Tuesday, March 31, 2015

Analysis of InsureKidsNow.gov Dental Providers in New York State

Title: Analysis of InsureKidsNow.gov Dental Providers in New York State
Author(s): Chin et al.
Journal: Pediatric Dentistry
Issue: Sept/Oct 13

Background: The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorizes the Children’s Health Insurance Program (CHIP), under title XXI of the Social Security Act, through 2013. CHIPRA adds $33 billion in federal funds for children’s coverage and expected to provide coverage to 4.1 million children who otherwise would not have been insured.

Included within CHIPRA are several dental provisions including pediatric dental coverage guarantee that ensures states to continue their existing programs and funds expansion for low income uninsured children. CHIPRA includes additional oral health provisions that address quality assurance, early prevention, expansion of the safety net, and most notably, provision of mandatory information for beneficiaries.

The national list of Medicaid and Children Health Insurance Program (CHIP) dental providers is required to be regularly updated with information that will assist families of eligible young children to identify and schedule appointments for services within their local community. InsureKidsNow.go (IKN) is a publicly accessible website that was created to satisfy this CHIRPA requirement. Available in both English and Spanish, IKN provides information on frequently asked questions, and a search menu to find providers by state, zip code, or individual address location.

Methods: Information on 4,634 dental provider locations was obtained by collapsing 21,921 listings. 160 locations were randomly telephoned to verify consistency and provision of pediatric restorative treatment. Dental provider locations to poor child population ratios were compared.

Results: Over 90 percent of locations were in less than a third of NYS counties. New York City/Long Island locations had 5.68 higher odds of accepting new pediatric patients compared to locations in the rest of NYS counties. Of the phone numbers called, 22 percent were invalid. Nearly 40 percent of valid calls were inconsistent with IKN. Over 90 percent of counties had at least one IKN dentist. The median child-in-poverty to provider ratio was 85:1.

Conclusion: Improved oversight of InSureKidsNow.gov is required to ensure validity and usefulness. Research on the quantity and type of child Medicaid/CHIP dental procedures in private practice is needed to accurately assess dental access.

Oral Health Literacy: Awareness and Practices Among Pediatric Dentists.

Oral Health Literacy: Awareness and Practices Among Pediatric Dentists.
Authors: Megan Stowers, DDS et al.
Journal: Pediatric Dentistry 2013
Resident: Margaret Maclin

To examine pediatric dentists’ awareness and experiences with oral health literacy and to identify communication techniques used with parents. 

- Active North American members of the American Academy of Pediatric Dentistry were invited to participate in the survey. 
- Surveys were
- Descriptive statistical analyses were completed, and Pearson’s chi-square crosstabs tests were used to compare categorical data between groups. 

- Data was collected from 22% (1,059 out of 4,737) of pediatric dentists
- 68 to 87% use basic communication techniques routinely
- 36 to 79% routinely use enhanced communication techniques. 
- ~59% (n=620) reported having had an experience with health literacy miscommunication
- 11% (n=116) are aware of an error in patient care that resulted from oral health literacy miscommunication. 
- Respondents who have had an experience with miscommunication were significantly more likely statistically to perceive barriers to effective communication as more significant than those without a history of miscommunication experience (P<.001). 

- Most pediatric dentists surveyed have experienced situations in which a parent has not sufficiently understood the information delivered to him or her; fewer are aware of an error in patient care that was a result of a parent’s difficulty with reading or understanding/communicating with dental personnel. 
- Basic communication techniques were most commonly used by pediatric dentists, who used enhanced communication techniques less routinely. 
- Pediatric dentists who have experienced oral health literacy miscommunication events perceive barriers to effective communication as being more significant. - Pediatric dentists, especially women and those who have experienced oral health literacy miscommunication events, are interested in formal training to improve their skills or their practice’s approach to parental education and communication. 

Atraumatic Restorative Treatment (ART) in Pediatric Dentistry Residency Programs: A Survey of Program Directors

Article Title: Atraumatic Restorative Treatment (ART) in Pediatric Dentistry Residency Programs: A Survey of Program Directors
Author: Elham Kateeb, BDS, MPH, PhD; et al.
Journal/Date: Pediatric Dentistry, Vol. 35 No. 7 Nov/Dec 2013
Resident: Slowikowski

Major Topic:  Use of ART in pediatric residency programs.

Main Purpose:  Assess factors related to the attitude of program directors toward ART and factors relate to the levels of clinical training on ART in US residency programs.

