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JADA Specialty Scan - Pediatric Dentistry
Pediatric DentistryJADA Specialty Scan

Providers take on new looks in parent, patient survey

Appearance makes a big difference in how parents and children perceive dental providers, according to a study published in the September-December issue of Journal of Dentistry for Children. Most parents preferred dentists who treat their children to wear scrubs but said they preferred a dentist to wear a white lab coat for their own care. Most children preferred their dentist to wear scrubs or a white lab coat compared with more formal attire.

Authors designed the study with a 3-fold purpose: first, to measure children’s preferences for their dentist’s attire; second, to measure guardians’ preferences for their children’s pediatric dentists’ attire; and third, to measure which attributes are associated with different types of attire.

A total of 100 guardians and 97 pediatric patients completed the questionnaire. More than 80% of guardians and 48% of pediatric patients were female. Among guardians, 52% were African American and 36% were white. Among pediatric patients, 57% were African American and 31% were white.

Photos of 2 men and 2 women (30- to 35-year-old, white) were shown dressed in professional attire, casual attire, white lab coat, and scrubs. All subjects were shown with a standardized physical stance, color of clothing, hairstyle, and facial expression. Professional attire consisted of a white-collared shirt and tie for men and a buttoned-down blouse for women. Casual attire consisted of a short-sleeved, solid-colored T-shirt and pants. The white coat was a standard issue coat provided by the Virginia Commonwealth University School of Dentistry. The scrubs were navy blue and issued by the VCU School of Dentistry.

Among children, 43% said they preferred a dentist in scrubs, while 37% ranked the white lab coat as their second most preferred attire. Guardians expressed the same preferences for dentists who treat their children, but at a slightly higher rate; 56% preferred a dentist in scrubs and 39% ranked the white lab coat as their second most preferred attire. For their own care, 56% of guardians said they preferred dentists who wore a white lab coat.

Guardians were most likely to associate a provider in scrubs as the most caring and compassionate. Providers in white coats were most likely to be chosen as most confident and in control (68%), most knowledgeable (73%), and as those whose advice guardians are most likely to follow (66%). White lab coats and scrubs ranked similarly (48% and 45%, respectively) for trustworthiness.

Differences between guardian’s preference for their own providers and their children’s’ providers were assessed using McNemar test. Differences between all guardians’ preferences for their children’s providers and all the children’s own preferences were assessed with χ2 test.

Children favored professional and casual attire more than adults did (6% versus 2% and 12% versus 3%, respectively). Guardians were more likely than children to choose scrubs (56% versus 43%, respectively).

“By knowing that parents chose the white coat as the preferred attire, we can suggest that pediatric dentists wear a white coat in photos on the practice website and social media platforms where many parents will have their first encounter with the provider,” the authors concluded. “This could convey a first impression of a provider who is knowledgeable, confident, and in control. By knowing that parents and children would prefer a pediatric dentist wearing scrubs for their attire, pediatric providers can choose to wear scrubs to make the patient more comfortable.”

Read the original article here.


Consulting Editor: Paul S. Casamassimo, DDS, MS
Professor Emeritus, The Ohio State University College of Dentistry
and Nationwide Children's Hospital, Columbus, OH

Consulting Editor: Arthur J. Nowak, DMD
Professor Emeritus, University of Iowa College of Dentistry
Affiliate Professor, University of Washington School of Dentistry

Caries control in primary teeth with silver diamine fluoride

Silver diamine fluoride (SDF) is more effective than any other active treatments or placebos in controlling caries in primary teeth after 1 year, according to a study published online October 4, 2017 in Caries Research.

Authors conducted their systematic review to see if SDF is more effective in controlling caries progression in children compared with other active treatments or placebos. They compiled 5,980 articles from a 6-month search in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, Brazilian Library in Dentistry, and Cochrane Library databases, and the gray literature. Among the 11 qualifying studies, 5 were at “low” risk of bias, 2 at “unclear,” and 4 studies at “high” in the key domains. Authors used the risk of bias tool from the Cochrane Collaboration for quality assessment of the studies. They used the Grading of Recommendations: Assessment, Development and Evaluation approach to assess the quality of evidence.

Authors chose randomized clinical trials with a parallel design. The trials compared the efficacy of SDF with other treatments or a placebo in arresting carious lesions in children’s primary teeth or permanent first molars. The main outcome was the arrest of the carious lesion in enamel or dentin.

The mean (standard deviation) age of the patients in the studies was 8 (0.5) years. A total of 8 studies included only primary teeth, 2 only permanent teeth, and 1 both teeth. The number of patients included in the studies ranged from 60 through 1,016.

Study researchers reported SDF used in different concentrations and application protocols. The most common concentration was 38%. One study used a solution of nanosilver fluoride, with a concentration of 34%. The application protocol for most studies was 1 application of SDF at baseline. SDF application was repeated every 6 months in 2 studies. Tannic acid was used before SDF in 2 studies. One study included a group that used SDF in a 3-week application at baseline. Follow-up periods ranged from 12 through 36 months.

