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Item Oral Manifestations of Acute Lymphocytic Leukemia(MDA, 2023-05) Yepes, Angela M.; Yepes, Juan F.; Jones, James E.; Pediatric Dentistry, School of DentistryLeukemia is the most prevalent malignancy of leukocytes and can occur in children and adults. Oral manifestations are part of the complexity of signs and symptoms in patients with leukemia and, in some patients, oral manifestations precede systemic manifestations. Oral signs of leukemia include spontaneous bleeding, gingival enlargement, and whiteness of the oral mucosa. Head and neck lymphadenopathy is common in patients with leukemia. Oral manifestations are the result of the direct invasion of immature cells in the oral cavity tissues or indirectly caused by the replacement of the normal blood cells for immature cells causing anemia, leucopenia, and thrombocytopenia. The dentist and axillary oral health care providers must be aware of the oral signs and symptoms that may suggest leukemia facilitating early diagnosis and indicated medical treatment of the patient. In this case report a 10-year-old female with acute lymphocytic leukemia (ALL), with oral lesions appearing in the maxillary gingiva, is presented. This presentation emphasis the importance of the physical exam (intra-oral and extra-oral) as well as the manifestations of ALL in the head and neck regions.Item Silver Diamine Fluoride and Progression of Incipient Approximal Caries in Permanent Teeth: A Retrospective Study(American Academy of Pediatric Dentistry, 2021) Polacek, Jenna; Malhi, Nimrat; Yang, Yu-Ju; Scully, Allison C.; Soki, Fabiana N.; Boynton, James R.; Pediatric Dentistry, School of DentistryPurpose: The purpose of this study was to evaluate the progression of incipient approximal caries lesions in permanent teeth of children and adolescents with and without silver diamine fluoride (SDF) application. Methods: A retrospective analysis of dental records and radiographs was performed. Baseline and follow-up bitewing radiographs were evaluated and scored using International Caries Classification and Management System (ICCMS) criteria to assess lesion progression. Results: A total of 131 lesions from 68 subjects (mean age equals 9.6 years) were evaluated radiographically and followed for up to 41 months (mean time equals 13.61±6.8 months); 23.6 percent of lesions in the SDF group progressed compared to 38.1 percent in the control group (P<0.001). On average, lesions in the control group increased more per month compared to the study group (P<0.001). The odds of lesion progression in the control group were 2.76 times the odds of progression in the study group. There was a statistically significant difference in lesion progression based on application method; lesions where SDF was applied with Superfloss progressed more per month, on average, versus microbrush application. Conclusions: Silver diamine fluoride may be an effective therapy to slow caries progression of incipient approximal lesions in permanent teeth in high caries-risk populations. Future studies are needed to detect differences in application methods.Item The status of climate studies in the United States and Canadian dental schools: Deans' perspectives(Wiley, 2021) Ester, Todd V.; Tucker-Lively, Felicia L.; Smith, Carlos; Taylor, George W.; Ware, Tawana K.; Inglehart, Marita R.; Pediatric Dentistry, School of DentistryObjectives: Institutions with a positive cultural climate make community members from all backgrounds valued and included, and treated equitably. Such an environment is optimally suited to prepare future dentists well for leading a diverse team of staff members and addressing the oral health care needs of increasingly more diverse patient populations. The objectives were to assess how many United States and Canadian dental schools had participated in a climate study at their parent institution and/or had conducted their own climate study, which topics these studies had addressed, how they collected their data, from whom they collected data, and how the findings affected these academic units. Methods: In January 2020, 54 of the 78 dental school deans in the United States and Canada responded to a web-based survey (response rate: 69%). Results: Forty-six parent institutions (85%) and 27 dental schools (50%) had conducted climate studies. Eighty-seven percent of parent institutions assessed the climate overall and the climate for specific groups (70%), such as for persons from underrepresented minority backgrounds (67%) or different religious backgrounds (59%). Most parent institution and dental school studies utilized surveys to collect