Dentistry Commons^™

Comparison Of Artificial Intelligence Vs Human Observer For Periapical Radiolucency Detection, Adam J. Pink

Theses and Dissertations

Objective: The aim of this study was to assess the performance of an Artificial Intelligence (AI) program (OverJet AI) with that of experienced endodontic residents, endodontists, a radiologist, and dental students in detecting periapical radiolucencies using radiographic images.

Methods: One hundred and fifty periapical radiographic images were analyzed using the OverJet AI software to determine the presence/absence of a periapical radiolucency as well as the size (small 1-3mm, medium 4-6mm, and large 6+mm). The unaltered images were also evaluated by two endodontic residents, two practicing endodontists, an oral radiologist and two 4th year dental students.

Results: Agreement between the AI …

Endodontic Access Through Zirconia Crowns: A Comparative Evaluation Of 3d Guided Versus Free-Handed Techniques, Maryam Alrughaib

Theses and Dissertations

Objective:

Accessing canals through full-coverage zirconia crowns is challenging and may increase the risk of misdirection, excessive dentin removal, and prolonged chair time. Guided endodontic access has been proposed to improve efficiency and precision. This study compared the accuracy and time efficiency of guided versus free-hand endodontic access through zirconia restorations. The hypothesis was that guided access would enhance canal localization precision and significantly reduce access time.

Methods:

Thirty-two extracted maxillary premolars were restored with 1-mm–reduced monolithic zirconia crowns (3Y-TZP, Katana HTML, Kuraray, Japan) and mounted in Modupro models. Teeth were assigned to two groups (n = 16 each): guided …

Understanding The Relationship Between Children's Oral Health Utilization And Parent's Use Of Healthcare Services, Shillpa Naavaal, Rashmi Lamsal

Dental Public Health and Policy Publications

Introduction: Parents play an influential role in their children's lives, but little is known about how their healthcare experiences connect. This study examined the relationship between parent's healthcare use and their child's overall and preventive dental care use.

Methods: We pooled three years (2017–2019) of Medical Expenditure Panel Survey (MEPS) data and merged child (0–17 years) and parent data. Our outcomes included any dental visit, preventive visit, and receipt of sealant or fluoride. The primary exposure variable was the parents’ medical and dental care use, grouped into four categories. Descriptive and bivariate analyses were conducted, and multivariable logistic regression analyses …

Investigating The Association Between Parental Paid Sick Leave Benefit And Children's Dental Care Utilization, Rashmi Lamsal, Shillpa Naavaal

Dental Public Health and Policy Publications

Objective: The purpose of this research is to examine the association between paid sick leave (PSL) benefit for employed parents and their child's dental care utilization, including preventive, diagnostic, and treatment services.

Methods: Using pooled data from the 2017–2019 Medical Expenditure Panel Survey, we created a dyadic observational unit linking children aged 0–17 years with their parents (n = 7652) specifically focusing on the younger children of employed parents. Descriptive statistics and a multivariate logistic regression model were employed to examine the association between parental PSL benefit and child dental care utilization, accounting for various child and …

Oral Health Impact And Cost-Effectiveness Of Resealing First Permanent Molars, Christina Scherrer, Pritam Deb, Jayden Ayash, Shillpa Naavaal

Dental Public Health and Policy Publications

Introduction: This study examined the cost-effectiveness and health impact of various dental sealant resealing scenarios for first permanent molars from the payer perspective.

Methods: The authors used a discrete event simulation model for 4,000 recently sealed first molars in a hypothetical cohort of 1,000 children aged 7 years over a 10-year time horizon. Scenarios included a base case of no resealing, resealing at first dental visit, and resealing at the age of 12 years.

Results: Without resealing, only 34.88% of teeth retained sealants after 10 years, whereas resealing at the age of 12 years increased this to …

Role Of Oral Health Providers In Supporting Hpv-Related Cancer Prevention In The Dental Setting, Megan Cloidt, Sarah Vivo, Aubree Thelen, Shillpa Naavaal

Dental Public Health and Policy Publications

Background: Human papillomavirus (HPV) vaccination can prevent HPV-related illness and associated cancers, including oropharyngeal. The safety and efficacy of HPV vaccination has been well-established, but national HPV vaccination rates remain unacceptably low with persistent disparities for certain populations. While vaccination has been one of the biggest public health accomplishments of the last century, vaccine hesitancy continues to grow in the United States, and remains a challenging element of low HPV vaccine uptake.

