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Open Access Publications from the University of California

Scholarly Works (3 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2015)

Purpose: White spot lesions (WSLs) are a common complication of orthodontic therapy. It has been proposed that treatment with casein phosphopeptide-amorphous calcium phosphate, the active ingredient in MI TM products can effectively reduce the appearance of WSLs.

The aim of this study was to investigate the effect of quarterly in-office applications of MI Varnish in combination with daily at-home application of MI Paste Plus on the prevention and regression of WSLs as compared to the use 1,100 ppm fluoride toothpaste and recommendation of fluoride mouth-rinse in orthodontic patients in a 12-month, randomized, single-blind, prospective, standard-of-care controlled clinical trial.

Methods: Forty subjects at least 11 years of age and undergoing therapy with full fixed orthodontic appliances were recruited from the UCSF Orthodontics Clinic. Subjects had at least two active WSLs on the maxillary and mandibular anterior teeth at baseline. Subjects were randomly assigned to experimental or control groups. The facial surfaces of anterior teeth were evaluated at baseline, 3, 6, and 12 months using the Enamel Decalcification Index, the International Caries Detection and Assessment System and the Nyvad criteria for caries lesion activity.

Data from the final time point will be collected after the submission of this thesis. In order to avoid unblinding the study investigators to subject group assignment, data collected over the first 6 months of the study will be presented here on the entire group of subjects as a collective.

Results: There was no difference in the number of 0s, 1s, 2s, and 3s scored for tooth surfaces in the EDI or ICDAS indices from baseline to 3 months to 6 months. There was no change in average EDI sums across time or average highest ICDAS scores across time. Gingival surfaces received higher WSL scores than mesial and distal surface scores, and occlusal surfaces scored virtually zero. Salivary fluoride levels increased significantly and plaque levels decreased significantly over time.

Conclusions: Gingival surfaces experienced greater surface coverage of WSLs and higher severity of demineralization. Plaque levels improved across subjects with quarterly oral hygiene reinforcement. Salivary fluoride levels increased over time across all subjects receiving topical fluoride.

    Cover page: MI Varnish and MI Paste Plus in a Caries Prevention and Remineralization Study
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2013)

    Objective

    This study aimed to identify factors associated with delayed or omission of indicated steroids for children seen in the emergency department (ED) for moderate-to-severe asthma exacerbation.

    Methods

    This was a retrospective study of pediatric (age ≤ 21 years) patients treated in a general academic ED from January 2006 to September 2011 with a primary diagnosis of asthma (International Classification of Diseases, Ninth Revision code 493.xx) and moderate-to-severe exacerbations. A moderate-to-severe exacerbation was defined as requiring 2 or more (or continuous) bronchodilators. We determined the proportion of visits in which steroids were inappropriately omitted or delayed (>1 hour from arrival). Multivariable logistic regression models were used to identify patient, physician, and system factors associated with delayed or omitted steroids.

    Results

    Of 1333 pediatric asthma ED visits, 817 were for moderate-to-severe exacerbation; 645 (79%) received steroids. Patients younger than 6 years (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.19-4.24), requiring more bronchodilators (OR, 2.82; 95% CI, 2.10-3.79), initially hypoxic (OR, 2.78; 95% CI, 1.33-5.83), or tachypneic (OR, 1.52; 95% CI, 1.05-2.20) were more likely to receive steroids. Median time to steroid administration was 108 minutes (interquartile range, 65-164 minutes). Steroid administration was delayed in 502 visits (78%). Patients with hypoxia (OR, 1.91; 95% CI, 1.11-3.27) or tachypnea (OR, 1.82; 95% CI, 1.17-2.84) were more likely to receive steroids 1 hour or less of arrival, whereas children younger than 2 years (OR, 0.16; 95% CI, 0.07-0.35) and those arriving during periods of higher ED volume (OR, 0.79; 95% CI, 0.67-0.94) were less likely to receive timely steroids.

    Conclusions

    In this ED, steroids were underprescribed and frequently delayed for pediatric ED patients with moderate-to-severe asthma exacerbation. Greater ED volume and younger age are associated with delays. Interventions are needed to expedite steroid administration, improving adherence to National Institutes of Health asthma guidelines.
      Cover page: Emergency Department Crowding and Younger Age Are Associated With Delayed Corticosteroid Administration to Children With Acute Asthma
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2016)

      Introduction

      The regular collection of 3-dimensional (3D) imaging data is critical to the development and implementation of accurate predictive models of facial skeletal growth. However, repeated exposure to x-ray-based modalities such as cone-beam computed tomography has unknown risks that outweigh many potential benefits, especially in pediatric patients. One solution is to make inferences about the facial skeleton from external 3D surface morphology captured using safe nonionizing imaging modalities alone. However, the degree to which external 3D facial shape is an accurate proxy of skeletal morphology has not been previously quantified. As a first step in validating this approach, we tested the hypothesis that population-level variation in the 3D shape of the face and skeleton significantly covaries.

      Methods

      We retrospectively analyzed 3D surface and skeletal morphology from a previously collected cross-sectional cone-beam computed tomography database of nonsurgical orthodontics patients and used geometric morphometrics and multivariate statistics to test the hypothesis that shape variation in external face and internal skeleton covaries.

      Results

      External facial morphology is highly predictive of variation in internal skeletal shape ([Rv] = 0.56, P <0.0001; partial least squares [PLS] 1-13 = 98.7% covariance, P <0.001) and asymmetry (Rv = 0.34, P <0.0001; PLS 1-5 = 90.2% covariance, P <0.001), whereas age-related (r(2) = 0.84, P <0.001) and size-related (r(2) = 0.67, P <0.001) shape variation was also highly correlated.

      Conclusions

      Surface morphology is a reliable source of proxy data for the characterization of skeletal shape variation and thus is particularly valuable in research designs where reducing potential long-term risks associated with radiologic imaging methods is warranted. We propose that longitudinal surface morphology from early childhood through late adolescence can be a valuable source of data that will facilitate the development of personalized craniodental and treatment plans and reduce exposure levels to as low as reasonably achievable.
        Cover page: Facial surface morphology predicts variation in&nbsp;internal skeletal shape
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