A technique for immediate evaluation of preclinical exercises.
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Education, Dental↗
Biomedical subjects
N S Seale
Publications and source records attributed to N S Seale.
Pulpal reaction to bleaching of teeth in dogs.
Hydrogen peroxide and heat are two components of a technique commonly used to bleach human teeth. The effects of these two components on pulp tissue of dog teeth were evaluated histologically. Hydrogen peroxide alone or with heat caused obliteration of odontoblasts, hemorrhage, resorption, and inflammatory infiltration, while heat alone was not detrimental. Pulpal changes demonstrated evidence of reversibility after 60 d.
Animals↗
Deactivation of the jaw depressor reflex by hot water applied to dentin.
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Animals↗
The academic medical center versus the private practice environment: do we need alternative treatment strategies?
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Academic Medical Centers↗
Hospital charges for dental caries related emergency admissions.
PURPOSE: The purpose of this investigation was to develop and test a model for identifying hospital charges resulting from patient admissions through the emergency room of a children's hospital to manage pediatric nontraumatic dental disease. METHOD: Model development involved data identification and collection at Children's Medical Center of Dallas, Texas. Its utility was tested in 4 children's hospitals across the United States. RESULTS: The model proved effective in determining hospital charges for pediatric caries-related admissions. Diagnosis codes assigned at the time of admission were not specific enough to limit identification to nontraumatic dental admissions. Extensive review of patient records determined that only one-third of admitted patients identified by the model were caries-related admissions. Fifty-two children were identified who were admitted to the 5 children's hospitals in 1997 due to dental caries or its complications. Median hospital charge per admission was $3,223 and the total hospital charges for these 52 children was $250,000. CONCLUSIONS: More specific ICD-9 diagnosis codes should be developed to identify these patients.
Abscess↗
Pediatric emergency room visits for nontraumatic dental disease.
PURPOSE: This study described the incidence and predisposing, enabling, and need factors of outpatients in a pediatric ER who sought care for nontraumatic preventable dental disease and analyzed treatment rendered by attending physicians and associated hospital charges for treatment. METHODS: Chart review of outpatients discharged from the ER of a children's hospital during 1996-97, using ICD-9 diagnostic codes for dental caries, periapical abscess and facial cellulitis yielded the data for this investigation. RESULTS: During 1996-97, 149 patients made 159 ER visits. The most common diagnoses were ICD-9 codes 521.0 for dental caries (48%) and 522.5 for periapical abscess (47%). Medicaid recipients used the ER at an intermediate level between patients with no payor source and those with private insurance. Almost one-half of the accounts changed status during the billing process, with the majority being entered as private pay upon admission, but changing to bad debt or charity after the registration records were processed and collection was attempted. Most patients were treated empirically by the ER physicians according to their presenting signs/symptoms. CONCLUSION: This study confirmed that parents utilize the ER as their child's primary dental care source.
Adolescent↗
Ferric sulfate pulpotomy in primary molars: a retrospective study.
PURPOSE: This investigation collected clinical and radiographic data from a retrospective chart review of patients receiving ferric sulfate pulpotomies with a sub-base of zinc oxide eugenol in a clinical practice over a five-year period. METHODS AND MATERIALS: Clinical and radiographic data were available for 242 primary molars in 171 children with follow-up times ranging from 4-57 mos (mean = 19 mos). RESULTS: The overall radiographic success rate ranged from 74-80%. The frequency of normal appearing pulps decreased over time. The most frequently observed pulpal responses were calcific metamorphosis (6-33%) and internal resorption (7-18%). Overall clinical success was 99%. Only 9 of the 242 teeth were extracted due to radiographic and/or clinical failure. A survival analysis demonstrated that the overall cumulative probability of survival remained high over time with a cumulative survival of over 90% after 3 years. CONCLUSIONS: The overall success rates in this study are lower than those reported previously in the literature for ferric sulfate pulpotomies, but are comparable with those reported for 1:5 dilution, 5-min formocresol pulpotomies.
Child↗
A comparison of Medicaid reimbursement for non-definitive pediatric dental treatment in the emergency room versus periodic preventive care.
