Eric

a H

idu,

MD

Inte

rnal

Med

icin

e-Pe

diat

rics

, PGY

-4M

aine

AAP

Spr

ing

Educ

atio

n Se

ries

May

18,

202

1

Tooth

Triage

: Dis

pariti

es in

Dent

al Hea

lth

Object

ives

1.Ex

plor

e gr

oups

that

exp

erie

nces

dis

pari

ties

in d

enta

l hea

lth.

2.

Rais

e aw

aren

ess o

f the

impo

rtan

ce p

edia

tric

den

tal c

are

give

n in

adeq

uate

co

vera

ge o

f adu

lts

3.Re

view

evi

denc

e-ba

sed

anti

cipa

tory

gui

danc

e 4.

Dev

elop

cata

log

ofre

sour

ces

in M

aine

5.In

trod

uce

futu

re d

irec

tion

sin

ped

iatr

ic d

enta

l car

e

I hav

e no

dis

clos

ures

.

Cases

5 yo F

emale

in Pe

diatri

c Clin

ic with

Tooth

Pain

26 yo

Female

in Me

d-Ped

s Clin

ic for

Hospit

al Fol

low Up

Cases

How

commo

n is

this?

Let th

is sit.

..D

enta

l car

ies a

re th

e m

ost c

omm

on c

hron

ic d

isea

se o

f chi

ldho

od.

In <

1 ye

ar o

lds

88%

ha

d re

gula

r doc

tor

appo

intm

ents

3.6%

had

regu

lar d

enti

stap

poin

tmen

ts

AAP

unpu

blis

hed

data

from

200

7-20

16 E

xpen

ditu

re d

ata

16%

Did

not

rece

ive

any

prev

enta

tive

dent

al ca

re

of C

hild

ren

42%

Had

a d

enta

l vis

it (c

ompa

red

to 6

7% o

f co

mm

erci

al in

sura

nce)

of C

hild

ren

on

Mai

neCa

re

4 in

10

Had

cari

es

Mai

ners

by

3rd

Grad

e

In Ma

ine D

uring

2015-

2017

Poor D

ental

Care

Associ

ated W

ith Ca

rdiom

etabol

ic Dise

ase●

n= 1

1,55

6●

Cros

s-se

ctio

nal s

tudy

●N

atio

nal L

ongi

tudi

nal S

tudy

of A

dole

scen

t to

Adul

t Hea

lth●

Pred

omin

antly

whi

te w

ith a

t lea

st h

igh

scho

ol e

duca

tion

●D

efer

red

dent

al c

are

●BM

I, ch

oles

tero

l, bl

ood

pres

sure

Ore

skov

ic e

t al.

2017

Jour

nal o

f the

Am

eric

an D

enta

l Ass

ocia

tion

Poor d

ental

care

associ

ated w

ith ca

rdiom

etabol

ic dise

aseOre

skov

ic e

t al.

2017

12-1

9 yo

26-3

2 yo

Jour

nal o

f the

Am

eric

an D

enta

l Ass

ocia

tion

Poor d

ental

care

associ

ated w

ith m

issed

schoo

l and

poor

schoo

l perf

orman

ce●

n= 2

,183

●Cr

oss-

sect

iona

l Stu

dy

●20

08 N

orth

Car

olin

a Ch

ild H

ealth

Ass

essm

ent a

nd M

onito

ring

Pro

gram

●Pr

edom

inan

tly w

hite

, non

- his

pani

c an

d pa

rent

s had

at l

east

som

e co

llege

with

pr

ivat

e he

alth

insu

ranc

e

Jack

son

et a

l. 20

11Am

eric

an Jo

urna

l of P

ublic

Hea

lth

Poor d

ental

care

associ

ated w

ith m

issed

schoo

l and

poor

schoo

l perf

orman

ce

●Ab

senc

es re

latin

g to

den

tal p

ain

wer

e m

ore

likel

y to

resu

lt in

poo

r per

form

ance

○1.94

(1.0

4 , 3

.63)

Very

Goo

d/Ex

celle

ntGo

od/F

air/

Poor

Mis

s sch

ool f

or d

enta

l pai

n1.

