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.

Purpose: The purpose of this retrospective chart review was to determine if the survival of two methods of vital pulp therapy (VPT) were influenced by the pre-operative radiographic depth and location of caries. Methods: Electronic patient records (axiUm®) that contained the procedure codes D3120, Indirect Pulp Therapy (IPT), or D3220, Therapeutic Pulpotomy (TP), were queried. Qualifying charts’ pre-operative and post-operative radiographs were viewed in MiPACS® by two raters. Visit records were queried again to identify any other treatment failures. Results: A total of 568 primary molars met the eligibility criteria. There was a difference in survival depending upon the treatment procedure (P < .0001), with D3220 having a significantly higher failure rate than D3120. In the 182 total cases with caries 2/3 to encroaching the pulp, therapy success was greater with IPT (P < .0001). Conclusion: IPT results in longer overall clinical success even at the deepest level of caries.

RESUMO Proposta de um método prático para avaliação do poder de neutralização existente na cavidade oral.A prevenção da doença cárie ainda é uma das principais metas da Odontologia. Considerando a multifatoriedade de sua etiologia, torna-se necessário o conhecimento do maior número de informações possíveis a respeito do paciente para que o cirurgião-dentista possa estabelecer um plano de tratamento preventivo individualizado a seus pacientes. A saliva, devido a suas várias funções, apresenta grande importância no combate a patogênese da doença. A análise da capacidade tampão é de extrema importância para que se possa prever o risco do paciente ao desenvolvimento da doença cárie. Vários testes têm sido utilizados para a determinação da capacidade tampão salivar, sendo que alguns exigem equipamentos laboratoriais e outros, mais simplificados, que permitem a utilização no consultório odontológico. A proposta do presente trabalho foi desenvolver um método prático para determinação do poder neutralizante existente na cavidade oral. O método proposto consiste na realização de bochecho com 10 ml de Coca-cola® durante 30 segundos, por parte dos 50 participantes (crianças, adolescentes e adultos) e determinação da variação do pH entre a mistura saliva + Coca-cola® e o pH inicial do refrigerante. Foram realizados dois métodos de determinação da capacidade tampão salivar – titulação com ácido lático e o método simplificado Dentobuff Strip® -e, após teste de correlação entre o método de neutralização proposto e os dois testes descritos acima foi encontrada correlação estatisticamente significante entre o método proposto e a titulometria com ácido lático (Pearson=0,304;p=0,032). Porém em relação ao Dentobuff Strip® não foi verificada correlação estatisticamente significante. De acordo com a proposta da metodologia apresentada nesta pesquisa, foi encontrada uma média de neutralização da saliva após o bochecho com o refrigerante, de 23,8% (dp=16,5) até o pH crítico do esmalte (5,5) e considerando o pH fisiológico da saliva em torno de 7,0, a neutralização até este valor foi de 17% (dp=12,4). Diante dos resultados foi possível concluir que o método desenvolvido apresentou-se prático e satisfatório para avaliação da capacidade de neutralização existente na cavidade oral e pode ser utilizado como mais um recurso para predição do risco de cárie do paciente. / SUMMARY Caries prevention remains one of the main goals in dentistry. Since caries is a multifactorial disease, it becomes necessary to obtain all possible information about the patient during anamnesis. Hence, the professional is able to establish an individual preventive treatment for each patient. Saliva bears several functions in the oral cavity; consequently, it is an important host factor that modifies the caries process. Saliva buffering capacity is one of the important factors usually taken into account to predict the individual caries risk. Several tests have been applied to identify this saliva function. Some of them require laboratorial features, whereas others are easy to handle, and can be applied at dental offices. The purpose of the present study was to develop a practical method to assess the neutralizing power inherent of the oral cavity. The methodology was based on a rinse of Coke Ô for 30 seconds, performed by 50 subjects (including children, teenagers and adults), followed by the assessment of pH variation between the initial sample of soft drink and the final mixture (saliva + Coke Ô). Along with this method, two other well known buffer capacity tests were performed – titration with lactic acid and Dentobuff Strip®. We found statistically significant correlation between the proposed method and the titration with lactic acid (Pearson=0.304;p=0.032). On the other hand, there was no significant correlation between the proposed method and the test using Dentobuff Strip®. According to our results, the mean saliva neutralizing power after soft drink rinse, considering the cases of the critical enamel pH (5.5) and physiological saliva pH (7.0), were 23.8% (sd=16.5) and 17.0% (sd=12.4), respectively. The proposed method was practical and reliable to assess the neutralizing power of oral cavity and may be an additional technique to predict caries risk.

