Organized dentistry as an agent for helping others: the leadership of Donna J. Rumberger.

Dr Donna Rumberger graduated from New York University College of Dentistry in 1980 and has practiced dentistry in Manhattan ever since. Even before her graduation, she was active in organized dentistry, always viewing it as a conduit for helping other people. Working with the American Association of Women Dentists, she was cofounder of the Smiles for Success Foundation, a program started in New York City that helps women advance from welfare into the workforce with restored, healthy smiles. That program now has expanded to 14 other cities. Working with organized dentistry in New York City, she has been instrumental in initiating and running the Skate Safe program, which provides mouthguards and oral home care education for inner city children in Harlem. In addition, she has worked with the dentistry merit badge program for the Boy Scouts of America Jamborees, helped coalesce women's dental organizations in New York City, and led her dental society to collaborate with Columbia University in a program to improve access to dental care. As further evidence of her ability to get things done, she also has served as president of the American Association of Women Dentists, the Midtown Dental Society, and the New York County Dental Society--one of the largest dental societies in the country.     

A retrospective study on the relevance of the dental curriculum in general practice

The undergraduate dental curriculum in Swedish dental schools has recently been changed. The aim of this study was to estimate the opinions of recently qualified dentists concerning their undergraduate education received according to the old curriculum. A questionnaire was mailed to all graduates who qualified from the dental school in Huddinge between 1981-1983. The response rate was 71%. The respondents indicated that their theoretical knowledge was in general better in subjects closely related to clinical dentistry compared with basic biological subjects or behavioural science subjects. In most subjects clinical competence was closely related to the level of theoretical knowledge. The results of this study suggest that the "old" dental curriculum was successful in imparting knowledge concerning traditional dental subjects and preventive dentistry, but less successful in imparting knowledge concerning basic and medical sciences, behavioural subjects and in relating theoretical and practical skills.     

儿童患者牙科恐惧症原因分析

目的:调查儿童患者牙科恐惧症的因素,分析医患间对这些因素感知的差异。方法:随机选择104名儿童口腔科医师及4～9岁的儿童口腔科患儿107人分别填写调查问卷,内容涉及对口腔科治疗时疼痛的认识。结果:患儿害怕口腔治疗的主要原因,医患间存在显著差异(P<0.001),患儿自述害怕就诊的首要原因是打针,其次为口内有水;从医时间长于15年的医师多认为是治疗时的疼痛感,从医时间短于5年的医生认为是牙钻等的声音导致患儿惧怕看牙。74.3%的医生在出现疼痛的操作前预告知患儿,从医时间延长,告知患儿的比率越低(P<0.001)。74.7%的患儿术前希望获知治疗是否疼痛。结论:医患间在惧怕口腔治疗的原因上存在差异。     

Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children.

Anxiety is a special variety of fear, experienced in anticipation of threatening stimuli. While some research workers have said that the response of a child improves with the number of visits, many have felt otherwise. The present study is yet another effort to find the patterns of anxiety in children during sequential dental visits. The main aim was to determine the physiological and behavioral variations during sequential dental visits and its impact on age and sex. The study was conducted at the outpatient Department of Pedodontics and preventive dentistry, Meenakshi Ammal Dental College and Hospital, Chennai to evaluate the physiological and behavioural measures of stress and anxiety in children. One hundred and fifteen children, between four and eleven years of age who reported for dental treatment were selected for the study.     

