Infant Oral Health: A Survey of General Dentists, Pediatric Dentists, and Pediatricians in Virginia

Pages 37
Views 12
of 37
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Description
Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2005 Infant Oral Health: A Survey of General Dentists, Pediatric Dentists, and Pediatricians in Virginia Rhea
Transcript
Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2005 Infant Oral Health: A Survey of General Dentists, Pediatric Dentists, and Pediatricians in Virginia Rhea DelCastillo Davis Virginia Commonwealth University Follow this and additional works at: Part of the Pediatric Dentistry and Pedodontics Commons The Author Downloaded from This Thesis is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact School of Dentistry Virginia Commonwealth University This is to certify that the thesis prepared by Rhea DelCastillo Davis, B.S., D.D.S. entitled, Infant Oral Health Care: A Survey of General Dentists, Pediatric Dentists, and Pediatricians in Virginia, has been approved by her committee as satisfactory completion of the thesis requirement for the degree of Master of Science. Arthur P. Mourino, D.D.S., M.S.D., Thesis Director, School of Dentistry Jim Ellis, M.S., Committee Member Tegwyn H Brickhouse, D.D.S., Ph.D., Committee Member Al M Best, Ph.D., Committee Member Michael D Webb, D.D.S., Director of Pediatric Dentistry, School of Dentistry Laurie C Carter, D.D.S., Ph.D., Director of Advanced Education, School of Dentistry F. Douglas Boudinot, Ph.D., Dean, School of Graduate Studies Date Infant Oral Health Care: A Survey of General Dentists, Pediatric Dentists, and Pediatricians in Virginia A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. by Rhea DelCastillo Davis, B.A. University of Virginia, May, 1997 D.D.S., Virginia Commonwealth University, May, 2002 Thesis Director: Arthur P. Mourino, D.D.S., M.S.D. Department of Pediatric Dentistry Virginia Commonwealth University Richmond, Virginia February, 2005 ii Acknowledgement To my mentors, Drs. Frank H. Farrington, Arthur P. Mourino, and Martin Walton, thank you for all of your guidance and encouragement in the past two years of this program. Thank you to Dr. Tegwyn Brickhouse and Al Best for helping me understand the mysteries of statistics. To my parents, Ricardo and Rosario DelCastillo, thank you for your love and support throughout my life. To my husband, Marcus, thank you for your never-ending patience and love for me. Finally, to Benjamin, Sean, and Joshua, you were worth the wait. iii Table of Contents List of Tables iv List of Figures v Abstract.vi Chapter 1. Introduction 1 2. Methods Results 7 4. Discussion Conclusion.17 References..26 Vita 28 iv List of Tables Table Page Table 1: Description of the Three Practitioners Survey Responses 20 Table 2: Practitioner Frequency of Talking to Parents about the First Dental Visit.21 Table 3: Average Recommended Age for the First Dental Visit by Practice Type..22 Table 4: Comparison of Practitioner Types Response to Who is Responsible for Infant Oral Health Care...23 Table 5: Logistic regression results comparing practitioner types (GD, PD,Ped), years in practice, and gender 24 Table 6: Comparison of Average Recommended Age for First Dental Visit By Practice Years within Practitioner Group 25 v List of Figures Figure Page Figure 1: Infant Oral Health Care Survey 18 Figure 2: Relationship between years in practice and the proportion recommending 1 year dental visit, separately for each practitioner group..19 vi ABSTRACT INFANT ORAL HEALTH CARE: A SURVEY OF GENERAL DENTISTS, PEDIATRIC DENTISTS, AND PEDIATRICIANS IN VIRGINIA By Rhea DelCastillo Davis D.D.S. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2004 Thesis Director: Arthur P. Mourino, D.D.S., M.S.D. Department of Pediatric Dentistry Purpose: The purpose of this study was to examine the knowledge, attitudes, and experiences related to infant oral health for both dental and medical providers. Methods: A survey of infant oral health care was sent to 300 randomly selected general dentists, 300 randomly selected pediatricians, and all pediatric dentists in Virginia. The survey contained questions regarding the providers routine infant oral health care regimen. In addition demographic data from the provider was collected. Responses to the questionnaire were tabulated and percent frequency distributions for responses to vii each item computed. Percents for all items were based on the total number of respondents in each of the three practitioner groups. Results: The response rate of the survey was 48%. While 100% of pediatricians treat the infant population, only 5% refer for the first dental visit by age one. In addition compared to dentists fewer pediatricians examine for dental decay or give oral hygiene instructions. Less than half of General dentists surveyed treat the infant population and only 12% refer for the first dental visit by age one. Compared to pediatricians and pediatric dentists general dentists were less likely