Procedures provided to Medicaid recipients by pediatric, general and public health dentists in the commonwealth of Virginia: fiscal years 1994 and 1995.

PURPOSE: The purpose of this study was to report any differences found among the mean percentages of procedures performed by three types of dental providers for each type of service performed. The study focused on the types of services provided by dentists to Medicaid children in Virginia. METHODS: Medicaid claims field for dental patients younger than age 21 were obtained and analyzed for fiscal years 1994 and 1995. Dental providers were categorized according to their practice: general practice (GP), pediatric dentist (PD) and public health dentist (PH). Each type of practitioner (GP, PD, and PH) was evaluated for percentages of diagnostic, preventive, and corrective services provided to their Medicaid patients. The preventive category was subdivided into preventive services (scaling, prophy, fluoride and oral hygiene instruction) and sealant services. RESULTS: For each type of service, the mean percentages of procedures performed were compared among the three types of dental providers. The evaluation of the diagnostic procedure variable resulted in the finding that GP practitioners performed a significantly greater percentage of diagnostic procedures to their Medicaid patients than do PD and PH dentists (p < 0.0001). The percentage of preventive procedures performed by PD and GP dentists was not significantly different but was significantly lower than those performed by PH dentists (p < 0.0001). Finally, PD dentists performed a significantly greater percentage of corrective procedures than both GP and PH dentists (p > 0.0037). CONCLUSION: Differences were found among the mean percentages of procedures performed by the three types of dental providers for each type of service performed.

Dentists' attitudes towards mouthguard protection.

PURPOSE: This study analyzed the attitudes of Virginia general dentists, orthodontists, and pediatric dentists towards mouthguard protection. METHODS: Questionnaires were constructed and mailed to 2500 dentists in Virginia. RESULTS: In this survey, 97% of orthodontists, 84% of pediatric dentists, and 67% of general dentists recommended mouthguard protection for their athletically active patients. The two main reasons for not recommending mouthguards were that the patient could obtain one from a less expensive source than the dental office and the dentist had not received formal training on fabrication or use of mouthguards. More recent graduates were more likely to have been taught mouthguard use and fabrication during their dental training. General dentists (59%) and pediatric dentists (56%) recommended the custom mouthguard while orthodontists recommended the prefabricated stock type (77%) as their primary choice of mouthguard. A majority of general dentists (58%), orthodontists (81%), and pediatric dentists (76%) recommended mouthguard protection for the contact sport of basketball which presently is a non-mandated mouthguard sport. CONCLUSION: Most dentists agree that athletically active patients require mouthguard protection. Many dentists, however, question whether they were the ones responsible for distributing and fabricating the mouthguards.

Pseudocysts of the mandibular condyle in children.

The authors evaluated the panoramic radiographs of 1,193 consecutively treated patients 18 years old and younger for the presence of asymptomatic radiolucencies in the mandibular condyles. The 27 radiographs initially selected were examined by four independent reviewers. Of the 1,193 patients, 18 (1.5 percent [10 female and eight male]) met the criteria for condylar pseudocysts. Follow-up radiographs showed minimal or no change in size of the radiolucencies. Clinicians need to be aware of these anatomic variations so that patients are not subjected to inappropriate treatment.

Recall intervals: effect on treatment needs: a retrospective study.

The purpose of this retrospective study was to examine the effect of recall intervals on the incidence of dental caries. Data were collected from patient records of a private pediatric dental practice. Variables examined were time of the recall interval, age, race and sex of the patient, and whether the patient lived in a fluoridated area. There were 207 patients who qualified for the study. Of the 207 patients in the study, 173 did not have any teeth with dental caries at the recall visit. A significant difference between increased caries activity and recall interval was not found in this study. There was no significant difference found between the explanatory variables and caries activity.

Recall intervals: effect on treatment needs of the handicapped patient: a retrospective study.

The purpose of the retrospective study was to examine the effect of recall intervals on incidence of dental caries in handicapped patients. Data was collected from patient records of a private pediatric dental practice. Variables examined were time of the recall interval, age, race and sex of the patient, handicap, and whether the patient lived in a fluoridated area or not. Approximately six hundred charts were reviewed which resulted in 83 patients that qualified for the study. Of the 83 patients in the study, 57 did not have dental caries at the recall visit. The relationship between increased caries activity and recall interval was not significant. However, a trend indicating an increased chance of developing caries after a twelve month recall interval was detected.

