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Background: Most studies regarding the oral health knowledge of medical practitioners are based on surveys., Aim: To assess medical practitioners' knowledge in diagnosing and managing children oral health issues using eye tracking technology., Design: Forty-one medical practitioners completed a cross-sectional survey questionnaire and subsequently viewed 5 clinical images of children's oral cavities to indicate the issues observed and their management. Tobii eye tracking device captured each participant's visual search behaviours and mean length of fixation (LOF) for each area of interest (AOI). Participant self-reported confidence in examining the oral cavity, and qualification level was recorded for data analysis., Results: No correlation between time spent viewing the soft tissues and self-reported confidence examining the oral cavity was observed (P = .25). Self-reported confidence in examining the oral cavity was not associated with a correct diagnosis. LOF on the decayed teeth was significantly associated with a correct diagnosis of 'caries' (P < .05), and paediatric training was associated with a correct diagnosis of dental caries (P < .05)., Conclusion: Medical practitioners' diagnosis and management were poorly correlated with their objective visual search behaviours of the intraoral images. Self-reported confidence in examining and managing oral issues was not correlated with a correct diagnosis, with the majority not confident of examining children oral cavity., (© 2020 BSPD, IAPD and John Wiley & Sons Ltd.)

Abstract: Many interdisciplinary oral health education programs have been implemented for pediatric primary care providers (e.g., pediatric nurse practitioner [PNP]) to raise awareness and gain skills related to the prevention of early childhood caries (ECC). However, no studies have evaluated if these educational programs provided to PNPs during their training resulted in clinical practice behavior changes. A 33-item survey was designed on a web-based platform (Survey Monkey) and distributed to 71 PNP graduates. The survey included demographics, current clinical practice, clinical practice behaviors, and perceived barriers to practice. Descriptive statistics were used to assess the survey items and thematic analyses on the open-ended questions. The survey response rate was 70% (50/71 PNPs). Most practicing PNPs were in acute care or specialty clinics (n = 33; 66%) where oral health was not part of the focused visit. Majority used knowledge learned in assessment and anticipatory guidance skills. However, only 14% of primary care providers were applying fluoride varnish with 10% billing for this procedure. Barriers to application were time, available supplies, COVID protocols, lack of support staff, or not billing due to minimal reimbursement. Many primary care-trained PNPs were practicing in acute or subspecialty areas where prevention of ECC is not viewed as part of their focused visit. Pediatric nurse practitioners working in primary care demonstrated some clinical practice changes. However, areas for improvement are time to perform a risk assessment and application of fluoride varnish, access to these supplies, and standard billing and insurance reimbursement for these preventable services., Competing Interests: Competing interests: The authors and coauthors have no financial or conflicts of interest to disclose. The authors acknowledge the continued funding support by the Health Resources and Services Administration [Grant ID: D88HP20129 and D88HP39034]., (Copyright © 2022 American Association of Nurse Practitioners.)

Objectives: To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice., Design: Retrospective claims-based analysis cohort study., Setting: Children with Medicaid insurance through an Ohio pediatric accountable care organization., Participants: Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017., Intervention: FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider., Main Outcome Measure: Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes., Results: The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4)., Conclusions: Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment., Competing Interests: C.G. and H.M. were paid employees of Partners For Kids during the study period. The authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The Centers for Disease Control and Prevention reports that topical fluoride application may prevent early childhood caries in high-risk populations. Yet, there are few published descriptions of caries prevention curricula for primary care residents., Methods: In 2003, the New Hampshire-Dartmouth Family Practice Residency hired a dentist and a hygienist to develop and implement a didactic and practical oral health curriculum., Results: Over 2 years, faculty and residents competent with oral health screening and fluoride varnish application rose from 0% to 69% to 100%. In the same period, the percentage of well-child visits (ages 6 months to 3 years) with documented oral health screening and fluoride varnish application rose from 0% to 80% to 91%., Conclusions: Our successful model of teaching early childhood caries prevention services within the well-child visit could be replicated by other residency programs. Programs may need start-up funding for initial training by dental professionals.

