Utilization of a hospital for treatment of pediatric dental emergencies

PURPOSE: The purpose of this study was to investigate dental emergencies treated at a hospital clinic and emergency department (ED) to: (1) analyze emergency types; (2) determine reasons for seeking hospital care; and (3) examine trends compared to previous studies from this institution. METHODS: Records of 2,683 emergencies from 1995 to 2003 were reviewed. Demographics, reason for seeking care, and treatment details were analyzed overall by emergency type and for subgroups of patients with severe early childhood caries (S-ECC) and patients referred from other EDs. RESULTS: Emergencies were: 51% trauma, 40% caries, and 9% "other" emergencies unrelated to trauma or caries. Common patient characteristics were: (1) young age; (2) non-Caucasian ethnicity; (3) Medicaid as payer; (4) no dentist; and (5) proximity to the hospital. Caries emergencies increased significantly over the study period (P = .008), and 22% had S-ECC. Patients referred from other EDs were: 11% of trauma patients who commonly required sutures and/or extractions; and 3% of caries patients, 82% with extraoral swelling. CONCLUSIONS: Characteristics of patients seeking hospital care for dental emergencies were: (1) young age; (2) non-Caucasian ethnicity; (3) Medicaid as payer; (4) no dentist; and (5) proximity to CHRMC. Use differed by ethnic groups: Caucasians presented mostly for trauma; African Americans presented equally for caries and trauma; and Hispanics and Asians presented primarily for caries. Access to care, caries, and severe early childhood caries remain significant problems despite multiple programs targeting children's' oral health in Washington State.     

Pattern of tooth loss in recipients of free dental treatment at the University Hospital of Amman, Jordan

The aim of this study is to document reasons for tooth loss in disadvantaged Jordanians who seek free dental care at the University Hospital/Dental Clinics. A 4-year (1998-2001) prospective study was undertaken involving 2200 randomly selected patients from this subpopulation. Of their 3069 lost teeth, 46.9% were lost due to caries and its sequel; 18% were lost because of periodontal disease; 8% were lost for a combination of caries and periodontal disease; 19.4% for pre-prosthetic reasons; 4% for orthodontic reasons; 2.8% for eruption problems and 0.7% due to trauma. Logistic regression analysis for reasons of tooth loss in this sector revealed that caries and its sequel was the predominant cause of tooth loss in patients 相似文献   

Malnutrition and dental caries: a review of the literature

Protein-energy malnutrition occurs when there are deficiencies in protein, energy foods or both, relative to a body's needs. This paper reviews the association of early childhood malnutrition with: (1) dental caries, (2) enamel hypoplasia, (3) salivary gland hypofunction, and (4) delayed eruption. Studies suggest that caries of the primary dentition is associated with early childhood malnutrition, though the effect on caries of the permanent dentition has essentially not been studied. Enamel hypoplasia, salivary glandular hypofunction and saliva compositional changes may be mechanisms through which malnutrition is associated with caries, while altered eruption timing may create a challenge in the analysis of age-specific caries rates.     

Dental and medical students' knowledge and opinions of infant oral health

Primary care providers' involvement with and perceptions of the epidemic of early childhood caries could be related to attitudes and knowledge of the disease as well as to differences in discipline-based recommendations. A cross-sectional survey of demographics, opinions on infant oral health care visits and importance of infant oral health care, knowledge of tooth eruption, and knowledge of health care guidelines of the American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) was administered by several methods to first- and fourth-year dental and medical students at two University of Illinois campuses. Some expected variations were found among dental and medical students pertaining to perceptions and knowledge of infant oral health. Higher proportions of dental students responded correctly or considered the issues very important. However, Rockford medicine students were more likely to know when children should be weaned, yet less likely to agree with recommendations for time of first dental visit. Furthermore, fourth-year dental students were less likely than first-year dental students to give the recommended answer for age of first dental visit. Variances of opinions and basic knowledge of infant oral health of dental and medical students showed inconsistencies with desired outcomes of educational and clinical experiences. Further research is needed to understand the role of experience and other factors to effectively educate primary care providers in this area.     

