Browsing by Subject "Pediatric dentistry"

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    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 Dentistry
    Objective: 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.
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    Prescription of Bitewing and Panoramic Radiographs in Pediatric Dental Patients: An Assessment of Current Trends and Provider Compliance
    (Journal of the American Dental Association, 2022-10) Menaker, Noah H.; Yepes, Juan F.; Vinson, LaQuia A.; Jones, James E.; Downey, Tim; Tang, Qing; Maupome, Gerardo
    Purpose: To evaluate prescription patterns for bitewing and panoramic radiographs (PR) for pediatric and adolescent dental patients following the implementation of the most recent ADA/FDA guidelines. Methods: Paid insurance claims data for all 50 states were accessed from January 1, 2013 to June 30, 2019 for patients age 18 years and younger; a 5% random sample population was extracted. Statistical analyses were performed to evaluate various imaging metrics for pediatric dentists (PD) and general practitioners (GP). Results: A total of 2,123,735 bitewing images were prescribed during 4,734,249 office visits. The average time interval between bitewing exams ordered by GPs was 13.9 (± 7.4) months, and for PDs this average was 13.0 (± 6.7) months (p<.0001). When divided by age group, 3.5% of all bitewings were taken on patients age 0-4 years. For PRs, 286,824 images were included in the present study. The average time interval between PRs ordered for the same patient was 3.4 (± 1.3) years for PDs and 3.3 (± 1.4) years for GPs. One percent of all PRs were prescribed for patients age 0-4, with 403 images attributed to PDs and 2348 to GPs. Conclusions: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. Practical Implications: Inclusion of individual caries risk with insurance claims data should be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.
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    Utilization of Silver Diamine Fluoride by Dentists in the United States: A Dental Claims Review
    (American Academy of Pediatric Dentistry, 2020) Scully, Allison; Yepes, Juan F.; Tang, Qing; Downey, Timothy; Maupome, Gerardo
    Purpose: A Current Dental Terminology (CDT) code, D1354, for silver diamine fluoride was made effective on January 1, 2016. The purpose of this study was to investigate the utilization of silver diamine fluoride (SDF) by pediatric dentists (PDs) and general dentists (GDs) in the United States. Methods: Data were obtained from a commercial dental insurance claims warehouse in the United States. Deidentified data for CDT code D1354 were collected from January 2016 to July 2019. Descriptive statistics and chi-square tests were used. Results: A total of 321,726 D1354 claims were found. Data showed that SDF use measured by average monthly claims, unique number of dentists, and percent of paid claims increased each year. Patients zero to nine years old were the most likely to receive SDF treatment. SDF was significantly more likely to be placed on posterior teeth and in children zero to eight years old (P<0.001). PDs were more likely than GDs to submit claims for SDF in children (P<0.001). Conclusions: Silver diamine fluoride use is increasing, especially in patients age zero to nine years. Pediatric dentists are more likely to use SDF in children than general dentists. Posterior teeth receive the majority of SDF treatment.