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Item Pediatric Phantom Dosimetry Evaluation of a New Rectangular Collimator(American Academy of Pediatric Dentistry, 2023) Martinez, Amanda; Yepes, Juan F.; Jones, James E.; Wong, Phillip; Johnson, K. Brandon; Canady, Sarah; Tang, Qing; Pediatric Dentistry, School of DentistryPurpose: To compare the effective dose (E) of the Tru-Image® rectangular collimator and the universal round collimator of a Planmeca® wall-mounted radiograph unit for two bitewing radiographs (right and left) on a pediatric phantom. Methods: Absorbed doses utilizing the Tru-Image ®rectangular collimator and universal round collimator were acquired using an anthropomorphic 10-year-old child phantom. Each set of 24 dosimeters was exposed to two bitewing exposures with the manufacturer's child settings. Fifty clinical exposures were completed for each set and three sets were exposed for each collimator. The average E per exposure was calculated. Results: The overall E for the Tru-Image ®rectangular collimator and the universal round collimator were 6.3 microsieverts (μSv) and 25.3 μSv, respectively. This difference was statistically significant (P <0.001). The highest equivalent dose for both collimators was delivered to the oral mucosa. When compared to the universal round collimator, the Tru-Image ® rectangular collimator had significant dose reduction at all locations (P <0.05). When normalized and adjusted to the same source-to-end distance, there was an overall 65 percent dose reduction with the rectangular collimator. Conclusion: The average effective dose was significantly reduced with the use of the Tru-Image ®rectangular collimator. Clinical use of this rectangular collimator should be considered in the pediatric population.Item Preventing Oral Dual Biofilm Development with Innovative Bioactive Varnishes(MDPI, 2025-02-18) Costa, Tainá de Lima; Puppin-Rontani, Regina Maria; de Castilho, Aline Rogéria Freire; Pediatric Dentistry, School of DentistryThis study introduces innovative varnishes incorporating natural bioactive compounds to inhibit the formation of oral dual biofilms, a critical contributor to dental caries and other oral diseases. The purpose of this study was to evaluate the effectiveness of bioactive varnishes containing tt-farnesol, quercetin, and theobromine in inhibiting the formation of mixed Streptococcus mutans and Candida albicans biofilms. Mixed biofilms of Streptococcus mutans UA159 and Candida albicans SC5314 were grown in 96-well plates containing a specialized culture medium. Approximately 0.2 mL of experimental varnishes with A-1.5% or B-4.5% concentrations of tt-farnesol, quercetin, and theobromine were separately added to the wells using a disposable applicator, with a vehicle varnish (lacking bioactives) serving as the control. Biofilms were incubated at 37 °C with 5% CO2 for 24 h. Microbial viability was determined in terms of colony-forming units per milliliter (CFU/mL), and biofilm morphology was evaluated qualitatively via scanning electron microscopy (SEM). Statistical analyses were performed using ANOVA/Tukey tests at a 5% significance level. Varnishes A and B achieved significant reductions in microbial populations within the biofilms (p < 0.05) compared to the vehicle control (C). SEM imaging revealed marked structural disruptions in the biofilms, validating the quantitative results. Higher bioactive concentrations demonstrated enhanced inhibitory effects. Bioactive varnishes enriched with theobromine, quercetin, and tt-farnesol represent a novel and effective strategy for inhibiting oral dual biofilm development, offering a promising advancement in preventive dentistry.Item Evaluation of Claim Reports for Potential Impact of COVID-19 on Pediatric Dental Procedures(American Academy of Pediatric Dentistry, 2023-01) Bauer, Brittany A.; Yepes, Juan F.; Vinson, LaQuia; Sanders, Brian J.; Eckert, George; Pediatric Dentistry, School of DentistryPurpose: To evaluate whether the postponement of dental elective procedures at the start of the COVID-19 pandemic was associated with an increased number of simple dental extractions, and/or decreased restorative procedures by analyzing data obtained from state-funded insurance dental claims. Methods: Paid dental claims collected from March 2019 to December 2019 and from March 2020 to December 2020 for children ages two to 13 years old were analyzed. Dental procedures were selected based on Current Dental Terminology (CDT) codes for simple dental extractions and restorative procedures. Statistical analyses were performed to compare the rates of procedure types between 2019 and 2020. Results: No differences in dental extractions but full-coverage restoration procedure rates per month and child were significantly lower than pre-pandemic (P=0.016). Conclusion: Further study required to determine the impact of COVID-19 on pediatric restorative procedures and access to pediatric dental care in the surgical setting.Item Guidelines and Standard Operating Protocol for Pediatric Dental Practice during COVID-19: A Systematic Review(Jaypee Brothers Medical Publishers, 2021) Kumar, Gyanendra; Yepes, Juan F.; Dhillon, Jatinder K.; Rehman, Ferah; Grewal, Monika; Pediatric Dentistry, School of DentistryObjective: To scrutinize and consolidate treatment protocols and infection control measures to be practiced in pediatric dentistry during COVID-19 pandemic. Study design: A systematic search pertaining to pediatric dental practice during COVID-19 was conducted using various electronic databases from 1st March to 31st July, 2020. The search resulted in a total of 145 records, out of which only 12 studies met our inclusion and exclusion criteria which were included in the present review. Results: Data analysis was compiled under the following categories: Triage, waiting area and operatory changes, dentist’s safety, procedures to be undertaken during COVID-19, specific guidelines for trauma and children with special healthcare needs (SHCN) and infection control. Teledentistry, personal protective equipment (PPE), minimally invasive dentistry and non-aerosol-generating procedures are highly recommended. Urgent care should be provided to patients with dental trauma and SHCN. Surface disinfection and hand hygiene are considered important. Conclusion: Transmission risk among children should not be overlooked and all the standard measures of prevention must be ensured in the pediatric practice.Item Effect of titanium dioxide on Streptococcus mutans biofilm(Sage, 2023) Sanders, Molly K.; Duarte, Simone; Ayoub, Hadeel M.; Scully, Allison C.; Vinson, LaQuia A.; Gregory, Richard L.; Pediatric Dentistry, School of DentistryBackground: Streptococcus mutans (S. mutans) participates in the dental caries process. Titanium dioxide (TiO2) nanoparticles produce reactive oxygen species capable of disrupting bacterial DNA synthesis by creating pores in cell walls and membranes. Objective: The objective of this study was to determine the effect of TiO2 on the disruption of S. mutans biofilm. Methods: This study was conducted in four phases involving a TiO2-containing toothbrush and TiO2 nanoparticles. Each phase was completed using 24 h established S. mutans biofilm growth. Phase one data was collected through a bacterial plating study, assessing biofilm viability. Biofilm mass was evaluated in phase two of the study by measuring S. mutans biofilm grown on microtiter plates following crystal violet staining. The third phase of the study involved a generalized oxygen radical assay to determine the relative amount of oxygen radicals released intracellularly. Phase four of the study included the measurement of insoluble glucan/extracellular polysaccharide (EPS) synthesis using a phenol-sulfuric acid assay. Results: Both exposure time and time intervals had a significant effect on bacterial viability counts (p = 0.0323 and p = 0.0014, respectively). Bacterial counts after 6 min of exposure were significantly lower than after 2 min (p = 0.034), compared to the no treatment control (p = 0.0056). As exposure time increased, the amount of remaining biofilm mass was statistically lower than the no treatment control. Exposure time had a significant effect on oxygen radical production. Both the 30 and 100 nm TiO2 nanoparticles had a significant effect on bacterial mass. The silver nanoparticles and the 30 and 100 nm TiO2 nanoparticles significantly inhibited EPS production. Conclusion: The TiO2-containing toothbrush kills, disrupts, and produces oxygen radicals that disrupt established S. mutans biofilm. TiO2 and silver nanoparticles inhibit EPS production and reduce biofilm mass. The addition of TiO2 to dental products may be effective in reducing cariogenic dental biofilm.Item Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data(Elsevier, 2023-08) Dentino, Francis C.; Yepes, Juan F.; Jones, James E.; Scully, Allison C.; Eckert, George J.; Downey, Tim; Maupome, Gerardo; Pediatric Dentistry, School of DentistryBackground Advancements in dental materials and changing parental preferences are modifying the frequency of