Caries risk assessment, prevention, and management in pediatric dental care

The recent increase in the prevalence of dental caries among young children has highlighted the need for a new approach to prevent caries in children at a younger age. New disease prevention management models call for children to have their first visit to the dentist at age 1 or when their first tooth erupts. This article addresses early childhood caries risk assessment, prevention, and management strategies in young children using the concept of the "dental home" and a simple six-step protocol to conduct an effective and comprehensive infant oral care visit.     

Determining the prevalence and risk factors for early childhood caries in a community dental health clinic

PURPOSE: The purposes of this study were to: (1) determine the prevalence of early childhood caries (ECC) among young children accessing dental services at a community dental clinic; (2) identify factors associated with the presence of ECC; and (3) determine the percentage of children who received treatment for ECC in this setting and the number who required referral to specialists. METHODS: The study population comprised children younger than 72 months attending the clinic between 1991 and 2004. A chart review was conducted. RESULTS: Eight hundred thirty-four charts met inclusion criteria; 71% had ECC, while the mean deft was 3.7+/-3.9 (SD). The average age at the first visit was 50.0+/-12.7 (SD) months. Those with ECC were significantly older at the first visit (P<.001), and the prevalence increased with family size (P=.011) and number of siblings (P=.019). ECC children were significantly more likely to come from households with lower monthly incomes (P=.033). The prevalence of ECC did not vary according to specific areas in Winnipeg where children resided (P=.20). CONCLUSIONS: Key risk factors for ECC included: (1) the child's sex; (2) low monthly income; (3) whether the child resided with both parents; and (4) a history of foiled dental visits. These data may assist in identifying children at greatest risk for ECC and may help public health agencies develop appropriate prevention strategies, including promoting early dental visits for infants.     

Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital

This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.     

Rethinking the role of community-based clinical education in pediatric dentistry

The early childhood caries epidemic has prompted a look at predoctoral clinical dental education in pediatric dentistry. The purpose of this study was to examine the contribution of community-based clinical education (CBE) to procedural and patient diversity in predoctoral pediatric dental education. Using procedural and demographic data from pediatric clinical experiences of the dental class of 2007 at The Ohio State University College of Dentistry, profiles of patient diversity, clinical pediatric dental procedures, and student efficiency were developed for both CBE sites and the campus-based clinic. Ninety-two students performed 16,523 procedures on children in the fourth year in CBE sites in the community compared to 4,268 on campus in their third year. Pediatric-dedicated CBE sites accounted for almost 12,000 pediatric dental procedures. Approximately 56 percent of children treated at CBE sites were minorities. CBE sites accounted for most of the dental student restorative experience for pediatric patients for the Class of 2007, giving each student on average multiple restorative procedures. The campus-based clinic provided largely diagnostic and preventive procedures but few restorative opportunities. We conclude that community-based dental clinical education presents an opportunity to enhance pediatric predoctoral student clinical experiences in both quantity and diversity.     

Dental caries patterns and oral health behaviors in Arizona infants and toddlers

OBJECTIVES: The aim of this study was to use tooth eruption sequence, and a tooth- and surface-specific caries analysis method to determine: (1) the temporal relationship between tooth eruption and caries onset; (2) the validity of pre-existing concepts of caries progression; and (3) the relationship of certain putative health behaviors with caries prevalence. METHODS: A total of 2,428 Arizona children aged 6-36-months, who were recruited from WIC programs (a federal program for low-income children at nutritional risk), health fairs and private day care centers, received visual dental caries examinations. Additionally, an oral health behavior survey was administered to the parents of the 1,529 children recruited from the WIC programs. RESULTS: Dental caries was detected soon after tooth eruption, and by 34-36 months of age 25% of this population had caries. Maxillary anterior caries developed as early as 10-12 months of age. Fissure caries of the molars, either by itself or with maxillary anterior caries, was seen as early as 13-15 months of age. Posterior proximal caries was seen as early at 19-21 months, and only was present in conjunction with the other patterns. Over 40% of the 13-36-month-old children whose parents completed the survey still used a bottle. Night-time bottle use was associated with maxillary anterior caries in 24-36-month-old children, but no association was found in younger children or with posterior caries patterns. Survey responses also showed that fewer than 15% of these children reported having had a dental visit. CONCLUSIONS: Dental caries was a significant health issue for these children under 3 years of age, and factors other than bottle feeding may play an important role in its etiology. Prevention of dental caries in children under age three will depend on a better understanding of the etiology as well as improved access to care.     

