Mineral Trioxide Aggregate and Diluted Formocresol Pulpotomy: Prospective and Retrospective Study Outcomes.

Mineral Trioxide Aggregate (MTA) has been used in many endodontic procedures with success. We hypothesized that MTA as a pulpotomy medicament elicits outcomes no different than that of the diluted formocresol (DFC). PURPOSE: The purpose of this study was to compare the outcomes of grey MTA and DFC in primary molar pulpotomies at a teaching institution and a pediatric dental practice. METHODS: At the teaching institution, 206 primary molars of 122 children were enrolled. At 48-months, 20 teeth treated with MTA and 25 teeth treated with DFC, were available for evaluation. At the private practice, dental records of 245 primary molars of 68 patients were available for evaluation. RESULTS: At 48 months, the results from both sites showed a radiographic success rate of 80 percent for DFC and 95 percent for MTA. The odds of radiographic failure were not affected by study sites. The Cox-regression analysis revealed that patient's age at the time of pulpotomy impacted the "hazard of exfoliation." Each year following the completion of DFC or MTA pulpotomy, there is a 4.6-times-more-likely chance for early exfoliation of the pulpotomized tooth. CONCLUSION: Grey MTA is an acceptable alternative for primary molar pulpotomies.

The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients.

PURPOSE: The purpose of this study was to compare the safety and effectiveness of oral and intranasal midazolam in healthy children by evaluating their physiological and behavioral responses. METHODS: Regimen A patients received 0.5 mg/kg oral midazolam with an intranasal saline spray placebo at their first appointment and 03 mg/kg intranasal midazolam with an oral midazolam placebo at their second appointment. Regimen B patients received the medications in the reverse order at each appointment. Physiological parameters and behavior ratings were recorded. RESULTS: There were no significant differences in physiologic parameters in the 2 treatment groups, except for significantly lower oxygen saturation in the oral group at t=20 minutes (P=.03) The oral group showed significantly lower crying scores at t=5 minutes (P=.02), and lower overall behavior scores at t=papoose and t=5 minutes (P=.04 and .03, respectively). Oral sedations were given ratings by providers of "effective" and "very effective" significantly more than intranasal sedations (P<.05). CONCLUSIONS: Both regimens have similar behavioral outcomes, with the oral group having improved crying and overall behavior early in the appointment, Oral sedations were considered to be more effective by providers than intranasal sedations. Clinically significant desaturations occur in both regimens, indicating the need for operators to recognize and respond to the need for airway correction according to American Academy of Pediatric Dentistry guidelines.

Illustrated information for parent education: parent and patient responses.

PURPOSE: The purpose of this study was to explore the effect of using illustrations, when educating parents about their child's upcoming operative appointment, on parents' and child patients' responses to the treatment. METHODS: Data were collected from 189 parents of 4- to 10-year-old pediatric dental patients who needed operative treatment. The parents received information about their child's upcoming operative visit either verbally or with the support of standardized illustrations (flip chart), and/or individualized drawings. Parents and providers responded to surveys following the operative appointments. RESULTS: Verbally informed parents were more likely to (a) miss the operative appointment (47% vs 19%/16%/10%; P<.001) and (b) remain in the operatory during treatment (47% vs 18%/26%/19%; P<.01) than parents who received standardized illustrations, individualized illustrations, or both illustrations. The patients whose parents had received verbal information behaved more negatively than the children whose parents had received illustrative information. Overall, Frankl behavior ratings ranged from 1="definitely negative" to 4="definitely positive" (3.30 vs 3.54; P=.04). CONCLUSIONS: Educating parents about the basic disease process of dental caries with the aid of illustrations increased parents' cooperation with the recommended dental treatment for their children and improved their children's behavior during the treatment.

Contemporary appraisal of factors influencing pediatric dental program directors' selection of residents.

PURPOSE: With the increasing number of applicants and changes to information available in applications, pediatric dentistry program directors must adapt the resident selection process. The evaluation approach was significantly impacted when the National Board Dental Examination (NBDE) changed to a pass/fail grading system. The purposes of this are study to examine what criteria pediatric dentistry program directors now use to select residents, and to evaluate current criteria against those used in the past. METHODS: A 30-item survey was structured similar to a previous questionnaire used in 2005. An invitation to participate was sent via email to all pediatric dentistry program directors for the 82 Commission on Dental Accreditation (CODA)-accredited programs located in the United States and Canada. Anonymous responses were analyzed. RESULTS: There were 58 responses (70.7% response rate). The overall most important factors were clinical grades, dental school class rank, dental school grade point average (GPA), and applicant's essay. The least important factors were the applicant being a graduate of the program's dental school, Advanced Dental Admission Test (ADAT) score, and applicant's fluency in a second language. The factor that had the most significant increase in importance from 2005 is the applicant's essay, followed by dental school reputation and the dental school's pediatric program reputation. CONCLUSIONS: The most important factors to program directors are clinical grades, dental school class rank, dental school GPA, and applicant's essay. The applicant's essay has increased in importance since 2005.

