Infant oral health education in U.S. dental school curricula.

PURPOSE: This study was performed to determine didactic and clinical curricular content about infant oral health in predoctoral pediatric dentistry programs. METHODS: 54 dental school departments of pediatric dentistry were surveyed about: 1) curricular content devoted to teaching infant oral health (IOH) and age of first dental visit; 2) methods used to teach IOH and hours dedicated to each method; and 3) whether students receive hands-on experiences with infants. RESULTS: Eighty-six percent of programs teach students to see infants at 12 months of age or younger. Curricular time ranged from 15 minutes to 13 hours (mean = 2 hrs, 20 min, median = 1 hr, 45 min). All programs used lectures; other formats included handouts, demonstration and small group seminar. Fifty percent provide clinical experiences, albeit they are not uniform for all students. One-fourth provides uniform, clinical hands-on experiences with infant oral examinations. CONCLUSIONS: The findings indicate varying degrees of acceptance about teaching infant oral health in our dental schools.

Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria.

PURPOSE: The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure. METHODS: Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base. RESULTS: Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years. CONCLUSIONS: The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.

A survey of pediatric dentists' management of dental caries in children three years of age or younger.

PURPOSE: The purpose of this investigation was to obtain information from practicing pediatric dentists about how they manage caries in children three years of age and younger and the problems they are encountering. METHODS: A survey mailed to a randomly selected sample of 1,000 members of the American Academy of Pediatric Dentists (AAPD) in January of 1997 asked them to: identify the types and extent of caries in the young age group; define and quantify methods used to manage caries; determine the representation of caries among different payer source groups; identify sources of information used in managing caries; and determine the criteria they use for assessing the success of different methods in managing caries. RESULTS: The response rate was 43%. Definitions of techniques of managing caries varied among practitioners, and the use of the methods differed for the different degrees of severity of caries. There was a significant relationship between the percentage of Medicaid in a practice and the percentage of children with caries and pulpal involvement. Personal experience/philosophy was most frequently identified as an important source among factors influencing treatment decisions and sources of information about managing. Criteria most frequently cited to determine effectiveness of treatment were "caries free at recall" (45%) and "stop progress of lesion" (30%). CONCLUSION: Practitioners use a variety of techniques to manage caries in the child < or = 3 years of age. Disease level and payer source factored heavily in their treatment decisions. Practitioners reported interest in receiving information and help from AAPD on the subject.

Alternative method of hemorrhage control in full strength formocresol pulpotomy.

PURPOSE: This investigation evaluated the success of a formocresol pulpotomy technique in which hemostasis was obtained with the same formocresol dampened cotton pellet used to medicate the root pulp stumps and to compare the findings of this investigation with data of published formocresol pulpotomy studies in which hemorrhage was controlled by traditional means. METHODS: Clinical and radiographic data were available for 194 primary molars in 112 patients with follow up times ranging from 5 to 109 months (mean = 38 months). RESULTS: Overall radiographic success was 87%. The most frequently observed pulpal responses were calcific metamorphosis (34%) and internal resorption (10%). Overall clinical success was 98%. Only 7 of 194 molars were extracted due to radiographic and/or clinical failure. Overall cumulative probability of survival remained high over time with a cumulative survival rate of over 94% over 4 years. CONCLUSIONS: The success rates for this variation of the formocresol technique are comparable to those success rates in the literature where hemostasis was obtained in a separate step using a nonmedicated cotton pellet. The results of this study suggest that using the same cotton pellet dampened with full strength formocresol to obtain hemorrhage control and medicate the root pulp is an acceptable variation of the traditional formocresol pulpotomy technique.

Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?

PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.

Purposeful assessment techniques (PAT) applied to an OSCE-based measurement of competencies in a pediatric dentistry curriculum.

Careful measurements of knowledge, attitude, and psychomotor and communication skills are necessary components of testing in a competency-based approach to education in dentistry. In an effort to address these requirements, Baylor College of Dentistry (BCD), Dallas, Texas, has applied Purposeful Assessment Techniques (PAT) to the Objective Structured Clinical Examination (OSCE) currently in use. PAT are those techniques that allow one to work toward development of linear measurement scales that are "person-free" and "item-free." Person-free measurement means that useful data are produced regardless of the group being measured and item-free measurement means that it does not matter which mix of items is completed over the course of an assessment. The Rasch probabilistic model and a guiding definition of Objective Measurement were used in an effort to implement PAT for the BCD OSCE. A Rasch analysis of a BCD-administered OSCE produced an item map that demonstrated the range of difficulty of items by student performance. This item map can be used to determine which items can be repeated on subsequent tests to allow for linear measurement of students' progression through the curriculum. The movement toward PAT described in this paper demonstrates how careful and evolving measurement in dental education can be of great benefit to faculty, staff, students, and the public.

