Characteristics of dental clinics in US children's hospitals.

PURPOSE: This study's purpose was to describe the workforce, patient, and service characteristics of dental clinics affiliated with US children's hospitals belonging to the National Association of Children's Hospital and Related Institutions (NACHRI). METHODS: A 2-stage survey mechanism using ad hoc questionnaires sought responses from hospital administrators and dental clinic administrators. Questionnaires asked about: (1) clinic purpose; (2) workforce; (3) patient population; (4) dental services provided; (5) community professional relations; and (5) relationships with medical services. RESULTS: Of the 222 NACHRI-affiliated hospitals, 87 reported comprehensive dental clinics (CDCs) and 64 (74%) of CDCs provided data. Provision of tertiary medical services was significantly related to presence of a CDC. Most CDCs were clustered east of the Mississippi River. Size, workload, and patient characteristics were variable across CDCs. Most were not profitable. Medical diagnosis was the primary criterion for eligibility, with all but 1 clinic treating special needs children. Most clinics (74%) had dental residencies. Over 75% reported providing dental care prior to major medical care (cardiac, oncology, transplantation), but follow-up care was variable. CONCLUSIONS: Many children's hospitals reported comprehensive dental clinics, but the characteristics were highly variable, suggesting this element of the pediatric oral health care safety net may be fragile.

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs.

PURPOSE: The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN). METHODS: A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts. RESULTS: Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792. CONCLUSIONS: The current US dental care system has extremely limited capacity to care for children with special health care needs.

Vital pulp therapy for the primary dentition.

The goal of primary tooth pulp therapy is the preservation of the primary teeth until their normal time of exfoliation. Teeth with carious involvement approaching the pulp can be treated with a variety of approaches, including three pulpotomy techniques--diluted formocresol, ferric sulfate, and mineral trioxide aggregate--and an indirect pulp therapy technique. Accurate diagnosis of the vitality status of the pulp is critical to the success of each treatment and involves careful radiographic and clinical assessment of the teeth to make sure that they are either healthy or reversibly inflamed.

Indirect pulp therapy: an alternative to pulpotomy in primary teeth.

Preservation of the primary teeth until their normal exfoliation is essential for normal oral function and facial growth of the child. To that end, treatment of primary teeth with large carious lesions approximating the pulp should be aimed at preserving the tooth. Currently, the pulpotomy is the most frequently used pulp treatment for cariously involved primary teeth. The purpose of this manuscript is to describe the use of an alternative to the pulpotomy, indirect pulp therapy (IPT), for the treatment of vital, primary teeth with carious involvement approaching the pulp. Accurate diagnosis of the vitality status of the pulp is critical to the success of IPT and involves careful radiographic and clinical assessment of the teeth to be sure they are healthy or at worst, reversibly inflamed. The indications for IPT are the same as for pulpotomy. The technique involves one appointment, requires that some carious dentin be left to avoid pulp exposure and requires the placement of a biologically sealing base and sealing final restoration. Teeth treated with IPT have success rates at least as good as those treated with pulpotomies, and IPT offers an acceptable alternative to pulpotomy as a treatment for vital, asymptomatic, cariously involved primary teeth.

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.

The future of pediatric dentistry advanced education: the need for change in training standards.

This report describes the background, rationale and process for revision of training standards for advanced educational programs in pediatric dentistry in the United States.

Light-cured calcium hydroxide vs formocresol in human primary molar pulpotomies: a randomized controlled trial.

PURPOSE: The purpose of this prospective study was to compare light-cured calcium hydroxide (Ca(OH)2) with diluted formocresol (FC) for its success as a primary molar pulpotomy medicament METHODS: Selection criteria included at least 2 matching, asymptomatic, contralateral primary molars requiring vital pulpotomies. Matched teeth in each patient were randomized to receive either Ca(OH)2 or FC as a pulpotomy medicament. All teeth were restored with prefabricated metal crowns. Twenty patients (34 pairs of teeth) were followed clinically and radiographically for > or =1 year. Two blinded, standardized, and calibrated examiners evaluated and scored each radiograph for signs of pathology, based upon a modified scale previously proposed. RESULTS: Findings were grouped in: (a) 0 - 6; (b) 7 - 12; and (c) 13 - 24 month intervals. Radiographic scoring favored the FC group of the 7- to 12- and 13- to 24-month intervals (P<.05). Clinical success was similar for Ca(OH)2 (94%) and FC (97%) at 12 months or less. Beyond 12 months, clinical success varied more (Ca(OH)2=84%, FC=97%), but not significantly (P=.08). Combined success rates were lower for Ca(OH)2 (56%) than FC (94%). CONCLUSIONS: Light-cured calcium hydroxide does not appear to be a viable alternative to diluted formocresol as a pulpotomy agent.

