Early Dental Trade Card with Unusual Logo.

James Washington Bartlett (1839-1910, FAG Memorial #124715057) was born in Derby Line, Orleans County, Vermont to Nathaniel Bartlett (1791-1866), a harness maker, and Martha Pinkham Bartlett (1798-1847). Little is known about his youth nor his education. He was evidently preceptor trained in dentistry but we were unable to determine with whom.

Dental caries on CT in the ER population: prevalence and reporting practices.

PURPOSE: Although dental caries can be identified on CT and may be treatable, the literature provides little, if any, guidance on the responsibility of a neuroradiologist in reporting them. Untreated dental caries can impact diet and nutrition and can result in a variety of complications such as an odontogenic abscess, tooth loss, sinusitis, and dental pain, which can impact quality of life. The estimated prevalence of untreated dental caries in adults is 27%. In our experience, the prevalence of untreated dental caries in patients presenting to the Emergency Department (ED) is higher but dental caries are often unmentioned or unrecognized. We aim to determine the frequency of unreported dental caries and propose a paradigm for reporting and management. METHODS: Our research was IRB-approved and HIPPA compliant. We searched the radiology database for adult patients who underwent a CT of the facial bones while in the Emergency Department between January 1, 2015 and June 30, 2015. The examinations were reviewed by a faculty neuroradiologist for the presence of untreated dental caries. Untreated dental caries were documented and characterized by depth. Caries that were partially or completely obscured by dental amalgam artifact were excluded. The radiology reports were reviewed to evaluate reporting frequency. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. RESULTS: A total of 200 patients (113 male, 87 female; age 18-98 years) underwent 200 CT examinations of the facial bones. One hundred fourteen (57%) patients had at least one dental caries. When caries were present, 14.9% of radiology reports included caries in the findings section and 9.6% of the reports mentioned caries in the impression. CONCLUSIONS: The presence of dental caries should be mentioned in the radiology report. The prevalence of untreated dental caries is higher in our cohort than reported in the general population, and dental caries are underreported by neuroradiologists at our institution. A paradigm for reporting and management was created upon collaboration with faculty from the University of Vermont Dental and Oral Health practice. A visit with a dentist should be recommended within 6 months if caries are limited to the enamel, within 3 months if caries involve the dentin, and within 2 weeks if caries extend in to the pulp. Further research is necessary to determine the clinical impact of improved reporting.

An ethnographic study of a community dentistry network serving Latine migrant farmworkers in Vermont: Barriers and access to care during the COVID-19 pandemic and beyond.

BACKGROUND AND OBJECTIVES: Primary dental healthcare services are not accessible for a majority of Latino/a/e migrant farmworkers in the United States. Unmet dental health needs are well documented in larger states like California, Florida and New York, but the dental healthcare picture in smaller states is not well understood. The goal of this qualitative ethnographic study was to understand the delivery model of a free dentistry network serving Latine farmworkers in rural Vermont and specific barriers experienced at the network during the COVID-19 pandemic. METHODS: Semi-structured ethnographic interviews were carried out with clinicians and transcripts were analysed using the constant comparison method to identify salient concerns and recommendations about barriers and delivery of care. RESULTS: Clinicians highlighted structural issues including farmworkers' lack of time off work and absence of transportation to attend appointments, concerns about COVID-19 safety, concerns about immigration surveillance and language barriers. Providers outlined steps for improved service delivery including mobile care at local farms, enhanced intercultural training for providers, recognizing dentistry as essential healthcare at the state level and the leverage of existing appointments for preventive health. Drawing on anthropological frameworks of place-based care and deservingness of healthcare, our ethnographic findings emphasize the role of community dentistry in bridging gaps in migrant healthcare during and beyond the COVID-19 pandemic.

Use of emergency departments for conditions related to poor oral healthcare: implications for rural and low-resource urban areas for three states.

