A machine learning model for orthodontic extraction/non-extraction decision in a racially and ethnically diverse patient population.

INTRODUCTION: The purpose of the present study was to create a machine learning (ML) algorithm with the ability to predict the extraction/non-extraction decision in a racially and ethnically diverse sample. METHODS: Data was gathered from the records of 393 patients (200 non-extraction and 193 extraction) from a racially and ethnically diverse population. Four ML models (logistic regression [LR], random forest [RF], support vector machine [SVM], and neural network [NN]) were trained on a training set (70% of samples) and then tested on the remaining samples (30%). The accuracy and precision of the ML model predictions were calculated using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. The proportion of correct extraction/non-extraction decisions was also calculated. RESULTS: The LR, SVM, and NN models performed best, with an AUC of the ROC of 91.0%, 92.5%, and 92.3%, respectively. The overall proportion of correct decisions was 82%, 76%, 83%, and 81% for the LR, RF, SVM, and NN models, respectively. The features found to be most helpful to the ML algorithms in making their decisions were maxillary crowding/spacing, L1-NB (mm), U1-NA (mm), PFH:AFH, and SN-MP(̊), although many other features contributed significantly. CONCLUSIONS: ML models can predict the extraction decision in a racially and ethnically diverse patient population with a high degree of accuracy and precision. Crowding, sagittal, and vertical characteristics all featured prominently in the hierarchy of components most influential to the ML decision-making process.

Can we predict orthodontic extraction patterns by using machine learning?

OBJECTIVE: To investigate the utility of machine learning (ML) in accurately predicting orthodontic extraction patterns in a heterogeneous population. MATERIALS AND METHODS: The material of this retrospective study consisted of records of 366 patients treated with orthodontic extractions. The dataset was randomly split into training (70%) and test sets (30%) and was stratified according to race/ethnicity and gender. Fifty-five cephalometric and demographic input data were used to train and test multiple ML algorithms. The extraction patterns were labelled according to the previous treatment plan. Random Forest (RF), Logistic Regression (LR), and Support Vector Machine (SVM) algorithms were used to predict the patient's extraction patterns. RESULTS: The highest class accuracy percentages were obtained for the upper and lower 1st premolars (U/L4s) (RF: 81.63%, LR: 63.27%, SVM: 63.27%) and upper 1st premolars only (U4s) extraction patterns (RF: 61.11%, LR: 72.22%, SVM: 72.22%). However, all methods revealed low class accuracy rates (<50%) for the upper 1st and lower 2nd premolars (U4/L5s), upper 2nd and lower 1st premolars (U5/L4s), and upper and lower 2nd premolars (U/L5s) extraction patterns. For the overall accuracy, RF yielded the highest percentage with 54.55%, followed by SVM with 52.73% and LR with 49.09%. CONCLUSION: All tested supervised ML techniques yielded good accuracy in predicting U/L4s and U4s extraction patterns. However, they predicted poorly for the U4/L5s, U5/L4s, and U/L5s extraction patterns. Molar relationship, mandibular crowding, and overjet were found to be the most predictive indicators for determining extraction patterns.

Insurance claim data trends in pulpal therapy for pediatric patients.

BACKGROUND: The purpose of this study was to identify differences in usage trends for 2 specific pulpal therapy treatments in pediatric patients during an 11-year period from January 1, 2010, through December 31, 2020. METHODS: Insurance data claims for children aged 2 through 12 years undergoing a pulpotomy or a pulpectomy performed by a general dentist (GD) or pediatric dentist (PD) from 2010 through 2020 were extracted from a dental data warehouse. The state where the provider was located was included in the extracted claim. RESULTS: Rates of undergoing a pulpotomy or pulpectomy declined from 2010 through 2020 (odds ratio [OR], 0.978 or 0.946, respectively; P < .001). PDs were more likely to perform pulpotomies than GDs (OR, 1.393; P < .001), but PDs were less likely to perform pulpectomies than GDs (OR, 0.225; P < .001). Younger patient age was a significant predictor for undergoing pulpotomy treatment for both GDs and PDs (ORs, 0.850 and 0.892, respectively; P < .001). With increasing patient age, PDs had increased odds of performing a pulpectomy (OR, 1.030; P < .001) and GDs had decreased odds of performing a pulpectomy (OR, 0.995; P = .04). When examining effects according to American Academy of Pediatric Dentistry national membership districts, the trends remained consistent with those above. CONCLUSIONS: The percentage of children undergoing pulpotomy and pulpectomy therapy declined from 2010 through 2020 among both GDs and PDs. PRACTICAL IMPLICATIONS: These changes in pulpal therapy practice might indicate a teaching change in pulpal therapy guidelines, suggesting that less invasive pulpal therapy can be used rather than pulpotomies or pulpectomies.

