Resident’s Name: Jessica Wilson
Article title: Survey of Oral Helath Knowledge and Behavior of Pregnant Minority Adolescents
Author(s): Fadavi et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2009. 31:5. 405-408.
Major topic: Pregnant Adolescents
Overview of method of research: Survey
Background:
Studies have shown that periodontal disease is a clinically significant risk factor for preterm low birth weight babies. Many women may be unaware of this correlation. In one study the most common periodontal finding in pregnant women was gingivitis due to plaque accumulation and periodontal status was significantly associated with smoking, insurance status and race with African-Americans and Hispanic-Americans experiencing higher rates than Caucasians.
Purpose:
To compare dental visits and oral health knowledge of African-American (AA) and Hispanic-American (HA) adolescents in a community health clinic.
Methods:
Subjects were between the ages of 12 and 20 who were pregnant within one year of the study and were patients of a community health center were given a questionnaire. The questionnaire contained 21 questions about demographics, dental behaviors and dental knowledge. 50 AAs and 61 HAs were used for analysis.
Results:
There were no significant differences in age, number of pregnancies, education level or employment status. There was a significant difference of 85% AAs and 60% HAs who used public assistance to pay for dental care. 31% of HAs and only 8% of AAs were self-pay. AAs were more likely to live with their parents or family while the HAs were more likely to live with their boyfriends/husbands. HAs were found to floss more than AAs, while AAs reported flossing more than HAs. Both groups were not likely to receive regular dental care while pregnant. Both groups had similar oral health knowledge, however HAs were more likely to know about the association between pregnancy and gingivitis.
Key points/Summary:
The younger the pregnant adolescent, the more likely they were to utilize dental care during pregnancy.
The subjects who had had previous dental visits were 13.6 times more likely to visit the dentist while pregnant.
The odds of a pregnant adolescent living with a husband/boyfriend visiting the dentist while pregnant were 4.4 times higher than those who did not.
Assessment of Article:
This was a simple questionnaire study with a low sample size, but some interesting enough findings.
Tuesday, May 31, 2011
Tuesday, May 24, 2011
The Childhood Obesity Epidemic: A Role for Pediatric Dentists?
Resident: Cho
Author(s): Vann et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2005. 27:271-276.
Major topic: Childhood Obesity
Type of Article: Literature Review
Main Purpose: Review the causes of childhood obesity, discuss relevance of obesity to dental health and disease, and highlight some of the actions pediatric dentists should take.
Key points:
Obesity is defined as an excess amount of body fat in proportion to lean body mass. BMI is calculated by the person’s weight in kg divided by the square of his or height in meters. BMI higher than 30 is considered obese.
8 common sense reasons for childhood obesity was discussed in Sports Illustrated: neighborhoods without sidewalks and parks, fear of childhood abduction, hard-working parents, less children in organized sports, emphasis on test scores, fast food, technology, and family traits.
Finnish study followed 516 children from birth to age 12 and used weight to predict caries experience. They found that obesity alone was not a good predictor of dental decay. Swedish study examined relationship between dental caries and risk factors for atherosclerosis in nearly 200 15-year olds in one small urban community. This study reported that children with DMFT score greater than 9 had a significantly higher BMI than caries-free children.
Recommendations:
AAP has 8 recommendations for Pediatric Dentists:
1. Encourage parents, teachers, coaches, and others who influence the child to discuss health habits.
2. Enlist policymakers to support a healthy lifestyle for children.
3. Encourage organizations responsible for health care to provide coverage for effective obesity prevention and treatment strategies.
4. Encourage public and private sources to fund research on obesity in children.
5. Support and advocate social marketing intended to promote healthy food choices.
Author(s): Vann et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2005. 27:271-276.
Major topic: Childhood Obesity
Type of Article: Literature Review
Main Purpose: Review the causes of childhood obesity, discuss relevance of obesity to dental health and disease, and highlight some of the actions pediatric dentists should take.
Key points:
Obesity is defined as an excess amount of body fat in proportion to lean body mass. BMI is calculated by the person’s weight in kg divided by the square of his or height in meters. BMI higher than 30 is considered obese.
8 common sense reasons for childhood obesity was discussed in Sports Illustrated: neighborhoods without sidewalks and parks, fear of childhood abduction, hard-working parents, less children in organized sports, emphasis on test scores, fast food, technology, and family traits.
Finnish study followed 516 children from birth to age 12 and used weight to predict caries experience. They found that obesity alone was not a good predictor of dental decay. Swedish study examined relationship between dental caries and risk factors for atherosclerosis in nearly 200 15-year olds in one small urban community. This study reported that children with DMFT score greater than 9 had a significantly higher BMI than caries-free children.
Recommendations:
AAP has 8 recommendations for Pediatric Dentists:
1. Encourage parents, teachers, coaches, and others who influence the child to discuss health habits.
2. Enlist policymakers to support a healthy lifestyle for children.
3. Encourage organizations responsible for health care to provide coverage for effective obesity prevention and treatment strategies.
4. Encourage public and private sources to fund research on obesity in children.
5. Support and advocate social marketing intended to promote healthy food choices.
5/24/11 Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs
Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs
Author(s): David Alert, DDS Herbert Severson, PhD, Judy Andrews, PhD
Journal: Ped Dent.
Year. Volume (number). Page #’s: 2006. vol 28 #2. 177-186
Major topic: How we can help stop tobacco use by adol.
Minor topic(s): Health effects of tobacco
Main Purpose: To provide clinicians with info on tobacco and health, the epidemiology of adol tobacco use, and cessation programs for parents and patients.
Overview of method of research: Review
Findings:
The use of tobacco products, particularly smoking represents the leading cause of preventable illness and death in the developed world (this was a question on the boards this year). Major gains have been made to reduce smoking in adults, however similar gains have not been realized in adolescents. Most tobacco users admit to starting when they were an adol. Every year more than 1 million teenagers become habitual smokers. We, as clinicians, should start screening for smoking and tobacco product risk factors at age 10(this was a question on the boards this year). Also, we should encourage parents who smoke to quit smoking. If they cannot or will not quit, we should advice them to not smoke around the kids, to have a smoke free home, and to watch their kids for smoking signs.
Tobacco is bad for you. It can cause a number of cancers, cardiovascular disease, respiratory disease, reproductive complications, etc. Adol who smoke have a reduced rate of lung growth and level of maximum lung function. Exposure to second hand smoke can also hinder lung growth, and increase the incidence of developing lung cancer. Chronic smoking can lead to increased prevalence and severity of perio disease. Studies have shown that approx. 50% of all perio cases can be attributed to smoking. Smoking and smokeless tobacco use can cause the following oral health issues.
1.Loss of taste
2. perio disease
3. stained teeth
4. altered taste perception
5. intraoral lesions
5. gum recession
7. drifting of teeth
8. abrasion to tooth enamel
9. oral malodor
Tobacco use by youths is assoc. with many risk factors, including having parents/friends who smoke, comorbid psych disorders, weight concerns, and ADD.
