Triazolam for Pediatric Dental Sedation: A Retrospective Evaluation of Safety and Changes in Visit Behavior.

Purpose: To describe triazolam in pediatric dental mild to moderate sedation and report changes to overall visit behavior for permanent first molar extraction. Methods: This retrospective chart review from 2018 to 2022 analyzed demographic, procedural, and behavioral data for children eight years and older receiving triazolam for a permanent first molar extraction. The outcomes included adverse events measured by deviations in heart rate and oxygen saturation and changes to overall visit-level Frankl scores from the referral to sedation visit. Descriptive statistics and non-parametric statistical analyses were conducted. Results: The study population (n equals 82) was predominantly female (61 percent), English-speaking (85 percent), and White (41 percent) or Black (39 percent). The most common indication for mild to moderate sedation was dental anxiety (28 percent). There were zero instances of adverse events requiring emergency intervention or the use of reversal medication. The change in visit-level Frankl scores was significantly positive (P<0.001). Conclusion: Triazolam is likely a safe choice for mild to moderate sedation, leading to improved overall visit behavior in children undergoing a permanent first molar extraction.

The changing profile of infective endocarditis: A multi-year retrospective study for dentists.

BACKGROUND: Infective endocarditis (IE) has high morbidity and mortality and is often attributed to dental procedures. AIM: This study characterized variables related to paediatric IE in a paediatric hospital cohort. DESIGN: A retrospective review of medical records, from January 1, 2008, to January 1, 2020, to examine demographic, medical and dental history, and risk factors associated with children diagnosed with IE at Nationwide Children's Hospital. RESULTS: Of the 242 patients who were admitted with tentative IE diagnoses, 67 met the inclusion criteria: 46 (69%) had underlying cardiac conditions and 21 (31%) had not. One-third had an infection with S. aureus and viridans streptococci. Age was significantly associated with intracardiac devices in children with IE. Mean hospitalization was 25 days, and the mortality was 6 (9%); 41(61%) required surgery for causative defects, and 24 (32%) had dental consultation during admission. CONCLUSION: Although cardiac-related conditions were present in most cases, IE occurred in patients without cardiac factors.

Medical Text Prediction and Suggestion Using Generative Pretrained Transformer Models with Dental Medical Notes.

BACKGROUND: Generative pretrained transformer (GPT) models are one of the latest large pretrained natural language processing models that enables model training with limited datasets and reduces dependency on large datasets, which are scarce and costly to establish and maintain. There is a rising interest to explore the use of GPT models in health care. OBJECTIVE: We investigate the performance of GPT-2 and GPT-Neo models for medical text prediction using 374,787 free-text dental notes. METHODS: We fine-tune pretrained GPT-2 and GPT-Neo models for next word prediction on a dataset of over 374,000 manually written sections of dental clinical notes. Each model was trained on 80% of the dataset, validated on 10%, and tested on the remaining 10%. We report model performance in terms of next word prediction accuracy and loss. Additionally, we analyze the performance of the models on different types of prediction tokens for categories. For comparison, we also fine-tuned a non-GPT pretrained neural network model, XLNet (large), for next word prediction. We annotate each token in 100 randomly sampled notes by category (e.g., names, abbreviations, clinical terms, punctuation, etc.) and compare the performance of each model by token category. RESULTS: Models present acceptable accuracy scores (GPT-2: 76%; GPT-Neo: 53%), and the GPT-2 model also performs better in manual evaluations, especially for names, abbreviations, and punctuation. Both GPT models outperformed XLNet in terms of accuracy. The results suggest that pretrained models have the potential to assist medical charting in the future. We share the lessons learned, insights, and suggestions for future implementations. CONCLUSION: The results suggest that pretrained models have the potential to assist medical charting in the future. Our study presented one of the first implementations of the GPT model used with medical notes.

Safety Training in US Pediatric Dentistry Advanced Education Programs: A Survey of Program Directors.