Persistent and worsening shortages of oral healthcare providers in rural areas, combined with limited acceptance of Medicaid and State Children's Health Insurance Programs, have left many patients without adequate access to dental care. Evidence suggests that such patients seek treatment in emergency departments (EDs) for problems that might have been prevented given adequate oral healthcare. This finding has public policy questions that are explored by this study. To investigate these questions, the State Emergency Department Databases available as part of the Healthcare Cost and Utilization Project and Area Resource Files were used, along with communication with state Medicaid offices for three diverse states: Utah, Vermont, and Wisconsin. While overall patterns of oral healthcare-seeking among the three states are similar, our research discovered important differences with implications for healthcare policy: In states with less generous Medicaid reimbursements, Medicaid beneficiaries in rural areas have ED care-seeking patterns like those of the uninsured. In more generous states, they seek care more like the privately insured. This suggests that Medicaid policy is one important tool in providing low-income and other vulnerable populations with access to higher-quality dental care.

Enrollment Challenges: Recruiting Men to Weight Loss Interventions.

Obese men are at an increased risk of chronic disease and are far less likely than women to attempt weight loss. There is a need to successfully recruit men to weight loss clinical trials. Overweight and obese men were recruited to a 6-month, randomized, controlled weight loss trial. Initial recruitment efforts were aimed at men in the workplace with less than or equal to 2 years of college education. After unsatisfactory interest from men and businesses alike, recruitment strategy shifted to enroll men outside the workplace with any educational background. Recruitment methods included word of mouth, email and website advertisements, printed posters in local businesses and doctors' offices, Facebook ads, and a 1-week newspaper ad campaign. Initial interest and enrollment was negligible with only 35 men enrolled in the first 7 months. The launch of a 1-week newspaper advertisement was the most useful recruitment technique and 102 overweight/obese men were successfully enrolled. Study retention remained high throughout the Gutbusters program, indicating targeted, effective recruitment, and not weight loss interest, may be the largest barrier to trial participation for overweight and obese men.

Diagnostic reliability of mandibular second molar maturation in the identification of the mandibular growth peak: A longitudinal study.

OBJECTIVE: To investigate the diagnostic reliability of mandibular second molar maturation in assessing the mandibular growth peak using a longitudinal design. MATERIALS AND METHODS: From the files of the Burlington and Oregon growth studies, 40 subjects (20 from each collection, 20 males and 20 females) with at least seven annual lateral cephalograms taken from 9 to 16 years were included. Mandibular second molar maturation was assessed according to Demirjian et al., and mandibular growth was defined as annual increments of Co-Gn distance. A full diagnostic reliability analysis (including positive likelihood ratio) was performed to establish the diagnostic reliability of dental stages E, F, and (pooled) GH in identifying the imminent mandibular growth peak. RESULTS: None of the dental maturation stages reliably identified the mandibular growth peak with greatest overall mean accuracy and positive likelihood ratio of 0.77 (stage F) and 2.7 (stage E), respectively. CONCLUSIONS: Use of the mandibular second molar maturation is not recommended for planning treatment requiring identification of the mandibular growth peak.

A collaborative community-based oral care program for school-age children.

PURPOSE/OBJECTIVES: In Vermont in 2001, less than half of school-age children on Medicaid received dental services. Vermont is a designated resettlement area for refugees, many of whom have never had dental care. A school-based oral health program was designed to meet the needs of this high-risk pediatric population. PROGRAM: A plan was developed to offer dental services to this group of children. Through the efforts of a multidisciplinary committee the Tooth Tutor Program, developed by the Vermont Department of Health, dental care was made available to the children. The Tooth Tutor Program provides cost-effective dental hygienist care to children in the school setting and includes referral to community dentists. OUTCOME: The program was able to provide services to approximately 500 children in the first 2 years with an increase in preventative services and decrease in restorative services from year 1 to year 2. After 3 years, a school-based dental service opened in 1 of the 3 target schools. CONCLUSION: A school-based dental service that includes education, screening, and referral can be an effective program for improving oral health among impoverished children. IMPLICATIONS FOR NURSING PRACTICE: For the community health clinical nurse specialist, the client is the community. Clinical nurse specialist practice in this community resulted in improved oral health for high-risk school-age children. This program can be adapted for other communities.

Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care.

Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by -$482 relative to the comparison (95% CI, -$573 to -$391; P < .001). The lower costs were driven primarily by inpatient (-$218; P < .001) and outpatient hospital expenditures (-$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196-205).

