42. HEALTHY SMILE HAPPY START

<h3>Context:</h3> Dental decay is the most common chronic disease in children, with racial minorities and children living in poverty having the highest prevalence. Dental fluoride varnish, a protective coating painted on teeth to help prevent caries, requires no special equipment and can be applied in &lt;2 minutes. Per the USPSTF and American Academy of Pediatrics, dental varnish application should be considered every 3-6 months during well child exams. <h3>Objective:</h3> Evaluate incorporation of fluoride varnish applications in well child visits. <h3>Study Design:</h3> Mixed-methods. <h3>Setting:</h3> Two residency clinics in Milwaukee, WI. <h3>Population studied:</h3> 6 month - 6 year well child visits, pre/post-provider survey. <h3>Intervention:</h3> Dental varnish application protocol was implemented in July–Sept. 2019. All providers completed the STFM Smiles for Life Module 6. <h3>Outcome measures:</h3> Pre/post-surveys were conducted to identify provider’s opinions including importance, sustainability, and barriers to implementation of a dental varnish protocol. Well child visit data from 7/1/19 1/15/20 (period 1) and 1/16/20 - 12/31/20 (period 2; representing COVID pandemic) was compared for both clinics regarding rates of preventative visits with fluoride dental varnish applied. A Z-test for Equality of Two Proportions was used to compare rates. Pre/post-survey answers were analyzed using 2-sample T–tests. <h3>Results:</h3> 1,984 well child visits in study period; 369 (19%) with varnish application. During period 1, 25% of visits at clinic 1 and 16% of visits at clinic 2 included a varnish application. There was no significant difference in application rates between periods (clinic 1=22% visits and clinic 2=15%). During the Covid-19 pandemic varnish applications decreased from 18.6 to 8.1 per month at clinic 1 (p&lt;0.01), but increased from 12.5 to 15.2 per month at clinic 2 (p=0.18). Our pre/post-surveys identified the same barriers to application (not enough training/time, unsure where to find supplies). Except for percentage of eligible patients seen for well child exams including fluoride varnish (63% v. 35% p&lt;0.01), no other survey responses were significantly different. <h3>Conclusions:</h3> Dental fluoride varnish application can be successfully implemented into academic primary care clinics to reach children most at risk, but not without challenges. Results of further surveys can be used to streamline protocols for sustainability. Optimized processes may be adapted by others to decrease health disparities.

Fluoride varnish application is an effective intervention in controlling dental caries. Objective of this study was to evaluate the effectiveness of six monthly application of sodium fluoride varnish in prevention of dental caries in deciduous teeth, permanent incisors and molars in children between six and seven years in a low resource setting, Sri Lanka. This was an open-label, randomized controlled trial (NCT02877888) in school children aged six to seven years, living in a district of Sri Lanka. Recruited children were randomly assigned to either a treatment (n=161) or to control group (n=162). Children in the treatment group received fluoride varnish professionally applied every 6 months combined with counselling on maintenance of oral hygiene and diet for a period of 2 years. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The primary outcome studied was the number of new caries in the two study groups. At each time interval, the mean number of new dental caries was significantly lower in the intervention group. When independent effect of the intervention on development of new dental caries was assessed, application of fluoride varnish every 6 months for a period of 2 years was significantly associated with less number of new dental caries compared to controls. Fluoride varnish application in a low resource setting is an effective method of preventing dental caries among children. A national level programme would contribute to the reduction of dental caries in this age group. Keywords: Clinical trial, Fluoride varnish, Dental caries, Caries prevention, Effectiveness

Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. Thecoronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis. Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases in childhood, with its incidence increasing globally. Thecoronavirus disease 2019 (COVID-19) pandemic has been associated with an increase in severity of cases of diabetic ketoacidosis. A retrospective cohort study was conducted, using patients' clinical records, between March 2016 and March 2024. Thesample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024). A retrospective cohort study was conducted, using patients' clinical records, between March 2016 and March 2024. Thesample was divided in three groups: pre-pandemic (March 2016 to March 2020), pandemic (March 2020 to March 2021), and post-pandemic (March 2021 to March 2024). There was an improvement in the post-pandemic period, with alower severity at presentation. However, the rate of ketoacidosis remained high, and the focus must remain on implementing preventative measures.