Description: Oral health providers have been traditionally siloed and largely uninvolved in vaccination counseling and administration, but the COVID-19 pandemic brought oral health providers, pharmacists and …

Effectiveness Of School Fluoride Delivery Programs: A Community Guide Systematic Review, Susan O. Griffin, Mei Lin, Christina Scherrer, Shillpa Naavaal, David P. Hopkins, Anita A. Jones, Tammy Alexander, Virginia A. Black, Elizabeth Clark, Lori K. Cofano, Raúl Isidro García, Anna Goddard, Jane Grover, Susan M. Kansagra, Thomas E. Kottke, Elizabeth C. Lense, Tooka Zokaie, The Community Preventive Services Task Force

Dental Public Health and Policy Publications

Introduction: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs in preventing caries.

Methods: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on school flouride varnish delivery program effectiveness in increasing fluoride varnish receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle– or high-income countries. Data synthesis conducted in 2024 used median …

Improving Dental Hygiene Students' Knowledge, Attitudes, And Confidence Toward Prenatal Oral Health Through Experiential Learning, Denise C. Mckinney, Sinjini Sikdar, Shillpa Naavaal

Dental Public Health and Policy Publications

Purpose Maintaining optimal oral health is essential for maternal health as well as the health of their child. The purpose of this pilot study was to examine dental hygiene (DH) students' knowledge of prenatal oral health before and after receiving an asynchronous prenatal oral health care training (POHCT), and their attitudes and self-perceived confidence before and after receiving an experiential learning opportunity with a pregnant and/or post-partum client at a Women's Infants and Children nutrition program (WIC) clinic.

Methods A one-group pre/post-test design was used. This IRB-approved study (#2027439-4) utilized a convenience sample of DH student participants (n=37) in their …

Smear Layer Removal By Irrigation Adjuncts: A Scanning Electron Microscopy Study, Triet D. Vuong

Theses and Dissertations

Purpose: This study aimed to compare the intracanal smear layer removal ability of two adjunctive irrigation modalities: the AdvErL EVO laser, the GentleWave^® Procedure, and their combination, after minimally invasive canal instrumentation.

Methods: Forty molars were accessed, the mesiobuccal canals of maxillary and mandibular molars were prepared up to apical size 25.04 using rotary instrumentation, then irrigated using: conventional needle irrigation (CNI), laser-assisted irrigation (LAI), the GentleWave^® Procedure (GWP), and LAI followed by GWP (LAI+GWP). The teeth were then decoronated and split longitudinally. One-half of each root was selected for preparation and analysis under scanning electron microscope. Blinded …

Comparative Evaluation Of Three Endodontic Rotary File Systems In S-Shaped Root Canals: An In-Depth Analysis, Mudher Bahar

Theses and Dissertations

Objective: This study compares three endodontic file systems—XP‐3D Shaper⁺, EdgeFile X7 and WaveOne Gold in S‐shaped simulated canals in resin blocks. It aimed to quantify canals volumetric changes post‐instrumentation to guide clinical selection of a system that preserves tooth structure while efficiently shaping root canals.

Methods: Thirty S‐shaped canals in resin blocks were divided into three groups (n=10) for instrumentation with XP‐3D Shaper⁺, EdgeFile X7 or WaveOne Gold using the crown‐down technique and manufacturers recommended settings. A no‐treatment control provided a baseline for volumetric changes measured via CBCT scans analyzed with ITK‐SNAP. Data were analyzed using ANOVA and Tukey’s test …

Subgingival Microbiomes Of Healthy And Periodontitis Subjects, Tareq Abdulrasoul

Theses and Dissertations

Background: Periodontitis is a common chronic inflammatory disease triggered by the dysbiosis of the subgingival microbiome. 16s rRNA sequencing has been used to profile the subgingival plaque samples in healthy and periodontitis subjects. Here, we have collected subgingival plaque samples from subjects and analyzed the microbiome profile from 16s rRNA sequencing. We hypothesized that periodontitis patients will have a different subgingival microbiome profile than that of healthy subjects.

Methods: Subgingival plaque samples were collected from periodontitis and healthy subjects who were indicated for periodontal surgeries (osseous resective and regenerative surgery for periodontitis patients or crown lengthening for healthy …

Perceptions Of A State-Level Hpv Vaccine Mandate And Exemption Option In Rural Virginia: A Qualitative Study, E. Marshall Brooks, Kendall Fugate-Laus, Ben Webel, Shillpa Naavaal

Dental Public Health and Policy Publications

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with …

Describing Trends In Virginia's Dentist And Dental Hygienist Workforce: Challenges And Opportunities, Shillpa Naavaal, Yetty Shobo, Barbara Hodgdon

Dental Public Health and Policy Publications

Purpose: Regular assessment of the dental workforce is essential to improve the population's oral health. This analysis aimed to understand the trends in the distribution of dentists and dental hygienists (DHs) in Virginia.