Does musculoskeletal function deteriorate in a predictable sequence in the elderly?

A variety of functions decline with aging, but whether losses occur in a predictable sequence is unknown. Improved understanding might facilitate the early detection and possible prevention of functional deterioration. We assessed self-reported difficulty with functional tasks in 288 community-dwelling elderly aged 65 to 97. We hypothesized that the ability to perform tasks involving strength, skill, and endurance (run errands, shop, yardwork or housework) would be lost first, followed by activities requiring less strength or mobility (rise from a chair with no hands, walk), followed by easier, but essential tasks (pick up clothes, rise from bed, lift a cup to the mouth). The patterns of decline were evaluated with Guttman scalograms. Picking up clothes and walking were reversed from the predicted order. Scale reliability was 0.92, indicating that functional decline is ordered; 75% of subjects fell into one of the modal sequence types. Analysis by self-reported presence of arthritis showed that 83% of nonarthritic subjects fit the predicted patterns (reliability = 0.95) versus 65% of arthritic subjects (reliability = 0.86), who tended to lose hand ability out of sequence. Sequential functional loss scales may tell more than the typical simple summation of functional loss, and may have predictive value to the clinician monitoring an elderly patient. If the sequence is accelerated or out of order, such as was seen in patients with arthritis, it may indicate the need for intervention. Examination of sequences of loss may help characterize adaptations to impairment and differences among subgroups.

Contraception and cervical colonization with mycoplasmas and infection with cytomegalovirus.

The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied in 66 intrauterine device (IUD) users as contrasted to 60 patients using oral contraception and 50 patients using neither an IUD nor oral contraception. No significant increase in colonization or genital mycoplasmas or infection with CMV was noted in IUD users. No CMV was isolated from users of the cooper-t IUD. It is unlikely that genital mycoplasmas are related to either the increased immunoglobulin levels seen in patients using the IUD or the antifertility effects of the IUD.

PIP: An ivestigation based on the hypothesis that the IUD might induce an endometritis related to a nonbacterial infection was undertaken in 66 IUD users and contrasted to 60 oral contraceptive (OC) users and 50 nonusers of OCs and IUDs. The relationship of cervical colonization of genital mycoplasmas and infection with cytomegalovirus (CMV) was studied yielding the following information: 1) Genital mycoplasma colonization among the groups studied differed insignificantly; 2) An insignificant increase in colonization of genital mycoplasmas or infection with CMV was noted in IUD users; 3) There were no CMV isolates from the group using the Copper T IUD; 4) CMV infection did not appear to be significantly increased by IUD presence; and 5) The overall rate of 5.2% of CMV infection was comparable with that of other studies. Results indicated the unlikelyhood that genital mycoplasmas are related to either the increased immunoglobulin levels noted in patients using the IUD or to the IUD's antifertility effects.

Trends in skiing injuries. Analysis of a 6-year study (1972 to 1978).

The trends in skiing injuries showed a decrease during a study conducted over six seasons, 1972 to 1978, at a Vermont ski resort. Over 11,000 interviews were conducted and nearly 1,000 control skiers were evaluated. The injuries totaled 1,711 in 407,600 skier days. Upper body injuries (pelvis, trunk, neck, head, and upper extremities) totaled 713 (42%) and lower extremity injuries totaled 998 (58%). Eighty percent of the lower extremity injuries were classified as (potentially) equipment related. The overall injury rate decreased 41% (upper body, 25%; lower extremity equipment-related (LEER), 43%; and lower extremity nonequipment-related rate was down 71%). Knee sprains did not decline as rapidly as the tibial fractures and ankle sprains. An increase in the relative frequency of properly functioning equipment is primarily responsible for the decline in LEER injuries. Although the relative frequency of properly adjusted bindings is increasing, more than one-half of the equipment in use is still set higher than recommended. Cooperation between all individuals responsible for equipment design, manufacture, installation, and use must continue, if further improvements in alpine skiing safety are to be realized.

Alternative medicine in Vermont--a census of practitioners: prevalence, patterns of use, and national projections.

