Retrospective Study of Prenatal and Postnatal Gaps in Oral Health Care Utilization: Medicaid Policy Implications.

OBJECTIVE: To assess the frequency and timing of dental treatment completion among pregnant and post-partum women served through the University of North Carolina at Chapel Hill (UNC-CH) Prenatal Oral Health Program (pOHP) dental clinic in the context of North Carolina (NC) dental Medicaid policies. METHODS: We completed a retrospective chart review of pregnant women referred to the program between May 2015 and May 2019. Data were collected from the time of referral until up to 2 years after their estimated due date (EDD). We assessed pre- and post-delivery dental appointment timing and dental treatment completion. RESULTS: The initial study population included 264 pregnant women. Overall, 213 patients (81%) attended at least one appointment, and 32 patients (12%) completed recommended treatments prior to their EDD. Fifty patients (19%) returned after delivery to resume dental care, with only 25 patients (10%) completing their recommended treatment plan. Women re-entered dental care at a median of 67 days (range 5-613 days) after their EDD and completed treatment at a median of 378 days (range 52-730 days) following delivery. CONCLUSIONS FOR PRACTICE: Despite dental clinic referral, most pregnant women do not complete recommended dental treatment before giving birth, and women who resumed dental care after birth demonstrated a lag-time between delivery and care completion. These findings highlight the need for extending post-pregnancy dental care coverage, which is limited under current dental Medicaid policies, posing a major public health issue for new mothers to continue oral health care.

Orthognathic speech pathology: impacts of Class III malocclusion on speech.

INTRODUCTION: Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS: To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS: A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS: Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Assessing students' mental health in two American dental hygiene programs.

OBJECTIVES: Dental hygiene students adapt to new environments while learning technical skills and providing clinical care during their education. Understanding how stress affects students in their professional healthcare program warrants exploration. This study assessed stress among dental hygiene students in two educational settings in the Southeastern United States. METHODS: First and second-year dental hygiene students (N = 136) from a community college setting (n = 67) and a university setting (n = 69) were invited to complete an anonymous online survey on mental health in fall 2019. Validated surveys on depression, anxiety, social support, and burnout were included. Data analysis included chi-squared and Mantel-Haenszel statistics, depending on the scale of measurement, with the level of significance set at 0.05 for all analyses. RESULTS: Participants included 54 dental hygiene students from a community college (Response rate = 80.6%) and 69 dental hygiene students from a university (RR = 100%). There was a statistically significant difference in the proportion of students reporting moderately severe or severe anxiety (p = 0.007), with 56% (n = 30) of the community college respondents and 36% (n = 24) of the university reporting these anxiety levels. Students attending a community college were also more likely to express feelings of worry (n = 34) compared to students in a university setting (p = 0.005). There was no statistically significant difference in depression (p = 0.07) or suicidal thoughts (p = 0.41). CONCLUSION: Dental hygiene students enrolled in these two programs reported high levels of self-reported stress, mental and emotional concerns that may increase suicidal tendencies.

Modified Carnoy's Compared to Carnoy's Solution Is Equally Effective in Preventing Recurrence of Odontogenic Keratocysts.

PURPOSE: Carnoy's solution (CS), the gold standard for adjunctive chemical cautery in treatment of odontogenic keratocysts (OKCs), has been banned for 7 years, leading to substitution with the non-chloroform containing modified Carnoy's solution (MC) without data to support its effectiveness. We performed this study to compare the earlier data with CS to the more current outcomes with MC. METHODS: A retrospective cohort study was conducted on patients diagnosed with OKC and treated by a single surgeon (GHB) with enucleation and curettage (EC), peripheral ostectomy, and application of CS or MC. The primary predictor variables were use of CS or MC. The primary outcome variables were recurrence (yes vs. no) and time to recurrence. Secondary variables included demographics, anatomic location, and whether teeth adjacent to the lesion were extracted. Statistical analyses included chi-squared test/Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curves. RESULTS: 77 patients, 36 patients in the CS group and 41 in the MC group, met inclusion criteria, including at least 1 year of follow-up time. Characteristics of the groups were similar: median age 41.5 and 46, 61% and 71% male gender, 81% and 90% posterior, and 64% and 50% mandibular lesions, respectively. Overall recurrence was similar, 14.29%, with 5 (13.9%) recurrences in the CS group and 6 (14.6%) in the MC group (P = 0.92). Median time to recurrence was 24 months for both groups. Preserving adjacent teeth was associated with a significant increase in recurrence (P = 0.0036). CONCLUSION: Based on this comparison of retrospective outcome data, we found no significant difference in recurrence rate or distribution of time to recurrence between OKCs treated with CS or MC. Aggressiveness of surgical technique is likely a predictive factor in recurrence rate. Future studies should focus on prospective studies and continuing follow-up of the MC group.