RESUMO Proposta de um método prático para avaliação do poder de neutralização existente na cavidade oral.A prevenção da doença cárie ainda é uma das principais metas da Odontologia. Considerando a multifatoriedade de sua etiologia, torna-se necessário o conhecimento do maior número de informações possíveis a respeito do paciente para que o cirurgião-dentista possa estabelecer um plano de tratamento preventivo individualizado a seus pacientes. A saliva, devido a suas várias funções, apresenta grande importância no combate a patogênese da doença. A análise da capacidade tampão é de extrema importância para que se possa prever o risco do paciente ao desenvolvimento da doença cárie. Vários testes têm sido utilizados para a determinação da capacidade tampão salivar, sendo que alguns exigem equipamentos laboratoriais e outros, mais simplificados, que permitem a utilização no consultório odontológico. A proposta do presente trabalho foi desenvolver um método prático para determinação do poder neutralizante existente na cavidade oral. O método proposto consiste na realização de bochecho com 10 ml de Coca-cola® durante 30 segundos, por parte dos 50 participantes (crianças, adolescentes e adultos) e determinação da variação do pH entre a mistura saliva + Coca-cola® e o pH inicial do refrigerante. Foram realizados dois métodos de determinação da capacidade tampão salivar – titulação com ácido lático e o método simplificado Dentobuff Strip® -e, após teste de correlação entre o método de neutralização proposto e os dois testes descritos acima foi encontrada correlação estatisticamente significante entre o método proposto e a titulometria com ácido lático (Pearson=0,304;p=0,032). Porém em relação ao Dentobuff Strip® não foi verificada correlação estatisticamente significante. De acordo com a proposta da metodologia apresentada nesta pesquisa, foi encontrada uma média de neutralização da saliva após o bochecho com o refrigerante, de 23,8% (dp=16,5) até o pH crítico do esmalte (5,5) e considerando o pH fisiológico da saliva em torno de 7,0, a neutralização até este valor foi de 17% (dp=12,4). Diante dos resultados foi possível concluir que o método desenvolvido apresentou-se prático e satisfatório para avaliação da capacidade de neutralização existente na cavidade oral e pode ser utilizado como mais um recurso para predição do risco de cárie do paciente. / SUMMARY Caries prevention remains one of the main goals in dentistry. Since caries is a multifactorial disease, it becomes necessary to obtain all possible information about the patient during anamnesis. Hence, the professional is able to establish an individual preventive treatment for each patient. Saliva bears several functions in the oral cavity; consequently, it is an important host factor that modifies the caries process. Saliva buffering capacity is one of the important factors usually taken into account to predict the individual caries risk. Several tests have been applied to identify this saliva function. Some of them require laboratorial features, whereas others are easy to handle, and can be applied at dental offices. The purpose of the present study was to develop a practical method to assess the neutralizing power inherent of the oral cavity. The methodology was based on a rinse of Coke Ô for 30 seconds, performed by 50 subjects (including children, teenagers and adults), followed by the assessment of pH variation between the initial sample of soft drink and the final mixture (saliva + Coke Ô). Along with this method, two other well known buffer capacity tests were performed – titration with lactic acid and Dentobuff Strip®. We found statistically significant correlation between the proposed method and the titration with lactic acid (Pearson=0.304;p=0.032). On the other hand, there was no significant correlation between the proposed method and the test using Dentobuff Strip®. According to our results, the mean saliva neutralizing power after soft drink rinse, considering the cases of the critical enamel pH (5.5) and physiological saliva pH (7.0), were 23.8% (sd=16.5) and 17.0% (sd=12.4), respectively. The proposed method was practical and reliable to assess the neutralizing power of oral cavity and may be an additional technique to predict caries risk.

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: This was a pilot study assessing the impact of a sensory adapted dental environment (SADE) on children with developmental disabilities (DD) receiving routine dental care. Methods: A crossover study of 22 children with DD, aged 6 through 21, was conducted at Virginia Commonwealth University Pediatric Dental clinic. Each participant was randomized to a sequence of two dental cleanings, one regular dental environment (RDE) and one SADE with a 3-4-month recall. Outcomes included physiological measures (heart rate and oxygen saturation) and cooperation (Frankl scores). Results: Study subjects completed a total of 36 visits. None of the physiological measures differed at either time point between the two treatment settings. The Frankl scores were significantly higher with SADE setting than RDE (p =0.0368). Forty-six percent of parents strongly agreed that they would prefer the SADE for their child’s next visit. Conclusion: SADE may be associated with improved behavior in children with DD.