Methods: Annual survey data (2013-2022) of dentists and DHs from the Virginia Department of Health Professions Healthcare Workforce Data Center was used to examine the trends in provider distribution by age, gender, race/ethnicity, and geography across Virginia.

Results: In 2022, there were 5,720 dentists and 5,290 DH licensees in Virginia. In the dentist workforce, there was a high representation of those aged ≥60 years …

Health, Beliefs, And Faith: Hpv Vaccine Uptake Intent Among Catholic, Evangelical, And Mainline Protestant Parents, Jeanine P.D. Guidry, Shillpa Naavaal, Linnea I. Laestadius, Carrie A. Miller, Gina Zurlo, Candace W. Burton, Kellie E. Carlyle, Julie Russo, Paul B. Perrin

Dental Public Health and Policy Publications

The HPV vaccine has the potential to prevent nearly 92% of HPV-related cancer cases, yet its uptake remains suboptimal. While well-documented barriers to HPV vaccine uptake include inadequate knowledge and lack of provider recommendation, religious preferences have emerged as another crucial factor influencing vaccination decisions. This study examined the interrelatedness of religion, beliefs, and HPV vaccination uptake among children among Catholic, Evangelical, and Mainline Protestant parents. A nationally representative survey was conducted among 1,068 U.S. parents from one of three major Christian denominations: Catholic, Evangelical, or Mainline Protestant. We examined the extent to which demographic factors, constructs from the Health …

Implementation Of A Cancer Education Program In Rural Counties With The Lowest Hpv Vaccination Rates And Health Rankings, Sarah Arezo, Shillpa Naavaal, Charlotte Garrett, Marcie S. Wright, Vanessa B. Sheppard, Michael A. Preston

Dental Public Health and Policy Publications

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods: We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students’ …

The Role Of Hdac6 In Periodontal Inflammation, Hannah S. Lohner

Theses and Dissertations

Periodontal disease is a polymicrobial infection-induced chronic inflammatory disease and results in irreversible tissue damage and bone loss. While bacteria play a large role in the initiation of this disease, excessive and prolonged inflammatory immune responses are fundamental for its progression, making host directed therapy (HDT) a possible and potentially valuable treatment. Histone Deacetylase 6 (HDAC6) is an enzyme that removes acetyl groups from both histone and non-histone proteins, giving it a potential role in regulating inflammation initiated by pathogenic oral bacteria. Previous studies indicated that HDACs act as a bivalent regulator in inflammatory responses; however, the role that HDAC6 …

The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Postoperative Comfort, Elizabeth S. Kleefisch Dds

Theses and Dissertations

Purpose:

To determine the effect of local anesthesia on postoperative comfort in patients undergoing dental care under general anesthesia.

Methods:

This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of 6 years scheduled for restorative dental treatment under general anesthesia (GA). Patient behavior was evaluated preoperatively and postoperatively using the Faces, Legs, Activity, Cry and Consolability (FLACC) or other pain score and postoperatively using the Parent’s Postoperative Pain Measure (PPPM). Intraoperatively, participants followed a standardized general anesthesia protocol and were given either local anesthetic (LA) infiltration using 2% Lidocaine 1:100,000 Epinephrine by …

An Examination Of Hiring Practices And Employee Retention Today Compared With Pre-Pandemic Characteristics In Orthodontics, Logan Passey

Theses and Dissertations

Purpose: Evaluate current hiring practices and employee retention characteristics in orthodontic private practices.

Methods: Orthodontists (n=1000) were surveyed regarding their hiring methods and outcomes. Responses were summarized with descriptive statistics. Chi-square tests were used to compare hiring practices and perceptions. Nonparametric Kruskal-Wallis tests were utilized in analysis of retention thresholds.