Factors influencing candidates' choice of a pediatric dental residency program.

The goal of this study was to identify the factors and program characteristics that influenced the program ranking decisions of applicants to pediatric dentistry residency programs. A questionnaire was sent to the first-year resident class in 2005 with a response rate of 69.2 percent (n=260). Approximately 55 percent were female (104/180) and 61 percent were non-His-panic white (110/180). The respondents reported that they applied to an average of nine programs, of which five were ranked. Most applicants were interested in a program that had a hospital component with a duration of two years. A program's ability to prepare the resident for an academic career was a minimal influence for 48.6 percent (87/179), and 57.5 percent (103/179) were not interested in a master's or Ph.D. degree. Factors associated with program ranking included modern clinical facilities, high ratio of dental assistants and faculty to residents, availability of assistants for sedation and general anesthesia cases, availability of a salary or stipend, and amount of clinical experience. Important non-clinical factors included hospitality during the interview, geographic location, and perceived reputation of the program. Opportunity to speak with the current residents in private, observing the interaction between residents and faculty, and touring the facilities were also highly considered. These findings may help program directors tailor their interviews and programs to suit the needs of applicants.

Pediatric dentists' job satisfaction: results of a national survey.

PURPOSE: The purpose of this study was to determine pediatric dentists' level of job satisfaction and to explore which factors (demographic and practice/work/patient characteristics) are related to their satisfaction. METHODS: Data were collected with mailed surveys from 385 and with web-based surveys from 966 pediatric dentists in the United States. Professional satisfaction was measured with the Professional Satisfaction Scale and the Dentists' Satisfaction Scale. RESULTS: Most respondents would choose dentistry (89 percent) and pediatric dentistry (92 percent) again and would recommend dentistry (85 percent) and pediatric dentistry (83 percent) to their child as a career. Male respondents were more satisfied with income, personal and professional time, staff, and practice management aspects, and female respondents were more satisfied with patient relations. The older the dentists were, the more satisfied they were. Respondents in academia were less stressed and less satisfied with their income than respondents in nonacademic settings. The more time spent in the operatory and the less administrative work, the more satisfied the respondents were. The fewer patients from a lower socioeconomic background they treated, the more satisfied they were. CONCLUSIONS: Overall, pediatric dentists have a high level of job satisfaction. Demographic factors and practice/work/patient characteristic are related to job satisfaction.

Oral health literacy: awareness and practices among pediatric dentists.

PURPOSE: The purpose of this study was to examine pediatric dentists' awareness and experiences with oral health literacy and to identify communication techniques used with parents. METHODS: Active North American members of the American Academy of Pediatric Dentistry were invited to participate in the survey. Descriptive statistical analyses were completed, and Pearson's chi-square crosstabs tests were used to compare categorical data between groups. RESULTS: Data were collected from 22 percent (N=1,059) of pediatric dentists; 68 to 87 percent use basic communication techniques routinely, while 36 to 79 percent routinely use enhanced communication techniques. Approximately 59 percent (N=620) reported having had an experience with health literacy miscommunication, while 11 percent (N=116) are aware of an error in patient care that resulted from oral health literacy miscommunication. Respondents who have had an experience with miscommunication were significantly more likely statistically to perceive barriers to effective communication as more significant than those without a history of miscommunication experience (P<.001). CONCLUSIONS: Most pediatric dentists have experienced situations in which a parent has misunderstood information. Basic communication techniques were most commonly used, while enhanced communication techniques were used less routinely. Those who have had experience with oral health literacy miscommunication events perceive barriers to effective communication as more significant.

Retrospective record review: reinforced zinc oxide-eugenol pulpotomy: a retrospective study.

PURPOSE: The purpose of this retrospective study was to evaluate pulpotomies completed without the use of a fixative, preservative, or astringent agent prior to placement of a reinforced zinc oxide-eugenol (ZOE) sub-base in the pulp chamber and subsequent restoration. METHODS: Clinical and radiographic data were collected from a private pediatric dental office in Toronto, Ontario, Canada. The pulpotomy technique used involved: amputation of coronal pulp; radicular hemostasis via pressure with dry cotton pellet; placement of ZOE into the pulp chamber; and restoration with stainless steel crown or amalgam. RESULTS: One-hundred-ninety primary molars in 116 children (follow-up=6-94 months; mean=35.8 months) met the inclusion criteria. The radiographic, clinical, and overall success rates were approximately 95%, 97%, and 94%, respectively. The most frequently observed pathologic pulpal response was furcation radiolucency (N=7, ∼4%). The patient's age at time of pulpotomy, restoration type, tooth type, arch, and location of treatment (in-office vs general anesthesia) were not statistically significant factors influencing the success of the reinforced ZOE pulpotomy technique. CONCLUSION: The success rates indicate that the reinforced zinc oxide-eugenol pulpotomy technique may be an acceptable treatment modality for primary molars requiring vital pulp therapy.

