Sean Boynes - Academia.edu (original) (raw)

Papers by Sean Boynes

Evaluating the advances and use of hypodermic needles in dentistry

PubMed, Oct 1, 2014

Different injection techniques and patient management methodologies have been proposed to decreas... more Different injection techniques and patient management methodologies have been proposed to decrease the fear patients may have concerning dental needles. Dental providers should have an understanding of the technological advances, changes in techniques, and patient perceptions associated with the hypodermic needle. This article provides an overview of the pain perception process associated with dental injections. It reviews the two main sensory nerve fibers associated with injection pain and discusses needle properties as well as complications and adverse occurrences.

PubMed, Feb 5, 2010

This assessment sought to identify and quantify complications that occur with anesthesia administ... more This assessment sought to identify and quantify complications that occur with anesthesia administration during dental treatment of consecutive patients who received care through the University of Pittsburgh School of Dental Medicine's (UPSDM) Department of Anesthesiology. This prospective study was completed by participating anesthesia caregivers at the UPSDM as a case-by-case evaluation. A standardized form delineating possible complications was used to collect data following 286 consecutive outpatient anesthetic cases administered within the UPSDM. After statistical analysis of five types of administered anesthesia, the overall complication rate was 22.4% in 286 cases. All of the complications were considered to be mild (90.6%) or moderate (9.4%); there were no reports of severe complications. The complications encountered most frequently were airway obstruction (18 reports) and occurrence of nausea/vomiting (12 reports). ASA classification, anesthetic technique, pre-existing medical findings, and the type of dental procedure performed all were variables that were found to affect the incidence of anesthesia-related complications. The overall complication rate from anesthesia administered during dental care is similar to or less than that reported within the hospital operating system environment.

Allergic Reactions to Local Anesthetic Formulations

Dental Clinics of North America, Oct 1, 2010

True allergic reactions to local anesthetics are rare adverse reactions. At the most, they repres... more True allergic reactions to local anesthetics are rare adverse reactions. At the most, they represent less than 1% of all adverse local anesthetic reactions. When true allergic reactions have been confirmed, the reactions are most commonly the type I anaphylactic and type IV delayed hypersensitivity responses. The type I immediate hypersensitivity reactions are the most severe and may be life-threatening. In the event a potential allergic reaction occurs in a dental office, the dentist needs to properly evaluate the events leading up to the reaction and provide a differential diagnosis. A referral should be given to any patient when an allergic reaction cannot be ruled out as an intravascular injection, toxic overdose, psychogenic reaction, or an idiosyncratic event.

Journal of the American Dental Association, Jul 1, 2017

he vital relationship between health and the economy has been recognized and studied, and countri... more he vital relationship between health and the economy has been recognized and studied, and countries with a healthier workforce see strong economic performance and gain. What often goes unnoticed, however, is the significant role dentists can play in improving the overall health of the population. Let's set the stage. National health expenditures are projected to grow at an average annual rate of 5.6% from 2016 through 2025 and reach 19.9% of gross domestic product by 2025. The top 20 medical conditions account for 57.6% of the spending, with more resources spent on diabetes than any other condition ($101.4 billion per year). Dental health service expenditures grow 5.1% annually and are expected to reach $185 billion in 2025. We see significant spending related to oral health in costly settings, such as hospital emergency departments 5,6 and operating rooms, in which 50% to 75% of total charges are hospital related. The oral health-systemic connection has been well documented for many conditions, with strong evidence in 2017 connecting oral health and rheumatoid arthritis. 8,9 Yet, the lack of detailed national-and state-level data Editorials represent the opinions of the authors and not necessarily those of the American Dental Association.

Ocular Complications Associated with Local Anesthesia Administration in Dentistry

Dental Clinics of North America, Oct 1, 2010

The most widely used method for controlling pain during dental procedures is the intraoral admini... more The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol.

