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Biomedical subjects

Stephen Wilson

Publications and source records attributed to Stephen Wilson.

29 records · Page 2Linked to original sources
PubMedDate not supplied

Effects of changing U.S. parenting styles on dental practice: perceptions of diplomates of the American Board of Pediatric Dentistry presented to the College of Diplomates of the American Board of Pediatric Dentistry 16th Annual Session, Atlanta, Ga, Saturday, May 26, 2001.

PURPOSE: This study surveyed board-certified pediatric dentists on their opinions about changes in U.S. parenting styles and the effects on the practice of pediatric dentistry. METHODS: A questionnaire was developed, piloted, and mailed to 1,129 members of the College of Diplomates of the American Board of Pediatric Dentistry during the summer of 2000. RESULTS: A total of 577 respondents (51%) returned questionnaires, equally distributed across AAPD districts, with male:female ratio of 4:1 and 90% married. A majority perceived parenting styles had changed during their practice lifetime (88% "absolutely or probably changed"), with older practitioners significantly more likely to say so. Ninety-two percent felt changes were "probably or definitely bad" and 85% felt that these changes had resulted in "somewhat or much worse" patient behavior. Practitioners report performing less assertive behavior management techniques than in the past due to these changes. CONCLUSIONS: Diplomates report that parenting changes have occurred and they believe these are negative (bad) and have adversely influenced behavior and caused changes in pediatric dentists' behavior management.

Adult↗
PubMedDate not supplied

The effect of music distraction on pain, anxiety and behavior in pediatric dental patients.

PURPOSE: The purpose of this study was to determine if audio distraction could decrease patient anxiety, pain and disruptive behavior during pediatric dental procedures. METHODS: Forty-five children between the ages of 4 to 6 years had two visits each involving restorative dentistry with local anesthesia in a mandibular quadrant. Visit #1 was a baseline session for all patients. During visit #2, the children were assigned to either an upbeat music group, a relaxing music group or a no music group. Variables measured were: (1) parent-reported anxiety via the Modified Corah Anxiety Scale, (2) self-reported anxiety via the Venham picture scale, (3) heart rate, (4) behavior via the North Carolina Behavior Rating Scale and (5) pain via a visual analogue scale. RESULTS: No significant differences were found among the three groups during experimental visit #2 across any variables. A majority of patients (90%) stated that they enjoyed the music and would like to listen to it during their next visit. CONCLUSIONS: Audio distraction was not an effective means of reducing anxiety, pain or uncooperative behavior during pediatric restorative dental procedures. However, patients did enjoy listening to the music during their visits.

Analysis of Variance↗
PubMedDate not supplied

Association between bispectral analysis and level of conscious sedation of pediatric dental patients.

PURPOSE: This preliminary investigation evaluated the associations among multiple factors designed to measure depth of sedation, such as changes in the patient's electroencephalogram (EEG) via a bispectral analysis (BIS), other physiological variables, observed behaviors and clinical assessment of sedation levels consistent with the American Academy of Pediatric Dentistry (AAPD) sedation guidelines. METHODS: Thirty-four healthy pediatric patients between three to six years of age were enrolled in this institutionally approved study. All children required dental restorations and were uncooperative. The children received a routine oral sedation regimen used in our clinic consisting of chloral hydrate, meperidine, and hydroxyzine that varied in dose for each child. Intraoperatively, nitrous oxide/oxygen was also administered. Physiological variables including oxygen saturation, blood pressure and heart rate were recorded in compliance with AAPD sedation guidelines. The behavior and levels of sedation consistent with AAPD guidelines were also recorded. The BIS monitor was used to obtain EEG information. RESULTS: Useful data were recorded from 21 patients. The mean age and weight of the children were 46.1 +/- 10 months and 16.1 +/- 5 kgs, respectively. The results show a significant association between observed patient behavior and the AAPD levels of sedation (chi2 = 105.1, df = 6, P< 0.0001), between levels of sedation and behavior as a function of 12 time-oriented periods during treatment, (chi2=41.90, df=22, P<0.005 and chi2=48.0, df=33, P=0.04, respectively) and between BIS readings as a function of both level of sedation and behavior (chi2=105.1, df=6, P<0.001 and chi2=28.5, df = 18, P< 0.05, respectively). CONCLUSIONS: There appears to be a significant association between observed patient behaviors during sedation and levels of sedation as measured by BIS and AAPD sedation guidelines. The study also showed that, under treatment conditions used in this study, BIS does not appear to be a more valid means of monitoring sedation depth than the current commonly accepted methods.

Analysis of Variance↗
PubMedDate not supplied

Comparison of the efficacy of oral midazolam alone versus midazolam and meperidine in the pediatric dental patient.

PURPOSE: The purpose of this study was to compare midazolam alone (Group A: 1 mg/kg) vs midazolam plus meperidine (Group B: 0.5 and 1 mg/kg, respectively) in regard to physiology and behavior of young children sedated for dental restorative care. METHODS: Twenty healthy children who met selection criteria were randomly assigned to 1 of 2 groups and subsequently treated in a prospective, crossover design. All sedative agents were administered orally, and all sedations included 50% nitrous oxide administered via a nasal hood. Heart rate, systolic and diastolic blood pressure, and behavior were recorded at 8 procedural or time periods during the visits. Chi-square and ANOVA were used to analyze the data. RESULTS: No difference in physiology or behavior was found between groups. However, higher heart rates and disruptive behaviors occurred more frequently during or after local anesthesia administration. CONCLUSIONS: Oral midazolam alone is just as effective as midazolam with meperidine. Disruptive behaviors accounted for increased heart rates.

