Joanna M. Douglass

Educating Pediatricians and Family Physicians in Children's Oral Health

Publication of Oral Health in America: A Report of the Surgeon General (SGROH) alerted the public and health professionals to the importance of oral health and the vulnerability of poor and underserved children to dental disease. In response, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the Society of Teachers of Family Medicine (STFM) have initiated training programs for residents and practicing physicians, allowing them to conduct oral health screenings, apply preventive strategies, and facilitate appropriate referrals to dentists. Training programs are increasingly available on the Web, but their quality and effectiveness are rarely assessed. To ensure greater inclusion of oral health in graduate medical education, voluntary curricular guidelines have been developed, and education in oral health is mandated in family medicine residency programs. Several initiatives engaging practicing physicians in oral health activities have demonstrated improved access and reduced dental disease in children, but evaluation of all programs is essential to determine cost effectiveness and outcomes. The actions of AAP, AAFP, STFM, and other large-scale initiatives have helped break down the traditional separation between medicine and dentistry. Collaboration between physicians and dentists should be encouraged at all levels of education to ensure improvement of the oral health of Americas children.

The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children

© 2014 Published by Elsevier Inc. The Image Gently in Dentistry campaign to be launched in September 2014 is a specific initiative of the Alliance for Radiation Safety in Pediatric Imaging, supported by organized dentistry and dental education as well as many dental specialty organizations. The objective of the campaign is to change practice by increasing awareness of the opportunities to improve radiation protection when imaging children in dental practices. Six practical steps are provided that underline the principle that one size does not fit all, especially when it comes to using radiography during pediatric dental procedures. When we image children, let us image gently: More is often not better.

Mobile dental vans: planning considerations and productivity.

Objectives: Many children, especially those from lower socio-economic families, have limited access to dental care, transportation problems and poor appointment attendance. Mobile dental clinics have been implemented in many communities to address these issues. Methods: Structured surveys were sent to the three mobile programs in Connecticut to collect information on the age of the program, issues encountered in planning and implementation, and ongoing costs and productivity. Results: Each mobile clinic had two operatories and operated 140–200 days per year. Programs provided 2921–3417 diagnostic and preventive procedures and 359–721 treatment procedures per year for an average daily production of 18–24 procedures. All programs required external funding to remain financially solvent. Conclusion: Implementation and management of these programs is complicated. However, they provide an innovative solution to bringing dental care to underserved children and when operated in conjunction with schools can eliminate transportation problems and missed appointments.

Prenatal nutrition intervention to reduce mutans streptococci among low‐income women

OBJECTIVES The objective of this study is to assess the effectiveness of a prenatal nutrition intervention to reduce sugar intake and mutans streptococci (mutans) among low-income women. METHODS Pregnant women were recruited from the obstetrics service at a community health center in Connecticut. Inclusion criteria were ≥18 years of age; mutans levels >10, 000 colony forming units/ml as determined by Dentocult SM® kits (Orion Diagnostica Oy, Espoo, Finland); and >3 months pregnant. Women were randomized to receive education alone [education intervention (EI)] or education and a 1-hour nutrition group session at 9 months and 6 weeks postpartum [education and nutrition intervention (EIN)]. Mutans and questionnaire data were collected at baseline, 9 months, 6 weeks, and 3 months postpartum. One hundred twenty completed the baseline visit and 93 (77%) completed all four visits. Sugar intake was assessed by the Food Frequency Questionnaire and clinical information was abstracted from medical charts. RESULTS Mean age was 26.3 years [standard deviation (SD)= 6], 73% were Hispanic, 29% had lived in the United States < 6 years; 48% completed high school; 27% were married; mean total sugar intake at baseline was 149g (SD = 85). Repeated measures analysis of variance showed that mutans levels declined significantly in both groups, but that the EI group had significantly lower mutans levels at the final assessment compared with EIN. Sugar intake also declined significantly, but there were no significant differences between groups. CONCLUSIONS The study demonstrated the following: a) the feasibility of conducting the intervention at community health center sites among low-income pregnant women; b) the effectiveness of education to reduce mutans/sugar intake; and c) the need to improve the nutrition intervention to obtain additional gains in mutans reduction.

Fluoride Varnish When Added to Caregiver Counseling Reduces Early Childhood Caries Incidence

Article Title and Bibliographic Information Fluoride varnish efficacy in preventing early childhood caries. Weintraub JA, Ramos-Gomez F, June B. J Dent Res 2006;85:172-6. Reviewer Joanna M. Douglass, BDS, DDS Purpose/Question To determine the efficacy of different fluoride varnish application frequencies in preventing early childhood caries among young, initially caries-free children whose caregivers received oral health counseling. Source of Funding Government: USPHS Research Grants P60 DE13058 and U54 DE142501 Type of Study/Design Randomized controlled trial Level of Evidence Level 1: Good-quality, patient-oriented evidence Strength of Recommendation Grade Not applicable

Evidence of Early Emergence of the Primary Dentition in a Northern Plains American Indian Population

The purposes of this study were to describe primary tooth emergence in an American Indian (AI) population during the first 36 mo of life to compare 1) patterns of emergence between male and female children and 2) tooth emergence between these AI children and other U.S. ethnic groups. Data were derived from a birth cohort of 239 AI children from a Northern Plains tribe participating in a longitudinal study of early childhood caries, with examination data at target ages of 8, 12, 16, 22, 28, and 36 mo of age (±1 mo). Patterns of emergence in AI children were characterized and sex comparisons accomplished with interval-censored survival methodology. Numbers of erupted teeth in AI children at each age were compared via Kruskal-Wallis tests against those in children of the same age, as drawn from a cross-sectional study of dental caries patterns in Arizona; these comparisons were based on the dental examinations of 547 White non-Hispanic and 677 Hispanic children. Characterization of time to achievement of various milestones—including emergence of the anterior teeth, the first molars, and the complete primary dentition—provided no evidence of sex differences among AI children. AI children had significantly more teeth present at 8 mo (median, 3) than either White non-Hispanic (P < 0.0063) or Hispanic (P < 0.0001) children (median, 2 each). This was also true at 12 mo (P < 0.001; medians, 8 vs. 6 and 7, respectively) and 16 mo (P < 0.001; medians, 12 vs. 11 each). Less pronounced differences were seen at 22 mo (P < 0.0001). White non-Hispanic and Hispanic children did not differ at any time considered (P > 0.05). These results provide evidence of earlier tooth emergence in AI children than in the other 2 ethnicities. Although the underlying etiology of the severity of early childhood caries in AI children is likely to be multifactorial, earlier tooth emergence may be a contributing factor. Knowledge Transfer Statement: The findings of this study have practical implications for practitioners providing childhood oral health care to ethnic groups with early tooth emergence. It may be important to provide parents with information on toothbrushing, dentist visits, and other practices supportive of good oral health as early as possible to protect their children’s primary dentition.