Digital Commons Network^™

Correlation Between Intraoral Markers And The Risk Of Obstructive Sleep Apnea In Children, Linda K. Powers

Theses and Dissertations

Specific aims: The purpose of this study was to explore the association between various intraoral markers and the risk of Obstructive Sleep Apnea (OSA) in children. Specifically, nine intraoral clinical characteristics were analyzed: ankyloglossia, palatal vault height, presence and level of dental wear, tonsillar grade, Friedman's classification, skeletal and dental classification, and posterior crossbite. The correlation between these features and the Pediatric Sleep Questionnaire (PSQ) and Pediatric Symptoms Checklist (PSC) scores were assessed.

Methods: Orthodontic patients aged 8-17 were recruited at the VCU Graduate Clinic. Intraoral measurements were collected from patients (n=100) by treating doctors. At this time, the PSQ …

Treatment Access And Outcomes For Craniofacial Care: Patient And Parent Perspectives, Benjamin F. Lowe Iii

Theses and Dissertations

Objective: The purpose was to evaluate whether craniofacial patients and their parents have adequate access to care, perceive this care as high quality, and believe that the incorporation of telehealth visits would benefit their current system of craniofacial care. Methods: An original survey was developed and sent to families in treatment with the Virginia Commonwealth University craniofacial team. The tool was used to gather demographic information and assess opinions toward access to, outcomes of, and telehealth services for craniofacial care. Patients 18 years and older took the survey for themselves, while patients under 18 years old had a parent/guardian take …

Effect Of Apical Preparation Size On Endodontic Treatment Outcomes, Joseph Vaughn

Theses and Dissertations

Objective: Previous authors have attempted to identify the ideal apical preparation size needed to achieve endodontic treatment objectives. Despite vast literature on the topic, there exists a lack of consensus on ideal apical enlargement, with few studies discussing the effect of apical prep enlargement on clinical outcomes. The purpose of this retrospective study was to evaluate the effect of final apical preparation size on endodontic outcomes in maxillary and mandibular molars treated in both a graduate endodontic clinic and a private practice.

Methods: A chart review was conducted for patients seen at the VCU graduate endodontic clinic as well as …

The Age And Primary Reason For The First Dental Visit In Children With Special Health Care Needs, Amanda Dickerson

Theses and Dissertations

Purpose: The aim of this project is to evaluate the average age and primary reason for the first dental visit among patients with special health care needs as well as to examine socioeconomic factors and other barriers related to children with special health care needs accessing care.

Methods: This is a cross-sectional survey that was distributed to caregivers of children with special health care needs. Study data was collected through REDCap, a secure web-based survey application. The inclusion criteria for participating in the survey included having a child with a special health care need that presented for a recall or …

Provider Racial Concordance And Medical Mistrust In Pediatric Dentistry, Chinelo Eke

Theses and Dissertations

Purpose: Studies have drawn varying conclusions on the importance of a racially concordant patient provider relationship. Medical mistrust has continued to garner attention as healthcare enterprises thread equity, diversity and inclusion throughout their organizational policies, practices and systems.

Methods: Parents/caregivers of pediatric patients at VCU Pediatric Dentistry were invited to participate. Surveys included questions about demographics, racial concordance, language preference, and the validated Group-Based Medical Mistrust Scale.

Results: A total of 246 guardians completed the survey. For guardians, 40% reported Black or African American, 31% Hispanic, and 19% Caucasian. Seventy-one percent of guardians reported speaking English, 18% Spanish, and 11% …

Utilization Of Intraoral Scanners For Fabrication Of Obturators For Patients Born With Cleft Lip/ Palate (Clp), Swara Fadnis

Theses and Dissertations

Objective: The goal of this cross-sectional study was to assess the knowledge and attitude of providers regarding incorporating a digital scanner for impression taking in children born with cleft lip and/or palate (CLP). Methods: A survey was sent out to members of the American Association of Pediatric Dentistry (AAPD). The survey included questions regarding the providers’ perception of incorporating digital intraoral scanners for impressions for fabrication of obturators. The survey also included questions about the providers’ reservations in using this technology in practice, what their experience has been with the incorporation of this technology into practice, and what is …