Accuracy of Model Estimation versus Tanaka and Johnston Arch Length Analysis.

OBJECTIVES: This study examines how accurate pediatric dentists are at estimating dental arch lengths by comparing their model estimations (guesstimating the arch length without measuring) to the Tanaka and Johnston mixed dentition arch length analysis. STUDY DESIGN: This study consisted of two parts, a survey of practitioners and a model estimating and measuring component. The survey was designed and given to 44 pediatric dentists to determine how many were practicing orthodontics and using arch length analyses routinely. Then 18 pediatric dentists and 13 pediatric dental residents examined 20 sets of mixed dentition models and estimated how much space was available. These estimations were compared to the calculated gold standard, the Tanaka and Johnston arch length analysis of the same models. RESULTS AND CONCLUSIONS: More than half of the dentists surveyed that practice comprehensive orthodontics use arch length estimates. Pediatric dentists and pediatric dental residents are just as good as each other at estimating arch length. Pediatric dentists and pediatric dental residents underestimated arch length by -3.6 and -3.1 mm, respectively. More research needs to be done to determine if model estimation is a clinically acceptable way to judge arch length.

Prevalence of molar-incisor hypomineralization and other enamel defects and associated sociodemographic determinants in Indiana.

BACKGROUND: The aim of this study was to determine the prevalence and severity of molar-incisor hypomineralization (MIH) in a cohort of school-aged children in Indiana. METHODS: A calibrated examiner screened eligible school-aged children for MIH and other enamel defects. The authors used the integrated Modified Developmental Defects of Enamel Index and the European Academy of Pediatric Dentistry criteria to examine the permanent first molars, permanent incisors, and primary second molars. The authors used descriptive statistics, exact 95% confidence intervals, and χ2 tests for analysis (α = 5%). RESULTS: A total of 337 participants (mean [standard deviation] age, 9.1 (1.7) years; 52% 6 through 8 years; 66% non-Hispanic white) were examined. The prevalence estimate for MIH was 13% as opposed to a 52% prevalence estimate for any enamel defect (AED) of any of the index teeth. Living in an area with water fluoridation levels greater than 0.7 parts per million or being non-Hispanic black was significantly associated with higher prevalence of AED (P < .05) but not with the prevalence of MIH. Demarcated opacities were the most prevalent defects (43%), followed by atypical restorations (32%). Higher age and higher number of MIH-affected surfaces were associated with larger MIH defect extension (P < .05). CONCLUSIONS: Nearly 1 in 6 children in Indiana had at least 1 permanent first molar with MIH. Water fluoridation levels and race or ethnicity were associated with the prevalence of AED but not with MIH prevalence. PRACTICAL IMPLICATIONS: US dental practitioners should be cognizant that MIH is a common finding. Children with a high number of MIH-affected surfaces would benefit the most from early identification and management as the extension of the defects tends to worsen with age.

U.S. Pediatric Dentists' Perception of Molar Incisor Hypomineralization.

Purpose: The purpose of this survey-based study was to target U.S. pediatric dentists in the Midwest region to determine their knowledge, perceptions, and clinical management strategies of molar incisor hypomineralization (MIH). Methods: After obtaining appropriate authorizations, all pediatric dentists identified by the American Academy of Pediatric Dentistry's 2016 to 2017 membership directory in the 12 Midwest states were invited to take part in the study. The questionnaire, adopted from previous studies, incorporated information of the participants' demographics and educational/clinical backgrounds and MIH-focused questions. Descriptive statistics and chi-square tests were used for analysis. An alpha level less than 0.05 was considered statistically significant. Results: A total of 251 out of 975 surveys were completed (26 percent). Nearly all participants were familiar with MIH. The majority reported the MIH prevalence to be less than 10 percent in their clinical practice (62 percent). Most respondents were either very confident (65 percent) or confident (34 percent) when diagnosing teeth with MIH. The most cited clinical challenge in managing MIH teeth was "long-term success of restorations" (79 percent). When analyzed individually, responses differed significantly for different demographics and educational characteristics of the respondents (P<0.05). Conclusion: MIH is generally well acknowledged by U.S. Midwest pediatric dentists, with differences related to their perceptions of the condition's prevalence as well as clinical and restorative management challenges.