Ferric sulfate pulpotomy in primary molars: a retrospective study.

PURPOSE: This investigation collected clinical and radiographic data from a retrospective chart review of patients receiving ferric sulfate pulpotomies with a sub-base of zinc oxide eugenol in a clinical practice over a five-year period. METHODS AND MATERIALS: Clinical and radiographic data were available for 242 primary molars in 171 children with follow-up times ranging from 4-57 mos (mean = 19 mos). RESULTS: The overall radiographic success rate ranged from 74-80%. The frequency of normal appearing pulps decreased over time. The most frequently observed pulpal responses were calcific metamorphosis (6-33%) and internal resorption (7-18%). Overall clinical success was 99%. Only 9 of the 242 teeth were extracted due to radiographic and/or clinical failure. A survival analysis demonstrated that the overall cumulative probability of survival remained high over time with a cumulative survival of over 90% after 3 years. CONCLUSIONS: The overall success rates in this study are lower than those reported previously in the literature for ferric sulfate pulpotomies, but are comparable with those reported for 1:5 dilution, 5-min formocresol pulpotomies.

Pediatric emergency room visits for nontraumatic dental disease.

PURPOSE: This study described the incidence and predisposing, enabling, and need factors of outpatients in a pediatric ER who sought care for nontraumatic preventable dental disease and analyzed treatment rendered by attending physicians and associated hospital charges for treatment. METHODS: Chart review of outpatients discharged from the ER of a children's hospital during 1996-97, using ICD-9 diagnostic codes for dental caries, periapical abscess and facial cellulitis yielded the data for this investigation. RESULTS: During 1996-97, 149 patients made 159 ER visits. The most common diagnoses were ICD-9 codes 521.0 for dental caries (48%) and 522.5 for periapical abscess (47%). Medicaid recipients used the ER at an intermediate level between patients with no payor source and those with private insurance. Almost one-half of the accounts changed status during the billing process, with the majority being entered as private pay upon admission, but changing to bad debt or charity after the registration records were processed and collection was attempted. Most patients were treated empirically by the ER physicians according to their presenting signs/symptoms. CONCLUSION: This study confirmed that parents utilize the ER as their child's primary dental care source.

Hospital charges for dental caries related emergency admissions.

PURPOSE: The purpose of this investigation was to develop and test a model for identifying hospital charges resulting from patient admissions through the emergency room of a children's hospital to manage pediatric nontraumatic dental disease. METHOD: Model development involved data identification and collection at Children's Medical Center of Dallas, Texas. Its utility was tested in 4 children's hospitals across the United States. RESULTS: The model proved effective in determining hospital charges for pediatric caries-related admissions. Diagnosis codes assigned at the time of admission were not specific enough to limit identification to nontraumatic dental admissions. Extensive review of patient records determined that only one-third of admitted patients identified by the model were caries-related admissions. Fifty-two children were identified who were admitted to the 5 children's hospitals in 1997 due to dental caries or its complications. Median hospital charge per admission was $3,223 and the total hospital charges for these 52 children was $250,000. CONCLUSIONS: More specific ICD-9 diagnosis codes should be developed to identify these patients.

A comparison of Medicaid reimbursement for non-definitive pediatric dental treatment in the emergency room versus periodic preventive care.

PURPOSE: This study compared the expenditure by the state Medicaid program for episodic, nondefinitive care provided through the emergency room (ER) of a children's hospital with the cost to Medicaid of covering that same child with the recommended preventive service calculated on the fee schedule of the state dental Medicaid program. METHODS: Records of patients discharged from the ER during 1996-1998 who had a payor source of Medicaid were reviewed and the reimbursement amount determined. This was compared to an estimate of preventive services which would have been reimbursed by Medicaid for each child. RESULTS: During 1996-1998, 97 patients made 102 visits to the ER. Of these, 9 were admitted to the hospital for treatment. The reimbursement amounts for patients admitted to the hospital were ten times greater than the anticipated amount for preventive care. The reimbursement amounts for preventive services was approximately three times more costly than outpatient treatment in the ER for symptoms related to dental caries. CONCLUSIONS: Greater expenditures by the state Medicaid program for treatment in the ER as compared to the cost to Medicaid for providing routine, preventive care depended on whether the child was treated as an inpatient or outpatient.

Color change and fracture resistance of two preveneered stainless-steel crowns after sterilization.

