James E Jones | Indiana University (original) (raw)

Papers by James E Jones

Dentistry 3000, Jul 22, 2019

T he number of children with caries requiring general anesthesia to achieve comprehensive dental ... more T he number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. This presentation reviews a secondary analysis of data collected in the registry over a 4-year period, 2010-2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%) for the 1991 patients reached for follow-up by the dentist anesthesiologist following their procedure. This analysis provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients. Example of a typical patient procedure will be presented for discussion.

Compendium of continuing education in dentistry, 2021

The purpose of this study was to quantify radiation dose from the XTG (Xray2Go) handheld X-ray de... more The purpose of this study was to quantify radiation dose from the XTG (Xray2Go) handheld X-ray device for bitewing and maxillary anterior occlusal projections using a pediatric phantom. The aim was to evaluate effects of thyroid shielding on total effective dose (E) and tissue equivalent doses (HT) and assess operator backscatter radiation. Methods:A pediatric phantom head with 24 tissue site dosimeters was exposed to radiation from the x-ray device. Exposures included: (1) right and left bitewing (BW) without thyroid collar on phantom, (2) BW with thyroid collar, (3) maxillary anterior occlusal (AO) without thyroid collar, (4) AO with thyroid collar. With each exposure type, new dosimeter sets were used and 30 exposures completed. The operator wore dosimeters on the forehead and right hand to quantify backscatter radiation. Average values of HT and E were calculated. Conclusions: Thyroid shielding made a statistically significant difference for radiation dose with the Xray2Go for B...

PubMed, Jan 15, 2023

Purpose: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private... more Purpose: The purpose of this study was to quantify the impact of the COVID-19 pandemic on private dental insurance claims for pediatric dental care. Methods: Commercial dental insurance claims for patients in the United States ages 18 and younger were obtained and analyzed. The claims dates ranged from January 1, 2019, to August 31, 2020. Total claims paid, average paid amount per visit, and the number of visits were compared between provider specialties and patient age groups from 2019 to 2020. Results: Total paid claims and total number of visits per week were significantly lower in 2020 compared to 2019 from mid-March to mid-May (P<0.001). There were generally no differences from mid-May through August (P>0.15), except for significantly lower total paid claims and visits per week for "other" specialists in 2020 (P<0.005). The average paid amount per visit was significantly higher during the COVID shutdown period for 0-5 year-olds (P<0.001) but significantly lower for all other ages. Conclusions: Dental care was greatly reduced during the COVID shutdown period and was slower to recover for "other" specialties. Younger patients ages zero to five years had more expensive dental visits during the shutdown period.

Journal of dentistry for children, Sep 15, 2020

Purpose: The purposes of this study were to: (1) examine the longevity of resin crowns (RCs), pre... more Purpose: The purposes of this study were to: (1) examine the longevity of resin crowns (RCs), pre-veneered stainless steel crowns (PVSSCs), and stainless steel crowns (SSCs) in primary maxillary incisors in a nationwide sample of private insurance claims; and (2) explore whether longer survival rates are related to the type of treating practitioner.
Methods: Private dental insurance claims were obtained from a national data warehouse. The paid insurance claims (2005 to 2016) included the treatment provided, number of teeth treated at an appointment, patient's age, and type of dentist.
Results: All three restoration types had acceptable longevity; however, SSCs and PVSSCs had significantly better longevity than RCs, with no significant difference in longevity between SSCs and PVSSC. The most common restoration of choice was SSCs (48 percent), followed by RCs (29.8 percent) and PVSSCs (22.2 percent).
Conclusion: SSCs and PVSSCs had greater longevity than resin crowns. The survival rate after six years was higher than 90 percent for all types of restorations. Teeth restored with SSCs lasted longer when placed by pediatric dentists than those placed by general dentists.

