What Child Oral Health-Related Behaviors Can First-time Mothers Actualize? A Pragmatic Prospective Study.

INTRODUCTION: First-time pregnant women are considered to be receptive to health information, rendering the prenatal period an opportune time to provide helpful information on the importance of child-related oral health. However, little is known about pregnant women's knowledge of child oral health-related behaviors (COHBs) during pregnancy and their implementation after birth. We sought to address this knowledge gap by a prospective investigation of intended and actualized oral health behaviors among first-time pregnant women. METHODS: We examined relationships between intended and actualized COHBs and their correlations with changes in oral health knowledge, health literacy, general self-efficacy, and dental neglect in a cohort of first-time pregnant clients at Women, Infants, and Children sites in North Carolina-participants of a large community-based study. The COHBs were related to diet (i.e., frequency of fruit juice and sweet snacks consumption and nighttime bottle-feeding) and oral hygiene practices (e.g., performance of daily oral hygiene and use of fluoridated toothpaste). Analyses relied on descriptive statistics and bivariate tests (Student's t and McNemar's). Data were collected from 48 participants (White, 44%; African American, 40%; Native American, 17%) at baseline and again at least 12 months after the birth of their first child. RESULTS: On average, most mothers actualized 3 of 5 COHBs (range, 1 to 4). Significant differences between before and after birth were noted for frequency of sweet snacks consumption and putting the baby in bed with a bottle. No correlation was found between knowledge, literacy, self-efficacy, neglect, and sociodemographic characteristics and COHB actualization. CONCLUSION: Our findings suggest that first-time mothers in the studied population are likely to implement some but not all positive intended COHBs during pregnancy. Interventions are needed to assist women in implementing these practices. We support that, for prenatal interventional efforts to reap positive benefits, messaging should be personalized and include specific guidance on how to implement these recommendations. KNOWLEDGE TRANSFER STATEMENT: A knowledge gap exists in our understanding of the relationship between first-time mothers' intended and actualized child oral health behaviors, with implications in the optimal timing of infant and early childhood oral health messaging. Our findings suggest that first-time mothers are likely to implement some but not all positive behaviors that they intended to adopt during pregnancy. Interventions are needed to assist women in implementing these practices.

A Contemporary Examination of First and Second Permanent Molar Emergence.

The emergence of first permanent molars (FPMs) and second permanent molars (SPMs) is an important developmental milestone influencing caries risk and the timing of sealant placement. Emergence times have been shown to vary by sex and race/ethnicity, while recent reports suggest a positive association with adiposity. Amid the changing demographics of the US population and the rising rates of pediatric overweight/obesity, we sought to examine the association of body mass index (BMI) with FPM/SPM emergence in a representative sample of US children and adolescents. We used cross-sectional data from 3 consecutive cycles of the National Health and Nutrition Examination Survey (2009 to 2014). The FPM analysis included ages 4 to 8 y ( n = 3,102 representing ~20 million children), and the SPM analysis included ages 9 to 13 y ( n = 2,774 representing ~19 million children/adolescents). The Centers for Disease Control and Prevention's growth chart data were used to calculate age- and sex-specific BMI percentiles, as measures of adiposity. Initial data analyses relied on descriptive statistics and stratified analyses. We used multivariate methods, including survey linear and ordinal logistic regression and marginal effects estimation to quantify the association between pediatric overweight/obesity and FPM/SPM emergence, adjusting for age, sex, and race/ethnicity. Forty-eight percent of 6-y-olds and 98% of 8-y-olds had all FPMs emerged, whereas SPM emergence varied more. Blacks (vs. whites) and females (vs. males) experienced earlier emergence of FPMs and SPMs. Overweight/obesity was associated with earlier FPM emergence, particularly among black females. Obesity but not overweight was associated with earlier SPM emergence. Overall, overweight/obesity accounted for 6 to 12 mo of dental acceleration. This study's results emanate from the most recent US-representative data and affirm that FPM/SPM emergence varies by race/ethnicity and sex and is positively influenced by BMI. Future research should further elucidate these associations with detailed eruption data and examine the implications of this variation for clinical care.

