A community survey on maternal perception about the initiation of dental home for infants in Lagos, Nigeria

INTRODUCTION

because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation after disease development, early preventive dental visits are widely encouraged by dental professional and academic stakeholders. Aim: this study aimed to determine the perceptions and practices of mothers with regards to the establishment of dental home at four local government areas (LGAs) in Lagos, Nigeria.

METHODS

was a community-based descriptive household survey conducted amongst mothers in Alimosho, Ikorodu, Surulere and Epe LGAs of Lagos State. Socio-demographic data, information about the importance of primary teeth, knowledge about dental home as well as their child´s age at first dental visit and reasons for attending was obtained with a validated, structured interviewer administered questionnaire. Descriptive statistics, Chi-square and multivariable regression analysis were conducted, and the level of significance was set at P<0.05.

RESULTS

the highest proportion of the mothers were aged between 26-30 years (27.4%; mean age: 34.58±7.8 years) and had a tertiary level of education (n=206, 59.9%); most respondents (n=80, 51.4%) did not know the age a child should be taken to the dental clinic for the first time and had not taken their child for any dental visit (n=229, 65.4%). Out of those who had previously taken their child for dental visits, the greater proportion (n=115, 95.0%) took the child when he/she was older than one year of age. Overall, only 126 (36.0%) respondents had a good perception about oral health and the need for a dental home while 224 (64.0%) respondents had poor knowledge. Logistic regression analysis of predictor variables that showed mothers with a tertiary level of education (OR=0.108; CI=0.0023-0.495) and those with 2-3 children (OR=0.482; CI=0.253-0.920) had significant lower odds of poor perception about the importance of a dental home.

CONCLUSION

maternal knowledge and practices with regards to dental home were poor and inadequate. It is necessary to create more awareness among parents/caregivers, especially through antenatal and immunization clinics to establish the concept of dental home.

A Resident-Led QI Project to Improve Dental Health at a Primary Care Pediatric Practice

BACKGROUND

Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5.

OBJECTIVE

Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month.

METHODS

From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates.

RESULTS

Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%.

CONCLUSIONS

Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.

Odontogenic Infection and dental Pain negatively impact Schoolchildren's Quality of Life

The aim of this study is to assess the prevalence of odontogenic infection in low-income Brazilian schoolchildren and evaluate its association with the subjective variables of oral health-related quality of life and dental pain. In this cross-sectional study, 230 schoolchildren aged eight to ten years old underwent a clinical oral survey in which the DMFT/dmft and PUFA/pufa indexes were measured. Afterward, children responded individually to the Child Perceptions Questionnaire (CPQ8-10) and self-reports of dental pain were collected. Data were statistically analyzed using MannWhitney or Kruskal-Wallis test with a post-test by Dunn's and Pearson correlation. Of the children evaluated, 42.6% had odontogenic infection and 80% reported experiencing dental pain. Children's age (p = 0.034) and past experience of dental pain (p < 0.002) were associated with odontogenic sepsis, in addition to impairment of their emotional well-being (p = 0.008), social welfare (p = 0.009) and overall impact on quality of life (p = 0.019). Toothache intensity (p < 0.001), frequency (p < 0.001) and duration (p < 0.001) were correlated to the overall impact on children's quality of life. The prevalence of odontogenic infection remains high among low-income Brazilian schoolchildren. Pediatric infection and its related pain induce not only various biological disorders but also impair children's self-perception of quality of life.

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants’ ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4–6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5–6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents’ reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p < 0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35–14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21–21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

Age and reasons for first dental visit among children in Lagos, Nigeria

BACKGROUND

An early first dental clinic appointment offers the prospect of prompt preventative care and parental education regarding the oral health of the child. The evidence-based recommendation by dental professionals all over the world is that a child should visit a dentist before or by 1 year of age.

AIM

This study aimed to determine the chronological age at and the purpose for a first dental clinic visit amongst children aged 16 years and below attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital (LUTH).

MATERIALS AND METHODS

This was a retrospective study conducted amongst children who attended the Paediatric Dental Clinic at the LUTH between January 2017 and December 2018. Data on age at first dental visit, reasons for attending and other information relevant to the study were collected. Descriptive statistics and Chi-square analysis were conducted, and the level of significance was set at P < 0.05.

RESULTS

A total of 1157 children were studied, comprising 580 (50.5%) males and 577 (49.9%) females. Their mean age on their first dental visit was 7.9 ± 3.7 years. Most of the children (31.4%) had their first dental visits at 7 and 9 years, and 0.8% of the children had their first dental visit below the age of 1 year. The most common reason for visiting the dental clinic was dental pain (33.1%). A higher proportion of the children (911 [79.0%]) had their first dental visit for therapeutic purposes, whereas 246 (21.0%) children visited the dental clinic for preventive care. Sex and age at first dental visit were statistically significantly associated with the reason for attendance (P < 0.001).

CONCLUSION

Most children had their first dental visit between the ages of 7 and 9 years, mainly because of pain. It is necessary to create more awareness among parents/caregivers and to establish the concept of dental home.