Comparison of mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars: 42-month follow-up and survival analysis.

PURPOSE: The purpose of this study was to test the hypothesis that there is no significant difference in the clinical and radiographic outcomes of diluted formocresol (DFC) compared to gray mineral trioxide aggregate (GMTA) pulpotomy in human primary molars. METHODS: A total of 152 children with 252 primary molars met selection criteria. Of those, 119 and 133 teeth were randomly assigned to the GMTA and DFC groups, respectively. Periapical radiographs, taken pre- and/or postoperatively and at each 6-month follow-up, were digitized and evaluated by three blinded and calibrated examiners. RESULTS: Over a 42-month period, a total of 865 clinical and radiographic evaluations were conducted. There was no significant difference in clinical success, with the cumulative proportion of GMTA-treated teeth surviving at 0.98 vs DFC-treated teeth at 0.95 (P>.05). Radiographic success, however, was significantly greater for GMTA vs DFC, with the cumulative proportion of GMTA-treated teeth surviving at 0.90 vs DFC-treated teeth at 0.47 (P<.001). Overall, DFC-treated teeth were 5.1 times more likely to fail than GMTA-treated teeth. Radiographic pathologies were observed more frequently in the DFC-treated teeth (P<.05). CONCLUSION: Gray mineral trioxide aggregate can be considered an acceptable replacement for diluted formocresol when used as a medicament for primary molar pulpotomies.

Comparison of gray mineral trioxide aggregate and diluted formocresol in pulpotomized primary molars: a 6- to 24-month observation.

PURPOSE: The purpose of this multisite, multioperator, prospective, randomized, controlled clinical trial was to evaluate 2-year outcomes of diluted formocresol (DFC) compared to gray mineral trioxide aggregate (GMTA) as pulpotomy medicaments. METHODS: Following the standard pulpotomy procedure, the pulp stumps of 252 primary molars in 168 healthy children were randomly covered with GMTA or DFC. Pulp chambers were filled with Intermediate Restorative Material (IRM(®)) and teeth were restored with stainless steel crowns. At each follow-up appointment, the clinical status of the treated tooth was assessed and radiographs were taken. A total of 694 clinical and radiographic evaluations were analyzed. RESULTS: Gender, study site, arch type, and tooth type did not influence treatment outcome. At the combined 6- to 24-month follow-up, clinical success in the DFC group was no different than for the GMTA group. Radiographically, a significantly lower success rate was found in the DFC group vs the MTA group at all time points (P<.01). Dentin bridge formation was observed at a significantly higher frequency among the GMTA group (P<.01), while internal root resorption was observed at a higher frequency in the DFC group (P<.01). CONCLUSION: At the combined 6- to 24-month follow-up, gray mineral trioxide aggregate demonstrated significantly better radiographic outcomes vs diluted formocresol as pulpotomy medicaments.

Factors influencing pediatric dental program directors' selection of residents and demographics of current directors.

The primary goal of this study was to examine the criteria that influence rankings of candidates by advanced education program directors in pediatric dentistry. Secondary objectives were to obtain information on the resident selection process and to explore demographics of current program directors. A survey was sent in 2005 to all sixty-three program directors of pediatric dentistry residency programs accredited within the United States for the graduating class of 2007. The survey had a response rate of almost 78 percent (49/63). Respondents were requested to rank the importance of eleven factors that are typically included in the selection criteria for pediatric dentistry residents. Factors were rated on a scale of critical, very important, fairly important, somewhat important, and not important. The four highest ranked criteria by program directors were the following, in order: National Board scores, dental school clinical grades, class rank, and grade point average (GPA). Other factors ranked in descending order of perceived importance were the following: dental school basic science grades, experience in pediatric dentistry, extracurricular activities, completion of a general practice residency or advanced education in general dentistry program, the application essay, a publication or professional presentation, and private practice experience. All directors ranked personal interviews as very important to critical. Letters of recommendation from a pediatric dentistry department chairperson or faculty member were viewed more favorably than letters from dental school deans and non-pediatric dentistry faculty. Fifty-seven percent of the directors responding (28/49) were male, and 81 percent (40/49) were white, non-Hispanic. Fifty-nine percent of the directors (29/49) graduated from a residency program over twenty years ago, with 39 percent (19/49) having been a director for less than five years.