to discuss the first dental visit or nutritional counseling. Amongst the three practitioner types, pediatric dentists provide the most thorough dental exam, however only 25% actually treat infants by one year of age. Access to dental care remains a significant factor in early childhood caries. Conclusion: Results from this research suggest that the majority of pediatricians and general dentists are not advising patients to see the dentist by one year of age. Concurrently the majority of dentists are not treating patients at one year of age, resulting in a critical problem with access to care. There is a need for increased infant oral health care education in the medical and dental communities to appropriately handle this infant population. INTRODUCTION Early childhood caries (ECC) has been reported by the Centers for Disease Control and Prevention to be the most prevalent infectious disease in our nation s children. Dental caries is 5 times more common than asthma and 7 times more common than hay fever in children (1). According to statistics by 5 years of age approximately 67% of children will have experienced dental decay (2). Decay of primary teeth can affect children s physical development, lead to malocclusion, and result in significant pain and potentially life threatening facial swellings. Unfortunately caries in children can progress very rapidly in only 6-12 months requiring intervention in a very short time span (3). The persistent problem of ECC has spurred the dental profession to adopt the concept of the dental home. The idea is to establish an early relationship between a family and a dental practitioner where the family will receive preventive instruction, dental care, counseling, and anticipatory guidance (15). The establishment of a dental home for children in their first year of life is an important factor to promote the early detection of high risk individuals and prevention of dental disease thereby decreasing the incidence of ECC. The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) advocate that children should be seen by a dentist for dental screening as early as 6 months of age and no later than 6 months after the first tooth 1 erupts or 12 months of age (4,5). This first dental visit encourages parents to establish a dental home and allows the dentist to use anticipatory guidance to reduce the risk for caries and gingival disease. Anticipatory guidance is an interactive tool that incorporates developmental milestones and functional considerations into caries prevention. This allows the risk for oral conditions of each individual patient to be addressed and includes caregivers in the anticipatory guidance process (14-16). Typically the one year dental visit allows the dentist to examine the child and to educate parents about effective home care, diet, injury prevention, and fluoride needs. This first dental visit embraces the importance of early intervention with optimal preventive strategies. Pediatricians have increased access to new mothers and children 6-12 months of age, by seeing them regularly for well child visits and have an opportunity to directly impact infant oral health care. The American Academy of Pediatrics (AAP) has realized the severe problem ECC poses and has recently changed its policies regarding the first dental visit. In 2002 the AAP revised its policy statement and lowered the age of the first dental visit from age 3 to age 1 for all children and as early as 6 months for children at high risk for dental disease. The AAP now advocates that all infants receive an oral health risk assessment by 6 months of age using the Caries Risk Assessment Tool developed by the AAPD (6). Their goal is to identify high-risk individuals and refer these individuals for immediate dental intervention. Medical and dental communities, both separately and in combination are trying to prevent or at least reduce the effects of oral disease. The policy is extremely new. The literature shows that the majority of children, whether private or publicly insured, are not 2 seeing the dentist by 1 year of age. The Medical Expenditure Panel Survey of 1996 found that 68% of children 18 months and younger had never been seen by a dentist (7). It is important to understand factors related to the low level of dental utilization for children under the age of one. Most likely, neither group understands the scope of dental disease in infants i.e. pediatricians not referring early enough to dentists and dentists not accepting very young children as regular patients. Studies show that more than half of pediatricians (63%) do not recommend a dental visit until the third birthday (8). According to the AAPD nearly 20% of pediatric dentists do not perform infant evaluations (9). To ensure that children can access needed care there is an obligation for education and collaboration between the medical and dental community. The goal of this research is to examine the knowledge, attitudes, and experiences related to infant oral health for both dental and medical providers. 