Predicting Negative Outcomes While Awaiting Dental Treatment Under General Anesthesia.

Purpose: To determine the wait time for dental treatment under general anesthesia (GA) and its impact on clinical outcomes in a pediatric population at federally qualified health centers in the United States.
Methods: Data were collected from 566 pediatric subjects who underwent dental rehabilitation under GA between July 1, 2013, and June 30, 2014. One-way analysis of variance and linear regression analyses were performed.
Results: Patients waited 110.6 days (±standard deviation: 103.9 days) between the initial and treatment visits. Regression analysis demonstrated that prolonged wait time was a significant predictor for an increased number of preoperative visits and more teeth treated than planned. Among the 25.1 percent of patients who returned for follow-up after surgery, 18.6 percent presented with pain, swelling, or broken/ displaced restorations. The Canadian diagnostic code system was associated with the American Society of Anesthesiologists classification system (P <0.001) and was not coincident with wait time.
Conclusion: Longer wait time was associated with continuous pain, more teeth treated than planned, and more frequent pre- and post-operative visits. Wait time was predictive of a higher number of preoperative visits. Initial visit pain, and extra- and intra-oral swelling were associated with the Canadian diagnostic system.

Opportunity for Interprofessional Collaboration: Screening for Pediatric Sleep-Disordered Breathing by Dentists.

Purpose: This study's purpose was to examine the sociodemographic and clinical correlates of sleep-disordered breathing in children receiving care at health center dental clinics. Methods: Data were collected from the Pediatric Sleep Questionnaire and the health records for two- to 18-year-old children at health centers located in seven states. Results: Subjects included 1,000 children (46.3 percent female, 53 percent Hispanic, 70.7 percent white), with mean (± standard deviation) age of 6.89±2.51. Of the sample, 11.9 percent had a Pediatric Sleep Questionnaire score of at least eight. On multiple logistic mixed-effect analysis, age, American Society of Anesthesiology status, anterior overjet, attention deficit hyper-activity disorder, and obesity were significant predictors of the presence of a Pediatric Sleep Questionnaire score of at least eight at a significance level of P=0.05. Conclusions: With 11.9 percent of the subjects at risk for sleep-disordered breathing conditions, dentists have an opportunity for interprofessional collaboration with primary and specialist physicians. Dentists should routinely screen children with the Pediatric Sleep Questionnaire tool, cross-reference-associated clinical indicators (such as age, American Society of Anesthesiology status, anterior overjet, attention deficit hyperactivity disorder, and obesity), optimize orofacial growth and development, and refer to and coordinate with physicians to manage high-risk children.

Opportunities for Age-Specific Interprofessional Collaboration Between Physicians and Dentists in Pediatric Patients.

Purpose: The purpose of this study was to examine national data for trends in pediatric patient visits to dentists and physicians that may inform future interprofessional practice. Methods: Data for 95,677 children, aged zero to 17 years, captured between 2011 and 2012 from the National Survey of Children's Health were examined to compare the number of visits made to dentists and physicians at each year of age. Results: The average age was 8.9±5.2 (standard deviation) years; 28.6 percent were receiving Medicaid. Comparisons showed that, while physician visits were more common than dentist visits at younger ages, children aged nine years and older had more dentist visits than physician visits per year (P<0.001). Stratified analyses showed similar patterns in the frequency of physician and dentist visits within boys (P<0.001), girls (P<0.001), English speakers (P<0.001), and non-English speakers (P<0.001). Conclusions: Physicians have an opportunity to address oral health in younger children, and dentists have an opportunity to address systemic health for older children. For five-year-olds and younger, physicians should incorporate oral health evaluations and dentist-referrals. For nine-year-olds and older, dentists should provide counseling on healthy weight, nutrition, and human papillomavirus (HPV) vaccination; monitoring for diabetes and asthma; and screening for smoking, vaping, and sleep apnea.

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries.

BACKGROUND: Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists. METHODS: A caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest. RESULTS: Overall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9-14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere. CONCLUSIONS: Caregiver acceptance of SDF treatment is high; child's age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

Caregiver satisfaction with interim silver diamine fluoride applications for their children with caries prior to operating room treatment or sedation.

OBJECTIVE: To ascertain caregiver satisfaction with silver diamine fluoride (SDF) application(s) as an intermediate care path for their children with caries. METHODS: Caregivers were recruited at two community health centers when they arrived for a previously scheduled operating room/sedation appointment for their children with caries who had previously been treated with SDF. They were asked to complete a survey regarding their satisfaction with SDF treatment while they waited during their children's dental treatment. RESULTS: Caregivers overwhelmingly reported that they were satisfied with SDF treatment (81.3%), and that the black mark was not an issue for their children (91.7%) or themselves (87.5%). Moreover, their perception of their children's oral health quality of life was high. CONCLUSIONS: By arresting caries, SDF offers an intermediate care path for pediatric patients for whom OR/sedation treatment was not immediately available. Moreover, most caregivers were satisfied with SDF treatment for their children.