September 2020 Volume LV Number 5


AAPD Pediatric Oral Health Research and Policy Center

July 2020 Volume LV Number 4

The Pediatric Oral Health Research and Policy Center (POHRPC) helps the AAPD be more effective in the public policy arena by analyzing research data and relevant policy and carrying out health services research that can have a positive impact on children’s oral and overall health. This area is led by Chief Policy Officer Dr. Paul Casamassimo, Director Dr. Robin Wright, and Policy Project Coordinator Ms. Clare Conte.
POHRPC Advisory Board for 2020-21
Paul S. Casamassimo (Chair), Chief Policy Officer, AAPD representative to Dental Quality Alliance
Homa Amini, Board Liaison 
Joel Berg, CODA Commissioner 
Scott W. Cashion, MSDA Board Representative and PDMCAC Chair
Kaaren G. Vargas, CSA Chair 
Jessica L. Roberston, CGA Chair 
Randall K. Lout, CCA Chair James Nickman, CDBP Chair 
James J. Crall, Expert Consultant
Michael Ignelzi, Expert Consultant 
Jessica Y. Lee, Expert Consultant 
Vinod Miriyala, Expert Consultant
John S. Rutkauskas, AAPD Chief Executive Officer
POHRPC Fellows
The POHRPC Research Fellows serve as principal investigators for Policy Center proj- ects and also act as an expert resource for the policy center by:
  • Constituting a queue of researchers prepared to respond to research opportuni- ties presented by/to the Policy Center.
  • Assisting the Policy Center in monitoring the quality of current research activities.
  • Identifying funding and research opportunities consistent with Policy Center goals.
  • Advising the POHRPC as requested by the Advisory Board and AAPD leadership.
Current Fellows are: Drs. Tegwyn Brickhouse, Donald Chi, Jessica Lee, Amr Moursi, Art Nowak, and Anupama Tate.

