Occupational Noise Exposure in the Pediatric Dental Setting.

Purpose: To evaluate the noise levels recorded in a hospital-based pediatric dental clinic and evaluate the occupational exposure personnel have to potentially hazardous levels of noise. Methods: A SoundAdvisor™ Sound Level Meter Model 831C was used to gather 19 days of background sound data (equivalent continuous sound levels, measured as LAeq) in the open bay, quiet room, sedation suite, and operating room settings. A Spartan™ Wireless Noise Dosimeter Model 730 (Larson Davis) was utilized to capture data about personal noise exposure of pediatric dental residents over 81 clinic sessions. Personal noise exposure was compared to the Occupational Safety and Health Administration (OSHA) stand- ard. Results: Background A-weighted sound pressure level was significantly less for the open bay than in the operating room, quiet room, and oral sedation setting (P<0.05), while the operating room was significantly less than the oral sedation setting (P=0.038). Personal LAeq was significantly less for the open bay than the quiet room (P=0.007) and oral sedation settings (P=0.007). There was a significantly larger percentage of time above 80 dBA captured in the oral sedation suite compared to the open bay (P=0.010) or operating room (P=0.023). Conclusions: Daily occupational noise exposure did not exceed the thresholds set forth by OSHA. Sedation and quiet room treatment settings were noted to be the loudest pediatric dental clinical environments.

Supplemental Oxygen Concentrations and the Use of Suction to Mitigate Risk of Oral Surgical Fires Using a Laboratory Model.

Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, is associated with an increased risk of spontaneous perioperative fire. The purpose of this in vitro study was to examine the effectiveness of intraoral suctioning for reducing oxygen pooling to safe levels during a simulated dental procedure. Methods: Phase one: Twenty trials were completed for each of the three suctioning devices: high-volume evacuation (HVE), fixed tip saliva ejector (SE), and Yankauer suction (YS). Phase two: Twenty trials were completed for each of three suctioning scenarios: no suctioning and continuous suctioning for the HVE and SE. Results: In phase one, the slope for change (decrease) in oxygen during suction was significantly larger for SE than HVE (P<0.001) and YS (P<0.001), but for HVE and YS were not significantly different. Mean oxygen levels during suction were significantly higher for SE than HVE (P<0.001) and YS (P<0.001). In phase two, oxygen increased faster for no suction than for SE and HVE (P<0.001) and increased faster for SE than HVE (P<0.001). Mean oxygen levels were significantly lower for HVE than for SE (P<0.001) and no suction (P<0.001), and significantly lower for SE than no suction (P<0.001). Conclusion: All three devices were effective for reducing intraoral oxygen concentration to acceptable levels during the procedure. The HVE was the most effective suction device for rapidly evacuating pooled intraoral oxygen.

Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality.

Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.

Topical fluoride impact in future restorative dental procedures: A claim study.

BACKGROUND: Caries is one of the most prevalent diseases affecting children. Topical fluoride is used to decrease the incidence of caries. The purpose of this study was to investigate the impact of fluoride varnish and gel applications on future restorative dental treatment claims. METHODS: The data were obtained in conjunction with a dental data warehouse through a partnership agreement. A retrospective analysis of dental claims made from 2010 through 2018 was completed. Data were extracted for patients aged 1 through 8 years with topical fluoride application and its subsequent impact on restorative dental claims. RESULTS: Data for 672,889 patients were included in the analysis. Patients who received topical fluoride had significantly lower numbers (P < .001) of restorative procedures and extractions per year and significantly increased time (P < .001) to their first restorative procedure or extraction after the index visit than patients who did not receive topical fluoride. CONCLUSIONS: The application of fluoride varnishes and gels increased the time to future restorative and extraction dental claims and decreased the number of future restorative and extraction dental claims. PRACTICAL IMPLICATIONS: This study is important because it found that the use of topical fluoride decreased the number of future restorative and extraction dental claims.

Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data.

