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Biomedical subjects

P Milgrom

Publications and source records attributed to P Milgrom.

At least 163 records · Page 9Linked to original sources
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Tooth decay in our poorest children: what can we do?

Dental programs for the poor have failed to deliver improved oral health for children to the same degree as their more well-off counterparts. Community health workers continue to identify dental problems as the greatest unmet need in their communities. Yet, many do not see this as a problem. Practitioners need to act in concert through their dental societies to establish and efficiently manage community-based outreach programs. Child dental health can also be improved by increasing access through public and non-profit community clinics and integrating child dental services with medical care.

Child↗
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Factors influencing whether low-income mothers have a usual source of dental care.

Mothers are both the source of dental caries and the managers of children's use of dental care. This is particularly important for the low-income population. The objective of this research was to explore predictors of having a usual source of dental care among low-income women. Eight-hundred-ten mothers (82 percent white, mean age twenty-seven years), drawn from among participants in an ABCD program in one Washington State County completed a study questionnaire. The study examined predisposing, enabling and illness level variables in relation to whether the mother reported a usual source of dental care for herself. Fifty-two percent of the subjects gave positive answers to the dependent variable Do you now have a dentist you can go to if you have a problem? The analysis suggests that mothers that report good oral health and believe in care for their children are five times as likely to have a usual source of care for themselves than mothers who report both poor oral health and more negative attitudes about dental care for children. The results suggest that interventions aimed at child health that ignore the welfare of the mother are likely to be less successful than those that also address the mothers' needs.

Adult↗
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Clinical study of diffusion hypoxia after nitrous oxide analgesia.

In order to estimate the incidence of diffusion hypoxia, arterial oxygen saturation was measured in 104 healthy adult dental patients who were administered nitrous oxide-oxygen analgesia and who did not receive postcessation oxygen. Pretreatment saturation levels as determined by pulse oximetry ranged from 93% to 100%. When the nitrous oxide-oxygen administration ceased, the saturation levels were from 95% to 100%. The mean saturation dropped about 2% over the next 4 min and then stabilized. No patient had a posttreatment oxygen saturation of less than 92%.

Adult↗
PubMedDate not supplied

A clinical evaluation of high- and low-fear children in Singapore.

Few studies have investigated the effects of fear of the dentist on oral health and quality of care. In this study the oral health of 114 fearful and nonfearful children aged ten to fourteen years, in two representative Singaporean primary schools is compared. Further, the hypothesis that poorer quality of care is provided to fearful children as a result of management problems, is tested. Although there was a significant difference in quality of restorations provided in the different schools, the hypothesis that more fearful children would be in poorer oral health or obtain poorer dental care was not supported. It is postulated that the poor management of fear at this age may result in avoidance when the children are no longer part of a school-based delivery system.

Chi-Square Distribution↗
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Common fears and their relationship to dental fear and utilization of the dentist.

Common fears were studied by household telephone interviews and mail survey in Seattle, Washington, to determine their relationship to dental fear and to utilization of the dentist. Dental fear was either the first or second most common fear, with a prevalence estimated between 183 and 226 persons per 1000 population. Dental fear was associated with fears of heights, flying, and enclosures. Respondents with multiple common fears other than fear of dentistry were more likely to delay or cancel dental appointments, report a longer period since their last visit to the dentist, and report poorer oral health and less satisfaction with oral appearance. Over 22 percent of the dentally fearful group reported two or more accompanying common fears.

Adult↗
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Clinical experience with TENS and TENS combined with nitrous oxide-oxygen. Report of 371 patients.

Transcutaneous electrical nerve stimulation (TENS) alone or TENS combined with nitrous oxide-oxygen (N2O) was administered for restorative dentistry without local anesthesia to 371 adult patients. A total of 55% of TENS alone and 84% of TENS/N2O visits were rated successful. A total of 53% of TENS alone and 82% of TENS/N2O patients reported slight or no pain. In multivariable analyses, pain reports were related to the anesthesia technique and patient fear and unrelated to sex, race, age, tooth, or depth of preparation.

Adult↗
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Effects of lidocaine with epinephrine on fear related arousal among dental phobics.

The effects of 2% lidocaine containing 72 μg epinephrine on fear related arousal were tested using a cross-over design on dental patients fearful of injections and other dental procedures. Heart rate and body movement in the dental operatory were monitored, and subjects' self-reported upset in the Epinephrine condition than in the No-Epinephrine condition (F = 4.8, p = .04), but the clinical significance was negligible. No interaction between initial fear levels and the drug condition could be established. Results suggest that pre-existing dental fear levels may produce greater self-report, behavioral or physiological arousal in the dental operatory than exogenous epinephrine.

Adult↗
PubMedDate not supplied

Epidemiology of dental emergency visits to an urban children's hospital.

All 1482 emergency room dental visits to Seattle's Children's Hospital and Medical Center from 1982 to 1991 were studied to evaluate trends in patients seeking care: 60% of visits were for trauma, the remainder for infection or other reasons. The number of visits was 2.1 times greater in 1991 than in 1982. Comparing the periods of 1982-1987 and 1988-1991, there was an increase in the proportion of infection-related visits from 30.5 to 43.5% of all visits. Spring/summer and weekends had the highest volume. More males (61.2%) than females received care. The largest number of visits (47.9%) occurred between 6:00 PM and midnight. Nearly two-thirds (62%) of children did not have a usual source of medical care; 30.2% of children had no medical insurance, and 21.5% received Medicaid benefits. Medicaid patients were twice as likely to be seen for infection as for trauma. Among the uninsured, there was no difference in the rates of trauma or infection. Non-Caucasian patients were twice as likely to be seen for infection as Caucasians. Infection visits were for pulpitis (32.1%), and periapical and gingival abscess (53.5%). Trauma patients were younger (66 months) than infection patients (89 months). Trauma was primarily to the maxillary anterior teeth (70.1%) and upper lip and gingiva (12.1%). Common agents for trauma were furniture, bicycles, and sports.

Age Factors↗
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Pain management in school-aged children by private and public clinic practice dentists.

A mail survey of 198 Seattle dentists who treat children assessed their beliefs about pain control in school-aged children and examined the relationship of those beliefs to pain management behaviors. The survey population of general dentists and pediatric dentists in clinics and private practice had a response rate of 89.6%. Two of three dentists always use local anesthetic when doing restorations or extractions and also provide more anesthetic at the child's request. One in three dentists never provides postoperative medication following tooth extractions. Ten percent regularly deny child pain and many do not believe child pain reports are valid. Dentists who work in private practice are more likely to provide local anesthetic than are dentists who work in clinics. Dentists who desire more control over a child are less likely to provide local anesthetic. Dentists who question children about comfort are more likely to provide additional anesthetic based on a child's report of discomfort and to provide postoperative medication if the dentist perceives a dental procedure to be painful.

Adolescent↗