The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia

Objectives

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities.

Methods

This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work.

Results

Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide.

Conclusions

Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry

OBJECTIVES

Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics.

METHODS

An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05.

RESULTS

More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%).

CONCLUSIONS

The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

Minimal Intervention Dentistry (MID) mainstream or unconventional option? Study exploring the impact of COVID-19 on paediatric dentists' views and practices of MID for managing carious primary teeth in children across the United Kingdom and European Union

Purpose

To explore the techniques used to manage carious primary teeth during the COVID-19 pandemic by paediatric dentists and dentists with a special interest in paediatric dentistry (DwSI) who are members of the British Society of Paediatric Dentistry (BSPD) and the European Academy of Paediatric Dentistry (EAPD), and their views on the use of minimal intervention dentistry (MID) in children prior to, during and post the COVID era.

Methods

A total of 212 paediatric dentists and DwSI completed an online questionnaire. Six MID techniques were explored: fissure sealants, resin infiltration, Hall Technique (HT), 38% silver diamine fluoride (SDF), atraumatic restorative treatment (ART), stepwise removal and selective caries removal.

Results

The majority were specialists (26%) followed by clinical academics (23.1%) working mainly in university teaching hospitals (46.2%). Routine dental treatment for children with carious primary teeth was provided by the majority (92.5%) during the pandemic. HT (96%) and 38% SDF (65.7%) were the most commonly used techniques among the BSPD members whereas conventional restoration of non-selective caries removal and pulp therapy remained the most widely used technique among the EAPD members (66.2%). Most of the MID techniques were used as a treatment option (48.1%) rather than a choice (43.4%), with most of these choices having been affected by the patient’s behaviour (82.5%). More than one thirds (39.2%) of the participants were reluctant to adopt MID after the pandemic. Several barriers such as lack of teaching and confidence as well as perceived lack of evidence were identified.

Conclusion

A range of MID techniques is practiced broadly by a sample of paediatric dentists and DwSI across the United Kingdom (U.K) and European Union (E.U). The majority of clinicians are willing to continue using these techniques going forward after COVID restrictions are lifted. The pandemic served as an opportunity for many dentists to become familiar with various MID practices, such as SDF, which has been already established some time ago.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries

BACKGROUND/AIMS

Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D).

MATERIALS AND METHODS

A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling.

RESULTS

In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05).

CONCLUSION

This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging

BACKGROUND

Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries.

AIM

To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed.

MATERIAL AND METHODS

Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images.

RESULTS

Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D.

CONCLUSIONS

Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.

Perception, knowledge, and attitudes towards molar incisor hypomineralization among Spanish dentists: a cross-sectional study

BACKGROUND

Molar incisor hypomineralization (MIH) is a growing health problem, and its treatment is a challenge. The purpose of the present study was to evaluate and compare the perceptions, knowledge, and clinical experiences of MIH in general dental practitioners (GDPs) and paediatric dentists (PDs) in Spain.

METHODS

All dentists belonging to the College of Dentists of the Region of Murcia, in the South-East of Spain, were invited to participate in a cross-sectional survey. They were asked to complete a two-part questionnaire including sociodemographic profiles and knowledge, experience, and perceptions of MIH. Data were analysed using Pearson's chi-square test, Fisher's exact test and Cramer's V test.

RESULTS

The overall response rate was 18.6% (214/1147). Most respondents were aged 31-40 years (44.86%), with more than 15 years of professional experience (39.72%). They worked mainly in the private sector (84.58%) and were licensed in dentistry (74.30%): 95.45% of PDs had detected an increase in the incidence of MIH in recent years (p <  0.001). Only 23.80% of GDPs claimed to have made a training course on MIH. With respect to the aetiology, chronic medical conditions (p = 0.029) and environmental pollutants (p = 0.008) were the only factors that showed significant between-group differences. Durability (p = 0.009) and remineralization potential (p = 0.018) were the factors where there was a between-group difference in the choice of the restoration material. In the case of post-eruptive fractures and opacities, the preferred material for both groups was resin-modified glass ionomer (RMGIC). However, in incisor lesions, composite was the material of choice for both groups, with significant differences (p = 0.032) in the use of glass ionomer. Most respondents expressed a need for continuing education on MIH.

CONCLUSION

Spanish dentists perceived an increase in the incidence of MIH. The material of choice was RMGIC for non-aesthetic sectors and composite for incisors. Dentists believe it is difficult or very difficult to manage MIH, since the long-term success of restorations of MIH lesions is compromised because resin adhesion is not good. Both GDPs and PDs believe they need more training on the aetiology, diagnosis, and treatment of MIH.

The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study

Purpose

The purposes of this study were to investigate paediatric dental practitioners’ training and confidence in using dental behaviour management techniques in the Arabian region and to assess the factors influencing the application of advanced behaviour management techniques. Methods: An online questionnaire was distributed to paediatric dental practitioners in the Arabian region. Data were analysed using descriptive statistics and Pearson Chi Square.

Results

A total of 113 responses were obtained. Of these, the majority were from Egypt (45%, n = 51). Just over half of the respondents were registered as specialists at the country where they were practicing paediatric dentistry (53%, n = 60). The use of behaviour management techniques varied amongst participants with tell-show-do (95%, n = 107) and positive reinforcement (89%, n = 101) being the most routinely used techniques. The majority of participants reported using voice control (83%) and parental separation (68%) techniques. Hand over mouth exercise (HOME) was only used by 24% (n = 27) of participants, whilst just over half of the participants, 53%, reported using protective stabilisation. A significant association was shown between country of practice, country of obtaining paediatric dental training, speciality status and the use of advanced behaviour management techniques, whilst confidence in using HOME and sedation were associated with work setting and country of practice, respectively.

Conclusion

The use of advanced behaviour management techniques was found to be high amongst respondents in the Arabian region. The lack of training in using these techniques, however, is of concern. Further assessment of the factors affecting the use of and confidence in applying advanced behaviour management techniques in the Arabian region is needed.