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Item A clinical study of sealants polymerized with two different light sources(2004) White, Marcia Stoddart; Avery, David R.; Platt, Jeffrey A., 1958-; Moore, B. Keith; Weddell, James A. (James Arthur), 1949-; Sanders, Brian J.; Matis, Bruce A.This clinical study investigated the efficacy of the new LED LCU technology when compared to that of the QTH LCU by evaluating retention and wear of Clinpro (3M ESPE) sealant material over six months of function. This study was designed as a split mouth, randomized clinical study. Sealants were placed and polymerized on contralateral teeth of 35 patients, 33 of which successfully completed the study. The sealants were evaluated for clinical retention at baseline, three months, and six months by two evaluators. For the wear analysis, the area of the sealant wear at six months is reported. Nine pairs of molars and 22 pairs of premolar teeth were used. This sample size is smaller than the original sample used for clinical evaluation, because a number of the baseline impressions had to be discarded due to poor impression quality. Subsequent impressions were taken at three months, and six months. Epoxy replicas were made from the impressions and the occlusal surface of each replica was digitized using SigmaScan software. A cummulative legit model was applied to the clinical data, and a linear model was applied to the wear analysis. The results for clinical retention over the six months of function were as follows. At Baseline, for the QTH, 97.3 percent of the teeth received an Alpha score; 2.7 percent received a score of B. For the LED, 87.7 percent received a score of A; 12.3 percent received a score of B. At three months follow-up, for the QTH, 93.1 percent received a score of A; 6.9 percent received a score of B. For the LED, 86.1 percent received a score of A; 12.5 percent received a score of B, and 1.14 percent received a score of C. At six months follow-up, for QTH; 91.7 percent received a score of A; 8.3 percent received a score of B. For the LED, 83.3 percent received a score of A; 15.3 percent received a score of B, and 1.14 percent received a score of C. The hypothesis was that there would be no significant difference in clinical retention and wear of Clinpro's sealant polymerized with the QTH or the LED light sources over six months of function. Based on the results of this clinical study, the following conclusions can be made: 1) At baseline, Clinpro's sealant polymerized with QTH light source showed marginally significant better retention than LED light source (p-value 0.05001). 2) There was no significant difference between light sources for sealant clinical retention at three-month and six-month follow up visits. 3) Wear analysis resulted in marginally significant more wear for molar sealants polymerized with LED LCU (p-value 0.0755). 4) Wear analysis showed no significant difference for premolar sealants polymerized with either light source.Item A comparison of hardness and abrasion resistance of two sealant materials after polymerization from different distances by different light sources(2008) Ritchie, Craig D.; Dean, Jeffrey A.; Avery, David R.; Sanders, Brian J.; Weddell, James A. (James Arthur), 1949-; Platt, Jeffrey A., 1958-; Tomlin, Angela; Moore, B. KeithBACKGROUND The efficacy of sealants to aid in the prevention of pit and fissure caries is well documented. In order for the sealants to be effective, they must be placed properly and retained for as long as possible. Clinicians must be aware that the proper placement of sealants is technique-sensitive and must be well controlled in order to achieve the best results. This study aims to determine if certain variables have an effect on curing of the sealant material to a degree that would compromise its integrity, strength, and longevity. METHODS AND MATERIALS Two commonly used sealant materials Ultraseal XT (Ultradent Products Inc., South Jordan, UT) and Delton (Dentsply International, Woodbridge, Ontario, Canada) were chosen and tested for microhardness and abrasion resistance after they were polymerized. This study did not focus on the materials themselves, but rather the technique by which they were polymerized and what effect this had on the materials. Three separate light sources, a traditional halogen light (QHL 75, Dentsply International, Woodbridge, Ontario, Canada), and two newer LED lights (Ultralume LED, Ultradent Products Inc., South Jordan, UT; and 3M Freelight LED, 3M Corp, St Paul, MN) were used in this study. The materials were then cured with each light at each of three different distances: contact (0.5 mm), 2 mm, and 10 mm. The effects of light source variation and distance from the material at the time of polymerization was then evaluated for any significance to sealant placement technique. Specimens were tested for each variable combination of sealant material, light source, and distance between the two while curing. Six samples were tested for each variable grouping for abrasion resistance, and four separate san1ples were tested fron1 the san1e grouping for Knoop hardness. The results were analyzed for significance to determine if certain techniques are or could be beneficial or damaging