Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study

Background

Armenia has trained physicians to practice family medicine (FM) for over 20 years. The pediatric population comprises a significant proportion of patients seen by FM practices, yet to date, there have been no studies assessing the knowledge and self-efficacy of FM physicians regarding pediatric care. As the first step is needs assessment to improve the quality of care, this study aims to assess the self-efficacy and knowledge of FM physicians regarding the care of pediatric patients.

Materials and Methods

We distributed a survey to attendees at an FM conference in Lori Province, Armenia. The survey instrument assessed demographics and experience, self-efficacy in providing pediatric care, and pediatric knowledge via questions adapted from the American Board of Family Medicine (ABFM).

Results

Eighty-seven percent of participants were female. Roughly half (45%) had trained through an FM residency program, while the remainder had retrained to become FM physicians following a residency in another field. Almost all (97%) practiced outside of the capital city, Yerevan. About half believed that their didactic (51%) and clinical education (48%) prepared them either "extremely" or "very" well. Overall, there was no clear relationship between participants' reported self-efficacy in a given area of pediatrics and their score in that area on the knowledge portion of the survey.

Conclusions

Our findings reveal opportunities for improvement in knowledge related to pediatric care in FM physicians in Armenia, as well as a lack of relationship between reported self-efficacy and knowledge. Thus, future programs should not rely solely on self-reported gaps to identify or prioritize areas of focus. Further study is recommended in other specialties in Armenia and internationally to improve future programs.

Associations of CYP2A6 Gene Polymorphism with Smoking Status Among Jordanians: Gender-Related Differences

BACKGROUND

Cytochrome P450 2A6 enzyme (CYP2A6), an essential hepatic enzyme involved in the metabolism of drugs, is responsible for a major metabolic pathway of nicotine. Variation in the activity of polymorphic CYP2A6 alleles has been implicated in inter-individual differences in nicotine metabolism.

AIMS

The objective of the current study was to assess the association between the smoking status and the cytochrome P450 2A6 enzyme (CYP2A6) genotype in Jordanians.

METHODS

In the current study, 218 (117 Male and 101 female) healthy unrelated Jordanian volunteers were recruited. CYP2A6*1B, CYP2A6*4 and CYP2A6*9 were determined and correlated with subject smoking status.

RESULTS

*1A/*1A was the most common genetic polymorphism in the overall study population, with no significant frequency differences between smokers and non-smokers. When the population was divided according to gender, only male smokers showed a significant correlation between genotype and smoking status. Considering the CYP2A6*9 genotype, the results showed differences in distribution between smokers and non-smokers, but only women showed a significant association between CYP2A6*9 allele genotype and smoking status.

CONCLUSION

The results of this study show that there is a significant association between CYP2A6*9 genotype and smoking status. They also show that CYP2A6 genotype is significantly influenced by gender.

Retrospective analysis of porous tantalum trabecular metal-enhanced titanium dental implants

STATEMENT OF PROBLEM

The design of porous tantalum trabecular metal-enhanced titanium (TM) dental implants promises improved osseointegration, especially when grafting materials such as demineralized bone matrix are used; however, studies are lacking.

PURPOSE

The purpose of this retrospective study was to compare TM implants with conventional titanium alloy (Ti) implants with and without demineralized bone matrix in terms of peri-implant bone remodeling in the first year after implant loading.

MATERIAL AND METHODS

A chart review was used for all patients receiving Tapered Screw-Vent Ti and TM implants. Implants were placed and restored by a single provider between 2011 and 2015. Peri-implant bone remodeling was compared by using a paired t test (α=.05).

RESULTS

A total of 82 patients received 205 implants, 44 TM and 161 Ti implants (control). No implants failed in the TM group (survival rate of 100%), and 3 implants in total, 1 immediate, failed in the Ti groups (survival rate of 98.1%). TM implants exhibited a 0.28-mm bone gain on average, whereas the control group demonstrated 0.20 mm of marginal bone loss after the first year of implant loading. Multivariate logistic regression analysis demonstrated that the odds of having bone loss was 64% less (odds ratio: 0.36; 95% confidence interval: 0.14-0.94) in the TM group than in the Ti group after controlling for bone grafting, implant location, immediate placement, bone type, and pretreatment bone level.

CONCLUSIONS

TM implants exhibited less peri-implant bone loss than the control Ti implants.

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists

Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management of 18 cases (primary and permanent dentition) according to perceived urgency. Repeated-measures logistic regression was used to analyze factors influencing perception of clinical scenarios. Results: Response rates for PD and GP were 45.5% and 36.3%, respectively. Perceived urgency varied by clinical scenarios, dentition (primary vs. permanent), and practitioner (PD vs. GP) (P<.001). Practitioners with fewer years in practice or seeing fewer pediatric patients managed more cases as urgent. Traumatic injuries in primary dentition (intrusion, pulp exposure, palatal displacement, avulsion) were managed as more urgent by GP than PD (P<.001). Emergencies related to infection and permanent dentition were perceived similarly by PD and GP. Conclusions: Clinical scenarios highlighted disagreement in the management of after-hours pediatric dental emergencies between GP and PD, especially trauma in primary dentition. General practitioners tended to refer to an ED or see urgently, and PD tended to defer care. By identifying needs for improved education in dental trauma management, we can increase utilization of the dental home, avoiding use of overburdened EDs.

