Publications by authors named "Sarat Thikkurissy"

16 Publications

  • Page 1 of 1

Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial.

Biol Blood Marrow Transplant 2020 09 4;26(9):1704-1710. Epub 2020 Jun 4.

Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Bloodstream infections (BSIs) from oral organisms are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. There are no proven strategies to decrease BSIs from oral organisms. The aim of this study was to evaluate the impact of daily xylitol wipes in improving oral health, decreasing BSI from oral organisms, and modulating the oral microbiome in pediatric HSCT recipients. This was a single-center 1:1 randomized controlled trial in pediatric HSCT recipients age >2 years. Age-matched healthy children were enrolled to compare the oral microbiome. The oral hygiene standard of care (SOC) group continued to receive the standard oral hygiene regimen. The xylitol group received daily oral xylitol wipes (with .7 g xylitol) in addition to the SOC. The intervention started from the beginning of the transplantation chemotherapy regimen and extended to 28 days following transplantation. The primary outcome was oral health at interval time points, and secondary outcomes included BSIs from oral organisms in the first 30 days following transplantation, oral microbiome abundance, and diversity and oral pathogenic organism abundance. The study was closed early due to efficacy after an interim analysis of the first 30 HSCT recipients was performed (SOC group, n = 16; xylitol group, n = 14). The xylitol group had a significantly lower rate of gingivitis at days 7, 14, and 28 following transplantation (P = .031, .0039, and .0005, respectively); oral plaque at days 7 and 14 (P = .045 and .0023, respectively); and oral ulcers >10 mm at day 14 (P = .049) compared with the SOC group. The xylitol group had no BSI from oral organisms compared with the SOC group, which had 4 (P = .04). The xylitol group had significantly lower abundance of potential BSI pathogens, such as Staphylococcus aureus (P = .036), Klebsiella pneumoniae (P = .033), and Streptococcus spp (P = .011) at the day after transplantation compared with the SOC group. Healthy children and young adults had significantly increased oral microbiome diversity compared with all HSCT recipients (P < .001). The addition of xylitol to standard oral care significantly improves oral health, decreases BSI from oral organisms, and decreases the abundance of pathogenic oral organisms in pediatric and young adult HSCT recipients.
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http://dx.doi.org/10.1016/j.bbmt.2020.05.019DOI Listing
September 2020

Impact of an Alternative Hours Dental Clinic for Adolescents.

Pediatr Dent 2018 Jul;40(4):288-290

Division of Pediatric Dentistry and Orthodontics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

The purposes of this study were to understand familial reasons for attending an alternative hours dental clinic and assess accompanying adult and patient satisfaction with expanded hours. A questionnaire was developed and administered to patients aged 14 years and older and their accompanying adult while attending either a recare or treatment appointment in the adolescent evening clinic (AEC). Questions included inquiries about demographics, and individual questions were directed to the accompanying adult and patient. Fifty questionnaires from accompanying adults and 55 questionnaires from patients were included in this study. Seventy-six percent and 42 percent of accompanying adults, respectively, said their reason for attending the AEC was not having their child miss school and to avoid missing work. Access to care is improved by providing extended clinic hours, but other barriers to care must also be considered. One hundred percent of accompanying adults would schedule their child again during the adolescent evening clinic hours.
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July 2018

Characterizing oral microbial communities across dentition states and colonization niches.

Microbiome 2018 04 10;6(1):67. Epub 2018 Apr 10.

Division of Periodontology, College of Dentistry, The Ohio State University, 4111 Postle Hall, 305, W 12th Avenue, Columbus, OH, 43210, USA.

Methods: The present study aimed to identify patterns and processes in acquisition of oral bacteria and to characterize the microbiota of different dentition states and habitats. Mucosal, salivary, supragingival, and subgingival biofilm samples were collected from orally and systemically healthy children and mother-child dyads in predentate, primary, mixed, and permanent dentitions. 16S rRNA gene sequences were compared to the Human Oral Microbiome Database (HOMD). Functional potential was inferred using PICRUSt.

