Mark Saxen | Indiana University (original) (raw)

Papers by Mark Saxen

Research paper thumbnail of A Review of Scientific Literature of Interest to Office-Based Anesthesiology Practitioners

Anesthesia Progress, Jun 1, 2019

Research paper thumbnail of A Review of Scientific Literature of Interest to Office-Based Anesthesiology Practice

Anesthesia Progress, Jun 1, 2017

Research paper thumbnail of Effects of endogenous calcium regulating peptides on opiate actions

Research paper thumbnail of Respiratory effects of a balanced anesthetic technique--revisited fifteen years later

PubMed, 1994

Five hundred and fifty patients underwent general anesthesia with fentanyl, diazepam, and methohe... more Five hundred and fifty patients underwent general anesthesia with fentanyl, diazepam, and methohexital. Forty-seven (8.5%) developed signs of hypoventilation or airway obstruction. Arterial blood gas analysis revealed mild hypoxemia in three of the 47 cases and mild hypercarbia in six. Airway obstruction was more predictive of abnormal blood gas values than was hypoventilation.

Research paper thumbnail of Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Oct 1, 1997

The purpose of this study was to test the hypothesis that topically applied 3% diclofenac in 2.5%... more The purpose of this study was to test the hypothesis that topically applied 3% diclofenac in 2.5% hyaluronan reduces aphthous ulcer pain. A randomized, double-blind, single dose study of 60 healthy adults with aphthous ulcers in three treatment groups--3% diclofenac in 2.5% hyaluronan, 2.5% hyaluronan, 3% viscous lidocaine--was undertaken. Visual analogue scale pain scores were obtained before and after gel application and hourly, for up to 8 hours after gel application. Statistical analysis was performed with repeated measures ANOVA with square root transformation and Bonferroni correction. A 48% overall reduction in pain (p < 0.01) was observed 10 minutes after gel application; however, no significant difference was found between the three topical agents. A 35% to 52% pain reduction (p < 0.01) was reported 2 to 6 hours after the application of diclofenac in hyaluronan, whereas hyaluronan gel alone and viscous lidocaine failed to produce significant VAS reductions. A dose of 3% diclofenac in 2.5% hyaluronan is an effective and novel treatment for this common, painful disorder.

Research paper thumbnail of A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Anesthesia Progress, Jun 1, 2018

Research paper thumbnail of Literature Review for Office-Based Anesthesia

Anesthesia Progress, Dec 1, 2017

Research paper thumbnail of Supplemental Oxygen Concentrations and the Use of Suction to Mitigate Risk of Oral Surgical Fires Using a Laboratory Model

PubMed, Jan 15, 2024

Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, i... more Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, is associated with an increased risk of spontaneous perioperative fire. The purpose of this in vitro study was to examine the effectiveness of intraoral suctioning for reducing oxygen pooling to safe levels during a simulated dental procedure. Methods: Phase one: Twenty trials were completed for each of the three suctioning devices: high-volume evacuation (HVE), fixed tip saliva ejector (SE), and Yankauer suction (YS). Phase two: Twenty trials were completed for each of three suctioning scenarios: no suctioning and continuous suctioning for the HVE and SE. Results: In phase one, the slope for change (decrease) in oxygen during suction was significantly larger for SE than HVE (P<0.001) and YS (P<0.001), but for HVE and YS were not significantly different. Mean oxygen levels during suction were significantly higher for SE than HVE (P<0.001) and YS (P<0.001). In phase two, oxygen increased faster for no suction than for SE and HVE (P<0.001) and increased faster for SE than HVE (P<0.001). Mean oxygen levels were significantly lower for HVE than for SE (P<0.001) and no suction (P<0.001), and significantly lower for SE than no suction (P<0.001). Conclusion: All three devices were effective for reducing intraoral oxygen concentration to acceptable levels during the procedure. The HVE was the most effective suction device for rapidly evacuating pooled intraoral oxygen.

Research paper thumbnail of Point: A 21st-century paradigm for the recognition of dental specialties in the United States

Journal of the American Dental Association, Mar 1, 2019

Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet... more Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished. Methods. This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined. Results. The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization. Conclusions. A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties. Practical Implications. This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.

