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Whitney K, Felt B, Collins-Anderson A, Bonuck K. The Feasibility of Screening for Sleep Problems in Early Childhood Education Programs. Behav Sleep Med 2024; 22:28-38. [PMID: 36751036 PMCID: PMC10404644 DOI: 10.1080/15402002.2023.2177294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Assess the feasibility and staff experience of screening for behavioral sleep problems (BSP) and sleep disordered breathing (SDB) in early childhood education (ECE) settings; examine BSP/SDB prevalence and caregivers' knowledge/attitudes, perception of child sleep problems, and sleep health engagement in this sample. METHOD Eight staff representatives from four ECE sites involved with sleep problem screening procedures within a larger RCT on ECE sleep health, discussed their experiences in a focus group; transcript content reviewed. A random subset of caregiver-child dyads (n = 59) from the four ECE sites completed sleep problem measures (BSP: Children's Sleep Habits Questionnaire, Short form [SF-CSHQ], Tayside Children's Sleep Questionnaire [TCSQ-sleep disturbance and difficulty] and SDB: Pediatric Sleep Questionnaire [PSQ], in addition to RCT measures (Parent Knowledge/Attitude/Self-efficacy/Beliefs survey and sleep health goals). Caregiver sleep health engagement was measured by the sleep health goals set. RESULTS ECE staff reported sleep problem screening as self-explanatory and doable but sometimes administratively burdensome. BSPs were identified in 44% (SF-CSHQ) to 63% (TCSQ-sleep disturbance) of children; SDBs in 13%. Only 11% of caregivers endorsed their child having a sleep "difficulty" (TCSQ). Sleep health goals were set by 85% of caregivers; 63% employed educational materials' language. CONCLUSION Sleep problem screening in ECE is feasible, and problems are elicited. While caregivers readily engage in setting healthy sleep goals, few endorse sleep as difficult. ECE education could improve caregiver understanding/recognition of sleep problems.
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Affiliation(s)
- Kimberly Whitney
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY
| | - Barbara Felt
- University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI
| | | | - Karen Bonuck
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY
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Soldo M, Matijević J, Malčić Ivanišević A, Čuković-Bagić I, Marks L, Nikolov Borić D, Jukić Krmek S. Impact of oral hygiene instructions on plaque index in adolescents. Cent Eur J Public Health 2020; 28:103-107. [PMID: 32592553 DOI: 10.21101/cejph.a5066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/11/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study, which consisted of a motivational lecture and hands-on training, was to evaluate the role of oral hygiene education for adolescents. METHODS The study population included sixty-two high school students between fourteen and fifteen years of age (thirty males and thirty-two females). The response rate was 76.5%. The measurement of oral hygiene level was performed using the modified Green Vermilion Index (GVI). The values were recorded at baseline, one week, three months, and six months after education through motivational lecture and hands-on training was performed. Descriptive and nonparametric statistical methods were used in statistical analysis. Level of significance was 0.05. RESULTS At the beginning of the study, the GVI of all examined subjects was 3.52 (SD = 0.70). One week after the motivational lecture and training, it decreased to 2.64 (SD = 0.69). Three months later, the level of plaque index had the lowest value (1.44; SD = 0.66). At the end of the study the level of plaque index increased to 2.52 (SD = 0.86). CONCLUSIONS A significant oral hygiene improvement in adolescents as a result of education was presented. However, due to a decline in oral hygiene level six months after the education, there is a need for educational programmes continuity.
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Affiliation(s)
- Mirko Soldo
- Department of Orthodontics, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Jurica Matijević
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Malčić Ivanišević
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Čuković-Bagić
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Luc Marks
- Centre for Special Care in Dentistry, Ghent University Hospital, Ghent, Belgium
| | | | - Silvana Jukić Krmek
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Hultquist AI, Bågesund M. Dentin caries risk indicators in 1-year-olds. A two year follow-up study. Acta Odontol Scand 2016; 74:613-619. [PMID: 27624864 DOI: 10.1080/00016357.2016.1227085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence. AIM Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence. DESIGN Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors. RESULTS An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel. CONCLUSIONS Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.
