Purpose: To determine which maintenance gas (sevoflurane versus desflurane) resulted in a faster emergence from general anesthesia and investigate the patient's emergence agitation. Methods: One group was maintained during general anesthesia with sevoflurane and the other with desflurane. Upon emergence the patient's behavior was evaluated.Results: The average emergence time for desflurane was 9.8; while the average for sevoflurane was 13.98 minutes. Patients who received premedication had an emergence time of 15.43 minutes, while patients who received no premedication emerged after 8.34 minutes.Zofran® was a significant predictor of purposeful actions. Patients were more aware of their surroundings when they received Zofran® compared to patients who did not receive Zofran®.Conclusion: Maintaining with desflurane and not premedicating patients allowed for a faster emergence from general anesthesia. Patients given Zofran® in their IV during the surgery had less emergence agitation then their counterparts.

Purpose: The purpose of this study was to correlate the presence of Streptococcus mutans and Streptococcus sobrinus with the incidence of dental caries in children as detected by the polymerase chain reaction (PCR).Methods: Subjects between the ages 2 to 16 years of age were used in this study. After the subjects received a dental examination, dental plaque samples were collected by rubbing a toothpick on the buccal surface of the most posterior tooth in each quadrant of the mouth. Children were grouped into low, moderate, and high caries risk categories by two different Caries Risk Assessment Tools (CAT 1 and CAT 2). PCR was used to amplify the dextranase (Dex) gene of S. mutans and S. sobrinus. Dextranase is an enzyme that hydrolyses glucans in a plaque matrix and is believed to be involved in the pathogenesis of dental caries. Identification of the amplified Dex gene sequences was made by gel electrophoresis which in turn was used to determine the presence of S. mutans and S. sobrinus.Results: S. mutans was detected in 57% of patients (65/115), S. sobrinus was detected in 10% of patients (12/115) and both organisms were present in 9% of patients (10/115). According to CAT 1, the incidence of S. mutans was 64.6%, 9.2%, and 26.2% in low, moderate, and high caries risk, respectively. The incidence of S. sobrinus was 66.6%, 16.7%, and 16.7% in low, moderate, and high caries risk, respectively. Conclusion: Presence of S. mutans and/or S. sobrinus as evaluated in this study had no direct correlation with caries risk level in children.

The purpose of this study was to examine the use of dental services for young children following a preventive oral health intervention in a pediatric medical clinic. Over a 3 year period (2005-2008), children 0-36 months of age, enrolled in Medicaid, were provided preventive oral health services in a medical setting. Descriptive statistics and multivariate logistic regression were used to determine the effect receiving the preventive oral health services in a medical setting with the outcomes of dental utilization. 15% were determined to have dental caries at the intervention and 42% found to have a dental visit post-intervention. Children determined to have decay at the intervention were significantly more likely to have one or more restorative or adjunctive service post-intervention. After receiving preventive oral health care in a medical clinic, the resulting utilization of dental services was higher than what is commonly reported for dental utilization in infant populations of low-income children.

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.

Objective: The purpose of the study was to determine if a co-payment resulted in a differential preference for general anesthesia (GA) or oral sedation (OS) and, if so, to examine whether age, the number of appointments, perceived risks of treatment, child's awareness during treatment, or insurance type appeared to play a role in this preference.Methods: Using a cross-sectional survey design, questionnaires were distributed to caregivers of patients in the waiting room of the Virginia Commonwealth University Pediatric Dental Clinic. Two different questionnaires were distributed randomly. Both surveys described a scenario with the need for dental treatment under general anesthesia (GA) or oral conscious sedation (OS). Seventy five surveys required a $50 co-payment for treatment completed under general anesthesia and the other 75 required the same co-payment for treatment completed under oral conscious sedation. Caregivers were asked to choose treatment modalities as well as to rate factors in their decision making including perceived risks and the number of dental visits. Results: Seventy seven survey respondents selected GA as their preferred treatment option for the described scenario. The other sixty six respondents chose OS sedation. For the insured population, the GA/OS odds ratio for the OS-co-payment group versus the GA-co-payment group was OR=2.21 (95% CI = 1.06, 4.60). In terms of the uninsured, the GA/OS odds ratio for the OS-co-payment group versus the GA-co-payment group was OR=17.5 (95% CI = 1.60, 191). The child's age, awareness during treatment, and type of insurance (public versus private) were not significantly related to treatment choice. The importance of the number of appointments was found to be significant (p-value = 0.0170) and outweighed the effect of the co-payment (p-value = 0.1757). The importance of associated risks was found to be significant (p-value = 0.0171) and this outweighed the effect of the co-payment (p-value = 0.8157).Conclusions: The presence of a co-payment does not as significantly impact the GA versus OS preference while the number of appointments and perceived risks associated with the treatment remain significant.

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.