Practice Ownership Intentions of Pediatric Dentistry Residents and the Influence of Educational Debt.

Purpose: The purpose of this study was to investigate the interest in practice ownership among pediatric dentistry residents and influencing factors, particularly educational debt. Methods: An invitation to participate in an anonymous survey was sent to 933 pediatric dentistry residents training in the United States in the spring of 2020. Results: The survey response rate was 32.9 percent. Of the respondents, 61.2 percent reported being extremely or very interested in practice ownership and 49.8 percent anticipated becoming a practice owner within five years of graduation. An inverse relationship was seen between one's level of comfort in assuming a business loan to acquire a practice and having an educational debt burden of $400,000 or greater (P=0.002). Practice management preparation was the most common concern related to future practice ownership. Those feeling completely, very, or moderately prepared to manage a dental practice were over 40 percent more likely to be extremely or very interested in practice ownership than were those who felt slightly or not at all prepared (P<0.001). Conclusions: There appears to be broad interest in practice ownership among pediatric dentistry residents. Relatively high educational debt may negatively influence future practice ownership, but it may be less influential than other factors.

Why the World Should Not Follow the Failed United States Model of Fighting Domestic Hunger.

Many industrialized nations have followed the lead of the United States (US) in reducing workers' wages and cutting government safety nets, while giving their populaces the false impression that non-governmental organizations can meet the food and basic survival needs of their low-income residents. The history of the last 50 years and the global COVID-19 pandemic demonstrate why that is a mistake, leading to vastly increased household food insecurity, poverty, and hunger. This paper takes a close look at US data to help to better understand the significant impact US federal government policy measures had on limiting hunger throughout the pandemic and how we can learn from these outcomes to finally end hunger in America and other developed nations. The top three policy prescriptions vital in ending household food insecurity in the US and industrialized countries are as follows: (1) to create jobs; raise wages; make high quality healthcare and prescription medicine free; and ensure that high quality childcare, education, transportation, and broad-band access are affordable to all; (2) to enact a comprehensive "Assets Empowerment Agenda" to help low-income people move from owing to owning in order to develop middle-class wealth; and (3) when the above two steps are inadequate, ensure a robust government safety net for struggling residents that provides cash, food, and housing assistance.

What we can learn from U.S. food policy response to crises of the last 20 years - Lessons for the COVID-19 era: A scoping review.

The U.S government has historically responded to human, natural and economic disruptions that threaten food insecurity by modifying federally-funded public food programs. The authors conducted a scoping review to identify and summarize available evidence on the efforts of a 20-year period to modify food benefit programs in response to emergencies; describe how food benefit programs interact to support vulnerable populations; identify key facilitators and barriers to effective implementation and impact; and assess relevance of evidence to COVID-19 pandemic. Scoping reviews address broad research questions aimed at mapping key concepts and available evidence in a defined area, and include academic and gray literature and reports from governments and NGOs. This review followed the PRISMA Extension for Scoping Reviews and included a three-stage search strategy. Studies were independently screened for eligibility by two researchers with multiple rounds of review. A content based charting method was used to summarize evidence. More than 2289 documents were identified and screened. After review, 44 documents were analyzed. Only 18% of documents reported program or policy impact data. Additionally, review of 149 policy records from State by State FNS Disaster Assistance Data from Oct 2016-Dec 2020 assessed 96 state specific food policy responses to 72 distinct events. Analysis revealed 53 distinct packages of food policy modifications used in response to crises. This scoping review demonstrates that few studies document the impact on food insecurity of food benefit modifications in response to crises. Most documents present output level details about costs and total number of individuals served. Many documents describe food policy response to crises without providing evaluation of response. Analysis points to SNAP and Child Nutrition Programs as most commonly modified food benefit programs in the wake of U.S. crises. The review concludes with a number of considerations for continued response to the ongoing COVID-19 crisis.

Delivery Methods of Silver Diammine Fluoride to Contacting Proximal Tooth Surfaces and History of Silver in Dentistry.

