COVID-19 Pandemic Emergency Department Utilization for Pediatric Dental.

PURPOSE: Early in the COVID-19 pandemic, restrictions from mid-March to mid-May 2020 curtailed community dental practice. The study purpose was to analyze the utilization of a pediatric hospital emergency department (ED) for dental emergencies over six months of practice disruption compared to two previous years. METHODS: Records of patients presenting to the ED were analyzed for volume, demographics, dental emergency type/acuity, and treatment. Study patients presented between March and September 2020; controls presented between March and September 2018 and March and September 2019. RESULTS: A total of 138 study patients (mean age equals 6.4 years) and 171 controls (mean age equals 7.0 years) were assessed. Emergency types were trauma (68 percent), caries (25 percent), and "other" (seven percent) for both periods (P=0.997). Nearly all patients triaged as "urgent." Medical radiology (P<0.001), laboratory tests (P<0.001), medication administration (P=0.016), ketamine sedation (P=0.014), and procedures by the medical team (P=0.014) increased for trauma patients in the study versus control period. Significantly more study patients with caries identified as persons of color: 69.7 percent versus 36.8 percent of controls (P=0.006). CONCLUSIONS: The emergency department medical and dental teams served as a safety net for both public health and the private practice dental community during the early pandemic. The effect on tertiary medical facilities should be considered when closing venues for the management of routine emergencies; it is more time-efficient and cost-effective and less resource-intensive to manage patients with dental emergencies in dental clinics.

Oral health and plaque microbial profile in juvenile idiopathic arthritis.

BACKGROUND: The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). METHODS: A cross-sectional exploratory study of subjects aged 10-18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing. RESULTS: The study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented. CONCLUSION: Increased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Changes in the oral health of US children and adolescents and dental public health infrastructure since the release of the Healthy People 2010 Objectives.

We examined progress in US children's oral health and dental public health infrastructure since the Healthy People 2010 Oral Health Objectives were issued. We summarize trends in the prevalence of dental caries and dental sealants on the basis of national and state-specific data. Trends in state oral health program activities, funding, and staffing were derived from annual surveys. The prevalence of dental caries in primary teeth of children aged 2-4 years increased from 18% in 1988-1994 to 24% in 1999-2004. Racial disparities persisted in that age group, with caries significantly more prevalent among non-Hispanic black and Mexican American children than among non-Hispanic white children. Caries prevalence in primary teeth of non-Hispanic white children aged 6-8 years remained unchanged, but increased among non-Hispanic black and Mexican American children. State-specific prevalence of caries among third-graders ranged from 40.6% to 72.2%. Caries in permanent teeth declined among children and adolescents, while the prevalence of dental sealants increased significantly. State oral health programs' funding and staffing remained modest, although the proportion of states with sealant programs increased 75% in 2000 to 85% in 2007 and the proportion with fluoride varnish programs increased from 13% to 53%. Progress toward improving the oral health of America during the past decade has been mixed. Greater attention to the oral health of young children is clearly needed, and child health professionals can be valuable partners in the effort. With continued high prevalence of a largely preventable disease, ongoing problems with access to basic oral health services, and increased national attention to health care reform, there is a clear need and opportunity for governments to make serious and sustained investments in dental public health.

A new oral health elective for medical students at the University of Washington.

BACKGROUND: Oral health is an important but inadequately addressed area in medical school curricula. Primary care practitioners are in an ideal position to help prevent oral disease but lack the knowledge to do so. PURPOSES: We developed an oral health elective that targeted 1st- and 2nd-year medical students as part of a previously described oral health initiative and oral health curriculum. METHODS: To promote interprofessional collaboration, we utilized medical-dental faculty teams for lectures and hands-on peer instruction by dental students for clinical skills. RESULTS: Evaluations revealed positive shifts in attitudes toward oral health and significant gains in oral health knowledge and self-confidence. Students rated the course highly and advocated for further integration of oral health into required medical curricula. CONCLUSIONS: We describe the elective including curriculum development, course evaluation results, and steps for implementing a successful oral health elective into medical education. We highlight interprofessional collaboration and constituency building among medical and dental faculty and administrators.

Evidence-based recommendations for the use of sealants.