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Bolding LM, Masri R, Arola D, Driscoll CF, Romberg E. Caries management by risk assessment (CAMBRA) and its effect on the surface roughness of various restorative materials. J Prosthet Dent 2015; 114:543-8. [PMID: 26182853 DOI: 10.1016/j.prosdent.2015.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM Whether topical anticaries medicaments used in the oral environment will affect the surface integrity of restorative materials is uncertain. PURPOSE The purpose of this in vitro study was to investigate the effect of various anticaries agents on the surface roughness of 3 different restorative materials. MATERIAL AND METHODS Sixty-four specimens of each restorative material (feldspathic porcelain, Ni-Cr metal ceramic alloy, and Ti-6Al-4V titanium alloy) were prepared and separated into 4 equal groups for soaking in anticaries agents (Prevident Dental Rinse, ACT mouth wash, chlorhexidine gluconate, and water). A profilometer was used to measure surface roughness before and after soaking the materials for 2 years of simulated usage. The mean change in surface roughness for each specimen was calculated. Statistical analysis was performed with a 2-way ANOVA, followed by the Tukey HSD test (α=.05). RESULTS A significant interaction was found between the materials and anticaries agents (F=2.64, P=.02). The significant interaction was between Prevident and chlorhexidine gluconate. Porcelain specimens soaked in Prevident produced a negative change (-0.072 ±0.35 μm) in surface roughness (smoother surface), while chlorhexidine gluconate produced a positive change (0.094 ±0.42 μm) in surface roughness (rougher surface). CONCLUSION Within the limitations of this in vitro study, it can be concluded that Prevident Dental Rinse and chlorhexidine gluconate may cause a change in the surface roughness of feldspathic porcelain.
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Affiliation(s)
- Lauren M Bolding
- Former Resident, Postgraduate Prosthodontics, Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, Md
| | - Radi Masri
- Associate Professor, Department of Endodontics, Prosthodontics and Operative Dentistry, School of Dentistry, University of Maryland, Baltimore, Md.
| | - Dwayne Arola
- Professor, Department of Mechanical Engineering, University of Maryland, Baltimore, Md
| | - Carl F Driscoll
- Program Director and Professor, Postgraduate Prosthodontics, Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland, Baltimore, Md
| | - Elaine Romberg
- Professor Emerita, Department of Orthodontics and Pediatric Dentistry, University of Maryland, Baltimore, Md
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Chi DL, Rossitch KC, Beeles EM. Developmental delays and dental caries in low-income preschoolers in the USA: a pilot cross-sectional study and preliminary explanatory model. BMC Oral Health 2013; 13:53. [PMID: 24119240 PMCID: PMC3906997 DOI: 10.1186/1472-6831-13-53] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anecdotal evidence suggests that low-income preschoolers with developmental delays are at increased risk for dental caries and poor oral health, but there are no published studies based on empirical data. The purpose of this pilot study was two-fold: to examine the relationship between developmental delays and dental caries in low-income preschoolers and to present a preliminary explanatory model on the determinants of caries for enrollees in Head Start, a U.S. school readiness program for low-income preschool-aged children. METHODS Data were collected on preschoolers ages 3-5 years at two Head Start centers in Washington, USA (N = 115). The predictor variable was developmental delay status (no/yes). The outcome variable was the prevalence of decayed, missing, and filled surfaces (dmfs) on primary teeth. We used multiple variable Poisson regression models to test the hypothesis that within a population of low-income preschoolers, those with developmental delays would have increased dmfs prevalence than those without developmental delays. RESULTS Seventeen percent of preschoolers had a developmental delay and 51.3% of preschoolers had ≥1 dmfs. Preschoolers with developmental delays had a dmfs prevalence ratio that was 1.26 times as high as preschoolers without developmental delays (95% CI: 1.01, 1.58; P < .04). Other factors associated with increased dmfs prevalence ratios included: not having a dental home (P = .01); low caregiver education (P < .001); and living in a non-fluoridated community (P < .001). CONCLUSIONS Our pilot data suggest that developmental delays among low-income preschoolers are associated with increased primary tooth dmfs. Additional research is needed to further examine this relationship. Future interventions and policies should focus on caries prevention strategies within settings like Head Start classrooms that serve low-income preschool-aged children with additional targeted home- and community-based interventions for those with developmental delays.
