Treatment planning for the pediatric patient.

Treatment planning for pediatric dental patients is a multifactorial, complex process that requires careful consideration of three distinct areas: the patient's caries risk status, the available treatment options and the child's behavior. Components of a caries risk assessment include: a review of the child's medical and dental history in combination with the findings of the clinical and radiographic examination. All decisions regarding appropriate treatment options for the patient are guided by the outcome of the caries risk assessment. The child's behavior is another overriding consideration as it determines how the treatment can be rendered. Information obtained through careful evaluation of each area results in a treatment plan specifically designed for each child's circumstance.

Child Life Interventions for Pediatric Dental Patients: A Pilot Study.

Purpose: The purpose of this pilot study was to assess whether child life intervention can be an effective alternative to pharmacologic behavior management in uncooperative pediatric dental patients. Methods: Thirty uncooperative four- to eight-year-old patients with no history of a negative invasive dental experience were randomly assigned into two groups: experimental (E) and control (C). Group E was given two 30- minute child life interventions (CLIs) by a certified child life specialist. Group C did not receive CLIs. Both groups then had an invasive restorative dental appointment, which was video recorded, edited, and viewed to assess behavior via the Houpt scale. Results: Group E demonstrated overall better cooperation for the appointment (Group C equals 3.63, and group E equals 4.07.) Conclusions: Child life interventions may be considered an adjunct to other behavior guidance techniques, but further investigations should be conducted to evaluate the effectiveness of CLIs on behavior in the dental setting.

Pediatric obesity curriculum in pediatric dental residency programs.

PURPOSE: The purpose of this investigation was to survey pediotric dental residents to determine the level of their formal education and clinical experiences involving the obese/overweight pediatric dental patient. METHODS: A 17-question survey was mailed to 195 residents in 41 randomly selected pediatric dentistry educational programs. Questions inquired about various aspects of residents' educational experiences, including formal curriculum-based courses and clinical experiences, with overweight patients and their parents. RESULTS: One-hundred thirty-five residents returned the survey for an overall response rate of 70 percent. Approximately 50 percent of respondents reported having a formal curriculum on managing the obese pediatric dental patient as part of resident training. Curriculum topics varied widely and many specific to managing the obese pediatric patient were under-represented. Residents who received a formal curriculum in managing the obese patient were significantly (P < 0.001) more likely to report feeling prepared to manage these patients in their offices. Most residents were taught to take weight but were not consistently taught to measure height and calculate BMI. When residents discussed their patient's overweight condition with the parents, responses were most frequently "neutral" and "accepting." CONCLUSION: Competency-based guidelines for managing the obese pediatric dental patient need to be developed and implemented in graduate programs.

Preventive resin restorations: practice and billing patterns of pediatric dentists.

PURPOSE: The purpose of this study was to determine practice patterns of pediatric dentists for preventive resin restorations (PRRs) and if they believe a code should be added to the American Dental Association's current dental terminology (CDT) for the PRR. METHODS: A 16-question survey sent to 475 pediatric dentists randomly selected from the American Academy of Pediatric Dentistry database, addressed demographics, treatment planning, techniques in preparation and restoration, billing practices, and perceptions about the need for a CDT code for PRRs. RESULTS: Two hundred thirty-eight (50%) surveys were returned, revealing that 72% of respondents perform PRRs and 64% feel that a PRR code should be added to the CDT Fifty-two percent believe not having a CDT code could cause dentists to perform more invasive dentistry to comply with billing requirements that Class I restorations be in dentin. PRRs are commonly treatment planned for deep pits and fissures with questionable decoy not entering dentin. Up to 50% of respondents could be erroneously billing for PRRs. CONCLUSIONS: Most pediatric dentists perform preventive resin restorations in their office and believe that a code for the procedure needs to be added to the current dental terminology.

Identifying Public Policy and Advocacy Practices Among Millennial Pediatric Dental Residents.

Purpose: This study's purpose was to identify public policy and advocacy practices among millennial pediatric dental residents in order to provide recommendations for engagement to the American Academy of Pediatric Dentistry (AAPD) leadership and pediatric dental residency program directors. Methods: A total of 138 residents from the 2016 Public Policy Advocacy Conference (PPAC) participated in a 13-item survey addressing demographics, advocacy education experience, student debt and financial contributions, resident training interests, the impact of the PPAC, and technology utilization. Sixty responses (45 percent response) were analyzed using SPSS software. Results: Residents believed that the PPAC was more beneficial than advocacy didactic education (P=0.008). The impact of the PPAC versus clinical experience was not significant (P=0.61). Pediatric dental residents were more likely to contribute financial donations to the AAPD's advocacy efforts following attendance of a program like the PPAC (P=0.051). Conclusion: Pediatric dental residents who participated in the PPAC or a local clinically oriented experience, perceived these two types of activities to provide greater value in their advocacy education than that of a didactic lecture in this subject area. Study results can be used to guide program directors in developing millennial-specific, resident-driven advocacy education experiences to fulfill Commission on Dental Accreditation advocacy curricula requirements.

Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder.

PURPOSE: The purpose of this study was to conduct a survey of Texas pediatric dentists to determine: (1) the percentage of patients they treat with attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD); (2) the behavior management techniques that are utilized to treat their patients who suffer from ADD/ADHD; and (3) the relative success rates of these techniques in their practices. METHODS: A 17-question, single-answer, multiple choice survey was mailed to 343 Texas pediatric dentists. The mailing list was obtained from American Academy of Pediatric Dentistry and Texas Academy of Pediatric Dentistry member rosters. One mailing was sent, including a self-addressed stomped envelope, for returned responses. RESULTS: A 54% response rate (186 surveys) revealed that nitrous oxide was the most frequently used pharmacologic behavior management technique; however, demerol/promethazine/nitrous oxide was rated as effective most often for treating ADD/ADHD patients. CONCLUSIONS: Practitioners believe the incidence of attention deficit disorder/attention deficit hyperactivity disorder is increasing, and they are familiar with the medications used to treat the conditions. Texas pediatric dentists are using a variety of sedation techniques and are interested in developing guidelines for sedation of these patients.

Concentration of formocresol used by pediatric dentists in primary tooth pulpotomy.

Diluted formocresol is the most widely recommended primary tooth pulpotomy medicament, but it is not commercially available. This investigation surveyed practicing pediatric dentists about the concentration of formocresol that they use to perform pulpotomies and, if they use diluted formocresol, where they obtain it. Eight-hundred-and-six surveys were sent to a randomly selected sample of practicing pediatric dentists, and 422 were returned for a 52% response rate. Eighty-four percent of the respondents use formocresol for their primary tooth pulpotomies. Of those, 69% use full strength, 27% use diluted and 4% don't know. Sources of diluted formocresol for those who use the diluted form include: 34% who buy it that way, 58% who dilute it themselves and 8% who have the pharmacy dilute it. The majority of pediatric dentists who use formocresol for primary tooth pulpotomies use a full strength formulation.

Evaluation of aggressive pulp therapy in a population of vitamin D-resistant rickets patients: a follow-up of 4 cases.

This investigation collected clinical and radiographic data from a retrospective chart review of 4 patients receiving prophylactic formocresol pulpotomies and stainless steel crowns following a dental abscess associated with a medical diagnosis of vitamin-D resistant rickets (VDRR) at Texas Scottish Rite Hospital for Children in Dallas, Tex. Clinical and radiographic data were available for 29 primary teeth in 4 children, with follow-up times ranging from 2 years, 1 month to 5 years, 6 months. Based on available recalls of 29 teeth treated following the prophylactic formocresol pulpotomy, 22 failed clinically. The earliest failure occurred at 3 months; the longest time to failure was 3 years, 9 months. No trends were discernable between tooth type and failure rate, although the shorter the time between eruption of the tooth and pulpotomy treatment, the greater the chance of success. Presently, there is not enough evidence to suggest that prophylactic pulpotomy therapy in VDRR patients is beneficial in preserving their primary dentition.

Using OSCE-based evaluation: curricular impact over time.

The Objective Structured Clinical Examination (OSCE) is becoming more widely used for performance assessment in dentistry. The department of pediatric dentistry at Baylor College of Dentistry (BCD) began incorporating the OSCE into its curriculum in 1995. This article describes the evolution of the department's use of the OSCE and its impact on teaching and the curriculum. The discussion focuses on logistics and station design, curricular content and order, student anxiety, writing and scoring exams, and curriculum assessment. BCD has found that using an OSCE-based testing format is time-consuming and labor-intensive, but provides unprecedented feedback about students' understanding and pinpoints areas of confusion. The demands of an OSCE-based testing format reveal that students can master, to the level of competency, only a finite amount of information in a given time period. The timed, interactive aspects of the OSCE create high levels of student anxiety that must be addressed. Writing and scoring OSCE items are different from traditional test items. The OSCE is a valuable mechanism to assess the students' progress toward competency. This review of the process of incorporating OSCEs into a curriculum is the foundation for future assessment of the OSCE and its use for curricular improvement.

