Comparisons between referred and non-referred patients to a university paediatric dental clinic.

BACKGROUND: Referrals of paediatric patients to a university clinic have been increasing over the last several years. AIM: To evaluate characteristics of referred and non-referred patients at the University of Iowa's Pediatric Dental Clinic (UIPDC). DESIGN: A retrospective chart review included dental records of 340 referred and 383 non-referred patients from July 1, 2015, to May 31, 2016 (n = 723). Age, distance to the clinic, size of the patient's community, insurance, number of teeth with decay, treatment needs, educational level of the provider, and presence of patient special health care needs were obtained. Descriptive statistics, bivariate analysis, and multivariable logistic regression were performed to analyze the outcomes (alpha = .05). RESULTS: Referred patients were more likely to live >60 miles away, live in a community of >75 000 people, have special health care needs, have caries/greater number of teeth with decay, need endodontic treatment, and were less likely to remain patients at the clinic (p < .0001). Referred patients were also more likely to need extractions (p = .0104), but less likely to need space maintenance/comprehensive orthodontic treatment (p = .0002). CONCLUSION: There was a difference in the complexity of patient treatment needs between referred and non-referred patients.

Assessment of respirable aerosol concentrations using local ventilation controls in an open multi-chair dental clinic.

Dental procedures require patients to be unmasked throughout most of a dental visit, with some procedures generating both inhalable and respirable aerosols. Understanding aerosol generation and transport were important to developing protocols to protect both the patient and workers in dental environments early in the COVID pandemic. This study investigated the need, suitability, and effectiveness of using local exhaust ventilation units during patient procedures and examined the impact of patient density in a large, multi-chair dental clinic at an academic institution. Phase One measured respirable aerosol concentrations at the dental assistant's breathing zone and in neighboring unoccupied patient operatories. Results were compared during four dental procedures with three local ventilation (LV) options, with a single faculty performing procedures on a simulated patient. Phase Two deployed LV in all active patient operatories during procedures on actual patients and examined the impact of clinic patient occupancy on respirable aerosol concentrations throughout the clinic. During Phase One, respirable aerosol concentrations in nearby operatories were significantly higher during ultrasonic scaling (mean = 3.8 and SD = 0.3 µg/m3) and lower during rubber cup polishing (mean = 0.8 and SD = 0.5 mg/m3) (p < 0.001). While the same trend was identified for the dental assistant, differences were not significant. There was no difference in respirable aerosol concentrations by LV type when measured at the dental assist (p = 0.51, task means 3 to 32. 5 µg/m3) or neighboring rooms (p = 0.93, task means 0.6 to 4.0 µg/m3), indicating no improved control for any device tested. For Phase Two, the clinic deployed the extraoral suction (EOS) system in each patient operatory. The background-adjusted aerosol concentrations were significantly reduced (F < 0.001) when the operatories were occupied at 50% compared to 25%, likely attributed to increased air filtration of the room with double the EOS systems in use. While this study provides only a single case investigation, findings confirming respirable aerosol concentrations by procedure and across days provided insights into patient scheduling, local exhaust ventilation selection, and operation, which could be useful to other open multi-chair dental clinics.

Clinical Versus Radiographic Caries Diagnosis in Primary Tooth Approximal Surfaces.

Purpose: The purpose of this study was to compare approximal carious lesions in dentin diagnosed by clinical examination with those diagnosed radiographically in high caries-risk children. Methods: Eighty-four Amish two- to 11-year-olds were evaluated clinically by calibrated examiners using standard epidemiological criteria and radiographically using standard criteria as part of baseline examinations for a two-year pilot clinical trial. Approximal carious surfaces diagnosed by clinical examination were compared to those diagnosed radiographically to determine the number of lesions misdiagnosed by clinical examination alone. Comparisons between the number of lesions detected by clinical exam and radiographic exam were made using McNemar's test. Results: Among 124 anterior approximal tooth surfaces, clinical examination alone identified 61 lesions (49.2 percent), while radiograph examination identified 72 lesions (58.1 percent); thus, nine percent of lesions were misdiagnosed by clinical examination alone. For the 412 posterior approximal tooth surfaces included in the study, 101 lesions (24.5 percent) were identified by clinical examination, whereas 229 lesions (55.6 percent) were identified via radiographic examination. Thus, 128 (31.1 percent) were misdiagnosed by clinical examination alone. Conclusions: Clinical examinations without radiographs significantly underestimate caries prevalence. Therefore, the use of radiographs should be encouraged in epidemiological studies and clinical trials.