PURPOSE: This study compared the expenditure by the state Medicaid program for episodic, nondefinitive care provided through the emergency room (ER) of a children's hospital with the cost to Medicaid of covering that same child with the recommended preventive service calculated on the fee schedule of the state dental Medicaid program. METHODS: Records of patients discharged from the ER during 1996-1998 who had a payor source of Medicaid were reviewed and the reimbursement amount determined. This was compared to an estimate of preventive services which would have been reimbursed by Medicaid for each child. RESULTS: During 1996-1998, 97 patients made 102 visits to the ER. Of these, 9 were admitted to the hospital for treatment. The reimbursement amounts for patients admitted to the hospital were ten times greater than the anticipated amount for preventive care. The reimbursement amounts for preventive services was approximately three times more costly than outpatient treatment in the ER for symptoms related to dental caries. CONCLUSIONS: Greater expenditures by the state Medicaid program for treatment in the ER as compared to the cost to Medicaid for providing routine, preventive care depended on whether the child was treated as an inpatient or outpatient.
Adolescent↗
Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?
PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.
Age Factors↗
A survey of pediatric dentists' management of dental caries in children three years of age or younger.
PURPOSE: The purpose of this investigation was to obtain information from practicing pediatric dentists about how they manage caries in children three years of age and younger and the problems they are encountering. METHODS: A survey mailed to a randomly selected sample of 1,000 members of the American Academy of Pediatric Dentists (AAPD) in January of 1997 asked them to: identify the types and extent of caries in the young age group; define and quantify methods used to manage caries; determine the representation of caries among different payer source groups; identify sources of information used in managing caries; and determine the criteria they use for assessing the success of different methods in managing caries. RESULTS: The response rate was 43%. Definitions of techniques of managing caries varied among practitioners, and the use of the methods differed for the different degrees of severity of caries. There was a significant relationship between the percentage of Medicaid in a practice and the percentage of children with caries and pulpal involvement. Personal experience/philosophy was most frequently identified as an important source among factors influencing treatment decisions and sources of information about managing. Criteria most frequently cited to determine effectiveness of treatment were "caries free at recall" (45%) and "stop progress of lesion" (30%). CONCLUSION: Practitioners use a variety of techniques to manage caries in the child < or = 3 years of age. Disease level and payer source factored heavily in their treatment decisions. Practitioners reported interest in receiving information and help from AAPD on the subject.
Adult↗
Alternative method of hemorrhage control in full strength formocresol pulpotomy.
PURPOSE: This investigation evaluated the success of a formocresol pulpotomy technique in which hemostasis was obtained with the same formocresol dampened cotton pellet used to medicate the root pulp stumps and to compare the findings of this investigation with data of published formocresol pulpotomy studies in which hemorrhage was controlled by traditional means. METHODS: Clinical and radiographic data were available for 194 primary molars in 112 patients with follow up times ranging from 5 to 109 months (mean = 38 months). RESULTS: Overall radiographic success was 87%. The most frequently observed pulpal responses were calcific metamorphosis (34%) and internal resorption (10%). Overall clinical success was 98%. Only 7 of 194 molars were extracted due to radiographic and/or clinical failure. Overall cumulative probability of survival remained high over time with a cumulative survival rate of over 94% over 4 years. CONCLUSIONS: The success rates for this variation of the formocresol technique are comparable to those success rates in the literature where hemostasis was obtained in a separate step using a nonmedicated cotton pellet. The results of this study suggest that using the same cotton pellet dampened with full strength formocresol to obtain hemorrhage control and medicate the root pulp is an acceptable variation of the traditional formocresol pulpotomy technique.
Child↗
Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria.
