Children are not the culprits here (okay, except the mollycoddled brats). they react according to whatever has been fed to them at home, school or places they go to. They usually are conditioned to equate the word doctor with pain. Hence, they become uncooperative out of fear.

Is there a solution? Of course. Communication. The biggest strength of a clinician. One should not rush the kid into the operatory when a child patient walks in. Let them observe and relax. if possible, take initial history seated on the normal chair. Tell them about the germs and the harm they cause. See to it that the kid is comfortable. Showing them gifts to be given later also motivates them to stay put.

While treating, try to use air rotor for shorter durations several times, instead of using fewer times for prolonged duration. it helps a great deal to alleviate fear. Using spoon excavators wherever possible, caries detecting dyes keeps the treatment comfortable for them too.  Giving the kids regular breaks helps too. Showing them the instruments reassures that there is nothing which is going to cause pain. Of course, scary looking forceps, and syringes should be kept out of vision. Always compliment the kid after completion of a step. Talking to them creates a relaxed atmosphere. Keep initial appointments short and do easy procedures to make kids accustomed to the operator and dentist.

Pediatric Dentistry is rewarding in a way no other branch of dentistry is; it creates lifelong bonds with the tiny tots. They demand some patience and love, and give a lot more return.

Two Day course in Interceptive orthodontics For Pedodontists, Orthodontists & Gen Dental Practitioners practicing Orthodontics Confirmed Dates November 2ND & 3RD 2015 course fee 20,000 

LIVE PATIENT DEMO!!!

contact: 98218983

BioGraft products are CE Certified and moderately priced.

IFGL Bio Ceramics encourage dissertation with its BioGraft products and for the purpose provide them at concessional prices. For details, please contact Rajesh Agarwal rajesh.agarwal@ifgl.in, Cell +91 9831056667, Direct +91 33 40106114

Also log on to http://www.kidspedo.tk

According to Paul Casamassimo, DDS, MS, the director of the AAPD Pediatric Oral Health Research and Policy Center, it is important to put the authors’ findings into context in recognition of the inherent limitations of this study.

Although the authors correctly indicate that children covered by Medicaid tend to be at higher risk for dental caries, the report does not recognize that these children may not have access to care or enjoy appropriate preventive services. The higher risk of dental caries, along with this lack of early preventive care, may result in the first visit being sought in response to existing decay that causes pain. Often, this necessitates restorative treatment at their first visit. In addition, children with higher risk of caries need an increased number of preventive services, so cost would likely be maximized. Finally, a body of literature speaks to the residual continued disease occurrence in children afflicted early in life with dental caries.

Inherent problems with extrapolating from Medicaid data include episodic care seeking, enrollment variations, no differentiation of levels of dental caries risk, lumping diagnostic and preventive services together, and the vast unknown of what is not reported or discernible from the data. Additionally, restorative expenditures, as compared with diagnostic and preventive costs, will be very high.

“Unfortunately, current data collection limitations and the dearth of studies on these consequences of dental caries do not allow a full picture of what preventive services may be doing for children,” said Warren Brill, DDS, AAPD president. “Our policies and guidelines encourage early preventive care not only to reduce cost, but also to improve the quality of life for children.”

Consideration of costs must take into account prevention’s effects on the reduction of emergency department visits for tooth pain and also the need for general anesthesia care to treat dental caries. Reports cited by the Pediatrics study authors include these "hidden costs," which can be sizable but are usually found in medical claims data, not dental data. Also, the Pediatrics study does not take into account costs such as emergency room visits and services that must be provided under general anesthesia.

Readers should also be aware of the hidden human costs of dental caries, which include the morbidities of chronic pain, impaired learning, lower self-esteem, and compromised nutrition.

“It was shocking to us to find that previous data was misinterpreted, and there was actually more expensive restorative procedures among kids with more preventive dental visits, because this is counterintuitive,” Sen explained in a university news release. “The problem is that these prior studies were limited by selection bias because children are not randomly taken to get preventive dental services. It may be overly cautious or concerned parents, or children with a family history of dental problems who get these visits, then also use more restorative care.”

To investigate further without bias, Sen’s team used data collected from 1998 to 2010 by Alabama’s Children’s Health Insurance Program (CHIP), ALL Kids, a low-cost, comprehensive healthcare coverage program for children younger than age 19; benefits of ALL Kids include regular dental care.

Children who were continuously enrolled in CHIP for at least three years were included. Children who used nonpreventive dental services the first year were not included, because there was no information about their prior preventive dental service use. A total of 14,972 kids younger than age 8 and 21,833 age 8 and older were included.

Using a technique called individual fixed effects, the team was able to use each child as their own control, and then compare what happens to child X in a year when they do not get preventive visits, to a year when they do get preventive visits.

“Simpler techniques gave us the same findings of earlier work, but this more advanced technique we used was an effective, though not foolproof, way of controlling for the selection problem of past literature,” Sen said.

What they found was that more preventive visits were associated with fewer subsequent restorative services for the same child for both age groups, even though the cost savings for CHIP do not appear to sufficiently cover the cost of the preventive services.

For example, the researchers found that when children had one preventive visit, their subsequent nonpreventive costs went down by an average of $25.67. However, this savings of $25.67 was not enough to offset what CHIP paid for the preventive visit. So when the costs of preventive visits and nonpreventive visits were added together, overall CHIP spending was actually $90.94 more.

