Infant oral health education in U.S. dental school curricula.

PURPOSE: This study was performed to determine didactic and clinical curricular content about infant oral health in predoctoral pediatric dentistry programs. METHODS: 54 dental school departments of pediatric dentistry were surveyed about: 1) curricular content devoted to teaching infant oral health (IOH) and age of first dental visit; 2) methods used to teach IOH and hours dedicated to each method; and 3) whether students receive hands-on experiences with infants. RESULTS: Eighty-six percent of programs teach students to see infants at 12 months of age or younger. Curricular time ranged from 15 minutes to 13 hours (mean = 2 hrs, 20 min, median = 1 hr, 45 min). All programs used lectures; other formats included handouts, demonstration and small group seminar. Fifty percent provide clinical experiences, albeit they are not uniform for all students. One-fourth provides uniform, clinical hands-on experiences with infant oral examinations. CONCLUSIONS: The findings indicate varying degrees of acceptance about teaching infant oral health in our dental schools.

Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?

PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.

Purposeful assessment techniques (PAT) applied to an OSCE-based measurement of competencies in a pediatric dentistry curriculum.

Careful measurements of knowledge, attitude, and psychomotor and communication skills are necessary components of testing in a competency-based approach to education in dentistry. In an effort to address these requirements, Baylor College of Dentistry (BCD), Dallas, Texas, has applied Purposeful Assessment Techniques (PAT) to the Objective Structured Clinical Examination (OSCE) currently in use. PAT are those techniques that allow one to work toward development of linear measurement scales that are "person-free" and "item-free." Person-free measurement means that useful data are produced regardless of the group being measured and item-free measurement means that it does not matter which mix of items is completed over the course of an assessment. The Rasch probabilistic model and a guiding definition of Objective Measurement were used in an effort to implement PAT for the BCD OSCE. A Rasch analysis of a BCD-administered OSCE produced an item map that demonstrated the range of difficulty of items by student performance. This item map can be used to determine which items can be repeated on subsequent tests to allow for linear measurement of students' progression through the curriculum. The movement toward PAT described in this paper demonstrates how careful and evolving measurement in dental education can be of great benefit to faculty, staff, students, and the public.

Texas pediatric dentists' attitudes toward practice issues and the role of the component society.

A questionnaire addressing practice issues in dentistry and members' expectations of component society activities was sent to members of the Texas Academy of Pediatric Dentistry (N = 269). Response rate was 73%. Respondents were not in full agreement with the American Academy of Pediatric Dentistry recommendation that children first be seen at 12 months, though younger and childless dentists had significantly greater agreement than those who were older and had children. Strong disapproval of proposed independent practice for hygienists was expressed, and strong support was given for assistants to perform coronal polishing and apply sealants. Three-fourths of respondents treat Medicaid patients. In evaluating the role of the component society, respondents--especially women--unanimously affirmed the responsibility of keeping dentists abreast of current information, but also expressed strong support for maintaining relationships with outside groups and representing member views on issues of health care reform. Based on the diffusion theory of communication, a program of proactive public relations is recommended for the first-visit issue.

Examination of esthetic improvement and surface alteration following microabrasion in fluorotic human incisors in vivo.

Improvement of appearance and alteration in surface enamel was evaluated following microabrasion of teeth with differing degrees of fluorosis stain in vivo. Eighty-two fluorotic permanent maxillary central incisors from 41 patients were divided into categories of mild (32), moderate (30), and severe (20). Teeth received 30-sec applications of PREMA until no stain remained or for a maximum of 10 min of treatment. Ten teeth needed only 5 min of treatment. All others received the maximum. Standardized intraoral photographs and duplicate polysiloxane impressions were taken prior to treatment, after 5 and 10 min of treatment, and at least 4 days after treatment. Slides were randomized and viewed independently by two standardized observers and rated for area of white spot lesions (WS), stain amount (SA), and stain intensity (SI). The Wilcoxon's signed rank test indicated a significant difference in the area of WS (P < 0.05) and SA and SI (P < 0.005) from pretreatment to successive ratings. Kruskal-Wallis analysis revealed significant differences among the three severity groups for amount of WS, SA, and SI (P < 0.005). Mildly stained teeth had the best esthetic result, moderately stained teeth improved but continued to demonstrate WS and staining, and severely stained teeth showed some improvement, but more than 50% of the surface had WS and > 25% of the surface was stained. SEMs at 10X magnification were made of the models and randomly rated for type, depth, description, and area of surface defects by the two observers. Mild teeth showed no significant changes from pretreatment to 10 min of treatment. Moderate and severe teeth showed no significant change in type and depth of defects from pretreatment to 10 min of treatment but were significantly worse in description and area of defects. Despite esthetic improvement in all groups, moderate and severe teeth showed more defective surfaces following microabrasion. This technique can only be recommended as definitive treatment for teeth with mild fluorosis.

Evaluation of cyclosporin-induced gingival overgrowth in the pediatric transplant patient.

