Purpose: The purpose of this study was to examine the knowledge, attitudes, and experiences related to infant oral health for both dental and medical providers.Methods: A survey of infant oral health care was sent to 300 randomly selected general dentists, 300 randomly selected pediatricians, and all pediatric dentists in Virginia. The survey contained questions regarding the providers' routine infant oral health care regimen. In addition demographic data from the provider was collected. Responses to the questionnaire were tabulated and percent frequency distributions for responses to each item computed. Percents for all items were based on the total number of respondents in each of the three practitioner groups.Results: The response rate of the survey was 48%. While 100% of pediatricians treat the infant population, only 5% refer for the first dental visit by age one. In addition compared to dentists fewer pediatricians examine for dental decay or give oral hygiene instructions. Less than half of general dentists surveyed treat the infant population and only 12% refer for the first dental visit by age one. Compared to pediatricians and pediatric dentists general dentists were less likely to discuss the first dental visit or nutritional counseling. Amongst the three practitioner types, pediatric dentists provide the most thorough dental exam, however only 25% actually treat infants by one year of age. Access to dental care remains a significant factor in early childhood caries.Conclusion: Results from this research suggest that the majority of pediatricians and general dentists are not advising patients to see the dentist by one year of age. Concurrently the majority of dentists are not treating patients at one year of age, resulting in a critical problem with access to care. There is a need for increased infant oral health care education in the medical and dental communities to appropriately handle this infant population.

Purpose: This study analyzed the percentage of Virginia practitioners utilizing vacuum form machines, types of appliances recommended, and types of patient information provided.Methods: Questionnaires were constructed and mailed to 2500 dentists.Results: 80% of dentists utilized vacuum form machines, 42.5% recommended mouthguards, 60.2% recommended home bleaching trays, 37.6% provided patient information on mouthguards, 37.1% provided patient information on home bleaching trays, 16.5% inquired on patient questionnaires about mouthguard protection during contact sports,and 17.3% inquired on patient questionnaires about tooth color satisfaction.Conclusions: Dentists use vacuum form machines for home bleaching trays more than mouthguards. General dentists and pediatric dentists provide patient information on mouthguards and home bleaching trays more often than orthodontists. General dentists provide patient information on home bleaching trays more often than pediatric dentists. Dentists in practice 25 or more years are the most likely to have patient questionnaires that address the use of mouthguards.

Purpose: The purpose of this study was to assess the utilization of dental services for children with autism spectrum disorders and identify barriers these children face when accessing dental services in the state of Virginia. Methods: A survey was mailed to families in the state of Virginia that care for at least one child with the neuro-developmental disorder on the autism spectrum scale. The mailing list was obtained from "The Autism Program of Virginia." This list contains the names of families/guardians of children with autism spectrum disorders. These individuals live throughout the State of Virginia. This project analyzed survey questions directly related to dental care access issues and other socioeconomic factors (age, race, family, income, sex and parental education). Results: The response rate of the survey was 29%. Autism was the most common diagnosis of the autism spectrum disorders among respondent's children (60%). No significant difference was found however, between access to dental services and the child's diagnosis. The majority of the children were white males between the ages of 3-11 years old. A history of difficult behavior in the dental office was a significant factor as to the amount of time that had past since the child's last dental visit, the child's ability to get care when needed and whether the child had a periodic dental provider. Income was significantly related to being able to get care when needed and having a periodic dental provider. No factors were significant as to whether a child was currently scheduled. Travel times were highly correlated with convenience with people having to travel more than one hour stating that receiving treatment was not convenient at all.Conclusion: Children with difficult behavior were statistically less likely to have a dentist for routine care, have longer intervals between treatment appointments and be less likely to receive care when needed. Pediatric dentists are treating the majority of these children. Twenty four percent of the children did not have a dentist for periodic oral health care. The most frequent reason for not being scheduled for a dental appointment was an inability to find a dentist with special skill or willingness to work with people having disabilities.