Results: Unweighted and weighted UniFrac distances were significantly smaller between each mother-predentate dyad than infant-unrelated female dyads. Predentate children shared a median of 85% of species-level operational taxonomic units (s-OTUs) and 100% of core s-OTUs with their mothers. Maternal smoking, but not gender, mode of delivery, feeding habits, or type of food discriminated between predentate microbial profiles. The primary dentition demonstrated expanded community membership, structure, and function when compared to the predentate stage, as well as significantly lower similarity between mother-child dyads. The primary dentition also included 85% of predentate core s-OTUs. Subsequent dentitions exhibited over 90% similarity to the primary dentition in phylogenetic and functional structure. Species from the predentate mucosa as well as new microbial assemblages were identified in the primary supragingival and subgingival microbiomes. All individuals shared 65% of species between supragingival and subgingival habitats; however, the salivary microbiome exhibited less than 35% similarity to either habitat.

Conclusions: Within the limitations of a cross-sectional study design, we identified two definitive stages in oral bacterial colonization: an early predentate imprinting and a second wave with the eruption of primary teeth. Bacterial acquisition in the oral microbiome is influenced by the maternal microbiome. Personalization begins with the eruption of primary teeth; however, this is limited to phylogeny; functionally, individuals exhibit few differences, suggesting that microbial assembly may follow a defined schematic that is driven by the functional requirements of the ecosystem. This early microbiome forms the foundation upon which newer communities develop as more colonization niches emerge, and expansion of biodiversity is attributable to both introduction of new species and increase in abundance of predentate organisms.
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http://dx.doi.org/10.1186/s40168-018-0443-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891995PMC
April 2018

Oral health and hematopoietic stem cell transplantation: A longitudinal evaluation of the first 28 days.

Pediatr Blood Cancer 2018 Jan 26;65(1). Epub 2017 Aug 26.

Department of Pediatric Dentistry and Orthodontics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Background: Mucositis is well described after pediatric hematopoietic stem cell transplant (HSCT) but other aspects of oral health such as dental plaque and gingivitis are poorly understood. The aim of this study was to describe dental plaque, gingivitis, and mucositis early after HSCT.

Methods: We conducted a prospective longitudinal observational study to describe dental plaque, gingivitis, and mucositis in the peritransplant period. We conducted comprehensive oral evaluations that included the Miyazaki tongue coating, modified simplified oral hygiene, modified gingivitis of Suomi and Barbano, and mucosal ulceration indices at baseline on days 0, +7, +14, and +28.

Results: Data were collected from 19 patients with a median age of 8.0 years (5.1-12.8) at time of HSCT. Sixteen patients (85%) had plaque accumulation that progressively worsened, 16 (85%) developed severe gingival inflammation, 13 (68%) developed mucositis, and 11 (58%) had oral ulcerations. All oral indices worsened from baseline during the study period. Gingivitis and oral plaque persisted in most patients at day +28 while mucositis and oral ulcerations slightly improved.

Discussion: Gingivitis, dental plaque, mucositis, and oral ulcerations are common after HSCT. Additional studies are needed to ascertain methods that decrease plaque and gingivitis development and severity.
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http://dx.doi.org/10.1002/pbc.26773DOI Listing
January 2018

Temperament as a Predictor of Nitrous Oxide Inhalation Sedation Success.

Anesth Prog 2017 ;64(1):17-21

Acting Assistant Professor, Department of Pediatric Dentistry, University of Washington, Seattle.

Little is known about implications of temperament for children who receive nitrous oxide inhalation sedation (NO/O) for dental care. The aim of this study was to investigate whether child temperament is associated with success in NO/O. Child-caregiver dyads were enrolled from patients aged 36-95 months receiving dental care with NO/O at a university-based pediatric dental clinic. To assess child temperament, 48 caregivers completed the Children's Behavior Questionnaire Short Form. Patient behavior was abstracted from Frankl scores recorded in the patient's chart. The overall behavioral failure rate was 15% (n = 7/48). There was no significant difference in sedation outcome associated with sex, health, insurance status, or complexity of treatment provided. Sedation outcome was significantly associated with the broad temperament domain of Effortful Control and its subscales Attentional Focusing and Inhibitory Control. The Negative Affectivity subscales of Frustration, Sadness, and Soothability and the Extraversion/Surgency subscales Activity and Impulsivity were also significantly associated with sedation outcome. The results of this study suggest that Effortful Control is associated with behavior during dental treatment with NO/O. The subscales of Attention Focusing, Inhibitory Control, Frustration, Fear, Sadness, Soothability, Activity, and Impulsivity may also be important determinants of child behavior during dental treatment.
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http://dx.doi.org/10.2344/anpr-63-03-01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278530PMC
June 2017

Parental Attitudes Toward Advanced Behavior Guidance Techniques Used in Pediatric Dentistry.

