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Sarvas E, Webb J, Landrigan-Ossar M, Yin L. Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report. Pediatrics 2024; 154:e2024067603. [PMID: 39034828 DOI: 10.1542/peds.2024-067603] [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: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/23/2024] Open
Abstract
Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.
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Affiliation(s)
| | | | | | - Larry Yin
- Associate Professor of Clinical Pediatrics, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
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Ruff RR, Godín TB, Niederman R. The effectiveness of medical nurses in treating children with silver diamine fluoride in a school-based caries prevention program. Community Dent Oral Epidemiol 2024; 52:398-405. [PMID: 37873685 DOI: 10.1111/cdoe.12925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) and fluoride varnish (FV) for the prevention of dental caries. METHODS CariedAway was a school-based study of SDF and FV versus dental sealants and atraumatic restorations. Within the SDF + FV arm, participants were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a paediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after 2 years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools. RESULTS A total of 417 children with no untreated caries at baseline were analysed including 298 treated by hygienists and 119 by nurses. The proportion of children who remained caries free after 2 years was 0.81 and 0.80 for those treated by hygienists and nurses, respectively, for a difference of 0.01 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin. CONCLUSIONS Nurses may be effective in treating children with silver diamine fluoride and other fluoride varnishes in school-based oral health programs.
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Affiliation(s)
- Ryan Richard Ruff
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
| | - Tamarinda Barry Godín
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
| | - Richard Niederman
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
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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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Goff SL, Gilson CF, DeCou E, Dick AW, Geissler KH, Dalal M, Kranz AM. Barriers and Facilitators to Optimal Fluoride Varnish Application. Acad Pediatr 2024; 24:755-764. [PMID: 37802248 PMCID: PMC10995105 DOI: 10.1016/j.acap.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE National guidelines recommend that all children under age six receive fluoride varnish (FV) in medical settings. However, application rates remain low. This study aimed to update understanding of barriers and facilitators to guideline concordant FV application. METHODS We conducted virtual semi-structured interviews with a purposive sample (eg, FV application rates, geographic location, practice size and type) of pediatric primary care clinicians and medical assistants in Massachusetts between February 1 and June 30, 2022. The Consolidated Framework for Implementation Research (CFIR) served as the study's theoretical framework and data were analyzed using a modified grounded theory approach. RESULTS Of the 31 participants, 90% identified as White and 81% as female. Major themes, which linked to four CFIR domains, included: variation in perceived adequacy of reimbursement; differences in FV application across practice types; variation in processes, protocols, and priorities; external accountability for quality of care; and potential levers for change. Important subthemes included challenges for small practices; role of quality measures in delivering guideline-concordant preventive oral health care; and desire for preventive care coordination with dentists. CONCLUSIONS This study suggests that potential barriers and facilitators to guideline concordant FV application exist at multiple levels that may warrant further study. Examples include testing the effectiveness of quality measures for FV application and testing strategies for implementing consistent processes and protocols for improving FV application rates.
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Affiliation(s)
- Sarah L Goff
- University of Massachusetts Amherst School of Public Health and Health Sciences (SL Goff, CF Gilson, and E DeCou), Health Promotion and Policy, Amherst, Mass.
| | - Charlotte F Gilson
- University of Massachusetts Amherst School of Public Health and Health Sciences (SL Goff, CF Gilson, and E DeCou), Health Promotion and Policy, Amherst, Mass
| | - Erin DeCou
- University of Massachusetts Amherst School of Public Health and Health Sciences (SL Goff, CF Gilson, and E DeCou), Health Promotion and Policy, Amherst, Mass
| | | | - Kimberley H Geissler
- UMass Chan Medical School-Baystate (KH Geissler), Department of Healthcare Delivery and Population Sciences, Springfield, Mass
| | - Michelle Dalal
- Boston Office, Reliant Medical Group (M Dalal), Milford, Mass
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Khami MR, Haghparast Ghomsheh A, Hessari H, Shati M. Knowledge of the health personnel involved in the fluoride varnish therapy programs of primary schools in Tehran, Iran. BMC Oral Health 2024; 24:649. [PMID: 38824605 PMCID: PMC11143676 DOI: 10.1186/s12903-024-04390-8] [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: 02/01/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) places great importance on oral health promotion programs in schools, given that approximately one billion people worldwide are students. This demographic not only includes the students themselves, but also extends to school staff, their families, and the broader community, all of whom are interconnected. The objectives of this study were firstly to assess the knowledge of health personnel conducting fluoride varnish treatment (FVT) in schools, and secondly to solicit their views on the effectiveness of their training methods. METHODS Data was collected from health personnel involved in FVT in schools, supervised by medical universities in Tehran province, using a questionnaire. The questionnaire was divided into four sections: demographic information, methods of receiving FVT training, respondents' knowledge regarding FVT, and opinions about the effectiveness of FVT training methods. The questionnaire was distributed via social media, phone conversations, and email. The collected data was analyzed using Mann-Whitney in SPSS Version 26. A regression model was also fitted to the data. RESULTS The present study included 403 participants. Among various educational methods, it was found that participation in previous workshops (P = 0.001) and FVT workshops (P = 0.013) was significantly correlated with a higher FVT knowledge score. Additionally, participation in previous oral health promotion programs was significantly associated with a higher knowledge score (P < 0.05). Therefore, a history of participating in previous health promotion programs significantly contributed to the participants' knowledge. CONCLUSION Participation in previous oral health programs was found to be significantly correlated with a higher knowledge score. The effectiveness of training programs can be attributed to participation in previous workshops and FVT workshops. This study provided insights into potential strategies for enhancing personnel training in national oral health programs.