to the quality of care provided by today's practitioners. RESULTS It was found that materials and light sources varied in combination and with different techniques (e.g., distance). In general, the top surface polymerized best when cured at a distance of 2 mm to 10 mm, while the bottom surface polymerized best at a distance of 0.5 mm. The halogen light consistently outperformed the two LED lights, with the 3M LED consistently producing the worst results. CONCLUSIONS The halogen curing light used in this study outperformed the LED lights in almost every category, despite the LED light manufacturer's claims of equality. For more reliable polymerization, the halogen light should be used. SIGNIFICANCE The practitioner must be aware of the material that he/she is using and how the chosen light source polymerizes that material. Manufacturers' claims and recommendations cannot be trusted to accurately produce the best results with every product on the market today, sometimes not even with the manufacturers' own products. It is crucial for practitioners to be well versed and knowledgeable about the products that they use, based on current research and not manufacturers' claims.Item Conscious Sedation of the pediatric dental patient: a comparison of meperidine versus butorphanol(2001) Guthrie, Andrew C. (Andrew Cleveland), 1969-; Sanders, Brian J.; Majcher, Thomas; Tomlin, Angela; Weddell, James A. (James Arthur), 1949-; Avery, David R.Treating pediatric dental patients four years old and younger can be difficult at times due to patient behavior. Conscious sedation has been employed as a means to control pediatric dental patients for several years. Butorphanol tartrate has been used safely for pain control in pediatric patients for several years, but has never been used for sedating pediatric dental patients. The purpose of this study is to compare the behavioral and physiologic effects of conscious sedation on pediatric dental patients using intramuscular meperidine and an equipotent dosage of intramuscular butorphanol. Forty conscious sedations of ASA I pediatric dental patients between the ages of 13 and 60 months were accomplished using either 2.0 mg/kg of intramuscular meperidine or 0.03 mg/kg of intramuscular butorphanol. Each sedation was videotaped and three viewers viewed the videotapes rating them with a computer program (ACS) involving a four-code behavior rating scale. The tlrree viewers rated patient behavior for each sedation also with a form with global rating, categorical, and dichotomous scales. Physiologic signs of oxygen saturation, blood pressure, heart rate, and respiration rate were monitored at baseline and every 5 minutes during treatment. The operator also rated the sedation patient behavior with a form that had pre-treatment Frankl, post-treatment Frankl, global rating categorical, dichotomous, and sedation success rating scales. The two groups demographic data, physiologic data, ACS data, the three viewer's behavior rating form, and the operator's behavior rating form were analyzed for any statistically significant differences between the groups. The statistical analysis of the demographic data revealed a statistically significant trend in the butorphanol group toward extractions. The meperidine group had a statistically significant higher mean oxygen saturation during treatment (99.63 percent) than the butorphanol group (99.20 percent). The butorphanol group spent significantly more time in the annoyed ACS behavior rating code and showed a trend toward less time spent in the quiet ACS behavior rating code. There were no statistically significant differences in the three viewers ratings of global rating, categorical, and dichotomous scales. The operators' ratings showed the meperidine group had a statistically significant better global rating than the butorphanol group. Overall butorphanol appears to be equal clinically to meperidine in physiologic effects and patient behavior effects. No adverse effects occurred with either medication. Butorphanol may be offered as an alternative sedative agent to other narcotic sedative agents with more side effects.Item Correlation between caries prevalence and socioeconomic status in children ages 6 to 36 months(2000) Ching, Brent Bing Yee; Weddell, James A. (James Arthur), 1949-; Sanders, Brian J.; Tomlin, Angela; Dean, Jeffrey A.; Klein, Arthur Irving, 1922-2004The purpose of this study was to evaluate the status of a sample of children ages 6 to 36 months with regard to prevalence of tooth decay in a community with an optimum fluoridated water supply. It was determined whether a relation existed between these data and the socioeconomic level of the family. One hundred and fifty children ages 6 to 36 months born and reared in Marion County, Indiana were examined with a dental mirror, explorer and a portable light. Parents/legal guardians of these children were given a questionnaire to obtain family history. Caries prevalence for children ages 6 to 12, 13 to 18, 19 to 24, 25 to 30, and 31 to 36 months were 4%, 0%, 22%, 23%, and 26%, respectively. Age, mother's educational attainment, and Medicaid experience remained significant predictors of caries experience: the odds of caries were 1.1 times for each monthly