Pediatr Dent 2016 Jan-Feb;38(1):30-6

Professor and chair, Department of Orthodontics, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.

Purpose: To re-examine parental attitudes toward advanced behavior management techniques in pediatric dentistry and determine whether cost, urgency, and amount of treatment influence parental preferences.

Methods: Parents viewed previously validated videotaped clinical vignettes of four advanced behavior guidance techniques: (1) passive immobilization; (2) active immobilization; (3) general anesthesia; and (4) oral sedation. The study was conducted in a children's hospital dental clinic and a suburban private pediatric dentistry office. Parents rated overall acceptance of the techniques, and acceptance under specified conditions using an anchored visual analogue scale.

Results: One hundred five parents completed the survey; 55 from the children's hospital and 50 from private practice. Oral sedation was rated as the most acceptable technique, followed by general anesthesia, active immobilization, and passive immobilization. As urgency, convenience, and previous experience increased, parental acceptance of the technique increased. As cost of treatment increased, parental acceptance decreased. Ratings between the children's hospital group and private practice group differed, as did the demographic variables of insurance, income, and race.

Conclusions: The hierarchy of parental acceptance of advanced behavior guidance techniques is changing with increasing approval of pharmacological management and decreasing approval of physical management. The health care delivery system, urgency, convenience, previous experience, and cost all influence parental acceptance.
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September 2017

Assessing Temperament as a Predictor of Oral Sedation Success Using the Children's Behavior Questionnaire Short Form.

Pediatr Dent 2015 Sep-Oct;37(5):429-35

Department of Pediatric Dentistry, University of Washington, Seattle, Wa., USA.

Purpose: The purpose of this study was to investigate whether temperament, as measured by the Children's Behavior Questionnaire Short Form (CBQ-SF), was associated with success in oral sedation.

Methods: Child-caregiver dyads were enrolled from patients presenting for midazolam, meperidine, and hydroxyzine oral sedation. Children between 36 and 95 months of age, American Society of Anesthesiology (ASA) classification I or II, with diagnostic radiographs, whose parents believed he/she would swallow oral medications, were enrolled. To assess child temperament, caregivers completed the CBQ-SF. Behavior during sedation and overall sedation results were recorded using the Houpt Behavior Rating Scale. Failure was defined by Houpt overall ratings of fair or worse. The presence of disruptive behavior was also quantified.

Results: The sample population consisted of 61 patient-caregiver dyads. The overall sedation success rate was 87 percent (N equals 53). Disruptive behavior was present during 28 percent (N equals 17) of total cases. There was not a significant difference in failure rate or presence of disruptive behavior by age, sex, ASA status, insurance status, reason for sedation, or type of treatment provided. High impulsivity scores were significantly associated with disruptive behavior (P=.04).

Conclusions: Impulsivity may be a determinant of a child's behavior during sedation.
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January 2017

A comparison of fospropofol to midazolam for moderate sedation during outpatient dental procedures.

Anesth Prog 2013 ;60(4):162-77

Private Practice, Denver, Colorado.

