Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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) …

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 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 …

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 …

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 …

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 …

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: …

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 …

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 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 …

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 …

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 …

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 …

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 …

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. …

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 …

Comparing The Sensitivity And Specificity Of Cbct And Mri In Detecting Osteoarthritis Of The Tmj: A Systematic Review, Gabriel R. Saavedra

Theses and Dissertations

The aim of this systematic review was to compare the sensitivity and specificity of cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in detecting osteoarthritis (OA) of the temporomandibular joint (TMJ). This was done by using computed tomography (CT) and the research diagnostic criteria for temporomandibular disorders (RDC/TMD) as reference methods and using CBCT and MRI as index methods. A specific search strategy was developed and applied to these electronic databases: PubMed, Embase, DOSS, and Cochrane. The search results returned 802 articles, which were then narrowed down using the inclusion/exclusion criteria, to four final articles that were included in …

Amixicile, A Novel Antimicrobial Agent, And Its Effect On The Salivary And Subgingival Microbiome In Rhesus Macaque Monkeys, Erin E. Block

Theses and Dissertations

Background/Purpose: Periodontitis is an inflammatory disease with a bacterial etiology in a susceptible host. A selective antibiotic with minimal systemic side effects could be a useful adjunct to traditional periodontal therapy. Amixicile is a novel antimicrobial agent that targets pyruvate: ferredoxin oxidoreductase (PFOR), an enzyme that is critical for anaerobic bacterial metabolism and has been found to have little-to-no side-effects in animal models. The aim of this study was to prospectively evaluate the effect of amixicile on clinical periodontal parameters and the composition of the oral microbiome in rhesus macaque monkeys. It was hypothesized that the amixicile would reduce growth …

Antibiotic-Loaded Dendrimer Hydrogels In Periodontal Bone Regeneration: A Feasibility Study, Nicholas G. Yesbeck

Theses and Dissertations

Purpose: Prescription of a complete course of oral antibiotics following bone grafting procedures is a common clinical practice in surgical periodontics. Prophylactic administration of antibiotics reduces the risk of surgical site infection and systemic administration is preferred over local delivery because of short duration of action in the latter circumstance. The goal of this study is to demonstrate the ability of dendrimer hydrogels (DH) to prolong the release kinetics of antibiotics in-vitro. A secondary goal will be to analyze the effect of different particulate bone allografts on the release kinetics of the antibiotic.

Methods: Dendrimer hydrogels (DH) were synthesized …

Influence Of Metal Sleeves In The Accuracy Of Dental Implant Placement Using Guided Implant Surgery, Coleman Adams

Theses and Dissertations

The fabrication of implant surgical guides through stereolithographic 3D printing has become a staple in dental implant guided surgery over the last couple decades. These surgical guides have typically utilized metal sleeves to assist in guidance of the drills during osteotome preparation. The metal sleeves can be costly and potentially cause deviations if improperly placed during post-processing of the guide. This research explored a novel method for the utilization of sleeve-free surgical guides by comparing the dimensional and angulational deviations between the implant guides with and without a metal sleeve. To achieve this goal, two separate aims were pursued. Our …

Perceived Efficacy Of Extrusion Of Maxillary Lateral Incisors With Aligners, Mason T. Bates

Theses and Dissertations

Purpose: To assess the perceived efficacy of aligners (Invisalign, Align Technology Inc) at performing extrusive movements of maxillary lateral incisors, determine a general threshold of when a maxillary lateral incisor is not extruding as predicted and requiring intervention, evaluate the frequency and methods of intervention to achieve the predicted extrusion, and to evaluate any related differences between orthodontists and general dentists, and between clinicians having treated various numbers of patients with Invisalign in the past 12 months.

Methods: An original 18-question survey was sent by mail to a randomized and geographically proportionate selection of orthodontic specialists (N = …

Knowledge, Perception, And Clinical Management Strategies Of Us Pediatric Dentists On Molar Incisor Hypomineralization, Courtney T. Brashier

Theses and Dissertations

Purpose: The purpose of this cross-sectional, survey-based study is to determine current US pediatric dentists’ knowledge, perceptions, and clinical management strategies for patients with molar incisor hypomineralization (MIH).

Methods: Following appropriate protocol and authorizations, all active pediatric dentists, general dentists, and post-doctoral student members identified by the 2020 American Academy of Pediatric Dentistry’s membership list were invited to partake in an anonymous email survey. Data regarding participants sociodemographic, education, and clinical backgrounds were collected in addition to information obtained from MIH-focused questions. Descriptive statistics and chi-square tests were used to compare and analyze data. A significance level was set at …

Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina

Theses and Dissertations

Purpose: The purpose of this study was to evaluate the Pediatric-Modified-STOP-Bang (PM-STOP-Bang) as a screening tool to assess sleep related breathing disorders (SRBD) within a pediatric population. The specific aims of this study were: 1) compare the PM-STOP-Bang scores with those from the validated Pediatric Sleep Questionnaire (PSQ), 2) determine the ability of the PM-STOP-Bang and the PSQ screening tools to accurately detect children of high risk for SRBD from a one-night home sleep apnea test (HSAT).

Methods: Orthodontic patients were screened using the PM-STOP-Bang at VCU Graduate Clinic. Patients (n=10) who were recruited and enrolled. Five were determined to …

Patient Perspectives On Teledentistry And Face-To-Face Doctor Interaction During Orthodontic Treatment, Jackson K. Griffeth D.M.D.

Theses and Dissertations

Purpose: Orthodontic patients were surveyed to determine the perceived value of doctor-to-patient face-to-face interaction, the desire for convenience and attitudes toward specific uses of teledentistry.

Methods: Participating private practice orthodontists emailed the survey to active patients. 75 self-pay patients from VCU Orthodontic clinic were also invited to complete the survey. Patients 18 years or older were asked to complete the survey regarding their own treatment. Parents of patients under age 18 were asked to complete a separate survey regarding their child’s treatment. Questions asked patients about the importance of face-to-face interaction with their orthodontist and their preferences for the inclusion …

The Value Of Postoperative Appointments Following Full Mouth Dental Rehabilitation Under General Anesthesia, Priyanka Patel

Theses and Dissertations

Purpose: Follow-up appointments after full mouth dental rehabilitation under general anesthesia (GA) have been suggested as a method for preventing future caries and need for repeat treatment under GA. The purpose of this study is to determine current practitioner and parental perceived value of the postoperative GA appointment.

Methods: Three separate surveys were administered for this study. The pre-appointment survey asked about the guardian’s desire to have a follow-up appointment. At the follow-up appointment, the post-appointment survey ascertained the level of patient satisfaction with their follow-up appointment and postoperative experience. American Academy of Pediatric Dentistry (AAPD) members were e-mailed a …