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Purpose Empathetic engagement is considered a vital component in forming respect-based relationships between patients and clinicians, leading to more optimal patient care. The purpose of this study was to explore whether there was a relationship between dental hygiene students' levels of empathy and student demographics including age, gender, year in school, and the degree type of dental hygiene program attending.Methods This was a cross-sectional observation study conducted among dental hygiene undergraduate students attending three dental hygiene programs in the Midwestern United States. Two programs offered associate degrees and one offered a baccalaureate degree. Participants completed the 20-item Jefferson Scale of Empathy©, student edition (JSE-S) along with demographic questions including age, gender, year in dental hygiene program, and degree type of dental hygiene program. Descriptive statistics and comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). Regressions were conducted to determine whether the students' year in dental hygiene program and the type of degree program were predictors of empathy.Results Forty-one participants completed the questionnaire for a 65% response rate. The mean empathy score was 83.05 ± 10.04 among the participants. There were no statistically significant differences between levels of empathy of first- and second-year students or those attending a two-year institution versus a four-year university. Age, year in program, and type of degree were not shown to be predictors of empathy.Conclusion Results from this study did not show relationships or predictors of empathy with dental hygiene students' demographics or type of degree program. Future research should expand beyond a small homogenous convenience sample and include a longitudinal gauge to assess potential fluctuations in empathy as students progress throughout the curriculum and as practicing clinicians.
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Higienistas Dentales , Empatía , Humanos , Estudios Transversales , Femenino , Masculino , Higienistas Dentales/educación , Higienistas Dentales/psicología , Adulto , Adulto Joven , Encuestas y Cuestionarios , Estudiantes de Odontología/psicología , Medio Oeste de Estados UnidosRESUMEN
Purpose: The purpose of this study was to evaluate the environmental impact of travel and anesthetic gas emissions associated with treating early childhood caries at a single institution. Methods: Outpatient preventive, treatment, and modeled general anesthesia (GA) cases in children 71 months old and younger were included in this retrospective chart review. The main outcomes were kilograms of carbon dioxide equivalents (kgCO2e) for travel- and anesthetic gas-related emissions. Descriptive statistics and non-parametric tests were used. Results: Most subjects had a caries treatment visit (n equals 3,630 out of 5,767), and nine percent of treatment visits (n equals 353 out of 3,630) received nitrous oxide (N2O), which added 29.4 kgCO2eto the visit emissions. Children without caries treatment had lower travel-related emissions (median equals 7.5 kgCO2e; interquartile range [IQR] equals 7.6) than children with caries treatment (median without N2O equals 8.7 kgCO2e; IQR equals 18.2; median with N2O equals 8.4 kgCO2e; IQR equals 10.3). Modeled GA travel emissions were estimated at 16.4 kgCO2e (IQR equals 21.9) with between 3.8-12.9 kgCO2e in anesthetic gas emissions. Total emissions were greatest for N2O treatment visits (median equals 43.3 kgCO2e; IQR equals 22.8). Conclusions: Travel-related emissions were greatest for children requiring caries treatment. Minimizing patient travel may reduce environmental impact. Nitrous oxide contributes a significant amount to a dental visit???s environmental impact. Community-focused models of care and applying systematic and practical case selection to reduce excess N2O emissions could reduce dental care-related carbon emissions.
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Anestésicos por Inhalación , Caries Dental , Óxido Nitroso , Humanos , Caries Dental/prevención & control , Preescolar , Estudios Retrospectivos , Óxido Nitroso/análisis , Óxido Nitroso/administración & dosificación , Lactante , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/administración & dosificación , Femenino , Masculino , Dióxido de Carbono/análisis , Anestesia General , Anestesia Dental , Atención Dental para NiñosRESUMEN
Purpose: The purpose of this study was to explore the perceived value of clinical photographs for traumatic dental injuries (TDIs). Methods: A survey was sent to members of the American Academy of Pediatric Dentistry (AAPD). The survey collected respondents' responses to case-based questions with and without photographs, and opinions about the value of photography for TDI. Results: A total of 496 respondents (5.8 percent response) completed the survey. Overall, no significant difference in correct answers was observed between cases with and without a photograph (P=0.09). The majority of respondents (82.2 percent) agreed that photographs should be taken for the management of TDIs, with 88.7 percent stating that the photographs aided in the diagnosis of TDIs. The majority of respondents acknowledged the time-saving (80.9 percent) and legal importance (77.0 percent) of photographs. Conclusion: Photographs should be taken in the management of traumatic dental injuries when possible for history and documentation purposes.