Tobacco Cessation
The best public health strategy is to prevent tobacco use completely, or to intervene as early as possible. Most cessation programs are implemented by schools and in the community. However, the effectiveness of these programs decrease over time. Dentists are in a unique position of being able to associate cessation advice with readily visible changes in oral health and status. Brief tobacco cessation in the dental office has been found to be effective when directed at adults. Since nearly 75% of all adol see the dentist at least yearly for care, the dental office is the ideal place to implement cessation programs. However, more research is necessary in terms of directing the advice towards adol.
The “5 A’s” is a recommended process that clinicians can follow. They can be applied and completed in up to 3 minutes. However, the adol. Needs to be a willing participant. The five A’s include
1. Ask about tobacco use
2. Advise to quit
3.Asses willingness to quit
4. Assist in quitting
5. Arranging follow up
6. Anticipatory guidance
(Don’t ask me why they call it the “5” A’s, when there are actually 6…)
Various pharmacological therapies have been shown to be effective in tobacco cessation. Bupropion SR, nicotine gums and inhalers and sprays and patches are all available on the market today. The FDA does not condone the use of these drugs in adol, however they are still prescribed to children to aid in cessation. The AAPD does NOT approve of children using these medications (this was a question on the boards this year).
Key points/Summary:
1. Tobacco is bad for you.
2. As physicians, particularly ones who see children multiple times a year, it is our duty to screen for and to assess tobacco use and risk. We should be asking EVERY adol about tobacco use and exposure at every visit.
3. Adol who use tobacco are likely to use it in adulthood
Assessment of Article:
Great conference review. I’m sure all of you ask every adol. You treat about tobacco use every time you see them, I however do not. I need to do a better job, and be more aware of it. In the past tobacco use and cessation programs have been a focus on the boards. It was on the boards this year, but only for a few questions.
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs
Author(s): David Alert, DDS Herbert Severson, PhD, Judy Andrews, PhD
Journal: Ped Dent.
Year. Volume (number). Page #’s: 2006. vol 28 #2. 177-186
Major topic: How we can help stop tobacco use by adol.
Minor topic(s): Health effects of tobacco
Main Purpose: To provide clinicians with info on tobacco and health, the epidemiology of adol tobacco use, and cessation programs for parents and patients.
Overview of method of research: Review
Findings:
The use of tobacco products, particularly smoking represents the leading cause of preventable illness and death in the developed world (this was a question on the boards this year). Major gains have been made to reduce smoking in adults, however similar gains have not been realized in adolescents. Most tobacco users admit to starting when they were an adol. Every year more than 1 million teenagers become habitual smokers. We, as clinicians, should start screening for smoking and tobacco product risk factors at age 10(this was a question on the boards this year). Also, we should encourage parents who smoke to quit smoking. If they cannot or will not quit, we should advice them to not smoke around the kids, to have a smoke free home, and to watch their kids for smoking signs.
Tobacco is bad for you. It can cause a number of cancers, cardiovascular disease, respiratory disease, reproductive complications, etc. Adol who smoke have a reduced rate of lung growth and level of maximum lung function. Exposure to second hand smoke can also hinder lung growth, and increase the incidence of developing lung cancer. Chronic smoking can lead to increased prevalence and severity of perio disease. Studies have shown that approx. 50% of all perio cases can be attributed to smoking. Smoking and smokeless tobacco use can cause the following oral health issues.
1.Loss of taste
2. perio disease
3. stained teeth
4. altered taste perception
5. intraoral lesions
5. gum recession
7. drifting of teeth
8. abrasion to tooth enamel
9. oral malodor
Tobacco use by youths is assoc. with many risk factors, including having parents/friends who smoke, comorbid psych disorders, weight concerns, and ADD.
Tobacco Cessation
The best public health strategy is to prevent tobacco use completely, or to intervene as early as possible. Most cessation programs are implemented by schools and in the community. However, the effectiveness of these programs decrease over time. Dentists are in a unique position of being able to associate cessation advice with readily visible changes in oral health and status. Brief tobacco cessation in the dental office has been found to be effective when directed at adults. Since nearly 75% of all adol see the dentist at least yearly for care, the dental office is the ideal place to implement cessation programs. However, more research is necessary in terms of directing the advice towards adol.
The “5 A’s” is a recommended process that clinicians can follow. They can be applied and completed in up to 3 minutes. However, the adol. Needs to be a willing participant. The five A’s include
1. Ask about tobacco use
2. Advise to quit
3.Asses willingness to quit
4. Assist in quitting
5. Arranging follow up
6. Anticipatory guidance
(Don’t ask me why they call it the “5” A’s, when there are actually 6…)
Various pharmacological therapies have been shown to be effective in tobacco cessation. Bupropion SR, nicotine gums and inhalers and sprays and patches are all available on the market today. The FDA does not condone the use of these drugs in adol, however they are still prescribed to children to aid in cessation. The AAPD does NOT approve of children using these medications (this was a question on the boards this year).
Key points/Summary:
1. Tobacco is bad for you.
2. As physicians, particularly ones who see children multiple times a year, it is our duty to screen for and to assess tobacco use and risk. We should be asking EVERY adol about tobacco use and exposure at every visit.
3. Adol who use tobacco are likely to use it in adulthood
Assessment of Article:
Great conference review. I’m sure all of you ask every adol. You treat about tobacco use every time you see them, I however do not. I need to do a better job, and be more aware of it. In the past tobacco use and cessation programs have been a focus on the boards. It was on the boards this year, but only for a few questions.
Substance Use Disorder (SUD) in Adolescence: A Review for the Pediatric Dentist
Resident: J. Hencler
Date: 05/25/2011
Article title: Substance Use Disorder (SUD) in Adolescence: A Review for the Pediatric Dentist
Author(s): Marcio A. da Fonseca, DDS, MS
Journal: Journal of dentistry for Children-76:3, 2009
Major topic: Substance abuse in adolescents
Type of Article: Literature review
Main Purpose: Review for the pediatric dentist
Key points in the article discussion:
Drug addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use. SUDs are maladaptive patterns of use accompanied by clinically significant impairment or distress, causing reduced functioning in major areas of life, risk-taking behavior, exposure to hazardous situation, and an increase in the likelihood of legal problems due to possession. Adolescents are more vulnerable to the risks of neuropathology as a result of substance abuse b/c their brains are still developing. Neurobiological changes during puberty contribute to 3 behavioral factors that relate to SUD development: 1) increase in peer affiliation; 2) decreased parental monitoring; and 3) risk-taking behaviors. The pediatric dentist is in a good position to help prevent and detect suspicious cases of substance abuse. Patterns of behavior that should raise suspicion include recent/sudden drop in grades, mood changes, school disciplinary action, antisocial behavior, drinking b/f 15 yo, and associating with peers w/ SUD. A good first step is to use the CRAFFT screening tool questions: 1) Ever ridden in a car driven by someone using alcohol/drugs? 2) Do you take drug to relax? 3) Do you take drugs while alone? 4) Do you forget things while using drugs? 5) Do people tell you to cut down on alcohol/drugs? 6) Have you gotten in trouble b/c alcohol/drugs? Drug addiction appears to have fast, severe, and deleterious effects in the oral cavity. Factors that contribute to increased risk of dental disease include: lack of adequate diet, dry mouth induced by drugs, tobacco, alcohol, and medications, poor OH, increased acidity, vomiting, and impaired smell and taste sensation leading to intake of heavily sweetened foods.