An analysis of the medical-dental referral process to a rural, community health center dental program

Internal Medicine Review, 2016

Local Anesthesia Administration by Dental Hygienists

Dental Clinics of North America, Oct 1, 2010

Within the last 30 years, the role of dental hygienists has expanded to include the administratio... more Within the last 30 years, the role of dental hygienists has expanded to include the administration of local anesthesia. Several studies have been performed to assess practice characteristics and effectiveness of these changes in state licensure regulations. Findings indicate an acceptance of this expansion in dental hygiene practice; however, the delegation of this pain control procedures remains controversial. To address this controversy, the authors have reviewed of current literature to assess the practice of local anesthesia administration by dental hygienists.

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Dental Clinics of North America, Oct 1, 2010

Needle phobia has profound health, dental, societal, and legal implications, and severe psycholog... more Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Evaluating Clinical Quality Assurance and Quality Events: EVT Coding & Oral Health Assessment

• Quality is described as the degree to which the entire set of characteristics of a product, pro... more • Quality is described as the degree to which the entire set of characteristics of a product, process, or service satisfies established, predicted, or obvious needs • In dentistry there is little consistency in the use of quality measures. • Differing ideas of what it really is and can be based on individual or group interpretations. o In health care,– previous descriptions are generally confined to “standard of care”

An analysis of the medical-dental referral process to a rural, community health center dental program

Internal Medicine Review, 2016

Evaluating the advances and use of hypodermic needles in dentistry

Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2014

Different injection techniques and patient management methodologies have been proposed to decreas... more Different injection techniques and patient management methodologies have been proposed to decrease the fear patients may have concerning dental needles. Dental providers should have an understanding of the technological advances, changes in techniques, and patient perceptions associated with the hypodermic needle. This article provides an overview of the pain perception process associated with dental injections. It reviews the two main sensory nerve fibers associated with injection pain and discusses needle properties as well as complications and adverse occurrences.

Ocular Complications Associated with Local Anesthesia Administration in Dentistry

The most widely used method for controlling pain during dental procedures is the intraoral admini... more The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol.

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Needle phobia has profound health, dental, societal, and legal implications, and severe psycholog... more Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Local Anesthesia Administration by Dental Hygienists

Within the last 30 years, the role of dental hygienists has expanded to include the administratio... more Within the last 30 years, the role of dental hygienists has expanded to include the administration of local anesthesia. Several studies have been performed to assess practice characteristics and effectiveness of these changes in state licensure regulations. Findings indicate an acceptance of this expansion in dental hygiene practice; however, the delegation of this pain control procedures remains controversial. To address this controversy, the authors have reviewed of current literature to assess the practice of local anesthesia administration by dental hygienists.

Allergic Reactions to Local Anesthetic Formulations

True allergic reactions to local anesthetics are rare adverse reactions. At the most, they repres... more True allergic reactions to local anesthetics are rare adverse reactions. At the most, they represent less than 1% of all adverse local anesthetic reactions. When true allergic reactions have been confirmed, the reactions are most commonly the type I anaphylactic and type IV delayed hypersensitivity responses. The type I immediate hypersensitivity reactions are the most severe and may be life-threatening. In the event a potential allergic reaction occurs in a dental office, the dentist needs to properly evaluate the events leading up to the reaction and provide a differential diagnosis. A referral should be given to any patient when an allergic reaction cannot be ruled out as an intravascular injection, toxic overdose, psychogenic reaction, or an idiosyncratic event.

The Journal of the American Dental Association, 2009

racticing dentists are continually searching for effective methods of delivering pain-free treatm... more racticing dentists are continually searching for effective methods of delivering pain-free treatment for their patients. For most restorative and surgical procedures, dentists are able to manage operative pain and discomfort by using intraorally administered local anesthetics. Anesthetic administration techniques for intraoral anesthesia in dentistry commonly rely on either infiltration or nerve block injection. Agents commonly used in the United States include the following amide anesthetic formulations: d2 percent lidocaine with 1:100,000 epinephrine (L100); d4 percent articaine with 1:200,000 epinephrine (A200); d4 percent articaine with 1:100,000 epinephrine (A100); d4 percent prilocaine with 1:200,000 epinephrine (P200); d3 percent mepivacaine without vasoconstrictor (Mw/o); d0.5 percent bupivacaine with 1:200,000 epinephrine (B200).