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Fotografía Dental , Traumatismos de los Dientes , Humanos , Traumatismos de los Dientes/terapia , Niño , Actitud del Personal de Salud , Odontología Pediátrica , Fotograbar , DocumentaciónRESUMEN
Purpose: To investigate opioid prescription fills following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric public accountable care organization (???Medicaid???) in central/southeastern Ohio. Patients aged 18 years and younger who had a dental procedure between January 2012 and February 2019 were identified, and claims were searched for opioid prescription fills within 14 days post-procedure. Trends in prescription fill percentages, types of opioid, procedure classification and patient characteristics were examined. Results: A total of 512,922 encounters among 212,813 patients were included. The overall opioid prescription fill was 4.9 percent. Percentages decreased throughout the study period from 6.1 percent (95 percent confidence interval [95% CI]=5.9 to 6.3) in 2012 to 3.4 percent (95% CI=3.1 to 3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill percentage fell from 15.7 percent (95% CI=15.2 to 16.1) in 2012 to 9.5 percent (95% CI=8.5 to 10.4) in early 2019. The most common opioids were hydrocodone (68.6 percent) and codeine (24.7 percent), with marked annual reductions in codeine prescription fills among children younger than 14 years. From 2017 to 2018, surgical extractions compared to endodontics-only procedures (risk difference [RD]=40.7; 95% CI=38.6 to 42.9) and older patient age (RD for 18-year-olds versus 13-year-olds=21.9; 95% CI=19.8 to 24.0) were strong risk factors for filling an opioid prescription. Conclusion: Post-procedure opioid prescription fill percentages have decreased since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in the likelihood of filling a prescription remained by procedural and demographic variables. There were marked trends in the types of opioid for which prescriptions were filled, which varied by patient age.
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Analgésicos Opioides , Medicaid , Humanos , Ohio , Masculino , Femenino , Estudios Retrospectivos , Niño , Adolescente , Analgésicos Opioides/uso terapéutico , Estados Unidos , Preescolar , Prescripciones de Medicamentos/estadística & datos numéricos , Lactante , Dolor Postoperatorio/tratamiento farmacológico , Atención Dental para Niños/estadística & datos numéricosRESUMEN
BACKGROUND: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments. METHODS: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients). RESULTS: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2. CONCLUSIONS: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA. PRACTICAL IMPLICATIONS: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2.
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Anestesia Dental , Anestesia General , Caries Dental , Restauración Dental Permanente , Humanos , Estudios de Casos y Controles , Anestesia General/estadística & datos numéricos , Masculino , Femenino , Preescolar , Restauración Dental Permanente/métodos , Restauración Dental Permanente/estadística & datos numéricos , Anestesia Dental/métodos , Lactante , Diente Primario , Diente Molar , Diente Canino , Estados Unidos , Medicaid , Incisivo , Atención Dental para Niños/métodos , Factores de Riesgo , Resinas Compuestas/uso terapéuticoRESUMEN
OBJECTIVES: This study aimed to systematically review the effect of sugar substitute consumption on caries prevention in permanent teeth among children and adolescents. DATA: Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing the clinical effect of sugar substitutes (both high- and low-intensity sweeteners) in preventing caries in permanent teeth among children and adolescents aged 6-19 were included. SOURCES: A systematic search was conducted in three databases (PubMed, Web of Science and Embase) without any restrictions on publication year. STUDY SELECTION: The initial search found 1,859 items, and finally, 15 studies (11 RCTs and 4 CCTs) with a total of 6325 participants (age: 6-18 years) were included. The Cochrane risk-of-bias assessment tools were used for quality assessment. Most (80%, 12/15) were graded as having a 'moderate' or 'high' risk of bias. All trials investigated sugar alcohol, which is a low-intensity sweetener. Xylitol was the most commonly investigated (73.3%, 11/15), followed by sorbitol (46.7%, 7/15), and erythritol (13.3%, 2/15). Results of the meta-analysis showed that both xylitol (standardized mean difference [SMD]: -0.50, 95% confidence interval [CI] -0.85 to -0.16, P = 0.005) and sorbitol (SMD: -0.10, 95% CI: -0.19 to -0.01, P = 0.03) had a significant effect in preventing dental caries compared to no treatment/placebo. No clinical trials on high-intensity sweeteners such as aspartame and saccharin were found. CONCLUSION: The consumption of xylitol or sorbitol is potentially effective in preventing caries in permanent teeth among children and adolescents. No clinical evidence is available regarding the role of high-intensity sweeteners in caries prevention. CLINICAL SIGNIFICANCE: The use of xylitol or sorbitol as sugar substitutes has a beneficial effect in preventing dental caries among children and adolescents.