BACKGROUND: Advancements in dental materials and changing parental preferences are modifying the frequency of use of restorative materials. This insurance claims analysis examined the trends in the use of amalgam and resin composite in the United States. METHODS: Commercial dental insurance claims were analyzed to compare 505,994 restorations, corresponding with procedure codes for 1-, 2-, and 3-surface amalgam or resin restorations. Paid claims collected nationwide from January 2010 through March 2020 were analyzed. Data for children aged 3 through 12 years were used, resulting in 219,632 unique patient identification numbers. Generalized estimating equation models applied to logistic regression were used. All tests were conducted using a 2-sided 5% significance level. RESULTS: In general, girls were less likely to receive amalgam than boys. A $20,000 increase in median household income was associated with a 16% decrease in the odds of amalgam being placed. Pediatric dentists (performing 15.1% of all restorations) were not as likely as general dentists (18.4%) to use amalgam. Having more surfaces in a restoration was associated with higher probability of amalgam placement. The percentage of amalgam restorations was higher for 2010 (26.9%) than for 2011 through 2020, and this pattern recurred in several of the years analyzed. Generally, patient age at time of amalgam restoration increased over time. CONCLUSION: The use of amalgam is trending down; the sharpest decline was noted in 2014. Pediatric dentists were less likely to use amalgam than general dentists. Girls and patients with higher socioeconomic status were less likely to have amalgam. PRACTICAL IMPLICATIONS: The findings of this study can inform and support clinical decisions and the formation of public policies.

Pediatric Phantom Dosimetry Evaluation of a New Rectangular Collimator.

Purpose: To compare the effective dose (E) of the Tru-Image® rectangular collimator and the universal round collimator of a Planmeca® wall-mounted radiograph unit for two bitewing radiographs (right and left) on a pediatric phantom.
Methods: Absorbed doses utilizing the Tru-Image ®rectangular collimator and universal round collimator were acquired using an anthropomorphic 10-year-old child phantom. Each set of 24 dosimeters was exposed to two bitewing exposures with the manufacturer's child settings. Fifty clinical exposures were completed for each set and three sets were exposed for each collimator. The average E per exposure was calculated.
Results: The overall E for the Tru-Image ®rectangular collimator and the universal round collimator were 6.3 microsieverts (µSv) and 25.3 µSv, respectively. This difference was statistically significant (P <0.001). The highest equivalent dose for both collimators was delivered to the oral mucosa. When compared to the universal round collimator, the Tru-Image ® rectangular collimator had significant dose reduction at all locations (P <0.05). When normalized and adjusted to the same source-to-end distance, there was an overall 65 percent dose reduction with the rectangular collimator.
Conclusion: The average effective dose was significantly reduced with the use of the Tru-Image ®rectangular collimator. Clinical use of this rectangular collimator should be considered in the pediatric population.

Evaluation of Claim Reports for Potential Impact of COVID-19 on Pediatric Dental Procedures.

PURPOSE: To evaluate whether the postponement of dental elective procedures at the start of the COVID-19 pandemic was associated with an increased number of simple dental extractions, and/or decreased restorative procedures by analyzing data obtained from state-funded insurance dental claims. METHODS: Paid dental claims collected from March 2019 to December 2019 and from March 2020 to December 2020 for children ages two to 13 years old were analyzed. Dental procedures were selected based on Current Dental Terminology (CDT) codes for simple dental extractions and restorative procedures. Statistical analyses were performed to compare the rates of procedure types between 2019 and 2020. RESULTS: No differences in dental extractions but full-coverage restoration procedure rates per month and child were significantly lower than pre-pandemic (P=0.016). CONCLUSION: Further study required to determine the impact of COVID-19 on pediatric restorative procedures and access to pediatric dental care in the surgical setting.

Financial Impact of COVID-19 on Dental Care for Pediatric Patients: a Dental Claims Review.

PURPOSE: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. METHODS: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. RESULTS: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. CONCLUSIONS: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.

Trends in dental insurance claims in the United States in the context of the COVID-19 pandemic: A 3-year perspective (2019-2022).

