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Bass T, Hill CM, Cully JL, Li SR, Chi DL. A cross-sectional study of physicians on fluoride-related beliefs and practices, and experiences with fluoride-hesitant caregivers. PLoS One 2024; 19:e0307085. [PMID: 39028748 PMCID: PMC11259263 DOI: 10.1371/journal.pone.0307085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 07/21/2024] Open
Abstract
The goal of this study was to describe medical providers' fluoride-related beliefs and practices, experiences with fluoride-hesitant caregivers, and barriers to incorporating oral health activities into their practice. In this cross-sectional study, we specifically tested the hypothesis of whether these factors differed between pediatric and family medicine providers. A 39-item online survey was administered to a convenience sample of pediatric and family medicine providers in Washington state and Ohio (U.S.A.). Responses to the fluoride survey were compared between pediatric and family medicine providers with a chi-square test (α = 0.05). Of the 354 study participants, 45% were pediatric providers and 55% were family medicine providers. About 61.9% of providers believed fluoridated water was highly effective at preventing tooth decay while only 29.1% believed prescription fluoride supplements were highly effective. Nearly all providers recommend over-the-counter fluoride toothpaste (87.3%), 44.1% apply topical fluoride in clinic, and 30.8% prescribe fluoride supplements. Most providers reported fluoride hesitancy was a small problem or not a problem (82.5%) and the most common concerns patients raise about fluoride were similar to those raised about vaccines. Lack of time was the most commonly reported barrier to incorporating oral health into practice, which was more commonly reported by family medicine providers than pediatric providers (65.6% vs. 50.3%; p = .005). Pediatric and family medicine providers have early and frequent access to children before children visit a dentist. Improving the use of fluorides through children's medical visits could improve pediatric oral health and reduce oral health inequities, especially for vulnerable populations at increased risk for tooth decay.
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Affiliation(s)
- Tiffany Bass
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
| | - Courtney M. Hill
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jennifer L. Cully
- Division of Oral Health, Children’s National Hospital, Washington, DC, United States of America
- Department of Pediatrics, George Washington University, Washington, DC, United States of America
| | - Sophie R. Li
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Donald L. Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
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Erat Nergiz M, Yalçin SS, Eryurt MA. Trends and associated factors of bottle-feeding in Turkey: dramatic change over the last three decades under the limited implemented code. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1299-1313. [PMID: 36842971 DOI: 10.1080/09603123.2023.2183941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The study aimed to examine the trends and associated factors of bottle-feeding among children aged 0-35 months. Data covering 11,205 mother-child pairs, from six recent Turkey Demographic and Health Surveys (TDHSs) were analyzed by using complex sample crosstabs and logistic regression. Bottle-feeding was on an upward trend from 33.0% to 51.5% from 1993 to 2013 and fell slightly 47.9% in 2018. Increasing trends of bottle-feeding were found in children aged 6-35 months, the East region, lower wealth index, maternal education under 5 years, Kurdish mothers, and the low antenatal care attendance. Multivariate analysis using data from TDHS-2018 showed that young maternal age, low birth weight and being 6-23 months of age were associated with higher rates of bottle-feeding. The prolonged bottle-feeding became widespread, and the bottle-feeding was common even in 35-month-old children. Interventions by the Government and stakeholders to minimize low rates of bottle-feeding should focus on high-risk groups.
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Affiliation(s)
- Meryem Erat Nergiz
- Department of Social Pediatrics, Institute of Child Health, Hacettepe University, Ankara, Turkey
- Department of Pediatrics Yenimahalle Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Siddika Songül Yalçin
- Department of Social Pediatrics, Institute of Child Health, Hacettepe University, Ankara, Turkey
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Hammouri EH, Mustafa AT, Jaradat TF, Ghozlan MM, Bani Salman MY, Ersheidat AA, Nawasra IM. Exploring Jordanian children and parents' awareness, behavior, and perception of pediatric oral health. BMC Oral Health 2024; 24:64. [PMID: 38195480 PMCID: PMC10777652 DOI: 10.1186/s12903-023-03838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND To evaluate children's and parents' practice and attitude toward oral hygiene and their knowledge about oral hygiene. METHODS This cross-sectional questionnaire-based study was conducted on randomly selected children who were seen in the Pediatric dentistry clinic in different Royal Medical Services hospitals. A modified questionnaire was used to gather information from the child or parents to gather the child's demographic data and evaluate the children's and parents' practice and attitude toward oral hygiene, their knowledge about oral hygiene, information about the parent and family, and oral examination, the questionnaire questions' reliability and validity were assessed by test-retest and Cronbach's Alpha test. RESULTS Three hundred seventy four patients were included, and the average age was 5.06 ± 3.58 SD years. Children's and parents' practice toward oral hygiene was inadequate where the majority (83.3%) brush their teeth occasionally, change their toothbrushes infrequently, apply toothpaste inappropriately, and less than half (47.2%) clean their tongue after teeth brushing. A significant number (73%) of candidates were aware that oral health has a significant role in their general health and can prevent dental problems. Participants agreed that maintaining a healthy mouth is an individual responsibility. The majority of participants came from large family size (the average family members 6.1 ± 1.7 SD) who live below the poverty line. CONCLUSION Our study demonstrated that awareness of oral health status in children below the age of 12 was poor. Although their oral knowledge was good their attitude and behavior were inadequate. These findings urge the need for expanded, well-organized, preventive educational programs that include school's syllabus, house visits, and hospitals for parents and children alike.
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Farsi D, Alagili D. Oral Health Knowledge, Attitudes, and Clinical Practices of Pediatricians and Pediatric Residents: A Cross-Sectional Study. Cureus 2023; 15:e50785. [PMID: 38239521 PMCID: PMC10795793 DOI: 10.7759/cureus.50785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
Background Pediatricians are the first line in the provision of healthcare for children. They can make an important contribution to the oral health of their patients because they usually see children and parents early and frequently in life. This study aims to assess the pediatricians' and pediatric residents' oral health knowledge, attitudes, and practices with patients. Methods A structured English survey was developed based on previous surveys in the literature. It collected data on oral health knowledge, attitudes, and practices. Pediatricians were visited and invited to take the survey. A link to the survey was sent via email to all pediatric residents. An oral health practice score was created based on participants' responses to the practice questions, and a linear regression assessed its predictors. Frequencies of oral health knowledge, attitudes, and practices were presented and compared between both groups by the chi-square test. Results A total of 218 pediatricians and residents were surveyed. The oral health knowledge was low overall, but it was higher among pediatricians, 10.0±1.9, compared to the residents, 8.2±2.5 (P<0.001). The attitude ranged from 66.3% agreeing with the statement "Limited time with patients makes it difficult to integrate oral health into primary care practice" to 87.4% agreeing with the statement "Primary healthcare physicians should know their local dentists to facilitate dental referral and treatment." Overall, pediatricians practice positive oral health behaviors more than pediatric residents, and higher knowledge levels predicted more positive oral health practices. Conclusion Despite acknowledging their important role in promoting oral health, pediatricians' and future pediatricians' knowledge is poor, and their participation in oral health continues to be limited. The potential for the non-dental workforce to greatly improve children's oral health is underexploited. The healthcare system should seek to integrate medical and dental practices better. Incorporating oral health into residency programs and providing continuous education courses are strongly encouraged.
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Affiliation(s)
- Deema Farsi
- Department of Pediatric Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Dania Alagili
- Department of Dental Public Health, King Abdulaziz University, Jeddah, SAU
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Abreu-Placeres N, Ekstrand KR, Garrido LE, Bakhshandeh A, Martignon S. An interdisciplinary intervention program to prevent early childhood caries in the Dominican Republic. FRONTIERS IN ORAL HEALTH 2023; 4:1176439. [PMID: 37771469 PMCID: PMC10527370 DOI: 10.3389/froh.2023.1176439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Objective The principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists. Materials and methods After ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria. Results At baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460). Conclusion The RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.
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Affiliation(s)
- Ninoska Abreu-Placeres
- Research Area Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Biomaterials and Dentistry Research Center (CIBO-Unibe), Research and Innovation Department, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Kim Rud Ekstrand
- Research Area Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luis Eduardo Garrido
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santo Domingo, Dominican Republic
| | - Azam Bakhshandeh
- Research Area Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefania Martignon
- UNICA—Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
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Incorporating Oral Health into Pediatric Practice: National Trends 2008, 2012, 2018. Acad Pediatr 2022; 22:1443-1451. [PMID: 35732259 DOI: 10.1016/j.acap.2022.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Oral health is a critical component of children's overall health, but past research has found that pediatricians report barriers to implementing oral health into practice. Recently, policies have further delineated the importance of oral health in primary medical care. We sought to determine how pediatricians' practices and perceived barriers related to oral health involvement have changed since 2008. METHODS There have been 3 nationally representative, cross-sectional, oral-health-focused periodic surveys of US American Academy of Pediatrics (AAP) members who provide health supervision: in 2008 (n = 1104; response rate (rr) = 69%), 2012 (n = 646; rr = 48%), and 2018 (n = 485; rr = 48%). The surveys asked about frequency of performing oral health tasks in children 3 years and younger, self-rated ability to perform these tasks, and attitudes about and barriers to oral health involvement. Predicted values from separate multivariable logistic regression models examined the independent effect of survey year. RESULTS In 2018, pediatricians reported they were more likely to provide fluoride varnish and dental referrals at a younger age and less likely to complete a caries risk assessment or oral examination. They reported diminished barriers to incorporating oral health into pediatric practice. Other oral health activities, notably the oral screening examination and caries risk assessment, remain underutilized by pediatricians. CONCLUSIONS From 2008 to 2018, more pediatricians reported performing a range of oral health tasks with fewer reported barriers. Ongoing efforts are needed to increase pediatricians' attention to oral screening examinations and caries risk assessments for all pediatric patients beginning in infancy, and to promote further use of fluoride varnish.
