Purpose: To evaluate early preventive dental services (PDS) provided by primary care providers (PCPs) in reducing future caries treat-ments among Alabama Medicaid recipients. Methods: Data from 2009 to 2019 Alabama Medicaid were used to evaluate effectiveness of 1st Look Program on PDS before age three years and incidence of caries treatments after age three years. PDS groups consisted of 1st Look-involved (PDS claims from PCPs), dentist-only (PDS claims from dental providers), and no early fluoride treatment participants (no PDS claims before age three years). Outcomes included frequency and expenditures of fluoride applications, simple restorations, and extensive treatments. Regression models were used to evaluate associations between PDS groups and outcomes while controlling for covariates. Results: Children in 1st Look -involved received more fluoride (3.0 versus 2.1 times; P<0.001) and were applied earlier (12.1 versus 22.9 months old; P<0.001) than dentist-only group. After adjusting for covariates, compared to dentist-only, 1st Look-involved group received earlier fluoride (beta value equals-11.1 months; 95 percent confidence interval [95% CI] equals-11.25 to-10.97) with greater frequency (incident rate ratio equals 1.49; 95% CI equals 1.47 to 1.51). Caries treatment counts were highest in dentist-only followed by 1st Look-involved and no early fluoride treatment groups in both simple restorations (2.7 versus 2.0 versus 0.2 times; P<0.001) and extensive treatments (2.8 versus 2.3 versus 0.2 times; P<0.001), which were consistent after adjusting for covariates. Conclusions: PDS were provided earlier by PCPs in Medicaid-qualified children, with reduced caries treatments on primary teeth, compared to PDS by dental providers only.

PURPOSE:The University of Alabama at Birmingham (UAB) School of Dentistry utilized a Community Dental Health Coordinator (CDHC) to transform a community-based dental education rotation into a positive learning experience for senior dental students. Based in a county health department's Women, Infant, and Children's (WIC) clinic and dental clinic, the initial rotation before implementation of the CDHC was received poorly by students and community partners. This paper reports how CDHC involvement improved student experiences with pediatric patients.METHODS:In 2018, the CDHC embedded in the WIC clinic where student rotations occur and developed relationships with the community partners to identify key issues. The CDHC then implemented qualitative improvements, including a restructured workflow, preparatory educational modules, and assessment systems to address the issues. Student performance reports, focus group discussions, and a postgraduation questionnaire provided data for evaluation of performance.RESULTS:By year 3, dental appointments for patients under age 6 increased, resulting in 95% of UAB students seeing this age patient; 74% completed four or more. Three-quarters of students reported performing restorative procedures on children. Student and community partner acceptance of the rotation also improved. Postgraduation questionnaires (32% response rate) indicate 35% of graduates continue to treat Medicaid patients after graduation.CONCLUSION:The CDHC's unique skills in community relationship-building, community-based dental screenings, and pediatric dental care coordination produced measurable improvements in community participation and student clinical experiences. The CDHC can be a vital part of dental education, especially in community education settings. Community-based dental education generated measurable improvements in students' clinical experiences.

For a mother-to-be, pregnancy presents an opportunity to improve not only her health and well being but also that of the immediate family, particularly the newborn infant. The National Consensus Statement of the Oral Health Care During Pregnancy Expert Group together with both governmental and non-governmental guidelines indicate that dental care is both safe and effective during pregnancy. These statements and guidelines may not be widely understood across all healthcare providers that form the perinatal care team, and confusion seems to exist among the general public regarding the safety of and necessity for dental care during pregnancy. Only about half of pregnant patients seek care, even those with dental problems. Previous articles in this series have reviewed appropriateness of dental care during a healthy pregnancy and specific steps to be taken in consideration of the altered physiology brought on by pregnancy and the increased risk associated with oral diseases such as changes in periodontal status, dental caries, and acid erosion; communication through the technique of motivational interviewing with patients who are either planning to become or are pregnant; and collaboration with the perinatal team of providers to ensure improved health outcomes for mother and baby. This final article in the series addresses considerations during and after pregnancy to ensure mother and child may follow a pathway to a future of good oral health.