Effectiveness of a Preventive Recall Strategy for Children After Dental Rehabilitation with General Anesthesia

PURPOSE

To test a more frequent preventive recall strategy following full-mouth dental rehabilitation (FMDR) in children with early childhood caries (ECC).

METHODS

Patients were randomized into two groups: controls, who were scheduled to return at six-month intervals (6-MR); and the intervention group, who were scheduled to return at three-month intervals (3-MR and 6-MR). At baseline and at each recall, a caries risk assessment (CRA) and dental exam were completed. Analyses followed CONSORT recommendations, resulting in three analyses: intent-to-treat; per-protocol; and an actual recall analysis.

RESULTS

Intent-to-treat analysis showed no significant difference in CRA at six months (P>0.7); per-protocol analysis showed borderline significance (P>.08); and actual recall analysis showed a statistically significant difference in CRA at six months (P=.021). For patients with both 3-MR and 6-MR, 44 percent were assessed at a high caries risk level; for patients with only a 6-MR, 72 percent were assessed as a high caries risk level (P=.021). No significant differences were found in caries incidence at six months.

CONCLUSIONS

Following full-mouth dental rehabilitation, patients who returned for follow-ups at both three- and six-month intervals had a greater decrease in caries risk level compared to patients seen at six-month follow-up intervals.

Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry

OBJECTIVES

To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry.

METHODS

A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results.

RESULTS

There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students.

CONCLUSIONS

Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice.

Pediatric dentists' perspective of general dentists' role in treating children aged 0-3 years

This study examined pediatric dentists' perspectives on the types of dental services general dentists provide to children who are 0-3 years old. A web-based survey was sent to 5185 pediatric dentists and 769 (14.8%) responded. Among the respondents, 58% agreed with general dentists' providing an age 1 dental visit. Only 24% agreed with general dentists' performing complex behavior management techniques, such as sedation, to patients aged 0-3 years. Those respondents who taught pediatric dentistry full time were more likely to agree with general dentists' providing an age 1 dental visit (P = 0.0088). Those who reported that their own dental school had adequately prepared them for this type of age 1 visit were also more in agreement (P < 0.0001). The results of this study promote better understanding of pediatric dentists' perceptions of the level of collaboration between general dentists and pediatric dentists; the types of oral health services general dentists can provide for children aged 0-3 years; and the anticipated level of competency of entry-level general dentists.

Dental patients' self-reported use of dietary supplements on medical history questionnaires

Dietary supplement effects and drug interactions can lead to significant adverse health events, thus potentially impacting the safe delivery of oral healthcare. This study sought to determine the frequency of, and factors impacting, dietary supplement use among 209 dental patients and whether the design of a medical history questionnaire influences reporting of supplement use. Patients were randomly allocated to 1 of 2 groups in which they completed either a standard medical history questionnaire (n = 107) or the same questionnaire with an additional item about dietary supplement use (n = 102). All patients were then administered a survey with questions about their demographics, their use and knowledge of dietary supplements, and the person or persons who recommended dietary supplement use to the patient. While 62% of the total population (130/209) reported supplement use, specific prompting nearly doubled the number of supplements reported (mean with prompting: 1.53; mean without prompting: 0.76; P < 0.0001). Patients younger than 30 years of age reported significantly less dietary supplement use than all other age groups except the 30-40 age group (P = 0.0003). An estimated 70% of all respondents were not aware of potentially detrimental side effects of dietary supplement use or possible interactions with conventional drug therapies. Since patients tended to report a greater use of dietary supplements when specifically asked about their use on a medical history questionnaire, a checklist or set of designated questions may be a suitable first step toward gathering this essential information.

Retrospective Study of the Survival Rates of Indirect Pulp Therapy Versus Different Pulpotomy Medicaments

PURPOSE

The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful.

METHODS

Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis.

RESULTS

At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001).

CONCLUSIONS

Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.

