Socioeconomically Disadvantaged Parents and Oral Health-related Information.

PURPOSE: To assess 1) how socioeconomically disadvantaged parents receive information about their child's oral health, 2) how they prefer to access information and 3) whether their gender, age, ethnicity/race, education, income and the number of children in their family affect oral health-related information use. MATERIALS AND METHODS: Survey data were collected from 506 parents/guardians at a pediatric community dental clinic. The majority of the respondents were female (87%) and African American (54%). They ranged in age from 16 to 73 years. RESULTS: The most frequently used sources for oral health-related information were family members (75%), the child's doctor (74%), other parents (57%) and the child's nurse (54%). The majority of the parents (84%) indicated that the paediatric community dental clinic should have a website with oral health-related information. A total of 79% would use such a website in their own home (73%), at a library (29%), at school (16%) or at work (16%). In addition, 86% also wanted to receive printed information from the community dental clinic. The data showed that European-American parents were more likely than African-American parents to have received information from the child's caregivers, parent support groups, the child's doctor, e-mail groups or books. The respondents' age, income and educational background affected which sources of information they used. CONCLUSIONS: The majority of socioeconomically disadvantaged parents/guardians would like to have access to web-based information about children's oral health and reported that they would use such information.

Self-reported temporomandibular joint disorder symptoms, oral health, and quality of life of children in kindergarten through grade 5: Do sex, race, and socioeconomic background matter?

BACKGROUND: The authors' objectives were to determine the percentage of children in kindergarten through grade 5 who reported symptoms of temporomandibular joint disorder (TMJD); to assess whether sex, race, and socioeconomic background mattered; and to explore the relationships between TMJD and children's oral health and oral health-related quality of life (OHRQoL). METHODS: The research team conducted face-to-face interviews with 8,302 children in kindergarten through grade 5 (51% female, 49% male; 53% African American, 42% white). They conducted oral health screenings with 7,439 children. RESULTS: Overall, 23.6% of the children reported pain when chewing tough food, and 18.8% reported pain when opening their mouth wide; 23.2% reported hearing a sound (clicking) when opening their mouth wide. Female students were more likely than male students and African American children were more likely than white children to report TMJD symptoms. The prevalence of TMJD symptoms did not correlate with whether the children had a need for oral health care services or whether they had an abscess or carious teeth with pulpal involvement. TMJD symptoms were associated significantly with children's OHRQoL. CONCLUSIONS: Considerable percentages of 4- to 12-year-old children reported TMJD symptoms, with girls and African American children being more likely than their counterparts to be affected. Experiencing TMJD symptoms was associated significantly with poorer OHRQoL. PRACTICAL IMPLICATIONS: Dental practitioners need to be aware that substantial percentages of kindergarten and elementary school-aged children experience TMJD symptoms. Taking a dental history and conducting an oral examination, therefore, should include assessments of the signs and symptoms of TMJD; treatment recommendations should be provided for affected children.

Michigan Dentists' Attitudes toward Medicaid and an Alternative Public Dental Insurance System for Children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentists' attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an email address registered with the Michigan Dental Association (n=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Michigan dentists' attitudes toward Medicaid and an alternative public dental insurance system for children.

PURPOSE: Healthy Kids Dental (HKD) was created as a pilot program of the Michigan State Medicaid program to increase access to care for Medicaid-eligible children. The purpose of this study was to evaluate dentist's attitudes toward Healthy Kids Dental and Medicaid in Michigan. METHODS: An online survey was sent to practitioners with an e-mail address registered with the Michigan Dental Association (N=4,285). RESULTS: Surveys were returned from 965 practitioners (~23 percent). Although practitioners were not fully satisfied with the HKD, their satisfaction with the program was significantly higher than their satisfaction with the traditional Medicaid program (P<.001). Sixty-four percent of providers that accept Medicaid limit the number of children seen in some manner, while 28 percent of providers that accept HKD limit the number of children seen. Families with traditional Medicaid who contact an office are significantly less likely to receive treatment for their child than families with HKD insurance who contact the same office (P<.001). CONCLUSIONS: Practitioners were more satisfied with programmatic and patient-related factors of the Healthy Kids Dental program than they were with Medicaid. Dentists were more likely to treat children with HKD than children with Medicaid when the parent contacts a dentist in Michigan.

Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars.

PURPOSE: The purpose of this multisite, multioperator, prospective, randomized, controlled clinical trial was to evaluate the 6-month outcomes of diluted formocresol (DFC) compared to gray mineral trioxide aggregate (GMTA) as pulpotomy medicament. METHODS: Determined by a power analysis, 252 molars of 152 children were recruited. The teeth were randomly assigned to receive GMTA or DFC. At the 6-month follow-up, 118 children with 203 treated teeth were evaluated. RESULTS: Four blinded and calibrated evaluators scored each radiograph for pathologies. Clinical success was similar for DFC (97%) and GMTA (100%), (P<.09). Radiographic success differed significantly (P<.04) for DFC (86%) and GMTA (95%). Pulp canal obliteration was radiographically observed in 25% of the DFC group and in 37% of the GMTA group (P=.07). Dentin bridging was observed in 22% of the GMTA group but was not found in the DFC group (P<.01). CONCLUSION: Teeth treated with GMTA showed more favorable radiographic outcomes than DFC at 6 months post-treatment.

