Noves tendències preventives en odontopediatria / Nuevas tendencias preventivas en odontopediatría / New preventive trends in pediatric dentistry

FONAMENT: Les patologies més prevalents en relació amb la salut bucal dels infants són les alteracions en el creixement I el desenvolupament oral, I la càries. La càries pot tenir greus repercussions en la salut general de l'infant, amb un alt cost de tractament I una disminució en la qualitat de vida. Actualment, la finalitat és establir protocols que ajudin el professional a prendre decisions individualitzades. OBJECTIU: Exposar I analitzar els nous conceptes preventius que influiran en la salut oral del pacient pediàtric: la visita primerenca I la llar dental, que faciliten els consells per a la cura bucal des que els infants són ben petits. MÈTODE: Revisió de la bibliografia I les guies publicades en els últims anys en relació amb les mesures preventives en salut bucodental infantil. RESULTATS I CONCLUSIONS: El canvi en la pauta d'administració del fluor de la pasta dental, amb l'evidència disponible, és la mesura de prevenció de la càries més efectiva que existeix. Al seu torn, un canvi d'hàbits d'higiene bucal de l'infant des del naixement afavorirà la prevenció de la malaltia. Finalment, els canvis socials de l'entorn implicaran noves estratègies preventives I un enfocament multidisciplinari

FUNDAMENTO: Las patologías más prevalentes en relación con la salud bucal de los niños son las alteraciones en el crecimiento y el desarrollo oral, y la caries. La caries puede tener graves repercusiones en la salud general del niño, con un alto coste de tratamiento y una disminución en la calidad de vida. Actualmente, la finalidad es el establecimiento de protocolos que ayuden al profesional a tomar las decisiones individualizadas. OBJETIVO: Exponer y analizar los nuevos conceptos preventivos que van a influir en la salud oral del paciente pediátrico: la visita temprana y el hogar dental, que facilitan los consejos para el cuidado bucal desde que los niños son muy pequeños. MÉTODO: Revisión de la bibliografía y de las guías publicadas en los últimos años en relación con las medidas preventivas en salud bucodental infantil. RESULTADOS Y CONCLUSIONES: El cambio en la pauta de administración del flúor de la pasta dental, con la evidencia disponible, es la medida de prevención de la caries más efectiva que existe. A su vez, un cambio de hábitos de higiene bucal del niño desde el nacimiento, va a favorecer la prevención de la enfermedad. Por último, los cambios sociales a nivel del entorno van a implicar nuevas estrategias preventivas y un enfoque multidisciplinario

BACKGROUND: The most prevalent problems in children's oral health are alterations in oral growth and development, and caries. Caries can result in serious consequences to the child ́s general health, with a high cost of treatments and a decrease in the quality of life. Currently, the tendency is to establish protocols to help the professional in making individualized decisions. OBJECTIVE: To present and analyze the new preventive concepts in oral health for children: the early visit and the dental home that will provide advice for oral care from very early stages. METHOD: Review of the recently published articles and guidelines addressing preventive strategies in childhood caries. RESULTS AND CONCLUSIONS: Based on the available evidence, the change in the fluoride concentration toothpaste regimen is the most effective measure for caries prevention. The establishment of oral hygiene habits from birth will favor the prevention of the disease. Finally, changes in social an environmental factors will require the development of new preventive strategies and a multi-disciplinary approach

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Social Media and Its Implications in Pediatric Dentistry.

Social media is increasingly being relied upon by health care professionals, including pediatric dentists, to make decisions in their practices. While social media serves as an excellent resource, there is lack of sound guidelines on its use by health professionals in dentistry. Pediatric dentists using social media for professional purposes need to be aware of the uses as well as the challenges it presents. More importantly, members and moderators of social media groups should ensure that all patient care-related information is de-identified and discussions are compliant with federal and state privacy laws and based on evidence-based recommendations.

Are U.S. Dentists Adequately Trained to Care for Children?

For decades, dental educators have noted changes in predoctoral dental education in pediatric dentistry, beginning with shifts in patients' characteristics and their availability for dental schools. During the same period, national data exposed a lingering dental caries epidemic in U.S. children yet reported more treatment of young poor children. The professional literature suggests a reluctance of the general dental community to care for children, particularly the very young who would most benefit from a dental home. The purpose of this commentary was to weigh evidence of several decades of studies on this seeming contradiction and provide the perspectives of dental students in training, those seeking advanced pediatric dentistry education or providing it, and end-users of our educational system who employ U.S. dental graduates to care for children. The usefulness of dental education establishment indicators is also reviewed, and recommendations for improvement are proposed.

Trends in General Anesthesia Utilization by Board-Certified Pediatric Dentists.

PURPOSE: The purpose of this study was to explore the trends and utilization of general anesthesia services among board-certified pediatric dentists practicing in the United States. METHODS: A 26 item survey was sent to 4,216 board-certified pediatric dentists by REDCap or mail. Results were tabulated, and trends were analyzed. RESULTS: A response rate of 31.8 percent was obtained. All American Academy of Pediatric Dentistry districts were represented proportionally. Most respondents (87 percent) reported using general anesthesia (GA) in their practices. Those who used GA, 50.4 percent reported using a hospital setting, and 60.5 percent used a physician anesthesiologist. Endotracheal intubation was the most common (88.5 percent) method of anesthesia delivery. Most diplomates (62.6 percent) favored dental anesthesiology as a recognized specialty by the American Dental Association. CONCLUSIONS: The majority of American Board of Pediatric Dentistry diplomates used general anesthesia in their practice. The preferred modality of delivery is oral/nasal intubation, with most services provided by physician anesthesiologists in a hospital/ambulatory setting. Physician anesthesiologists are inclined to provide care in a hospital-based setting. Dentist anesthesiologists provided care in the dental office. Most respondents support dental anesthesiology as a recognized specialty of the American Dental Association.