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Affiliation(s)
- Mohammad Reza Khami
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, P.O. Box 1417614411, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, 1439955934, Iran
| | - Ali Haghparast Ghomsheh
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, P.O. Box 1417614411, Tehran, Iran.
| | - Hossein Hessari
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, P.O. Box 1417614411, Tehran, Iran
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, 1439955934, Iran
| | - Mohsen Shati
- Mental Health Research Center (MHRC), School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, School of public health, Iran University of Medical Sciences, Tehran, Iran
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Raszewski Z, Chojnacka K, Mikulewicz M. Investigating Bioactive-Glass-Infused Gels for Enamel Remineralization: An In Vitro Study. J Funct Biomater 2024; 15:119. [PMID: 38786631 PMCID: PMC11122500 DOI: 10.3390/jfb15050119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Dental hypersensitivity remains widespread, underscoring the need for materials that can effectively seal dental tubules. This study evaluated the potential of bioactive-glass-infused hydroxyethyl cellulose gels in this context. METHODS Five gels were synthesized, each containing 20% bioactive glass (specifically, 45S5, S53P4, Biomin F, and Biomin C), with an additional blank gel serving as a control. Subjected to two months of accelerated aging at 37 ± 2 °C, these gels were assessed for key properties: viscosity, water disintegration time, pH level, consistency, adhesion to glass, and element release capability. RESULTS Across the board, the gels facilitated the release of calcium, phosphate, and silicon ions, raising the pH from 9.00 ± 0.10 to 9.7 ± 0.0-a range conducive to remineralization. Dissolution in water occurred within 30-50 min post-application. Viscosity readings showed variability, with 45S5 reaching 6337 ± 24 mPa/s and Biomin F at 3269 ± 18 mPa/s after two months. Initial adhesion for the blank gel was measured at 0.27 ± 0.04 Pa, increasing to 0.73 ± 0.06 Pa for the others over time. Gels can release elements upon contact with water (Ca- Biomin C 104.8 ± 15.7 mg/L; Na- Biomin F 76.30 ± 11.44 mg/L; P- Biomin C 2.623 ± 0.393 mg/L; Si- 45S5-45.15 ± 6.77mg/L, F- Biomin F- 3.256 ± 0.651mg/L; Cl- Biomin C 135.5 ± 20.3 mg/L after 45 min). CONCLUSIONS These findings highlight the gels' capacity to kickstart the remineralization process by delivering critical ions needed for enamel layer reconstruction. Further exploration in more dynamic, real-world conditions is recommended to fully ascertain their practical utility.
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Affiliation(s)
| | - Katarzyna Chojnacka
- Department of Advanced Material Technologies, Faculty of Chemistry, Wroclaw University of Science and Technology, Smoluchowskiego 25, 50-372 Wroclaw, Poland;
| | - Marcin Mikulewicz
- Department of Dentofacial Orthopaedics and Orthodontics, Division of Facial Abnormalities, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland;
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Stichtenoth G, Gonser M, Hentschel R, Janke E, Maul H, Schmitt A, Steppat S, Werner J, Herting E. Betreuung von Neugeborenen in der Geburtsklinik (Entwicklungsstufe
S2k, AWMF-Leitlinien-Register-Nr. 024–005, März 2021). Z Geburtshilfe Neonatol 2024; 228:137-150. [PMID: 38608666 DOI: 10.1055/a-2195-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Guido Stichtenoth
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Markus Gonser
- Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
| | - Roland Hentschel
- Neonatologie/Intensivmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg
| | - Evelin Janke
- Katholische Bildungsstätte für Berufe im Sozial- und Gesundheitswesen GmbH, Akademie St. Franziskus, Lingen (Ems)
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Anne Schmitt
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken
| | | | - Janne Werner
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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Dhull KS, Dutta B, Pattanaik S, Gupta A, Md I, Wandile B. Decoding Early Childhood Caries: A Comprehensive Review Navigating the Impact of Evolving Dietary Trends in Preschoolers. Cureus 2024; 16:e58170. [PMID: 38741840 PMCID: PMC11090680 DOI: 10.7759/cureus.58170] [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: 02/12/2024] [Accepted: 03/14/2024] [Indexed: 05/16/2024] Open
Abstract
This comprehensive review delves into the intricate relationship between evolving dietary trends in preschoolers and the prevalence of early childhood caries (ECC). The investigation meticulously analyzes ECC epidemiology, etiology, and preventive strategies. The review unveils the multifaceted nature of ECC, highlighting microbial, dietary, and environmental factors contributing to its development. Significantly, the study explores the global prevalence of ECC and its substantial implications for the overall health, nutrition, and development of preschool-aged children. The implications for public health and policy are deliberated, advocating for targeted interventions and collaborative efforts among healthcare professionals, policymakers, educators, and parents. The conclusion presents a compelling call to action, urging collective engagement to mitigate the impact of ECC and prioritize the well-being of preschoolers. This review offers valuable insights for healthcare professionals, policymakers, educators, and parents to inform evidence-based strategies for addressing ECC and promoting early childhood oral health.
