American Academy Of Pediatric Dentistry Research Articles

Early Childhood Feeding Practices and Its Association with Early Childhood Caries

Early childhood caries (ECC) is one of the most prevalent dental diseases among children and is related to their early feeding practices. This multi-factorial disease involves susceptible tooth and host, fermentable carbohydrates in the diet, cariogenic micro-organisms and time (American Academy of Pediatric Dentistry, 2008). Thus, this study aimed to identify the associations between bottle-feeding and weaning practices, and ECC formation. By using convenience sampling, 201 children were recruited from the IIUM Outpatient Dental Clinic and ten kindergartens around the area of Kuantan, in the state of Pahang (Malaysia). Examination for caries was conducted visually to determine caries status (with or without caries). The caregivers were requested to fill in a questionnaire regarding feeding practices of their children. The findings of the study indicated that 67% of the children identified with caries practiced bottle-feeding in bed either sometimes or always (every night/day) (p=0.005). The prevalence of ECC was also significantly (p4 years) among the study population. In addition, the mean intake of sweetened drinks among children with ECC was significantly higher than those with no ECC (5.4 vs. 3.1 servings/week, p=0.001). The results of this research indicated that the increased frequency and prolonged duration of bottle-feeding practices, as well as high consumption of sweet drinks during weaning, could be associated with the formation of ECC. In conclusion, these findings would increase the awareness particularly among parents regarding bottle-feeding practices and weaning diet contents and its potential implication on their children’s oral health.

Success of Two Caries Risk Assessment Tools in Children: A Pilot Study With a 3-Year Follow-Up.

Caries risk is defined as the dental caries probability under the individual bacteriological environment, dietary habits, and environmental factors. Assessment of caries risk plays a major role in the prevention of dental caries. The aim of this study was to compare the effectiveness of two different caries risk assessment methods on caries-free preschool children. A sample of 90 caries-free 4- to 6-year-old children were selected from 400 preschool children. The selection was limited to children who had no dental caries, visible plaque, and systemic disease. American Academy of Pediatric Dentistry's Caries Risk Assessment Tool (CAT) and Clinpro Cario L-Pop (CCLP; 3M ESPE, Germany) were used to categorize children into caries risk groups. Children were classified as being in high-, medium-, or low-risk groups by two methods. Determining risk factors according to CAT were examined. The compliance among the two methods was evaluated. Sixty-eight children were reevaluated intraorally after 3 years. The compliance between CAT and CCLP was sought using Kappa test. Statistical evaluation revealed moderate compliance among methods at baseline. The three most determinant factors in the high-risk group according to CAT were no topical fluoride exposure, no use of dental services, and active caries in mother. CAT is found statistically more successful than CCLP in predicting caries risk 3 years later. Caries risk assessment is effective to predict future caries and can be helpful for the clinician to choose the right tailor-made caries prevention plans.

Innate Immunity Signatures of Early Childhood Caries (ECC) and Severe Early Childhood Caries

Caries that affects children under the age of 6 is known as early childhood caries (ECC). According to the American Academy of Pediatric Dentistry (AAPD), ECC is defined as the presence of one or more teeth with caries (cavities or no cavities), missing teeth due to caries or the presence of restoration deciduous teeth in children under 71 months. If it occurred on the smooth surface of the tooth in children under 3 years of age, the disease is classified as severe early childhood caries (S-ECC). Streptococcus mutans plays important role in the etiology of caries of preschool children, which is a contagious pathological entity. The pathogen is an acidogenic and aciduric bacteria. The occurrence of caries is a complex process of interaction between host factors (teeth), microorganisms, substrates (carbohydrates) and the environment, including saliva. This mini review aims to summarize current findings on several markers of innate immune system related to ECC and S-ECC namely lysozyme, salivary lactoferrin, IL-8, CD36 of salivary neutrophils, and sCD14

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101. RESIDENT-LED QI INITIATIVE TO IMPROVE ASSESSMENT AND CARE OF PATIENTS WITH EARLY CHILDHOOD CARIES