Purpose: The purpose of this study is to examine infant oral health knowledge and readiness of expectant mothers to incorporate preventive oral health behaviors for their infants. Methods: The study used a prospective cohort design to examine the effect of prenatal education and motivational counseling with expectant mothers about infant oral health care readiness. Participants were all enrolled in a prenatal care program called Centering Pregnancy offered by VCU’s Department of Obstetrics and Gynecology. They all completed a pre-survey questionnaire, followed by a motivational counseling intervention, and then completed a post-survey questionnaire. Results: A sample of 30 pregnant women completed the pre- and post-survey. The participants were predominantly white (60%) who had finished college (67%) with an average age of 28.8 years. Based on the analysis of the readiness (RAPIDD scale) responses, the participants showed an improvement in their value for dental health with a p-value illustrating a significant overall change between the pre and post surveys (p < .02). The results for the knowledge portion of the survey demonstrated an increase in their infant oral health education, showing a significant change across time (p < .0001). The results to the last portion of the pre and post survey illustrated that the participants learned at what age to establish a dental home for their infant. Conclusion: This study has shown that with the proper educational tools parents are able to accept and improve their knowledge related to infant oral health and the prevention of early childhood caries.

The purpose of this study was to investigate the role of child temperament and its effect on the outcome of conscious sedation using the following agents: Chloral Hydrate (35mg/kg), Meperidine (2mg/kg), and Hydroxyzine (2mg/kg).The Emotionality, Activity, Sociability (EAS) Temperament Survey for Children was used to measure the child's temperament. The temperament survey measures three realms (Emotionality, Activity, Sociability/Shyness). The sedation outcomes were rated using the modified North Carolina Behavior Rating Scale (NCBRS) from 1-4 (Quiet, Annoyed, Upset, and Wild). The final sample population consisted of 34 children, 24 girls (71%) and 10 boys (29%), ranging in age from 0-9 years old (M=5.6 years old, SD=1.8 years old). The sample population showed moderate emotionality (M=2.56, SD=0.96, p=0.5707), high activity (M=4.15, SD=0.72, p=0.2423), high sociability (M=3.63, SD=0.60, p=0.7853), and moderate shyness (M=2.50, SD=0.86, p=0.9930). Of the critical events, local anesthesia (F=74%, M=1.31, SD=0.58) and rubber dam placement (F=77%, M=1.26, SD=0.51) showed the most disruptive behaviors. Correlation results showed no significant temperament influence on overall effectiveness of sedation for the EAS sub-scales. Individual EAS scores, moderate emotionality, high activity, high sociability, and moderate shyness, did not predict the overall effectiveness of the sedation in this population.

Purpose: This study examined differences in oral health status and dental treatment needs by HMO regions in Virginia. Methods: The Division of Dental Health (DDH), Virginia Department of Health (VDH), completed the 1999 Virginia Oral Health Needs Assessment (VSOHNA) with the cooperation of the Virginia Department of Education. The survey used a probability proportional to size (PPS) sample design in selecting school children from public schools in the Commonwealth of Virginia. Surface (DMFS/dfs) and tooth-level (DMFT/dft) data were collected as indicators of dental disease on all children. Child-level data was also recorded for each student consisting of age, race, gender, enrollment in a free and reduced lunch program, medical insurance status, dental insurance status, and history of dental visits. A descriptive and regression analysis was completed to examine the relationship between HMO regions and oral health status indicators. Results: The survey included more than 5,000 children in 200 schools and 52 school districts. The mean DMFT/dft levels were 1.47 (.33) and 1.7 (.03), respectively. The mean level of untreated decay (dt) for all schoolchildren was 0.66 (0.01). First graders had the highest levels of untreated disease at 0.71, while third graders had a mean of 0.66. The Central region of the state appeared to have the highest level of untreated decay. Conclusion: There were no significant differences in the percentage of "caries-free" children between the HMO regions. Untreated dental disease of Virginia schoolchildren varied according to the region in which they lived.