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Affiliation(s)
- Donald L Chi
- University of Washington, Box 357475, Seattle 98195, WA, USA
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Beil H, Rozier RG, Preisser JS, Stearns SC, Lee JY. Effect of early preventive dental visits on subsequent dental treatment and expenditures. Med Care 2012; 50:749-56. [PMID: 22525611 PMCID: PMC3419323 DOI: 10.1097/mlr.0b013e3182551713] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Professional organizations recommend a preventive dental visit by 1 year of age. This study compared dental treatment and expenditures for Medicaid children who have a preventive visit before the age of 18 months with those who have a visit at age 18-42 months. METHODS This retrospective cohort study used reimbursement claims for 19,888 children enrolled in North Carolina Medicaid (1999-2006). We compared the number of dental treatment procedures at age 43-72 months for children who had a visit by age 18 months with children who had a visit at ages 18-24, 25-30, 31-36, and 37-42 months using a zero-inflated negative binomial model. The likelihood and amount of expenditures at age 43-72 months were compared by group using a logit and ordinary least squares regression. RESULTS Children who had a primary or secondary preventive visit by age 18 months had no difference in subsequent dental outcomes compared with children in older age categories. Among children with existing disease, those who had a tertiary preventive visit by age 18 months had lower rates of subsequent treatment [18-24 mo incidence density ratio (IDR): 1.19, 95% confidence interval (CI), 1.03-1.38; 25-30 mo IDR: 1.21, 95% CI, 1.06-1.39; 37-42 mo IDR: 1.39, 95% CI, 1.22-1.59] and lower treatment expenditures compared with children in older age categories. CONCLUSIONS In this sample of preventive dental users in Medicaid, we found that children at highest risk of dental disease benefited from a visit before the age of 18 months, but most children could delay their first visit until the age of 3 years without an effect on subsequent dental outcomes.
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Affiliation(s)
- Heather Beil
- School of Nursing, University of North Carolina at Chapel Hill, NC 27599-7590, USA.
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Weber-Gasparoni K, Goebel BM, Drake DR, Kramer KW, Warren JJ, Reeve J, Dawson DV. Factors associated with mutans streptococci among young WIC-enrolled children. J Public Health Dent 2012; 72:269-78. [DOI: 10.1111/j.1752-7325.2012.00335.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hirsch GB, Edelstein BL, Frosh M, Anselmo T. A simulation model for designing effective interventions in early childhood caries. Prev Chronic Dis 2012; 9:E66. [PMID: 22380939 PMCID: PMC3366771 DOI: 10.5888/pcd9.110219] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Early childhood caries (ECC)--tooth decay among children younger than 6 years--is prevalent and consequential, affecting nearly half of US 5-year-olds, despite being highly preventable. Various interventions have been explored to limit caries activity leading to cavities, but little is known about the long-term effects and costs of these interventions. We developed a system dynamics model to determine which interventions, singly and in combination, could have the greatest effect in reducing caries experience and cost in a population of children aged birth to 5 years. METHODS System dynamics is a computer simulation technique useful to policy makers in choosing the most appropriate interventions for their populations. This study of Colorado preschool children models 6 categories of ECC intervention--applying fluorides, limiting cariogenic bacterial transmission from mothers to children, using xylitol directly with children, clinical treatment, motivational interviewing, and combinations of these--to compare their relative effect and cost. RESULTS The model projects 10-year intervention costs ranging from $6 million to $245 million and relative reductions in cavity prevalence ranging from none to 79.1% from the baseline. Interventions targeting the youngest children take 2 to 4 years longer to affect the entire population of preschool-age children but ultimately exert a greater benefit in reducing ECC; interventions targeting the highest-risk children provide the greatest return on investment, and combined interventions that target ECC at several stages of its natural history have the greatest potential for cavity reduction. Some interventions save more in dental repair than their cost; all produce substantial reductions in repair cost. CONCLUSION By using data relevant to any geographic area, this system model can provide policy makers with information to maximize the return on public health and clinical care investments.