The Environment Of Interprofessional Education In Graduate Education: Exploring Professional Programs Of Occupational Therapy, Physician Assistant, And Physical Therapy, Allison R. Kaczmarek

Theses and Dissertations

Interprofessional education (IPE) is an educational approach of increasing popularity in professional schools for the preparation of a collaborative ready healthcare workforce. The accrediting bodies of professional education programs in occupational therapy (OT), physician assistant (PA), and physical therapy (PT) have incorporated standards for outcomes addressing IPE. Although they have endorsed the Health Professions Accreditors Collaborative (HPAC) consensus document on quality IPE, we do not have a contemporary snapshot of the IPE environments in the curriculum of their accredited programs. This dissertation, a collection of three distinct inquiries, has two aims: first, to provide a description of IPE as it …

Cone Beam Computed Tomographic Analysis Of Outcomes In Ridge Augmentation Using Titanium Mesh And Titanium Reinforced Ptfe Membranes, Lina Elnakka

Theses and Dissertations

Objective: The primary goal of this study is to evaluate and compare the average vertical and horizontal bone gain between titanium reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) using superimposition of preoperative and postoperative (CBCT). The secondary goal is to evaluate and compare the surgical outcomes between the two techniques.

Methods: A retrospective chart review was completed to assess the clinical and radiographic outcomes of patients who underwent ridge augmentation therapy using either Ti-PTFE or Ti-mesh. Preoperative and postoperative CBCT scans were superimposed using InVivo 3D imaging software. Vertical component of the augmented site (L1) was assessed along a vertical …

Food Deserts And Pediatric Oral Health Status In An Under-Resourced Urban Community, Jessica T. Mcauliffe

Theses and Dissertations

Purpose: The aim of this analysis of survey data was to assess the influence of living within a food desert as a predictor of oral health problems among children of East Henrico County, Virginia.

Methods: Survey participants were recruited and questionnaires applied online. Residing in a food desert, using access to affordable produce as a proxy value, was the independent variable, while self- reported assessment of the child’s oral health status was the primary outcome variable. Analyses controlled for other indirect factors of pediatric oral health. Logistic regression was used to model the association between the self-reported access to healthy …

Motivations Of Adult Patients Seeking Orthodontic Retreatment, Scott V. Philips

Theses and Dissertations

Objective: The aims of this study were (1) to compare the reasons adult patients seek orthodontic first-time treatment to the reasons adult patients seek orthodontic retreatment, and (2) to compare the concerns, motivations, and satisfaction levels of adult patients seeking orthodontic retreatment across the different previous treatment provider types of orthodontist, general dentist, and Direct-to-Consumer company.

Methods: At their initial orthodontic visit, adult patients (N=108) were invited to participate in the digital survey (REDCap) study. Subjects were recruited from the graduate orthodontics clinic at Virginia Commonwealth University and seven private orthodontic practices across the United States. Visual Analogue Scales were …

Morphometric Analysis Of Premolars And Its Relevance To Root Canal Anatomy, James Degracie

Theses and Dissertations

Introduction: Premolars are especially challenging to treat endodontically due to their small size and often-intricate anatomy. While the majority of premolars present with one or two root canals, the presence of three root canals has been reported. The aim of this study was to investigate the correlation between the root-to-crown width ratio (RCWR) and number of root canals in maxillary and mandibular premolars.

Methods: Data was retrieved from the electronic health records of patients treated at Virginia Commonwealth University School of Dentistry. A total of 100 premolars which had both periapical radiograph (PA) and cone beam computed tomography scans (CBCT) …

Impact Of Portal Of Exit On The Prevalence Of Apical Periodontitis In Root Canal Treated Maxillary Molars With Missed Second Mesiobuccal Canals: A Cbct Study, Jing Ye

Theses and Dissertations

Objective: To evaluate the association of portal of exit (POE) of the second mesiobuccal (MB2) canal with the prevalence of apical periodontitis (AP) in previously treated maxillary molars

Methods: Cone beam computed tomography (CBCT) scans of 106 previously treated maxillary molars seen for either recall or retreatment in the past 3 years were included in the study. Scans were reviewed by one endodontic resident and one board-certified endodontist to determine the POE (separate versus common) of the missed MB2 canal and the presence or absence of a periapical hypo-dense area. Association between AP and portal of exit was assessed using …

