Browsing by Author "Martinez Mier, E. Angeles"
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Item Acceptance of Behavior Guidance Techniques Used in Pediatric Dentistry by Parents From Diverse Backgrounds(Sage, 2019-08) Martinez Mier, E. Angeles; Walsh, Christopher R.; Farah, Christopher C.; Vinson, LaQuia A.; Soto-Rojas, Armando E.; Jones, James E.; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjective. To investigate if parental background affects acceptance of behavior guidance techniques. Background. Behavior guidance techniques are used for the safe and effective treatment of pediatric patients. Acceptance of these techniques may vary by racial and ethnic background. Methods. A total of 142 parents were recruited and asked to rate videos showing: active restraint/protective stabilization (AR), general anesthesia (GA), nitrous oxide sedation (N2O), oral premedication/sedation (OP), passive restraint/protective stabilization (PR), tell-show-do (TSD), and voice control (VC) techniques. Results. Hispanic parents rated VC most acceptable, followed by TSD, PR, and pharmacologic techniques. Black and white parents rated TSD, followed by N2O, as most acceptable, and AR and PR as least favorable. Hispanics found GA significantly less acceptable than whites or blacks. Hispanics were less accepting of AR than blacks; but more accepting of PR than whites. TSD was highly rated among all 3 cohorts. Parental background affected acceptance of the techniques in this study.Item ADDENDUM: Critical windows of fluoride neurotoxicity in Canadian Children(Elsevier, 2022) Farmus, Linda; Till, Christine; Green, Rivka; Hornung, Richard; Martinez Mier, E. Angeles; Ayotte, Pierre; Muckle, Gina; Lanphear, Bruce P.; Flora, David B.; Dental Public Health and Dental Informatics, School of DentistryItem Anti-Caries Efficacy of Fluoride at Increasing Maturation of a Microcosm Biofilm(2019-08) Ayoub, Hadeel Mohammed; Lippert, Frank; Gregory, Richard L.; Martinez Mier, E. Angeles; Anderson, GregoryDental biofilm is a main contributing factor in the initiation and progression of dental caries. The maturation of dental biofilms is expected to alter the anti-caries efficacy of fluoride compounds. In the first aim, we conducted a series of modeldevelopment experiments to test different variables to standardize a reproducible in-vitro microbial caries model. We evaluated: surface conditioning using saliva; sucrose concentrations and caries lesion severity; growth media conditions and mineral saturation; dental substrate types; pH cycling protocol characteristics. In the second aim, we used the developed model to evaluate the changes in the anti-caries efficacy of three fluoride compounds (Sodium fluoride (NaF); Stannous fluoride (SnF2); Amine fluoride (AmF); and deionized water (DIW- negative control)) at increasing maturation of a microcosm biofilm. We continued the pH cycling protocol for 4 days, 8 days, and 12 days. We tested biofilm cariogenicity and carious lesion severity at each maturation stage. In the third aim, we used the developed model to test the effect of different exposure periods (early vs. late exposure) of the biofilm to three fluoride compounds (NaF, SnF2, AmF, DIW) in comparison to DIW. We also evaluated the recovery of biofilm cariogenicity with each exposure period. We evaluated, for each exposure period and recovery stage, biofilm cariogenicity and carious lesion severity. We analyzed the relationships between different variables (biofilm age, fluoride compound type, exposure period) using ANOVA models. In conclusion: 1. The present model allows testing the effect of biofilm maturation on the anti-caries efficacy of fluoride compounds. 2. Biofilm maturation plays an important role in increasing biofilm tolerance against fluoride treatment; it could also influence the selection of fluoride compounds to achieve optimum cariostatic effect. 3. Exposure period, and type of fluoride compound, both influence the biofilm tolerance to fluoride anti-caries effect; they may also result in a sustainable release of fluoride over time.Item Critical windows of fluoride neurotoxicity in Canadian children(Elsevier, 2021) Farmus, Linda; Till, Christine; Green, Rivka; Hornung, Richard; Martinez Mier, E. Angeles; Ayotte, Pierre; Muckle, Gina; Lanphear, Bruce P.; Flora, David B.; Dental Public Health and Dental Informatics, School of DentistryBackground: Fluoride has been associated with IQ deficits during early brain development, but the period in which children are most sensitive is unknown. Objective: We assessed effects of fluoride on IQ scores across prenatal and postnatal exposure windows. Methods: We used repeated exposures from 596 mother-child pairs in the Maternal-Infant Research on Environmental Chemicals pregnancy and birth cohort. Fluoride was measured in urine (mg/L) collected from women during pregnancy and in their children between 1.9 and 4.4 years; urinary