Pretreatment modeling. A technique for reducing children's fear in the dental operatory

Research on modeling indicates that this technique offers dentists a means of reducing fear in child patients of all ages. As a preventive measure used with children who have had no prior exposure to dental treatment, it can be particularly efficacious. Based on the assumption that much of adult dental avoidance is based on dental fears acquired in childhood treatment, the reduction of children's dental fear would have a positive effect on the individual's tendency to seek out dental health care throughout his or her lifespan. For the dentist, there are also short- and long-term benefits. Dental management of the child is prerequisite to providing good dental care. Pedodontics as a specialty recognizes behavioral management of the child cannot be separated from the quality of the dentist's work. Fear has been identified as an important factor in disruptive behavior of school age children in the dental office. Practicing dentists consider the fearful, disruptive child to be among the most troublesome of problems in their clinical work. The child must cooperate or at least passively comply with the dentist's procedures in order to have the technical work completed. By reducing disruptive patient behavior (crying, screaming children whose peripheral and gross motor movements often make direct contact with the dentist or his equipment) the most unpalatable aspect of pediatric dentistry is minimized. Further, the actual time for treatment becomes shorter rather than longer. Although modeling is not restricted to videotape media, the emergence of current videotape technology provides the practitioner with the means for incorporating patient viewing of prerecorded modeling tapes as part of the usual waiting period. Such a procedure would mean that in the long run, the dentist will spend more time doing dentistry and less in behavioral management tasks.     

Paediatric dentistry in the new millennium: 2. Behaviour management--helping children to accept dentistry

Children's dentistry can be a challenge for both the patient and the dentist. The way a dentist interacts with the child patient will have a major influence on the success of any clinical or preventive care. In order to deliver high-quality dentistry to a child whilst also developing a positive attitude towards dental health, the dentist should have a good understanding of the factors that might affect the behaviour of children in the dental setting. A working knowledge of strategies to minimize anxiety and make positive behaviour more likely is essential, as is a grasp of how best to deal with anxiety or negative behaviour.     

初诊儿童牙科不合作行为分析

目的 探讨初次到牙科就诊的儿童其不合作行为与儿童气质、龋病严重程度等因素的相关性,以期制定个性化的牙科治疗方案,预防和应对初诊儿童的牙科不合作行为.方法 从2007年12月-2008年12月初次到儿童口腔科就诊的儿童中随机抽取195名3～7岁儿童为研究对象,对儿童进行口腔检查和实施相应的治疗措施,并对治疗过程中儿童的牙...     

Sedation in dental practice.

The recent publication of the Department of Health's report from the Expert Working Party on General Anaesthesia, has made recommendations on sedation in the dental practice. This article discusses the use of benzodiazepines by the general dental practitioner.     

First-year students' perceptions about pediatric dental behavior guidance techniques: the effect of education

The purpose of this study was to evaluate the effect of a dental education component on dental students' perceptions toward behavior guidance techniques in pediatric dentistry. A questionnaire was completed by seventy-three first-year dental students, before and after a course on human development and behavior guidance techniques in pediatric dentistry. The acceptability of behavior guidance techniques and situations in pediatric dentistry was scored with a visual analog scale before and after the course, compared, and evaluated in relation to demographic data. After the course, statistically significant increases (ANOVA) in the acceptability of aversive behavior guidance (voice control, hand over mouth, and immobilization), sedation, general anesthesia, and modeling were found. Statistically significant decreases (ANOVA) in acceptability were found in mentioning the possibility of pain during treatment and with a parent being in the clinic or talking with the child during treatment. Female or married students, those who had previously received dental treatment, or those who had a dentist in the family showed statistically significant changes that indicated more empathy toward the children. We conclude that undergraduate dental education may have a significant short-term influence on dental students' perceptions of behavior guidance in pediatric dentistry.     

Dental hygiene's interdisciplinary relationship with dental public health: a position paper

Dental hygienists' collaboration with social institutions, health-care workers and organisations, educational institutions, and dentistry can prevent oral diseases. Dental hygienists working in these organisations can reach an unprecedented number of people, thereby increasing preventive oral care to many undeserved. Working within a dental public health career increases choices and opportunities for the dental hygienist and benefits the public.     

Primary identification of an abused child in dental office: a case report

Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. The authors present a case of child abuse with multiple bruises. The child had been spanked in the previous night and the morning of the attendance by his mother. This case emphasized that all practitioners should be vigilant when patients present with abnormal injuries which may be the result of abuse and further investigation should be instigated.     