increase in age. Gender, father's educational attainment, family household income, and single parent status remained marginally significant predictors of caries experience. Results for similar correlation studies between caries prevalence and socioeconomic status for children ages 6 to 36 months are inconsistent. Further research is needed for children ages 6 to 36 months. Caries experience begins before age one. Patients, parents, and health care professionals need to be aware that the caries process begins at an early age, and prevention should begin as early as 6 months of age.Item Correlation between caries prevalence, socioeconomic status, and cultural findings in Hispanic children ages 6 months to 8 years(2002) Kugar, Jennifer R.; Yoder, Karen S. Masbaum, 1941-; Avery, David R.; Sanders, Brian J.; Weddell, James A. (James Arthur), 1949-; Martinez Mier, Esperanza de los A. (Esperanza de los Angeles), 1967-; Mallatt, Mark E. (Mark Edward), 1950-; Dean, Jeffrey A.There has been a tremendous influx in the number of Hispanic immigrants into the US over the past couple of decades. Many newcomers have families with small children, and dental needs in this pediatric population are disproportionately high. The purpose of this study was to determine if there was any correlation between the increased prevalence of caries and socioeconomic or cultural factors in Hispanic children ages six months to eight years old. To accomplish this, 127 children were given dental examinations by a calibrated dental examiner, and their parents completed a two-page questionnaire with questions regarding socioeconomic factors, den1ographics, and cultural issues. The bivariate relation between caries status and demographic and cultural variables was examined using chi-square tests or Fisher's exact tests for categorical variables and logistic regression for continuous variables. Bivariate relation between defs and demographic and cultural variables was examined using analysis of variance (ANOVA). The mean defs for children up to age two was 1.53; ages two to five the mean defs was 7.73, and for ages six to eight, 9.18. As the prevalence of caries increases with age, the child is more likely to access dental care, but despite this, there is an overall mean 79 percent of untreated decay (of decayed, missing and filled surfaces). In the permanent dentition, the overall mean DMFS was found to be 2.22. There were several factors found to be statistically significant to the incidence of defs. If the child had dental insurance, the child was more likely to have higher defs. If a child had more siblings, the defs score was higher. If the child was on the bottle at less than age one-and-a-half, the child was less likely to have dental caries. If the child on the bottle was older than age one-and-a-half, the child was much more likely to have dental caries. The older the child is when the child goes off the bottle, the more likely the child will have a higher caries experience. There is an extraordinarily large number of untreated caries found in Hispanic children. The reasons for this are multifactorial, but involve cost, language barriers, being new to the area, and not having seen a dentist yet. Identifying those at high risk such as single mothers, those with increased numbers of siblings, and infants that are still on the bottle, or older children that are at increased jeopardy due to prolonged use of the bottle are important factors in treating those that are underserved. Local dental and community organizations could benefit from being apprised of the unmet dental need of Hispanic children and some of the contributing factors. By further investigating and understanding some of the socioeconomic and cultural issues that present barriers to care, treatment might become more accessible and available. Adverse outcomes such as missed school and opportunities for acculturation, inadequate nutrition, pain, and infection might be avoided or diminished.Item Efficacy of the Indiana school water fluoridation program(2002) Garabedian, Andrew Hrair, 1973-; Mallatt, Mark E. (Mark Edward), 1950-; Weddell, James A. (James Arthur), 1949-; Christen, Arden G., 1932-; Sanders, Brian J.; Dean, Jeffrey A.In 1973 the state of Indiana initiated a program to fluoridate the water in rural school systems to a concentration of 4.0 ppm. Today, the optimal concentration is 3.5 ppm. When it was initiated, school water fluoridation was a popular method of providing fluoride supplementation to children who didn't have access to community-fluoridated water. Today, only Indiana runs a school water fluoridation program, and the CDC has stated that continuation of these efforts should be based on caries risk, alternate preventive measures, and periodic evaluation of program effectiveness. The purpose of this study was to assess the efficacy of the Indiana school water fluoridation program in order to determine if children participating in the program develop less caries with no increased risk of fluorosis. Four hundred sixty students were examined from Northwestern Consolidated School Corporation in Shelby County (fluoridated school) and North Knox School Corporation in Knox County (non-fluoridated school). Three hundred ninety-one