39(0

.67,

2.8

8)3.

89 (1

.96,

7.7

5)

Jack

son

et a

l. 20

11Am

eric

an Jo

urna

l of P

ublic

Hea

lth

Early

inter

ventio

n is e

ssent

ial

14 sta

tes ha

ve no

preve

ntati

ve cov

erage

Main

ecare

covera

ge for

adult

s (21+

)●

Only

cov

ers

extr

acti

on

○Traum

atic

inju

ry○“Se

vere

ly d

ecay

ed” t

eeth

that

“pos

e a

seri

ous t

hrea

t” d

urin

g an

othe

r sur

gery

or

radi

atio

n th

erap

y●

“Med

ical

ly n

eces

sary

” den

ture

s○On

e se

t eve

ry 5

yea

rs

Who i

s at

risk?

Risk a

ssessm

ents

●AA

P●

AAPD

●Ca

lifor

nia

Den

tal A

ssoc

iatio

n●

ADA

Ris

k Fa

ctor

s

●M

ater

nal D

enta

l Dis

ease

●Bo

ttle

/Sip

py C

up

●Fr

eque

nt S

nack

ing

●Sp

ecia

l Hea

lth C

are

Nee

ds●

Med

icai

d El

igib

le

Prot

ecti

ve F

acto

rs

●H

as a

den

tal h

ome

●Fl

uori

de e

xpos

ure

○In wat

er○Sup

plem

ents

○Varni

sh in

last

6 m

o ●

Brus

hes t

eeth

twic

e da

ily

Racial

/ethn

ic mi

norit

iesHig

her pr

evalen

ce of

untre

ated c

aries

Lower

preval

ence

of den

tal se

alant

s

Black

childr

en at

incre

ased r

isk of

carie

s●

n= 1

,023

●

Cros

s-se

ctio

nal s

tudy

by

paid

surv

ey w

ith h

ygie

nist

per

form

ed e

xam

●En

glis

h sp

eaki

ng, n

on-h

ispa

nic i

n N

orth

east

ern

Ohio

ped

iatr

ic p

rim

ary

care

of

fices

●Bl

ack

child

ren

wer

e m

ore

likel

y to

hav

e○Be

en to

the

hosp

ital/

ED fo

r a d

enta

l-rel

ated

issu

e in

the

last

12

mo

○Low

er o

ral h

ealth

qua

lity

of li

fe sc

ore

○Poor

acc

ess t

o fo

od

Selv

araj

et a

l 202

0Jo

urna

l of P

ublic

Hea

lth

Den

tist

ry

Black

childr

en at

incre

ased r

isk of

carie

sSe

lvar

aj e

t al 2

020

Jour

nal o

f Pub

lic H

ealt

h D

enti

stry

Immi

grant

s

Compar

ing A

frican

& Asi

an Pe

diatri

c Refu

gees

●n=

228

●Cr

oss-

sect

iona

l stu

dy b

y re

tros

pect

ive

char

t rev

iew

●Re

fuge

e H

ealth

Pro

gram

at H

asbr

o Ch

ildre

n’s H

ospi

tal a

nd

St. J

osep

h Pe

diat

ric

Den

tal C

ente

r in

Prov

iden

ce, R

I

Oga

wa

et a

l. 20

19Pe

diat

ric

Den

tist

ry

●As

ian

patie

nts

○had

high

er c

arie

s ris

k

Oga

wa

