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Objectives: This systematic review was aimed to examine the effectiveness of nutritional advise interventions compared with usual care, or exercise, or exercise combined with nutritional advice as a means of improving the body weight, body composition, physical function, and psychosocial well-being of frail, obese older adults.Methods: CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and Scopus databases were searched to identify relevant studies. The quality of the included studies was assessed using Cochrane's risk of bias tool 2. Meta-analysis was performed with respect to body weight and fat mass. Other outcomes were synthesized narratively.Results: Eight articles (from two studies) with a total of 137 participants were included in the review. The results revealed that nutritional advice was more effective than exercise in reducing body weight and fat mass. The nutritional advice was also beneficial in enhancing physical function and psychosocial well-being. However, it was less effective than exercise or combined interventions in increasing muscle strength and preventing lean mass loss.Conclusions: Nutritional advice is an essential intervention for reducing body weight and fat mass, for enhancing physical function, and for improving the psychosocial well-being of obese older adults experiencing frailty. The limited number of studies included in this review suggests that there is a need for more well-designed interventional studies in order to confirm these findings.

Background In this study, the authors examine the cost-effectiveness of light-polymerized resin-based fluoride sealants on primary molars in high caries risk children younger than 6 years. Methods The authors examined the cost-effectiveness of pit-and-fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value. Results Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period. Conclusions PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk. Practical Implications Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.

Management of the complex chronic disease of early childhood caries requires a system of coordinated health care interventions which can be led by a dental hygienist and where patient self-care efforts are paramount. Background and purpose Even after receiving costly surgical treatment under general anesthesia in the operating room, many children develop new and recurrent caries after only 6-12 months, a sequela that can be prevented. This article describes the chronic disease management (CDM) of dental caries, a science-based approach that can prevent and control caries. Methods In this article, we (1) introduce the concept of CDM of dental caries, (2) provide evidence that CDM improves oral health outcomes, and (3) propose a dental hygienist–led team-based oral health care approach to CDM. Although we will be describing the CDM approach for early childhood caries, CDM of caries is applicable in children, adolescents, and adults. Conclusions Early childhood caries disease control requires meaningful engagement of patients and parents by the oral health care team to assist them with making behavioral changes in the unique context of their families and communities. The traditional dentist/hygienist/assistant model needs to evolve to a collaborative partnership between care providers and patients/families. This partnership will be focused on systematic risk assessment and behaviorally based management of the disease itself, with sensitivity toward the familial environment. Early pilot study results demonstrate reductions in the rates of new caries, dental pain, and referral to the operating room compared with baseline rates. Dental hygienists are the appropriate team members to lead this approach because of their expertise in behavior change and prevention.

Background The authors examined the association between light-polymerized resin-based fluoride-releasing sealants and the development of pit-and-fissure caries on primary molars. Methods In this 3-year retrospective study, the authors reviewed the dental records of 297 children (1,352 teeth) younger than 6 years who were at high caries risk. Sealant placement or nonplacement on primary molars in the outpatient clinic and operating room setting was recorded, and random-effects logistic regression analysis accounting for the effect of data clustering was performed to measure caries incidence over time. Results The odds of developing pit-and-fissure carious lesions on sealed primary molars were 0.055 times (95% confidence interval [CI], 0.011 to 0.285; P = .001) and 0.013 times (95% CI, 0.001 to 0.159; P = .001) the odds of that on nonsealed primary molars in the outpatient clinic and in the operating room, respectively. In molars that became carious, those sealed were associated with longer time to caries development in both the outpatient clinic (2.69 years, 95% CI, 2.08 to 3.29) and operating room (1.97 years, 95% CI, 1.45 to 2.48). Conclusions Sealed primary molars were less likely to develop pit-and-fissure caries when placed in both the clinic and operating room settings. Practical Implications Dental sealants on primary molars should be considered for children at high caries risk.