Frontiers in oral health, Dec 15, 2022

Background: The Covid-19 pandemic exacerbated dental staffing shortages, which impact care delive... more Background: The Covid-19 pandemic exacerbated dental staffing shortages, which impact care delivery and ultimately oral health equity. Federal funding efforts like the Paycheck Protection Program (PPP) sought to aid traditionally underserved businesses including those owned by veterans, minority racial and ethnic groups, and women. Objectives: (1) To examine differences in PPP funding between veteran-and nonveteran-owned dental care delivery businesses and organizations and (2) to analyze other relevant factors associated with variation in PPP funding levels for dental businesses. Methods: Using publicly available PPP data, we ran unadjusted bivariable and adjusted multivariable linear regression models to estimate associations between loan approval amount and forgiveness amount, veteran status, and relevant covariates. Results: Minority racial and ethnic groups and women received less PPP funding and less loan forgiveness, on average, compared with non-minority groups. In the adjusted model with no missing self-reported demographic observations at p < 0.10, veterans received more PPP funding and loan forgiveness, on average, compared to non-veterans. Conclusion: To our knowledge, this is the first comprehensive analysis of all dental recipients of PPP funding throughout the United States. Despite PPP program intentions and strategies, traditionally underserved dental businesses did not receive increased funding to support employment.

Research Square (Research Square), Aug 4, 2020

Objectives: To describe survival outcomes of silver diamine uoride (SDF) among a population-based... more Objectives: To describe survival outcomes of silver diamine uoride (SDF) among a population-based sample receiving care in community settings. Methods: We analyzed data on SDF applications from de-identi ed dental claims on Oregon Health Plan patients served by Advantage Dental in 2016, who had been seen in 2015. Survival rates of SDF alone, SDF applied with a sedative lling, and SDF with a same-day restoration were compared. Failure was de ned as a restoration or extraction of the tooth 7 to 365 days after initial application, while survival was de ned a patient that returned 180 or more days after application and the tooth did not have restoration or extraction. Differences were assessed through Wilcoxon equality of survivor function tests and log-rank equality of survivor tests to compare failure rates, Cox Proportional Hazards models to assess factors associated with survival of SDF, and Kaplan-Meier survival estimate to calculate the probability of survival over time. Results: SDF alone had an overall survival rate of 76%. SDF placed with sedative lling and with a same-day restoration had survival rates of 50% and 84% respectively, likely re ecting the intent of treatment. SDF alone survived exceptionally well on primary cuspids, permanent molars, and permanent bicuspids and among patients aged 10 to 20 years, with modest variation across caries risk assessment categories. A single annual application of SDF was successful in 68% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration. Conclusions: SDF is a minimally invasive non-aerosolizing option that demonstrably prevented and arrested early stage dental caries among patients in one "real world" community dentistry setting. Professional organizations, policy makers, providers, and payors should consider broadening the option to use SDF by informing clinical guidelines, reimbursement policies, and treatment decisions, especially amidst COVID-19 pandemic driven guidelines to minimize risk of exposure to airborne pathogens. Future research should address clinical, social, health service delivery, workforce, and economic outcomes including costs and invasive procedures deferred, using diverse population-based samples, and the mechanisms underlying the success of a single application and the potential for SDF to prevent caries found in this study. Trial registration: N/A Background Dental caries, the most common disease of childhood and most prevalent health condition worldwide, persists despite concerted clinical and public health efforts to eliminate it over the last half-century [1,2]. Untreated caries contributes to health problems including pain, poor quality of life, and psychosocial suffering, as well as societal burdens that include reduced productivity at work and school [1,3,4]. Preventing dental caries through oral health education, home hygiene, the avoidance of fermentable carbohydrates, consumption of uoridated water, and access to and utilization of routine dental screenings, examinations, and care is essential in reducing disease incidence and burden, meeting population-level oral health goals, and addressing patient concerns [1,4]. Because dental caries is a progressive disease, treating it as early as possible can halt extant disease, prevent or forestall subsequent cases, improve the longevity of teeth and their supporting structures, and, when possible, help patients avoid more invasive procedures and associated risks [4,5]. As in primary prevention, secondary approaches that leverage treatment-asprevention are particularly valuable when implemented at the population level [1,5,6]. Dental public health and oral health stakeholders seek to maximize caries prevention and treatment approaches that are safe, simple, effective, low-cost, minimally invasive, and amenable to delivery in a variety of community settings and by multiple members of dental treatment teams. Silver diamine uoride (SDF) has been approved for dental use in numerous countries including, since 2014, the United States, where its off-label use for the secondary prevention of caries beginning in 2016 has been subsequently formalized through clinical guidelines released in 2018 [7-9]. SDF has gained prominence among other non-invasive treatments in arresting established caries, though effectiveness varies by frequency of application (e.g., annually vs. biannually), preparation of concentrations, tooth type (e.g. permanent versus primary), and tooth surface (e.g., coronal vs. root surfaces) [6,10-17]. SDF has also been demonstrated to prevent new carious lesions on root surfaces among older adults, while limited evidence indicates its potential to prevent caries in primary teeth for at least 24 months following initial application [15,18,19]. Numerous