Biologic restoration of primary anterior teeth: a case report

Restoration of primary maxillary incisors, severely destroyed by trauma or caries is a commonly faced problem in a Pediatric dental clinic. Most cases are observed in children with early childhood caries. In the past, the only option would have been to extract the affected teeth and replace them with prosthetic substitutes. However, the availability of natural crowns and roots would allow the use of biologic restorations to preserve the integrity of patient's natural dentition as presented in this case report.     

Patient and Provider Acceptance of Oral HIV Screening in a Dental School Setting

In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening in health care settings regardless of the patient's level of risk. This pilot study was developed in response to the suggestion by some health care professionals that dental settings would be appropriate for expansion of HIV testing. This project consisted of two parts: oral fluid HIV testing of patients in the clinic of a dental school and a survey of the clinical dental faculty members' attitudes about acceptability of routine HIV testing in the dental clinic. When patients' agreement to participate in oral fluid HIV testing was examined, 8.2 percent of the patients contacted by the clinic administration staff completed testing. When approached by a faculty member or student during the dental visit admission and tested during the dental visit, however, 88.2 percent completed testing. Of the faculty members who took the survey, 27.4 percent were neutral, 26.4 percent were somewhat in agreement, and 32.1 percent were willing to incorporate HIV testing into routine dental care. In this pilot study, HIV testing of dental patients was most successful when a dental care provider approached patients about testing. If consent was given, the testing was performed during the visit. For the faculty members, the major barrier to testing was a lack of protocol familiarity.     

Dental emergencies presenting to a university-based paediatric dentistry clinic in the West Indies

OBJECTIVES: The aims of the present study were to investigate the type and prevalence of dental emergencies presenting at a teaching hospital paediatric emergency clinic in Trinidad, and to describe the socio-demographic factors related to the use of the service. DESIGN AND METHODS: The authors used a prospective study of consecutive dental patients presenting to a paediatric emergency clinic. Data recorded included type of presenting emergency and socio-demographic variables. RESULTS: Data were available for 309 participants; 47% were male and 53% female. The average age of the participants was 8.66 years (SD = 3.75 years; range = 1-16 years). Seventy-three per cent of the participants' parents were involved in manual work or unemployed, and 21% were in nonmanual/professional employment; the occupation was not known in 6% of cases. Caries-related problems accounted for 74% of emergencies. Dental trauma mostly affected the upper permanent incisor teeth, with concussion, subluxation and intrusion being the most common injuries. CONCLUSION: Dental emergencies presenting to this university-based clinic were predominantly related to caries and trauma. The service was more frequently utilized by children in the mixed dentition stage, children from lower socioeconomic groups and those living in the local area. The frequency of caries-related problems indicates the need for more community-based preventive strategies, including encouraging greater attendance for routine dental care and dental health education. Strategies for oral health promotion should also be developed to prevent dental trauma.     

A three-year retrospective study of emergency visits at an oral health clinic in south-east Queensland

Background: There is little information available regarding dental emergencies for children in Australia. The aim of this study was to investigate the reasons for dental emergency cases which were treated at a public oral health clinic in a low socioeconomic district in south‐east Queensland. Methods: From a register kept at a public oral health clinic, we analysed the monthly number of emergency visits for children over a three‐year period (January 2008 to August 2010) with respect to numbers treated, reasons for presentation and types of treatment rendered. Results: During the period 2008–2010, there was a mean of 196 ± 86 cases presenting for emergency care each month. The proportions of the various types of emergencies remained fairly consistent over the three‐year period, with the majority presenting for caries related problems (74–75%), followed by trauma (8–9%), orthodontic treatment related (2–5%) and other reasons (16–11%). Between 8–11% of cases were preschool children who were added to the waitlist for treatment for caries under general anaesthesia at the public hospital. Conclusions: Trends in the past three years at a public oral health clinic in a low socioeconomic district in south‐east Queensland show that dental caries constitute nearly three‐quarters of all paediatric emergency appointments.     