Policy entrepreneurship in the reform of pediatric dentistry.

In a recently published IJHPR article, Cohen and Horev ask whether an individual who holds rightful governmental power is able to effectively "challenge the equilibrium" in ways that might "clash with the goals" of an influential group". This question is raised within the context of a shift in governmental policy that imposed the potential for cost management by HMOs acting as financial intermediaries for pediatric dental care in an effort to provide Israeli children better access to affordable dental care. The influential group referred to consists of Israel's private dentists and the individual seeking to challenge the equilibrium was an Israeli Minister of Health whom the authors consider to be a policy entrepreneur.The Israeli health care system is similar to that of the United States in that private benefit plans and self-pay financing dominate in dental care. This is in contrast to the substantial role of government in the financing and regulation of medical care in both countries (with Israel having universal coverage financed by government and the US having government financing the care of the elderly and the poor as well as providing subsidies through the tax system for the care of most other Americans).Efforts to expand governmental involvement in dental care in both countries have either been opposed by organized dentistry or have suffered from ineffective advocacy for increased public investment in dental care.In the U.S., philanthropic foundations have acted as or have supported health policy entrepreneurs. The recent movement to introduce the dental therapist, a type of allied dental professional trained to provide a narrow set of commonly-needed procedures, to the U.S. is discussed as an example of a successful challenge to the equilibrium by groups supported by these foundations. This is a somewhat different, and complementary, model of policy entrepreneurship from the individual policy entrepreneur highlighted in the Cohen-Horev paper.The political traction gained to change the equilibrium favored by organized dentistry - in both Israel and the U.S. - may reflect aspirations for care that is more accessible, patient-centered, accountable and equitable. Evolving aspirations may lead to policy changes to systematize the disparate, disaggregated dental care delivery system in both counties. A change in payment incentives to provide more value is being explored for medical care, and its expansion to dental care can be anticipated to be among the policies considered in the future.

Pediatric Dental-Focused Interprofessional Interventions: Rethinking Early Childhood Oral Health Management.

Evidence of effectiveness for prevention of early childhood caries suggests that parent engagement needs to occur perinatally and that unconventional providers, helping professionals like social workers and dietitians and lay health workers like community health workers, are most effective. This finding, coupled with the emergence of population-based accountable care, value-based purchasing with global payments, understanding of common risk factors for multiple conditions, and social determinants of health behaviors, calls for a rethinking of early childhood oral health care. A population-based model that incorporates unconventional providers is suggested together with research needed to achieve caries reductions in at-risk families.

Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice.

A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice.

SPECIAL FEATURE. PEDIATRIC DENTISTRY.

There are approximately 2 million children living in the state of Michigan who will receive dental care with one of more than 5,500 MDA member dentists. Of these 5,500 MDA members, only approximately 100 are pediatric dentists.(1-3) Thus, it's safe to say that most children will find their dental homes in general dental offices. These general dentists will be providing preventive, diagnostic, and restorative care to most children under most circumstances. And with that in mind, it's of great importance that all dentists be comfortable providing high quality care to the majority of children, referring only a select group for care by a pediatric dentist.

Tratamiento de luxación discal sin reducción: responsabilidad del odontopediatra / Treatment of disk displacement without reduction: the pediatric dentist´s responsibility

Actualmente, es frecuente la consulta por trastornos temporomandibulares (TTM) en la clínica odontopediátrica, siendo reconocida la múltiple causalidad de los mismos. Se presenta la resolución de una situación clínica de una paciente de 13 años de edad que acudió a la Cátedra de Odontología Integral Niños (OIN), presentando dolor muscular y articular del lado derecho, limitando la apertura bucal a 25 mm confortable y a 28 mm forzada, con desvío de la mandíbula hacia la izquierda. Refería haber sido atendida en una guardia médica el día anterior con bloqueo en apertura, luego de 8 meses de evolución, con síntomas de chasquido y doloir, sin haber realizado consulta alguna. Se indicó tratamiento sintomático y se solicitaron estudios complementarios. El diagnóstico fue de luxación discal sin reducción. Con la evaluación integral, se hallaron factores concomitantes, tales como maloclusión, hiperlaxitud, respiración bucal y parafunciones. En el abordaje terapéutico, se colocó un intermediario oclusal para reposicionamiento mandibular, se realizó tratamiento fonoaudiológico miofuncional y reeducación postural global (RPG). La paciente evolucionó favorablemente; a los 6 meses resolvió el ruido articular y al año estaba asintomática, con 37 mm de apertura, comenzando su tratamiento de ortodoncia y manteniendo controles durante 4 años. El compromiso de la familia y la participación de un equipo de trabajo, permitió la resolución integral del caso. El odontopediatra tiene la responsabilidad de alertar a padres y pacientes sobre factores de riesgo, diagnosticar TTM y orientar los tratamientos, involucrándose cuando corresponde su intervención, o derivando en forma oportuna...