Medicine and Health Sciences Commons^™

How Stromal Interactions Play A Role In The Quest For Human Papillomavirus Specific Cancer Therapeutics, Alexis-Leigh A. Fakunmoju

Theses and Dissertations

High-risk human papillomaviruses (HPV), like HPV16 and HPV18, are associated with malignant cancer growth within the oropharynx and cervix. Globally, HPV-induced cancers, including oropharyngeal and cervical cancers, contribute 5% to the overwhelming burden of all cancers. HPV is highly transmissible by sexual contact via micro abrasions to the mucosa. Once exposure occurs, the virus begins replication and creates an intimate relationship with the host’s cellular proteins. While most HPV is cleared quickly by our immune system, persistent infections, or infections in immune compromised individuals, are susceptible to transformation and tumor progression. Early detection measures like PAP smears and preventable measures …

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 …

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 …

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 …

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 …

Probing The Porphyromonas Gingivalis Nitrosative Stress Response Network, Alexandra Galina

Theses and Dissertations

Objective: To persist in the oral cavity, the perio-pathogen Porphyromonas gingivalis must have an efficient nitrosative stress response mechanism. To better understand how P. gingivalis responds to nitrite (NO₂^-) we must determine what genes are involved in the nitrosative stress response network.

Methods: Through genomic screening, a list of genes was generated that were hypothesized to be part of the nitrosative stress response network and believed to be involved in nitrate/nitrite metabolism or redox state of the cells. Protein coding regions were replaced with the ermF sequence by allelic exchange mutagenesis. 15 mutants were created …

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. …

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 …

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 …

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 …

The Value Of Educating Teachers, Coaches, And Athletic Trainers On The Management Of Dental Trauma., Laura Satoski

Theses and Dissertations

Purpose: The aim of this study is to investigate the baseline knowledge and assess the benefit of educating teachers, coaches, and athletic trainers about the management of sports-related dental injuries.

Methods: Teachers, coaches, and athletic trainers working in youth sports activities across the city of Richmond and the Greater Richmond Region were recruited via email. Participants answered a pre-seminar survey to evaluate their baseline knowledge and determine whether they experienced dental trauma with their athletes previously. The survey also indicated whether they participated in a public or private sports facility. The participants watched a pre-recorded virtual seminar educating them on …

Peri-Implantitis Incidence And Effect Of Supportive Periodontal Therapy On Outcomes: Retrospective Cohort Study, Michael Ha

Theses and Dissertations

Purpose: Management of peri-implantitis is becoming an increasing component of dental practice. Dental implants can develop peri-implantitis lesions which occur in a non‐linear and accelerating pattern compared to a gradual periodontitis lesion. It is crucial to diagnose and treat this disease early, or ideally prevent it. Contemporary implants have a rough surface texture which is difficult to properly decontaminate as a crucial component for treatment prognosis. Evidence on the long-term effects of Periodontal implant maintenance therapy (PIMT) on implants is limited. This study aims to investigate the effect of periodontal maintenance on peri-implant tissue health.

Methods: A retrospective chart review …

Removal Of Prefabricated Zirconia Crowns From Primary Anterior Teeth With Er,Cr:Ysgg Laser Compared To A High-Speed Handpiece: An In- Vitro Study, Andrew Crowell

Theses and Dissertations

Purpose: The aim of this study was to compare the time and pulpal temperature changes associated with the removal of prefabricated zirconia crowns from primary anterior teeth using an Er,Cr:YSGG laser compared to a rotary hand-piece.

Methods: This in-vitro study was conducted using extracted primary incisors. Teeth were prepared and restored with prefabricated zirconia crowns (NuSmile^®, Houston, TX, USA) sizes 4 and 5 cemented with resin-modified glass-ionomer cement. Restored teeth were stored in a humidor for at least 48 hours prior to removing crowns from the teeth using either an air-rotary hand-piece (HG, N=17) or erbium, chromium: …

Effect Of Moderate Sedation Regimen (Diazepam, Meperidine, And Hydroxyzine) Dosages On Patient Behavior And Outcome Of Sedation In Pediatric Dentistry: A Retrospective Study, Taibah M A M J Albaker

Theses and Dissertations

Purpose: To determine if behavior at consult visit and sedation medication dosages are associated with the success of sedation visits and patient’s behavior using the diazepam, meperidine, and hydroxyzine (DMH) regimen.

Methods: A retrospective chart review was conducted of 324 VCU Pediatric Dentistry Department patients who underwent 404 moderate conscious sedation visits with DMH regimen from April 2017 to June 2022. Sedation visits were graded as “Successful” or “Unsuccessful” and “Good” or “Poor behavior.” The primary variables of interest included Frankl behavior at consult visit and the sedation medication dosages. Logistic regression models were used to determine if these factors …

Detection And Reporting Of Child Abuse And Neglect: A Survey Amongst Pediatric Dental Care Providers In The United States, Daniel J. Lander

Theses and Dissertations

Purpose: The purpose of this study is to survey pediatric dental care providers in the United States to evaluate their knowledge in the detection and reporting of child abuse and neglect (CAN). Methods: This study has been modeled as a cross sectional- survey based research study. Email invitations were sent to pediatric dentists, orthodontists, and others who work in pediatric dental practices in the United States through email lists of the American Association of Pediatric Dentists (AAPD) and the American Association of Orthodontists (AAO). The survey completion page included sample text and the public survey link for providers to use …