Diagnostic accuracy of intraoral photographic orthodontic records.

OBJECTIVE: The aims of this study were (1) to investigate how relevant intraoral photographs are to contemporary orthodontic diagnosis and (2) to assess orthodontists' ability to accurately diagnose angle classification and dental midlines using standardized intraoral photographs. METHODS: Study participants were orthodontists who completed a survey regarding photography protocols and their use of intraoral photographs for diagnosis. Each participant was randomized to complete 1 visual diagnostic task regarding either angle classification or midlines. Accuracy was compared across groups and camera angulations. RESULTS: In all, 80% of 192 respondents reported using photographs and clinic notes to plan orthodontic treatment; 50% also included dental casts. For the angle task, accuracy judging molar and canine classification was 79.9% and 51.3%, respectively with ideal standardized photographs. As camera angulation deviated, accuracy decreased significantly (P < 0.0001). For the midline task, accuracy judging the direction of deviation decreased with a small camera angulation change yet increased with a large change (P < 0.001). CONCLUSIONS: When using ideal intraoral photographs alone to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to significantly decrease. CLINICAL SIGNIFICANCE: For the clinician who wants to have the most accurate and complete records, our results suggest that intra-oral photos alone may not be adequate when it comes to judging occlusal relationships such as angle classification and esthetic parameters like midlines. When using ideal intraoral photographs to diagnose angle classification and midline relationships, accuracy is not likely to be greater than 80%. As camera angulation becomes less ideal, by as little as 15 degrees when judging angle classification or 4 degrees when judging midlines, accuracy is likely to decrease significantly. Understanding these limitations will allow clinicians to improve both their clinical photography technique and their diagnostic skills.

Prenatal Oral Health Counseling by Primary Care Physicians: Results of a National Survey.

Objectives Limited information exists on the extent oral health is addressed in the context of prenatal care. This study sought to investigate characteristics of primary care physicians (PCP) who provide oral health counseling to pregnant women. Methods The study relied upon data from the 2013 Survey of PCP on Oral Health. Provision of oral health counseling to pregnant women (sometimes vs. rarely/never) was the primary outcome. Covariates included respondents' demographic and practice characteristics, oral health-related training, knowledge, attitudes, preparedness and clinical behaviors. The analytical strategy included bivariate tests and multivariable Poisson regression modeling, accounting for the survey design; inference was based upon marginal effects estimation. Results Two-thirds of PCP (233 out of 366 respondents) reported providing oral health counseling to pregnant women. In bivariate comparisons, female PCP, PCP with oral health-specific instruction during medical training, favorable oral health-related attitudes, behaviors, preparedness, and knowledge were more likely to provide counseling (p < 0.05). Multivariable analyses confirmed the independent associations of female gender [marginal effect = + 9.7 percentage points (p.p.); 95% confidence interval (CI) = 0.0-19.0], years in practice (- 0.4 p.p. for each added year; 95% CI = - 0.09 to 0.0), oral health continuing education (+ 13.2 p.p.; 95% CI = 2.6-23.8), preparedness (+ 23.0 p.p.; 95% CI = 16.9-29.0) and oral health counseling of adult patients with other conditions (+ 8.8 p.p.; 95% CI = 4.6-13.3) with prenatal oral health counseling. Conclusions for Practice A considerable proportion of PCP nationwide counsel pregnant patients on oral health. Provider attributes including education and preparedness appear as promising targets for interventions aimed to enhance pregnant women's oral health and care.

