Master of Science, The Ohio State University, 2008, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Dental Hygiene, The Ohio State University, 2021, Dental Hygiene

The administration of local anesthesia is an important focus in the field of dentistry, and its application has facilitated painless treatment among patients, allowing dental professionals to provide appropriate patient care. Current research related to the success and safety of local anesthesia application among registered dental hygienists, evidences its importance. However, there presents a lack of research related to the administration of local anesthetic among dental hygienists in different practice settings, as well as the utilization rate. The purpose of this study is to: identify the utilization rate of local anesthesia by dental hygienists and identify the reasoning associated with use or non-use of this skill. A quantitative, cross-sectional survey research design was used on a non-probability sample of dental hygienists practicing in the state of Ohio. The survey was designed with demographic questions, questions regarding use of local anesthesia, the non-use of local anesthesia, and attitudes related to local anesthesia application. The data evidenced that 95.7% reported having administered local anesthesia while licensed. Results further indicated that 93.5% reported that they like to administer local anesthesia. The findings from this study suggest that there is active utilization of local anesthesia among registered dental hygienists and that there is an appreciation for the skill. Additional research is recommended to explore the qualitative reasons for use and non-use of local anesthesia and the perceptions related to this skill, and to better understand the potential relationships among variables associated with the profession of dental hygiene and local anesthesia application.

Committee: Rachel Kearney BSDH, MS (Advisor); Joen Iannucci DDS, MS (Committee Member); Rebecca Henderson BSDH, MS (Committee Member) Subjects: Dental Care; Dentistry; Education

Master of Science, The Ohio State University, 2014, Dentistry

The purpose of this study was to investigate the perceived need, according to dental practitioners, for anesthesia providers in dentistry. This was accomplished through surveying a population of dental practitioners who currently practice within the State of Ohio. The data was used to evaluate the sectors of dentistry which may benefit the most from utilization of anesthesiology services. We found that the respondents to our survey felt there was a need for anesthesia services for their patient population. We measured perceived need for anesthesia services in two ways. “Practitioner Need” measured those dentists who either currently utilize the services of an anesthesia provider or would consider using the services of an anesthesia provider. “Patient Need” measured the frequency of those dentists who have patients who could benefit from dentistry performed while also receiving general anesthesia. We found that 46.1% of dentists had a “Practitoner Need”, and that 71.0% of dentists had a “Patient Need”. “Unmet Need”, measured by cross-referencing those dentists who did not intend to use an anesthesia provider with those dentists who felt they had patients who could benefit from anesthesia services, was found to be 34.4%. To better understand the needs of the dental community, we analyzed the responses with reference to the area of dentistry in which the respondents practiced. Our analysis showed that there is clearly a need for anesthesiology services to be provided to the dental community in the State of Ohio, and there seemed to be some reluctance among the general dental practitioners population to utilize the services of anesthesia providers. Dental practitioners themselves have recognized the need for anesthesia providers to aid in treating their patients, be they fearful, anxious, medically compromised, special needs, and/or “high maintenance”. Increased knowledge and awareness of the field of anesthesiology in dentistry must be a priority in (open full item for complete abstract)

Committee: Simon Prior BDS, MS, PhD (Advisor); Megann Smiley DMD, MS (Committee Member); William M. Johnston MS, PhD (Committee Member) Subjects: Dental Care; Dentistry

Master of Science, The Ohio State University, 2012, Dentistry

The aim of this study was to further investigate the need and demand for sedation and general anesthesia (GA) in the field of dentistry and to gain a better understanding of the feelings and attitudes patients have with regards to receiving dental care and the possibility of receiving adjunct anesthesia services in coordination with their dental treatment. This was accomplished through the surveying of 180 patients who presented for emergency dental care at the Ohio State University's and Indiana University's dental emergency clinics over a 2 month period. We found the incidence of respondents to our survey who reported being very afraid of dental treatment (16.9%) to be consistent with those found in other studies. We found that 48.6% of respondents reported delaying dental care on more than 5 occasions and 81% delaying care on more than 1 occasion. Two major factors responsible for this delay were cost (87.5%) and fear (48.8%). Those who were “very afraid” were significantly more likely to delay care on > 5 occasions (P=0.036) and of this same group, 76.7% were never offered sedation while 69% had never been offered GA as an adjunct to their dental care. We found that 55.2% of those described as “very afraid” were unaware that sedation or GA was available for their care, and that the inverse relationship comparing fear/anxiety levels to the knowledge/availability of anesthesia services was found to be statistically significant (P=0.038). Our results also showed that when respondents were asked if they were likely to choose sedation or GA in the future as a supplement to their dental treatment 83.4% of all respondents said yes, with 87% of those in the “somewhat fearful/very fearful” category indicating yes. Interestingly 76.8% of those in the “not at all afraid” category indicated that they would like to receive sedation or GA for future dental care. 63% of those patients likely to choose some form of adjunct anesthesia for their future treatment stated general (open full item for complete abstract)