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Caries Dental , Dentición Permanente , Sorbitol , Edulcorantes , Xilitol , Humanos , Caries Dental/prevención & control , Adolescente , Niño , Xilitol/uso terapéutico , Sorbitol/uso terapéutico , Edulcorantes/uso terapéutico , Eritritol/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Purpose: To evaluate the knowledge, practices and attitudes of Ohio school nurses regarding school absenteeism (SA) for dental treatment. Methods: A 40-item questionnaire was generated and distributed to 246 attendees at an annual conference for Ohio school nurses in December 2019. Results: The response rate was 65.9 percent (n=162 out of 246 attendees) and 136 surveys were eligible for inclusion. The sample was female (100 percent), worked at public schools (86.0 percent, n=117) and trained as registered nurses (83.8 percent, n=114). Nurses reported no change in concerns over children missing school for dental appointments in the last five years (69.9 percent, n=95) and most agreed that SA for dental visits "almost never" negatively impacted the educational needs of children. The medical history of the patient was the most common factor when determining the duration of a school excuse (81.6 percent, n=111) and the potential for pain was the most common dental consideration (93.4 percent, n=127). Nurses reported that they "sometimes" had problems with a child after a dental visit (44.9 percent, n=61) and pain was the most reported problem (83.8 percent, n=114). Conclusion: Nurses did not feel that SA for dental treatment negatively impacted the educational needs of children.
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Atención Odontológica , Instituciones Académicas , Niño , Humanos , Femenino , Ohio , Encuestas y Cuestionarios , DolorRESUMEN
Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients' values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making.
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Terapia Asistida por Animales , Adolescente , Niño , Humanos , Conducta Infantil , Atención a la Salud , Ansiedad al Tratamiento Odontológico/prevención & controlRESUMEN
Purpose: To conduct a pilot study assessing resident performance and self-efficacy during sedation-related simulations. Methods: Residents completed one informed consent and two sedation-related emergency simulations. Performance was measured for each simulation. Self- efficacy (i. e., confidence) was measured via pre- and post-simulation questionnaires. Descriptive and nonparametric statistics were calculated. Results: Twenty-five residents completed the simulations. Second-year residents performed better than first-year residents in both informed consent and emergency simulations; however, only the informed consent simulation was significant (P<0.02). Self-efficacy significantly increased after completing the simulations (18 percent pre-simulation versus 42.7 percent post-simulation, P<0.001). Residents identified communication skills as an area of improvement after the simulations. For the emergency vignettes, residents expressed feeling inadequate knowledge, problem-solving skills, and teamwork during the simulation. Conclusions: Simulations improved resident confidence in obtaining informed consent and managing certain sedation-related emergencies, but residents felt ill-prepared to manage an emergency. Further study is warranted to understand the best-practice frequency of sedation-related emergency simulation to promote skill retention.
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Internado y Residencia , Humanos , Niño , Proyectos Piloto , Encuestas y Cuestionarios , Competencia ClínicaRESUMEN
BACKGROUND: Children with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs. METHODS: Children (≤ 18 years) who sought treatment at the emergency department of a major children's hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models. RESULTS: Of 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI. CONCLUSIONS: The total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting. PRACTICAL IMPLICATIONS: In an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.
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Lesiones Traumáticas del Encéfalo , Humanos , Niño , Femenino , Masculino , Estudios de Casos y Controles , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/epidemiología , Servicio de Urgencia en Hospital , Atención Odontológica , Modelos LogísticosRESUMEN
'Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children undergoing dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a dental treatment visit including sealants, restorative care, dental local anesthesia, and simple surgical procedures. The primary outcome measures were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommenda- tions Assessment, Development and Evaluation approach were done. RESULTS: Forty articles qualified for analysis from 219 screened articles. Included studies evaluated the effectiveness of pre-visit preparation and in office strategies rendered pre-/post- or during treatment such as positive imagery, direct observation/modeling, desensitization, tell-show-do and its modifications, voice control, positive reinforcement, memory restructuring, bio- feedback and breathing relaxation, animal assisted therapy, combined therapies, and cognitive behavior therapy. The certainty of evidence ranged from Very low to high and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most of the basic non- pharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal assisted therapy, combined tell-show-do and audiovisual distraction, and cognitive behavior therapy showing large effects in reduction of anxiety based on some scales.
