Purpose: To assess the effect of dental Medicaid reforms in the state of Virginia on dental plan performance. Methods: This project is a retrospective cohort study of 825,000 dental claims obtained from the Virginia Department of Medical Assistance Services. This cohort includes dental claims for children enrolled in Virginia’s Medicaid program from July 1, 2002 through June 30, 2008. The independent variable was enrollment pre or post policy reform with July 1, 2005 as the period dividing date. The dependent variable was dental benefit utilization measured as the average number of restorative, preventative, and total procedures. Statistical methods include Welch’s t-test and repeated measures mixed model ANOVA controlling for gender, race, age, length of enrollment, gaps in patient enrollment, citizenship status, and geographic location. Results: This cohort of data showed a significant increase in the total number of procedures utilized by enrolled children (P value < 0.001). There were also significant increases in restorative services across all periods of enrollment. Conclusion: The consolidation of Virginia’s multiple managed care programs into a single vendor with increased reimbursement levels resulted in increased in access to care and improved utilization of dental services for children enrolled in Medicaid.

PURPOSE: The purpose of this study is to describe the subgingival bacterial biodiversity in untreated chronic periodontitis patients through the use of next generation 16S rRNA molecular analysis, and to determine similarities or differences between deep and shallow pockets within the same patients. METHODS: The analysis involved paired subgingival plaque samples from 24 subjects diagnosed with Generalized Moderate to Severe Chronic Periodontitis. One sample was selected from a single site having a probing depth >5 mm (i.e. Deep Site), and the other from a site with a probing depth <3mm (i.e. Shallow Site) within each subject. Bacterial DNA amplification of the V4-V6 region of the 16S rRNA was performed. The amplicons were sequenced via 454 Roche Genome Sequencer FLX System. The identified sequences were evaluated, and then compared to calculated false discovery rates. RESULTS: A total of 119 independent microbial genera were identified within the samples analyzed. Seven genera were identified to be statistically significant (p<0.05) in their association to deep or shallow sites following t-test and boot strap randomization: Actinomyces (p=0.004), Methylobacterium (p=0.028), Veillonella (p=0.028), and Rothia (p=0.038), and Streptococcus (p=0.033) in Shallow sites; while Mycoplasma (p=0.007) and Fusobacterium (p=0.016) were associated with deep sites. However, taking into account the calculated false discovery rates, it is suggested that none of the 119 microbial genera identified in this study were significantly associated with either deep nor shallow sites. CONCLUSION: The microbial genera identified within this study to be associated with deep and shallow sites follows the traditional pattern anticipated from the literature. However, the calculated false discovery rates suggest that these results may have occurred by chance and not due to a true difference.

The purpose of this study was to investigate the effects of a fluoride releasing orthodontic primer on demineralization adjacent to brackets. Twenty-two patients were recruited for this study. One premolar was randomly chosen as the experimental tooth, the contralateral tooth was the control. Teeth were visually analyzed for white spot lesions (WSLs). Knoop microhardness was used to determine hardness. Visual examination results showed no significant difference in the number of WSLs observed between Opal Seal and Transbond XT over the duration of this study. Solid conclusions could not be drawn from the results of microhardness testing. Therefore, it cannot be concluded that there is a difference in enamel hardness between Opal Seal and Transbond XT. However, prior to 90 days, teeth showed a significant difference in WSLs. Suggesting a protective effect of Opal Seal that diminished with time. Future studies are necessary to determine the clinical performance of this product.

AIM: Extraction of a tooth can lead to alveolar ridge resorption which can be minimized by socket preservation. The aim of this study is to analyze vertical and horizontal alveolar ridge dimensions clinically and by CBCT immediately following extraction and 3-4 months following socket preservation. METHODS: The preserved group (P) consisted of 20 patients with1-2 non-molar teeth requiring extraction with socket preservation, while the control group (C) consisted of 5 patients requiring extraction alone. An acrylic stent was fabricated presurgically in order to measure vertical and horizontal ridge dimensions clinically and radiographically immediately following extraction and 3-4 months following socket preservation. RESULTS: Overall, P sites gained ridge height and lost minimal ridge width over 3-4 months, while C sites lost both ridge height and width. Preserved sites in which the teeth were extracted due to caries had the most significant gain in the radiographic vertical occlusal dimension (RVO). Overall, high correlations were found between the clinical and radiographic measurements at the initial surgery and at the 3-4 month follow up. CONCLUSIONS: The preserved group had minimal ridge resorption and more socket bony fill when compared to the non-preserved group 3-4 months following tooth extraction, especially when the tooth was extracted due to caries. Additionally, the CBCT can be a useful diagnostic tool to evaluate socket preservation healing, as it compares well to clinical assessments of socket healing.