Committee: Simon Prior BDS PhD MS (Advisor); Megann Smiley DMD (Committee Member); Robert Rashid DDS (Committee Member) Subjects: Dental Care; Dentistry

Master of Science, The Ohio State University, 1969, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2008, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2006, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2008, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2005, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2007, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 2024, Dentistry

Introduction: Previous studies on intraosseous (IO) injections have shown high success rates in providing anesthesia in cases of symptomatic irreversible pulpitis. TuttleNumbNow (TNN) is a local anesthesia technique with no published studies investigating its use in patients with symptomatic irreversible pulpitis. Thus, the purpose of this study is to determine the anesthetic efficacy of the TNN technique as a supplemental intraosseous injection in mandibular teeth diagnosed with irreversible pulpitis. Methods and Materials: In this clinical, prospective study, fifty-five emergency patients diagnosed with symptomatic irreversible pulpitis in a mandibular posterior tooth received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The TNN technique was used to administer 1.8 mL of 4% articaine with 1:100,000 epinephrine. Success of the TNN technique was defined as none-to-mild pain upon endodontic access or initial instrumentation. When the TNN technique failed, 1.8 mL of 4% articaine with 1:100,000 epinephrine was delivered via the X-tip intraosseous system. The Heft-Parker VAS Scale was used to record patients' pain throughout the phases of each injection and the stages of endodontic access. Results: The TNN technique achieved anesthetic success in 28% (12/43) of subjects with a mean injection pain of 30 mm (mild) on the VAS. In cases of TNN technique failure, the X-tip achieved anesthetic success in 57% (17/30) of subjects with a mean injection pain of 54 mm (moderate) on the VAS. The X-tip showed a cumulative success rate of 75%. The X-tip (73%) showed a higher proportion of success than TNN (35%) in mandibular first molars. Conclusion: The TNN technique is not advocated as a supplemental injection for posterior mandibular teeth with symptomatic irreversible pulpitis. Further studies with a larger sample size should be conducted to determine the TNN technique's value as a supplemental injection in endodontics.

Committee: Sara Fowler (Advisor); John Nusstein (Committee Member); Melissa Drum (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2022, Dentistry

Purpose: To evaluate resident performance and self-efficacy in moderate sedation skills through different simulation styles as part of an advanced dental education program. Methods: Simulation exercises for informed consent via standardized patients and emergency management via mannequins were integrated into the resident sedation curriculum. Resident performance was evaluated quantitatively by a standardized grading rubric completed by an attending faculty and qualitatively through reflection exercises. Resident self-efficacy was measured via pre- and post-simulation questionnaires. Descriptive and non-parametric statistics were calculated. Results: Twenty-five residents completed three simulations. Second year residents performed better than first year residents in both informed consent and emergency simulations; however, the difference was only statistically significant for the informed consent simulation (p<.02). Self-efficacy significantly increased after completing the simulations for all residents (18% strongly agreed with self-efficacy statements pre-simulation versus 42.7% post-simulation, p<.0001). Overall, 69.5% strongly agreed that the simulations were helpful. The qualitative analysis of reflections revealed that residents felt prepared with the technical elements of informed consent, but not as much for emergency management. Residents identified communication skills as an area of improvement in both simulation formats. For emergency management, residents felt that improvement was needed in knowledge, problem-solving skills, and teamwork. Conclusions: Simulations were effective at improving self-efficacy in emergency management and informed consent. While self-efficacy increased, residents approaching graduation still felt unprepared in many facets of managing a sedation-related emergency. Simulation training can address these deficits, but best practices in terms of simulation style, frequency, and (open full item for complete abstract)