The aim of this study was to explore dental students' attitudes about treating populations that are low-income rural, non-white, and with special needs. All 259 students in all four years at one U.S. dental school were invited in January 2018 to participate in a survey with questions about treating these three populations in the following areas: personal value, perceived preparedness, comfort, future intent to treat, and professional responsibility. A total of 227 students completed the survey, for an overall 87.6% response rate. By class, participants were as follows: D1 n=63, 100% response rate; D2 n=60, 98.4% response rate; D3 n=67, 98.5% response rate; and D4 n=37, 53.6% response rate. The results showed that dental school class did not predict willingness to treat the specified populations. Regarding populations that are rural and non-white, personal value and professional responsibility significantly correlated with intent to treat. Women perceived stronger professional responsibility regarding treatment of populations that are low-income rural (M=1.97, SD=1.09; p=0.004) and non-white (M=1.95, SD=1.07; p=0.013) than did men (M=2.44, SD=1.23; M=2.34, SD=1.22, respectively). More advanced students reported greater preparedness regarding populations that are rural and non-white, but not patients with special needs. Preparedness correlated with intent to treat for patients with special needs only. Women were less comfortable than men in treating patients with special needs (χ2=6.10, p=0.014). Hometown residence had a limited effect for patients with special needs only. Rural residence did not predict students' attitudes about serving rural patients. Overall, the students reported positive intentions to serve populations that are low income, but showed less confidence and willingness in treating patients with special needs, especially among women. These results suggest that the students' comfort in serving patients with low income was more static and less malleable than preparedness. As preparedness and personal value were positively correlated, students may have found worthwhile what they felt prepared to do.

Abstract This resource is a case-based activity created to educate students about caring for medically complex dental patients. It is intended to be used in the first semester of the predoctoral dental students' second year. It aims to familiarize students with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the context of electronic information exchange, as well as with writing an official medical consult letter, practicing oral hygiene demonstrations, and researching and formulating a comprehensive periodontal treatment plan. Case-based learning is an effective way to achieve multiple objectives. First, case-based learning, when completed in small groups, facilitates small-group communication and cooperation, as well as encouraging a thorough understanding of concepts. Second, students profess to enjoy working with “real” patients in a safe setting. Third, facilitated small-group discussions offer a less formal, more interactive forum for information exchange.

BACKGROUND:Alternatives to vital pulpotomy treatment in primary teeth are being sought because of the high formaldehyde content of traditional formocresol (FC) pulpotomy medicaments.AIM:The aim was to compare the clinical and radiographic success of vital pulpotomy treatment in primary molars using 3% sodium hypochlorite (NaOCl) versus a 1:5 dilution of Buckley's FC.DESIGN:Pulpotomies were performed in primary molars of healthy children between 3 and 10 years old. Sixty-five primary teeth were randomized into two groups that were evaluated for treatment outcomes. Following treatment, the pulp chamber was filled with zinc oxide eugenol (ZnOE) and restored with a stainless steel crown cemented with glass ionomer cement. Clinical and radiographic outcomes were recorded at 6 and 12 months.RESULTS:The control (FC) and experimental (NaOCl) groups demonstrated 100% clinical success at 6 and 12 months. The NaOCl group had 86% (19/22) radiographic success at 6 months and 80% (12/15) at 12 months. The FC group had 84% (21/25) radiographic success at 6 months and 90% (9/10) at 12 months. No significant differences were found in the radiographic outcomes between the two groups at 6 and 12 months (Fisher's exact test; P=0.574 and P=0.468, respectively).CONCLUSION:NaOCl demonstrated clinical and radiographic success comparable to FC.

PURPOSE:This study utilized multiple genetic analyses to detect evidence of maternal MS acquisition in children with S-ECC. METHODS:Twenty-seven mother/child pairs were selected from children with 5-ECC preceding dental rehabilitation under general anesthesia. Plaque samples were collected from the mother, child, and the child's carious lesion. Arbitrarily primed-polymerase chain reaction (AP-PCR) genotyped 6-8 MS isolates from each plaque sample, and unique genotypes were identified. Representative MS isolates with unique genotypes were characterized by pulsed-field gel electrophoresis (PFGE). Cluster analysis using the Dice band-based similarity coefficient was used to generate dendrograms from gel bonding patterns. A Dice coefficient >70% indicated similarity or match among PFGE genotypes. RESULTS:In 26% (7/27) of mother/child pairs, all of the child's isolates matched the mother. In 15% (4/27), some of the child's genotypes matched the mother, and in 59% (16/27), no isolates matched the mother. Maternal transmission was a mode of MS acquisition in 41% (11/27) of mother/child pairs, while acquisition from non-maternal sources occurred in 74% (20/27). CONCLUSIONS:MS genotypes that did not match maternal strains were identified in the majority of children (74%) within this S-ECC population. Evidence of maternal transmission was detected in 41% of mother/child pairs.