In response to the potential benefits of task specific training in rehabilitation of gait after stroke and the need for affordable, simple ways to implement it, our group designed the elliptically based robotic gait trainer (EBRGT). A design review of the EBRGT, covering the design goals, an overview of the mechanical and electrical design, and a discussion of the novelty of the device and why it may be beneficial for individuals with hemiparesis secondary to stroke is discussed (Chapter 2). To characterize the new device, a study was performed to determine if the EBRGT produced a gait pattern that mimicked level surface walking in healthy adults (chapter 3). Sagittal plane kinematic analysis suggested the EBRGT produced joint movement patterns that are similar to level surface walking at the hip and knee with less similarity between activities at the ankle. Electromyography (EMG) revealed that the EBRGT induced a cyclic muscle firing pattern that had some similarities when compared to level surface walking. We also examined the feasibility of ambulatory individuals after stroke to use the EBRGT and if their movement patterns were similar to healthy adults walking on the same device (Chapter 4). All six participants were able to walk on the device with minimal assistance. These participants had joint kinematics and EMG similar to healthy adults, suggesting that individuals with hemiparesis perform a gait like movement when using the EBRGT. Lastly, a study was performed to determine if the EBRGT could improve gait parameters and function in ambulatory individuals with hemiparesis after stroke (chapter 5). Four participants walked on the EBRGT 3x/week for 4 or 8 weeks. After the intervention, all 4 participants increased their preferred gait speed. One participant had an improvement in gait speed that indicated functional gains. The results of this research suggest that the EBRGT can produce a gait pattern that has some similarities to level surface walking and that it is feasible for ambulatory individuals with hemiparesis to use the device. The device may also improve gait parameters in ambulatory individuals after stroke, but future studies with a control group need to be performed.

Schizophrenia is a devastating disorder affecting millions of people in the United States. Studies leading to new understanding of and intervention for this disorder are essential, as current interventions are minimally effective. The end result is high rates of re-hospitalization, impaired occupational performance and decreased community reintegration. According to the Diagnostic and Statistical Manual of Mental Disorders, symptoms of schizophrenia are categorized as positive or negative, with both types of symptoms impacting successful occupational engagement. Based on behavioral observations occupational therapists have hypothesized that this population may also experience sensory modulation disorder (SMD). Although electrophysiological studies support the presence of SMD, studies focusing on the relationship between the observable behaviors of these two disorders are lacking. The purpose of this project is to examine the relationship between symptoms of SMD and schizophrenia. A cross-sectional design was used for this study. A convenience sample of 40 subjects was recruited from two outpatient psychiatric programs in Chicago, Illinois. Multi-site testing using the Positive and Negative Syndrome Scale (PANSS) and the Adolescent/Adult Sensory Profile (A/ASP) was used to address the following questions: 1) Is there a relationship between symptoms of schizophrenia and patterns of SMD? 2) Can positive and negative symptoms of schizophrenia reliably predict patterns of sensory modulation disorder? A Spearman correlation coefficient was used to examine the relationship between symptoms of schizophrenia and patterns of SMD, indicated a significant positive relationship between positive symptoms of schizophrenia and the low registration and sensory sensitivity quadrants of the A/ASP. Furthermore, a Mann Whitney U test uncovered significantly higher sensory sensitivity scores in African Americans compared to Caucasians. No significant relationships were found between negative symptoms and patterns of SMD. Stepwise regression found that positive symptoms predicted higher low registration scores and a combination of positive symptoms, race and gender were the best predictors of higher sensory sensitivity scores. This study did find a relationship between positive symptoms and patterns of SMD, suggesting that the relationship may actually be between psychosis and SMD and not schizophrenia. However, due to the small sample size, results should be interpreted cautiously and further studies completed.