Fluoride varnish reduces children's tooth decay, yet few clinicians provide it. Most state Medicaid programs have covered this service during medical visits for children aged 1 to 5 years, but private insurers began covering it only in 2015 due to the Patient Protection and Affordable Care Act (ACA) mandate that they cover a set of recommended preventive services without cost-sharing. Evidence on clinicians' behavior change postmandate is limited. To examine monthly changes in fluoride varnish applications among pediatric clinicians following the ACA mandate. Using all-payer claims data from Massachusetts, this cohort study applied an interrupted time-series approach with linear regression models comparing changes in monthly clinician-level outcomes before and after the mandate. Participants included clinicians who billed at least 5 well-child visits for patients aged 1 to 5 years and were observed at least once premandate. Adjusted for clinician fixed effects, models were assessed overall and separately for clinicians categorized by their monthly share of well-child visits paid by private insurers before the mandate: mostly private (>66% of visits paid by private insurers), mostly public (<33% of visits paid by private insurers), or mixed (33%-66% of visits paid by private insurers) insurance types. Analysis was performed from June 1, 2022, to July 31, 2023. Preenactment and postenactment of the ACA mandate for private insurers to cover fluoride varnish applications without cost-sharing. Clinician-month measures of whether fluoride varnish was provided during at least 1 well-child visit and the share of such visits, analyzed separately for clinicians who did and did not apply fluoride varnish premandate. The sample included 2405 clinicians, with 107 841 clinician-months. Premandate, 10.48% of the visits included fluoride varnish applications. Two years postmandate, the likelihood of ever applying fluoride varnish was 13.64 (95% CI, 10.97-16.32) percentage points higher. For clinicians providing fluoride varnish premandate, the share of visits with fluoride varnish increased by 9.22 (95% CI, 5.41-13.02) percentage points. This increase was observed in clinicians who treated children with insurance that was mostly mixed and mostly private; no substantial change was observed among those treating children with mostly public insurance. In this cohort study of pediatric primary care clinicians, an association between the ACA mandate and an increase in fluoride varnish application was observed, especially among clinicians primarily treating privately insured patients and those applying it premandate. However, application remains infrequent, suggesting persistent barriers.

Applying fluoride varnish or resin-based fissure sealants to first permanent molars helps prevent occlusal caries, but it has not been possible in this review to reach reliable conclusions about which one is better to apply. The available studies do not suggest either intervention is superior, but we assessed this evidence as having very low certainty. We found very low-certainty evidence that placing resin-based sealant as well as applying fluoride varnish works better than applying fluoride varnish alone. Fourteen studies are currently ongoing and their findings may allow us to draw firmer conclusions about whether sealants and varnish work equally well or whether one is better than the other.

Introduction: Dental caries is the most common chronic disease in childhood and a major problem for world public healthcare. For dental caries onset, the presence of dental plaque is primordial, being plaque removal one of caries preventive measures. Children younger than 3 years old depend on adults for dental plaque controlling. Objective: To assess the quality of oral hygiene of children before and after a motivational program conducted with their caregivers. Material and methods: Twelve caregivers and 16 children (from 10 to 36 months old) entered the study. The children’s oral hygiene quality was assessed with the Oral Hygiene Index (OHI) of upper and lower incisors at baseline, 1 and 3 months after the instructional lecture on oral health given to the caregivers. Results: It was verified a statistical difference in OHI of upper/lower incisors between baseline and 3 months after the lecture. At 1-month assessment after the lecture, there was an improvement in OHI of the upper incisors. There was no statiscally significant difference between upper and lower incisors. All incisors OHI for the three assessments showed a statiscally significant difference between the groups at baseline and 1 month after the lecture, returning to the initial indexes after 3 months. Conclusion: Punctual health education activities are not effective. They need to be continuous to institute changes in behavior regarding oral health.

Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries

Allergy and infection have being exerted seriously adverse effect on children’s health. On the one hand, asthma and allergy have become the most common chronic diseases in childhood and the leading cause of pediatric hospitalization worldwide. The prevalence of childhood asthma has considerably increased since the 1950s, with some suggestion of plateauing in developed regions but rapidly increasing in low- and middle-income countries over recent years. On the other hand, pneumonia as the most prevalent infectious disease is the leading cause of mortality in children under 5 years old globally. Approximately 99% of the pneumonia death occurs in developing countries. During recent decade, China has witnessed a rapid increase in the prevalence of childhood asthma and allergies and the morbidity of childhood infectious diseases such as pneumonia tend to be very high. Environmental exposure is thought to be the most important factor which is responsible for this rising trend and serious burden of childhood allergic and infectious diseases. Ambient air pollution has been widely suggested to be associated with the incidence and prevalence of allergies and infections, and a distinct need is then to find out the key component of air pollution and the critical exposure window so as to develop more effective measures of prevention and intervention. A large body of evidence mainly from developed countries suggested that traffic-related air pollution (TRAP) plays a key role in the exacerbation and development of allergies and infections. However, differences in the chemical and physical composition of air pollution, both in level and source, between China and developed countries prompts the need for further investigation into the role of outdoor air pollution in the development of childhood allergic and infectious diseases. On the other hand, due to the rapid urbanization progress in China, a huge number of people, especially the new couples and expected parents, migrated into new buildings in urban areas during the past decade. New building materials, decoration materials, and new furniture caused high indoor level chemicals, such as volatile and semi volatile organ compounds (VOCs and SVOCs). Due to lack of central air conditioning and heating systems, mold and dampness in dwellings is very serious in the southern China with subtropical climate. Thus, indoor environmental risk factors are also serious in China, which play important role in the rapid increase in the allergic diseases and high prevalence of infectious diseases in childhood. Although the impact of environmental pollution on children’s health has attracted wide attention and extensive research, some key scientific issues such as “main environmental pollutants, critical exposure windows, and whether the exposure cause diseases” still remain unclear. This paper summarizes the effects of prenatal (one year before pregnancy, entire pregnancy and three trimesters of pregnancy) and postnatal (first year, past year, and entire postnatal period) exposure to both indoor and outdoor environmental pollution on childhood allergic and infectious diseases, and also analyzed the relative importance of the critical exposure time windows for different diseases. We concluded that most studies mainly from developed countries found a positive association between traffic related air pollution and childhood allergic diseases. However, in China, early life exposure to classical air pollution (such as industrial air pollution) also exerts an adverse effect on childhood asthma and allergies. The recent studies identified relative importance of traffic-related air pollution exposure in different critical time windows (such as different trimester of pregnancy) in the development of different allergic diseases. This paper also concluded that early-life exposure to indoor mould/dampness and renovation significantly increased risk of childhood allergic and infectious diseases. According to the analysis of available literatures, this study proved the hypothesis of “fetal origins of disease” in children, and revealed that exposure to indoor and outdoor environmental pollution during pregnancy and early postnatal period played an important role in the onset and development of childhood allergic and infectious diseases, which provides a scientific basis for effective prevention and intervention strategies to reduce childhood allergies and infections. Finally, this study summarized the different influences, and expected the problems and challenges of effective prevention and reduction of childhood allergies and infections.

