Infant oral health care: a survey of general dentists, pediatric dentists, and pediatricians in Virginia

PURPOSE: This study's purpose was to examine the current knowledge, attitudes, and experiences related to infant oral health for dental and medical providers in Virginia. METHODS: A survey of infant oral health care was sent to: (a) 300 randomly selected general dentists; (b) 300 randomly selected pediatricians; and (c) all pediatric dentists in Virginia. Survey respondents were tabulated, and percent frequency distributions for responses to each item were computed. RESULTS: The surveys return rate was 48%. A total of 100% of pediatric dentists treated infants and were more likely to recommend that children be seen by age 1 (P < .001). All pediatricians treated infants as well, while only 5% referred for the first dental visit by 1 year of age. Forty-five percent of general dentists surveyed treated infants, and only 12% referred for the first dental visit by 1 year of age. The logistic regression results indicated that there were differences between practitioner type regarding the recommended age of the first dental visit and years in practice. CONCLUSIONS: The majority of pediatricians and general dentists are not advising patients to see the dentist by 1 year of age. There is a need for increased infant oral health care education in the medical and dental communities.     

Nursing bottle weaning and prevention of dental caries: a survey of pediatricians

Numerous studies have documented the cariogenic effects of prolonged or nocturnal bottle feeding in children. Guidelines prepared by the American Academy of Pediatrics (AAP) suggest that pediatricians advise parents to begin bottle weaning when their child is approximately nine months of age and accomplish weaning soon after the first birthday. However, little information exists concerning the advice pediatricians give to parents about nursing bottle weaning. Information about bottle weaning advice was obtained from 127 pediatricians selected from the American Academy of Pediatrics (AAP) Fellowship listing (1985-86). The majority of respondents discussed bottle weaning with parents and recommended a specific age for accomplishment of bottle weaning. Bedtime bottle feeding was discouraged actively, mainly due to the increased risk of dental caries. Implications of the findings are discussed.     

Behavior management techniques among pediatric dentists practicing in the southeastern United States.

PURPOSE: This study identifies those techniques most often utilized by pediatric dentists practicing in the Southeastern United States. It also assesses how the utilization pattern may have changed within the last five years, and identifies those factors that may have influenced the changes as perceived by the practicing dentists. METHODS: A questionnaire was mailed to 528 pediatric dentists who were members of the American Academy of Pediatric Dentistry, or The Southeastern Society of Pediatric Dentistry, or both. RESULTS: The response rate after one mailing and one reminder was 64%. The majority of dentists utilized less aversive behavior management techniques (e.g., parents in the operatory and nitrous oxide oxygen) and had decreased or discontinued use of such controversial techniques as Hand-Over-Mouth-Exercise (HOME) and Hand-Over-Mouth-With-Airway Restriction (HOMAR). The majority of dentists reported that their reasons for changes in the utilization pattern for most techniques were parental influences and legal and ethical concerns. CONCLUSIONS: Chi square analysis indicated significant differences (P < 0.05) in the frequency of use of behavior management techniques and age of practitioner, American Board of Pediatric Dentistry status, type of specialty training, and type of practice.     

Antibiotic use for treating dental infections in children: a survey of dentists' prescribing practices

BackgroundThe authors conducted a study to examine the antibiotic prescribing practices of general and pediatric dentists in the management of odontogenic infections in children.MethodsThe authors relied on a cross-sectional study design to assess the antibiotic prescribing practices of general and pediatric dentists in North Carolina. The survey instrument consisted of five clinical case scenarios that included antibiotic-prescribing decisions in a self-administered questionnaire format. The participants were volunteers attending one of four continuing education courses. The authors invited all pediatric dentists in private practice to participate in the study, as well as general practitioners who treated children in general practice. The authors compared the practitioners&;apos; responses for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association.ResultsA total of 154 surveys were completed and returned (55 percent response rate). The mean age of respondents was 47 years, and the mean number of years in practice was 19. Of the 154 overall, 106 (69 percent) were general practitioners and 48 (31 percent) were pediatric dentists. Across the three in-office clinical case scenarios, adherence to professional prescribing guidelines ranged from 10 to 42 percent. For the two weekend scenarios, overall adherence to the professional prescribing guidelines dropped to 14 and 17 percent. Dentists who had completed postgraduate education (n = 73 [51 percent]) were more likely (P < .05) to have adhered to published guidelines in prescribing antibiotics.ConclusionsThe results of this survey show that dentists&;apos; adherence to professional guidelines for prescribing antibiotics for odontogenic infections in children was low. There appears to be a lack of concordance between recommended professional guidelines and the antibiotic prescribing practices of dentists. Clearer, more specific guidelines may lead to improved adherence among dentists.     

