Man Wai Ng

Preventive oral health intervention for pediatricians

This policy is a compilation of current concepts and scientific evidence required to understand and implement practice-based preventive oral health programs designed to improve oral health outcomes for all children and especially children at significant risk of dental decay. In addition, it reviews cariology and caries risk assessment and defines, through available evidence, appropriate recommendations for preventive oral health intervention by primary care pediatric practitioners.

Parental Perspectives of Early Childhood Caries

Background. Parental perspectives of children with early childhood caries may help inform the development and improvement of caries prevention strategies. Objectives. This study aimed to explore parents’ experiences, perceptions, and expectations regarding prevention and management of early childhood caries. Methods. The authors conducted semistructured interviews with 25 parents of children aged 2 to 5 years, with a known history of caries. All interviews were transcribed and coded, and iterative analyses were conducted to identify key emergent themes within the data. Results. Parents had limited knowledge of behaviors contributing to early childhood caries and when to first seek regular dental care. Parents expected pediatricians to provide education on how to prevent childhood caries, conduct preliminary oral health assessments, and help establish early linkages between medical and dental care. Conclusion. The findings make a strong case for pediatricians to take responsibility for engaging and educating parents on fostering optimal oral health and helping to access early childhood dental care.

Disease Management of Early Childhood Caries: ECC Collaborative Project

Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice.

Early childhood caries: risk-based disease prevention and management.

Early childhood caries (ECC), common in preschoolers, can lead to pain and infection if left untreated. Yet, ECC is largely preventable, and if it is identified early and the responsible risk factors are addressed, its progression can be halted or slowed. This article reviews the rationale for a first dental visit by age 1 year, caries risk assessment, and risk-based prevention and management of ECC and discusses strategies for providers to implement these contemporary evidence-based concepts into clinical practice.

Disease Management of Early Childhood Caries: Results of a Pilot Quality Improvement Project

Objectives. The purpose is to report findings of a quality improvement (QI) project implemented at two hospital-based dental clinics that care for children with early childhood caries (ECC). Methods. We tested a disease management (DM) approach in children younger than age 60 months with ECC. Results. After 30 months, for the 403 and 234 DM patients at Children’s Hospital Boston (CHB) and Saint Joseph Hospital (SJH) who returned for at least two visits, rates of new cavitation, pain, and referrals to the OR were 26.1, 13.4 and 10.9% for CHB and 41.0, 7.3 and 14.9% for SJH. Rates of new cavitation, pain, and referrals to the OR for historical controls were 75.2, 21.7, and 20.9% for CHB and 71.3, 31.3, and 25.0% for SJH. Conclusions. A risk-based DM approach utilizing QI strategies to address ECC can be implemented into practice and has the potential to improve care and health outcomes.

Cost‐effectiveness of a disease management program for early childhood caries

OBJECTIVES To assess the cost-effectiveness of a pilot disease management (DM) program aimed at preventing early childhood caries among children younger than 5 years. METHODS The DM program was implemented in the Boston Childrens Hospital-based dental practice in 2008. Health care costs were obtained from the hospital finance department and non-health care costs were estimated through a parent survey. The measure of effectiveness was avoided hospital-based visits for restorative treatment or extractions. Incremental costs (2011 US

The impact of Title VII on general and pediatric dental education and training.

) and effectiveness were estimated from a health care system, societal, and public payer perspectives over 3, 6, and 12 months, by comparing DM participants (n = 395) to a historical comparison group (n = 123) using generalized linear models. Bootstrapping and other sensitivity analyses were used to incorporate uncertainty in the analyses. RESULTS The DM program was associated with a reduction in societal costs of

NEW VISIONS IN PEDIATRIC DENTISTRY - KEEPING HEALTHY TEETH CARIES FREE: PEDIATRIC CAMBRA PROTOCOLS

20 (p = 0.85),

Riga-Fede Disease A Rare Sublingual Traumatic Ulcerative Lesion in a Child

215 (p = 0.24), and

Trends in Pediatric Dental Care Use

669 (p < 0.01) per patient and a reduction in the number of hospital-based visits for restorative treatment or extractions by 0.44 (p < 0.01), 0.42 (p < 0.01), and 0.45 (p < 0.01) per patient over 3, 6, and 12 months, respectively. The probability of it being less costly and more effective was 61.5 percent, 81.9 percent, and 98.6 percent over 3, 6, and 12 months, respectively. Consistent results were observed from a health care system and public payer perspectives. CONCLUSIONS The DM program appears cost-effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate the DM program on a larger scale.