Wednesday, July 30, 2014

Factors associated with sealant outcome in 2 pediatric dental clinics: A multivariate hierarchical analysis

Mark Dawoud                                                                                    Date: 07/29/2014

Article title: Factors associated with sealant outcome in 2 pediatric dental clinics: A multivariate hierarchical analysis

Authors: Nathan G. West, DMD; Melina A. Ilief-Ala, DMD; Joanna M. Douglass, BDS, DDS and James I. Hagadorn, MD, MS

Journal: Pediatric Dentistry Volume 33 Jul/Aug 2011

Type of Article: retrospective study

Main Purpose: To determine whether placement of one-time sealants placed by pediatric dental residents or dental students have different outcomes.

Overview of method of research: Records were taken from 2 inner-city pediatric dental clinics.  The charts of 203 children, ranging from 6-10 years old, had a total of 481 sealants on permanent first molars. The patients had at least 2 years of follow-up. Patients in the study were treated by a pediatric dental resident or by a dental student.

Findings: Univariate analysis revealed longer follow-up and younger age were associated with sealant failure. A history of caries reduced the protective effect of increased age. Operator type (resident vs. student), child behavior and isolation technique were not associated with sealant failure.


Summary:  1) No significant association between a resident or student was found with sealant failure. 2) Sealant failure was associated with caries history prior to sealant placement, longer duration of follow-up, and age of child were significantly associated with sealant failure. 3) The type of isolation and patient behavior were not significantly associated with sealant failure.

Beyond Word Recognition: Understanding Pediatic Oral Health Literacy


Article Title: Beyond Word Recognition:  Understanding Pediatric Oral Health Literacy
Author: Julia Anne Richman, DDS, MSD MPH; Colleen E. Huebner, PhD, MPH; Penelope J. Leggott, BDS, MS; Wendy E. Mouradian, MD, MS; Lloyd M. Mand, PhD.
Journal: Pediatric Dentistry
Date: September/October 2011
Major Topic: Pediatric Oral Health Literacy

Main Purpose: To evaluate pediatric oral health literacy in parents. 

Introduction: Literacy in health care is specific to health related terms and knowledge or “health literacy”.  For dentistry, it is oral health literacy and American Dental Association(ADA) defines this as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. “  The ADA has a tool that they have developed to measure oral health literacy.  The purpose of this study is to determine parent oral health literacy and how it might correlate to their child’s oral health.

Methods: Study location was at 2 Headstart programs in western Washington State, centers were in primarily in non-fluoridated areas.  Parents were asked to participate in the study that consisted of a three-part assessment (word recognition, vocabulary knowledge, and comprehension) and objective assessment of their child’s oral health (excellent, very good, good, fair, poor).  The assessment tool is called Oral Health Literacy Inventory for Parents (OH-LIP). The assessment was comprised of 35 pediatric oral health-related words and terms that came from research instrument called Things to Know about Baby Teeth and from suggestions from pediatric faculty and residents of common words and phrases.  The interviews were recorded and scored using a numerical scale that correlated their response to a numerical value for analysis (1=correct, 0.5=partially correct, 0=incorrect, 0=if the parent passed on the question)

Results: 45 parents participated in the study.  The majority of participants were female, Caucasian and from lower income families. 
     OH-LIP 1: Word Recognition- highest scoring section – 78% read each word correctly
     OH-LIP 2: Vocabulary knowledge- many incomplete and incorrect – Only 1 of the 35 terms was scored fully correct for 75% of parents (permanent teeth)
     OH-LIP 3 : Comprehension-not good, most frequently scored word as incorrect was decay when used in the following context.  “Tooth decay in primary teeth often means there will be tooth decay in permanent teeth.”

OH-LIP 1 and 2 and parental education were not found to be statistically significant association.  There was a statistically significant association between parental education and OH-LIP 3.  There was no statistical significance for a association of parent reported oral status of their child and OH-LIP 1,2,or 3.   Parents who claimed their child’s oral health was excellent, fair or poor had higher scores on the OH-LIP then parents who rated their child’s oral health as good or very good.

Discussion/Assessment:  Word recognition is usually used as to determine a person’s level of health literacy.  This study’s results show that might be an over estimation in the realm of oral health literacy.   Article was bit unclear at times due to statistical jargon.