Despite the figures, the researchers caution against interpreting findings only with dollar figures in mind.

THE STUDY….

Parents who clean their baby’s pacifier by sucking on it may be protecting their infants from developing allergies, according to an article published online May 6 in Pediatrics.

Bill Hesselmar, MD, associate professor of pediatric allergology at the University of Gothenburg in Sweden, and colleagues analyzed the records of 184 infants born at Mölndal Hospital in Gothenburg whose mothers were recruited into the study. Parents kept diaries covering the first year of life for the infants, and a pediatric allergist examined the children at 18 and 36 months of age. Saliva samples were collected from infants at 4 months of age, and all pacifier cleaning practices were obtained through parental interviews.

The researchers found that children (n = 65) whose parents sucked their pacifiers to clean them before giving them to the children were less likely to have asthma (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01 – 0.99), eczema (OR, 0.37; 95% CI, 0.15 – 0.91), and sensitization to potential allergens (OR, 0.37; 95% CI, 0.10 – 1.27) at 18 months of age than children whose parents did not suck the pacifiers (n = 58). The protective effect against eczema remained at age 36 months (hazard ratio, 0.51; P = .04).

When the researchers adjusted for delivery mode and mother’s education, they found that parents who delivered vaginally were significantly more likely to suck pacifiers than parents of cesarean-delivered infants (P = .02) and that the protective effect of pacifier sucking against eczema remained with the child during the first 18 months (OR, 0.27; 95% CI, 0.086 – 0.819; P = .02).

Children born vaginally and exposed to parental oral microbiota had the lowest prevalence of eczema, at 20%, compared with 54% for cesarean-born children not exposed to parental oral microbiota.

The evidence suggests that having their parents suck on their pacifiers and being exposed to bodily fluids during vaginal birth positively influences infants’ microbiota composition, the researchers write.

The small scale of the study may be a weakness, the researchers note, but it also may be a strength because of the detailed and structured follow-up that was possible.

"By no doubt, this habit allows for a close oral contact between parents and child," the researchers write, "facilitating bacterial transfer at a very young age, before the child starts to use spoons."

“A child’s teeth are susceptible to decay as soon as they begin to erupt,” Jonathan Shenkin, DDS, MPH, a pediatric dentist in Maine and a pediatric dental spokesperson for the ADA said in the press release. “Cavity-causing bacteria, especially Streptococcus mutans, can be transferred from adult saliva to children that may increase their risk of developing cavities,” Dr. Shenkin said.

“Licking a pacifier, as promoted in the study, can potentially transfer cavity-causing bacteria from the parent to baby which may increase the baby’s chance of developing tooth decay as they grow,” the ADA statement continues.

Bill Hesselmar, MD, PhD, an associate professor at the Queen Silvia Children’s Hospital and the Department of Pediatrics at the Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues reported their findings in an article published online May 6 in Pediatrics.

When asked about the ADA’s concerns, the researchers said they are not well founded. “There is no convincing evidence that ‘close salivary contact’ between parents and child [is] causally related to enhanced risk of caries,” said coauthor Agnes Wold, MD, PhD, a professor in the Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, in an email interview. “Actually, the opposite has been reported in a study: ‘close salivary contact’ is inversely related to the risk of caries development. Large meta-analysis studies show that there is no correlation at all between pacifier use, per se, and caries development.”

“We have looked quite deep into the published literature to look for the evidence that ‘transfer of cariogenic bacteria’ from parent to infant is a causative factor behind caries. We have not found any convincing evidence of causality,” Dr. Wold continued.

“It is clear that S mutans is transferred via saliva from people in the family to the baby. However, S mutans cannot establish before the teeth have erupted. This means that transfer of parental mouth bacteria prior to tooth eruption will lead to establishment of a microflora in the infant, but not of S mutans. Once the teeth erupt, there is a possibility that S mutans can colonize. The question is: Is there a greater or lesser possibility that a caries-driving microflora will establish in a child who has been exposed to parental saliva prior to tooth eruption?” Dr. Wold continued.

“We do not know this, but we know that if we have a rich normal flora in the gut, it is more difficult for a pathogenic bacterium to establish, a phenomenon called ‘colonization resistance.’ Thus, it is possible that early transfer of saliva from parent to child protects against S mutans colonization, enhances the risk of S mutans colonization, or plays no role,” Dr. Wold concluded.

Not all dentists agree with the ADA’s position either. Saliva is sometimes thought of in a negative way, but this study should help to change that, according to Joel H. Berg, DDS, president of the American Academy of Pediatric Dentistry, who commented on the controversy in an interview.

“The main point it brings to light is the fact that there are many unknown or underappreciated benefits of saliva…. It’s one of the great protectors of the body — nature’s way of protecting us against cavities, naturally cleansing the teeth, and in this case, it apparently imparts a kind of immune protective effect,” explained Dr. Berg, who was not involved in the controversial study.

“The minerals that help to heal cavities that are forming emanate from saliva,” Dr. Berg added.

“Keep an Eye on Salivary Research”

Dr. Berg cautioned that this is only 1 study, and clinicians should not be telling parents to clean their child’s pacifier by sucking it. Corroborating studies are needed, he said.

“Given that it’s the first time a study like this has shown what it showed, surely there will be other studies…to corroborate the findings,” Dr. Berg said.

“I would tell clinicians to keep an eye on salivary research,” Dr. Berg added.

J Dent Res. Published online September 27, 2012. Abstract