Purpose: Compare moderate oral sedation of pediatric patients using Hydroxyzine and Meperidine with either Diazepam or Midazolam in management of pediatric dental patients. Methods: Randomized, double-blind, crossover pilot study of patients 3 to 7 years of age requiring two sedation visits. Frankl and Houpt behavior scores recorded at injection time, initiation of treatment and 100% oxygen at end of treatment. Postoperative phone call surveys conducted within eight hours and within 24 hours of discharge. Wilcoxon Signed-Rank tests, Fisher’s Exact Chi-squared test and 0.10 significance level. Results: 25 subjects completed 35 sedations. Eight participants completed both treatments and demonstrated significantly higher total Houpt Scores with Diazepam at all treatment stages. Frankl scores favored Diazepam at injection time. More abnormal behavior was found with Midazolam, less memory of the visit with Diazepam, but longer sleep time with Diazepam. Conclusions: Sedation with the Hydroxyzine, Meperidine and Diazepam regimen may allow for a better overall sedation experience. Postoperative monitoring is essential. The results are promising and demonstrate the value of a larger study on sedation with Diazepam.

Purpose: The purpose of this study is to determine the impact that the introduction of articaine has had on local anesthetic selection by general and pediatric dentists for use in three different age groups of children.Methods: Using a cross sectional survey design, a questionnaire regarding the use of local anesthetics in children was mailed to a random sample of 500 general dentists from North Carolina, 500 general dentists from Virginia, and all 230 pediatric dentists from North Carolina and Virginia. The 16-item questionnaire included questions regarding the preferred local anesthetic to use in three different age groups, 2-3 years of age, 4-6 years of age, and 7-10 years of age. Furthermore, the questionnaire also included questions specifically on articaine use in the three different age groups and any related side effects. The association between dental practitioner type and anesthetic use was tested using chi-square or Fisher's exact test.Results: A sample of 337 dentists completed the questionnaire. There was no significant difference in preference of articaine except in older patients aged 7-10 years old where general dentists prefer articaine significantly more than do pediatric dentists (28.1% versus 15.9%). Lidocaine with epinephrine was the local anesthetic that was most preferred in all age groups by all practitioners. Pediatric dentists preferred lidocaine more often than general dentists and general dentists preferred lidocaine without epinephrine more often than pediatric dentists. Twenty-one percent of all dentists surveyed have used articaine in children under 4 years of age and 13% list articaine as the preferred local anesthetic for children under 4 years of age.Conclusion: While lidocaine with epinephrine is still the preferred local anesthetic for use in children, the use of articaine in children is very prevalent among general and pediatric dentists. Articaine use becomes more prevalent as the age of the patient increases and many pediatric and general dentists are using articaine in children under four years of age.

Purpose: To assess dental students and pediatric dental residents’ knowledge and attitudes towards motivational interviewing and evaluate the efficacy of a pediatric-focused brief motivational interviewing training program. Methods: A total of 66 participants were enrolled; 35% were third year dental students, 46% were fourth year dental students and 18% were pediatric dental residents. Participants completed three questionnaires: the first before the training, the second immediately after the training and the third approximately 3.5 months after the training. Results: A significant increase in correct responses was found for 4 of the 5 questions assessing participants’ knowledge. Participants were satisfied with the training (94%) and were interested in further training (89%). Participants believed patients and their parents would benefit from the intervention (97%). Conclusions: The pediatric-focused BMI training program is a valuable addition to pre-doctoral and residency curricula by preparing students and residents to employ this beneficial technique.

Purpose: Evaluate behavior assessment and agreement among dentist, guardian, and child. Evaluate child behavior by appointment type. Methods: Patients recruited from the pediatric dental department at Virginia Commonwealth University for this convenience sample. Inclusion criteria: patients presenting for clinical exams and/or restorative treatment without the use of advanced behavior guidance between August 29, 2018, and March 7, 2019; ages 4-12-years-old; and scheduled with a single clinician. Appointments were stratified by difficulty. Behavior was assessed by dentist and caregiver using the Frankl Scale. Patient self-assessed cooperation using an age-appropriate modified Frankl Scale, developed for this study. Agreement assessed among the 3 scores at each appointment using descriptive statistics and Cohen’s Kappa. Behavior trends across appointment type assessed using Kruskal-Wallis test. SAS software (2013, Cary, NC). P-value < 0.05. Results: Forty-one patient-guardian dyads enrolled in the study. Five dyads experienced multiple encounters. Demographics for the patients enrolled: 59% male; 44% Caucasian, 29% African American, 5% Asian, 2% Hispanic, 20% other/multiracial. Average patient age: 7.6 (range: 4- 12). Most patients had 1 encounter (n=36, 88%). Frankl Score agreement for provider/guardian was 79% (k=0.335), provider/child was 70% (k=0.248), and guardian/child was 81% (k=0.314). In disagreements, guardians rated behavior better than provider. Disagreement was split for provider/child and guardian/child, with the child tending to rate themselves higher, and the guardian tending to rate the child higher respectively. Marginal evidence that hard appointments resulted in poorer behaviors. Conclusion: There is fair agreement between child, guardian, and provider. In disagreements, guardians tend to rate the child’s behavior better compared to the provider and child self-assessment. Dental providers tend to be more critical of patient behavior. Marginal evidence to support harder appointments result in poorer behaviors.

Thesis (M.S.)--University of Michigan, 2003. / Includes bibliographical references.