Career perspectives of senior dental students from different backgrounds at a single Middle Eastern institution.

BACKGROUND: Differences between dental students in terms of social, economic and cultural backgrounds are likely to impact their professional career plans. The aim of this study was to explore the professional career plans among final year dental students from different backgrounds at a single Middle Eastern institution (Jordan university of Science and Technology-JUST). METHODS: Fifth year dental students at JUST were invited to fill out a paper based self-administered questionnaire. Data was collected on students` demographics, their future career plans and the impact of social and economic changes on such plans, their interest in postgraduate studies and the specialty of choice in addition to the influence of a group of factors on that choice. Data was also collected on the value of non-academic workshops, guidance regarding career plans, participants` preferred pattern of work (full-time versus part-time) and retirement plans. Students were categorized according to their nationalities. Pearson's chi squared test, one way ANOVA and post hoc tests were used to measure statistical significance between measured variables and backgrounds of participants. The level of significance was set at P ≤ 0.05. RESULTS: A total of 227 students completed the survey (response rate = 84%). 47% of the participants were Jordanians, 27% were Malaysians, 11% were from Gulf States (Saudi Arabia, Bahrain, Kuwait and Qatar), 10% were from conflict zones in the Middle East (Syria, Iraq, Palestine and Yemen) and 5% comprised students from other nationalities. Significant differences were found between students from different backgrounds in their funding sources (Chi square = 132, P < 0.01), practice plans (Chi square = 43, P < 0.01), the impact of social and economic changes on their career choices (Chi square = 34, P < 0.01), planned work pattern within the first 10 years post-graduation (chi square = 18, P < 0.05) and 10-20 years after graduation (69%, Chi square = 22, P < 0.01) and retirement plans (Chi square = 25, P < 0.05). Students from different nationalities agreed on most factors affecting their choice of a specialty, except for the reputation of the specialty (P < 0.05). CONCLUSION: Several differences in career plans were found between dental students from variable backgrounds studying a single institution. Many of these disparities could reflect variations in socioeconomic backgrounds.

Executive Function as a Risk Factor for Incisor Trauma.

BACKGROUND/AIM: Executive function is the ability to guide behavior to achieve goals or complete tasks. This study explored the relationship between executive function, as assessed by the Behavior Rating Inventory of Executive Function Parent Form Questionnaire (BRIEF® ) and incisor trauma. MATERIAL AND METHODS: This study included children in the mixed dentition with recent incisor trauma (n=28) and a control group (n=30) without recent incisor trauma. Subjects' parents completed the BRIEF® , while a clinical examination assessed subjects' occlusal relationships. Parents also completed a custom questionnaire that investigated their child's medical history and daily activities. Fisher Exact and unpaired t-tests compared BRIEF® scores, occlusal characteristics, medical history, and reported daily activities of the two groups. RESULTS: The trauma group had a greater percentage of participants with a Class II dental relationship (p=0.01). There was no significant difference between groups with respect to mean BRIEF® t-scores within the Global Executive Composite. There was a statistically significant difference between groups with respect to the percentage of subjects with clinically significant (≥65) BRIEF® t-scores within the Inhibit (p=0.05) and Emotional Control (p=0.02) subscales and Behavioral Regulation Index (p=0.02). There were no statistically significant differences between groups with respect to age, gender, overbite, overjet, medical history, body mass index, or daily activities. CONCLUSIONS: Children in the mixed dentition with a Class II dental relationship are at greater risk for incisor injury, as well as those involved in outdoor activities. Specific executive dysfunctions such as impulsivity and poor emotional control may increase the risk for incisor trauma. This article is protected by copyright. All rights reserved.