In traditional research, the "level of significance" refers to the probability value used to reject the null hypothesis. In evidence-based research, a similar term, "the level of evidence" refers to the quality of the published report that is analyzed critically in the context of a systematic review. A systematic review, the principal research tool of evidence-based dentistry, is distinct from a classical narrative literature review in that it is focused to examine the strengths and weaknesses of the research methodology, design and data analysis of each report included in the review. A systematic review is very clearly defined, and sets out to find what evidence there is for prescribing a particular intervention for a given patient. Evidence-based recommendations are grounded on systematic reviews, and the evaluation of systematic reviews in a given domain of dentistry is critical for the successful implementation of evidence-based dental practice. In the context of sealants, the evidence indicates that the intervention is effective in preventing dental decay on the molars and premolars of susceptible children and adolescents (Level of evidence: II-1). The preventive effect for second-generation sealants ranges from 33 percent to 71 percent. The median preventive effect is higher when sealants are reapplied, compared to a single application, because sealant effectiveness decreases over time. The majority of studies have focused on molars, and fewer studies have examined the preventive effect of sealants on premolars. In this paper, the authors have developed evidence-based recommendations for the use of sealants by discussing the level of evidence and, when applicable, the number needed to treat (NNT) and the prevented fraction (PF), two fundamental criteria in evidence-based dental practice.

Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States.

OBJECTIVE: To investigate whether measures of obesity are associated with periodontitis. DESIGN: A case-control study. SETTING: A nationally representative sample using data from the Third National Health and Nutrition Examination Survey. PARTICIPANTS: The sample included 2452 nonsmokers, aged 13 to 21 years, who received a periodontal examination and had complete information for age, sex, and smoking habits. MAIN EXPOSURES: Skinfold thickness, weight, and waist circumference were examined as independent variables in logistic regression models. Final models were adjusted for sex, race/ethnicity, poverty index ratio, last dental visit, and self-reported calcium intake. MAIN OUTCOME MEASURES: Cases were subjects with the presence of 1 or more periodontal sites with both a loss of tissue attachment of 3 mm and a probing depth of 3 mm (n = 111). Subjects who did not meet these criteria were classified as controls (n = 2341). RESULTS: Total body weight and waist circumference were associated with periodontitis, but the association varied by age. Adolescents aged 13 to 16 years were not at increased risk of chronic periodontitis, while adolescents aged 17 to 21 years had an increased risk per 1-kg increase in body weight (adjusted odds ratio, 1.06 [95% confidence interval, 1.01-1.09]). Similarly, adolescents aged 13 to 16 years were not at increased risk for periodontal disease, while adolescents aged 17 to 21 years were at an increased risk of periodontal disease per 1-cm increase in waist circumference (adjusted odds ratio, 1.05 [95% confidence interval, 1.01-1.08]). CONCLUSION: Periodontitis may follow patterns similar to other chronic conditions that originate early in life and are related to central adiposity.

An oral health curriculum for medical students at the University of Washington.

Oral health disparities are a major public health problem, according to the U.S. Surgeon General. Physicians could help prevent oral disease, but lack the knowledge to do so. To create an oral health curriculum for medical students at the University of Washington School of Medicine, the authors (beginning in 2003) (1) reviewed current evidence of medical education and physician training in oral health, (2) developed oral health learning objectives and competencies appropriate for medical students, and (3) identified current oral health content in the undergraduate curriculum and opportunities for including additional material. The authors identified very few Medline articles on medical student education and training in oral health. The United States Medical Licensing Examination Steps 2 and 3 require specific clinical knowledge and skills in oral and dental disorders, but other national curriculum databases and the Web site of the Liaison Committee on Medical Education devote no significant attention to oral health. To develop learning objectives, the authors reviewed major oral health reports, online oral health educational resources, and consulted with dental faculty. The curriculum was assessed by interviewing key medical school faculty and analyzing course descriptions, and was found to be deficient in oral health content. The authors developed five learning themes: dental public health, caries, periodontal disease, oral cancer, and oral-systemic interactions, and recommend the inclusion of corresponding competencies in targeted courses through a spiral curriculum. Current progress, the timeline for curriculum changes at the University of Washington, and the ethical values and attitudinal shifts needed to support this effort are discussed.