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Item Literature Review for Office-Based Anesthesia(Allen Press, 2021) Saxen, Mark A.; Oral Pathology, Medicine and Radiology, School of DentistryItem Literature Review for Office-Based Anesthesia(Allen Press, 2022) Saxen, Mark A.; Oral Pathology, Medicine and Radiology, School of DentistryItem A Preliminary Study of Anatomical Changes Following the Use of a Pedicled Buccal Fat Pad Flap During Primary Palatoplasty(Sage, 2022-05) Kotlarek, Katelyn J.; Jaskolka, Michael S.; Fang, Xiangming; Ellis, Charles; Blemker, Silvia S.; Horswell, Bruce; Kloostra, Paul; Perry, Jamie L.; Oral Pathology, Medicine and Radiology, School of DentistryObjective: The purpose of this study was to examine the surgical impact of the pedicled BFP flap on the LVP muscle and surrounding VP anatomy following primary palatoplasty. Design: Observational, prospective Setting: MRI studies were completed at 3 imaging facilities. All participants with BFP flap were operated on by the same surgeon. Participants: Five pediatric participants with CP±L who underwent primary palatoplasty with BFP flap placement. Comparison groups consisted of 10 participants: 5 with CP±L who did not receive the BFP flap and 5 healthy controls. Interventions: All participants underwent nonsedated MRI 2–5 years postoperatively. Main Outcomes and Measures: Anatomical measures of the velopharynx and LVP among the 3 participant groups Results: Median values were significantly different among groups for velar length (p = .042), effective velar length (p = .048), effective VP ratio (p = .046), LVP length (p = .021), extravelar LVP length (p = .009), and LVP origin-origin distance (p = .030). Post hoc analysis revealed a statistically significant difference between the BFP and traditional repair groups for effective VP ratio (p = .040), extravelar LVP length (p = .033), and LVP length (p = .022). Conclusions: This study provides preliminary support that the BFP flap creates a longer velum, with increased distance between the posterior hard palate and the LVP, and a larger effective VP ratio compared to traditional surgical techniques. Future research is needed to determine if this procedure provides a more favorable mechanism for VP closure.Item A Review of Current Literature of Interest to the Office-Based Anesthesiologist(American Dental Society of Anesthesiology, 2022-10-06) Saxen, Mark A.; Oral Pathology, Medicine and Radiology, School of DentistryItem Effects of artificial honey and epigallocatechin-3-gallate on streptococcus pyogenes(Springer, 2022-08-26) Jiang, Xiaoge; Lin, An; Li, Shijia; Shi, Yangyang; Zhou, Fangjie; Felix Gomez, Grace Gomez; Gregory, Richard L.; Zhang, Chaoliang; Chen, Song; Huang, Ruijie; Oral Pathology, Medicine and Radiology, School of DentistryBackground Streptococcus pyogenes is an important global human pathogen that causes pharyngitis, and antibacterial therapy has become an important part of the overall therapy for pharyngitis. As natural derivatives, honey and green tea are often recommended for patients with pharyngitis in traditional Chinese medicine without experimental theoretical basis on wether the combined effect of honey and green tea on pharyngitis is better than they alone. The aims of this study were to explore the effects of artificial honey (AH) and epigallocatechin-3-gallate (EGCG) on S. pyogenes and elucidate the possible mechanisms, which were investigated using MIC (the minimum inhibitory concentration), FIC (fractional inhibitory concentration) index, growth pattern, biofilm formation and RT-qPCR. Results The MIC of AH on S. pyogenes was 12.5% (v/v) and the MIC of EGCG was 1250 μg/ml. The FIC index of AH and EGCG was 0.5. The planktonic cell growth, growth pattern and biofilm formation assays showed that AH and EGCG mixture had stronger inhibitory effect on S. pyogenes than they alone. RT-qPCR confirmed that the expression of hasA and luxS gene were inhibited by AH and EGCG mixture. Conclusions AH and EGCG mixture can inhibit the planktonic cell growth, biofilm formation and some virulence genes expression of S. pyogenes, better than they alone. The combination of honey and green tea have the potential to treat pharyngitis as natural derivatives, avoiding drug resistance and double infection.Item Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies(Frontiers Media, 2021) Gordon, Sara C.; Kaste, Linda M.; Mouradian, Wendy E.; Beemsterboer, Phyllis L.; Berg, Joel H.; Murdoch-Kinch, Carol Anne; Oral Pathology, Medicine and Radiology, School of DentistryDentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.Item Entrustable professional activities framework for assessment in predoctoral dental education, developed using a modified Delphi process(Wiley, 2021) Ramaswamy, Vidya; Fitzgerald, Mark; Danciu, Theodora; Nalliah, Romesh; de Peralta, Tracy; Munz, Stephanie M.; Murdoch-Kinch, Carol Anne; Oral Pathology, Medicine and Radiology, School of DentistryPurpose/objectives: The purpose of this study was to define and develop a set of Entrustable Professional Activities (EPAs) for dental education using a modified Delphi consensus approach. EPAs define the core tasks that a graduating dentist needs to perform independently in practice. The EPA framework facilitates assessment of competencies as they manifest in the tasks and independence needed to be ready for practice. Methods: Feedback was obtained from participants about a list of EPAs, with modifications made after each of the 3 rounds, using a modified Delphi approach. Phase 1 included attendees at the ADEA Fall 2017 meeting (n = 35) who participated in an EPA workshop primarily composed of academic deans. The Phase 2 "reactor panel" consisted of 10 dental schools' academic deans and other individuals with expertise and interest in dental curriculum and assessment (n = 31). Phase 3 participants were attendees at the ADEA CCI 2019 meeting (n = 91) who also participated in