Is Oral Biopsy Associated With Change in Tobacco or Alcohol Use?

PURPOSE: Tobacco and alcohol remain the predominant risk factors for oral cancer, but the relation between having an oral biopsy and cessation of these risk factors is unknown. Therefore, this investigation examined whether there might be an association between oral biopsy and change in risk factor use. MATERIALS AND METHODS: A survey was sent to a cohort consisting of a consecutive sample of subjects identified in the University of North Carolina Oral Pathology database. The predictor variable was oral biopsy diagnosis, with 3 levels consisting of hyperkeratosis, dysplasia, or carcinoma. The outcome variable was change in risk factor use, coded as "no change in usage," "decreased usage" or "quit." Other study variables included age, gender, and race. The proportional odds model was used to assess the effect of explanatory variables on change in use, and the P value was set at .05. RESULTS: The response rate was 37.4% for a total sample of 605 subjects. White non-Hispanics composed 85% of respondents and women composed 49.5%, with no significant difference among diagnostic categories. The global test for change in cigarette use was significant, with age contributing to variability in behavioral change. Although not statistically significant, larger percentages of patients with more severe diagnoses quit cigarettes and alcohol following biopsy. The youngest respondents were 3.7 times more likely not to quit before biopsy or to continue to smoke following biopsy (95% confidence interval, 1.98-6.91). CONCLUSION: The results of this study suggest that oral biopsy provides an ideal opportunity to focus on risk factor cessation. Different diagnoses provide objective data on which to base a discussion about carcinogenesis and the roles played by the risk factors in this process. Differences in risk factor cessation associated with demographics emphasize the need for all clinicians to address cessation with all patients.

Buffered Versus Non-Buffered Lidocaine With Epinephrine for Mandibular Nerve Block: Clinical Outcomes.

PURPOSE: Outcomes for peak blood levels were assessed for buffered 2% lidocaine with 1:100,000 epinephrine compared with non-buffered 2% lidocaine with 1:100,000 epinephrine. PATIENTS AND METHODS: In this institutional review board-approved prospective, randomized, double-blinded, crossover trial, the clinical impact of buffered 2% lidocaine with 1:100,000 epinephrine (Anutra Medical, Research Triangle Park, Cary, NC) was compared with the non-buffered drug. Venous blood samples for lidocaine were obtained 30 minutes after a mandibular nerve block with 80 mg of the buffered or unbuffered drug. Two weeks later, the same subjects were tested with the alternate drug combinations. Subjects also reported on pain on injection with a 10-point Likert-type scale and time to lower lip numbness. The explanatory variable was the drug formulation. Outcome variables were subjects' peak blood lidocaine levels, subjective responses to pain on injection, and time to lower lip numbness. Serum lidocaine levels were analyzed with liquid chromatography-mass spectrometry. Statistical analyses were performed using Proc TTEST (SAS 9.3; SAS Institute, Cary, NC), with the crossover option for a 2-period crossover design, to analyze the normally distributed outcome for pain. For non-normally distributed outcomes of blood lidocaine levels and time to lower lip numbness, an assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3). Statistical significance was set at a P value less than .05 for all outcomes. RESULTS: Forty-eight percent of subjects were women, half were Caucasian, 22% were African American, and 13% were Asian. Median age was 21 years (interquartile range [IQR], 20-22 yr), and median body weight was 147 lb (IQR, 130-170 lb). Median blood levels (44 blood samples) at 30 minutes were 1.19 µg/L per kilogram of body weight. Mean blood level differences of lidocaine for each patient were significantly lower after nerve block with the buffered drug compared with the non-buffered agent (P < .01). Mean score for pain on injection for nerve block (n = 46 scores) was 3.3 (standard deviation, 0.9). Seventy-eight percent of subjects reported lower or the same pain scores with the buffered drug; 61% of subjects reported a shorter time to lower lip numbness with the buffered drug. CONCLUSIONS: Buffering 2% lidocaine with epinephrine can produce clinical outcomes favorable for subjects and clinicians without clinically detrimental peak blood lidocaine levels.

Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block.

PURPOSE: To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI. PATIENTS AND METHODS: In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than .05. RESULTS: Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P < .01). CONCLUSIONS: After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.

Buffered 1% Lidocaine With Epinephrine Can Be as Effective as Nonbuffered 2% Lidocaine With Epinephrine for Maxillary Field Block.

PURPOSE: Buffering local anesthetics with epinephrine (Epi) offers clinicians options not often considered. This study assessed outcomes for pulpal anesthesia, pain on injection, and time to midface numbness for buffered 1% lidocaine with 1:100,000 Epi versus nonbuffered 2% lidocaine with 1:100,000 Epi. MATERIALS AND METHODS: In this trial with a randomized, crossover design, buffered 1% lidocaine was compared with nonbuffered 2% lidocaine. Subjects were adult volunteers who served as their own controls. The predictor variables were alternate drug formulations. The outcome variables were subjects' responses to cold and electric pulp testing (EPT) stimulation of the maxillary first molar and canine, pain levels during the injection, and time to midface numbness. After maxillary field blocks with 40 mg of buffered lidocaine or 80 mg of nonbuffered lidocaine, subjects reported pain on injection and responses of the maxillary first molar and canine after cold and EPT stimulation. Teeth were tested before field block and at 30-minute intervals until a positive response was detected. Two weeks later, subjects were tested with the alternate drug combinations. For all outcome variables, assessment of treatment difference, calculated as 1% buffered minus 2% nonbuffered, was performed with the Wilcoxon rank sum test with significance at P < .05. RESULTS: More of the 24 subjects were women and Caucasian. The median age was 23.5 years (interquartile range, 21, 25 years), and the median body weight was 155 lb (interquartile range, 128.5, 176.5 lb). Pain levels during the injection were significantly lower for 1% buffered lidocaine, with P = .04. Times to response after injection were not significantly different between the 2 drug formulations for the cold test on a molar, with P = .08, or the cold test on a canine, with P = .22. However, times to response were significantly longer for nonbuffered drugs for EPT on the molar and canine, both with P = .01. CONCLUSIONS: Buffering 1% lidocaine with 1:100,000 Epi reduces the pain on injection with a maxillary field block and results in similar lengths of pulpal anesthesia tested with a cold stimulus as compared with nonbuffered 2% lidocaine with 1:100,000 Epi.

Characterizing the orthodontic patient's purchase decision: A novel approach using netnography.

INTRODUCTION: A deeper and more thorough characterization of why patients do or do not seek orthodontic treatment is needed for effective shared decision making about receiving treatment. Previous orthodontic qualitative research has identified important dimensions that influence treatment decisions, but our understanding of patients' decisions and how they interpret benefits and barriers of treatment are lacking. The objectives of this study were to expand our current list of decision-making dimensions and to create a conceptual framework to describe the decision-making process. METHODS: Discussion boards, rich in orthodontic decision-making data, were identified and analyzed with qualitative methods. An iterative process of data collection, dimension identification, and dimension refinement were performed to saturation. A conceptual framework was created to describe the decision-making process. RESULTS: Fifty-four dimensions captured the ideas discussed in regard to a patient's decision to receive orthodontic treatment. Ten domains were identified: function, esthetics, psychosocial benefits, diagnosis, finances, inconveniences, risks of treatment, individual aspects, societal attitudes, and child-specific influences, each containing specific descriptive and conceptual dimensions. A person's desires, self-perceptions, and viewpoints, the public's views on esthetics and orthodontics, and parenting philosophies impacted perceptions of benefits and barriers associated with orthodontic treatment. CONCLUSIONS: We identified an expanded list of dimensions, created a conceptual framework describing the orthodontic patient's decision-making process, and identified dimensions associated with yes and no decisions, giving doctors a better understanding of patient attitudes and expectations.

Maximum Quantity of Bone Available for Harvest From the Anterior Iliac Crest, Posterior Iliac Crest, and Proximal Tibia Using a Standardized Surgical Approach: A Cadaveric Study.