Research Square (Research Square), Jan 13, 2020

Introduction: Poor oral health remains a national concern impacting overall health and continues ... more Introduction: Poor oral health remains a national concern impacting overall health and continues to burden an already overtaxed health care system. These issues are exacerbated by differing levels of coverage nationally, particularly in those states that lack any public oral health coverage. Those with significant and immediate need are forced to seek care from alternative settings and often are not equipped to provide dental treatment. Oregon operates a unique system called Coordinated Care Organizations (CCOs) designed to link providers from across disciplines and focus on prevention and chronic disease management. Methods: Using claims data from the All-Payer, All-Claims (APAC) database, this paper evaluates claims from 2013 to 2015 for all patients presenting to an emergency department (ED) or as an inpatient for a non-traumatic dental condition (NTDC) in the state of Oregon. Results: ED visits for NTDCs increased from 2013 to 2015 with 79% of ED visits for a dental condition paid for by Medicaid, and those aged 20-34 had the highest visit rate across all 3 years. Black and

Impact of Opioid Prescribing Policy Changes The TennCare Dental Experience

Evaluating the advances and use of hypodermic needles in dentistry

PubMed, Oct 1, 2014

Different injection techniques and patient management methodologies have been proposed to decreas... more Different injection techniques and patient management methodologies have been proposed to decrease the fear patients may have concerning dental needles. Dental providers should have an understanding of the technological advances, changes in techniques, and patient perceptions associated with the hypodermic needle. This article provides an overview of the pain perception process associated with dental injections. It reviews the two main sensory nerve fibers associated with injection pain and discusses needle properties as well as complications and adverse occurrences.

PubMed, Feb 5, 2010

This assessment sought to identify and quantify complications that occur with anesthesia administ... more This assessment sought to identify and quantify complications that occur with anesthesia administration during dental treatment of consecutive patients who received care through the University of Pittsburgh School of Dental Medicine's (UPSDM) Department of Anesthesiology. This prospective study was completed by participating anesthesia caregivers at the UPSDM as a case-by-case evaluation. A standardized form delineating possible complications was used to collect data following 286 consecutive outpatient anesthetic cases administered within the UPSDM. After statistical analysis of five types of administered anesthesia, the overall complication rate was 22.4% in 286 cases. All of the complications were considered to be mild (90.6%) or moderate (9.4%); there were no reports of severe complications. The complications encountered most frequently were airway obstruction (18 reports) and occurrence of nausea/vomiting (12 reports). ASA classification, anesthetic technique, pre-existing medical findings, and the type of dental procedure performed all were variables that were found to affect the incidence of anesthesia-related complications. The overall complication rate from anesthesia administered during dental care is similar to or less than that reported within the hospital operating system environment.

Allergic Reactions to Local Anesthetic Formulations

Dental Clinics of North America, Oct 1, 2010

True allergic reactions to local anesthetics are rare adverse reactions. At the most, they repres... more True allergic reactions to local anesthetics are rare adverse reactions. At the most, they represent less than 1% of all adverse local anesthetic reactions. When true allergic reactions have been confirmed, the reactions are most commonly the type I anaphylactic and type IV delayed hypersensitivity responses. The type I immediate hypersensitivity reactions are the most severe and may be life-threatening. In the event a potential allergic reaction occurs in a dental office, the dentist needs to properly evaluate the events leading up to the reaction and provide a differential diagnosis. A referral should be given to any patient when an allergic reaction cannot be ruled out as an intravascular injection, toxic overdose, psychogenic reaction, or an idiosyncratic event.