The success of stainless steel crowns placed with the Hall technique: a retrospective study.

BACKGROUND: In this retrospective study, the authors evaluated the clinical and radiographic success of stainless steel crowns (SSCs) used to restore primary molars with caries lesions, placed by means of both the traditional technique (involving complete caries removal and tooth reduction before placement of the SSC) and the Hall technique (involving no caries removal, no crown preparation and no use of local anesthetic before placement of the SSC). METHODS: The authors conducted a retrospective chart review by using the patient records at a private pediatric dental practice at which the Hall technique had been introduced in June 2010 as an alternative treatment to traditional SSC placement. The inclusion criteria were caries lesions on a primary molar with no clinical or radiographic evidence of pulpitis, necrosis or abscess, as well as follow-up of at least six months or until failure, whichever came first. They graded restoration success by using a four-point scale based on presence or loss of the SSC, and whether or not the patient needed further treatment associated with pulpal pathology or secondary caries. They collected and summarized patient demographic information. They used a Kaplan-Meier survival curve along with 95 percent confidence intervals to evaluate clinical success. RESULTS: The authors found that 65 (97 percent) of 67 SSCs placed with the Hall technique (mean observation time, 15 months; range, four-37 months) and 110 (94 percent) of 117 SSCs placed with the traditional technique (mean observation time, 53 months; range, four-119 months) were successful. CONCLUSION: Findings of this study show a similar success rate for SSCs placed with the traditional technique or the Hall technique.

Current trends in pulp therapy: a survey analyzing pulpotomy techniques taught in pediatric dental residency programs.

PURPOSE: The study's purpose was to survey directors of pediatric dental residency programs in order to evaluate the materials currently being taught and used for pulpotomy procedures for primary teeth in educational and clinical settings. METHODS: A web-based survey was emailed to all graduate pediatric dental residency program directors in the United States. RESULTS: Seventy one emails were sent to program directors, 47 responded but only 39 respondents (55%) were included in the study. Results suggested a slight decrease in utilization of formocresol 1:5 dilution (P<.01) and an increase in both ferric sulfate (P<.05) and mineral trioxide aggregate (MTA; P<.02) utilization for primary tooth pulpotomy procedures. The most common reasons for elimination of formocresol (18% of respondents) were systemic health concerns and carcinogenicity, in addition to evidence-based literature. Even though 25% of respondents have begun to use MTA for primary pulpotomy procedures, the most common reason for utilization of other medicaments over MTA was its higher cost. CONCLUSIONS: With 82% of graduate pediatric dental residency programs still utilizing formocresol 1:5 dilution for pulpotomy procedures in primary teeth, there has been no major shift away from its clinical use, in spite of increased usage of newer medicaments over the last 5 years.

Partnered disaster preparedness: lessons learned from international events.

Military, governmental, and civilian agencies routinely respond to disasters around the world, including large-scale mass casualty events such as the earthquake in Pakistan in 2005, Hurricane Katrina in the United States in 2005, and the earthquake in Haiti in 2010. Potential exists for improved coordination of medical response between civilian and military sectors and for the creation of a planned and practiced interface. Disaster preparedness could be enhanced with more robust disaster education for civilian responders; creation of a database of precredentialed, precertified medical specialists; implementation of a communication bridge; and the establishment of agreements between military and civilian medical/surgical groups in advance of major catastrophic events.

Effect on behavior of dental treatment rendered under conscious sedation and general anesthesia in pediatric patients.

PURPOSE: The purpose of this study was to determine if there were differences in the amount of time it took to exhibit positive behavior following dental treatment under general anesthesia (GA) vs conscious sedation (CS). METHODS: This retrospective study examined charts of a pediatric dental office between 1999 to 2003. Patients presenting before 36 months old for an initial exam who were diagnosed with early childhood caries were included in the study. Following the initial exam, the patients were treated under GA or CS. These patients were followed to determine their behavior at the 6-, 12-, and 18-month recoil appointments. RESULTS: Thirty-nine patients who received treatment under GA were identified and 41 were treated under CS. The former were 3.9 times (P < .01) (P = .0057) more likely to exhibit positive behavior at the 6-month recall appointment. Although not statistically significant, a trend toward positive behavior was exhibited at the 12- and 18-month appointments. CONCLUSION: Clinicians should consider future behavior, in addition to caries, when determining treatment modalities for children presenting to their office with dental caries.