students were statistically evaluated, 204 from the fluoridated school and 187 from the non-fluoridated school. A thorough visual examination was conducted by the same examiner collecting data on DMFS, defs, and fluorosis in grades 1-6. DMFS scores were 28 percent less for fluoridated students compared with non-fluoridated students (0.95 versus 1.32). Although the effect of fluoridation status on caries in permanent teeth is not statistically significant, the author believes this difference may be clinically significant. Analysis of defs scores showed fluoridated students with 6 percent less defs than non-fluoridated students, although the results were not statistically significant. Only 3.92 percent of the students at the fluoridated school showed fluorosis, while 10.16 percent showed signs of mild fluorosis at the non-fluoridated school. Conclusion: While not statistically significant, children attending the school fluoridated with 3.5 ppm of fluoride developed less caries and suffered no increase of fluorosis compared with children attending schools not participating in the school fluoridation program. Further analysis is necessary through statewide blind examinations at numerous school systems to further assess the efficacy of the Indiana School Water Fluoridation Program.Item Fissure penetration and microleakage of a conventional pit and fissure sealant and a flowable composite: a comparative study using three different bonding systems(2002) Chan, Terence; Moore, B. Keith; Platt, Jeffrey A., 1958-; Sanders, Brian J.; Tomlin, Angela; Weddell, James A. (James Arthur), 1949-; Dean, Jeffrey A.The concepts of using a pit and fissure sealant material to prevent dental caries have been well established in dental research. Effectiveness of a pit and fissure sealant material is limited to its ability to remain bonded to the occlusal surfaces. Adding a dentin-bonding agent between the etched enamel and the sealant material has been demonstrated as a way of optimizing bond strength in the face of moisture and salivary contamination. The purpose of this study was to examine if there was a difference in fissure penetration or microleakage between a conventional pit and fissure sealant or a flowable composite when used as a pit and fissure sealant, while using three different adhesive systems. Delton Direct Delivery System (Dentsply), an opaque, light cured pit and fissure sealant and the commercially available flowable composite, Revolution Formula 2 (Kerr) was selected for this study. Three clinically used adhesive systems selected for this study were: conventional phosphoric acid etching; Opti-bond Solo Plus(Kerr), a single bottle system; and Prompt L-Pop (3M ESPE), an all-in-one primer adhesive. One hundred fifty extracted caries-free third molars, selected for well-defined occlusal pits, were randomly divided into six treatment groups. Fissure penetration and microleakage was examined after immersion of the treated teeth in 5.0-percent methylene blue solution for 18 hours; the teeth were removed and thoroughly cleaned. Mesial and distal flat-ground sections were obtained and examined at X20; microleakage was recorded as either present or absent, and penetration was recorded as either complete or incomplete. The interaction between the material and the adhesive system was non-significant based on the logistic regression model for the penetration and the microleakage, so that only the main effects of material and adhesive system were included in the final model. Enamel conditioning with the total-etch and single-bottle adhesive system provided consistently microleakage resistance when compared with the use of the all-in-one bonding system. The all-in-one adhesive system demonstrated the most microleakage regardless of the material used for the pit and fissure sealant. The hypothesis of this thesis was that there would be no significant difference in fissure penetration or microleakage between the conventional pit and fissure sealant or the flowable composite, regardless of the adhesive system used. The results of this study support the hypothesis that there was no significant difference in fissure penetration between the materials. The result did demonstrate that there was significant difference in microleakage between the three different adhesive systems used.Item Maternal anxiety and the child's behavior in the dental chair(2005) Heckman, Hayley Brooke; Sanders, Brian J.; Dean, Jeffrey A.; Legan, Joseph J.; Weddell, James A. (James Arthur), 1949-; Avery, David R.The literature is varied as to whether there is a positive correlation or if there is no relation between maternal anxiety and a child's behavior at the dentist's office. The purpose of this study was to determine if there is a correlation between maternal anxiety and a child's behavior in the dental chair at the first dental visit. The hypothesis for this research study was that there would be a positive correlation found between maternal anxiety and a child's behavior in the dental chair. A total of 59 essentially healthy children between the ages of 1.2 and 9. 