Quality of Impressions and Work Authorizations Submitted by Dental Students Supervised by Prosthodontists and General Dentists

Preclinical fixed prosthodontics is taught by Department of Prosthodontics faculty members at Virginia Commonwealth University School of Dentistry; however, 86% of all clinical cases in academic year 2012 were staffed by faculty members from the Department of General Practice. The aims of this retrospective study were to quantify the quality of impressions, accuracy of laboratory work authorizations, and most common errors and to determine if there were differences between the rate of errors in cases supervised by the prosthodontists and the general dentists. A total of 346 Fixed Prosthodontic Laboratory Tracking Sheets for the 2012 academic year were reviewed. The results showed that, overall, 73% of submitted impressions were acceptable at initial evaluation, 16% had to be poured first and re-evaluated for quality prior to pindexing, 7% had multiple impressions submitted for transfer dies, and 4% were rejected for poor quality. There were higher acceptance rates for impressions and work authorizations for cases staffed by prosthodontists than by general dentists, but the differences were not statistically significant (p=0.0584 and p=0.0666, respectively). Regarding the work authorizations, 43% overall did not provide sufficient information or had technical errors that delayed prosthesis fabrication. The most common errors were incorrect mountings, absence of solid casts, inadequate description of margins for porcelain fused to metal crowns, inaccurate die trimming, and margin marking. The percentages of errors in cases supervised by general dentists and prosthodontists were similar for 17 of the 18 types of errors identified; only for margin description was the percentage of errors statistically significantly higher for general dentist-supervised than prosthodontist-supervised cases. These results highlighted the ongoing need for faculty development and calibration to ensure students receive the highest quality education from all faculty members teaching fixed prosthodontics.

Quantifying Appointments, Treatment Time, Impressions, and Diagnostic Data of Cases Staffed by General Dentists and Prosthodontists in a Dental School Clinic

The aim of this retrospective study was to quantify differences between general dentists and prosthodontists regarding appointments, treatment time, impressions, and preoperative diagnostic data in teaching predoctoral clinical fixed prosthodontics. Electronic dental records (n=356) of patients treated at one dental school in academic year 2012 were randomly selected for review to obtain the following data: faculty and student demographics, number of appointments and treatment time from preparation to cementation, number of impressions made, completion of oral disease control treatment (ODCT), and presence of preoperative periapical radiographs and diagnostic casts. The results showed that ODCT was completed in 78%, preoperative radiographs were present in 76%, and diagnostic casts made in 53% of the cases reviewed. There was no statistically significant difference in number of appointments, treatment time, or number of final impressions when students were staffed by general dentists or prosthodontists. When students were supervised by multiple faculty members, there was generally an increase in treatment time and number of appointments and final impressions. Although this study found no statistically significant differences between general dentists and prosthodontists regarding the criteria evaluated, the results suggest that faculty development and calibration are needed to ensure ODCT is completed and preoperative radiographs are present prior to initiating fixed prosthodontic procedures.

Differences in Outcomes for Female and Male Students in Special Education

Interest in differences in outcomes for male and female students in special education has increased in recent years. Using the nationally representative, longitudinal National Education Longitudinal Study of 1988 (NELS-88) data set, a logistic regression model was used to examine the extent to which outcome variables were differentially associated with gender for students participating in special education. Evidence was obtained for several differential effects, with most results favoring males. Among other findings, females as compared to males with disabilities were less likely to obtain a high school diploma, were less likely to be employed, earned less, and were more likely to be a biological parent. Recommendations are provided for improved transition services, the implementation of promising practices related to self-determination, and renewed emphasis on comprehensive and flexible life—career preparation to foster better outcomes among females with disabilities.

Stimulation of Critically Ill Patients: Relationship to Sedation

OBJECTIVES

To describe the number and type of stimulation events and the relationship of stimulation to sedation level in patients receiving mechanical ventilation.

METHODS

A 4-hour direct observation was conducted in 103 patients receiving mechanical ventilation. Stimulation events and sedation level before and after the stimulation were documented. Eight categories of stimulation events were developed in a previous pilot study of 36 patients receiving mechanical ventilation. Sedation was measured continuously by using a processed electroencephalographic score (patient state index [PSI]) and intermittently by using the Richmond Agitation-Sedation Scale.

RESULTS

Patients were mostly alert/mildly sedated (54.4%) at study enrollment. During the 349 hours of observation, 58.8% of the time included stimulation events. General auditory types of stimulation were most common (41.2% of observed time), followed by respiratory management and tactile family stimulation. For all events, auditory-talking, tactile-general, tactile-noxious, and tactile-highly noxious stimuli were associated with higher PSIs (all P < .001) after stimulation; other stimuli were not. Level of consciousness influenced response to stimuli, with almost all types of stimuli increasing PSI for patients more deeply sedated (PSI < 60) just before the stimuli. However, the effect of stimulation on PSI for more alert patients (PSI > 60) was small and variable.

DISCUSSION

Critically ill patients receiving mechanical ventilation are subjected to various forms of auditory and tactile stimulation frequently throughout the day. All types of stimuli increased arousal in patients who were more deeply sedated. The effect of stimulation in patients who were not deeply sedated was minimal and inconsistent.

Orthodontic marketing through social media networks: the patient and practitioner's perspective

OBJECTIVE

To (1) assess orthodontic patient and practitioner use of and preferences for social media and (2) investigate the potential benefit of social media in marketing and communication strategies in orthodontic practices.

MATERIALS AND METHODS

A survey was developed and randomly distributed to orthodontists via the American Association of Orthodontists and to patients/parents via private practices throughout the United States. Participants were asked to answer questions related to their use of social media and their perceptions of the use of social media in the orthodontic practice.