Management of a Pediatric Patient With Epidermolysis Bullosa Receiving Comprehensive Dental Treatment under General Anesthesia

The purpose of this report was to detail clinical considerations and a general anesthetic approach for a 3-year-old pediatric dental patient with epidermolysis bullosa, a group of rare genetic disorders characterized by blister development following minor trauma or traction to the skin or mucosal surfaces. Challenges in providing comprehensive dental treatment and care under general anesthesia are discussed. Early evaluation is vital to preventing the consequences of severe early childhood caries.     

Behavior of dental phobic residents of large and small communities

The purpose of the present study was to characterize differences among dental phobic patients in past dental experience between residents of standard metropolitan areas (SMSA), and non-SMSA. Over a period of 1 year, the records of 41 dental phobic patients were evaluated. These patients were attending a special Israeli Defense Force clinic designed to treat dental phobics. The mean time since the last routine visit in both groups was 12.42 +/- 6.54 years and the mean age at which the patients had had their last routine dental treatment was 14.56 +/- 4.62 years. Over a two-year period prior to the present visit, the main reason for SMSA patients to seek any dental care was dental pain (P = 0.015). All other variables that compared the dental behavior of SMSA patients with non-SMSA patients showed no difference. The findings suggest that the availability of dentists in the SMSA did not increase the seeking of dental care. The fact that SMSA residents were more likely to seek care because of pain suggests that residents of non-SMSA areas were more likely to tolerate pain without seeking care. These findings underscore the need for proper behavioral and pain management during childhood.     

Forced eruption: part II. A method of treating nonrestorable teeth--Periodontal and restorative considerations.

In selected cases, forced eruption may be a useful approach in treating isolated nonrestorable teeth as a result of trauma, caries, or iatrogenic dentistry. This paper has presented the biologic rationale, objectives, technics and clinical cases to demonstrate the principle. Evaluation has been made of potential difficulties which may develop with the technic and areas for future research have been identified.     

The role of caries prevention protocol in pediatric dentistry specialty programs

Advanced specialty education programs in pediatric dentistry are often overwhelmed with patients who need restorative and surgical care, often on an emergency basis. Still, the Commission on Dental Accreditation Standards for Advanced Specialty Education Programs requires that residents receive didactic and clinical training in the prevention of dental caries. This paper contains several recommendations for strengthening the training of pediatric dental residents in caries risk assessment and prevention, including the suggestion that pediatric dental training programs become "dental homes" for their patients.     

Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system .     

Dental treatment in a patient with epidermolysis bullosa

Epidermolysis bullosa (EB) is a rare inherited group of genodermatoses characterized by mucocutaneous fragility and blister formation, either spontaneously or as a result of minimal mechanical trauma. The repetition of these episodes in the oral cavity leads to atrophy of the mucosa, causing microstomia, ankyloglossia, tongue denudation, and vestibule obliteration, characteristics that make dental treatment difficult. Patients with EB are at high risk for caries due to the presence of dental anomalies; they also tend to have a soft diet and difficulties with mechanical removal of the dental biofilm. This case report presents a patient diagnosed with EB and describes the difficulties faced by the clinician during dental treatment as well as the measures adopted to safely manage the patient's dental care.     

Cleft-affected children in Mayo: 1999-2007

The aims of this study were to investigate the medical and dental care of children born in Mayo with cleft lip and/or palate in the period 1999-2007. Thirteen subjects were identified--nine males and four females. Galway was the main locus for cleft surgical referral and care, with 10 subjects receiving treatment by the same surgeon. A total of 54% of subjects required ENT care, with 62% receiving speech and language therapy. DMFT and dmft were zero and 0.037, respectively. Mean age at first dental visit (to a private or community dental clinic, specialist paediatric dental practice or Western Health Board orthodontic service) was 21 months. This represents progress in the objective of early access and provision of dental care for this special care dentistry needs group.