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Affiliation(s)
- Kanika S Dhull
- Pedodontics and Preventive Dentistry, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, IND
| | - Brahmananda Dutta
- Pedodontics and Preventive Dentistry, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, IND
| | | | - Aditi Gupta
- Pediatric Dentistry, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, IND
| | - Indira Md
- Pedodontics and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, IND
| | - Bhushan Wandile
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Klaophimai A, Tosrisawatkasem O, Horsophonphong S. Antibacterial effects of children's and adults' toothpastes containing different amounts of fluoride: An in vitro study. J Dent Res Dent Clin Dent Prospects 2024; 18:23-28. [PMID: 38881638 PMCID: PMC11179140 DOI: 10.34172/joddd.40705] [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: 09/23/2023] [Accepted: 01/03/2024] [Indexed: 06/18/2024] Open
Abstract
Background In recent years, fluoride concentrations in toothpaste for children and adults have increased. However, the effects of different concentrations on bacterial activity have rarely been compared. We aimed to investigate and compare the antibacterial activity of children's and adults' toothpaste containing 500, 1000‒1100, and 1450‒1500 ppm fluoride. Methods Three strains of bacteria (Streptococcus mutans, Streptococcus salivarius, and Lactobacillus casei) were cultured in brain heart infusion agar. Thirty commercially available toothpaste products for children and adults containing 500, 1000‒1100, and 1450‒1500 ppm fluoride were selected and tested. Toothpaste's ability to inhibit bacterial growth was evaluated by agar diffusion assay, in which plates were incubated for 24 hours, and then the diameter of the microbial inhibition zone was measured. Comparisons between children's and adults' fluoride toothpastes were made using the Mann-Whitney U test. The association between bacterial growth inhibition and sodium lauryl sulfate (SLS) was analyzed by the chi-square test. A P value of <0.05 was considered statistically significant. Results No difference in the inhibition zone was observed for different fluoride concentrations. However, there were significant differences between toothpastes for children and adults, with higher inhibition zones for adults' toothpastes. Most toothpastes for adults contained SLS, which was associated with antibacterial activity. Conclusion Fluoride concentrations ranging from 500 to 1500 ppm did not affect bacterial growth. The antibacterial activity of toothpastes for adults was significantly higher than that of toothpastes for children, which was mainly attributed to the SLS usually added to adult formulations.
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Affiliation(s)
- Arthit Klaophimai
- Department of Oral Microbiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Orada Tosrisawatkasem
- Department of Oral Microbiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sivaporn Horsophonphong
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Pontigo-Loyola AP, Mendoza-Rodriguez M, de la Rosa-Santillana R, Rivera-Pacheco MG, Islas-Granillo H, Casanova-Rosado JF, Márquez-Corona MDL, Navarrete-Hernández JDJ, Medina-Solís CE, Manton DJ. Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods. Pediatr Rep 2024; 16:243-253. [PMID: 38651460 PMCID: PMC11036215 DOI: 10.3390/pediatric16020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.
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Affiliation(s)
- América Patricia Pontigo-Loyola
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Martha Mendoza-Rodriguez
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Rubén de la Rosa-Santillana
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Maria Gracia Rivera-Pacheco
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Horacio Islas-Granillo
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | | | - María de Lourdes Márquez-Corona
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - José de Jesús Navarrete-Hernández
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
| | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico; (A.P.P.-L.); (M.M.-R.); (R.d.l.R.-S.); (M.G.R.-P.); (H.I.-G.); (M.d.L.M.-C.)
- Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata” of Faculty of Dentistry, Autonomous University of the State of Mexico, Toluca 50130, Mexico
| | - David J. Manton
- Department of Cariology, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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Yu J, Song G, Yu J. Assessment of knowledge, attitude, and practice on early childhood caries among dental undergraduates and residents in China. BMC MEDICAL EDUCATION 2024; 24:232. [PMID: 38438890 PMCID: PMC10913565 DOI: 10.1186/s12909-024-05188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Early childhood caries (ECC) causes severe, widespread oral health issues in children. Dental undergraduates and residents are expected to have a solid understanding of ECC for children's oral health promotion. This study aimed to evaluate the knowledge, attitude, and clinical practice on ECC among dental undergraduates and residents in China. METHODS A 23-item electronic questionnaire was distributed to 598 dental undergraduates (4th- and 5th-year undergraduates) and residents (1st-, 2nd-, and 3rd-year residents) at the School of Stomatology, Wuhan University, China (in April-May 2023). SPSS Statistics was used to analyze the data using the Chi-square test at a significance level of 0.05. RESULTS A total of 422 questionnaires were completed by participants (recovery rate: 70.6%) from various academic levels. Around 77.3% of participants had heard of ECC (mainly from textbooks), and only 27.5% considered themselves familiar with it. Residents (79.8%) had higher risk awareness of ECC on children's overall health than undergraduates (58.3%) (p < 0.05), but only 54.0% of participants correctly defined ECC. Most participants had a positive understanding of ECC's pathogenic factors and preventive measures, including feeding patterns (71.6%), fluoride application (93.4%), and teeth cleaning (93.1%). Furthermore, only 50.2% of participants encountered ECC cases in clinic. CONCLUSIONS Despite having a suboptimal level of ECC-related knowledge and practice, dental undergraduates and residents in China demonstrated a more positive attitude towards its etiology-based prevention. Strengthening ECC education, guidance, and practice may enable them to gain a better understanding of ECC learning, which would benefit children's oral health.
