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Browsing by Author "Yepes, Juan F."
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Item Antenatal and Intrapartum Risk Factors for Use of Emergency and Restorative Medicaid Dental Services for Children(2015-09) Yepes, Juan F.; Bush, Heather M.; Li, Hsin-Fang; Talbert, Jeffrey; Nash, David A.; Department of Pediatrics, IU School of MedicinePurpose: To investigate the relationship between antenatal/intrapartum factors and Medicaid use. Methods: Three databases were used: (1) birth records; (2) Medicaid files; and (3) Medicaid dental claims. Results: Children of Caucasian mothers were 34 percent more likely to have more than one restorative claim versus children of African American mothers (odds ratio [OR] equals 1.34, 95 percent confidence interval [95% CI] equals 1.10 to 1.65, P<.005). Children born with low birth weight were 37 percent more likely to have emergency claims (OR equals 1.37, 95% CI equals 1.02 to 1.83, P=.03). The adjusted analysis found that Caucasian mothers had higher odds ratio of having a dental claim than African American mothers (P<.001): 33 percent for a restorative claim and 56 percent for an emergency claim. When race was analyzed, the odds of a restorative claim among African American mothers were 2.5 times higher in children delivered by C-section versus those vaginally delivered (OR equals 2.52, 95% CI equals 1.02-6.2, P<.001). Conclusions: This study found: an association between children of Caucasian mothers and the likelihood of experiencing claims; and a relationship between children born with low birth weight and C-section and the likelihood of use of Medicaid services.Item Blood levels of lead and dental caries in permanent teeth(Wiley, 2020) Yepes, Juan F.; McCormick-Norris, Jayme; Vinson, LaQuia A.; Eckert, George J.; Hu, Howard; Wu, Yue; Jansen, Erica C.; Peterson, Karen E.; Téllez-Rojo, Martha M.; Martinez Mier, Esperanza Angeles; Pediatric Dentistry, School of DentistryObjectives: The purpose of this study was to determine whether there is an association between lead exposure within the ages of 1-4 years and dental caries in the permanent dentition between ages 9-17 among Mexican youth. Methods: Data were collected for the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort from a group of 490 children born and reared in Mexico City. Among ages 1-4 years, blood lead levels were measured in micrograms of lead per deciliter of blood (μg/dL) and the presence of caries in adolescence was determined using the International Caries and Detection and Assessment System (ICDAS). The relationship between blood levels of lead and decayed, missing, or filled surfaces (DMFS) was examined using negative binomial regression. Covariates were selected based on previous studies and included age, gender, socioeconomic status, oral hygiene, body mass index, and diet. The nonlinear relationship between lead and DMFS was examined using smoothing splines. Results: The mean overall blood lead level (BLL) was 4.83 μg/dL (S.D. of 2.2). The mean overall caries level (DMFS) was 4.1. No statistically significant association was found between early childhood blood lead levels and dental caries in adolescence. Conclusion: This study shows a lack of association between exposure to lead between the ages of 1-4 years of age and dental caries in permanent dentition later in life. Other covariates, such as age and sugar consumption, appeared to play a more prominent role in caries development.Item Comparison of Anesthesia for Dental/Oral Surgery by Office-based Dentist Anesthesiologists versus Operating Room-based Physician Anesthesiologists(Allen Press, 2017) Saxen, Mark A.; Urman, Richard D.; Yepes, Juan F.; Gabriel, Rodney A.; Jones, James E.; Oral Pathology, Medicine and Radiology, School of DentistryFew studies have examined the practice characteristics of dentist anesthesiologists and compared them to other anesthesia providers. Using outcomes from the National Anesthesia Clinical Outcomes Registry and the Society for Ambulatory Anesthesia Clinical Outcomes Registry for dental/oral surgery procedures, we compared 7133 predominantly office-based anesthetics by dentist anesthesiologists to 106,420 predominantly operating room anesthetics performed by physician anesthesia providers. These encounters were contrasted with 34,191 previously published encounters from the practices of oral and maxillofacial surgeons. Children younger than 6 years received the greatest proportion of general anesthetic services rendered by both dentist anesthesiologists and hospital-based anesthesia providers. These general anesthesia services were primarily provided for complete dental rehabilitation for early childhood caries. Overall treatment time for complete dental rehabilitation in the office-based setting by dentist anesthesiologists was significantly shorter than comparable care provided in the hospital operating room and surgery centers. The anesthesia care provided by dentist anesthesiologists was found to be separate and distinct from anesthesia care provided by oral and maxillofacial surgeons, which was primarily administered to adults for very brief surgical procedures. Cases performed by dentist anesthesiologists and hospital-based anesthesia providers were for much younger patients and of significantly longer duration when compared with anesthesia administered by oral and maxillofacial surgeons. Despite the limited descriptive power of the current registries, office-based anesthesia rendered by dentist anesthesiologists is clearly a unique and efficient mode of anesthesia care for dentistry.Item Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia(Allen Press, 2023) Rafla, Rebecca R.; Saxen, Mark A.; Yepes, Juan F.; Jones, James E.; Vinson, LaQuia A.; Oral Pathology, Medicine and Radiology, School of DentistryObjective: The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented. Methods: Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment. Results: Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute. Conclusion: This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.Item Dental Manifestations of Pediatric Bone Disorders(Springer, 2017-12) Yepes, Juan F.; Pediatric Dentistry, School of DentistryPurpose of Review Several bone disorders affecting the skeleton often are manifest in the maxillofacial region. This review presents the most common bone disorders in children and their dental–oral manifestations: fibrous dysplasia, Paget’s disease, osteogenesis imperfecta, renal