The Prevalence and Factors Associated with Sibling-Recurrent Dental Treatment Under General Anesthesia at an Academic Institution

Purpose: The purpose of this study was to assess the prevalence of and factors that contribute to sibling-recurrent dental general anesthesia (DGA) at the Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, Va., USA. Methods: Subjects were recruited from July 25, 2017 to March 15, 2018. The guardian of patients with siblings who attended a university pediatric dental clinic were provided a questionnaire to assess the prevalence and factors associated with recurrent DGA. A provider survey was completed to ensure inclusion/exclusion criteria were met. Results: A total of 40 families with a child presenting for general anesthesia (GA) and who had at least one sibling were included in the study. Of these, 45 percent had sibling-recurrent GA treatment; 20 percent of patients had one sibling; and 25 percent had two or more sibling-recurrent DGA (P<.05). Additionally, 13 percent of the children currently presenting for GA had already been treated under GA, and 15 percent of the siblings previously treated with GA had recurrent caries after GA. Conclusions: Sibling-recurrent general anesthesia is high at Virginia Commonwealth University's Pediatric Dentistry Clinic. This increased prevalence could be due to parental acceptance and positive experiences with DGA. Dental providers should be proactive with prevention of recurrent DGA.

Review of a three-year study on the dental care of onco-hematological pediatric patients

The aim of this study was to provide an updated review of dental procedures undertaken at the dental unit of the Onco-hematology service of the Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (ICr/HC-FMUSP). We retrospectively reviewed 565 of 1902 medical and dental records of patients diagnosed with onco-hematological diseases who were seen in a 3-year study (January 2015 to December 2017). We assessed data regarding population characteristics, onco-hematological diagnosis and dental procedures performed. Of the selected medical records, preventive dentistry was the most common procedure undertaken in this population, followed by oral maxillofacial surgeries, restorative dentistry and oral mucositis treatment. The most prevalent malignant diagnosis was acute lymphocytic leukemia, and the most prevalent nonmalignant diagnosis was sickle-cell anemia. Preventive dental procedures represent most of the dental procedures undertaken in hospitalized onco-hematological pediatric patients.

Trends in Pediatric Dental Care Use

This article explores trends in 3 areas of dental services use for children less than 21 years of age. First, it examines the change in access to prevention, diagnostic, and treatment services over time among Medicaid-enrolled children and how access to care is affected by state-level factors. Second, it evaluates trends and health care costs associated with the treatment of oral health conditions in the operating room of pediatric hospitals. Third, it examines the trends in use of emergency departments for dental needs among children in the United States.

Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel

BACKGROUND

To prevent child maltreatment, the identification of vulnerable children is essential. In Norway, public dental health personnel (PDHP) report suspicion of child maltreatment to child welfare services (CWS) at a relatively high rate. However, their reasons for reporting and the response from CWS have not been investigated. The objectives of this study were to (1) explore the reasons that PDHP send reports of concern, (2) examine how CWS responds to PDHP reports, and (3) assess whether different reasons for concern are associated with a given response from CWS.

METHODS

A national cross-sectional study was conducted by an electronic survey distributed to public dental hygienists and dentists in Norway. Descriptive statistics were calculated in terms of mean (SD) distributions and frequency, expressed as % (n). To account for clustering of responses among respondents, binomial generalized estimating equation analysis was used to estimate odds ratios (ORs) and confidence intervals (CIs) of CWS responses across number of reports with different reasons for concern.

RESULTS

Of a total of 1542 questionnaire recipients, 1200 (77.8%) responded to the survey. From 2012 to 2014, 42.5% of the respondents sent 1214 reports to CWS, with a mean number of 2.7 (SD = 2.0) reports per respondent. The PDHP sent the reports due to suspicion of neglect or physical, sexual and/or psychological abuse. Non-attendance at dental appointments and grave caries were reported most frequently. Among the reports, 24.5% resulted in measures being taken by CWS, 20.7% were dropped, and 29.4% lacked information from CWS on the outcome. Reports due to suspicion of sexual abuse, (OR 1.979, 95% CI (1.047-3.742), P = 0.036), grave caries (OR 1.628, 95% CI (1.148-2.309), P = 0.006), and suspicion of neglect (OR 1.649, 95% CI (1.190-2.285), P = 0.003) had the highest association with the implementation of measures.

CONCLUSIONS

PDHP report on several forms of child maltreatment and contributes in detection of victimized children. However, the relatively low number of measures being taken by CWS and the number of reports that lack a response to reporters reveal a need for a closer cooperation between the services, as this would benefit both the children at risk and the services.

Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study

PURPOSE

This study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors.

METHODS

Thirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes.

RESULTS

Twenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks.

CONCLUSIONS

Most parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Parent's Sense of Coherence and Children's Oral Health-Related Behaviors: Is There an Association?

PURPOSE

Parental capacity to face day-to-day stressors has a relevant role in recognizing and mobilizing resources to control children's oral health behaviors. This capacity has been explored by means of the sense of coherence. The purpose of this study was to explore the association between mothers' sense of coherence (SOC) and their preschool children's oral health-related behaviors.