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Affiliation(s)
- Jingjing Yu
- Department of Paediatric Dentistry, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Guangtai Song
- Department of Paediatric Dentistry, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jian Yu
- Department of Paediatric Dentistry, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
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Bakhurji E. PARENTAL EDUCATION, CARIES EXPERIENCE, PLAQUE ACCUMULATION, AND Mutans Streptococci COUNT MAY PREDICT THE INCREMENT OF EARLY CHILDHOOD CARIES IN PRESCHOOL CHILDREN OVER 24 MONTHS. J Evid Based Dent Pract 2024; 24:101961. [PMID: 38448123 DOI: 10.1016/j.jebdp.2023.101961] [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] [Indexed: 03/08/2024]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. J Evid Based Dent Pract. 2022 Sep;22(3):101732. SOURCE OF FUNDING Government TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.
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Sudradjat H, Meyer F, Fandrich P, Schulze Zur Wiesche E, Limeback H, Enax J. Doses of fluoride toothpaste for children up to 24 months. BDJ Open 2024; 10:7. [PMID: 38296947 PMCID: PMC10831090 DOI: 10.1038/s41405-024-00187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
AIM The aim of this study was to test the dose of fluoride toothpaste by parents for their children aged up to 24 months. METHODS Parents who use fluoride toothpastes for their children were asked to dose two commercially available toothpastes (A and B) with 1000 ppm fluoride each for their children as they would normally do at home. The toothpaste amounts were weighed, and as reference, the weight of an 'optimal' grain of rice-size amount of each toothpaste was used. RESULTS 61 parents dosed a mean of 0.263 ± 0.172 g toothpaste A and 0.281 ± 0.145 g toothpaste B. The parents' mean doses were 5.9 times higher for toothpaste A and 7.2 times higher for toothpaste B than an 'optimal' grain of rice-size amount (the reference dose as recommended). The difference between parent's and reference dose was statistically significant (p < 0.001). Moreover, 39.3% of parents were not aware about conditions of use and warnings that have to be printed on the package of fluoride toothpastes. CONCLUSION In this study, parents significantly overdosed the toothpaste for their children. To avoid fluoride intake from toothpaste, parents can choose fluoride-free alternatives for the oral care of their infants and toddlers.
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Affiliation(s)
- Henny Sudradjat
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
- Private dental practice, Braunschweig, Germany
| | - Frederic Meyer
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Pascal Fandrich
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Erik Schulze Zur Wiesche
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany
| | - Hardy Limeback
- Faculty of Dentistry, University of Toronto, Toronto, ON, M5G 1G6, Canada
| | - Joachim Enax
- Dr. Kurt Wolff GmbH & Co. KG, Research Department, Johanneswerkstr. 34-36, 33611, Bielefeld, Germany.
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Couto FM, de Sousa FSDO, Vicente GC, Castro DPDF, Nadanovsky P, Dos Santos APP, Barja-Fidalgo F. Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children. Int J Paediatr Dent 2024; 34:11-25. [PMID: 37101236 DOI: 10.1111/ipd.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information. AIM To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic. DESIGN Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument. RESULTS Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment. CONCLUSION Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.
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Affiliation(s)
- Flávia Macedo Couto
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Gabriela Cristina Vicente
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Daniel Pereira de Faria Castro
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Fernanda Barja-Fidalgo
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Garcés-Elías MC, Del Castillo-López CE, Beltrán JA, Agudelo-Suárez AA, León-Manco RA. Toothpaste use in Peruvian children during COVID-19 pandemic: results from a National Demographic and Health Survey. Eur Arch Paediatr Dent 2023; 24:779-786. [PMID: 37759131 DOI: 10.1007/s40368-023-00845-8] [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: 01/06/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To determine the impact of COVID-19 pandemic on use of toothpaste in Peruvian children. METHODS A national database of Peruvian children from 0 to 11 years old was used to develop a cross-sectional study, with a final sample of 51, 013 subjects. Data were obtained of results of the Demographic and Family Health Survey (ENDES); the questionnaire was self-reported. The use of toothpaste and fluoride concentration in toothpaste were dependent variables, and for the independent variable, the year was considered; in addition, other covariates were included. The statistical analyses applied were descriptive, bivariate, and multivariate tests. RESULTS Use of toothpaste was 98.99% (n = 50,134), while fluoride toothpaste with < 1000 ppm was used by 77.29% (n = 27,366). For bivariate analysis, use of toothpaste was associated with place and area of residence, altitude, natural region, and age; for use of fluoride toothpaste with minimum 1000 ppm, there was an association with place and area of residence, natural region, wealth index, and age. In a multivariate manner, year only presented a positive association with use of fluoride toothpaste < 1000 ppm (RPa:1.04; 95%CI 1.01-1.07). CONCLUSIONS Year 2020 of COVID-19 pandemic had a positive impact on the use of < 1000 ppm fluoride toothpaste in Peruvian children.
