Advancements in tooth autotransplantation.

BACKGROUND: Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning. TYPES OF STUDIES REVIEWED: The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States. RESULTS: Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.

The 2021 report on oral health in America: Directions for the future of dental public health and the oral health care system.

In the two decades between Oral Health in America: A Report of the Surgeon General and Oral Health in America: Advances and Challenges much good happened but intractable challenges persist. Inequity in oral health status, utilization, and access to care continue to negatively affect the health and economic wellbeing of Americans and their families, local, state, and federal health care systems, and American society overall. To move the nation forward, we argue that: more emphasis is needed in prevention; access to care must be improved to mitigate inequity; newer understandings of oral disease must be leveraged in the service of health and health care; the value that oral health brings to economic wellbeing must be elucidated; better policy choices must be made in all of the above; and more effective oral health care leaders in driving policy change must be trained.

Double-Blind, Randomized Clinical Trial Comparing One Percent Buffered Versus Two Percent Unbuffered Lidocaine Injections in Children.

Purpose: Buffered local anesthetics offer an alternative to conventional, unbuffered anesthetic formulations; however, evidence about their use in children is scant. The purpose of this study was to determine the anesthetic and physiologic differences associated with the use of buffered one percent and unbuffered two percent lidocaine (both with 1:100,000 epinephrine) in children. Methods: In this randomized, double-blinded, crossover study, 25 children ages 10 to 12 years old received two inferior alveolar never blocks, at least one week apart, randomized to alternating sequences of two drug formulations: (1) formula A-three mL buffered one percent lidocaine (i.e., including 0.3 mL of 8.4 percent sodium bicarbonate); or (2) formula B-three mL unbuffered two percent lidocaine. Primary outcomes were mean blood lidocaine levels (15 minutes post-injection), timing of clinical signs onset, response to pain on injection, and duration of anesthesia. Analyses relied upon analysis of variance for crossover study designs and a P<0.05 statistical significance criterion. Results: The buffered formulation resulted in significantly lower mean blood lidocaine levels compared to unbuffered-a 63 percent (P<0.05) weight-adjusted relative decrease. The authors found no important differences in pain upon injection, onset, and duration of anesthesia. Conclusion: The buffered local anesthetic formulation showed equal effectiveness with a double-concentration unbuffered formulation while resulting in lower mean blood lidocaine levels-an important gain for the prevention of anesthetic toxicity.

Development and testing of a patient-centered dental home assessment for low-income families.

OBJECTIVES: The purpose of this study was to develop an instrument in English (ENG) and Spanish (SPA) for use in assessing perceptions of dental home characteristics among low-income adults. METHODS: An expert panel selected 21 items from a pool of 81 items mapped to domains in the American Academy of Pediatrics' medical home. Pilot testing with mothers (n = 795) of children in Early Head Start (EHS) resulted in an expanded 36-item scale, which was field-tested in interviews with ENG- (NENG = 665) and SPA-speakers (NSPA = 116). An exploratory factor analysis of 23 usable items was carried out in an EHS reference group (NENG-EHS = 272). The selected model was evaluated by confirmatory factor analysis (CFA) in two other subgroups (NENG-NonEHS = 393; NSPA = 116). We tested measurement and structural invariances using a multiple-group approach. Known-groups validity was examined by testing factor mean differences between two groups defined by whether or not the mother used a single dental office. RESULTS: A three-factor CFA model with 10 items was retained for its close fit for all three subgroups. Invariance tests found the two ENG subgroups to be homogenous and were combined. Several item and factor parameters in the SPA group differed from the combined ENG group. The proposed dental home measure demonstrated good known-group validity in that people who used the same dental office reported better dental care experiences. CONCLUSIONS: An instrument to measure the dental home concept among low-income adults was developed with three domains (accessible-comprehensive, compassionate, and health literate care) that demonstrated good validity and reliability.

Sexual orientation-related oral health disparities in the United States.