Summary of conclusions:
Any substance abuse by young patients carries high-risk b/c the likelihood of progression to more dangerous drugs and their effect on physical, physiologic, neurological, and emotional development. The key to recognition of substance abuse is the professional’s willingness to ask parents and adolescents about it.
Date: 05/25/2011
Article title: Substance Use Disorder (SUD) in Adolescence: A Review for the Pediatric Dentist
Author(s): Marcio A. da Fonseca, DDS, MS
Journal: Journal of dentistry for Children-76:3, 2009
Major topic: Substance abuse in adolescents
Type of Article: Literature review
Main Purpose: Review for the pediatric dentist
Key points in the article discussion:
Drug addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use. SUDs are maladaptive patterns of use accompanied by clinically significant impairment or distress, causing reduced functioning in major areas of life, risk-taking behavior, exposure to hazardous situation, and an increase in the likelihood of legal problems due to possession. Adolescents are more vulnerable to the risks of neuropathology as a result of substance abuse b/c their brains are still developing. Neurobiological changes during puberty contribute to 3 behavioral factors that relate to SUD development: 1) increase in peer affiliation; 2) decreased parental monitoring; and 3) risk-taking behaviors. The pediatric dentist is in a good position to help prevent and detect suspicious cases of substance abuse. Patterns of behavior that should raise suspicion include recent/sudden drop in grades, mood changes, school disciplinary action, antisocial behavior, drinking b/f 15 yo, and associating with peers w/ SUD. A good first step is to use the CRAFFT screening tool questions: 1) Ever ridden in a car driven by someone using alcohol/drugs? 2) Do you take drug to relax? 3) Do you take drugs while alone? 4) Do you forget things while using drugs? 5) Do people tell you to cut down on alcohol/drugs? 6) Have you gotten in trouble b/c alcohol/drugs? Drug addiction appears to have fast, severe, and deleterious effects in the oral cavity. Factors that contribute to increased risk of dental disease include: lack of adequate diet, dry mouth induced by drugs, tobacco, alcohol, and medications, poor OH, increased acidity, vomiting, and impaired smell and taste sensation leading to intake of heavily sweetened foods.
Summary of conclusions:
Any substance abuse by young patients carries high-risk b/c the likelihood of progression to more dangerous drugs and their effect on physical, physiologic, neurological, and emotional development. The key to recognition of substance abuse is the professional’s willingness to ask parents and adolescents about it.
Saturday, May 21, 2011
Alcohol Abuse and dependence, Psycophathology, medical management and dental implications
Resident: Roberts
Date: 5/25/11
Article: Alcohol Abuse and dependence, Psycophathology, medical management and dental implications
Author: Arthur F, Stephen M, et al.
Journal: JADA
Volume: 134
Year: 2003
Definitions
Alcohol abuse is distinguished by the harmful consequences of repeated use such as: impairment in judgement, slurred speech, mood change, inability to fulfill obligations at school, work or home.
Background
14 million americans are affected. It is the 3 largest progressive psychiatric illness in the U.S. It has physiological altering effects such as low-grade hypertension leading to an increase in triglycerides and low density lipoproteins leaving an individual susceptible to coronary artery and cerebrovascular diseases. It is an irritant to the G.I. tract and may cause gastritis, stomach or duodenal ulcers. 20% of people with long- term consumption are believed to have cirrhosis and pancreatitis. The oral cavity is at risk for an increased chance of cancer of the oral cavity, pharynx, hypo-pharynx, larynx, esophagus and stomach. Salivary glands(mainly parotid) have been shown to enlarge over time with complications of xerostomia, periodontitis, glossitis and angular cheilitis. Regions of the brain(frontal lobes, limbic structures, hippocampus and cerebellum) are susceptible to atrophy and shrinkage with heavy long-term use. Poor nutrition due to caloric displacement can leave an individual deprived of nutrients such as proteins, minerals, trace elements, riboflavin, pyridoxine, vitamin E, D, and K, as well as enhanced excretion of magnesium and zinc. Fetuses are susceptible to the effects of excessive alcohol intake and have been proven to have a lack of normal neural circuitry and a host of behavioral problems. Individuals who drink alcohol should be aware of complications with concomitant use of other medications such as acetaminophen, aspirin, ibuprofen, antibiotics(cephalosporins, erythromycin, metronidazole, tetracycline), anti fungal agents, barbiturates, chloral hydrate, and opioids may cause harmful interactions.
Treatment
Involves confrontation and overcoming patients denial of problem, removing alcohol from the body which takes about 5 days(in which a person may undergo withdrawal symptoms...), Beta blockers can be given to reduce heart rate and tremors, rest and adequate nutrition(including multiple vitamins, especially thiamine and magnesium), rescue medications can be given which can reduce a person interest in alcohol or have unpleasant physical effects when a person consumes alcohol.
Conclusion
An alcohol abusing parent may not be fully capable of caring for some or all of the needs of their children. As pediatric dentist we should be helpful in identifying these situations and intervening where possible. As noted in the article, adolescents who consume alcohol at an earlier age are more likely to abuse alcohol later in life. We should work to educate are patients and parents on the oral and systemic problems that are associated with alcoholism.
Tuesday, May 17, 2011
Dental Needs and Status of Autistic Children: Results From the National Survey of Children’s Health
Article title: Dental Needs and Status of Autistic Children: Results From the National Survey of Children’s Health
Author(s): Kopycka-Kedzierawski & Auinger.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2008. 30:1. 54-58.
Major topic: Dental Needs of Autistic Children
Overview of method of research: Survey
Background:
In a report from the Centers for Disease Control and Prevention on autism among 8-year-old children living in 14 areas of the US in 2002, the prevalence of children with autism ranged from 3.3-10.6 cases per 1,000 children.
Purpose:
To assess the oral health status and dental needs of a nationally representative sample of 1 to 17-year-old children with or without autism.
