Purpose: To assess the treatment modalities of pediatric dentists for restoring Class II lesions in primary molars. Methods: A survey of eight cases was emailed to AAPD members, who were asked to choose a stainless steel crown (SSC) or composite resin. Treatment choice was associated with provider type, years in practice, behavior management, lesion detection, and patient age. Results: Clinically detectable caries restored under general anesthesia were treated more often with a SSC. Faculty and residents chose a SSC at a greater rate. Providers with 10 or more years experience chose a SSC more often. Conclusions: The scope of treatment planning encompasses numerous factors. Because of the multifactorial nature of treatment planning for the pediatric dental patient, it would be beneficial for the AAPD to produce a treatment planning decision tree in order to better direct practitioners in their development of patient-centered treatment plans.

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: This study investigates knowledge about HPV and examines if pediatric dental providers should include HPV education for guardians of patients 10-18 years. Methods: Legal guardians of 10-18 year-old patients of the Virginia Commonwealth University Pediatric Dental Clinic were enrolled in this prospective cohort study. Participants completed a baseline survey, were provided HPV education, completed an initial follow-up survey, and then completed a 6-month follow-up survey. Results: A total of 54 participants completed the baseline and initial follow-up surveys and 17 completed the 6-month follow-up survey. The average number of correct responses was 3.4 of 6 knowledge questions, which significantly improved to 5.4 at follow-up (P<.0001). The greatest increase in the percent responding correctly was regarding HPV and oropharyngeal cancer from 22% baseline to 91% at initial follow-up (P<.0001). Regarding Stage of Change, 14 (23%) of those not initially in the Action group had improved at least 1 stage. At the 6-month follow-up, 3 (43%) guardians reported completing the HPV vaccine series. Conclusions: These results demonstrate limited knowledge about HPV and highlight the pediatric dental provider’s ability to educate. Since the greatest knowledge gap pertained to HPV and oropharyngeal cancer, it is important for pediatric dental providers to increase their role in HPV education. As oral cancers are the purview of dentists, practitioners should be involved with their patients’ consideration of the HPV vaccine.

Purpose: To understand guardian and child preferences for the appearance of their pediatric dentist. This was a cross-sectional descriptive study using survey methodology with patients and parents that attended the VCU Pediatric Dental clinic. Methods: A total sample of 100 guardians and 97 pediatric patient participants completed the computer-based questionnaire. Four subjects were asked to pose for photographs wearing various combinations of attire (professional, casual, white coat, scrubs). Results: Among guardians, 56% reported preferring a provider in scrubs, with white coat the second most preferred attire (39%) for their children. For pediatric patients, scrubs were still most often selected, but at a lower rate (43%). White coat remained the second most preferred option at 37%. Conclusions: Children and parents have strong perceptions and preferences regarding their dentists’ attire. The results of this study can be used, by providers, to improve the comfort, and acceptance of care by patients and guardians.

Purpose: The purpose of this study was to use data obtained from the 1999 Virginia Statewide Oral Health Survey to provide a descriptive account of the oral health status for Virginia schoolchildren and examine the relationship between a child's insurance status and indicators of oral health status.Methods: The Division of Dental Health (DDH), in the Virginia Department of Health (VDH), completed the 1999 Virginia Oral Health Needs Assessment (VSOHNA) in cooperation with 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. Descriptive and multi-variable regression analyses were completed to examine the relationship between insurance status and oral health status indicators. Results: In the primary dentition, schoolchildren with medical and dental insurance had the highest level of caries-free teeth at 46%, compared to the schoolchildren with no insurance at 34%, and those with medical insurance only at 31%. In the primary dentition, schoolchildren with no insurance had the highest prevalence of untreated decay at 65%, when compared to schoolchildren with medical insurance only at 42%, and those with both medical and dental insurance at 25%. There were no significant relationships between insurance status and caries experience or untreated decay in the permanent dentition.Conclusion: In the primary dentition, children with no insurance or medical insurance only were more likely to have untreated decay than those with both medical and dental insurance. Insurance status does not appear to be associated with caries experience or with untreated disease in the permanent dentition.

DEVELOPMENT OF A DENTAL ACCESS SURVEY INSTRUMENT FOR CHILDREN WITH AUTISM SPECTRUM DISORDERSBy Roy H. Rogers, B.A., B.S., D.D.S.A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University.Virginia Commonwealth University, June 2003Thesis Director: Frank H. Farrington, D.D.S., M.S.Department of Pediatric DentistryPurpose: The purpose of this study was to develop a survey instrument or questionnaire to evaluate access to dental care for children with autism spectrum disorders.Methods: The research methods of this study were conducted in a 16-step process. Survey questions were evaluated based on analysis of response frequencies and item non-response (missing data), the content of open-ended responses on the questionnaire, the researcher's judgment regarding how well the question worked within the questionnaire design construct, redundancy across questions, and whether or not the question met the project's proposed analytical goal (purpose): to evaluate access to dental care for children with autism spectrum disorders. Judgment-based evaluation of each question was tabulated using Excel spreadsheet format.Results: The overall response rate for the pilot test mailing was 46.8% (22/47). The overall sample size was reduced from n=50 to n=47 due to one undeliverable survey instrument/questionnaire and two survey instrument/questionnaires returned because neither respondent had any children with autism spectrum disorders. The mean age of children sampled was 7.1 years with a standard deviation of 3.6 years. 68.2% (15/22) of the children were male and 31. 8% (7/22) were female. 22.7% (5/22) found it difficult to locate a dentist to treat their child. 54.5% (12/22) of children were treated by a pediatric dentist. 52.9% (9/17) required the use of restraints when being treated by a dentist. 52.4% (11/22) described their child's behavior as uncooperative requiring either nitrous oxide, oral sedatives, or general anesthesia in order to be treated. 81.8% (18/22) of respondents indicated that their child had some form of dental/medical health care coverage including but not limited to private health insurance. Survey questions 9, 10, 14, 15, 20, 25, and 51 were revised, questions 2, 4, 5, 28, and 38 were omitted, and one question was added (question number 4) in the final survey instrument.