Hypnosis as an adjunct to the administration of local anesthetic in pediatric patients.

This study investigates the acceptance of local anesthetic injection, utilizing hypnosis in twenty-nine children, ages four to thirteen years. Each subject was evaluated twice, once utilizing hypnosis before injection, and once without. A double blind research design was used to avoid effects of expectancy. Subjects in the study were videotaped during the procedure. Their behavior was rated independently by two pediatric dentists, using the North Carolina Behavior Rating Scale (NBRS). Transcutaneous pulse oximetry data were also recorded for each subject. The resulting data were evaluated for statistically significant differences between the two methods and for interrater reliability. Results showed no statistically significant differences in oxygen saturation due to hypnosis condition, order of treatment, sex, race, or age. Statistically significant differences were found in pulse rate and behavior, attributable to hypnosis condition and age, but not to sex, race, or order of treatment. Pulse rate decreased with hypnosis, as did crying. The hypnosis condition seemed to be more successful with younger children (four to six years old).

Evaluation of the Eyberg Child Behavior Inventory as a predictor of disruptive behavior during an initial pediatric dental examination.

The purpose of this study was to investigate relationships between the Eyberg Child Behavior Inventory (ECBI), a parent rating scale of children's behaviors at home, and children's disruptive behaviors during an initial dental visit. Behaviors of 18 Headstart children, 40 to 55 months of age, undergoing an initial exam were observed. Four possible negative behaviors based upon the North Carolina Behavior Rating Scale (NCBRS), were recorded by two observers for each subject during five phases of an initial dental visit and statistically compared to the total ECBI score and individual answers within the ECBI questionnaire. Overall, the majority of subjects displayed clinically acceptable behavior. Four disruptive behaviors explained 92.9% of the variation in responses by the subjects to the initial visit. These were: high hand movement during the intraoral examination, crying or verbal protest during prophylaxis, oral physical resistance during prophylaxis, and oral-physical resistance during fluoride application. The following 6 questions explained 99.3% of the variation in ECBI responses by parents or guardians: (#9) refuses to obey until threatened with punishment, (#15) whines, (#18) hits parents, (#24) verbally fights with friends his own age, (#28) constantly seeks attention, and (#35) is overactive or restless. While the total number of subjects observed were too low to generate statistically significant results, the trends appear to indicate that a child's disruptive or nondisruptive behavior at home is not a reliable predictor of disruptive or nondisruptive behavior within the dental setting. These findings are independent of gender or race.

Comparison of dentofacial morphology in monozygotic twin pairs with their siblings using LISREL.

Lateral cephalometric radiographs from 33 families of monozygotic twins and their siblings were digitized. Seven dentofacial parameters were measured: 1 to SN, 1 to NA, 1 to NA(mm), 1 to 1, 1 to Mandibular Plane Angle, 1 to NB(mm) and 1 to APg(mm). Data from monozygotic twin pairs and siblings were analyzed using LISREL to determine variance components of heredity, common environment and random environment. Five of the parameters measured showed heredity as the primary factor of variance, while two, 1 to NB(mm) and 1 to APg(mm) showed a common environment as having the greatest effect.

Comparison of craniofacial morphology in monozygotic twins with their siblings.

Lateral cephalometric radiographs from 33 families of monozygotic twins and their siblings were digitized. Eight skeletal parameters were measured: FA to SN, SNA, SNB, ANB, angle of convexity, mandibular plane to SN angle, Y axis and pogonion to NB distance. Monozygotic twin pairs and their siblings showed a normal distribution pattern for all the skeletal parameters, except the pogonion to NB distance measurement. There was found to be a statistically significant correlation between age and facial angle and ANB. A familial aggregation effect was found for SNA, ANB and angle of convexity. Some genetic influence was found for FA, mandibular plane angle and Y axis, while the Pg to NB distance showed neither genetic influence, nor a familial aggregation.

Prevention for children and adolescents.

Preventive oral health care for the growing child begins before birth and continues through adolescence. The basic elements of a good preventive program remain the same but the importance of each one changes as the child grows and develops. As the child grows, the parent's role in oral health care changes. The infant is totally dependent upon the parent for all aspects of care, the young child is beginning to assume some responsibility for his own care but the parent must still see that things are done properly, and with the teenager, the parent's role has been religated to that of observer with greatly reduced control over what is accomplished. In the same way as the parental role changes from that of provider to that of observer, the professional role changes from teaching parents what to do to that of provider of care the parents cannot provide.