Is Dental Utilization Associated with Oral Health Literacy?

The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children's Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients' OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL.

Addressing selection bias in dental health services research.

When randomization is not possible, researchers must control for non-random assignment to experimental groups. One technique for statistical adjustment for non-random assignment is through the use of a two-stage analytical technique. The purpose of this study was to demonstrate the use of this technique to control for selection bias in examining the effects of the The Supplemental Program for Women, Infants, and Children's (WIC) on dental visits. From 5 data sources, an analysis file was constructed for 49,512 children ages 1-5 years. The two-stage technique was used to control for selection bias in WIC participation, the potentially endogenous variable. Specification tests showed that WIC participation was not random and that selection bias was present. The effects of the WIC on dental use differed by 36% after adjustment for selection bias by means of the two-stage technique. This technique can be used to control for potential selection bias in dental research when randomization is not possible.

A Cholera Conjugate Vaccine Containing O-specific Polysaccharide (OSP) of V. cholerae O1 Inaba and Recombinant Fragment of Tetanus Toxin Heavy Chain (OSP:rTTHc) Induces Serum, Memory and Lamina Proprial Responses against OSP and Is Protective in Mice.

BACKGROUND: Vibrio cholerae is the cause of cholera, a severe watery diarrhea. Protection against cholera is serogroup specific. Serogroup specificity is defined by the O-specific polysaccharide (OSP) component of lipopolysaccharide (LPS). METHODOLOGY: Here we describe a conjugate vaccine for cholera prepared via squaric acid chemistry from the OSP of V. cholerae O1 Inaba strain PIC018 and a recombinant heavy chain fragment of tetanus toxin (OSP:rTTHc). We assessed a range of vaccine doses based on the OSP content of the vaccine (10-50 µg), vaccine compositions varying by molar loading ratio of OSP to rTTHc (3:1, 5:1, 10:1), effect of an adjuvant, and route of immunization. PRINCIPLE FINDINGS: Immunized mice developed prominent anti-OSP and anti-TT serum IgG responses, as well as vibriocidal antibody and memory B cell responses following intramuscular or intradermal vaccination. Mice did not develop anti-squarate responses. Intestinal lamina proprial IgA responses targeting OSP occurred following intradermal vaccination. In general, we found comparable immune responses in mice immunized with these variations, although memory B cell and vibriocidal responses were blunted in mice receiving the highest dose of vaccine (50 µg). We found no appreciable change in immune responses when the conjugate vaccine was administered in the presence or absence of immunoadjuvant alum. Administration of OSP:rTTHc resulted in 55% protective efficacy in a mouse survival cholera challenge model. CONCLUSION: We report development of an Inaba OSP:rTTHc conjugate vaccine that induces memory responses and protection against cholera in mice. Development of an effective cholera conjugate vaccine that induces high level and long-term immune responses against OSP would be beneficial, especially in young children who respond poorly to polysaccharide antigens.

Covalent modification of Lys19 in the CTP binding site of cytidine 5'-monophosphate N-acetylneuraminic acid synthetase.

Periodate oxidized CTP (oCTP) was used to investigate the importance of lysine residues in the CTP binding site of the cytidine 5'-monophosphate N-acetylneuraminic acid (CMP-NeuAc) synthetase (EC 2.7.7.43) from Haemophilus ducreyi. The reaction of oCTP with the enzyme follows pseudo-first-order saturation kinetics, giving a maximum rate of inactivation of 0.6 min(-1) and a K(I) of 6.0 mM at pH 7.1. Mass spectrometric analysis of the modified enzyme provided data that was consistent with beta-elimination of triphosphate after the reaction of oCTP with the enzyme. A fully reduced enzyme-oCTP conjugate, retaining the triphosphate moiety, was obtained by inclusion of NaBH3CN in the reaction solution. The beta-elimination product of oCTP reacted several times more rapidly with the enzyme compared to equivalent concentrations of oCTP. This compound also formed a stable reduced morpholino adduct with CMP-NeuAc synthetase when the reaction was conducted in the presence of NaBH3CN, and was found to be a useful lysine modifying reagent. The substrate CTP was capable of protecting the enzyme to a large degree from inactivation by oCTP and its beta-elimination product. Lys19, a residue conserved in CMP-NeuAc synthetases, was identified as being labeled with the beta-elimination product of oCTP.

