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The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment.Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale.A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006).Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

Objective: To interview health professionals in a Latino community about the association between diabetes and periodontitis, and provide a basis to develop interventions for them to promote oral health and good glycemic control among patients with diabetes. Methods: Five dentists, seven nurses and two nutritionists were interviewed about their practices relevant to oral health and diabetes, knowledge about the association, beliefs about Latinos, recommendations on reaching others in their fields, and barriers. The interviews were audiotaped, transcribed, and analyzed qualitatively. Results: Professionals identified policy, community and practice barriers for promoting diabetic control and oral health. Conclusions: Producing a resource list, cross-educating professionals about diabetes and oral health, training professionals to better serve Latino patients, developing appropriate protocols for each profession regarding the association between diabetes and periodontitis, and educating the community about diabetic control, oral health and disease prevention were identified as potential strategies to improve oral health among Latino persons with diabetes.

Objectives: A large study of risky pre-teen behavior provided an opportunity to examine self-reported toothbrushing frequency for stability over time and adequacy. Methods: 1115 metropolitan African-American children at risk for violence and drug use self-reported toothbrushing frequency in at least one of five measurement points from 5th to 8th grade as part of a larger study. Longitudinal data were available for 815 students. Results: 81% reported mainly twice daily, 8% reported mainly once daily, 10% changed over time, and 1% were consistently less than once daily. Conclusions: Overall, the children reported once or twice daily toothbrushing frequency, stable between 5th and 8th grades. A minority of children showed low or inconsistent frequencies and these results may provide an opportunity for intervention to improve habits.

To evaluate parental acceptance of provision of tobacco cessation and prevention education to children and parents by private practice pediatric dentists.Receptionists gave confidential questionnaires to parents of child dental patients in five private pediatric dentistry practices. Demographic information and questions about dentist interventions were asked, with the most intrusive questions concerning parental tobacco use.Ninety-four percent (234) of parents responded. Over 90 percent of parents favored dentists speaking to 1) the child on the dangers of tobacco use and the benefits of avoiding tobacco, 2) parents about the effects of tobacco use on their children, and 3) parents about cessation. Among tobacco-using parents, 76 percent favored interventions directed at child tobacco use and warnings about adult smoking and children, dropping to 59 percent favoring dentist provisions of cessation education to parents. Users were less approving than nonusers on both parental interventions (P=.001).Parents showed high acceptance of various levels of tobacco interventions by pediatric dentists in private practice. Tobacco users, however, were less accepting than nonusers. Pediatric dentists may be more willing to provide such messages with this information, but they may also need training to prepare themselves to handle negative reactions.

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

Background Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge. Methods Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption. Results Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) ( P Conclusion Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge. Practical Implications When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

To investigate factors affecting the internal brain drain of healthcare professionals in the Kingdom of Saudi Arabia.A cross-sectional study was conducted using an anonymous self-administered online questionnaire sent to all Saudi students enrolled in healthcare profession programs in North America. The data was collected between January and March 2008 at the University of Illinois at Chicago, Chicago, Illinois, United States of America. Results were analyzed using logistic regression analyses.A total of 377 completed questionnaires were returned. Results revealed that 71% of respondents intended to return to work within the 2 major urban cities Riyadh and Jeddah. Respondents who completed their undergraduate studies in a large city were more likely to work in the same city (odds ratio [OR]=3.2; p=0.000; 95% confidence interval [CI] = 2.0-5.2). Furthermore, 51% of the students were willing to work in a rural area for a 50% or more increase in their salary. Finally, men were more willing to work in a rural area for a financial incentive (OR=2.3; p=0.006, 95% CI = 1.3-4.3).This study suggests that realistic financial incentives would probably not suffice to attract Saudi healthcare providers to rural areas. The provision of medical schools in smaller cities and rural areas is predicted to be a more effective method for improving the current maldistribution of healthcare providers.