Anesthesia Progress

The Journal of the American Dental Association, 2021

Purpose: To evaluate prescription patterns for bitewing and panoramic radiographs (PR) for pediat... more Purpose: To evaluate prescription patterns for bitewing and panoramic radiographs (PR) for pediatric and adolescent dental patients following the implementation of the most recent ADA/FDA guidelines. Methods: Paid insurance claims data for all 50 states were accessed from January 1, 2013 to June 30, 2019 for patients age 18 years and younger; a 5% random sample population was extracted. Statistical analyses were performed to evaluate various imaging metrics for pediatric dentists (PD) and general practitioners (GP). Results: A total of 2,123,735 bitewing images were prescribed during 4,734,249 office visits. The average time interval between bitewing exams ordered by GPs was 13.9 (± 7.4) months, and for PDs this average was 13.0 (± 6.7) months (p<.0001). When divided by age group, 3.5% of all bitewings were taken on patients age 0-4 years. For PRs, 286,824 images were included in the present study. The average time interval between PRs ordered for the same patient was 3.4 (± 1.3) years for PDs and 3.3 (± 1.4) years for GPs. One percent of all PRs were prescribed for patients age 0-4, with 403 images attributed to PDs and 2348 to GPs. Conclusions: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. Practical Implications: Inclusion of individual caries risk with insurance claims data could be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs.

Anesthesia Progress, Mar 1, 2023

ObjectiveThe risk of a spontaneous surgical fire increases as oxygen concentrations surrounding t... more ObjectiveThe risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented.MethodsThirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment.ResultsMean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute.ConclusionThis study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.

PubMed, Jul 15, 2020

Purpose: The purpose of this study was to examine if there are differences in the success rate of... more Purpose: The purpose of this study was to examine if there are differences in the success rate of primary teeth treated with pulpotomies performed by general dentists (GDs) versus pediatric dentists (PDs), using submitted paid insurance dental claims. The extraction time after pulpotomy was examined. Methods: Data for this study were obtained from a private dental insurance claims warehouse. The insurance claims data were retrieved, and a retrospective analysis was performed over seven years (2008 to 2015). The survival rate was estimated using proportional hazard survival analysis. Results: The total number of paid dental claims that used the CDT code for pulpotomy was 401,638. For teeth that received pulpotomy, the average time between pulpotomy and extraction was 1.1 years if the pulpotomies were performed by GDs. The average time was 1.3 years if the pulpotomies were performed by PDs (P<0.0001). GDs had an extraction rate of 7.83 percent after pulpotomies and the placement of stainless steel crowns, while PDs had an extraction rate of 4.09 percent. Conclusions: There is a significant difference in the success rate of teeth treated with pulpotomies performed by pediatric dentists versus general dentists, with pulpotomies performed by the former having a longer survival rate.

Journal of Patient Safety, Mar 26, 2020

Objectives Surgical operatory fires continue to occur in the United States, often with devastatin... more Objectives Surgical operatory fires continue to occur in the United States, often with devastating consequences. Because more than 21% concentrations of oxygen are necessary for the onset of such combustion, this study examined fluctuations of surgical site oxygen levels. Better understanding how these more than 21% concentrations occur will not only add to surgical fire prevention efforts generally but also potentially reduce patient or staff harm and practitioner liability as well. Methods Performing an in situ dental procedure with supplemental nasal-cannulated oxygen and a dental dam, we measured oxygen pooling, defined as any fraction of inspired oxygen (FIO2) greater than the 21% FIO2 of air, on top of and behind a dental dam, and during the application of high-volume intraoral suction. Results Findings indicated statistically significantly higher concentrations (as much as twice the <30% recommended safe level) behind the dental dam compared with on top of it. During real-time measurements of FIO2 for four 120-second trials per participant, oxygen levels exhibited significant fluctuation above and below a more stringent 24.9% safety threshold established in prior research. Application of high-speed intraoral dental suction reduced FIO2 to near atmospheric levels in 30 (96.7%) of 31 of the cases by 60 seconds. Conclusions These results demonstrate the elevated risk associated with above-safe levels of oxygen pooling during a simple dental procedure. Although future research is needed to still more exactly characterize conditions leading to the onset of surgical fires, this study also demonstrates the ability of high-speed intraoral suction to dramatically and rapidly decrease that risk.