data from faculty (parent institutions: 76%/dental schools: 96%), staff (74%/93%), administrators (72%/93%), and students (72%/89%). Overall, climate study results positively affected parent institutions' and dental schools' humanistic environment (61%/63%) and the recruitment of faculty (46%/50%), students (46%/46%), and staff (41%/43%). Conclusions: Climate studies are a widely accepted practice at dental schools and their parent institutions. Their results can play a vital role in shaping the climate of these academic units by fostering efforts to increase diversity, equity, and inclusion.Item Contemporary predoctoral paediatric behaviour guidance education in the United States and Canada(Wiley, 2022) Weishuhn, David; Scully, Allison; Amini, Homa; Salzmann, Larry; Boynton, James R.; Pediatric Dentistry, School of DentistryPurpose: To determine the contemporary educational experiences of predoctoral dental students in the United States and Canada regarding behaviour guidance (BG) of the child patient and assess trends from a previous study in 2004. Methods: Data were collected from 32 predoctoral paediatric dentistry programme directors in the United States and Canada via a web-based survey. Results: The didactic curriculum hours devoted to the teaching of BG techniques in 2019 are similar to 2004. A majority (60.7%) of programmes do not have a formal assessment of competency with BG techniques. Lectures (n = 28), clinical experience (n = 28) and observation (n = 26) were the most common techniques implemented to teach BG techniques, and tell-show-do (100%), non-verbal communication (82.1%), positive reinforcement (89.3%) and distraction (82.1%) were the techniques that more than 75% of dental students most commonly have hands-on experience with during their dental education. In 2019, students tended to have more hands-on experience with nitrous oxide/oxygen inhalation and less hands-on experience with aversive techniques and sedation. Conclusions: The majority of dental schools do not have a formal competency in BG of the child patient. Compared with 2004, nitrous oxide/oxygen is used more by dental students and there is less predoctoral education in aversive BG techniques.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 A retrospective clinical study of resin-modified glass ionomer restorations in the primary posterior dentition(2023-06-01) Dean, Jeffrey A.; Peterson, Hans; Moawad, Amal N. A.; Sanders, Brian J.; Al-Hosainy, AshrafThe study's objective was to evaluate the survival rate of resin-modified glass ionomer (RMGI) when used in a capsule form for restoring primary molars. The study was performed in a private pediatric dental practice in Indianapolis, Indiana. Patients included in this retrospective study had at least one RMGI restoration that had been in place at least 12 months previous to the restoration exam and chart review., The material used was Fuji II LC in capsules (GC., Alsip, IL). The cavity preparations were similar to that of amalgam restorations except that there was less extension for prevention, they were more conservative and with rounded line angles. The restorations were placed per the manufacturer’s instructions. The restorations were evaluated using a grading system that is a modification of the one used by Gunner Ryge. The results were as follows: 114 restorations were evaluated in 48 patients with a mean age of restorations of 35.42 months (12 to 76 months). The restorations received Alpha and Bravo grades for Marginal Integrity and for Wear at a rate of 96.0 and 95.6%, respectively, and 95.0% had no Recurrent Caries. The study showed a 93% success rate for restorations. This result supports previous research in that RMGI may be the material of choice when attempting to intracoronally restore primary molars. Also, the use of the capsule form which is mixed through trituration eliminated possible hand mixing errors, and the use of application tips and bulk filling the cavity might improve the overall strength of the restorations.