Maintaining and Improving the Oral Health of Young Children.

Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries remains greater than 40% among children 2 to 19 years of age. Although dental visits have increased in all age, race, and geographic categories in the United States, disparities continue to exist, and a significant portion of children have difficulty accessing dental care. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of disease, interventions to maintain and restore health, and the social determinants of children's oral health.

Parent-reported penicillin allergies in children: A qualitative study.

BACKGROUND: Penicillin allergies are commonly reported in children. Most reported penicillin allergies are false, resulting in the unnecessary selection of alternative antibiotic treatments that promote antibiotic resistance. While formal allergy testing is encouraged to establish a diagnosis of penicillin allergy, children are rarely referred for allergy testing, and study of parents' experiences and perceptions of their child's reported penicillin allergy is limited. We aimed to describe parents' experiences and perceptions of their child's penicillin allergy and attitudes towards penicillin allergy testing to identify opportunities to engage parents in antimicrobial stewardship efforts. METHODS: This was a qualitative descriptive study. RESULTS: Eighteen parents participated in this study. Parents' children were on average 2 years old when the index reaction occurred, and 7 years had passed since the reaction. Transcripts revealed that participants were receptive to penicillin allergy testing for their child after learning the consequences of penicillin allergy and availability of allergy testing. Four major themes emerged from data (1) parents' making sense of allergy; (2) parents' impressions of allergy label, (3) parents' attitudes towards allergy testing, and (4) parents' desire to be informed of testing availability. CONCLUSIONS: Efforts are needed to engage parents in addressing spuriously reported penicillin allergies.

Incorporating Oral Health into Pediatric Practice: National Trends 2008, 2012, 2018.

OBJECTIVE: Oral health is a critical component of children's overall health, but past research has found that pediatricians report barriers to implementing oral health into practice. Recently, policies have further delineated the importance of oral health in primary medical care. We sought to determine how pediatricians' practices and perceived barriers related to oral health involvement have changed since 2008. METHODS: There have been 3 nationally representative, cross-sectional, oral-health-focused periodic surveys of US American Academy of Pediatrics (AAP) members who provide health supervision: in 2008 (n = 1104; response rate (rr) = 69%), 2012 (n = 646; rr = 48%), and 2018 (n = 485; rr = 48%). The surveys asked about frequency of performing oral health tasks in children 3 years and younger, self-rated ability to perform these tasks, and attitudes about and barriers to oral health involvement. Predicted values from separate multivariable logistic regression models examined the independent effect of survey year. RESULTS: In 2018, pediatricians reported they were more likely to provide fluoride varnish and dental referrals at a younger age and less likely to complete a caries risk assessment or oral examination. They reported diminished barriers to incorporating oral health into pediatric practice. Other oral health activities, notably the oral screening examination and caries risk assessment, remain underutilized by pediatricians. CONCLUSIONS: From 2008 to 2018, more pediatricians reported performing a range of oral health tasks with fewer reported barriers. Ongoing efforts are needed to increase pediatricians' attention to oral screening examinations and caries risk assessments for all pediatric patients beginning in infancy, and to promote further use of fluoride varnish.

The Harold Amos Medical Faculty Development Program: Evaluation of a National Program to Promote Faculty Diversity and Health Equity.

Purpose: The Harold Amos Medical Faculty Development Program (AMFDP), a national program of the Robert Wood Johnson Foundation, seeks to support academic physicians from historically disadvantaged backgrounds and serves as a model program for promoting faculty diversity and health equity. Our objective was to determine differences in scientific productivity, promotions and retentions, and leadership attainment among faculty applicants to this national minority faculty development program. Methods: Final-round interview applicants from 2003 to 2008 were selected. Differences in publications, grants, promotions/retentions, and leadership positions through 2013 were compared between funded scholars and unfunded nonscholars. Semistructured interviews were conducted to identify factors that facilitated and hindered academic success. Results: A total of 124 applicants (76 scholars and 48 nonscholars) who participated in final-round interviews from 2003 to 2008 were eligible. Scholars and nonscholars had similar number of publications. Scholars had greater number of grants and grant dollars, but differences were not significant after accounting for AMFDP program awards. Scholars were more likely to hold leadership positions (28% vs. 10%, p=0.02), but equally likely to be promoted (67% vs. 58%, p=0.32) and retained (84% vs. 75%, p=0.21). In interviews, all participants endorsed mentoring, funding, and nonscientific education to academic success, but scholars reported greater availability of leadership opportunities consequent to AMFDP. Conclusion: There were few differences in academic productivity attributable to a national faculty diversity program. However, program participants were more likely to endorse and attain leadership positions. Academic institutions should consider facilitating leadership development of minority faculty as a means of advancing health equity research and training.