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Affiliation(s)
- M C Garcés-Elías
- Faculty of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - J A Beltrán
- Faculty of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - R A León-Manco
- Faculty of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru
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16
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Pbert L, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 330:1666-1673. [PMID: 37934215 DOI: 10.1001/jama.2023.21408] [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] [Indexed: 11/08/2023]
Abstract
Importance Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years. Population Asymptomatic children and adolescents aged 5 to 17 years. Evidence Assessment The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. Recommendations The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Jiang W, Wang G, Wu W, Shao C, Pan H, Chen Z, Tang R, Chen Z, Xie Z. The effect of calcium phosphate ion clusters in enhancing enamel conditions versus Duraphat and Icon. AUST ENDOD J 2023; 49 Suppl 1:46-57. [PMID: 36127810 DOI: 10.1111/aej.12689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to evaluate and compare the remineralisation, mechanical, anti-aging, acid resistance and antibacterial properties of calcium phosphate ion clusters (CPICs) materials with those of Duraphat and Icon. The remineralisation and mechanical properties were investigated using scanning electron microscopy, Fourier-transform infrared (FTIR) spectroscopy and nanoindentation. CPICs induced epitaxial crystal growth on the enamel surface, where the regrown enamel-like apatite layers had a similar hardness and elastic modulus to natural enamel (p > 0.05). Acid resistance and anti-aging properties were tested based on ion dissolution and surface roughness. CPICs exhibited similar calcium and phosphate ion dissolution to the control (p > 0.05), and its roughness decreased after thermocycling (p < 0.05), thereby decreasing the risk of enamel surface demineralisation. The minimum inhibitory concentration was 0.1 mg/ml, and the minimum bactericidal concentration ranged from 0.05 to 0.1 mg/ml. Overall, this biomimetic CPICs is a promising alternative to dental demineralisation.
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Affiliation(s)
- Wen Jiang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Diseases of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Gang Wang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Diseases of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenzhi Wu
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Diseases of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Changyu Shao
- Department of Chemistry, Center for Biomaterials and Biopathways, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haihua Pan
- Department of Chemistry, Center for Biomaterials and Biopathways, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhi Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Ruikang Tang
- Department of Chemistry, Center for Biomaterials and Biopathways, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhuo Chen
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Diseases of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhijian Xie
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Clinical Research Center for Oral Diseases of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
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Chen AYA, Geissler KH, Dick AW, Goff S, Kranz AM. Association Between Insurance Type and Fluoride Varnish Application During Well-Child Visits in Massachusetts. Acad Pediatr 2023; 23:1213-1219. [PMID: 37169254 PMCID: PMC10524787 DOI: 10.1016/j.acap.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To compare rates of fluoride varnish (FV) applications during well-child visits for children covered by Medicaid and private medical insurance in Massachusetts. METHODS This cross-sectional study analyzed well-child visits for children aged 1 to 5 years paid by Medicaid and private insurance during 2016.Çô18 in Massachusetts. Multivariate regression models, with all covariates interacting with insurance type, were used to calculate odds ratios and adjusted predicted probabilities of fluoride varnish during well-child visits by calendar year and age. RESULTS Across 957,551 well-child visits, 40.0% were paid by private insurers. Unadjusted rates of fluoride varnish were significantly lower among well-child visits paid by private insurers (6.6%) than visits paid by Medicaid (14.2%). In the fully interacted regression model, the odds of a visit including fluoride varnish were significantly lower for older children than for children aged 1 for visits paid by both insurance types. Adjusted rates of fluoride varnish increased significantly from 2016 to 2018 for both insurance types. Moreover, rates were higher among visits for children covered under Medicaid than privately insured children in all years, and the differences by insurance type declined over time (2016: 8.0% points, 95% confidence interval.á=.á.êÆ8.7 to .êÆ7.3, 2018: 5.3% points, 95% confidence interval.á=.á.êÆ6.6 to .êÆ3.9). CONCLUSIONS Rates of fluoride varnish applications during well-child visits were low for both Medicaid and private insurance despite growth from 2016 to 2018 in Massachusetts. Low rates are concerning because this is a recommended service with the potential to help address racial, geographic, and income-based disparities in access and oral health outcomes.
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Affiliation(s)
| | - Kimberley H Geissler
- University of Massachusetts Amherst School of Public Health & Health Sciences (KH.áGeissler and.áS.áGoff).
| | - Andrew W Dick
- RAND Corporation (A.áYu-An.áChen and.áAW.áDick), Boston, Mass.
| | - Sarah Goff
- University of Massachusetts Amherst School of Public Health & Health Sciences (KH.áGeissler and.áS.áGoff).
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Tuan WJ, Leinbach LI, Gill SA. Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:178-185. [PMID: 36126220 PMCID: PMC9897270 DOI: 10.1097/phh.0000000000001630] [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] [Indexed: 02/02/2023]
Abstract
CONTEXT Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride. OBJECTIVE This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities. DESIGN We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors. PARTICIPANTS Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center. MAIN OUTCOME MEASURE The presence of dental caries based on diagnoses in EHRs. RESULTS The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC. CONCLUSION Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.