Introduction:  ART was developed in the 80’s as a way to provide treatment that is more efficient, affordable, and less traumatic.  Meta-analysis in 2010 showed that the survival rate of the one surface ART restoration over two years was 93% and 62% for multiple surface restorations on primary teeth.  A second systematic review in 2011 showed that when compared to amalgam restorations there was no statistical difference between the two over 12 and 24 months in primary teeth.  In the 2012 revisions of the guidelines, AAPD considered ART a definitive treatment used with populations that have little access traditional dental care.  However, the AAPD also considers a different kind of ART or interim therapeutic restoration (ITR) as a recommended interim restorative treatment.  ART and ITR are similar in technique but differ in therapeutic goals.  Due to the established fact that what is learned in school and residency strongly influence future dentists attitudes and behaviors, the underutilization of ART in practice maybe due to lack of exposure while in these programs.  There very little know about training of dentists in ART.
Methods:  Cross-sectional study of US pediatric dental residency program directors with a pretested web based questionnaire of 51 items.  The questionnaire validated using cognitive analysis (by consulting and pretesting the instrument with experts).  The questionnaire: 1) program directors characteristics; 2) residency program characteristics (behavior management and the used of Minimally Invasive Dentistry techniques in the program) 3) the characteristics of the patient population served by the program 4) the attitude of program directors toward ART 5) the level and format of clinical instruction on ART.  10 statements on ART was measured on the 5-point Likert scale.  Statistical analysis was completed SPSS 18.0 software.

Results: 80% response rate was achieved, 61 out of 76 program directors responded.  Attitudes of program directors toward ART were determined to be positive.  89% of program directors stated they provide clinical instruction in ART but only 30% used this technique “very often” or “often.”  Specifically programs tended to use ART for one surface anterior interim restoration.   There were 5 variables that influenced director’s attitude.  Significant variables toward a positive attitude for ART were child’s caries risk, professional guidelines and standard of care and a patient insurance status. 

Conclusion/Discussion:  Previous 2 studies have shown favorable attitudes toward MID in general and toward ART in particular among civilian, federal, and public health dentists.  This study showed that 80% of pediatric dentistry residency programs in the US provided clinical training on ART.   It was determined that ART is primarily used for primary, anterior, single-surface cavities and as an interim restoration.  Pediatric dentistry residency programs underuse ART, by only 30% of programs using it “often” or “very often” as a caries management technique.  Attitude of program directors toward ART was a strong predictor of clinical training provided.  Directors perceived importance of professional guidelines in making treatment decision was very predictive of a positive attitude toward ART.


Root Resorption Patterns of Primary Mandibular Molars and Location of the Premolar Successors: A Radiographic Evaluation
Peretz et al
Pediatric Dentistry 2013
Resident: Avani Khera, DMD


The purpose of this study was to investigate root resorption patterns of primary mandibular molars and to describe the premolar successors' location throughout the resorption.


A total of 271 radiographs of primary mandibular molars (56 first molars and 171 second molars) of 187 5- to 12-year-old patients were reviewed, and the patterns of root resorption and the premolars' location were evaluated.


In the primary first molar, approximately 55 percent of the root resorption occurred in the distal root, and 41 percent of the root resorption was symmetrical. In the primary second molar, approximately 56 percent of the root resorption was symmetrical, and 36 percent was in the distal root. More mesial root resorption (~71 percent) occurred when the second premolar was mesial.


Primary mandibular first molars begin to resorb at seven years old. The premolars' location between the primary roots is associated with root resorption. Distal root resorption should be expected when caries is present in the distal aspect of a primary second molar.

Gingival Evaluation of the Pediatric Cardiac Patient

Authors: Erez Nosrati, et al.

Publication: Pediatric Dentistry, V 35/NO; 5 Sep/Oct ’12.

Type of Study: Cross-Sectional

Purposes: 1.) Evaluate the gingival condition of children with congenital cardiovascular diseases and compare them to a healthy control group. 2.) Determine if there is an association between CCD and higher prevalence of gingivitis and periodontal disease

Background: Recent research has shown that moderate to severe periodontitis increases the level of systemic inflammation. Periodontal pathogens have been identified in atherosclerotic plaques, which suggests that these bacteria play a role in atherogenesis. Congenital cardiovascular diseases (CCD) are among the most common developmental anomalies in children and are the leading cause of death from congenital malformations. Three common forms of CCDs are ventricular septal defect, aortic valve stenosis, and coarctation of the aorta. Previous research has shown that CCD children generally suffer poorer oral health than healthy children. Thus, high levels of dental plaque and gingivitis associated with poor oral health may but CCD patient at a risk of developing bacterial endocarditis.

