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

Enamel defects in primary teeth predispose children to early childhood caries and are often not detected nor intervened upon until damage from caries has occurred. In this study, we utilized a novel imaging device, the ProScope digital microscope, to assess the enamel quality in vivo of young children ages 9 months -3 years. We also used a parental survey and medical record review to elucidate factors leading to defects in our population. Based on clinical exam, patients were separated into intact and defective enamel groups. The final sample included 45 children with intact enamel and 30 children with enamel defects. ProScope images were captured with a 100x lens during the exam and were later assessed based on the modified Developmental Defects of Enamel index by five raters. We found that children in the defective enamel group had higher dft scores of 1.34 vs. 0.29 (p=0.008), more caregivers who smoke in the home at 50% vs. 26.7% (p=0.04), and more parents reporting soft teeth in their children at 33% vs. 6.7% (p=0.003). The ProScope, when compared to the gold standard of visual clinical exam for detecting enamel defects, had a sensitivity of 82.7% and specificity of 77.3%. We found an inter-rater reliability of 0.438 among the five raters. We concluded that enamel defects in primary teeth might be the missing link between maternal smoking and offspring caries rates as reported in previous studies. Additionally, children with enamel defects and children identified by their parents as having soft teeth had a higher risk of dental caries, and therefore those children should receive increased preventive care and counseling. The ProScope was useful for evaluating enamel defects, but might be best suited for serial evaluation of enamel defects and incipient carious lesions to document progression over time in the same patient.

Committee: Ann Griffen DDS, MS (Advisor); Paul Casamassimo DDS, MS (Committee Member); Robert Rashid DDS (Committee Member) Subjects: Dentistry; Health Care

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

Committee: Not Provided (Other) Subjects:

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

Purpose: To evaluate and compare the vertical gap between the milled titanium framework obtained from different impression techniques, and the abutment replica of the patient model. Materials and Methods: Four implant Simulated Patient Model was duplicated from a demonstration resin model. The implant impression of the edentulous arch was obtained using 6 techniques: Conventional splinted Open-Custom tray impression and digitized using scan bodies and bench top scanner (CNV), Intraoral scanning using manufacturer scan bodies (IOS), Intraoral scanning using Optisplint (JIGI), Benchtop scanning of the assembled Optiplint after pouring in type IV stone (JIGE), Photogrammetry using ICAM (DOM), Photogrammetry using MicronMapper (SB). N=6 for all groups. CAD/CAM titanium bar was designed directly to the MUA from all the scans (N=36) using 5 axis milling machine. Modified one-screw test was used to evaluate the fit of the bar to the Simulated Patient Model, and the gaps were measured using Nikon Measurescope MM- 1. A Pairwise analysis between the gap measurements for 6 measuring sites in 6 groups was established by performing 2-way ANOVA and post hoc Tukey test. Results: The result of the 2-way ANOVA showed that the technique and the location significantly influenced the gap size. A14 wa not consistently the largest gap among the groups. The pairwise analysis showed that CNV, DOM, and JIGE were clinically acceptable with no significant difference between the gap size. JIGE had the smallest gap size, IOS had the widest gap size. JIGI improved the quality of intraoral scanning. DOM had smaller gap size compared to SB, JIGE had significantly smaller gaps when compared to JIGI. Conclusions: Utilizing the 1-screw test did not consistently reveal the largest gap at the distal-most site. Intraoral scanning of full arch implant prosthetics using regular scan bodies consistently produced the largest measured gaps. Photogrammetry and benchtop scanning of scannable verificat (open full item for complete abstract)

Committee: Robert Seghi (Advisor); Damian Lee (Committee Member); Scott Schricker (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2023, Dentistry

Purpose: The aim of this pre-post design study was to determine the usability and feasibility of a virtual simulation-based learning experience to educate pediatric dental providers regarding human papilloma virus (HPV) and the HPV vaccine. Methods: Sixteen residents at one pediatric dental residency program were recruited. All residents completed a pre-simulation survey to assess their baseline knowledge, skills, and attitudes toward discussing HPV with patients. Participants then completed a telehealth standardized patient encounter where they were tasked with discussing HPV and the HPV vaccine with a teenage patient and their parent. All participants then completed an online learning experience. Following this exercise, participants repeated the same standardized patient encounter and then completed a post-simulation survey to assess changes from baseline. Results: There was a significant difference between pre and post survey responses for eight of eleven questions (p<0.05) and pre and post standardized patient encounter performance for two of twelve vaccine discussion elements (p<0.05). Participants reported increased knowledge regarding discussing HPV and its connection to overall and oral health, as well as increased confidence in discussing common side effects and safety of the vaccine. Participants showed improved performance in communicating the safety and efficacy of the vaccine as well as sharing age-based dosing recommendations. Most participants reported the simulation equipped them with new knowledge and that they plan on applying at least one new thing they learned into their future clinical practice. Conclusions: Standardized patient encounters and virtual learning experiences are an accessible and effective way to increase knowledge regarding HPV and the HPV vaccine that exists among dental trainees and help dental providers feel confident aligning their recommendation for the HPV vaccine with the guidelines set by dental professional organizations (open full item for complete abstract)