3 METHODS A one-page survey was sent to 300 randomly selected general dentists, 300 randomly selected pediatricians, and all pediatric dentists in Virginia to assess their attitudes, experiences, and knowledge of infant oral health care. General dentists, pediatricians, and pediatric dentists were selected because each group has in their respective mission to provide care to the pediatric population. General dentists have expertise in oral health care, however the early intervention associated with infant oral health is still new to dentistry. Many dental practitioners are not comfortable with crying squirming toddlers and caregiver counseling. Pediatricians are most likely to interact with new caregivers and infants and are comfortable in the process of anticipatory guidance however they have little training in oral health. Pediatric dentists have varying amounts of infant oral health training and an increased comfort level working with children, but may not have access to those less than three years of age. A list of general dentists was obtained from the Virginia Dental Association (VDA). The VDA randomly selected 300 practicing dentists from the list, thereby allowing general dentists from all regions of the state to be surveyed. Similarly, the American Academy of Pediatrics provided a list of pediatricians in Virginia. 300 pediatricians were randomly selected from the provided list. A list of the practicing 112 pediatric dentists in Virginia was obtained from the AAPD. The 712 surveys sent out 4 represent approximately 10% of all general dentists in the state, 12.5% of all pediatricians in the state, and 100% of all pediatric dentists at the time of the survey. All practitioners received an explanation of the study and were given the opportunity to ask questions. If the practitioner agreed to participate in the study, the survey was completed and returned in the provided stamped addressed envelope. Any responses from doctors who were retired or were not general dentists, pediatricians, or pediatric dentists were not included in the survey. Any written comments or multiple answers to questions were not included in the results. Doctors were given 30 days to respond to the survey. After 30 days a second mass mailing was sent to all doctors with a note explaining the second mailing. Doctors were again given 30 days to respond to the survey. Any responses received after the total 2 months were excluded. The survey presented a series of 17 questions, 7 multiple choice, and 10 yes or no questions (Fig. 1). The survey was field tested by a group of faculty members at Virginia Commonwealth University. The faculty members included pediatricians, pediatric dentists, general dentists, and a statistician to help identify problems or confusion in the survey. A final version of the survey was created from comments collected. Participants were asked several yes/no questions regarding their routine infant oral health care protocol. In addition demographic data such as the practitioner s age, gender, and years of practice, were ascertained from the questionnaire. Responses to the questionnaire were tabulated and percent frequency distributions for responses to each item computed. Percents for all items were based on the total number of respondents in each of the three subgroups (general dentists, pediatricians, and pediatric dentists). The 5 percentage responding to each questionnaire item was compared using an exact chisquare test if cell frequencies were small or a Pearson chi-square test if the cell frequencies were adequate. Continuous variables, such as recommended and actual age, were analyzed using ANOVA. All tests were performed at alpha =.05. 6 RESULTS Of the 712 surveys sent out, 379 surveys were returned for a return rate of 53.2%. The return rate was 128 (42.6%) for general dentists, 121 (40.3%) for pediatricians, and 93 (83%) for pediatric dentists. A total of 37 surveys were eliminated. 32 surveys were excluded because the practitioner indicated that they were specialists in an area other than general dentistry, pediatrics, or pediatric dentistry. Five surveys were excluded because the practitioner indicated that they were retired or no longer in clinical practice. The number of total usable surveys was 342 out of 712 for an overall return rate of 48%. Survey responses were compared between the three practitioner types. Tabulated responses are listed in Table 1. Practitioners were first asked if they treat children aged 0-36 months in their office. 