et a

l. 20

19

Compar

ing A

frican

& Asi

an Pe

diatri

c Refu

gees

Pedi

atri

c D

enti

stry

●As

ian

patie

nts

○had

high

er c

arie

s ris

k○req

uire

d m

ore

emer

gent

inte

rven

tion

Oga

wa

et a

l. 20

19

Compar

ing A

frican

& Asi

an Pe

diatri

c Refu

gees

Pedi

atri

c D

enti

stry

Compar

ing R

efugee

vs. U

S Pedi

atric P

atien

ts●

n= 2

24●

Cros

s-se

ctio

nal s

tudy

with

ora

l hea

lth a

sses

smen

ts●

Refu

gee

Hea

lth A

sses

smen

t Pro

gram

with

Mas

sach

uset

ts D

epar

tmen

t of P

ublic

Hea

lth○Afr

ica-

Som

alia

, Lib

eria

, and

Sud

an○Eas

tern

Eur

ope-

Bosn

ia●

Thir

d N

atio

nal H

ealth

and

Nut

ritio

n Ex

amin

atio

n Su

rvey

of U

S ch

ildre

n●

Rate

s of u

ntre

ated

cari

es a

nd h

isto

ry o

f car

ies

Cote

et a

l. 20

04Pe

diat

rics

Easter

n Euro

pean v

s. Afr

ican R

efugee

sCo

te e

t al.

2004

Pedi

atri

cs

Cote

et a

l. 20

04

Compar

ing r

efugee

s to US

patie

nts

Cote

et a

l. 20

04

●Ea

ster

n Eu

rope

an R

efug

ees -

Whi

te U

S Ch

ildre

n○2.8

X m

ore

likel

y to

hav

e ha

d ca

ries

○9X m

ore

likel

y to

hav

e ac

tive

untr

eate

d ca

ries

●Af

rica

n Re

fuge

es -

Blac

k US

Chi

ldre

n○½ a

s lik

ely

to h

ave

had

cari

es○Jus

t as l

ikel

y to

hav

e ac

tive

untr

eate

d ca

ries

Pedi

atri

cs

Low in

come

Higher

preva

lence

of un

treate

d cari

es Low

er pre

valen

ce of

dental

seala

nts

Lower

preval

ence

of too

th ret

entio

nChi

ldren

with

specia

l hea

lth ca

re ne

eds

Develo

pmen

tal de

lay an

d cari

es rat

e●

n= 1

15●

Cros

s-se

ctio

nal s

tudy

●H

ead

Star

t in

Was

hing

ton

Stat

e●

Inde

pend

ent v

aria

ble:

Dev

elop

men

tal d

elay

●D

epen

dent

var

iabl

e: P

reva

lenc

e of

den

tal d

isea

se

Chi e

t al.

2013

BMC

Ora

l Hea

lth

Factor

s asso

ciated

with

incre

ased c

aries

Chi e

t al.

2013

Prev

alen

ce R

atio

P va

lue

Dev

elop

men

tal D

elay

1.26

0.04

Olde

r Age

(5 v

s. 3)

4.21

<0.0

01

Com

mun

icat

ion

Diff

icul

ty2.

47<0

.001

Low

er P

aren

tal E

duca

tion

2.58

<0.0

01

Hav

ing

a D

enta

l Hom

e0.

610.

01

Fluo

rida

ted

Wat

er0.