RESULTS

Of the participants, 76% of orthodontists and 89% of patients/parents use social media. Furthermore, Facebook was the social media platform that was most preferred. Social media use was more common in female and younger adult participants. Orthodontists posted information more often in the morning (40%) and afternoon (56%), and patients/parents used social media mainly in the evening (76%). The most commonly used marketing strategies in the orthodontic practices were social media (76%) and a practice website (59%). Social media and practice websites were positively related with new patient starts (P  =  .0376, P  =  .0035, respectively).

CONCLUSIONS

Most orthodontists and patients/parents used social media. Social media may be an effective marketing and communication tool in an orthodontic practice.

Current trends in headgear use for the treatment of Class II malocclusions

Objective: 

To investigate American and Canadian orthodontists’ opinions and perceptions on the use of headgear in the treatment of Class II malocclusions.

Materials and Methods: 

An online survey was sent to randomly chosen orthodontists (n  =  1000).

Results: 

The study was completed by 948 orthodontists; 62% of the orthodontists indicated that they were using headgear in their practice. Those who were not using the appliance (38%) reported that this was mainly due to the availability of better Class II correctors in the market and lack of patient compliance. Of those who use headgear, 24% indicated that the emphasis on headgear use during their residency was an influential aspect of their decision making (P &lt; .05). Nearly a quarter of those who do not use headgear reported that learning about other Class II correctors through continuing education courses was an important factor (P &lt; .05). There was no difference between the headgear users and nonusers in the year and location of practice. Compared with previous studies, this study showed a decline in the use of headgear among orthodontists.

Conclusions: 

Despite a decline, more than half of the orthodontists (62%) believe headgear is a viable treatment. Availability of Class II correctors in the market and familiarity with these appliances though continuing education courses are the reasons for the remaining 38% of orthodontists to abandon use of the headgear.

Service-learning's impact on dental students' attitude towards community service

BACKGROUND

This study evaluated service-learning programme's impact on senior dental students' attitude towards community service at Virginia Commonwealth University (VCU) School of Dentistry. Experience gained through service-learning in dental school may positively impact dental students' attitude towards community service that will eventually lead into providing care to the underserved.

MATERIALS AND METHODS

Two surveys (pre- and post-test) were administered to 105 senior dental students. For the first survey (post-test), seventy-six students of 105 responded and reported their attitude towards community service immediately after the service-learning programme completion. Three weeks later, 56 students of the 76 responded to the second survey (retrospective pre-test) and reported their recalled attitude prior to the programme retrospectively.

RESULTS

A repeated-measure mixed-model analysis indicated that overall there was improvement between pre-test and post-test. Scales of connectedness, normative helping behaviour, benefits, career benefits and intention showed a significant pre-test and post-test difference. An association between attitude towards community service and student characteristics such as age, gender, ethnicity and volunteer activity was also examined. Only ethnicity showed an overall significant difference. White dental students appear to have a differing perception of the costs of community service.

CONCLUSIONS

The service-learning programme at VCU School of Dentistry has positively impacted senior dental students' attitude towards community service.

Antibiotic Prescribing Habits of Oral and Maxillofacial Surgeons in Conjunction With Routine Dental Implant Placement

PURPOSE

Although various prophylactic systemic antibiotic regimens have been suggested to minimize failure after dental implant placement, the role of antibiotics in implant dentistry is still controversial. The purpose of the present survey was to determine the current antibiotic prescribing habits of oral and maxillofacial surgeons in conjunction with routine dental implant placement to determine whether any consensus has been reached among such practitioners.

MATERIALS AND METHODS

An electronic survey was sent by electronic mail to all members of the American College of Oral and Maxillofacial Surgeons. The questions asked were related to whether antibiotics were routinely prescribed either pre- or postoperatively during routine dental implant placement, and, if so, what antibiotics, dosage, frequency, and duration were used. The survey participants were also asked to specify whether they were in solo private practice, group private practice, academia, military, or "other." The results were tabulated and analyzed using SAS software. Descriptive statistics and χ(2) analyses were used.

RESULTS

A total of 217 members responded to the survey. Overall, 112 of 217 (51.6%) prescribed antibiotics preoperatively (95% confidence interval [CI] 50.0 to 58.2%) and 152 of 213 (71.4%) prescribed antibiotics postoperatively (95% CI 65.0 to 77.0%) during routine dental implant placement. Also, 72 (34%) indicated that they prescribed antibiotics both pre- and postoperatively. The most common preoperative regimen used was amoxicillin 2 g given 1 hour before the procedure (32%, n = 36). The most common postoperative regimen used was amoxicillin 500 mg 3 times daily for 5 days (53%, n = 81).