Early childhood caries is prevalent in the United States, especially among Hispanic children. One consequence may be premature loss of primary teeth, raising concern about developmental challenges. This study examined speech sound articulation errors association with premature loss of the primary maxillary incisors of bilingual children (Spanish/English).Hispanic children were assessed with a speech sound articulation test at 7 to 10 years of age against their history of primary maxillary anterior incisor loss. The exposed group (N =25) experienced premature extraction of these incisors, and the unexposed group (N =8) had normal dental exfoliation.The groups were similar regarding: age at speech assessment; gender; language spoken at home; socioeconomic status; caries prevalence; mean number of decayed, missing, filled and sealed teeth. Higher values for the dental articulation errors (P=.04) were revealed among exposed vs unexposed. Exposed boys had more total speech articulation errors (P=.03), dental-related errors (P=.048), and other errors (P=.04) than the unexposed boys, although of small sample size.Bilingual children who experienced early primary tooth loss exhibited differences in speech sound production vs those who did not. Further research is warranted to determine the extent early tooth loss in bilingual children predicts speech problems.

Case-based learning offers exposure to clinical situations that health professions students may not encounter in their training. The purposes of this study were to apply the Diffusion of Innovations conceptual framework to 1) identify characteristics of case studies that would increase their adoption among dental and dental hygiene faculty members and 2) develop and pretest interactive web-based case studies on sensitive oral-systemic health issues. The formative study spanned two phases using mixed methods (Phase 1: eight focus groups and four interviews; Phase 2: ten interviews and satisfaction surveys). Triangulation of quantitative and qualitative data revealed the following positive attributes of the developed case studies: relative advantage of active learning and modeling; compatibility with a variety of courses; observability of case-related knowledge and skills; independent learning; and modifiability for use with other oral-systemic health issues. These positive attributes are expected to increase the likelihood that dental and dental hygiene faculty members will adopt the developed case study once it is available for use. The themes identified in this study could be applied to the development of future case studies and may provide broader insight that might prove useful for exploring differences in case study use across dental and dental hygiene curricula.

The incorporation of web-based learning into the dental curriculum has been consistently recommended in the literature on reform in dental education. There has been growing support for web-based learning in dental and dental hygiene education as demonstrated by deans’ identifying this as a planned curricular innovation. The purpose of our study was to explore characteristics of e-courses that may serve to increase adoption among dental and dental hygiene faculty members. Eight ninety-minute focus groups (three dental; five dental hygiene) were conducted with dental (n=27) and dental hygiene (n=23) faculty members from six academic institutions. The resulting data were analyzed to identify two overarching themes and associated subthemes with regard to benefits and barriers influencing adoption of e-courses. A working conceptual framework, based on the Diffusion of Innovations, was developed from these themes to understand the characteristics that may influence the rate of adoption of e-courses among dental and dental hygiene faculty members. Analysis of the data revealed four main adoption barriers: 1) low perceived relative advantage to faculty members; 2) low compatibility with current curriculum; 3) high perceived time commitment; and 4) complexity of e-course development. This exploratory assessment identifies leverage points for facilitating the adoption and sustainability of e-courses in dental and dental hygiene education.

The purposes of this study were to: (1) determine the level of parental knowledge regarding initial trauma management; and (2) assess which factors could influence that level of knowledge.A self-administered questionnaire was given to parents of patients that attended 1 of 2 dental clinics. The questionnaire consisted of 3 parts and assessed patient and parental demographics and knowledge of dental trauma management.Four hundred sixty-seven questionnaires were completed. Most patients had Medicaid insurance (79%). Most parents would seek care from a dentist (71% broken tooth; 62% avulsed tooth). Only 31% knew that avulsed permanent teeth could be placed back into the socket, and only 25% of parents chose milk as a transport medium for avulsed teeth. A mere 3% of parents answered all 5 trauma management questions correctly, and 10% had no correct responses. The number of correct responses was not affected by clinic location, history of previous trauma, sex, education, or insurance status. Parents of recalled patients had more correct responses (P.05).Knowledge of dental trauma management was poor. The fact that parents of recalled patients were somewhat more knowledgeable suggests that the dental visit can be an effective vehicle for education. The management of dental trauma should be part of the dental health education provided at dental visits.