A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial.

BACKGROUND: Enhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients' and clinicians' behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes. METHODS: This article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake. DISCUSSION: This study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment. TRIAL REGISTRATION: Trial registration: Dutch Trial Register NTR5677 . Registered 17th January 2016.

The New Careers in Nursing Program: A Strong Investment in the Future of Nursing.

In 2008, faced with the challenges of a looming nursing shortage and a nursing workforce that did not mirror the diversity of the population of the United States, the Robert Wood Johnson Foundation considered how to contribute to a solution. A key challenge was how to rapidly and effectively build a cadre of diverse nurses who were ready to take on the leadership challenges of an evolving health care system. From that challenge, the New Careers in Nursing program was developed. A collaboration between the Robert Wood Johnson Foundation and the American Association of Colleges of Nursing, the program set about to change the face of nursing. After investing in over 3,500 scholars and as the program winds down, the program's impact can be seen in the scholars, the schools, the nursing profession, and the future investments of the Robert Wood Johnson Foundation.

Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations regarding the intake of fluoride from reconstituted infant formula and its potential association with enamel fluorosis. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following question: Is consumption of infant formula reconstituted with water that contains various concentrations of fluoride by infants from birth to age 12 months associated with an increased risk of developing enamel fluorosis in the permanent dentition? TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry (CEBD), conducted a MEDLINE search to identify systematic reviews and clinical studies published since the systematic reviews were conducted that addressed the review question. RESULTS: CEBD staff identified one systematic review and two clinical studies. The panel reviewed this evidence to develop recommendations. CLINICAL IMPLICATIONS: The panel suggested that when dentists advise parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis development. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: This article presents evidence-based clinical recommendations for the prescription of dietary fluoride supplements. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following questions: when and for whom should fluoride supplements be prescribed, and what should be the recommended dosage schedule for dietary fluoride supplements? TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry, conducted a MEDLINE search to identify publications that addressed the research questions: systematic reviews as well as clinical studies published since the systematic reviews were conducted (June 1, 2006). RESULTS: The panel concluded that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride. CLINICAL IMPLICATIONS: These recommendations are a resource for practitioners to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. Providers should carefully monitor the patient's adherence to the fluoride dosing schedule to maximize the potential therapeutic benefit.

Children's oral health and the role of the pediatrician.

PURPOSE OF REVIEW: Oral health is an integral part of the overall health of children. Pediatricians must be competent in issues of oral health and disease if they are to fulfill their role as professionals dedicated to the health of children. This review will update pediatricians on the epidemiology of child oral disease, highlight the importance of good oral health in special populations of children, and examine the role pediatricians can play in maintaining children's oral health. RECENT FINDINGS: Dental caries continues to be a common chronic disease of childhood and has increased in the youngest age groups. Oral disease has implications beyond the mouth and can cause significant problems for children with other chronic diseases. Pediatricians receive very little education on oral health during their medical training and numerous barriers exist to incorporating oral health into practice. Despite these facts, opportunities exist to both increase knowledge and overcome the barriers to incorporating oral health into daily practice. Collaboration with other child health professionals to improve children's oral health will make the job of the pediatrician easier. SUMMARY: Pediatricians have an opportunity to increase their knowledge of children's oral health, incorporate it into their daily clinical routine, and improve the overall health of children.

Oral health and pediatricians: results of a national survey.