Comparison of triazolam to a chloral hydrate/hydroxyzine combination in the sedation of pediatric dental patients.

The purpose of this study was to compare the effectiveness of triazolam to chloral hydrate with hydroxyzine when sedating young children for dental treatment. Twenty children, age 21 to 74 months, with a mean age of 44 months, were given triazolam. Twenty children, age 23 to 64 months, with a mean age of 42 months, were given chloral hydrate with hydroxyzine. The children were given an elixir of either .02 mg/kg triazolam or 40 mg/kg chloral hydrate with 25 mg hydroxyzine. All subjects received 50% nitrous oxide and were restrained with a Papoose Board. The sedations were videotaped and evaluated by two pediatric dentists not involved in the study. They rated the success of the sedations by degree of sleep, crying, body movements, and overall behavior. Time until onset of action of the agents given, oxygen saturation of arterial blood, and heart rate were measured. The vital signs were consistent for the two groups. There was no statistical difference in the effectiveness of sedation between the two groups.

Comparison of a chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients.

The purpose of this study was to compare the effectiveness of a chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients. Twenty children were given 40 mg/kg chloral hydrate and 25 mg hydroxyzine, and 20 children were given 40 mg/kg chloral hydrate and 25 mg hydroxyzine and 0.5 mg/kg meperidine. All children were between the ages of 24 and 60 months and all medications were given orally 1 hr before treatment. The children received 50% nitrous oxide for the entire procedure. All children were restrained in a Papoose Board. The patients were videotaped and their behavior was rated by two independent pediatric dentists using the Houpt Scale. The independent evaluators did not know which sedation regimen had been used. They rated success of the sedations by degree of sleep, crying, body movements, and overall behavior. Oxygen saturation of arterial blood, and heart rate also were measured. The vital signs were consistent for the two groups. There was no significant difference in the effectiveness of the two drug regimens.

Objective evaluation of an airway management appliance in infants with craniofacial anomalies.

This study describes an intraoral appliance designed to reposition the tongue to facilitate a patent airway for infants experiencing respiratory distress. Transcutaneous pulse oximetry is used to objectively evaluate this method of airway management in 15 neonates with craniofacial anomalies. The appliance can significantly improve the blood oxygen saturation level in the infants in whom it is used (P less than .0001).

Cotton roll isolation versus Vac-Ejector isolation.

A visible-light-cured, white pit-and-fissure sealant was applied to 523 teeth in school children using either cotton rolls or a VacEjector for isolation. After a minimum of six months, the patients were recalled and the retention of the sealants was evaluated. No significant difference in sealant retention was found between the two isolation methods.

The team approach to the management of ectodermal dysplasias.

1. The medical and dental needs of ED patients require multidisciplinary treatment. Because of the difficulty in identifying centers with genetic and dental services, locating the availability of these services should be undertaken first. 2. A team member for the specialties of genetics, pediatrics, dermatology, opthalmology, otolaryngology, orthodontics, prosthetics, and pediatric/general dentistry must be identified at each center. 3. An individual to act as liaison with other groups must be identified. 4. A team leader must be named; this individual may be the same or different from the specialists, and local teams must be established. 5. A protocol for communication among national and regional centers, identified specialists, and local teams must be established. 6. Each center should attempt to identify specialists in the region interested in participation. 7. Demographics of identified families need to be established. 8. As patient populations are found, the need for new centers can be identified. 9. As groups of the necessary specialists are identified in a need area, the establishment of new centers can begin. 10. A protocol for uniform record keeping and the centralization of the record base should be established. 11. Treatment protocols should be established to allow coordination of treatment and to support the research aspects of the centers. 12. Efforts need to be directed at establishing financial support for treatment not covered by third-party carriers. 13. Lobbying efforts need to be planned to seek changes in existing laws to provide for adjunctive dental care coverage under medical insurance policies. 14. Efforts need to be initiated to seek private and public funding for the centers. Grant preparation needs to be undertaken to seek support for research activities. 15. A protocol for the recording of ectodermal dysplasia information through a central registry, as is done through the Centers for Disease Control (CDC) with other recognized birth defects, is called for.