Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital.
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This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students. (+info)
Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program.
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OBJECTIVE: Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge. METHODS: The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims. RESULTS: Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children. CONCLUSION: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction. (+info)
Capitation registration and social deprivation in England. An inverse 'dental' care law?
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OBJECTIVE: To examine associations between NHS child dental registration data and area deprivation scores of English Health Authorities (N= 100) in 1996/97 and 1997/98. METHOD: The Department of the Environment index of local conditions and the Jarman Underpriviledge Area Score from the 1991 census were used to measure deprivation. Prior to September 1997, children got free dental treatment under a capitation scheme with an NHS dentist. If they did not attend within 24 months their registration lapsed on the last day of December of the second registration year and they were deleted from the capitation list. After September 1997 the registration period was reduced to 15 months. OUTCOME: Curve-linear regression of the Health Authority (HA) percentage of children registered, lapses in capitation registrations and deprivation scores. RESULTS: In England 68% of children were registered in December 1996. The percentage registered in each Health Authority was associated with deprivation (DoE, r2=0.33, Jarman, r2=0.27 p<0.01). In January 1997, 17.8% (1,345,142) of children registered lapsed (HA range 12.8% to 30.3%) and this was also significantly associated with deprivation (DoE r2=0.66, Jarman, r2=0.51 p<0.01). Similar results were found in 1997/98. CONCLUSIONS: Registration and lapse rates were significantly associated with social deprivation confirming that there is an inverse 'dental' care law for children in England. NHS capitation may widen dental health inequalities. (+info)
The influence of two different dental local anaesthetic solutions on the haemodynamic responses of children undergoing restorative dentistry: a randomised, single-blind, split-mouth study.
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OBJECTIVES: This investigation was designed to study the haemodynamic effects of two different local anaesthetic solutions during restorative dental treatment in children. DESIGN: A randomised, single-blind, split-mouth cross-over design was employed using children undergoing bilaterally similar restorative treatments over two visits. SETTING: The study was performed in a dental hospital paediatric dentistry department. METHODS: Ten children participated. At one visit the local anaesthetic was 2% lidocaine (lignocaine) with 1:80,000 epinephrine (adrenaline); at the other the anaesthetic was 3% prilocaine with 0.03IU/ml felypressin. Local anaesthetic was administered at a dose of 0.5 ml/10 kg body weight. Blood pressure and heart rate were measured before and during treatment with an automatic blood pressure recorder. Data were analysed by ANOVA and Student's paired t test. RESULTS: Significant differences between treatments in diastolic blood pressure (F = 2.37; P = 0.05) and heart rate (F = 2.98; P< 0.02) were noted. The heart rate increased ten minutes following the injection of the epinephrine-containing solution. The diastolic blood pressure fell 20 minutes after injection of lidocaine with epinephrine. CONCLUSION: The choice of local anaesthetic solution influences the haemodynamic response during restorative treatment in children. (+info)
The face of a child: children's oral health and dental education.
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Dental care is the most common unmet health care need of children. Those at increased risk for problems with oral health and access to care are from poor or minority families, lack health insurance, or have special health care needs. These factors place more than 52 percent of children at risk for untreated oral disease. Measures of access and parental report indicate unmet oral health needs, but do not provide guidance as to the nature of children's oral health needs. Children's oral health needs can be predicted from their developmental changes and position in the life span. their dependency and environmental context, and current demographic changes. Specific gaps in education include training of general dentists to care for infants and young children and those with special health care needs, as well as training of pediatric providers and other professionals caring for children in oral health promotion and disease prevention. Educational focus on the technical aspects of dentistry leaves little time for important interdisciplinary health and/or social issues. It will not be possible to address these training gaps without further integration of dentistry with medicine and other health professions. Children's oral health care is the shared moral responsibility of dental and other professionals working with children, parents, and society. Academic dental centers hold in trust the training of oral health professionals for society and have a special responsibility to train future professionals to meet children's needs. Leadership in this area is urgently needed. (+info)
Children and informed consent: a study of children's perceptions and involvement in consent to dental treatment.
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AIM: The aim of the study was to find out to what extent children are involved in consenting to their dental care. METHODS: It was conducted using a structured interview with 60 8-13-year-old children. In the control group, verbal consent was given by the parent, whilst in the study group written consent was given by the parent and verbal assent by the patient. Interviews were conducted after dental treatment. RESULTS: The findings indicate that children in the study group felt they were more involved in deciding about their dental treatment compared with the control group. CONCLUSION: Children want to be more involved in consenting to their dental treatment. (+info)
Treatment outcomes and costs of dental sealants among children enrolled in Medicaid.
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OBJECTIVES: This retrospective cohort analysis of children enrolled in the North Carolina Medicaid program compared the likelihood of restorative treatments and associated cumulative Medicaid expenditures for teeth with or without dental sealants. METHODS: We assessed the dental experience of the cohort of 15 438 children from 1985 to 1992 on the basis of enrollment and claims files. We conducted regression analyses for outcomes (caries-related services involving the occlusal surface [CRSOs] of permanent first molars) and cumulative expenditures, controlling for characteristics of the child, the treating dentist, and the child's county of residence. RESULTS: Overall, 23% of children received at least 1 sealant and 33% at least 1 CRSO. Sealants were effective in preventing CRSOs, although the degree of effectiveness was highest for children with the greater levels of CRSOs before sealant placement. Estimated cumulative Medicaid expenditures indicated expenditure savings from sealants within 2 years of application for children with 2 or more prior CRSOs. CONCLUSIONS: Sealant placement was associated with expenditure savings to Medicaid for certain high-risk children, so Medicaid and, more broadly, society will benefit by providing for sealant placement in these children. (+info)
A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation.
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The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for pediatric dental patients. The study sample included 22 children whose parents or guardians selected GA care for their child. Selection criteria limited inclusion to healthy children (American Society of Anesthesiologists' classification I) aged 24-60 months. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental relative based value unit scale. (+info)