fluoride was adjusted for specific gravity. We estimated infant fluoride exposure (mg/day) using water fluoride concentration and duration of formula-feeding over the first year of life. Intelligence was assessed at 3-4 years using the Wechsler Preschool and Primary Scale of Intelligence-III. We used generalized estimating equations to examine the associations between fluoride exposures and IQ, adjusting for covariates. We report results based on standardized exposures given their varying units of measurement. Results: The association between fluoride and performance IQ (PIQ) significantly differed across prenatal, infancy, and childhood exposure windows collapsing across child sex (p = .001). The strongest association between fluoride and PIQ was during the prenatal window, B = -2.36, 95% CI: -3.63, -1.08; the association was also significant during infancy, B = -2.11, 95% CI: -3.45, -0.76, but weaker in childhood, B = -1.51, 95% CI: -2.90, -0.12. Within sex, the association between fluoride and PIQ significantly differed across the three exposure windows (boys: p = .01; girls: p = .01); among boys, the strongest association was during the prenatal window, B = -3.01, 95% CI: -4.60, -1.42, whereas among girls, the strongest association was during infancy, B = -2.71, 95% CI: -4.59, -0.83. Full-scale IQ estimates were weaker than PIQ estimates for every window. Fluoride was not significantly associated with Verbal IQ across any exposure window. Conclusion: Associations between fluoride exposure and PIQ differed based on timing of exposure. The prenatal window may be critical for boys, whereas infancy may be a critical window for girls.Item Financial assessment of the community-based dental education program at the Indiana University School of Dentistry(Wiley, 2022-12) Shukla, Anubhuti; Amrutham, Bhavya Vaishnavi; Romito, Laura; Rodriguez, Andres Alfredo Mantilla; Martinez Mier, E. Angeles; Biomedical Sciences and Comprehensive Care, School of DentistryBackground There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana. Objective With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018–2021). Methods Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years. Results The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended. Conclude We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.Item Fluoride Content of Infant Formula Commercially Available in Central Indiana(2024) Altamimi, Ayman M.; Lippert, Frank; E. Soto-Rojas , Armando; Martinez Mier, E. AngelesBACKGROUND: Fluorides have a well-established role in dental caries prevention. Fluoride content in infant formula has raised concerns about whether it is within safe levels for the developing teeth. There is a large number of products on the market with likely varying fluoride concentrations, and these products’ fluoride content will differ depending on whether, for example, fluoridated water was used during manufacturing or reconstitution. Several studies have been published on infant formula containing fluoride and the associated risk of developing enamel fluorosis. However, few recent studies in the US have determined whether liquid or powder infant formula fall within safe/recommended levels. Purpose: This study measured the fluoride content of infant formula sold in grocery stores in central Indiana, prepared using three types of water (Purified, Nursery, and Tap) to determine if they fall within safe levels. Alternative hypotheses: There is a significant difference in the concentration of fluoride between different brands of infant formula. Material & Methods: We analyzed twenty different infant formula products sold in grocery stores in the Indianapolis, Indiana area for their fluoride content. Samples were reconstituted with Nursery water (containing approx. 1.0 ppm fluoride), Tap water (approx. 0.7 ppm fluoride) and Purified water (negligible fluoride content). A sample for the tests was taken from each preparation and the concentrations of fluoride of all samples was determined using the fluoride microdiffusion method. The statistical analysis of results was carried out using two-way ANOVA. Results: When comparing the mean (SD) fluoride concentration among the three types of infant formula reconstitution with water, tap water had significantly higher fluoride concentration mean than both Nursery water and purified water (P <.001 at α=.050 level). Nursery water also had significantly higher fluoride concentration mean than purified water (P <.001 at α=.050 level). When the three types of water were used for reconstitution of the 20 infant formula brands, the overall highest fluoride concentration mean was seen when tap water was used for reconstitution (0.950) followed by nursery water (0.789) while the least fluoride concentration was in purified water (0.102). Conclusion: Within the study's limitations, it can be concluded that apart from one formula none of the tested