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Biomedical subjects

N Sue Seale

Publications and source records attributed to N Sue Seale.

10 recordsLinked to original sources
PubMed2004

General dentists' perceptions of educational and treatment issues affecting access to care for children with special health care needs.

This study analyzed a data subset of a national survey of general dentists conducted in 2001 to determine their overall care of children with special health care needs (CSHCN). In the survey, dentists were asked to respond to questions in the following areas: did they provide care for CSHCN (children with cerebral palsy, mental retardation, and those who are medically compromised); what were their perceptions of the training they received in dental school related to CSHCN; what was their interest in additional training for CSHCN; and what factors influenced their willingness to provide care for CSHCN? Only about 10 percent see CSHCN often or very often, and only one in four respondents had hands-on experience with these patients in dental school. Postgraduate education in general practice or advanced general dentistry residency had no effect on willingness to care for CSHCN. Older dentists, those accepting Medicaid for all children, and those practicing in small communities were more likely to see CSHCN. Dentists willing to see CSHCN also were more likely to perform procedures associated with special needs and underserved child populations including pharmacologic management and stainless steel crowns. Dentists with hands-on educational experiences in dental schools with CSHCN were less likely to consider such factors as level of disability and patient behavior as obstacles to care and were more likely to desire additional education in care of CSHCN.

Adolescent↗
PubMed2003

Access to dental care for children in the United States: a survey of general practitioners.

BACKGROUND: In response to concern that inadequate dental school training may create a barrier to access to care for children, the authors conducted a survey concerning general practitioners' practice patterns involving child patients. METHODS: The authors requested a list of 4,970 randomly chosen general practitioners from the American Dental Association Survey Center. They then sent those dentists a written survey asking whether and in what numbers they treat children; the ages and caries levels of any children they do treat; their perceptions of their educational experiences in pediatric dentistry, and their perceived needs for continuing education in pediatric dentistry. They analyzed data using chi2. RESULTS: Ninety-one percent of the general dentists surveyed treated children, but those younger than 4 years of age, with high levels of caries, and whose care is funded by Medicaid were represented in very low numbers. The types of patients treated and procedures performed by the respondents were significantly (P < or = .05) associated with the intensity of the respondents' educational experiences, except for the number and types of Medicaid patients they treated. CONCLUSIONS: These data indicate that the vast majority of general practitioners treat children in their practices, but there still are groups of children for whom access to dental care is a problem. PRACTICE IMPLICATIONS: Very young children, children with high levels of caries and Medicaid-covered children have difficulty finding dental care in the general practice community.

Chi-Square Distribution↗
PubMed2003

U.S. predoctoral education in pediatric dentistry: its impact on access to dental care.

This study sought to identify faculty, organization, patient pool, and procedures taught in predoctoral pediatric dentistry programs using a questionnaire sent to all fifty-five U.S. dental schools in 2001. Forty-eight (87 percent) programs reported an average of 3.9 full-time and 2.1 part-time FTE faculty, resulting in a mean faculty to student ratio of 1:6.4. One-third employ general dentists to teach pediatric dentistry, and 36 percent report fewer faculty than five years ago. Two-thirds were stand-alone departments. Over half (55 percent) reported increases in patient pools, but also a lack of patients with restorative needs. Half of the programs supplemented school-based pools with special populations, and two-thirds sent students on external rotations, most often to treat high-caries children. Those not using external rotations cited lack of faculty. Accepted patients averaged about four years, with only 6 percent of the pool under three years. Low-income or Medicaid-covered children accounted for 88 percent of school patient pools. Half of the schools felt the pool inadequate to meet competencies, attributable to lack of patients' restorative needs or inadequate intake numbers. Fewer than half of the programs (48 percent) provided hands-on experience with disabled patients, and one-third afforded every student with this experience. Pediatric dentistry was mentioned in fewer than half of the competency documents. Results suggest that U.S. pediatric dentistry predoctoral programs have faculty and patient pool limitations that affect competency achievement and adversely affect training and practice.

Adolescent↗
PubMed2002

Using OSCE-based evaluation: curricular impact over time.

The Objective Structured Clinical Examination (OSCE) is becoming more widely used for performance assessment in dentistry. The department of pediatric dentistry at Baylor College of Dentistry (BCD) began incorporating the OSCE into its curriculum in 1995. This article describes the evolution of the department's use of the OSCE and its impact on teaching and the curriculum. The discussion focuses on logistics and station design, curricular content and order, student anxiety, writing and scoring exams, and curriculum assessment. BCD has found that using an OSCE-based testing format is time-consuming and labor-intensive, but provides unprecedented feedback about students' understanding and pinpoints areas of confusion. The demands of an OSCE-based testing format reveal that students can master, to the level of competency, only a finite amount of information in a given time period. The timed, interactive aspects of the OSCE create high levels of student anxiety that must be addressed. Writing and scoring OSCE items are different from traditional test items. The OSCE is a valuable mechanism to assess the students' progress toward competency. This review of the process of incorporating OSCEs into a curriculum is the foundation for future assessment of the OSCE and its use for curricular improvement.

Clinical Competence↗
PubMedDate not supplied

Management of caries in the child three years of age and younger: a survey of post-doctoral pediatric dentistry program directors.