Behavior symposium Workshop A report - current guidelines/revision.

A Workshop of attendees was convened following the completion of the American Academy of Pediatric Dentistry (AAPD) symposium, "Beyond the Guidelines: Factors Affecting Behavior Guidance." The title of Workshop A was Guidelines/Revisions and charges were to review whether the current AAPD Behavior Management Guidelines were adequate to guide delivery of dental care for children with specific attention to their effectiveness and safety, the protection of the pediatric patient and dentist, and the newly revised Protective Stabilization guideline, considering the presentations during the symposium. Major themes emerged as areas for consideration in future revisions of the guidelines: 1) toxic stress and the culture of poverty; 2) behavior risk assessment; 3) contemporary knowledge of pain theory; 4) deferred treatment; 5) parental presence in the operatory and 6) current use of protective stabilization. These issues were examined in the context of the current economic, social, and political environment. A summary of the topics and discussions that took place regarding the adequacy of the guidelines is presented.

Relative value of oral health in well-child care: a survey of pediatricians in Texas and Ohio.

PURPOSE: The purpose of this study was to assess knowledge, penetration, and support of the American Academy of Pediatrics' (AAP) 2003 oral health policy statement among pediatricians and compare the perceived relative value of oral health among health topics. METHODS: A 33-question survey was sent to 1,320 randomly selected pediatricians in Texas and Ohio. The survey queried practice patterns, perceived importance of oral health, and familiarity/implementation of the AAP policy. RESULTS: The return rate was 30 percent, with a 23 percent useable response rate; 51 percent of the pediatricians had read the policy, and 74 percent were implementing some component. Overall, 40 percent referred one-year-old infants to a dentist and 29 percent believed it was important. Parental acceptance was identified to be the most common barrier for dental referral by one year of age. Oral health anticipatory guidance ranked fifth at the six- and 12-month office visits but ranked second at the 24-month visit. CONCLUSION: While three out of four pediatricians were implementing some portion of the AAP's 2003 oral health policy, referral rates and perceived importance of oral health remained low among pediatricians.

Pulpotomy versus pulpectomy for carious vital primary incisors: randomized controlled trial.

PURPOSE: The purpose of this prospective, randomized, split-mouth investigation was to compare the success rates of formocresol pulpotomies (FC) and Vitapex(®) pulpectomies (RCT) in asymptomatic carious vital primary incisors. METHODS: Matched contralateral pairs of asymptomatic, carious, vital primary incisors were randomized to receive FC or RCT by 2 standardized operators and restored with stainless steel crowns. Seventy-four incisors were followed clinically and radiographically for up to 23 months. Two standardized examiners evaluated radiographic findings using separate pulpotomy and pulpectomy scales (modified Zurn/Seale). RESULTS: Incisors present at each interval (5-9, 10-14, and 15-23 months) showed no clinical failures. One FC incisor was lost early and counted as a failure. Though not significantly different, there were higher numbers of successful radiographic outcomes for FC than RCT at each observation interval. Cumulative final radiographic success was 89% (n=33) for FC and 73% (n=27) for RCT. (P=.11). CONCLUSIONS: Anecdotal claims that pulpotomies are unsuccessful in primary incisors are unfounded. There was no significant difference in success rates of pulpotomies and pulpectomies in the pulp treatment of asymptomatic vital primary incisors. Intracanal resorption of Vitapex(®) was seen in all pulpectomy teeth and did not affect pulpectomy outcome.

Dental education's role in improving children's oral health and access to care.

In 2000, Oral Health in America: A Report of the Surgeon General identified disparities in oral health and access to care for vulnerable populations, including children. The report identified a declining dental school applicant pool, shortages of dental school faculties, and an overcrowded curriculum as dental education factors affecting disparities. Dental school applications are up, but the dentist/population ratio is projected to decline, and the shortage of dental faculty has worsened-limiting dental students' experiences with children. Current Commission on Dental Accreditation (CODA) standards do not include essential curriculum required to care for children. We recommend that CODA revisions to predoctoral and postdoctoral programs include care of infants, characteristics of children that distinguish them from adults, mandatory service learning experiences, emphasis upon social responsibility for all dentists, and use of objective standardized clinical examinations (OSCEs). Additionally, we recommend prioritization of limited pediatric dental resources to young children with disease and older children with complex dental requirements or special health care needs. Critical dental education goals for children should be developed through a special American Dental Education Association task force. Only the dental education community can assure that the dental workforce is better trained to care for children.