PURPOSE: The purposes of this investigation were to 1) measure success of a primary tooth pulpotomy technique that applies formocresol in the sub-base without the common five-minute application of a formocresol impregnated cotton pellet; and 2) compare success rates of the pulpotomy procedure using traditional criteria found throughout the literature with new criteria recently established, excluding internal resorption as a radiographic failure. METHODS: Clinical and radiographic data were collected from a retrospective chart review of patients receiving formocresol pulpotomies with the application of formocresol in the zinc oxide-eugenol sub-base. RESULTS: Clinical and radiographic data were available for 196 primary molars in 122 children (followup=six to 103 months; mean=49 months). Traditional assessment of radiographic success and failure yielded a success rate of 79%. Alternative assessment excluding internal resorption as a failure yielded a 99% success rate. Most frequently observed pulpal responses were calcific metamorphosis and internal resorption. Overall clinical success was 99%. Two of the 196 teeth were extracted due to failure. A survival analysis demonstrated that the overall probability of survival remained high over time with a cumulative survival of over 95% after six years. CONCLUSIONS: The overall success rates in this study indicate that the formocresol pulpotomy technique incorporating formocresol in the zinc oxide-eugenol sub-base is a very successful treatment modality for primary molars requiring pulp therapy.
Chi-Square Distribution↗
Infant oral health education in U.S. dental school curricula.
PURPOSE: This study was performed to determine didactic and clinical curricular content about infant oral health in predoctoral pediatric dentistry programs. METHODS: 54 dental school departments of pediatric dentistry were surveyed about: 1) curricular content devoted to teaching infant oral health (IOH) and age of first dental visit; 2) methods used to teach IOH and hours dedicated to each method; and 3) whether students receive hands-on experiences with infants. RESULTS: Eighty-six percent of programs teach students to see infants at 12 months of age or younger. Curricular time ranged from 15 minutes to 13 hours (mean = 2 hrs, 20 min, median = 1 hr, 45 min). All programs used lectures; other formats included handouts, demonstration and small group seminar. Fifty percent provide clinical experiences, albeit they are not uniform for all students. One-fourth provides uniform, clinical hands-on experiences with infant oral examinations. CONCLUSIONS: The findings indicate varying degrees of acceptance about teaching infant oral health in our dental schools.
Child, Preschool↗
Evaluation of morphine as compared to meperidine when administered to the moderately anxious pediatric dental patient.
This investigation evaluated two narcotic regimens used to sedate pediatric dental patients who previously demonstrated uncooperative behavior. One consisted of submucosal morphine (0.15 mg/kg), and the other, oral meperidine (2.2 mg/kg); both were administered in combination with oral promethazine (1.1 mg/kg). Patients 2-7 years old were sedated with one of the two regimens and videotaped during dental treatment. If sedation was successful, the child received the other regimen at the next appointment, resulting in a total of 42 sedations in 29 children. Later, patient behavior was rated blindly by two independent observers viewing tapes of specific events during dental treatment. Fourteen of 23 (61%) patients receiving morphine and 11 of 19 (58%) patients receiving meperidine were sedated successfully. Vital signs, including pulse, respirations, blood pressure, and oxygen saturation were monitored and remained stable for both groups. ANOVA for repeated measures showed no significant differences for any vital sign in either group across time. Wilcoxon's signed rank test revealed significant improvement for the patients successfully treated in both groups when presedation behavior was compared with behavior during the events of rubber dam application, operative, restorative treatment, and exit (meperidine, P < 0.005 and morphine, P < 0.001). Improvement also was seen in the meperidine group for the event of local anesthesia (P < 0.01). Chi-square analysis showed no statistically significant differences in effectiveness or safety between the two sedative regimens.
Administration, Buccal↗
Comparison of two ultrasonic cleaning units for deterioration of cutting edges and debris removal on dental burs.
