer Cement Class II Restorations in Primary Molars.

OBJECTIVE: To determine the three-year survival rate of Class II resin-modified glass-ionomer cement (RMGIC), Vitremer, restorations in primary molars and to compare these results with measurements of survival of Class II restorations of standard restorative materials. STUDY DESIGN: Data on Class II restorations placed in primary molars during a six-year period were collected through a chart review and radiographic evaluation in the office of a board-certified pediatric dentist. A radiograph showing that the restoration was intact was required at least 3 years after placement to qualify as successful. If no radiograph existed, the restoration was excluded. If the restoration was not found to be intact radiographically or was charted as having been replaced before three years it was recorded as a failure. The results of this study were then compared to other standard restorative materials using normalized annual failure rates. RESULTS: Of the 1,231 Class II resinmodified glass-ionomer cement restorations placed over six years 427 met the inclusion criteria. There was a 97.42% survival rate for a 3-year period equivalent to an annual failure rate of 0.86%. CONCLUSIONS: A novel approach comparing materials showed that in this study Vitremer compared very favorably to previously published success rates of other standard restorative materials (amalgam, composite, stainless steel crown, compomer) and other RMGIC studies.

Hypertension in children: an overview.

Hypertension in children is an increasing concern for health care professionals. Updated guidelines for the treatment of hypertension in children and adolescents were published in 2004. This report reviews the epidemiology and management of pediatric hypertension and suggests an oral health protocol to apply to hypertensive children in the dental setting. A web search was performed using Medline, PubMed, ISI Citation Index, and Cochrane evidence-based databases for articles regarding hypertension in children published in English between 1998 and 2004. Relevant articles describing the epidemiology, classification, pathophysiology, and management of pediatric hypertension are discussed, and recommendations for dental treatment of pediatric patients are suggested. The incidence of pediatric hypertension can reach 5 percent. Data on the prevalence of pediatric hypertension in the dental setting is scarce. However, using the prevalence in the general population, at least fifty young patients will be hypertensive in a busy general or pediatric practice. Dental students and residents should have the opportunity to screen for hypertension during their training and familiarize themselves with the appropriate techniques in children. Oral health professionals should become aware of the implications of hypertension in children.