Moderate intravenous (IV) sedation combined with local anesthesia is common for outpatient oral surgery procedures. An ideal sedative agent must be safe and well tolerated by patients and practitioners. This study evaluated fospropofol, a relatively new sedative/hypnotic, in comparison to midazolam, a commonly used benzodiazepine, for IV moderate sedation during oral and maxillofacial surgery. Sixty patients were randomly assigned to either the fospropofol or the midazolam group. Each participant received 1 μg/kg of fentanyl prior to administration of the selected sedative. Those in the fospropofol group received an initial dose of 6.5 mg/kg, with 1.6 mg/kg supplemental doses as needed. Those in the midazolam group received initial doses of 0.05 mg/kg, followed by 0.02 mg/kg supplemental doses. The quality of sedation in each patient was evaluated with regard to (a) onset of sedation, maintenance, and recovery profile; (b) patient and surgeon satisfaction; and (c) hemodynamic stability and adverse effects. The fospropofol group demonstrated shorter physical recovery times than midazolam patients, taking a mean of 11.6 minutes versus 18.4 minutes for physical recovery (P = .007). Cognitive recovery comparison did not find any difference with a mean of 7.5 minutes versus 8.8 minutes between the 2 drug groups (P = .123). The fospropofol group had a higher rate of local anesthetic injection recall (90.5 vs 44.4%, P = .004). Other parameters of recall were comparable. Two adverse effects demonstrated significance, with more patients in the midazolam group experiencing tachycardia (48.2 vs 9.4%, P = .001), and more patients in the fospropofol group experiencing perineal discomfort (40.6 vs 0, P < .001). No significant difference was found in any other measures of sedation safety, maintenance, or satisfaction. Fospropofol, when administered intravenously by a dentist anesthesiologist at the indicated dose in this study, appears to be a safe, well-tolerated alternative to midazolam for intravenous moderate sedation during minor oral surgery procedures.
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http://dx.doi.org/10.2344/0003-3006-60.4.162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891457PMC
March 2014

Pulpotomy to stainless steel crown ratio in children with early childhood caries: a cross-sectional analysis.

Pediatr Dent 2011 Nov-Dec;33(7):496-500

Department of Pediatric Dentistry, College of Dentistry, The Ohio State University, USA.

Purpose: This study's purpose was to determine the pulpotomy-to-crown ratio (PCR) in a high-early childhood caries patient population and factors associated with choice of pulpotomy and crown treatments.

Methods: This was a retrospective quality assurance chart review. Five calibrated examiners (kappa=0.86) rated radiographic caries from available films. Demographic data, including age, health status, medications, and pain score, were collected along with pulpotomy- and crown-related treatment characteristics of location of tooth, treatment site, and level of operator skill.

Results: The record review of 521 patients (mean age=5.1 ± 1.9 years old) revealed 1,365 stainless steel crowns (SSCs) performed with 461 pulpotomies in a 6-month period, in both operating rooms (1,043 SSCs) and ambulatory settings (322 SSCs). The mean PCR was 0.34, with PCR decreasing with increasing patient age. Pulpotomy and crown treatments increased with radiographic caries severity with a significant association between pulpotomy and radiographic severity (P<.001). More severe pain was associated with greater likelihood of pulpotomy (P<.001). Age, operator type, and site of treatment did not affect choice of pulpotomy.

Conclusions: The mean pulpotomy-to-crown ratio in this high-early childhood caries pediatric population was 0.34. Pain, the American Society of Anesthesiologists classification system, and radiographic caries severity were predictors of pulpotomy, but operator type and location of treatment were not.
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May 2012

Continued care of children seen in an emergency department for dental trauma.

Pediatr Dent 2011 Sep-Oct;33(5):426-30

Division of Pediatric Dentistry and Community Oral Health, the College of Dentistry, The Ohio State University, Columbus, Ohio, USA.

Purpose: The purpose of this retrospective study was to determine the rate of continuing care for dental trauma patients seen after-hours in a hospital emergency department (ED) and identify predictors for and barriers to seeking continuing care.

Methods: Records of 856 patients treated at Nationwide Children's Hospital (NCH) ED for dental trauma between September 2003 and December 2007, were screened for avulsion, luxation, and intrusion injuries. A qualifying cohort (QC) of 175 patients was included based on injury and root development. A quality assurance survey was conducted with 96 parents of these patients to determine barriers and predictors for follow-up treatment.

Results: Patients averaged 2.5 follow-up visits at NCH. The most commonly reported barriers to receiving treatment were: having to miss school (21%), taking time off of work (17%), and costs associated with dental care (13%). No statistical significance (P=.22) was found between number of follow-up visits and the patient retaining the injured tooth. The number of follow-up visits was not significantly different between patients with private and public insurance.

Conclusions: School, work, and costs associated with ongoing trauma management affect follow-up compliance irrespective of payment source.
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December 2011

Rapid treatment reduces hospitalization for pediatric patients with odontogenic-based cellulitis.

Am J Emerg Med 2010 Jul 2;28(6):668-72. Epub 2010 Apr 2.

Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Department of Dentistry, Nationwide Children's Hospital, Columbus, OH, USA.

Purpose: The study aimed to assess characteristics of facial cellulitis admissions and their relationship to cost of hospitalization (COH) and length of stay (LOS) in children ages 0 to 20 years at an urban hospital and to compare outcomes of rapid management to published and national statistics for LOS and COH.

Methods: A retrospective review of 376 charts of facial cellulitis admissions between 2000 and 2006 revealed 63 of confirmed odontogenic cases from which cellulitis characteristics, COH, and LOS were gleaned. Variables were correlated to LOS and COH. Data on LOS and cost of admission were compared to published studies and 506 entries from the 2006 Kids' Inpatient Database (KID).

Results: Of 63 charts included, children included were 8.3 years (SD, +/-3.8 years) and equal in sex distribution. Treatment rendered and site of infection had no significant relationship to COH. Overall mean hospital LOS was 2.08 days and significantly less as compared to 3.97 days for published studies and 3.4 days for KID (P < .0001). The mean overall hospital COH was $4166 and significantly less compared to $3223 in the literature and $8998.43 for KID.

Conclusion: In the management of pediatric facial cellulitis of odontogenic origin, rapid treatment had a significant positive impact on length of stay and total cost of treatment compared to published studies and nationally reflective data.
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http://dx.doi.org/10.1016/j.ajem.2009.02.028DOI Listing
July 2010

Beyond the dmft: the human and economic cost of early childhood caries.

J Am Dent Assoc 2009 Jun;140(6):650-7

Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA.

Background: Early childhood caries (ECC) is the most common disease of childhood and often is accompanied by serious comorbidities affecting children, their families, the community and the health care system. This report describes morbidity and mortality associated with ECC and its treatment.

Methods: The authors reviewed the literature for descriptions and quantification of morbidity associated with ECC and organized a wide range of studies into a visual model--the morbidity and mortality pyramid--that begins to convey the breadth and depth of ECC's penetration.

Results: ECC exacts a toll on children, affecting their development, school performance and behavior, and on families and society as well. In extreme cases, ECC and its treatment can lead to serious disability and even death. In finding access to care and managing chronic pain and its consequences, families experience stress and, thus, a diminished quality of life. Communities devote resources to prevention and management of the condition. The health care system is confronted with management of the extreme consequences of ECC in hospital emergency departments and operating rooms.

Conclusions: Traditional epidemiologic measures such as the decayed-missing-filled teeth (dmft) index do not adequately portray the effects of ECC on children, families, society and the health care system.

Clinical Implications: The impact of prevention and management of ECC requires the attention of health care professionals and decision makers and extends well beyond the dental office to regulatory and child advocacy agencies as well as public health officials and legislators.
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http://dx.doi.org/10.14219/jada.archive.2009.0250DOI Listing
June 2009

The impact of oral health on the quality of life of young patients with congenital cardiac disease.

Cardiol Young 2009 Jun 14;19(3):252-6. Epub 2009 Apr 14.

Division of Pediatric Dentistry, The Ohio State University College of Dentistry and Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.

The purposes of our study were, first, to determine the prevalence of dental caries in young patients with congenital cardiac disease, second, to determine the effect of oral health in their quality of life, third, to examine parental knowledge about associations between oral health and cardiac health, and fourth, to examine parental perceptions regarding access to dental care. A standardized questionnaire was given to a convenience sample of parents of 43 children with cardiac disease and 43 healthy controls from 12 to 71 months of age. In every patient, we performed a dental examination. Descriptive statistics, the two-tailed t-test, and Fisher's exact test were used for statistical analysis. Of the children with cardiac disease, 17% had caries, compared to 13% of the control group. Almost half of those with cardiac disease had never seen a dentist, compared to 35% of the control subjects. Of the parents of those with cardiac disease, one-fifth did not know whether oral health was important for the heart, compared to one-tenth of controls. Insurance and access to care were not barriers to obtain dental treatment. Statistically significant differences were, first, parents of children with congenitally malformed hearts felt more guilt about their child's oral health than control parents (p = 0.026), second, they were more upset about the dental problems and/or treatments of their children (p = 0.012), and third, they thought that dental problems and/or dental treatment made their children more irritable (p = 0.012). Our findings indicate that it is of paramount importance that cardiologists and their associated staff educate patients and families about oral health and other issues associated with congenital cardiac disease.
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http://dx.doi.org/10.1017/S1047951109003977DOI Listing
June 2009

Association between early childhood caries and behavior as measured by the Child Behavior Checklist.