The number of alternative/holistic practitioners in Vermont was estimated by two methods: scanning advertisements (yellow pages, newspaper and magazine ads, brochures), and by word-of-mouth canvassing. We located 897 Vermonters who derive most of their annual income practicing at least 1 of 97 different types of alternative medicine and therapy. Most practitioners were female and most practiced more than one type of healing. Bodyworkers were the most prevalent practitioners, followed by chiropractors, acupuncturists, herbalists, and holistic psychotherapists. On a per-capita basis, there is 1 alternative practitioner per 652 Vermonters (or 153 practitioners per 100,000 population). This census nearly equals that of Vermont's M.D. population. Extrapolating this Vermont census to a nationwide estimate of alternative practitioners suggests there are over 403,000 full-time alternative/holistic healers practicing in the United States.

Smoking cessation practices in dental offices.

We have surveyed the health promotion efforts of dentists and dental hygienists in general dental practice in Chittenden County, Vermont, in relation to smoking. The response rate was 61 percent. Smoking issues were addressed by 76 percent of dentists and 81 percent of dental hygienists in approximately one quarter of their smoking patients. Although the majority of both dentists and dental hygienists advised their patients to change their smoking behavior, their advice was usually to cut down rather than to quit. Most of the respondents--78 percent of dentists and 93 percent of dental hygienists--considered it appropriate to give advice about smoking during visits for routine dental care and 68 percent and 89 percent, respectively, were willing to learn brief methods of advising their patients about smoking. Experience with giving advice about smoking and agreement that it was appropriate to give such advice were both strongly related to willingness to learn brief methods of giving such advice. In individual dental practices, there were virtually no correlations between the dentist's and the dental hygienist's behaviors as far as the proportion of patients from whom a smoking history was taken, the proportion of smokers advised about smoking, the content of the advice, or the nature of the advice. Only nine percent of dentists and 11 percent of dental hygienists were current smokers.

A statewide survey of dentists' smoking cessation advice.

The general practitioners of the Vermont State Dental Society (251) were surveyed in 1986 to determine their smoking cessation activities. Seventy-eight percent of the dentists completed the survey and 87% reported that they discussed concerns about smoking with their patients who smoke. They estimated spending an average of 2.4 minutes addressing cigarette smoking issues. Among those dentists who discussed smoking issues, the majority (60%) provided some advice on ways to change smoking behavior. The remaining 40% provided no guidance regarding smoking behavior change. The larger the proportion of smokers advised about smoking, the greater the dentists' interest in using incentives to help smokers make an attempt to quit.

Pediatric dental rehabilitation procedures in the OR.

Children with significant baby bottle tooth decay and children who are challenged by significant physical and emotional limitations are candidates for dental rehabilitaion procedures with general anesthesia. Rehabilitation of children's primary teeth is important to prevent pain, infection, and tooth loss. To provide skilled care for children undergoing dental rehabilitation procedures, perioperative nurses must understand normal dentition, tooth anatomy, and caries prevention and formation and be able to meet children's developmental and emotional needs. Perioperative nurses also must collaborate with dentists to maintain appropriate supply inventories that are unique to dental rehabilitation procedures.

Health status and needs of Latino dairy farmworkers in Vermont.

Vermont is a new Latino destination where many Spanish-speaking migrants have found work on dairy farms. One hundred twenty Latino workers were surveyed on 59 Vermont dairy farms to develop a demographic profile and evaluate their self-assessed health status and barriers to care. The study found, similar to other studies, the majority of workers were young, male Mexicans. However, the workers in this study, as compared to others, originated farther south in Mexico and there were significant regional differences in educational attainment. Workers defined health in terms of their ability to work and the majority believed themselves to be in good health. The majority felt that moving to the United States has not changed their health status. The most common health issue reported was back/neck pain, followed by dental and mental health issues. Workers are both physically and linguistically isolated and reported isolation as the most challenging aspect of dairy farm work. Fear of immigration law enforcement was the primary barrier to care. Community-based initiatives, including partnerships with colleges and universities, outreach to farm employers and the adoption of "bias-free policing" are strategies that can increase access to health care for Latino dairy farmworkers in the United States.