Background Early childhood caries (ECC), defined as one or more decayed, missing, or filled teeth in children under 6 years, is the most common, chronic, preventable condition in childhood. ECC affects 28% of US children 2-5 years of age, particularly children of lower socioeconomic status. The American Academy of Pediatric Dentistry (AAPD) and the AAP recommend that children establish a dental home by 12 months, but lack of standardized ECC assessments and dental referral processes are often barriers to optimal care. Aim Statement In this 12- month long resident-led QI project we aimed to improve the ECC risk assessment rate for children 6 months to 6 years to 70%, and to improve the dental referral rate to 90%. Interventions The Model of Improvement was used for this QI project from December 2017 to December 2018 at a community clinic affiliated with an academic center. An electronic Oral Risk Assessment Tool was created based on AAP guidelines. Residents performed 6 plan-do-study-act (PDSA) cycles utilizing 7 interventions derived from tertiary key drivers. Measures Process, outcome and balancing measures were collected via electronic medical record review (resident documentation of EEC screening, dental referrals and developmental screening respectively). Statistical control charts were utilized to display and analyze the data. API rules were applied to detect special cause variation. Results 281 patients were screened. Oral health risk assessment improved from 37.84% to 77.74%. Initially, 72.22% of screened patients were at high risk for caries (with >1 risk factor for ECC on risk assessment tool). Over time, this rate significantly decreased to 52.46% largely due to family education. On average, 47.66% of screened patients had a dental home. Residents reached outcome goal of 90% referral rate for those patients without a dental home. Developmental screening rate, as a balancing measure, remained at 100% compliance. Conclusions and Next Steps Implementation of this QI project showed our patient population was at high-risk for ECC, which had previously been unknown, and decreased with our interventions. Creation of an electronic screening tool facilitated screening. Family education and providing a referral list of community dentists were the most successful interventions. Next steps include creating an electronic dental referral system and partnering with community dentists to enhance ECC-related family and patient education.

Early Childhood Caries; A Predictive Model Using Variables Regularly Documented During Well-Child Visits

Purpose: In spite of the importance of oral health to overall health, most young children do not receive an early dental visit by 12 months of age, as recommended by the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD). By the time many children have a dental visit, a majority of the behavioral and dietary risk factors for dental caries have been established. Early childhood caries are often present at the first dental visit, frequently necessitating extensive treatment and the risks associated with …

Pediatric dentists who accept new Medicaid-enrolled children report higher willingness to advocate for community water Fluoridation

BackgroundDentists, who advocate for Community Water Fluoridation (CWF), can help decrease the dental caries disparity gap between low and high socioeconomic groups. Advocating for CWF, a cause that promotes oral health at the population level is an altruistic behavior. Dentists who accept and provide services to Medicaid-insured children, who are from low socioeconomic backgrounds, are also considered altruistic. We tested the association between accepting new Medicaid-insured children every month, and willingness to advocate for CWF programs in pediatric dentists (PDs).MethodsIn 2016, a 22-item pilot tested online survey was sent to 5394 PD members of the American Academy of Pediatric Dentistry. Descriptive analysis and a multiple adjusted logistic regression model was conducted.ResultsDentists who accept new Medicaid-insured children every month (OR: 1.62; 95% CI: 1.06–2.47; p = 0.02) were more willing to advocate for CWF compared to their counterparts. Those practicing primarily in rural (OR = 4.67; 95% CI: 1.82–11.9; p = 0.001), and urban areas (OR = 2.27; 95%CI: 1.05–4.89; p = 0.04), and those willing to promote fluoridated water consumption to parents in the clinic (OR = 3.40; 95% CI: 1.87–6.21; p = < 0.0001) were significantly more likely to be willing to advocate for CWF. PDs trained in public health advocacy during pediatric residency alone (OR = 2.37; 95% CI: 1.24–4.51; p = 0.009), or during both pre-doctoral dental education and pediatric residency (OR = 3.51; 95% CI: 1.87–5.6; p = < 0.0001) were more willing to advocate for CWF compared to their counterparts.ConclusionsPDs who accepted new Medicaid-insured children every month were more willing to advocate for CWF programs compared to those who did not.

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures.

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.

A study to assess the association between early childhood caries and relationship of Streptococcus mutans in saliva of mother, child and sibling pairs

Background: Early childhood caries (ECC) is a specific form of rampant caries that initially affects the primary maxillary anterior teeth of infants and children. According to American Academy of Pediatric Dentistry (AAPD) 2011, early childhood caries is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a child under the age of six. The objective of this study was to assess the association between early childhood caries and relationship of Streptococcus mutans in saliva of mother, child and sibling pairs.Methods: Group 1 consists of fifty children with early childhood caries along with their mothers and siblings with the child age between 15 months to 5 years and sibling’s age between 4 years to 10 years, whereas group 2 consists of fifty caries free children along with their mothers and siblings. For both groups, saliva samples were taken from the child, mother and sibling pairs to estimate the Streptococcus mutans count and to determine pH of saliva in these children. DMFT scores, debris scores checked for child, mother and sibling pairs.Results: Streptococcus mutans count was significantly high in group 1 than that of the group 2. Mothers were more co related to the children in the acquisition of Streptococcus mutans than the siblings. Increased no of meals of the child, pacifier use, low socio-economic status and low maternal education showed significant high correlation with caries prevalence. Low pH score was also significantly correlated with the increase in caries rate.Conclusions: Maternal factors such as high DMFT scores, low education levels, prolonged bottle-feeding with sweetened milk, pacifier use are strong risk indicators for identifying high caries-susceptible children.