Background: Caries risk assessment (CRA) tools may assist in identifying children at risk of early childhood caries., Aim: To complete a systematic review of CRA and develop a Canadian CRA tool for preschool children for use in non-dental clinical settings., Design: Systematic searches of relevant databases were conducted. Potential variables were based on strength of associations (odd ratios, relative risk, hazard ratios, etc), frequency of occurrence, and existing CRA tools. Quality of the evidence assessments were performed by at least two review teams through consensus following GRADE., Results: Overall, 25 publications met the inclusion criteria, all prospective in design. Based on this review, variables to be considered when developing a new CRA tool for use with preschool children are as follows: age, socioeconomic status, family toothbrushing habits, fluoride exposure, infant feeding practices, dietary habits/behaviours, dental home, caries experience, visible plaque, and enamel defects. The environmental scan identified 22 CRA tools suggesting other additional variables to consider including in a CRA tool, including special healthcare needs, enamel defects, and dental attendance., Conclusions: This review informed the development of a Canadian CRA tool for use by primary healthcare professionals, which may improve access to oral health assessments and increase interprofessional collaboration., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to evaluate whether Public Health Dental Hygiene Practitioner (PHDHP) referrals to pediatric dentists were more successful for children younger than 3 years old and those with dental caries., Methods: We reviewed the electronic health records of 1,450 children, age 1 to 12 years, who completed a dental visit with a PHDHP in 2017 at UPMC Children's Hospital of Pittsburgh's (CHP) Primary Care Center. We tracked whether children who visited the onsite PHDHP accepted a referral to CHP pediatric dentists, and if so, whether they successfully completed the referral., Results: Of the 1,450 children who visited the PHDHP, 67 percent (n = 973) accepted a referral to CHP pediatric dentists. Of these referrals, 32 percent (312/973) were successfully fulfilled. The proportions of accepted and fulfilled referrals were significantly higher for children older than 3 years old and those with dental caries. After controlling for child age, gender, and insurance status, children with dental caries had 5.7 times greater odds of successful referral from the PHDHP to the pediatric dentist compared to children without dental caries (95 percent CI 4.1-7.9)., Conclusions: PHDHPs were more successful referring children older than 3 years old and those with dental caries to pediatric dentists. PHDHPs are allied dental health professionals that can be effective at referring children to pediatric dentists when they have dental caries. Additional strategies are needed to enhance the success rate of dental referrals for young children under 3 years old., (© 2020 American Association of Public Health Dentistry.)

Aim: Many Australian children have dental decay in their deciduous teeth. Poor oral health can negatively impact a child's ability to eat, speak, sleep and socialise, with adverse impacts later in life. Paediatricians are well placed to examine children's teeth and to provide advice and education about oral health. Using a sample of Australian paediatricians, we aimed to determine: (i) self-reported oral health knowledge and skills, (ii) frequency of office-based oral health-related discussions, (iii) perceived role of paediatricians and (iv) barriers to oral health-related discussions., Methods: Members of a national network of paediatricians - the Australian Paediatric Research Network - completed a multi-topic survey, which included questions designed to assess oral health knowledge, current practice and barriers to oral health-related discussions., Results: Of 430 active members, 178 (41%) completed the survey. Few paediatricians reported very good/excellent ability to assess plaque build-up (8%) and dental caries (17%). Only 10% reported broaching the issue of oral health with all patients. Significant barriers included lack of professional training (52%) and other more pressing issues needing to be addressed (67%)., Conclusions: The increasing (and inequitable) rates of dental decay in Australian children mean that paediatricians should play a key role in the management of children's oral health. Many paediatricians reported a lack of specific training in oral health and limited ability to assess children and educate families. Despite the traditional divide between medicine and oral health, this study highlights the opportunity for Australian paediatricians to improve oral health through early intervention in the consultation room and beyond., (© 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Dental fluorosis is a long-existing public health issue resulting from inequitable access to potable water. Socially disadvantaged rural communities in fluoride-endemic areas, where a conventional irrigation system is absent and groundwater containing natural fluoride is the predominant source of drinking water, face a significant oral public health threat. This study aimed to determine the association between water fluoride levels and dental fluorosis. A systematic review aligned with PRISMA principles was conducted using the SPIDER search methodology and relevant keywords on many search engines, such as Google Scholar, PubMed, Elsevier, Sage, Web of Science, Cochrane, and Scopus. This review sought to ascertain the PICO model's application as a search strategy tool. The reviewers gathered and assessed 1164 papers from January 2010 to January 2023. In total, 24 research papers from diverse databases were included. Using the Newcastle–Ottawa Scale, grades resulting from several data screens were evaluated. According to a previous systematic review, there may be publication bias in studies examining the association between fluoride in drinking water and dental fluorosis. The findings of this systematic review indicate that subpar fluoride is detrimental to human health. The author outlines legislative tools and technological advancements that might reduce fluoride levels. [ABSTRACT FROM AUTHOR]

Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80–1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1–2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83–2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4. [ABSTRACT FROM AUTHOR]

Introduction: Early childhood caries (ECC) is a significant worldwide oral health problem that needs to be looked after by parents. Some parents do not care about the oral health of their children, and they more frequently visit pediatricians. So, pediatricians are one of the most reliable profession for preventing children's oral diseases, and promoting awareness. Objective: The aim of the study was to know the knowledge and awareness of pediatricians' about early childhood caries (ECC) in lumbini province, Nepal. Materials and Methods: A total of 40 pediatricians were selected by using census sampling method and were requested to fill out an objective questionnaire pertaining to individual's knowledge about ECC, without providing any oral health information taking duration of the study from March 2021 to September 2021. Results: About 23(56.5%) of pediatricians understood the importance of pediatric dentistry. About 34(86.2%) of pediatricians performed oral examination regularly. Around 17% of pediatricians had knowledge of the ECC. Only 14(33.3%) of pediatricians acknowledged the cariogenicity of sugar containing medical syrups. Conclusions: The study shows poor knowledge regarding ECC, oral health, and dental treatment need in children among the surveyed pediatricians although having good knowledge about pediatric speciality and importance of primary dentition. Thus, there is a need to update the Pediatricians on recent recommendations about ECC and its early screening. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the knowledge level and practice of pediatricians and pediatric residents regarding children's oral health in Kuwait. Subjects and Methods. A nationwide cross-sectional survey was distributed to pediatricians and pediatric residents practicing in Kuwait. Data concerning demographic variables, knowledge on dental caries preventive measures, current anticipatory guidance, and experience with dental problems and oral care were collected using online and paper-based surveys. Results. A total of 230 completed the survey with a response rate of 50.1%. Most respondents (81%) had noticed dental caries in children more frequently. Two-thirds of respondents felt confident in detecting dental caries. However, more than two-thirds were unfamiliar with preventive dental practices and the management of dental trauma. Only 16.5% of the respondents got satisfactory knowledge score on the preventive measures questions, and nearly 51% got satisfactory knowledge on the recent anticipatory guidance questions. No significant correlations were found between gender or years of practice and knowledge scores. Respondents' confidence in detecting caries was significantly associated with the knowledge score of the anticipatory guidance (p = 0.003). Conclusion. Dental caries is an oral problem commonly encountered by many pediatricians and pediatric residents in Kuwait. The majority has adequate knowledge of the current anticipatory guidance of oral health issues, but they have insufficient knowledge levels on oral preventative measures. Adequate education and training in oral health are highly recommended. [ABSTRACT FROM AUTHOR]

Importance: Dental caries is the most common chronic disease in children in the US. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children aged 2 to 5 years had dental caries in their primary teeth. Prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%). Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries.Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening and interventions to prevent dental caries in children younger than 5 years.Population: Asymptomatic children younger than 5 years.Evidence Assessment: The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with oral fluoride supplementation at recommended doses in children 6 months or older whose water supply is deficient in fluoride. The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with fluoride varnish application in all children younger than 5 years. The USPSTF concludes that the evidence is insufficient on performing routine oral screening examinations for dental caries by primary care clinicians in children younger than 5 years and that the balance of benefits and harms of screening cannot be determined.Recommendation: The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children younger than 5 years. (I statement). [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of resin infiltration technique in arresting superficial proximal carious lesions of posterior teeth. Study Design: Quasi experimental study. Place and Duration of Study: Operative dentistry department, de' Montmorency College of Dentistry Lahore, from Oct 2018 to Mar 2019. Methodology: Meeting inclusion criteria were selected. Informed consent was obtained. After application of rubber dam; etchant gel was applied to superficial proximal carious lesions in these patients; water-rinsed and air-dried for 30 sec; resin was then infiltrated into each lesion. Patients were recalled after 6 months for follow up. Results: Total patients were 30 out of which 18 (60%) were males and 12 (40%) were females. Mean age of patients was 25.77 years ranging from 16-35 years. Success of resin infiltration technique in superficial proximal carious lesions in posterior teeth was 86.7% measured by bitewing radiograph taken on follow up after 6 months to see any progression of carious lesion. Conclusion: Resin infiltration was effective in 86.7% patients in arresting progress of superficial proximal carious lesions with no significant difference for age and gender. Hence it is suggested that resin infiltration being promising micro invasive approach should be considered in addition to non-operative and operative treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children's oral health is well documented. For well over a decade, there have been calls for pediatricians to address children's oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians' in children's oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children's oral health. Methods: Arksey & O'Malley's five-stage review process was used to comprehensively map studies undertaken on pediatrician's knowledge and practice regarding children's oral health. Key search terms were developed and a total of 42 eligible articles are included in the review. Results: The studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice. Conclusions: This scoping review highlights growing international interest in the role of pediatricians in children's oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%. Materials and Methods: A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey. Results: A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients. Conclusion: Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health. [ABSTRACT FROM AUTHOR]