Jenny Harris: 'We have been guilty of neglecting dental neglect'

Whilst at this year's British Dental Conference and Exhibition in Manchester, paediatric dentistry consultant, Jenny Harris spoke to the BDJ about neglecting dental neglect, managing paediatric patients and the GDP's role in child protection.     

Increasing general dentists' provision of care to child patients through changes in the undergraduate pediatric dentistry program

Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998-99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded, fifteen from each of the three surveyed classes. Dentists who graduated after the changes to the program (2000, 2002) reported that they performed a greater number of complex pediatric dentistry procedures and treated more toddler and preschool children than the group that graduated before the changes (1993). Referrals to pediatric dentistry specialists were higher in the 1993 group than in the 2000 and 2002 groups. In conclusion, an adequate pool of pediatric patients is critical to provide dental students with sufficient learning experiences. The dentists who graduated from the program after the changes were implemented are providing more comprehensive treatment to younger children.     

Challenges and dilemmas in behaviour guidance of the pediatric dental patient

In addition to the pressures of providing a high quality of dental care for children, dentists practising pediatric dentistry are faced with some legal and ethical concerns regarding the use of behaviour management techniques. The following article will discuss some of the pressures and ethical dilemmas facing dentists treating children. Strategies for making the dental appointment more humane for child, parent and dentist are suggested. The most perplexing issues in pediatric dentistry today are related to the management of patients. In addition to questions regarding clinical management, dentists treating children have to make careful judgements concerning management of patient's behaviour. The following scenarios are a few examples of the situations that often arise during the dental treatment of child and adolescent patients: "I really had to raise my voice to Jamie today and use a lot of physical restraint to administer the local anesthetic. I was not happy about being so aggressive, but it was important to get that filling done. I wonder, though, how he is going to feel about going to the dentist now?" "I feel frustrated that I did not get any work done on that four-year-old today, but I did not want to use undue force. Maybe I should have been more forceful; hand-over-mouth-exercise might have worked, but I always feel uncertain about using that technique and I wonder what the parents will think if I use it."     

A survey of senior dental students' experiences with young dental patients in Pennsylvania

The purpose of this study was to determine graduating dental students' perceptions about their training and experience in examination and treatment of infants and their plans to examine infants upon graduation. A survey was distributed to dental students graduating from Pennsylvania dental schools in 2007 and 2008. Of the returned surveys, 47.9 percent correctly identified 12 months as the recommended age for the first dental exam. Sixty-five percent of responders felt they would be comfortable performing exams on young children. This study's primary objective was to test the association between performance of a clinical exam in a young child, enjoyment of clinical and didactic pediatric dental experience, plans for additional training in pediatric dentistry and willingness to see children younger than two years old in practice. Performing a clinical exam on a young child was associated to willingness to see children younger than two years of age in practice. Early exposure (lecture or clinical) to young pediatric patients while in dental school was significantly associated to perceived comfort with oral exam of young patients but not to reported willingness to see them in practice.     

Elective subjects in the dental curriculum. Perceptions by graduates in relation to dental practice and continuing education

A bstract — Graduates from a dental curriculum which included elective subjects were surveyed and a majority expressed satisfaction with it. Electives chosen did not seem to have influenced career choice, although students had some opportunity to choose them based on their initial types of practice. Some dental electives prepare students significantly better for dental practice, and this is a general trend for all electives. The overall curriculum was perceived to be strongest in aspects of adult dentistry and weakest in child, adolescent, and dentistry for the disabled and the aged. It is precisely in these areas that a disparity was demonstrated between the need for, and attendance at continuing education courses. Dentistry is practised largely as it is taught and major remedies lie in the dental curriculum and in continuing education in defined areas.     