Results: Survey response rate was 7.2% (72 responses). When comparing thresholds previous to, and after the COVID-19 pandemic, there was an increase in open clinical positions compared with non-clinical and managerial positions (p=.0008). 68% of orthodontists reported a decrease in qualified applications for clinical positions compared with non-clinical and managerial …

A Retrospective Chart Review Of Avulsion Injuries Treated At Virginia Commonwealth University., Ryan Hediger

Theses and Dissertations

A RETROSPECTIVE CHART REVIEW OF AVULSION INJURIES TREATED AT VIRGINIA COMMONWEALTH UNIVERSITY. By: Ryan Hediger, DMD

Objective: Outcomes related to healing following an avulsion injury are multifactorial. However, contemporary literature suggests that tooth survival can be enhanced after such injuries by promptly replanting the tooth and adhering to proper management guidelines. Despite the abundance of resources available, the actions taken immediately after the avulsion injury play a pivotal role in determining the fate of an avulsed tooth. The primary objective of the current investigation is to unveil prognostic factors associated with the survival of avulsed teeth.

Methods: A chart review …

Intersectionality, Racial Discrimination And Oral Healthcare Utilization Among Black Adults In Baltimore City, Maryland, Briona M. Phillips

Theses and Dissertations

INTRODUCTION: Oral health is essential for overall well-being, yet disparities persist, particularly among marginalized populations including Black adults. Limited access to and underutilization of oral healthcare services exacerbate these disparities. Discrimination, both individual and systemic, acts as a significant barrier to accessing care, contributing to disparities in oral health outcomes. Individuals facing discrimination experience mistrust and fear within oral healthcare settings, leading to delayed or avoided care. Therefore, investigating and addressing discrimination among Black adults is essential for promoting equitable access to oral healthcare, improving overall oral health outcomes, and lessening existing disparities.

PURPOSE: The purpose of this dissertation was …

Outcomes Of Anterior Crossbite Correction On Alveolar Bone Morphology In Patients With Cleft Lip And Palate, Katherine J. Hayes

Theses and Dissertations

Objective: To determine if patients with cleft lip and/or cleft palate (CLP) with dental correction of the anterior crossbite during growth display differences in alveolar bone thickness around the maxillary central incisors compared to patients without crossbite correction.

Methods: This retrospective study evaluated post-treatment cone beam computed tomography (CBCT) images of growing patients with CLP with anterior crossbites who underwent Phase I orthodontic treatment (n=32). CBCTs were sorted by whether the crossbite was corrected (n=16) or not corrected (n=16) during Phase I. Alveolar bone thickness was measured on the buccal and palatal aspects of the central incisors at 3 mm, …

Validation Of A Screening Tool For Sleep Apnea In Children, Brandon Khor

Theses and Dissertations

Objective: The aims of this study were to (1) determine the ability of a pediatric obstructive sleep apnea (POSA) questionnaire to identify high-risk patients through confirmation with an at-home sleep apnea test (HSAT) and (2) to evaluate the correlation between high-risk patients as identified by the questionnaire (PM-STOP-Bang) and an already validated POSA screening tool.

Methods: Orthodontic patients aged 12-17 who met the inclusion criteria were consecutively enrolled in the study (n=16). At the initial orthodontic appointment, the clinician filled out the PM-STOP-Bang questionnaire. Subsequently, participants were invited to complete a one-night HSAT (WatchPat, WP-Itamar-Medical, Caesarea, Israel), which recorded diagnostic …

Factors Important To Underrepresented Minority Applicants In Ranking Orthodontic Programs, Alyssa Patterson

Theses and Dissertations

Purpose: To determine if there was a difference in desirability of various factors used by applicants ranking orthodontic programs depending on their racial or ethnic background.

Method: A survey was distributed to orthodontic residents to assess overall preferences, and differences in desirability of various factors between underrepresented minority (URM) and non-URM applicants.

Results: For applicants overall, “clear aligner therapy training”, “good quality of clinical faculty” and “high number of cases started” had the highest mean desirability. “Racial and ethnic diversity among current and former residents”, “racial and ethnic diversity among faculty” and “participation in care of Medicaid patients” were significantly …

A Radiographic Analysis Of Teeth With Carrier-Based Obturation Requiring Retreatment, Robert W. Rudnicki

Theses and Dissertations

Objective: The purpose of this study was to determine observer accuracy and agreement in detecting carriers using preoperative radiographs, as well as to identify potential radiographic indicators for the presence of carriers.

Methods: A chart review was conducted for patients seen at the VCU graduate endodontic clinic. Eligible cases included previously treated teeth that were nonsurgically retreated, with and without identified carriers. 100 cases were identified, including 61 carrier and 39 non-carrier cases. Preoperative radiographs were randomized, and evaluators assessed each case for the presence of carrier-based obturation. Evaluators included three endodontists, one general dentist, and four endodontic residents. Statistical …

Characteristics Of Permanent Teeth Diagnosed With Pulpal Necrosis: A Retrospective Study, William Lee

Theses and Dissertations

Objective: To determine associations of pulpally necrotic teeth with demographics, clinical findings, radiographic presentation, and periapical status.