Mixed Dentition Cavitated Caries Incidence and Dietary Intake Frequencies
Author: Dr. Oitip Chankana DDS, MSc, PhD et. al. 
Journal: Pedatric Dentistry 2011; 33(3): 233-240
Main Topic: New carious lesions
Type of Article:  Case Series
Main Purpose: To examine risk factors for children with new cavitated caries between 5 and 9 years old.
Methods: This study used data from the Iowa Fluoride Study (IFS). Subjects were recruited immediately after birth from 8 Iowa hospitals and followed by mail and periodic assessments and exams. Patients were mostly caucasion with SES.  Subjects with both primary dentition (~5 years old) and mixed dentition (~9 years old) caries exams and at least 2 diet diaries, including at least 1 from 5 to 6.5 years old and 1 from 7 to 8.5 years old (to ensure at least 1 diary before starting school and at least 1 after) were included in these analyses. Number of patients = 198. 
 Diet: 
  • The food and beverage intakes for 2 weekdays and 1 weekend day were recorded by parents using 3-day diaries that were sent every 1.5 to 6 months (1.5 months to 8.5 years old). 
  • Detailed information collected of: consumption times, types of items, quantities. 
  • Annual dietary diaries (ie, at 5–8 years old) were abstracted by trained registered dietitians or diet technicians. 
  • If the 5-, 6-, 7-, and/or 8-year-old diary was missing, then a substitution was made using the diaries 6 months succeeding or preceding the yearly diary.  
  • Food and beverage intake frequencies were estimated from the diaries and categorized so that consumption within a 30-minute interval counted as 1 eating event. 
  • More than 1 serving of the same beverage or food consumed within 30 minutes was considered 1 event. T
  • he eating events then were identified as either meals or snacks, based on the time of consumption and nature of the food. 
  • Only 3 meals per day were allowed: 1 during the morning; 1 at the middle of the day; and 1 during evening hours. 
  • Unlimited eating events, however, were allowed for snacks.
  • Beverages were categorized as: milk; 100% juices; juice drinks; powder-sugared beverages; regular (sugared) soda pop; diet soda pop; sports drinks; and water. 
  • Foods were categorized as: sugar-based desserts (jelly, pudding, etc); candy; added sugar (table sugar, honey, brown sugar, etc); baked starch with sugar (cookies, cake, etc); unsweetened cereals; presweetened cereals; unprocessed starches (boiled potato, bread, rice, etc); and processed starches (potato chips, etc). 
  • The intake frequency of each food and beverage category was counted and averaged for each child across the 3 days for each annual diary (at 5, 6, 7, or 8 years old). Results at 5 and/or 6 years old and at 7 and/or 8 years old were averaged separately, and these 2 means were subsequently averaged to form an overall measure for each child. The dietary variables were presented in order by percentage of children with some intake (5–8 years old) at snacking occasions in each of the beverage, sugar-based, and starch-based food groups.

Results—Thirty-seven percent had new cavitated caries. The mean new cavitated caries count for all children was 1.17 surfaces (±2.28 SD). In multivariable logistic regression, the following were significantly associated (P<.10) with having new cavitated caries: noncavitated caries experience at 5 years old (odds ratio [OR]=2.67, P=.03); cavitated caries experience at 5 years old (OR=3.39, P=.004); greater processed starch at snack frequency (OR=3.87, P=.07); being older (OR=1.68, P=.04); and less frequent tooth-brushing (P=.001).
Conclusion—Results suggested that increased tooth-brushing frequency and reduced consumption of processed starches as snacks may reduce caries incidence in younger school-aged children.
Assessment: I think that this article had lots of different variables that are hard to account for with accuracy. I also think that there was a lot of time and energy put into this research which did not glean any new information or theories only confirmed ones that are already well accepted. 