infant formulas sold in central Indiana grocery stores when reconstituted with purified water were found to decrease the chance of infants exceeding UL levels for both age groups but were found to increases the chance exceeding the AI levels for infants aged 0–6 months. All tested infant formulas reconstituted with nursery and tap water were found to increase the chance of infants exceeding the UL, and the AI levels for both groups resulted in increasing the chance of fluoride concentrations exceeding the recommended/safe levels. Thus, the type of water used for reconstitution rather than the type of formula appears to be the determining factor for the levels of fluoride intake associated with infant formula. Clinical Significance: With the recent increase in the utilization of infant formula, different brands with varying fluoride concentrations and the different modes of reconstitution must be evaluated to determine if their fluoride concentrations will fall within safe/recommended levels and thus increase the risk of enamel fluorosis development.Item Prevalence, Clinical Presentation, and Associated Sociodemographic Characteristics of Molar Hypomineralization in Indiana, USA(2020-05) Ahmed, Azza Tagelsir Mohamed; Martinez Mier, E. Angeles; Dean, Jeffrey; Soto, Amanda; Lippert, Frank; Mohammed, Aghareed; Miller, JamesMolar Hypomineralization (MH) of the first permanent molars (FPMs) and the second primary molars (SPMs) is a common developmental defect of enamel, with global prevalence of 14% and 5% respectively. Children with MH represent a special pediatric population because their affected molars have extreme susceptibility to enamel breakdown, decay and tooth sensitivity. Although the problem of MH has been described almost twenty years ago mainly through reports from Europe, there is very little information about the problem from the USA. In this dissertation, MH was explored both from the perspectives of pediatric dentists’ (PDs) and at population level. The majority of the survey respondents perceived MH prevalence to be <10% in their clinical practice (62%). The most cited clinical challenge in managing MH teeth was “long-term success of restorations” (79%). When analyzed individually, responses differed significantly for different demographics and educational characteristics of the respondents (p<0.05). At population level, MH of the FPMs (Molar Incisor Hypomineralization (MIH) cohort: 337 schoolchildren, average age 9 years) and of the SPMs (Hypomineralized Second Primary Molar (HSPM) cohort: 423 schoolchildren, average age 7 years) had prevalence estimates of 13% and 6% respectively. In the MIH cohort, water fluoridation or non-Hispanic Black race/ethnicity was significantly associated with higher collective prevalence of enamel defect (EDs) (P<0.05), but not with the prevalence of MH of the FPMs. In the HSPM cohort, race/ethnicity was significantly associated with higher overall prevalence of EDs of SPMs, but not with the HSPM prevalence. Older age group (>10 years), living in central Indiana, and water fluoridation were significantly associated with higher overall prevalence of EDs (P<0.01), but not with the HSPM prevalence. Caries experience was significantly higher in children with MH of FPMs and/or SPMs than in the group without MH. We concluded that USA pediatric dentists’ respondents were well aware of the MH problem, but demonstrated discrepancies in different aspects of the MH problem. At population level, MIH and HSPM were common presentation with prevalence estimates similar to the global figures. Certain demographic characteristics were significantly associated with the overall prevalence of the enamel defects of the examined teeth.Item Primary Coronal Caries Prevention with Silver Diamine Fluoride – Investigations into Efficacy and Mode of Action(2021-01) Sorkhdini, Parand; Lippert, Frank; Gregory, Richard; Martinez Mier, E. Angeles; Crystal, Yasmi O.; Stelzner, SarahDental caries continues to be one of the most prevalent preventable diseases worldwide. Silver diamine fluoride (SDF) is a topical solution comprised of silver, ammonia and fluoride. It is a safe, effective, efficient, noninvasive and cost-effective method in caries management. However, there is little clinical evidence supporting the use of SDF (or SDF followed by application of potassium iodide[KI] to mitigate staining) as anti-caries agents on sound enamel and early enamel carious lesions. In this dissertation, I studied the mechanism behind SDF’s ability to prevent coronal caries which has not been studied yet. In the first and second aims, I investigated the effectiveness of SDF, SDF+KI, fluoride (potassium fluoride [KF]) and silver (silver nitrate [AgNO3]) controls to SDF and deionized water (DIW) in preventing enamel demineralization and enhancing remineralization using chemical, biofilm and pH-cycling models. In both chemical demineralization and pH-cycling