Summary: Cross-sectional analysis that consisted of a test group of 50 7 to 13 year old children diagnosed with CCD and divided into ventricular septal defect (VSD), aortic valve stenosis (AVS), and coarctation of the aorta (COA). The control group consisted of 25 healthy children with no systemic diseases. The parents’ subjects were given a questionnaire regarding the child’s systemic health. Periodontal evaluations for each subject were then performed using the modified gingival index, the modified plaque index, and recession was measured by measuring the distance from the gingival margin to the CEJ. Overall, it was found that CCD children have higher levels of gingivitis, plaque, recession, and calculus than healthy control children. This may be a result of the following: 1.) CCD children brush and floss less than their healthy counterparts. 2.) They ingest heavily sweetened medications and nutritional supplements. 3.) Some CCD children take medications containing sucrose and diuretics, which can cause xerostomia and predispose them to gingivitis and periodontal diseases. Overall, a high level of oral care is recommended for CCD children since neglect can worsen their cardiovascular condition and potentially cause infective endocarditis. The AAPD recommends that these patient have maintenance appointments every six months or as indicated by the patient’s individual risk or susceptibility to disease.

Monday, March 30, 2015

The Experience of Medical Clinicians Implementing Fluoride Varnish in Connecticut


Article title: The Experience of Medical Clinicians Implementing Fluoride Varnish in Connecticut

Authors: O’Callaghan et al.

Journal: Pediatric Dentistry V35/No.5 Sept/Oct 13

Abstract: The study’s purpose was to evaluate the success and barriers encountered by Connecticut medical clinicians providing and billing for infant oral health screenings and fluoride varnish.

·      Caries is the most common chronic disease of childhood when left untreated.
·      Children are more likely to visit medical offices than dental offices.
·      Only 75% of 3 and 4 year olds failed to meet the AAPD recommendation of the number of dental visits per year as oppose to the 19% from medical visit.

·      Clinicians trained and registered in providing oral health services were surveyed about practice demographics, training effectiveness, and implementation barriers.
o   Questions asked type of practice, percentage of Medicaid children in practice, effectiveness of training program, and barriers to implementation of these services.
·      156 responded to the survey.
·      Most respondents were female, worked for at least 10 years and had at least 25 percent of patients on Medicaid.
·      60% felt well prepared to provide oral screenings.
·      40% felt well prepared when applying fluoride varnish.
·      39% felt prepared for billing services.
·      30% of respondents provided fluoride varnish.
·      Clinicians were likely to provide fluoride varnish and bill for the services if they felt well prepared after the training.
·      23% of clinicians did not refer patients.
·      50% reported barriers and requested extra training. Hands-on fluoride varnish application was the most frequently requested additional training.

·      Trained medical providers who provide oral health services can play an important role in the oral health of children at risk for dental caries.
·      Clinicians’ perceived degree of preparation influenced their provision of infant oral health services.

·      Implementing oral health services in the medical office is a multifaceted problem that needs attention to clinician knowledge and confidence. As well as, an integration of the billing system.

Effects of Glass Ionomer Temporary Restorations on Pulpal Diagnosis and Treatment Outcomes in Primary Molars

Anna Abrahamian
March 31, 2015

Article Title:  Effects of Glass Ionomer Temporary Restorations on Pulpal Diagnosis and Treatment Outcomes in Primary Molars

Author: J Coll DMD, MS et al.

Journal:  Pediatric Dentistry, Volume 35(5): 416-421

Date: September/October 2013

Purpose: To evaluate 1) if glass ionomer interim temporary restorations (ITR) placed for 1-3 months prior to vital pulp therapy (VPT) improved accuracy of diagnosing the pulp’s clinical status and subsequent VPT success, and 2) the effect of the location of the carious lesion on VPT.

Methods: 117 primary molars that received pulp therapy (pulpotomy or indirect pulp treatment (IPT)) with or without ITR were evaluated retrospectively. All teeth had caries extending >50 percent into dentin; caries lesion location was identified (proximal or non-proximal). Two examiners rated pulp status assessment, caries location, and pulp treatment, and correlated treatment outcomes after a mean of 34.7 months to these factors.  Criteria for clinical failure for the VPTs of IPT and FCP were: postoperative pain or sensitivity, abnormal mobility, presence of a sinus tract, or other gingival swelling. Criteria for radiographic failure included internal or external root resorption, widening of the periodontal ligament, furcation or periapical radiolucencies, or other signs of bony destruction. Vital pulp therapy was considered a success if primary molars showed none of the aforementioned signs or symptoms following an IPT or FCP.

Results: VPT failed more often in first primary molars than in second primary molars. Using ITR improved diagnosis of the pulp status, clinical success of VPT, and first molar VPT success. First primary molars had more proximal lesions than second molars. Failure of VPT was greater for teeth with proximal lesions.  Use of ITR significantly improved VPT in teeth with proximal lesions but not non-proximal lesions.

Conclusions: ITR placed prior to VPT improved pulpal diagnosis and VPT outcomes. Vital pulp therapy was less successful in primary molars with proximal lesions, and ITR significantly improved the success.  Of note, immediate placement of SSCs at the time of VPT appeared to improve the success rate of FCPs, and this was probably due to decreased microleakage from the SSCs; other studies did not always use immediate SSCs as final restorations.