Methods:
In the 2003 National Survey of Children’s Health conducted, parents reported the status of their child’s health. A random-digit-dial sample of households with children under 18 years of age was selected from across the US and one child was randomly selected from within the household. The parent or guardian who was the most familiar with the child’s health status was chosen as the respondent. The weighted response rate was 55%. Interviews included questions about:
1. their children’s overall health, including oral status, physical and mental health status, function status
2. health care access and utilization
3. dental and medical insurance status
4. family functioning
5. social well-being
Interviews regarding 95,554 children over the age of 1 who had their natural dentition were conducted and of those, 495 parents answered yes to the question, “Has a doctor or health professional ever told you that (child’s name) has autism?”
Results:
Less than 1% of parents reported their children had autism. The parents of 52% of autistic children reported that their child’s teeth were in excellent or very good condition and another 30% in good condition. The parents of 69% of nonautistic children reported excellent or good children and another 22% in good condition.
Parents with an autistic child were more likely to report fair to poor condition of their child’s teeth than those nonautistic children. Autistic children were more likely than nonautistic children to be: 6-11 year old, male, no-Hispanic white, living in a household with more than a high school education and to have current health insurance.
Autistic and nonautistic children were comparable in regards to dental pain, presence of cavities, broken teeth, misaligned teeth, hygiene, discoloration, enamel problems or bruxism.
Nonautistic children were more likely to have gum problems, problems with nerves (root canal problems) and to have no specific problem even though their parent reported fair or poor teeth.
Key points/Summary:
Parents of US autistic children were more likely to report their children’s dentition to be in fair or poor condition than parents of US nonautistic children.
Autistic and nonautistic children with fair or poor teeth are faced with similar dental problems.
Assessment of Article:
Although the number of autistic children was small and therefore it was difficult to draw statistically significant results and the results were based on the reports of parents which were not verified, the fact that this was one of the largest surveys conducted on the heath of US children made this article interesting.
Author(s): Kopycka-Kedzierawski & Auinger.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2008. 30:1. 54-58.
Major topic: Dental Needs of Autistic Children
Overview of method of research: Survey
Background:
In a report from the Centers for Disease Control and Prevention on autism among 8-year-old children living in 14 areas of the US in 2002, the prevalence of children with autism ranged from 3.3-10.6 cases per 1,000 children.
Purpose:
To assess the oral health status and dental needs of a nationally representative sample of 1 to 17-year-old children with or without autism.
Methods:
In the 2003 National Survey of Children’s Health conducted, parents reported the status of their child’s health. A random-digit-dial sample of households with children under 18 years of age was selected from across the US and one child was randomly selected from within the household. The parent or guardian who was the most familiar with the child’s health status was chosen as the respondent. The weighted response rate was 55%. Interviews included questions about:
1. their children’s overall health, including oral status, physical and mental health status, function status
2. health care access and utilization
3. dental and medical insurance status
4. family functioning
5. social well-being
Interviews regarding 95,554 children over the age of 1 who had their natural dentition were conducted and of those, 495 parents answered yes to the question, “Has a doctor or health professional ever told you that (child’s name) has autism?”
Results:
Less than 1% of parents reported their children had autism. The parents of 52% of autistic children reported that their child’s teeth were in excellent or very good condition and another 30% in good condition. The parents of 69% of nonautistic children reported excellent or good children and another 22% in good condition.
Parents with an autistic child were more likely to report fair to poor condition of their child’s teeth than those nonautistic children. Autistic children were more likely than nonautistic children to be: 6-11 year old, male, no-Hispanic white, living in a household with more than a high school education and to have current health insurance.
Autistic and nonautistic children were comparable in regards to dental pain, presence of cavities, broken teeth, misaligned teeth, hygiene, discoloration, enamel problems or bruxism.
Nonautistic children were more likely to have gum problems, problems with nerves (root canal problems) and to have no specific problem even though their parent reported fair or poor teeth.
Key points/Summary:
Parents of US autistic children were more likely to report their children’s dentition to be in fair or poor condition than parents of US nonautistic children.
Autistic and nonautistic children with fair or poor teeth are faced with similar dental problems.
Assessment of Article:
Although the number of autistic children was small and therefore it was difficult to draw statistically significant results and the results were based on the reports of parents which were not verified, the fact that this was one of the largest surveys conducted on the heath of US children made this article interesting.
Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism
Meghan Sullivan Walsh May 17, 2011
Literature Review - St. Joseph/LMC Pediatric Dentistry
Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center- Providence
Article Title: Parental Attitudes Regarding Behavior Guidance of Dental Patients with Autism
Authors: Jennifer Marshall, DDS, MSD; Barbara Sheller, DDS, MSD; Lloyd Manci, PhD; Bryan J. Williams, DDS, MSD, MEd
Journal: Pediatric Dentistry
Volume (number), Year, Page #’s; 30, 5, Sep/Oct 08, pages 400-407.
Major Topic: Evaluating autistic parents’ ability to predict dental treatment cooperation and their attitude regarding behavior guidance techniques or (BGT).
Overview of Method of Research: Autistic children from a hospital, dental school and private practice were recruited for this study between 2003 to 2004. Prior to the child’s treatment at the next appointment parents were asked to predict what treatment would be accomplished and whether certain coping strategies would be effective. Post operatively another survey was handed to the parents regarding their acceptability of certain BGT’s and to rank their own anxiety at the dentist.
Findings: 85 Autistic children were analyzed with a mean age 9.6. The majority of the patients were from educated parents and most were treated for preventative recall (56%). Parents accurately predicted their child would allow for an examination (88%) and cooperate for radiographs (84%). However, they tended to overestimate their child’s willingness to cooperate regarding prophylaxis and fluoride treatment (54%) The parents did not differ before of after treatment on the efficacy of a particular BGT. 54% of parents also rated all BGT’s acceptable, basic BGT more acceptable than advanced. Protective stabilization acceptance were as follows; parental restraint (84%), staff restraint (63%), stabilization device (54%.) Dentists rated distraction (86%), frequent breaks (81%) and rewards (80%) the top three more effective BGT’s. When BGT’s were used, parents showed greater acceptability and efficacy post operatively. Parental opinion was also positive towards tell show do, mouth props, rewards, frequent breaks, parental restraint and hand-holding by a staff member.
Key Points: Summary: An important difference in this study to other studies on BGTs is that prior to the appointments, parents had consented and understood the methods of strategies and may have seen these methods already used on their children. The parents were overwhelmingly positive towards the many techniques and their efficacy. This is important to note that when parents are familiar to a particular technique or method before hand they are more willing to accept and act favorably towards the appointments. Interesting to note 92% were in favor of stabilization devices when they were directely involved in the care of their child. These finding emphasize the importance of informed consent and the positive impact it has on parental acceptance. Four major points were concluded for familial acceptance: 1) family involvement, 2) highly supportive and structured environment, 3) Predictability and routine, and 4) Functional approach to problem behaviors.
Assessment of the Article: Good clean research study. Would have liked to see parental attitudes towards BGT methods during more stressful appointments like operative, emergency, and GA. I do agree that having parents actively involved in the care and well aware of what is going on in the room, will save the clinician from potential miscommunications and misunderstandings regarding dental treatment.