COVID-19 and dental emergencies: reflections on teledentistry / COVID-19 e emergências odontológicas: reflexões em teleodontologia

Early in 2020, the COVID-19 virus spread throughout the world. On March 11, 2020 the World Health Organization declared COVID-19 a pandemic due to the level of spread and the severity of the disease. In efforts to control the spread of COVID-19 and reduce the number of new infections and deaths, people around the world took steps that had not been taken in modern history. As countries and locales issued "shelter in place edicts" the economic and social impact on businesses and professions was dramatic. The field of dentistry was similarly affected as edicts were made by governmental officials that elective dental procedures be stopped. In the state of Iowa, Governor Kim Reynolds issued a proclamation mandating that effective March 27, 2020 all dentists and their staff refrain from performing "elective dental procedures and nonessential or elective surgeries". With this turn of events, dental practices across the state were effectively shut down, only being allowed to treat emergency patients. Prior to the COVID-19 pandemic, the Iowa Dental Board, Delta Dental of Iowa, and the University of Iowa College of Dentistry shared an interest in exploring telehealth as a means of improving access to dental care for vulnerable populations. While steady progress was being made prior to the Pandemic, once the practice of dentistry in Iowa was restricted, the interest in telehealth, or "Teledentistry" soared. At the University Of Iowa College Of Dentistry, procedures were put in place to allow all emergency patients to be triaged through Teledentistry prior to being appointed in the Clinic. Using synchronous Teledentistry systems, "e-visits" prior to emergency care became the "new normal". Patients calling in for an emergency appointment were offered a menu of options for these e-visits including: 1) phone call; 2) phone call and sharing of images; or 3) a ZOOM meeting. All e-visits were provided by Dental faculty members at the University of Iowa with experience overseeing patient care in the Dental Emergency Clinic ranging from three to ten years. Final decisions on appointing patients were made by the provider based on existing records (when available), subjective symptoms (pain), objective findings (visible swelling), patients distress level, expectations and availability. During the initial 8-weeks following closure of our dental clinics (March 16-May 15), a total of 491 patients were seen in our dental emergency clinics, all of whom had been triaged by phone calls or e-visits. Most Patients reported overall satisfaction about the procedure. Based on our experience, Teledentistry (e-visits) are a useful tool to help in prioritizing dental emergencies. (AU)