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Kranz AM, Gahlon G, Dick AW, Goff SL, Whaley C, Geissler KH. Variation in prices for an evidence-based pediatric preventive service. Health Serv Res 2022; 57:1175-1181. [PMID: 35467008 PMCID: PMC9441288 DOI: 10.1111/1475-6773.13995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. DATA SOURCES Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016-2018). STUDY DESIGN We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. DATA COLLECTION/EXTRACTION METHODS Private claims for fluoride varnish during medical visits for children aged 1-5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. PRINCIPAL FINDINGS Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. CONCLUSIONS Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.
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Affiliation(s)
| | | | | | - Sarah L. Goff
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | | | - Kimberley H. Geissler
- School of Public Health & Health SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
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Phillips SB, May OW, Stager CG, Gregg A. An Assessment of Pediatric Primary Care Providers’ and Parents’ Dental Health Knowledge and Practices. J Pediatr Health Care 2022; 37:227-233. [PMID: 37141221 DOI: 10.1016/j.pedhc.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION One in five children aged < 5 years has experienced caries, making it the most prevalent chronic disease in childhood. The failure to address a child's dental health can lead to short-term and long-term complications and problems with permanent dentition. Primary care pediatric providers are in the position to participate in the prevention of caries because of the frequency they see young children before establishing a dental home. METHOD A retrospective chart review and two surveys were developed to collect data from health care providers and parents of children aged < 6 years about their dental health knowledge and practices. RESULTS While providers report being comfortable discussing dental health with patients, review of medical records shows inconsistent discussion and documentation of dental health. DISCUSSION There appears to be a lack of education regarding dental health among parents and health care providers. Primary care providers are not effectively communicating the importance of childhood dental health and are not routinely documenting dental health information.
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Affiliation(s)
- Sara B Phillips
- Sara B. Phillips, Assistant Professor, Department of Pediatrics, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL..
| | - Olivia W May
- Olivia W. May, Associate Professor, Department of Pediatrics, College of Community Health Sciences, The University of Alabama, Tuscaloosa, AL
| | - Catanya G Stager
- Catanya Stager, Post-Doc Fellow, Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL
| | - Abbey Gregg
- Abbey Gregg, Assistant Professor, Department of Community Medicine and Population Health and the Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL
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Reddy SM, Shaik N, Pudi S, Yennavaram VK, Kotha A, Avidapu R. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022; 15:591-595. [PMID: 36865720 PMCID: PMC9973115 DOI: 10.5005/jp-journals-10005-2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Primary precautionary approaches for oral health is an essential tool concerning public health, as dental caries is one of the eminently prevailing chronic diseases among children across the globe. As pediatricians and pediatric healthcare professionals are more likely to encounter children when compared to general dentists, it is crucial for them to be acquainted with possible risk factors and diseases occurring in early childhood. Therefore, it is highly advocated to take necessary steps at an initial stage to help promote pragmatic results during childhood and succeeding adulthood phases. Objectives The pediatrician's attitude toward dental health and his dental screening, counseling, and referral practices. Material and methods This was a cross-sectional study in the Hyderabad district, following area sampling on a sample of 200 child healthcare professionals, as calculated based on a pilot study. A definitive and validated questionnaire was used for the collection of data, and pediatric health professionals were approached in their workplaces. Results About 44.5% of pediatricians usually check teeth during routine tongue and throat examinations. Around 59.5% of them suspect cavities when the child looks undernourished. A total of >80% of them voted that oral health cannot be neglected, as it is an integral part of a child's general health and dental screening, and referral at regular intervals of time is their responsibility. Only 8.5% advised fluoridated toothpaste, whereas only 62.5% counseled parents on the dental ill effects of nighttime bottle-feeding and digit sucking. Conclusion Although all the pediatricians had appropriate attitudes toward oral health, they were not put into action by many. Dental public health significance Pediatricians play a vital role as potential partners in the oral health promotion of children and their families. A pediatric primary care provider's regular screening, counseling, and referral would help his/her patients in getting the right treatment done at the right time. How to cite this article Reddy SM, Shaik N, Pudi S, et al. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(5):591-595.
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Affiliation(s)
- Sushma Mudhi Reddy
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Naseemoon Shaik
- Department of Pedodontics & Preventive Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Sriharsha Pudi
- Department of Prosthodontics Crown and Bridge, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Vijay Kumar Yennavaram
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Arpitha Kotha
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Rajashekhar Avidapu
- Department of Public Health Dentistry, MNR Dental College and Hospital, Hyderabad, Telangana, India
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Ribeiro YJS, Ferreira LG, Nelson-Filho P, Arnez MFM, Paula-Silva FWG. Influence of digital media in the oral health education of mother-child pairs: study protocol of a parallel double-blind randomized clinical trial. Trials 2022; 23:639. [PMID: 35945570 PMCID: PMC9361624 DOI: 10.1186/s13063-022-06602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dental caries is the most common non transmissible chronic disease in childhood and the control of dental biofilm in children is one of the greatest challenges in oral disease prevention. Digital media applications can help patients in improving their oral hygiene performance and reducing the number of appointments due to pain and discomfort reasons. This study aims to investigate the use of an smartphone application (WhatsApp) to deliver oral health education to mother-child pairs, with the ultimate goal of controlling dental biofilm and caries through digital activities focused on oral hygiene. Methods This study was designed as a randomized, double-blind, parallel clinical trial involving 100 pairs of mothers and children (6–12 years old). The mothers and children will be randomly allocated to the control group (n = 50 pairs), who will receive a single visit conventional oral health education, or to the experimental group (n = 50 pairs), who will receive both a single visit conventional oral health education and educational videos through WhatsApp Messenger, twice a week. Before randomization of the groups and after the intervention, pairs will be evaluated regarding to plaque index (VPI), gingival bleeding index (GBI), and number of decayed, missing and filled permanent or primary teeth (DMF-T) modified by the inclusion of active non-cavitated carious lesions (Nyvad criteria). Socioeconomic data, dental history, and oral health literacy will obtained using questionnaires (Oral Health Literacy Assessment Task for Paediatric Dentistry; BOHLAT-P). Chi-square, Student’s t-test, paired Student’s t-test, Mann-Whitney, and Friedman tests will be used with a 5% significance level. Discussion This intervention proposal is designed to motivate behavioral change in mother-child pairs. We hypothesize that adding digital media to traditional oral health programs will provoke improvements in oral hygiene behavior and health outcomes. To our knowledge, this is the first study evaluating the effect of educational videos communicated by digital media (WhatsApp) on the oral health of mother-child pairs evaluated by long-term dental examinations. In addition, we will assess the maternal level of comprehension of the provided information via a literacy assessment tool. The clinical trial is registered at the Brazilian Registry of Clinical Trials (No. RBR-7s8bw6m). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06602-4.
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Affiliation(s)
- Yuri Jivago Silva Ribeiro
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Luanna Gonçalves Ferreira
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Maya Fernanda Manfrin Arnez
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil
| | - Francisco Wanderley Garcia Paula-Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Bloco M, Sala 28, São Paulo, Ribeirão Preto, SP, Brazil.
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Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure. J Am Dent Assoc 2022; 153:319-329. [PMID: 35078590 PMCID: PMC8969190 DOI: 10.1016/j.adaj.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children. METHODS The authors examined 2018-2019 National Survey of Children's Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold. RESULTS Children with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047). CONCLUSIONS TSE in children is associated with caries and inadequate oral health care visits. PRACTICAL IMPLICATIONS The pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children's teeth condition and increase oral health care visits.
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Clark MB, Braun PA. Promotion of Oral Health and Prevention of Dental Caries Among Children in Primary Care. JAMA 2021; 326:2139-2140. [PMID: 34874439 DOI: 10.1001/jama.2021.20396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Schroth RJ, Rothney J, Sturym M, Dabiri D, Dabiri D, Dong CC, Grant CG, Kennedy T, Sihra R. A systematic review to inform the development of a Canadian caries risk assessment tool for use by primary healthcare providers. Int J Paediatr Dent 2021; 31:767-791. [PMID: 33497015 DOI: 10.1111/ipd.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries. AIM To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings. DESIGN Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE. RESULTS Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance. CONCLUSIONS This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration.
