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The aim of this study was to evaluate the effectiveness of an innovative pediatric interprofessional education clinical experience using oral‐systemic health as the clinical population example for improving the self‐reported interprofessional competencies of family nurse practitioner, dental, and medical students. The objectives of the interprofessional experience were for students to apply pediatric oral health assessment, identify the pediatric oral‐systemic connection, and practice a team‐based approach to improve oral‐systemic outcomes. In spring 2015, fall 2015, and spring 2016, a total of 162 family nurse practitioner, dental, and medical students participated in this interprofessional experience at Bellevue Pediatric Outpatient Clinics together with a pediatric dental resident. Team members collaborated in reviewing the patient chart, taking the patient's medical and dental history, performing an oral assessment, applying fluoride varnish, and providing education and anticipatory guidance. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used as a pretest and posttest to evaluate the degree to which students perceived changes in their attitudes about interprofessional competencies following the learning experience. In the results, all students had improved mean scores from pretest to posttest after the experience, and these changes were statistically significant for all students: nurse practitioner (p<0.01), dentistry (p<0.01), and medicine (p<0.001). The mean change from pretest to posttest was statistically significant for each of the six interprofessional competency domains (p<0.01). In both pediatric dental and primary care settings, the changes from pre‐ to posttest were significant (p<0.001). The experience was similarly effective for all groups of students in increasing their attitudes about interprofessional collaboration. These findings suggest that a clinical approach can be an effective strategy for helping health professions students develop interprofessional competence. [ABSTRACT FROM AUTHOR]

On March 15, 2020, routine dental care in New York State paused due to the COVID-19 pandemic. The pause lasted 10 weeks in part to preserve critical supplies of personal protective equipment (PPE). This interruption of access to dental care led to an overall deterioration of oral health, an increase in prescribing and use of antibiotics and analgesic medications, especially opiates, and a rise in visits to hospital emergency centers. New York University's College of Dentistry, an academic ambulatory dental center, normally sees over 1,000 patient visits per day. Most visits are patients who require urgent care or are in the process of treatment to restore debilitating oral health problems. NYU Dentistry responded to the State pause by creating a nascent teledentistry service that began operations on March 17, 2020. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the trends of pediatric dental rehabilitation in hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) during the COVID-19 public health emergency (PHE) from 2019 to 2021 across states and demographic groups. Methods: This cross-sectional study utilized the 2019 to 2021 Transformed Medicaid Statistical Information System Analytical Files to examine trends in dental rehabilitation for children ages 12 years and younger enrolled in Medicaid or the Children's Health Insurance Program. The final analytic sample included 20,508,093 beneficiaries from 2019, 19,436,957 beneficiaries from 2020, and 20,416,440 beneficiaries from 2021. Chi-square tests were used to compare dental rehabilitation usage across groups (age, sex, race/ethnicity, and place of service). Results: Rehabilitation of Medicaid beneficiaries performed in HOPDs showed a decrease year over year (51 to 34 to 30; P<0.001), while the usage in ASCs increased (1,307 to 1,310 to 1,367; P<0.001). For all three years, the highest usage was seen in Non-Hispanic (NH) American Indian/Alaskan Native children (154, 66, 74; P<0.001), while the lowest usage was seen in NH Black children (21, 16, 17; P<0.001). Rehabilitation for Hispanic children had the greatest relative recovery over the three years (39 to 34 to 38; P<0.001). Conclusions: Dental rehabilitation usage in ambulatory surgery centers showed continued growth through the public health emergency. There was significant variation in rates across states and demographics. [ABSTRACT FROM AUTHOR]

Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis. Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 µg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 µg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry. Results: Radiographic analysis showed significantly greater (P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly (P < .05) wider coronal sutures and greater sutural area compared to controls. Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis. [ABSTRACT FROM AUTHOR]

A piano concert series and jazz reception program was organized at the College of Dentistry at New York University, in 2007. An anonymous survey to assess the response of faculty, staff, and students to the concert series was conducted during 2010 to 2011. Overwhelmingly, the respondents recommend that music concerts in the dental college be continued. Support is apparent in the overall recommendation and in questions dealing with stress, productivity, music, the auditorium, and the community. Differences between groups defined by status (student, faculty, other, or unknown) and by previous music study (yes, no, or unknown) were small. Events such as a concert series organized at the College of Dentistry apparently can have positive influence on work–life balance. [ABSTRACT FROM AUTHOR]

The introduction of mobile electronic devices, as opposed to paper forms, in pediatric outreach programs of the New York University College of Dentistry is discussed. Since 2007, students have been receiving training on how to operate a personal digital assistant (PDA) and use it in community outreach for non-invasive oral-facial screenings and patient education. The shift from using paper forms to electronic media had a positive impact among the academic community, as it resulted in saving time and reducing the possibility of data collection errors. It may represent a significant improvement in data collection and patient education; and it provides an opportunity to enhance research and quality assessment. [ABSTRACT FROM AUTHOR]

The article discusses the prevention of reynosyntosis and improvement of postoperative outcomes of craniosyntosis on rabbits by using Noggin protein. It also suggests the inhibition of bone morphogenetic proteins activity may prevent postoperative resynostosis and the use of Noggin therapy has potential for clinical use for infants with craniosyntosis.