Committee: Homa Amini DDS, MPH, MS (Advisor); Janice Townsend DDS, MS (Committee Member); Erin Gross DDS, PhD, MS (Committee Member) Subjects: Dentistry; Education; Health Education

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

Purpose: We know little about what adolescents, pregnant or not, think about oral health care. We know little about barriers that pregnant adolescents face with oral health care. Our purpose was to evaluate knowledge, attitudes, and current practices regarding dental care and oral health in pregnant and non-pregnant adolescents and young adults as well as barriers to care during pregnancy. Methods: Between November 2020 and March 2021, surveys were distributed to pregnant patients in a teen pregnancy clinic and males and females in a primary care clinic. The 18-question survey asked about personal dental health and dental care during pregnancy. Analysis was done using chi-square and Fisher's exact tests, with statistical significance at p<0.05. Results: There were 215 total respondents; 196 were female, and 31% were pregnant. Almost half were Black or African-American, 70% had Medicaid or public insurance, and 75% went to the dentist annually or twice annually for check-ups. Only 1% indicated that pregnant females should never go to the dentist. The majority of pregnant respondents had not been to the dentist while pregnant, and less than 5% had been in the six months prior to pregnancy. Conclusions: Dental care during pregnancy is underutilized, consistent with other studies. Reported barriers to dental care were providers' refusal of treatment due to respondent's pregnancy status, low priority, safety concerns, lack of time, and finances. Results suggest the need for improved knowledge for not just pregnant females to know that it is safe to get dental care, but for healthcare providers as well so pregnant women are not refused care.

Committee: Kim Hammersmith (Advisor); Homa Amini (Committee Member); Paul Casamassimo (Committee Member) Subjects: Dental Care; Dentistry

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

Purpose: To investigate opioid prescription fill patterns following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric Medicaid accountable care. Patients aged ≤ 18 who had a dental procedure during 1/2012-2/2019 were identified and claims were searched to identify opioid prescription fills within 14 days post-procedure. Results: Overall, 512,922 encounters were included. The overall opioid prescription fill rate was 4.9%. Rates decreased throughout the study from 6.1% (95% CI: 5.9-6.3) in 2012 to 3.4% (3.1-3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill rate fell from 15.7% (15.2-16.1) in 2012 to 9.5% (8.5-10.4) in early 2019. The most common opioids were hydrocodone (68.6%) then codeine (24.7%) with marked annual reductions in codeine prescription fills among children <14. In 2017-2018, surgical extractions (risk difference (RD): 40.7; 95% CI: 38.6-42.9) and older patient age (RD for 18 year-olds: 21.9; 19.8-24.0) were strong risk factors for filling an opioid prescription. Conclusions: Post-procedure opioid prescription fill rates have decreased significantly since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in likelihood of filling a prescription remain by procedural and demographic variables.

Committee: Janice Townsend DDS, MS (Advisor); Yuri Sebastião PhD, MPH (Committee Member); Homa Amini DDS, MS (Committee Member); Ashok Kumar DDS, MS (Committee Member) Subjects: Dental Care; Dentistry

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

Statement of problem. While the accuracy of digital implant impressions in single unit and short span situations has been demonstrated, the effect of various scan bodies and scan techniques on the accuracy and scan time in completely edentulous situations is not well understood. Purpose. The purpose of this study was to evaluate the effects of 4 different scanning techniques and 5 different commercially available intraoral scan bodies on the trueness (distance and angular deviation), precision (variance amongst the scans) and scan time in a completely edentulous situation with 4 implants. Materials and Methods. Five different intraoral scan body systems were evaluated: AF ( IO-Flo, Atlantis Denstply Implants), NT (Nt-Trading GmbH & Co. KG), DE (Dess-USA), C3D (Core3Dcentres NA), and ZI (Zimmer Biomet Dental), and 4 different scanning techniques were evaluated: unmodified master model (NO), glass fiduciary markers placed on the edentulous ridge (GB), pressure indicating paste brushed over the ridge and palate (PP), and floss tied between the scan bodies (FL). Five identical polyurethane edentulous maxillary models with 4 parallel dental implant analogs (TSV 4.1, Zimmer Biomet Dental) in the first molar and canine positions. The scan bodies were attached to the models and the entire surface was scanned using a calibrated structured blue light industrial scanner (Carl Zeiss Optotechnik GmbH) to generate a master reference model. Five consecutive digital impressions were made of the model using an intraoral scanner (Trios, 3Shape A/S) and 1 of the 4 techniques (n=5) assigned at random. The test scans were superimposed over the master reference model using a best fit algorithm, and then the distance deviation and angular deviation of the scan bodies was calculated. Scan time was also recorded. A two-factor ANOVA was used to examine the effect of scan body and technique on the trueness and on scan time, with subsequent Tukey or Bonferroni-corrected Student's t-tes (open full item for complete abstract)