use of restorative materials. This insurance claims analysis examined the trends in the use of amalgam and resin composite in the United States. Methods Commercial dental insurance claims were analyzed to compare 505,994 restorations, corresponding with procedure codes for 1-, 2-, and 3-surface amalgam or resin restorations. Paid claims collected nationwide from January 2010 through March 2020 were analyzed. Data for children aged 3 through 12 years were used, resulting in 219,632 unique patient identification numbers. Generalized estimating equation models applied to logistic regression were used. All tests were conducted using a 2-sided 5% significance level. Results In general, girls were less likely to receive amalgam than boys. A $20,000 increase in median household income was associated with a 16% decrease in the odds of amalgam being placed. Pediatric dentists (performing 15.1% of all restorations) were not as likely as general dentists (18.4%) to use amalgam. Having more surfaces in a restoration was associated with higher probability of amalgam placement. The percentage of amalgam restorations was higher for 2010 (26.9%) than for 2011 through 2020, and this pattern recurred in several of the years analyzed. Generally, patient age at time of amalgam restoration increased over time. Conclusion The use of amalgam is trending down; the sharpest decline was noted in 2014. Pediatric dentists were less likely to use amalgam than general dentists. Girls and patients with higher socioeconomic status were less likely to have amalgam.Item Translation and cultural adaptation of the Children’s Experiences of Dental Anxiety Measure (CEDAM) to Brazilian Portuguese(2024-04) Santos, Julia Henriques Lamarca; Gavião, Maria Beatriz Duarte; Steiner-Oliveira, Carolina; Paschoal, Marco Aurelio Benini; Castilho, Aline Rogéria Freire; Barbosa, Taís de Souza; Pediatric Dentistry, School of DentistryObjective: The Children’s Experiences of Dental Anxiety Measure (CEDAM) was originally developed in English to assess important aspects of dental anxiety for children. The aims of the study were to translate and perform the cultural adaptation of the CEDAM to Brazilian Portuguese. Material and Methods: The CEDAM consists of 14 items, measured by a Likert scale of 3 points, that indicates the intensity of dental anxiety. The questionnaire was translated to Brazilian Portuguese, back-translated to English, reviewed by an Expert Committee and pretested in 10 eight- to twelve-year-old schoolchildren. Results: The Expert Committee Review compared the original, translated (T1, T2) and back-translated (BT1, BT2) versions and recommended some changes in order to achieve good understanding of the items. In the pretest, only question 8 was misunderstood by one child, i.e., the translated version was well understood by more than 85% of the participants. Conclusion: The Brazilian CEDAM was culturally adapted for the evaluated population of children.Item Bioactive Compounds Enhance the Biocompatibility and the Physical Properties of a Glass Ionomer Cement(MDPI, 2024-11-07) de Castilho, Aline Rogéria Freire; Rosalen, Pedro Luiz; Oliveira, Marina Yasbeck; Burga-Sánchez, Jonny; Duarte, Simone; Murata, Ramiro Mendonça; Puppin Rontani, Regina Maria; Pediatric Dentistry, School of DentistryIn order to characterize a novel restorative material, knowledge about the toxicological effect on human cells and the physical behavior of a glass ionomer cement (GIC) containing flavonoids was established. The flavonoids apigenin, naringenin, quercetin, and liquiritigenin were manually incorporated into a GIC. In the control group, no incorporation was performed. Two cell culture assays evaluated the toxicity of GICs: SRB and MTT. For both assays, the keratinocyte cell line (HaCaT) was exposed to GIC (n = 3/group) for 24 h. The physical properties of the GICs were evaluated by compressive strength (n = 10), surface roughness (n = 10), and hardness (n = 10) tests. Cell viability by SRB ranged from 103% to 97%. The control revealed a significant decrease in the metabolism of cells (61%) by MTT, while the GIC+apigenin slightly increased the succinic dehydrogenase activity (105%; p > 0.05), also confirmed microscopically. The compressive strength and roughness values were similar among groups, but the hardness increased after the incorporation of naringenin and quercetin into GIC (p < 0.05). The incorporation of flavonoids positively altered the biological and physical properties of the GICs.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.