Policy Center Welcomes Clare Conte to the Team
Clare Conte, M.P.H., joined the Policy Center in November 2019 as the new policy project coordinator. She earned her master’s degree in public health from the University of Cincinnati and a bachelor’s degree in community health services from Ohio University in Athens, Ohio. Clare came to the AAPD from Children’s Dental Ser- vices, where she served the greater Minnesota school-based care and portable care program for nearly three years as an integral member coordinating care for children across the state.
Harris Fellowship Research Shows Dental Care Affected by School Absenteeism Policies
Dr. Brittaney Hill, the 2019-2020 Samuel D. Harris Research and Policy Fellow, completed her research project focusing on school absenteeism as a result of dental appointments. Titled The Impact of School Attendance on Dental Visits: The Care- giver Perspective, the research project consists of a cross-sec- tional study in which caregivers of school-aged children were surveyed about school attendance policies and their impact on their child’s dental care. Her research findings were presented to the POHRPC at NashVirtual. Dr. Hill currently serves as a full- time Clinical Assistant Professor in the Department of Pediatric Dentistry at the University of Illinois at Chicago.
Pediatric Dental Workforce Study Reported in JADA
"Pediatric Dental Workforce in 2016 and Beyond" by Surdu and colleagues appeared in the July, 2019 issue of the Journal of the American Dental Association. Commissioned by the AAPD, the study conducted by the Center for Health Workforce Stud- ies at the University at Albany, SUNY, gathered exhaustive data on the current supply and distribution of pediatric dentists relative to their patient populations. According to the report, the number of U.S. pediatric dentists is projected to continue to increase beyond the next decade. If children in underserved populations face fewer access barriers, then the higher number of pediatric dentists will be poised to care for the large amount of unmet oral health needs. The study also found that the sup- ply of pediatric dentists is lowest in states with a larger percent- age of rural populations. These research results suggest op- portunities for providing care in areas not traditionally served by pediatric dentistry, particularly in smaller population centers where the need is great for oral health services for children.6
Pediatric Dental Workforce Study Holds Continued Interest
Chief Policy Officer Dr. Paul Casamassimo, in conjunction with the Center for Health Workforce Studies, presented two half- hour webinars in September 2019 based on the article "Pedi- atric Dental Workforce in 2016 and Beyond." The first webinar covered the methods, modeling approach and projected outcomes of the study. The second webinar discussed the implications of the study for the day-to-day practice of pedi- atric dentists. To view the webinars, you can visit the Dental Workforce webpage under the Policy Center.7 Dr. Casamassimo also shared the workforce study findings with pediatric dental residents and pediatric dentists serving as legislative advocates in a well-received presentation at the Pediatric Oral Health Advocacy Conference on March 2, 2020, held in Washington, D.C. He discussed the impact of the findings on current and future policy decisions of the AAPD, as well as the implications for practice decisions of early career pediatric dentists.
Policy Center Publications Move Forward
  • The Importance of the Age One Dental Visit. Authored by Drs. Suzanne Baker and Jessica Lee, this technical brief was published online and in print in October 2019. It provides up-to-date facts and a scientific rationale for a first dental visit by age one. The brief also addresses how early dental visits can prevent suffering and reduce the dollars spent on future surgical and emergency dental services.8 The brief was distributed to Congressional offices along with AAPD’s legislative fact during the March 1 – 4, 2020, Pediatric Oral Health Advocacy Conference in Washington, D.C.
  • Treating Tooth Decay: How to Make the Best Restor- ative Choices for Children’s Health. This consumer- friendly informational piece explains restorative choices for children’s long-term oral health through concise language and eye-catching visuals. The publication will highlight the importance of parental choice and the clinical judgment of a dentist in treatment decisions. The electronic version of the brief will be available online by early summer, 2020. Contributing authors: Drs. Judith Chin, Yasmi Crystal, Eu- gene McGuire, and Paul Casamassimo.
  • Silver Diamine Fluoride. The Policy Center is developing a fact sheet clarifying the AAPD’s position on key issues surrounding Silver Diamine Fluoride (SDF), such as establishing SDF as a covered benefit from both private and public third-party carriers. The fact sheet will serve as a companion to the AAPD’s Policy on the Use of Silver Diamine Fluoride for Pediatric Dental Patients and clinical practice guideline on Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs.
  • Value-Based Payments in Pediatric Dentistry. From the Council on Government Affairs via the Medicaid/CHIP Advisory Committee, the POHRPC was asked to develop a technical brief on value-based care and payment system approaches in dentistry. The brief will describe and evalu- ate the models currently in the marketplace and their effectiveness, as well as proposed approaches and models.
Conference Participation Builds Legislative Awareness
At the National Conference of State Legislators (NCSL) held in Nashville on Aug. 4 – 8, 2019, Dr. Jeannie Beauchamp and Policy Center staff provided key policy- related messages at the AAPD exhibit booth to legislators and legislative aides from nearly every state. Topics of interest included early preventive visits, fluo- ridation, state funding of Medicaid dental programs, and the effectiveness of the Mouth Monsters campaign.
AAPD Builds Visibility at NNOHA Conference
A 90-minute session titled "Speak Up for Patient Health: Critical Conversations on Controversial Issues" was presented by Dr. Robin Wright at the 2019 Annual Meeting of the National Net- work for Oral Health Access (NNOHA) in Las Vegas, Nevada on Oct. 15, 2019. Based on the results of a 2019 survey of pediatric dentist members, the session offered practical information on how to hold effective conversations on potentially embarrass- ing topics, engage adolescents in more open conversations, and provide much needed information on vital health con- cerns. In addition, the AAPD again sponsored an exhibit booth at the meeting.9
Beverage Guidelines Presentation at the National Oral Health Conference
Originally scheduled for April 4 – 7, 2020, in San Diego, the Na- tional Oral Health Conference, sponsored by the Association of State and Territorial Dental Directors and American Association of Public Health Dentistry, was held virtually in June 2020. Dr. Paul Casamassimo will present a 60-minute videoconference titled "What Should and Shouldn’t Young Children Be Drinking? New Evidence-Based Recommendations from Four National Health and Nutrition Organizations." He will discuss the 2019 beverage guidelines from the AAPD, Academy of Nutrition and Dietetics, American Academy of Pediatrics and American Heart Association.10
AAPD Informs ADA Members on the HPV Vaccine
Dr. Robin Wright presented a one-hour continuing education webinar through the American Dental Association (ADA) on Sept. 25, 2019, to over 300 attendees. The presentation provid- ed sound advice on how to introduce the HPV vaccine during a dental visit, explain the treatment to encourage compliance, and handle difficult questions from parents about HPV and the vaccine. The webinar can be accessed online.11
BIG NEWS FOR LITTLE TEETH Slides Ready for AAPD Members to Speak to Their Communities
In response to member requests, the Policy Center collaborated with the Publications Department to create a slide presentation for members to use when they speak to parents, caregivers, teachers and other interested audiences in their communities. The slide set provides the latest information and research on topics such as oral health care, oral hygiene, nutrition, injury prevention, nonnutritive sucking, and more.12
Update on the Safety Committee
The AAPD Safety Committee was formed to advance safety cul- ture in pediatric dentistry, to integrate what we do know about safety into pediatric dental practice, and to examine what we still do not know. Building awareness among membership has been a top goal of this undertaking. There has been consider- able interest and enthusiasm for the topic among members this year, and there is still much work to do. The committee is pleased with the progress made thus far with the develop- ment, planning and coordination of their current main projects.
Safety Symposium: A First for AAPD
Hidden Threats and Safe Practices: Steps to creating a safe dental home, the first safety symposium presented by AAPD, featured recognized experts from major areas of dental and medical practice and aimed to help attendees develop a culture of safety, mitigate potential harm in pediatric dental practice, and take proactive steps for the well-being of both providers and patients. One hundred and eighty guests attended the Symposium this past November 2019, including speakers and exhibitors. For members who missed the presentations, they can be viewed on the continuing education app, AAPD CE. The member feedback has been encouraging. As we plan to hold a second safety symposium, we look forward to engaging new dentists in the field.