The caries experience and behavior of dental patients with autism spectrum disorder (ASD).
Resident: Roberts
Date: 5/18/11
Article title: The caries experience and behavior of dental patients with autism spectrum disorder (ASD).
Authors: Cheen Loo, Graham Richard, et al.
Journal: JADA
Volume #: 139
Year: 2008
Background: The authors conducted a study to evaluate ASD with those who were unaffected by the disorder in the areas of: behavior, and caries prevelance.
Methods: The authors reviewed the patient charts of 395 patients with ASD and 386 charts of patients who did not have ASD. They noted age, sex, residence(home or institutionalized), presence of a seizure disorder, other diagnosis, medications, caries prevalence, caries severity, and behavior.
Results: ASD Male:Female ration of 4:1, Sex distribution was equal to the unaffected group, which was younger and had higher rates of DMFT than did the ASD group. A significantly higher percentage of patients with ASD were uncooperative and required dental treatment to take place under general anesthesia. In the ASD group 55.2 percent of patients were uncooperative (that is they exhibited either negative or definitely negative behavior and only 9.2 percent exhibited definitely positive behavior). Caries prevalence and severity of decay was not associated with institutionalization, presence of seizure disorder or additional diagnosis. Regarding ASD patients with primary teeth, they were 83.4 percent less likely to have caries than were those unaffected. In the permanent dentition, they were 65.9 percent less likely to have caries than were those unaffected. No significant difference was noted in the amount of decay severity between male and female patients with ASD.
Conclusion: People with ASD were more likely to be caries free and had lower DMFT scores than those were unaffected. Significantly more ASD patients were uncooperative and required GA to treat decay than did others.
Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism
Resident: Adam J. Bottrill
Date: 18MAY11
Region: Providence
Article title: Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism
Journal: Journal of Dentistry for Children
Page #s: 84-91
Vol:No Date: 72:2, 2010
Major topic: Developmental disabilities, ADD, Autism, Dental care
Minor topic(s): None
Type of Article: Descriptive article
Main Purpose: The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.
Key points in the article discussion:
I. General:
A. 13% of all children peat the MCHB definition of children with SCHN.
B. SHCN Children almost twice as likely to have unmet oral healthcare needs.
C. Considerations: speciale diet, medication, self-unjurious behavior, communication problems, orofacial malformations,
II. ADHD
A. Prevalence of 4-12% with persistence into adolescence of 60-80%
B. Impulsivity, inatention, hyperactivity... I'm sorry, but this paragraph makes me laugh. It describes almost every child with whom I've ever interacted.
C. Three types:
1. Hyperactivity/Impulsivity
2. Inattentive
3. Combined
D. Suggestions for Tx:
1. Frequent breaks
2. Reinforcement of positive behavior.
3. Those children on meds may be more behaved after taking them.
III. Intellectual Disability (mental retardation)
A. Sub-average functioning in 2 or more of the following areas: communication, self-help, home living, social and interpersonal skills, use of community resources, self-direction, health, safety, leisure, work
B. Prevalence: 1%
C. Mild/Moderate/Severe/Profound
D. ID children often have co-morbidities
E. Anxiety and uncooperative behavior in the dental setting.
F. Abnormal tooth eruption, maloclusions, missing/fused teeth, microdontia, abnormal jaw structure, macroglossia, perio disease.
G. Latex allergy, cardiac problems
H. knowing the child's mental age will help with behavior management. Manage to the "mental age".
I. Communicate to the patient's level: reward behavior, verbal reinforcement.
J. Communicate with the parents in order to gain useful tips on how to control behavior.
K. "Desensitization visits", picture books, "blanky/bobo"
IV. ASDS
A. Autism, Asperger S, PDD
B. Prevalence: 6.5/1000
C. Common deficits include: language, social skills, restricted stereotyped patterns of behavior
D. Prevalence of ID in those with ASD: 50-60%
E. Unusual responses to common smells, tastes, textures
1. Can interfere with hygiene and nutrition
F. Higher prev of obesity
G. Challenging behaviors more prev during childhood than adolescence... ALTHOUGH rapid increases in size and strength make any of these behaviors more dangerous.
H. Sources of discomfort can always bring about behavior changes... Important to take thorough med history.
I. Generally, ASD kids have good oral health and average caries and perio rates.
J. Encourage parents and teachers to use NON food rewards.
H. Some medications have side effects including weight gain, abnormal movements and increased risk of diabetes.
I. Visual supports to increase chances of succesful visit: schedules, "social stories", books, pictures.
J. Some dentists keep a copy of a social story to send to families prior to visit.
K. Use the same staff, appointment time, day of the week etc...
L. ASK THE PARENTS... about everything.
Assessment of Article: The title of the article doesn't seem to accurately depict the content.
Date: 18MAY11
Region: Providence
Article title: Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism
Journal: Journal of Dentistry for Children
Page #s: 84-91
Vol:No Date: 72:2, 2010
Major topic: Developmental disabilities, ADD, Autism, Dental care
Minor topic(s): None
Type of Article: Descriptive article
Main Purpose: The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.
Key points in the article discussion:
I. General:
A. 13% of all children peat the MCHB definition of children with SCHN.
B. SHCN Children almost twice as likely to have unmet oral healthcare needs.
C. Considerations: speciale diet, medication, self-unjurious behavior, communication problems, orofacial malformations,
II. ADHD
A. Prevalence of 4-12% with persistence into adolescence of 60-80%
B. Impulsivity, inatention, hyperactivity... I'm sorry, but this paragraph makes me laugh. It describes almost every child with whom I've ever interacted.
C. Three types:
1. Hyperactivity/Impulsivity
2. Inattentive
3. Combined
D. Suggestions for Tx:
1. Frequent breaks
2. Reinforcement of positive behavior.
3. Those children on meds may be more behaved after taking them.
III. Intellectual Disability (mental retardation)
A. Sub-average functioning in 2 or more of the following areas: communication, self-help, home living, social and interpersonal skills, use of community resources, self-direction, health, safety, leisure, work
B. Prevalence: 1%
C. Mild/Moderate/Severe/Profound
D. ID children often have co-morbidities
E. Anxiety and uncooperative behavior in the dental setting.
F. Abnormal tooth eruption, maloclusions, missing/fused teeth, microdontia, abnormal jaw structure, macroglossia, perio disease.
G. Latex allergy, cardiac problems
H. knowing the child's mental age will help with behavior management. Manage to the "mental age".
I. Communicate to the patient's level: reward behavior, verbal reinforcement.
J. Communicate with the parents in order to gain useful tips on how to control behavior.
K. "Desensitization visits", picture books, "blanky/bobo"
IV. ASDS
A. Autism, Asperger S, PDD
B. Prevalence: 6.5/1000
C. Common deficits include: language, social skills, restricted stereotyped patterns of behavior
D. Prevalence of ID in those with ASD: 50-60%
E. Unusual responses to common smells, tastes, textures
1. Can interfere with hygiene and nutrition
F. Higher prev of obesity
G. Challenging behaviors more prev during childhood than adolescence... ALTHOUGH rapid increases in size and strength make any of these behaviors more dangerous.