PURPOSE: This study compared the fracture resistance and color stability of two commercially available, preveneered stainless-steel crowns before and after four sterilization techniques. METHODS: Thirty-five crowns from each of two manufacturers were divided into five groups. Four groups were sterilized twice using one of the following techniques: steam autoclave at both 121 degrees C (15 PSI) for 20 min and 132 degrees C (30 PSI) for 8 min; Chemiclave with formaldehyde at 132 degrees C for 20 min; and 2% gluteraldehyde for 10 h. The fifth group from each manufacturer was the control. Color of facings was measured before and after each sterilization in triplicate using a colorimeter, and the variance of each color parameter was analyzed for significance. Fracture resistance was measured for each group and differences between the control and experimental groups analyzed for significance. RESULTS: The results of this study show that high heat and chemical sterilizations have little effect on color and fracture resistance of the preveneered stainless-steel crowns. Student's t test analysis revealed a significantly decreased resistance to fracture with Kinder Krowns sterilized in 2% gluteraldehyde. Chemiclave sterilization caused the most negative color change in all three color parameters measured for both types of crowns. CONCLUSIONS: As neither steam technique produced significant changes in fracture resistance or color changes that were clinically detectable, the results of this study indicate that the two steam techniques tested can be used by clinicians to sterilize either Kinder Krowns or Nu Smile preveneered stainless-steel crowns.

Fenestration gingival defect in erupting permanent mandibular incisors: a case report.

Bilateral fenestration of the labial gingival tissue of the permanent mandibular central incisors is described. The situation was followed over a 2-year period with no treatment other than prophylaxis and oral hygiene instruction. The final outcome was an apical positioning of the gingival margin, which was lower than that of the adjacent uninvolved teeth.

Factors that affect career choices of pediatric dentistry advanced education students.

A questionnaire addressing factors that affect career choices by pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. The responses were analyzed for women and men and citizens and noncitizens. Concern for spouse career opportunities affected women's personal career decisions significantly more (P < 0.05) than it did for men. Women rated previous federal/military experience significantly less (P < 0.05) influential on their career choice than did men. Geographic preference when making career decisions was significantly more (P < 0.001) important to citizens than it was for noncitizens. Noncitizens assigned significantly higher (P < 0.001) ratings to an interest in teaching and research than did citizens. A preference for practicing with a parent or relative and previous federal/military experience affected career choices by noncitizens significantly more (P < 0.05) than they did citizens. This study suggests that numerous career-influencing factors in pediatric dentistry are perceived differently by women and men, and citizens and noncitizens.

Funding sources for research for advanced education students in pediatric dentistry.

1. Of the hospital programs, 10 of 17 (41%) reported no funding requirement while only 5 of 33 (15%) school based programs reported no funding requirement. 2. Departmental funds were identified most often (N = 28) and ranked number one most often (N = 16) as the funding source for graduate student research. 3. The average level of research funding available for each student ranged from $100 to $3,500, with an average of $1,250. 4. One-half of the programs reported no change in their funding levels over the past five years. 5. Programs associated with dental schools reported more funding opportunities available to their students than programs associated with hospitals.

Career preferences of pediatric dentistry advanced education students.

A questionnaire addressing career preferences of pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. Men were in combined specialty programs significantly more than women (P < 0.05, chi-square) and U.S. citizen students were significantly older than non-citizens (P < 0.05, t-test). The collected data reflected differences in career preferences between men and women, and citizens and noncitizens. Women reported a significant preference for private practice, part-time associate and public health practice than did men. Although not significant, men declared equal preference for full-time private practice either solo or as an associate. Noncitizens were found to have a significant preference when compared to citizens for academic full- and part-time, hospital/institutional full- and part-time, research, full- and part-time positions, and for additional training.

Texas pediatric dentists' attitudes toward practice issues and the role of the component society.

A questionnaire addressing practice issues in dentistry and members' expectations of component society activities was sent to members of the Texas Academy of Pediatric Dentistry (N = 269). Response rate was 73%. Respondents were not in full agreement with the American Academy of Pediatric Dentistry recommendation that children first be seen at 12 months, though younger and childless dentists had significantly greater agreement than those who were older and had children. Strong disapproval of proposed independent practice for hygienists was expressed, and strong support was given for assistants to perform coronal polishing and apply sealants. Three-fourths of respondents treat Medicaid patients. In evaluating the role of the component society, respondents--especially women--unanimously affirmed the responsibility of keeping dentists abreast of current information, but also expressed strong support for maintaining relationships with outside groups and representing member views on issues of health care reform. Based on the diffusion theory of communication, a program of proactive public relations is recommended for the first-visit issue.