Research paper thumbnail of The mouse paw withdrawal assay: A method for determining the effect of calcitonin gene-related peptide on cutaneous heat nociceptive latency time

Life Sciences, 1993

Previously we have shown that calcitonin gene-related peptide (CGRP) modulates nociception and th... more Previously we have shown that calcitonin gene-related peptide (CGRP) modulates nociception and the effect of opioid analgesics in the central nervous system of mice. Cutaneous primary afferent nerve terminals also contain a high concentration of CGRP, however the lack of a suitable method for assessing cutaneous nociceptive latency changes in the hindpaw skin of the mouse hindered our investigations. We report here on the development of an assay to investigate the effect of CGRP on nociception in the dorsal hindpaw skin. Subcutaneous injection of CGRP produced a modest elevation of withdrawal latency time at doses that were two orders of magnitude greater than the physiologic levels determined in naive animals by radioimmunoassay. This elevation of threshold was minimal when compared to the elevation produced by mepivacaine. These results indicate that subcutaneous injection of CGRP into the dorsal hindpaw skin of the mouse produces a modest increase in paw withdrawal latency times at high, non-physiologic doses.

Research paper thumbnail of Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia

Anesthesia Progress

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 gro...

Research paper thumbnail of Emerging Demand in Pediatric Dentistry for Office-Based General Anesthesia by Dentist Anesthesiologists in the United States

Journal of Anesthesia & Intensive Care Medicine, 2017

Pediatric dentists have traditionally relied upon self-administered sedation techniques to provid... more Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based anesthesia is an emerging trend. Recent research have examined and compared these two models of office-based anesthesia services a survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) found that over 70% of board-certified US pediatric dentists use some form of sedation or anesthesia in their offices. Furthermore, less than 20% administer IV sedation and 20 to 40% use a dentist anesthesiologist. Therefore, the first purpose of this review is to explore the use of office-based sedation and anesthesia by pediatric dentists practicing in the United States. The second purpose of this review is to identify what graduate training programs in pediatric dentistry and dental anesthesiology are addressing to meet the future demands for deep sedation/ general anesthesia services required for pediatric dentistry.

Research paper thumbnail of Local Anesthetic Effects in the Presence of Chronic Osteomyelitis (Necrosis) of the Mandible: Implications for Localizing the Etiologic Sites of Referred Trigeminal Pain

CRANIO®, 1995

The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthe... more The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthesia of the inferior alveolar nerve can be used as a guide to locate the etiologic sites of referred trigeminal pain emanating from the mandible; (2) to describe the salient histopathologic features of a lowgrade, nonsuppurative osteomyelitis seen in this patient population. Forty-six patients with idiopathic facial pain were subjected to a specific protocol of local anesthetic injections to sequentially block branches of the mandibular nerve to determine the effects on his/her pain. If this significantly reduced or altered the pain on three separate appointments, then exploratory surgery was conducted near identified zones of unanesthetized gingiva. Blocking (92%), bridging (4%), and divergence (4%) were observed patterns of anesthetic resistance of the mucogingival tissues used to categorize the incomplete anesthesia. A 1 00% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary pathology. Medullary fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflammatory cell infiltrates and clusters of lymphocytes. It is concluded that Ratner's method of diagnostic anesthesia be implemented when searching for occult pain producing pathology of the jaws.

Research paper thumbnail of Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

Dentistry Journal, 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.

Research paper thumbnail of Comparison of Intubated Versus Nonintubated Airway Management in Children Under General Anesthesia Provided by Dentist Anesthesiologists

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an esse... more Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (...

Research paper thumbnail of Preventing Dental Surgical Fires: Characterizing Nasal-Cannulated Supplemental Oxygen Pooling in an In Situ Dental Procedure

Journal of Patient Safety

Research paper thumbnail of Advancing the Safe Delivery of Office-Based Dental Anesthesia and Sedation

Research paper thumbnail of Point: A 21st-century paradigm for the recognition of dental specialties in the United States

The Journal of the American Dental Association

Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet... more Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished. Methods. This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined. Results. The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization. Conclusions. A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties. Practical Implications. This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.

Research paper thumbnail of Literature Review for Office-Based Anesthesia

Anesthesia progress, 2018

Research paper thumbnail of The Effects of Different Levels of Ambient Oxygen in an Oxygen-Enriched Surgical Environment and Production of Surgical Fires

Anesthesia progress, 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 = .0168) and 100% ( p = .002). Likewise, the number of events with 80% oxygen was significantly lower than with 100% oxygen ( p = .0019). Flow rate has a significant effect on the time to the first event ( p = .0002), time to first audible pop ( p = .0039), and time to first flash or fire ( p < .0001). No combustion occurred at oxyge...

Research paper thumbnail of A Review of Scientific Literature of Interest to Office-Based Anesthesiology Practitioners

Anesthesia Progress, Jun 1, 2019

Research paper thumbnail of A Review of Scientific Literature of Interest to Office-Based Anesthesiology Practice

Anesthesia Progress, Jun 1, 2017

Research paper thumbnail of Effects of endogenous calcium regulating peptides on opiate actions

Research paper thumbnail of Respiratory effects of a balanced anesthetic technique--revisited fifteen years later

PubMed, 1994

Five hundred and fifty patients underwent general anesthesia with fentanyl, diazepam, and methohe... more Five hundred and fifty patients underwent general anesthesia with fentanyl, diazepam, and methohexital. Forty-seven (8.5%) developed signs of hypoventilation or airway obstruction. Arterial blood gas analysis revealed mild hypoxemia in three of the 47 cases and mild hypercarbia in six. Airway obstruction was more predictive of abnormal blood gas values than was hypoventilation.

Research paper thumbnail of Sustained relief of oral aphthous ulcer pain from topical diclofenac in hyaluronan

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Oct 1, 1997

The purpose of this study was to test the hypothesis that topically applied 3% diclofenac in 2.5%... more The purpose of this study was to test the hypothesis that topically applied 3% diclofenac in 2.5% hyaluronan reduces aphthous ulcer pain. A randomized, double-blind, single dose study of 60 healthy adults with aphthous ulcers in three treatment groups--3% diclofenac in 2.5% hyaluronan, 2.5% hyaluronan, 3% viscous lidocaine--was undertaken. Visual analogue scale pain scores were obtained before and after gel application and hourly, for up to 8 hours after gel application. Statistical analysis was performed with repeated measures ANOVA with square root transformation and Bonferroni correction. A 48% overall reduction in pain (p &lt; 0.01) was observed 10 minutes after gel application; however, no significant difference was found between the three topical agents. A 35% to 52% pain reduction (p &lt; 0.01) was reported 2 to 6 hours after the application of diclofenac in hyaluronan, whereas hyaluronan gel alone and viscous lidocaine failed to produce significant VAS reductions. A dose of 3% diclofenac in 2.5% hyaluronan is an effective and novel treatment for this common, painful disorder.

Research paper thumbnail of A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Anesthesia Progress, Jun 1, 2018

Research paper thumbnail of Literature Review for Office-Based Anesthesia

Anesthesia Progress, Dec 1, 2017

Research paper thumbnail of Supplemental Oxygen Concentrations and the Use of Suction to Mitigate Risk of Oral Surgical Fires Using a Laboratory Model

PubMed, Jan 15, 2024

Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, i... more Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, is associated with an increased risk of spontaneous perioperative fire. The purpose of this in vitro study was to examine the effectiveness of intraoral suctioning for reducing oxygen pooling to safe levels during a simulated dental procedure. Methods: Phase one: Twenty trials were completed for each of the three suctioning devices: high-volume evacuation (HVE), fixed tip saliva ejector (SE), and Yankauer suction (YS). Phase two: Twenty trials were completed for each of three suctioning scenarios: no suctioning and continuous suctioning for the HVE and SE. Results: In phase one, the slope for change (decrease) in oxygen during suction was significantly larger for SE than HVE (P<0.001) and YS (P<0.001), but for HVE and YS were not significantly different. Mean oxygen levels during suction were significantly higher for SE than HVE (P<0.001) and YS (P<0.001). In phase two, oxygen increased faster for no suction than for SE and HVE (P<0.001) and increased faster for SE than HVE (P<0.001). Mean oxygen levels were significantly lower for HVE than for SE (P<0.001) and no suction (P<0.001), and significantly lower for SE than no suction (P<0.001). Conclusion: All three devices were effective for reducing intraoral oxygen concentration to acceptable levels during the procedure. The HVE was the most effective suction device for rapidly evacuating pooled intraoral oxygen.

Research paper thumbnail of Point: A 21st-century paradigm for the recognition of dental specialties in the United States

Journal of the American Dental Association, Mar 1, 2019

Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet... more Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished. Methods. This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined. Results. The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization. Conclusions. A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties. Practical Implications. This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.

Research paper thumbnail of The mouse paw withdrawal assay: A method for determining the effect of calcitonin gene-related peptide on cutaneous heat nociceptive latency time

Life Sciences, 1993

Previously we have shown that calcitonin gene-related peptide (CGRP) modulates nociception and th... more Previously we have shown that calcitonin gene-related peptide (CGRP) modulates nociception and the effect of opioid analgesics in the central nervous system of mice. Cutaneous primary afferent nerve terminals also contain a high concentration of CGRP, however the lack of a suitable method for assessing cutaneous nociceptive latency changes in the hindpaw skin of the mouse hindered our investigations. We report here on the development of an assay to investigate the effect of CGRP on nociception in the dorsal hindpaw skin. Subcutaneous injection of CGRP produced a modest elevation of withdrawal latency time at doses that were two orders of magnitude greater than the physiologic levels determined in naive animals by radioimmunoassay. This elevation of threshold was minimal when compared to the elevation produced by mepivacaine. These results indicate that subcutaneous injection of CGRP into the dorsal hindpaw skin of the mouse produces a modest increase in paw withdrawal latency times at high, non-physiologic doses.

Research paper thumbnail of Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia

Anesthesia Progress

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 gro...

Research paper thumbnail of Emerging Demand in Pediatric Dentistry for Office-Based General Anesthesia by Dentist Anesthesiologists in the United States

Journal of Anesthesia & Intensive Care Medicine, 2017

Pediatric dentists have traditionally relied upon self-administered sedation techniques to provid... more Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based anesthesia is an emerging trend. Recent research have examined and compared these two models of office-based anesthesia services a survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) found that over 70% of board-certified US pediatric dentists use some form of sedation or anesthesia in their offices. Furthermore, less than 20% administer IV sedation and 20 to 40% use a dentist anesthesiologist. Therefore, the first purpose of this review is to explore the use of office-based sedation and anesthesia by pediatric dentists practicing in the United States. The second purpose of this review is to identify what graduate training programs in pediatric dentistry and dental anesthesiology are addressing to meet the future demands for deep sedation/ general anesthesia services required for pediatric dentistry.

Research paper thumbnail of Local Anesthetic Effects in the Presence of Chronic Osteomyelitis (Necrosis) of the Mandible: Implications for Localizing the Etiologic Sites of Referred Trigeminal Pain

CRANIO®, 1995

The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthe... more The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthesia of the inferior alveolar nerve can be used as a guide to locate the etiologic sites of referred trigeminal pain emanating from the mandible; (2) to describe the salient histopathologic features of a lowgrade, nonsuppurative osteomyelitis seen in this patient population. Forty-six patients with idiopathic facial pain were subjected to a specific protocol of local anesthetic injections to sequentially block branches of the mandibular nerve to determine the effects on his/her pain. If this significantly reduced or altered the pain on three separate appointments, then exploratory surgery was conducted near identified zones of unanesthetized gingiva. Blocking (92%), bridging (4%), and divergence (4%) were observed patterns of anesthetic resistance of the mucogingival tissues used to categorize the incomplete anesthesia. A 1 00% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary pathology. Medullary fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflammatory cell infiltrates and clusters of lymphocytes. It is concluded that Ratner's method of diagnostic anesthesia be implemented when searching for occult pain producing pathology of the jaws.

Research paper thumbnail of Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

Dentistry Journal, 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.

Research paper thumbnail of Comparison of Intubated Versus Nonintubated Airway Management in Children Under General Anesthesia Provided by Dentist Anesthesiologists

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an esse... more Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (...

Research paper thumbnail of Preventing Dental Surgical Fires: Characterizing Nasal-Cannulated Supplemental Oxygen Pooling in an In Situ Dental Procedure

Journal of Patient Safety

Research paper thumbnail of Advancing the Safe Delivery of Office-Based Dental Anesthesia and Sedation

Research paper thumbnail of Point: A 21st-century paradigm for the recognition of dental specialties in the United States

The Journal of the American Dental Association

Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet... more Background. Specialty-based practice is a fundamental component of US medicine and dentistry, yet the recognition of new dental specialties has markedly diminished in the past 50 years while medical specialization has flourished. Methods. This article reviews the history of specialty development while focusing on the underlying scientific, educational, and cultural changes in both professions. The process of dental specialty recognition is also examined. Results. The current dental specialty recognition process provides a set of criteria aspiring specialties need to fulfill at the time of application, yet the relationship between the criteria and the sequence for attaining them is undefined. Scientific development and evidence-based practice have grown to become the cornerstone of contemporary health care specialization. Conclusions. A new paradigm for specialty and subspecialty development in dentistry is needed. A model is presented herein that recognizes scientific development as the basis for specialization and describes a formal, sequenced process for the development of emerging specialties and subspecialties. Practical Implications. This new paradigm for dental specialty recognition builds on the current criteria for specialization while encouraging cross-disciplinary interaction and nurturing the development of emerging specialties and subspecialties in dentistry. Doing so will allow dentistry to maintain its lead role in the maintenance of oral health and oral disease treatment in the US population.

Research paper thumbnail of Literature Review for Office-Based Anesthesia

Anesthesia progress, 2018

Research paper thumbnail of The Effects of Different Levels of Ambient Oxygen in an Oxygen-Enriched Surgical Environment and Production of Surgical Fires

Anesthesia progress, 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 = .0168) and 100% ( p = .002). Likewise, the number of events with 80% oxygen was significantly lower than with 100% oxygen ( p = .0019). Flow rate has a significant effect on the time to the first event ( p = .0002), time to first audible pop ( p = .0039), and time to first flash or fire ( p < .0001). No combustion occurred at oxyge...