An avidin-biotin based ELISA for quantitation of antibody to bacterial polysaccharides.

A solid phase immunoassay utilizing avidin-biotin binding has been developed for measuring anticapsular polysaccharide antibodies. Capsular polysaccharides of Escherichia coli K1, Haemophilus influenzae type b, Staphylococcus aureus types 5 and 8, and levan from Aerobacter levanicum have been biotinylated through -OH or COOH groups with retention of antigenicity. Polysaccharides were immobilized on avidin-coated microtiter wells for use in an enzyme-linked immunosorbent assay (ELISA) to detect antibody. Two preparations of biotinylated S. aureus type 8 polysaccharide were equivalent as antigens in ELISA. Specificity was demonstrated by absorption of antisera, by competitive inhibition with purified antigens, and by reaction with specific monoclonal or myeloma antibodies. Reproducibility of the assay for H. influenzae type b and S. aureus type 8 antibody was demonstrated by replicate titrations of high and low level antisera.

Prevention of nonspecific binding of immunoglobulin to Staphylococcus aureus protein A in ELISA assays.

The Fc region of IgG of most mammals binds protein A on S. aureus resulting in high backgrounds when measuring specific antibodies to S. aureus in the ELISA. Removal of protein A from S. aureus or modification of the Ig Fc to prevent binding to protein A could affect specific antibody binding. We compared effects of blockage of Fc binding to protein A with purified protein A to trypsin removal of protein A from S. aureus, on specific antibody binding. When NMS was incubated without and with protein A (0 microgram, 50 micrograms, 200 micrograms and 400 micrograms) and high protein A Cowan I was the bound S. aureus antigen in the ELISA, absorbance OD405 was 0.769, 0.240, 0.224 and 0.210 +/- SE 0.026. When mouse Mab (IgG1, kappa) to bovine IgA was incubated without and with protein A (400 micrograms) prior to reaction with bovine IgA in the ELISA, absorbance was 0.645 and 0.639, indicating protein A had no effect on specific antibody binding. To determine the effect of trypsin on specific binding, Becker S. aureus was trypsin treated before linking it to microtiter wells. When Mab (IgM) to Becker (Nelles et al., Infect. Immun. (1985) 49, 14) was incubated with protein A (400 micrograms) before use in the ELISA, trypsin treatment of Becker resulted in reduced specific antibody activity (untreated Becker = 1.306, trypsin treated Becker = 0.331). These results suggest that purified protein A can be used to block nonspecific binding via Fc of Ig to S. aureus, thus avoiding trypsin denaturation of surface antigens.

Predominance of two newly described capsular polysaccharide types among clinical isolates of Staphylococcus aureus.

A capsular polysaccharide typing schema for Staphylococcus aureus, based upon the preparation of rabbit typing sera with eight prototype strains, has been reported ( Karakawa and Vann , 1982). These antisera were used to classify the capsular polysaccharides of 246 S. aureus isolates from patients in a survey of hospitals in several countries and 49 consecutive blood isolates obtained over a 17-month period in a clinical study at the Boston Veterans' Administration Medical Center. Two capsular types, 5 and 8, accounted for about 70% of these isolates; most of the remaining strains could not be typed with the available antisera. The clinical study of bacteremia identified capsular types 5 and 8 among both community-acquired and nosocomial isolates and showed that strains bearing these two types caused the patterns of disease reported for staphylococcal bacteremia. There was an association between the phage type and the capsular type of these bacteremic strains. The capsular types of the "classic" encapsulated strains of S. aureus, M (type 1) and Smith (type 2), were not observed among blood isolates in this study. The observation that most clinical isolates of S. aureus belong to two recently defined capsular types provides a new focus for investigations into the virulence of this common nosocomial pathogen and suggests the potential for protective acquired immunity against staphylococcal bacteremia.