The period from age 6 through 12 years is probably the most dynamic period for craniofacial, dental, emotional, and social changes during child growth. Growth modification and intervention related to dental eruption and space problems can be critical. All interventions are undertaken on a rapidly changing social and emotional substructure that can make success or failure precarious. Effective counseling and coaching to establish and maintain healthy dietary habits as well as good oral hygiene are important to reduce an individual child's risk of dental caries.

This article explores trends in 3 areas of dental services use for children less than 21 years of age. First, it examines the change in access to prevention, diagnostic, and treatment services over time among Medicaid-enrolled children and how access to care is affected by state-level factors. Second, it evaluates trends and health care costs associated with the treatment of oral health conditions in the operating room of pediatric hospitals. Third, it examines the trends in use of emergency departments for dental needs among children in the United States.

Objectives To assess the cost-effectiveness of a pilot disease management (DM) program aimed at preventing early childhood caries among children younger than 5 years. Methods The DM program was implemented in the Boston Children's Hospital-based dental practice in 2008. Health care costs were obtained from the hospital finance department and non-health care costs were estimated through a parent survey. The measure of effectiveness was avoided hospital-based visits for restorative treatment or extractions. Incremental costs (2011 US$) and effectiveness were estimated from a health care system, societal, and public payer perspectives over 3, 6, and 12 months, by comparing DM participants (n = 395) to a historical comparison group (n = 123) using generalized linear models. Bootstrapping and other sensitivity analyses were used to incorporate uncertainty in the analyses. Results The DM program was associated with a reduction in societal costs of $20 (p = 0.85), $215 (p = 0.24), and $669 (p < 0.01) per patient and a reduction in the number of hospital-based visits for restorative treatment or extractions by 0.44 (p < 0.01), 0.42 (p < 0.01), and 0.45 (p < 0.01) per patient over 3, 6, and 12 months, respectively. The probability of it being less costly and more effective was 61.5 percent, 81.9 percent, and 98.6 percent over 3, 6, and 12 months, respectively. Consistent results were observed from a health care system and public payer perspectives. Conclusions The DM program appears cost-effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate the DM program on a larger scale.

최근 2세에서 5세 사이 소아의 우식 발생율이 상당히 증가하고 있다. 유아기우식증(Early Childhood Caries)은 향후 영구치의 우식 발생 가능성에 대한 예측인자이며 사회 저소득층과 다문화 가정 자녀에서 특히 발생빈도가 높은데, 이는 충분히 예방과 관리가 가능하다. 만1세때부터 정기적으로 치과를 방문하고 이 때 우식위험도를 체계적으로 평가하여 환자들에게 맞춤형 예방 전략을 제시할 수 있기 때문이다. 유아기우식증의 예방을 위한 CAMBRA (Caries Management by Risk Assessment)에 대해 가장 최신의 개념과 사용법을 소개하고자 한다. 소아치과의사는 CAMBRA를 통해 개개인의 위험인자를 분석하여 연령에 따른 적절한 예방법을 수립하고 향후 우식 발생시 치료방향의 지침을 정하게 된다. 【Early childhood caries prevalence has increased significantly in children ages 2~5 years. ECC disproportionately affects lower socioeconomic and minority groups, is a predictor for future decay, but is preventable and manageable. Caries risk assessment systematically derives a patient's caries risk and is important during an infant oral health visit beginning at age 1. Information obtained through a risk assessment can guide a disease management care path tailored to an individual's age and risk to effectively treat and manage one's caries disease process.】

Early childhood caries (ECC), common in preschoolers, can lead to pain and infection if left untreated. Yet, ECC is largely preventable, and if it is identified early and the responsible risk factors are addressed, its progression can be halted or slowed. This article reviews the rationale for a first dental visit by age 1 year, caries risk assessment, and risk-based prevention and management of ECC and discusses strategies for providers to implement these contemporary evidence-based concepts into clinical practice.