Pediatric Dentists' Silver Diamine Fluoride Education, Knowledge, Attitudes, and Professional Behavior: A National Survey.

Silver diamine fluoride (SDF) is an inexpensive treatment for arresting cavitated carious lesions in a minimally invasive way. The aims of this study were to assess U.S. pediatric dentists' SDF educational experiences, knowledge, attitudes, and professional behavior and to explore the relationships among these constructs. For the cross-sectional survey, recruitment emails were sent to all 6,230 members of the American Academy of Pediatric Dentistry (AAPD). Responses were received from 582 members (response rate 9.34%). In the results, only 3% of the respondents reported having been well/very well educated about SDF in classroom settings in dental school and only 9.6% during their residency. Positive SDF professional development was reported frequently (education through publications 53%, online resources 41%, continuing education courses 38%). The majority knew much/very much about what SDF is used for in dentistry (77%), about treating caries in pediatric patients (80%), and which problems SDF use can have (62%). Their SDF attitudes were positive: SDF use was considered a good treatment alternative for restorations in children with behavioral problems (85%) and for patients who were medically fragile (85%) or had severe dental anxiety (81%). Among the respondents, 31% used SDF often/very often to arrest carious lesions in primary teeth, and 87% expected increased future SDF use. The more SDF professional education the respondents had, the more self-reported knowledge they had (r=0.52; p<0.001), the more positive their SDF-related attitudes (r=0.25; p<0.001), and the more likely they were to use SDF (r=0.37; p<0.001). These results suggest that expanded education about the proper use, benefits, and limitations of SDF is needed and is likely to increase pediatric dentists' SDF utilization.

Behavior Management in Pediatric Dentistry: An Overview and Interpretation

In 1895, the first definition of behavior management was mentioned by McElroy with the following words: although the operative dentistry may be perfect, the appointment is a failure if the child departs in tears”. This approach, which argues that the success of dental treatment in pediatric patients depends on the attitude created in children rather than in the technical or clinical evaluation, was supported by the following words in American Academy of Pediatric Dentistry (AAPD)'s guideline about 100 years later: “Behavior guidance techniques, both nonpharmalogical and pharmalogical, are used to alleviate anxiety, nurture a positive dental attitude, and perform quality oral health care safely and efficiently for infants, children, adolescents, and persons with special health care needs”. The terms of behavior management, which is the global term of choice, or behavior guidance which is now used by AAPD are widely used in dental literature.

A Review on the Dental Management of specially abled patients with a systematic approach towards the Dental management of patients with Cardiovascular Disorders – An Evidence Based Decision Tree Analysis

The American Academy of Pediatric Dentistry (AAPD) defines special care needs as “any physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment that requires medical management, health care intervention and/or use of specialized services or programs. The condition may be congenital, developmental or acquired through disease, trauma or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity”. [1] Special care dentistry works on meeting the dental needs of a wide spectrum of specially abled patients who may be medically compromised, those with learning and physical disabilities, mentally challenged, pregnant, geriatric, anxious and petrified patients and referrals from head and neck oncology who are under radiotherapy, chemotherapeutic drugs for management of head and neck carcinomas. Hence it is very important for the dentists to have a thorough knowledge and undergo additional training for managing these patients during dental treatment. Cardio vascular disorders comprise of a group of diseases of the heart and vascular system. It has been reported in literatures that sometimes dental professionals play a key role in diagnosing various cardiovascular pathologies during routine dental examination. In this article, a review on the dental management of special care patients and an emphasis on the dental treatment protocol for patients with cardiovascular diseases through a decision tree analysis has been done.

