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Early in 2020, the COVID-19 virus spread throughout the world. On March 11, 2020 the World Health Organization declared COVID-19 a pandemic due to the level of spread and the severity of the disease. In efforts to control the spread of COVID-19 and reduce the number of new infections and deaths, people around the world took steps that had not been taken in modern history. As countries and locales issued “shelter in place edicts” the economic and social impact on businesses and professions was dramatic. The field of dentistry was similarly affected as edicts were made by governmental officials that elective dental procedures be stopped. In the state of Iowa, Governor Kim Reynolds issued a proclamation mandating that effective March 27, 2020 all dentists and their staff refrain from performing “elective dental procedures and nonessential or elective surgeries”. With this turn of events, dental practices across the state were effectively shut down, only being allowed to treat emergency patients. Prior to the COVID-19 pandemic, the Iowa Dental Board, Delta Dental of Iowa, and the University of Iowa College of Dentistry shared an interest in exploring telehealth as a means of improving access to dental care for vulnerable populations. While steady progress was being made prior to the Pandemic, once the practice of dentistry in Iowa was restricted, the interest in telehealth, or “Teledentistry” soared. At the University Of Iowa College Of Dentistry, procedures were put in place to allow all emergency patients to be triaged through Teledentistry prior to being appointed in the Clinic. Using synchronous Teledentistry systems, “e-visits” prior to emergency care became the “new normal”. Patients calling in for an emergency appointment were offered a menu of options for these e-visits including: 1) phone call; 2) phone call and sharing of images; or 3) a ZOOM meeting. All e-visits were provided by Dental faculty members at the University of Iowa with experience overseeing patient care in the Dental Emergency Clinic ranging from three to ten years. Final decisions on appointing patients were made by the provider based on existing records (when available), subjective symptoms (pain), objective findings (visible swelling), patients distress level, expectations and availability. During the initial 8-weeks following closure of our dental clinics (March 16-May 15), a total of 491 patients were seen in our dental emergency clinics, all of whom had been triaged by phone calls or e-visits. Most Patients reported overall satisfaction about the procedure. Based on our experience, Teledentistry (e-visits) are a useful tool to help in prioritizing dental emergencies.KeywordsTeledentistry; E-visits; Zoom visits.

It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Purpose/aim The aim of this pilot study was to evaluate feasibility and gather initial data for a definitive study to test the clinical and microbiological effectiveness of a nursing facility (NF) customized oral hygiene protocol, intended to be delivered by dental hygienists and NF personnel. Materials and methods A convenience sample of 8 Eastern Iowa NFs was recruited, and each NF was assigned to one of three intervention groups: (1) control (current oral hygiene practice), (2) educational program only, and (3) educational program plus 1% chlorhexidine varnish monthly application. Demographic information, systemic health data, patient centered data, oral health data, and microbiology samples were collected at baseline and after 6 months. Results Recruitment response rates were 21% for NFs and 23% for residents. A total of 81 residents were examined at baseline and of those, 49 were examined at 6 months (39.5% attrition). There were no statistically or clinically significant differences among the intervention groups at 6 months for any of the recorded clinical or microbiological outcomes. Conclusions Recruitment and retention posed a significant challenge to this trial, even with a relatively short observation period. Results from this pilot study did not encourage further investigation of this customized oral hygiene protocol.

Objectives To examine the characteristics associated with emergency department (ED) utilization in Iowa for nontraumatic dental conditions (NTDCs), and those associated with having multiple visits to the ED for NTDCs before the Medicaid expansion program in Iowa. Methods State Emergency Department Database for Iowa was used for 2012, which comprised of all outpatient ED visits in the state. Logistic regression was used for bivariate and multivariable analyses to model the odds of visiting the ED for NTDCs, relative to other conditions, and odds of visiting the ED multiple times relative to a single time in 2012 for NTDCs. The hospital charges associated with the NTDC ED visits were also examined. Results ED visits for NTDCs comprised 1.41% of all ED visits in Iowa during 2012 with a mean charge of $557. Of the patients presenting for NTDCs in 2012, 17% presented multiples times. Young adults, Medicaid enrollees or uninsured, and those residing in metropolitan areas had greater odds of presenting to the EDs for NTDCs compared with other conditions, and presenting multiple times to EDs for NTDCs. Those with more chronic conditions also had greater odds of repeatedly visiting the ED for NTDCs. Conclusions Low-income young adults in Iowa rely on EDs for their dental needs that can have substantial costs. The Dental Wellness Plan (DWP) is intended to facilitate dental care access by providing dental coverage to low-income Iowans. This study provides baseline data that will be used to evaluate the success of DWP in improving access to dental care.

Objectives:TheAffordableCareActispredictedtoincreasedentalbenefitscoverage for millions of Americans. Utilization of expanded function dental auxiliaries (EFDAs) can contribute to increased workforce capacity. Iowa currently allows EFDAs to perform certain nonrestorative procedures. This study investigated dentists’ willingness to use auxiliaries for restorative procedures in order inform recent discussions about expanding scope of practice for EFDAs to include such procedures. Methods: This study examined responses from 677 primary care dentists who responded to the 2013 Survey of Iowa Dentists (response rate = 59 percent). The authors performed univariate and bivariate analyses (χ

Objectives:Theatraumaticrestorativetreatment(ART)wasdevelopedasanaffordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. Methods: A conjoint survey was completed by 723 members of the American Academyof PediatricDentistry.Threefactors(ageof thechild,levelof cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis.Factors such as lesion location,depth,and extension werefixed in the nine clinical scenarios. Results: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent).Age of the child was the most important factor in pediatric dentists’ decisions to use ART (46 percent) compared with level of cooperation (41 percent) and typeof insurancecoverage(11percent).Fortheagefactor,theageof 2yearshadthe greatest utility (0.55) compared with age 4 (−0.09) and age 6 (−0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (−0.119). Conclusions: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

The American Academy of Pediatric Dentistry recommends that children have their first dental visit no later than age one. However, not all dental schools have made hands-on infant oral health programs a reality in their predoctoral programs. To target high-caries risk infants/toddlers and provide dental students more hands-on experience with this age group, the University of Iowa Department of Pediatric Dentistry established an Infant Oral Health Program (IOHP) affiliated with the local Special Supplemental Food Program for Women, Infants, and Children (WIC) clinic. This article reports the IOHP activities and describes how this program is integrated into a dental school curriculum. Most of the children served were around age one, from racial and ethnic minority groups, and had never been to the dentist. More than 600 fourth-year dental students received hands-on experience providing preventive dental care for infants and toddlers. A 2004 survey of dentists who graduated from the University of Iowa suggested that those who rotated at the IOHP while in dental school were more willing to see very young children when compared to dentists who did not rotate at the IOHP. These findings suggest that community-based IOHPs can provide an important community resource for preventive dental care for high-caries risk young children, while complementing the pediatric dental experience in a dental school curriculum.

Objectives: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective. Methods: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted ToothYears (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child’s sixth birthday. Results: For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility = 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars. Conclusions: Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.

Objective: This paper examines the cost to the Iowa Medicaid program of hospitalizing young children for restorative dental care under general anesthesia, and describes the dental services received in this setting. Methods: Medicaid dental claims for young children receiving restorative dental care under general anesthesia during fiscal year 1994 were matched with corresponding hospital and anesthesia claims. Results: The total cost to the Medicaid program of treating a child in the hospital under general anesthesia was $2,009 per case. Less than 2 percent of Medicaid-enrolled children under 6 years of age who received any dental service accounted for 25 percent of all dollars spent on dental services for this age group, including hospital and anesthesia care. The most frequent type of procedure was stainless steel crowns (SSCs), with an average of almost six per case. Conclusions: Early identification, prevention, and intervention are critically important to prevent the costly treatment of children with ECC in hospital operating rooms.

Objectives: Relatively little is known about associations between primary and permanent tooth fluorosis. In this study, associations between dental fluorosis of the permanent and primary dentitions were assessed. Methods: Subjects (n=601) are in the Iowa Fluoride Study, which included fluorosis examinations of the primary and early-erupting permanent dentitions by trained dentist examiners. Relative risks, correlations, and logistic regression assessed associations between permanent tooth fluorosis and primary molar fluorosis. Results: Ten percent had primary molar fluorosis at age 5; 36% had definitive (mostly mild), 28% questionable, and 36% no permanent incisor fluorosis at age 9. Those with primary molar fluorosis were significantly more likely to have definitive permanent incisor fluorosis (76% vs. 32%), and permanent molar fluorosis (59% vs. 16%). The strong association between primary and permanent tooth fluorosis is independent of level of fluoride intake. Conclusions: Detection of primary tooth fluorosis in pre-school children should alert clinicians and parents to the high likelihood of subsequent fluorosis in the permanent dentition.

– Objectives: Several studies have focused on the timing of fluoride intake relative to the development of dental fluorosis. This study reports the relationships of fluoride intake during the first 48 months of life with fluorosis on early-erupting permanent teeth. Methods: Subjects were followed from birth to 48 months with questionnaires every 3–4 months. Questionnaires gathered data on intakes from water, diet, supplements, and dentifrice to estimate total fluoride intake. Early-erupting permanent teeth of 579 subjects were assessed for fluorosis using the Fluorosis Risk Index (FRI) at approximately age 9. Fluorosis cases were defined as having FRI definitive or severe fluorosis on both maxillary central incisors. Individuals with FRI questionable fluorosis were excluded. The importance of fluoride intake during different time periods was assessed using t-tests and logistic regression. Results: One hundred and thirty-nine (24%) subjects had fluorosis on both maxillary central incisors. Mean fluoride intake per unit body weight (bw) ranged from 0.040 to 0.057 mg/kg bw, with higher intake during earlier time periods and relative stability after 16 months. In bivariate analyses, fluoride intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central incisors, with the first year most important (P

Objectives: This study reports changes in non-cavitated tooth surface diagnoses after a 4-year period. Methods: Dental examinations were conducted for Iowa Fluoride Study cohort children who had non-cavitated lesions in the primary dentition and were also examined an average of 4 years later in the mixed dentition. Comparison of fluoride exposures, socioeconomic factors, and beverage consumption patterns were made between children who had lesions progress and those who did not. Results: Of 129 non-cavitated pit and fissure lesions in the first exams, 40 (31%) progressed to either frank decay or filled status, while among 132 non-cavitated smooth surface lesions, 7 (5%) were filled and none had frank decay in the second exam. No fluoride, socioeconomic status or beverage variables were significantly Associated with lesion progression. Conclusions: Non-cavitated smooth surface lesions rarely progressed in this age group, but nearly one-third of pit and fissure lesions progressed.

To examine the characteristics associated with emergency department (ED) utilization in Iowa for nontraumatic dental conditions (NTDCs), and those associated with having multiple visits to the ED for NTDCs before the Medicaid expansion program in Iowa.State Emergency Department Database for Iowa was used for 2012, which comprised of all outpatient ED visits in the state. Logistic regression was used for bivariate and multivariable analyses to model the odds of visiting the ED for NTDCs, relative to other conditions, and odds of visiting the ED multiple times relative to a single time in 2012 for NTDCs. The hospital charges associated with the NTDC ED visits were also examined.ED visits for NTDCs comprised 1.41% of all ED visits in Iowa during 2012 with a mean charge of $557. Of the patients presenting for NTDCs in 2012, 17% presented multiples times. Young adults, Medicaid enrollees or uninsured, and those residing in metropolitan areas had greater odds of presenting to the EDs for NTDCs compared with other conditions, and presenting multiple times to EDs for NTDCs. Those with more chronic conditions also had greater odds of repeatedly visiting the ED for NTDCs.Low-income young adults in Iowa rely on EDs for their dental needs that can have substantial costs. The Dental Wellness Plan (DWP) is intended to facilitate dental care access by providing dental coverage to low-income Iowans. This study provides baseline data that will be used to evaluate the success of DWP in improving access to dental care.

Background Few studies have used insurance claims data to retrospectively assess the natural history—a natural process or flow of events without any special interventions—and treatment outcomes of teeth with dental sealants. Methods The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996–2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars. Results Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care. Conclusions Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations. Clinical Implications Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

Background The authors conducted a study to evaluate whether administrative changes, including higher fee schedules for dental services in the Indiana dental Medicaid program and the State Children's Health Insurance Program (SCHIP), were associated with improved dentist participation and utilization of dental services by children. Methods The authors evaluated dentists' participation and children's use of services for the two years before fees were increased to 100 percent of the 75th percentile of usual and customary fees, compared with two years after the increase. They obtained administrative data from the Indiana Department of Family and Social Services Administration and the Indiana Department of Public Health to determine participation rates and service use. Results The number of dentists seeing a Medicaid-enrolled child increased from 770 in fiscal year (FY) 1997 to 1,096 in FY 2000. The number of Medicaid-enrolled children with any dental visit increased from 68,717 (18 percent) to 147,878 (32 percent), with little difference between children enrolled through the Medicaid-SCHIP and traditional Medicaid programs by FY 2000. The mean number of visits per child per year and the mean number of procedures per child per year remained relatively constant. The cost per enrolled child increased from $1.70 to $6.70 per month, while the cost per child with a visit increased from $9 to $21 per month. Conclusion The increase in fees and changes in administration of the Indiana dental Medicaid program were positively associated with improved dentist participation and children's use of dental services. Practice Implications Changes beyond increasing fees to 100 percent of the 75th percentile may be needed if Medicaid-enrolled children are to have access to dental care commensurate with their lower oral health status and greater need for services. Sustained fee increases also are important. As of 2003, no increase in dental fees had occurred in the Indiana Medicaid program since the increase in FY 1998.

Knowledge concerning risk factors for primary dentition caries in young children is incomplete. Models are presented for caries development using longitudinally gathered fluoride exposure and dietary intake data in the Iowa Fluoride Study. Primary tooth caries examinations were conducted at age 5. Dietary (beverage) and fluoride exposure data were gathered longitudinally from age 6 weeks through 4 years (n = 291); 23% had decayed or filled surfaces. Logistic regression revealed that beverage components and toothbrushing made unique contributions to caries experience. Water consumption (36–48 months), milk consumption (24–36 months), and fluoridated toothpaste brushings (36–48 months) were negatively associated with caries; sugared beverages and milk (6 weeks to 12 months) were positively associated. Although fluoride exposure is important, sugared beverages contribute substantially to caries risk, while water and milk consumption and frequent toothbrushing early can have protective effects.

Far too often a less-than-optimal esthetic result occurs after orthodontic treatment due to demineralization of enamel adjacent to fixed orthodontic appliances in patients with inadequate oral hygiene. In vitro studies have shown that a resin-modified glass ionomer (RMGI) cement and a fluoride varnish might help clinicians combat this problem. The purpose of this study was to evaluate, in vitro, the effect of a fluoride-releasing cavity varnish on inhibition of enamel demineralization adjacent to orthodontic brackets bonded with RMGI and composite resin cements. Brackets were bonded to 48 extracted human third molars. Half were bonded with a composite resin (Transbond, 3M Unitek, Monrovia, Calif) and half with an RMGI (Fuji Ortho LC, GC America, Alsip, Ill). Each group was further divided into 2, with half receiving an application of fluoride-releasing varnish (Duraflor, Pharmascience, Montreal, Quebec, Canada). The samples were cycled in an artificial caries solution for an hour twice daily for 31 days. After each caries challenge, the teeth were brushed with a soft toothbrush to simulate normal mechanical wear of the varnish. The loss of fluoride varnish was timed. Teeth were sectioned longitudinally and photographed under polarized light microscopy. Mean lesion depth was measured, and analysis of variance (ANOVA) (P

– Objectives: Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis. Methods: As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4–7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data. Results: Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant. Conclusions: Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.

The Affordable Care Act is predicted to increase dental benefits coverage for millions of Americans. Utilization of expanded function dental auxiliaries (EFDAs) can contribute to increased workforce capacity. Iowa currently allows EFDAs to perform certain nonrestorative procedures. This study investigated dentists' willingness to use auxiliaries for restorative procedures in order inform recent discussions about expanding scope of practice for EFDAs to include such procedures.This study examined responses from 677 primary care dentists who responded to the 2013 Survey of Iowa Dentists (response rate = 59 percent). The authors performed univariate and bivariate analyses (χ(2) and t-tests) to examine characteristics of dentists who indicated willingness to utilize an auxiliary for newly proposed restorative functions.Thirty-seven percent of respondents indicated they would delegate at least one of the newly proposed restorative functions to an auxiliary. Pediatric dentists were significantly more likely to be willing to delegate (P = 0.042). Placing stainless steel crowns was most acceptable (31.9 percent of respondents), followed by amalgam restorations (22.3 percent), and composites (18.6 percent).Many dentists are willing to delegate reversible restorative procedures. Increasing scope of practice for auxiliaries may increase capacity of the existing dental workforce and improve access for newly insured populations. Expanding scope of practice for dental auxiliaries offers a viable mechanism to rapidly increase states' dental capacity in response to rising demands for dental care, including newly insured Medicaid populations.

Objectives Dental fluorosis prevalence has increased in the United States, Canada, and other nations due to the widespread availability of fluoride in many forms, with fluoride ingestion during the first three years of life appearing most critical in fluorosis etiology. With few contemporary studies of fluoride ingestion in this age group, the purpose of this paper is to describe patterns of estimated fluoride ingestion from birth to 36 months of age from water, dentifrice, and dietary fluoride supplements and combined. Methods Repeated responses to separate series of questions about water intake, use of fluoride dentifrice, and use of fluoride supplements were collected by questionnaire as part of the longitudinal Iowa Fluoride Study and used to estimate fluoride intake. Estimated intake is reported by source and combined at different ages. Effects of subject age and other covariates on fluoride intake were assessed using regression methods appropriate for the analysis of correlated data. Results For most children, water fluoride intake was the predominant source, especially through age 12 months. Combined daily fluoride intake increased through 9 months, was lower at 12 and 16 months, and increased again thereafter. Mean intake per unit body weight (bw) was about 0.075 mg F/kg bw through 3 months of age, 0.06 mg F/kg bw at 6 and 9 months, 0.035 mg F/kg bw at 12 and 16 months, and 0.043 mg F/kg bw from 20-36 months. Depending on the threshold chosen (e.g., 0.05 or 0.07 mg F/kg bw), variable percentages of the children exceeded the levels, with percentages greatest during the first 9 months. Regression analyses showed fluoride intake (mg F/kg bw) from 1.5-9 months to decrease with increasing child's age, mother's age, and mother's education, with a complex three-way interaction among these factors. From 12-20 months, fluoride intake increased with increasing child age and decreased with increasing mother's age. No statistically significant relationships were found for fluoride intake from 24-36 months. Conclusions There is considerable variation in fluoride intake across ages and among individuals. Longitudinal studies may be necessary to fully understand the relationships between fluoride ingestion over time and development of fluorosis.

Objectives This paper presents data on the prevalence of primary tooth fluorosis among children residing in Iowa, and the relationships between fluorosis prevalence and selected measures of fluoride exposures. Methods Children in the study cohort were followed prospectively during the first year of life. This study assessed their home water fluoride concentrations and use of fluoride dentifrice or dietary fluoride supplements. A total of 637 children (320 females and 317 males) were examined for fluorosis using a modification of the TSIF index at age 4 1/2 to 5 years, with 90.4 percent having intact primary dentitions. Results 74 children (11.6%) had fluorosis present on one or more of their primary teeth, and 71 children (11.1%) had two or more teeth affected. Nearly all fluorosis was mild, with the primary second molar teeth most commonly affected. Fluorosis was significantly associated with higher water fluoride concentration, but not with the use of dentifrice or fluoride supplements. Conclusions The results of this study show that primary tooth fluorosis is relatively uncommon, but is most frequently seen on the posterior teeth, particularly the primary second molars, which form at later stages of development. This finding suggests that primary tooth fluorosis is mostly a postnatal phenomenon, and is associated with higher water fluoride levels.

The authors clinically examined two restorative materials to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries.Forty subjects, each in need of two Class II restorations in primary molars, took part in this study. Each patient received one Class II restoration of resin-modified glass ionomer cement and one of amalgam. The authors evaluated the restorations at six-month, one-year, two-year and three-year recall appointments. On exfoliation, teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins.The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations (P.05). Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam (P.0001).The resin-modified glass ionomer cement functioned clinically as well as amalgam for Class II restorations in primary molars. However, the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam.Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam.

The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis.A conjoint survey was completed by 723 members of the American Academy of Pediatric Dentistry. Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios.Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists' decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (-0.09) and age 6 (-0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (-0.119).Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.

In 2007, the University of Iowa's advanced training program in pediatric dentistry replaced the traditional formocresol vital pulpotomy technique with a 5% sodium hypochlorite (NaOCl) technique. The purpose of this study was to evaluate the clinical/radiographic success over 21 months of 5% NaOCl as the medicament in primary molar pulpotomies compared to published data for formocresol and ferric sulfate pulpotomies.A retrospective chart audit was performed to evaluate results for all primary molar pulpotomies completed during a 12-month period using NaOCl. Dental records were reviewed for clinical and radiographic findings subsequent to pulp therapy. Clinical and radiographic criteria used to determine pulpotomy success were based on scientific literature.One hundred ninety-two NaOCl primary molar pulpotomies were completed in 118 patients; 131 (68%) primary molars from 77 children were available for follow-up examination (mean time since pulpotomy=10.5 months). NaOCl pulpotomies had a 95% clinical and 82% overall radiographic success rate. External root resorption was the most common pathologic finding. Pulpotomy success diminished over time.Clinical and radiographic success rates in this study on NaOCl pulpotomies are comparable to formocresol and ferric sulfate pulpotomies reported in the literature. Further study with longer observation periods is warranted.

Objectives: The “optimal” intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight (mg F/kg bw) but is based on limited scientific evidence. The purpose of this paper is to present longitudinal fluoride intake data for children free of dental fluorosis in the early-erupting permanent dentition and free of dental caries in both the primary and early-erupting permanent teeth as an estimate of optimal fluoride intake. Methods: Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks; 3, 6, 9, 12, 16, 20, 24, 28, 32, and 36 months; and then at 6-month intervals thereafter. Estimates of total fluoride intake at each time point were made by summing amounts from water, dentifrice, and supplements, as well as other foods and beverages made with, or containing, water. Caries data were obtained from examinations of children at ages 5 and 9 years, whereas fluorosis data were obtained from examinations of children only at age 9 years. Results: The estimated mean daily fluoride intake for those children with no caries history and no fluorosis at age 9 years was at, or below, 0.05 mg F/kg bw for nearly all time points through the first 48 months of life, and this level declined thereafter. Children with caries had generally slightly less intakes, whereas those with fluorosis generally had slightly higher intakes. Conclusions: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an “optimal” fluoride intake is problematic.

The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n = 1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.

The purpose of this study was to conduct a secondary data analysis of results from a 1985 survey of La Leche League International (LLLI) members to further investigate the relationship between breast-feeding and caries prior to age 3 (CPA3).Subjects were 576 LLLI mothers who responded to a 23-item questionnaire concerning the following factors for their oldest child: (1) breast-feeding habits; (2) fluoride status; (3) use of antibiotics; (4) carbohydrate ingestion; (5) history of caries; and (6) oral hygiene practices.CPA3 was reported in 10% of all children breast-fed for more than 3 years. Later weaning was found to be significantly associated with CPA3 (odds ratio [OR]=2.03; P=.0001). Late initiation of oral hygiene was marginally associated with CPA3 (OR=0.77; P=.08). Among children who developed CPA3, bivariate analyses found a greater frequency of breast-feeding (P=.012) and presence of night-time breast-feeding (P=.049) to be associated with caries detected at an earlier age. Children with caries on their maxillary incisors were more likely to have been breast-fed at night (P=.027) and more frequently during the night (P=.032).This retrospective study, based on a report of La Leche League International members, found later weaning to be significantly associated with an increased likelihood of developing CPA3.

A survey of 121 pediatric cardiology clinics investigated the current practices and attitudes toward oral health education and oral screenings in pediatric cardiology clinics for patients susceptible to infective endocarditis. Most pediatric cardiology clinics do not provide oral health education and oral screenings, but believe it would be beneficial.

The purpose of this study was to determine if a relationship existed between a mother's perception of her child's temperament and the child's risk factors for early childhood caries (ECC).Data was collected from 629 records of children ages 0 to 4 who were patients of the University of Iowa's Infant Oral Health Program. Data included: (1) maternal report of child's temperament; (2) knowledge of ECC; (3) dietary and oral hygiene habits; and (4) clinical evidence of cavitated and noncavitated lesions and visible plaque on maxillary incisors. Chi-square tests and logistic regression models were used to analyze the data.Bivariate analyses showed that children reported as "easy" were more likely to: (1) be younger (P=.001); (2) be breast-fed to sleep (P=.046); (3) be breast-fed throughout the night (P=.012); and (4) have their teeth brushed twice daily (P=.006). Children reported as "difficult" were more likely to: (1) be bottle-fed to sleep (P=.002); and (2) have noncavitated lesions (P=.044). Final logistic regression analysis indicated that children perceived as "easy" were more likely to breast-fed throughout the night (odds ratio [OR]= 1.77; P=.016), while those perceived as "difficult" were more likely to be bottle-fed to sleep (OR=1.74; P=.016).Maternal reported child temperament may be related to important early childhood caries risk factors.