METHODS

Mothers and their pre-school children were recruited during immunization programs at community health centers in Edmonton, Canada. Participants answered eight questions on socio-demographics (covariates), parents' SOC (main independent variable), and children's oral health-related practices (outcome variables). Statistical analyses comprised a two-sample t test, chi-square test, and logistic regression.

RESULTS

A total of 378 pairs of mothers/ children participated in this study. Children's mean age was 3.92±(1.33) years. Mothers' SOC was statistically associated with children's frequency of sugar consumption and frequency and pattern of dental visits. The children of mothers who had higher levels of SOC presented a lower frequency intake of food or drink containing sugar and were more likely to visit the dentist for preventive purposes.

CONCLUSIONS

Mothers' sense of coherence had a significant association with children's oral health-related behaviors; a higher SOC of mothers was associated with more positive behaviors among their children.

School dental screening programmes for oral health

BACKGROUND

School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status.

OBJECTIVES

To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 15 March 2017), MEDLINE Ovid (1946 to 15 March 2017), and Embase Ovid (15 September 2016 to 15 March 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included six trials (four were cluster-RCTs) with 19,498 children who were 4 to 15 years of age. Four trials were conducted in the UK and two were based in India. We assessed two trials to be at low risk of bias, one trial to be at high risk of bias and three trials to be at unclear risk of bias.None of the six trials reported the proportion of children with untreated caries or other oral diseases.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found it to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported cost-effectiveness and adverse events.

AUTHORS' CONCLUSIONS

The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.

Failed Attendances at Hospital Dental Clinics among Young Patients with Cleft Lip and Palate

Objective:

To determine the frequency of missed dental appointments among children with a cleft lip and/or palate (CL/P).

Design:

A prospective study of failed appointments over a 12-month period.

Setting:

Three different CL/P clinics within a British dental hospital.

Patients:

Forty-five CL/P children (mean age of 8.8 years) and 45 age-matched, gender-matched, and postal code–matched noncleft patients.

Main outcome measures:

The overall percentage of missed appointments at three different clinics by CL/P patients and the difference in attendance rates at the pediatric dentistry clinic between CL/P and non-CL/P children.

Results:

Pediatric dentistry had the highest rate of missed appointments (22.4%), followed by the multidisciplinary cleft clinic (9.2%) and the orthodontic clinic (8.8%). CL/P patients missed a significantly greater proportion of their pediatric dentistry appointments than noncleft children (22.4% versus 11.9%). Patients with a bilateral CL/P were significantly more likely to miss an appointment than patients with a unilateral CL/P. Age, gender, medical history, and distance traveled had no significant effect on attendance rates.

Conclusions:

Further work is needed to identify risk factors for poor attendance and to develop strategies to reduce the frequency of missed appointments in this vulnerable group.

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008

OBJECTIVE

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage.

METHODS

We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category.

RESULTS

In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children.

CONCLUSION

Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance.

Dental Treatment and Expenditures Under General Anesthesia Among Medicaid-Enrolled Children in North Carolina

PURPOSE

Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution.

METHODS

This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization.

RESULTS

For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001).

CONCLUSIONS

Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Costs and Resource Use Among Child Patients Receiving Silver Nitrate/Fluoride Varnish Caries Arrest

PURPOSE

The purpose of this study was to assess the impact of silver nitrate/fluoride varnish (SN/FV) on care costs.

METHODS

A retrospective matched cohort study, using Oregon Medicaid claims (January 1, 2012 to December 31, 2014) for patients younger than 21 years old, compared patients treated with SN/FV to matched patients not treated with SN/FV. The number of services and costs were compared using student's t test and generalized estimating equation (GEE) regression models.

RESULTS

Patients treated with SN/FV (n equals 4,612) and matched patients treated conventionally (n equals 13,498) averaged 28±7 (SD) months of continuous eligibility based on initial treatment date. The number of first-year services and total services over an average of 28 months were higher for patients treated with SN/FV (10.6 versus 6.7 in year one; 19.3 versus 8.8 overall; P<0.0001). Excluding diagnostic/preventive services, costs were higher in patients treated conventionally than patients treated with SN/FV in the first year. Overall costs were similar ($698 versus $707; P=.52). The average number of services was 58 percent higher (95 percent confidence interval [CI] 1.54 to 1.63) for patients treated with SN/FV, but costs remained similar.

CONCLUSION

Patients treated with silver nitrate/fluoride varnish accrued a greater number of services and higher total costs over approximately 28 months but lower treatment costs than patients treated conventionally.

Meeting the oral health needs of 12-year-olds in China: human resources for oral health

BACKGROUND

An appropriate level of human resources for oral health [HROH] is required to meet the oral health needs of population, and enable maximum improvement in health outcomes. The aim of this study was to estimate the required HROH to meet the oral health needs of the World Health Organization [WHO] reference group of 12-year-olds in China and consider the implications for education, practice, policy and HROH nationally.

