Fluoride Knowledge and Prescription Practices Among Dentists

Fluoride Prescribing Behaviors for Medicaid-Enrolled Children in Oregon

INTRODUCTION

This study aims to examine physician and dentist fluoride prescription patterns and identify the factors associated with fluoride prescriptions for Medicaid-enrolled children. The hypothesis is that dentists will be the primary prescribers of fluoride and that caries risk factors will be associated with fluoride prescriptions.

METHODS

Data were analyzed for Oregon children aged 0-17 years enrolled in Medicaid for ≥300 days in both 2016 and 2017. The outcome variable was receiving a fluoride prescription in 2017. A 2-tailed chi-square test was used to assess fluoride prescribing differences between physicians and dentists. Multivariable logistic regression models were used to examine the likelihood of receiving a fluoride prescription in 2017 and to generate ORs. Model covariates included child's age, sex, race, ethnicity, Medicaid plan type, previous fluoride prescription, previous restorative dental treatment, and water fluoridation status.

RESULTS

Of 200,169 Medicaid-enrolled children, 6.7% (n=13,337) received fluoride prescriptions. Physicians were >3 times as likely to prescribe fluoride as dentists (73.4% vs 23.0%, p<0.001). Children with a history of fluoride prescriptions (OR=14.30, p<0.001) and any restorative dental treatment (OR=1.58, p<0.001) were significantly more likely to receive a fluoride prescription, whereas children living in areas with water fluoridation were significantly less likely (OR=0.50, p=0.01).

CONCLUSIONS

Physicians play an important role in prescribing fluoride to Medicaid-enrolled children, especially those at increased dental caries risk. Additional research is needed on strategies to ensure that all high-risk children have an opportunity to benefit from prescription fluoride.

Topical fluoride use: Knowledge, attitudes and practices of undergraduate dental students of three Dental Colleges in South India

OBJECTIVES

For effective utilisation of topical fluorides in caries prevention, dental professionals should have adequate knowledge regarding its appropriate use. The decision regarding preventive treatments like topical fluorides is influenced by knowledge acquired during undergraduate training. The aim of this study was to assess the knowledge, attitudes and practices of undergraduate dental students in the use of topical fluorides.

METHODOLOGY

A descriptive cross-sectional questionnaire study was conducted from June to August 2015 following ethical clearance. Three willing Dental Colleges from 3 states of South India participated. Information regarding the knowledge, attitudes and practices of students in the use of topical fluorides was collected using a validated questionnaire.

RESULTS

Nine hundred and seventy-two dental students (79.6% females, 20.4% males) participated. Freshers and preclinical batches had poor overall knowledge of fluorides, which did not show substantial improvement by internship. Self-applied topical fluoride use (fluoridated toothpaste) was seen in more than 90% of interns, and majority had "positive fluoride attitude." Having knowledge of topical fluorides and positive attitudes to topical fluorides did not result in "good oral self-care behaviour" nor appropriate clinical use of topical fluorides. Students who used topical fluorides for persons with history of caries had highest odds of brushing twice a day (OR = 2.7, 95% CI = 1.54, 4.12) and a "positive fluoride attitude" (OR = 1.2, 95% CI = 0.21, 1.57).

CONCLUSION

Dental students showed deficiencies in their knowledge and understanding of topical fluorides. Dental education in India needs emphasis on topical fluorides across all years, with a special focus on caries risk-based topical fluoride use.

Early Childhood Caries-Related Knowledge, Attitude, and Practice: Discordance between Pediatricians and Dentists toward Medical Office-Based Prevention in Taiwan

The aim of this study was to assess the knowledge, attitude, and practice regarding early childhood caries (ECC) prevention and implementation of medical setting-based caries prevention among pediatricians and dentists in Taiwan. Data were collected from currently practicing pediatricians and general and pediatric dentists using self-administered questionnaires. A total of 301 questionnaires were completed by the pediatricians (n = 105), general dentists (n = 117), and pediatric dentists (n = 79). The pediatric dentists obtained significantly higher knowledge and practice scores than the general dentists and pediatricians (p < 0.0001). The pediatricians’ attitude score related to engaging physicians in medical office-based caries prevention was significantly higher than the attitude scores of the general and pediatric dentists (p < 0.05). A Spearman rank correlation analysis indicated a significant positive correlation between knowledge and practice among the general dentists (r_s = 0.271, p < 0.01) and pediatricians (r_s = 0.262, p < 0.01). The correlation between knowledge and attitude among the pediatricians was significantly positive (r_s = 0.242, p < 0.05). Attitude and practice among the pediatricians were significantly positively correlated (r_s = 0.271, p < 0.01). Pediatricians lacked ECC-related knowledge; however, they had a more positive attitude toward medical office-based prevention when they had a higher level of knowledge. Oral health-related education for pediatricians is necessary if such medical office-based caries prevention programs are to be implemented in Taiwan.

Differential diagnosis of dental fluorosis made by undergraduate dental students

OBJECTIVE

To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment.

METHODS

Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes.

RESULTS

Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree.

CONCLUSION

Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network

OBJECTIVES

Few studies have examined dentists' subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP).

METHODS

Data were collected as part of a questionnaire entitled 'Assessment of Caries Diagnosis and Caries Treatment', completed by 547 practitioners who belong to The Dental Practice-Based Research Network (DPBRN), a consortium of participating practices and dental organizations.

RESULTS

Sixty-nine percent of DPBRN dentists perform CRA on their patients. Recently graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and individualized prevention was weaker than expected (r = 0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use CRA appear to use this information in restorative decisions.

CONCLUSION

A substantial percentage of DPBRN dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.