Dental caries experience and association to risk indicators of remote rural populations.

BACKGROUND: Dental caries continues to be the most common infectious disease of childhood; however, it is no longer pandemic, but endemic in specific sectors of populations. Therefore, it is important to identify and target patients at risk of developing caries in order to develop specific preventive measures. AIM: This study aims to test dental caries risk indicators for significant associations with caries severity. DESIGN: Five separate, small, isolated rural villages in Mexico with varying degrees of caries prevalence were selected for this observational study. A total of 248 children were examined. Risk indicators were assessed via questionnaire and water and salt fluoride analysis. Caries severity was measured by the International Caries Detection and Assessment System (ICDAS-I). RESULTS: Prevalence of caries ranged from 95% to 100% for the five villages. Mean total DMFS (decayed, missing, or filled surfaces-permanent teeth) and dmfs (decayed, missing, or filled surfaces-primary teeth) scores ranged from 2.5 to 5.0 and from 11.3 to 16.9, respectively. Multivariable models showed age and drinking soda between meals to be significantly associated with DMFS, and drinking juice and being female were significantly associated with dmfs. CONCLUSION: DMFS and dmfs were high in each village, significantly different between villages, and associated with specific risk indicators.

An evaluation of DNA yield, DNA quality and bite registration from a dental impression wafer.

BACKGROUND: The authors determined the amount and quality of the DNA captured by a bite impression wafer and analyzed any inaccuracies in the impression wafer. METHODS: The authors made bite registrations for subjects aged 7 to 12 years by using a dental impression wafer (Toothprints, Kerr, Orange, Calif.), obtained an oral rinse sample, took cheek cells by using buccal swabs and made an alginate impression to pour a stone model. They extracted and quantified the DNA from the dental impression wafer, mouthwash and buccal swabs by using the Quant-iT PicoGreen (Invitrogen, Carlsbad, Calif.) assay and a real-time polymerase chain reaction (RT-PCR) assay. They compared the stone models and imprints from the wafer. RESULTS: The average amounts of DNA determined by using Quant-iT PicoGreen from the buccal swab, mouthwash and dental impression wafer samples were 113.61, 509.57 and 1.03 micrograms, respectively. The average amounts of DNA determined by using RT-PCR from the buccal swab, mouthwash and dental impression wafer samples were 11.5240, 22.2540 and 0.0279 mug, respectively. The bite registrations and stone models had an average of 14 percent of mismatches. CONCLUSION: The dental impression wafers captured DNA but not in high quantities. They did not produce an accurate representation of the dentition. CLINICAL IMPLICATIONS: The dental impression wafers captured enough DNA to permit amplification. The accuracy of the bite registration was not sufficient for identification purposes. Therefore, dental impression wafers may be useful only as a reservoir for DNA.

Public assistance orthodontic treatment needs: a report from the state of Indiana.

OBJECTIVE: To determine how many of the orthodontic cases covered by Indiana Medicaid between 1999-2001 would be classified pretreatment as having a malocclusion severe enough to warrant treatment. METHODS: Six examiners were trained and then paired together to examine 249 patient orthodontic case records, consisting either of pre-treatment photographs only, pre-treatment models only, or both pre-treatment models and photos. The examiners applied the Index of Orthodontic Treatment Needs (IOTN) to assign each case a Grade of One to Five, with Grade One representing Ideal Occlusion and Grade Five being Extreme Malocclusion. When two examiners within a pair could not agree, a third examiner reviewed the case record to determine agreement. RESULTS: Of the 249 patient cases examined, 9 were not gradable. In the cases where only pretreatment models were available (n=157), 10% received a Grade of One or Two (Ideal Occlusion or Mild Malocclusion, respectively). Among the cases in which both pretreatment models and photos were available (n=46), 44% of the photos were graded One or Two, while only 2% of the models were graded as One or Two. In the cases where only pretreatment photographs were available (n=37), 27% of cases were Grade One or Two. CONCLUSION: While several of the cases (11%) submitted during the time period of 1999 to 2001 to the Indiana State Medicaid Division for reimbursement were rated as having Ideal Occlusions or Mild Malocclusions, the vast majority (89 %) were scored as having either Moderate, Severe, or Extreme Malocclusion.

Dental fracture fragment attachment: fracture model and luting agent comparisons.