Journal of the American Dental Association, Jul 1, 2017

he vital relationship between health and the economy has been recognized and studied, and countri... more he vital relationship between health and the economy has been recognized and studied, and countries with a healthier workforce see strong economic performance and gain. What often goes unnoticed, however, is the significant role dentists can play in improving the overall health of the population. Let's set the stage. National health expenditures are projected to grow at an average annual rate of 5.6% from 2016 through 2025 and reach 19.9% of gross domestic product by 2025. The top 20 medical conditions account for 57.6% of the spending, with more resources spent on diabetes than any other condition ($101.4 billion per year). Dental health service expenditures grow 5.1% annually and are expected to reach $185 billion in 2025. We see significant spending related to oral health in costly settings, such as hospital emergency departments 5,6 and operating rooms, in which 50% to 75% of total charges are hospital related. The oral health-systemic connection has been well documented for many conditions, with strong evidence in 2017 connecting oral health and rheumatoid arthritis. 8,9 Yet, the lack of detailed national-and state-level data Editorials represent the opinions of the authors and not necessarily those of the American Dental Association.

Ocular Complications Associated with Local Anesthesia Administration in Dentistry

Dental Clinics of North America, Oct 1, 2010

The most widely used method for controlling pain during dental procedures is the intraoral admini... more The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol.

An analysis of the medical-dental referral process to a rural, community health center dental program

Internal Medicine Review, 2016

Local Anesthesia Administration by Dental Hygienists

Dental Clinics of North America, Oct 1, 2010

Within the last 30 years, the role of dental hygienists has expanded to include the administratio... more Within the last 30 years, the role of dental hygienists has expanded to include the administration of local anesthesia. Several studies have been performed to assess practice characteristics and effectiveness of these changes in state licensure regulations. Findings indicate an acceptance of this expansion in dental hygiene practice; however, the delegation of this pain control procedures remains controversial. To address this controversy, the authors have reviewed of current literature to assess the practice of local anesthesia administration by dental hygienists.

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Dental Clinics of North America, Oct 1, 2010

Needle phobia has profound health, dental, societal, and legal implications, and severe psycholog... more Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Evaluating Clinical Quality Assurance and Quality Events: EVT Coding & Oral Health Assessment

• Quality is described as the degree to which the entire set of characteristics of a product, pro... more • Quality is described as the degree to which the entire set of characteristics of a product, process, or service satisfies established, predicted, or obvious needs • In dentistry there is little consistency in the use of quality measures. • Differing ideas of what it really is and can be based on individual or group interpretations. o In health care,– previous descriptions are generally confined to “standard of care”

An analysis of the medical-dental referral process to a rural, community health center dental program

Internal Medicine Review, 2016

Evaluating the advances and use of hypodermic needles in dentistry

Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2014

Different injection techniques and patient management methodologies have been proposed to decreas... more Different injection techniques and patient management methodologies have been proposed to decrease the fear patients may have concerning dental needles. Dental providers should have an understanding of the technological advances, changes in techniques, and patient perceptions associated with the hypodermic needle. This article provides an overview of the pain perception process associated with dental injections. It reviews the two main sensory nerve fibers associated with injection pain and discusses needle properties as well as complications and adverse occurrences.

Ocular Complications Associated with Local Anesthesia Administration in Dentistry

The most widely used method for controlling pain during dental procedures is the intraoral admini... more The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol.

Needle Phobia: Etiology, Adverse Consequences, and Patient Management

Needle phobia has profound health, dental, societal, and legal implications, and severe psycholog... more Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.