Project USAP 2000--use of sedative agents by pediatric dentists: a 15-year follow-up survey

PURPOSE: A national survey of members of the American Academy of Pediatric Dentistry was conducted to provide a 15-year update of information regarding the use of sedative agents by pediatric dentists. METHODS: All 3,315 active members of the Academy were sent questionnaires regarding the frequency of their use of sedation and 1,778 responded. Practitioners were questioned regarding their use of sedative agents and the nature of their patients receiving sedation. In addition, they were questioned in regard to their use of restraints and reasons for change in their use of sedation during the past two years. RESULTS: In regard to the use of nitrous oxide alone, 47% of practitioners responded that they use nitrous oxide less than 11% of the time. In regard to other types of sedative agents, most practitioners use little, if any, sedation. Eighty-two percent use sedation for less than 11% of their patients. Of the 1,778 respondents, 1,224 used drugs other than nitrous oxide. In a typical three-month period, they performed 77,112 sedations. Of that number, 61,662 (80%) were administered by only 478 practitioners who use sedation on the average of once or greater each day. CONCLUSIONS: In comparison with previous surveys in 1985, 1991 and 1995, these results demonstrate an overall increased use of sedation by pediatric dentists. However, the increased use is due primarily to an increase in the numbers of practitioners who are heavier users of sedation (once or greater each day).     

Dentists' attitudes towards mouthguard protection.

PURPOSE: This study analyzed the attitudes of Virginia general dentists, orthodontists, and pediatric dentists towards mouthguard protection. METHODS: Questionnaires were constructed and mailed to 2500 dentists in Virginia. RESULTS: In this survey, 97% of orthodontists, 84% of pediatric dentists, and 67% of general dentists recommended mouthguard protection for their athletically active patients. The two main reasons for not recommending mouthguards were that the patient could obtain one from a less expensive source than the dental office and the dentist had not received formal training on fabrication or use of mouthguards. More recent graduates were more likely to have been taught mouthguard use and fabrication during their dental training. General dentists (59%) and pediatric dentists (56%) recommended the custom mouthguard while orthodontists recommended the prefabricated stock type (77%) as their primary choice of mouthguard. A majority of general dentists (58%), orthodontists (81%), and pediatric dentists (76%) recommended mouthguard protection for the contact sport of basketball which presently is a non-mandated mouthguard sport. CONCLUSION: Most dentists agree that athletically active patients require mouthguard protection. Many dentists, however, question whether they were the ones responsible for distributing and fabricating the mouthguards.     

Survey of dental prophylaxes rendered by pediatric dentists in New England

BACKGROUND: The objective of this anonymous postal survey was to assess the provision of dental prophylaxis by pediatric dentists in New England. METHODS: The questionnaire survey was sent by first class mail in September, 2001 to all 217 American Academy of Pediatric Dentistry (AAPD) members in active private practice in the six New England States of Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. A self-addressed, stamped envelope was provided to facilitate the returned response. RESULTS: The survey had a response rate of 70%. Most practitioners (93%) routinely recommended dental prophylaxis for their recall patients. The proportion of practitioners who considered the following indications for recommending dental prophylaxis was: plaque, stain, and/or calculus removal - 99%; caries prevention - 75%; prior to topical fluoride application - 82%; prior to sealant application - 58%; and for behavioral modification - 68%. Almost two thirds of the practitioners (62%) defined dental prophylaxis as referring to both rubber cup pumice prophylaxis as well as to toothbrush prophylaxis. However, only one in four practitioners (26%) had modified her/his clinical practice to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis. CONCLUSION: Pediatric dentists in New England routinely provide dental prophylaxis to their recall patients.     

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.     

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.     

Radiographic recommendations for the transitional dentition: comparison of general dentists and pediatric dentists

A survey which included brief case histories and intraoral photos of four transitional dentitions, including examples of ectopic and delayed eruption, as well as carious lesions, was mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Radiographic options were listed, from which each dentist was to indicate all films needed for each child's examination. Surveys were returned by 1273 (43%) dentists, including 713 (36%) general dentists and 560 (56%) pediatric dentists. The pediatric dentists took significantly more diagnostic radiographs than did the general dentists for each of the four transitional dentition cases. Pediatric dentists were more likely than the general dentists to take panoramic films and combinations which included panoramic films, bite-wing radiographs and periapical films. The most frequently ordered combinations were bite-wing radiographs plus panoramic films and bite-wing radiographs plus anterior periapical films. General dentists recommended bite-wing radiographs films only more frequently than did pediatric dentists. In view of the results of this study and the USDHHS guidelines for radiographic examinations, (1987) education must be provided for both general dentists and pediatric dentists regarding appropriate radiographic examinations for transitional dentition patients.     