Early assessment of pediatric oral status at national guard (NG)-cross sectional study

IntroductionAccording to the American Academy of Pediatric Dentistry, it is recommended that pediatric dental home begins before 12 months of age. Studies reported the prevalence of early childhood caries among preschool children in Saudi Arabia ranging from 85% to 96% However there was lack of studies reporting the prevalence of caries among infant/toddlers. In Riyadh city the incidence of dental trauma among children (6 months to 4 years) was recorded 12% and 48% and oral lesion was 10.26%. AimAssessment of oral health status for infants/toddlers between 6 months and 3 years old to determine frequency of dental caries, oral hygiene, dental trauma, oral lesion, and relate it to the caregiver oral care practice. Material & methodsEthical approval was obtained from KAIMRC at KAMC-Jed. A collaboration between the Dental Department and Family Medicine Department at Iskan (PHC) Center in Jeddah was done at 2015/2016 to examine infant/toddlers oral health status at the well-baby clinic. This cross-sectional study is using the previously collected data in this first dental preventive program. The sample was 151 infant/toddlers. The chart included interview-based questionnaire which was answered by the caregiver during the visit. ResultsThe frequency of dental caries was9% with sever early childhood caries mostly affecting upper central incisors. This indicated the importance to establish early preventive dental care within well-baby clinic. The plaque was accumulated mostly on posterior teeth. The frequency of trauma was very low and no reported oral lesion. Conclusions: This study Indicated the urgent need to reach infant/toddlers within well-baby clinic to enhance early oral care and to preventive caries.

A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children.

At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear. This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment. The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is protected by copyright. All rights reserved.

A Survey of Pediatric Dentists on the Treatment Timing and Modalities for White Spot Lesions in the United States.

The purpose of this study was to estimate the prevalence of white spot lesions (WSLs) in various practice settings and patient populations, and to gather information about the treatment timing and modalities used by pediatric dentists in the United States. A fourteen question, multiple choice, electronic survey was developed and distributed to 6,092 active American Academy of Pediatric Dentistry (AAPD) members. A total of 625 active members responded, garnering a 9.7% response rate. Before treatment, there were significantly more WSLs reported in Corporate practice than Multi-Doctor Practice (P=0.002), and significantly more WSLs in Academics/Hospital-Based Practices than in Multi-Doctor Practices (P=0.002). For WSLs after treatment, there were significantly more WSLs in Academic/Hospital-Based practices than in single-practitioner settings (P=0.003). Approximately 38% of pediatric dentists preferred to treat WSLs before, during or after orthodontic treatment, while 23% treat only before and 20% treat only after treatment. The three most common treatment modalities for WSLs, were prescription fluoride toothpaste (5000 ppm), fluoride varnish, and fluoride rinse. Approximately 47% of respondents reported they were "very comfortable" treating WSLs and 31.0% felt "comfortable." The prevalence of WSLs differed across types of practice. There is no agreement among pediatric dentist as to timing and treatment modalities for WSLs.

Attitude and willingness of pediatric dentists regarding dental care for children with developmental and intellectual disabilities

Children with developmental and/or intellectual disabilities (DD/ID) are considered to be at greater risk of developing dental disease and are more likely to have unmet dental needs than other children. The purpose of this study was to determine the attitude and willingness of pediatric dentists and residents to provide dental care for children with DD/ID. Two surveys were created and emailed via SurveyMonkey® to pediatric dentists and post-doctoral student members of the American Academy of Pediatric Dentistry. Five hundred and seventy-four pediatric dentists (9%) and 143 pediatric dentistry residents (13%) responded. Ninety-nine percent of the practicing pediatric dentists do provide dental care for children with DD/ID. Ninety-six percent of the practitioners are confident/very confident in treating these children with nonpharmacological methods, while 86% are confident/very confident with pharmacological methods. Among the residents, 99% are willing to provide dental care to children with DD/ID after they graduate. Eighty-six percent of the residents are confident/very confident in treating these children with nonpharmacological methods, while 70% are confident/very confident with pharmacological methods. Pediatric dentist and resident respondents to the survey were overwhelmingly willing to provide dental care for patients with DD/ID and are confident with pharmacological and nonpharmacological treatment modalities.

Developmental defects of enamel increase caries susceptibility in Chinese preschool children.

