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Maintaining the integrity of the enamel surface: the role of dental biofilm, saliva and preventive agents in enamel demineralization and remineralization. J Am Dent Assoc. 2008;139(Suppl):25S–34S. 20. Filoche S, Wong L, Sissons CH. Oral biofilms: emerging concepts in microbial ecology. J Dent Res. 2010;89:8–18. 21. Featherstone JD, Domejean-Orliaguet S, Jenson L, Wolff M, Young DA. Caries risk DecisionsInDentistry.com assessment in practice for age 6 through adult. J Calif Dent Assoc. 2007;35:703–713. 22. American Academy of Pediatric Dentistry. The Dental Home. Available at: aapd.org/ assets/ 1/7/DentalHomeNeverTooEarly.pdf. Accessed November 7, 2017. 23. Edelstein B, Vargas CM, Candelaria D, Vemuri M. Experience and policy implications of children presenting with dental emergencies to U.S. pediatric dentistry training programs. Pediatr Dent. 2006;28:431–437. 24. Kierce EA, Boyd LD, Rainchuso L, Palmer CA, Rothman A. Association between early childhood caries, feeding practices and an established dental home. J Dent Hyg. 2016;90:18–27. 25. Blackburn J, Morrisey MA, Sen B. Outcomes associated with early preventive dental care among Medicaid-enrolled children in Alabama. JAMA Pediatr. 2017;171:335–341. 26. Alabama Department of Public Health. The Oral Health of Alabama’s Kindergarten and Third Grade Children Compared to the General U.S. Population and Healthy People 2020 Targets. Available at: astdd.org/docs/al-3rd-grade-bss- 2011-2013.pdf. Accessed November 7, 2017. 27. American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. Available at: aapd.org/media/policies_guidelines/g_fluorideth erapy.pdf. Accessed November 7, 2017. 28. American Academy of Pediatric Dentistry. Policy on Interim Therapeutic Restorations. Available at: aapd.org/ media/ policies_ guide lines/p_itr.pdf. Accessed November 7, 2017. 29. American Academy of Pediatric Dentistry. Guideline on Caries-Risk Assessment and Management for Infants, Children, and Adolescents. Available at: aapd.org/media/ policies_guidelines/g_cariesriskassessment.pdf. Accessed November 7, 2017. 30. American Academy of Pediatric Dentistry. Policy on Early Childhood Caries (ECC) Classifications, Consequences, and Preventive Strategies. Available at: aapd.org/ media/ policies_ guidelines/p_eccclassifications.pdf. Accessed November 7, 2017. 31. Arrow P KE. Minimum intervention dentistry approach to managing early childhood caries: A randomized control trial. Community Dent Oral Epidemiol. 2015;43: 511–520. 32. Edelstein BL. Chronic disease management strategies of early childhood caries: support from the medical and dental literature. Pediatr Dent. 2015;37:281–287. 33. Horst JA, Ellenikiotis H, UCSF Silver Caries Arrest Committee, Milgrom PM. UCSF protocol for caries arrest using silver diamine fluoride: Rationale, indications, and consent. J Calif Dent Assoc. 2016;44:16–28. 34. Shah S, Bhaskas V, Venkataraghavan K, Choudhary P, Ganesh M, Trivedi K. Efficacy of silver diamine fluoride as an antibacterial as well as antiplaque agent compared to fluoride varnish and acidulated phosphate fluoride gel: an in vivo study. Indian J Dent. 2013;24:575–581. 35. Yee R, Holmgren C, Mulder J, Lama D, Walker D, van Palenstein Helderman W. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res. 2009;88:644–647. 36. Mouradian WE, Wehr E, Crall JJ. Disparities in children’s oral health and access to dental care. JAMA. 2000;284:2625–2631. 37. Vargas CM, Ronzio CR. Disparities in early childhood caries. BMC Oral Health. 2006;6(Suppl 1):S3. 38. Savage JS, Fisher JO, Birch LL. Parental influence on eating behavior: conception to adolescence. J Law Med Ethics. 2007;35:22–34. 39. American Academy of Pediatrics. State Medicaid Payment for Caries Prevention Services by Non-Dental Professionals. Available at: paconnect.wpengine.netdna-cdn.com/wp- content/uploads/2013/07/AAP-OH ReimbursementChart-2.pdf. Accessed November 7, 2017. 40. Hale KJ, American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics. 2003;111:1113–1116. 41. Foster T, Perinpanayagam H, Pfaffenbach A, Certo M. Recurrence of early childhood caries after comprehensive treatment with The answer sheet and further instructions are located on the tear-out card that appears here, or take the test online at DecisionsInDentistry.com. CE QUESTIONS 1. The American Academy of Pediatric Dentistry defines early childhood caries as the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child age 71 months or younger. True False 2. Which bacterium is associated with dental caries? A. Porphyromonas gingivalis B. Streptococcus mutans C. Actinobacillus actinomycetemcomitans D. Fusospirochetes 3. Caries management by risk assessment measures which of the following? A. Disease indicators B. Risk factors C. Protective factors D. All of the above 4. A caries risk assessment evaluation can be performed during any routine dental examination or prophylaxis. True False 5. When should the dental home be established? A. By six months B. By nine months C. By 12 months D. By 15 months 6. Which of the following should be part of the care provided in a dental home? A. Comprehensive assessment B. Individualized preventive care C. Referral to specialists, if needed D. All of the above 7. What amount of fluoride toothpaste is recommended for children age 36 months to 60 months? A. Smear B. Rice-sized C. Pea-sized D. Blob 8. Which is a topical treatment that can be used to arrest caries and address caries lesions in primary teeth? A. Silver diamine fluoride B. Permanent restoration C. Interim therapeutic restoration D. Glass ionomer 9. Which university offers an Oral Health Nursing Education and Practice Program? A. University of North Carolina School of Dentistry B. Forsyth School of Dental Hygiene C. New York University’s Rory Meyers College of Nursing D. University of the Pacific Arthur A. Dugoni School of Dentistry 10. According to the American Academy of Pediatrics, at what age should the first oral health risk assessment be performed? A. Six months B. Nine months C. 18 months D. 24 months December 2017 • Decisions IN DENTISTRY 39 general anesthesia and follow-up. J Dent Child (Chic). 2006;73:25–30. 42. Oliveira AF, Chaves AM, Rosenblatt A. The influence of enamel defects on the development of ECC in a population with low socioeconomic status: A longitudinal study. Caries Res. 2006;40:296–302. 43. Salone LR, Vann WF Jr, Dee DL. Breastfeeding: an overview of oral and general health benefits. J Am Dent Assoc. 2013;144:143–151.