OBJECTIVE: Recent reports have documented health disparities according to sexual orientation and used the minority stress model as a framework for understanding their origins. To date, however, sexual orientation-related disparities in the oral health domain have not been evaluated. Accordingly, this study sought to investigate potential health disparities in objectively-assessed and subjective reports of oral heath among lesbian, gay, and bisexual adults relative to the heterosexual community-dwelling US population. METHODS: We used three consecutive cycles (2009-2014) of National Health and Nutrition Examination Survey (NHANES) data for men and women aged 18-59 years. We examined clinical measures of dental caries, tooth loss, chronic periodontitis, and oral human papillomavirus (HPV) as well as subjective reports of oral health status and use of dental services. RESULTS: Clinical measures of oral disease did not differ according to sexual orientation; however, bisexual adults were more likely to rate their oral health unfavorably (41%) than heterosexual adults (27%). Gay men reported "bone loss around teeth" more frequently (35%) than heterosexual (11%) and bisexual (10%) men. Bisexual individuals were more likely to confront barriers to accessing dental care (30%) versus heterosexual adults (19%). CONCLUSIONS: While clinical measures of oral health did not substantially differ between sexual orientation strata, subjective measures of oral health were worse among gay, lesbian, and bisexual adults versus heterosexual adults. Further study of the psychosocial construction of oral health among sexual minorities is warranted.

A Scoping Review of Inborn Errors of Metabolism Causing Progressive Intellectual and Neurologic Deterioration (PIND).

Background: Progressive intellectual and neurological deterioration (PIND) is a rare but severe childhood disorder characterized by loss of intellectual or developmental abilities, and requires quick diagnosis to ensure timely treatment to prevent possible irreversible neurological damage. Inborn errors of metabolism (IEMs) constitute a group of more than 1,000 monogenic conditions in which the impairment of a biochemical pathway is intrinsic to the pathophysiology of the disease, resulting in either accumulation of toxic metabolites and/or shortage of energy and building blocks for the cells. Many IEMs are amenable to treatment with the potential to improve outcomes. With this literature review we aim to create an overview of IEMs presenting with PIND in children, to aid clinicians in accelerating the diagnostic process. Methods: We performed a PubMed search on IEMs presenting with PIND in individuals aged 0-18 years. We applied stringent selection criteria and subsequently derived information on encoding genes, pathways, clinical and biochemical signs and diagnostic tests from IEMbase (www.iembase.org) and other sources. Results: The PubMed search resulted in a total of 2,152 articles and a review of references added another 19 articles. After applying our selection criteria, a total of 85 IEMs presenting with PIND remained, of which 57 IEMs were reported in multiple unrelated cases and 28 in single families. For 44 IEMs (52%) diagnosis can be achieved through generally accessible metabolic blood and urine screening tests; the remainder requires enzymatic and/or genetic testing. Treatment targeting the underlying pathophysiology is available for 35 IEMs (41%). All treatment strategies are reported to achieve stabilization of deterioration, and a subset improved seizure control and/or neurodevelopment. Conclusions: We present the first comprehensive overview of IEMs presenting with PIND, and provide a structured approach to diagnosis and overview of treatability. Clearly IEMs constitute the largest group of genetic PIND conditions and have the advantage of detectable biomarkers as well as amenability to treatment. Thus, the clinician should keep IEMs at the forefront of the diagnostic workup of a child with PIND. With the ongoing discovery of new IEMs, expanded phenotypes, and novel treatment strategies, continuous updates to this work will be required.

Pharmacologic management for pediatric dental patients in the 21st century.

Most children are able to cooperate during conventional, in-office dental treatment using traditional, communicative behavior guidance techniques that are carefully selected and applied to the developmental needs of a particular child. Children who are unable to cooperate during conventional treatment due to a lack of psychological or emotional maturity and/or the existence of a mental, physical, or medical disability may require pharmacologic techniques such as procedural sedation or general anesthesia to complete rehabilitative dental treatment. Patient safety dictates that careful preparation and robust case selection processes guide clinical decision-making related to pharmacologic behavior guidance. Before using these techniques, the sedation provider must demonstrate an adequate understanding of these techniques, from definitions and best practices to case selection and patient safety. This article presents essential information-with an emphasis on best practices and patient safety-for dentists who are considering pharmacologic behavior guidance for the children they treat.

Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting.

OBJECTIVE: There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children. STUDY DESIGN: A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4-12. RESULTS: Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference. CONCLUSIONS: Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

Lower Oral Health Literacy may Lead to Poorer Oral Health Outcomes.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Oral health literacy and associated oral conditions: A systematic review. Firmino RT, Ferreira FM, Palva SM, Granvlle-Garcia AF, Fraiz FC, Martins CC. JADA 2017; 148(8):604-13. SOURCE OF FUNDING: Government and foundation. This study was supported by the Brazilian Ministry of Education Coordination for the Improvement of Higher Education Personnel, the Minas Gerais State Research Foundation, and the Brazilian National Council for Scientific and Technological Development. TYPE OF STUDY/DESIGN: Systematic review.

Absence of a moderating effect of parent health literacy on Early Head Start enrollment and dental use.

OBJECTIVES: To examine the moderating effect of parents' health literacy (HL) on the effectiveness of North Carolina Early Head Start (EHS) in improving children's dental use. METHODS: Parents of 479 children enrolled in EHS and 699 Medicaid-matched parent-child dyads were interviewed at baseline when children were approximately 10 months old and 24 months later. We used in-person computer-assisted, structured interviews to collect information on sociodemographic characteristics, dental use, and administer the Short Assessment of Health Literacy - Spanish and English (SAHL-S&E). This quasi-experimental study tested whether the interaction effect between EHS and parents' HL was associated with dental use. Logit (any use) and marginalized zero-inflated negative binomial count models (number of dental visits) included random effects to account for clustering and controlled for baseline dental use, dental need, survey language, and a propensity score covariate. RESULTS: Nineteen percent of parents in EHS had low literacy compared to 12 percent of parents in the non-EHS group (P < 0.01). The interaction term between EHS and parent's HL was not significant in the adjusted logit model (ratio of aORs 0.98, 95 percent CI: 0.43-2.20) or the adjusted count model (ratio of aRRs 0.88, 95 percent CI: 0.72-1.09). CONCLUSIONS: Parents in EHS had a higher prevalence of low HL compared to non-EHS parents. Parents' HL did not moderate the relationship between EHS and child dental use, suggesting that EHS results in similar improvements in dental use regardless of parent's HL levels.

Molecular Pathophysiology of Epithelial Barrier Dysfunction in Inflammatory Bowel Diseases.

Over the years, the scientific community has explored myriads of theories in search of the etiology and a cure for inflammatory bowel disease (IBD). The cumulative evidence has pointed to the key role of the intestinal barrier and the breakdown of these mechanisms in IBD. More and more scientists and clinicians are embracing the concept of the impaired intestinal epithelial barrier and its role in the pathogenesis and natural history of IBD. However, we are missing a key tool that bridges these scientific insights to clinical practice. Our goal is to overcome the limitations in understanding the molecular physiology of intestinal barrier function and develop a clinical tool to assess and quantify it. This review article explores the proteins in the intestinal tissue that are pivotal in regulating intestinal permeability. Understanding the molecular pathophysiology of impaired intestinal barrier function in IBD may lead to the development of a biochemical method of assessing intestinal tissue integrity which will have a significant impact on the development of novel therapies targeting the intestinal mucosa.

An Algorithm-Based Approach for Behavior and Disease Management in Children.