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Affiliation(s)
- Wen-Jan Tuan
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Leah I. Leinbach
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Stephanie A. Gill
- Departments of Family and Community Medicine (Drs Tuan and Gill), Public Health Sciences (Drs Tuan and Leinbach), and Surgery (Dr Leinbach), College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Lukac PJ, Bell D, Sreedharan P, Gornbein JA, Lerner C. The Application of Dental Fluoride Varnish in Children: A Low Cost, High-Value Implementation Aided by Passive Clinical Decision Support. Appl Clin Inform 2023; 14:245-253. [PMID: 36634698 PMCID: PMC10060097 DOI: 10.1055/a-2011-8167] [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: 08/16/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Fluoride is vital in the prevention of dental caries in children. In 2014, the U.S. Preventive Services Task Force deemed fluoride varnish a recommended preventive service (grade B). Electronic health record-based clinical decision support (CDS) tools have shown variable ability to alter physicians' ordering behaviors. OBJECTIVES This study aimed to increase the application of fluoride varnish in children while analyzing the effect of two passive CDS tools-an order set and a note template. METHODS Data on outpatient pediatric visits over an 18-month period before and after CDS implementation (October 15, 2020-April 15, 2022) were queried, while trends in application rate of fluoride were examined. We constructed a multiple logistic regression model with a primary outcome of whether a patient received fluoride at his/her visit. The primary predictor was a "phase" variable representing the CDS implemented. Physician interaction with CDS as well as the financial effects of the resulting service use were also examined. RESULTS There were 3,049 well-child visits of children aged 12 months to 5 years. The addition of a fluoride order to a "Well Child Check" order set led to a 10.6% increase in ordering over physician education alone (25.4 vs. 14.8%, p = 0.001), while the insertion of fluoride-specific text to drop-down lists in clinical notes led to a 6.2% increase (31.5 vs. 25.4%, p = 0.005). Whether a patient received topical fluoride was positively associated with order set implementation (odds ratio [OR] = 5.87, 95% confidence interval [CI]: 4.20-8.21) and fluoride-specific drop-down lists (OR = 7.81, 95% CI: 5.41-11.28). Female providers were more likely to use order sets when ordering fluoride (56.2 vs. 40.9% for males, p ≤ 0.0001). Added revenue totaled $15,084. CONCLUSION The targeted use of order sets and note templates was positively associated with the ordering of topical fluoride by physicians.
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Affiliation(s)
- Paul J. Lukac
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
- Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
| | - Douglas Bell
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Priya Sreedharan
- Office of Health Informatics and Analytics, University of California, Los Angeles, Los Angeles, California, United States
| | - Jeffrey A. Gornbein
- Department of Biostatics, School of Public Health, University of California, Los Angeles, Los Angeles, California, United States
| | - Carlos Lerner
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States
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Danesh DO, Peng J, Hammersmith KJ, Gowda C, Maciejewski H, Amini H, Wapner AW, Meyer BD. Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:186-195. [PMID: 36459615 DOI: 10.1097/phh.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice. DESIGN Retrospective claims-based analysis cohort study. SETTING Children with Medicaid insurance through an Ohio pediatric accountable care organization. PARTICIPANTS Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017. INTERVENTION FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider. MAIN OUTCOME MEASURE Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes. RESULTS The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4). CONCLUSIONS Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.
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Affiliation(s)
- David O Danesh
- Division of Pediatric Dentistry, College of Dentistry (Drs Danesh, Hammersmith, Amini, and Meyer), Department of Pediatrics, College of Medicine (Dr Gowda), and Division of Health Services Management and Policy, College of Public Health (Dr Wapner), The Ohio State University, Columbus, Ohio; Department of Dentistry (Drs Danesh, Peng, Hammersmith, Amini, and Meyer), Partners For Kids (Dr Gowda and Ms Maciejewski), Center for Clinical Excellence (Ms Maciejewski), Division of Emergency Medicine (Dr Wapner), and Information Technology Research and Innovation (Dr Peng), Nationwide Children's Hospital, Columbus, Ohio
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Woolf AD, Stierman BD, Barnett ED, Byron LG. Drinking Water From Private Wells and Risks to Children. Pediatrics 2023; 151:190542. [PMID: 36995188 DOI: 10.1542/peds.2022-060645] [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] [Accepted: 11/16/2022] [Indexed: 02/04/2023] Open
Abstract
Drinking water for approximately 23 million US households is obtained from private wells. These wells can become contaminated by pollutant chemicals or pathogenic organisms, leading to significant illness. Although the US Environmental Protection Agency and all states offer guidance for construction, maintenance, and testing of private wells, most states only regulate the construction of new private water wells. With a few exceptions, there is little regulation after construction. Well owners are responsible for their own wells. Children may also drink well water at child care or when traveling. Illness resulting from children’s ingestion of contaminated water can be severe. This report reviews relevant aspects of groundwater and wells; describes the common chemical and microbiologic contaminants; gives an algorithm with recommendations for inspection, testing, and remediation for wells providing drinking water for children; and provides references and Internet resources for more information.
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Affiliation(s)
- Alan D Woolf
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan D Stierman
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Lori G Byron
- Indian Health Service (retired), SCL Health, Billings, Montana
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Woolf AD, Stierman BD, Barnett ED, Byron LG. Drinking Water From Private Wells and Risks to Children. Pediatrics 2023; 151:190540. [PMID: 36995187 DOI: 10.1542/peds.2022-060644] [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] [Accepted: 11/16/2022] [Indexed: 01/31/2023] Open
Abstract
Drinking water for >23 million US households is obtained from private wells. These wells can become contaminated by chemicals, naturally occurring toxic substances, or pathogenic organisms that can cause illness in children. Although the US Environmental Protection Agency and most states offer some guidance for the construction, maintenance, and testing of private wells, most states only regulate the construction of new private water wells. With few exceptions, well owners are responsible for their own wells after the initial construction. Children may also drink well water at childcare or when traveling. This policy statement provides recommendations for the inspection, testing, and remediation of private wells to provide safe drinking water for children.
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Affiliation(s)
- Alan D Woolf
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan D Stierman
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Lori G Byron
- Indian Health Service (retired), SCL Health, Billings, Montana
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Abstract
Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries remains greater than 40% among children 2 to 19 years of age. Although dental visits have increased in all age, race, and geographic categories in the United States, disparities continue to exist, and a significant portion of children have difficulty accessing dental care. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of disease, interventions to maintain and restore health, and the social determinants of children's oral health.