CONCLUSIONS

We found no consensus among oral and maxillofacial surgeons regarding the use of antibiotics in association with routine dental implant placement, the type of regimen to use, or whether such use is even effective in preventing early implant loss. Furthermore, most of the antibiotic regimens being used are not in accordance with the recommendations current in the published data.

Communication practices and preferences between orthodontists and general dentists

OBJECTIVE

To evaluate similarities and differences in orthodontists' and general dentists' perceptions regarding their interdisciplinary communication.

MATERIALS AND METHODS

Orthodontists (N  =  137) and general dentists (N  =  144) throughout the United States responded to an invitation to participate in a Web-based and mailed survey, respectively.

RESULTS

The results indicated that orthodontists communicated with general dentists using the type of media general dentists preferred to use. As treatment complexity increased, orthodontists shifted from one-way forms of communication (letters) to two-way forms of communication (phone calls; P < .05). Both orthodontists and general dentists reported that orthodontists' communication regarding white spot lesions was inadequate. When treating patients with missing or malformed teeth, orthodontists reported that they sought input from the general dentists at a higher rate than the general dentists reported (P < .005).

CONCLUSIONS

Orthodontists' and general dentists' perceptions of how often specific types of media were used for interdisciplinary communication were generally similar. They differed, however, with regard to how adequately orthodontists communicated with general dentists and how often orthodontists sought input from general dentists. The methods and extent of communication between orthodontists and general dentists need to be determined on a patient-by-patient basis.

Interproximal reduction of teeth: differences in perspective between orthodontists and dentists

OBJECTIVE

To determine if interproximal reduction of teeth (IPR) is perceived differently by orthodontists and general dentists.

MATERIALS AND METHODS

A Web-based survey containing statements about IPR was developed and randomly distributed to orthodontists and general dentists.

RESULTS

The majority of orthodontists and general dentists strongly agreed that IPR is a minimally invasive procedure that poses little risk for the development of interproximal decay. However, general dentists were more likely to perform post-IPR polishing and to apply topical fluoride than are orthodontists (P < .0001). A greater percentage of orthodontists strongly believed that the esthetic and occlusal benefits of IPR outweigh the potential risk of tooth decay when IPR was performed (P < .0001). A greater percentage of general dentists were hesitant to perform IPR, despite research supporting that IPR has little negative effect on the health of teeth.

CONCLUSIONS

The results of this study disproved the null hypothesis that orthodontists and general dentists share similar views regarding the use of IPR during orthodontic treatment. General dentists were more conservative in their views of IPR and were less comfortable with performing IPR as a routine procedure. General dentists felt more strongly about the importance of post-IPR polishing and application of topical fluoride. Orthodontists were more likely to have researched the long-term effects of IPR on the health of teeth and therefore felt more comfortable performing IPR during orthodontic treatment.

Evaluation of Flexural, Diametral Tensile, and Shear Bond Strength of Composite Repairs

Objective

Repairing composite restorations may be a more conservative treatment than replacing the entire restoration. The objective of this in vitro study was to determine the best repair method by measuring flexural, diametral tensile, and shear bond strength of repaired composites in which the surfaces were treated with chemical primers (Add & Bond or Silane Bond Enhancer), a bonding agent (Optibond Solo Plus [OBSP]), or mechanical retention with a bonding agent.

Methods

Filtek Supreme Ultra shade B1B was placed in special molds to fabricate specimens that served to test the flexural, diametral tensile, or shear strength of the inherent resin substrate. The same molds were modified to make specimens for testing repair strength of the resin. Repairs were made immediately or after aging in deionized water at 37°C for seven days. All repair sites were finished with coarse Sof-Lex discs to simulate finishing new restorations or partially removing aged restorations. Repair surfaces were treated with one of the following: 1) phosphoric-acid etching and OBSP; 2) Add & Bond; 3) phosphoric-acid etching, Silane Bond Enhancer, and OBSP; or 4) quarter round bur, phosphoric-acid etching, and OBSP. Specimens were placed back in the original molds to fabricate specimens for diametral tensile or flexural testing or in an Ultradent jig to make specimens for shear bond testing. Composite resin in shade B5B was polymerized against the treated surfaces to make repairs. Two negative control groups for the three testing methods consisted of specimens in which repairs were made immediately or after aging without any surface treatments. Controls and experimental repairs were aged (water 37°C, 24 hours) before flexural, diametral tensile, or shear testing in an Instron Universal testing machine at a crosshead speed of 0.5 mm/min.

Results

Experimental flexural repair strengths ranged from 26.4% to 88.6% of the inherent substrate strength. Diametral tensile repair strengths ranged from 40% to 80% of the inherent substrate strength, and shear bond strength repairs ranged from 56% to 102%. Geometric means were statistically analyzed with two-way analysis of variance on their log-transformed values. Significant differences were determined using Tukey honestly significant difference (p&lt;0.05).

Conclusions

Depending on the mechanical property being tested, surface treatments produced different results. OBSP produced more consistent results than chemical primers.

