published_or_final_version / abstract / Dentistry / Doctoral / Doctor of Philosophy

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: 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 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.

To examine the pediatric dentists’ perspective on level of care to children 0-3 years old by general dentists, an electronic survey was sent out to 5185 AAPD members and 769 responded (response rate: 14.8%). Forty-six percent agreed with a general dentist providing a dental home to children 0-3 years old. Only 24% agreed that general dentists could perform complex restorative and behavior management procedures for 0-3 years old. Younger respondents, pediatric dentists who practice in rural areas or teaching pediatric dentistry, and those who perceived adequate exposure during dental school were more likely to agree on general dentists proving a dental home (p values ranged from <0.0001 to 0.022). This study finding can help guide what level of care general dentists may provide and when a referral to a pediatric dentist is recommended and the appropriate competency level of entry-level general dentists to care for 0-3 years old.

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.