Purpose: Incorporation of patient safety and quality improvement into the educational framework of all health care trainees, including those in dentistry, is growing. The purpose of this study was to characterize the current state of patient safety training and education in US pediatric dentistry residency programs. Methods: A 19-item web-based survey was emailed to all US pediatric dentistry residency program directors in 2021. The survey collected information regarding program background, safety education, safety protocol and experience, attitudes toward safety, and potential support for safety education. Data were analyzed using descriptive statistics and Fisher's exact test. Results: Seventy-two directors (76 percent response rate) completed the survey. The majority felt safety education was somewhat (11 percent, N equals six) or extremely important (68 percent, N equals 49) for residents. Only six percent (N equals four) reported residents entered their program with an adequate understanding of safety science. Most (74 percent, N equals 53) taught safety science through both didactic seminars and clinical experience. Timeouts under general anesthesia (78 percent, N equals 56) and emergency simulations (72 percent, N equals 52) were more common modes of clinical safety training. Overall, a limited number of program directors had familiarity with many safety tools used to prevent adverse events. Program directors' experience with adverse events was not associated with opinions regarding the importance of safety education. The majority expressed interest in AAPD supporting safety education. Conclusions: Although program directors feel safety education is important, programs do not sufficiently address safety education and look for support to help integrate safety measures into education.

Accuracy of Parental Self-Report of Medical History in a Dental Setting: Integrated Electronic Health Record and Nonintegrated Dental Record.

Purpose: The purpose of this study was to evaluate the extent of concordance and significance of inaccuracies between a parent-reported medical history in a nonintegrated electronic dental record (EDR) and an integrated electronic health record (EHR). Methods: In a retrospective institutional review board chart review, a single trained examiner compared medical histories in an EDR with the same patient's history from an EHR for concordance in sociodemographic, medical condition, allergy, and medication variables deemed significant to dental care. Of 4,282 possible patient comparisons, 291 patients were randomly sampled and compared. Concordance between record types was generated for each variable using the EHR as the ideal standard. Data were analyzed using percent match comparison and logistic regression. Results: Only 10 of 45 variables (22 percent) met the standard to match. Present conditions were more likely to be unreported than falsely reported in the EDR (58 percent). Logistic regression revealed multiple significant associations between sociodemographic variables and concordance between the EDR and EHR on specific medical conditions and medications. Conclusions: Discrepancies exist between parent-reported medical histories (EDR) and composite health histories (EHR), with the potential to compromise patient safety and create an opportunity for medical error. Social determinants of health are associated with true-positive and true-negative reporting of medications and medical conditions. EHRs allow clinicians access to a greater depth of health history information in real time compared to nonintegrated health records, but medical history-taking skills should remain at the forefront of dental education and dental practice.

Caregiver Preferences of Greetings by Dental Staff.

Purpose: To assess the attitudes and preferences of caregivers accompanying children to dental appointments toward greetings by dental staff.
Methods: English-speaking caregivers accompanying children to dental appointments completed a sex-specific survey consisting of 21 questions pertaining to the current visit, demographics, subject's relationship to the child, preference for greeting by providers, and previous uncomfortable experiences with greetings by providers.
Results: The sample included 238 subjects: 197 (82.8 percent) biological parents; 17 (7.1 percent) biological grandmothers/grandfathers; and 24 (10.0 percent) adults had a different relationship to the child. The single most preferred greeting was "mom" (70.0 percent) or "dad" (72.2 percent), with some variation in preferences among caregivers who were not biological parents. The second most preferred greeting was the first name for both males and females. African-American females preferred to be greeted by the first name compared to white females (P <.03). Older females preferred to be greeted by "grandma" compared to younger females (P <.01).
Conclusion: No single greeting was acceptable to all subjects. Using "mom" or "dad" was acceptable to most caregivers but not universally accepted. First name was acceptable to most, including caregivers who were not biological parents.

Evaluation of the Ability of Five- to 11-Year-Olds to Brush Their Teeth Effectively with Manual and Electric Toothbrushing.

Purpose: This study's purposes were to: (1) correlate toothbrushing effectiveness measured by plaque removal with children's parent- reported ability to perform life tasks and their executive function; and (2) compare plaque removal by children using a manual versus electric toothbrush. Methods: A convenience sample of 120 healthy five- to 11-year-olds was randomly and evenly assigned to manual or electric tooth- brush groups. A questionnaire was developed from items selected from previously validated social science instruments and completed by caregivers. Plaque was measured by calibrated scorers using the Oral Hygiene Index-Simplified before and after children brushed with respective toothbrushes. Statistical significance was established at P<0.05. Results: The type of toothbrush had no effect on brushing effectiveness. Ability to write a complete address, tie shoes independently, cut meat with a knife, and cut out complex shapes were associated with better toothbrushing effectiveness. Increasing ability to play a musical instrument and wash dishes independently were associated with increased plaque removal. Parents were good predictors of a child's readiness to brush, based on plaque removal scores. Conclusions: Certain life skills and quality of performance of tasks were associated with toothbrushing effectiveness in five- to 11-year-olds and may be used to determine a child's readiness to brush independently.