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MacRitchie HMB, Longbottom C, Robertson M, Nugent Z, Chan K, Radford JR, Pitts NB. Development of the Dundee Caries Risk Assessment Model (DCRAM) - risk model development using a novel application of CHAID analysis. Community Dent Oral Epidemiol 2011; 40:37-45. [DOI: 10.1111/j.1600-0528.2011.00630.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Weber-Gasparoni K, Kanellis MJ, Qian F. Iowa's Public Health-Based Infant Oral Health Program: A Decade of Experience. J Dent Educ 2010. [DOI: 10.1002/j.0022-0337.2010.74.4.tb04880.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Fang Qian
- Department of Preventive and Community Dentistry-all in the College of Dentistry; University of Iowa
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Brickhouse TH, Rozier RG, Slade GD. Effects of enrollment in medicaid versus the state children's health insurance program on kindergarten children's untreated dental caries. Am J Public Health 2008; 98:876-81. [PMID: 18382008 DOI: 10.2105/ajph.2007.111468] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared levels of untreated dental caries in children enrolled in public insurance programs with those in nonenrolled children to determine the impact of public dental insurance and the type of plan (Medicaid vs State Children's Health Insurance Program [SCHIP]) on untreated dental caries in children. METHODS Dental health outcomes were obtained through a calibrated oral screening of kindergarten children (enrolled in the 2000-2001 school year). We obtained eligibility and claims data for children enrolled in Medicaid and SCHIP who were eligible for dental services during 1999 to 2000. We developed logistic regression models to compare children's likelihood and extent of untreated dental caries according to enrollment. RESULTS Children enrolled in Medicaid or SCHIP were 1.7 times (95% confidence interval [CI] = 1.65, 1.77) more likely to have untreated dental caries than were nonenrolled children. SCHIP-enrolled children were significantly less likely to have untreated dental caries than were Medicaid-enrolled children (odds ratio [OR]=0.74; 95% CI=0.67, 0.82). According to a 2-part regression model, children enrolled in Medicaid or SCHIP have 17% more untreated dental caries than do nonenrolled children, whereas those in SCHIP had 16% fewer untreated dental caries than did those in Medicaid. CONCLUSIONS Untreated tooth decay continues to be a significant problem for children with public insurance coverage. Children who participated in a separate SCHIP program had fewer untreated dental caries than did children enrolled in Medicaid.
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Affiliation(s)
- Tegwyn H Brickhouse
- School of Public Health, University of North Carolina, Chapel Hill, NC, USA.
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Quaglio JM, Sousa MB, Ardenghi TM, Mendes FM, Imparato JCP, Pinheiro SL. Association between clinical parameters and the presence of active caries lesions in first permanent molars. Braz Oral Res 2007; 20:358-63. [PMID: 17242799 DOI: 10.1590/s1806-83242006000400014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 07/06/2006] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to evaluate the association between clinical parameters and the presence of active caries lesions on the occlusal surface of first permanent molars. Forty eight children (5.8-13.8 years-old) with at least one first permanent molar present were selected. The clinical parameters evaluated were gender, age, DMF-T and dmf-t, presence of active white spots in other teeth, general plaque index, tooth's dental arch (upper or lower), tooth's side (right or left), presence of visible plaque and eruption degree of the first permanent molars. The first permanent molars were evaluated through visual inspection by two examiners in order to assess the presence of active or inactive caries lesions on the occlusal surface. Univariate and multivariate analyses for determination of the association between clinical parameters and the presence of active caries lesions in these teeth were performed. The presence of active white spots in other teeth was associated with the presence of active caries lesions in the first permanent molars, in both univariate and multivariate analyses (Odds ratio = 8.8 and 1.9, respectively). The presence of abundant visible plaque on the occlusal surface of the first permanent molars (Odds ratio = 3.5 in the univariate analysis, and 3.9 in the multivariate one) also presented a significant association. In conclusion, the presence of active white spots in other teeth and the presence of considerable visible plaque were associated with the presence of active caries lesions on the occlusal surfaces of first permanent molars.