Pharmacologic behavior management for dental treatment is an approach to provide invasive yet compassionate care for young children; it can facilitate the treatment of children who otherwise may not cooperate for traditional in-office care. Some recent highly publicized procedural sedation-related tragedies have drawn attention to risks associated with pharmacologic management. However, it remains widely accepted that, by adhering to proper guidelines, procedural sedation can assist in the provision of high-quality dental care while minimizing morbidity and mortality from the procedure. The purpose of this paper was to propose an algorithm for clinicians to consider when selecting a behavior and disease management strategy for early childhood caries. This algorithm will not ensure a positive outcome but can assist clinicians when counseling caregivers about risks, benefits, and alternatives. It also emphasizes and underscores best-safety practices.

A Cost Analysis of Three Pharmacologic Behavior Guidance Modalities in Pediatric Dentistry.

Purpose: The aims of this study was to compare dental treatment costs for three pharmacologic behavior guidance modalities: (1) dental office-based moderate sedation (SED); (2) hospital-based general anesthesia (GA-H); and (3) dental office-based general anesthesia (GA-OFF). Methods: Data were collected for healthy two- to six-year-olds who had full-mouth rehabilitation using GA-H at the University of North Carolina Children's Hospital, Chapel Hill, N.C., USA. Patients served as their own controls to compare costs across the three modalities. Rendered treatments were quantified using relative value units (RVUs). Costs included opportunity costs and administrative data. We relied upon ordinary least squares analyses to examine the relationship between total costs and RVUs. Results: Of 200 consecutive hospital records, 65 met the inclusion criteria. The mean age was 4.4 years old (range equals two to six years old; 41 ASA I, 24 ASA II). Dental treatment using GA-H averaged 118 minutes (range equals 62 to 256 minutes), with a mean of 12 teeth (range equals six to 20) treated. GA-H costs were 4.1 times greater than GA-OFF costs (range equals 1.1 to 4.9), and 4.5 times greater than SED costs (range equals 0.9 to 7.1); GA-OFF costs were 1.1 times greater than SED costs (range equals 0.7 to 1.6). Conclusions: Treatment completed (measured in relative value units) was correlated highest with costs for dental office-based moderate sedation and least for hospital-based general anesthesia. If more than four SED appointments are needed, GA-OFF may provide cost-savings; however, at no point does GA-H offer cost-savings.

Pediatric Dentists' Attitudes, Perceptions, and Experience with the Affordable Care Act.

PURPOSE: Pediatric oral health benefits were designated as one of 10 Essential Health Benefits (EHB) in the Affordable Care Act. Although it provided coverage for many children, several issues prevent its success. The purpose of this study was to document experience with, attitudes toward, and perceptions of the Affordable Care Act (ACA) among pediatric dentists. METHODS: The study was conducted using a survey consisting of nine multiple choice questions and one open-ended item and was distributed electronically in November 2015 to active and life members of the American Academy of Pediatric Dentistry. RESULTS: Respondents reported patients deferring treatment due to high out-of-pocket costs. Providers perceive that patients do not have enough information to understand their benefits. Providers reported not having enough information to understand how these benefits affect their practices. CONCLUSIONS: Pediatric dentists report deferral of both preventive and restorative care due to high out-of-pocket costs. Pediatric dentists do not feel they have adequate information regarding the Affordable Care Act and its effect on their practices. The majority of pediatric dentists believe that parents have difficulty understanding their children's benefits.

"They Told Me to Take Him Somewhere Else": Caregivers' Experiences Seeking Emergency Dental Care for Their Children.

PURPOSE: The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. METHODS: Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016. Interviews were transcribed verbatim, coded, and analyzed inductively using Atlas. ti.7.5.9. RESULTS: The UC experienced significantly more emergency first visits (33 percent) than the CC (five percent, P<0.001), and the majority of these UC visits were referrals. Caregivers were dissatisfied with the experienced barriers of access to care and lack of child-centeredness, specifically the referral out of the dental home for emergency dental care. CONCLUSIONS: A considerable proportion of children's first visits at dental safety net clinics was emergency related. Children's caregivers voiced issues related to access to care and lack of child-centered care. Discordance was apparent between how professional organizations define the dental home and how caregivers experience it in the context of emergency care.

Provider Perceptions of Treatment Options for Immature Permanent Teeth.