Silver has a long history of use in medicine and dentistry, as its powerful antimicrobial properties have benefited mankind immensely. Silver formulations can be traced back to Hippocrates, and silver nitrate has centuries of use in medicine, including being utilized intraorally since at least the early 1800s. In the past roughly 40 years, silver diammine fluoride (SDF) has been used in many parts of the world to treat tooth sensitivity and for chemical attenuation of dental caries lesions. SDF was more recently introduced in North America for treatment of dental sensitivity with widespread off-label use as a dental caries infection inhibitor. Accordingly, SDF has been the subject of much dental research and many published articles in dentistry. In addition to providing significant chemical interference of progression of caries infections, SDF has the ability to prevent initiation of the caries process. This article gives a brief history of silver use in medicine and dentistry and documents a simplified procedure to saturate contacting proximal surfaces of teeth with 38% SDF solution, followed by fluoride varnish coverage, to prevent caries lesions and intercept progression of existing caries infections.

Oral health and plaque microbial profile in juvenile idiopathic arthritis.

BACKGROUND: The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). METHODS: A cross-sectional exploratory study of subjects aged 10-18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing. RESULTS: The study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented. CONCLUSION: Increased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Long-Term Food Insecurity, Hunger and Risky Food Acquisition Practices: A Cross-Sectional Study of Food Charity Recipients in an Australian Capital City.

Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21-79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.

Charitable Food Systems' Capacity to Address Food Insecurity: An Australian Capital City Audit.

Australian efforts to address food insecurity are delivered by a charitable food system (CFS) which fails to meet demand. The scope and nature of the CFS is unknown. This study audits the organisational capacity of the CFS within the 10.9 square kilometres of inner-city Perth, Western Australia. A desktop analysis of services and 12 face-to-face interviews with representatives from CFS organisations was conducted. All CFS organisations were not-for⁻profit and guided by humanitarian or faith-based values. The CFS comprised three indirect services (IS) sourcing, banking and/or distributing food to 15 direct services (DS) providing food to recipients. DS offered 30 different food services at 34 locations feeding over 5670 people/week via 16 models including mobile and seated meals, food parcels, supermarket vouchers, and food pantries. Volunteer to paid staff ratios were 33:1 (DS) and 19:1 (IS). System-wide, food was mainly donated and most funding was philanthropic. Only three organisations received government funds. No organisation had a nutrition policy. The organisational capacity of the CFS was precarious due to unreliable, insufficient and inappropriate financial, human and food resources and structures. System-wide reforms are needed to ensure adequate and appropriate food relief for Australians experiencing food insecurity.

Silver Diammine Fluoride: Rejuvination of a 172-Year-Old (or Older?) Dental Caries Attenuation.

In 2015, Elevate Oral Care (http://www.elevateoralcare.com) introduced a 38% silver diammine fluoride (SDF) solution to the dentistry marketplace in North America. The company named the product "Advantage Arrest™ Silver Diamine Fluoride 38%" (Figure 1). The chemistry and nomenclature for SDF (AgFH6N2) is described as such: "Silver diammine fluoride is a metal ammine complex of silver fluoride. The ammonia ligands are thus "ammine", but the term "amine" is sometimes used incorrectly for this chemical. In addition to that spelling difference, it is sometimes also called "ammoniacal silver fluoride", which is also sometimes improperly spelled as "ammonical silver fluoride."1.

Phase Four, Randomized, Double-Blinded, Controlled Trial of Phentolamine Mesylate in Two- to Five-year-old Dental Patients.

PURPOSE: The purpose of this study was to evaluate, using a randomized, double-blind methodology: (1) the safety of phentolamine mesylate (Oraverse) in accelerating the recovery of soft tissue anesthesia following the injection of two percent lidocaine plus 1:100,000 epinephrine in two- to five-year-olds; and (2) efficacy in four- to five-year-olds only. METHODS: One hundred fifty pediatric dental patients underwent routine dental restorative procedures with two percent lidocaine plus 1:100,000 epinephrine with doses based on body weight. Phentolamine mesylate or a sham injection (two to one ratio) was then administered. Subjects were monitored for safety and, in four- to five-year-olds, for efficacy during the two-hour evaluation period. RESULTS: There were no significant differences in adverse events between the phentolamine and sham injections. Compared to sham, phentolamine was not associated with nerve injury, increased analgesic use, or abnormalities of the oral cavity. Phentolamine was associated with transient decreased blood pressure in some children. In four- and five-year-olds, phentolamine induced more rapid recovery of lip anesthesia by 48 minutes (P<0.0001). CONCLUSIONS: Phentolamine was well tolerated and safe in three- to five-year-olds; in four- to five-year-olds, a statistically significant more rapid recovery of lip sensation compared to sham injections was determined.