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Affiliation(s)
- Juliana Maria Quaglio
- Department of Pediatric Dentistry, School of Dentistry, Hermínio Ometto University Center, Araras, Brazil
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Petti S, Hausen H. Caries-Preventive Effect of Chlorhexidine Gel Applications among High-Risk Children. Caries Res 2006; 40:514-21. [PMID: 17063023 DOI: 10.1159/000095651] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 01/23/2006] [Indexed: 12/31/2022] Open
Abstract
Evidence on the caries-preventive effect of chlorhexidine (CHX) among high-risk children is inconclusive, possibly because obscured by fluoride exposure. We investigated the effect of CHX among initially 3-year-old subjects whose baseline d(3)ft was = 0 and whose only regular fluoride exposure came from toothpaste. The subjects were assigned to three groups: high-risk test (HRT, n = 70), high-risk control (HRC, n = 71), and low-risk control (LRC, n = 70). Risk classification was based on salivary mutans streptococcal levels (MS, </>or=1.0 x 10(5) cfu/ml). Basic measures (oral hygiene, dietary counselling every 4 months) were given to all groups. HRT also underwent CHX gel applications for 3 consecutive days at 3-month intervals for 15 months. Eighteen months after baseline d(3)ft increments and proportions of children with d(3)ft increment >or=1 (%d(3)ft increment >or=1) among all groups were assessed. Anti-MS effect on high-risk children and caries-preventive effect on all children were statistically analysed by residual change analysis (MS), non-parametric tests and logistic regression analysis (caries). No differences were found between the groups in basic programme compliance. CHX significantly reduced MS levels. %d(3)ft increment >or=1 and mean d(3)ft increments were 34.3%, 0.56 (HRT), 32.4%, 0.54 (HRC) and 11.4%, 0.11 (LRC), with HRT/HRC values statistically significantly higher than LRC values and no significant difference between HRT and HRC. HRT children were not less likely to show new lesions than HRC children (OR = 1.09; 95% confidence interval 0.54-2.19), while high-risk children were 4 times more likely to show new lesions than low-risk children (OR = 3.71; 95% confidence interval 1.53-9.03). CHX gel applications showed moderate anti-MS effect but negligible caries-preventive effect.
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Affiliation(s)
- S Petti
- G. Sanarelli Department of Public Health Sciences, La Sapienza University, Rome, Italy.
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Pediatric Oral Health and Nutrition. TOP CLIN NUTR 2005. [DOI: 10.1097/00008486-200507000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quiñonez RB, Downs SM, Shugars D, Christensen J, Vann WF. Assessing cost-effectiveness of sealant placement in children. J Public Health Dent 2005; 65:82-9. [PMID: 15929545 DOI: 10.1111/j.1752-7325.2005.tb02791.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The lack of cost-effectiveness information regarding sealant placement strategies is thought to have influenced reimbursement policies and subsequent sealant utilization in dental practice. This study compared three strategies for managing the occlusal surfaces of first permanent molars: seal all (SA), risk-based (RBS), and seal none (SN). METHODS A decision tree was developed for various possible outcomes following each of the above strategies. Due to the complexity of the decision tree, a Markov model was used to allow for the construction of a chain of events representing the natural history of sealant retention, caries formation, and their associated health states. The outcome measures were the incremental cost per month gained in a cavity-free state over a ten-year period. RESULTS Our theoretical model showed that RBS strategy improved clinical outcomes, in the form of cavity-free months, and saved money over SN. The strategy of sealing both high and low risk teeth (SA) further improved outcomes but at an additional cost compared to RBS. However, the cost was small, .08 dollars for each additional cavity-free month gained per tooth. Further, minor changes in the baseline assumptions resulted in the SA strategy being the dominant strategy. CONCLUSION This study provides evidence that sealing children's first permanent molars can improve outcomes and save money by delaying or avoiding invasive treatment and the destructive cycle of caries. In a time of limited funds for dental services, these results can assist payers in establishing more rational sealant reimbursement policies.
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Affiliation(s)
- Rocio B Quiñonez
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599, USA.