Wear of composite resin restorations in primary versus permanent molar teeth.

The purpose of this investigation was to compare the wear rates of posterior composite resin restorations in primary versus permanent teeth. Based on theories of composite wear in primary molars, as well as on empirical observations, we hypothesized that wear would be greater in permanent tooth restorations. In Part I of the study, quantitative wear data from four different clinical trials (three permanent tooth studies and one primary tooth study) were compared. The same posterior composite restorative material was investigated in each of the four studies. In Part II of the study, quantitative wear data were drawn from a single clinical trial wherein the same experimental posterior composite material was placed in primary and permanent molars in the same children. In Part II, the baseline sample size included posterior composite restorations placed in 92 primary and 95 permanent molars in all children (ages 7-10). Quantitative wear data were obtained by the cast assessment method at baseline, six, 12, and 24 months. The 24-month sample size was based on 48 available primary molar restorations and 89 permanent molar restorations. The loss of primary restorations was due almost exclusively to natural exfoliations. Findings in Part I revealed no significant difference in the wear of primary versus permanent molar restorations. In Part II, wear findings for primary molar versus permanent teeth, respectively, were as follows (in micrometers): 47 versus 49 at six months; 86 versus 80 at 12 months; and 133 versus 131 at 24 months. With a Wilcoxon two-sample test and an alpha level of 0.05, there were no significant differences at any recall for the wear rate of primary versus permanent restorations. These results differ sharply from findings reported by others.

Assessing composite resin wear in primary molars: four-year findings.

Many investigators have reported minimal wear of resin restorations in primary molars. Until recently, quantitative wear assessments have not been reported. The purpose of this investigation was (1) to present and contrast data from two 48-month clinical trials wherein quantitative wear assessments were used to evaluate wear of resin restorations in primary molars, and (2) to compare these results with those using the USPHS method of wear assessment. The data were collected from two different clinical trials. One was conducted at the University of California in San Francisco by Tonn and Ryge (TR Trial). The other was conducted at the University of North Carolina at Chapel Hill by Oldenburg, Vann, and Dilley (OVD Trial). The OVD Trial had a sample size of 45 patients with 106 restorations; the TR Trial had 44 patients with 96 restorations. The restorations in both trials were Class I and II restorations in occlusion. They were placed with the experimental light-cured posterior composite resin F-70, later marketed as Ful-Fill. At baseline, six, 12, 24, 36, and 48 months, restorations were evaluated by two evaluators trained in USPHS criteria as well as by a quantitative method of wear assessment, the standard cast technique as described by Leinfelder. Interstudy comparisons were made by Chi-square tests (USPHS evaluations) and ANOVA (quantitative assessments). The results showed that resin restorations in primary molars exhibited progressive wear with time in service. The rate and quantity of wear were very similar to those seen in permanent posterior teeth over 36 months. Findings agree with previous reports that the USPHS evaluation criteria are insensitive in detecting early wear in primary molars.

Structure of the type 5 capsular polysaccharide of Staphylococcus aureus.

The Staphylococcus aureus type 5 capsular polysaccharide is composed of 2-acetamido-2-deoxy-L-fucose (1 part), 2-acetamido-2-deoxy-D-fucose (1 part), and 2-acetamido-2-deoxy-D-mannuronic acid (1 part). On the basis of methylation analysis, optical rotation, high-field one- and two-dimensional 1H- and 13C-n.m.r. experiments, and selective cleavage with 70% aqueous hydrogen fluoride, the polysaccharide was found to be a partially O-acetylated (50%) polymer of the repeating trisaccharide unit, [----4)-3-O-Ac-beta-D-ManpNAcA-(1----4)-a-L-FucpNAc-(1----3) -beta-D-FucpNAc-(1----]n.

Structural studies of the Escherichia coli K93 and K53 capsular polysaccharides.