METHODS

We estimated the need of HROH to meet the needs of 12-year-olds based on secondary analysis of the epidemiological and questionnaire data from the 3rd Chinese National Oral Health Survey, including caries experience and periodontal factors (calculus), dentally-related behaviour (frequency of toothbrushing and sugar intake), and social factors (parental education). Children's risk for dental caries was classified in four levels from low (level 1) to high (level 4). We built maximum and minimum intervention models of dental care for each risk level, informed by contemporary evidence-based practice. The needs-led HROH model we used in the present study incorporated need for treatment and risk-based prevention using timings verified by experts in China. These findings were used to estimate HROH for the survey sample, extrapolated to 12-year-olds nationally and the total population, taking account of urban and rural coverage, based on different levels of clinical commitment (60-90%).

RESULTS

We found that between 40,139 and 51,906 dental professionals were required to deliver care for 12-year-olds nationally based on 80% clinical commitment. We demonstrated that the majority of need for HROH was in the rural population (72.5%). Over 93% of HROH time was dedicated to prevention within the model. Extrapolating the results to the total population, the estimate for HROH nationally was 3.16-4.09 million to achieve national coverage; however, current HROH are only able to serve an estimated 5% of the population with minimum intervention based on a HROH spending 90% of their time in providing clinical care.

CONCLUSIONS

The findings highlight the gap between dental workforce needs and workforce capacity in China. Significant implications for health policy and human resources for oral health in this country with a developing health system are discussed including the need for public health action.

[Utilization of dental services for children: a review of the influencing factors and the possible improvements]

It has been reported that children's oral health conditions are correlated with their attendance to dental health services. Evaluating the influencing factors of utilization of dental services for children may give ways to improve the services per se, and furtherly the children's oral health. The present review retrieved and summarized domestic and foreign studies on the utilization of oral health services for children based on the Andersen behavior model. It was concluded that the utilization of dental services for children was affected by demographic characteristics, social structure, health belief, family factors, community factors and perceived/evaluated needs. To improve the utilization of dental services for children, effort should be made by means of changing caregivers' health belief, developing oral health insurance system, setting up regular oral health resources and increasing the financial support for oral health services by government.

Impact of Early Head Start in North Carolina on Dental Care Use Among Children Younger Than 3 Years

OBJECTIVES

To examine the effects of North Carolina Early Head Start (EHS), an early education program for low-income children younger than 3 years and their families, on dental care use among children.

METHODS

We performed a quasi-experimental study in which we interviewed 479 EHS and 699 non-EHS parent-child dyads at baseline (2010-2012) and at a 24-month follow-up (2012-2014). We estimated the effects of EHS participation on the probability of having a dental care visit after controlling for baseline dental care need and use and a propensity score covariate; we included random effects to account for EHS program clustering.

RESULTS

The odds of having a dental care visit of any type (adjusted odds ratio [OR] = 2.5; 95% confidence interval [CI] = 1.74, 3.48) and having a preventive dental visit (adjusted OR = 2.6; 95% CI = 1.84, 3.63) were higher among EHS children than among non-EHS children. In addition, the adjusted mean number of dental care visits among EHS children was 1.3 times (95% CI = 1.17, 1.55) the mean number among non-EHS children.

CONCLUSIONS

This study is the first, to our knowledge, to demonstrate that EHS participation increases dental care use among disadvantaged young children.

Effects of medical and mental status on treatment modalities in patients treated under general anaesthesia at the KTU Faculty of Dentistry in Trabzon, Turkey: A comparative retrospective study

This study evaluated the differences in dental conditions and treatment modalities between disabled and non-cooperative healthy children under general anaesthesia. The data were collected from paediatric patients between 3 and 15 years of age who received dental treatment under general anaesthesia. Patients with at least one mental/physical disturbance (group 1) and other healthy non-cooperative patients (group 2) were compared with regard to gender, age, weight, and treatment time-type. The statistical analyses were performed using Fisher's exact and Mann-Whitney U tests. No significant differences were observed between the groups with regard to gender, weight and treatment-time (p>0.05). The numbers of treated teeth (p<0.01) and extractions (p<0.001) were higher in group 1 than in group 2, whereas the frequency of advanced restorative procedures for group 1 was lower than that for group 2, including preventive-resin-restoration (p<0.001), glass-ionomer-cement (p<0.05), root-canal (p<0.001) and stainless-steel-crowns (p<0.001). This study supports the hypothesis that the general condition of the patients may alter the type of treatment provided and confirms the necessity of performing preventive procedures.

Addressing Selection Bias in Dental Health Services Research

When randomization is not possible, researchers must control for non-random assignment to experimental groups. One technique for statistical adjustment for non-random assignment is through the use of a two-stage analytical technique. The purpose of this study was to demonstrate the use of this technique to control for selection bias in examining the effects of the The Supplemental Program for Women, Infants, and Children’s (WIC) on dental visits. From 5 data sources, an analysis file was constructed for 49,512 children ages 1–5 years. The two-stage technique was used to control for selection bias in WIC participation, the potentially endogenous variable. Specification tests showed that WIC participation was not random and that selection bias was present. The effects of the WIC on dental use differed by 36% after adjustment for selection bias by means of the two-stage technique. This technique can be used to control for potential selection bias in dental research when randomization is not possible.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: I. Material Choice

PURPOSE

The purpose of this study was to assess the preferences of pediatric dentists in Canada and the United States about clinical decision-making related to the placement of direct restorative materials.