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Terapia Asistida por Animales , Terapia Conductista , Animales , Humanos , Anestesia Local , Materiales Dentales , Atención OdontológicaRESUMEN
PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children and youth with special health care needs (CYSHCN) during preventive and dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit (exam, fluoride application, radiographs, and prophylaxis) or a treat- ment visit (simple surgical treatment, sealants, restorative care with or with local anesthesia) with control or other interventions. The primary outcome measures for the studied interventions were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included Randomized Controlled Trials (RCTs), performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Eleven articles qualified for analysis from 219 screened articles. Included studies evaluate the effectiveness of in office strategies such as modeling, audio-visual distraction, sensory adapted dental environment, and picture exchange communication system. The certainty of evidence ranged from Very low to Low and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most basic non-pharmacological behavior guidance techniques showed some trivial to small reduction in self-reported anxiety and/ or improvement in behavior, with audiovisual distraction, Sensory Adapted Dental Environment, and Picture Exchange Communication System showing large reduction in anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.
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Anestesia Local , Terapia Conductista , Adolescente , Niño , Humanos , Materiales Dentales , Fluoruros , Atención a la SaludRESUMEN
PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for a child undergoing preventive dental visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a pre- ventive visit including examination, prophylaxis, fluoride application and radiographs. Workgroup (WG) identified moderate-to-high quality system- atic reviews (SRs) published on hypnosis, audiovisual distraction, and parental presence/ absence; and decided to exclude these interventions from current SR to avoid duplication. The primary outcome measures for the studied interventions included reduction in anxiety, fear, pain, and improve- ment in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias. Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Fifteen articles qualified for analysis from 219 screened articles. WG found studies evaluating effectiveness of pre- visit preparation and in-office strategies rendered pre- or during treatment such as positive imagery, communication, modeling, tell-show-do, magic tricks, mobile applications, positive reinforcement, and sensory adapted dental environment. The certainty of evidence ranged from Very low to Moderate and the magnitude of effect varied from trivial to a large change in the desired outcomes. CONCLUSIONS: Most basic nonpharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with mobile application and modeling showing large effects in reduction of anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.
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Terapia Conductista , Comunicación , Niño , Humanos , FluorurosRESUMEN
BACKGROUND/AIMS: Avulsion of a permanent tooth is one of the most severe traumatic dental injuries, comprising an estimated 0.5%-16% of all dental injuries. The aim of this study was to estimate the direct financial costs of tooth avulsion in children based on stage of root maturity and the occurrence of ankylosis and to report patients' characteristics and outcomes of treatment. MATERIALS AND METHODS: A retrospective review of the dental records of children ages 6-18 who sustained a permanent tooth avulsion from 2010 to 2020 was completed. Relative Value Units (RVUs) were used to calculate the estimated cost of dental trauma care over the 2-year post-injury period for five different scenarios of avulsed teeth based on the stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted. RESULTS: There were 452 avulsed permanent teeth in 348 patients. Of those, 157 teeth were included in the cost analysis. Overall, the average direct dental cost of avulsion was 46.4 RVUs equal to $1619 USD based on the 2021 conversion rate ($34.89 per RVU). Direct costs ranged between 40 RVUs ($1396) and 52.8 RVUs ($1842) depending on the root maturation and ankylosis status or whether the tooth was replanted; however, ANOVA test did not show any statistically significant differences between the mean RVUs of different groups (p = .85). Patients returned 9.5 times on average over the 2-year study period for dental trauma care after avulsion. CONCLUSION: The average direct cost of tooth avulsion within the limits of this study was $1619 USD. On average, patients returned for 9.5 follow-up visits after the avulsion. The stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted or not were not significantly associated with the direct cost of dental care.
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Anquilosis del Diente , Avulsión de Diente , Humanos , Niño , Avulsión de Diente/terapia , Reimplante Dental , Resultado del Tratamiento , HospitalesRESUMEN
BACKGROUND/AIM: Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports. MATERIALS AND METHODS: This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed. RESULTS: During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained. CONCLUSIONS: Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard.