The structures of the Escherichia coli K93 and K53 capsular polysaccharides have been investigated by chemical and spectroscopic methods. The repeating unit of both polymers was found to be----3)-beta-D-Galf-(1----f)-beta-D-GlcAp-(1. The O-5 and O-6 atoms of D-galactose are acetylated in the repeating unit of the K93 polymer, but only O-2 is acetylated in the K53 polymer. The K93 polysaccharide is cross-reactive with the Neisseria meningitidis Group A capsular polysaccharide (of known structure). The K53 polysaccharide, although structurally similar to that from K93 organisms, does not cross-react with the Group A polymer.

Adverse events and outcomes of conscious sedation for pediatric patients: study of an oral sedation regimen.

BACKGROUND: The authors report on adverse events and sedation outcomes for an oral sedation regimen of chloral hydrate, meperidine and hydroxyzine with 100 percent oxygen, or O2, supplementation. METHODS: In a five-year retrospective study, the authors examined 195 records of conscious sedation performed in 111 healthy children aged 24 to 48 months (mean, 47 months). The authors analyzed age, sex, weight, methods of drug delivery, waiting time after drug administration, treatment rendered, treatment time, adverse events, sedation outcomes and the number of visits needed to complete treatment using descriptive statistics, chi 2 tests, t test and analysis of variance. RESULTS: Adverse events--including vomiting, desaturation, prolonged sedation and an apneic event--occurred in 3 percent of all sedations and were minor. Seventy-two percent of sedations had satisfactory behavioral outcomes, 23 percent had unsatisfactory outcomes, and 5 percent of the cases were aborted because of disruptive behavior. Sex was not a significant factor for the success. Patient compliance with drinking medications (P = .013) and a longer waiting time after medication intake (P = .012) yielded better sedation outcomes. CONCLUSIONS: Minimal minor adverse events occurred with this sedation regimen. The success rate was 72 percent. Compliance with taking oral medications and waiting time appeared to be important factors in predicting sedation success. CLINICAL IMPLICATIONS: This oral sedation regimen offers reasonable outcomes with minimal adverse events under a strict protocol and use of O2 supplementation. The results also revealed associations that give guidance for case selection and outcome prediction.

Pediatric dentists' participation in the North Carolina Medicaid program.

Data on Medicaid participation by dentists in North Carolina were obtained from the North Carolina Division of Medical Assistance and through a survey of pediatric dentists. As a group, pediatric dentists were the most active participants in the North Carolina Medicaid program during the 1990-91 state fiscal year and provided a disproportionate share of treatment for Medicaid-eligible children. Seventy-five per cent of the pediatric dentists limit their Medicaid participation. Top reasons given for limiting access for new Medicaid patients included low reimbursement rates, broken or canceled appointments, and need for prior authorization of Medicaid treatment plans. This paper explores several critical issues regarding access to dental care for children served by the Medicaid program in North Carolina.

Screening panoramic radiographs in children: prevalence data and implications.

The purpose of this paper was to review the rationale for the radiographic screening of asymptomatic pediatric patients and to report the prevalence of selected pathologic and developmental conditions using panoramic radiographs. Three observers participated in this retrospective study that utilized panoramic radiographs from 849 subjects, aged 3-9 years, chosen randomly from the School of Dentistry treatment records of the University of North Carolina at Chapel Hill. Findings indicated that 2.4% of the subjects had supernumerary teeth, 7.8% were missing permanent teeth, 9.1% had ectopic eruption, 0.1% had radiolucencies of the jaws, and 0.1% had radiopacities of the jaws. These prevalences are discussed in light of recent evidence concerning the risk/benefit ratio of the panoramic radiograph. We conclude that the panoramic radiograph is a poor projection for screening the dental needs of asymptomatic healthy children; alternative screening protocols should be examined.

An investigation of capnography and pulse oximetry as monitors of pediatric patients sedated for dental treatment.