METHODS

A cross-sectional web-based survey was used to collect the preference of all active pediatric members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth in healthy, developmentally delayed (DD), and medically compromised (MC) children. Bivariate and multivariate analyses were performed to determine the association between the predictor variables and all materials at two-tailed P<0.05.

RESULTS

A response rate of 19.3 percent (n equals 762) was achieved. For DD patients, stainless steel crowns were the most preferred material for primary teeth, and a similar frequency of amalgam and composite were preferred for permanent teeth. Amalgam usage was increasingly preferred in the DD population versus healthy and MC patients.

CONCLUSIONS

Composite resin was the most preferred restoration for Class I, II, and V restorations in primary and permanent teeth in healthy and medically compromised individuals. In DD individuals, stainless steel crowns and amalgam were preferred more frequently.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: III. Preferred Level of Participation in Decision-making

PURPOSE

The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making.

METHODS

A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain to elicit participants' preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05).

RESULTS

Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [CI] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent CI equals 1.11 to 11.77).

CONCLUSION

The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision-making.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: II. Rubber Dam Isolation

PURPOSE

The purpose of this study was to assess usage, indications, and contraindications for rubber dam isolation (RDI) by pediatric dentists in Canada and the United States.

METHODS

A cross-sectional, web-based, self-administered survey was utilized to collect the opinions of all active pediatric dentist members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain on the RDI utilization and its perceived indications and contraindications. Bivariate and multivariate analyses for RDI usage and its predictor were performed at two-tailed P<0.05.

RESULTS

A response rate of 19.3 percent was obtained. Most participants (72.5 percent) reported using RDI "all the time." The material with the lowest usage of RDI was composite (82 percent) in the primary dentition and stainless steel crown (80.7 percent) in the permanent dentition. The three top-noted reasons for not using RDI included decreased trauma to the patient (66.2 percent), being able to prevent soft tissue from interfering without using RDI (55.9 percent), and decreased time for appointments (45.6 percent).

CONCLUSION

Rubber dam isolation was valued by the majority of pediatric dentists when restoring primary and permanent dentition for all materials.

Survey of American Academy of Pediatric Dentistry on Nitrous Oxide and Sedation: 20 Years Later

PURPOSE

The purpose of this study was to survey the membership of the American Academy of Pediatric Dentistry (AAPD) and determine the current status of nitrous oxide (N2O) utilization in their dental practices while also comparing the findings to a similar survey completed 20 years ago.

METHODS

A 55-item questionnaire on the use of N2O was sent to the AAPD membership.

RESULTS

The total number of respondents was 1,632 (26 percent). Sixty-two percent are board-certified, 97 percent use N2O in their office, 18 percent indicated greater than 80 percent of their patient pool required N2O versus six percent in 1996. Fifty percent of parents expressed concerns about N2O use.

CONCLUSIONS

Changes have occurred in the use of nitrous oxide since 1996, including: (1) a greater percentage of practitioners using N2O; (2) perceptions that more pediatric patients need N2O; (3) a shift in use of N2O by duration of practitioner experience; (4) an increased percentage of board-certified respondents; and (5) possible increasing parental concerns about N2O.

Provision of Oral Health Care to Children under Seven Covered by Bolsa Família Program. Is This a Reality?

Over the last decade, there has been a great improvement in the oral health of Brazilians. However, such a trend was not observed among five-year-old children. Dental caries are determined by the interplay between biological and behavioral factors that are shaped by broader socioeconomic determinants. It is well established that dental disease is concentrated in socially disadvantaged populations. To reduce social and health inequalities, the Brazilian government created Family Health Program (ESF), and the Bolsa Família Program, the Brazilian conditional cash transfer program (Bolsa Família Program). The aim of this study was to examine the oral health care and promotion provided by the Family Health Teams to children and caregivers covered by the Bolsa Família Program. Data was collected through interviews with three groups of participants: 1) dentists working for the Family Health Program; 2) Family Health Program professionals supervising the Bolsa Família Program health conditionalities (Bolsa Família Program supervisors); and 3) parents/caregivers of children covered by the Bolsa Família Program. A pretested questionnaire included sociodemographic, Bolsa Família Program, oral health promotion, dental prevention and dental treatment questions. The results showed that most dentists performed no systematic efforts to promote oral health care to children covered by the Bolsa Família Program (93.3%; n = 69) or to their parents/caregivers (74.3%; n = 55). Many dentists (33.8%) did not provide oral health care to children covered by the Bolsa Família Program because they felt it was beyond their responsibilities. Nearly all Bolsa Família Program supervisors (97.3%; n = 72) supported the inclusion of oral health care in the health conditionality of the Bolsa Família Program, but 82.4% (n = 61) stated they did not promote oral health activities to children covered by the Bolsa Família Program. Children in the routine care setting were more often referred to dentists than children covered by the Bolsa Familia Program (p≤0.001). Parents/caregivers (99.2%; n = 381) agreed that oral health care is important and 99.5% (n = 382) would like their children to be seen regularly.