Quality improvement (QI) and measurement are increasingly used in health care to improve patient care and outcomes. Despite current barriers in oral health measurement, there are nascent QI and measurement efforts emerging. This paper describes the role that QI and measurement can play in improving oral health care delivery in clinical practice by presenting a QI initiative that aimed to test and implement a chronic disease management approach to address early childhood caries.

Objectives . The purpose is to report findings of a quality improvement (QI) project implemented at two hospital-based dental clinics that care for children with early childhood caries (ECC). Methods . We tested a disease management (DM) approach in children younger than age 60 months with ECC. Results . After 30 months, for the 403 and 234 DM patients at Children’s Hospital Boston (CHB) and Saint Joseph Hospital (SJH) who returned for at least two visits, rates of new cavitation, pain, and referrals to the OR were 26.1, 13.4 and 10.9% for CHB and 41.0, 7.3 and 14.9% for SJH. Rates of new cavitation, pain, and referrals to the OR for historical controls were 75.2, 21.7, and 20.9% for CHB and 71.3, 31.3, and 25.0% for SJH. Conclusions . A risk-based DM approach utilizing QI strategies to address ECC can be implemented into practice and has the potential to improve care and health outcomes.

Background. Parental perspectives of children with early childhood caries may help inform the development and improvement of caries prevention strategies. Objectives. This study aimed to explore parents’ experiences, perceptions, and expectations regarding prevention and management of early childhood caries. Methods. The authors conducted semistructured interviews with 25 parents of children aged 2 to 5 years, with a known history of caries. All interviews were transcribed and coded, and iterative analyses were conducted to identify key emergent themes within the data. Results. Parents had limited knowledge of behaviors contributing to early childhood caries and when to first seek regular dental care. Parents expected pediatricians to provide education on how to prevent childhood caries, conduct preliminary oral health assessments, and help establish early linkages between medical and dental care. Conclusion. The findings make a strong case for pediatricians to take responsibility for engaging and educating parents on fostering optimal oral health and helping to access early childhood dental care.

An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

The 2014 Early Childhood Caries Conference encompassed evidence-based reviews on the state of the science regarding early childhood carries (ECC) epidemiology, etiology, prevention, and disease management. The purpose of this paper was to discuss the work presented at the conference and identify opportunities in research, policy, and clinical management that may improve early childhood caries outcomes and lower costs of care. While great progress has been made since the 1997 ECC Conference, there remains a paucity of high-quality evidence from randomized controlled trials on what are the most effective means to prevent and manage ECC. Analyses of studies indicate that some approaches, such as chlorhexidine, iodine, and remineralizing agents, have not shown consistent findings in preventing ECC. However, evidence exists to yield recommendations in some areas. There are useful risk assessment indicators to identify preschool children at risk for caries. Fluoridated toothpaste and fluoride varnish currently are the most effective chemotherapeutic strategies to prevent ECC. Motivational interviewing, a form of patient-centered counseling, is effective for motivating oral health behaviors and shows promise for reducing caries. Additionally, evidence is emerging that shows the value of chronic disease management approaches and integrating ECC oral health care within medical care settings. Recommendations for future directions in ECC research and policy were also key outcomes of the conference.

In recent years there has been a growing interest in exploiting potential forecast gains from the non-linear structure of self-exciting threshold autoregressive (SETAR) models. Statistical tests have been proposed in the literature to help analysts check for the presence of SETAR-type non-linearities in an observed time series. It is important to study the power and robustness properties of these tests since erroneous test results might lead to misspecified prediction problems. In this paper we investigate the robustness properties of several commonly used non-linearity tests. Both the robustness with respect to outlying observations and the robustness with respect to model specification are considered. The power comparison of these testing procedures is carried out using Monte Carlo simulation. The results indicate that all of the existing tests are not robust to outliers and model misspecification. Finally, an empirical application applies the statistical tests to stock market returns of the four little dragons (Hong Kong, South Korea, Singapore and Taiwan) in East Asia. The non-linearity tests fail to provide consistent conclusions most of the time. The results in this article stress the need for a more robust test for SETAR-type non-linearity in time series analysis and forecasting. Copyright © 2004 John Wiley & Sons, Ltd.