INTRODUCTION: Current treatment options for immature permanent teeth with pulpal necrosis include both apexification and regenerative endodontics. The purpose of this study was to survey endodontists on the use of these 2 treatment options. METHODS: Surveys were created by using Qualtrics and Teleform software and distributed by using the Salant and Dillman method. Endodontists (n = 1615) in 4 geographically and demographically diverse states, North Carolina, New York, Texas, and California, were surveyed. Data were analyzed by using descriptive statistics and χ2 analysis. Level of significance was set at 0.05. RESULTS: A 32.9% response rate was obtained. The majority of responders reported that apexification was the treatment of choice when considering the evidence base supporting the treatment (60%) and the predictability of treatment outcome (77.8%). Apexification was also the preferred treatment by 57.3% of respondents when asked to consider patient compliance, by 51.2% when considering the number of required patient appointments, and by 53.3% when considering the likelihood of tooth discoloration. Regenerative endodontics was reported as the preferred treatment by 89% of respondents when considering continued root development and by 66.7% when considering apical closure. The respondents' age and continuing education courses taken were significantly associated with their preferred treatment option. CONCLUSIONS: The results of our study indicate that endodontists consider both clinical and patient factors when treating immature teeth with pulpal necrosis. Increase in continuing education options may increase adoption of regenerative endodontic therapy.

Enrollment in early head start and oral health-related quality of life.

PURPOSE: Dental problems in young children are widespread and can negatively impact quality of life. We examined the effect of enrollment in North Carolina Early Head Start (EHS)-a federally funded early education program for children under three years of age and their families-on oral health-related quality of life (OHRQoL). METHODS: In this quasi-experimental study, we interviewed 479 EHS and 699 Medicaid matched parent-child dyads at baseline (children's average age 10 months) and 24 months later. Parents reported OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS), a 0-52 point scale with higher scores representing more negative impacts. We used a marginalized semicontinuous two-part model to estimate: (1) the effect of EHS on the probability of reporting any follow-up impacts (ECOHIS ≥ 1), and (2) the difference in overall mean ECOHIS follow-up scores. We controlled for baseline ECOHIS, language, and EHS and non-EHS group imbalances using a propensity score. RESULTS: At follow-up, negative OHRQoL impacts were more often reported by parents of non-EHS than EHS children (45 versus 37%, P < .01). In the adjusted model, EHS parents reported a lower odds of negative OHRQoL impacts (OR 0.70; 95% CI 0.52, 0.94). Mean adjusted ECOHIS scores were not significantly different (EHS: 1.59 ± 3.34 versus non-EHS: 2.11 ± 3.85, P > 0.05). CONCLUSIONS: This study is the first to demonstrate that families of young children enrolled in EHS report improved OHRQoL compared to their non-enrolled peers. These results highlight the potential effectiveness of improving the quality of life of low-resource families through early childhood education.

Impact of Early Head Start in North Carolina on Dental Care Use Among Children Younger Than 3 Years.

OBJECTIVES: To examine the effects of North Carolina Early Head Start (EHS), an early education program for low-income children younger than 3 years and their families, on dental care use among children. METHODS: We performed a quasi-experimental study in which we interviewed 479 EHS and 699 non-EHS parent-child dyads at baseline (2010-2012) and at a 24-month follow-up (2012-2014). We estimated the effects of EHS participation on the probability of having a dental care visit after controlling for baseline dental care need and use and a propensity score covariate; we included random effects to account for EHS program clustering. RESULTS: The odds of having a dental care visit of any type (adjusted odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.74, 3.48) and having a preventive dental visit (adjusted OR = 2.6; 95% CI = 1.84, 3.63) were higher among EHS children than among non-EHS children. In addition, the adjusted mean number of dental care visits among EHS children was 1.3 times (95% CI = 1.17, 1.55) the mean number among non-EHS children. CONCLUSIONS: This study is the first, to our knowledge, to demonstrate that EHS participation increases dental care use among disadvantaged young children.