models there were no statistically significant differences between SDF and SDF+KI in preventing coronal caries. In the biofilm model, however, SDF+KI was significantly less effective in preventing demineralization than SDF. In the third aim, I investigated the efficacy of SDF, SDF+KI, KF, AgNO3, and DIW on the remineralization of active subclinical enamel carious lesions. Here, SDF+KI was significantly more effective in promoting remineralization than SDF. I calculated changes in color, and the results show applying KI after SDF significantly reduced the dark staining caused by SDF. In conclusion: SDF and SDF+KI appear to be effective options in preventing and in the treatment of primary coronal caries. Further clinical research is required to confirm the present findings.Item Redesign of an informed consent form to increase participation in a school-based dental program(Wiley, 2021) Mantilla Rodriguez, Andres A.; Soto, Armando; Martinez Mier, E. Angeles; Cariology, Operative Dentistry and Dental Public Health, School of DentistryObjectives The study aimed to determine if modifications to the design of a consent form and consenting process increased participation rates in the Indiana University School of Dentistry's Mobile School-Based Dental Program (Seal Indiana). Methods Kaizen methodology was followed to identify problem areas in the consenting process. Additionally, stakeholders were invited to participate in focus groups and fill out surveys to identify issues preventing participation in the Seal Indiana program (N = 48) and later to evaluate the changes made (N = 48). The redesigned form and process were then used in a pilot study at 14 sites to determine the impact that changes had on levels of participation as measured by the number of consent forms completed and returned. Results There was a statistically significant increase in the number of consent forms returned. The measured change represented a 32 percent increase in program participation (P value = 0.035). A statistically significant increase was observed in how participants viewed the attractiveness of the form and how easy it was to read and comprehend. Conclusions In order to increase consenting rates, our results indicate modifications to the consent form should be focused on the following characteristics: esthetics, ease of reading and comprehending information, and making the Health Insurance Portability and Accountability Act of 1996 (HIPPA) privacy regulations easier to read and comprehend.Item Studies on the Dietary Intake of Fluoride and the Concentration of Fluoride in Urine Over the Course of Pregnancy(2021-06) Castiblanco Rubio, Gina Alejandra; Martinez Mier, E. Angeles; Téllez Rojo, Martha Maria; Preciado, Alejandra Cantoral; Tekwe, Carmen; Duarte, Simone; Lippert, FrankThe use of maternal urinary fluoride as a biomarker of prenatal fluoride exposure in epidemiology studies is increasing. However, the knowledge on maternal exposure to fluoride and its biomarkers, has not increased alongside. The objective of this dissertation was to improve our understanding of the dietary intake of fluoride (a major source of fluoride exposure), and spot urinary fluoride levels during pregnancy. Two secondary data analyses utilizing data from the Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) project were conducted, in a population of women living in a salt-fluoridated community. The first study estimated the dietary intake of fluoride over the course of pregnancy and assessed the influence of compliance with the dietary recommendations of intake of beneficial nutrients for pregnancy (calcium, iron, folate and protein) on the dietary intake of fluoride. The second study compared spot urinary fluoride in women during pregnancy and non-pregnancy (using one-year postpartum as a proxy for the non-pregnant state) and assessed associations between dietary factors (dietary fluoride intake, addition of table salt, calcium intake from diet and supplements, and dietary acid load) and urinary fluoride levels at each state. Results revealed that the median dietary intake of fluoride in pregnant women was 0.7 mg/day, increased with gestational age and in women who were moderately and highly compliant with recommendations of intake of beneficial nutrients for pregnancy. On the other hand, spot urinary fluoride levels during pregnancy did not significantly differ with those of women one-year postpartum, increased with gestational age, and decreased in calcium-supplemented women only during pregnancy. The dietary intake of fluoride, calcium, and dietary acid load were not associated with urinary fluoride in either state. Finally, reporting the addition of table salt to meals was associated with an increase in urinary fluoride only at one-year postpartum. The studies in this dissertation highlight the need for a deeper understanding of fluoride exposure and its biomarkers in the pregnant population.