No início de 2020, o vírus da COVID-19 se espalhou pelo mundo. Em 11 de março de 2020, a Organização Mundial da Saúde declarou a COVID-19 uma pandemia devido ao nível de disseminação e à gravidade da doença. Em esforços para controlar a propagação do COVID-19 e reduzir o número de novas infecções e mortes, pessoas em todo o mundo tomaram medidas que nunca haviam sido tomadas na história moderna. Como países e localidades emitiram ordens para ficar em casa, o impacto econômico e social nas empresas e profissões foi dramático. O campo da Odontologia foi afetado da mesma forma, com decretos que interromperam os procedimentos odontológicos eletivos. No estado de Iowa, a governadora emitiu uma proclamação exigindo que, em 27 de março de 2020, todos os dentistas e sua equipe se abstivessem de realizar "procedimentos odontológicos eletivos e cirurgias não essenciais ou eletivas". Com essa decisão, as práticas odontológicas em todo o estado foram efetivamente encerradas, sendo permitidas apenas o tratamento de pacientes emergenciais. Antes da pandemia do COVID-19, o Conselho de Odontologia de Iowa, e a companhia de seguro Delta Dental de Iowa e a Faculdade de Odontologia da Universidade de Iowa compartilhavam o interesse de explorar a telessaúde como um meio de melhorar o acesso à assistência odontológica para populações vulneráveis. Enquanto um progresso constante estava sendo feito antes da pandemia, a partir do momento que a prática da Odontologia em Iowa se tornou restrita, o interesse pela telessaúde, ou "teleodontologia", aumentou. Na Faculdade de Odontologia da Universidade de Iowa, foram implementados procedimentos para permitir que todos os pacientes de emergência fossem submetidos a uma triagem utilizando Teleodontologia antes de serem marcadas consultas na Clínica. Utilizando sistemas síncronicos de Teleodontologia, as "visitas eletrônicas" antes do atendimento de emergência tornaram-se o "novo normal". Os pacientes que ligavam para uma consulta de emergência receberam um menu de opções para essas visitas eletrônicas, incluindo: 1) telefonema; 2) telefonema e compartilhamento de imagens; ou 3) uma reunião pelo ZOOM. Todas as visitas eletrônicas foram realizadas por professores da Faculdade de Odontologia da Universidade de Iowa, com experiência de três a dez anos em supervisionar o atendimento a pacientes na Clínica de Emergência Odontológica. As decisões finais sobre a marcação de consultas para os pacientes foram tomadas pelo professores com base em prontuários (quando disponíveis), sintomas subjetivos (dor), achados objetivos (inchaço visível), nível de sofrimento dos pacientes, expectativas e disponibilidade do paciente e profissional. Durante as oito semanas iniciais após o fechamento de nossas clínicas odontológicas (16 de março a 15 de maio), um total de 491 pacientes foram atendidos em nossas clínicas de emergência odontológica, todos eles submetidos a triagem por telefonemas ou visitas eletrônicas. A maioria dos pacientes relatou satisfação geral com o procedimento. Com base em nossa experiência, a Teledentistry (visitas eletrônicas) é uma ferramenta útil para ajudar na priorização de emergências odontológicas (AU)

Iowa nursing facility oral hygiene (INFOH) intervention: A clinical and microbiological pilot randomized trial.

PURPOSE/AIM: The aim of this pilot study was to evaluate feasibility and gather initial data for a definitive study to test the clinical and microbiological effectiveness of a nursing facility (NF) customized oral hygiene protocol, intended to be delivered by dental hygienists and NF personnel. MATERIALS AND METHODS: A convenience sample of 8 Eastern Iowa NFs was recruited, and each NF was assigned to one of three intervention groups: (1) control (current oral hygiene practice), (2) educational program only, and (3) educational program plus 1% chlorhexidine varnish monthly application. Demographic information, systemic health data, patient centered data, oral health data, and microbiology samples were collected at baseline and after 6 months. RESULTS: Recruitment response rates were 21% for NFs and 23% for residents. A total of 81 residents were examined at baseline and of those, 49 were examined at 6 months (39.5% attrition). There were no statistically or clinically significant differences among the intervention groups at 6 months for any of the recorded clinical or microbiological outcomes. CONCLUSIONS: Recruitment and retention posed a significant challenge to this trial, even with a relatively short observation period. Results from this pilot study did not encourage further investigation of this customized oral hygiene protocol.

Success rates of Hall technique crowns in primary molars: a retrospective pilot study.

The purpose of this retrospective observational study was to assess success rates, both clinical and radiographic, of stainless steel crowns (SSCs) placed on primary molars using the Hall technique. A retrospective analysis was performed on recorded data of patients with any primary molar treated with an SSC that was placed using the Hall technique at the University of Iowa College of Dentistry during 2011-2015. The primary outcome measure was the success or failure of the SSCs placed with the Hall technique. These outcomes were categorized as either clinical and radiographic success or failure. Clinical failure was defined as the need for pulp therapy or extraction following crown placement. Radiographic failure was defined as the presence of any pathological condition-including external or internal root resorption, bifurcation radiolucency, widened periodontal ligament, or ectopic eruption of permanent first molar adjacent to the Hall crown-following crown placement. Records indicated that 100 boys received a total of 179 crowns (61.1% of all Hall crowns placed), and 64 girls received 114 crowns. The mean age of the patients was 5.1 years (SD, 2.4 years). Of 293 SSCs included in the study, 180 received at least 1 follow-up examination after a mean of 9.9 months (SD, 6.5 months). At the first follow-up visit, 178 (98.9%) of 180 SSCs placed using the Hall technique were clinically successful. Of 87 crowns with radiographs available, 85 (97.7%) were radiographically successful. At the second follow-up visit (after a mean of 20.1 months), 74 of 76 (97.4%) were rated as clinically successful, and 37 of 39 (94.9%) were radiographically successful. Results of this study provide evidence of high clinical and radiographic success rates for SSCs placed on primary molars with the Hall technique.