PURPOSE: The 3 most common sites for obtaining autogenous bone grafts are the anterior iliac crest (AIC), posterior iliac crest (PIC), and proximal tibia (PT). The purpose of this study was to determine the maximum amount of corticocancellous bone that could be harvested from the AIC, PIC and PT when using a standardized surgical approach. MATERIALS AND METHODS: The maximum volume of cortical and cancellous bone from the AIC, PIC, and PT was harvested from 44 cadavers using approaches from a review of the literature. Uncompressed and compressed corticocancellous bone volumes were measured by water volume displacement. Bivariate analyses of bone volumes, gender, and medical comorbidities were performed using the exact Wilcoxon rank-sum test. A general linear model using ranks was used to assess the effect of gender, medical comorbidity, and site separately for total uncompressed and compressed bone measurements. RESULTS: Forty-two AIC corticocancellous grafts provided an uncompressed total average of 26.29 mL and a compressed total average of 20.58 mL. Thirty-three PIC grafts yielded a total average of 33.82 mL of uncompressed bone and 24.11 mL of compressed. Thirty-eight PT samples provided a total average of 18.11 mL of uncompressed bone and 9.03 mL of compressed bone. No statistically relevant correlations were found between compressed bone volumes and body mass index or age. No statistically relevant association was found between bone quantity and medical comorbidity for any of the graft sites. The average rank of bone volume per site after controlling for gender and medical comorbidity showed that the PIC yielded the most and the PT yielded the least compressed and uncompressed bone amounts (P < .001). CONCLUSION: Results indicate that the PIC has a larger maximum amount of corticocancellous bone than the AIC and PT with a standardized approach. The maximum volumes of attainable bone from the AIC, PIC, and PT were lower than commonly cited in the literature.

Pregnant Women's Infant Oral Health Knowledge and Beliefs: Influence of Having Given Birth and of Having a Child in the Home.

Introduction Prenatal oral health interventions can positively impact maternal and child oral health, yet limited information exists concerning how to best educate pregnant women about infant oral health. Our objective was to examine the influence of having given birth on pregnant women's infant oral health knowledge and beliefs. Methods We conducted a secondary analysis of data collected from a cross-sectional survey of pregnant women ≥18 years old attending UNC's Ultrasound Clinic. Four binomial items were categorized as infant knowledge (IK) and five rated on a Likert scale (1-5) as infant belief (IB). Overall IK and IB scores were calculated, averaging the items within each construct. Respondents were categorized into two groups: multiparous (N = 268), women having at least one previous live birth and a child between 2 and 6 years old, or nulliparous (N = 186), women with no previous live births or a child between 2 and 6 years old. Regression models for IK and IB were conducted using SAS 9.2 with maternal demographic characteristics, dental utilization, and birth history as explanatory variables (p ≤ 0.05). Results IK was affected by race (p = 0.04), mother's oral health self-rating (p = 0.0002), and birth history (p < 0.0001). On average, IK was 0.12 units higher in subjects with a history of giving birth, adjusting for explanatory variables. IB was influenced by maternal oral health beliefs (p = 0.002) and history of access to dental care (p = 0.0002). IB did not differ based on birth history (p = 0.17). Discussion The influence of birth history on pregnant women's infant oral health knowledge and beliefs can be considered in future intervention designs to maximize available resources.

Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting.