37<0

.001

BMC

Ora

l Hea

lth

Autis

m Spe

ctrum

disor

der●

n= 2

00●

Case

-con

trol

stud

y w

ith q

uest

ionn

aire

and

clin

ical

exa

min

atio

n●

Alex

andr

ia, E

gypt

●Ca

rrie

d di

agno

sis o

f ASD

by

DSM

IV, m

atch

ed to

con

trol

s mat

ched

to a

ge, s

ex,

and

soci

oeco

nom

ic st

atus

Kha

tib

et a

l. 20

13Jo

urna

l of I

nter

nati

onal

Ped

iatr

ic D

enti

stry

Patien

ts with

ASD h

ave m

ore di

fficul

ty wit

h den

tal he

alth

Kha

tib

et a

l. 20

13Jo

urna

l of I

nter

nati

onal

Ped

iatr

ic D

enti

stry

Not a

ll CSH

CN ar

e crea

ted eq

ual

●n=

150

●Re

tros

pect

ive

Long

itudi

nal C

ohor

t stu

dy●

Patie

nts f

rom

a p

riva

te d

enta

l pra

ctic

e in

Cha

rlot

te, N

C●

Com

pari

ng m

ultip

le d

iffer

ent s

peci

al h

ealth

care

nee

ds○Au

tism

Spe

ctru

m D

isor

der (

ASD

)○Co

ngen

ital H

eart

Dis

ease

(CH

D)

○Cere

bral

Pal

sy (C

P)○Do

wn

Synd

rom

e (D

S)○Co

ntro

l

Fran

k et

al.

2019

Pedi

atri

c D

enti

stry

CSHCN

have

associ

ated

risk f

actors

Fran

k et

al.

2019

●Pu

blic

insu

ranc

e●

Suga

r dri

nks/

snac

ks●

Dry

mou

th-in

duci

ng m

edic

atio

n●

Oral

hyg

iene

diff

icul

ty●

Liqu

id/p

uree

d di

et●

G-tu

be d

epen

dent

Pedi

atri

c D

enti

stry

Not a

ll CSH

CN ar

e crea

ted eq

ual

Fran

k et

al.

2019

Pedi

atri

c D

enti

stry

Congen

ital H

eart D

isease

Assoc

iated

with D

ental

Disea

seCarr

illo

et a

l. 20

18

●n=

156

●Re

tros

pect

ive

revi

ew●

Hyp

othe

size

d re

ason

s●

Poor

den

tal h

ygie

ne●

Cari

ogen

ic d

iets

●Su

gar-

base

d m

edic

atio

ns●

Pare

ntal

anx

ietie

s ab

out

stre

ssfu

l situ

atio

ns

Jour

nal o

f the

Can

adia

n D

enta

l Ass

ocia

tion

Conclu

sions

What

can we

do

?

Antic

ipator

y Guid

ance

Eviden

ced-ba

sed an

ticipa

tory g

uidan

ce

0-11 m

o●

Pare

ntal

hyg

iene

●Av

oid

bott

le p

ropp

ing

●W

ashc

loth

on

gum

s●

Don

’t sh

are

uten

sils

●D

on’t

put p

acifi

er in

you

r mou

th

Caregi

ver be

havior

to pr

event

Verti

cal tr

ansm

ission

●n=

3,0

35●

Cros

s-se

ctio

nal s

urve

y●

Japa

nese

3 y

ear o

lds a

nd th

eir c

areg

iver

s●

Oral

exa

ms a

nd q

uest

ionn

aire

s●

Div

ided

by

if th

ey a

void

ed sh

arin

g ut

ensi

ls/p

acifi

ers

●Ou

tcom

e va

riab

le-c

arie

s on

exam

Wak

agur

i et a

l. 20

11Ca

ries

Res

earc

h

Caregi

ver be

havior

to pr

event

Verti

cal tr

ansm

ission

Wak

agur

i et a

l. 20

11Ca

ries

Res

earc

h

1-4 yo

●D

isco

urag

e th

umb

suck

ing

●Av

oid

juic

e an

d su

gary

bev

erag

es

Dietar

y Advi

ce Im

pact

●n=

782

●Co

chra

ne R

evie

w M

eta-

Anal

ysis

●Th

ree

stud

ies,

2 in

Bra

zil,

1 in

the

UK●

Advi

ce g

iven

to p

regn

ant w

omen

and

wom

en w

ith c

hild

ren

<1 y

o○Br

east

feed

ing,

avo

idin

g su

gar

○Advi

se a

roun

d us

ing

bott

les a

roun

d sl

eep

●Ou

tcom

es fo

llow

ed u

p to

6 y

ears

old

●M

oder

ate

grad

e of

cer

tain

ty

Rig

gs e

t al.