Purpose: The purpose of this pilot study was to determine if there is a difference in post-operative pain experience for children following dental restorations and/or extractions under general anesthesia (GA), with and without local anesthetic (LA). The alternative hypothesis is that children will experience less post-operative discomfort and soft tissue trauma when using intra-ligamental local anesthetic during the intra-operative time period. Methods: Patients were recruited for this single blind, randomized, prospective cohort study with the following inclusion criteria, children age 2-6 years requiring general anesthesia for dental treatment. Patients were randomized into categories of either receiving a standardized local anesthetic or no local anesthetic for the dental procedure. A Wong-Baker Faces Pain Scale (Figure 1) was utilized to evaluate pre-operative and post-operative pain. Data were compared using a pooled t-test and two way mixed model ANOVA controlling for sex, ethnicity, and intra-op meds given. Results: Currently, 33 patients have been enrolled in the study. No difference was found in the LA versus the no LA groups, and significantly more pain was reported in the extraction versus non-extraction groups. With the limited sample size, current trends indicate that pain scores do depend on whether or not treatment included the extraction of a tooth. Conclusion: When adequately powered (n=100), this study could assist clinicians providing dental surgeries under general anesthesia care by providing evidence based criteria for the provision of local anesthetic during general anesthesia to reduce need for intra-operative pain medication to relieve post-operative pain.

Enamel decalcification caused by poor oral hygiene is a significant problem in orthodontics. Bioactive glass-containing resins have been shown to release Ca2+ ions into surrounding solution. The purpose of this study was to determine the shear bond strength of four different compositions of orthodontic resin prepared with bioactive glass (N=20). Premolars were bonded using one of four BAG-BOND compositions. Brackets were debonded and ARI scores were given. The mean shear bond strength was 7.23 ± 2.47 MPa (62 BAG-BOND), 8.25 ± 2.87 MPa (65 BAG-BOND), 8.78 ± 3.08 MPa (81BAG-BOND) and 5.80 ± 2.27 MPa (85 BAG-BOND). 65 and 81 BAG-BOND were significantly higher than 85 BAG-BOND. The 62 BAG-BOND group was not statistically significantly different from any other group. All groups exhibited a cohesive bond failure and were not statistically significant from each other. Three compositions of the novel orthodontic adhesive exhibited adequate bond strength for clinical applications.

The purpose of this study was to evaluate effect of final rinse of ethanol on bond strength in teeth obturated with Gutta Percha (GP)/AH Plus® or Resilon/Epiphany®SE™. Thirty-two extracted human anterior teeth were shaped to size 30, 0.06 taper and subjected to an identical irrigation protocol. Specimens were randomly divided into eight groups according to final irrigating solution (saline, 70%, 95%, 100% ethanol) and obturation material. Two millimeter thick slices were obtained by sectioning each obturated root. Bond strength was determined using micropush-out assay. Data was analyzed using Student’s t-test. Obturation with GP/AH Plus® formed a statistically significant stronger bond than Resilon/Epiphany®SE™. A final rinse with ethanol (irrespective of ethanol concentration) did not enhance push-out bond strength with GP/AH Plus®. Push-out bond strength of Resilon/Epiphany®SE™ decreases with increased ethanol concentration with Resilon/Epiphany®SE™. Among Resilon/Epiphany®SE™ groups, 70% ethanol resulted in strongest bond strength.

The skeletal and dental changes associated with rapid maxillary expansion (RME) are well documented. Effects on the soft tissues and the potential impact on facial esthetics have not been well researched. The purpose of this study was to evaluate immediate changes in facial soft tissues as a result of RME by comparing threedimensional digital photogrammetric images before and after RME treatment. The 3dMDface System was used to obtain photographic images of 21 patients (mean age = 11.8 years) before and after RME treatment for transverse maxillary deficiency. A control group of 13 patients (mean age = 12.7 years) also had two images taken at a similar time interval. Mean expansion was 6.5 mm in the RME patients. Intercanthal distance, nose width, and intercommissural width changed significantly in the RME patients from T0 to T1 (P = 0.011, P = 0.050, and P = 0.003, respectively). Intercommissural width, however, was the only measure that significantly changed as compared with the control group (P = 0.041). Changes in intercanthal distance and nose width were significantly related to the amount of expansion achieved (R2 = 0.428, P = 0.0013 and R2 = 0.501, P = 0.0003, respectively).