Local Anesthesia Administration by Dental Hygienists

Within the last 30 years, the role of dental hygienists has expanded to include the administratio... more Within the last 30 years, the role of dental hygienists has expanded to include the administration of local anesthesia. Several studies have been performed to assess practice characteristics and effectiveness of these changes in state licensure regulations. Findings indicate an acceptance of this expansion in dental hygiene practice; however, the delegation of this pain control procedures remains controversial. To address this controversy, the authors have reviewed of current literature to assess the practice of local anesthesia administration by dental hygienists.

Allergic Reactions to Local Anesthetic Formulations

True allergic reactions to local anesthetics are rare adverse reactions. At the most, they repres... more True allergic reactions to local anesthetics are rare adverse reactions. At the most, they represent less than 1% of all adverse local anesthetic reactions. When true allergic reactions have been confirmed, the reactions are most commonly the type I anaphylactic and type IV delayed hypersensitivity responses. The type I immediate hypersensitivity reactions are the most severe and may be life-threatening. In the event a potential allergic reaction occurs in a dental office, the dentist needs to properly evaluate the events leading up to the reaction and provide a differential diagnosis. A referral should be given to any patient when an allergic reaction cannot be ruled out as an intravascular injection, toxic overdose, psychogenic reaction, or an idiosyncratic event.

The Journal of the American Dental Association, 2009

racticing dentists are continually searching for effective methods of delivering pain-free treatm... more racticing dentists are continually searching for effective methods of delivering pain-free treatment for their patients. For most restorative and surgical procedures, dentists are able to manage operative pain and discomfort by using intraorally administered local anesthetics. Anesthetic administration techniques for intraoral anesthesia in dentistry commonly rely on either infiltration or nerve block injection. Agents commonly used in the United States include the following amide anesthetic formulations: d2 percent lidocaine with 1:100,000 epinephrine (L100); d4 percent articaine with 1:200,000 epinephrine (A200); d4 percent articaine with 1:100,000 epinephrine (A100); d4 percent prilocaine with 1:200,000 epinephrine (P200); d3 percent mepivacaine without vasoconstrictor (Mw/o); d0.5 percent bupivacaine with 1:200,000 epinephrine (B200).

Frontiers in oral health, Dec 15, 2022

Background: The Covid-19 pandemic exacerbated dental staffing shortages, which impact care delive... more Background: The Covid-19 pandemic exacerbated dental staffing shortages, which impact care delivery and ultimately oral health equity. Federal funding efforts like the Paycheck Protection Program (PPP) sought to aid traditionally underserved businesses including those owned by veterans, minority racial and ethnic groups, and women. Objectives: (1) To examine differences in PPP funding between veteran-and nonveteran-owned dental care delivery businesses and organizations and (2) to analyze other relevant factors associated with variation in PPP funding levels for dental businesses. Methods: Using publicly available PPP data, we ran unadjusted bivariable and adjusted multivariable linear regression models to estimate associations between loan approval amount and forgiveness amount, veteran status, and relevant covariates. Results: Minority racial and ethnic groups and women received less PPP funding and less loan forgiveness, on average, compared with non-minority groups. In the adjusted model with no missing self-reported demographic observations at p < 0.10, veterans received more PPP funding and loan forgiveness, on average, compared to non-veterans. Conclusion: To our knowledge, this is the first comprehensive analysis of all dental recipients of PPP funding throughout the United States. Despite PPP program intentions and strategies, traditionally underserved dental businesses did not receive increased funding to support employment.

