A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries.

BACKGROUND: Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists. METHODS: A caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest. RESULTS: Overall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9-14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere. CONCLUSIONS: Caregiver acceptance of SDF treatment is high; child's age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

Caregiver satisfaction with interim silver diamine fluoride applications for their children with caries prior to operating room treatment or sedation.

OBJECTIVE: To ascertain caregiver satisfaction with silver diamine fluoride (SDF) application(s) as an intermediate care path for their children with caries. METHODS: Caregivers were recruited at two community health centers when they arrived for a previously scheduled operating room/sedation appointment for their children with caries who had previously been treated with SDF. They were asked to complete a survey regarding their satisfaction with SDF treatment while they waited during their children's dental treatment. RESULTS: Caregivers overwhelmingly reported that they were satisfied with SDF treatment (81.3%), and that the black mark was not an issue for their children (91.7%) or themselves (87.5%). Moreover, their perception of their children's oral health quality of life was high. CONCLUSIONS: By arresting caries, SDF offers an intermediate care path for pediatric patients for whom OR/sedation treatment was not immediately available. Moreover, most caregivers were satisfied with SDF treatment for their children.

Dental Status and Treatment Needs of Children in Foster Care.

Purpose: This study compared the dental status and treatment needs of children in foster care with other children enrolled in Florida Medicaid. Methods: The study was a retrospective dental records review of patients who were associated with a foster care agency and an age-matched group of other Medicaid recipients in 2016. Results: We abstracted the electronic dental records of 548 two- to 18-year-olds in foster care and an age-matched group of 548 Medicaid-enrolled children not in foster care. Compared with other Medicaid-enrolled children, those in foster care were more likely to have experienced dental caries overall (75.7 percent versus 58.8 percent; P<.0001), in the permanent dentition (63.6 percent versus 45.1 percent; P<.0001), and in the primary dentition (32.7 percent versus 18.8 percent; P<.0001). Children in foster care had 1.6 times greater prevalence of pulpitis, 1.4 times as many root canal treatments, 5.8 times more diagnoses of severe gingivitis, 3.5 times more diagnoses of periodontitis, and 1.3 times more treatment-planned extractions. Conclusions: Children in foster care had more dental needs, higher caries prevalence, and received more dental care than other Medicaid-enrolled children. Poor oral health status is a public health concern for children in the foster care system. (Pediatr Dent 2019;41(3):206-10) Received December 18, 2018 | Last Revision March 12, 2019 | Accepted March 14, 2019.

Hospital inpatient admissions for nontraumatic dental conditions among Florida adults, 2006 through 2016.

BACKGROUND: In this study, the authors analyzed patterns, trends, and correlates of hospital inpatient admissions for nontraumatic dental conditions (NTDCs) in Florida for the calendar years 2006 through 2016. METHODS: The study was a retrospective analysis of hospital inpatient admissions for NTDCs throughout Florida. The authors derived data from a database maintained by the Florida Agency for Health Care Administration, the state's primary health policy and planning entity. RESULTS: There were 26,659 hospital inpatient admissions for NTDCs during the 11-year period. The number of admissions increased from 1,808 in 2006 to 3,542 in 2016, and total charges increased from $46.1 million to $166.5 million. The most common diagnosis was periapical abscess without sinus. Emergency departments were the most frequent source of admission. CONCLUSIONS: Hospital inpatient admissions for NTDCs are a growing challenge in Florida. If trends continue, hospital inpatient admissions for NTDCs will place an increasing burden on the state's health care system. PRACTICAL IMPLICATIONS: Increasing numbers of hospital inpatient admissions for NTDCs are largely a consequence of using emergency departments to address dental-related conditions. This growing dental public health concern has major implications for health care resources and outcomes.

Improving systems of care for people with special needs: the ASTDD Best Practices Project.

Improving the oral health of children and adults requires not only that patients receive high quality clinical care, but also that they gain access to the dental office in the first place. Access to care can be promoted among many systems of care, both within and outside of dentistry. The Association of State and Territorial Dental Directors has developed a Best Practices Project to share ideas and cultivate best practices for state and community oral health programs. A new topic is being developed that will describe successful practices to improve the oral health of persons with special needs. These individual practices are examples of broader approaches to improving the oral health of people with special needs. These approaches include: (1) improving the competency of the dental workforce; (2) improving the financing system; (3) better organizing community resources; (4) empowering parents and caregivers; and (5) promoting advocacy. To date, 16 practices have been identified, and 3 of them are described in this article. The purposes of this paper were to: (1) describe how the Association of State and Territorial Dental Directors' Best Practice Project can improve systems of care for people with special oral health needs; and (2) highlight 3 successful practices.