January FY 22

[clawry]

This month's article was submitted by Jen Hannon. Jen has chosen an article regarding dental caries in the pediatric population. This article is an interesting read, especially for those who provide anesthesia for dental cases as well as pediatric CRNAs. The article is titled Evidence-Based Dentistry Update on Silver Diamine Fluoride. Please review the article and answer the following questions for discussion:

) Has your dentist ever offered or applied SDF to yours, or your children's teeth?



2) We know dental health is a window into cardiac health. How do you approach the giving of suggestions, if any, to parents and patients in the pediatric population with poor dentition?

Please see e mail for attached article.

[Tracey Trainum]

1. No my dentist has not offered or applied SDF to my teeth or my children's. We have however had sealants applied to my children's teeth per recommendations from our dental practice. After reading the article SDA is something I would consider if recommended. Although there is risk of discoloration or dark staining on the affected areas, as well as gingival irritation and metallic taste, the SDA treatment regimen has a good success rate of arresting further decay in treated areas.
2. There is a strong correlation between dental health, overall general health, and particularly cardiac health. I have not started incorporating any sort of dental discussion with patients when I encounter poor dental exams and/or associated medical problems. After reading the article and thinking about the topic of dental health, I do now feel it is important to take the opportunity to have a small discussion with patients. Being that we are health care providers we have the opportunity to educate patients and influence their health status. I do something similar with I encounter patients with OSA that do not use their CPAP machines. We are doing brief dental exams so this is a great opportunity for us to take a few short minutes to discuss the impact of dental health on overall health issues/problems.

[Dahlia Rouchon]

1. My dentist has not recommended the SDF treatment to me nor my family.
2. The pediatric popluation I care for have not had any poor dentition. Those pediatric patieents I have cared for were for full mouth restorations. I have referred them to their dentist for appropriate therapy specific to their care. However thorough dental examination with the pediatric population is performed and notice/information are provided to the risks with anesthesia and effects it can have on overall health.

[nanci]

1) My dentist has not recommended SDF treatment to me.
2) I have not given any suggestions or recommendations to parents or pediatric patients about dental health.

[Belilnda]

1. Our dentist offers the application of plain Fluoride to my son and even to myself after a dental cleaning as covered by our insurance but I have never heard of SDF treatment. This is very interesting and seems as though it may have its place for management of poor dentition and optimization of overall health in certain populations.

2. I do note poor dentition in my patients and try to ascertain what it may be related to and use it as springboard for encouraging cessation of smoking or illicit drug use that may be the culprit. Also, some medications can be the causative agent. I find that most people don't realize the increased risk of endocarditis etc related to poor dentition.

[Anne McNulty]

(1) My dentist offers fluoride treatment after routine cleaning .I do not know if the dentist I go to offers SDF treatment. The side effects of this treatment are perplexing. SDF stains but reduces cariogenic bacteria. Silver is a heavy metal, we do not need this exposure, I find this SDF interesting but questionable. My personal preference is that the parent should supervise the children's teeth brushing to the best of their ability. (2) When I have a patient with poor dentition, advise them to see a dentist when they recover from surgery.

[aileenm4]

1. our dentist has never offered SDF, but my kids have regular Flouride applied during visits
2. in pediatrics I do not specifically offer any dental advioce to parents, we discuss taking out baby teeth if necessary during cases on very lose teeth as to avoid issues with aspiration, we do take out quite a few baby teeth in the OR. It is interesting to me aboutn the application of SDF in the office, the article reads that vaseline to the lips is applied and that cotton balls are sourrounding the individual teeth as to avoid getting the stuff on the gum to avaoid irritation. I wonder how easy this is especially with multiple teeth, in younger children or those with anxiety or who are unable to cooperate. I believ that the significant stainingof the anterior teeth would be a deterant to parents wanting this application in the US. we do alot of dental procedures and the process results in very pretty baby teeth after removal of the cavities and aplication of tooth colored material.

[Jessica Hadley]

1. My dentist has not offered SDF to my children, however they do have Flouride painted on with their with each cleaning.
2. I am not currently not caring for pediatric patients however, based on this article SDF may be an option for some dental caries for children.

[Wai-Ling Lo]

1) Has your dentist ever offered or applied SDF to yours, or your children's teeth?
No my dentist hasn't offered SDF to me. I think the discoloration of teeth after application make it less appearing to adult.

2) We know dental health is a window into cardiac health. How do you approach the giving of suggestions, if any, to parents and patients in the pediatric population with poor dentition?
I do not work with pediatric patients. However, I work with cardiac patients a lot. Some may suffer from endocarditis because of poor dentition. In that case, they are already advised to see their dentist. I just reinforce the importance of dental care and visit. SDF may seems to be a viable option for some elderly.

[Soo-Ok Kim]

1) No, my dentist didn't offer SDF to me nor to my kids.
2) I routinely take care of pediatric patients. But, I don't routinely discuss dental care. I give positive reinforcement if I need to examine kids' teeth and advise kids to follow parents' direction for brushing teeth, so forth.

[mary clothier]

1) Our Dentist has never mentioned SDF treatments for our children or us! Our children received regular fluoride treatments and additional fluoride @ home, as we have well water.

2) I have not offered any dental suggestions or advice to my pediatric patients parents.

[Amy Schutter]

1. My dentist has never offered SDF treatment for any of our family members. We do however get fluoride treatments painted on our teeth after each cleaning.

2. I do not typically offer suggestions for dental care to my patients with poor dentition

[Amy Swank]

1. Our Dentist has not ever offered to apply SDF to myself or my children’s teeth. They have received fluoride varnish however.
I think that the dark staining of the teeth would be off putting.

2. I have not cared for pediatric dental patients since working at JH. I have not been in the situation where I would feel comfortable suggesting improvements in dental care to the parents or to the patients in these situations. I do consider the socioeconomic make up of this population with regards to poor nutritional status and oftentimes exposure to second hand and third hand smoke, and asthma with these pediatric patients.