Illustrated information for parent education: parent and patient responses.

PURPOSE: The purpose of this study was to explore the effect of using illustrations, when educating parents about their child's upcoming operative appointment, on parents' and child patients' responses to the treatment. METHODS: Data were collected from 189 parents of 4- to 10-year-old pediatric dental patients who needed operative treatment. The parents received information about their child's upcoming operative visit either verbally or with the support of standardized illustrations (flip chart), and/or individualized drawings. Parents and providers responded to surveys following the operative appointments. RESULTS: Verbally informed parents were more likely to (a) miss the operative appointment (47% vs 19%/16%/10%; P<.001) and (b) remain in the operatory during treatment (47% vs 18%/26%/19%; P<.01) than parents who received standardized illustrations, individualized illustrations, or both illustrations. The patients whose parents had received verbal information behaved more negatively than the children whose parents had received illustrative information. Overall, Frankl behavior ratings ranged from 1="definitely negative" to 4="definitely positive" (3.30 vs 3.54; P=.04). CONCLUSIONS: Educating parents about the basic disease process of dental caries with the aid of illustrations increased parents' cooperation with the recommended dental treatment for their children and improved their children's behavior during the treatment.

The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients.

PURPOSE: The purpose of this study was to compare the safety and effectiveness of oral and intranasal midazolam in healthy children by evaluating their physiological and behavioral responses. METHODS: Regimen A patients received 0.5 mg/kg oral midazolam with an intranasal saline spray placebo at their first appointment and 03 mg/kg intranasal midazolam with an oral midazolam placebo at their second appointment. Regimen B patients received the medications in the reverse order at each appointment. Physiological parameters and behavior ratings were recorded. RESULTS: There were no significant differences in physiologic parameters in the 2 treatment groups, except for significantly lower oxygen saturation in the oral group at t=20 minutes (P=.03) The oral group showed significantly lower crying scores at t=5 minutes (P=.02), and lower overall behavior scores at t=papoose and t=5 minutes (P=.04 and .03, respectively). Oral sedations were given ratings by providers of "effective" and "very effective" significantly more than intranasal sedations (P<.05). CONCLUSIONS: Both regimens have similar behavioral outcomes, with the oral group having improved crying and overall behavior early in the appointment, Oral sedations were considered to be more effective by providers than intranasal sedations. Clinically significant desaturations occur in both regimens, indicating the need for operators to recognize and respond to the need for airway correction according to American Academy of Pediatric Dentistry guidelines.

Infant oral health examinations: pediatric dentists' professional behavior and attitudes.

PURPOSE: The purposes of this study were to: (1) determine pediatric dentists' behaviors and attitudes concerning infant oral health examinations (IOHEs); and (2) explore how respondents who do or do not perform IOHEs differ in their behavior and attitudes concerning IOHEs. METHODS: Survey data were collected from 2157 members of the AAPD (response rate=49%). Most respondents were male (67%) and practiced in solo practices (45%). RESULTS: While 84% of the respondents agreed with the AAPD policy concerning IOHEs and reported that they perform IOHEs, only 53% indicated that they see infants 12 months old or less. The majority of respondents engaged in oral hygiene education (86%) and performed soft and hard tissue exams (81% and 75%, respectively). Fewer practitioners assessed family dynamics (33%), or talked about injury prevention (53%). The respondents had positive attitudes concerning IOHEs. These attitudes were correlated with the number of IOHEs conducted. CONCLUSIONS: The finding that only 53% of the respondents see 1-year-old children or younger shows that efforts need to continue to increase the percentage of dentists who offer IOHEs. Most respondents held rather positive attitudes toward IOHEs. They differed in the amount of time they schedule for these exams and the issues they address.

Using insurance claims and demographic data for surveillance of children's oral health.

OBJECTIVES: This paper examines the utility of using private insurance and Medicaid dental claims as well as demographic data for assessing the oral health of children aged 5-12 years in Genesee County, Michigan, communities. METHODS: Dental insurance claims data from Delta Plan of Michigan and Michigan Medicaid, plus demographic data from the 1990 US Census (percent poverty) and from the 1995 National Center for Educational Statistics (percent free or reduced lunch eligibility), were compared to findings from two school-based oral health surveys. These surveys were the 1995 Genesee County Oral Health Survey and the 1998-2001 Mott Children's Health Center oral health screenings. Data were analyzed using zip codes, representing communities, as the comparison unit. Statistical comparisons using correlation coefficients were used to compare the findings from the six data sets. RESULTS: Using the insurance claims and school-based data, some communities consistently demonstrated high levels of dental caries or treatment for the primary dentition. The demographic measures were significantly associated with many of the primary dentition survey measures. The demographic data were more useful in identifying communities with high levels of dental disease, particularly in the primary teeth, than the insurance claims data. CONCLUSIONS: When screening is not practical, readily available demographic data may provide valuable oral health surveillance information for identification of high-risk communities, but these data do not identify high-risk individuals. In these analyses, demographic data were more useful than dental insurance claims data for oral health surveillance purposes.