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Affiliation(s)
- Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melina Sturym
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Darya Dabiri
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Donya Dabiri
- University of Toledo Medical Center, University of Toledo, Toledo, OH, USA
| | - Cecilia C Dong
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cameron G Grant
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tara Kennedy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Rena Sihra
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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14
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Selvaraj D, Curtan S, Copeland T, McNamee E, Debelnogich J, Kula T, Momotaz H, Nelson S. Caries disparities among Medicaid-enrolled young children from pediatric primary care settings. J Public Health Dent 2021; 81:131-142. [PMID: 33135213 PMCID: PMC8756375 DOI: 10.1111/jphd.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/09/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study are to determine the overall and racial differences in the extent of caries experience and to examine the association between child and parent/caregiver characteristics and caries among 3-6-year-old Medicaid-enrolled children. METHODS This study reports baseline cross-sectional data from a larger pragmatic clinical trial in pediatric primary care practices. Child-level clinical dental exams included decayed and filled teeth (dft) using ICDAS criteria and parent/caregiver questionnaire collected information on socio-demographics, child oral health behaviors, oral health related quality of life (OHQoL), and food environment. RESULTS A total of 1,024 parent/caregiver-child dyads participated in the study. The overall caries experience (dft) was 49 percent and untreated decay was 42 percent. Children who were Black had 1.3 and 1.2 times significantly higher frequency of untreated primary decay and caries experience compared to non-Black children. An overall logistic regression model predicted that race, increased age, receiving dental care in the past 12 months for a cavity/toothache, and lower caregiver OHQoL was significantly associated with increased odds of the child having caries. Non-Black caregivers with less education, whose child was older, and lower child OHQoL had increased odds of having a child with caries, but these same variables were not predictive for the Black children. CONCLUSIONS Racial disparities exist with respect to caries experience and untreated decay within a Medicaid-enrolled population of young children attending well-child visits. Pediatric primary care offices are well-positioned to provide dental surveillance and preventive care and could play an important role in decreasing oral health inequities.
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Affiliation(s)
- David Selvaraj
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Shelley Curtan
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Tashyana Copeland
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Erin McNamee
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Jelena Debelnogich
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Taylor Kula
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Hasina Momotaz
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Suchitra Nelson
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
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15
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Floríndez LI, Floríndez DC, Price ME, Floríndez FM, Como DH, Polido JC, Baezconde-Garbanati L, Pyatak E, Cermak SA. Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3751. [PMID: 33916808 PMCID: PMC8038332 DOI: 10.3390/ijerph18073751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023]
Abstract
Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child's diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents' perceptions of their child's diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child's oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families.
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Affiliation(s)
- Lucía I. Floríndez
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Mia E. Price
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | | | - Dominique H. Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | - Jose C. Polido
- Division of Dentistry, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
| | | | - Elizabeth Pyatak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | - Sharon A. Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
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16
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Ramos-Gomez F, Kinsler JJ, Askaryar H, Verzemnieks I, Garell C. Evaluation of an interprofessional education program in pediatric dentistry, medicine, and nursing. J Dent Educ 2021; 85:1228-1237. [PMID: 33665840 DOI: 10.1002/jdd.12578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/19/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE The purpose of this study was to assess whether the Strategic Partnership for Interprofessional Collaborative Education in the Pediatric Dentistry (SPICE-PD) program at the UCLA School of Dentistry positively affected interprofessional experiences and practice patterns of pediatric and general dentistry residents, pediatric medical residents, and pediatric nurse practitioner students (PNPs). METHODS Data collection included a year-end online survey given to participants in the interprofessional program upon graduation from their UCLA dental/medical/nursing programs. Of the 318 participants who were recruited into SPICE-PD, 208 (65%; 208/318) completed the survey. Chi-square tests were used to assess differences in key outcome variables by dental/medical specialty. RESULTS Most dental, medical, and nursing participants thought SPICE-PD helped them learn to work more effectively with interprofessional colleagues and reported knowing more about the abilities and contributions of other health professionals as a result of the program. While most pediatric medical residents and PNPs thought SPICE-PD improved their skills to screen for early childhood caries (N = 91% and N = 100%), PNPs were more likely than pediatric medical residents to report SPICE-PD improved their skills to apply fluoride varnish (98% versus 72%; p < 0.001). Almost all pediatric medical residents and PNPs thought primary care providers should incorporate oral health into routine patient care and provide referrals to dental professionals when necessary. CONCLUSION Increased interprofessional education and coordination of care through programs such as SPICE-PD can help bridge the gap between dental and medical care and lead to improved oral health outcomes and more comprehensive and preventive patient care.
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Affiliation(s)
- Francisco Ramos-Gomez
- Division of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, California, USA
| | - Janni J Kinsler
- School of Dentistry, University of California, Los Angeles, California, USA
| | - Hamida Askaryar
- Divisions, Growth & Development, Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, California, USA
| | - Inese Verzemnieks
- School of Nursing, University of California, Los Angeles, California, USA
| | - Cambria Garell
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, California, USA
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17
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Meyer BD, Danesh DO. The Impact of COVID-19 on Preventive Oral Health Care During Wave One. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.636766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Early childhood caries burdens children, their families, and the health care system. Utilizing fluoride varnish at medical well-child visits with non-dental primary care providers can be an interprofessional strategy to combat early childhood caries. The COVID-19 pandemic dramatically altered preventive health care delivery and the effects on preventive oral health care delivery have not been previously described.Methods: This analysis used descriptive statistics and non-parametric Wilcoxon Mann-Whitney tests to compare preventive oral health utilization among 1 to 5-year old children in two state Medicaid agencies before and during the pandemic. Fluoride utilization rates at dental visits and medical well-child visits were calculated as number of users per 1,000 enrolled children. Additionally, the proportion of well-child visits that included fluoride application was calculated for each state.Results: During the pandemic, the quarterly fluoride utilization rate significantly decreased at dental visits (pre-pandemic = 153.5 per 1,000 enrolled children; pandemic = 36.1 per 1,000 enrolled children, p < 0.001) and signficantly decreased at medical well-child visits (pre-pandemic = 72.2 per 1,000 enrolled children; pandemic = 32.3 per 1,000 enrolled children, p = 0.03) during the pandemic.Conclusions: The findings highlight the importance of interprofessional collaboration among non-dental primary care providers and dental providers to provide access to preventive oral health services, particularly when access to dentists is limited. Future directions might include rigorous evaluations of co-located medical and dental services or the use of interprofessional telehealth technologies.
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18
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The Burden of Early Childhood Caries in Children under 5 Years Old in the European Union and Associated Risk Factors: An Ecological Study. Nutrients 2021; 13:nu13020455. [PMID: 33573027 PMCID: PMC7911369 DOI: 10.3390/nu13020455] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
The associations among early childhood caries (ECC), socioeconomic status, and sugar consumption are of the utmost importance, due to their potential policy implications. The purpose of this study was to identify trends in ECC burden in children under 5 years old among European Union (EU) member states over time and to evaluate the relationship with its risk factors. Global Burden of Disease 2019 data were analyzed to estimate the burden of ECC over time, specifically incidence, prevalence, and years lived with disability (YLDs) for children under 5 years old. Four ecological variables with a potential effect on YLDs for ECC were used to investigate the association between 2014 and 2017. The YLDs rate was consistently higher among Eastern EU countries over time. Univariate models showed a positive significant association between at-risk-of-poverty rate and YLDs rate, while GDP per capita and urbanization were inversely associated with YLDs rate. In the multivariate analysis, sugar consumption, GDP per capita and urbanization showed significant association with YLDs rate. After stratification by region, association remained significant only in the Eastern EU countries between GDP, urbanization, and YLDs rate, while sugar consumption and at-risk-of-poverty rate had no significant impact on YLDs rates. This study found increasing ECC burden in the EU. The complexity of the problem indicates the need for innovative and personalized policy approaches to tackle the disease.
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19
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Achalu P, Bhatia A, Turton B, Luna L, Sokal-Gutierrez K. Sugary Liquids in the Baby Bottle: Risk for Child Undernutrition and Severe Tooth Decay in Rural El Salvador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010260. [PMID: 33396399 PMCID: PMC7795345 DOI: 10.3390/ijerph18010260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
As communities worldwide shift from consuming traditional diets to more processed snacks and sugar-sweetened beverages (SSBs), increases in child obesity and tooth decay and persistence of undernutrition are particularly apparent in Latin American countries. Further evidence of shared risk factors between child undernutrition and poor oral health outcomes is needed to structure more effective health interventions for children’s nutrition. This study aims to identify dietary, oral health, and sociodemographic risk factors for child undernutrition and severe early childhood caries (sECC) among a convenience sample of 797 caregiver–child pairs from rural Salvadoran communities. Caregiver interviews on child dietary and oral health practices were conducted, and their children’s height, weight, and dental exam data were collected. Multivariable regression analyses were performed using RStudio (version 1.0.143). Caregiver use of SSBs in the baby bottle was identified as a common significant risk factor for child undernutrition (p = 0.011) and sECC (p = 0.047). Early childhood caries (p = 0.023) was also a risk factor for developing undernutrition. Future maternal–child health and nutrition programs should coordinate with oral health interventions to discourage feeding children SSBs in the baby bottle and to advocate for policies limiting SSB marketing to young children and their families.