Committee: Beau Meyer (Advisor); Kimberly Hammersmith (Committee Member); Janice Townsend (Committee Member) Subjects: Dentistry; Education

Master of Science, The Ohio State University, 2022, Dentistry

Providing sedation and anesthesia in dentistry is an important treatment adjunct that greatly increases the number of patients who are available to receive dental and oral care comfortably and safely. For over fifty years dentists have been training in anesthesiology and in March 2019 the American Dental Association recognized dental anesthesiology as the 10th dental specialty. As the demand for anesthesia for dental procedures increases, the number of dentists providing sedation in their offices and training in anesthesia is growing as well. However, it is unclear if the teaching standards in dental schools are changing and adequately training future dentists in this field. This survey was designed to determine whether current fourth year dental students are learning about sedation and anesthesia in their predoctoral training. Fourth year students attending a dental school with an anesthesia residency were compared to those attending dental schools without anesthesia programs. The findings showed that dental students in schools without an anesthesia residency were significantly less likely to have heard about the specialty and were less likely to work with a dentist anesthesiologist in the future. Dental schools should consider teaching their predoctoral students about the many methods of providing safe sedation and the specialty of anesthesiology to make available valuable dental care to more patients.

Committee: Kelly Kennedy (Advisor); Mark Wenzel (Committee Member); William Johnston (Committee Member) Subjects: Dentistry; Education; Health Care

Master of Science, The Ohio State University, 2021, Dentistry

Purpose: The primary aim of this study was to identify treatment planning factors associated with higher odds of repeat dental treatment under general anesthesia (GA) among young children (aged 0-48 months). The secondary objective of this study was to characterize and compare patient variables (caries pattern, social determinants of health, and demographics) of children with and without repeat GA. Methods: Healthy children (ages 0-48 months) receiving dental treatment under general anesthesia between November 2011 and December 2016 were identified. Children who received repeat dental treatment under general anesthesia within 48 months of their first dental surgery (cases) were matched with children who did not have repeat general anesthesia for dental treatment (controls). Demographic information, social determinants of health markers, and intraoperative data from the initial dental surgery (GA1) were collected using the hospital's integrated electronic health record. Chi-squared tests were used to find differences in demographic and social determinants of health data. Wilcoxon rank sum tests were used to analyze the distribution of caries and treatment in each group and for each tooth type. Logistic regression models were used to find associations between repeat dental surgery (GA2) and treatment types. Results: 152 cases were identified and matched to 304 controls. The mean (standard deviation) age at GA1 was 31 months (8) for cases and 36 months (7) for controls (P < .0001). 57.9% of cases and 53% of controls were male (P = .32). The mean time elapsed between GA1 and GA2 in cases was 27 months. Cases tended to be more white (54.6%) compared to controls (30.6%) (P < .0001). Seventy-five percent of cases spoke English, compared to 54.6% of controls (P < .0001). Significant associations between GA2 and full coverage treatment on primary first molars (P = .04; OR 0.6 (95% CI 0.3, 0.9)), and primary second molars (P = .02; OR 0.2 (95% CI 0.02, 0.5)) were found. (open full item for complete abstract)

Committee: Ehsan Azadani (Advisor); Paul Casamassimo (Committee Member); Kim Hammersmith (Committee Member); Janice Townsend (Committee Member); Ashok Kumar (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2020, Dentistry

Significant barriers to care impact special populations in dentistry. Patients in this population requiring general anesthesia for dental treatment often face long hospital wait lists and providers unable to treat them. Office-based anesthesia provided by dentist-anesthesiologists offers as a safe solution to help address the access to care issues faced by these patients. Because the regulatory landscape has been shaped by a mix of safety and external non-safety related factors, much variation exists between states for the regulation of office-based anesthesia in dentistry. These variations may affect the availability of dentist-anesthesiologists to help treat special populations in the office-based environment. The purpose of this study is to describe the perceptions of North American Dentist-Anesthesiologists regarding specific regulations on access to care and safety as well as the influence of the regulatory environment when providing general anesthesia services to dentists in an office-based environment. It was also sought to identify and analyze the differences in perceptions and practice characteristics of mobile and fixed-facility dentist-anesthesiologists. Lastly, it was desired to gain insight regarding the effect of regulations on the distribution of dentist-anesthesiologists across the country. An online questionnaire-based survey was distributed to active members of the American Society of Dentist Anesthesiologists at its 2019 annual conference. The results of valid surveys (n=46) were summarized with descriptive statistics. Fisher's Exact Tests were also used to describe mobile (n=30) and fixed-facility (n=16) Dentist-Anesthesiologist differences. Dentist-Anesthesiologist demographic data from the survey sample closely approximated that of previous studies. Generally, the opinions of dentist-anesthesiologists regarding the regulations were homogenous. An inverse relationship was generally seen between the perception of regulations' effect on s (open full item for complete abstract)