100% of all pediatricians and pediatric dentists (p-value .0001) responded yes to this question. Only 57 (45%) of general dentists responded yes while 71 (55%) of general dentists do not treat this age group. Examination Practitioners who treated children aged 0-36 months in their office were asked what was included in a routine infant check up. General dentists (100%), pediatricians (99%), and pediatric dentists (100%) similarly reported providing evaluations of proper oral development. Likewise almost all general dentists (98%), pediatricians (98%) and pediatric dentists (100%) examine for oral pathology. There was some evidence that 7 fewer pediatricians examine for dental decay (95%) than general dentists (100%) or pediatric dentists (100%) (p-value .03). Education Fewer pediatricians provide oral hygiene instructions (93%) than general dentists (98%) or pediatric dentists (100%). Fewer general dentists (84%) provide nutritional counseling than pediatricians (98%) or pediatric dentists (95%) (p-value .004). All practitioners were found to evaluate fluoride needs equally (95-98%, p-value .5). In addition all practitioners discuss risk of baby bottle decay equally (98-100%, p-value = 1). Fewer pediatricians (59%) provide parent education with regards to dental decay (pvalue .0001) than do general dentists (95%) or pediatric dentists (96%). Dental Home There was also a difference in the pattern of the frequency of talking to parents about an infant s first dental visit (p-value .0001) as seen in Table 2. A pediatrician speaks to parents predominantly all of the time or most of the time (84 %) regarding the first dental visit. A pediatric dentist also talks to parents about an infant s first dental visit predominantly all of the time or most of the time (93 %). In comparison to the pediatricians and pediatric dentists, a smaller proportion of general dentists reported talking to parents about the first dental visit all of the time or most of the time (79 %). There are clear differences in the practitioner types with regards to the recommended age for a child s first dental visit as shown in Table 3. 74% of pediatric dentists recommend that children be seen within the first year. Only 12 % of general dentists and 8 5% of pediatricians make this recommendation (p-value .0001). In contrast 49% of general dentists and 69% of pediatricians recommend a child s first dental visit occur at 3 years of age. Using Tukey s Honestly Significant Difference test, there is no significant difference between the general dentist s average recommended age (2.64 yrs) and the pediatrician s recommended age (2.83 yrs). There is a significant difference between each of these two and the pediatric dentist s recommended age (1.29 yrs). The actual age children are seen for their first visit is again clearly different between the three practitioner types (p-value .0001). 100% of pediatricians report seeing children in the first year whereas fewer general dentists (2%) and pediatric dentists (25%) do. 72% of pediatric dentists report seeing children within the first two years however, 88% of general dentists do not see children until the age of 3 or later. Practitioners were asked who was primarily responsible for infant oral health care (Table 4). The majority of practitioners (77% of general dentists, 75% of pediatricians, and 80% of pediatric dentists) responded that both dentists and pediatricians were responsible for infant oral health care. 17% of general dentists and 18% of pediatric dentists felt that only dentists were responsible. Correspondingly 23% of pediatricians felt that only pediatricians were responsible. Survey responses for each of the practitioner types were then analyzed according to gender differences. There is a gender difference in the practitioner types with the majority of practitioners being male. 89% of general dentists were male, 67% of pediatric dentists male, and 52% of pediatricians male (p-value .0001). 9 In evaluating the responses for the recommended age of the first dental visit multivariable logistic regression was used to test both practitioner type and gender simultaneously. The results of the logistic regression, shown in Table 5, indicate that there are differences between each of the practitioner types with regards to the recommended age of the first dental visit (p-value .0001). There is no evidence of a gender effect for the recommended age of the first dental visit. (p-value =.5573). Logistic regression was also used to evaluate the effect practitioner type and gender had on the actual age a practitioner saw a child for the first dental visit. Again once the differences between general dentists, pediatricians, and pediatric dentists was taken into account there was no evidence of a gender effect in the actual age of a child s first visit (p-value =.0929). Survey responses for each of the practitioner types were also analyzed by the number of years in practice. There is some evidence that the general dentist is older (mean = 21.1, SD = 11.1) than the pediatrician or pediatric dentist (mean = 18.8, SD = 10). In evaluating the responses to recommended and actual age for a child s first visit multivariable logistic regression was again used to te
Advertisements
Related Documents
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks
SAVE OUR EARTH

We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

More details...

Sign Now!

We are very appreciated for your Prompt Action!

x