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Affiliation(s)
- David M Krol
- Medical Director, Connecticut Children's Care Network.,Medical Director, Care Integration, Connecticut Children's, Hartford, Connecticut
| | - Kaitlin Whelan
- Peak Pediatrics, Thornton Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Yang Z, Cai T, Li Y, Jiang D, Luo J, Zhou Z. Effects of topical fluoride application on oral microbiota in young children with severe dental caries. Front Cell Infect Microbiol 2023; 13:1104343. [PMID: 36960045 PMCID: PMC10028198 DOI: 10.3389/fcimb.2023.1104343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
While the effect of fluoride on severe early childhood caries (S-ECC) is clear, knowledge of how it influences the oral microbiota and the consequential effects on oral health is limited. In this cohort study, we investigated the changes introduced in the oral ecosystem before and after using fluoride varnish in 54- to 66-month-old individuals (n=90: 18 children were sampled at 5 different time points). 16S rDNA was amplified from bacterial samples using polymerase chain reaction, and high-throughput sequencing was performed using Illumina MiSeq platforms. Many pronounced microbial changes were related to the effects of fluoride varnishing. The health-associated Bacteroides and Uncultured_bacterium_f_Enterobacteriaceae were enriched in the saliva microbiome following treatment with fluoride varnishing. Co-occurrence network analysis of the dominant genera showed that different groups clearly showed different bacterial correlations. The PICRUSt algorithm was used to predict the function of the microbial communities from saliva samples. The results showed that starch and sucrose metabolism was greater after fluoride use. BugBase was used to determine phenotypes present in microbial community samples. The results showed that Haemophilus and Neisseria (phylum Proteobacteria) was greater before fluoride use. We conclude that the changes in oral microbiology play a role in fluoride prevention of S-ECC.
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Affiliation(s)
- Zhengyan Yang
- Department of Preventive Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
| | - Ting Cai
- Department of Preventive Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
| | - Yueheng Li
- Department of Preventive Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
| | - Dan Jiang
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
| | - Jun Luo
- Department of Preventive Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
- *Correspondence: Jun Luo, ; Zhi Zhou,
| | - Zhi Zhou
- Department of Preventive Dentistry, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Biomedical Engineering of Higher Education, Department of Preventive Dentistry, Chongqing, China
- *Correspondence: Jun Luo, ; Zhi Zhou,
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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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Xu J, Shi H, Luo J, Yao H, Wang P, Li Z, Wei J. Advanced materials for enamel remineralization. Front Bioeng Biotechnol 2022; 10:985881. [PMID: 36177189 PMCID: PMC9513249 DOI: 10.3389/fbioe.2022.985881] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Dental caries, a chronic and irreversible disease caused by caries-causing bacteria, has been listed as one of the three major human diseases to be prevented and treated. Therefore, it is critical to effectively stop the development of enamel caries. Remineralization treatment can control the progression of caries by inhibiting and reversing enamel demineralization at an early stage. In this process, functional materials guide the deposition of minerals on the damaged enamel, and the structure and hardness of the enamel are then restored. These remineralization materials have great potential for clinical application. In this review, advanced materials for enamel remineralization were briefly summarized, furthermore, an outlook on the perspective of remineralization materials were addressed.
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Affiliation(s)
- Jiarong Xu
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
| | - Hui Shi
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, China
| | - Jun Luo
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, China
| | - Haiyan Yao
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, Jiangxi, China
| | - Pei Wang
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, Jiangxi, China
| | - Zhihua Li
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, Jiangxi, China
- *Correspondence: Zhihua Li, ; Junchao Wei,
| | - Junchao Wei
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Clinical Research Center for Oral Diseases, Nanchang, China
- Jiangxi Province Key Laboratory of Oral Biomedicine, Nanchang, Jiangxi, China
- *Correspondence: Zhihua Li, ; Junchao Wei,
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Knowledge Level and Consumption Behavior of Native Plants, Meats, and Drinking Waters with High Fluoride Concentrations about the Relation to the Potential Health Risk of Fluoride in Lamphun Province Thailand: A Case Study. SUSTAINABILITY 2022. [DOI: 10.3390/su14148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Fluoride exposure from natural, agricultural, and industrial sources has harmed people living in fluoride-affected areas. Fluoride accumulates in the human body after being exposed to it through the food chain. The population consisted of 371 community health volunteers who were surveyed and chosen based on personal fluoride information. Only 39 residents were chosen to be interviewed and take part in the trial, which involved drinking fluoride-containing groundwater (>1.5 part per million: ppm) and urine testing that revealed urine fluoride level (>0.7 ppm). In addition, 47 biological samples and eight commercially bottled water specimens were examined. The information was gathered in four ways: (1) a questionnaire-based survey of fluoride knowledge, (2) food consumption behavior with locally grown vegetables, fruits, poultry, and meat, and commercially bottled water produced by groundwater in fluoride-affected areas, (3) a semi-food frequency questionnaire, and (4) fluoride content measurements using an ion-selective electrode. According to the analyses, the participants ranged in age from 51 to 60 years, with approximately 60.38% of them female and born and raised in polluted areas. The majority of subjects had a low level of fluoride knowledge (65.23%). The respondents’ primary source of drinking water (100.00%) was commercially bottled water; they chewed camellia sinensis 11.56% of the time (1 to 5 years) and they drank tea 9.16% of the time (during 1 to 5 years). Sus scrofa domesticus was responsible for the intake of vegetables and fruits, whereas Brassica chinensis, Jusl var para-chinensis (Bailey), and Tsen and Lee were responsible for the intake of poultry and animal flesh. They were all purchased at a local farm. The hazard quotient was greater than one, and the fluoride concentration (ppm) ranged between 75.00% (0.29–5.20), 57.14% (0.01–0.46), 88.89% (0.07–0.91), 100.00% (0.43–3.07), 100.00% (0.58–0.77), 42.86% (0.12–0.62 ppm.), 60.00% (0.11–1.44), and 33.33% (0.10–0.80) in drinking water, fruit, young and mature plants. Fluoride ingestion may pose a health concern. Under the 95th percentile condition, 74.47% consumed water with a high fluoride level, vegetables and fruits, and poultry and meats.