Although oral health care providers (OHP) are key in the secondary prevention of eating disorders (ED), the majority are not engaged in assessment, referral, and case management. This innovative pilot project developed and evaluated a web-based training program for dental and dental hygiene students and providers on the secondary prevention of ED. The intervention combined didactic and skill-based objectives to train OHP on ED and its oral health effects, OHP roles, skills in identifying the oral signs of ED, communication, treatment, and referral. Using a convenience sample of OHP (n=66), a pre-/post-test evaluated short-term outcomes and user satisfaction. Results revealed statistically significant improvements in self-efficacy (p

In this pilot study, we tested a new program for training medical care providers in the primary prevention and early detection of oral cancer. The training program consisted of two modules: (1) oral cancer epidemiology and head and neck examinations for the early detection of oral cancer and (2) assessment and counseling of patients in tobacco cessation. On a pretraining questionnaire, the 8 participating clinicians (3 primary care physicians, 4 ENT nurses, and 1 physician assistant) indicated that they had only a limited awareness of oral cancer, that they generally did not routinely examine asymptomatic patients for oral cancer, and that they engaged in only a limited amount of risk assessment/counseling with their patients. On a post-training questionnaire, they indicated that their training had been well received and would prompt them to increase their efforts to examine their patients for early signs of oral cancer and to counsel them about its risks.

The purpose of this study was to evaluate and compare intranasal (IN) and oral (PO) midazolam for effect on behavior, time of onset, maximum working time, efficacy, and safety for patients requiring dental care.Forty anxious subjects (20 IN, 20 PO, Frankl Scale 3 and 4, ages 2-6 years, ASA I and II) were sedated randomly with either IN (0.3 mg/kg) or PO (0.7 mg/kg) midazolam. The dental procedure under sedation was videotaped and rated by a blinded and calibrated evaluator using Houpt's behavior rating scale.There was no statistical difference for overall behavior (F3,27 = 0.407; P = .749). The planned contrasts showed significant interactions between time and route (IN vs PO) between 25 and 30 minutes after starting sedation. The time of onset (P = .000) and the working time (P = .007) were significantly different between IN and PO midazolam. There were no statistically significant differences in vital signs (O2 sat, HR, RR, BP) between PO and IN (P = .595). IN subjects showed more movement and less sleep toward the end of the dental procedures, and faster onset time but shorter working time than PO. Vital signs were stable throughout the procedures with no significant differences.Mean onset time was approximately 3 times faster with IN administration compared to PO administration. Mean working time was approximately 10 minutes longer with PO administration than it was with IN administration. Overall behavior under PO and IN was similar. However, more movement and less sleep were shown in subjects under IN than those under PO toward the end of the dental session. All vital signs were stable throughout the procedures and showed no significant differences between PO and IN administration.

A multicenter retrospective review of 172 epineural digital nerve repairs using microsurgical techniques was performed. A total of 71 men and 25 women ranged in age from 5 to 64 years (mean age, 33.3 years). Sharp injuries occurred in 55.6% of patients and mild crush occurred in 44.4%. Isolated nerve injuries occurred in only 24.6% of patients. The majority of digital nerve injuries involved other structures: flexor tendons (33.5%), tendons and fractures (9.0%), and fractures (4.2%). Replantations were performed in 18 digits (21.6%) and revascularizations in 7 digits (7.2%). Injury to repair was less than 1 day in 47.8%, 2 to 7 days in 22.6%, 8 to 30 days in 23.3%, and 31 to 300 days in 6.3%. Follow-up averaged 22.2 months (range, 6-77 months). The authors found a significant correlation between age and recovery of sensibility as measured by Weber's two-point discrimination test (p < 0.001). Patients older than 40 years demonstrated significantly poorer recovery of sensibility than patients younger than 40 years. A trend of better sensibility return was noted in the younger age decades (

Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists.The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week.The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P.001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment.The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment.Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.