2019

Co

chra

ne R

evie

w

Dietar

y Advi

ce Im

pact

Rig

gs e

t al.

2019

Co

chra

ne R

evie

w

5-10

yo●

Avoi

d su

gary

dri

nks

●M

outh

gua

rds w

ith sp

orts

11+ yo

●Ad

oles

cent

tran

sitio

n to

olki

t●

Subs

tanc

e us

e●

Eatin

g di

sord

ers

●Pi

erci

ngs

Toothb

rushin

g●

How

ofte

n?●

Twic

e pe

r day

●W

hat w

ith?

○Fluor

ide-

cont

aini

ng to

othp

aste

for a

ll●

How

muc

h?○< 3

yo-s

mea

r lea

ve o

n○3-6

yo-

pea-

size

d, sp

it OK

, don

’t ri

nse

●W

ho n

eeds

supe

rvis

ion?

○Can’t

brus

h te

eth

until

they

can

tie

shoe

s ~7-

8 yo

○Floss

ing

star

ts 5

-10

yo

Specia

l Heal

thcare

Needs

Guide

lines

●H

ave

a de

ntal

hom

e w

ith fl

exib

le a

ppoi

ntm

ents

●Re

fer a

s ear

ly a

s pos

sibl

e●

Be a

war

e of

pat

ient

’s se

nsor

y is

sues

/tri

gger

s●

Dev

elop

indi

vidu

aliz

ed p

reve

ntat

ive

plan

(bru

shin

g, m

outh

gua

rds,

etc.)

●En

cour

age

low

car

b di

et w

hen

able

●Re

view

med

icat

ions

that

cau

se d

ry m

outh

We ca

n’t ju

st talk

abou

t gett

ing t

o a de

ntist

...Lu

o et

al 2

020

Gett

ing

Advi

ce

Hav

ing

a D

enta

l App

oint

men

t

Jour

nal o

f Pub

lic H

ealt

h D

enti

stry

Inter

ventio

ns

inter

ventio

ns Fluori

de●

Perf

orm

ed b

y pr

ovid

ers

●Ev

ery

3-6

mon

ths

●Ap

ply

to a

ll te

eth

●Af

ter f

irst

eru

ptio

n●

Dry

with

gau

ze●

Can

drin

k/ea

t sof

t foo

ds●

No

brus

hing

that

eve

ning

Sealan

ts●

Perf

orm

ed b

y de

ntis

ts/a

ssoc

iate

s●

Appl

y to

mol

ars

●Af

ter e

rupt

ion

of th

e fis

t mol

ars

(~

6 yo

)●

Last

2-4

yea

rs●

Reco

mm

ende

d fo

r all

child

ren

Fluori

dated

water

-St

arte

d in

the

1945

in G

rand

Rap

ids

-In

201

6, 7

3% o

f US

popu

latio

n-

Dec

reas

e to

oth

deca

y by

25%

-

Mai

ne ra

nks 2

3rd

in th

e US

-79

.3%

of t

he p

opul

atio

n se

rved

Schoo

l seala

nt pr

ogram

s●

Fund

ed a

t sta

te a

nd fe

dera

l lev

els

●Pr

ovid

e se

alan

ts in

the

scho

ol se

ttin

g●

Sieg

al e

t al.