PURPOSE: To assess the prevalence of postdischarge nausea and vomiting (PDNV) after Le Fort I osteotomy with and without the use of a multimodal antiemetic protocol shown to decrease postoperative nausea and vomiting (PONV). MATERIALS AND METHODS: Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution formed the intervention cohort for an institutional review board-approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol. The comparison group consisted of consecutive patients who underwent similar surgical procedures at the same institution before protocol implementation. All patients were asked to complete a postdischarge diary documenting the occurrence of nausea and vomiting. Those who completed the diaries were included in this analysis. Data were analyzed with the Fisher exact test and the Wilcoxon rank sum test. A P value less than .05 was considered significant. RESULTS: Diaries were completed by 85% of patients in the intervention group (79 of 93) and 75% of patients in the comparison group (103 of 137). Patients in the intervention (n = 79) and comparison (n = 103) groups were similar in the proportion of patients with validated risk factors for PDNV, including female gender, history of PONV, age younger than 50 years, opioid use in the postanesthesia care unit (PACU), and nausea in the PACU (P = .37). The prevalence of PDNV was unaffected by the antiemetic protocol. After discharge, nausea was reported by 72% of patients in the intervention group and 60% of patients in the comparison group (P = .13) and vomiting was reported by 22% of patients in the intervention group and 29% of patients in the comparison group (P = .40). CONCLUSION: Modalities that successfully address PONV after Le Fort I osteotomy might fail to affect PDNV, which is prevalent in this population. Future investigation will focus on methods to minimize PDNV.

Course of the mandibular incisive canal and its impact on harvesting symphysis bone grafts.

PURPOSE: To characterize the anatomic course of the mandibular incisive canal to define parameters for harvesting autogenous bone from the symphysis of the mandible. MATERIALS AND METHODS: A series of osteotomies were completed between the mental foramina in the anterior mandibles of 19 cadavers. Methylene blue dye was used to help identify the incisive canal. From the canal, distances to key adjacent landmarks were measured with a Boley gauge to 0.1 mm. Measurements included distances from the mandibular incisive canal to the buccal cortex, the lingual cortex, the inferior border of the mandible, the apices of the teeth, and the buccal cementoenamel junction (CEJ) of the teeth. RESULTS: The canal decreased in diameter from lateral to medial. It tended to be closer to the buccal cortical bone than to the lingual cortex (P < .001) and was, at times, directly abutting the buccal cortex (average distance to buccal cortex, 3.5 mm). The canal maintained a relatively constant distance from the apices of the teeth (approximately 7 to 8 mm), coursing inferiorly under the longer canines bilaterally. The canal became increasingly difficult to identify toward the midline, likely dispersing into microscopic tributaries. CONCLUSIONS: The authors suggest several modifications to the standard surgical approach to the symphysis area during the harvest of bone grafts. When the goal is to avoid the mandibular incisive canal, osteotomies should not exceed a depth of 4 mm, should be at least 5 mm anterior to the mental foramen, and 9 mm below the root apices (or 23 mm below the lowest facial CEJ) and should maintain the contour of the mandible's inferior border. Alternatively, some degree of canal compromise can be accepted and larger grafts can be obtained by increasing the depth of the harvest in the horizontal dimension or decreasing the distance from the osteotomy to the root apices (or the CEJ) in the vertical dimension.

Monitoring for periodontal inflammatory disease in the third molar region.

PURPOSE: To assess changes at 2-year intervals in the periodontal status of the third molar region in participants enrolled with asymptomatic third molars and no clinical evidence of third molar region periodontal pathology. PARTICIPANTS AND METHODS: The included participants who presented with a healthy periodontal status (all probing depths [PDs], <4 mm) in the third molar region, defined as distal of second molars and around adjacent third molars, were from a larger longitudinal study of participants with asymptomatic third molars. Full-mouth periodontal PD data from 6 sites per tooth were obtained clinically at enrollment and at subsequent 2-year intervals. Data were aggregated to the patient level. Outcome variables were the presence or absence of periodontal pathology, defined as at least 1 PD of at least 4 mm in the third molar region. RESULTS: One hundred twenty-nine participants had a third molar region PD shallower than 4 mm at enrollment. Most participants were Caucasian (85%), women (60%), younger than 25 years (62%), educated beyond high school (84%), and with good oral health habits. At 6 years, excluding the 61 participants lost to follow-up, 47% participants had had third molars removed, 21% had developed at least 1 PD of at least 4 mm in the third molar region since enrollment, and 32% retained the periodontal status at enrollment (all PDs in third molar region, <4 mm). Demographic characteristics were not statistically different for participants followed for 6 years compared with those lost to follow-up. CONCLUSIONS: Although not all participants could be followed for 6 years after enrollment or chose to retain third molars, one third of participants maintained the third molar region periodontal status assessed at baseline for 6 years after enrollment; no clinical evidence of pathology developed over time.