H. Sources of discomfort can always bring about behavior changes... Important to take thorough med history.
I. Generally, ASD kids have good oral health and average caries and perio rates.
J. Encourage parents and teachers to use NON food rewards.
H. Some medications have side effects including weight gain, abnormal movements and increased risk of diabetes.
I. Visual supports to increase chances of succesful visit: schedules, "social stories", books, pictures.
J. Some dentists keep a copy of a social story to send to families prior to visit.
K. Use the same staff, appointment time, day of the week etc...
L. ASK THE PARENTS... about everything.
Assessment of Article: The title of the article doesn't seem to accurately depict the content.
Caries Risk Assessment and Caries Status of Children with Autism
Resident: Swan
Date: 5/18/2011
Article Title: Caries Risk Assessment and Caries Status of Children with Autism
Authors: Marshall et al.
Journal: Pediatric Dentistry Jan/Feb 2010
Main Purpose: To describe the dental caries status of children with autism and to explore associations between caries status and several of the caries risk indicators of the CAT. (Caries risk Assessment Tool-adopted by AAPD in 2002, revised 2006)
Methods: 99 Children with autism were recruited from a hospital, a dental school (residency), and 9 private practice offices between 2003/2004. Data was collected via parent interviews, registration information, dentist treatment notes/charting, radiographs, parent surveys given post-appointment.
Factors indluded for analysis were concurrent diagnoses, medications, diet preferences, oral hygiene details, previous hx of dental tx under GA, past and current autism tx interventions, ease of tooth-brushing, parents' education level, patient demographics, dentist tx notes (oral hygiene/caries findings).
***Testing of reliability between examiners was not done, and no standardized rating for oral hygiene was used.
Results: New caries lesions diagnosed for 40 children (40%). 65 (65%) had hx of caries. Mean total DMFT (primary and permanent) was 3.7. 60% of children 7 and younger had new caries, while 34% older than 7 had new caries. Asians had highest % of patients with new caries (56%) while African Americans had lowest (0) (Not statistically significant).
Some significant findings:
From CAT Part I:
-47% of patients were taking medication. Of those, 65% experienced dry mouth as side effect.
-1/4 of parents indicated difficulty in finding a dental home for their child.
-No association was found between caries status and food rewards, self-restricted diet, or physician-recommended diet.
-Not significant, but all three of kids who never had teeth brushed had new caries and mean DMFT of 7.3. No association between hygiene habits, primary tooth-brusher, toothbrush used, toothpaste usage was found.
From CAT Part II:
-oral hygiene rated as good/excellent for 43%, poor for 17%. Worse oral hygiene equated to more caries. (New caries for good hygiene=28%, for poor hygiene=59%
-having radiographs available (62%) made for significantly greater DMFT
Discussion: Autism has historically been a marker of high caries risk for several reasons: 1. medications causing xerostomia, 2. preference for soft/sweet foods, 3. poor oral hygiene, 4. requiring help with brushing.
In this study, the only risk indicator associated with increased caries was increased visible plaque, indicated by dentist rating of oral hygiene
***Autism should be viewed as an indicator of high risk for caries. This study suggests an increased risk for caries, especially in the <7 crowd.
The psychoactive meds taken by these patients would seem to increase caries risk with their xerostomic side effects; however, increased risk wasn't associated with their use. This has been supported by other studies. Another risk factor identified in this study was the patients' preference for soft/sweet foods, although an associated increase of caries wasn't seen.
Autistic children tend to prefer structures, routines, rituals. Each child in school should have an IEP (Individualized Education Plan) tailored to them. These children would likely benefit from addition of tooth-brushing after every meal as an addition to their IEP. We should each consider providing a formal request to the child's school requesting this.
Basic prevention strageties for children with autism:
1. routine care visits, 2. fluoride treatments, 3. diet counseling, 4. oral home care
Study limitations: dentists did not use standardized hygiene rating scale. (Authors believe standardized scale would show similar results). Also, testing of reliability between examiners should be done in future studies. Parents in this study demonstrated a high level of involvement in their child's oral health, as many still helped brush into the teenage years.
Date: 5/18/2011
Article Title: Caries Risk Assessment and Caries Status of Children with Autism
Authors: Marshall et al.
Journal: Pediatric Dentistry Jan/Feb 2010
Main Purpose: To describe the dental caries status of children with autism and to explore associations between caries status and several of the caries risk indicators of the CAT. (Caries risk Assessment Tool-adopted by AAPD in 2002, revised 2006)
Methods: 99 Children with autism were recruited from a hospital, a dental school (residency), and 9 private practice offices between 2003/2004. Data was collected via parent interviews, registration information, dentist treatment notes/charting, radiographs, parent surveys given post-appointment.
Factors indluded for analysis were concurrent diagnoses, medications, diet preferences, oral hygiene details, previous hx of dental tx under GA, past and current autism tx interventions, ease of tooth-brushing, parents' education level, patient demographics, dentist tx notes (oral hygiene/caries findings).
***Testing of reliability between examiners was not done, and no standardized rating for oral hygiene was used.
Results: New caries lesions diagnosed for 40 children (40%). 65 (65%) had hx of caries. Mean total DMFT (primary and permanent) was 3.7. 60% of children 7 and younger had new caries, while 34% older than 7 had new caries. Asians had highest % of patients with new caries (56%) while African Americans had lowest (0) (Not statistically significant).
Some significant findings:
From CAT Part I:
-47% of patients were taking medication. Of those, 65% experienced dry mouth as side effect.
-1/4 of parents indicated difficulty in finding a dental home for their child.
-No association was found between caries status and food rewards, self-restricted diet, or physician-recommended diet.
-Not significant, but all three of kids who never had teeth brushed had new caries and mean DMFT of 7.3. No association between hygiene habits, primary tooth-brusher, toothbrush used, toothpaste usage was found.
From CAT Part II:
-oral hygiene rated as good/excellent for 43%, poor for 17%. Worse oral hygiene equated to more caries. (New caries for good hygiene=28%, for poor hygiene=59%
-having radiographs available (62%) made for significantly greater DMFT
Discussion: Autism has historically been a marker of high caries risk for several reasons: 1. medications causing xerostomia, 2. preference for soft/sweet foods, 3. poor oral hygiene, 4. requiring help with brushing.
In this study, the only risk indicator associated with increased caries was increased visible plaque, indicated by dentist rating of oral hygiene
***Autism should be viewed as an indicator of high risk for caries. This study suggests an increased risk for caries, especially in the <7 crowd.
