November 2019 Volume LIV Number 6

 
 
 
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Policy Center Updates

November 2019 Volume LIV Number 6

Your Slides Are Ready
A nearby hospital wants you to speak at its child birthing class. The local pre-school program has invited you to address its teaching staff. While both are good educational (and marketing) opportunities, who has the time? You do! Because your slides are ready.
 
Big News for Little Teeth is a new slideshow the AAPD has created for members to use during speaking engagements. Visually appealing, the presentation gathers the latest information and research on topics such as oral health care, oral hygiene, nutrition, injury prevention, and more. Potential audiences include expecting parents as well as parents/caregivers of  infants, toddlers, school-age children, adolescents, and teenagers. It also works for school teachers, social workers, public health professionals, and the like.
 
The 80+ slide collection is divided into nine sections so you can choose which slides work best  for the audience and speaking engagement. In addition to a section for soon-to-be-parents and five sections for different age groups of  children, the slideshow includes sections on topics such as fluo- ride, sealants, and cosmetic dentistry. It is accompanied by speaker notes with AAPD policies related to visual information on the slides.
 
This members-only resource can be downloaded free at https://www.aapd.org/resources/member/ highlight-item/new-resource/big-news-for-little-teeth/
 
This slide from Big News for Little Teeth introduces topics for the expecting parent section.
 
Slide show offers speaker notes with relevant AAPD policies.
 
Updated Research Agenda
The Council on Scientific Affairs, chaired by Donald L. Chi, D.D.S., Ph.D., has updated and affirmed the 2019 - 2020 AAPD Research Agenda to guide the profession in relevant research that will help fill scientific gaps, better inform clinical practice, and improve individual patient and population oral health outcomes. Ve urge aca- demic, state, federal, philanthropic and corporate funding agencies to devote resources to the following areas:
 
  • Improved diagnosis, prevention, and management of  dental and craniofacial conditions through the life course (e.g., emerging dental caries management agents, precision/personalized oral health care, technologies and strategies to monitor and promote health and self-care).
  • Interdisciplinary research to understand and eliminate oral health disparities and promote oral health for all (e.g., basic behavioral and social determinants of  health, applied microbiology and microbiome research, development of  evidence-based public health interventions, clinical trials focusing on children and vulnerable populations, integration of  dentistry into the broader health care delivery system, bioinformatics, quality of care, models of  interprofessional collaboration, data sharing, training, and team science).
  • Translational research to move scientific knowledge into practice and policy (e.g., dissemination and implementation of  evidence- based care principles into clinical practice, barriers to dissemination and implementation, policy and practice partnerships)."

AAPD Announces a Pediatric Dental
Specific Voluntary Accreditation Process
 
For nearly 40 years, the American Association for Accreditation  of  Ambulatory Surgery Facilities' mission (AAAASF) has been active in patient safety in the outpatient surgical arena. In 2018, AAAASF partnered with the AAPD to develop a voluntary sedation/general anesthesia accreditation model for pediatric dental practices. This is in response to the commitment by pediatric dentists to continue to provide safe environments in which to treat children, and is designed for practices interested in demonstrating that commitment to their patient families. Through this partnership, both AAAASF and AAPD will enhance a sense of  trust between providers and families seeking care in pediatric dental facilities.
 
The intent is to offer an opportunity for pediatric dental offices to voluntarily choose to be accredited by an independent organization documenting safe and competent delivery of  deep sedation and gen- eral anesthesia in their office setting. This accreditation process will then be expanded for in-office moderate sedation services.
 
Our goal is to establish and maintain the highest level of  safety and preparedness in pediatric dental facilities.  This is achieved, in part, by proper credentialing and training of  dental and anesthesia providers and focusing on training and education in additional areas including emergency equipment and medications. This process sends a clear message to patients and regulators that AAPD and the indi- vidual facility is fully committed to the safety of  its patients.
 
Together, we look forward to being the driving force for pediatric dental patient safety worldwide.
 
State of Little Teeth Report Works for Community Outreach
The new second edition of  the State of  Little Teeth Report draws on the latest scientific research and best available expertise to examine the public health crisis of  tooth decay among children in the U.S. In addition, it discusses our mission of  patient safety, our approach to an evidence-based practice of  pediatric dentistry, and our programs of child advocacy.  Here are ways to use the new report in your outreach efforts to your patients and community:
 
  • Offer a copy to school nurses - and school librarians
  • Use it as support material for career day and other public pre- sentations
  • Provide a copy to local pre-schools and day care centers
  •  Drop one off at local pharmacies
  • Send a copy to the PR department of  the hospital with which you are affiliated
  • Share with your referring dental and medical offices
  • Email a copy to your local health department
  • Place a copy in the "adult reading section" of  your reception area
  • Post it on your office website
 
To download the full publication, visit http://mouthmonsters.mychild- rensteeth.org/wp-content/uploads/2019/02/StateofLittleTeeth.2ndEdition.pdf."
 