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Goff SL, Gahlon G, Geissler KH, Dick AW, Kranz AM. Variation in Current Guidelines for Fluoride Varnish Application for Young Children in Medical Settings in the United States. Front Public Health 2022; 10:785296. [PMID: 35309203 PMCID: PMC8930922 DOI: 10.3389/fpubh.2022.785296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background The United States Preventive Services Task Force recommends that medical providers apply fluoride varnish (FV) to the teeth of all children under 6 years of age, but fewer than 10% of eligible children receive FV as recommended. Prior studies suggest that variation in clinical guidelines is associated with low uptake of other evidence-based health-related interventions, but consistency of national guidelines for the delivery of FV in medical settings is unknown. Methods Eligible guidelines for application of FV in medical settings for children under 6 years of age were published in the past 10 years by national pediatric or dental professional organizations or by national public health entities. Guidelines were identified using the search terms fluoride varnish + [application; guidelines, or recommendations; children or pediatric; American Academy of Pediatrics (AAP); American Academy of Pediatric Dentistry] and a search of Guideline Central. Details of the guidelines were extracted and compared. Results Ten guidelines met inclusion criteria. Guidelines differed in terms of periodicity recommendations and whether FV was indicated for children with a dental home or level of risk of dental caries. Conclusion Numerous recommendations about FV delivery in medical settings are available to pediatric medical providers. Further study is warranted to determine whether the variation across current guidelines detected in this study may contribute to low FV application rates in medical settings.
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Affiliation(s)
- Sarah L. Goff
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
- *Correspondence: Sarah L. Goff
| | | | - Kimberley H. Geissler
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, United States
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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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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:2172-2178. [PMID: 34874412 DOI: 10.1001/jama.2021.20007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dental caries is the most common chronic disease in children in the US. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children aged 2 to 5 years had dental caries in their primary teeth. Prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%). Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening and interventions to prevent dental caries in children younger than 5 years. POPULATION Asymptomatic children younger than 5 years. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with oral fluoride supplementation at recommended doses in children 6 months or older whose water supply is deficient in fluoride. The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with fluoride varnish application in all children younger than 5 years. The USPSTF concludes that the evidence is insufficient on performing routine oral screening examinations for dental caries by primary care clinicians in children younger than 5 years and that the balance of benefits and harms of screening cannot be determined. RECOMMENDATION The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children younger than 5 years. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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32
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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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Beal J, Hearnshaw A, Oddie S, Furness J. American recommendations. Br Dent J 2021; 230:187. [PMID: 33637903 PMCID: PMC7908950 DOI: 10.1038/s41415-021-2755-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Carrillo-Díaz M, Ortega-Martínez AR, Ruiz-Guillén A, Romero-Maroto M, González-Olmo MJ. Impact of Breastfeeding and Cosleeping on Early Childhood Caries: A Cross-Sectional Study. J Clin Med 2021; 10:1561. [PMID: 33917683 PMCID: PMC8067957 DOI: 10.3390/jcm10081561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
The type and duration of breastfeeding can be key factors in the development of early childhood caries (ECC). The association between nighttime feeding and ECC was investigated. Specifically, whether cosleeping is a potential mediator of children's oral health was investigated, considering many of the etiological factors of caries. In this cross-sectional study, 212 children (aged 2-4 years) from Madrid (Spain) who breastfed at night were examined to assess the mean decayed/filled primary teeth (dft) index, and a questionnaire was administered to the mothers to collect data on the practice of breastfeeding and cosleeping and its duration, the number of nighttime feeding sessions, sugar content in the diet, dental hygiene habits, and age at first dental visit. The dft index was lower in the group that breastfed for less than 18 months (p = 0.02). In addition, there were significant differences in the dft index in the group breastfeeding for more than 18 months between those who coslept for 18 months or more and those who coslept for less than 18 months (p < 0.05), as well as between those who coslept for 18 months or more and those who did not cosleep (p < 0.01). In conclusion, breastfeeding at night from 18 months onwards is considered a risk factor for ECC.
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Affiliation(s)
- María Carrillo-Díaz
- Department of Nursing and Dentistry, Rey Juan Carlos University, 28922 Alcorcón, Spain;
| | | | - Ana Ruiz-Guillén
- Department of Nursing and Dentistry, Rey Juan Carlos University, 28922 Alcorcón, Spain;
| | - Martín Romero-Maroto
- Department of Orthodontics, Rey Juan Carlos University, 28922 Alcorcón, Spain; (M.R.-M.); (M.J.G.-O.)
| | - María José González-Olmo
- Department of Orthodontics, Rey Juan Carlos University, 28922 Alcorcón, Spain; (M.R.-M.); (M.J.G.-O.)
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