Objective: This purpose of this study was to describe pediatric medical residents' knowledge of oral health and dental-referral behavior and to examine factors that may influence whether providers can identify tooth decay, provide risk assessment or refer children to dental providers. The objective was to provide baseline data of pediatric medical residents prior to receiving the oral health education and training in the provision of preventive oral health services.Methods: This project utilized a cross-sectional prospective cohort study design. An oral health knowledge and referral behavior questionnaire was delivered to pediatric medical residents in training at two academic health centers. This project aimed to describe pediatric medical residents' knowledge of oral health and dental referral behavior as measured by the questionnaire. This study was designed to provide baseline information for a larger project called "Bright Smiles" developed by the Virginia Department of Health's Division of Dental Health. The self-administered questionnaire focused on extracting knowledge and opinions of residents and faculty in selected areas of infant oral- health services along with their confidence in providing these services. Results: The frequency of dental examinations correlated with how often providers see tooth decay in infants and toddlers. The frequency of examining for signs of dental decay was correlated with confidence in detecting tooth decay. The frequency of assessing the potential for developing tooth decay in infants and toddlers was correlated with the providers' confidence in evaluating risk of tooth decay. All above findings were correlated to a statistically significant value. Conclusion: Providers, while able to identify tooth decay in infants and toddlers, lack confidence in the ability to refer children to dental providers and the ability to perform certain aspects of oral-health risk assessment.

Purpose: To determine which method of anesthesia risk presentation parents understand and prefer across their demographic variables Methods: As a cross-sectional study, questionnaires were distributed to 50 parents of patients (<7 years of age) in the VCU Pediatric Dental Clinic. Parents were asked of their own and their children’s demographics, previous dental and anesthesia experiences, and anesthesia understanding. Parents were then asked to rate the level of risk of several risk presentations and finally asked which method of risk presentation they most understood or preferred. Data analysis was performed using descriptive statistics, correlation coefficients, likelihood chi square tests, and repeated measures logistic regression. Results: There was no evidence of a differential preference due to gender (P = 0.28), age (P > .9), education (P = 0.39) or whether they incorrectly answered any risk question (P > 0.7). There was some evidence that the three types were not equally preferred (likelihood ratio chi- square = 5.31, df =2, P-value = 0.0703). The best estimate is that 60% prefer charts, 34% prefer numbers, and 36% prefer activity comparisons. There was a relationship between the average relative risk of general anesthesia and age (r = –0.38, P = 0.0070). Younger individuals indicate High risk more often and older individuals indicate Low risk more often. Conclusion: There was no preference of risk presentation type due to gender, age, or education, but there was evidence that each was not equally preferred. Healthcare providers must be able to present the risk of anesthesia in multiple ways to allow for full patient understanding.

Purpose: to assess the retentive strengths of passive fit esthetic anterior restorations using three commercially available cements. Methods: Three resin dies were fabricated from the intaglio surface of each restoration type. Each die was prepared following the current accepted guidelines on primary anterior tooth crown preparation. The three prepared teeth were replicated to produce 30 dies for each of the three restoration types. The prepared teeth were further separated into nine groups of 10 teeth each. Thirty EZ Pedo Crowns, 30 NuSmile Primary Crowns and 30 Unitek crowns were cemented using hand pressure employing the luting cement assigned to the corresponding group. The units were allowed to cure for 7 days. The force required to dislodge the restoration was tested using the Instron Universal Testing Machine. The data was statistically analyzed using a two-way ANOVA to analyze the force required to dislodge the restorations. A two-way logistic regression was used to analyze the failure types. Results: There were no significant differences in restoration retention rates between restoration types (P = 0.4412) but there were significant differences between types of cements used. (P < .0001). The differences with regard to cement types were consistent across the restoration groups (P = 0.7682). Tukey’s HSD multiple comparison procedure indicated FujiCem was significantly more retentive than either Fuji I or Ketac Cem cements and there were no significant differences in restoration retention rates between the Fuji I and Ketac Cem cements. Conclusion: The type of restoration did not matter between cements but cement type did matter with FujiCem cement being more retentive than the other types of cements tested.

Purpose: The purpose of this study was to create an experimental design to compare the regimen of ketamine-midazolam to chloral hydrate-meperidine-hydroxyzine for moderate oral conscious sedation. Methods: Patients between 36 and 83 months of age have been randomly assigned to receive 1 of the 2 regimens. Dosages, times, and vital signs will be recorded. Procedures will be recorded on video for assessment of sedation level and behavior. Patients will be contacted to evaluate postoperative sleeping, discomfort, and amnesia. Data will be analyzed using two-group t-tests (TOST) of equivalence in means to compare the two groups across the study period. Results: Patient enrollment of the study has begun. In order not to break the blind randomized code, future data analysis is pending final data collection. Conclusions: This study will assist clinicians by establishing if a regimen of ketamine-midazolam is a comparable alternative to a regimen of chloral hydrate-meperidine-hydroxyzine for sedations.

The objective was to determine the prevalence of vital teeth requiring non-surgical root canal therapy (NSRCT) that present with radiolucencies in mature permanent teeth in a pediatric population. A retrospective electronic dental chart review of children treated with NSRCT at VCU’s School of Dentistry between November 30, 2009 and March 1, 2013 was conducted. The presence or absence of a periapical radiolucency was determined from digital radiographs by three calibrated dentists. Specific characteristics of each tooth were collected. Statistical analysis using logistic regression was completed on all teeth with radiolucencies and vital teeth with radiolucencies. NSRCT was completed on 551 teeth. Radiolucencies were present in 246 teeth. Vitality data on access was only available in 184 teeth. In these, the prevalence of vital teeth with radiolucencies was 45.1% (n=83). Significant differences were noted for tooth type, gender, and puberty. Post-pubertal subjects had more vital teeth with radiolucencies than pubertal subjects.