2010

Main

e Reso

urces

Partn

ership

for C

hildre

n’s

oral h

ealth

●W

orks

to im

plem

ent s

trat

egie

s to

prom

ote

oral

hea

lth●

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with

serv

ices

acr

oss M

aine

http

s://

ww

w.m

aine

pcoh

.org

/cov

id19

/map

From

the fir

st too

th●

Prom

otin

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in

fant

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ddle

rs, p

resc

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in p

rim

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care

●M

E, N

H, V

T, M

A, R

I, CT

●H

ealth

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iles 2

020

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leng

e●

Virt

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ols f

or p

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tric

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http

s://

ilike

myt

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.org

/ohp

p/

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e Acce

ss Imm

igran

t Netw

ork●

Foun

ded

in 2

002

by S

omal

i Com

mun

ity●

Conn

ects

imm

igra

nts t

o he

alth

and

soci

al

serv

ices

in P

ortla

nd●

Expa

nded

serv

ices

to S

outh

Sud

anes

e, R

wan

dan,

Bu

rund

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and

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gole

se p

eopl

e●

Wor

king

on

Mid

dle

East

ern

imm

igra

nts

●Co

mm

unity

Hea

lth W

orke

rs●

Wor

ksho

ps, e

vent

s

Main

ely Te

eth●

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ing

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land

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a●

Den

tal h

ygie

nist

●

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s out

side

refe

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s●

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and

emer

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○flu

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triti

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adv

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○seala

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spec

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207-

808-

9498

●ht

tps:

//m

aine

lyte

eth.

com

/

Future

direc

tions

H.P.10

14: “An

Act to

Impro

ve Ora

l Heal

th an

d Acce

ss to D

ental

Care

for Ma

ine C

hildre

n”Vir

tual d

ental

home

●Em

bedd

ed d

enta

l hyg

ieni

st e

valu

ates

●E-

cons

ults

with

den

tists

●Tr

ial w

ith H

eadS

tart

pro

gram

s

Learn

ing P

oints

1.D

ispa

riti

es e

xist

:a.

Raci

al/E

thni

c M

inor

ities

-Im

mig

rant

gro

ups d

iffer

b.Lo

w In

com

ec.

Spec

ial H

ealth

Car

e N

eeds

-Aut

ism

, DD

, CH

D

2.An

tici

pato

ry G

uida

nce

help

s:

a.D

ecre

ased

sw

eets

, dec

reas

ed b

ottle

pro

ppin

gb.

Shar

ing

uten

sils

?c.

Yes,

you

shou

ld b

rush

twic

e pe

r day

3.Th

ere

are

mul

tipl

e re

sour

ces

a.Pa

rtne

rshi

p fo

r Chi

ldre

n’s

Oral

Hea

lthb.

AAP

4.Th

e ti

me

to a

ct is

bef

ore

age

21

Case

Follow

Up

Thank

You

Refere

nces

Acad

emy

of P

edia

tric

Den

tistry

; 202

0: 2

75; 8

0

Ahov

uo-S

alor

anta

A.,

Fors

s H

., W

alsh

T.,

Nor

dbla

d A.

, Mak

ela

M.,

Wor

thin

gton

HV.

"Pit

and

fissu

re s

eala

nts

for p

reve

ntin

g de

ntal

deca

y in

per

man

ent t

eeth

." C

ochr

ane

Dat

abas

e Sy

stem

ic R

evie

w. 2

017;

201

7(7)

Amer

ican

Aca

dem

y of

Ped

iatri

c D

entis

try. "

Man

agem

ent o

f den

tal p

atie

nts

with

spe

cial

hea

lth c

are

need

s." T

he re

fere

nce

Man

ualo

fPed

iatri

c D

entis

try. C

hica

go, I

LL: A

mer

ican

Brig

ht F

utur

es G

uide

lines

for H

ealth

Sup

ervi

sion

of I

nfan

ts, C

hild

ren,

and

Ado

lesc

ents

. "Pr

omot

ing

Ora

l Hea

lth"

Brow

n C

J., S

mith

G.,

Shaw

L.,,

Par

ry J

., Sm

ith A

J. “T

he e

rosi

ve p

oten

tial o

f fla

vour

edsp

arki

ng w

ater

drin

ks.”

Inte

rnat

iona

l Jou

rnal

of P

aedi

atric

Den

tistry

200

7; 1

7:86

-91

Car

rillo

C.,

Rus

sell

J., J

udd

P., C

asas

MJ.