Relationship processes and resilience in children with incarcerated parents

Children with incarcerated parents are at risk for a variety of problematic outcomes, yet research has rarely examined protective factors or resilience processes that might mitigate such risk in this population. In this volume, we present findings from five new studies that focus on child- or family-level resilience processes in children with parents currently or recently incarcerated in jail or prison. In the first study, empathic responding is examined as a protective factor against aggressive peer relations for 210 elementary school age children of incarcerated parents. The second study further examines socially aggressive behaviors with peers, with a focus on teasing and bullying, in a sample of 61 children of incarcerated mothers. Emotion regulation is examined as a possible protective factor. The third study contrasts children's placement with maternal grandmothers versus other caregivers in a sample of 138 mothers incarcerated in a medium security state prison. The relation between a history of positive attachments between mothers and grandmothers and the current cocaregiving alliance are of particular interest. The fourth study examines coparenting communication in depth on the basis of observations of 13 families with young children whose mothers were recently released from jail. Finally, in the fifth study, the proximal impacts of a parent management training intervention on individual functioning and family relationships are investigated in a diverse sample of 359 imprisoned mothers and fathers. Taken together, these studies further our understanding of resilience processes in children of incarcerated parents and their families and set the groundwork for further research on child development and family resilience within the context of parental involvement in the criminal justice system.

Peracetic acid: a practical agent for sterilizing heat-labile polymeric tissue-engineering scaffolds

Advanced biomaterials and sophisticated processing technologies aim at fabricating tissue-engineering scaffolds that can predictably interact within a biological environment at the cellular level. Sterilization of such scaffolds is at the core of patient safety and is an important regulatory issue that needs to be addressed before clinical translation. In addition, it is crucial that meticulously engineered micro- and nano- structures are preserved after sterilization. Conventional sterilization methods involving heat, steam, and radiation are not compatible with engineered polymeric systems because of scaffold degradation and loss of architecture. Using electrospun scaffolds made from polycaprolactone, a low melting polymer, and employing spores of Bacillus atrophaeus as biological indicators, we compared ethylene oxide, autoclaving and 80% ethanol to a known chemical sterilant, peracetic acid (PAA), for their ability to sterilize as well as their effects on scaffold properties. PAA diluted in 20% ethanol to 1000 ppm or above sterilized electrospun scaffolds in 15 min at room temperature while maintaining nano-architecture and mechanical properties. Scaffolds treated with PAA at 5000 ppm were rendered hydrophilic, with contact angles reduced to 0°. Therefore, PAA can provide economical, rapid, and effective sterilization of heat-sensitive polymeric electrospun scaffolds that are used in tissue engineering.

An interprofessional educational approach to oral health care in the geriatric population

An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population.

Parents' preferences regarding appearance and attire of orthodontists

Objective:

To evaluate parents' preferences regarding the appearance and attire of orthodontists.

Materials and Methods:

Parents attending their child's first orthodontic appointment were asked to choose from among sets of photographs of potential orthodontic providers. Selected factors were varied within the sets, including sex and age of the provider as well as attire (casual, formal, white coat, or scrubs), hairstyle (loose or tied back for women, facial hair or clean shaven for men), and presence of a nametag.

Results:

A total of 77 parents participated. There were significant differences in choice of provider in terms of the provider's sex (P &lt; .0001), age (P  =  .0013), dress (P &lt; .0001), hair (P &lt; .0001), and nametag (P  =  .0065). There were no significant differences in preference attributable to parent characteristics (P &gt; .05).

Conclusion:

Parents of orthodontic patients demonstrated clear preferences for choosing a provider related to factors that are not within the control of the practitioner (sex and age) as well as factors that can be changed by the practitioner (attire, hairstyle, and wearing a nametag).

Influence of active reminders on oral hygiene compliance in orthodontic patients

OBJECTIVE

To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population.

MATERIALS AND METHODS

In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2).

RESULTS

BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2.

CONCLUSION

A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.

Factors affecting orthodontists' management of the retention phase

Objective:

To test the null hypothesis that orthodontist characteristics and factors related to retainer choice do not influence the management of the retention phase with regard to frequency and duration of follow-up care provided.

Materials and Methods:

Orthodontists (n  =  1000) were randomly selected to participate in an online survey divided into three categories: background, retainer choice, and time management.

Results:

Of the 1000 selected participants, 894 responded. When deciding the type of retainer to use, the following were considered most frequently: pretreatment malocclusion (91%), patient compliance (87%), patient oral hygiene (84%), and patients' desires (81%). Orthodontists who considered the presence of third molars (P  =  .03) or “special needs” patients (P  =  .02) had significantly more follow-up visits than those who did not. When vacuum-formed retainers (VFRs) were prescribed, there were significantly fewer visits (P  =  .02) compared to when other types of retainers were used. As practitioner experience increased, so did the number of visits (P &lt; .0001). Orthodontists who considered the primary responsibility of retention to fall on the patient had significantly fewer follow-up visits (P &lt; .0001) than those who considered it either a joint or orthodontist-only responsibility.