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Affiliation(s)
- Priyanka Achalu
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA;
- Correspondence: ; Tel.: +1-408-839-2691
| | - Abhishek Bhatia
- FXB Center for Health and Human Rights, The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA 02138, USA;
| | - Bathsheba Turton
- Department of Dentistry, University of Puthisastra, Phnom Penh 12211, Cambodia;
| | - Lucy Luna
- Asociación Salvadoreña Pro Salud Rural (ASAPROSAR), Santa Ana 02201, El Salvador;
| | - Karen Sokal-Gutierrez
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA;
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20
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Martin M, Pugach O, Avenetti D, Lee H, Salazar S, Rosales G, Songthangtham N. Oral Health Behaviors in Very Young Children in Low-Income Urban Areas in Chicago, Illinois, 2018-2019. Prev Chronic Dis 2020; 17:E152. [PMID: 33274700 PMCID: PMC7735487 DOI: 10.5888/pcd17.200213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Because most data on oral health do not include infants and toddlers, we aimed to describe the oral health behaviors of low-income children younger than 3 years and determine factors associated with child tooth brushing. Methods We obtained data from the Coordinated Oral Health Promotion Chicago study, which included 420 families with children aged 6 to 36 months and their caregivers in Cook County, Illinois. We assessed child frequency of brushing from caregiver reports and objectively determined child dental plaque scores. Significant factors associated with tooth brushing frequency and dental plaque score were identified using the Least Absolute Shrinkage and Selection Operator variable selection. Results Mean child age was 21.5 (SD, 6.9) months, and only 45% of caregivers brushed their children’s teeth twice per day or more. The mean plaque score was 1.9 (SD, 0.6), indicating high levels of plaque. Child brushing frequency was higher when children were older; used the correct toothpaste amount; brushed for a longer duration; and when caregivers brushed their own teeth more frequently, had more help with the overall care of the child’s teeth, and had family to help. Child brushing frequency was lower for caregivers with more interference from activities of daily life. Children whose caregivers had more adult help with child brushing had better plaque scores; worse plaque scores were seen in children with higher sugary beverage and food consumption and lower household incomes. Conclusion The tooth brushing behaviors of young children are strongly associated with those of their parents and with the level of family support for brushing. Interventions to improve brushing in young children should focus on the entire family.
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Affiliation(s)
- Molly Martin
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,University of Illinois at Chicago, 840 South Wood St, M/C 856, Chicago, IL 60612.
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - David Avenetti
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,College of Dentistry, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Helen Lee
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,College of Medicine, Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Shojanny Salazar
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Nattanit Songthangtham
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
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21
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Clark MB, Keels MA, Slayton RL. Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics 2020; 146:peds.2020-034637. [PMID: 33257404 DOI: 10.1542/peds.2020-034637] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in caries prevention. This clinical report aims to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries, while minimizing the likelihood of enamel fluorosis. Fluoride varnish application is now considered the standard of care in pediatric primary care. This report highlights administration, billing, and payment information regarding the fluoride varnish procedure.
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Affiliation(s)
- Melinda B Clark
- Department of Pediatrics, Albany Medical Center, Albany, New York;
| | - Martha Ann Keels
- Department of Surgery and Pediatrics, Duke University, Durham, North Carolina.,The Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Rebecca L Slayton
- Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, Washington
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22
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Pourat N, Chen X, Lu C, Zhou W, Hoang H, Hair B, Bolton J, Sripipatana A. The role of dentist supply, need for care and long-term continuity in Health Resources and Services Administration-funded health centres in the United States. Community Dent Oral Epidemiol 2020; 49:291-300. [PMID: 33230861 DOI: 10.1111/cdoe.12601] [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: 04/06/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Health Resources and Services Administration-funded health centres (HCs) are an important source of dental services for low-income and vulnerable patients in the United States. About 82% of HCs in 2018 had dental workforce, but it is unclear whether this workforce meets the oral health needs of HC patients. Thus, we first examined (a) whether dental workforce was associated with any dental visits vs none and (b) whether HC patients with any visits were more likely to have a visit at the HC vs elsewhere. We then examined (c) if need for oral health care and long-term continuity at the HC were associated with dental visits and visits at the HC. METHODS This study used the 2014 Health Center Patient Survey, a nationally representative study of US HC patients, and the 2013 Uniform Data System, an administrative dataset of HC characteristics. We also used the 2013 Area Health Resource File to measure the contribution of local supply of dentists. We included working-age adult patients (n = 5006) and used multilevel structural equation models with Poisson specification. RESULTS Larger dental workforce at the HC was significantly associated with 1% higher likelihood (relative risk [RR]: 1.01, 1.00-1.02) of any visits and 10% higher likelihood of a visit at the HC among those with a visit (RR: 1.10, 1.06-1.14). Patient self-reported oral health need was positively associated with 157% higher likelihood of dental visits (RR: 2.57, 2.29-2.88), and 42% higher likelihood of dental visit at the HC vs elsewhere (RR: 1.42, 1.19-1.69). Long-term continuity with the HC was not significantly associated with likelihood of dental visits, but was associated with 26% higher likelihood of visits at the HC among those who had any visits (RR: 1.26, 1.02-1.56). DISCUSSION The findings highlight the potential impact of increasing dental workforce at HCs to promote access; the high level of need for oral health care at HCs; and the increased effort required to promote access among newer patients who may be less familiar with the availability of oral health care at HCs. Together, these findings reinforce the importance of addressing barriers of use of oral health services among low-income and uninsured patients.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, University of California, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, University of California, Los Angeles, CA, USA
| | - Connie Lu
- UCLA Center for Health Policy Research, University of California, Los Angeles, CA, USA
| | - Weihao Zhou
- UCLA Center for Health Policy Research, University of California, Los Angeles, CA, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Brionna Hair
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Joshua Bolton
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
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23
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Edelstein BL. Pediatric Dental Care and Oral Health: Past Successes and Current Challenges. Acad Pediatr 2020; 20:885-888. [PMID: 32619543 DOI: 10.1016/j.acap.2020.06.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Burton L Edelstein
- Dental Medicine and Health Policy & Management, Columbia University Irving Medical Center, New York, NY.
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24
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Dickson-Swift V, Kenny A, Gussy M, McCarthy C, Bracksley-O’Grady S. The knowledge and practice of pediatricians in children's oral health: a scoping review. BMC Oral Health 2020; 20:211. [PMID: 32711481 PMCID: PMC7382799 DOI: 10.1186/s12903-020-01198-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children's oral health is well documented. For well over a decade, there have been calls for pediatricians to address children's oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians' in children's oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children's oral health. METHODS Arksey & O'Malley's five-stage review process was used to comprehensively map studies undertaken on pediatrician's knowledge and practice regarding children's oral health. Key search terms were developed and a total of 42 eligible articles are included in the review. RESULTS The studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice. CONCLUSIONS This scoping review highlights growing international interest in the role of pediatricians in children's oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews.
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Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, P.O. Box 199, Bendigo, 3552 Australia
| | - Amanda Kenny
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, P.O. Box 199, Bendigo, 3552 Australia
| | - Mark Gussy
- College of Social Science, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS UK
| | - Colleen McCarthy
- La Trobe Rural Health School, PO Box 199, Bendigo, Vic 3552 Australia
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Roguski M, McBride-Henry K. Insights into the oral health crisis amongst pre-schoolers in Aotearoa/New Zealand: a discourse analysis of parent/caregiver experiences. BMC Oral Health 2020; 20:182. [PMID: 32605561 PMCID: PMC7325262 DOI: 10.1186/s12903-020-01173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The oral health of pre-schoolers is garnering international as a crisis as good oral health is a key precursor to positive health outcomes. Internationally, and within Aotearoa/New Zealand, responses been restricted to those based in a medical model and the commercialisation of oral health. Absent from existing commentary are the lived realities of parents/caregivers beliefs, attitudes and responsiveness, or lack of, to the oral health of pre-schoolers. METHODS The researcher undertook a discursive analysis of parents/caregivers narratives to understand the barriers to engaging in effective protective behaviours. The 15 focus groups were conducted in urban and rural locations across Aotearoa/New Zealand. RESULTS A discursive analysis revealed several pervasive discourses, including 'second chance' and 'enjoyment' discourses, and systems-related deficits that act as barriers to engaging in good oral healthcare practices. CONCLUSIONS The analysis demonstrates the benefit of placing the lived experiences of parents/caregivers as central to the development of oral health interventions. There is a need to link oral health data with primary care data and to distribute accurate oral health information to support parents'/caregivers' decision making. This research reveals several pervasive discourses and systems-related deficits that provide a fertile ground for future public health responsiveness.