PURPOSE: The purpose of this study was to report the results of a survey of pediatric dentistry post-doctoral program directors regarding education of post-doctoral students about management of caries in children 3 years-of-age or younger. METHODS: Fifty-two pediatric dentistry advanced education program directors were sent questionnaires inquiring about payer sources in their programs, distribution of caries in children 3 years of age or younger within the payer sources, the methods they teach and use to treat the caries, and the effectiveness of treatment and outcome data about the success of their treatment. RESULTS: Twenty-nine programs responded (56%). On average, two-thirds (66%) of the patients in post-doctoral pediatric dentistry programs are Medicaid patients. Program directors are fairly uniform in how they define methods of caries management, and they rate definitive therapy as the most effective method to manage all types of caries. Literature/textbooks were most frequently cited as the major source of scientific evidence to support treatment decisions. Fewer than 20% of program directors have outcome data on the effectiveness of their methods of treatment. CONCLUSIONS: Medicaid is the major payer source for patients in post-doctoral programs and definitive therapy is considered by program directors to be the most effective approach to managing caries in this patient population. Program directors rely on the literature and textbooks and few have outcome data.

Administrative Personnel↗
PubMedDate not supplied

Concentration of formocresol used by pediatric dentists in primary tooth pulpotomy.

Diluted formocresol is the most widely recommended primary tooth pulpotomy medicament, but it is not commercially available. This investigation surveyed practicing pediatric dentists about the concentration of formocresol that they use to perform pulpotomies and, if they use diluted formocresol, where they obtain it. Eight-hundred-and-six surveys were sent to a randomly selected sample of practicing pediatric dentists, and 422 were returned for a 52% response rate. Eighty-four percent of the respondents use formocresol for their primary tooth pulpotomies. Of those, 69% use full strength, 27% use diluted and 4% don't know. Sources of diluted formocresol for those who use the diluted form include: 34% who buy it that way, 58% who dilute it themselves and 8% who have the pharmacy dilute it. The majority of pediatric dentists who use formocresol for primary tooth pulpotomies use a full strength formulation.

Chemistry, Pharmaceutical↗
PubMedDate not supplied

Evaluation of aggressive pulp therapy in a population of vitamin D-resistant rickets patients: a follow-up of 4 cases.

This investigation collected clinical and radiographic data from a retrospective chart review of 4 patients receiving prophylactic formocresol pulpotomies and stainless steel crowns following a dental abscess associated with a medical diagnosis of vitamin-D resistant rickets (VDRR) at Texas Scottish Rite Hospital for Children in Dallas, Tex. Clinical and radiographic data were available for 29 primary teeth in 4 children, with follow-up times ranging from 2 years, 1 month to 5 years, 6 months. Based on available recalls of 29 teeth treated following the prophylactic formocresol pulpotomy, 22 failed clinically. The earliest failure occurred at 3 months; the longest time to failure was 3 years, 9 months. No trends were discernable between tooth type and failure rate, although the shorter the time between eruption of the tooth and pulpotomy treatment, the greater the chance of success. Presently, there is not enough evidence to suggest that prophylactic pulpotomy therapy in VDRR patients is beneficial in preserving their primary dentition.

Abscess↗
PubMedDate not supplied

The use of stainless steel crowns.

The stainless steel crown (SSC) is an extremely durable restoration with several clear-cut indications for use in primary teeth including: following a pulpotomy/pulpectomy; for teeth with developmental defects or large carious lesions involving multiple surfaces where an amalgam is likely to fail; and for fractured teeth. In other situations, its use is less clear cut, and caries risk factors, restoration longevity and cost effectiveness are considerations in decisions to use the SSC. The literature on caries risk factors in young children indicates that children at high risk exhibiting anterior tooth decay and/or molar caries may benefit by treatment with stainless steel crowns to protect the remaining at-risk tooth surfaces. Studies evaluating restoration longevity, including the durability and lifespan of SSCs and Class II amalgams demonstrate the superiority of SSCs for both parameters. Children with extensive decay, large lesions or multiple surface lesions in primary molars should be treated with stainless steel crowns. Because of the protection from future decay provided by their feature of full coverage and their increased durability and longevity, strong consideration should be given to the use of SSCs in children who require general anesthesia. Finally, a strong argument for the use of the SSC restoration is its cost effectiveness based on its durability and longevity.

Child↗
PubMedDate not supplied

Behavior management conference panel III report-Legal issues associated with managing children's behavior in the dental office.

Panel III reviewed the legal issues associated with managing child behavior in the dental setting. The first issue addressed was a review of the recent changes in informed consent for behavior management techniques in pediatric dentistry. Discussions focused on: (1) who should obtain informed consent; (2) who can give informed consent; and (3) what constitutes appropriate documentation. Recent legal actions related to poor outcomes and poor communication using behavior management techniques were identified and discussed. Addressed was the current movement by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) towards empowering the child-patient to be a co-decision maker at all appointments and its impact on decisions in the dental office about approaches to behavior management. Finally, liability issues accompanying increased use of sedation in the dental office were identified and discussed. The recommendations of the panel were: (1) consideration should be given to changing the language in the current American Academy of Pediatric Dentistry (AAPD) guidelines, so written consent is not required for any procedure; (2) the AAPD should create language for use in creating sample consent forms (suggestive, not prescriptive); (3) guidelines recommending the possibility of treatment deferral, when appropriate, should be strengthened; and (4) the AAPD should work with advanced education program directors to standardize the quality and number of educational experiences in the use of conscious sedation.

Anesthesia, Dental↗