7 years of age with no previous dental treatment were selected for this study. Informed consent was obtained with approval from the Institutional Review Board. All children received an initial dental examination, dental prophylaxis, a fluoride treatment, and radiographs when indicated clinically. The children were videotaped during the dental appointment with consent obtained from the parents. The child's cooperativeness during the dental treatment was measured using the four-point Frankl scale and was evaluated by two separate investigators. The mother's anxiety was measured using a modification of Corah's Dental Anxiety Scale. Fifty-six of these children presented to the dental clinic with their mothers, while the other three presented with their fathers. There were 31 females and 28 males. The correlation between the 1natemal anxiety score and the child's behavior score was estimated using a Spearman rank correlation coefficient, adjusted for the child's age. In addition, Spearman correlation coefficient shows a 95-percent confidence interval. In this study, there was an attempt to determine if the relationship that exists between a mother and child allows the fears of the mother to be expressed through the behavior of the child. However, this research showed that there is no significant correlation between the dental anxiety level of the mother or father and the behavior of the child at the first dental visit. Ultimately, there was no difference in the results between those that presented with their fathers versus those with their mothers; however, there was not a large enough sample to make this conclusive.Item A socioeconomic correlation of oral disease in six to thirty-six month old children(1980) Weddell, James A. (James Arthur), 1949-; Avery, David R.; Beiswanger, Bradley B.; Gish, Charles W., 1923-; Hennon, David Kent, 1933-; Koerber, Leonard G.; Klein, Arthur Irving, 1922-2004; Vargus, BrianA survey of 441 children between the ages of 6 and 36 months, born and reared with a fluoridated water supply, revealed dental caries in 2.5 percent of those 6 to 17 months of age, 9.1 percent of those 18 to 23 months of age, and in 38.7 percent of the children 24 to 26 months of age. No significant differences were found in defs and deft relative to sex, race, or socioeconomic status. Caries prevalence is affected by method of feeding; children who had prolonged bottle-feeding (more than 15 months) had significantly increased caries. In 299 Caucasian children, gingivitis was present in 13.2 percent of those 6 to 17 months of age, 33.9 percent of those 18 to 23 months of age, and in 38.5 percent 24 to 36 months of age. There was little difference in the severity of the gingivitis, although significant difference in the frequency of gingivitis was demonstrated. The prevalence of gingivitis increased with age. Young children with dental caries also showed an increased prevalence of gingivitis. The presence of gingivitis, the presence of dental caries, and the absence of professional dental care in these young children all illustrate the necessity for prevention and treatment of oral disease in children under 36 months of age.Item The use of cell demodulated electronic targeted anesthesia to control dental operative pain in pediatric patients(1999) Toppi, Gary R. (Gary Robert), 1966-; Avery, David R.; Sanders, Brian J.; Weddell, James A. (James Arthur), 1949-; Tomlin, Angela; Barton, Douglas Harvey, 1943-The pain-controlling effects of a recently introduced electronic dental anesthesia device (CEDETA) were compared with those of local anesthesia in this study. Procedures performed involved full-coverage stainless steel crowns on maxillary primary molars, some of which required indirect pulp therapy and pulpotomies. A total of 55 children, aged 6 years to 10 1/2 years, were randomly selected to have treatment done with CEDETA or local anesthetic. Eight of these patients were treated with both CEDETA and local anesthetic at different appointments. At various times during each procedure, the patient and operator rated the patient's level of discomfort using a 6-point Visual Analog Scale. For each of the five evaluation steps, no significant differences existed in discomfort ratings between the CEDETA and local anesthetic methods for the group of eight patients or for the entire group. Operator ratings of patient discomfort did not vary significantly between the two methods of anesthesia for each of the evaluation steps, except at the step of maximum output or after injection, when the CEDETA group as a whole had significantly lower operator-rated pain. In general, patients tended to rate their perceptions of pain higher than those of the operator. Although the operator and patients in this study found CEDETA to be as effective as local anesthetic for controlling dental operative pain, a number of factors must be considered when deciding to use this type of electronic dental anesthesia. A substantial monetary investment is required to purchase the CEDETA device and the disposable electrodes and batteries to power the unit. There is an increased operating expense for each procedure done when using CEDETA, because of the additional time needed for the operator, staff, and patients to become familiar with the use of the device. Additional setup and break-down time is also needed when using CEDETA as opposed to local anesthetic.