Pediatr Dent 2008 Nov-Dec;30(6):505-9

Department of Pediatric Dentistry, University of Detroit Mercy Dental School, Detroit, Mich, USA.

Purpose: This study's purpose was to use a standardized behavioral assessment instrument to compare the observed behavior of caries-free (CF) with caries-active (CA) children requiring restoration under general anesthesia (GA).

Methods: Healthy 30- to 60-month-olds, either CF or in need of dental restoration under GA, were selected in 4 equal-size cohorts of 30 subjects from both private practice settings and a clinic. Trained assistants administered the child behavior checklist, a standardized, age-appropriate instrument to assess child behavior problems to parents at the time of appointment.

Results: The 60 CF and 60 CA subjects did not differ significantly (P<.05) between clinic and private practice for age, gender, and race and were collapsed into groups of 60 CF and 60 CA children (mean ages=41.2 and 45.2 months, respectively). Compared to CF children, CA children had significantly higher (more problems) scores for categories of: anxious/depressed; sleep problems; aggressive behavior; externalizing and total problems; and attention deficit/hyperactivity problems. CA children scores for withdrawn, sleep problems, and attention deficit/hyperactivity problems were also higher than normal, but neither group had scores outside normative ranges.

Conclusions: No significant age, gender, behavior, or race differences were noted for site of care, but caries-active children had significantly more behavior problems than caries-free children.
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April 2009

Should fear of malpractice dissuade dentists from caring for children?

J Dent Child (Chic) 2008 Sep-Dec;75(3):271-5

Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus Children's Hospital, Columbus, Ohio, USA.

Purpose: Little information is available on malpractice related to dentistry for children. The purpose of this report was to examine characteristics of malpractice allegations related to dentistry for children from the National Practitioner Databank (NPDB) from February 1, 2004 to November 22, 2006.

Methods: The public use file of the NPDB was obtained and transformed into a searchable database and allegations involving children were sorted and characterized by payment size, reason, practitioner type, and location.

Results: During the roughly 34-month study period, 571,172 total cases were evaluated. 51,691 (9%) of these involved dentists; 367 reports were identified using age-based variable reporting. The majority of cases (275; 75%) involved 10- to 19-year-old children and 92 (25%) of the cases involved 0- to 9-year-old children. One case was an infant younger than one year old. No cases were found with the provider citation of dental resident. The geographic distribution of cases was consistent with relation to practitioner (dentist) density and mean age.

Conclusion: The allegation of malpractice related to dentistry for children is a very small portion of both dental and general health malpractice in the United States.
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March 2009

Concordance and contrast between community-based physicians' and dentist anesthesiologists' history and physicals in outpatient pediatric dental surgery.

Anesth Prog 2008 ;55(2):35-9

Ohio State University College of Dentistry, Columbus, OH 43218, USA.

The objectives of this study were to compare history and physical examinations (H&Ps) done by community-based physicians and dentist anesthesiologists for children undergoing general anesthesia for dental rehabilitation. One hundred sixty-eight records were evaluated from the Nationwide Children's Hospital Dental Surgery Center of patients anesthetized between June 2006 and March 2007. These patients had H&Ps completed by both a community-based physician and a dentist anesthesiologist prior to general anesthesia. H&P forms were reviewed by the 3 authors to identify missing data, American Society of Anesthesiologists (ASA) classification, and impact on care. There was a statistically significant difference with respect to 10 of 17 sections examined, with the community-based physicians' H&Ps tending to be incomplete more often. Over 20% of community-based physicians made no mention of the history of present illness. One third of all physician H&Ps were missing vital sign recordings. No significant difference was noted between the physicians' and dentist anesthesiologists' ratings of ASA status. The physician H&P altered course of anesthesia treatment in <1% of studied cases. Statistically significant deficiencies were noted in the physician H&P in 60% of categories.
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http://dx.doi.org/10.2344/0003-3006(2008)55[35:CACBCP]2.0.CO;2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424014PMC
August 2008