The Use Of Silver Diamine Fluoride In Dentistry In Virginia, Jessica Eisenberg

Theses and Dissertations

Purpose: The purpose of this research was to determine the use of silver diamine fluoride (SDF) in dentistry in Virginia and the factors that affect the practitioners’ decision. Methods: A survey was sent to the members of the Virginia Dental Association (VDA) by email and posted on the VDA social media accounts. The survey questions measured the practitioner’s demographics, knowledge, and factors that affect their utilization of SDF. Results: Most providers were general dentists (77%). The most common clinical situations for SDF use were to arrest caries in children with behavioral issues (77%), to delay restorative treatment (73%), in medically …

Histone Acetylation In Periodontal Diseases, Sarang Saadat

Theses and Dissertations

Background: Emerging data has indicated the significant role of epigenetic control in inflammation. Acetylation of lysine residues on histones is a major epigenetic modification of chromatin, which is required for cytokine gene expression and regulated in inflammatory diseases. It has been shown that periodontal bacteria induce histone acetylation in oral epithelial cells and experimental periodontitis in rodents. In this study, we investigated the acetylation level of histone 3 (H3) in gingival tissue from healthy and periodontitis patients. We hypothesize that cytokine over-production in periodontitis is associated with the hyper acetylation of histones. Methods: Periodontitis and healthy subjects who need periodontal …

A Six-Month Comparison Of Orthodontic Pain Associated With Fixed Edgewise Appliances And Clear Aligners, Victor Chan

Theses and Dissertations

Title: A Six-Month Comparison of Orthodontic Pain Associated with Clear Aligners and Fixed Edgewise Appliances

Objective: To document and compare pain perception, intensity, and analgesic use over a sixmonth period between patients treated with fixed appliances (FA) and clear aligners (CA).

Methods: A prospective, parallel, two-arm, multi-center, longitudinal cohort study was conducted with 87 adults treated with CA (n=59) or FA (n=28). Subjects were selected according to inclusion and exclusion criteria. A seven-item, digital survey was sent at three timepoints (preappointment, 2-days post-appointment, and 7-days post-appointment) at each adjustment over a six-month period. The variables measured included pain experience, pain …

Behavioral Screening And Chiral Bioanalysis Of Emerging Stimulant-Type Drugs In Rats, Tyson R. Baird

Theses and Dissertations

The epidemic of drug use in the United States and elsewhere in the world has resulted in tragic loss of life and substantial economic costs. Novel psychoactive substances (NPS) are one of the contributors to this problem, and the lack of information about many of these drugs compounds their risk. This dissertation proposes a strategy to use intracranial self-stimulation (ICSS) as a behavioral screening tool to assess emerging drugs of abuse for their abuse potential in order to generate a proactive threat assessment. A series of stimulant-type drugs including methcathinone, α-pyrrolidinohexanophenone (α-PHP), cocaine, and the phenyltropane analogs of cocaine WIN35428 …

Clear Aligner Therapy In The Mixed Dentition: Indications And Practitioner Perspectives, Nicholas M. Lynch

Theses and Dissertations

Introduction: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors.

Methods: An original, 22-item survey was mailed to both a randomized, nationally representative sample of practicing orthodontic specialists (n = 800) and to a specific, randomized sub-sample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents’ demographic information, experience with clear aligner therapy, and perceived advantages/disadvantages of CAMD compared to fixed appliance therapy (FA). Responses were compared using McNemar’s chi-squared and paired t-tests to assess CAMD versus FA. …

Academic Health Science Centers And Health Disparities: A Qualitative Review Of The Intervening Role Of The Electronic Health Record And Social Determinants Of Health, Wies Rafi

Theses and Dissertations

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an …

Threshold Levels Of Patient And Parent Esthetic Concern In The Mixed Dentition, Justin Josell

Theses and Dissertations

Purpose: The mixed dentition is a period of unique dental changes for developing children and their parents. The purpose of this study is to determine threshold levels of concern regarding diastema spacing and angulation of maxillary incisors during the “Ugly Duckling Stage” in pediatric patients and their parents.

