There is high patient acceptance of care provided by dental auxiliaries and students.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The acceptability of care provided by dental auxiliaries: A systematic review. Dyer TA, Robinson PG. J Am Dent Assoc 2016; 147(4): 244-54. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review.

Dental therapists: improving access to oral health care for underserved children.

Disparities in dental health care that characterize poor populations are well known. Children suffer disproportionately and most severely from dental diseases. Many countries have school-based dental therapist programs to meet children's primary oral health care needs. Although dental therapists in the United States face opposition from national and state dental associations, many state governments are considering funding the training and deployment of dental therapists to care for underserved populations. Dental therapists care for American Indians/Alaska Natives in Alaska, and Minnesota became the first state to legislate dental therapist training. Children should receive priority preference; therefore, the most effective and economical utilization of dental therapists will be as salaried employees in school-based programs, beginning in underserved rural areas and inner cities.

Confronting dental uncertainty in old age.

OBJECTIVE: To provide an overview of the literature about uncertainty in health care and how it relates to the oral health care of older people. BACKGROUND: The medical literature describes uncertainty in health care from the initial informed-consent to its impact on a patient's ability to cope with undesirable outcomes. METHODS: A narrative review of the medical, dental and psychological literature was conducted to identify pertinent information on the theory and implications of uncertainty in healthcare. The findings are infused into a case-report illustrating the recurrence of uncertainty experienced by an older woman who had multiple treatments over several years to restore her dentition damaged severely by dental caries. RESULTS: Uncertainty originates from inadequate understanding, incomplete information and undifferentiated alternatives leading to unnecessary diagnostic tests and healthcare costs. A conceptual taxonomy clarifies the characteristics of uncertainty in the context of scientific, practical or personal sources and offers management possibilities through effective communications to identify choices and probabilities that help patients to adapt and cope with adverse events. CONCLUSIONS: Uncertainty pervades healthcare. It can lead patients to self-blame, anger and withdrawal from care unless it is communicated effectively so that they can adapt and cope with the disappointment of adversity and continue with alternative approaches to care.

Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model.

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

Chronicling the dental therapist movement in the United States.

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic.

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

Perspectives of board certified pediatric dentists on adding a pediatric oral health therapist to the dental team.

PURPOSE: The purpose of this study was to determine the perspectives of board certified pediatric dentists regarding adding a pediatric oral health therapist/dental therapist to the dental team. METHODS: A 27-item online survey was e-mailed to all diplomates of the American Board of Pediatric Dentistry Questions assessed knowledge and opinions regarding the concept of a pediatric oral health therapist, as well as perspectives on the parameters under which such a person could practice. Survey results were tabulated and frequency distributions calculated. RESULTS: Seventy-five percent of respondents had limited or no knowledge regarding the concept of a pediatric oral health therapist; 79% had limited or no knowledge regarding the use of dental therapists in Alaska. Seventy-one percent disagreed with adding a therapist to the dental team. Pediatric dentists practicing in the public sector were more knowledgeable and supportive. Sixty-six percent indicated they treated children with Medicaid/CHIP insurance. Of those, most disagreed that therapists would enable them to care far more children. CONCLUSIONS: Pediatric dentists are generally not knowledgeable regarding the role of therapists internationally Nevertheless, the majority oppose adding such an individual to the dental team in the United States.

Socio-ecological factors associated with returning for post-operative care after dental treatment under general anesthesia.

PURPOSE: The aim of this study was to determine if specific variables in a theorized socio-ecological model are associated with returning for post-operative care after dental treatment under general anesthesia. METHODS: A 26 item cross-sectional survey assessing socio-ecological variables of 100 families of patients receiving dental treatment under general anesthesia was conducted. Chi-square tests and logistic regressions were used to investigate associations between returning for post-operative care with child, family, clinic and environmental variables described in the proposed socio-ecological model. RESULTS: Forty-seven percent of patients returned for post-operative care. Children without a dental home had lower odds of returning than children referred from a continuous source of care. Children with an ASA II/III classification had lower odds of returning for post-operative care than children who were ASA I. CONCLUSIONS: One child level and one environmental level variable in the theorized socio-ecological model had an impact on whether patients returned for post-operative care after dental treatment under general anesthesia. Further investigation of socio-ecological variables influencing dental health behaviors is needed.

Thirty-Month Outcomes of Biodentine ® Pulpotomies in Primary Molars: A Retrospective Review.