Methods: Virginia Commonwealth University uses AxiUm software to record dental treatment and treatment notes. The current study involves a keyword search using the term “pulpal necrosis”. Factors compiled and evaluated included but not limited to patient demographics, location in the dental arch, clinical findings, radiographic presentation, and periapical status.

Results: Data has revealed that teeth with pulpal necrosis can present with a variety of different clinical findings. All of the following were observations of teeth with pulpal necrosis. A total of 325 teeth …

Age Of First Dental Visit And Early Childhood Oral Health Quality Of Life, Richard Greene

Theses and Dissertations

Objective: This project aims to examine the association between the age of a child's first dental visit and their Early Childhood Oral Health Impact Scale (ECOHIS) score.

Methods: A 22-item cross-sectional survey was distributed to caregivers of healthy children aged 5 years and younger with an American Society of Anesthesiology (ASA) I and II status who presented for new patient exams.

Results: In total, 117 caregivers participated in the survey. The ECOHIS was assessed on a 5-point Likert scale and scores ranged from 0-52; higher values indicate poor oral health having a greater impact on the child and family. Those …

Assessment Of Maxillary Sinus Pneumatization In Dentate And Edentulous Areas Using Cone Beam Computed Tomography, Catherine Ramundo

Theses and Dissertations

Objectives: The primary goal of this retrospective analysis is to analyze the morphologic changes that occur following extraction in regards to sinus pneumatization.

Methods: The patient population was selected from the VCU School of Dentistry Graduate Periodontics Department. Cone Beam Computed Tomography scans (CBCT) was obtained from patients that had a posterior tooth extracted. A horizontal tangent line was drawn to the inferior border of the nasal cavity, acting as a constant reference point for measuring the extent of maxillary sinus pneumatization. Radiographic measurements were performed from a horizontal line at this fixed anatomical marker to the deepest level of …

The Value Of Educating Teachers, Coaches, And Athletic Trainers On The Management Of Dental Trauma., Darlene W. Jean

Theses and Dissertations

Purpose: To investigate the benefit of educating teachers, coaches, and athletic trainers about dental trauma to prevent incidents and improve the management of students/athletes with dental trauma.

Methods: Teachers, coaches, and athletic trainers throughout the greater Richmond metro area were recruited via email. Participants answered a pre-seminar survey to evaluate their baseline knowledge and determine whether they have experienced dental trauma with their students/athletes previously. The participants were given the option to attend an in-person or virtual seminar educating them on the basic management of traumatic dental injuries and how to guide affected students/athletes and their families to obtain optimal …

Clinical Outcomes Of Primary Anterior Esthetic Crowns In Pediatric Dentistry, Jenan Alahmad

Theses and Dissertations

Clinical Outcomes of Primary Anterior Esthetic Crowns in Pediatric Dentistry - A Prospective Cohort Study

By: Jenan Alahmad, BDS

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University.

Virginia Commonwealth University, 2024

Thesis Advisor: Parthasarathy Madurantakam, DDS, MDS, PhD

Department of Pediatric Dentistry

BODY

Purpose: This prospective cohort study aimed to compare the effectiveness of restoring maxillary anterior teeth in children (aged 3-6 years) with three different materials: Zirconia Crowns (ZC), Resin Composite Crowns (RC), and Pre-veneered Stainless-Steel Crowns (PVSSC). The study aims to assess the Oral …

A Preliminary Report Of A Randomized Controlled Clinical Trial Comparing Ferric Sulfate With Zin Oxide Eugenol And Non-Eugenol Based Material For Pulpotomy In Primary Molar Teeth, Sarah Balal

Theses and Dissertations

Purpose: This study aimed to evaluate the effect of eugenol and non-eugenol-based Zinc Oxide Eugenol (ZOE) cements on primary tooth pulpotomies where Ferric Sulfate (FS) is used as a medicament.

Methods: Children aged 3-7 years with dental caries in their primary molars that have clinical and radiographic diagnosis of reversible pulpitis and undergoing dental treatment under Oral Conscious Sedation (OCS) or General Anesthesia (GA) were recruited. Children were randomly assigned to receive either FS and ZOE (IRM) or FS and non-eugenol based (CAVIT). The outcomes were assessed based on failure rates of the materials separately for clinical or radiographic evidence …