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Affiliation(s)
- Michael Roguski
- Kaitiaki Research and Evaluation, 47 Rawhiti Terrace, Kelburn, Wellington, 6012 New Zealand
| | - Karen McBride-Henry
- Health Services Research Centre, Victoria University of Wellington, PO Box 600, Wellington, 6140 New Zealand
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26
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Martin MA, Zimmerman LJ, Rosales GF, Lee HH, Songthangtham N, Pugach O, Sandoval AS, Avenetti D, Alvarez G, Gansky SA. Design and sample characteristics of COordinated Oral health Promotion (CO-OP) Chicago: A cluster-randomized controlled trial. Contemp Clin Trials 2020; 92:105919. [PMID: 31899372 PMCID: PMC7309222 DOI: 10.1016/j.cct.2019.105919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
Abstract
COordinated Oral health Promotion (CO-OP) Chicago is a two-arm cluster-randomized trial with a wait-list control. The primary aim is to evaluate the efficacy of an oral health community health worker (CHW) intervention to improve oral health behaviors in low-income, urban children under the age of three years. Exploratory aims will determine cost-effectiveness, and if any CHW intervention impact on child tooth brushing behaviors varies when CHWs are based out of a medical clinic compared to a community setting. This paper describes progress toward achieving these aims. Participating families were recruited from community social service centers and pediatric primary care medical clinics in Cook County, Illinois. Sites were cluster-randomized to CHW intervention or usual services (a wait-list control). The intervention is oral health support from CHWs delivered in four visits to individual families over one year. The trial sample consists of 420 child/caregiver dyads enrolled at the 20 participating sites over 11 months. Participant demographics varied across the sites, but primary outcomes values at baseline did not. Data on brushing frequency, plaque, and other oral health behaviors are collected at three timepoints: baseline, 6-, and 12-months. The primary analysis will assess differences in caregiver-reported child brushing frequency and observed plaque score between the two arms at 12-months. The trial is currently in the active intervention phase. The trial's cluster-randomized controlled design takes a real-world approach by integrating into existing health and social service agencies and collecting data in participant homes. Results will address an important child health disparity. ClinicalTrials.gov identifier: NCT03397589. CLINICAL TRIAL REGISTRATION: University of Illinois at Chicago Protocol Record 2017-1090. National Institutes of Dental & Craniofacial Research of the National Institutes of Health (NIDCR) Protocol Number: 17-074-E. NCT03397589.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States; University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States.
| | - Lacey J Zimmerman
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States
| | - Genesis F Rosales
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Helen H Lee
- University of Illinois at Chicago, College of Medicine, 1853 W Polk St, Chicago, IL 60612, United States; University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Nattanit Songthangtham
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Oksana Pugach
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Anna S Sandoval
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - David Avenetti
- University of Illinois at Chicago, College of Dentistry, 801 S Paulina St, Chicago, IL 60612, United States
| | - Gizelle Alvarez
- University of Illinois at Chicago, Institute for Health Research and Policy, 1747 W Roosevelt Road, Chicago, IL 60608, United States
| | - Stuart A Gansky
- University of California, Box# 1361, San Francisco, CA 94143, United States
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Abstract
In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.
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Affiliation(s)
- Mary E Northridge
- NYU Langone Dental Medicine-Brooklyn, Postdoctoral Residency Program, Brooklyn, New York 11220, USA; , ,
- Hansjörg Wyss Department of Plastic Surgery, NYU School of Medicine, Brooklyn, New York 11220, USA
| | - Anjali Kumar
- NYU Langone Dental Medicine-Brooklyn, Postdoctoral Residency Program, Brooklyn, New York 11220, USA; , ,
| | - Raghbir Kaur
- NYU Langone Dental Medicine-Brooklyn, Postdoctoral Residency Program, Brooklyn, New York 11220, USA; , ,
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28
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Patton S, Severe S. Nursing Students’ Assessment and Parent Reports of Their Children’s Oral Health Behaviors as Predictors of Tooth Decay Risk—A Cross-Sectional, Correlational Study. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206819895846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The aim of this study is to evaluate the relationship between children’s tooth decay risk score and a dental examination and parent reports of oral health practices. Materials and Methods: A cross-sectional correlational study utilizing data from an oral health assessment was performed by undergraduate nursing students and parents completed the permission forms. Results: Four hundred and fifty-six children received an oral health assessment. None of the percentages were found to be at high risk for tooth de cay and 21% were referred for further evaluation and dental treatment. Twenty-seven % of parents reported that their child was not being seen by a dentist and 49% reported that they had not established recommended tooth brushing practices in early childhood. In this analysis, the physical examination measures accounted for a significant amount of risk: R2 = 0.55, F(5,317) = 7.62, P < .00. The parent report measures offered little predictive power beyond the examination: R2 = 0.029, F(7,310) = 3.01, P = .00. Conclusions: These findings identify a need for a broader perspective to inform oral risk assessment and interventions to address oral health disparities. A social determinant of health framework would improve nursing students’ competency to identify children in need of early intervention. Oral health promotion at the family and community level would improve the preventive oral health practices.
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Affiliation(s)
- Susan Patton
- Eleanor Mann School of Nursing, University of Arkansas, Arkansas, USA
| | - Stephanie Severe
- Eleanor Mann School of Nursing, University of Arkansas, Arkansas, USA
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29
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Luo H, I Garcia R, Moss ME, Bell RA, Wright W, Wu B. Trends of children being given advice for dental checkups and having a dental visit in the United States: 2001-2016. J Public Health Dent 2020; 80:123-131. [PMID: 31951026 DOI: 10.1111/jphd.12356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/06/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objectives of this study were to describe trends of children being given dental checkup advice by primary care providers (PCPs) and having dental visits and to assess factors associated with being given dental checkup advice and having a dental visit. METHODS Data were from the annual, cross-sectional Medical Expenditure Panel Survey (MEPS) from 2001 to 2016. The sample included 126,773 children ages 2-17 years. We used predictive margins to estimate the probability of being given dental checkup advice and having a dental visit. We examined time trends of the proportion of children being given dental checkup advice from PCPs, as well as trends in the proportion of children having a dental visit from 2001 to 2016. Multiple logistic regression was used to assess the association between being given dental checkup advice and having a dental visit. RESULTS Overall, the proportion of children being given dental checkup advice increased from 31.4% in 2001 to 51.8% in 2016 (Trend P < 0.001). No significant increasing trend was found for having a dental visit among those being given dental checkup advice (Trend P > 0.05). Children being given dental checkup advice were more likely to have a dental visit (AOR = 1.54, P < 0.001). CONCLUSIONS Although there was an increase in the proportion of children being given advice to have dental checkups by PCPs from 2001 to 2016, there was no significant increase in having a dental visit among children being given the advice. More research is needed to better understand how dental care advice from a PCP can effectively motivate and facilitate dental care for children.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Raul I Garcia
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - Mark E Moss
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Wanda Wright
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, NC, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York City, NY, USA
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Reich SM, Ochoa W, Gaona A, Salcedo Y, Espino Bardales G, Newhart V, Lin J, Díaz G. Disparities in Caregivers' Experiences at the Dentist With Their Young Child. Acad Pediatr 2019; 19:969-977. [PMID: 30904582 PMCID: PMC6828576 DOI: 10.1016/j.acap.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence. METHODS An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese. RESULTS Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000. CONCLUSIONS Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.
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Affiliation(s)
- Stephanie M Reich
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz),.
| | - Wendy Ochoa
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Amy Gaona
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | - Yesenia Salcedo
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
| | | | - Veronica Newhart
- Department of Health Informatics (V Newhart), University of California, Irvine
| | - Joyce Lin
- Department of Human Development and Family Studies (J Lin), Purdue University, Lafayette, Ind
| | - Guadalupe Díaz
- School of Education (SM Reich, W Ochoa, A Gaona, Y Salcedo, and G Díaz)
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Fisher-Owens SA. The Interprofessional Role in Dental Caries Management: Ways Medical Providers Can Support Oral Health (Perspectives from a Physician). Dent Clin North Am 2019; 63:669-677. [PMID: 31470921 DOI: 10.1016/j.cden.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Medical providers are important allies in the prevention of dental caries. Through raising the issue by asking about risks and strengths, offering anticipatory guidance and counseling, encouraging and following up on referrals, and applying preventive fluoride, medical providers can have a direct, positive impact on oral health. Further, improving communication with referrals, bidirectionally, benefits patient care as well as provider satisfaction. By collaborating on advocacy efforts, medical and dental providers can broaden their impact while building relationships, with the end goal of improved health for patients throughout their lifetime. Reintegrating the mouth into the body and oral health into systemic health has benefits for patients and providers alike, and can and should be accomplished in the medical home.
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Affiliation(s)
- Susan A Fisher-Owens
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA.