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Abstract
OBJECTIVE To compare levels of dental utilization and untreated dental decay among children aged 1 to 3 years that are likely to occur under 2 potential guidance policies: (1) pediatricians refer all toddlers to dentists for screening (consistent with American Academy of Pediatric Dentistry and the American Dental Association recommendations; DENT), and (2) pediatricians receive training in caries risk assessment, screen toddlers, and refer at-risk children to dentists (consistent with American Academy of Pediatrics recommendations; PED). METHODS Using decision analysis, we estimated the impact of PED and DENT assuming alternately unlimited dental capacity for Medicaid-insured patients and fixed Medicaid dental capacity. Results With unlimited capacity, if DENT were implemented, then dental utilization is estimated to increase from 27% under the status quo to 65% and untreated decay to decrease from a mean of 0.60 surfaces to 0.52 surfaces per child. If PED were implemented, then dental utilization and untreated decay would decrease from status quo levels to an estimated 11% and 0.47 surfaces, respectively, assuming that diagnostic sensitivity and specificity both equaled 1; they would decrease to 13% and 0.53 surfaces, respectively, if sensitivity equaled 0.76 and specificity equaled 0.95. With fixed capacity, under DENT, untreated decay is estimated to increase to 0.63 surfaces because low-risk private-pay patients would crowd out at-risk Medicaid-insured children, whereas under PED, untreated decay would still be less than under the status quo. CONCLUSIONS Implementing PED will decrease untreated decay under most plausible scenarios, whereas switching to DENT will increase the burden of disease if Medicaid dental capacity is limited.
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Affiliation(s)
- Kari Jones
- Division of Public-Private Partnerships, National Center for Health Marketing, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K-39, Atlanta, GA 30341, USA.
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Blinkhorn AS, Gratrix D, Holloway PJ, Wainwright-Stringer YM, Ward SJ, Worthington HV. A cluster randomised, controlled trial of the value of dental health educators in general dental practice. Br Dent J 2003; 195:395-400; discussion 385. [PMID: 14551632 DOI: 10.1038/sj.bdj.4810566] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2002] [Accepted: 02/28/2003] [Indexed: 11/09/2022]
Abstract
AIM To test the effectiveness of dental health educators in general dental practice. OBJECTIVE To evaluate the effectiveness and cost of primary care trusts seconding dental health educators free of charge to suitable general dental practices to provide dental health counselling to mothers of regularly attending pre-school children at risk to caries. METHOD Two-cell, parallel group, cluster randomised, controlled clinical trial of two years' duration. CLINICAL SETTING 30 general dental practices in North-West England. PARTICIPANTS 269 mothers of 334 pre-school children. INTERVENTIONS Those in the test group were given visits to a dental health educator over a 2-year period to counsel mothers of at-risk, pre-school children. The rest were held as a control. MAIN OUTCOME MEASURES Caries prevalence of the children and dental health knowledge, attitudes and toothbrushing skills of the parents. The full costs of the exercise were kept throughout. The statistical analysis controlled for the clustering of children within practices. RESULTS After 2 years, 271 (81%) children and 248 (92%) mothers remained in the study. There was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. At the end of the study there was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. No difference in plaque levels was found. The mothers in the test group were more knowledgeable, had better attitudes towards the dental health of their offspring and better toothbrushing skills than those in the control. Each 2-hour session to counsel ten parents cost pound 40. CONCLUSION Primary care trusts should carefully consider the cost value of seconding dental health educators to counsel parents of regularly attending, at-risk, pre-school children when considering such an option.
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Affiliation(s)
- A S Blinkhorn
- The Unit of Oral Health and Development, The University Dental Hospital of Manchester.
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Abstract
Clinical decisions are often made with incomplete information, yet patient care decisions are made every day. Patients vary clinically, uncertainty exists in diagnostic and prognostic information, and many preventive and treatment alternatives have not been formally assessed for their effectiveness. Because scientific information will never answer all clinical questions, clinical decisions are partially based on probabilistic information. This paper describes how to apply clinical decision making to diagnosing and managing dental caries and periodontal diseases. By using explicit information to quantify probabilities and outcomes, clinical decision making analyzes decisions made under uncertain conditions and the uncertain impact of clinical information. Clinical decision making incorporates concepts for preventing, diagnosing and treating dental caries and periodontal diseases: risk assessment, evidence-based dentistry, and multiple oral health outcomes. This information can serve as a tool for clinicians to augment clinical judgment and expertise.
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Affiliation(s)
- B Alex White
- Dental Service of Massachusetts, 465 Medford Street, Boston, MA 02129-1454, USA.
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Watson MR. Response to Kanellis: Caries Risk Assessment and Prevention, Strategies for Head Start, Early Head Start, and WIC. J Public Health Dent 2000. [DOI: 10.1111/j.1752-7325.2000.tb03331.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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