The present epidemiological study aimed to compare the prevalence and severity of developmental defects of enamel (DDE) and dental caries between urban and suburban Chinese preschool children. A total of 1351 3- to 6-year-old children were invited to participate in this study and received dental examinations. A modified DDE index was used to assess the prevalence and severity of DDE. The dental caries diagnosis was based on the World Health Organization (WHO) health survey methods for field studies and was recorded using the decayed, missing and filled tooth (dmft) index. The caries status was further classified as caries or severe caries according to a modification of the American Academy of Pediatric Dentistry definition. Overall, the DDE prevalence was 48.3% among the 1351 preschool children. The DDE prevalence was higher in innercity children (54.1%) than in suburban children (42.0%; P<0.001). In contrast, the suburban children had a higher prevalence of dental caries (65.2% vs 57.5%; P=0.004) and a higher mean dmft score (3.5±4.2 vs 2.9±3.8; P=0.005) than the innercity children. Only 23.9% of the children were free of both DDE and caries. The caries risk increased significantly and independently as DDE severity increased (linear trend, 95% confidence interval=[1.32, 1.69], age [1.60, 1.88], urban residence [1.18, 2.15] and breastfeeding experience [1.04, 1.60]) after controlling for other demographic risk factors. The study provides new evidence that DDE is a significant contributing factor for the highly prevalent and progressive dental caries observed in Chinese preschool children. These results highlight the importance of including DDE in caries risk assessments.

Effectiveness of an audio-visual aid on the knowledge of school teachers regarding the emergency management of dental injuries.

Traumatic dental injuries (TDI) occur frequently in the school environment. Many studies have shown that teachers' knowledge on the emergency management of TDI is inadequate. The aim of this study was to evaluate the knowledge level among schoolteachers in Chennai, India, regarding TDI using a questionnaire and to evaluate the effectiveness of a newly developed audio-visual aid (AV) as an educational tool by reapplying the questionnaire. The questionnaire was distributed to 345 teachers in 15 randomly selected schools. A pro forma document along with the questionnaire surveyed the teachers' demographic details and their knowledge regarding the emergency management of TDI. Then, a video containing evidence-based information about the emergency management of TDI in accordance with the American Academy of Pediatric Dentistry (AAPD) guidelines was played for the participants. The questionnaire was readministered to test the teachers' knowledge after they viewed the video. In total, 301 teachers responded to the questionnaire. Wilcoxon's signed-rank test/chi-square test showed that, after the teachers viewed the video, their knowledge had significantly improved relative to the handling of TDI (P<.0001). Their attitude towards the AV aid was positive, and all participants (100%) found the AV helpful. Almost 99.7% of the participants reported increased confidence in handling dental injuries. There is a substantial lack of basic knowledge regarding the emergency TDI management among schoolteachers. The proposed AV aid is an effective tool for providing management strategies.

Is Maximal Dosage for Local Anesthetics Taught Consistently Across U.S. Dental Schools? A National Survey.

Administration of safe and effective local anesthesia is a cornerstone of dental practice, but there is some discrepancy in recommendations for maximum doses, with the Council on Dental Therapeutics and American Academy of Pediatric Dentistry's guidelines differing from the guidelines of manufacturers and contemporary textbooks. The aim of this study was to determine the level of uniformity across U.S. dental schools in teaching maximal safe doses for commonly used local anesthetics. Faculty members primarily responsible for teaching local anesthesia to dental students at all 62 U.S. dental schools that had graduated classes were invited to participate in a survey in March 2017. The survey included questions about maximum doses taught, awareness of the existence of two differing guidelines, and whether one or both guidelines were commonly taught to students. A total of 37 responses were received, for a response rate of 60%. The respondents included oral and maxillofacial surgeons, general dentists, dental anesthesiologists, and periodontists. Of the respondents, 22% reported being unaware of the existence of more than one standard, and there was inconsistency in teaching practices. A majority (73%) reported teaching the higher maximum dose (7 mg/kg) for lidocaine, while a similar but smaller majority (60%) reported teaching the lower dose threshold (4.4 mg/kg) for mepivacaine. This study found no standard recommended maximum dose of lidocaine or mepivacaine being taught in U.S dental schools. Students should be made aware that there is more than one standard, and teaching should emphasize sound medical and pharmacologic principles. There is also a need to ensure that questions on dental licensing examinations are consistent regarding maximum safe doses for local anesthesia.

The Knocked Out Permanent Tooth: A Review of Emergency Instructions on Pediatric Dentistry Practice Websites

Purpose Parents seek emergency instructions from pediatric dentistry practice websites when tooth avulsion injuries occur. The American Academy of Pediatric Dentistry (AAPD) endorses the 2012 International Association of Dental Traumatology (IADT) guidelines for the management of all types of traumatic dental injuries, including avulsion of permanent teeth (Dent Traumatol. 2012; 28:88-96). This study reviewed the internet websites of AAPD-affiliated private practices for the presence …