OBJECTIVES: We showed in a previous analysis the patterns of disruption for private dental insurance claims in the United States caused by the SARS-CoV-2 pandemic in 2020. The present report examines trends during 2020 and 2021, that is, contrasting perspectives during 2019 with the acute phase of the pandemic in 2020, and 2021. METHODS: Private dental insurance paid claims from a data warehouse were obtained, encompassing a 5% random sample of records between January 2019 and December 2021 for child and adult insureds who filed a claim in 2019, 2020, and 2021. We classified claims into one of four categories based on the likelihood of being associated with urgent/emergency care. RESULTS: The precipitous reduction in dental care claims in March-June 2020 recovered to almost pre-pandemic levels by the fall of 2020. However, a downward decline in private dental insurance claims started in the late fall of 2020 and continued through 2021. Differential impacts in dental care categories-in terms of urgency of care-were evident 2021, closely resembling previous trends in 2020. CONCLUSIONS: Dental care claims from the first year of the 2020 SARS-CoV-2 pandemic were contrasted with perspectives in 2021. A downward trend in demand/availability changes in dental care insurance claims set in for 2021, perhaps linked to perceptions of the overall economic situation. Such downward trend has continued overall, even after considering seasonal changes and the acceleration of the pandemic during the Delta, Omicron, and other variants.

Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia.

OBJECTIVE: The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented. METHODS: Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment. RESULTS: Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute. CONCLUSION: This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.

The Saudi Arabian national demographic and health survey, 2017: Study design and oral health-related influences.

Objective: To describe the study design, and the distal and proximal influences on oral health reported in the national demographic and health survey (DHS) of the Kingdom of Saudi Arabia (KSA) in 2017. Methods: The 2017 KSA DHS used an innovative multistage stratified random-sampling technique to select the population sample by using primary health care centers' (PHCs) catchment areas as the primary sampling unit. Over 45,000 household heads plus a family member were interviewed. A conceptual framework for distal and proximal oral health influences specific to the KSA was adapted based on the oral health surveillance model. Cross-tabulation and Chi-square tests were performed with consideration for sample weights to provide estimates representative for the KSA population. Frequencies and weighted percentages for each variable reflecting each construct were reported. Results: The total number of individuals included in the analysis was n = 55,511, ages ranging between 2 and > 65 years. Lack of dental care when needed was reported for 22.5 % of the population (males = 20.8 %/females = 24.7 %). Proportion of population from Central, West, East, South, and North regions who reported available dental care services when needed was 62.3 %, 58.0 %, 58.9 %, 62.3 %, and 60.1 %, respectively. PHCs were the most regular source for dental care (55.1 %). In total, 48.3 % visited the dentist at least once last year (males = 49.4 % /females = 46.8 %). Dental pain was the most common reason for last dental visit (69.0 %), while only 6.4 % reported visited the dentist for routine visit. Only 15.3 % reported brushing their teeth at least twice per day (males = 14.6 % /females = 16.4 %). Conclusion: Two major oral health influences previously reported to have a significant negative influence on oral health, namely, limited routine dental check-up visits and inadequate oral hygiene, were present among KSA residents. Further inferential study is needed to investigate such influence on oral health status within the KSA population.

Insurance claim data trends in pulpal therapy for pediatric patients.

