Survey of Iowa general dentists regarding the age 1 dental visit

PURPOSE: The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit. METHODS: A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data. RESULTS: Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months. CONCLUSIONS: The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.     

Infant oral health education in U.S. dental school curricula.

PURPOSE: This study was performed to determine didactic and clinical curricular content about infant oral health in predoctoral pediatric dentistry programs. METHODS: 54 dental school departments of pediatric dentistry were surveyed about: 1) curricular content devoted to teaching infant oral health (IOH) and age of first dental visit; 2) methods used to teach IOH and hours dedicated to each method; and 3) whether students receive hands-on experiences with infants. RESULTS: Eighty-six percent of programs teach students to see infants at 12 months of age or younger. Curricular time ranged from 15 minutes to 13 hours (mean = 2 hrs, 20 min, median = 1 hr, 45 min). All programs used lectures; other formats included handouts, demonstration and small group seminar. Fifty percent provide clinical experiences, albeit they are not uniform for all students. One-fourth provides uniform, clinical hands-on experiences with infant oral examinations. CONCLUSIONS: The findings indicate varying degrees of acceptance about teaching infant oral health in our dental schools.     

Survey of treatment provided for young children by West Virginia general dentists

PURPOSE: The purpose of this study was to survey the treatment provided by West Virginia general dentists (GDs) for young children. METHODS: A survey was mailed to 683 GDs in West Virginia. Respondents were questioned about their referrals to pediatric dentists, the youngest age for which they perform specific procedures, conscious sedation utilization, and whether they treat Medicaid-covered children. RESULTS: The response rate was 72%. Half of the GDs responded that they frequently referred children younger than 3 years old, and only one third reported performing dental examinations on a child 2 years old or younger. All responding GDs performed the surveyed procedures in 5-year-olds, but fewer respondents performed complex procedures for children < or = 2 years old. More than half of the GDs responded that they frequently had difficulty with referrals to a pediatric dentist due to distance/ transportation or not accepting new Medicaid patients. Medicaid-covered children were not treated by 25% of general dentists. CONCLUSIONS: Most GDs in West Virginia treat older children, but care is limited for children < or = 2 years old. Further studies are needed to uncover the specifics of these findings to improve the access and care for young West Virginia children.     

Indiana infant-toddler dental care survey.

The purpose of this project was to survey Indiana dentists concerning dental care for Indiana infants and toddlers. Dental care issues covered were the age for a child's first dental visit, frequency of rampant or nursing caries cases examined, and dental referral sources for infants and toddlers. The survey also helped determine the dentist's perception of parents' attitudes toward services recommended by the dentist. A twelve question survey was mailed to 2006 general and pediatric dentists in the State of Indiana. The results of the survey were: 1. A large percentage of Indiana dental practitioners do not recommend the first dental visit or examine children for their dental visit until the child is more than one year of age. 2. A majority of Indiana dental practitioners see children with nursing caries or rampant caries on a monthly basis. 3. The majority of Indiana dental practitioners refer children with nursing caries to pediatric dentists for treatment. 4. Although the full treatment plan may undergo some modification based on various parental concerns, a majority of practitioners do not experience difficulty in obtaining treatment plan acceptance for nursing or rampant caries cases.     

Practices and opinions of pediatric and general dentists in Connecticut regarding the age 1 dental visit and dental care for children younger than 3 years old

PURPOSE: This study aimed to determine the percentage of general and pediatric dentists in Connecticut that were aware of, and practice, the current AAPD guidelines for the age one dental visit and to determine the services they provide to 0-2-yr-old patients. METHODS: A survey was mailed to Connecticut general and pediatric dentists seeking information on practice type, years in practice, training, ages of children seen, procedures performed and opinions regarding the age one dental visit. RESULTS: The response rate was 42% for general dentists and 84% for pediatric dentists, giving a sample of 113 and 60 dentists, respectively. All responding pediatric dentists reported seeing 0-2-yr-olds as compared to 42% of general dentists. Although not statistically significant, general dentists who were female or in practice less than 10 years were more likely to see 0-2-yr-olds. The majority of pediatric dentists reported performing all procedures surveyed, however, only just over half of general dentists provided topical fluoride or restorative care. Among pediatric dentists, 98% were aware of the AAPD guidelines and 92% agreed with them compared to 41% and 45% of general dentists respectively. CONCLUSIONS: Nearly all Connecticut pediatric dentists are caring for 0-2-yr-olds compared to 42% of Connecticut general dentists.     