Committee: Bryant Cornelius DDS, MBA, MPH (Advisor); John Draper PhD (Committee Member); Canise Bean DMD, MPH (Committee Member); Courtney Jatana DDS, MS (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2019, Dentistry

Purpose: To assess the level of understanding of Spanish-speaking caregivers consenting to dental care under general anesthesia (DGA) utilizing two different consent-delivery pathways. Methods: Seventy-eight parents of children who never had GA for dental treatment were recruited. Participants were randomly assigned to one of two groups: 1) Interpreter, or 2) Video. Parents then completed an eight-question survey to evaluate comfort level with GA and comprehension of areas required for informed consent. Data was analyzed using Fisher's Exact Test and Pearson's Chi Squared test. Results: A high percentage of parents in both groups understood risks associated with GA (89% interpreter group vs 90% video group). Families in both groups had difficulty understanding indications for DGA (64% interpreter group vs. 60% video group) and expectation of post-operative pain (50% interpreter vs. 55% video group). All parents in both groups understood if their child has been sick recently, they should tell the dentist before their appointment. Overall, 97% of participants believed they sufficiently understood the information presented about DGA. The mean score for comfort level with GA was 7.03 for the interpreter group and 6.82 for the video group (Range 1-10). Conclusions: Differences between consent pathways were not significantly different for risk understanding, importance of pre-operative illness, and acquisition of consent-related knowledge.

Committee: Paul Casamassimo (Advisor); Homa Amini (Committee Member); Dennis McTigue (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2018, Dentistry

Introduction: It is common practice during surgical removal of wisdom teeth to administer local anesthetics to the surgical site.1 This serves to reduce the required depth of general anesthesia or sedation required during the operation, and to offer postoperative pain control. Lidocaine is the most commonly used local anesthetic for dental procedures.2 Ropivacaine is a longer acting local anesthetic,6 but it is infrequently used in the dental setting. They are both safe and effective, especially in the low doses used in dentistry. This study aims to compare post-operative pain and patient preference in subjects undergoing extraction of two mandibular third molars using 2% lidocaine with 1:100,000 epinephrine or 0.75% ropivacaine. Materials and Methods: All patients received 2mcg/kg of IV fentanyl. Patients requiring moderate sedation received 2mg boluses of IV midazolam as needed. Patients requiring general anesthesia received 2mg/kg of IV propofol, and 1mg/kg of IV succinylcholine if they were intubated. General anesthesia was maintained with either propofol or sevoflurane. Patients then received a 3 mL injection of 2% lidocaine with epinephrine on one mandibular side and 3 mL of 0.75% ropivacaine on the opposite side according to randomly assigned groups. The extractions were performed by the surgeon. The patients' post-operative pain was scored for each side of the mouth from 0 to 10 (0 being no pain, 10 being the worst pain) in PACU, at 6 hours post-procedure, and the morning after. A preferred side was also recorded at 6 hours post-procedure and the morning after the procedure. Results: The mean pain score in PACU for the lidocaine side was 1.07, and for the ropivacaine side was 1.13. The mean pain score at hour 6 for the lidocaine side was 3.15, and for the ropivacaine side was 2.42. The mean pain score the morning after the procedure for the lidocaine side was 2.73, and for the ropivacaine side was 2.38. There was a significant difference overall in p (open full item for complete abstract)

Committee: Bryant Cornelius (Advisor); Courtney Jatana (Committee Member); William Johnston (Committee Member); Hany Emam (Committee Member) Subjects: Dentistry