Community Dentistry and Oral Epidemiology, Feb 1, 2017

Objectives: This study aimed to calculate the fluoride concentrations of commonly consumed foods ... more Objectives: This study aimed to calculate the fluoride concentrations of commonly consumed foods and beverages for two-year-old children utilizing market basket information for the U.S. Midwest region. Methods: Total Diet Study food lists were cross-referenced with National Health and Nutrition Examination Survey-What We Eat in America data to determine the foods and beverages to be included. Fluoride concentrations were determined using a modification of the hexamethyldisiloxane microdiffusion technique. Fluoride concentrations were summarized for each of the food categories. Daily dietary fluoride intake was estimated using a simulation analysis. Results: Food and beverage fluoride concentrations varied widely, ranging from nondetectable for some oils and dairy products to more than 3.0 µgF/g food for some processed meats, fish, and fruits. The estimated mean (±SD) daily dietary fluoride intake, excluding dentifrice and supplements, was 412 ± 114 µgF/day. The estimated average ingestion for a two-year-old weighing 12.24 kg was 0.034 ± 0.009 mg/kg/day. A diet based on foods and beverages in the fifth percentile of fluoride intake distribution for an average child would result in 247 µgF/day or 0.020 mg/kg/day, while a diet with foods and beverages in the ninety-fifth percentile would result in a total intake of 622 µgF/day, or 0.051 mg/kg/day. Conclusions: The fluoride concentrations of foods and beverages varies widely and, if items in the 95th percentile of fluoride intake distribution are ingested, children could consume more fluoride than the recommended 0.05 mg/kg/day. Fluoride intake calculated in this study was higher than historically reported dietary levels.

Anesthesia Progress, Dec 1, 2017

Few studies have examined the practice characteristics of dentist anesthesiologists and compared ... more Few studies have examined the practice characteristics of dentist anesthesiologists and compared them to other anesthesia providers. Using outcomes from the National Anesthesia Clinical Outcomes Registry and the Society for Ambulatory Anesthesia Clinical Outcomes Registry for dental/oral surgery procedures, we compared 7133 predominantly office-based anesthetics by dentist anesthesiologists to 106,420 predominantly operating room anesthetics performed by physician anesthesia providers. These encounters were contrasted with 34,191 previously published encounters from the practices of oral and maxillofacial surgeons. Children younger than 6 years received the greatest proportion of general anesthetic services rendered by both dentist anesthesiologists and hospital-based anesthesia providers. These general anesthesia services were primarily provided for complete dental rehabilitation for early childhood caries. Overall treatment time for complete dental rehabilitation in the office-based setting by dentist anesthesiologists was significantly shorter than comparable care provided in the hospital operating room and surgery centers. The anesthesia care provided by dentist anesthesiologists was found to be separate and distinct from anesthesia care provided by oral and maxillofacial surgeons, which was primarily administered to adults for very brief surgical procedures. Cases performed by dentist anesthesiologists and hospital-based anesthesia providers were for much younger patients and of significantly longer duration when compared with anesthesia administered by oral and maxillofacial surgeons. Despite the limited descriptive power of the current registries, office-based anesthesia rendered by dentist anesthesiologists is clearly a unique and efficient mode of anesthesia care for dentistry.

PubMed, Jan 15, 2020

Purpose: This study's purpose was to evaluate the effective dose (E) and equivalent dose (HT) of ... more Purpose: This study's purpose was to evaluate the effective dose (E) and equivalent dose (HT) of exposing a pediatric phantom to the extraoral bitewing programs of the Planmeca ProMax 2D S3 (ProMax) and Instrumentarium Orthopantomograph OP30 (OP30) and compare these results with dosimetry associated with the intraoral bitewing and panoramic radiograph. Methods: Dosimetry was acquired by placing 24 dosimeters in tissues of interest in a 10-year-old phantom. Manufacturer child settings were used for all scans. Repeat exposures of 20 scans were utilized. The average values of E and HT were calculated. Results: The E for the ProMax and OP30 units, respectively, were 16.84 μSv and 5.82 μSv. The highest E for both units was delivered to the thyroid, remainder tissues, and salivary glands. The highest HT for both units was delivered to the oral mucosa, salivary glands, extrathoracic airway, and thyroid. The mean differences between units were statistically significant (P<0.05). Conclusions: The average effective dose of the ProMax was higher than for the OP30. The effective dose of the pediatric extraoral bitewing is three to 11 times higher than that of the intraoral bitewing and comparable to the traditional panoramic radiograph of a pediatric phantom. Pediatric extraoral bitewing radiation protection guidelines are recommended.

PubMed, May 15, 2017

Purpose: The purposes of this study were to: (1) evaluate the relationship between appointment fa... more Purpose: The purposes of this study were to: (1) evaluate the relationship between appointment failure and the factors of age, gender, race, insurance type, day of week, scheduled time of surgery, distance traveled, and weather; (2) investigate reasons for failure; and (3) explore the relationships between the factors and reasons for failure. Methods: Electronic medical records were accessed to obtain data for patients scheduled for dental care under general anesthesia from May 2012 to May 2015. Factors were analyzed for relation to appointment failure. Results: Data from 3,513 appointments for 2,874 children were analyzed. Bivariate associations showed statistically significant (P<0.05) relationships between failed appointment and race, insurance type, scheduled time of surgery, distance traveled, snowfall, and temperature. Multinomial regression analysis showed the following associations between factors and the reason for failure (P<0.05): (1) decreased temperature and increased snowfall were associated with weather as reason for failure; (2) the African American population showed an association with family barriers; (3) Hispanic families were less likely to give advanced notice; and (4) the "additional races" category showed an association with fasting violation. Conclusion: Patients who have treatment under general anesthesia face specific barriers to care.

Dentistry journal, Aug 15, 2016

The purpose of this study was to determine if differences in behavior exist following dental trea... more The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA) or office-based general anesthesia (OBGA) in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12-and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6-and 12-month recall visits (p = 0.038 & p = 0.029). Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

Journal of education and ethics in dentistry, 2016

Aims: The purpose of this study was to determine self-reported stress levels and coping mechanism... more Aims: The purpose of this study was to determine self-reported stress levels and coping mechanisms utilized by current pediatric dental residents to generate recommendations to program directors. Subjects and Methods: A 26-question online survey was completed by 250 current United States and Canadian pediatric dental residents and summarized using frequencies and percentages. Statistical Analysis Used: Relationships between various factors and stress levels were evaluated separately using Mantel-Haenszel Chi-square tests for ordered categorical responses. Relationships between various factors and depressive symptoms were evaluated separately using Pearson Chi-square tests. All test were performed with a significance level of P = 0.05. Results: Forty percent of respondents report their stress level as high or medium-high. Stress levels were individually related to gender, academic demands, clinical demands, sleep factors, and hours per week devoted to the residency program. The most common coping mechanisms employed include exercise or sports (68%), television (66%), and socializing (62%). Conclusions: Prospective applicants should recognize the potential for additional stressors that present when one enters into a postgraduate training program; current residents should monitor their stress levels and employ healthy coping mechanisms. Program directors should be cognizant of lifestyle burdens encountered as a resident, evaluate stress levels at timely intervals, and refer to appropriate health and wellness assistance programs as necessary.