To assess the cost-effectiveness of a pilot disease management (DM) program aimed at preventing early childhood caries among children younger than 5 years.The DM program was implemented in the Boston Children's Hospital-based dental practice in 2008. Health care costs were obtained from the hospital finance department and non-health care costs were estimated through a parent survey. The measure of effectiveness was avoided hospital-based visits for restorative treatment or extractions. Incremental costs (2011 US$) and effectiveness were estimated from a health care system, societal, and public payer perspectives over 3, 6, and 12 months, by comparing DM participants (n = 395) to a historical comparison group (n = 123) using generalized linear models. Bootstrapping and other sensitivity analyses were used to incorporate uncertainty in the analyses.The DM program was associated with a reduction in societal costs of $20 (p = 0.85), $215 (p = 0.24), and $669 (p0.01) per patient and a reduction in the number of hospital-based visits for restorative treatment or extractions by 0.44 (p0.01), 0.42 (p0.01), and 0.45 (p0.01) per patient over 3, 6, and 12 months, respectively. The probability of it being less costly and more effective was 61.5 percent, 81.9 percent, and 98.6 percent over 3, 6, and 12 months, respectively. Consistent results were observed from a health care system and public payer perspectives.The DM program appears cost-effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate the DM program on a larger scale.

Despite professional recommendations calling for earlier first dental visits, Massachusetts children, on average, have their first dental visit at 3 years of age. This article will discuss the age-one dental visit and early establishment of a dental home. The components of an infant oral health visit will be outlined, including how to efficiently and effectively perform a caries risk assessment and a successful knee-to-knee exam. All dentists are challenged to improve their collective standard of care by incorporating infant oral health into their practices.

Background 28% of US children aged 2 to 5 years old have early childhood caries (ECC), a disease that is largely preventable if children receive early and consistent oral health interventions. Yet, strategies ensuring timely delivery of these services remain unclear. Objectives To describe efforts in two primary care centers to increase rates of oral health education (OHE) and fluoride varnish (FV) applications during well-child visits. Methods In accordance with American Academy of Pediatrics Guidelines (released September 2015), we implemented universal OHE and FV applications in children under 5 years of age. Nurses entered patient caries risk assessment responses into electronic medical records (EMR). The frequency of FV applications and billing were assessed through monthly automated EMR data extraction. Key PDSA intervention cycles included implementation of nursing-driven protocols to allow independent abbreviated OHE and FV applications, daily automated data reports on completed and eligible OHE and FV, reminder signage and email newsletters, in-person communications, and redesign of the billing sheet layout. Results Over a 20 month period, in Center 1, FV orders increased from 57% to 80% and FV billing increased from 10% to 70%, while OHE was largely maintained above the target of 80%. In Center 2, FV orders and billing increased from 42% to 67% and 10% to 36% respectively, while OHE currently averages 59%. Conclusions Revision of processes and protocols contributed to increased rates of FV orders, FV billing and OHE completed. We anticipate continued improvement leading to reduced dental caries rates among our patient populations.

Early childhood caries (ECC), common in preschoolers, can lead to pain and infection if left untreated. Yet, ECC is largely preventable, and if it is identified early and the responsible risk factors are addressed, its progression can be halted or slowed. This article reviews the rationale for a first dental visit by age 1 year, caries risk assessment, and risk-based prevention and management of ECC and discusses strategies for providers to implement these contemporary evidence-based concepts into clinical practice.