Traditional methods of monitoring sedated pediatric dental patients have major shortcomings. This study evaluated the use of capnography in conjunction with pulse oximetry for monitoring children during conscious sedation for dental treatment. The specific purposes of the study were to determine if capnography would: (1) detect ventilatory changes that subsequently cause an oxyhemoglobin desaturation as detected by pulse oximetry; and (2) detect an airway obstruction. Ten pediatric dental patients (mean age 2 years, 10 months) were sedated with 75 mg/kg of chloral hydrate in strict accordance with the Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients of the American Academy of Pediatric Dentistry and the American Academy of Pediatrics (1985). All patients were monitored continuously using both capnography and pulse oximetry. Analysis of data obtained using these monitors revealed that specific end-tidal CO2 values were not predictive for subsequent oxyhemoglobin desaturations and that capnography was very accurate in detecting complete obstruction of the airway. Pulse oximetry revealed that all patients had mild oxyhemoglobin desaturations and that 50% had moderate desaturations.

The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients.

PURPOSE: This study was performed to compare the effects of nitrous oxide/oxygen (N2O/O2) versus oxygen (O2) as adjuncts to an oral narcotic regimen for pediatric conscious sedation. METHODS: Using a randomized double-blind crossover design, 19 children (mean age 41 +/- 8.6 months) were sedated with chloral hydrate (50 mg/kg), meperidine (1.5 mg/kg) and hydroxyzine pamoate (25 mg) for two appointments. Patients were assigned randomly to receive 100% O2 at one visit and 50% N2O/O2 at the other. Physiologic parameters were measured in five-minute intervals, including respiratory rate, pulse rate (PR), oxyhemoglobin saturation (SpO2) and end-tidal carbon dioxide. Data analyses focused on true desaturations and apnea, level of sedation and sedation outcomes. RESULTS: There were no differences in PR, SpO2 and risk of desaturation between the inhalation agents. The level of sedation was deeper and the sedation outcomes were better in the N2O/O2 group. CONCLUSION: N2O/O2 deepened the sedation while improving its success with minimal alteration in physiologic parameters.

A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation.

PURPOSE: The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for the treatment of pediatric dental patients. METHODS: The study sample included 22 children whose parents/guardian selected GA care for their child. Selection criteria limited inclusion to healthy children (ASA I) ages 24-60 m.o. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental Relative Based Value Units Scale (RBVU). RESULTS: Ordinary Least Squares Regression analysis techniques showed the association of RBVU to the total societal costs of GA and CS to be significant (P < 0.01) with an adjusted R2 of .64 and .78 respectively. When regression lines were plotted, the intersection represented RBVU level at which societal costs of GA and CS were the same. CONCLUSION: Under the conditions of this pilot study, it is concluded that CS costs exceed GA costs at a RBVU level of 66.4, which would equate to more than three CS appointments.

Conscious sedation of pediatric dental patients: an investigation of chloral hydrate, hydroxyzine pamoate, and meperidine vs. chloral hydrate and hydroxyzine pamoate.

This study evaluated two oral sedative regimens for the conscious sedation of pediatric dental patients (mean age 37.0 months) unmanageable by traditional behavior management techniques. Regimen A included chloral hydrate (Noctec--E.R. Squibb and Sons, Princeton, NJ) at 50 mg/kg with 25 mg hydroxyzine pamoate (Vistaril--Pfizer Laboratories, New York, NY), plus meperidine (Demerol--Winthrop-Breon, New York, NY) at 1.5 mg/kg. Regimen B included chloral hydrate at 50 mg/kg with 25 mg hydroxyzine pamoate. In a crossover research design, 10 patients were assigned randomly to receive one regimen, to be followed by the alternative regimen during the second appointment. The primary purpose of this study was to determine if meperidine would improve patient behavior, and increase the prevalence of respiratory compromise. A secondary purpose of the study was to develop an objective method to assess behavior during the conscious sedation of pediatric dental patients. Results revealed that the addition of oral meperidine to chloral hydrate and hydroxyzine pamoate resulted in improved behavior (P less than 0.01) during local anesthetic injection, rubber dam delivery, and the operative dental procedure. There was no increase in the prevalence of respiratory compromise with the addition of meperidine.