Patients with special health care needs in pediatric dental practices

PURPOSE: The objective of this study was to determine the involvement of pediatric dentists in practice in managing patients with special health care needs (SCHN) upon completion of training. METHODS: A questionnaire was developed, pilot tested, modified and sent to a randomly selected sample of 950 pediatric dentists in practice who were active and fellow members of the American Academy of Pediatric Dentistry. RESULTS: Fifty-one percent of the dentists responded. The majority were males between the ages of 41 and 50 years. Most practiced in communities with over 500,000 citizens. Most were trained in hospital-based programs, and 84% reported comprehensive didactic courses on SHCN patients during training. SCHN patients were routinely appointed in an integrated schedule in their practices. Seventy-one percent of responders continue to follow the patients after 21 years of age. Most had buildings and offices that were handicapped accessible. Patient profiles remained similar since initiating private practice with notable increases reported in the new and recall patients and patients with complicated medical histories categories. CONCLUSIONS: The results of this survey demonstrate the continuing involvement of pediatric dentists in private practice in scheduling and treating patients with special health care needs after the completion of training.     

Colorado dental practitioners' attitudes and practices regarding tobacco-use prevention activities for 8- through 12-year-old patients

BACKGROUND: Tobacco use is a leading risk factor for oral morbidities and mortalities such as oral cancers and periodontitis. This study characterizes the factors related to dentists and hygienists conducting tobacco-use prevention counseling with 8- through 12-year-old patients. METHODS: The study used a mailed survey of dentists (n = 434), orthodontists (n = 91) and hygienists (n = 160) practicing in Colorado to collect data on the practitioners' tobacco-use prevention counseling activity, demographic characteristics, barriers to counseling and attitudes toward tobacco use. The authors used multiple logistic regression to determine which variables were associated independently with a dental practitioner's counseling children. RESULTS: The response rate was 25.6 percent. Prevalence of tobacco-use prevention counseling for children was low (38 percent for dentists and 44 percent for hygienists). Among dentists, the perception of tobacco use in children as a problem, perceived effectiveness of counseling and perceived role of a dental practitioner in counseling children were associated positively with counseling. Lack of skills was associated negatively with counseling. Among hygienists, perceived role in counseling children was associated positively and lack of time was associated negatively with counseling. CONCLUSIONS: Few dental practitioners counsel 8- through 12-year-old patients about tobacco use. Factors related to counseling appear to be amenable to education of dentists, in particular, regarding the importance of the problem, the effectiveness of counseling and skill development. CLINICAL IMPLICATIONS: Preventing tobacco use among children is integral to promoting patients' oral health. Training dentists through continuing education should increase the frequency of tobacco-use prevention counseling with children by both dentists and hygienists.     

Dietary determinants of dental caries and dietary recommendations for preschool children

OBJECTIVES: The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. METHODS: Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, and nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. RESULTS: Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. CONCLUSIONS: Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar-containing drinks in the bottle or sippy cup, discouraging the behavior of a child sleeping with a bottle, promoting noncariogenic foods for snacks, fostering eating patterns consistent with the Food Guide Pyramid, limiting cariogenic foods to mealtimes, rapidly clearing cariogenic foods from the child's oral cavity either by toothbrushing or by consumption of protective foods, and restricting sugar-containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.     

Opinions of practitioners and program directors concerning accreditation standards for postdoctoral pediatric dentistry training programs.

PURPOSE: This study was performed to assess opinions of program directors and practitioners about the importance and necessary numbers of experiences required by current accreditation standards for training of pediatric dentists. METHODS: A 32-item questionnaire was sent to all program directors of ADA-accredited postdoctoral pediatric dentistry training programs and to a random sample of 10% of the fellow/active membership of the American Academy of Pediatric Dentistry. RESULTS: An overall response rate of 56% was obtained from the single mailing. Practitioners and program directors differed significantly (P < or = 0.05) only in their opinions about the number of submucosal and intravenous sedation cases required for proficiency of eight experiences surveyed. The two groups differed significantly in 3 of 12 areas in terms of importance attributed for practice of contemporary pediatric dentistry: initiating and completing a research paper, biostatistics/epidemiology, and practice management. Program directors had little difficulty obtaining required experiences, and program dependence on Medicaid did not negatively affect quality of education. CONCLUSION: Practitioners and program directors agreed on the importance of most experiences and activities required by current accreditation standards.     

Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder

PURPOSE: The purpose of this study was to conduct a survey of Texas pediatric dentists to determine: (1) the percentage of patients they treat with attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD); (2) the behavior management techniques that are utilized to treat their patients who suffer from ADD/ADHD; and (3) the relative success rates of these techniques in their practices. METHODS: A 17-question, single-answer, multiple choice survey was mailed to 343 Texas pediatric dentists. The mailing list was obtained from American Academy of Pediatric Dentistry and Texas Academy of Pediatric Dentistry member rosters. One mailing was sent, including a self-addressed stomped envelope, for returned responses. RESULTS: A 54% response rate (186 surveys) revealed that nitrous oxide was the most frequently used pharmacologic behavior management technique; however, demerol/promethazine/nitrous oxide was rated as effective most often for treating ADD/ADHD patients. CONCLUSIONS: Practitioners believe the incidence of attention deficit disorder/attention deficit hyperactivity disorder is increasing, and they are familiar with the medications used to treat the conditions. Texas pediatric dentists are using a variety of sedation techniques and are interested in developing guidelines for sedation of these patients.     

Decision Making of Israeli,East European,and South American Dental School Graduates in Third Molar Surgery: Is There a Difference?

PURPOSE: This study was designed to evaluate decision making among Israeli, Eastern European, and South American dental school graduates in oral surgery issues. MATERIALS AND METHODS: During a military dental convention, a survey was conducted among 85 dentists that included a questionnaire and a panoramic image presentation. RESULTS: Removal of the mandibular third molar was recommended more often by the Israeli graduates, Eastern European dentists recommended less maxillary antagonist extraction, and South American graduates had the lowest rate of recommendation for extraction of a partially impacted mesioangular and distoangular mandibular third molar in a 19-year-old patient, and of a fully impacted horizontal mandibular third molar in 19- and 35-year-old patients. In all groups, more dentists recommended extraction of disease-free third molars in 35-year-old than in 19-year-old patients. CONCLUSION: According to study results, decision making regarding third molar treatment is not evidence-based and is not rational. Further postgraduate education in this area is warranted.     

A survey on radiation exposure reduction methods including rectangular collimation for intraoral radiography by pediatric dentists in the United States

BackgroundThe authors conducted a survey of the American Academy of Pediatric Dentistry (AAPD) to determine awareness of the Image Gently Campaign in Dentistry (IGCD) and to ascertain radiologic practices, including radiation dose-reduction strategies such as rectangular collimation.MethodsAn institutional review board approved an electronic survey sent to 7,087 AAPD members covering practitioner demographic characteristics, radiographic techniques, and dose-reduction practices, including rectangular collimation. Responses were tabulated and analyzed using binomial tests, χ² tests, and Fisher exact tests.ResultsA total of 1,124 pediatric dentists or residents in pediatric dentistry responded, (response rate 16%, margin of error ± 2.7%). The largest group (23.8%) graduated after 2010. More than 90% indicated that they followed American Dental Association (ADA)-AAPD radiation exposure guidelines, but only 33.5% were aware of IGCD. Almost all respondents used direct digital systems, storage phosphor plates, or both. Only 22.3% (n = 220) used rectangular collimation. Nonusers indicated that they were unfamiliar with collimation (33.3%) or concerned about potential for increased cone cuts (30.2%), 11.6% of respondents were unaware of any regulatory requirements for inspections of radiographic equipment recurring at regular intervals, and 4.1% of respondents considered use of lead aprons optional.ConclusionsAlthough the pediatric dentists surveyed believe they are in compliance with ADA-AAPD guidelines, most are unaware of IGCD recommendations. Use of digital radiography is almost ubiquitous, but use of rectangular collimation is limited.Practice ImplicationsDentists treating children should be familiar with ADA-AAPD radiation exposure guidelines and should consider using the dose-reduction strategies recommended by IGCD.     

Oral and pharyngeal cancer: knowledge and opinions of dentists in British Columbia and Nova Scotia

Oral and pharyngeal cancers are largely preventable and can be successfully treated when diagnosed at an early stage. Dentists in British Columbia and Nova Scotia were surveyed regarding their knowledge and opinions about oral and pharyngeal cancer. In February 1998 a pretested 41-item survey was mailed to a random sample of dentists in British Columbia and the population of dentists in Nova Scotia. A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%) only 56.7% agreed that their knowledge of the subject was current. Most dentists correctly identified tobacco use (99.4%) and alcohol use (90.4%) as risk factors, but fewer correctly identified factors such as the use of spicy foods (57.0%) and poor oral hygiene (46.3%) as not being risk factors. Only 42.5% identified both erythroplakia and leukoplakia, in that order, as the conditions most likely associated with oral cancer. Indices of risk and diagnostic knowledge were constructed by summing the number of correct responses to items in each domain. On 16 risk factors the mean correct score was 9.2, and on 14 diagnostic procedures the mean correct score was 10.0. Only 38.5% of dentists had consistent levels of knowledge on both indices. Differences between the provinces were statistically significant (p < 0.01) for only 2 knowledge items. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses. Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of risk and diagnostic factors for oral cancer.