Methods: This study is modeled as a cross sectional-survey among pediatric patients and parents. The surveys contain photographs of a sex-neutral, mixed-dentition smile with variations of midline spacing and incisal angulation which randomly differ in quantifiable values. Participants were asked to rate each photograph on a visual analog scale.

Results: The interaction …

Outcome Of Endodontic Microsurgery: Success And Survival Rates At Virginia Commonwealth University, Abdullah Alawadhi

Theses and Dissertations

Introduction: Endodontic microsurgery treatment is an option for teeth with apical periodontitis and may be indicated for teeth with previous endodontic treatment that have not healed, teeth with canal obstructions which would impede a non-surgical approach, and where a biopsy is needed. The purpose of this study is to evaluate healing after endodontic microsurgery in 2-dimensional PA radiographs and 3 dimensional CBCT imaging. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University in the Graduate Endodontic Clinic between the years 2010 to 2020. Cases were identified using the CDT codes and a key word search …

Use Of Passive Immobilization During Oral Conscious Sedation: Parental Perceptions And Utilization By Pediatric Dentists In The United States, Jennifer N. Levine

Theses and Dissertations

Use of Passive Immobilization During Oral Conscious Sedation: Parental Perceptions and Utilization by Pediatric Dentists in The United States, Levine J, Caudill, C (Virginia Commonwealth University School of Dentistry, Richmond, VA)

Research supported by the Alexander Fellowship

Purpose: To assess change in parental attitudes of passive immobilization after viewing an informational video and evaluate how pediatric dentists are currently using passive immobilization during oral conscious sedations (OCS).

Methods: A survey consisting of six statements on a 5-point Likert scale was completed by parents at their child’s OCS consultation appointment before and after viewing an educational video demonstrating benefits of passive …

The Effect Of Er:Yag, Nd:Yag And Co2 Laser Combined With Hydrogen Peroxide, Sodium Hypochlorite, Chlorohexidine Or Fluoride On Reducing Oral Bacterial Count Implicated In Root Caries, Nitya Reddy

Theses and Dissertations

Purpose: Lasers have been used for treatment of dentinal hypersensitivity and for various bacterial reduction indications in periodontology. Their effectiveness in killing oral bacteria is not well known. The compounding effect of the combination of a laser treatment and adjunct antimicrobial agent use on bacterial viability is still evolving. The purpose of this in vitro study was to evaluate the effect of three lasers commonly used in dentistry in conjunction with chlorhexidine (CHX), hydrogen peroxide (H₂O₂), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on viability of oral bacteria associated with root caries.

Methods: Three …

The Effect Of Crowding On The Accuracy Of 3d Printed Aligners, Tonya Spangler

Theses and Dissertations

Purpose: To evaluate the accuracy of three-dimensionally (3D) printed aligners compared to conventional vacuum-formed thermoplastic aligners with varying levels of dental crowding.

Methods: Digital intraoral scans of 10 different cases were assigned to their respective groups (n=10, each, 30 total) as follows: no crowding (control), moderate crowding, and severe crowding. Using 3Shape software, digital aligner samples were created in standard tessellation language (STL) file format and randomly 3D printed. The same STL files of each case were also sent to a dental laboratory for the fabrication of vacuum-formed samples, which is the current technology used for manufacturing aligners. The intaglio …

Viral Overexpression Of Rprd2 In Mouse Nucleus Accumbens Induces Anxiety-Like Behavior And Regulates Genes Associated With Microtubule Transport, Claire Nuhad Atiyeh

Theses and Dissertations

Anxiety disorders are the most prevalent mental illness in the United States with many individuals underdiagnosed and undertreated (Anxiety & Depression Association of America, 2021; Bandelow et al., 2017). While stress is a known risk factor for developing anxiety disorders, there is emerging evidence that biological variability in the expression of key proteins in the brain may contribute to regulating an organism’s stress-related behaviors. Earlier work from our laboratory identified a protein, called Regulation of Nuclear Pre-mRNA Domain Containing 2 (RPRD2), that was differentially expressed in the brain of mice stratified in terms of their phenotypic response to chronic stress …

Parental Attitudes Regarding The Primary Dentition, Dental Decay, And Trauma, Kathryn Dundervill

Theses and Dissertations

Purpose: The purpose of this study is to identify the ability of parents in the VCU Pediatric Dental Clinic to recognize signs of decay and trauma and to determine their knowledge regarding the primary dentition.