Committee: Burak Yilmaz DDS, PhD (Advisor); Edwin McGlumphy DDS, MS (Committee Member); Jeremy Seidt PhD (Committee Member); William Johnston MS, PhD (Committee Member) Subjects: Dentistry

Master of Science, The Ohio State University, 2015, Dentistry

The objective of this study was to complete a retrospective chart review to determine the effectiveness and complications of different oral and nasal conscious sedation regimens used at Nationwide Children's Hospital (NCH) in the pediatric dental population. The most common regimens used at NCH; oral midazolam, nasal midazolam, and other midazolam combinations;were evaluated to determine their association with the outcome measures of effectiveness, patient behavior, work completed, and complications. In addition, the study sought to find any associations that exist between variables from the patients; medical history and pre-sedation physical exam and the outcome, intra-operative, and post-operative morbidity of the sedation. Retrospective data was obtained from the electronic medical record used at NCH (Epic) for of all patients seen for dental sedation between the years of 2012-2014 and from a post-sedation quality assurance survey (QAS) that is given to all parents following sedations. Data was available for a total of 701 sedation appointments. Practitioner rating of effectiveness for all sedation regimens combined is as follows: Effective (54.11%), somewhat effective (28.89%), ineffective (16.57%), and overly sedated (0.44%). Oral midazolam was the regimen most often rated as either effective or somewhat effective (88.8%). Most components of the medical history and physical examination were not significantly associated with sedation outcome or complications. However, increased weight of the patient and obesity both were significantly associated with lower dosages given of both oral and nasal midazolam. This study showed that practitioners rate the majority of oral and nasal sedation appointments as effective for the most common sedation regimens used at NCH. This suggests that conscious sedation is a useful clinical adjunct for patients who require advanced behavior guidance techniques.

Committee: Homa Amini (Advisor) Subjects: Dental Care; Dentistry

Master of Science, The Ohio State University, 2010, Dentistry

Purpose: The purpose of this study was to determine whether full-mouth rehabilitation of children with severe early childhood caries (S-ECC) had any impact on parental stress as measured by the Parenting Stress Index (PSI). Methods: This IRB-approved longitudinal case control study consisted of a cohort examined at the Nationwide Children's Hospital Dental Surgery Center (DSC). Children were required to have a minimum of 6 carious teeth for inclusion. Patients were treated under general anesthesia for S-ECC. The primary caregiver completed the PSI and demographic information. Patients were scheduled for a recall visit 1-3 months later with standardized study personnel. Caregivers re-accomplished the PSI. Continuous variables were analyzed using the Student's t-test. Results: Forty parent-child dyads completed the initial and 3 month recall visits for pilot data. Mean age of children was 43 months (±12.5). Mean caregiver age was 27.4 years (±8.3). Children presented with a mean of 9.6 carious teeth ((±3.4). Treatment of S-ECC did not significantly impact parental stress (p=0.426) or total family stress (p=.237). There were small but significant changes in three subscales within the Child Domain: Adaptability (p=0.034), Reinforces Parent (p=0.039), and Mood (p=0.038). Conclusions: Parental stress levels, as measured by the PSI, are not significantly altered by treatment of S-ECC under general anesthesia.

Committee: Sarat Thikkurissy DDS, MS (Advisor); Henry Fields DDS, MS (Committee Member); Dennis McTigue DDS, MS, MSD (Committee Member) Subjects: Dental Care; Families and Family Life; Health; Health Care; Psychological Tests

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

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1975, 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, 1971, 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, 1971, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1968, 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, 1966, Graduate School

Committee: Not Provided (Other) Subjects:

Master of Science, The Ohio State University, 1970, Graduate School

Committee: Not Provided (Other) Subjects: