Sarvas, Elise

Background/Objectives: The purpose of this study is to assess whether the addition of an oxymetazoline (OXY) hemostatic solution, which can be used to manage pulpal bleeding, maintains higher MTA survivability than pulpotomies treated with FS. Methods: In this retrospective cross-sectional study, patient data (n = 75) were used to assess radiographic and clinical signs and symptoms of pathosis in primary molars treated with a pulpotomy and a stainless-steel crown. Pulpotomies treated with FS (Group 1) were compared to those treated with MTA with OXY-induced hemostasis (Group 2). Restricted mean survival times (RMSTs) were calculated for the two groups, and Cox proportional hazards regression was used to analyze the effects of patient and practice level covariates on radiographic and clinical pathosis. Results: Cox proportional-hazard regression identified three potential covariates (age, pulpotomy groups, and procedure location) that predicted radiographic pathosis. The adjusted hazard ratio for Group 2 was 0.30 (95% CI: 0.11–0.82), indicating improved radiographic outcomes compared with Group 1 (p = 0.02). The 36-month RMST for Group 2 was 30.1 months (95% CI: 26.5–33.7) compared to 24.7 months (21.6–27.8) for Group 1 (p = 0.025). Conclusions: A pulpotomy utilizing OXY hemostasis prior to MTA placement led to a higher chance of pulpotomy survival than FS.

Background: Graduates of U.S. dental schools must meet curriculum and competency requirements set by the school and by the Commission on Dental Accreditation. Little is known about the impact of this training on recent alumni in practice. This cross-sectional study surveyed recent alumni about their preparedness and comfort in treating the oral health needs of children before and after a curriculum change in the predoctoral pediatric dental clinical course. Results were used to inform future curriculum improvement. Methods: Five classes of dental school alumni were surveyed at least 6 mo after graduation. Information about their practice setting, patient pool demographics, comfort and preparedness in diagnosing and treating common pediatric oral health conditions, and open-ended thoughts on caring for the oral health needs of children were obtained. Responses were analyzed before and after a curriculum change that introduced predoctoral students to patient care in the graduate pediatric dental clinic. Results: Electronic and mailed paper surveys were sent to 552 alumni, with 218 (39.3%) returned. A majority (91.1%) reported seeing pediatric dental patients in practice. There was no difference in the incidence of seeing pediatric patients before or after the curriculum change. Participants reported high comfort and confidence in diagnosing pediatric oral health conditions, and there were no significant differences seen pre or post intervention. Conclusions: Surveyed alumni reported similar comfort levels in diagnosing and treating common pediatric oral health conditions both before and after the curriculum change. General dentist alumni still struggle with recommending that the first dental visit happen at the eruption of the first tooth or the child’s first birthday. More information is needed to assess how to educate competent clinicians in a predoctoral setting. Knowledge Transfer Statement: The recommendations from this article can be used by dental educators to improve clinical and didactic teaching and to ensure dental learners’ education and competency.

Background: U.S. dental school graduates must complete competencies in oral health care across the life course. While they have met these requirements, little is known about graduates’ assessment of how this training prepared them for practice. Future practice setting may affect the training needs of dental school graduates. This quality improvement survey looked at alumni narratives regarding their predoctoral training in pediatric dentistry, the adequacy of this training, how practice setting influenced their training needs, and what recommendations they would make for curriculum change. Methods: As part of a larger survey, semi-structured interviews were conducted of 14 recent alumni in general dental practice; the questions covered their graduation year, current practice setting, recollection of their predoctoral pediatric dental training, the adequacy of that training, and recommendations on how to prepare future graduates to care for pediatric dental patients. Interviews were transcribed and assessed for these themes. Results: Half of the practitioners were in private practice, and half worked in rural or community clinics. Recent alumni felt comfortable and confident treating the oral health needs of a pediatric population but overwhelmingly said that they wanted more hands-on experience in dental school. They especially highlighted the need to see patients with challenging behavior and more complex operative treatment needs. Alumni working in rural areas or community clinics emphasized the need for these skills because of the lack of referral options. Conclusions: Recent alumni wish they had had more hands-on pediatric dental experiences in dental school to better prepare them for the challenges they face in practice. These experiences may be limited, and one suggestion would be to channel these opportunities to practitioners who will work in areas where there are insufficient resources and fewer options for referral. Knowledge Transfer Statement: The recommendations from this article can be used by dental educators to improve clinical and didactic teaching and to ensure dental learners’ education and competency.

Objective Identify sociodemographic factors and comorbidities predictive of nasoalveolar molding (NAM) treatment completion and noncompletion in infants with cleft lip with or without (+/–) cleft palate in a rural-suburban population. Design Retrospective cohort study. Setting Tertiary medical center. Patients, Participants Infants diagnosed with cleft lip +/- cleft palate who initiated NAM treatment between 2013 and 2023. Forty-seven patients met inclusion criteria. Main Outcome Measure(s) Prevalence of NAM treatment completion, defined as continued attendance of NAM appointments until initial lip repair surgery. Results NAM treatment noncompletion rate of 23.4%. Noncomplete NAM treatment was associated with greater additional unscheduled NAM visits ( P < .001); increased days inpatient after birth ( P < .001); NICU admission ( P < .001); public insurance ( P = .007); preterm birth ( P = .008); history of social work visits ( P = .024); increased comorbidities ( P = .028); non-Caucasian race ( P = .034); and presence of siblings ( P = .036). Associated comorbidities included use of feeding tube ( P < .001); and conditions related with renal ( P < .001); cardiac ( P = .004); failure to thrive ( P = .009); syndromes ( P = .009); orthopedic ( P = .011); pulmonary ( P = .022); and ophthalmologic systems ( P = .041). Conclusions Increased overall health complexity, public insurance status, and need for social work support were identified as factors associated with NAM noncompletion. These variables can help identify patients at risk of noncompletion and empower providers to supply individualized support and resources.

Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child’s dental home, and advocating for safe and accessible dental procedures.