The effects of two ultrasonic cleaning units on surface deterioration and cleaning effectiveness of dental burs were compared in this study. The units tested were the Dextrex Model L 503B (Dextrex Chemical Industries, Inc., Bowling Green, KY) industrial ultrasonic unit and a conventional dental ultrasonic unit L & R T-21 B (L & R Manufacturing Co., Kearny, NJ). SEM photomicrographs of the burs were made before cleaning; and burs were processed for 10 min in each unit. Forty-eight new burs (24 #1/2A diamond and 24 #330 carbide) contaminated with human blood and 48 burs contaminated with tooth debris following cavity preparation were used to evaluate cleanliness. To assess deterioration, 48 new burs were evaluated for changes in the number of diamond chips or pits (carbide burs) and color changes following ultrasonic cleaning. Neither unit sufficiently cleaned the burs, as evidenced by remnants of remaining blood and debris on the burs. The loss of diamond chips was statistically significant for the burs processed in the Dextrex unit (P < 0.001) as well as for burs processed in the L & RT 21-B unit (P < 0.01). The mean number of pits was significant in carbide burs processed in both units as well (Dextrex unit: P < 0.01; L & RT-21 B unit: P < 0.001). No differences were noted in color changes for any of the burs in either unit. These data showed that the industrial-type unit was no more effective in cleaning dental burs than the conventional unit, though both units caused significant amounts of deterioration in the cutting surfaces.
Carbon↗
The experiences of women pediatric dental residents: a survey.
A survey of 430 female pediatric dentists in the United States determined concerns and experiences they had during their advanced training programs. The return rate was 54%. Up to 83% (24) of the women who were pregnant during their residencies asked not to be exposed to certain environmental hazards during pregnancy and the postpartum period. They requested that program directors establish policies on known environmental hazards. Eighty-eight women (41%) commented that programs should offer flexible, preestablished and preannounced maternity leave policies. Survey respondents also expressed concerns about personal safety (5%), the lack of female role models (9%), and the need for more information on business management (30%). When the women were analyzed according to age, the following were significant (P less than .05): professional acceptance was of greatest concern to women ages 41-48; pregnancy and maternity leave, and balancing career with parenthood, significantly concerned women 25-32; and women ages 33-40 said business management was the issue causing the greatest frustration as a practicing pediatric dentist. While most respondents felt that they have the same professional opportunities as men, their greatest frustrations are a lack of acceptance by the professional and lay communities and trying to balance a career and motherhood.
Adult↗
Attitudes of program directors toward women in pediatric dentistry training programs.
The number of women entering pediatric dentistry graduate programs is increasing. A formal survey was conducted in the fall of 1990 to determine what impact, if any, this increase is having on the programs. The survey sample consisted of the 57 pediatric dentistry graduate program directors from the United States and Canada. The survey form included program data about gender distribution in the current and previous classes, and female faculty distribution within the programs. The survey requested information about the attitudes of various groups of individuals who interacted with the residents relative to the gender of the resident and again, relative to whether the resident was pregnant. Inquiry was made concerning maternity leave policies and selected treatment scenarios involving pregnant residents. Finally, questions were asked about motivational factors, personal priorities, and policy change for female vs. male residents. Fifty forms were returned for a return rate of 88%. The 48 forms analyzed revealed that 52% of current classes are female and 51% of applicants for 1991 were female. Women comprise 23% of full-time and 26% of part-time faculty. There was no single issue perceived by program directors as a group to be a significant concern or problem relating to gender. Program directors would consider removing pregnant females from contact with combative patients (83%) and environmental hazards (85%), but fewer would consider removing them from contact with for HIV+ or Hb+ patients.
Administrative Personnel↗
Opinions of pediatric dentists regarding their board certification process.
Despite frequently heard criticisms of the board certification process in pediatric dentistry, pediatric dentists have never been surveyed on this issue. To achieve a representative opinion, a formal survey was conducted during the summer and fall of 1990. The survey sample consisted of 300 practitioners selected randomly from the list of 4300 United States pediatric dentists. The survey form included demographic data, board status, general opinions about the process, and specific estimates of the reliability, validity, and utility of each of the five examination components. Comments were encouraged. A follow-up reminder was sent several weeks after the initial mailing. Ten forms were returned as undeliverable, reducing the sample to 290. In all, 150 forms were returned, for a return rate of 52%. One hundred and thirty-eight forms were completed and analyzed. This number included 54 pediatric Diplomates and 84 nonboarded pediatric dentists. The Written and Oral sections generally were rated more favorably than the Case History, Site Visit, and Simulation sections. Nonboarded respondents were significantly more critical of the process on every item, without exception. All differences exceeded the 0.01 level.
Attitude of Health Personnel↗