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32
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Hariyani N, Soebekti RH, Setyowati D, Bramantoro T, Palupi LS, Oktarina, Putriana E. Factors influencing the severity of dental caries among Indonesian children with autism spectrum disorder - a pilot study. Clin Cosmet Investig Dent 2019; 11:227-233. [PMID: 31552917 PMCID: PMC6677381 DOI: 10.2147/ccide.s205041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022] Open
Abstract
Aim To assess the prevalence of dental caries among autism spectrum disorders (ASD) children in Surabaya, Indonesia, and to explore the association between oral health-related behaviors comprising toothbrushing, snacking and dental visiting and the severity of caries. Methods The prevalence and severity of caries were assessed using DMF-T/dmf-t and PUFA/pufa indexes for mixed dentitions. The parents or carers’ responses were collected to identify the oral health-related behaviors that were associated with caries severity. Results This study shows that almost 79% of ASD children in Surabaya were experiencing caries and 47.1% had untreated caries with pulp involvement or more severe conditions. Oral health behaviour factors associated with the severity of dental caries experienced by children with autism were brushing frequency (Β [95% CI] =2.46 [0.09–4.83] and 2.03 [0.78–3.28]), brushing time (Β [95% CI] =3.76 [1.32–6.20] and 2.03 [0.74–3.32]) and cleansing after snack (B [95% CI] = 2.04 [0.20–3.89] and 1.21 [0.23–2.18]) in DMF-T/dmf-t and PUFA/pufa indexes, respectively. Conclusions The prevalence of caries among children with autism in Surabaya was high. The severity was associated with brushing and snacking behaviors. Caries in children with autism should be paid attention, and research in modifying daily activities are needed to allow them to adopt more healthy oral health-related behaviors.
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Affiliation(s)
- Ninuk Hariyani
- Dental Public Health Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Roesanto Heroe Soebekti
- Dental Public Health Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dini Setyowati
- Dental Public Health Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Taufan Bramantoro
- Dental Public Health Department, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Listyati Setyo Palupi
- Personality and Social Psychology Department, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
| | - Oktarina
- Research and Development Centre for Humanities and Health Management, Ministry of Health Republic of Indonesia, Surabaya, Indonesia
| | - Ekky Putriana
- General Dentist, Private Practice, Surabaya, Indonesia
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33
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Scherrer CR, Naavaal S. Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia. J Pediatr 2019; 212:201-207.e1. [PMID: 31253412 DOI: 10.1016/j.jpeds.2019.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the cost-benefit of fluoride varnish application during pediatric well-visits for the Medicaid/Children's Health Insurance Program population in Virginia (VA) from a Medicaid payer perspective. To provide initial cost estimates from the primary care provider (PCP) perspective. STUDY DESIGN A systematic search of recent literature was completed to obtain input data for a Monte Carlo cost-benefit simulation and for the fluoride varnish application time, labor, and materials costs for PCPs. The analysis was conducted from a Medicaid perspective; costs and savings related to fluoride varnish application in primary dentition through 7.5 years were calculated for all Medicaid-eligible children up to 3 years of age in VA. Sensitivity analysis was performed to mitigate the effects of parameter uncertainty. RESULTS Delivering fluoride varnish to all children <3 years old in VA who annually receive well-visits through Medicaid but did not receive fluoride varnish at those visits would reduce the percent of 7.5 year olds with decay from 63.2% to 39.8%. Accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid. From the PCP perspective, the Medicaid reimbursement rate for fluoride varnish is 3.8-12.0 times the direct fluoride varnish application cost (labor and materials). CONCLUSIONS Application of fluoride varnish by a PCP to children under 3 years of age is cost-saving in this study population. Costs to provide fluoride varnish from the PCP perspective are favorable compared with the Medicaid reimbursement, but additional studies on optimizing fluoride varnish application into the well-visit workflow are needed.
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Affiliation(s)
- Christina R Scherrer
- Department of Systems and Industrial Engineering, Kennesaw State University, Marietta, GA.
| | - Shillpa Naavaal
- Department of Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, VA; Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA
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Rozier RG, White BA, Wang M, Meyer BD, Lee JY. Development and testing of a patient-centered dental home assessment for low-income families. J Public Health Dent 2019; 79:253-263. [PMID: 31209896 PMCID: PMC6746601 DOI: 10.1111/jphd.12323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to develop an instrument in English (ENG) and Spanish (SPA) for use in assessing perceptions of dental home characteristics among low-income adults. METHODS An expert panel selected 21 items from a pool of 81 items mapped to domains in the American Academy of Pediatrics' medical home. Pilot testing with mothers (n = 795) of children in Early Head Start (EHS) resulted in an expanded 36-item scale, which was field-tested in interviews with ENG- (NENG = 665) and SPA-speakers (NSPA = 116). An exploratory factor analysis of 23 usable items was carried out in an EHS reference group (NENG-EHS = 272). The selected model was evaluated by confirmatory factor analysis (CFA) in two other subgroups (NENG-NonEHS = 393; NSPA = 116). We tested measurement and structural invariances using a multiple-group approach. Known-groups validity was examined by testing factor mean differences between two groups defined by whether or not the mother used a single dental office. RESULTS A three-factor CFA model with 10 items was retained for its close fit for all three subgroups. Invariance tests found the two ENG subgroups to be homogenous and were combined. Several item and factor parameters in the SPA group differed from the combined ENG group. The proposed dental home measure demonstrated good known-group validity in that people who used the same dental office reported better dental care experiences. CONCLUSIONS An instrument to measure the dental home concept among low-income adults was developed with three domains (accessible-comprehensive, compassionate, and health literate care) that demonstrated good validity and reliability.
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Affiliation(s)
- Richard Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Alexander White
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Dental Ecology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mian Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beau D Meyer
- Department of Pediatric Dentistry, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica Y Lee
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pediatric Dentistry, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zickafoose JS, Lechner A, Williams T. TRICARE For Children: Between Medicaid And Marketplace Plans For Comprehensiveness And Cost Sharing. Health Aff (Millwood) 2019; 38:1366-1376. [PMID: 31381384 DOI: 10.1377/hlthaff.2019.00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
TRICARE provides health care benefits to nearly two million children of active duty, retired, National Guard, and reserve service members. Child health advocates and congressional reports have raised questions regarding the adequacy of these benefits, compared with other sources of children's health insurance. To help address these questions, we compared TRICARE benefits with benefits from Medicaid and Marketplace plans because they represent alternative sources of coverage for many of the families enrolled in TRICARE. Overall, we found that TRICARE benefits fell in the middle-between Medicaid plans' more comprehensive benefits with no cost sharing and Marketplace plans' more restrictive benefits with higher cost sharing.
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Affiliation(s)
- Joseph S Zickafoose
- Joseph S. Zickafoose ( ) is a senior researcher with Mathematica Policy Research and resides in Nashville, Tennessee
| | - Amanda Lechner
- Amanda Lechner is a researcher with Mathematica Policy Research and resides in Sacramento, California
| | - Thomas Williams
- Thomas Williams is a senior fellow with NORC at the University of Chicago, in Illinois
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36
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Hartnett E, Haber J, Catapano P, Dougherty N, Moursi AM, Kashani R, Osman C, Chinn C, Bella A. The Impact of an Interprofessional Pediatric Oral Health Clerkship on Advancing Interprofessional Education Outcomes. J Dent Educ 2019; 83:878-886. [DOI: 10.21815/jde.019.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
Affiliation(s)
| | - Judith Haber
- Rory Meyers College of Nursing; New York University
| | - Peter Catapano
- Pediatric Dental Clinic; Bellevue Hospital Center and Clinical Associate Professor; Department of Pediatrics; School of Medicine and College of Dentistry; New York University
| | - Nancy Dougherty
- Department of Pediatric Dentistry; College of Dentistry; New York University
| | - Amr M. Moursi
- Department of Pediatric Dentistry; College of Dentistry; New York University
| | - Ramin Kashani
- College of Dentistry; New York University
- Bellevue Hospital Center
| | - Cindy Osman
- School of Medicine; New York University
- Bellevue Pediatric Clinic
| | - Courtney Chinn
- Department of Pediatric Dentistry; College of Dentistry; New York University
| | - Abigail Bella
- Teaching Oral-Systemic Health; Rory Meyers College of Nursing; New York University
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37
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Huang D, Sokal-Gutierrez K, Chung K, Lin W, Khanh LN, Chung R, Hoang HT, Ivey SL. Maternal and Child Nutrition and Oral Health in Urban Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2579. [PMID: 31331011 PMCID: PMC6696721 DOI: 10.3390/ijerph16142579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 02/02/2023]
Abstract
The global nutrition transition has contributed to child obesity and dental caries in developing countries, including Vietnam. Few studies have described the nutrition and oral health of mothers and children. This a descriptive study of the nutrition and oral health characteristics of a convenience sample of 571 children aged 2 to 5 years and their mothers from 5 urban preschools in Central and South Vietnam. The mothers completed a written survey, and the children received dental exams and weight/height measurements. High rates of bottle-feeding and the consumption of sweets were reported. One in 4 children were overweight/obese. Dental caries increased in prevalence and severity by age-at 5 years, 86.7% of children had tooth decay in an average of 8.5 teeth, and 70.9% experienced mouth pain. Most mothers and children suffered from untreated dental disease. Public health programs should focus on nutrition and oral health promotion, as well as dental treatment from pregnancy and birth onward.
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Affiliation(s)
- Debbie Huang
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA.