CONCLUSIONS

No collaboration was observed between the Bolsa Família Program and the Family Health Program with regard to the provision of oral health care. Making oral health care a Bolsa Família Program conditionality may reduce oral health care inequalities for extreme poor children under seven in Brazil.

Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region

In 2003, 19 public dental clinics in Västra Götaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region.

OBJECTIVE

To evaluate caries increment and to perform a cost analysis of the programme.

BASIC RESEARCH DESIGN

A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n = 3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n = 13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n = 11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (≈ 44€) per adolescent.

RESULTS

Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15.

CONCLUSIONS

This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Västra Götaland Region in Sweden.

An Innovative Project Breaks Down Barriers to Oral Health Care for Vulnerable Young Children in Los Angeles County

Despite the high rate of untreated tooth decay, many young children in California under six years of age have never been to a dentist. Numerous and complex barriers to access to oral health care for young children exist, and a multifaceted approach is required to improve receipt of preventive and treatment services that could improve the oral health of this population. This policy brief describes the UCLA-First 5 LA 21st Century Dental Homes Project, which was designed to improve oral health care for young children in 12 Federally Qualified Health Center (FQHC) clinic sites with co-located dental and primary care services and its accessibility in their service areas throughout Los Angeles County. The project funded infrastructure and staffing, provided technical assistance to improve operations, trained clinical personnel to provide oral health care to young children, implemented a quality improvement learning collaborative, trained parents and child care providers in oral hygiene and healthy habits, and disseminated information to promote effective policies. Early data on the project indicated twofold increases in delivery of both diagnostics and treatment visits for young children, and a threefold increase in preventive services for young children during the program.

Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program

INTRODUCTION

Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities.

METHODS

Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015.

RESULTS

In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively).

CONCLUSIONS

Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.

Identifying and prioritising areas of child dental service need: a GIS-based approach

AIM

To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia.

DESIGN

All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics).

RESULTS

The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere.

CONCLUSION

The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

Parent's pro-health awareness concerning oral health of their children in the light of survey research

BACKGROUND

Oral hygiene is a crucial part of caring for young children. This problem is frequently marginalized or even ignored by parents/guardians, what affects child's whole further life.

OBJECTIVES

The assessment of parents' knowledge concerning oral hygiene and prevention of dental caries in infants and young children.

MATERIALS AND METHOD

The test group consisted of parents, as well as men and women currently expecting a child. The study was conducted in a form of a survey, using an original questionnaire, which was carried out in several hospitals in Lodz and online, on a popular local forum for parents. The data obtained were analyzed statistically, allowing the assessment of health awareness of respondents and the creation of various profiles of parental knowledge on the subject investigated.

RESULTS

Most of respondents knew the age at which milk and permanent teeth erupt, gave the correct frequency of brushing child's teeth and were in favor of limiting sweets in the diet. A total of 59% correctly gave the number of deciduous teeth and 66% had heard of the "bottle tooth decay". All respondents thought that helping and controlling a child while brushing their teeth is indispensable, but they did not know the best time to start using the toothpaste with fluoride. The information about child's oral hygiene was more often looked for by women (67%) than by men (29%). The study also showed that if a training on the given subject was organized, 60% of respondents would be willing to participate in it.

CONCLUSION

In the test group, pro-health awareness is insufficient to maintain the oral health of the offspring and requires constant developing.

Prospective study on dental extractions carried out for paediatric patients under general anaesthetic in a district general hospital

BACKGROUND

The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation.

AIM

To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures.

METHOD

Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon.

RESULTS

78 paediatric cases requiring dental extractions were carried out during the study period. 91% of referrals came from local general dental practitioners (GDPs). The indication for the GA was included in 59% of the referral letters. The number of teeth extracted per case ranged from 1 - 14. In 18% of cases treatment under local anaesthetic had been attempted previously. Conscious sedation had not been attempted in any of the cases. There were 5 cases (6.4%) of repeat general anaesthetic procedures.

CONCLUSION

Local guidance regarding appropriate paediatric referrals should be distributed to primary care referrers. Treatment under conscious sedation should be considered for paediatric cases and an improved referral pathway to the community dental service should be developed. Preventative advice should be reinforced to the referrer and to the patient.

The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte's method of categorizing people's perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child's age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.