Emergency department visits and revisits for nontraumatic dental conditions in Iowa.

OBJECTIVES: To examine the characteristics associated with emergency department (ED) utilization in Iowa for nontraumatic dental conditions (NTDCs), and those associated with having multiple visits to the ED for NTDCs before the Medicaid expansion program in Iowa. METHODS: State Emergency Department Database for Iowa was used for 2012, which comprised of all outpatient ED visits in the state. Logistic regression was used for bivariate and multivariable analyses to model the odds of visiting the ED for NTDCs, relative to other conditions, and odds of visiting the ED multiple times relative to a single time in 2012 for NTDCs. The hospital charges associated with the NTDC ED visits were also examined. RESULTS: ED visits for NTDCs comprised 1.41% of all ED visits in Iowa during 2012 with a mean charge of $557. Of the patients presenting for NTDCs in 2012, 17% presented multiples times. Young adults, Medicaid enrollees or uninsured, and those residing in metropolitan areas had greater odds of presenting to the EDs for NTDCs compared with other conditions, and presenting multiple times to EDs for NTDCs. Those with more chronic conditions also had greater odds of repeatedly visiting the ED for NTDCs. CONCLUSIONS: Low-income young adults in Iowa rely on EDs for their dental needs that can have substantial costs. The Dental Wellness Plan (DWP) is intended to facilitate dental care access by providing dental coverage to low-income Iowans. This study provides baseline data that will be used to evaluate the success of DWP in improving access to dental care.

Potential utilization of expanded function dental auxiliaries to place restoratives.

OBJECTIVES: The Affordable Care Act is predicted to increase dental benefits coverage for millions of Americans. Utilization of expanded function dental auxiliaries (EFDAs) can contribute to increased workforce capacity. Iowa currently allows EFDAs to perform certain nonrestorative procedures. This study investigated dentists' willingness to use auxiliaries for restorative procedures in order inform recent discussions about expanding scope of practice for EFDAs to include such procedures. METHODS: This study examined responses from 677 primary care dentists who responded to the 2013 Survey of Iowa Dentists (response rate = 59 percent). The authors performed univariate and bivariate analyses (χ(2) and t-tests) to examine characteristics of dentists who indicated willingness to utilize an auxiliary for newly proposed restorative functions. RESULTS: Thirty-seven percent of respondents indicated they would delegate at least one of the newly proposed restorative functions to an auxiliary. Pediatric dentists were significantly more likely to be willing to delegate (P = 0.042). Placing stainless steel crowns was most acceptable (31.9 percent of respondents), followed by amalgam restorations (22.3 percent), and composites (18.6 percent). CONCLUSIONS: Many dentists are willing to delegate reversible restorative procedures. Increasing scope of practice for auxiliaries may increase capacity of the existing dental workforce and improve access for newly insured populations. Expanding scope of practice for dental auxiliaries offers a viable mechanism to rapidly increase states' dental capacity in response to rising demands for dental care, including newly insured Medicaid populations.

The willingness of US pediatric dentists to use atraumatic restorative treatment (ART) with their patients: a conjoint analysis.

OBJECTIVES: The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. METHODS: A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. RESULTS: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119). CONCLUSIONS: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

Teaching atraumatic restorative treatment in U.S. dental schools: a survey of predoctoral pediatric dentistry program directors.

The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.

Atraumatic Restorative Treatment (ART) in pediatric dentistry residency programs: a survey of program directors.