Purpose: The purpose of this study was to evaluate the clinical and radiographic effectiveness of Biodentine® as a pulpotomy medicament for use in primary molars. Methods: A retrospective chart review was conducted on children who had received full-mouth dental rehabilitation under general anesthesia between January 1, 2013, and May 1, 2018. Three clinical outcomes (pain, pathologic mobility, and soft tissue pathology) and two radiographic outcomes (pathologic radiolucency and pathologic root resorption) defined a composite outcome of pulp therapy failure. Results: The final study sample consisted of 208 children with a mean age of 4.9 years. The total number of primary molars that received a Biodentine® pulpotomy over the 30-month posttreatment period was 608. Survival analyses determined that the cumulative probability of clinical survival at 30 months was 93.7 percent (95 percent confidence interval [95% CI] equals 83.7 percent to 99.2 percent) and radiographic survival probability was 85.6 percent (95% CI equals 76.3 percent to 93.7 percent). The majority (n equals 14 out of 20; 70 percent) of failed Biodentine® pulpotomies occurred before 18 months. Conclusions: Primary molar pulpotomies utilizing Biodentine® as the pulpal medicament had favorable clinical and radiographic results after 30 months. Biodentine® can be considered an alternative to other commonly used primary tooth pulpotomy medicaments.

A practice profile of board certified pediatric dentists based upon characteristics of the dental home.

PURPOSE: This study's purposes were to: (1) develop a practice profile of board certified pediatric dentists based upon the characteristics of the dental home; and (2) suggest a construct for an index that could assist in the determination of the existence of a dental home. METHODS: A survey was conducted of American Board of Pediatric Dentistry diplomates. Questions were asked that profiled practices based on the 7 characteristics of a dental home: (1) accessibility; (2) family centered; (3) continuous; (4) comprehensive; (5) coordinated; (6) compassionate; (7) culturally competent. RESULTS: Seventy-five percent of respondents were knowledgeable about the dental home and reported that they regularly apply the concept in practice; 95 percent believed that it is important for a practice to function as a dental home. A dental home assessment tool was thought to be potentially useful by 72 percent of respondents. While 73 percent said a dental home cannot exist independently of a specific dental office, academic/public health respondents were more likely to respond that it could. CONCLUSIONS: Participants' variability in responses suggests that functional criteria associated with the 7 characteristics of a dental home would be helpful in determining the success of providing a dental home. A potential construct for a dental home index was suggested.

Effect of a financial incentive on returning for post-operative care following general anesthesia.

UNLABELLED: The aim of this study was to examine whether the use of a ten dollar financial incentive improved parental compliance in returning for their child's post-operative care appointment following dental treatment under general anesthesia at the University of Kentucky Pediatric Dentistry residency program. STUDY DESIGN: Parents/guardians of 69 children scheduled for dental treatment carried out under general anesthesia at the University of Kentucky Pediatric Dentistry residency program from Oct 2007 to March 2008 were offered a $10 incentive if they returned for their one week post-operative care appointment. All subjects who returned received a $10 incentive by mail. A control consisting of 100 patients treated at the University of Kentucky Pediatric Dentistry residency program from October 2006 to April 2007 was used to determine historical return rates for post-operative care after dental treatment under general anesthesia. RESULTS: Sixty-six percent (66%) of the control group returned for their post-operative care appointment. Sixty-five percent (65%) of the incentive group returned for their post-operative care appointment. CONCLUSION: Offering a $10 incentive did not increase the return rate for post-operative care following dental treatment under general anesthesia in a small study population.

The Effect of an Audiovisual Preoperative Intervention in Reducing Parental Anxiety Prior to a Child's Sedation Appointment: A Pilot Study.

Purpose: The purpose of this pilot study was to determine whether an audiovisual intervention was more effective than verbal instructions at reducing preoperative anxiety levels for parents whose children were having their first experience of dental treatment with the use of oral sedation. Methods: A prospective clinical trial was conducted. Parents were systematically assigned to either view an animated video (intervention group) or receive standardized verbal instructions (control group). Questionnaires modified from the Amsterdam Preoperative Anxiety and Information Scale were distributed to parents at the assessment appointment before the preoperative information was given (T0) and again at the subsequent sedation appointment (T1). The change in parental anxiety levels between T0 and T1 was measured (Δ equals T0-T1). Results: A total of 40 subjects comprised of 20 individuals each in the control and intervention group were included in the final analytical data set. There were no significant differences in the effectiveness of reducing preoperative parental anxiety between the audiovisual intervention and the verbal instructions. Conclusions: The audiovisual intervention was effective at reducing preoperative parental anxiety, but the reduction was not significantly different from using verbal instructions. Dentists may wish to incorporate audiovisual aids to supplement verbal instructions during the sedation preoperative consultation.

Opinions of Early Head Start staff about the provision of preventive dental services by primary medical care providers.

