Impact of COVID-19 on pediatric dental care in two epicenters: Italy and Brazil.

The study aimed to compare the adherence of Brazilian and Italian pediatric dentists to the biosafety measures and operative protocols recommended by the health authorities during COVID-19 pandemic and to classify the participants according to their risk of infection. An online questionnaire with 34 questions about sociodemographic and occupational data, dental practice organization, biological risk management, and clinical operative protocols was sent to Brazilian and Italian pediatric dentists using a convenience sampling strategy. Chi-square test and multivariate analysis (two-step cluster) were performed (α = 5%). Of 641 respondents (377 Brazilians and 264 Italians), most were female (94% and 70%, respectively), aged 20-39 years (63%), with over 10 years of professional experience (58% and 49%, respectively). Based on adherence to recommended biosafety measures, participants were classified as "safer" (n = 219) or "less safe" (n = 422). Adherence to recommended protocols by the majority of participants resulted in low contagion rates (Brazilians = 5%; Italians = 12.5%). Participants with extensive professional experience in the dental setting exhibited a greater tendency to implement multiple adaptations (three or more) in their practice. Most participants (Brazilians = 92%; Italians = 80.7%) adopted the recommended minimal intervention dentistry approaches, with the use of fissure sealants and the use of non-rotary instruments for caries removal the most frequently techniques used among Brazilians (36%) and Italians (66%), respectively. Two different profiles of pediatric dentists were identified based on the biosafety protocols adopted during the pandemic. In addition, changes were implemented in the dental care provided to children, with focus on the minimal intervention dentistry.

In-Office Pediatric Emergency Dental Visits During and After the COVID Pandemic.

Purpose: To describe the demographics of patients younger than 18 years of age who sought dental emergency visits during the COVID-19 pandemic, the treatment provided, the patients' payment sources and the impact of the pandemic on oral health. Methods: A retrospective electronic chart review was conducted for dental emergency visits between 2020 and 2023 at the University of Detroit Mercy School of Dentistry, Detroit, Mich., USA. The data set included the patients' demographics, insurance type, reason(s) for the dental emergency visit and the provider's diagnosis and treatment provided. Results: Six- to 10-year-old children were the most frequently seen group for an emergency dental visit (40 percent). The majority had public insurance. Delta Dental was the most common payment source (47 percent). Diseases of pulp and periapical tissues accounted for the highest proportion of emergency visits (55 percent) and extractions were the most common treatment performed (54 percent). Conclusion: During the COVID-19 pandemic, children may not have received optimum dental care and lacked regular dental visits and preventive treatment, which probably led to an increase in the severity of dental conditions.

Estimated Carbon Emissions Associated With Dental Treatment For Early Childhood Caries.

Purpose: The purpose of this study was to evaluate the environmental impact of travel and anesthetic gas emissions associated with treating early childhood caries at a single institution. Methods: Outpatient preventive, treatment, and modeled general anesthesia (GA) cases in children 71 months old and younger were included in this retrospective chart review. The main outcomes were kilograms of carbon dioxide equivalents (kgCO2e) for travel- and anesthetic gas-related emissions. Descriptive statistics and non-parametric tests were used. Results: Most subjects had a caries treatment visit (n equals 3,630 out of 5,767), and nine percent of treatment visits (n equals 353 out of 3,630) received nitrous oxide (N2O), which added 29.4 kgCO2eto the visit emissions. Children without caries treatment had lower travel-related emissions (median equals 7.5 kgCO2e; interquartile range [IQR] equals 7.6) than children with caries treatment (median without N2O equals 8.7 kgCO2e; IQR equals 18.2; median with N2O equals 8.4 kgCO2e; IQR equals 10.3). Modeled GA travel emissions were estimated at 16.4 kgCO2e (IQR equals 21.9) with between 3.8-12.9 kgCO2e in anesthetic gas emissions. Total emissions were greatest for N2O treatment visits (median equals 43.3 kgCO2e; IQR equals 22.8). Conclusions: Travel-related emissions were greatest for children requiring caries treatment. Minimizing patient travel may reduce environmental impact. Nitrous oxide contributes a significant amount to a dental visit???s environmental impact. Community-focused models of care and applying systematic and practical case selection to reduce excess N2O emissions could reduce dental care-related carbon emissions.