This prospective longitudinal study compared the patterns of oral health behaviors between low and high socioeconomic status (SES) families participating in the Iowa Fluoride Study for a period of 9 years.Information on oral health behaviors, including consumption of juices/juice drinks, soda pop, and powder-based drinks, dental visits, and tooth-brushing frequency, was collected longitudinally at periodic intervals from 6 to 108 months of age. Dental exams were conducted at 5 and 9 years of age. Classification of low socioeconomic status (SES; n=70) and high-SES (n= 128) children was based on baseline family income and mothers' education levels, with middle SES excluded.Low SES children consistently had significantly greater consumption of soda pop and powder-based beverages. There were, however, virtually no differences at any time point between groups in: (1) tooth-brushing frequency; (2) use of dentifrice; or (3) fluoride concentration in drinking water. Furthermore, the mean number of decayed and filled surfaces was significantly higher in the low-SES group.Results suggest that beverage consumption patterns are a key difference between high- and low-socioeconomic status families and could in part explain differences in caries experience between subjects of different SES. Modification of the pattern of soda pop and powder-based beverage consumption in the low-SES groups might reduce their caries experience.

The purpose of this study was to assess Iowa general dentists regarding the age 1 dental visit.A 15-item survey was mailed to 1,521 licensed dentists to address their knowledge, attitudes, and behavior regarding the age 1 dental visit. Chi-square statistics and logistic regression models were used to analyze data.Seven hundred fifteen (47%) useable surveys were returned from 2 mailings. Five hundred forty (76%) general dentists were familiar with the American Academy of Pediatric Dentistry (AAPD) age 1 dental visit recommendation. Most reported obtaining this information through continuing education (37%). Eleven percent believed the first dental visit should occur between 0 and 11 months of age, and 66% reported seeing children younger than 2. "Prefer to refer infants to a pediatric dentist" (20%) was the most common reason for not seeing children 0 to 23 months old. Bivariate and multivariate logistic regression analyses indicated that dentists who believed children should have their first dental visit at 0 to 23 months and those willing to see children at age 0 to 23 months were younger, more recent graduates, more likely to be female, aware of the AAPD recommendations, and were already seeing children 0 to 23 months.The majority of Iowa general dentists are aware of the AAPD age 1 dental visit recommendation.

Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors.Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type.Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer.Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants.The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars.Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care.Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations.Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.

The authors conducted a study to evaluate whether administrative changes, including higher fee schedules for dental services in the Indiana dental Medicaid program and the State Children's Health Insurance Program (SCHIP), were associated with improved dentist participation and utilization of dental services by children.The authors evaluated dentists' participation and children's use of services for the two years before fees were increased to 100 percent of the 75th percentile of usual and customary fees, compared with two years after the increase. They obtained administrative data from the Indiana Department of Family and Social Services Administration and the Indiana Department of Public Health to determine participation rates and service use.The number of dentists seeing a Medicaid-enrolled child increased from 770 in fiscal year (FY) 1997 to 1,096 in FY 2000. The number of Medicaid-enrolled children with any dental visit increased from 68,717 (18 percent) to 147,878 (32 percent), with little difference between children enrolled through the Medicaid-SCHIP and traditional Medicaid programs by FY 2000. The mean number of visits per child per year and the mean number of procedures per child per year remained relatively constant. The cost per enrolled child increased from dollars 1.70 to dollars 6.70 per month, while the cost per child with a visit increased from dollars 9 to dollars 21 per month.The increase in fees and changes in administration of the Indiana dental Medicaid program were positively associated with improved dentist participation and children's use of dental services.Changes beyond increasing fees to 100 percent of the 75th percentile may be needed if Medicaid-enrolled children are to have access to dental care commensurate with their lower oral health status and greater need for services. Sustained fee increases also are important. As of 2003, no increase in dental fees had occurred in the Indiana Medicaid program since the increase in FY 1998.

The purpose of this report was to describe the quantity of published literature and types of studies supporting the use of 4 pediatric dentistry procedures: (1) ferric sulfate pulpotomy; (2) stainless steel crowns; (3) space maintainers; and (4) atraumatic restorative technique (ART).When available, titles and abstracts of reports written in English and published over a 36-year period (1966-2002) concerning these procedures were retrieved from MEDLINE. They were classified using a modified classification scheme that, in addition to the study designs, also considered the 4 dimensions of measuring dental outcomes.The quantity of available literature concerning each dental procedure varied considerably. Even though many reports were published on treatments, only a small proportion of the published literature for each procedure was found to evaluate outcomes, regardless of outcome dimension. Besides outcomes evaluations, studies on techniques, material properties, and review articles comprised a large proportion of the literature. Clinical dimension of outcomes was most commonly studied. Case series and case reports were the most frequently used study designs to report outcomes.The outcomes-related literature to support some of the commonly performed treatments is limited both in quantity and study types. More reports are needed to develop the evidence base to support the commonly performed procedures in pediatric dental practice. Additional analyses reporting of the literature are also needed to assess internal and external validity of the studies.

Objectives Very little independent research has been done on the new self-etching primer/adhesives in dentistry. A recent clinical study compared two sealant application techniques involving self-etching primer adhesives and the traditional phosphoric acid etch. The purpose of this study was to compare these two techniques in an Iowa school-based sealant program. Methods Twelve-month sealant retention data on 208 students from the Des Moines, Iowa, school-based sealant program were analyzed retrospectively. Results Sealant retention reported at the person level showed that 60 percent of the students who received sealants at the five schools had to be recalled at one year to have one or more surfaces resealed. A logistic regression model at the person level demonstrated that the phosphoric acid technique was six times as likely to have retention of all the sealed tooth surfaces as those sealed with Prompt-L-Pop. Conclusions In this study, many students had to be recalled to the chair 12 months after sealant application due to incomplete retention. Though sealants were retained in larger numbers with phosphoric acid, overall sealant retention at the tooth level was lower than previously published for clinical studies and school-based programs. Examining retention data at the person level, however, allows program administrators to plan resources more effectively and reevaluate sealant protocol to ensure as few children return for sealant reapplication.

