Survey of treatment provided for young children by West Virginia general dentists.

PURPOSE: The purpose of this study was to survey the treatment provided by West Virginia general dentists (GDs) for young children. METHODS: A survey was mailed to 683 GDs in West Virginia. Respondents were questioned about their referrals to pediatric dentists, the youngest age for which they perform specific procedures, conscious sedation utilization, and whether they treat Medicaid-covered children. RESULTS: The response rate was 72%. Half of the GDs responded that they frequently referred children younger than 3 years old, and only one third reported performing dental examinations on a child 2 years old or younger. All responding GDs performed the surveyed procedures in 5-year-olds, but fewer respondents performed complex procedures for children < or = 2 years old. More than half of the GDs responded that they frequently had difficulty with referrals to a pediatric dentist due to distance/ transportation or not accepting new Medicaid patients. Medicaid-covered children were not treated by 25% of general dentists. CONCLUSIONS: Most GDs in West Virginia treat older children, but care is limited for children < or = 2 years old. Further studies are needed to uncover the specifics of these findings to improve the access and care for young West Virginia children.

Increasing minority enrollment utilizing dental admissions workshop strategies.

Oral Health in America, the landmark U.S. surgeon general's report, inextricably connects oral health disparities with poor access to oral care by vulnerable populations. Furthermore, the report associates an insufficiently diverse dental workforce with oral health disparities among some minority groups. Successful strategies to curtail oral health disparities and remedy work-force issues require collaboration among all involved in dental education. As gatekeepers to dental programs, admissions committees are significant stakeholders in diversifying the dental workforce. The purpose of this article is to demonstrate that a workshop on diversity in admissions can modify the perceptions of individuals involved in the student recruitment and admissions processes and lead to increased matriculation of underrepresented minority students. Emerging from the workshop were key concepts and action steps for promoting a holistic review of dental applicants. Results since implementing the workshop recommendations have been positive, with underrepresented minority dental student acceptances increasing sixfold. The workshop was cosponsored by the Robert Wood Johnson Foundation and facilitated by two nationally recognized dental educators.

Wrist kinetics after scapholunate dissociation: the effect of scapholunate interosseous ligament injury and persistent scapholunate gaps.

The purpose of this study was to investigate the effects of cutting of the scapholunate interosseous ligament (SLIL) and persistent widening of the scapholunate (SL) joint on changes in moment arms of the principal wrist motor tendons. In seven fresh frozen cadaveric upper extremities, excursions of the extensor carpi radialis longus (ECRL) and brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) were recorded simultaneously with wrist joint angulation during wrist flexion-extension and radioulnar deviation. Tendon excursions were measured in intact wrists, then in the wrists with complete SLIL sectioning and in those with moderate or severe persistent SL joint widening. The data were converted to moment arms of the tendons. The results showed that moment arms of the ECRL and ECRB tendons after SLIL sectioning were, respectively, 110+/-6% and 105+/-3% of those in the intact wrist. In the wrists with moderate or severe SL joint widening, moment arms of the flexors significantly increased (P < 0.01 and P < 0.001, respectively). During radioulnar deviation, moment arms of the ECRL, ECRB, ECU, and FCU tendons decreased after SLIL sectioning and the SL joint widening. However, moment arms of the FCR tendon significantly increased 122+/-23% after the SLIL section, 133+/-28% after the moderate SL joint widening, and 138+/-24% after the severe SL joint widening compared with those of the intact wrists. This study demonstrated that integrity of the SLIL and appropriate SL joint space are important for mechanics of wrist motor tendons. Loss of integrity of the SLIL and persistent SL joint widening increase mechanical effects of the radial side wrist motor tendons, which may contribute to the pathomechanics of scaphoid malrotation, scapholunate advanced collapse, and early osteoarthritis in the radioscaphoid joint interface seen in SL dissociation. The results also suggest that reduction of the displaced SL joint is imperative to the recovery of wrist kinetics after SL dissociation.

Caries risk assessment/treatment programs in U.S. dental schools: an eleven-year follow-up.