PubMed, Mar 15, 2017

Purpose: The purpose of this study was to determine the effects of fluoride varnish on the enamel... more Purpose: The purpose of this study was to determine the effects of fluoride varnish on the enamel shear bond strength of pit and fissure sealants. Methods: Ninety-six teeth were divided into three duplicated test groups: sealant (S)/sealant thermocycle (ST) received Clinpro Sealant only; varnish sealant (VS)/varnish sealant thermocycle (VST) received five percent sodium fluoride (NaF) varnish plus sealant (VPS); and VPS/VPS thermocycle (VPST) received NaF, polish with Clinpro Prophy Paste, plus sealant. One set of each group (ST, VST, VPST) was thermocycled to represent aging, and one set (S, VS, PVS) was not. The shear bond strengths for the thermocycled groups and nonthermocycled groups were determined, and two-way analysis of variance tested the effects of thermocycling and varnish. Results: Thermocycling did not have a significant effect on the peak stresses of the groups (P=0.0552), so sets were combined. The peak stress for S/ST was significantly higher than for VS/VST (P<0.0001). The peak stress for VPS/VPST was significantly higher than for VS/VST (P<0.0001). The peak stress for S/ST was significantly higher than VPS/VPST (P=0.025). Conclusion: Fluoride varnish applied immediately before pit and fissure sealant placement negatively affected the shear bond strength of the sealant. Mechanically cleaning a fluoride varnish-coated tooth with prophy paste did not provide pit and fissure sealant enamel shear bond strengths comparable to those of untreated enamel.

PubMed, Mar 15, 2019

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainles... more Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

Anesthesia Progress, Mar 1, 2018

Surgical fires require an oxygen-enriched environment, a flammable substrate, and an ignition sou... more Surgical fires require an oxygen-enriched environment, a flammable substrate, and an ignition source. We hypothesized ambient oxygen concentration is proportional to the latency time to combustion and the incidence of surgical fires that are detected. We examined latency time and number of events, utilizing the VanCleave et al model of intraoral fire ignition under 60, 80, and 100% oxygen concentration and flow rates of 4 and 10 L/min. Results demonstrated that ambient oxygen concentration and flow rate correlated positively to the initiation of combustion. The number of combustion events with 60% oxygen was significantly lower than with both 80% (p ¼ .0168) and 100% (p ¼ .002). Likewise, the number of events with 80% oxygen was significantly lower than with 100% oxygen (p ¼ .0019). Flow rate has a significant effect on the time to the first event (p ¼ .0002), time to first audible pop (p ¼ .0039), and time to first flash or fire (p , .0001). No combustion occurred at oxygen concentrations less than 60% or flows less than 4 L/min. We conclude that latency time to combustion is directly proportional to ambient oxygen concentration and flow rate. Minimum oxygen concentration and flow rate were identified in our model. Further research is indicated to determine the minimal clinical oxygen concentration and flow rate needed to support combustion of an intraoral fire in a patient.

PubMed, 2013

Purpose: The purpose of this study was to identify factors influencing behavior guidance techniqu... more Purpose: The purpose of this study was to identify factors influencing behavior guidance technique utilization among practicing pediatric dentists and explore potential barriers to the incorporation of previously unused techniques. Methods: The data for this study were obtained from a web-based survey containing 15 multiple choice questions concerning the practitioners' past, current, and anticipated future behavior guidance technique utilization. Results: Most respondents received hands-on training in 10 of the American Academy of Pediatric Dentistry behavior guidance techniques. The type of training was associated with the practitioners' level of comfort using a given technique upon graduation and with the current frequency of technique utilization. Residency type impacted hands-on behavior guidance training, with 39 percent of respondents reporting no intravenous sedation training. The type of practice was associated with the frequency of behavior guidance technique utilization, as was graduation decade. Currently practicing dentists cited legal concerns, parental acceptance to change, and limited resources as perceived obstacles in the incorporation of new techniques. Conclusions: Behavior guidance technique selection and utilization among practicing pediatric dentists was influenced by multiple factors, including advanced education training, residency type, graduation decade, and practice type. Obstacles to the incorporation of previously unused techniques appear to be multifactorial.