Administration, Oral↗
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Research in pediatric dental postgraduate programs and residencies: results of a survey.

PURPOSE: The purpose of this study was to determine various aspects of the research experiences in postgraduate and residency training programs in pediatric dentistry. METHODS: A survey was developed and sent to all directors of postgraduate and residency training programs in pediatric dentistry. The survey consisted of 21 items on various topics related to research experiences of the postgraduate students and residents. The items varied in structure, but most contained response sets deemed appropriate for the intent of the question. The directors were asked to complete the survey and return the questionnaire in a self-addressed stamped envelope within a 3-week period. If a program did not respond within 6 weeks, a follow-up survey was sent. The response sets were collated and analyzed with descriptive and nonparametric statistics. RESULTS: Forty of 55 programs responded with usable data sets. All reporting programs indicated that research experiences occur for residents and all have access to statistical assistance. Eighty-seven percent devote clinical hours to student research and 50% of the students share data or protocols. Only a minority (7%) of programs has not published student research in the last 5 years. Interference with revenue-generating clinic times (45%), lack of faculty understanding/interest in research (40%), and lack of financial resources (32%) were the 3 major obstacles for postgraduate research. CONCLUSIONS: Despite research being accomplished in postgraduate programs in pediatric dentistry, variability in key factors (eg, devoted research time) is common among programs. The impact of this variability on the profession and its advancement of scientific endeavors are unknown.

Attitude of Health Personnel↗
PubMedDate not supplied

Pharmacological management of the pediatric dental patient.

Pharmacological management of the pediatric dental patient is considered a subcategory of a broader collection of professional mediated activities known as behavior management techniques. Pharmacological techniques are generally divided into either: (1) various levels of sedation; or (2) general anesthesia. Pharmacological techniques are not universally offered by practicing dentists for a host of reasons including, but not limited to: (1) variation in practitioner training and philosophy; (2) state rules and regulations; (3) cost and reimbursement; and (4) safety issues.

Anesthesia, Dental↗
PubMedDate not supplied

An analysis of behavior management papers published in the pediatric dental literature.

PURPOSE: Behavior management is considered a keystone entity in pediatric dentistry. The purpose of this article was to: (1) categorize behavior management literature primarily published in Pediatric Dentistry and the Journal of Dentistry for Children over the past 30 years to determine the quantity of survey, opinion, and clinical publication types; and (2) focus on the specific techniques of behavior management, sanctioned by the American Academy of Pediatric Dentistry, to determine the extent of evidence-based support for the techniques. METHODS: A search of articles focusing on behavior management, but excluding sedation, was conducted of Pediatric Dentistry and the Journal of Dentistry for Children from 1970 to the present time. The publications were reviewed, data on authors, titles, and publication dates entered into a spreadsheet, and the publications divided into different types for analysis. RESULTS: One hundred sixty-eight articles were identified and used for analysis. The number of publications involving clinical studies was less than a third (30%) of the total number of articles identified, 38% were opinion papers, and 32% were surveys or descriptions of behavior management in the dental setting. The number of clinical studies peaked in the mid 1980s, and surveys have increased over the past decade. CONCLUSIONS: The evidence-based data to support a clinical science of the effectiveness of behavior management techniques in pediatric dentistry is limited and needs further development.

Behavior Control↗
PubMedDate not supplied

Children sedated for dental care: a pilot study of the 24-hour postsedation period.

PURPOSE: The purpose of this prospective, pilot study was to investigate postsedation events during the first 24 hours after discharge from the treatment facility in children sedated for dental treatment. METHODS: This prospective study involved a convenience sample of 30 healthy patients, ranging from 2 to 5 years of age, who were scheduled to undergo sedation in the dental clinic for operative procedures. Depending on the extent of dental need, child temperament, and other preoperative assessment variables, the children received either a triple combination of chloral hydrate, meperidine, and hydroxyzine ranging in dose from 20 to 30 mg/kg, 1 to 2 mg/kg, 1 to 2 mg/kg, respectively, or midazolam alone (0.5-0.75 mg/kg). Care was provided consistent with the American Academy of Pediatric Dentistry (AAPD) and hospital sedation guidelines. Parents were given a questionnaire concerning events that may occur during the 24 hours after the sedation and were told they would be interviewed via telephone regarding these events. The principal investigator called 24 hours after the sedation visit and interviewed the parents using the questionnaire given to the parents. Data analysis included descriptive statistics, frequency, and chi-square analysis. RESULTS: Data from 30 sedations were used. Differences were noted between a chloral hydrate, meperidine, and hydroxyzine regimen compared to midazolam alone for incidence of sleep on the way home or shortly after arriving at home, but not for postoperative pain, vomiting, eating, evening sleep, and memory. Those receiving the combination regimen were more likely to sleep on the way to and at home than those who received midazolam alone. CONCLUSIONS: It may be concluded that: (1) opportunities for the occurrence of an adverse event may occur on the way or at home following a sedation appointment; and (2) discharge criteria of the AAPD guidelines on elective use of minimal, moderate, or deep sedation and general anesthesia for pediatric dental patients should be met or exceeded as a precautionary measure to prevent adverse events once a child who has received sedative agents leaves a health care facility.

Anesthesia Recovery Period↗