Evidence-Based Dentistry Committee (EBDC) Update
At the Ad Interim Meeting in September, the Board of  trustees approved the following topics for future clinical practice guidelines that the EBDC had selected based on the literature search and review.
 
  • Frenectomy and Lactation
  • Vital treatment of  immature permanent teeth
  • Caries risk assessment and oral health determinants
 
The EBDC continues to oversee the two new evidence-based clini- cal practice guidelines:
  • Clinical Practice Guidelines for use of  Non-Vital Pulp Therapies in Primary Teeth; and
  • Clinical Practice Guideline on Behavior Guidance for Pediatric Dental Patients.
 
The Non-Vital Pulp Therapy Vorkgroup has developed a draft systematic review manuscript. The results of  this systematic review will form the basis for the recommendations in the non-vital pulp therapy clinical practice guideline scheduled for completion in 2020. The Behavior Guidance Guideline Vorkgroup is awaiting the publi- cation of  the Cochrane systematic review on "non-pharmacological interventions for managing dental anxiety in children." They will evaluate and appraise the systematic review.
 
Fire During Deep Sedation and General Anesthesia—Urban Myth or Real Nightmare?
Jung-Wei "Anna" Chen, D.D.S., M.S., Ph.D.
 
With the shift in parenting styles and practitioners' preferences, the treatment paradigm has changed from traditional behavior management to increased use of  office-based deep sedation/general anesthesia (DS/GA). A lot of  safety issues have been mentioned and discussed about office-based DS/GA. However, one issue can cause severe complications and impact to both patients and practitioners yet is rarely mentioned: fire during DS/GA.
 
According to the American Society of  Anesthesiologists' Practice Advisory for the Prevention and Management of  Operating Room (OR) Fires, an estimated 50 - 200 OR fires occur in the United States every year, with as many as 20 percent of  reported fires resulting in serious injury or death.1  On the dental side, the real number is still a mystery. A recent article in the Journal of  the American Dental Association (JADA) published a case report about a patient fire during dental care.2 Despite very few articles published in the dental field, as responsible practitioners,  we should be aware of  the risk of  fire during DS/GA.
 
Why does DS/GA have a fire risk? First, we have to understand the fire triad-an oxidizer, an ignition source, and a fuel (Figure 1).
  • Oxidizer: During DS/GA, oxidizers can include oxygen and nitrous oxide.
  • Ignition Source: Ignition starts with a sudden increase in temperature. Repeated friction between hard or rough surfaces can cause an increase in temperature, which can spark and ignite. In dental offi òce settings, ignition sources may include lasers, high speed handpieces with dull burs (especially diamond burs), elec- trosurgery units, titanium, and zirconia materials.
  • Fuel: During DS/GA, fuels include tracheal tubes, sponges, and drapes (throat packs).
 
Let’s think about a scenario: A pediatric dentist is practicing office-based DS/GA, and the anesthesiologist requests to use cut dry, which means using a high-speed handpiece with very minimal water irrigation. The patient was placed under DS/GA with high oxygen saturation around the nose and mouth. The throat pack is dry, and the dentist chooses to use a dull bur that touches the rubber dam clamp or zirconia or stainless steel crown, which can cause a spark. The dental assistant is also not using a high-power suction due to low/no water irrigation. This is a perfect storm for causing a fire, because the fire triad requirements are all fulfilled.
 
This is not just a hypothetical exercise or warning; it has happened. Safety requires an awareness of  the real risk of  fire during office-based DS/GA. Fires in office-based DS/GA cases are rare. However, the consequences from them can be detrimental, and fast emergency reactions are needed. The complications can be swelling and occlusion of  the airway, up to third-degree (full thickness) burns to the mouth and throat, and most certainly, a psychological shock to the patient, parents, practitioners and health care provider team. In order to place the patient's safety as the priority, pediatric dentists should review the fire risks prior to conducting office-based DS/GA.
 
The following tips can help dental practitioners prevent fires du ing office-based DS/GA.
  1. Avoid having all components of  the fire triad at the same time during DS/GA.
  2. Do not cut dry, using a high-speed handpiece with minimal irrigation.
  3. Use high-power suction during the entire DS/GA treatment.
  4. Discuss the fire risks with your anesthesiologist before starting treatment, and review possible emergency protocols if  one happens.
References
1Practice Advisory for the Prevention and Management of  Operating Room Fires. Anesthesiol- ogy 2008;108(5):786-801.
2Bosack, RC. Patient fire during dental care. JADA 2016;147(8):661-666."
 

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