BACKGROUND: The purpose of this study was to identify differences in usage trends for 2 specific pulpal therapy treatments in pediatric patients during an 11-year period from January 1, 2010, through December 31, 2020. METHODS: Insurance data claims for children aged 2 through 12 years undergoing a pulpotomy or a pulpectomy performed by a general dentist (GD) or pediatric dentist (PD) from 2010 through 2020 were extracted from a dental data warehouse. The state where the provider was located was included in the extracted claim. RESULTS: Rates of undergoing a pulpotomy or pulpectomy declined from 2010 through 2020 (odds ratio [OR], 0.978 or 0.946, respectively; P < .001). PDs were more likely to perform pulpotomies than GDs (OR, 1.393; P < .001), but PDs were less likely to perform pulpectomies than GDs (OR, 0.225; P < .001). Younger patient age was a significant predictor for undergoing pulpotomy treatment for both GDs and PDs (ORs, 0.850 and 0.892, respectively; P < .001). With increasing patient age, PDs had increased odds of performing a pulpectomy (OR, 1.030; P < .001) and GDs had decreased odds of performing a pulpectomy (OR, 0.995; P = .04). When examining effects according to American Academy of Pediatric Dentistry national membership districts, the trends remained consistent with those above. CONCLUSIONS: The percentage of children undergoing pulpotomy and pulpectomy therapy declined from 2010 through 2020 among both GDs and PDs. PRACTICAL IMPLICATIONS: These changes in pulpal therapy practice might indicate a teaching change in pulpal therapy guidelines, suggesting that less invasive pulpal therapy can be used rather than pulpotomies or pulpectomies.

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims.

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.

Características fonológicas en población escolar con dislexia: Un modelo de ecuaciones estructurales / Phonological features in a school population with dyslexia: A structural equation model

Resumen Introducción: El trastorno específico del aprendizaje es una entidad nosológica del neurodesarrollo, las manifestaciones clínicas se hacen evidentes en la etapa escolar y son persistentes en el transcurso de la vida. La dislexia (DS) se caracteriza por una afectación en la comprensión y fluidez del proceso lector, asociada a déficits neurocognitivos. Objetivo: Analizar. la relación existente entre fluidez fonológica, repetición, denominación y comprensión verbal en niños con diagnóstico de DS. Método: Se empleó una muestra de N=114 personas con diagnóstico de DS escolarizados, en edades entre 7 y 16 años y un. muestreo no probabilístico. Construimos un modelo de ecuaciones estructurales (MEE) en el software RCran 4.0.4, para analizar la relación entre las variables latentes (fluidez fonológica, fluidez semántica, repetición de pseudopalabras, repetición de frases, denominación y comprensión verbal), a través de los resultados de pruebas psicométricas estandarizadas; Test de Fluencia Verbal, Test de Boston, Evaluación Neuropsicológica Infantil y Escala Weschler IV de Inteligencia. Resultados: Las covarianzas entre fluidez fonológica y todos los componentes del lenguaje (LG) fueron positivas; fluidez semántica (σxy=0,55), repetición de pseudopalabras (σxz=0,53), repetición de frases (σxw=0,64), denominación del LG (σxv=0,60), comprensión verbal (σxy=0,57), lo que indica una relación directa. En las personas con DS, a menor fluidez fonológica mayores deficiencias del LG. Conclusión: En la DS la fluidez fonológica y semántica es limitada y se relaciona de manera directa con las manifestaciones clínicas de este trastorno del neurodesarrollo (TN).

Abstract Introduction: The specific learning disorder is a nosological entity of neurodevelopment, the clinical manifestations become evident in the school stage and are persistent throughout life. Dyslexia (DS) is characterized by an impairment in the comprehension and fluency of the reading process, associated with neurocognitive deficits. Objective: To analyze the relationship between phonological fluency, repetition, naming and verbal comprehension in children diagnosed with dyslexia (DS). Method: A sample of (N=114) school patients with DS diagnosis between the ages of 7 and 16 years, selected by non-probability sampling, was used. We built a structural equation model (MEE) in RCran 4.0.4 software, to analyze the relationship between the latent variables (phonological fluency, semantic fluency, pseudoword repetition, sentence repetition, naming and verbal comprehension), through the results of standardized psychometric tests; Verbal Fluency Test, Boston Test, Child Neuropsychological Assessment and Weschler Intelligence Scale IV. Results: Covariances between phonological fluency and all language (LG) components were positive; semantic fluency (σxy=0.55), pseudoword repetition (σxz=0.53), sentence repetition (σxw=0.64), LG naming (σxv=0.60), verbal comprehension (σxy=0.57), indicating a direct relationship. In people with DS, the lower the phonological fluency the greater the language deficits. Conclusion: In DS, phonological and semantic fluency is limited and is directly related to the clinical manifestations of this neurodevelopmental disorder (TN).

