July 2007 "A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science [Dental Medicine]."

June 2008 "A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry."

June 2010 "A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry."

June 2010 A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry.

June 2011 "A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry."

July 2011 A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry.

Indiana University-Purdue University Indianapolis (IUPUI) / This study was undertaken to investigate histologically the effect of a combination of an antibiotic and an anti-inflammatory enzyme when used as a medication in direct pulp therapy. The pulps of 56 teeth in two Macaca Speciosa monkeys, exposed and left open to the oral environment for 24 hours to insure contamination, received direct treatment with one of four experimental medications: (1) vancomycin, starch, and hyaluronidase; (2) vancomycin, starch, and water; (3) starch and water; and (4) starch and hyaluronidase. At 30 days the teeth were removed from one animal and at 90 days•from the other for histologic interpretation. A satisfactory response was observed in 92.9 per cent of the teeth treated with vancomycin, starch, and hyaluronidase; in 71.5 per cent of the teeth treated with vancomycin, starch, and water; and in 42.9 per cent of the teeth treated with both starch and water and starch and hyaluronidase. None of the teeth treated with vancomycin, starch, and water and vancomycin, starch, and hyaluronidase became necrotic,while 35.7 per cent of the teeth treated with starch and water or starch and hyaluronidase became necrotic. Under the conditions of this investigation, vancomycin containing pulp capping agents are effective in controlling infection and in promoting reparative dentin formation in monkeys. The benefit of hyaluronidase when used in combination with vancomycin was questionable.

Background   Decision-making within the dental field is an essential factor that influences every aspect of the profession. It is of absolute importance for patients to receive the most suitable treatment for their individual situation. Aim The aim of this study was to examine whether dentists in the county of Västerbotten, Sweden, made suitable therapy choices when faced with teeth with diseases in the dental pulp or in the periradicular tissues. Methods  This was executed by analyzing data from patient journals and deciding whether the chosen treatment was the optimal one or if considered questionable. When faced with questionable treatment choices, the aim was to determine if there was a common denominator between these cases.  Factors taken in consideration when analyzing the journals were the patient’s sex and age, the tooth treated, the total number of teeth including wisdom teeth, x-ray images, cause of the treatment, sex of the dentist responsible and a description of case. In total, 360 patients were analyzed, and 51 were excluded. Result  The result showed that 95% of the analyzed patient cases had a suitable treatment. Conclusion The conclusion was that dentists in Västerbotten make good treatment choices and that it is not possible to draw any conclusions regarding the questionable treatments.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Anxiety is a debilitating and difficult sensation many people face on a daily basis. Up to 20% of American adults experience dental anxiety2. Dental anxiety can present both psychologically and physiologically as a barrier to starting, completing and/or finishing dental treatment.2,4 Catastrophizing the procedure, which is common practice in anxious patients, will alter and increase the perception of pain66. Approaching and understanding dental anxiety has shown to produce more positive treatment outcomes and overall increased patient satisfaction2, 4, 6. Non-pharmacological approaches to reducing dental anxiety can be a quick, non-invasive, method to put patients at ease and can save chair time for both practitioner and patient, as well as a more pleasant experience for the patient. Objectives: The goal of this study is to investigate non-pharmacologic approaches to reducing dental anxiety prior to non-surgical root canal treatment. This will be done by comparing an Auditory Alone Brief Relaxation period (ABR) to a Relaxation Virtual Reality period (RVR). Materials and Methods: 60 subjects who need non-surgical root canal treatment was randomly allocated into 2 groups. One group received earphones to listen to a guided brief relaxation recording, focusing on breathing and a body scan. The other group received virtual reality goggles and choose a scene of their liking to experience. State Trait Anxiety Indicator (STAI), Visual Analog Scale (VAS), and vitals were measured to objectively determine baseline anxiety score followed by the same metrics after brief relaxation or virtual reality experience. A student will perform root canal treatment, and VAS and vitals were again be recorded at the end of the appointment. Results: Both RVR and ABR showed a statistically significant decrease in anxiety in STAI-S (p value <.001 for both), STAI-T (p value 0.025 ABR; <.001 RVR). VAS scores also significantly reduced from T1 to T2 to T3 time frame. Discussion: Our study investigated and compared two different interventions in reducing anxiety prior to endodontic therapy. The results showed that both ABR and RVR reduced anxiety prior to endodontic therapy and had an effect even after the endodontic therapy was completed. Additionally, when comparing the time points T1, T2, and T3, heart rate decreased throughout the procedure and more importantly, after the intervention (ABR or RVR) was delivered. Both anxiety scales, STAI and VAS showed a statistical significant decrease in anxiety throughout the appointment. Conclusion: Non-pharmacological techniques like guided meditation and virtual reality are a valid and unique approach to reducing anxiety prior to endodontic therapy. Both ABR and RVR interventions reduced the feelings of anxiety throughout the entire endodontic appointment. This study displays the ease of incorporating both interventions to reduce anxiety in an economical and noninvasive fashion.

Indiana University-Purdue University Indianapolis (IUPUI) / This was a histologic study of continued apical development in the pulpless permanent teeth of dogs. The vital pulps were exposed to the oral fluids for one week. The root canals were filled with either calcium hydroxide and camphorated parachlorophenol (CMCP) or calcium hydroxide and distilled water. A vital dye, Procion red was injected to demonstrate the formation of calcified tissue. After four months, the animals were sacrificed. Decalcified semi-serial sections were studied. In 31 of 61 pulpless permanent teeth, with incompletely developed roots, continued apical development occurred. Apical calcified tissue resembling cementum was observed in 55 per cent of the specimens treated with calcium hydroxide and CMCP and in 42 per cent of those, with calcium hydroxide and distilled water. Complete closure of the apical foramen was observed in 29 and 11 per cent of the specimens respectively. Inflammation of the periapical tissues was present in 48 per cent of the calcium hydroxide and CMCP group and in 79 per cent of the other group. A significant association was found between the degree of inflammation and apical closure, (P<.001) for the calcium hydroxide-CMCP group, (P<.005) for the calcium hydroxide-distilled water group. The results suggest that calcium hydroxide and CMCP was superior to calcium hydroxide and distilled water and that the addition of CMCP to the paste reduced inflammation. Procion dye was shown to be an effective in vivo dental hard tissue marker.