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA.
| | - Karen Sokal-Gutierrez
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
| | - Kenny Chung
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Wenting Lin
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
- Department of Dental Medicine, Long Island Jewish Medical Center, 270-05 76th Ave, Queens, NY 11040, USA
| | - Linh Ngo Khanh
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
| | - Raymond Chung
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
| | - Hung Trong Hoang
- Faculty of Odonto-Stomatology and Department of Dental Public Health, University of Medicine and Pharmacy-Ho Chi Minh City, 217 Hồng Bàng, Phường 11, Quận 5, Hồ Chí Minh 700000, Vietnam
| | - Susan L Ivey
- Health Research for Action, University of California Berkeley School of Public Health, 2140 Shattuck Avenue, 10th Floor, Berkeley, CA 94704, USA
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Liu M, Mu H, Peng W, Zhao L, Hu W, Jiang Z, Gao L, Cao X, Li N, Han J. Time-dependent C5a and C5aR expression in dental pulp cells following stimulation with LTA and LPS. Int J Mol Med 2019; 44:823-834. [PMID: 31257457 PMCID: PMC6657968 DOI: 10.3892/ijmm.2019.4246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022] Open
Abstract
Clinically, deep decay can lead to inflammation in the dental pulp. Apart from the use of various materials to sooth the inflamed pulp, there is currently no adequate treatment, and the gold standard, calcium hydroxide, that is used to cover the dentin/pulp, has limited effect. Sometimes the pulp will remain infected and cause pulpitis, and ultimately, the pulp will need to be removed. The first principle of oral treatment is to protect the pulp. Therefore, it is necessary to study the immune response and regeneration of pulp cells in conditions of deep decay. Of the terminal complement system proteins, complement 5a (C5a) has the most potent effect compared to complement 3a (C3a) and complement 4a (C4a). C5a is 20- to 2,500-fold stronger than C3a and C4a. The purpose of this study was to elucidate the association between C5a, secreted by complement activation, and the duration of inflammation. Another key goal was to detect the expression of C5a and its receptor, complement 5a receptor (C5aR). To this end, the cells were divided into 4 groups as per stimulation with lipoteichoic acid (LTA) or lipopolysaccharide (LPS) as follows: i) The 1 µg/ml LTA group; ii) the 1 µg/ml LPS group; iii) the 1 µg/ml LTA and 1 µg/ml LPS group; and iv) the PBS-only group, which served as a control. There were 5 time points for all 4 groups: 1, 2, 3, 5 and 7 days. Reverse transcription-quantitative polymerase chain reaction was used to detect the gene expression levels of C5a, C5aR and interleukin (IL)-6 at different time points. Western blot analyses was carried out to detect the expression of C5aR. Transmission electron microscopy was also conducted to assess the ultra-structural features of dental pulp cells. The gene expression trends of C5a and C5aR mRNA were identical. C5a and C5aR mRNA was highly expressed on the second day of LTA or LPS stimulation. However, in the LTA and LPS co-stimulation group, C5a and C5aR mRNA were highly expressed on both the first and second day, with higher levels on the second day. IL-6 expression decreased as time progressed in the LTA only and in the LTA + LPS co-stimulation groups. However, a peak in its expression was observed on the second day in the LPS group. On the whole, this study demonstrates that a 1 µg/ml concentration of LTA and LPS stimulates human dental pulp cells to activate the expression of C5a.
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Affiliation(s)
- Mingyue Liu
- Department of Prosthodontics, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Haibin Mu
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Wenting Peng
- Department of Stomatology, Dezhou People's Hospital, Dezhou, Shandong 253000, P.R. China
| | - Lin Zhao
- Department of Stomatology, Dezhou People's Hospital, Dezhou, Shandong 253000, P.R. China
| | - Weiping Hu
- Department of Prosthodontics, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Zhuling Jiang
- Department of Oral Implantology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Li Gao
- Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Xiaofang Cao
- Department of Endodontics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Ning Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Jingying Han
- Department of Orthodontics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
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Abu-Zahra R, Antos NJ, Kump T, Angelopoulou MV. Oral health of cystic fibrosis patients at a north american center: A pilot study. Med Oral Patol Oral Cir Bucal 2019; 24:e379-e384. [PMID: 31011138 PMCID: PMC6530948 DOI: 10.4317/medoral.22756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/10/2019] [Indexed: 01/22/2023] Open
Abstract
Background The objective of this study was to describe the oral health status of Cystic Fibrosis (CF) children in a US facility. Material and Methods Twenty CF children ages 6-18 were recruited from Children’s Hospital of Wisconsin Pulmonary Clinic. Parents completed a health questionnaire. Clinical examinations checked dental caries using the dmft/DMFT index, dental hygiene using the Simplified Greene-Vermillion Index (DI-S), gingival inflammation using the Community Periodontal Index of Treatment Needs, and enamel defects using the modified Developmental Defects of Enamel Index. Results The majority (90%) brush twice a day, 65% consume sugary snacks, and 70% visit the dentist every 6 months. Clinically, they presented DMFT 0.25 and dmft 0.90, fair oral hygiene with DI-S 1.02, 75% had mild gingivitis and 50% had enamel defects. The more antibiotics they took, significantly more frequent (p=0.007) and more severe (p=0.017) enamel defects were noted. Similar trend was found between the number of surgeries and the presence of enamel defects (p=0.076) and dental caries (p=0.028). Conclusions Within the limitations of this study, CF patients were found to be at oral health risk due to the high prevalence of dental enamel defects. Oral health for CF children should be part of the multidisciplinary care. Key words:Cystic fibrosis, oral health, teeth, United States.
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A Study Concerning Tooth Decay Incidence in Children with Ages Between 3 and 6 Years. ARS MEDICA TOMITANA 2019. [DOI: 10.2478/arsm-2018-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Deciduous teeth cavities represent a frequent type of illness, which constitutes one of the most important dental health problems in pre-school children, caused by the direct implications and the possible consequences that it may have on permanent teeth. Even if a decrease in the incidence of dental cavities is registered in the industrialized countries of the world, when it comes to deciduous teeth, the frequency of the cavities is still high, at least for some certain social groups of the population. The purpose of the study is to collect current data on dental morbidity in the preschool population. There is not as much data concerning dental health in pre-school children as there is about school children, the reason being that preschoolar children are more difficult to consult. Material and Method: The study was conducted in a pediatric-clinic in Bucharest for a period of 5 years (ian. 01, 2013-dec. 31, 2018). The children included in the study are children who have had tooth decay. The number of children who participated in the study is 276. Results and Discussions: Of the 276 children studied, the highest incidence of tooth decay was for the age group between 3-4 years. This may signify, on one hand, a relatively high number of cavities at a young age, and on the other hand, the level of parental interest in dental care. Conclusions: The main conclusion of our study highlights the need to establish dental health education programs in both national and community level, where kindergartens and schools, have a great potential for influencing dental health care habits in children.
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Hendaus MA, Siddiq K, AlQadi M, Siddiqui F, Kunhiabdullah S, Alhammadi AH. Parental perception of fluoridated tap water. J Family Med Prim Care 2019; 8:1440-1446. [PMID: 31143736 PMCID: PMC6510084 DOI: 10.4103/jfmpc.jfmpc_192_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%. MATERIALS AND METHODS A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey. RESULTS A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients. CONCLUSION Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.
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Affiliation(s)
- Mohamed A. Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad General Corporation, Doha, Qatar
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medical and Research Center, Doha, Qatar
- Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
| | - Khaled Siddiq
- Department of Pediatrics, Academic General Pediatrics Fellowship Program, Hamad General Corporation, Doha, Qatar
| | - Mohanad AlQadi
- Department of Pediatrics, Academic General Pediatrics Fellowship Program, Hamad General Corporation, Doha, Qatar
| | - Faisal Siddiqui
- Department of Pediatrics, Pediatric Residency Program, Hamad General Corporation, Doha, Qatar
| | - Shafeeque Kunhiabdullah
- Department of Pediatrics, Pediatric Residency Program, Hamad General Corporation, Doha, Qatar
| | - Ahmed H. Alhammadi
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad General Corporation, Doha, Qatar
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medical and Research Center, Doha, Qatar
- Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
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A Clinical Vignette-Based Study of Physicians' Adherence to Guidelines for Dental Referrals of Young Children. Acad Pediatr 2019; 19:195-202. [PMID: 30361125 DOI: 10.1016/j.acap.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The American Academy of Pediatrics (AAP) recommends an oral health risk assessment and referral to a dental home by a child's first birthday. We evaluated the adherence of primary care providers (PCPs) to AAP dental referral guidelines for children age <4 years and barriers to implementation of these guidelines. METHODS A cross-sectional survey of PCPs randomly selected from the 435 practices in North Carolina identified as providing well-child visits for Medicaid children age <4 years was completed in 2013. The PCPs' referral recommendations were assessed using 4 vignettes of 18-month-old children at various risk of dental caries (low, moderate, high, or highest) and different levels of dentist supply (adequate or inadequate). Barriers to guideline adherence specified in the Cabana framework were analyzed for their associations with PCP adherence, using logistic regression models stratified by caries risk and dentist supply. RESULTS The survey yielded 219 (50%) usable responses from the sample of 435 PCPs. On average for all vignettes, 61% of providers chose a referral recommendation in agreement with guidelines. Underreferral averaged 40%. With adequate workforce, guideline-adherent responses varied from 26% for low-risk children to >90% for high-risk children. An inadequate workforce reduced adherence for most levels of risk. Generally, correct knowledge of risk status, barriers to risk assessment, and pediatric practice were associated with adherence, but not always in the hypothesized direction. CONCLUSIONS PCPs' adherence to referral guidelines varies according to caries risk and dentist supply, but generally they underrefer low- to moderate-risk patients by a significant degree.