Patterns of radiograph use in a population of commercially insured children.

BACKGROUND: The objective of this study was to evaluate differences in number and type of radiographs used among 3 age groups (0-5, 6-12, 13-18 years) by general dentists, pediatric dentists, and other specialists, and to determine the association between number and type of radiographs and clinical need. METHODS: A retrospective analysis of insurance claims by age group and oral health care provider type included children aged 0 through 8 years in 2005 who had a minimum of 10 years of continuous eligibility. Indicator claim variables were calculated to identify high-risk, high-need patients. RESULTS: A total of 6,712,155 records from 105,010 patients and 34,406 providers were analyzed. There was a significant effect (P < .001) of age on the number of radiographs obtained per visit. The estimated rates of radiographs per visit for ages 0 through 5, 6 through 12, and 13 through 18 were 0.373, 0.492, and 0.393, respectively. There was a significant interaction effect between age and provider type. For patients younger than 13 years, general dentists had lower rates of obtaining radiographs than did pediatric dentists, with no significant difference between providers for the 13- through 18-year age group. Treatments received, except for extractions and prosthodontics, were significantly associated with rate of radiographs per visit, with "number of restorations" as an indicator of increased risk, need, or both showing an inverse association with radiograph use. CONCLUSIONS: Child age and provider type had an effect on number of radiographs obtained per visit. Lack of caries diagnostic codes and uncommon use of risk codes hindered interpretation of whether use, frequency, or both is associated with need. PRACTICAL IMPLICATIONS: Radiograph use should follow existing guidelines or recommendations based on clinical need.

Trends in dental insurance claims in the United States before and during the SARS-CoV-2 pandemic in 2020.

OBJECTIVES: The SARS-CoV-2 pandemic disrupted health care services. Previous reports estimated reductions in demand and supply of dental care services, but actual changes have not been reported. The present report depicts a perspective of trends in claims from private dental practice in the United States during 2019 and 2020. METHODS: Private dental insurance paid claims data from a data warehouse (encompassing 66+ carriers in the United States) were obtained for children and adults (treatments identified by their American Dental Association Code of Dental Procedures and Nomenclature [CDT]), encompassing a 5% random sample of all records between January 2019 and December 2020. A market-based treatment classification placed CDT codes into one of four categories based on the likelihood of being associated with urgent/emergency care. RESULTS: Claims for 3.8 million patients constituted the 5% random sample for analyses. Substantial drops in the provision of treatment items were quantified for a large segment of private dental insurance plans at a national level, showing differential impacts in dental care categories. CONCLUSIONS: Week-by-week, detailed descriptions of demand/availability changes in dental care throughout the first year of the 2020 SARS-CoV-2 pandemic were obtained through contrasting perspectives in 2019. Provision of dental care and associated impacts fluctuated over time subject to treatment urgency, but also modified as the weeks/months of dental office lockdowns ebbed in and out of the dental market.

Prescription of bite-wing and panoramic radiographs in pediatric dental patients: An assessment of current trends and provider compliance.

BACKGROUND: The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic radiographs (PRs) for pediatric and adolescent dental patients after the implementation of the most recent guidelines from the American Dental Association and US Food and Drug Administration. METHODS: The authors accessed paid insurance claims data for all 50 states from January 1, 2013, through June 30, 2019, for patients 18 years and younger and extracted a 5% random sample population. The authors performed statistical analyses to evaluate various imaging metrics for pediatric dentists (PDs) and general practitioners (GPs). RESULTS: A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits. The average (standard deviation [SD]) time interval between bite-wing examinations ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7) months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients aged 0 through 4 years. For PRs, the authors included 286,824 images in this study. The average (SD) time interval between PRs ordered for the same patient was 3.4 (1.3) years for PDs and 3.3 (1.4) years for GPs. One percent of all PRs were ordered for patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 to GPs. CONCLUSIONS: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. PRACTICAL IMPLICATIONS: Inclusion of patient caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.