Multimodal protocol reduces postoperative nausea and vomiting in patients undergoing Le Fort I osteotomy.

PURPOSE: To assess the impact of a multimodal antiemetic protocol on postoperative nausea and vomiting (PONV) after Le Fort I osteotomy. MATERIALS AND METHODS: Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution were recruited as the intervention cohort for an institutional review board-approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol, including total intravenous anesthesia; prophylactic ondansetron, steroids, scopolamine, and droperidol; gastric decompression at surgery end; opioid-sparing analgesia; avoidance of morphine and codeine; prokinetic erythromycin; and fluids at a minimum of 25 mL/kg. The comparison group consisted of consecutive patients from a larger study who underwent similar surgical procedures before protocol implementation. Data, including occurrence of PONV, were extracted from medical records. Data were analyzed in bivariate fashion with the Fisher exact and Wilcoxon rank-sum tests. Logistic regression was used to compare the likelihood of nausea and vomiting in the 2 cohorts after controlling for demographic and surgical characteristics. A P value less than .05 was considered significant. RESULTS: The intervention (n = 93) and comparison (n = 137) groups were similar in gender (58% and 65% female patients; P = .29), race (72% and 71% Caucasian; P = .85), age (median, 19 and 20 years old; P = .75), proportion of patients with known risk factors for PONV (P = .34), percentage undergoing bimaxillary surgery (60% for the 2 groups), and percentage for whom surgery time was longer than 180 minutes (63% and 59%; P = .51). Prevalence of postoperative nausea was significantly lower in the intervention group than in the comparison group (24% vs 70%; P < .0001). Prevalence of postoperative vomiting was likewise significantly lower in the intervention group (11% vs 28%; P = .0013). The likelihood that patients in the comparison group would develop nausea was 8.9 and that for vomiting was 3.7 times higher than in the intervention group. CONCLUSION: This multimodal protocol was associated with substantially decreased prevalence of PONV in patients undergoing Le Fort I osteotomy.

Pain with pericoronitis affects quality of life.

PURPOSE: To assess the association between patients' pericoronitis pain symptoms and quality-of-life (QOL) outcomes for lifestyle and oral function. PATIENTS AND METHODS: Subjects (American Society of Anesthesiologists health risk assessment level I or II) with mild symptoms of pericoronitis were enrolled in a study approved by the institutional review board and asked to complete a QOL instrument specifically for third molar problems covering lifestyle, oral function, and pain. Subjects assessed lifestyle and oral function using a 5-point Likert-type scale, ranging from "no trouble" (score, 1) to "lots of trouble" (score, 5), and worst and average pain using a 7-point Likert-type scale, ranging from "no pain" (score, 1) to "worst pain imaginable" (score, 7). Pain levels reported at enrollment were compared with QOL outcomes for lifestyle and oral function using Spearman correlation coefficients. Correlations of at least 0.6 were considered clinically quite important, and correlations of at least 0.4 were considered clinically important. Associations between these outcome measurements were considered statistically significant at a P value less than .05. RESULTS: Most of the 113 subjects were Caucasian (51%), women (56%), 23 years old or younger (58%), and well educated (91% with at least some college). Mean pain levels ± standard deviation were low (worst pain, 3.3 ± 1.5; average pain, 2.4 ± 1.2). All pain outcomes were significantly associated with items in the lifestyle and oral function domains (P < .01). Clinically important correlations were seen between pain outcomes and daily routine, social life, eating a regular diet, chewing food, and talking (P < .0001). CONCLUSIONS: Clinically important correlations existed between subjects' pericoronitis pain and lifestyle and oral function, associations not often considered by clinicians or policy makers.