Background As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children. Methods The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years. Results The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth. Conclusion Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children. Practice Implications Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

The purpose of this study was to report the occurrence of having a dental visit and/or a topical fluoride treatment from age 36 months to 72 months among a cohort of children followed longitudinally since birth.Families of children enrolled in a study of fluoride ingestion were asked about their children's dental appointments and office fluoride treatments occurring during the time interval since the previous mailed questionnaire. Percentages of children who had at least 1 dental visit and at least 1 fluoride treatment during each 6-month period, each year of life, and cumulatively from birth were calculated separately. Factors related to dental visits were assessed using generalized linear models.Among those with complete data, 71% reported a visit cumulatively from birth to 48 months, 89% from birth to 60 months, and 96% by age 72 months. Similarly, 27% reported a professional fluoride treatment by 48 months, 44% by 60 months, and 66% by 72 months.Among children who had not been seen by a dentist by age 3, almost all were seen by age 6. Similarly, among those who had no professional fluoride treatment by age 3, almost two-thirds received one by age 6.

This study assessed the relationship between interdental spacing patterns and caries experience in the primary dentition.Caries examinations were conducted amoung 356 children 4 to 6 years of age. At the time of the examinations, alginate impressions were obtained and poured in yellow stone. From the stone casts, each interdental area was categorized as: (1) space1 mm, (2) space1 mm, (3) no space, teeth in contact, or (4) no space, teeth overlapped. These categories were collapsed into presence or absence of space for each interdental site, and counted for each individual. Analyses assessed the relationships between interdental spacing and caries experience with separate analyses for anterior spacing, posterior spacing and total spacing.Children with more total interdental spaces had less decay experience and less untreated decay than children with fewer interdental spaces, and children with more molar spacing had less molar decay experience; however, these relationships were weak. Correlation analyses demonstrated significant relationships between number of decayed surfaces and total number of interdental spaces (r=-0.11, P=.04) and number of molar sites with interdental spaces (r=-0.13, P=.02). Multivariate analyses revealed the total number of interproximal spaces to be weakly associated with interproximal caries experience, but that fluoride exposure was a much stronger predictor.Absence of interdental spaces is weakly associated with greater decay experience in the primary dentition.

The seriousness and societal costs of dental caries in preschool children are enormous. National data shows that caries is highly prevalent in poor and near poor US preschool children, yet this disease is infrequently treated. The etiology includes elevated colonization levels of mutans streptococci, high frequency sugar consumption, and developmental defects on primary teeth. A necessary first step in preventing dental caries in preschool children is evaluating the child's caries risk factors that include socioeconomic status, previous carious experience, presence of white spot lesions, presence of visible plaque, perceived risk by dental professionals, and microbiologic testing for the presence or quantity of mutans streptococci. Based on this knowledge, different preventive strategies, as well as different intensities of preventive therapies, can be employed. Caries preventive strategies in preschool children include diet modifications to reduce high frequency sugar consumption, supervised tooth brushing with fluoridated dentifrice, systemic fluoride supplements to children living in a nonfluoridated area that are at risk for caries, professional topical fluoride with fluoride varnish, and sealants for primary molars.

It is commonly believed that teething in infants can cause a variety of signs and symptoms. Previous studies have suggested an association between teething and fever, irritability, drooling, rashes, vomiting, diarrhea, night crying, and convulsions.The objective of this study was to evaluate differences in the beliefs of pediatricians, pediatric dentists and parents regarding symptoms caused by teething in infants.A survey consisting of demographic information and questions concerning commonly reported symptoms associated with teething was administered to 100 randomly selected Iowa pediatricians, all practicing pediatric dentists in Iowa (n = 33) and a convenience sample of 120 parents from the greater Iowa City area. Responses were analyzed using the Chi-square test.Response rates for each group were: pediatricians 45%; pediatric dentists 76%; and parents 50%. The majority of individuals in each group believed that teething in infants can cause swollen gums, drooling, irritability, inflamed gums, restlessness, sleeplessness, and fever. There were significant differences in the percent of agreement relating to drooling (p = 0.001), inflamed gums (p = 0.001), and sleeplessness (p = 0.027). A greater percentage of pediatric dentists and parents agreed that these symptoms were caused by teething than did pediatricians. The largest difference between groups was related to the association between teething and diarrhea. The majority of parents (56.7%) and pediatric dentists (52.0%) believed that diarrhea is associated with teething compared to just 9.1% of pediatricians.These results support the hypothesis that differences regarding beliefs about teething symptoms exist between parents, pediatricians, and pediatric dentists. There is more agreement between parents and pediatric dentists than between either of these groups and pediatricians.