The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study.

PURPOSES: Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study. METHODS: Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention. RESULTS: Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements. CONCLUSION: It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Silver Diamine Fluoride in Pediatric Dentistry Training Programs: Survey of Graduate Program Directors.

PURPOSE: The purpose of this study was to investigate practice, teaching, and perceived barriers to the use of silver diamine fluoride and other caries control agents in U.S. pediatric dentistry residency programs. METHODS: A 14-question survey regarding use and teaching of caries control agents was sent via email to residency program directors in 2015. Survey participants responded, using a web-based survey tool, by completing a paper and pencil survey instrument, or by interview. RESULTS: Surveys were completed by 74 directors or associate directors (87 percent adjusted response rate). More than a quarter (25.7 percent) reported use of silver diamine fluoride, with 68.9 percent expecting to increase use. The use of silver diamine fluoride was not associated with region or program type. Programs reported commonly used caries control agents of fluoride varnish (100 percent), acidulated phosphate fluoride foam (48.6 percent), silver nitrate (9.5 percent), and povidone iodine (1.3 percent). Most felt silver diamine fluoride should be used only with high-risk patients (89.2 percent), and the majority agreed it could be used in primary and permanent teeth. The most frequently reported barrier to use of silver diamine fluoride was parental acceptance (91.8 percent). CONCLUSIONS: Silver diamine fluoride is being rapidly adopted in graduate pediatric dentistry training programs, with the majority expecting to incorporate it into their teaching clinics and curricula.

Modern Management Principles Come to the Dental School.

The University of Washington School of Dentistry may be the first dental school in the nation to apply lean process management principles as a primary tool to re-engineer its operations and curriculum to produce the dentist of the future. The efficiencies realized through re-engineering will better enable the school to remain competitive and viable as a national leader of dental education. Several task forces conducted rigorous value stream analyses in a highly collaborative environment led by the dean of the school. The four areas undergoing evaluation and re-engineering were organizational infrastructure, organizational processes, curriculum, and clinic operations. The new educational model was derived by thoroughly analyzing the current state of dental education in order to design and achieve the closest possible ideal state. As well, the school's goal was to create a lean, sustainable operational model. This model aims to ensure continued excellence in restorative dental instruction and to serve as a blueprint for other public dental schools seeking financial stability in this era of shrinking state support and rising costs.

Glass ionomer restorative cement systems: an update.

Glass ionomer cements have been used in pediatric restorative dentistry for more than two decades. Their usefulness in clinical dentistry is preferential to other materials because of fluoride release from the glass component, biocompatibility, chemical adhesion to dentin and enamel, coefficient of thermal expansion similar to that of tooth structure, and versatility. The purpose of this paper was to review the uses of glass ionomer materials in pediatric dentistry, specifically as pit and fissure sealants, dentin and enamel replacement repair materials, and luting cements, and for use in glass ionomer/resin-based composite stratification tooth restoration (the sandwich technique). This article can also be used as a guide to research and clinical references regarding specific aspects of the glass ionomer systems and how they are used for young patients.

Dental repair material: a resin-modified glass-ionomer bioactive ionic resin-based composite.

This report documents treatment and repair of three carious teeth that were restored with a new dental repair material that features the characteristics of both resin-modified glass-ionomer restorative cement (RMGI) and resin-based composite (RBC). The restorative products presented are reported by the manufacturer to be the first bioactive dental materials with an ionic resin matrix, a shock-absorbing resin component, and bioactive fillers that mimic the physical and chemical properties of natural teeth. The restorative material and base/liner, which feature three hardening mechanisms, could prove to be a notable advancement in the adhesive dentistry restorative materials continuum.

Use of fluoride products for young patients at high risk of dental caries.