Campus-Based, Community-Based, and Philanthropic Contributions to Predoctoral Pediatric Dental Clinical Education: Two Years of Experiences at One Dental College

The aim of this study was to investigate the contribution of a tiered predoctoral pediatric dentistry clinical education model to competency achievement by dental students over a two-year clinical education. Retrospective data were obtained for academic years 2012-13 and 2013-14 from three sources: a campus-based, dental school-housed clinic; division-directed clinics in community-based pediatric and special needs clinics (DDC); and clinics affiliated with the dental college's community-based dental education (CBDE) program, the OHIO Project (OP). A fourth dataset was obtained for the same two-year period from a biannual clinic event held at the college in conjunction with Give Kids a Smile Day (GKAS). Procedures considered essential to the care of children were sorted by 12 dental codes from all services for patients 18 years of age and younger. The dental school clinic provided 11,060 procedures; the DDC, 28,462; the OP, 17,863; and GKAS, 2,028. The two-year total was 59,433 procedures. Numbers of diagnostic and preventive procedures were 19,441, restorative procedures were 13,958, and pulp and surgical procedures were 7,392. Site contribution ranged from 52.2 to 144.9 procedures per attending student, with the DDC yielding the highest per student average for each year (126.4 and 144.9) and the dental school clinic the lowest (52.2 and 53.1). This study found that a combination of school-based, community-based, and philanthropic pediatric dental experiences offered a large number of essential pediatric dentistry experiences for predoctoral dental students, with CBDE opportunities offering the largest contribution.

The Impact of Medicaid Reform on Children's Dental Care Utilization in Connecticut, Maryland, and Texas

OBJECTIVE

To measure the impact of Medicaid reforms, in particular increases in Medicaid dental fees in Connecticut, Maryland, and Texas, on access to dental care among Medicaid-eligible children.

DATA

2007 and 2011-2012 National Survey of Children's Health.

STUDY DESIGN

Difference-in-differences and triple differences models were used to measure the impact of reforms.

PRINCIPAL FINDINGS

Relative to Medicaid-ineligible children and all children from a group of control states, preventive dental care utilization increased among Medicaid-eligible children in Connecticut and Texas. Unmet dental need declined among Medicaid-eligible children in Texas.

CONCLUSIONS

Increasing Medicaid dental fees closer to private insurance fee levels has a significant impact on dental care utilization and unmet dental need among Medicaid-eligible children.

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children

PURPOSE

The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children.

METHODS

This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models.

RESULTS

In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, P<.05).

CONCLUSIONS

There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

Improving access to dental care for vulnerable children; further development of the Back2School programme in 2013

This paper describes a service evaluation of a dental treatment programme providing care to children not normally taken to the dentist. It explains the extension of the Back2School programme from the pilot phase and assesses if a mobile dental unit (MDU) can provide a high quality service. The public health competencies it illustrates include oral health improvement, developing and monitoring quality dental services, and collaborative working.

Influence of Oral Problems and Biopsychosocial Factors on the Utilization of Dental Services by Preschool Children

PURPOSE

The purpose of this study was to evaluate the influence of oral problems and biopsychosocial factors on the use of dental services by preschoolers.

METHODS

A cross-sectional study was carried out with preschoolers in northeastern Brazil. Parents answered questions on visits to the dentist and sociodemographic characteristics, and completed the Brazilian version of the Early Childhood Oral Health Impact Scale. An oral examination was performed by three dentists who were calibrated for the diagnosis of dental caries, traumatic dental injury, and malocclusion. Descriptive statistics and Poisson regression analysis with robust variance were performed (α equals five percent).

RESULTS

There were 841 children in the study whose prevalence rate of utilization of dental services was 24 percent. Utilization was significantly associated with the child's age, mother's schooling over eight years, household income, severity of dental caries, and impact on the quality of life of the family.

CONCLUSION

Caries severity, sociodemographic factors, and psychological factors exerted an influence on the utilization of dental services by preschool children.

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study

OBJECTIVE

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty.

METHODS

We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation.

RESULTS

Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history.

CONCLUSION

This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

Treatment provided in the Public Dental Service in Finland in 2009

OBJECTIVES

To analyse treatment measures provided in the Public Dental Service (PDS) and to discuss the therapy given against treatment needs as expressed in the national clinical epidemiological studies.

METHODS

In 2009, the Chief Dentists of the PDS units collected data from their local registers on patients and treatment provided. Data were obtained from 166 PDS units (86%). Treatment patterns were compared between age groups, provider groups and geographical areas using chi-square tests.

RESULTS

Altogether 8.9 million treatments were provided for 1.7 million patients. Examinations, restorative treatment and anaesthesia accounted for 61.3% of all treatments. Preventive measures (8.4%) and periodontal treatment (6.3%) were small proportions of the total. Prosthetic treatment was uncommon (0.5%). Working age adults received half of all treatments (53.2%), the young a third (36.4%) and the elderly 10.4%. Dental hygienists or dental assistants provided 29.7% of all treatment for children and adolescents, 11.1% for adults and 14.1% for the elderly.

CONCLUSION

Relatively healthy children had plenty of examinations and preventive measures, and adults had mostly restorative care when their needs were more periodontal and prosthetic care, indicating that treatment given was not fully in line with needs.