THE EFFECTS OF MOTIVATIONAL INTERVIEWING IN PREGNANCY ON KNOWLEDGE AND RETENTION OF INFANT ORAL HEALTH INFORMATION By Andrew D. Zima, Jr., B.S., M.S., D.D.S. A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Major Director: Tegwyn H. Brickhouse, D.D.S., Ph.D Associate Professor, Department of Pediatric Dentistry Purpose: The purpose was to examine the effect of motivational counseling in pregnancy with readiness and acceptance of infant oral health information. Methods: The study used a prospective cohort design to examine the effect of prenatal education and motivational counseling with expectant mothers about infant oral health care readiness. Participants were all enrolled in a prenatal care program called Centering Pregnancy offered by VCU’s Department of Obstetrics and Gynecology. They all completed a pre-survey questionnaire, followed by a motivational counseling intervention, and then completed a post-survey questionnaire. A third survey was sent out 1 year post-partum. The participants were evaluated for their willingness to accept v vi information, their knowledge about infant oral health, and the retention and implementation of infant oral health information. Results: A sample of 87 pregnant women completed the pre- and post-survey and 11 of these participants completed and mailed back the 1 year post-partum survey. Based on the analysis of the readiness (RAPIDD scale) responses, the participants showed statistically significant overall improvements in their pre versus post survey openness to health information (p < .0039) and value for dental health (p < .001). The results for the knowledge portion of the survey demonstrated an increase in their infant oral health education, showing a significant change across time (p < .0001) from the pre survey to both the post and 1 year post partum surveys. The results to the last portion of the pre, post, and 1 year survey illustrated that the participants learned at what age to establish a dental home for their infant. Conclusion: This study has shown that with the proper educational tools parents are able to accept and improve their knowledge related to infant oral health and the prevention of early childhood caries. Data suggests that parents are implementing routine home infant oral health measures, but fewer have established a dental home by age 1.

Purpose: This was a pilot study to assess the impact of a preventive strategy following full-mouth dental rehabilitation (FMDR) under general anesthesia in children with early childhood dental caries. Methods: Sixty-six patients completed FMDR and were included in the analysis. At the consultation visit, caries risk assessment (CRA) and dental exam information were recorded, and caregivers completed an oral health knowledge (OHK) questionnaire. Patients returned for a post-surgery and recall visit. Caregivers received oral hygiene instructions in a motivational-interviewing style. Results:At the consultation visit all patients were high risk. At the post-surgery visit, only 47% remained high risk (chi-square P Conclusions: Preliminary data demonstrates that the preventive strategy is effective in reducing CRA level in children following FMDR.

Purpose: The purpose was to determine differences in serum vitamin D, parathyroid hormone (PTH), and calcium levels between patients with early childhood caries (ECC) and patients without dental decay. Materials and Methods: Serum vitamin D, PTH, and calcium levels were obtained from 30 children without dental decay who acted as controls and 60 children with ECC. A questionnaire was filled out by the parent/guardian of each participant consisting of questions regarding medical and dental history, exposure to sources of vitamin D and demographic information. Results: The difference in the vitamin D levels of the participants was most strongly associated with race. African American participants demonstrated lower levels of vitamin D than non-African Americans. After adjusting for race- related differences there was no significant difference in the Vitamin D levels in the ECC cases and the healthy controls. Conclusions: The results of this study suggest that vitamin D levels, at least among non-African Americans, are unrelated to caries development. Future research in this area must control for important confounding factors such as skin pigmentation, season of measurement of serum vitamin D, sun exposure, fluoride exposure, water fluoridation status and tooth brushing in order to allow for vitamin D levels to be better tested against caries experience.

Purpose: The purpose of this study is to examine the social determinants of CHIP (Child Health Investment Partnership) of Roanoke Valley children who participated in the preventive oral health program compared to those who did not. Methods: This is a retrospective cohort study of children (n=2,425) enrolled in CHIP of Roanoke Valley from September 2008-September 2014. Bivariate analysis and multivariable logistic regression models were used to compare age, gender, race, locality, parents’ education level, age at enrollment, and length of enrollment for oral health program participants versus those who did not participate. Results: Children who were Hispanic as well as children who enrolled in CHIP at an earlier age were more likely to enroll in the oral health program. Conclusions: By focusing on enrolling children at earlier ages, there is the potential to increase the use of dental care to match the recommended periodicity of dental care for young children.