Patterns of radiograph use in a population of commercially insured children.

BACKGROUND: The objective of this study was to evaluate differences in number and type of radiographs used among 3 age groups (0-5, 6-12, 13-18 years) by general dentists, pediatric dentists, and other specialists, and to determine the association between number and type of radiographs and clinical need. METHODS: A retrospective analysis of insurance claims by age group and oral health care provider type included children aged 0 through 8 years in 2005 who had a minimum of 10 years of continuous eligibility. Indicator claim variables were calculated to identify high-risk, high-need patients. RESULTS: A total of 6,712,155 records from 105,010 patients and 34,406 providers were analyzed. There was a significant effect (P < .001) of age on the number of radiographs obtained per visit. The estimated rates of radiographs per visit for ages 0 through 5, 6 through 12, and 13 through 18 were 0.373, 0.492, and 0.393, respectively. There was a significant interaction effect between age and provider type. For patients younger than 13 years, general dentists had lower rates of obtaining radiographs than did pediatric dentists, with no significant difference between providers for the 13- through 18-year age group. Treatments received, except for extractions and prosthodontics, were significantly associated with rate of radiographs per visit, with "number of restorations" as an indicator of increased risk, need, or both showing an inverse association with radiograph use. CONCLUSIONS: Child age and provider type had an effect on number of radiographs obtained per visit. Lack of caries diagnostic codes and uncommon use of risk codes hindered interpretation of whether use, frequency, or both is associated with need. PRACTICAL IMPLICATIONS: Radiograph use should follow existing guidelines or recommendations based on clinical need.

Oral health risk assessment timing and establishment of the dental home.

Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation's children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant's dental flora is the mother or another intimate care provider, through shared utensils, etc. Decreasing the level of cariogenic organisms in the mother's dental flora at the time of colonization can significantly impact the child's predisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.

The paradigm shift in the etiology, prevention, and management of dental caries: its effect on the practice of clinical dentistry.

Treatment of dental caries as an infectious disease will require a paradigm shift in the way dentists and other health care professionals approach prevention and management of the disease. Prevention of dental caries has relied upon patient cooperation and often requires significant lifestyle changes that are at best difficult to implement and maintain or at worst ignored. This paradigm shift in the etiology, prevention, and treatment of dental caries demands that clinicians redirect their energies and emphasis from the "surgical" approach to dental caries to a "medical" strategy that focuses on early (prenatal if possible) risk assessment of the mother and implementation of appropriate therapeutic intervention, including use of antimicrobials, risk assessment of infants at 6 months of age, and a reduction in the levels of caries-producing bacteria. This revolution in how dentists practice and think will require that they develop strategies and curriculum to "retrain" practicing dentists and to train current and future dental students and residents as well as other medical colleagues on the essentials of the paradigm shift.

Providing oral health to the little ones.

The dental profession has achieved successes in reducing the incidence of tooth decay and periodontal disease in adults and teens. The same cannot be said of Early Childhood Caries, which is the most prevalent chronic childhood disease and the greatest unmet healthcare need among youngsters, particularly those from underserved populations. The authors elucidate the infectious, transmissible disease process underlying ECC, the milestones at which preventive intervention is vital to successful treatment of infant patients, and protocols for preventive treatment. The concept of the "Dental Home," its critical role in the dental health of families with young children, and the best-practice timeline for its establishment, are delineated. The authors offer guidelines for caries risk assessment, specific treatment recommendations for the prevention of infant caries, and strategies to facilitate pediatric practice.