The prevalence of gingival overgrowth secondary to the administration of cyclosporin (CS) is currently reported between 8 and 70%, depending upon the source. Information concerning pediatric patients is limited. To determine the prevalence of the condition in a population of children, 26 pediatric liver or kidney transplant recipients were evaluated for the presence of overgrowth related to CS administration. Twenty-two (84.6%) exhibited gingival overgrowth. Chi-square analysis revealed no relationship between the occurrence or severity of overgrowth and transplant type, gender, age at transplant, length of time on CS, concurrent medications, or any local oral factor examined (P < 0.05). A statistically significant association (P = 0.03) was found between increased oral debris and the occurrence of gingival overgrowth; however, this was not thought to be a causative relationship. Nifedipine, a known cause of gingival overgrowth, was taken by half of the patients, but was not found to statistically influence the occurrence or severity of gingival overgrowth. Cyclosporin blood levels were evaluated over time and found to be variable, not only between patients but also for individuals. No relationship was evident between the blood level and the presence or severity of overgrowth.

An assessment of the success of meperidine and promethazine sedation in medically compromised children.

A retrospective study evaluated the success of orally administered meperidine (1.0 mg/lb) and promethazine (0.5 mg/lb) combined with N20:02, and determined predictors of success in a medically, physically and/or mentally compromised population. Behavior of 143 uncooperative patients (mean age 6.4 years) was evaluated during 282 sedations. A simplified Success Index rated outcome: 1-failure, 2-moderately successful; 3-highly successful. Variables were examined for effect on outcome of sedation: physical and/or neurologic component of medical diagnosis; previous hospital experience; medication category. Children taking medications with CNS actions were significantly less likely to have either moderately successful (p = .008) or highly successful appointments (p = .002). Children with a neurologic component to their medical diagnosis were significantly less likely to have a highly successful appointment (p = .001). Oral sedation was effective for this population (77 percent were successful) and certain characteristics of the patient's condition can predict success.

Evaluation of morphine as compared to meperidine when administered to the moderately anxious pediatric dental patient.

This investigation evaluated two narcotic regimens used to sedate pediatric dental patients who previously demonstrated uncooperative behavior. One consisted of submucosal morphine (0.15 mg/kg), and the other, oral meperidine (2.2 mg/kg); both were administered in combination with oral promethazine (1.1 mg/kg). Patients 2-7 years old were sedated with one of the two regimens and videotaped during dental treatment. If sedation was successful, the child received the other regimen at the next appointment, resulting in a total of 42 sedations in 29 children. Later, patient behavior was rated blindly by two independent observers viewing tapes of specific events during dental treatment. Fourteen of 23 (61%) patients receiving morphine and 11 of 19 (58%) patients receiving meperidine were sedated successfully. Vital signs, including pulse, respirations, blood pressure, and oxygen saturation were monitored and remained stable for both groups. ANOVA for repeated measures showed no significant differences for any vital sign in either group across time. Wilcoxon's signed rank test revealed significant improvement for the patients successfully treated in both groups when presedation behavior was compared with behavior during the events of rubber dam application, operative, restorative treatment, and exit (meperidine, P < 0.005 and morphine, P < 0.001). Improvement also was seen in the meperidine group for the event of local anesthesia (P < 0.01). Chi-square analysis showed no statistically significant differences in effectiveness or safety between the two sedative regimens.

Spin-off applications of mouthguards.

The spin-off applications of mouthguards are many and varied. Their uses range from protective to therapeutic and span all areas of medicine and dentistry. The designs range from simple minor modifications of the soft athletic mouthguard to sophisticated adaptations containing gears or electric switches. Their creative applications have provided relief to the cancer patient, increased independence to the handicapped and limited mobility patient, protection to the dentition of the patient undergoing general anesthesia, relief for the TMJ syndrome sufferer, and decreased risk of damage to the teeth and palate of the intubated infant, to name only a few. The adaptations and applications of this simple device are inspired by the needs of the patient and limited only by the imagination of the provider.

Prevalence of dental abscess in a population of children with vitamin D-resistant rickets.

A population of patients with vitamin D-resistant rickets whose present ages range from 4 to 22 years was examined to determine the prevalence of dental abscess associated with that condition. For those patients affected with abscesses in the primary dentition, four associated factors were examined: 1) the age at onset of the first abscess; 2) the tooth/teeth most commonly involved; 3) whether or not other teeth were involved over time; and 4) the order of occurrence of multiple abscesses. Six of 24 patients (25%) were affected with abscesses of the primary dentition; all had multiple abscesses. Males were more commonly involved than females. The sequence of involvement generally followed the pattern of tooth eruption; however, dental treatment in susceptible individuals shortened the time between eruption and abscess. Medication dose and measurement of radiographs were not reliable predictors of the occurrence of abscesses in this population; however, the results indicate that one abscess is a predictor of future abscesses for that patient.

Giant cell lesion associated with secondary hyperparathyroidism: case report.

A child with a giant cell lesion (brown tumor) associated with secondary hyperparathyroidism due to chronic renal failure was reported. The patient presented at age 6 years, 5 months with swelling in the right mandible that was biopsied and diagnosed histologically as a giant cell lesion. The patient received a successful kidney transplant 8 months later and the giant cell lesion resolved during the 17 months following the operation.