Contemporary perspectives on vital pulp therapy: views from the endodontists and pediatric dentists.

The purpose of this study was to determine the level of agreement between pediatric dentists and endodontists at a pulp therapy symposium conjointly sponsored by the American Association of Endodontists (AAE) and the American Academy of Pediatric Dentistry (AAPD) on November 2-3, 2007. Presymposium and postsymposium tests were administered, and respondent answers were compared between pediatric dentists and endodontists. Opinions on 3 areas were sought: pulp therapy for cariously involved primary teeth; indirect pulp treatment (IPT) for cariously involved immature permanent teeth; and innovative treatment options including pulpal revascularization and regeneration. Results were analyzed with chi2 tests. Comparisons of presymposium and postsymposium responses and between the 2 groups of attendees indicated that the pediatric dentistry and endodontic communities agree that formocresol will be replaced as a primary tooth pulpotomy agent, that mineral trioxide is the first choice to take its place, that IPT in primary teeth holds hope as a replacement for pulpotomy, and that IPTis an acceptable pulp therapy technique for cariously involved young permanent teeth. Both groups believe that pulp revascularization and regeneration will be viable treatment modalities in the future. The AAE and the AAPD are positioned to begin preparation of best practice guidelines that share common language and treatment recommendations for pulp therapies performed by both specialties.

Caries risk assessment practices among Texas pediatric dentists.

PURPOSE: The purpose of this study was to determine current caries risk assessment (CRA) practices of Texas pediatric dentists. METHODS: A 20-question survey was sent to all 204 active members of the Texas Academy of Pediatric Dentistry. The mailing list was obtained from the Texas Academy of Pediatric Dentistry roster. RESULTS: The response rate was 62% (127/204). Eighty-three percent of respondents reported that parents are receptive to education about caries risk factors. Socioeconomic status was unrelated to receptivity. Ninety-three percent of respondents reported that they are actively involved in CRA. Thirty-eight percent of those responding reported performing CRAs on greater than 76% of their patients; 9% reported no CRA use. Forty percent of respondents reported that they assess caries risk but do not document the caries risk status. Seventy percent of respondents reported a desire for more CRA education. No significant differences were found between: (1) year o fgraduation; (2) practice type; or (3) payer sources received and CRA practices. CONCLUSIONS: A need exists for more comprehensive caries risk assessment practices and increased documentation of caries risk status by Texas pediatric dentists. The continuing education of dental professionals in caries risk assessment is essential.

The critical incident technique: a useful tool for conducting qualitative research.

The critical incident technique (CIT) is a well-established qualitative research tool used in many areas of the health sciences, including nursing, medicine, and dentistry, and their respective education systems. It is a flexible set of principles that can be modified and adapted to meet the specific situation at hand. By gathering factual reports made by observers, researchers can build a picture of the situation under study. The CIT maximizes the positive and minimizes the negative attributes of anecdotes, effectively turning anecdotes into data. In this, the first of two companion articles, the origins and current state of the CIT and its potential applications in dentistry and dental education are described.

The critical incident technique and pediatric dentistry: a worked example.

Evaluating dental students' experiences in pediatric dentistry may help dental educators better prepare graduates to treat the children in their communities. This qualitative investigation aimed to collect and analyze data using the critical incident technique (CIT). Sixty dental students at one southwestern dental school participated in 103 recorded interviews. They described 150 positive and 134 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) the instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The contribution made by the patient to dental students' education has not been previously addressed. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

Appraisal of Pediatric Dental Resident Research Presented at the American Academy of Pediatric Dentistry Annual Meeting.

Purpose: Majority of research in pediatric dentistry is carried out in advanced education programs in the country. The purpose of this study was to evaluate the abstracts of resident research posters presented at AAPD annual session for research design and topic and to assess if the resident research was published in the peer-reviewed journals. Methods: All the U.S programs based resident posters presented at AAPD between years 2013 to 2016 were evaluated. We also conducted a search on Google Scholar and PubMed to ascertain how many of these resident projects were published as manuscripts in peer reviewed journals between the years 2013-2017. All data was synthesized and analyzed using Excel Sheet and Wizard Pro Statistical software. Results: An average of 321 resident research posters were presented at AAPD annual session each year. Though a variety of research design is being presented, majority studies were cross-sectional design and case reports. Conclusions: Survey design makes for one-third of the total research. Importantly, only 3.7 percent of the research is being published in peer-reviewed journals.