The purpose of this survey was to identify the number and characteristics of caries risk assessment/treatment (CRA/ Tx) programs in U.S. dental schools in 2009 and compare the results to those of the 1998 survey. A survey of U.S. dental schools was conducted in 2009 using the same eleven-question survey instrument as in 1998. Results were analyzed using stratified random sampling and chi-square tests for six of the questions. Additionally, data from the other questions were directly compared. Two questions showed a statistically significant difference: an increase in programs supervised by one school department and the number of schools using CRA as a graduation requirement. Positive changes are occurring in the development of CRA/Tx programs in U.S. dental schools. A wide variety of approaches to teaching this subject, including use of terminology and treatment philosophies, is evident. The evolution of this subject has been slow and varied over the past eleven years. Changing from a mainly surgical approach model to a medical model is occurring, but a more integrated method is needed to clarify terminology, diagnosis, treatment, and communications with researchers, clinicians, teachers, patients, and third-party payers.

The impact of a continuing education oral health program on providing services for young children by dentists, dental hygienists and dental assistants.

PURPOSE: The purpose of this study was to determine the impact of a 4 hour continuing education (CE) program on the oral health knowledge and behaviors of dentists, dental hygienists and dental assistants in providing oral health services to young children in West Virginia general dental practices. METHODS: A free CE program was provided for 92 general dentists, 123 dental hygienists and 37 dental assistants (n=252) at 4 sites across West Virginia. Participants completed a pre- and post-test on topics including the timing of the first dental exam, fluorides, xylitol, Alternative Restorative Technique (ART) and their practice pattern of caring for children under 3 years old. A 6 month follow-up questionnaire was mailed to participants to assess outcomes. RESULTS: Participants showed a 22% increase in knowledge from the pre-test to the post-test (p<0.001) for all questions except for ART, which showed no change. The majority of dentists and hygienists (89%) increased their comfort in providing services for children under 3 years old. Participants (80%) stated they would increase the number of children under 3 years old they examine, yet 6 months after the program only 42% responded affirmatively (p<0.001). At the time of the program, 62% reported that they currently examine children at 1 year of age, and there was no significant change 6 months later. While 54% responded that they would contact their local physicians about early oral health care, only 27% followed through. CONCLUSION: This program significantly increased the participants' knowledge and comfort level for providing infant and toddler oral health care. However, it did not motivate most to alter their practice behaviors to conform to national best practice guidelines.

Lateral tibial plateau fracture depression as a predictor of lateral meniscus pathology.

The goal of this study was to determine if the degree of lateral tibial plateau fracture depression on computed tomography (CT) images predicted the presence of lateral meniscus tears. The study group comprised 85 patients who sustained a lateral tibial plateau fracture and underwent open reduction and internal fixation by the same surgeon. Degree of plateau depression was measured in millimeters by CT. Operative reports were retrospectively reviewed to determine if the lateral meniscus tear was intact or torn at the time of surgery. Twenty-eight patients had a lateral meniscus tear noted at the time of surgery. No significant differences existed in gender, mechanism or energy level of injury, Schatzker classification, or type of fracture among patients with a lateral meniscal tear as compared to those without a tear. Patients with > or =10 mm of plateau depression had an eight-fold increase in risk of having a lateral meniscus tear compared to those with <10 mm of depression. Patients younger than 48 years had a four-fold increase in risk of having a lateral meniscus tear than older patients.This study demonstrated an association between the amount of tibial plateau depression and the likelihood of a lateral meniscus tear. These findings may be used to predict those who have sustained a tear of the lateral meniscus and to advise the surgeon to prepare for a repair. Further prospective studies using magnetic resonance imaging as a tool to evaluate the extent of soft tissue injuries in plateau fractures is needed.

Local anesthetic syringe ergonomics and student preferences.

With a diverse population of dentists, dental hygienists, and dental assistants, there is a wide range of sizes and shapes of individuals. Ergonomic considerations have resulted in the design of many adjustable delivery systems, chairs, and pieces of equipment. Companies have marketed instrumentation specifically for people with small hands, yet little research has been done regarding the advertising claims. The objective of this study was to compare the perceptions of dental and dental hygiene students after they used a conventional syringe and a petite syringe that has been marketed as advantageous for individuals with smaller hands. The two syringes were compared for aspiration, injection, and sense of control. A total of 181 students were invited to serve as subjects in the study, and ninety participated. The study involved two phases. During phase I, students used conventional and petite syringes to give a simulated inferior alveolar nerve block injection. In phase II, students gave a simulated palatal injection using both sizes of syringes. After performing the simulations, the students responded to a questionnaire. The students reported that the petite syringe gave them control, and 62.2 percent of them preferred it to the conventional syringe. There were differences in preferences between female and male students and also differences in preferences based on students' glove sizes. The female students preferred the petite syringe when aspiration was required. Overall, the students who wore small and extra small gloves had a preference for the petite syringe and felt it provided a sense of control, a key component when learning to provide injections.