“Ora

l Hea

lth o

f Chl

dren

with

Con

geni

tal H

eart

Dis

ease

at a

Ped

iatri

c H

ealth

Sci

ence

Cen

tre.”

Jour

nal o

f the

Can

adia

n D

enta

l Ass

ocia

tion.

201

8; 8

4(7)

Col

vara

BC

., Fa

ustin

o-Si

lva

DD

., M

eyer

E.,

Hug

o FN

., H

ilger

t JB.

, Cel

este

RK.

"Mot

ivat

iona

l Int

ervi

ewin

g in

Pre

vent

ing

Early

Chi

ldho

od C

arie

s in

Prim

ary

Hea

lthca

re: A

Com

mun

ity-b

ased

Ran

dom

ized

Clu

ster

Tria

l." T

he J

ourn

al o

f Pe

diat

rics.

201

8;20

1: 1

90-5

Chi

DL.

, Ros

sitc

h KC

., Be

eles

EM

. "D

evel

opm

enta

l del

ays

and

dent

al c

arie

s in

low

-inco

me

pres

choo

lers

in th

e U

SA: a

pilo

t cro

ss-s

ectio

nal s

tudy

and

pre

limin

ary

expl

anat

ory

mod

el."

BMC

Ora

l Hea

lth. 2

013;

13(

53)

Cot

e S.

, Gel

tman

P.,

Nun

n M

., Li

turi

K., H

ensh

aw M

., G

arci

a R

I. "D

enta

l Car

ies

of R

efug

ee C

hild

ren

Com

pare

d w

ith U

S C

hild

ren.

" Ped

iatri

cs. 2

004;

114

(6)

Cen

ters

for D

isea

se C

ontro

l. "S

choo

l Sea

lant

Pro

gram

s". h

ttps:

//ww

w.c

dc.g

ov/o

ralh

ealth

/den

tal_

seal

ant_

prog

ram

/sch

ool-s

eala

nt-p

rogr

ams.

htm

Dye

BA,

Xia

nfen

L.,

Thor

nton

-Eva

ns G

. "O

ral H

ealth

Dis

parit

ies

as D

eter

min

ed b

y Se

lect

ed H

ealth

Pep

le 2

020

Ora

l Hea

lth O

bjec

tives

for t

he U

nite

d St

ates

, 200

9-20

10. "

CD

C, N

CH

S D

ata

Brie

f. 20

12

Fran

k M

., Ke

els

MA.

, Qui

none

z R

., D

ivar

is R

M. "

Den

tal C

arie

s R

isk

Varie

s Am

ong

Subg

roup

s of

Chi

ldre

n w

ith S

peci

al H

ealth

Car

eN

eeds

." Pe

diat

ric D

entis

try. 2

019;

41(

5) 3

78-8

4

Hoy

vik

AC.,

Lie

B., G

rjibo

vski

AM

., W

illum

sen

T. "O

ral H

ealth

Cha

lleng

es in

Ref

ugee

s fro

m th

e M

iddl

e Ea

st a

nd A

frica

: A C

ompa

rativ

e St

udy.

" Jou

rnal

of I

mm

igra

nt a

nd M

inor

ityH

ealth

. 201

9; 2

1:44

3-45

0

Jack

son

SL.,

Vann

WF.

, Kot

ch J

B., P

ahel

BT.

, Lee

JY.

"Im

pact

of P

oor O

ral H

ealth

on

Chi

ldre

n's

Scho

ol A

ttend

ance

and

Per

form

ance

." Am

eric

an J

ourn

al o

f Pub

lic H

ealth

. 201

1; 1

01 (1

0).