Extensive education in oral hygiene home care, nutrition counseling, and routine reinforcement of home-care instructions at periodic check-ups lead to better oral health for many young children and teenagers. In addition, resistance to dental caries infection can be increased significantly by intelligent use of bonded resin sealants and systemic and topical fluoride products. This article discusses protocols for use of in-office applied topical fluoride and daily at-home use of topical fluoride products for children and teens at high risk of dental caries.

Oral hygiene behaviors and caries experience in Northwest PRECEDENT patients.

OBJECTIVES: To investigate the association between oral hygiene behaviors (toothbrushing, water rinsing after brushing, interproximal cleaning, and adjunctive use of fluoride products) and recent caries (past 24 months) in a random sample of patients in Northwest PRECEDENT practices. METHODS: Practitioner-members of Northwest PRECEDENT, a dental practice-based research network, conducted a longitudinal study on caries risk assessment. At baseline, patients completed a questionnaire on oral self-care, snacking, health, and socio-demographics. A dental examination recorded readily visible heavy plaque and decayed, missing, and filled teeth; chart review captured new caries and treatments in the previous 24 months. Bivariate and multiple generalized estimating equations (GEE) log-linear regression models stratified by age-groups were used to relate oral hygiene behaviors to the primary outcome of mean dental caries in the past 24 months on data from 1400 patients in 63 practices. The primary exposure of interest was fluoride toothbrushing frequency. RESULTS: Fluoride toothbrushing once per day or twice or more per day by patients 9-17 was significantly associated with a 50% lower mean caries rate compared with fluoride toothbrushing less than once per day, after adjustment for covariates [rate ratios (RR) = 0.5; 95% confidence intervals (CI) = 0.3-0.8]. After adjustment, for patients 18-64, fluoride toothbrushing two or more times per day was significantly associated with a 40% lower recent mean caries rate (RR = 0.6; 95% CI = 0.4-0.9); in patients 65+, twice a day or more fluoride toothbrushing was not associated with lower caries rates (RR = 1.1; 95% CI = 0.7-1.8). Of the other oral hygiene variables, after adjustment, patients 18-64 who rinsed with water after brushing had a 40% lower mean caries rate compared with no rinsing (RR = 0.6; 95% CI = 0.4-0.9) and the presence of readily visible heavy plaque was significantly associated with an increase in the mean caries rate for patients 18-64 (RR = 1.6; 95% CI = 1.2-2.2) and 65+ (RR = 2.5; 95% CI = 1.8-3.5). CONCLUSIONS: In the present study, the frequency of fluoride toothbrushing and the presence of readily visible heavy plaque were the factors most strongly associated with mean caries rate. In young patients with permanent dentition, the daily application of fluoride toothpaste appears more important than emphasis on thorough plaque removal. While for adults, the protective effect of twice daily fluoride toothbrushing disappears with advancing age and the presence of readily visible heavy plaque becomes increasingly associated with caries risk.

Pediatric dentists' willingness to participate in practice-based research networks.

PURPOSE: The purpose of this study was to determine the willingness of pediatric dentists to participate in practice-based research networks (PBRNs) and the factors associated with their willingness. METHODS: A 29-item cross-sectional survey was collected from pediatric dentists in Washington, Oregon, Idaho, Utah, and Montana. Logistic regression models were used to test for demographic and educational factors associated with a willingness to participate in PBRNs. RESULTS: Of 337 surveys mailed or emailed, 171 (51 percent) were returned. Seventy-four (43 percent) pediatric dentists expressed a willingness to participate in PBRNs. Younger age (P=.01), greater number of regularly read scientific journals (P=.04), frequent utilization of scientific web searches (P=.05), national dental meetings for practice guidance (P=.001), lack of concern about time to participate (P=.01), and quality of data obtained in PBRN studies (P=.03) were associated with increased willingness to participate. Caries prevention was the most important topic in which to conduct more research. CONCLUSIONS: There is a broad base of pediatric dentists willing to participate in dental practice-based research networks. Younger age and greater utilization of certain practice guidance resources were associated with increased willingness to participate. Practitioner demand for additional research is in the area of caries prevention.