Tracking early visits to the dentist: a look at the first 3 years of the Manitoba Dental Association’s Free First Visit program

INTRODUCTION

In 2010, the Manitoba Dental Association launched its Free First Visit (FFV) program to provide dental screening for infants and toddlers. In this article, we review 3 years of FFV data submitted by participating dentists.

METHODS

Data from tracking forms were reviewed for children≤36 months of age. These forms include the age of the child at the time of their FFV, their home postal code and caries status. Descriptive and bivariate analyses were carried out, and postal code geomapping was completed.

RESULTS

Of the 8396 tracking forms submitted, 51.8% were for boys. The mean age at the time of the first visit was 24.2±7.8 months. Although only 8.5% had an FFV by 12 months, 26.7% had an FFV by 18 months. The average number of FFVs per month was 231.4±49.7. Postal code mapping revealed that participation was highest for children in the southern half of the province, including some high-needs neighbourhoods in Winnipeg. Pediatric dentists provided most FFVs and saw significantly younger children compared with general dentists (23.8±7.8 months of age vs. 25.2±7.7 months, p<0.001).

CONCLUSIONS

Although many Manitoba children have had an FFV, few visit a dentist by 12 months, as recommended by the dental profession. There is a need to improve the proportion of children visiting a dentist by the recommended age, and general practitioners should assume a greater role in providing this service.

Use of preventive dental care among medicaid-enrolled, school-aged US children in immigrant and nonimmigrant families: trends in Pennsylvania From 2005 through 2010

OBJECTIVES

We describe trends in receipt of preventive dental care among Medicaid-enrolled children in Pennsylvania between 2005 and 2010, comparing the US children of immigrants with their co-ethnic peers in nonimmigrant families.

METHODS

We analyzed Pennsylvania Medicaid claims, birth records, and census data for children born in Pennsylvania and enrolled in Medicaid for 10 or more months during any of the calendar years assessed.

RESULTS

Receipt of preventive dental care was more likely among Latino children in immigrant families than among their peers in nonimmigrant families; also, it was more likely among White children in immigrant families than among their peers in nonimmigrant families. Rates of preventive dental care use among African American and Asian children in immigrant and nonimmigrant families were comparable. From 2005 to 2010, the percentage of Latino children in nonimmigrant families who received preventive dental care increased from 33% to 61%. Changes in other groups were significant but less dramatic.

CONCLUSIONS

Receipt of preventive dental care has increased among Medicaid-enrolled children in Pennsylvania, with marked gains among Latino children. Within each racial/ethnic group, the children of immigrants were either more likely than or equally likely as children in nonimmigrant families to receive care.

Dental workforce capacity and California's expanding pediatric Medicaid population

The number of children eligible for Medicaid dental coverage in California will increase to nearly 5 million because of the Affordable Care Act the transition of nearly 880,000 children from California's Children's Health Insurance Program (CHIP) to Medicaid. This study assesses the dental capacity to serve this population. Supply projections indicate that deficits are likely in rural and urban counties after the CHIP population is and the ACA is fully implemented.

Do early dental visits reduce treatment and treatment costs for children?

PURPOSE

The purpose of this paper was to determine if number and cost of dental treatments in high caries-risk children differs in children with early dental intervention compared to children with later intervention.

METHODS

Billing data from children age zero to seven years old, whose first dental visit was between January 1, 2004 and December 31, 2004, were collected from 20 corporate treatment centers serving children from lower socioeconomic status backgrounds. Data included age at first visit, dental treatment codes, and associated costs for eight years after the first dental visit. Treatment included restorations, crowns, pulpotomies, and extractions. First visit age was categorized into early starters (younger than four years old) and late starters (four years of age or older). Linear regression with cluster adjustment for clinic determined a difference in costs and dental treatments by early and late starters.

RESULTS

Of 42,532 subjects, 17,040 (40 percent) were early starters and 25,492 (60 percent) were late starters. There were 3.58 more dental procedures performed on late starters, over eight years of follow-up, than on early starters (P<.001). Late starters spent $360 more over eight years of follow-up than early starters (P<.001).

CONCLUSION

In this study, number of procedures performed were fewer and cost of treatment less for children seen earlier versus later.

Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective to the take-up of mammography screening

While there are abundant descriptions of socioeconomic inequalities in preventive health care, knowledge about the true mechanisms is still lacking. Recently, the role of cultural health capital in preventive health-care inequalities has been discussed theoretically. Given substantial analogies, we explore how our understanding of cultural health capital and preventive health-care inequalities can be advanced by applying the theoretical principles and methodology of the life-course perspective. By means of event history analysis and retrospective data from the Survey of Health Ageing and Retirement, we examine the role of cultural capital and cultural health capital during childhood on the timely initiation of mammography screening in Belgium (N = 1348). In line with cumulative disadvantage theory, the results show that childhood cultural conditions are independently associated with mammography screening, even after childhood and adulthood socioeconomic position and health are controlled for. Lingering effects from childhood are suggested by the accumulation of cultural health capital that starts early in life. Inequalities in the take-up of screening are manifested as a lower probability of ever having a mammogram, rather than in the late initiation of screening.