Background: Obstructive sleep apnea has become recognized as one of the most common, under-diagnosed chronic diseases. Recently studies have shown increased numbers among the pediatric and adolescent population. OSA in children is associated with behavioral problems, poor school achievements, and in severe cases, pulmonary hypertension. OSA is often the Achilles heel of pediatric sedation and analgesic programs; during sedation, children with OSA have an increased vulnerability of their airway undergoing pharyngeal collapse and of having upper airway obstruction. Consequently, pediatric dentists who practice sedation dentistry should exercise extra precautions when treating patients with risk of sleep apnea. Currently there is no screening tool used in pediatric dentistry for diagnosing OSA during the pre-operative appointment or consultation for patients undergoing minimal and moderate oral conscious sedation. The purpose of this study was to develop and test a concise and easy-to-use questionnaire as a screening tool to aid in the diagnosis of OSA in pediatric patients. Materials and Methods: A retrospective chart review of 180 patients under the age of 18, who completed a polysomnogram at the VCU Center for Sleep Medicine between February 2011 and February 2013. A validated adult questionnaire, STOPBANG, was modified using more typical pediatric risk factors for OSA: presence of snoring (S), tonsillar hypertrophy (T1), tiredness; pESS>10 (T2), observed obstruction (O), neuroPsych-behavioral symptoms such as ADHD or daytime irritability (P), BMI percentile for age (B), age at diagnostic screening (A), presence of neuromuscular disorder (N), and presence of genetic/congenital disorder (G). A positive scoring from these variables was measured against the standard OSA measure, Apnea-Hypopnea Index. A multiple logistic regression analysis tested for relationships. Results: There was a statistically significant relationship P= .0007 for the S(T1)OPBANG scale, with a minimum of 4 variables needed to have a sensitivity of 57% and a specificity of 78%. There was also a statistically significant relationship P= .0040 for the S(T2)OPBANG, the cutoff>5 yielding sensitivity=36%, and specificity=90%. Only obstruction, BMI, and age showed a strong significant relationship to OSA. The presence of an obstruction was positively related to apnea (P = 0.0010). Most of the other components had an odds-ratio larger than one (indicating a nominally positive relationship). Conclusions: While both STOPBANG screening tools showed a statistically significant relationship, only obstruction, BMI, and age showed a predictive relationship to OSA. Consequently, consideration of other risk factors may be beneficial for future studies.

Purpose: The purpose of this study is to examine the pain response experienced by children undergoing simple tooth extractions using 2% Lidocaine injection versus Oraqix topical anesthetic gel. Methods: This study is being conducted at VCU pediatric dentistry clinic. The sample size will consist of 15 children ages 7-12 undergoing a simple extraction procedure. Each participant is randomly assigned to one of two groups, the lidocaine injection group or the Oraqix topical group. The pain level will be measured at four key events during the procedure. The first event will evaluate the pain at baseline. The second event will measure pain during the anesthetic injection or Oraqix topical gel application. The third event will record the response after the tooth has been extracted and the final event will evaluate pain five minutes post operatively. The children are asked to rate their pain using the Facial Pain Scale after all four events. The dentist and an independent observer watching a video of the extraction will also examine and rate the pain responses of each child at each of the four events. Results: The first two participants received lidocaine injection and experienced some pain upon injection. This pain was supported by what the dentist rated as well. One child felt pain on extraction and the other felt nothing. The dentist rated both children as feeling pain. The Oraqix child felt nothing upon application but felt pain during the extraction and post-operatively. The dentist rated the child as feeling nothing during the entire procedure. Conclusions: It appears that the lidocaine injection group’s pain rating matches the pain rating given by the dentist. The Oraqix patient experienced no pain upon application, but did feel pain upon extraction and five minutes post-op. The dentist’s rating contradicted this by rating the child as feeling no pain through the entire procedure. This study is limited by the number of participants and needs more patients to further evaluate other children’s pain responses.