Objectives: The United States has a public health crisis of dental caries in children's primary teeth. Fifty‐five percent of children have dental caries by age 8. The majority of these children are nonwhite and poor. Caries could be decreased by 40% if fluoride varnish (FV) application started with tooth eruption. Design and Sample: A four‐month FV application QI project was implemented in a rural pediatric practice. The staff was trained by the Vermont Department of Health using the From the First Tooth protocol. Children aged 9, 18, 24, and 30 months. Measures: Pre‐ and postproject questionnaires were completed. A caries risk tool assessed a child's risk and access to dental care. Completed FV applications were recorded and staff interviewed weekly. Intervention: FV application was offered at well child checks (WCCs). Results: Fifty‐six percent of sample patients received FV at their WCCs. Qualitative themes included the following: reasons subjects did/did not receive FV, ease of FV application, increased oral hygiene education, visit flow, application time, older children's FV need, and billing issues. Conclusion: This economical, FV application program can be readily implemented by nurse practitioners and nurses in pediatric practices where children have inadequate dental care. [ABSTRACT FROM AUTHOR]

Evidence for the effects of low birth weight, breastfeeding and maternal smoking on childhood caries is mainly cross-sectional. We examined the association of these 3 putative early life factors with caries increment over a 4-y period among young children. We used data from a 4-y longitudinal caries-risk assessment study carried out among Scottish children. Early life factors were measured when children were aged 1 y (baseline). Caries assessment was repeated annually from ages 1 to 4, and the number of decayed, missing and filled primary tooth surfaces (dmfs) were used as a repeated outcome measure. The associations of low birth weight, breastfeeding and maternal smoking with dmfs at baseline and over time (trajectories) were assessed in linear mixed models. A total of 1,102 children were included in this analysis. Birth weight, breastfeeding and maternal smoking were not associated with dmfs at baseline. However, low birth weight and maternal smoking were associated with the rate of change in dmfs. By wave 4, the predicted mean difference in dmfs was 1.86 between children with low and normal birth weight, and 1.66 between children of smoking and non-smoking mothers. Children with low birth weight and smoking mothers had greater caries increments than those with normal weight and non-smoking mothers, respectively. There was no association between breastfeeding duration and childhood caries, either at baseline or over time. [ABSTRACT FROM AUTHOR]

Dental caries is one of the most prevalent and significant health problems in the United States. According to the American Academy of Pediatric Dentistry, more than one-fourth of children between the ages of two and five years experience early childhood caries before entering kindergarten. The purpose of this study was to explore parent's knowledge of preschool children's oral health risk factors. A descriptive design was used with a convenience sample of 87 parents of children who attended day care centers and preschools. Seventeen knowledge questions were used to assess parents' knowledge of their child's oral health. Results showed that parents lacked knowledge in some aspects of oral health care. The majority of parents knew that baby teeth are important, and both baby and permanent teeth should be brushed. Fewer, however, perceived that cavities in baby teeth lead to cavities in permanent teeth. Similarly, parents knew the role of food in the dental caries, but fewer perceived that cavities may be caused by using a bottle or infant drinking cup to drink fluid other than water and frequent snacking. Findings illuminate the knowledge gaps in this sample of parents of preschoolers. Pediatric nurses can play a key role in promoting children's oral health and preventing dental caries by proving anticipatory guidance and education to children and their parents at well child visits, during hospitalization, and in school and community settings. [ABSTRACT FROM AUTHOR]