ABSTRACTBackground:The prevalence of dental caries requires pediatric dentistry to pursue efficient preventive methods to tackle the problem. Multiple research has explored the fluoride varnish effectiveness for remineralization, yet the results show contrasting findings. The proposed research evaluates the effectiveness by which different fluoride varnishes can remineralize primary teeth with demineralized enamel.Materials and Methods:A total of sixty extracted primary teeth received artificial enamel lesions under randomized selection that split them into four groups numbering fifteen specimens each for Groups A and B and C and D. The pH cycling procedure was applied to the samples for 14 days. Metabolic testing of surface microhardness took place using a Vickers hardness tester before initiating treatment and after completion. The research used ANOVA statistical analysis together with posthoc tests while setting the significance threshold at P < 0.05.Results:The application of fluoride varnishes in all test groups produced substantial increases in surface microhardness values than those observed in the control group. The highest level of tooth remineralization occurred in Group A where the restoration increased by 45%, while Group B achieved 38% and Group C gained 30%. The control group experienced inferior dental improvements compared with the experimental groups having only a 5% hard tissue increase. The results demonstrated that Group A obtained superior values compared with other groups, while statistical findings indicated a significant group variation with P < 0.001.Conclusion:The highest level of primary tooth remineralization occurs when using 5% sodium fluoride varnish as an effective preventive treatment. Tricalcium phosphate and amorphous calcium phosphate fluoride varnishes demonstrated strong effectiveness in addition to 5% sodium fluoride varnish. Research findings demonstrate that fluoride varnishes need to be considered a fundamental approach for handling young children’s early enamel lesion management.

Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Fluoride varnish is a prevention measure for dental caries among children, but few studies have assessed its use in medical settings. This study aimed to determine the period-specific and cumulative prevalence of the receipt of fluoride varnish application among children in the medical setting and associated factors. A parent study enrolled 1326 primary caregiver/child dyads in Indiana, Iowa, and North Carolina; conducted 6 child dental examinations with primary caregiver questionnaires; and administered intermediate questionnaires every 4 months during 2013-2022. Responses were combined from 2- or 4-month time periods to determine the 1.5-year cumulative rates for children aged 1 to 9.5 years. Researchers conducted bivariate and multivariable logistic regression analyses to assess factors associated with the receipt of fluoride varnish application only from age 1 to 2.5 years. The 18-month cumulative prevalence of the receipt of fluoride varnish application in the medical setting from the child's age of 1 to 2.5 years was 20.4%, and the prevalence decreased to 12.9%, 6.4%, and 1.9% among children aged 2.5 to 4 years, 6.5 to 8 years, and 8 to 9.5 years, respectively. The following factors were significantly positively associated with fluoride varnish application in the medical setting: Medicaid insured, low annual household income, Duke University study site, child's frequent consumption of sugary beverages, child enrolled in other public assistance programs, and child's infrequent dentist visits. The prevalence of fluoride varnish application in the medical setting is low. Factors associated with the receipt of fluoride varnish can be targeted to increase caries prevention through the expanded use of fluoride varnish application in the medical setting.

Objective This study aimed to assess the effect of fluoride varnish on glass ionomer microhardness changes after endogenous acid erosion challenge. Methodology In this study, 40 conventional glass ionomer (CGI; Fuji IX) and 40 resin-modified glass ionomer (RMGI; Fuji IILC) discs were fabricated and divided into 4 subgroups (n = 10) for immersion in synthetic gastric acid or saliva for 27 h with/without fluoride varnish application. The surface microhardness was measured at baseline and after immersion, and the change in microhardness was calculated. Data were analyzed using analysis of variance and T-test. Results A reduction in microhardness was noted in all subgroups following immersion. The lowest change in microhardness of both CGI and RMGI occurred in artificial saliva. In CGI groups, the highest reduction in microhardness occurred in synthetic gastric acid with fluoride varnish application, and the reduction was significantly different from that of the CGI group with fluoride varnish application (p value = .01). In RMGI groups, the highest reduction in microhardness was noted in synthetic gastric acid without fluoride varnish application, and the reduction was significantly different from that of the other groups (p value < .05). Conclusions Exposure to synthetic gastric acid caused a significant reduction in microhardness of RMGI. Varnish application significantly decreased the acid susceptibility of RMGI, but not that of CGI.