Filled Opioid Prescriptions Following Pediatric Dental Procedures Among Medicaid-Insured Children in Ohio.

Purpose: To investigate opioid prescription fills following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric public accountable care organization (???Medicaid???) in central/southeastern Ohio. Patients aged 18 years and younger who had a dental procedure between January 2012 and February 2019 were identified, and claims were searched for opioid prescription fills within 14 days post-procedure. Trends in prescription fill percentages, types of opioid, procedure classification and patient characteristics were examined. Results: A total of 512,922 encounters among 212,813 patients were included. The overall opioid prescription fill was 4.9 percent. Percentages decreased throughout the study period from 6.1 percent (95 percent confidence interval [95% CI]=5.9 to 6.3) in 2012 to 3.4 percent (95% CI=3.1 to 3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill percentage fell from 15.7 percent (95% CI=15.2 to 16.1) in 2012 to 9.5 percent (95% CI=8.5 to 10.4) in early 2019. The most common opioids were hydrocodone (68.6 percent) and codeine (24.7 percent), with marked annual reductions in codeine prescription fills among children younger than 14 years. From 2017 to 2018, surgical extractions compared to endodontics-only procedures (risk difference [RD]=40.7; 95% CI=38.6 to 42.9) and older patient age (RD for 18-year-olds versus 13-year-olds=21.9; 95% CI=19.8 to 24.0) were strong risk factors for filling an opioid prescription. Conclusion: Post-procedure opioid prescription fill percentages have decreased since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in the likelihood of filling a prescription remained by procedural and demographic variables. There were marked trends in the types of opioid for which prescriptions were filled, which varied by patient age.

Trends of Pediatric Dental Rehabilitation Using General Anesthesia by Service Location During the COVID-19 Public Health Emergency, 2019 to 2021.

Purpose: The purpose of this study was to investigate the trends of pediatric dental rehabilitation in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) during the COVID-19 public health emergency (PHE) from 2019 to 2021 across states and demographic groups. Methods: This cross-sectional study utilized the 2019 to 2021 Transformed Medicaid Statistical Information System Analytical Files to examine trends in dental rehabilitation for children ages 12 years and younger enrolled in Medicaid or the Children's Health Insurance Program. The final analytic sample included 20,508,093 beneficiaries from 2019, 19,436,957 beneficiaries from 2020, and 20,416,440 beneficiaries from 2021. Chi-square tests were used to compare dental rehabilitation usage across groups (age, sex, race/ethnicity, and place of service). Results: Rehabilitation of Medicaid beneficiaries performed in HOPDs showed a decrease year over year (51 to 34 to 30; P<0.001), while the usage in ASCs increased (1,307 to 1,310 to 1,367; P<0.001). For all three years, the highest usage was seen in Non-Hispanic (NH) American Indian/Alaskan Native children (154, 66, 74; P<0.001), while the lowest usage was seen in NH Black children (21, 16, 17; P<0.001). Rehabilitation for Hispanic children had the greatest relative recovery over the three years (39 to 34 to 38; P<0.001). Conclusions: Dental rehabilitation usage in ambulatory surgery centers showed continued growth through the public health emergency. There was significant variation in rates across states and demographics.

Caregivers' Perceptions of Dental Therapists.