PURPOSE: The purpose of this study was to investigate the extent of clinical training on atraumatic restorative treatment (ART) among pediatric dentistry residency programs and assess program directors' attitudes toward ART. METHODS: All U.S. Pediatric Dentistry residency programs' directors were asked to complete a web-based survey. Sixty-one of the 76 directors (80 percent) completed the survey, with no significant response bias. RESULTS: Eighty-nine percent of the responding programs provided clinical instruction on ART. Of these, 30 percent provided ART training often/very often. ART was used mostly in single-surface cavities (43 percent) and as an interim treatment in primary teeth (57 percent). Factors associated with ART clinical training included not placing amalgams in primary teeth (P<.03) and having directors with positive attitudes toward ART (P<.001). Factors associated with directors' positive attitudes included believing that child's caries risk (P<.006), professional guidelines (P<.003), and patient insurance status (P<.04) were all important in selecting restorative treatment. CONCLUSIONS: Atraumatic restorative therapy appears to be underused in pediatric dentistry residency programs in the United States. Residency directors' attitudes were highly predictive of the amount of clinical training provided, suggesting that directors need to be better informed about the use of ART.

Sodium hypochlorite pulpotomies in primary teeth: a retrospective assessment.

PURPOSE: In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies. METHODS: A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature. RESULTS: One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time. CONCLUSIONS: Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Iowa's public health-based infant oral health program: a decade of experience.

The American Academy of Pediatric Dentistry recommends that children have their first dental visit no later than age one. However, not all dental schools have made hands-on infant oral health programs a reality in their predoctoral programs. To target high-caries risk infants/toddlers and provide dental students more hands-on experience with this age group, the University of Iowa Department of Pediatric Dentistry established an Infant Oral Health Program (IOHP) affiliated with the local Special Supplemental Food Program for Women, Infants, and Children (WIC) clinic. This article reports the IOHP activities and describes how this program is integrated into a dental school curriculum. Most of the children served were around age one, from racial and ethnic minority groups, and had never been to the dentist. More than 600 fourth-year dental students received hands-on experience providing preventive dental care for infants and toddlers. A 2004 survey of dentists who graduated from the University of Iowa suggested that those who rotated at the IOHP while in dental school were more willing to see very young children when compared to dentists who did not rotate at the IOHP. These findings suggest that community-based IOHPs can provide an important community resource for preventive dental care for high-caries risk young children, while complementing the pediatric dental experience in a dental school curriculum.

Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes--a longitudinal study.

OBJECTIVES: The "optimal" intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight (mg F/kg bw) but is based on limited scientific evidence. The purpose of this paper is to present longitudinal fluoride intake data for children free of dental fluorosis in the early-erupting permanent dentition and free of dental caries in both the primary and early-erupting permanent teeth as an estimate of optimal fluoride intake. METHODS: Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks; 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 months; and then at 6-month intervals thereafter. Estimates of total fluoride intake at each time point were made by summing amounts from water, dentifrice, and supplements, as well as other foods and beverages made with, or containing, water. Caries data were obtained from examinations of children at ages 5 and 9 years, whereas fluorosis data were obtained from examinations of children only at age 9 years. RESULTS: The estimated mean daily fluoride intake for those children with no caries history and no fluorosis at age 9 years was at, or below, 0.05 mg F/kg bw for nearly all time points through the first 48 months of life, and this level declined thereafter. Children with caries had generally slightly less intakes, whereas those with fluorosis generally had slightly higher intakes. CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an "optimal" fluoride intake is problematic.

Lip biting in a pediatric dental patient after dental local anesthesia: a case report.

Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia of the inferior alveolar nerve, particularly among children. Children presenting with this self-limiting condition are often times misdiagnosed as having a localized bacterial infection. In some extreme cases, children have been unnecessarily hospitalized and treated with systemic antibiotics or surgical interventions. This case report describes a child who bit his lip after a dental appointment and was subsequently hospitalized for monitoring. Pediatric nurses are in a unique position to help parents and primary care physicians properly diagnose and manage this benign condition palliatively.