The psychoactive meds taken by these patients would seem to increase caries risk with their xerostomic side effects; however, increased risk wasn't associated with their use. This has been supported by other studies. Another risk factor identified in this study was the patients' preference for soft/sweet foods, although an associated increase of caries wasn't seen.
Autistic children tend to prefer structures, routines, rituals. Each child in school should have an IEP (Individualized Education Plan) tailored to them. These children would likely benefit from addition of tooth-brushing after every meal as an addition to their IEP. We should each consider providing a formal request to the child's school requesting this.
Basic prevention strageties for children with autism:
1. routine care visits, 2. fluoride treatments, 3. diet counseling, 4. oral home care
Study limitations: dentists did not use standardized hygiene rating scale. (Authors believe standardized scale would show similar results). Also, testing of reliability between examiners should be done in future studies. Parents in this study demonstrated a high level of involvement in their child's oral health, as many still helped brush into the teenage years.
05/18/2011 Prevalence of Parent-Reported Diagnosis of Autism Spectrum (ASD) Disorder Among Children in the US, 2007
Resident: J. Hencler
Date: 05/18/2011
Article title: Prevalence of Parent-Reported Diagnosis of Autism Spectrum (ASD) Disorder Among Children in the US, 2007
Author(s): Kogan et al
Journal: Pediatrics Vol 124, No 5, 11/2009
Type of Article: Survey
Main Purpose: To report the prevalence of ASD.
Background:
ASD is a grp of neurodevelopmental disorders comprising autism and 2 related less severe disorders: Aspergers and Pervasive developmental disorder not otherwise specified (PDD-NOS). Characteristics include impairments in social interactions and communication as well as restricted, repetitive, and stereotyped patterns of behavior. Recent US studies report prevalences ranging from 50-90 in 10000 children w/ notable variation in child age, gender, ethnicity, and socioeconomic status.
Overview of method of research:
Random-digit-dial telephone survey was conducted on the health of children <18yo based on interview with a parent. 91642 interviews were completed and analyses for this study were limited to 78037 children who were 3-17yo. Interview questions asked: currently dx w/ ASD? Ever dx w/ ASD, but not currently dx? Never dx w/ ASD? Severity of ASD? Demographic/socioeconomic characteristics? Health care experiences?
Findings:
Prevalence of ASD was 110 per 10000 children. ASD dx most common to least common age grps: 9-11yo>>6-8yo>15-17yo. Boys found to have ASD 4X more than girls. Caucasians most common to have ASD. A very high % of children w/ ASD and children w/ past but not current dx of ASD had co-occuring conditions including ADD, ADHD, anxiety, behavior disorders, depression, and/or developmental delay. Those w/ severe or moderate ASD were more commonly had at 1 of the 5 co-occuring conditions. Children w/ current ASD had better access to care, however, children w/ current ASD had poorer perceived quality of care.
Key points in the article discussion:
In 2007, 1.1% of US children 3-17yo were reported to have ASD dx. Nearly 40% of all children reported to have ever had a dx of ASD, a parent reported a past dx but not a current dx. Although ASD dx at young ages should still be valid at a later age, difficulty with and a lack of precision in dx ASD at a very young age could result in a minority of children who no longer meet ASD criteria as they age. Some explanations include 1) ASD may have been initially suspected on the basis of a developmental screening but subsequently ruled out and never truly dx, 2) some children w/ developmental delay, MR, and learning disabilities may have been initially classified as ASD to facilitate receipt of needed services, such as early intervention programs, and 3) b/c parent reported current ASD was not externally validated, the parents may have responded no b/c their child no longer receives special ed or other autism-specific services. Several previous studies have shown that the ave age of dx is decreasing, which leads to an increase in prevalence at any 1 pt in time. Important changes in the 1990s included broadening dx criteria for ASD, increase in dx services, greater awareness, and growing acceptance that autism can co-occur w/ other conditions have all played a role in the continued rise in ASD prevalence rates. The AAP released 2 reports recommending earlier and more frequent surveillance for ASD and more aggressive educational and behavioral interventions. These recommendations reflect the recognition that earlier ID and intensive intervention can improve functioning.
Summary of conclusions:
The ASD prevalence found in this survey was higher than previous US estimates. More inclusive survey questions, increased population awareness, and improved screening and ID by providers may partly explain these findings.
Date: 05/18/2011
Article title: Prevalence of Parent-Reported Diagnosis of Autism Spectrum (ASD) Disorder Among Children in the US, 2007
Author(s): Kogan et al
Journal: Pediatrics Vol 124, No 5, 11/2009
Type of Article: Survey
Main Purpose: To report the prevalence of ASD.
Background:
ASD is a grp of neurodevelopmental disorders comprising autism and 2 related less severe disorders: Aspergers and Pervasive developmental disorder not otherwise specified (PDD-NOS). Characteristics include impairments in social interactions and communication as well as restricted, repetitive, and stereotyped patterns of behavior. Recent US studies report prevalences ranging from 50-90 in 10000 children w/ notable variation in child age, gender, ethnicity, and socioeconomic status.
Overview of method of research:
Random-digit-dial telephone survey was conducted on the health of children <18yo based on interview with a parent. 91642 interviews were completed and analyses for this study were limited to 78037 children who were 3-17yo. Interview questions asked: currently dx w/ ASD? Ever dx w/ ASD, but not currently dx? Never dx w/ ASD? Severity of ASD? Demographic/socioeconomic characteristics? Health care experiences?
Findings:
Prevalence of ASD was 110 per 10000 children. ASD dx most common to least common age grps: 9-11yo>>6-8yo>15-17yo. Boys found to have ASD 4X more than girls. Caucasians most common to have ASD. A very high % of children w/ ASD and children w/ past but not current dx of ASD had co-occuring conditions including ADD, ADHD, anxiety, behavior disorders, depression, and/or developmental delay. Those w/ severe or moderate ASD were more commonly had at 1 of the 5 co-occuring conditions. Children w/ current ASD had better access to care, however, children w/ current ASD had poorer perceived quality of care.
Key points in the article discussion:
In 2007, 1.1% of US children 3-17yo were reported to have ASD dx. Nearly 40% of all children reported to have ever had a dx of ASD, a parent reported a past dx but not a current dx. Although ASD dx at young ages should still be valid at a later age, difficulty with and a lack of precision in dx ASD at a very young age could result in a minority of children who no longer meet ASD criteria as they age. Some explanations include 1) ASD may have been initially suspected on the basis of a developmental screening but subsequently ruled out and never truly dx, 2) some children w/ developmental delay, MR, and learning disabilities may have been initially classified as ASD to facilitate receipt of needed services, such as early intervention programs, and 3) b/c parent reported current ASD was not externally validated, the parents may have responded no b/c their child no longer receives special ed or other autism-specific services. Several previous studies have shown that the ave age of dx is decreasing, which leads to an increase in prevalence at any 1 pt in time. Important changes in the 1990s included broadening dx criteria for ASD, increase in dx services, greater awareness, and growing acceptance that autism can co-occur w/ other conditions have all played a role in the continued rise in ASD prevalence rates. The AAP released 2 reports recommending earlier and more frequent surveillance for ASD and more aggressive educational and behavioral interventions. These recommendations reflect the recognition that earlier ID and intensive intervention can improve functioning.