Ohio dental care providers' treatment of young children, 2002

BACKGROUND: Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children. METHODS: Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character. RESULTS: Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations. CONCLUSIONS: Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them. PRACTICE IMPLICATIONS: New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

Comparison of nutritional counseling between provider types

OBJECTIVE: The goal of this study was to compare the provision of and attitudes toward nutritional counseling between pediatricians and pediatric dentists. METHODS: Questionnaires were mailed to 500 US members of the American Academy of Pediatric Dentistry and the American Academy of Pediatrics. RESULTS: The survey had a response rate of 33% (pediatric dentists=36%; pediatricians=29%). 84% of pediatricians routinely offered nutritional counseling compared to 71% of pediatric dentists. With respect to cariogenic foods, 82% of pediatric dentists and 74% of pediatricians correctly recommended bottle contents, and 33% of pediatric dentists and 19% of pediatricians correctly recommended snacks. 79% of pediatric dentists compared to 69% of pediatricians believed nutritional counseling had at least some effectiveness. Eighty-nine percent of both specialties somewhat or strongly agreed that nutritional counseling was an important aspect of oral health care. CONCLUSIONS: While pediatric dentists made slightly better recommendations than pediatricians regarding cariogenic foods, both provider types demonstrated a need for more education regarding nutritional counseling.     

General dentists' referral of children younger than age 3 to pediatric dentists

PURPOSE: The purpose of this study was to assess which variables are associated with Iowa general dentists' referral of children younger than age 3 to pediatric dentists. METHODS: A survey was mailed to all Iowa general dentists (N=1,089). Respondents were asked how likely (never, sometimes, often, always) they were to refer children younger than age 3 to pediatric dentists in the past 12 months. Associations between referral patterns with practice, dentists,' and patients' characteristics were determined. RESULTS: The adjusted response rate was 65%. Nearly 50% of all dentists reported often or always referring children younger than age 3. Dentists who referred were more likely to be males and to have been in practice longer. Dentists who perceived that they had not received adequate exposure to preschool children younger than age 3 in dental school were more likely to refer. Dentists with smaller percentages of children within their practices were more likely to refer. Dentists most often referred children who were uncooperative, had severe decay, or had special needs. CONCLUSIONS: About one half of Iowa's general dentists refer children younger than age 3 to a pediatric dentist. Initiatives need to be undertaken to address dentists' reluctance to care for young children.     

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BackgroundThe authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.MethodsThe authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.ResultsSixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.ConclusionsWSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist.Clinical implicationsGeneral dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.     

Oral health care of children: gynecologists and pediatricians' perspective

Gynecologists, pediatricians and other medical professionals are more likely to see expecting mothers and infants much earlier than dentists. Thus, it is essential for these specialists to be aware of the infectious nature of dental caries and its associated risk factors and make appropriate decisions regarding timely and effective intervention. OBJECTIVE: To know the perception of gynecologists and pediatricians towards oral health care of children. METHODS: A cross sectional questionnaire survey was conducted. RESULTS: The present study shows that the pediatrician is more actively involved in the oral health care of children as compared to gynecologists in Bangalore city, India. CONCLUSION: Pediatricians and gynecologists need to update themselves on recent recommendations, regarding infant oral health so as to ensure that all their patients receive timely preventive and restorative dental care.     