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 Patterns of radiograph use in a population of commercially insured children(Elsevier, 2022-05) Fontana, Margherita; Yepes, Juan F.; Eckert, George J.; Hale, Kevin J.; Benavides, Erika; Pediatric Dentistry, School of DentistryBackground The objective of this study was to evaluate differences in number and type of radiographs used among 3 age groups (0-5, 6-12, 13-18 years) by general dentists, pediatric dentists, and other specialists, and to determine the association between number and type of radiographs and clinical need. Methods A retrospective analysis of insurance claims by age group and oral health care provider type included children aged 0 through 8 years in 2005 who had a minimum of 10 years of continuous eligibility. Indicator claim variables were calculated to identify high-risk, high-need patients. Results A total of 6,712,155 records from 105,010 patients and 34,406 providers were analyzed. There was a significant effect (P < .001) of age on the number of radiographs obtained per visit. The estimated rates of radiographs per visit for ages 0 through 5, 6 through 12, and 13 through 18 were 0.373, 0.492, and 0.393, respectively. There was a significant interaction effect between age and provider type. For patients younger than 13 years, general dentists had lower rates of obtaining radiographs than did pediatric dentists, with no significant difference between providers for the 13- through 18-year age group. Treatments received, except for extractions and prosthodontics, were significantly associated with rate of radiographs per visit, with “number of restorations” as an indicator of increased risk, need, or both showing an inverse association with radiograph use. Conclusions Child age and provider type had an effect on number of radiographs obtained per visit. Lack of caries diagnostic codes and uncommon use of risk codes hindered interpretation of whether use, frequency, or both is associated with need. Practical Implications Radiograph use should follow existing guidelines or recommendations based on clinical need.Item The Saudi Arabian national demographic and health survey, 2017: Study design and oral health-related influences(Elsevier, 2023-01) Abogazalah, Naif; Yiannoutsos, Constantin; Martinez-Mier, Esperanza-Angeles; Tantawy, Muhammad; Yepes, Juan Fernando; Pediatric Dentistry, School of DentistryObjective To describe the study design, and the distal and proximal influences on oral health reported in the national demographic and health survey (DHS) of the Kingdom of Saudi Arabia (KSA) in 2017. Methods The 2017 KSA DHS used an innovative multistage stratified random-sampling technique to select the population sample by using primary health care centers’ (PHCs) catchment areas as the primary sampling unit. Over 45,000 household heads plus a family member were interviewed. A conceptual framework for distal and proximal oral health influences specific to the KSA was adapted based on the oral health surveillance model. Cross-tabulation and Chi-square tests were performed with consideration for sample weights to provide estimates representative for the KSA population. Frequencies and weighted percentages for each variable reflecting each construct were reported. Results The total number of individuals included in the analysis was n = 55,511, ages ranging between 2 and > 65 years. Lack of dental care when needed was reported for 22.5 % of the population (males = 20.8 %/females = 24.7 %). Proportion of population from Central, West, East, South, and North regions who reported available dental care services when needed was 62.3 %, 58.0 %, 58.9 %, 62.3 %, and 60.1 %, respectively. PHCs were the most regular source for dental care (55.1 %). In total, 48.3 % visited the dentist at least once last year (males = 49.4 % /females = 46.8 %). Dental pain was the most common reason for last dental visit (69.0 %), while only 6.4 % reported visited the dentist for routine visit. Only 15.3 % reported brushing their teeth at least twice per day (males = 14.6 % /females = 16.4 %). Conclusion Two major oral health influences previously reported to have a significant negative influence on oral health, namely, limited routine dental check-up visits and inadequate oral hygiene, were present among KSA residents. Further inferential study is needed to investigate such influence on oral health status within the KSA population.Item Prescription of bite-wing and panoramic radiographs in pediatric dental patients: An assessment of current trends and provider compliance(Elsevier, 2022-01) Menaker, Noah H.; Yepes, Juan F.; Vinson, LaQuia A.; Jones, James E.; Downey, Tim; Tang, Qing; Maupomé, Gerardo; Pediatric Dentistry, School of DentistryBACKGROUND: The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration. METHODS: The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs). RESULTS: A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients aged 0 through 4 years. For PRs, the authors included 286,824 images in this study. The average (SD) 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 ordered for patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 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 patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.