Retention of Low Income Children in Three Dental Studies Investigating Early Childhood Caries

Background: To our knowledge no dental studies have looked closely at subject retention, which is crucial to better understand oral health disparities. In this paper, we report retention rates and review and attempt to assess which retention strategies utilized in 3 dental research studies investigating ECC were effective for retaining WIC-enrolled children. The purpose of this paper is to discuss challenges that were encountered when working with these populations, describe characteristics of those not retained, and summarize some recommendations for future dental studies working at WIC sites. Methods: Three dental studies were conducted at WIC clinics in Iowa. Retention strategies focused on maintenance of contact over time, persistence in rescheduling appointments, utilization of incentives, high recruitment, and frequent communication with parents and program staff. Results: Retention rates in the studies ranged from 60 to 75 percent at the final research interventions. Studies were challenged by frequent moves of subjects, missed appointments, disconnected phones, busy schedules of parents, transportation problems, loss of child custody, family illness, and lack of interest. Those not retained in the studies were more likely to be younger, single, and less educated, with a lower household income and a non-Caucasian child. Lower retention was also associated with the presence of carious lesions. Conclusions: Despite many challenges, studies had good retention rates and benefited from the retention strategies. Future dental studies at WIC clinics may also benefit from arranging transportation, obtaining a free, 800 callback number, and offering after-hours appointments for working parents

Atraumatic Restorative Treatment (ART) in Pediatric Dentistry Residency Programs: A Survey of Program Directors

Purpose: The purpose of this study was to investigate the extent of clinical training on atraumatic restorative treatment (ART) among pediatric dentistry residency programs and assess program directors’ attitudes toward ART. Methods: All U.S. Pediatric Dentistry residency programs’ directors were asked to complete a web-based survey. Sixty-one of the 76 directors (80 percent) completed the survey, with no significant response bias. Results: Eighty-nine percent of the responding programs provided clinical instruction on ART. Of these, 30 percent provided ART training often/very often. ART was used mostly in single-surface cavities (43 percent) and as an interim treatment in primary teeth (57 percent). Factors associated with ART clinical training included not placing amalgams in primary teeth (P<.03) and having directors with positive attitudes toward ART (P<.001). Factors associated with directors’ positive attitudes included believing that child’s caries risk (P<.006), professional guidelines (P<.003), and patient insurance status (P<.04) were all important in selecting restorative treatment. Conclusions: Atraumatic restorative therapy appears to be underused in pediatric dentistry residency programs in the United States. Residency directors’ attitudes were highly predictive of the amount of clinical training provided, suggesting that directors need to be better informed about the use of ART

Teaching Atraumatic Restorative Treatment in U.S. Dental Schools: A Survey of Predoctoral Pediatric Dentistry Program Directors

The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.This project was funded by NIH/NIDC R T32 Grant DEO 14678-06

The willingness of US pediatric dentists to use Atraumatic restorative treatment (ART) with their patients: a conjoint analysis

Objectives: The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. Methods: A conjoint survey was completed by 723 members of the American Academy of PediatricDentistry.Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. Results: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists’ decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (−0.09) and age 6 (−0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (−0.119). Conclusions: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.This project was funded by NIH/NIDC R T32 grant DEO 14678-06

Examination criteria and calibration procedures for prevention trials of the Early Childhood Caries Collaborating Centers.

ObjectivesTo summarize diagnostic criteria and examiner training and calibration of the National Institute of Dental and Craniofacial Research-funded Early Childhood Caries Collaborating Centers (EC4) and report examiner calibration results from 2010 to 2014. The EC4 at Boston University, University of Colorado, and University of California San Francisco are performing randomized controlled early childhood caries (ECC) prevention trials with caries as the main outcome measure.MethodsThe EC4 with University of Iowa consultants developed standardized tooth and tooth surface status examination criteria for use in field conditions, examiner training materials, and examiner calibration and re-calibration methodologies. Calibration and re-calibration were performed with 1- to 5-year-old children in the San Francisco Mission District in which assessments from each examiner to be calibrated were compared with those from a single gold standard examiner from 2010 to 2014. Cohen's kappa statistic was used to determine inter-examiner agreement.ResultsA total of seven examiners were successfully (re)calibrated during that period, examining a total of 231 children. Overall unweighted Cohen's kappas for 10 surface conditions exceeded the criterion of 0.70. However, separate agreement for assessment of noncavitated lesions, as in other studies, was lower.ConclusionsAn experienced multidisciplinary and multi-institutional team was able to develop criteria and training materials to anticipate situations and field conditions the main trials would encounter. Examiners were successfully trained and (re)calibrated

Examination criteria and calibration procedures for prevention trials of the Early Childhood Caries Collaborating Centers.

ObjectivesTo summarize diagnostic criteria and examiner training and calibration of the National Institute of Dental and Craniofacial Research-funded Early Childhood Caries Collaborating Centers (EC4) and report examiner calibration results from 2010 to 2014. The EC4 at Boston University, University of Colorado, and University of California San Francisco are performing randomized controlled early childhood caries (ECC) prevention trials with caries as the main outcome measure.MethodsThe EC4 with University of Iowa consultants developed standardized tooth and tooth surface status examination criteria for use in field conditions, examiner training materials, and examiner calibration and re-calibration methodologies. Calibration and re-calibration were performed with 1- to 5-year-old children in the San Francisco Mission District in which assessments from each examiner to be calibrated were compared with those from a single gold standard examiner from 2010 to 2014. Cohen's kappa statistic was used to determine inter-examiner agreement.ResultsA total of seven examiners were successfully (re)calibrated during that period, examining a total of 231 children. Overall unweighted Cohen's kappas for 10 surface conditions exceeded the criterion of 0.70. However, separate agreement for assessment of noncavitated lesions, as in other studies, was lower.ConclusionsAn experienced multidisciplinary and multi-institutional team was able to develop criteria and training materials to anticipate situations and field conditions the main trials would encounter. Examiners were successfully trained and (re)calibrated