OBJECTIVE: This study investigates the opinions of the Early Head Start (EHS) staff about physicians and nurses providing preventive dental services for children in EHS. METHODS: A cross-sectional survey was undertaken of the EHS staff having contact with families in EHS programs in North Carolina (NC). A self-completed questionnaire solicited their opinions (agree, disagree, don't know) about whether physicians and nurses can "provide preventive dental care" and "identify dental problems" in infants and toddlers. Staff knowledge (four items) and attitudes (five items) were tested for their association with whether staff had an opinion (agree/disagree versus don't know) and if so, what that opinion was (agree versus disagree) using the generalized estimating equation method. RESULTS: Questionnaires were completed by 476 staff (98 percent response) in 18 programs (100 percent response). The majority of staff believed that physicians and nurses can provide preventive dental services (66 percent) and identify dental problems (52 percent). Staff placing importance on ensuring access to dental care and who were knowledgeable about fluoride uses were more likely to have an opinion. Among staff with an opinion, those familiar with the NC program where these services are provided in medical offices were more likely to agree that physicians and nurses can provide preventive services and identify problems. CONCLUSIONS: Although the opinions of the majority of the EHS staff are not a barrier to using primary medical care providers to deliver preventive dental care, education is needed for staff who are unfamiliar with this approach.

The dental therapist movement in the United States: A critique of current trends.

Dental therapists are members of the oral health workforce in over 50 countries in the world typically caring for children in publically funded school-based programs. A movement has developed in the United States to introduce dental therapists to the oral health workforce in an attempt to improve access to care and to reduce disparities in oral health. This article critiques trends in the United States movement in the context of the history and success of dental therapists practicing internationally. While supporting the dental therapist movement, we challenge: a) the use of dental therapists treating adults, versus focusing on children; b) the use of dental therapists in the private versus the public/not-for-profit sector; and c) requirements that a dental therapist must also be credentialed as a dental hygienist.

Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities.

OBJECTIVE: The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programme's preventive dental services for children. METHODS: Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART. RESULTS: The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period. CONCLUSIONS: Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.

Saskatchewan's school-based dental program staffed by dental therapists: a retrospective case study.

OBJECTIVES: The poor oral health of Saskatchewan's children, in concert with a significant shortage of dentists, prompted the province in the early 1970s to seek an alternative method of addressing the oral health care needs of children. The result was the Saskatchewan Health Dental Plan (SHDP), which trained and employed dental therapists in school-based clinics to provide basic dental care to all children. The program was initiated over the opposition of Saskatchewan's dentists. The purpose of this research was to provide information and data previously not documented in the refereed dental literature regarding the only school-based program staffed by dental therapists to ever exist in North America. METHODS: This case study reviews the program's planning, opposition, implementation, and achievements based on a comprehensive review of published articles as well as a search of the grey literature. Additionally, Saskatchewan Health provided annual reports for each year of the program's existence. RESULTS: During its thirteen years of existence, the school-based program proved popular with parents and achieved significant success in providing necessary dental care for children. It was terminated in 1987 by the newly elected provincial Conservative government, which was not supportive of such social programs. CONCLUSIONS: The SHDP serves as a successful model of school-based dental care for children. However, the termination of the plan demonstrates the vulnerability of publicly funded dental health programs to conflicting political ideologies and special interest groups.

The virtual dental home: a critique.

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a "cloud" dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.

The perceptions of first nation participants in a community oral health initiative.

The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental program for children and their caregivers living in geographically isolated Canadian Aboriginal communities. The goal of the program is to improve access to preventive dental services for children of 0-7 years of age. It utilises community health workers in collaboration with dental therapists to promote and deliver the program. Almost half of the province of Manitoba's (n=27) First Nations communities have implemented COHI since 2005. The objective of this investigation was to explore the opinions of COHI from the perspective of community members whose children had participated in the program. Purposeful selection identified caregivers of enrolled children for a semi-structured interview. The targeted caregivers had children who met at least one of the following criteria: (1) 0-2 years old; (2) 5-7 years old; (3) had two or more children either currently or formerly enrolled in COHI. Six open-ended questions guided the interview process. Content analysis was used to code transcripts and identify themes. One hundred and forty-one interviews were completed in 13 communities. Participants defined good oral health as the absence of dental cavities, which reflects a Western biomedical model of disease. The local, community-based nature of COHI was viewed as essential to its success in increasing access to preventive dental services and improving children and caregivers' oral health knowledge and behaviours. In conclusion, a local, community-based oral health prevention programme is perceived as having a beneficial effect on children and caregivers' oral health knowledge and behaviours. However, oral health preventive messages need to be further integrated into traditional Aboriginal holistic models of wellness.

Loss of Permanent First Molars in the Mixed Dentition: Circumstances Resulting in Extraction and Requiring Orthodontic Management.

Extraction of significantly compromised permanent first molars may be indicated during the mixed dentition stage of occlusal development. The purpose of this article was to review circumstances that can result in the loss of a permanent first molar-including dental caries, molar incisor hypomineralization, eruption disturbances of permanent teeth, and failure of restorative treatment to affirm that a complete dental arch is not necessary for the existence of a functional dental arch. The extraction of permanent first molar(s) with subsequent orthodontic treatment in a young patient can be considered a cost-effective alternative to placing complex restorations that require replacement over the lifespan. Approaches to establish a functional dental arch in the event of the loss of a permanent first molar(s) are outlined. Additionally, orthodontic diagnostic and treatment principles are reviewed. Case histories are provided to illustrate the clinical management of permanent first molar extractions to achieve a functional dental arch.