Research Square (Research Square), Aug 4, 2020

Objectives: To describe survival outcomes of silver diamine uoride (SDF) among a population-based... more Objectives: To describe survival outcomes of silver diamine uoride (SDF) among a population-based sample receiving care in community settings. Methods: We analyzed data on SDF applications from de-identi ed dental claims on Oregon Health Plan patients served by Advantage Dental in 2016, who had been seen in 2015. Survival rates of SDF alone, SDF applied with a sedative lling, and SDF with a same-day restoration were compared. Failure was de ned as a restoration or extraction of the tooth 7 to 365 days after initial application, while survival was de ned a patient that returned 180 or more days after application and the tooth did not have restoration or extraction. Differences were assessed through Wilcoxon equality of survivor function tests and log-rank equality of survivor tests to compare failure rates, Cox Proportional Hazards models to assess factors associated with survival of SDF, and Kaplan-Meier survival estimate to calculate the probability of survival over time. Results: SDF alone had an overall survival rate of 76%. SDF placed with sedative lling and with a same-day restoration had survival rates of 50% and 84% respectively, likely re ecting the intent of treatment. SDF alone survived exceptionally well on primary cuspids, permanent molars, and permanent bicuspids and among patients aged 10 to 20 years, with modest variation across caries risk assessment categories. A single annual application of SDF was successful in 68% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration. Conclusions: SDF is a minimally invasive non-aerosolizing option that demonstrably prevented and arrested early stage dental caries among patients in one "real world" community dentistry setting. Professional organizations, policy makers, providers, and payors should consider broadening the option to use SDF by informing clinical guidelines, reimbursement policies, and treatment decisions, especially amidst COVID-19 pandemic driven guidelines to minimize risk of exposure to airborne pathogens. Future research should address clinical, social, health service delivery, workforce, and economic outcomes including costs and invasive procedures deferred, using diverse population-based samples, and the mechanisms underlying the success of a single application and the potential for SDF to prevent caries found in this study. Trial registration: N/A Background Dental caries, the most common disease of childhood and most prevalent health condition worldwide, persists despite concerted clinical and public health efforts to eliminate it over the last half-century [1,2]. Untreated caries contributes to health problems including pain, poor quality of life, and psychosocial suffering, as well as societal burdens that include reduced productivity at work and school [1,3,4]. Preventing dental caries through oral health education, home hygiene, the avoidance of fermentable carbohydrates, consumption of uoridated water, and access to and utilization of routine dental screenings, examinations, and care is essential in reducing disease incidence and burden, meeting population-level oral health goals, and addressing patient concerns [1,4]. Because dental caries is a progressive disease, treating it as early as possible can halt extant disease, prevent or forestall subsequent cases, improve the longevity of teeth and their supporting structures, and, when possible, help patients avoid more invasive procedures and associated risks [4,5]. As in primary prevention, secondary approaches that leverage treatment-asprevention are particularly valuable when implemented at the population level [1,5,6]. Dental public health and oral health stakeholders seek to maximize caries prevention and treatment approaches that are safe, simple, effective, low-cost, minimally invasive, and amenable to delivery in a variety of community settings and by multiple members of dental treatment teams. Silver diamine uoride (SDF) has been approved for dental use in numerous countries including, since 2014, the United States, where its off-label use for the secondary prevention of caries beginning in 2016 has been subsequently formalized through clinical guidelines released in 2018 [7-9]. SDF has gained prominence among other non-invasive treatments in arresting established caries, though effectiveness varies by frequency of application (e.g., annually vs. biannually), preparation of concentrations, tooth type (e.g. permanent versus primary), and tooth surface (e.g., coronal vs. root surfaces) [6,10-17]. SDF has also been demonstrated to prevent new carious lesions on root surfaces among older adults, while limited evidence indicates its potential to prevent caries in primary teeth for at least 24 months following initial application [15,18,19]. Numerous

Research Square (Research Square), Jan 13, 2020

Introduction: Poor oral health remains a national concern impacting overall health and continues ... more Introduction: Poor oral health remains a national concern impacting overall health and continues to burden an already overtaxed health care system. These issues are exacerbated by differing levels of coverage nationally, particularly in those states that lack any public oral health coverage. Those with significant and immediate need are forced to seek care from alternative settings and often are not equipped to provide dental treatment. Oregon operates a unique system called Coordinated Care Organizations (CCOs) designed to link providers from across disciplines and focus on prevention and chronic disease management. Methods: Using claims data from the All-Payer, All-Claims (APAC) database, this paper evaluates claims from 2013 to 2015 for all patients presenting to an emergency department (ED) or as an inpatient for a non-traumatic dental condition (NTDC) in the state of Oregon. Results: ED visits for NTDCs increased from 2013 to 2015 with 79% of ED visits for a dental condition paid for by Medicaid, and those aged 20-34 had the highest visit rate across all 3 years. Black and

Impact of Opioid Prescribing Policy Changes The TennCare Dental Experience