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Martin M, Rosales G, Sandoval A, Lee H, Pugach O, Avenetti D, Alvarez G, Diaz A. What really happens in the home: a comparison of parent-reported and observed tooth brushing behaviors for young children. BMC Oral Health 2019; 19:35. [PMID: 30791896 PMCID: PMC6385429 DOI: 10.1186/s12903-019-0725-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background Most studies of tooth brushing behaviors rely on self-report or demonstrations of behaviors conducted in clinical settings. This study aimed to determine the feasibility of objective assessment of tooth brushing behaviors in the homes of high-risk children under three years old. We compared parent self-report to observations to determine the accuracy of self-report in this population. Methods Forty-five families were recruited from dental and medical clinics and a community social service agency. Research staff asked questions about oral health behaviors and observed tooth brushing in the homes. Brushing was also video-recorded. Video-recordings were coded for brushing behaviors by staff that did not collect the primary data; these abstracted data were compared to those directly observed in homes. Results Most families were Hispanic (76%) or Black (16%) race/ethnicity. The majority of parents had a high school education (42%) or less (24%). The mean age of children was 21 months. About half of parents reported brushing their child’s teeth twice a day (58%). All parents tried to have their children brush, but three children refused. For brushing duration, 70% of parents reported differently than was observed. The average duration of brushing was 62.4 s. Parent report of fluoride in toothpaste frequently did not match observations; 39% said they used toothpaste with fluoride while 71% actually did. Sixty-eight percent of parents reported using a smear of toothpaste, while 61% actually did. Brushing occurred in a variety of locations and routines varied. Abstracted data from videos were high in agreement for some behaviors (rinse with water, floss used, brushing location, and parent involvement: Kappa 0.74–1.0). Behaviors related to type of brushing equipment (brushes and toothpaste), equipment storage, and bathroom organization and clutter had poor to no agreement. Conclusions Observation and video-recording of brushing routines and equipment are feasible and acceptable to families. Observed behaviors are more accurate than self-report for most components of brushing and serve to highlight some of the knowledge issues facing parents, such as the role of fluoride.
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Affiliation(s)
- Molly Martin
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA.
| | - Genesis Rosales
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - Anna Sandoval
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - Helen Lee
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - Oksana Pugach
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - David Avenetti
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - Gizelle Alvarez
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
| | - Anabelen Diaz
- University of Illinois at Chicago, 1747 West Roosevelt Road, Room 547, M/C 275, Chicago, IL, 60608, USA
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Weber-Gasparoni K. Examination, Diagnosis, and Treatment Planning of the Infant and Toddler. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Horner AJ, Nativio DG. Unique Factors Affecting the Management and Prevention of Caries in the Childhood Cancer Survivor. J Pediatr Health Care 2019; 33:53-57. [PMID: 30126733 DOI: 10.1016/j.pedhc.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/06/2018] [Accepted: 06/16/2018] [Indexed: 11/25/2022]
Abstract
Childhood cancer survivors are at high risk for a myriad of complications secondary to oncologic treatment regimens. Caries is one of the major sequela of oncologic treatment that place the childhood cancer survivor at risk for complications in adulthood. Dental caries can be prevented with optimum dental care, early identification, and patient education. A barrier to their prevention is the lack of routine dental care received by this population. Health care providers are in a prime position to remedy this problem through their frequent contact with the childhood cancer survivor during sick and well-child office visits. The purpose of this article is to convey information and tools related to dental caries in the pediatric cancer survivor younger than 18 years to enhance primary care providers', acute care pediatric nurse practitioners', and oncology providers' knowledge of risk stratification, early identification, and treatment regimens for caries in the childhood cancer survivor.
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Affiliation(s)
- Abbey J Horner
- Abbey J. Horner, Professional Staff Nurse, University of Pittsburgh, Pittsburgh, PA..
| | - Donna G Nativio
- Donna G. Nativio, Associate Professor, University of Pittsburgh School of Nursing, Pittsburgh, PA
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Abstract
Dental health in early childhood is a predictor for oral health as we age, and oral health is an important factor affecting overall health. For this reason, providing good guidance and early intervention is imperative to help set our patients up for success. To do this, providers must be familiar with dental anatomy and development, as well as recommendations for caries prevention, pacifier use, juice consumption, fluoride, and the establishment of a dental home. Aside from general oral health care, providers must also be able to provide guidance regarding dental trauma prevention and management. As health care providers are often the first point of contact after injury, they must be able to provide acute care and appropriate referral as necessary. [Pediatr Ann. 2019;48(1):e3-e8.].
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Fontana M, Eckert GJ, Keels MA, Jackson R, Katz B, Levy BT, Levy SM. Fluoride Use in Health Care Settings: Association with Children's Caries Risk. Adv Dent Res 2018; 29:24-34. [PMID: 29355412 DOI: 10.1177/0022034517735297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).
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Affiliation(s)
- M Fontana
- 1 University of Michigan, Ann Arbor, MI, USA
| | - G J Eckert
- 2 Indiana University, Indianapolis, IN, USA
| | | | - R Jackson
- 2 Indiana University, Indianapolis, IN, USA
| | - B Katz
- 2 Indiana University, Indianapolis, IN, USA
| | - B T Levy
- 4 University of Iowa, Iowa City, IA, USA
| | - S M Levy
- 4 University of Iowa, Iowa City, IA, USA
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Abstract
Background The mouth is integral in the development of feeding, the initiation of digestion, and for speech and socialization. Signs of systemic disease and nutritional deficiencies often manifest in the mouth, and poor oral health can exacerbate many systemic conditions. Methods This review addresses the fetal development of the mouth, major anomalies, common minor physical findings, and pathologic conditions and their management. Results Pediatric practitioners have historically been poorly trained in diagnosis and management of oral conditions, so this article provides an overview of oral embryology and pathology, with a focus on hard and soft tissue disease identification, triage, and management. For primary prevention to be effective, pediatric providers must be knowledgeable about the process of dental caries, prevention of the disease, and available interventions, including fluoride. Conclusion The embryology and anatomy of the oral cavity are complex, and the mouth is crucial to many physiologic processes. Pediatric primary care providers are uniquely positioned to prevent, identify, and triage dental caries, the most common chronic disease of childhood.
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Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
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Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
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Zhu Y, Close K, Zeldin L, White B, Rozier R. Implementation of Oral Health Screening and Referral Guidelines in Primary Health Care. JDR Clin Trans Res 2018; 4:167-177. [DOI: 10.1177/2380084418810332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the oral health screening and referral practices of pediatric providers, their adherence to American Academy of Pediatrics oral health guidelines, and barriers to adherence. Methods: Providers in 10 pediatric practices participating in the North Carolina Quality Improvement Initiative, funded by the Child Health Insurance Program Reauthorization Act of 2009, were asked to complete a 91-item questionnaire. Questions on risk assessment and referral practices were based on those recommended by the American Academy of Pediatrics. Adherence to oral health guidelines was assessed by practitioners’ evaluation of 4 vignettes presenting screening results for an 18-mo-old child with different levels of risk and caries status. Respondents chose referral recommendations assuming adequate and inadequate dentist workforces. Logit models determined the association between barriers specified in Cabana’s framework and adherence (count of 6 to 8 adherent vignettes vs. 0 to 5). Results: Of 72 eligible providers, 53 (74%) responded. Almost everyone (98.1%) screened for dental problems; 45.2% referred in at least half of well-child visits. Respondents were aware of oral health guidelines, expressed strong agreement with them, and reported confidence in providing preventive oral health services. Yet they underreferred by an average of 42% per vignette for the 7 clinical vignette-workforce scenarios requiring an immediate referral. Frequently cited barriers were providers’ beliefs that 1) parents are poorly motivated to seek dental care, 2) oral health counseling has a small effect on parent behaviors, 3) there is a shortage of dentists in their community who will see infants and toddlers, and 4) information systems to support referrals are insufficient. Conclusion: Pediatric clinicians’ beliefs lead to a conscious decision not to refer many patients, even when children should be referred. Knowledge Transfer Statement: Evidence suggests that the primary care–dental referral process needs improvement. This study identifies barriers to delivering recommended preventive oral health services in pediatrics. The information can be used to improve the screening and referral process and, thus, the quality of preventive oral health services provided in primary care. Results also can guide researchers on the selection of interventions that need testing and might close gaps in the referral process and improve access to dental care.
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Affiliation(s)
- Y. Zhu
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - K. Close
- Oral Health Section, Division of Public Health, NC Department of Health and Human Services, Raleigh, NC, USA
| | - L.P. Zeldin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - B.A. White
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
| | - R.G. Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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