Control groups varied. Atraumatic restorative treatment (ART) was used by 3 studies as ART restorations in primary teeth and ART sealants in permanent molars. Two studies used fluoride varnish. In 4 studies, the patients from the control group did not receive any active treatment, no treatment at all, or saline solution or water application.

Authors concluded that the arrest of caries at 12 months promoted by SDF was 66% higher (95% confidence interval [CI], 41% to 91%; P < .00001) than that by other active material, but it was 154% higher (95% CI, 67% to 85%; P < .00001) than that by placebos. Overall caries arrestment was 89% higher (95% CI, 49% to 138%; P < .00001) than using active materials/placebo. They graded the quality of the evidence as high.

Read the original article here.


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How sports, energy drinks affect biofilm formation and metabolism of Streptococcus mutans

Sports and energy drinks with sugars or sugar substitutes can inhibit the formation of biofilm and metabolic activity of Streptococcus mutans. Gatorade Protein Recover Shake (chocolate) and Starbucks Doubleshot Espresso Energy increased the formation and metabolic activity of S. mutans. The findings are from a study in the September-December issue of Journal of Dentistry for Children.

Authors designed the study to see how sports and energy drinks affect S. mutans in vitro biofilm formation and metabolic activity. They cultured S. mutans strain UA159 using tryptic soy broth (TSB), growing bacteria in 5% carbon dioxide at 37°C. They bought the sports and energy drinks from a local grocery store.

Authors cultured the biofilm with and without a dilution (1:3 ratio) of a variety of sports and energy drinks in bacterial media for 24 hours. The biofilm was washed, fixed, and stained. After washing the biofilm 3 times with saline, the authors extracted crystal violet from the biofilm cells. They measured biofilm growth by reading absorbance of the crystal violet. They measured biofilm metabolic activity after the biofilm reduced a biofilm-reducing tetrazolium dye (XTT) to a water-soluble orange compound.

Authors found that sports drinks had higher initial pH values than the energy drinks, even when they were diluted at a 1:3 ratio in TSB. Most beverages greatly inhibited the formation of S. mutans biofilm. The positive control (0.12% chlorhexidine) totally inhibited S. mutans biofilm formation and metabolic activity. Gatorade Protein Recover Shake and Starbucks Doubleshot Espresso Energy showed statistically significant increases (P < .05) in S. mutans biofilm formation compared with the TSB control.

Gatorade Protein Recover Shake and Starbucks Doubleshot Espresso Energy greatly increased biofilm (30-fold and 22-fold, respectively) and metabolic activity (2-fold and 3-fold, respectively). Other drinks produced much less (P < .05) biofilm than the control. Sucrose, high-fructose corn syrup, and sucralose at all concentrations showed increased metabolic activity and exhibited an overall trend for enhancing metabolic activity as their concentrations increased.

“Sports and energy drinks have numerous ingredients, and it is highly likely that a common ingredient found in all these drinks may help inhibit the biofilm formation and metabolic activity,” the authors noted. “It is speculated the vitamin content in the sports drinks and the caffeine content in energy drinks may inhibit biofilm formation and metabolic activity.”

Read the original article here.

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AAPD statement supports third-party reimbursement, more practice-based research for SDF

Silver diamine fluoride should remain an important part of an ongoing caries management plan, according to the 2017 policy statement from the American Academy of Pediatric Dentistry’s Council on Clinical Affairs. The statement also supports third-party reimbursement for SDF-related fees and calls for more practice-based, SDF research.

The statement focuses on the ability of SDF to arrest active carious lesions in child and infant populations. The statement is based on a review of professionals, academics, clinicians, researchers, and current literature related to SDF and silver nitrate as marketed in the United States: a 38% solution fluoride solution equal to 5% fluoride in a colorless liquid, with a pH of 10.

The statement warns against the potential for black stains on carious lesions with SDF use and recommends before-and-after images of the teeth be obtained. The stain potential is based on the theory that SDF reacts with hydroxyapatite in an alkaline environment to form calcium fluoride and silver phosphate as major reaction products. These produce enough fluoride to form fluorapatite, which can discolor demineralized or cavitated surfaces.

The statement points to a series of studies that show SDF is more effective than fluoride varnish and that SDF retains 2 to 3 times more fluoride than that delivered by sodium fluoride, stannous fluoride, or acidulated phosphate fluoride.

“The use of SDF has not shown to reduce adhesion of resin or glass ionomer restorative materials,” the statement reads. “The use of SDF poses little toxicity or fluorosis risk when used in adults and children.”

Read the AAPD statement online.

Register for AAPD 2018

Register now for the American Academy of Pediatric Dentistry’s annual meeting, May 24-27 in Honolulu, Hawaii.

Why attend?

  • Premiere continuing education.

  • More than 250 exhibitors.

  • Content presented by leaders in pediatric dentistry.

  • Opportunity to network with colleagues and friends.
Visit for details on registration, housing and the meeting schedule, including the Aloha Fest Welcome Reception.


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JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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