Teledentistry Implementation in a Private Pediatric Dental Practice During the COVID-19 Pandemic.

Purpose: (1) Implementation of teledentistry in a private pediatric practice during COVID-19 pandemic, (2) Evaluate dental care that was assessed and managed during the COVID-19 pandemic. Methods: Urgent dental care provided during the recommended deferment of elective dentistry (3/16/20-5/17/20) was documented. Encounters were documented by type and management (conventional vs. teledentistry). Results were summarized using descriptive statistics. Associations were compared with Chi-squared or Fisher's exact test. Results: There were 137 emergency patient encounters during the study period. The types were: orthodontics (32 percent), caries (22 percent), eruption concerns (18 percent), trauma (16 percent), "other" (12 percent) (i.e., ankyloglossia, aphthous ulcers). Almost half (48 percent) were managed with teledentistry. The highest utilization of conventional dentistry was caries (70 percent), and for teledentistry was "Other" (75 percent) and eruption concerns (60 percent). Conclusion: Nearly half of emergency encounters in this sample were managed with teledentistry. Teledentistry was a necessary modality of care during the beginning of the COVID-19 pandemic and has uses and implications beyond the triage of acute dental emergencies.

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists.

Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management of 18 cases (primary and permanent dentition) according to perceived urgency. Repeated-measures logistic regression was used to analyze factors influencing perception of clinical scenarios. Results: Response rates for PD and GP were 45.5% and 36.3%, respectively. Perceived urgency varied by clinical scenarios, dentition (primary vs. permanent), and practitioner (PD vs. GP) (P<.001). Practitioners with fewer years in practice or seeing fewer pediatric patients managed more cases as urgent. Traumatic injuries in primary dentition (intrusion, pulp exposure, palatal displacement, avulsion) were managed as more urgent by GP than PD (P<.001). Emergencies related to infection and permanent dentition were perceived similarly by PD and GP. Conclusions: Clinical scenarios highlighted disagreement in the management of after-hours pediatric dental emergencies between GP and PD, especially trauma in primary dentition. General practitioners tended to refer to an ED or see urgently, and PD tended to defer care. By identifying needs for improved education in dental trauma management, we can increase utilization of the dental home, avoiding use of overburdened EDs.

Infant Oral Health.

It may be easy to discount oral health in infancy because most infants are not born with teeth and only a few teeth erupt during the first year of life. Infancy, however, is a critical time for formation of habits. Positive habits, such as twice-daily brushing with fluoride toothpaste starting at first teeth eruption, provides topical fluoride, which is important for remineralization of the tooth and helps establish a lifelong healthy practice. Negative habits, such as bottle propping and frequent juice consumption, reinforce behaviors that promote caries and obesity. This article reviews normal dental development and eruption. Congenital anomalies affecting the mouth as well as acquired conditions, primarily dental caries, are reviewed. Oral health preventive modalities, including professionally applied products and home-based strategies, are discussed.

Dental Emergency Practice Characteristics Among North Carolina Pediatric and General Dentists.

PURPOSE: The purpose of this study was to assess after-hours practice characteristics of pediatric dentists (PDs) and general dentists (GDs) and determine how patients-of-record obtain after-hours emergency dental care. METHODS: A 29-item survey was electronically distributed to PDs and GDs in North Carolina in September 2014. Demographics and after-hours emergency practice characteristics were assessed. Survey respondents were subsequently called after-hours to validate reported after-hours emergency protocol. Descriptive and bivariate statistics compared responses from PDs and GDs. Concordance between survey and telephone responses was analyzed. RESULTS: Eighty-six (46 percent) PDs and 1,199 (36 percent) GDs completed the survey; 86 (100 percent) and 1,015 (85 percent) met inclusion criteria, respectively. Most dentists allowed patients to reach them via pager/cell phone after-hours (82.1 percent of PDs, 72.8 percent of GDs; P=0.04). More PDs than GDs had established after-hours emergency protocols (95.3 percent versus 56.7 percent, P<0.001), practiced in a group (71.1 percent versus 40.9 percent, P<0.001), and shared call (64.0 percent versus 30.1 percent, P<0.001). Telephone and survey responses significantly differed for GDs (P<0.001) but not PDs (P=0.14). CONCLUSIONS: After-hours emergency care is an important component of a comprehensive dental home. More pediatric dentists than general dentists provided after-hours emergency dental care. Survey and telephone responses were more consistent and favorable for PDs than GDs. This highlights gaps in emergency dental practice and breakdown of the dental home.

A policy review of after-hours emergency dental care responsibilities.

OBJECTIVES: To examine professional guidelines and/or requirements of state and national dental organizations regarding the responsibility of dentists for after-hours emergency care. METHODS: Guidelines of national dental professional organizations, specialties, and all 50 state dental boards were examined for language pertaining to after-hours emergency care. Guidelines were categorized as: a) no guidelines; b) deferral to American Dental Association (ADA) guidelines; c) specific guidelines outlined. RESULTS: Most states and national guidelines were similar to the ADA: dentists are obliged to make reasonable arrangements for the emergency dental care of patients of-record and not-of-record. Oral surgery maintains the most stringent guidelines of all specialties. Results of the 50 states reviewed: no guidelines-16 states (32 percent), deferral to ADA guidelines-21 states (42 percent), and specific guidelines outlined-13 states (26 percent). CONCLUSIONS: Current after-hours emergency guidelines are nonspecific and open to interpretation. Variability between state guidelines likely contribute to unnecessary hospital emergency visits and increased healthcare costs, undermining the goal of establishing and maintaining dental homes.