Early childhood caries (ECC) prevalence has increased significantly in children ages 2–5 years.1 ECC disproportionately affects lower socioeconomic and minority groups, is a predictor for future decay, but is preventable and manageable2. Caries risk assessment systematically derives a patient’s caries risk and is important during an infant oral health visit beginning at age one. Information obtained through a risk assessment can guide a disease management care path tailored to an individual’s age and risk to effectively treat and manage one’s caries disease process.3

Article Title and Bibliographic Information Children’s school performance: impact of general and oral health. Blumenshine SL, Vann WF, Gizlice Z, Lee JY. J Public Health Dent 2008;68(2):82-7. Reviewer Man Wai Ng, DDS, MPH Purpose/Question To examine the impact of socioeconomic factors, general health factors, and poor oral health status on school performance using data from the 2005 North Carolina Child Health Assessment and Monitoring Program survey. Source of Funding Government: Maternal and Child Health grant #5 T17 MC 00015 15. The University of North Carolina Brauer Research Fellowship was a second source of support Type of Study/Design Cross-sectional study Level of Evidence Level 3: Other evidence Strength of Recommendation Grade Not applicable

Recent increases in caries prevalence in young children, especially among minorities and the economically disadvantaged, highlight the need for early establishment of dental homes and simple, effective infant oral care preventive programs for all children as part of a medical disease prevention management model.1–3 This article presents an updated approach and practical tools for pediatric dental caries management by risk assessment, CAMBRA, in an effort to stimulate greater adoption of infant oral care programs among clinicians and early establishment of dental homes for young children.

The recent increase in the prevalence of dental caries among young children has highlighted the need for a new approach to prevent caries in children at a younger age. New disease prevention management models call for children to have their first visit to the dentist at age 1 or when their first tooth erupts. This article addresses early childhood caries risk assessment, prevention, and management strategies in young children using the concept of the "dental home" and a simple six-step protocol to conduct an effective and comprehensive infant oral care visit.

Background: Whether information sources influence health protective behaviours during influenza pandemics or other emerging infectious disease epidemics is uncertain. Methodology: Data from cross-sectional telephone interviews of 1,001 Hong Kong adults in June, 2009 were tested against theory and data-derived hypothesized associations between trust in (formal/informal) information, understanding, self-efficacy, perceived susceptibility and worry, and hand hygiene and social distancing using Structural Equation Modelling with multigroup comparisons. Principal Findings: Trust in formal (government/media) information about influenza was associated with greater reported understanding of A/H1N1 cause (β = 0.36) and A/H1N1 prevention self-efficacy (β = 0.25), which in turn were associated with more hand hygiene (β = 0.19 and β = 0.23, respectively). Trust in informal (interpersonal) information was negatively associated with perceived personal A/H1N1 susceptibility (β =20.21), which was negatively associated with perceived self-efficacy (β =20.42) but positively associated with influenza worry (β = 0.44). Trust in informal information was positively associated with influenza worry (β = 0.16) which was in turn associated with greater social distancing (β = 0.36). Multigroup comparisons showed gender differences regarding paths from trust in formal information to understanding of A/H1N1 cause, trust in informal information to understanding of A/H1N1 cause, and understanding of A/H1N1 cause to perceived self-efficacy. Conclusions/Significance: Trust in government/media information was more strongly associated with greater self-efficacy and handwashing, whereas trust in informal information was strongly associated with perceived health threat and avoidance behaviour. Risk communication should consider the effect of gender differences. © 2010 Liao et al., published_or_final_version

This policy is a compilation of current concepts and scientific evidence required to understand and implement practice-based preventive oral health programs designed to improve oral health outcomes for all children and especially children at significant risk of dental decay. In addition, it reviews cariology and caries risk assessment and defines, through available evidence, appropriate recommendations for preventive oral health intervention by primary care pediatric practitioners.