Purpose: To investigate caretakers' understanding of midlevel providers and determine if there is theoretical acceptance of midlevel dental therapist (DT) integration into the dental workforce. Methods: Validated DT integration surveys were disseminated to caregivers of pediatric medical patients in an urban teaching hospital. Subjects completed a questionnaire regarding previous care received by a midlevel medical provider and were questioned on the acceptance of a midlevel dental provider (i.e., DTs) into the dental workforce. Results: Two hundred two questionnaires were evaluated for recalled previous medical midlevel care (ML; 71.2 percent) and those who were unaware of ML care being provided to their child (UML; 28.7 percent). MLs were significantly in agreement with DTs performing primary tooth restorations (P<0.001), permanent tooth restorations (P=0.001), primary tooth extractions (P=0.022), and emergency treatment (P<0.001). UMLs and MLs significantly agreed that procedures be completed with the supervision of a dentist (P<0.001). Conclusions: Caregivers of pediatric medical patients are receptive to the concept of DTs and largely agree with them performing dental procedures. However, the dissemination of information on DTs to the public is necessary to increase awareness of their education, scope of practice and integration into the dental field.

Acceptance of Behavior Guidance Techniques in Pediatric Dentistry Between American and Colombian Parents.

Purpose: To compare the degree of acceptance of behavior guidance techniques (BGT) in pediatric dentistry between American and Colombian parents. Methods: American parents (n=150) and Colombian parents (n=150) of children between three and 12 years of age undergoing pediatric dental treatment participated in this multicenter cross-sectional study. Parents viewed a video depicting 10 BGTs approved by the American Academy of Pediatric Dentistry and rated their acceptance on a visual analog scale. Differences in the degree of acceptance were analyzed using quantile regression analysis. The level of significance was set at five percent. Results: American parents generally demonstrated higher median acceptance scores across various BGTs compared to Colombian parents (P<0.05). American parents exhibited higher acceptance levels of tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, presence/absence of parents and nitrous oxide, with statistically significant differences noted. American parents also displayed higher acceptance scores for advanced techniques such as protective stabilization, conscious sedation and general anesthesia. Conclusion: American parents consistently exhibited higher acceptance BGTs, suggesting variations in cultural attitudes toward pediatric dental care between the two groups.

COVID-19 Pandemic-Related Behavioral and Attitudinal Changes in Caregivers.

Purpose: To identify pandemic-related behavioral and attitudinal changes in caregivers. Methods: A 38-question cross-sectional survey was developed and distributed to English-speaking caregivers accompanying children for dental care in a hospital dental clinic. The questionnaire surveyed caregiver beliefs and behaviors regarding COVID19, whether the pandemic altered their use of medical and dental care or at-home health habits, as well as their attitudes toward medical and dental teams. Results: The 594 respondents varied in age, marital status, education and income level. Trust was high regarding medical and dental teams, government public health management and mask policies for children. However, those respondents who did not think children should be required to wear masks at school if the health department recommended it and respondents who did not think that government agencies would protect them if another pandemic happened were less likely to change perceptions on dental care, preventive dentistry, sugar intake and toothbrushing (P<0.05). No other strong and consistent relationships were found. Conclusions: In a safety-net dental clinic population, over half of caregivers changed dental behaviors and attitudes following the pandemic. Caregivers cynical of mask mandates and governmental pandemic management were not in the group to change their dental attitudes and behaviors. No other consistent pattern of demographic variables offered a clear profile of group beliefs and behaviors, suggesting the necessity of inquiring individuals and families about their oral health perceptions and behaviors.

Effectiveness of oral health interventions for schoolchildren from disadvantaged backgrounds: a systematic review protocol.