Visionaries or Dreamers? The Story of Infant Oral Health

Resident: Hofelich

Article title: Visionaries or Dreamers? The Story of Infant Oral Health
Authors: Arthur J. Nowak, DMD, MA, Rocio B. Quinonez, DMD, MS, MPH
Journal: Pediatric Dentistry Volume 33 Vol 2 Mar/Apr 2011 
Type of Article: Literature Review
Main Purpose:  This article reviews the early history of oral health promotion during infancy and early childhood, the progress made since 1986, and what remains to be done.
Key Points:
       1890s- W.D. Miller published Microorganisms of the Human Mouth describing dental decay as a chemo-parasitic process including decalcification and dissolution
       late 1920s- Sullivan articles describing the importance of infant oral health
       1914, 1924, 1937- GV Black states that oral care should be made early in life as soon as the baby has a tooth
       1940 - Stephan demonstrated changes in pH (critical 5.5), Stephan Curve (time required for pH of saliva to return to 6 or 7 after sucrose challenge)
       1945 - Grand Rapids, MI is the first to have community water fluoridation
       1960s - Keyes and Fitzgerald reported on the interaction of plaque and a carbohydrate rich diet on a tooth,  Venn diagram was presented
       1967 - AAP promoted pediatricians discuss infant oral health at 2.5 years old for referral and 4 years for dental care, many revisions afterwards, dental referral remained at 36 months until the early 2000s
       1980s - 1990s -  the use of various terminology to describe dental disease in young children did not reflect the multifactorial nature of the disease. The use of such names as nursing caries, baby bottle tooth decay and milk bottle syndrome was confusing from a clinical, advocacy, and research perspective to describe a single entity, despite the various etiologies.33  The term Early Childhood Caries (ECC ) was coined at a Centers for Disease Control (CDC ) workshop in 1994. Although the term did not encompass the exact etiology of the disease, it was broadly descriptive, and became an important step in allowing stakeholders to improve communications and set agendas on how best to address this disease.
       1998 -  presentation for the Diplomates of the ABPD emphasized the opportunities of establishing preventive strategies beginning with the mother and described the concept of a defined period called the window of infectivity whereby infants acquired Mutans streptococci from their mothers, but only after the emergence of the primary teeth
       2004 -  AAPDs infant oral health policy was revised - confirmed that primary health care providers refer a child to a dental home by the first birthday, new evidence reported showed reduced dental costs for children who received an early preventive dental visit compared to those seen at 5 years of age.
       2009 -  Casamassimo et al., introduced a morbidity and mortality pyramid commonly used in health care. This pyramid better delineates human costs associated with ECC, family associated morbidity, the economic burden it places on the health care systems, and mortality as a significant outcome often overlooked by stakeholders
Results: Concepts on primary prevention and early intervention were reported as early as the 19th century. Progress to positively impact the oral health of children has been made. Nevertheless, the advice of early scholars and clinicians that oral care and prevention must begin early with the caregivers and the emergence of the infants first tooth have not been fully embraced by the profession.
Conclusions: A historical perspective on oral health care for infants and toddlers has been presented. There is a need to move away from the surgical approach of managing oral disease and embrace the concepts of primary care beginning perinatally while more broadly addressing social determinants of health.

Assessment:  A little cumbersome to read, but good background information about our specialty.
Article Title: Maternal Beliefs and Motivations for First Dental Visit by Low-Income Mexican-American Children in California
Author: Kristin S. Hoeft, et. al
Journal: Pediatric Dentistry
Date: Sept/Oct 2011
Major Topic: Cultural Tendencies Toward Care

Main Purpose: Examined Mexican-American beliefs and motivations surrounding the first dental visit for their children.

Introduction: Establishing a dental home early in a child’s development (first tooth eruption or by 12 months of age) has been shown to prevent disease and provide parental education on oral health. America’s most at-risk population for dental disease (families of low socio-economic status) do not seek dental care before age 1. This can be attributed to lack of sufficient knowledge about when first visits should occur. Latino children are among the highest rate for ECC. Some research suggests Mexican immigrant parents might have poor knowledge of proper diet, preventative measures, and recognizing oral disease. There is lack of evidence in the literature regarding the age and motivation for first dental visits for Mexican-American children, which could be the major factors in this health disparity.

Methods: A qualitative approach was used to gain an understanding of Mexican-American parents’ knowledge, beliefs and practices surrounding their child’s oral health and first dental visit in San Jose, Cali.  Participants included:

1. Primary caregivers of children aged 10 or less with aim that the youngest child be aged 5 years or less and
2.  self-identified as first or second generation immigrants from Mexico

An interview approach was used (sometimes with interpreter), with the main questions being:

1.     When did you take your child to the dentist for the first time?
2.     How old was he/she?
3.     How did you decide/know it was time to take him/her?