OBJECTIVE: Pediatricians have regular opportunities to perform screening dental examinations on young children and to educate families on preventive oral health. We sought to assess pediatricians' current attitudes and practices related to oral health of children 0-3 years old. METHODS: A Periodic Survey of Fellows, focused on oral health in pediatricians' office settings, was sent to 1618 postresidency fellows of the American Academy of Pediatrics. RESULTS: The response rate was 68%. More than 90% of pediatricians said that they should examine their patients' teeth for caries and educate families about preventive oral health. However, in practice, only 54% of pediatricians reported examining the teeth of more than half of their 0-3-year-old patients. Four percent of pediatricians regularly apply fluoride varnish. The most common barrier to participation in oral health-related activities in their practices was lack of training, which was cited by 41%. Less than 25% of pediatricians had received oral health education in medical school, residency, or continuing education. Most pediatricians (74%) reported that availability of dentists who accept Medicaid posed a moderate to severe barrier for 0-3-year-old Medicaid-insured patients to obtain dental care. CONCLUSIONS: Pediatricians see it within their purview to educate families about preventive oral health and to assess for dental caries. However, many pediatricians reported barriers to fully implementing preventive oral health activities into their practices. Pediatricians and dentists need to work together to improve the quality of preventive oral health care available to all young children.

Educating pediatricians and family physicians in children's oral health.

Publication of Oral Health in America: A Report of the Surgeon General (SGROH) alerted the public and health professionals to the importance of oral health and the vulnerability of poor and underserved children to dental disease. In response, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the Society of Teachers of Family Medicine (STFM) have initiated training programs for residents and practicing physicians, allowing them to conduct oral health screenings, apply preventive strategies, and facilitate appropriate referrals to dentists. Training programs are increasingly available on the Web, but their quality and effectiveness are rarely assessed. To ensure greater inclusion of oral health in graduate medical education, voluntary curricular guidelines have been developed, and education in oral health is mandated in family medicine residency programs. Several initiatives engaging practicing physicians in oral health activities have demonstrated improved access and reduced dental disease in children, but evaluation of all programs is essential to determine cost effectiveness and outcomes. The actions of AAP, AAFP, STFM, and other large-scale initiatives have helped break down the traditional separation between medicine and dentistry. Collaboration between physicians and dentists should be encouraged at all levels of education to ensure improvement of the oral health of America's children.

Perceptions of oral health training and attitudes toward performing oral health screenings among graduating pediatric residents.

BACKGROUND: There is a lack of access to oral health services for American children. Some propose that pediatricians be trained to deliver preventive screening and education to families until they access a dental home. However, little is known about the current oral health training provided during pediatric residency. OBJECTIVE. The purpose of this work was to evaluate the oral health training that pediatricians receive during residency and their attitudes toward performing basic oral health screenings. METHODS: The American Academy of Pediatrics Survey of Graduating Residents is an annual, randomly sampled national survey of graduating pediatric residents. The 2006 Survey of Graduating Residents surveyed 611 residents and examined their perception of their oral health training and their attitudes about performing oral health screenings. RESULTS: Thirty-five percent of residents received no oral health training during residency. Of those who did, 73% had <3 hours of training, and only 14% had clinical observation time with a dentist. Seventy-one percent felt that they had too little oral health training, and only 21% felt that their residency was very good or excellent in preparing them to perform oral health-risk assessments. Residents felt confident in their ability to offer anticipatory guidance but not to do the more technical oral health screenings. The majority of residents believed that pediatricians should conduct basic oral health screenings. Multiple regression analysis indicated that residents who received >or=3 hours of oral health training, who applied for jobs in the inner city, and whose career goal was to work in primary practice are those most likely to support this idea. CONCLUSIONS: Pediatric residents currently receive little training in oral health, and the majority wish for more. This study shows that oral health training during residency can increase pediatrician confidence in participating in important oral health promotion tasks, including anticipatory guidance, oral screenings, and oral health-risk assessment.

A mobile medical care approach targeting underserved populations in post-Hurricane Katrina Mississippi.

On August 29, 2005, Hurricane Katrina devastated the Gulf Coast Mississippi region, damaging health care infrastructure and adversely affecting the health of populations left behind. Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health, operated mobile medical units to provide health services to underserved populations in the affected areas. Data collected from all patient encounters from September 5-20, 2005 demonstrate that in addition to common respiratory illnesses, skin conditions, and minor injuries, a high proportion of visits were for vaccine administration and chronic medical problems including hypertension, diabetes, and asthma. Mobile medical units staffed by primary care clinicians experienced in dealing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.