Purpose: The purpose of this study was to determine the relationship of CYP2B6 genotype to the clinical response to meperidine in pediatric dental patients. Methods: Twenty-five patients, ASA I/ II, 45–92 months old, received an oral sedative regimen containing meperidine for dental treatment. The North Carolina Behavior Rating Scale (NCBRS) and Overall Effectiveness of Sedation Scale (OESS) were used to assess their behavior and sedation outcome. Saliva DNA samples were genotyped by PCR-RFLP. Results: We found the following genotype distributions: homozygous wild-type 1*1 (n = 8, 32%), heterozygous 1*6 (n = 13, 52%), and homozygous variant 6*6 (n = 4, 16%). The genotypes were predictive of a significant decrease in the overall effectiveness of sedation. Conclusion: Variation in CYP2B6 appears to be predictive of less successful sedations; wild-type individuals experienced more successful sedations than the homozygous variant 6*6. Future research regarding the enzyme kinetics of meperidine is needed to determine the exact enzymatic function of CYP2B6 and its variants.

Purpose: The purpose of this study was to asses fluoride varnish use by dental practitioners in Virginia. Methods: Using a cross sectional survey design, all dentists in Virginia who are members of the Virginia Dental Association (VDA) were sent an online survey about usage and knowledge of fluoride varnish. Results: The majority of the respondents were general dentists (79%) followed by pediatric dentists (12%). Fluoride varnish use increased with year of graduation from dental school. Dentists who thought fluoride varnish was more effective and less time consuming use it more than other topical fluorides. Dentists who thought their patients prefer fluoride varnish use it more than other topical fluorides.Conclusion: The majority of dentists are not aware of the advantages of fluoride varnish. However, those who are, choose to use it as opposed to foams and gels. Recent graduates, with more exposure to fluoride varnish, use it more frequently.

Purpose: The purpose of this study is to examine parental Functional Health Literacy and their child’s subsequent utilization of dental services. Methods: This was a prospective cohort study of children (n=1175) enrolled in the Child Health Investment Partnership of Virginia (CHIP). Descriptive statistics and separate multivariate logistic regressions were used to determine the relationship between functional health literacy measures; 1) Health Care Literacy (HCL), 2) Personal Health Literacy (PHL), and 3) LSP 22 scale, with utilization as measured as number of dental visit/s. Results: Descriptive analysis of the cohort reveals: 45% black, 40% white, 10% Hispanic, 5% other, 41% of parents not having a high school diploma or GED, >75% were enrolled in CHIP by the age of one, 90% had Medicaid, 80% lived in Roanoke City, 87% had a normal birth weight, 86% were term pregnancies, and 91% did not have asthma. All literacy measures, PHL, HCL, LSP 22, and LSP 22 Target Range were positively associated with having dental utilization. Hispanic race had a less likely chance of having multiple dental visits even when within target range of LSP 22. Conclusion: Parents of children enrolled in CHIP with higher levels of functional health literacy as measured by the Life Skills Progression Instrument demonstrated an increased likelihood of dental utilization for their children.