Dental utilization for Medicaid-enrolled adults with developmental disabilities in Iowa residential care facilities.

The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n=1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.

Four-year cost-utility analyses of sealed and nonsealed first permanent molars in Iowa Medicaid-enrolled children.

OBJECTIVES: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective. METHODS: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday. RESULTS: For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility= 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars. CONCLUSIONS: Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.

Caries prior to age 3 and breastfeeding: a survey of La Leche League members.

PURPOSE: The purpose of this study was to conduct a secondary data analysis of results from a 1985 survey of La Leche League International (LLLI) members to further investigate the relationship between breast-feeding and caries prior to age 3 (CPA3). METHODS: Subjects were 576 LLLI mothers who responded to a 23-item questionnaire concerning the following factors for their oldest child: (1) breast-feeding habits; (2) fluoride status; (3) use of antibiotics; (4) carbohydrate ingestion; (5) history of caries; and (6) oral hygiene practices. RESULTS: CPA3 was reported in 10% of all children breast-fed for more than 3 years. Later weaning was found to be significantly associated with CPA3 (odds ratio [OR]=2.03; P=.0001). Late initiation of oral hygiene was marginally associated with CPA3 (OR=0.77; P=.08). Among children who developed CPA3, bivariate analyses found a greater frequency of breast-feeding (P=.012) and presence of night-time breast-feeding (P=.049) to be associated with caries detected at an earlier age. Children with caries on their maxillary incisors were more likely to have been breast-fed at night (P=.027) and more frequently during the night (P=.032). CONCLUSION: This retrospective study, based on a report of La Leche League International members, found later weaning to be significantly associated with an increased likelihood of developing CPA3.

Child temperament and risk factors for early childhood caries.

PURPOSE: The purpose of this study was to determine if a relationship existed between a mother's perception of her child's temperament and the child's risk factors for early childhood caries (ECC). METHODS: Data was collected from 629 records of children ages 0 to 4 who were patients of the University of Iowa's Infant Oral Health Program. Data included: (1) maternal report of child's temperament; (2) knowledge of ECC; (3) dietary and oral hygiene habits; and (4) clinical evidence of cavitated and noncavitated lesions and visible plaque on maxillary incisors. Chi-square tests and logistic regression models were used to analyze the data. RESULTS: Bivariate analyses showed that children reported as "easy" were more likely to: (1) be younger (P=.001); (2) be breast-fed to sleep (P=.046); (3) be breast-fed throughout the night (P=.012); and (4) have their teeth brushed twice daily (P=.006). Children reported as "difficult" were more likely to: (1) be bottle-fed to sleep (P=.002); and (2) have noncavitated lesions (P=.044). Final logistic regression analysis indicated that children perceived as "easy" were more likely to breast-fed throughout the night (odds ratio [OR]= 1.77; P=.016), while those perceived as "difficult" were more likely to be bottle-fed to sleep (OR=1.74; P=.016). CONCLUSIONS: Maternal reported child temperament may be related to important early childhood caries risk factors.

Associations between dental fluorosis of the permanent and primary dentitions.

OBJECTIVES: Relatively little is known about associations between primary and permanent tooth fluorosis. In this study, associations between dental fluorosis of the permanent and primary dentitions were assessed. METHODS: Subjects (n = 601) are in the Iowa Fluoride Study, which included fluorosis examinations of the primary and early-erupting permanent dentitions by trained dentist examiners. Relative risks, correlations, and logistic regression assessed associations between permanent tooth fluorosis and primary molar fluorosis. RESULTS: Ten percent had primary molar fluorosis at age 5; 36% had definitive (mostly mild), 28% questionable, and 36% no permanent incisor fluorosis at age 9. Those with primary molar fluorosis were significantly more likely to have definitive permanent incisor fluorosis (76% vs. 32%), and permanent molar fluorosis (59% vs. 16%). The strong association between primary and permanent tooth fluorosis is independent of level of fluoride intake. CONCLUSIONS: Detection of primary tooth fluorosis in pre-school children should alert clinicians and parents to the high likelihood of subsequent fluorosis in the permanent dentition.