Conclusions:

The null hypothesis was rejected because the number of follow-up visits during the retention phase was affected by practitioner experience, whether VFRs were used, whether the orthodontist considered the presence of third molars or special-needs patients when choosing the type of retainer, and to whom the orthodontist attributed responsibility during the retention phase.

Evaluating dentin surface treatments for resin-modified glass ionomer restorative materials

This in vitro study evaluated the effect of six surface treatments on the shear bond strength of three resin-modified glass ionomers (RMGIs) to dentin. Occlusal surfaces of caries-free third molars were reduced to expose only dentin. Surface treatments were smear layer intact (negative control), Cavity Conditioner, EDTA, Ketac Primer, Self Conditioner, and etching with 35% phosphoric acid followed by the application of Optibond Solo Plus. Filtek Z250 composite resin bonded with Optibond Solo Plus served as a positive control. Conditioning agents were used according to the manufacturers' instructions. After surface treatments, Fuji II LC, Riva LC, Ketac Nano, and Filtek Z250 were placed in copper-band matrices 5 mm in diameter and 2 mm in height and were light-cured for 20 seconds. Specimens were stored in 100% humidity for 24 hours, after which they were placed in deionized water for 24 hours at 37°C. They were then tested under shear forces in an Instron Universal Testing Machine at a crosshead speed of 0.5 mm/min. A two-way analysis of variance and Tukey honestly significant difference statistical analyses (p<0.05) indicated significant interaction between RMGIs and conditioning agents. Acid etching followed by Optibond Solo Plus provided highest bond strengths for all three RMGIs, which were not statistically different from the positive control.

Self-ligating vs conventional brackets as perceived by orthodontists

OBJECTIVE

To determine if there are significant clinical differences between self-ligating brackets (SLB) and conventional brackets (CB) during orthodontic treatment, as perceived by orthodontists.

MATERIALS AND METHODS

A survey was developed and distributed to evaluate how SLB compare to CB in terms of orthodontists' perceptions (n  =  430).

RESULTS

SLB were preferred during the initial stage of treatment based on the shorter adjustment appointments and faster initial treatment progress they provided (P < .0001). On the other hand, practitioners preferred CB during the finishing and detailing stages of treatment (P < .0001). CB were also preferred over SLB because they were cheaper and resulted in fewer emergency appointments.

CONCLUSIONS

The orthodontists' preference was significantly influenced by (1) the proportion of patients treated with SLB (P < .0001), (2) the number of cases it took them to become accustomed to SLB (P < .0001), and (3) the average appointment intervals associated with SLB (P < .0001).

Sedation in adults receiving mechanical ventilation: physiological and comfort outcomes

OBJECTIVE

To describe the relationships among sedation, stability in physiological status, and comfort during a 24-hour period in patients receiving mechanical ventilation.

METHODS

Data from 169 patients monitored continuously for 24 hours were recorded at least every 12 seconds, including sedation levels, physiological status (heart rate, respiratory rate, oxygen saturation by pulse oximetry), and comfort (movement of arms and legs as measured by actigraphy). Generalized linear mixed-effect models were used to estimate the distribution of time spent at various heart and respiratory rates and oxygen saturation and actigraphy intervals overall and as a function of level of sedation and to compare the percentage of time in these intervals between the sedation states.

RESULTS

Patients were from various intensive care units: medical respiratory (52%), surgical trauma (35%), and cardiac surgery (13%). They spent 42% of the time in deep sedation, 38% in mild/moderate sedation, and 20% awake/alert. Distributions of physiological measures did not differ during levels of sedation (deep, mild/moderate, or awake/alert: heart rate, P = .44; respirations, P = .32; oxygen saturation, P = .51). Actigraphy findings differed with level of sedation (arm, P < .001; leg, P = .01), with less movement associated with greater levels of sedation, even though patients spent the vast majority of time with no arm movement or leg movement.

CONCLUSIONS

Level of sedation most likely does not affect the stability of physiological status but does have an effect on comfort.

Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists

INTRODUCTION

Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment.

METHODS

This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions.

RESULTS

All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05).

CONCLUSIONS

The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Perceptions of soft tissue laser use in orthodontics

OBJECTIVES

To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment.

MATERIALS AND METHODS

An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n  =  538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists' use of soft tissue lasers.

RESULTS

The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P < .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P < .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists.

CONCLUSIONS

Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.

A Within-Subject Normal-Mixture Model with Mixed-Effects for Analyzing Heart Rate Variability

Data on heart rate variability (HRV) have been used extensively to indirectly assess the autonomic control of the heart. The distributions of HRV measures, such as the RR-interval, are not necessarily normally distributed and current methodology does not typically incorporate this characteristic. In this article, a mixed-effects modeling approach under the assumption of a two-component normal-mixture distribution for the within-subject observations has been proposed. Estimation of the parameters of the model was performed through an application of the EM algorithm, which is different from the traditional EM application for the normal-mixture methods. An application of this method was illustrated and the results from a simulation study were discussed. Differences among other methods were also reviewed.