Purpose: The purposes of this study were four-fold: 1) to determine the types and effectiveness of various topical anesthetics being used among dentists currently treating children, 2) to determine the types of procedures for which topical anesthetics are being used among children, 3) to understand the awareness and use of a relatively newer compounded topical gel Oraqix (Dentsply Caulk) among children, 4) to understand the adverse reactions to topical anesthesia that are seen among children. Methods: A cross sectional survey was designed, regarding the type, procedural use, effectiveness, and adverse reactions noted among children to various topical anesthetics. The survey sampled n=4933 actively practicing member dentists from a database of willing survey participants obtained from the American Academy of Pediatric Dentistry. The survey consisted of 14-items in multiple choice/answer format. The survey was pilot tested by a committee of faculty, and attached via e-mail with a cover letter containing a direct survey link for the study participants. Surveys were collected, posted, and managed through www.surveymonkey.com. Results: The study received 1255 responses from practitioners who are actively treating children giving an effective response rate of 25%. Of those that participated 94% are Pediatric dentists, 6% General dentists or “Other” specialists who treat children. The majority of respondents (95%) routinely use topical anesthetic, rating it as effective or very effective clinically. The most commonly used topical was 20%-Benzocaine gel with a reported 96% effective rate. The most common procedures topical anesthetics are being used for are pre-injection of local anesthetic and extraction of exfoliating deciduous teeth. Very few of the responding practitioners have ever heard of or used Oraqix gel prior to this survey. Many though, would consider using Oraqix if proven effective. Only 10% of respondents reported an adverse reaction to topical anesthetics, the most common being contact dermatitis or tissue sloughing from prolonged contact, followed by an allergic or aversive reaction to the dyes or flavoring in the topical anesthetic. Conclusions: The overwhelming majority of dentists treating children routinely use topical anesthetics to reduce pain response among children. 20%-Benzocaine gel is the most widely used topical anesthetic being used for dental procedures on children. Adverse reactions to topical anesthetic noted among practitioners treating children are very low but must still be strongly considered as potential life threatening risks if not used appropriately. Many practitioners treating children are still looking for the “ideal” topical anesthetic with improvements in taste, the ability to stay localized, the method of delivery, and improved effectiveness being key areas for future research.

Purpose: The purpose of this retrospective chart review was to determine how primary molars needing vital pulp therapy have been treated in the past four years at Virginia Commonwealth University (VCU) and to determine which treatments: indirect pulp therapy (IPT), formocresol pulpotomy, and ferric sulfate pulpotomy have been successful. Methods: AxiUm records that contained the procedure codes D3120 (Pulp Cap – Indirect) or D3220 (Therapeutic Pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures i.e. extractions or pulpectomy. Results: In 2010, 52% of vital pulp therapies were ferric sulfate pulpotomies and in 2014 over 90% were indirect pulp therapy. Indirect pulp therapy had a 96.2% success rate, formocresol pulpotomy had a 65.8% success rate and ferric sulfate had a 62.9% success rate at three years (PConclusions:Indirect pulp therapy is a successful treatment option for the primary tooth with deep caries approaching the pulp

Purpose: To determine if there is an association between early childhood caries (ECC) and vitamin D deficiency, as measured via a serum sample. An exploratory goal was to investigate the possibility of measuring vitamin D with a salivary assay. Methods: Serum samples of patients who were scheduled for a dental or otolaryngology procedure under general anesthesia were assessed for 25-hydroxyvitamin D (25(OH)D), parathyroid hormone and calcium. Results: Our analysis indicates that the vitamin D levels of the controls and ECC group were significantly different. There were significant inverse correlations between: 1) PTH levels and vitamin D and 2) decayed, missing, filled teeth (dmft) and vitamin D. Conclusions: A relationship between low serum levels of vitamin D and the prevalence of ECC for children 0 to 6 years of age was observed. The salivary assay was unable to measure vitamin D, but future studies should still explore this non-invasive technique.

Purpose: The purpose of this study is to evaluate the oral health-related quality of life for patients treated at Give Kids a Smile. Methods: Participants were asked to complete a 25-question survey regarding their child’s oral health-related quality of life (OHRQoL), with answers ranked on a 0 to 4 point scale. Results: A total of 78 questionnaires were completed, with the mean score of 5.19. Conclusions: Give Kids a Smile was created to treat children with unmet oral healthcare needs, therefore it was hypothesized that the OHRQoL for the children treated would be negatively impacted and thus this score high. This was not demonstrated in the current study and these findings could be due to a variety of factors, including relying on the parent to report the child’s symptoms as well as low oral health literacy for parents completing the questionnaires.