a 2-day EPA workshop. Results: In phase 1, overall ratings for acceptability of the EPAs were satisfactory. In phase 2, the next iteration of EPAs was judged as satisfactory for inclusion in curriculum, match well with clinical practice and clarity. In phase 3, the EPAs were judged as satisfactory for being an "entrustable, essential, and important task of the profession." Qualitative feedback suggested wording, measurability, and specific focus of EPA statements is important. Conclusions: A preliminary set of EPAs was designed for predoctoral dental education through a systematic, careful consensus building approach involving a diverse set of participants.Item Are Adults Over 18 Years of Age with Anaemia More Likely to Develop Chronic Periodontitis Than Adults Without Anaemia? - A Systematic Review and Meta-Analysis(Wolters Kluwer, 2023-08-30) Roberts, Madison; Jimson, Sudha; Srinivasan, Mythily; Oral Pathology, Medicine and Radiology, School of DentistryAims and objectives: Periodontitis is a chronic disease affecting the supporting tissues of the teeth and exhibits bidirectional relation with systemic diseases. This study aims to determine the association between chronic periodontitis and erythrocyte functional measures: total red blood cells (RBCs), hemoglobin (Hb) concentration, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) by systematic review and meta-analysis. Materials and methods: A systematic search of the electronic databases PUBMED, OVID, Embase, Web on Science, and Google Scholar was undertaken from inception to July 2022. English language studies that evaluated the erythrocyte functional measures in periodontitis and health were selected. Other review reports, letters/opinion articles, studies without a definition of periodontitis, and the concomitant presence of systemic conditions (diabetes, kidney disease, cancer) were excluded. Two reviewers determined full-text eligibility in a blinded process. Meta-Essentials software was used to generate forest plots and to determine heterogeneity and publication bias. Results: Twenty-six studies involving 1082 patients with chronic periodontitis and 980 healthy controls were analyzed. Pooled results showed lower Hb concentration (Hedges' g = -1.16; 95% confidence intervals [CI], -1.7 to -0.62), RBC counts (Hedges' g = -0.85; 95% CI, -1.31 to -0.38) and packed cell volume (-0.56; 95% CI, -1.02 to -0.11) in patients with chronic periodontitis. Conclusion: This meta-analysis showed a decreasing trend in the hematological parameters, including hemoglobin concentration, number of erythrocytes, and hematocrit in patients with chronic periodontitis compared to healthy controls.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 Perceptions on Oral Ulcers From Facebook Page Categories: Observational Study(JMIR, 2023-01) Simhadri, Suguna; Yalamanchi, Sriha; Stone, Sean; Srinivasan, Mythily; Oral Pathology, Medicine and Radiology, School of DentistryBackground: Oral ulcers are a common condition affecting a considerable proportion of the population, and they are often associated with trauma and stress. They are very painful, and interfere with eating. As they are usually considered an annoyance, people may turn to social media for potential management options. Facebook is one of the most commonly accessed social media platforms and is the primary source of news information, including health information, for a significant percentage of American adults. Given the increasing importance of social media as a source of health information, potential remedies, and prevention strategies, it is essential to understand the type and quality of information available on Facebook regarding oral ulcers. Objective: The goal of our study was to evaluate information on recurrent oral ulcers that can be accessed via the most popular social media network—Facebook. Methods: We performed a keyword search of Facebook pages on 2 consecutive days in March 2022, using duplicate, newly created accounts, and then anonymized all posts. The collected pages were filtered, using predefined criteria to include only English-language pages wherein oral ulcer information was posted by the general public and to exclude pages created by professional dentists, associated professionals, organizations, and academic researchers. The selected pages were then screened for page origin and Facebook categories. Results: Our initial keyword search yielded 517 pages; interestingly however, only 112 (22%) of pages had information relevant to oral ulcers, and 405 (78%) had irrelevant information, with ulcers being mentioned in relation to other parts of the human body. Excluding professional pages and pages without relevant posts resulted in 30 pages, of which 9 (30%) were categorized as “health/beauty” pages or as “product/service” pages, 3 (10%) were categorized as “medical & health” pages, and 5 (17%) were categorized as “community” pages. Majority of the pages (22/30, 73%) originated from 6 countries; most originated from the United States (7 pages), followed by India (6 pages). There was little information on oral ulcer prevention, long-term treatment, and complications. Conclusions: Facebook, in oral ulcer information dissemination, appears to be primarily used as an adjunct to business enterprises for marketing or for enhancing access to a product. Consequently, it was unsurprising that there was little information on oral ulcer prevention, long-term treatment, and complications. Although we made efforts to identify and select Facebook pages related to oral ulcers, we did not manually verify the authenticity or accuracy of the pages included in our analysis, potentially limiting the reliability of our findings or resulting in bias toward specific products or services. Although this work forms something of a pilot project, we plan to expand the project to encompass text mining for content analysis and include multiple social media platforms in the future.