Examining the Cost Effectiveness of Early Dental Visits

Resident: Adam J. Bottrill
Date: 04JUN10
Region: Providence
Article title: Examining the Cost Effectiveness of Early Dental Visits
Author(s): Lee, Jessica Y. et al
Journal: Pediatric Dentistry
Page #s: pp. 102-104
Year: 2006, 28:2
Major topic: Cost, Early Dental Visits
Minor topic(s): Anticipatory Guidance
Type of Article: Topic summary
Main Purpose: To review the scientific evidenceand rationale for early dental visits.
Overview of method of research: Pseudo Meta Analysis

Key points in the article discussion:

I. General
A. AAPD, ADA and AAPHD all currently recommend all children have their first dental visit within the first year of life. AAP recommends the same early visit, but only for children who are at high risk for dental caries.
B. This early visit offers an opportunity to educate and inform parents about oral health and home care (anticipatory guidance)… similar to the “well child” visit to the pediatrician.

II. Dental Home
A. Evidence suggests that in order to prevent oral disease, preventive intervention must begin early in life.
B. A “dental home” is where a qualified dental health specialist delivers or supervises primary dental health care theat is comprehensive, continuously accessible, family centered, coordinated, compassionate, and culturally competent.
C. Studies show that many pediatricians and physicians recommend a low-risk child starting dental visits around 3yo.

II. Early Dental Visit
A. Children under age 6 have less than half the dental visits of those between 6 and 18yo.
B. By age 1, <>1yo accounted for MANY more of the restorative and emergency visits. Whereas children who began care at <1yo were much more likely to only have preventative visits.
C. This study also concluded that the children who began care later than age 1yo had much higher dental care-related costs.
D. This study may be flawed due to the fact that children who began care at <1yo likely had parents who were more motivated were thus likely to have better oral health.
E. What the authors would LIKE to think is that this improved oral health was due to the anticipatory guidance received by parents at such an early age.

Assessment of article: I think it is pretty safe to assume that the AAPD generally knows what they’re talking about. Kids should get to the dentist by age 1yo…. Period.

The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age Children

The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age Children

New Evidence from a Large Randomized Trial

Authors: Kramer, Vanilovich, et. al.

Journal: Caries Research

2007;41:484-488

Major Topic: Effect of prolonged breast-feeding on caries in young children.

Findings: This was the largest randomized trial ever conducted in the area of human lactation and it found no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early age.

Stuff: There has been mixed findings in the past concerning breast-feeding and cariogenicity. This article sites several of these articles, but most of the research has been purely observational. That is what makes this randomized trial so special.

The study was performed at health clinics in Belarus. There were two groups, with one as a control and the other receiving a pro-breast-feeding intervention--basically breast-feeding motivational interviewing. The result was that the experimental group did a lot more breast-feeding and for longer periods of time.

In all, 13,889 children were followed over a 6.5 year period. Dental examinations were performed using mirror only and the DMFT surfaces were recorded.

Conclusions: Although there were some weaknesses in the study, which the authors point out in the beginning, it's nice to see have some more data on this subject. Let's just let the moms breast-feed.

Association Between Infant Breastfeeding and Early Childhood Caries

Brian Schmid DMD

Journal: Pediatrics
Authors: Hiroko Iida, Peggy Auingerm, Ronald J Billings and Michael Weitzman
Date: 2007
Summary:
Data from the NHANES health survey was collected and analyzed pertaining to children 2-5 years old. Criteria included: whether the child was ever breastfed, age upon stoppage of breastfeeding, the age of first being fed something other than breastmilk or water and when the child began regular daily feedings of something besides breastmilk or water. Results: There was no statistical difference in rates of ECC between those exclusively breastfed more or less than 9 months. ECC rates increased with age while severe ECC rates did not. Family income below the poverty line and being Mexican American were associated with higher rates of ECC and severe ECC. Maternal smoking during pregnancy was related to higher ECC. 36.3% of children who had a dental visit within the last year had ECC while 18.5% who had ECC had not been to the dentist in the last year. Having been breastfed had no independent correlation with ECC while the following did: increased child age, Mexican heritage, living below the poverty line, maternal smoking during pregnancy and have had a dental visit within the last year.
Smoking may be developmentally related to weaker enamel or environmentally due to a higher risk of poor dietary and health decision on the part of the mother. Low SES has long been known to be a risk factor for ECC due mainly to education, diet and access to dental care. In children 2-5 years old, parents are more likely to bring their child to the dentist with overt concerns, while those without visible decay will often delay the initial dental visit.
Breastfeeding does not cause dental caries. Going to the dentist causes dental caries. It's science.

06/04/2010 Association of Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants

Resident: Hencler
Date: 06/04/2010

Article title: Association of Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Author(s): Wan Et Al
Journal: J Dent Res 80(10): 1945-1948, 2001

Major topic: Streptococcus mutans Infection and Oral Developmental Nodules
Type of Article: Observational

Main Purpose:
Investigate a possible association between Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants

Overview of method of research:
60 pre-term and 128 full-term infants were examined at 3 and 6 months old for oral developmental nodules and salivary samples were taken and cultured for S. mutans levels.

Findings:
56 infants had S. mutans. Full-term infants were 2.1 times likely to have S. mutans. Oral nodules were present in 103 infants and less prevalent in pre-term infants. Of the 56 infants that had S. mutans, 47 (84%) also had nodules. S. mutans infection was strongly associated with nodules. Infants with S. mutans were grouped according to their bacteria levels and compared to the numbers of nodules found. There was a positive “dose response” association between S. mutans and nodules

Key points in the article discussion:
The present study showed that S. mutans could be isolated in pre-dentate infants as early as 3 months old. The level of S. mutans found in each of the 56 infants was relatively low and is likely due the lack of teeth. This study found that the potential for infection of a pre-dentate infant is proportional to the S. mutans levels in the mother. Full-term children were found to have a higher prevalence of S. mutans probably due to the fact that pre-term children having less personal contact with their mothers or more likely that their oral tissues are less mature and are not optimal for colonization. Pre-term infants were found to have a lower prevalence of developmental oral nodules which may be related to delayed or disrupted fetal development, resulting in less epithelial maturation and a reduced propensity to form epithelial remnants and microcysts. Analysis of the data showed a strong dose-response relationship between nodules and S. mutans infection, and risk analyses suggested that those with oral nodules were over 7 times more likely to be colonized with S. mutans. Since full-term children showed a higher prevalence of nodule, this may explain their higher infection rate of S. mutans compared with pre-term children who had a lower prevalence of nodules.

Summary of conclusions:
The association between nodules and S. mutans may be related to a reduced turnover of mucosal cells which encourage developmental nodule formation and also better adhesion and retention of S. mutans.

Assessment of article:
Interesting article. After reading this it seems there may be more of an individual association between the reduced turnover of mucosal cells and nodules or S. mutans, rather than an association between S. mutans and nodules. I don’t think this research showed a proportional relationship where oral nodules may be associated with S. mutans infection. There may be wishful shenanigans afoot.