An interprofessional school-based initiative to increase access to oral health care in underserved Florida counties.

OBJECTIVE: To examine and describe the effect of an oral health education program on school-based nurses' acquisition of oral health knowledge. METHODS: Three-hour synchronous videoconference sessions provided training for nurses to conduct oral health risk assessments, screen for oral diseases, deliver oral health education, apply fluoride varnish, and refer children identified in need of further assessment and treatment to a dentist. Oral health knowledge acquisition was assessed by comparing pre-training and post-training examination scores. Analyses included descriptive statistics and the Wilcoxon signed-rank test. RESULTS: Seventeen nurses from Suwannee, Lafayette, and Hamilton counties participated in the oral health education training program. Analyses of the school-based nurses' test results showed a significant increase in correct answers on the post-training test (93%) compared to the pre-training test (56%). Six hundred forty-one children from six elementary public schools received oral health education, oral screenings, and fluoride varnish applications. Fifty-eight percent of the children had untreated caries, 43% had treated caries, 15% had sealant on permanent molars, and 3% required urgent care. Nurses successfully referred children identified in need of further assessment and treatment to a dentist. CONCLUSIONS: The synchronous videoconference oral health training program was effective in improving school-based nurses' oral health knowledge. The knowledge acquired by school-based nurses via oral health training programs can be leveraged to increase access to oral health care for vulnerable and unserved school-aged populations.

Oral health inequities: Recommended public policies to achieve health equity.

In the United States (US), racial and ethnic minority populations experience poorer oral health than the general population. Social and commercial determinants of health embedded in structural and institutional racism and/or discrimination generate and exacerbate oral health inequities. We provide examples of oral health disparities (including oral health status and workforce issues) among selected racial and ethnic minority groups in the US. In addition, we compiled four priority areas based on research over the last two decades to guide actions to improve oral health equity. These four priority areas aim to improve health care models, interventions, and policies to help close gaps and reduce disparities in oral health and access to dental care.

Everolimus for cardiac rhabdomyomas in children with tuberous sclerosis. The ORACLE study protocol (everOlimus for caRdiac rhAbdomyomas in tuberous sCLErosis): a randomised, multicentre, placebo-controlled, double-blind phase II trial.

INTRODUCTION: Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma. METHODS: ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure. CONCLUSIONS: ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.

Dental Status and Treatment Needs of Children in Foster Care.

Purpose: This study compared the dental status and treatment needs of children in foster care with other children enrolled in Florida Medicaid. Methods: The study was a retrospective dental records review of patients who were associated with a foster care agency and an age-matched group of other Medicaid recipients in 2016. Results: We abstracted the electronic dental records of 548 two- to 18-year-olds in foster care and an age-matched group of 548 Medicaid-enrolled children not in foster care. Compared with other Medicaid-enrolled children, those in foster care were more likely to have experienced dental caries overall (75.7 percent versus 58.8 percent; P<.0001), in the permanent dentition (63.6 percent versus 45.1 percent; P<.0001), and in the primary dentition (32.7 percent versus 18.8 percent; P<.0001). Children in foster care had 1.6 times greater prevalence of pulpitis, 1.4 times as many root canal treatments, 5.8 times more diagnoses of severe gingivitis, 3.5 times more diagnoses of periodontitis, and 1.3 times more treatment-planned extractions. Conclusions: Children in foster care had more dental needs, higher caries prevalence, and received more dental care than other Medicaid-enrolled children. Poor oral health status is a public health concern for children in the foster care system. (Pediatr Dent 2019;41(3):206-10) Received December 18, 2018 | Last Revision March 12, 2019 | Accepted March 14, 2019.

Hospital inpatient admissions for nontraumatic dental conditions among Florida adults, 2006 through 2016.

BACKGROUND: In this study, the authors analyzed patterns, trends, and correlates of hospital inpatient admissions for nontraumatic dental conditions (NTDCs) in Florida for the calendar years 2006 through 2016. METHODS: The study was a retrospective analysis of hospital inpatient admissions for NTDCs throughout Florida. The authors derived data from a database maintained by the Florida Agency for Health Care Administration, the state's primary health policy and planning entity. RESULTS: There were 26,659 hospital inpatient admissions for NTDCs during the 11-year period. The number of admissions increased from 1,808 in 2006 to 3,542 in 2016, and total charges increased from $46.1 million to $166.5 million. The most common diagnosis was periapical abscess without sinus. Emergency departments were the most frequent source of admission. CONCLUSIONS: Hospital inpatient admissions for NTDCs are a growing challenge in Florida. If trends continue, hospital inpatient admissions for NTDCs will place an increasing burden on the state's health care system. PRACTICAL IMPLICATIONS: Increasing numbers of hospital inpatient admissions for NTDCs are largely a consequence of using emergency departments to address dental-related conditions. This growing dental public health concern has major implications for health care resources and outcomes.