Disadvantaged schoolchildren from rural and low socioeconomic backgrounds face persistent oral health inequalities, specifically dental caries, and periodontal diseases. This protocol aims to review the effectiveness of promotive and preventive oral health interventions for improving the oral health of primary schoolchildren in these areas. We will search the PubMed, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Library, Web of Science, Dentistry and Oral Sciences databases for studies published from 2000-2023. The review includes randomised/nonrandomised controlled trials and community trials evaluating the effectiveness of promotive and preventive oral health interventions on at least one of these outcomes: changes in dental caries status, periodontal disease status, oral hygiene status/practices, sugar consumption, or smoking behaviours. Two reviewers will independently assess the searched articles, extract the data, and assess the risk of bias in the studies using the Cochrane Risk of Bias 2 (ROB 2) for randomised controlled trials and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomised controlled trials. Both narrative and quantitative analyses will be conducted. However, only narrative synthesis will be performed if the data are substantially heterogeneous. The synthesised evidence from this review can inform policymakers on evidence-based interventions to improve the oral health outcomes of schoolchildren from rural and low socioeconomic backgrounds. Systematic Review Registration PROSPERO (Registration number: CRD42022344898).

Retrospective evaluation of pediatric dental treatments under deep sedation.

This study identified the dental treatment modalities administered to patients undergoing dental procedures under deep sedation and examined potential relations among treatment types, age, gender and tooth types. This study protocol included data from 502 patients, including a total of 5141 teeth, who underwent dental procedures under deep sedation between October 2022 and October 2023. The dental treatments were categorized based on primary types and subtypes. Subsequently, this study examined the associations between treatment types and age, gender and tooth type. Data were analyzed using the Chi-Square test, with the significance level set at 5%. Most patients (76.9%) were aged 0-6 years, and 93.4% of the treated teeth were primary teeth. The predominant treatment was restorative therapy (61.6%), followed by extraction (27.2%), endodontic treatment (6.1%), and preventive treatment (5.1%). Among restorative materials, compomer was the most frequently applied (49.8%). Significant differences between the treatment types were observed in terms of age group and tooth type (p < 0.001 for both) but not gender (p = 0.920). Based on our findings, restorative treatments and tooth extraction are the most frequently performed procedures, whereas endodontic treatments are performed less frequently under deep sedation.

Are we adequately managing the oral health needs of children: a survey of the experience of general dentists and self-assessed confidence in pediatric dentistry.

Childhood caries is a public health problem with a significant burden on the community. The specialist dental workforce cannot adequately manage all treatment needs in children. Therefore, the general dental community remains critical in delivering care to children. The purpose of this study was to investigate the self-rated confidence of general practitioners in treating children. A cross-sectional survey was designed that involved general dentists in various primary care centers in Jordan. Participants were asked to complete a questionnaire about their experience and self-perceived level of confidence in performing various procedures in children using the Likert scale. Descriptive statistics, t-tests and one-way analysis of variance (ANOVA) were used for data analysis. A total of 150 general dentists completed the questionnaire. The overall confidence score was high (3/4). Most respondents (86.7%) reported high confidence in providing prophylaxis and preventive treatment. The lowest level of confidence was reported for dental trauma and interceptive orthodontics. No statistically significant gender disparity was found except for the management of dental trauma in which males were significantly more confident than females. Regarding years of experience, confidence levels in dental trauma management were significantly higher among dentists with 5-10 years of experience compared to the recently graduated and the longest qualified dentists (p = 0.008). Similarly, for interceptive orthodontics, participants with 5-10 years of practice were significantly more confident compared to dentists in the other groups (p = 0.021). One-third of participants (30.1%) were not willing to treat children and considered them disruptive to their practice. Overall, This study revealed low levels of confidence in dental trauma management and interceptive orthodontics in children. Modification of dental curricula to increase clinical exposure should positively reflect on future levels of confidence. Strategies should be implemented to encourage general dentists to treat children to ensure equitable access for all.

Punxsutawney, Pennsylvania Pamphlet Proselytizing Preventive Dentistry, by Drs. Morrison and Henry.

Advice on preventive dental care for children, prior to 1900 is scarce. In the 1890s, Drs. Morrison and Henry, two Punxsutawny, Pennsylvania dentists, cogently offered such advice in their promotional pamphlet, along with some lessons on life, as reflected by precious stones.

Access to oral health care services for children with disabilities: a mixed methods systematic review.