Safety Toolkit Up and Running
This year saw the Safety Toolkit launch an online repository of safety information, regularly updated and available on the AAPD website.13 The Safety Toolkit aims to assist providers in maintaining the safest environment for pediatric patients. This collection of resources contains current recommendations in major areas of dental practice related to safety, using best prac- tice guides, policies, training materials and office-friendly tools.

Safety in Academy Media
In March 2019, the AAPD podcast Pedo Teeth Talk featured Dr. John Molinari discussing infection control with the emergence of the COVID-19 disease pandemic. Safety topics continue to be published monthly in the Policy Center section of Pediatric Dentistry Today.

Collaboration with American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF)
The AAPD has partnered with the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) to develop a voluntary sedation/general anesthesia accreditation model for pediatric dental practices. This is in response to the unwavering commitment by pediatric dentists to continue to provide safe environments in which to treat children. The intent is to offer an opportunity for pediatric dental offices to choose to be accredited voluntarily by an independent organization documenting safe and competent delivery of deep sedation and general anesthesia in their office settings. This accredita- tion process will be expanded for in-office moderate sedation services in the future. Pediatric dentists are being trained as surveyors to evaluate practices going through the accredita- tion process. Look for more information about this program in the coming months.

Evidence-Based Dentistry Committee (EBDC) Update
Members of the EBD Committee for 2020-21 are:
J. Timothy Wright, Chair 
Anupama R. Tate, Board Liaison
Donald Chi Council on Scientific Affairs 
Randall K. Lout Council on Clinical Affairs 
Carolyn Crowell Ex-Officio Member
Noel K. Childers, Editor-in-Chief
James A. Coll
The search for a new Evidence-Based Dentistry Manager has been placed on hold until fall of 2020. Dr. Robin Wright contin- ues to provide support for the EBDC in the interim.
Assessment and Proposal of Guideline Topics
Three topics that were deemed of greatest importance to pro- vide timely and important guidance to clinicians were submit- ted to the Board. At the Ad Interim Meeting in September 2019, the Board approved the following topics for future clinical practice guidelines that the EBDC had selected based on the literature search and review:
  • Frenectomy/frenotomy and lactation
  • Vital treatment of immature permanent teeth
  • Caries risk assessment and oral health determinants
Ongoing Guideline Topics and Workgroup Progress
The EBDC continues to oversee development of three new evidence-based clinical practice guidelines:
  • Use of Non-Vital Pulp Therapies in Primary Teeth. The Non- Vital Pulp Therapy Guideline Workgroup is comprised of Drs. James Coll (Chair), Kaaren Vargas, Shahad Al Shamali, Chia-Yu Chen, Abdullah Marghalani, Yasmi Crystal and Vineet Dhar. The Non-Vital Pulp Therapy Workgroup has completed both the systematic review and guideline, hav- ing vetted the draft guideline through an external group of shareholder organizations, the EBDC, CCA and CSA. The guideline has been submitted to Pediatric Dentistry for publication and as an information item to the Board of Trustees and General Assembly.
  • Behavior Guidance for Pediatric Dental Patients. The Behav- ior Guidance Guideline Workgroup is comprised of Drs. Vineet K. Dhar (Chair), Elizabeth S. Gosnell, Cameron L. Ran- dall, and Rebecca L. Slayton. It is awaiting the publication of the Cochrane systematic review on "non-pharmacologi- cal interventions for managing dental anxiety in children." They will evaluate and appraise the systematic review. At the request of the Workgroup Chair, additional content experts were recruited and approved by the EBDC for this guideline and approved by the Board of Trustees.
  • Frenectomy and Lactation. A list of five workgroup candi- dates, as well as alternate nominees, was developed and approved by the Board of Trustees. There are existing systematic reviews to inform this guideline, so it will move forward in selecting a Chair and initiating guideline devel- opment.
Chief Policy Officer Dr. Paul S. Casamassimo Director Dr. Robin Wright
Project Coordinator Clare Conte

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