AimThe aim of this study was to evaluate the in vitro effects of topical fluoride varnish and fluoride-releasing adhesive on the shear bond strength (SBS) of orthodontic brackets.Materials and methodsA total of 60 extracted premolars were bonded to 0.022, stainless steel brackets and equally divided into three groups (n = 20) based on the adhesive used—Group I- Transbond XT Plus color change (3M Unitek), Group II- Transbond XT followed by application of fluoride varnish, and Group III- Transbond XT (3M Unitek) adhesive and their bond strengths were compared. Brackets were debonded with a universal testing machine. The modified adhesive remnant index (ARI) was also recorded. Data were analyzed by using an analysis of variance, and a post hoc test was performed for multiple comparisons among the groups.ResultsThere were no significant differences between the SBSs (p = 0.91) between the groups. Also, no significant difference was found in the modified ARI (p = 0.093).ConclusionThe orthodontic adhesives used in our study, with or without the application of topical fluoride varnish, did not have a significant effect on the bond strengths of brackets.Clinical significanceAdhesives evaluated in this study can be successfully used for bonding brackets.How to cite this articleChauhan C, Mangla R, Gandhi G, et al. Evaluation of the Effects of Topical Fluoride Varnish and Fluoride Releasing Adhesive on Shear Bond Strength of Orthodontic Brackets: An In Vitro Study. Int J Clin Pediatr Dent 2023;16(1):37-41.

BackgroundAsthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, only 50% of US youth accurately follow their care plans, which leads to millions of preventable hospitalizations, emergency room visits, and sick days every year. We present a feasibility study of a novel, user-centered approach to increasing young people’s lung-function monitoring and asthma self-care. Promoting Lung Assessment in Youth (PLAY) helps young people become active managers of their asthma through the Web 2.0 principles of participation, cocreation, and information sharing. Specifically, PLAY combines an inexpensive, portable spirometer with the motivational power and convenience of mobile phones and virtual-community gaming.ObjectiveThe objective of this study was to develop and pilot test InSpire, a fully functional interface between a handheld spirometer and an interactive game and individualized asthma-care instant-messaging system housed on a mobile phone.MethodsInSpire is an application for mobile smartphones that creates a compelling world in which youth collaborate with their physicians on managing their asthma. Drawing from design-theory on global timer mechanics and role playing, we incentivized completing spirometry maneuvers by making them an engaging part of a game young people would want to play. The data can be sent wirelessly to health specialists and return care recommendations to patients in real-time. By making it portable and similar to applications normally desired by the target demographic, InSpire is able to seamlessly incorporate asthma management into their lifestyle.ResultsWe describe the development process of building and testing the InSpire prototype. To our knowledge, the prototype is a first-of-its kind mobile one-stop shop for asthma management. Feasibility testing in children aged 7 to 14 with asthma assessed likability of the graphical user interface as well as young people’s interest in our incentivizing system. Nearly 100% of children surveyed said they would play games like those in PLAY if they involved breathing into a spirometer. Two-thirds said they would prefer PLAY over the spirometer alone, whereas 1/3 would prefer having both. No children said they would prefer the spirometer over PLAY.ConclusionsPrevious efforts at home-monitoring of asthma in children have experienced rapid decline in adherence. An inexpensive monitoring technology combined with the computation, interactive communication, and display ability of a mobile phone is a promising approach to sustainable adherence to lung-function monitoring and care plans. An exciting game that redefines the way youth conduct health management by inviting them to collaborate in their health better can be an incentive and a catalyst for more far-reaching goals.

Traffic-related air pollution and the local burden of childhood asthma in Bradford, UK