Results: According to the interviews done by 48 women (with 2.5 children per family), 51% of the respondents indicated that the main reasons for the first dental visit included: pain/visible problems, parents’ proactive desire to get a check-up, or to avoid future dental problems. 49% indicated their visits were prompted by a pediatrician’s recommendation or a school requirement. Once established in a dental home, 94% continued care. The mean age for first visit was 3 years. Three cases were reported that dentists discouraged visits for care before 3 years.

Discussion: Results from this study indicate that few children access dental care under 24 months. Most Mexican origin parents reported taking their children to the dentist around age 3, and were split on their reason/motivation for doing so (~ half seeking care on their own accord and half prompted from an outside source). Results did fortify the notion that establishing a dental home led to regular dental care. A limitation of this study is that it is not a representative sample. The results of this study possibly included recall bias (mothers trying to recall when and at what age the child was at first visit). Authors noted caution when using this information to generalize between other Latino populations.
The study noted that Pediatricians are largely responsible for prompting parents to seek dental care. However, only 5% of physicians are referring children under age 1. Most children visit their medical provider (85%) more than their dental provider (20%), thus pediatricians can and do play a large role in influencing the timing of the first visit.
Schools also serve an important role in initiating dental care.  Many programs and school districts require a dental visit before a child can be enrolled. However, these children are often past the recommended age for initial care.

Conclusion: Low-income, urban Mexican-American parents report seeking dental care for the first time when their child is 3 years of age. Physicians are well situated to play an integral role in prompting parents to seek care at the recommend age of 1 year.


Effectiveness of an Oral Health Program in Improving the Knowledge and Competencies of Head Start Staff

Author: Courtney Hugh Chinn, DDS

Journal: Pediatric Dentistry, Volume 33/Number 5; September-October 2011

Purpose: The purpose of this paper was to describe the Columbia Head Start Oral Health Program (C-HSOHP) and assess the changes of pediatric oral health knowledge and competency of Head Start and Early Head Start staff after participating in C-HSOHP.

Introduction: The Head Start/Early Head Start programs are federally funded programs that give grants to local public and private entities that provide child development and health services to economically disadvantaged children. One of the requirements of the HS/EHS programs is to have a health care professional assess the dental health of a child within 90 days of program enrollment. The staff at the HS/EHS programs is trained to assist families to connect with social and medical services, which includes dental services. C-HSOHP was established to help local HS/EHS in neighborhoods of upper Manhattan to serve as a resource and support for continuing education, consultation, and technical assistance in the maternal and child health populations.

Methods: Four HS/EHS grantees in New York City participated in the 2008-2009 C-HSOHP. All four grantees received 2-hour staff training and assisted referral materials, 3 grantees received at least 1 parental educational session, and 1 grantee received onsite dental screenings. Each grantee had the option to choose which training session(s) to participate in based on what they perceived were the specific oral health needs and concerns of the community they were serving.  Seventy-one HS/EHS staff members of grantees were invited to participate in the study, of which only 61 completed both pre and post surveys of the study. Both pre and post surveys were identical and assessed: demographic information, frequency of oral health issues among children, attitude regarding pediatric oral health, and respondents’ self-efficacy and locus of control.
Results: After C-HSOHP training, there was a significant increase, 20% and 24% respectively, in staff who reported referring for pediatric dental services as not difficult or not difficult at all and in staff who reported completing all needed dental treatment as not difficult or not difficult at all. There was also a significant increase in staff who reported being confident or very confident in teaching parents about children’s oral health issues, in referring a child for dental services, and in talking to a dentist regarding an oral health concern. There was not a significant statistic increase in the staff’s perception for either the importance of oral health or the effectiveness of an oral health program following C-HSOHP. The author attributes this data to the fact that HS/EHS staff has previous knowledge in pediatric oral health issues as they had received previous training for helping parents find dental homes for the participating children.

Conclusion: C-HSOHP appears to improve HS/EHS staff’s level of confidence and preparation in topic related to oral health. Furthermore, the program appears to improve HS/EHS staff’s ability to assist families access pediatric dental services.