May 2018 Volume LIII Number 3


Pediatric Oral Health Research and Policy Center Updates

May 2018 Volume LIII Number 3

New Practice Facts: 2017 Survey of Pediatric Dental Practice Now Online

The AAPD Survey of Dental Practice, last published in 2011, supplies up-to-date information on critical functions of pediatric dental practices, as well as offers an inside look at such topics as changing demographics of the profession, perceptions of busyness, geographic variations in the pediatric dental workforce, Medicaid participation, and charitable care. The survey was distributed to 6,505 selected AAPD members last summer, garnering a response rate of 39 percent (2,549 responses out of 6,505).

Here are some intriguing facts from the survey:

• Seventy percent of pediatric dentists accept Medicaid patients. Publically insured patients
represent a higher percentage of their practices in 2016 (34 percent) than in 2011 (26 percent).
• The majority of pediatric dentists in 2016 were women (52 percent) compared with 14 percent in 1998.
• Data suggest a move away from solo to group practice. In 2016, 45 percent of pediatric dentists reported three or more dentists in their primary work setting compared to 11 percent in 2011.
• The percentage of pediatric dentists providing charitable care increased from 74 percent in 2011 to 78 percent in in 2016. The estimated dollar value of care provided free on an annual basis increased from $15,700 in 2011 to $18,300 in 2016.
• Patients’ wait times to see the dentist upon arrival to the office remain at the national average of eight minutes.
• Pediatric dentists who reported being "not busy enough" in their practices were more likely to located in urban counties with populations greater than 1.5 million people (25 percent). Those practicing in counties with under 275,000 population were the least likely to report not being busy enough (11 percent).
• Perceptions of busyness also varied by regions of the country, as shown by the following chart.

Dentists' ratings of the current supply of pediatric dentists in their local area Northeast region Midwest region South Region West Region Nationwide
There is a shortage 12% 16% 9% 6% 10%
The current supply is adequette 40% 61% 45% 40% 45%
There is an oversupply 48% 23% 46% 54% 45%

You will find more facts of interest by viewing the full survey at AAPD_CHWS_survey_Pediatric_Dentistry_final.pdf.

Results from the comprehensive pediatric dentist workforce study conducted in conjunction with the Survey of Dental Practice will be published this fall. Commissioned by the AAPD and produced by the Center for Health Workforce Studies, Albany, N.Y., the workforce study has gathered and analyzed credible evidence to provide solid projections of future supply and demand for pediatric dentists in the U.S.

Final Report Now Available: Predictive Model for Caries Risk Based on Determinants of Health Available to Primary Care Providers

A full report of the third year of re- search exploring oral health promotion in primary care is now available on the AAPD Policy Center website at policy_center/.

With an aim of creating a history-based, caries-risk screening tool that more easily assimilates into the work flow of a well-child visit, a predictive model was developed at Nationwide Children’s Hospital (NCH). The modelcharacterizesthelikelihoodachild would have oral disease or risks of future disease at the time of their first dental visit and is based upon information noted in the early well-child visits.

The study, with over 2,000 infants, pro- duced a predictive model that suggests the odds of a child having tooth decay at the first dental visit more than doubles for every year of increasedage.

Additionally, it offers clues to assist health care professionals identify tooth decay risk in young children before even looking in their mouths. Starting at the 18-month well-child visit, health care providers can use five vari- ables to assess the odds of future or present tooth decay risk. The five variables are:

• Age of the child
• History of a preventive dental health visit
• Duration of breastfeeding (past age 1)
• No-show rate (such as broken appoint- ments, etc.)
• Preferred spoken language

With such a predictive tool, health care providers could easily administer caries-risk assessment as a part of the well-child visit without taking time from other equally im- portanthealth concerns.

New Committee on Safety Update

The AAPD Committee on Safety was created to:

• Examine the processes and culture of patient safety as they pertain to the practice of pediatric dentistry.
• Make recommendations to the AAPD as to possible initiatives the organizationcouldimplement toenhance the safetyof children in a pediatric dental office.

Its vision is the safest possible oral health care delivery system, protecting the health and well-being of patients and their provid- ers. Its mission is to apply the diverse resources of the American Academy of Pediatric Dentistry in aiding dentists to create a culture of safety for both patients and providers in the dental setting. This is done by building and incorporating systems of safety into all aspects of the delivery of oral health care.

The committee has had multiple conference calls and met in Chicago in December 2017 and April 2018. They have completed a Delphi exercise in which various topics related to safety were reviewed and discussed (Sedation, Office Policies and Procedures, Physical Safety Patients, Physical Safety Staff, Infection Control, and Therapeutics). They also assisted in updating the joint AAP/AAPD sedation guideline.

Some of the potential deliverables the committee would produce are:

• "Safety Corner" in each issue of Pediatric Dentistry Today (PDT).
• "Office Safety Elements" manual/toolkit.
• Safety Symposium in 2019.
• Review and update existing AAPD sedation policies and recommendations to match joint AAP/AAPD sedation guideline and addendum.
• Engage OSAP (The Organization for Safety, Asepsis and Prevention) about hosting another webinar (e.g., infection control).

Evidence-based Dentistry Committee Update

Two new EBD guidelines were accepted by the National Guideline Clearinghouse:

• Clinical Practice Guidelines for use of Vital Pulp Therapies in Primary Teeth with Deep Caries, and
• Clinical Practice Guideline on the Use of Silver Diamine Fluoride for Dental Caries Management in Children, Adolescents and Individuals with Special Healthcare Needs.

Patient education materials based on the new guidelines have been developed for silver diamine fluoride, pulpotomy and indirect pulp therapy. They are available through the AAPD’s online store.

The non-vital pulp systematic review workgroup, comprised of Drs. Shahad Al Shamali, Chia-Yu Chen, James Coll, Abdullah Marghalani, N. Sue Seale, and Kaaren Vargas, met in December to begin work and the workgroup will meet again for a full-day work session at the 2018 Annual Session. In vivo and in vitro protocols will be registered within the year.

The EBD Committee is forming a new workgroup on behavior guidance for the pediatric dental patient. The new behavior guideline, based on an existing systematic review, will be published in early 2019.

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