Infection with cytomegalovirus is not associated with premature mortality

Over 90% of the world’s population acquires a cytomegalovirus (CMV) infection. This infection, although asymptomatic or self-limiting, is a major burden to the immune system. For this reason, and because CMV immunization is possible, determining whether CMV can cause reduced longevity, particularly among those with coronary artery disease, is important and previous reports have been conflicting. Thus our objective was to assess the association between CMV infection as defined serologically and antibody levels against CMV and longterm survival (18 years). We completed a prospective observational cohort study of 915 consecutive patients (mean age 58 years) undergoing coronary angiography. CMV immunoglobulin levels were measured at baseline using either a whole cell CMV antigen or a purified protein antigen (gB). After adjustment for potentially confounding variables (age, race, gender, body mass index, the presence or absence of coronary artery disease, the number of diseased vessels, diabetes, renal disease, hypertension, dialysis, congestive heart failure, and the maximum percent reduction in luminal diameter), Cox’s proportional hazards models showed no association between CMV seropositivity or levels of antibodies against CMV by either assay and longevity for both patients with or without coronary artery disease (CAD) nor for those under or over 70 years of age at baseline. Our observations suggest that universal immunization against CMV may not improve longevity.

Infection with cytomegalovirus is not associated with premature mortality

Over 90% of the world's population acquires a cytomegalovirus (CMV) infection. This infection, although asymptomatic or self-limiting, is a major burden to the immune system. For this reason, and because CMV immunization is possible, determining whether CMV can cause reduced longevity, particularly among those with coronary artery disease, is important and previous reports have been conflicting. Thus our objective was to assess the association between CMV infection as defined serologically and antibody levels against CMV and long-term survival (18 years). We completed a prospective observational cohort study of 915 consecutive patients (mean age 58 years) undergoing coronary angiography. CMV immunoglobulin levels were measured at baseline using either a whole cell CMV antigen or a purified protein antigen (gB). After adjustment for potentially confounding variables (age, race, gender, body mass index, the presence or absence of coronary artery disease, the number of diseased vessels, diabetes, renal disease, hypertension, dialysis, congestive heart failure, and the maximum percent reduction in luminal diameter), Cox's proportional hazards models showed no association between CMV seropositivity or levels of antibodies against CMV by either assay and longevity for both patients with or without coronary artery disease (CAD) nor for those under or over 70 years of age at baseline. Our observations suggest that universal immunization against CMV may not improve longevity.

The role of volume of multi-surface restorations in posterior teeth: Treatment options

Teeth containing large defective restorations are frequently indicated to receive crowns to prevent catastrophic fracture. There is a considerable lack of consensus as to when the size of an existing restoration needing retreatment is sufficiently large to warrant a crown. In addition, the treating dentist's gender, age, and location also have been found to influence this decision. An in vitro method was developed to estimate a restoration's volume proportion (VP). This study validates and investigates correlations between the restoration's VP, the decision to indicate a crown, and the responding dentist's demographic information. The coronal portions of occlusal view and bitewing radiographic images of restored posterior teeth were traced to yield four surface areas used in estimating the restoration's VP. An online survey of 15 patients, including intraoral and radiographic images of defective restorations, was created. Dentists were invited to select treatment for each patient's tooth, with options including replacing the restoration only or indicating a crown. Analysis was accomplished using repeated-measures logistic regression. Of the 300 respondents, 17% were female and 14% were from outside the U.S. The relationship between a responding dentist indicating a crown and the restoration's VP, the tooth type (molar or premolar), and nationality (U.S. or foreign dentist) were all deemed statistically significant. Crowns were indicated for molars significantly more often than for premolars, with a significant VP interaction. The final model of tooth, VP, nationality, and the interaction of tooth and VP was used to generate mean predicted proportions for indicating a crown.

Actigraphy: analyzing patient movement

BACKGROUND

Actigraphic data during simulated participant movements were evaluated to differentiate among patient behavior states.

METHODS

Arm and leg actigraphic data were collected on 30 volunteers who simulated 3 behavioral states (calm, restless, agitated) for 10 minutes; counts of observed participant movements (head, torso, extremities) were documented.

RESULTS

The mean age of participants was 34.7 years, and 60% were female. Average movement was significantly different among the states (P < .0001; calm [mean = .48], restless [mean = 2.16], agitated [mean = 3.75]). Mean actigraphic measures were significantly different among states for both arm (P < .0001; calm [mean = 6.8], restless [mean = 28.5], agitated [mean = 52.6]) and leg (P < .0001; calm [mean = 3.5], restless [mean = 18.7], agitated [mean = 37.7]).

CONCLUSION

Distinct levels of behavioral states were successfully simulated. Actigraphic data can provide an objective indicator of patient activity over a variety of behavioral states, and these data may offer a standard for comparison among these states.