BACKGROUND: Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs. METHODS: This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care. RESULTS: Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities. CONCLUSION: There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities. TRIAL REGISTRATION: Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.

Restorative and patient factors associated with repeat general anesthesia for dental treatments in young children: A case-control study.

BACKGROUND: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments. METHODS: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients). RESULTS: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2. CONCLUSIONS: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA. PRACTICAL IMPLICATIONS: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2.

A Tele-detection and referral pAthways model for early childhood cariEs control- a protocol for a randomized factorial study: the TRACE study.

BACKGROUND: Early childhood caries (ECC) is one of the most common childhood diseases affecting the primary teeth of children younger than 6 years of age. ECC progression can be reversed in the early stages although these lesions often go undetected. New approaches are needed to detect oral diseases at an early stage when they can be better controlled. The aim of the study is to assess the effectiveness of ECC tele-detection methods combined with referral pathways with and without user fee removal in controlling ECC. METHODS: A randomized factorial trial will be used to compare two tele-dentistry detection methods for ECC (intraoral camera and smartphone camera) and two referral pathways (user fee removal versus conventional care). The study will recruit children younger than 6 years of age in marginalized communities in Alexandria, Egypt. The primary outcome is the percentage of teeth receiving indicated care, while the secondary outcomes are the oral health-related quality of life, acceptance of teledentistry by dentists, procedure time, and child cooperation. Two-way analysis of variance will be used to assess the effect of the two factors as between group variables on the outcomes after 6 and 12 months. The interaction between detection methods and referral pathways will also be assessed, and the effect of confounders will be controlled in a multivariable linear regression model. DISCUSSION: The findings of this study have the potential to inform clinical practice and oral healthcare policies for ECC management. Successful tele-detection and referral pathways could be integrated into oral healthcare systems, leading to improved oral health outcomes for children. TRIAL REGISTRATION: The trial has been registered on ClinicalTrials.gov in August 2023 (initial release) ID: NCT06019884.

The child dental care reform in Israel - service uptake from 2011 to 2022.

BACKGROUND: The 2010 Child Dental Care Reform of the National Health Insurance Law marked a turning point in the Israeli oral healthcare system by establishing Universal Health Coverage of dental care for children. Initially, the reform included children up to age 8 and gradually expanded to age 18 in 2019. The basket of services includes preventive and restorative treatments provided by the four Health Maintenance Organizations (HMO). The aim of this study was to examine the uptake of child dental services during the first decade of the reform. METHODS: A retrospective analysis was conducted to determine the treatment uptake, type and amount of the services delivered based on annual service utilization reports submitted by the HMOs to the Ministry of Health in the years 2011-2022. RESULTS: The number of insured children increased from 1,546,857 in 2011 to 3,178,238 in 2022. The uptake of dental services gradually increased during the study period with a slight decrease in 2020. The percentage of children who used the services gradually increased from 8 to 33%, with the incremental inclusion of additional age groups. From 2012 onwards the most common treatments provided were preventive, however the single most common treatment was dental restoration. In 2022 35% of the population of Israel was under the age of 18. Out of these, about a third received dental treatment via the HMOs. This is a significant achievement, since before the reform all treatments were paid out-of-pocket. After a short period of increasing uptake, a stable service utilization pattern was evident that can indicate better public awareness and service acceptance. CONCLUSION: Although this is a reasonable uptake, additional efforts are required to increase the number of children receiving dental care within the public insurance. Such an effort can be part of a multi-disciplinary approach, in which pediatricians and public health nurses can play a vital role in dental caries prevention, enhancement of awareness and service utilization.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care: A Cluster Randomized Clinical Trial.

Importance: Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. Objective: To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). Design, Setting, and Participants: The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Interventions: Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Main Outcomes and Measures: Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Results: Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). Conclusions and Relevance: In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. Trial Registration: ClinicalTrials.gov Identifier: NCT03385629.