Managing pediatric dental patients: issues raised by the law and changing views of proper child care

The purpose of this paper was to examine legal issues regarding the management of pediatric dental patients and changing views of proper child care. Standards of care in pediatric dentistry are not static. They change in response to research, patterns of reimbursement, patient and parental expectations of reasonable care, and consensus among practitioners. The law pertaining to accountability for pediatric dental patient treatment largely reflects standards of care established by the pediatric dentistry profession. However, the law can also reflect changes in public expectations of reasonable care that can effectively outrun the discipline's efforts to reflect new knowledge or changing public concerns. A major impetus for considering the care of children in all settings has been the increasing recognition of suboptimal children's care, as well as concerns that children have either been abused or neglected in a number of settings. Too often, practices towards children have been untested and based only on the assumption that what is done is "for the child's own good." Pediatric dentists can respond to changing standards of reasonable care for pediatric dental patients, as expressed in legal decisions. They can also usefully consider how attention to child maltreatment has sensitized parents to be better consumers of services on their children's behalf. Rather than reacting only to public pressures for better means of behavior management, the challenge is to exceed expectations via new research and thoughtful anticipation of improvements that can be made.     

Nutrition in the practice of pediatric dentistry.

Nutrition is an important aspect of the total environment of a growing child. The dentist should evaluate the nutrition of pediatric patients from the physical parameters of the child including growth, general appearance, posture, muscle control, oral findings, and dietary history. Some common malnutrition problems of the pediatric age group include deficiencies of iron, calcium, vitamins A, C, and D, protein and/or calories, and excess ingestion of calories. The causes of and means of preventing nursing-bottle syndrome are easily preventable in this form of dental caries which has many dental, systemic, and economic consequences. The use of group dynamics as an effective and enjoyable method of teaching preventive dentistry is discussed.     

A randomized clinical trial of triazolam in 3- to 5-year-olds.

Triazolam has shown promise as a sedative agent for use in pediatric dentistry. However, the efficacy of triazolam has not been previously examined in a placebo-controlled study. The present clinical trial used a two-group, randomized, double-blind study design to compare the efficacy of oral triazolam with that of a placebo. The primary hypothesis tested was that triazolam would reduce negative behaviors of pediatric dental patients compared with a placebo. A secondary hypothesis was that triazolam would increase the efficiency of dental treatment by reducing the need for time-consuming behavior management by the pediatric dentist. The subjects were 54 3- to 5-year-old children, randomly assigned to the drug and placebo groups. The active drug, 0.03 mg/kg triazolam (Halcion), or lactose placebo was given orally 30 min before dental treatment. Behavior management techniques commonly used in pediatric dentistry were used during dental treatment. A single pediatric dentist provided all of the dental treatment. The procedure included an inferior block anesthesia and careful attention to anesthesia effectiveness. All sessions were video-taped and the tapes coded for child and dentist behaviors by an independent observer. There were no statistically significant differences between the groups with respect to completion of dental treatment. There were no significant differences found in either the total time or the percent of time that the subjects exhibited disruptive movements, verbal or non-verbal distress. The total use of time in the dental chair was slightly higher in the placebo than in the drug group due to more time spent preparing the child. Contrary to preliminary reports in the literature, this investigation found little or no improvement in child behavior when triazolam was used as a sedative compared with a placebo. However, triazolam did shorten the length of dental treatment, primarily by reducing dentist time in preparing the child for the dental procedure (e.g., establishing rapport and shaping behavior).     

Paediatric dentistry experience of the first cohort of students to graduate from Dublin Dental School and Hospital under the new curriculum

AIM: To assess undergraduate clinical experience in Paediatric Dentistry in students graduating under a new curriculum. METHODS: An audit using logbooks completed by 34 students for all patients for whom they had provided treatment in the university paediatric dentistry clinic. RESULTS: A total of 177 child patients had received treatment from the students, age range 2-8 years. Students had performed an average of 13 restorative techniques. Sixty-eight percent had provided stainless steel crowns and 71% at least one pulpotomy for a primary tooth. All students had provided fissure sealants. Eighteen had carried out extractions and 8 had provided treatment for fractured incisors on this clinic. CONCLUSIONS: The cohort of students included had a wide range of experience of paediatric dentistry which compared favourably with accepted guidelines. A relative lack of experience of dental extractions currently remains a problem.