Few studies in North America have assessed dental fluorosis of the primary dentition and few, if any, anywhere have assessed the relative importance in fluorosis etiology of fluoride intake during different time periods or from multiple sources. The purpose of this paper is to report on analyses relating estimated prenatal fluoride intake and fluoride intake during different parts of the first year of life to primary tooth fluorosis.As part of The Iowa Fluoride Study, subjects were recruited at birth and studied longitudinally. Trained examiners assessed dental fluorosis for children aged 4-7 years using the Tooth Surface Index of Fluorosis (TSIF) adapted for the primary dentition. Detailed parent questionnaires at childbirth were used to estimate prenatal fluoride intake and questionnaires sent at 6 weeks and 3, 6, 9, and 12 months were used to estimate fluoride intake during the first year of life (combined fluoride intake from water, food and beverage, supplements, and dentifrice). There were 504 children with prenatal and at least four of the five postnatal responses with complete data.Fluorosis prevalence was 12.1%, occurring primarily on the second primary molars. Receiver operating characteristic (ROC) curves and logistic regression were used to assess the importance of different time periods' fluoride intake. In bivariate analyses, fluoride intake during each time interval was individually significantly related to fluorosis occurrence. For multivariate analyses, the period from 6 to 9 months was most important individually (P = 0.0001), and no other period was jointly statistically significant.Results suggest that the middle of the first year of life is most important in fluorosis etiology for the primary dentition in this setting.

Background Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later caries experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. Methods As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2-3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n = 67) of these children. Results Interexaminer agreement for any d1 and any d2-3 lesions at the person level was 100 percent. At the tooth level for d1d2-3f, there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa = .24. For d2-3 it was 99.4 percent agreement and kappa = .81. Prevalence of untreated d2-3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2-3 or filled surfaces, while over 63 percent had no d1, d2-3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2-3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. Conclusion Despite some concern with reliability of diagnosing d1 lesions, it appears that the d1d2-3 criteria are informative and useful in assessing the primary dentition.

The purpose of this study is to report the prevalence of having a dental visit and/or a topical fluoride treatment at the dental visit from birth to age 36 months from an observational, longitudinal study of a cohort of children followed since birth.Multiple questionnaires were sent to the families of children enrolled in a study of fluoride ingestion to ask parents if their child had had a dental (or dental hygiene) appointment and/or a fluoride treatment during the time interval since the previous mailed survey. Data were analyzed to determine the percentages of children who had at least one dental visit or at least one fluoride treatment by one, two or three years of age.Three hundred and forty parents completed all eleven questionnaires during the 36-month study period. Of these, 2% reported having taken their child for a dental visit by one year of age, 11% by two years of age and 31% by three years of age. Of those with a visit by three years of age, 19% received at least one fluoride treatment.Despite recommendations for early dental visits, only 31% of the children in this cohort had been seen by a dentist by the time they reached their third birthday and 19% of these had received a professional fluoride treatment.

Objective This study compared time required and 12-month retention for two methods of sealant placement: traditional acid-etch technique and air-abrasion technique without acid etch. Methods Sealants were placed on the permanent first molars of 84 children in grades 1-4 who were randomly assigned to treatment groups. All sealants were placed in a school setting by the same clinician. Chair time required for sealant placement was recorded, and retention rates were determined for each technique 12 months after placement. Results Mean chair time for placement of sealants on four first molars using the air-abrasion technique was significantly less than for the acid-etch technique (7:36 minutes vs 10:56 minutes). Fifty-eight children were available at 12-month follow-up; an examiner not involved in sealant placement and masked as to the technique used determined retention. Rates of complete retention for occlusal surfaces were not significantly different for the two techniques, although the rate for acid etch was higher than that for air abrasion (95% vs 87%). The complete retention rates for the acid-etch technique were significantly higher than air abrasion for buccal and distolingual surfaces. These rates were 65 percent and 58 percent, respectively, for acid etch and 6 percent and 28 percent, respectively, for air abrasion. Conclusion Although more research is needed to improve air-abrasion applications, it does not appear that air abrasion without acid etching offers a significant advantage over traditional sealant placement methods and, in fact, appears to be inferior to the acid-etch technique for use in public health settings.

Background The prevalence of fluorosis of the permanent teeth has increased during the past few decades in the United States and Canada. However, primary-tooth fluorosis has been largely overlooked, because it is often difficult to recognize. This article describes primary-tooth fluorosis, both as characterized in the literature and as seen clinically. Methods The authors review and summarize previous studies of primary-tooth fluorosis and discuss its etiology. In addition, the authors describe the condition, based on findings from the literature, and their own experiences in characterizing it as part of a longitudinal investigation of fluoride exposures, dental fluorosis and dental caries. Results Several studies indicate that primary-tooth fluorosis can be prevalent and severe in areas of very high water fluoride concentrations. In these areas, primary-tooth fluorosis is likely the result of both pre-and postnatal exposures. Studies have documented that primary-tooth fluorosis does occur in areas with optimal or suboptimal water fluoride concentrations, and that in these settings primary-tooth fluorosis is most likely caused by postnatal exposures and is seen most commonly in the primary molars. Primary-tooth fluorosis, however, is often more difficult to identify than fluorosis in permanent teeth, and clinicians may be unfamiliar with its characteristics and may not recognize its somewhat subtle appearance. Conclusion Primary-tooth fluorosis may be related to occurrence of fluorosis in the permanent dentition, so that its recognition by the clinician should raise awareness of possible increased risk for the permanent dentition. Clinical Implications The detection of primary-tooth fluorosis in a young child should prompt the clinician to carefully review the child's past fluoride exposures and current fluoride practices, as well as those of any younger siblings.