Pediatric Phantom Dosimetry of a Portable Handheld X-ray Device.

The purpose of this study was to quantify radiation dose from the XTG (Xray2Go) handheld X-ray device for bitewing and maxillary anterior occlusal projections using a pediatric phantom. The aim was to evaluate effects of thyroid shielding on total effective dose (E) and tissue equivalent doses (HT) and assess operator backscatter radiation. Methods:A pediatric phantom head with 24 tissue site dosimeters was exposed to radiation from the x-ray device. Exposures included: (1) right and left bitewing (BW) without thyroid collar on phantom, (2) BW with thyroid collar, (3) maxillary anterior occlusal (AO) without thyroid collar, (4) AO with thyroid collar. With each exposure type, new dosimeter sets were used and 30 exposures completed. The operator wore dosimeters on the forehead and right hand to quantify backscatter radiation. Average values of HT and E were calculated. Conclusions: Thyroid shielding made a statistically significant difference for radiation dose with the Xray2Go for BW projections at specific tissue sites, including the thyroid, lymph nodes, and muscle, and for overall effective dose. Radiation to the operator from the device was very low and indistinguishable from background radiation.

Hegemonia e emancipação, elementos representacionais do objeto social da escola / Hegemonía y emancipación, elementos representacionales del objeto social colegio / Hegemony and emancipation, representational elements of the social object school

La escuela, como espacio de relaciones o como establecimiento educador por la transmisión de conocimientos, mantiene una relación directa con las familias. Este estudio problematiza la relación escuela / familia en grados escolares superiores de secundaria en el contexto de la Ciudad de Pasto - Colombia. El objetivo es explorar las representaciones sociales que sobre el colegio tienen padres y madres de familia de estudiantes de secundaria. Se cuenta con información de 143 personas vinculadas a instituciones educativas públicas. Con el uso de un cuestionario de preguntas abiertas se indagó la dimensión de información y la dimensión de actitud del contenido representacional. Los resultados muestran tres categorías: desempeño de los docentes, enseñanza y desempeño de estudiantes como parte del contenido representacional, las cuales median en la imagen del colegio. Estos resultados permiten inferir que existen elementos tendientes a la conformación de representaciones sociales hegemónicas y representaciones sociales emancipadas.

A escola, como espaço de relações ou como estabelecimento educador pela transmissão de conhecimentos, mantém uma relação direta com as famílias. Este estudo problematiza a relação escola / família em grau escolar - ensino médio - no contexto da Cidade de Pasto - Colômbia. O objetivo é explorar as representações sociais que a escola tem pais e mães de família de estudantes de secundaria (ensino médio). Conta-se com informação de 143 pessoas vinculadas a instituições educativas públicas. Com o uso de um questionário de perguntas abertas indagou-se a dimensão de informação e a dimensão de atitude do conteúdo representacional. Os resultados mostram três categorias: desempenho dos docentes, ensino e desempenho de estudantes como parte do conteúdo representacional, as quais mediam na imagem da escola. Estes resultados permitem inferir que existem elementos tendentes à conformação de representações sociais hegemônicas e representações sociais emancipadas.

The school, as a space for relationships or as an educational establishment for the transmission of knowledge, maintains a direct relationship with families. This study problematizes the school / family relationship in upper secondary school grades in the context of the city of Pasto - Colombia. The objective is to explore the social representations that parents of high school students have about the school. It has information of 143 people linked to public educational institutions. With the use of a questionnaire of open questions, the dimension of information and the attitude dimension of the representational content were investigated. The results show three categories: teacher performance, teaching and student performance as part of the representational content, which mediate the image of the school. These results allow us to infer that there are elements tending to the conformation of hegemonic social representations and emancipated social representations.