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.

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.

Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-analysis.

PURPOSE: This systematic review and meta-analysis assessed outcomes in primary teeth for the vital pulp therapy (VPT) options of indirect pulp therapy (IPT), direct pulp capping (DPC), and pulpotomy after a minimum of 12 months to determine whether one VPT was superior. METHODS: The following databases were searched from 1960 to September 2016: MEDLINE, EMBASE, CENTRAL, EBSCO, ICTRP, Dissertation abstracts, and grey literature for parallel and split-mouth randomized controlled trials of at least 12 months duration comparing the success of IPT, DPC, and pulpotomy in children with deep caries in primary teeth. Our primary outcome measure was overall success (combined clinical and radiographic). Three authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Meta-analysis and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Forty-one articles qualified for meta-analysis (six IPT, four DPC, and 31 pulpotomy) from 322 screened articles. The 24-month success rates were: IPT=94.4 percent, and the liner material (calcium hydroxide [CH]/bonding agents) had no effect on success (P=0.88), based on a moderate quality of evidence; DP =88.8 percent, and the capping agent (CH/alternate agent) did not affect success (P=0.56), based on a low quality of evidence. The combined success rate for all pulpotomies was 82.6 percent based on 1,022 teeth. Mineral trioxide aggregate (MTA) (89.6 percent) and formocresol (FC) (85.0 percent) success rates were the highest of all pulpotomy types and were not significantly different (P=0.15), with a high quality of evidence. MTA's success rate (92.2 percent) was higher than ferric sulfate (FS) (79.3 percent) and approached significance (P=0.06), while FS's success rate (84.8 percent) was not significantly different from FC (87.1 percent), both with a moderate quality of evidence. MTA and FC success rates were significantly better than CH (P=0.0001), with a moderate quality of evidence. At 18 months, sodium hypochlorite (NaOCl) success rate was significantly less than FC (P=0.01) with a low quality of evidence. CONCLUSIONS: The highest level of success and quality of evidence supported IPT and the pulpotomy techniques of MTA and FC for the treatment of deep caries in primary teeth after 24-months. DPC showed similar success rates to IPT and MTA or FC pulpotomy, but the quality of the evidence was lower. Systematic Review Registration Number: PROSPERO 2015: CRD42015006942.

Strengthening the American Academy of Pediatric Dentistry's Public Policy Advocate Network: Identifying Advocacy Efforts and Recommendations.

PURPOSE: The purposes of this study were to collect information on involvement, training, and barriers to participation in advocacy efforts for Public Policy Advocates (PPAs) of the American Academy of Pediatric Dentistry (AAPD) and make recommendations to the AAPD. METHODS: Preliminary data were collected from the PPAs during structured AAPD program meetings, conference calls, and individual interviews. Based on these data, a survey was created, piloted, and sent electronically to all PPAs. Data were analyzed and collated by frequencies. RESULTS: Responses from 38 PPAs (100 percent) revealed they were involved with state legislatures and state chapters of the AAPD and American Dental Association. Eighty-two percent of the PPAs requested additional public policy training and clearer communication channels within the network. PPAs are funding their own advocacy efforts, and the time and resources spent away from patient care is a financial barrier. CONCLUSIONS: The Public Policy Advocate network holds a broad policy skill set and voluntarily commits time and resource to advocate for the support of the pediatric dental patient at state and federal government levels. The American Academy of Pediatric Dentistry can strengthen the PPA's self-directed leadership role at state and federal levels through formalized training, restructuring of the network, and increased resources.

Dental students' knowledge about careers in academic dentistry.

The purposes of this study were to determine the knowledge of fourth-year dental students regarding certain issues related to an academic career and to ascertain their intent to pursue such a career. Factors contributing to the students' intent to pursue academia were assessed, including the effect of dental school programs designed to educate students about a career in dental education. Surveys were sent to twelve U.S. dental schools that reported having either a mandatory or elective academic career educational program or no program at all. The surveys were completed by fourth-year dental students who were queried as to their knowledge of selected academic issues. Surveys were returned by 561 students from eleven of the twelve selected dental schools. Knowledge level of academic issues among respondents was overwhelmingly low. Factors contributing to the intent to pursue some form of faculty career were gender, plans to specialize, knowledge of academic issues, having a parent in higher education, and personal teaching experience. The results of this study suggest that dental students in general do not possess the knowledge and information necessary to make an informed decision regarding a career in dental education.