PURPOSE: The purpose of this study was twofold: 1. To compare two different research models for simulating a traumatic anterior tooth fracture: the blunt trauma method (standard method) and an AL2O3 sectioning method (experimental method). 2. To compare the bond strength of tooth fragments bonded with resin modified glass ionomer vs. a light cured composite resin. METHODS: Two hundred bovine incisors were used in the study and kept in plain tap water throughout. The study consisted of five basic steps: 1. Fracture of the teeth by either blunt trauma (chisel and hammer) or AL2O3 sectioning disc. 2. Luting of the fractured fragments back to the teeth using either a composite resin or resin modified glass ionomer. 3. Thermocycling of the repaired teeth. 4. Dislodging the teeth to determine the strength of repair. 5. Determination of fracture type. RESULTS: One-way ANOVA revealed a statistically significant difference in the forces required to fracture the resin modified glass ionomer and composite resin regardless of whether the teeth were originally fractured with the blunt force method (p=0.030) or the disc sectioning method (p=.001). One-way ANOVA also revealed a statistically significant difference between the forces required for fracture by blunt trauma and the disc fracture techniques with the resin modified glass ionomer group (p=0.000345). However, there was no significant difference when the two techniques were compared for the composite resin (p= 0.2941). CONCLUSIONS: 1. The resin modified glass ionomer was significantly stronger than the composite resin when both the blunt trauma and the disc fracture techniques were employed. 2. The study's results do not support substituting the ease of the AL2O3 disc for the more time-consuming blunt trauma method.

Fluoride varnish concentration gradient and its effect on enamel demineralization.

PURPOSE: Two of the 4 fluoride varnishes available on the American market today are sold in 10-mL tubes of 5% NaF varnish (Duraphat and Duraflor). Pilot studies have shown that a separation of contents within these tubes exists. The purpose of the current study was 4-fold: (1) to measure the fluoride concentration gradient in 10-mL tubes of fluoride varnish, based on resting position of the tube prior to use; (2) to compare and contrast fluoride concentration gradients of Duraphat, Duraflor, and CavityShield; (3) to compare this gradient to the ability to inhibit caries in an artificial caries environment; and finally, (4) to determine if quantitative light fluorescence (QLF) can detect differences in lesions developed when exposed to an artificial caries environment and fluoride varnish. METHODS: Human teeth specimens were subjected to a caries challenge and treated with a sample of fluoride varnish from 1 of 5 categories: Duraphat stored horizontally and vertically for 1 week, Duraflor stored horizontally and vertically for 1 week, or a CavityShield 0.4 mL "unidose." All specimens were then analyzed with the QLF system and with confocal microscopy. RESULTS: Results showed no significant fluoride ppm differences exist between groups (P=.29). It was shown that the order in which Duraflor varnish was dispensed from tubes significantly affected the fluoride concentration (P<.05). The order effect was not significant for Duraphat (P=.99). QLF data analysis showed there was no significant difference (P>.05) in the amount of remineralization obtained by using any varnish stored in any position. CONCLUSIONS: These results indicate that all 3 brands of fluoride varnish are able to remineralize incipient in vitro carious lesions, regardless of what part of the 10-mL tube the varnish is taken from. However, a fluoride concentration gradient exists in tubes of Duraflor. Also, QLF is able to detect demineralized and remineralized incipient lesions.

Comparing infant oral glucose clearance with and without a water rinse.

The purpose of this study was to test the hypothesis that a small rinse of water in an infant's mouth immediately following formula consumption would significantly improve oral glucose clearance. Though statistically significant results were not obtained at all time intervals, this study lends validity to the hypothesis that a small water rinse immediately following formula feeding could help enhance oral glucose clearance in infants.

The impact of early palatal obturation on consonant development in babies with unrepaired cleft palate.

OBJECTIVE: The purpose of this investigation was to determine whether palatal obturators enhance consonant development during babbling for babies with unrepaired cleft palate. PARTICIPANTS: Fourteen babies with cleft palate who had worn anterior palatal obturators prior to palatal surgery were matched to 14 unobturated babies according to cleft type, sex, and age at time of presurgical evaluation. MAIN OUTCOME MEASURES: Spontaneous vocalizations of the obturated and unobturated groups were compared to determine whether differences were evident in size of consonant inventory as well as place and manner of consonant production. RESULTS: Paired t tests revealed no significant differences between the groups in size of consonant inventory or place and manner of consonant production. There was a trend for babies in the obturated group to produce more glottal consonants. CONCLUSIONS: In general, the findings of this study suggested that palatal obturators do not appear to facilitate production of anterior palatal consonants during babbling.