osteodystrophy, hypophosphatasia, and osteoporosis. The specific intraoral characteristics will reviewed in detail. Recent Findings Recent studies confirmed the close relationship between the mandible and the maxilla with the most prevalent systemic bone disorders in children. Summary This review will help practitioners to integrate the oral health into the systemic health and improve the multidisciplinary approach of pediatric patients between medicine and dentistry.Item Dental X-Ray Exposure The Past has become the Future(California Dental Association, 2019) Miles, Dale A.; Yepes, Juan F.; Pediatric Dentistry, School of DentistryMost dental X-ray procedures are delegated to office staff and some recommendations and techniques, such as selection criteria and rectangular collimation for intraoral imaging, have been ignored or forgotten by some dentists. Some of the X-ray exposure recommendations, updated by the American Dental Associtation’s Science Institute in June 2018, and the need to adopt guidelines proposed by the public campaign Image Gently are discussed to help the reader develop safe X-ray protocols, from intraorals to CBCT.Item The Effects of Different Levels of Ambient Oxygen in an Oxygen-Enriched Surgical Environment and Production of Surgical Fires(The American Dental Society of Anesthesiology, 2018) Davis, Leah B.; Saxen, Mark A.; Jones, James E.; McGlothlin, James D.; Yepes, Juan F.; Sanders, Brian J.; Oral Pathology, Medicine and Radiology, School of DentistrySurgical fires require an oxygen-enriched environment, a flammable substrate, and an ignition source. We hypothesized ambient oxygen concentration is proportional to the latency time to combustion and the incidence of surgical fires that are detected. We examined latency time and number of events, utilizing the VanCleave et al model of intraoral fire ignition under 60, 80, and 100% oxygen concentration and flow rates of 4 and 10 L/min. Results demonstrated that ambient oxygen concentration and flow rate correlated positively to the initiation of combustion. The number of combustion events with 60% oxygen was significantly lower than with both 80% ( p = .0168) and 100% ( p = .002). Likewise, the number of events with 80% oxygen was significantly lower than with 100% oxygen ( p = .0019). Flow rate has a significant effect on the time to the first event ( p = .0002), time to first audible pop ( p = .0039), and time to first flash or fire ( p < .0001). No combustion occurred at oxygen concentrations less than 60% or flows less than 4 L/min. We conclude that latency time to combustion is directly proportional to ambient oxygen concentration and flow rate. Minimum oxygen concentration and flow rate were identified in our model. Further research is indicated to determine the minimal clinical oxygen concentration and flow rate needed to support combustion of an intraoral fire in a patient.Item Financial Impact of COVID-19 on Dental Care for Pediatric Patients: a Dental Claims Review(American Academy of Pediatric Dentistry, 2023-02) Rector, Julia M.; Scully, Allison C.; Yepes, Juan F.; Jones, James E.; Eckert, George; Downey, Timothy; Maupome, Gerardo; Pediatric Dentistry, School of DentistryPurpose: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. Methods: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. Results: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. Conclusions: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.Item Mandatory Drug Testing of Dental Students: To Test or Not to Test: Viewpoint 1: Drug Testing of Dental Students Should Be Mandatory for the Benefit of Students, Institutions, Patients, and the Profession and Viewpoint 2: Mandatory Drug Testing of Dental Students Carries Costs and Risks for Institutions and Students and Has Unproven Benefits(ADEA, 2019-08) Gibson, Tanya Marie; Loza-Herrero, Maria A.; Yepes, Juan F.; Kim-Berman, Hera; Dilbone, Deborah A.; Perez, Herminio; Pediatric Dentistry, School of DentistryAn educational institution’s decision to test or not test its students for drug use is controversial and complex. Although negative consequences of substance use disorder are well known, the consumption of prohibited substances continues to increase in young adults. Given the awareness of increasing drug use on college campuses and the potential impact on future health care professionals, issues associated with mandatory drug testing of dental students warrant investigation. The purpose of this Point/Counterpoint article is to present opposing viewpoints on whether mandatory student drug testing (MSDT) should be implemented for dental students. Viewpoint 1 affirms that MSDT is legal, ensures public safety, is recognized as a need in health care education, promotes professional and ethical responsibility, and is cost-effective. Viewpoint 2 asserts that MSDT has not been proven to be an effective deterrent for student drug use and it poses risks and costs for both institutions and students, ranging from potential violation of students’ civil liberties to the consequences of false positive tests. This article’s presentation of the recent literature on both sides of this issue provides dental educators with pertinent information for considering implementation of MSDT in their institutions.Item Parental factors associated with routine dental visits in American children(2018) Yepes, Juan F.; Gibson, Joe; Nuñez-Castorena, Jessica; Eckert, George; Maupomé, GerardoBackground: Various factors have been associated with children with relatively low use of dental care. These include lower level of parents’ education, poor diet, smoking at home, lower household income, lack of dental insurance, living in a rural location, and cognitive impairment or disability. Goal: To further identify and characterize parental factors related with reduced use of routine dental visits in Indianapolis, Indiana, USA. Methods: Analyses of the 2012 Marion County Health Department survey were undertaken using multilevel logistic regression to assess the effect of individual and community variables on the probability of children’s use of routine dental visits. Results: Children from parents with a higher level of education, who did not smoke in the home, and families who ate fast food less often in the preceding 7 days, were more likely to have a routine dental visit in the prior 12 months. Conclusions: This study further delineates the complex associations between parental level factors and one important aspect of children’s oral health.
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