Practice patterns among male and female general dentists in a Washington State population

BACKGROUND: Women make up about 14 percent of general dentists in the United States, and the proportion is projected to exceed 29 percent by 2020. METHODS: The authors obtained dental benefits claims data from the Washington Dental Service (WDS), Seattle, and used them to examine the practice patterns of 265 women and 1,947 men engaged in general dentistry for at least 26 days in 2001. Practice variables of interest included age, days worked, procedures performed and total income from WDS reimbursements and patient copayments. The number, age and sex of patients treated also were obtained. Using productivity data, the authors also estimated the potential impact of an increase in the percentage of female dentists in the state. RESULTS: The authors found no differences between male and female dentists in the number of procedures per patient, income per patient or income per day of work. Frequency distributions of various services were highly similar for both groups. Multiple regression models showed no influence of dentist's sex on total income. However, the mean and median numbers of days worked were about 10 percent lower for female dentists than for male dentists. This difference was consistent with the finding that female dentists treated approximately 10 percent fewer patients, performed about 10 percent fewer procedures and had a combined income of about 10 percent less than that of male dentists. CONCLUSION: Practice patterns of male and female dentists generally were equivalent in this WDS population. CLINICAL IMPLICATIONS: Female and male dentists provided a similar range of services and earned an equal income per patient treated and per day worked. However, women worked fewer days per year than did men, irrespective of age. If the dental work force and practice patterns remain unchanged otherwise, the total number of patients treated per dentist will decrease slightly as women make up an increasing proportion of dentists.     

Determinants of oral health behaviour among Iranian dentists

AIM: To study the oral health behaviour of Iranian dentists. DESIGN: A cross-sectional study. Setting: Two annual dental meetings in Tehran, Iran. PARTICIPANTS: 1,033 dentists responded, 980 were eligible for this study. METHOD: Data were collected using a self-administered questionnaire which covered dentists' oral self-care, dental attendance, and smoking. Recommended oral self-care (ROSC) included tooth brushing > 1/day, eating sugary snacks < daily, and regularly using fluoride toothpaste. Knowledge of preventive dental care was assessed by nine Likert-scale statements. Dentist's gender, age, and professional reading were recorded. Statistical evaluation was by the Chi-square test and logistic regression. RESULTS: In total, 59% of respondents reported brushing their teeth at least 2/day, 59% consumed sugary snacks < daily, 74% used fluoride toothpaste regularly, and 76% were non-smokers. Of all, 27% followed ROSC. Women reported desirable behaviours more frequently than did the men (p < 0.01). Female gender (OR 1.4-2.3), being a non-smoker (OR 1.3-1.5), and wider professional reading (OR = 1.2) were the major factors that contributed to dentists' desirable oral health behaviour. CONCLUSIONS: That only a small number of Iranian dentists follow the ROSC calls for more attention to behavioural contributions to oral diseases and its consequences with general and oral health, regarding both dental curriculum and continuing education.     

State Medicaid Early and Periodic Screening,Diagnosis, and Treatment guidelines: Adherence to professionally recommended best oral health practices

BackgroundThe authors evaluated the adherence of state Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) guidelines to recommended best oral health practices for infants and toddlers.MethodsThe authors obtained state EPSDT guidelines via the Internet or from the Medicaid-CHIP State Dental Association, Washington. They identified best oral health practices through the American Academy of Pediatric Dentistry (AAPD), Chicago. They evaluated each EPSDT dental periodicity schedule with regard to the timing and content of seven key oral health domains.ResultsThirty-two states and the District of Columbia (D.C.) had EPSDT dental periodicity schedules. With the exception of the dentist referral domain, 29 states (88 percent) adhered to the content and timing of best oral health practices, as established by the AAPD guideline. For the dentist referral domain, 31 of the 32 states and D.C. (94 percent) required referral of children to a dentist, but only 11 states (33 percent) adhered to best oral health practices by requiring referral by age 1 year.ConclusionsWith the exception of the timing of the first dentist referral, there was high adherence to best oral health practices for infants and toddlers among states with separate EPSDT dental periodicity schedules.Practical ImplicationsStates with low adherence to best oral health practices, especially regarding the dental visit by age 1 year, can strengthen the oral health content of their EPSDT schedules by complying with the AAPD recommendations.     

Oral health in the pediatric practice setting: a survey of Washington State pediatricians

BACKGROUND: Pediatric health care providers may be the only source of preventive oral health education for families of young children who lack access to professional dental care. OBJECTIVE: We surveyed Washington State pediatricians in order to characterize their oral health-related educational needs and anticipatory guidance practices. METHODS: A 38-question survey was mailed to all 606 general pediatricians in Washington State. Topics included anticipatory practices and confidence in oral health-related activities. RESULTS: Of 483 eligible participants, 271 returned completed surveys (response rate: 57%). A median of 30 percent of the well-child visit was devoted to providing anticipatory guidance. A majority (83.7%) of respondents reported providing anticipatory guidance on oral health. CONCLUSION: Washington State pediatricians are already involved in providing oral health anticipatory guidance. Certain factors are identified that should be addressed to allow pediatricians to promote oral health more effectively.     