Khat

ib A

A., E

l Tek

eya

MM

., El

Tan

taw

i MA,

Om

ar T

. "O

ral h

ealth

sta

tus

and

beha

viou

rs o

f chi

ldre

n w

ith A

utis

m S

pect

rum

Dis

orde

r: a

case

-con

trol s

tudy

." In

tern

atio

nal J

ourn

al o

f Pae

diat

ric D

entis

try. 2

014;

24:

314

-323

Kum

ar S

., Ta

daka

mad

la J

., Jo

hnso

n N

W. "

Effe

ct o

f Too

thbr

ushi

ng F

requ

ency

on

Inci

denc

e an

d In

crem

ent o

f Den

tal C

arie

s: A

Sys

tem

atic

Rev

iew

and

Met

a-An

alys

is."

Jour

nal o

f

Den

tal R

esea

rch.

201

6; 9

5(11

) 123

0-12

36

Luo

H.,

Gar

cia

RI.,

Mos

s M

E., B

ell R

A., W

right

W.,

Wu

B. "T

rend

s of

chi

ldre

n be

ing

give

n ad

vice

for d

enta

l che

ckup

s an

d ha

ving

ade

ntal

vis

it in

the

Uni

ted

Stat

es: 2

001-

2016

."Jo

urna

l of P

ublic

Hea

lth D

entis

try. 2

020;

80(

2) 1

23-1

31

Oga

wa

JT.,

Kian

g J.

, Wat

ts D

-J.,

Lew

is C

., "O

ral H

ealth

and

Den

tal C

linic

Atte

ndan

ce in

Ped

iatri

c R

efug

ees.

" Ped

iatri

c D

entis

try. 2

019;

41

(4)

Ore

skov

ic N

M.,

Gal

lucc

i GO

., C

hase

II.,

Milli

ren

CE.

, Ric

hmon

d TK

. "O

ral h

ealth

sta

tus

and

long

itudi

nal c

ardi

omet

abol

ic ri

sk in

a n

atio

nal s

ampl

e of

you

ng a

dults

." Jo

urna

l of A

mer

ican

Den

tal A

ssoc

iatio

n. 2

017;

148

(12)

Rig

gs E

., Ki

lpat

rick

N.,

Slac

k-Sm

ith L

., C

hadw

ick

B., Y

ella

nd J

., M

uthu

MS.

, Gom

ersa

ll JC

. "In

terv

entio

ns w

ith p

regn

ant w

omen

, new

mot

hers

and

oth

er p

rimar

y ca

regi

vers

for p

reve

ntin

g ea

rly c

hild

hood

car

ies.

" Coc

hran

e D

atab

ase

Syst

ems

Rev

iew

s. 2

019;

201

9(11

)

Selv

araj

D.,

Cur

tan

S., C

opel

and

T., M

cNam

ee E

., D

ebel

nogi

ch J

., Ku

la T

., M

omot

az H

., N

elso

n S.

"Car

ies

disp

ariti

es a

mon

g M

edic

aid-

enro

lled

youn

g ch

ildre

n fro

m p

edia

tric

prim

ary

care

set

tings

." Jo

urna

l of P

ublic

Hea

lth D

entis

try.

2020

; 1-1

2 ht

tps:

//doi

.org

/10.

1111

/jphd

.123

24

Partn

ersh

ip fo

r Chi

ldre

n's

Ora

l Hea

lth. w

ww

.mai

nepc

oh.o

rg

Sieg

al M

D.,

Ric

hard

son

Det

ty A

M. "

Do

scho

ol-b

ased

den

tal s

eala

nt p

rogr

ams

reac

h hi

gher

risk

chi

ldre

n?" J

ourn

al o

f Pub

lic H

ealth

Den

tistry

. 201

0; 7

0: 1

81-1

87

Wak

agur

i S.,

Aida

J.,

Osa

ka K

., M

orita

M.,

Ando

Y. "

Asso

ciat

ion

betw

een

Car

egiv

er B

ehav

iour

s to

Pre

vent

Ver

tical

Tra

nsm

issi

onan

d D

enta

l Car

ies

in T

heir

3-Ye

ar-O

ld C

hild

ren.

" Car

ies

Res

earc

h. 2

011;

45:

281

-286