Purpose: The purpose of this study is to assess the impact of preventive dental services (screening, oral health education, and fluoride varnish) given by pediatric medical providers with an assessment of caregivers interviewed at baseline and at 6-months follow-up.Methods: Using a prospective cohort study design, an oral health knowledge and socio-demographic questionnaire was delivered to a cross-section of caregivers of preschool-aged children seen at VCU Children's Pavilion. Baseline data was used to conduct a cross-sectional analysis of caregivers prior to their children receiving preventive dental services (screening, oral health education, and fluoride varnish). Subsequently, six months into the program, caregivers of children receiving preventive dental services were retested on their oral health knowledge. The 23-item questionnaire included knowledge, behavior and opinion items on risk factors for dental diseases, care of child's teeth, and socio-demographic characteristics of the family. Data collection occurred in the clinic waiting rooms and the examination rooms. Results: A sample of 120 caregivers completed the baseline questionnaire. Caregivers at baseline reported 89% of the children have never been to a dentist. Sixty-four percent of caregivers have never been told by a doctor or nurse when their child should go to the dentist. After receiving preventive dental care in a primary care setting, there was a significant increase in the use of fluoridated toothpaste and less trouble brushing the child's teeth. Caregivers reported a significant increase in information given to them by medical residents about how to brush the child's teeth.Conclusion: The delivery of preventive dental services in a primary care setting is effective in improving certain aspects of caregiver oral health knowledge, though persistence is needed to further caregiver education in an effort to improve the oral health of children.

The purpose of this study was to assess the baseline oral health quality of life of high-risk children and examine differences in oral health quality of life according to the child's treatment needs at an oral screening exam. We hypothesized that a child's oral health related Quality of Life (QOL) would be correlated with dental treatment needs. This study was a cross-sectional design with subjects who were 8-14 year old patients of Virginia Commonwealth University and/or members of the Boys and Girls Club of Metro Richmond. The oral health quality of life was measured using the Child Perception Questionnaire (CPQ). It is a multidimensional scale that includes items concerning functional aspects including oral pain and discomfort, but also includes psychological and social aspects. The four domains tested are: oral symptoms, functional limitations, emotional well-being and social well-being. The children were asked to report on these domains as they related to their oral health in the past 3 months. The dental treatment needs of the children were categorized as (0) no future needs, or (1) restorative or orthodontic needs. Those with no future needs were scheduled for a 6 months periodic exam and prophylaxis (cleaning). The children in need of restorative treatment were scheduled for such (restorations, stainless steel crowns, extractions), and those in need of orthodontics were referred for consult to an orthodontist. The final sample population consisted of 107 children, predominately African American (84%). The intra-oral screenings revealed 75% of children required future dental treatment, specifically 84% restorative and 12% orthodontic work and 25% in need of preventative recall (cleaning and exam at 6 months). Overall, children reported high levels of oral health quality of life. When asked about the overall health of their teeth, lips, jaws and mouth, 39 % (n=42) reported excellent or very good, 50% (n=53) reported good, and 9% (n=10) reported fair or poor. When asked how "overall life" was affected by oral health, 72% (n=77) reported very little or not at all, 13% (n=14) reported some, and 15% (n=16) reported a lot or very much. There were no significant correlations between the oral health quality of life domains and the children's dental treatment needs.

Purpose: To determine whether Bispectral Index Monitoring is an effective tool for quantifying sedation depth after the administration of oral drug regimens in children.Methods: This retrospective study reviewed the charts of 75 children who received oral conscious sedation for dental treatment. Data collected from the chart included; 1) BIS values at 5 minute intervals and at five critical events: pre-operative, local anesthesia delivery, rubber dam placement (if utilized), during operative treatment, and postoperatively, 2) behavior ratings at the five critical events and an overall behavior assessment, 3) treatment data, and 4) demographic data. Results: The mean BIS value for orally sedation children in this study was 84.53 (SD = 5.76). The mean overall sedation assessment was 2.04 (SD = 1.16). No significant correlation was found between BIS values and behavioral ratings.Conclusion: The BIS monitor provided limited information regarding the depth of sedation in children undergoing oral sedation for dental treatment.

Purpose: The purpose of this study was to determine the knowledge and treatment protocols for physicians in Virginia emergency departments in regards to the emergent treatment of avulsed teeth.Methods: Using a cross sectional survey design, an 8-item questionnaire regarding the treatment of avulsed teeth was emailed to 75 emergency department chairpersons in Virginia. After 30 days, a reminder paper copy of the questionnaire was mailed and an email reminder with the on-line link was sent. After 60 days the study was closed. Comparisons were made using chi-square analysis based on percentages to test for significance. Results: The response rate was 52 % (n = 39). There were no associations between physician knowledge of the treatment of avulsed teeth and whether there was a protocol for treatment, an in-house dental team, or an on-call dentist available. Conclusion: Most of the physicians have some knowledge of the treatment of avulsed teeth; however further training would help ensure appropriate treatment.