Methods: This is a cross-sectional study that determined parental attitude and knowledge toward the function of primary teeth, childhood dental decay and dental trauma. Study data was collected through REDCap, a secure web-based survey application. Parents who brought their child to the VCU Pediatric Dental Clinic for a new patient examination or a recall examination were included in the study. The survey was only formatted …

Exploring Dynamic Navigation For Palatally Impacted Canine Uncovery Surgery., Daniel Joseph Hall

Theses and Dissertations

Purpose: The objective of this study was to compare the exposure/uncovery of palatally impacted canines via the use of dynamic navigation guidance to the traditional freehand approach. Outcomes evaluated include the time to plan and perform exposure, area/size of initial access to locate the impacted tooth and the final size of the osteotomy to completely uncover the impacted tooth.

Methods: In order to simulate various frequently encountered clinical scenarios, three different model types were used. Six plastic models of each model type were fabricated from epoxy resin. Each model contained 2 bilaterally, palatally impacted canines, that were randomly embedded in …

A Method For Predicting Dose Changes For Hn Treatment Using Surface Imaging, Sarah E. Holler

Theses and Dissertations

Head and neck cancer is commonly treated with a six- to seven-week course of radiotherapy, during which a patient’s anatomy may change substantially, due to target reduction or weight loss. Anatomical changes lead to reduction in treatment quality due to decreased setup reproducibility and altered dose deposition compared to the original plan. Few clinics have developed a standard method for triggering resimulation and replan due to anatomic changes. This work investigates a new method for determining when to resimulate and replan HNC patients by utilizing their topographic anatomical changes to predict differences in planned versus delivered dose distributions. The first …

Adaptations In Orthodontics For Current And Future Covid-19 Best Practices, Jordan Lamb

Theses and Dissertations

Purpose: To determine what adaptations orthodontists made in their practices during the COVID-19 pandemic in response to safety recommendations and to determine which of these adaptations orthodontists plan to continue to implement after resolution of the COVID-19 pandemic.

Methods: An original 34-question survey was sent by mail to a randomized and geographically proportionate selection of actively practicing orthodontic specialists (N = 1000). Questions asked orthodontists about the changes they made during the pandemic in four overarching categories (infection control, social distancing, appliance use, and tele-orthodontics) and whether they anticipated keeping those changes post-pandemic. The data were compared between categorical responses …

Outcome Of Vital Pulp Therapy On Immature Permanent Teeth With Calcium Silicate-Based Materials: Retrospective Cohort Study, Brian I. Hone

Theses and Dissertations

Introduction: The purpose of vital pulp therapy is to maintain pulp viability by eliminating bacteria from the dentin-pulp complex and to establish an environment in which apexogenesis can occur. The aim of this retrospective cohort study was to evaluate the clinical and radiographic outcomes of vital pulp therapy on immature permanent teeth using different calcium silicate-based materials. Methods: This study was carried out in the Virginia Commonwealth University Graduate Endodontics department in Richmond, Virginia. Vital pulp therapy cases performed by graduate endodontic residents were retrospectively searched and charts were reviewed to determine inclusion into this study. All cases …

Characteristics Of Posterior Permanent Teeth With A Periradicular Diagnosis Of Symptomatic Apical Periodontitis: A Retrospective Study, Christina A. Martin

Theses and Dissertations

The diagnosis of apical periodontitis is based on radiographic manifestations and the results of the various clinical tests that can be performed as part of a routine dental examination. Apical periodontitis producing clinical symptoms involving a painful response to biting and/or percussion or palpation is given the diagnosis of symptomatic apical periodontitis (SAP). This study aimed to determine associations of SAP with gender, age, radiographic findings, diagnostic testing, pulpal diagnosis, and location of the tooth in the arch. Data for this study were obtained from patients of record treated at Virginia Commonwealth University School of Dentistry in the Department of …