Os websites são um dos principais e mais ágeis veículos para difusão e busca por informação na área da saúde, apresentando um grande potencial para o estabelecimento de ações educativas distância. Este estudo descreve o desenvolvimento e avaliação da qualidade técnica e de conteúdo da Seção Odontologia do website Portal dos Bebês. A definição dos conteúdos a serem abordados nesta seção do website se deu a partir da revisão da literatura e dos resultados de uma avaliação diagnóstica, a respeito da higiene e cuidado com a saúde bucal do bebê, realizada com 60 pais de crianças entre 0 e 36 meses de idade. Aceitaram o convite para participar da avaliação do website 49 cirurgiões dentistas (10 homens e 29 mulheres, com idade média de 27,34 anos) e 41 pais (02 homens e 39 mulheres, com idade média de 34,20 anos). Os participantes preencheram anonimamente um formulário online com perguntas sobre dados demográficos, uso da internet e sobre a qualidade técnica (cirurgiões dentistas) e do conteúdo do website (cirurgiões dentistas e pais). A qualidade técnica pautou-se no questionário Emory, compreendendo as subescalas precisão, autores, atualizações, público, navegação, links e estrutura. A maioria dos consideram os aspectos técnicos como excelente (40%) ou adequado (57%). A média da pontuação total do questionário Emory foi igual a 88%. Houve diferença significativa entre as subescalas do Emory, sendo de particular importância a menor pontuação obtida na subescala precisão. A média da pontuação do conteúdo foi igual a 4,5 (máximo de 5 pontos). Houve diferença pequena, porém significativa, entre a pontuação do conteúdo higiene bucal do bebê e cárie precoce da infância. A avaliação do conteúdo estava relacionada ao tempo de atuação profissional. Os pais avaliaram seu conhecimento prévio sobre a saúde e higiene bucal do bebê como sendo bom (56%) ou muito bom (22%). A pontuação média total do conteúdo foi 4,2. Embora com diferença pequena, a pontuação do conteúdo alimentação foi significativamente menor do que os conteúdos primeira visita ao dentista, higiene bucal e cárie precoce da infância. Os pais estavam satisfeitos (60%) ou muito satisfeitos (34%) com o website, sendo que esta satisfação estava relacionada à idade de seus filhos. Todos os pais indicariam o website a outros pais. É necessária a adequação de alguns conteúdos do website de forma melhor atingir as necessidades do público alvo. A Seção Odontologia do Portal dos Bebês apresenta pode ser utilizada como instrumento para educação aos pais quanto a saúde bucal na primeira infância. / The websites are the fastest main diffusion and information search media in health area, presenting a great potential to establish educational actions at distance. This study describes the development and evaluation of the technical quality and content of Dentistry Section of Portal dos Bebes website. The content definition to be addressed on this section was based on a literature review and on the outcomes of a diagnostic assessment regarding to oral hygiene and care conducted with sixty parents and/or caregivers of babies aged from 0 to 36 months. Forty-nine dentists (10 men and 29 women; mean age of 27.34 years old) accepted to evaluate the website and 41 parents (2 men and 39 women; mean age of 34.2 years old) participated in the research. The participants anonymously fulfilled an online form containing questions on the demographical area, internet use, technical quality (dentists) and website content (dentists and parents).The technical quality based on Emory questionnaire regarding accuracy, authorship, updates, public, navigation, links and structure of the website were assessed. Most of the participants considered technical aspects as either excellent (40%) or adequate (57%). The total average score of Emory questionnaire achieved 88%. There was statistical significance among Emory subscales, highlighting the lowest score obtained by accuracy item. The average of content score was 4.5 (5.0 was considered the highest score). There was a small but significant difference between the content score baby oral hygiene and early caries childhood. The content evaluation was related to professional acting time. The parents assessed their previous knowledge on oral health and hygiene which was considered as either good (56%) or very good (22%). The total mean average was 4.2. Although with a low difference, the score relating to feeding was significant lower than that related to oral hygiene and early caries childhood. The parents were either satisfied (60%) or very satisfied (34%) with the website which had been related with the age of their children. Furthermore, all parentswould refer the website to other parents. It is necessary a better adequacy concerning some website contents aiming to reach the needs of the targeted public. The Dentistry section of Portal dos Bebes website may be a tool for the learning of parents concerning oral health at the early childhood.