Are we reaching very young children with needed dental services?

Recommendations by the Academy of Pediatric Dentistry urging a dental/oral examination of all infants before one year of age, have had limited impact on the profession and the general public. Significant numbers of pediatric dentistry specialists and general practitioners who provide care for children, disagree with the recommendations. Between the mid 1970s and 1990's, there has been no change in the percent of children less than six years of age who were reported to have visited a dentist in the past year. A review is provided of the dental disease needs and dental service patterns of very young children in the various demographic populations in an attempt to 1) increase practitioner awareness of the continuing needs for services and 2) develop a dialogue between the organizations of the profession and the dentists in practice, regarding directions to be taken in the future.     

What's in a dental practice-based research network?: Characteristics of Northwest PRECEDENT dentists,their patients and office visits

ObjectivesThe authors conducted a study to describe the general dentists, practices, patients and patient care patterns of the dental practice-based research network (PBRN) Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT).MethodsNorthwest PRECEDENT is a dental PBRN of general and pediatric dentists and orthodontists from five U.S. states in the Northwest: Idaho, Montana, Oregon, Utah and Washington. The authors collected data from general dentists in Northwest PRECEDENT (n = 101) regarding the diagnosis and treatment of oral diseases in a survey with a systematic random sample of patients (N = 1,943) visiting their practices. They also obtained demographic data from the general dentists and their patients.ResultsThe authors found that 50 percent of the general dentists were 51 to 60 years of age, 14 percent were female and 76 percent were non-Hispanic white. More than one-half (55 percent) of the dentists had practiced dentistry for more than 20 years, 83 percent had private solo practices and 32 percent practiced in rural community settings. The majority (71 percent) of patients visiting the dental practices was in the age range of 18 to 64 years, 55 percent were female and 84 percent were non-Hispanic white. In terms of reasons for seeking dental care, 52 percent of patients overall visited the dentist for oral examinations, checkups, prophylaxis or caries-preventive treatment. In the preceding year, 85 percent of the patients had received prophylaxis, 49 percent restorative treatments, 34 percent caries-preventive treatments and 10 percent endodontic treatments.ConclusionsNorthwest PRECEDENT general dentists are dispersed geographically and are racially and ethnically diverse, owing in part to efforts by network administrators and coordinators to enroll minority dentists and those who practice in rural areas. Estimates of characteristics of dentists and patients in Northwest PRECEDENT will be valuable in planning future studies of oral diseases and treatments.     

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.     

Utilization of stainless steel crowns by general dentists and pediatric dental specialists in Indiana

The purpose of this study was to evaluate utilization of the stainless steel crown by both the general and pediatric dentists in Indiana. Although reports indicate that there has been a dramatic reduction in dental caries in the US, almost 20 percent of children have dental decay by age four, with almost 80 percent having a cavity by 17 years of age. After reviewing the literature, Seale has recommended that the stainless steel crown is the most successful restoration for children with a rate of high caries. All dental schools in North America teach the value of using stainless steel crowns and the method of tooth preparation. We hypothesized that greater use of the stainless steel crowns would be made by specialists than by general dentists. In this study, of the 200 questionnaires distributed, 62.5 percent were returned and analyzed. The results imply that stainless steel crowns are being significantly underutilized in general dental practice. It is interesting, and perhaps of concern, that the general dentists are not interested in continuing education courses about this subject. Over the next few years, with the aging of the pediatric dental community in Indiana, general (not specialty) dentists will treat most of the children. Because of this, pre-doctoral education needs to place more emphasis on preparation and utilization of the stainless steel crown.     

Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study

The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian <1 percent Asian-American) was similar to that for the clinic in general. Reimbursement for dental care was primarily via Medicaid (91 percent) with <10 percent covered by insurance or payment by responsible parents. For one quarter of the children, the emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.