Summary of conclusions:
The ASD prevalence found in this survey was higher than previous US estimates. More inclusive survey questions, increased population awareness, and improved screening and ID by providers may partly explain these findings.
Monday, May 16, 2011
5/18/11 Dental Injuries in Autistic Children
Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Dental Injuries in Autistic Children
Author(s): Ceyhan Altun, DDS, PhD, Gunseli GUven DDS, PhD, et al
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2010. V32. No 4. 343-346
Major topic: Trauma in autistic kids
Overview of method of research: Turkish cross sectional survey. The dental injuries of 186 children and adolescents (138 males and 48 females) 93 w/ autism (autistic group, AG), and 93 without (control group, CG) were classified according to drawings and text based on the world health organization (WHO) system (Andreasen). The system took into account age, sex, # and type of teeth involved, and type of injury. The data was entered into a computer, and analyzed using the SPSS software.
Findings:
Types of injuries ranged from crown discoloration and enamel fracture to subluxation. The most common injury was enamel fracture, and the rate of fracture was higher in the CG group as compared to the AG group. The most injured tooth was the max. CI. There were no significant differences in the rates of traumatic dental injuries between children and adolescents, between males and females, or between the AG or CG groups. However, the distribution of types of traumatic dental injuries differed significantly between the two groups.
Assessment of Article: Straight forward review. Relevant to our daily practice.
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Dental Injuries in Autistic Children
Author(s): Ceyhan Altun, DDS, PhD, Gunseli GUven DDS, PhD, et al
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2010. V32. No 4. 343-346
Major topic: Trauma in autistic kids
Overview of method of research: Turkish cross sectional survey. The dental injuries of 186 children and adolescents (138 males and 48 females) 93 w/ autism (autistic group, AG), and 93 without (control group, CG) were classified according to drawings and text based on the world health organization (WHO) system (Andreasen). The system took into account age, sex, # and type of teeth involved, and type of injury. The data was entered into a computer, and analyzed using the SPSS software.
Findings:
Types of injuries ranged from crown discoloration and enamel fracture to subluxation. The most common injury was enamel fracture, and the rate of fracture was higher in the CG group as compared to the AG group. The most injured tooth was the max. CI. There were no significant differences in the rates of traumatic dental injuries between children and adolescents, between males and females, or between the AG or CG groups. However, the distribution of types of traumatic dental injuries differed significantly between the two groups.
Assessment of Article: Straight forward review. Relevant to our daily practice.
Cooperation predictors for dental patients with autism
Resident: Cho
Author(s): Marshall et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2007. 29, 369-376.
Major topic: Autism
Type of Article: Scientific Article
Main Purpose: To identify and evaluate predictors of cooperation for pediatric dental patients with autism.
Methods: Subjects were recruited from CHRMC Department of Dental Medicine, UW Pediatric Dental Clinic, and 9 private practices in Western Washington. Subjects had a diagnosis of autism from the DSM-IV or equivalent.
Twenty-six possible predictors of cooperation (including demographics, appointment description, life skills, personal hygiene skills, and medical history) were evaluated by using parent surveys, direct questioning of the parents by the dentist or dental team member, and dentist treatment notes.
Findings:
108 autistic children (80 males and 28 females) were evaluated over a period of 6 months. The mean age was 9.8 years.
Life skills significantly predictive of uncooperative behavior were: nonverbal or minimal use of language, echolalic (repetition of words previously spoken) language, inability to understand language at an age-appropriate level, inability to follow multistep instructions, inability to read at 6+ years old, attending special education, and attending a specialized classroom.
Children who were unable to sit for a haircut or required coaxing or restraint were more uncooperative with the dentist.
Even with repeated dental visits, returning patients were not significantly more cooperative than new patients.
Key points/Summary:
Characteristic features of autistic children making cooperation difficult in a dental setting: language and social limitations, concurrent diagnoses, medications used to treat behavioral symptoms, learning disabilities/mental retardation, heightened sensory perceptions, and an inability to generalize previously learned behaviors.
Having multiple “risk factors” for uncooperative behavior predicted uncooperative behavior in the dental setting.
Five independent variables were identified as potential “risk factors” for uncooperative behavior: age 4-7 vs. >7, reading, toilet training, concurrent diagnoses, and expressive language. Having 2 or more of these “risk factors” was strongly associated with uncooperative behavior.
Assessment of Article:
Overall, good study. It was interesting that whether the patient was new or returning did not correlate with the predicted cooperativity of the patient.
Author(s): Marshall et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2007. 29, 369-376.
Major topic: Autism
Type of Article: Scientific Article
Main Purpose: To identify and evaluate predictors of cooperation for pediatric dental patients with autism.
Methods: Subjects were recruited from CHRMC Department of Dental Medicine, UW Pediatric Dental Clinic, and 9 private practices in Western Washington. Subjects had a diagnosis of autism from the DSM-IV or equivalent.
Twenty-six possible predictors of cooperation (including demographics, appointment description, life skills, personal hygiene skills, and medical history) were evaluated by using parent surveys, direct questioning of the parents by the dentist or dental team member, and dentist treatment notes.
Findings:
108 autistic children (80 males and 28 females) were evaluated over a period of 6 months. The mean age was 9.8 years.
Life skills significantly predictive of uncooperative behavior were: nonverbal or minimal use of language, echolalic (repetition of words previously spoken) language, inability to understand language at an age-appropriate level, inability to follow multistep instructions, inability to read at 6+ years old, attending special education, and attending a specialized classroom.
Children who were unable to sit for a haircut or required coaxing or restraint were more uncooperative with the dentist.
Even with repeated dental visits, returning patients were not significantly more cooperative than new patients.
Key points/Summary:
Characteristic features of autistic children making cooperation difficult in a dental setting: language and social limitations, concurrent diagnoses, medications used to treat behavioral symptoms, learning disabilities/mental retardation, heightened sensory perceptions, and an inability to generalize previously learned behaviors.
Having multiple “risk factors” for uncooperative behavior predicted uncooperative behavior in the dental setting.
Five independent variables were identified as potential “risk factors” for uncooperative behavior: age 4-7 vs. >7, reading, toilet training, concurrent diagnoses, and expressive language. Having 2 or more of these “risk factors” was strongly associated with uncooperative behavior.
Assessment of Article:
Overall, good study. It was interesting that whether the patient was new or returning did not correlate with the predicted cooperativity of the patient.
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