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Traumatismos en Atletas , Baloncesto , Traumatismos de los Dientes , Masculino , Femenino , Humanos , Estados Unidos , Traumatismos en Atletas/epidemiología , Instituciones Académicas , Atletas , Baloncesto/lesiones , IncidenciaRESUMEN
OBJECTIVE: To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization. METHODS: This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities. RESULTS: Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH. CONCLUSIONS: Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.
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Gastos en Salud , Medicaid , Estados Unidos , Niño , Humanos , Estudios Retrospectivos , Medición de Riesgo , Ohio , Atención OdontológicaRESUMEN
PURPOSE: The purpose of this study was to evaluate caries treatment decisions agreement in primary teeth among board-certified pedi- atric dentistry faculty at a single teaching institution. METHODS: Ten full-time faculty selected a treatment for each of 64 primary teeth in 17 children based on clinical photos and radiographs. Cases were presented under three different social and behavioral scenarios. Descriptive and kappa statistics were calculated. RESULTS: The interrater reliability was 0.59 for the decision at the surgical versus nonsurgical level and 0.55 for the treatment-specific decision (e. g., crown versus extraction). Surgical treatments were the predominant preference (76 percent of responses). Non- surgical treatments were preferred for early-stage lesions and in nonideal social and behavioral scenarios. Surgical options were unanimously preferred in sedation or general anesthesia. CONCLUSIONS: Different clinical scenarios highlight different treatment preferences among faculty. Further emphasis should be placed on calibrating the decision-making process for selecting caries treatment in primary teeth among pediatric dentists.
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Caries Dental , Docentes de Odontología , Niño , Caries Dental/terapia , Susceptibilidad a Caries Dentarias , Humanos , Reproducibilidad de los Resultados , Diente PrimarioRESUMEN
OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.
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Oximetazolina , Tetracaína , Anestésicos Locales , Humanos , Flujometría por Láser-Doppler , MaxilarRESUMEN
BACKGROUND: Controversy exists on the acceptability of medical immobilization (MI). AIM: To identify regulations, professional conventions, and opinions on the acceptability of MI and to identify practice patterns through a pilot study of members of the International Association of Paediatric Dentistry (IAPD) and their colleagues. DESIGN: A 22-item questionnaire was developed and electronically distributed to 1191 members of the IAPD. RESULTS: Responses were received from 182 dentists in 45 countries. The majority (74.9%) of respondents use MI, and 29.1% use an immobilization device. MI with an immobilization device was reported as professionally acceptable (58.1%) and permitted by medicolegal regulations (70.8%) in their countries of practice. Dentists rated acceptability of MI higher than they perceived parents would overall and perceived MI to be more acceptable by parents for emergency situations and for children with special healthcare needs but 19.8% of respondents found it totally unacceptable in all scenarios. Use and opinions of acceptability varied by geographical location with respondents from North America being more accepting of MI. Most dentists felt that the use of an immobilization device could lead to lasting psychological trauma (72.3%) and violation of the rights of the child (55.4%) but that it improves access to care (58.5%). CONCLUSION: The acceptability of MI remains an area of controversy for paediatric dentists internationally.
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Actitud del Personal de Salud , Odontología Pediátrica , Niño , Odontólogos/psicología , Humanos , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
Purpose: This cross-sectional study evaluated knowledge, practices, and beliefs of Ohio dentists treating school-aged children regarding school absenteeism in relation to compliance with dental appointments.
Methods: A 26-item questionnaire was distributed to 7,274 dentists licensed in the state of Ohio in 2019. Eligible participants were pediatric dentists (PDs) and general dentists (GDs) who treated individuals younger than 16 years of age.
Results: A return rate of 13.5 percent (958 total participants) provided a sample consisting of approximately 90 percent of GDs, a mean age of 48.5 years and primarily practicing in suburban locations. Respondents felt parental attitudes had changed over the past five years, with a significantly higher proportion of PDs reporting increased parental concerns about school absences than GDs (59.5 percent versus 31.5 percent; P <0.001). Length of excused absence increased with treatment complexity. PDs were more likely to permit longer absences than GDs and to allow parents to decide the length of absence, particularly for children with special health care needs. PDs were 6.6 times more likely to report that concerns about school absences often negatively affected oral health (P <0.001).
Conclusion: Dentists acknowledged that school absences and school policy affected parental choices regarding dental visits, with PDs consistently stating a greater effect than GDs.