The first visit to the dentist should take place within 6 months after the first deciduous tooth erupts, and not later than in the 12th month of the child's life. To assess the role of paediatricians in the prophylaxis of early childhood caries, the authors studied recommendations given to parents about the age when their child should see the dentist for the first time. The survey covered 250 parents of children aged from 11 to 69 months who attended nursery schools and kindergartens in Lublin. Our results show that paediatricians only referred 12.80% (n = 32) of all children at the age of between 3 to 66 months for their first visit to the dentist. Herein, half of the references were of children younger than 2 years (Me = 24.0). In total, the mean age of the child was 22.41 ± 13.24 months on reference. Thus, paediatricians refer children to the dentist for their first visit too seldom and too late. It is essential that paediatricians learn to participate to a greater extent in the prevention of early childhood caries. The cooperation between the paediatrician and the dentist is necessary to provide complex and comprehensive care to developmental age patients. [ABSTRACT FROM AUTHOR]

Background Early-life feeding behaviors foretell later dietary habits and health outcomes. Few studies have examined infant dietary patterns and caries occurrence prospectively. Objective Assess whether patterns in food and drink consumption before age 12 months are associated with caries incidence by preschool age. Methods We collected early-life feeding data within a birth cohort from low-income families in Porto Alegre, Brazil. Three dietary indexes were defined, based on refined sugar content and/or previously reported caries associations: a count of sweet foods or drinks introduced <6-months (e.g., candy, cookies, soft drinks), a count of other, nonsweet items introduced <6-months (e.g., beans, meat), and a count of sweet items consumed at 12 months. Incidence of severe early childhood caries (S- ECC) at age 38 months ( N = 458) was compared by score tertile on each index, adjusted for family, maternal, and child characteristics using regression modeling. Results Introduction to a greater number of presumably cariogenic items in infancy was positively associated with future caries. S- ECC incidence was highest in the uppermost tertile of the '6-month sweet index' (adjusted cumulative incidence ratio, RR, versus lowest tertile: 1.46; 95% CI: 0.97, 2.04) and the uppermost tertile of the '12-month sweet index' ( RR: 1.55; 95% CI: 1.17, 2.23). The association was specific for sweet items: caries incidence did not differ by tertile of the '6-month nonsweet index' ( RR: 1.00; 95% CI: 0.70, 1.40). Additionally, each one-unit increase on the 6-month and the 12-month sweet indexes, but not the 6-month nonsweet index, was statistically significantly associated with greater S- ECC incidence and associated with more decayed, missing, or restored teeth. Results were robust to minor changes in the items constituting each index and persisted if liquid items were excluded. Conclusions Dietary factors observed before age 12-months were associated with S- ECC at preschool age, highlighting a need for timely, multilevel intervention. [ABSTRACT FROM AUTHOR]

Objective: Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. The etiology and associated factors of ECC should be studied adequately to overcome this health hazard. The aim of this study was to determine caries prevalence and its consequences in toddlers in an Anatolian city, Kırıkkale. Materials and Methods: Examinations were performed in family medicine centers by three calibrated dentists during a period of 6 months. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper‑case letters refer to permanent and lower‑case letters to primary teeth), and decayed, missed, and filled surfaces (DMFS). Results: Totally 3171 toddlers were included (52% males and 48% females). The mean age was 25.8 ± 10.1 months. The prevalence of ECC in preschool children was 17.3%, while the mean df(t) was 0.63 ± 1.79. ECC increased significantly with age. Dental caries were mostly observed in primary maxillary central teeth. Occlusal and buccal surfaces were the most affected sites. The difference in distribution of caries between maxilla and mandibula was found to be statistically significant (P < 0.05). Conclusions: When compared to other data obtained from various epidemiologic studies, the toddlers living in Kırıkkale city center had a significant caries level. This observation had clearly suggested that early preventive measures should urgently be put into effect all over the city. [ABSTRACT FROM AUTHOR]

Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children's Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work—Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629. [ABSTRACT FROM AUTHOR]