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Background Improvement initiatives rely on measures to assess their impact. When outcomes are expressed as percentages, unanticipated changes to the denominator due to complexities and interactions among processes, population and contextual factors can result in measures that fail to register real improvements. For example a pediatric oral health collaborative focused on the incidence of new dental caries as a key measure. Despite uptake of process changes, a prevalence measure failed to register associated improvement in appointment rates (fig 1). Data exploration suggested the measure was confounded with exposure to process changes and recruitment of new patients. Objectives To assess whether applying Monte-Carlo simulation can help project designers test the performance of outcome measures under an array of anticipated conditions. Methods Data were obtained via a database application installed at each practice which calculated monthly collaborative measures using standard definitions, and produced a file that was uploaded to the collaborative team. A template with a Monte-Carlo simulation platform was constructed to model a typical practice panel. Random variables modeled patient appointment intervals based on hypothetical subpopulations with varying appointment compliance. Results The model tested two alternative definitions of caries incidence, and suggested that a modified definition would more accurately reflect improvements in caries incidence (fig 2). Based on predictions, the application was modified to incorporate two alternative operational definitions, which were then applied retrospectively by selected practices. Data using the revised definitions more closely conformed to simulated predictions (fig 3). Conclusions Monte Carlo simulation enables advance testing of alternative operational definitions to optimize measure performance.

Background: Cytokines play important roles in antiviral action. We examined whether polymorphisms of IFN-γ,TNF-α and IL-10 affect the susceptibility to and outcome of severe acute respiratory syndrome (SARS). Methods: A case-control study was carried out in 476 Chinese SARS patients and 449 healthy controls. We tested the polymorphisms of IFN-γ,TNF-α and IL-10 for their associations with SARS. Results: IFN- γ+874A allele was associated with susceptibility to SARS in a dose-dependent manner (P < 0.001). Individuals with IFN-γ +874 AA and AT genotype had a 5.19-fold (95% Confidence Interval [CI], 2.78-9.68) and 2.57-fold (95% CI, 1.35-4.88) increased risk of developing SARS respectively. The polymorphisms of IL-10 and TNF-α were not associated with SARS susceptibility. Conclusion: IFN-γ+874A allele was shown to be a risk factor in SARS susceptibility. © 2006 Po Chong et al; licensee BioMed Central Ltd., published_or_final_version

Panel IV convened to address whether and how dental education curricula on behavior management needs to adapt to the changing needs and expectations of families and patients. There was a general consensus that behavior management should have a greater focus in dental education. Predoctoral and postdoctoral students may be expected to have different levels of exposure to behavior management concepts and techniques, but communications training should be a greater emphasis throughout dental education. Panel members specifically addressed behavior management techniques, including immobilization, restraint, sedation, and general anesthesia. Major recommendations from the panel included: 1) promote more research in behavior management; 2) update the AAPD guidelines on behavior management; 3) develop competencies/proficiencies for training programs and defining standardized outcomes; 4) introduce an AAPD task force to examine sedation issues that pertain to pediatric dental education; 5) explore new teaching methods of behavior management strategies and techniques; 6) develop a public awareness campaign to educate the public regarding what pediatric dentists do best.

The failure rates of restorative procedures for children undergoing dental rehabilitation under general anesthesia, performed by pediatric dental residents in advanced educational programs, were evaluated in order to determine treatment outcomes and best practices.Retrospective review of 504 dental records of children receiving comprehensive dental treatment under general anesthesia at children's hospitals in Boston between 1990-1992 and in Washington, DC, between 1994-1998, were undertaken. Data regarding restoration outcomes were evaluated using chi square tests with correction for continuity. Only records of patients who returned for follow-up at least six months after their rehabilitations were evaluated. T-tests were performed on parametric data.Two-hundred and forty-one (48%) of the records were evaluated. Stainless steel crowns (SSCs) had significantly lower failure rates than amalgams (P0.001, chi2=63). The highest failure rates were seen in composites (P0.001, chi2=112) and composite strip crowns (P0.001, chi2=121).SSCs are the most reliable restorations while composite restorations are the least durable. Failure of restorations appears to be related to follow-up length.