1 Myth or Fact: Dentistry Damages Devices? ● Pacemakers and other programmable devices are susceptible to electromagnetic radiation ● Unipolar devices are less susceptible but still can be affected ● Shielding and refinements in cellphones and devices reducing risk

2 Myth or Fact: Dentistry Damages Devices and Data? Miller CS et al. Selective interference with pacemaker activity by electrical dental devices. OOOOE 1998;85:33-6 ● Regardless of polarity, pacemakers were affected by electrosurgery, ultrasonic scaler and ultrasonic cleaner ● Handpieces, amalgamator, curing light, pulp tester, x-ray unit, and sonic scaler were all benign ● Electric toothbrushes ok

3 Anything Else? ● Anecdote: My cardiology colleagues say that in some patients with CHD, the reduced IE coverage is prompting delay in repair ● Low-dose anti-neoplastics are growing in popularity (multiple sclerosis and cyclophosphamide) ● Implanted “pacers” are increasing in use (gastroparesis) ● Do not assume that historical disease-treatment patterns hold in today’s pediatric medicine!

4 Periodicity of care MYTHBUSTERS Trooth-Busters

5 Periodicity of care MYTHBUSTERS Trooth-Busters

Recall Frequency ● Cochrane Collaboration: 1. Beirne PV, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2007, Issue 3. ● NGCH- refers to AAPD Reference Manual ● AAP : 1. Bright Futures: A National Health Promotion InitiativeBright Futures: A National Health Promotion Initiative AAP 3 rd ed. ● EBD/ADA: 1. The effectiveness of routine dental checks: a systematic review of the evidence base Davenport CF, Elley KM, Fry-Smith A, Taylor- Weetman CL, Taylor RS. Br Dent J. 2003; 195(2):87-98; The effectiveness of routine dental checks: a systematic review of the evidence base ● Frequency should be based on risk of the child and not the calendar, insurance policies or the beginning of the school year ● How about the ordering of radiographs? ● Hold on, it’s coming! 6

Caries Risk Assessment ADA/EBD: 1. Caries risk assessment and prevention: strategies for Head Start, Early Head Start, and WIC Kanellis MJ. J Public Health Dent. 2000; 60(3):210-7 Caries risk assessment and prevention: strategies for Head Start, Early Head Start, and WIC 2. Caries Risk Assessment- Council on Clinical Practice AAPD: 1.Policy on use of a caries risk assessment tool (CAT) Pediatri Cent 2008;30(suppl): AAP: 1. Promoting Oral Health, in Bright Futures: Guidelines for Health Supervision 3 rd ed. Elk Grove Village: AAP. Cochran Collaboration: 1. Nothing PubMed; 1. Prevention and Management of dental Decay in the pre-school child. Scottish Intercollegiate Guidelines Network, 2005

Sign of caries risk ● 12 month old infant ● Initial Examination ● Plaque on anterior teeth ● Is there a risk for ECC? ● EB Decision ‘Reviews suggest that visible plaque on the labial surfaces of infants maxillary incisors is a sign of caries risk’ Cochran Oral Health Group- nothing! NGCH NGCH 1.Clinical guideline on infant oral health care. 1.Clinical guideline on infant oral health care. AAPD ● Goggle 1. Dental plaque - Wikipedia, the free encyclopedia Dental plaque is biofilm (usually colorless) that builds up on the teeth. If not removed regularly, it can lead to dental cavities or periodontal problems (such as gingivitis). ADA EBD 1. Risk factors for dental caries in young children: a systematic review of the literature Harris R, et al. Community Dent Health Are mutans streptococci detected in preschool children a reliable predictive factor for dental caries risk? A systematic review Thenisch NL, et al Caries Res. 2006;40(5): PubMed 1. Early Plaque accumulation- a sign for caries risk in young children. Alaluusua S et al Effect of Mutans Streptococcal Colonization on Plaque Formation and regrowth in young children. Lee C et al. 2008;

Caries Risk Assessment Tool 1.Component in the clinical decision making process 2. Risk factors vary with race, culture and time 3. Requires social, behavioral, environmental information 4. At initial examination and periodically as risks change 9

Periodicity of Radiographs ● Ordering of radiographs only after a review of histories, completing a dental examination and a risk assessment. ● Order only if the child’s cooperation is acceptable ● Order only if there is an expectation that the information will affect patient care ● Minimize patient’s exposure ● Ionizing radiation can result in high cumulative effective doses of radiation ● The Selection of Patients for X- Ray Examinations. DHHS, CDRH, 1987 ● The Selection of Patients for X- Ray Examinations. FDA/ADA, 2004 ● Exposure to Low-Dose Ionizing Radiation. Fazel et al. NEJM

Evidence and Guidelines change- Our search for excellence hasn’t ! 11

12 MYTHBUSTERS Trooth-Busters