The purpose of this study was to describe and assess the use of fissure sealant retention as a quality measure of the delivery system for pediatric dentistry. The Pediatric Dentistry Section at the Ohio State University College of Dentistry adopted Sealant retention as a measure of quality. Sealant retention in first and second molars was evaluated at each six-month recall appointment. Sealants were categorized as satisfactory or unsatisfactory. Two hundred five sealants were evaluated between March 1998 and March 1999. The mean age of the patients at the time of sealant evaluation was 14.0 ± 2.9. Mean sealant retention period was 29.8 ± 23.2 months, with a range of 0.9 to 148 months. Median sealant retention period was 23.2 months. Overall, 75.6 percent of the sealed teeth were classified as satisfactory. Use of this data in making improvements is discussed. Our results indicate that the use of sealant retention is a suitable measure for quality of care in pediatric dentistry. [ABSTRACT FROM AUTHOR]

A comprehensive oral health care program for Head Start children in New York City is described. Head Start is a federally funded pre-school program for low-income families and their children. It provides activities that help children grow mentally, socially, emotionally and physically. In 1994, a public-private partnership was created between New York Administration for Children's Services and New York University College of Dentistry. The program consists of periodic visits to different Head Start centers by a dental team composed of pediatric dentists, residents, hygienists and students. At the center, the team provides diagnostic and preventive services to children and oral health education to children, parents and staff. Referrals are then made to the College of Dentistry or to a community provider for treatment and follow-up. Free transportation is provided between Head Start centers and the college clinic. Over 13 years, 25,000 children have received diagnostic, preventive and treatment services. [ABSTRACT FROM AUTHOR]

SOCE mediated by ORAI1 affects the metabolism, redox status, and function of enamel cells in teeth. Preventing CRAC'd teeth: Store-operated Ca2+ entry (SOCE) through CRAC channels, specifically complexes formed by ORAI Ca2+ channels and STIM Ca2+ sensors, mediates Ca2+ uptake in enamel cells in teeth. Eckstein et al. described a patient with a null mutation in ORAI1 that likely accounted for the defective enamel mineralization in his teeth. In mice, deficiency of ORAI1, but not that of ORAI2, decreased SOCE in enamel cells and resulted in compromised enamel structure. In an enamel cell line, ORAI1 knockdown increased mitochondrial cellular respiration, resulting in altered redox status that increased the efficiency of Ca2+ uptake in the ER. These results indicate that ORAI1 is the major CRAC channel in enamel cells and reveal the mechanisms by which SOCE affects enamel cell function. Store-operated Ca2+ entry (SOCE) channels are highly selective Ca2+ channels activated by the endoplasmic reticulum (ER) sensors STIM1 and STIM2. Their direct interaction with the pore-forming plasma membrane ORAI proteins (ORAI1, ORAI2, and ORAI3) leads to sustained Ca2+ fluxes that are critical for many cellular functions. Mutations in the human ORAI1 gene result in immunodeficiency, anhidrotic ectodermal dysplasia, and enamel defects. In our investigation of the role of ORAI proteins in enamel, we identified enamel defects in a patient with an ORAI1 null mutation. Targeted deletion of the Orai1 gene in mice showed enamel defects and reduced SOCE in isolated enamel cells. However, Orai2−/− mice showed normal enamel despite having increased SOCE in the enamel cells. Knockdown experiments in the enamel cell line LS8 suggested that ORAI2 and ORAI3 modulated ORAI1 function, with ORAI1 and ORAI2 being the main contributors to SOCE. ORAI1-deficient LS8 cells showed altered mitochondrial respiration with increased oxygen consumption rate and ATP, which was associated with altered redox status and enhanced ER Ca2+ uptake, likely due to S-glutathionylation of SERCA pumps. Our findings demonstrate an important role of ORAI1 in Ca2+ influx in enamel cells and establish a link between SOCE, mitochondrial function, and redox homeostasis. [ABSTRACT FROM AUTHOR]

Purpose: To assess the oral health status of children with Down syndrome (DS) in the United States and evaluate the oral health needs of families with DS. Methods: Among 320 parents who consented to participate, 260 (81.2 percent) surveys were completed. A survey was distributed through the National Down Syndrome Society to parents of children with DS up to age 21 years, which asked questions about children’s general and oral health. Results: Parents who reported that their children had difficulty rinsing and spitting were more likely to report their child’s overall general health as poor (P<0.05). Parents’ frequency of daily toothbrushing was similar to their children’s toothbrushing habits (P<0.05). Conclusions: Dysphagia for children with Down syndrome may negatively impact oral health in addition to general health. Encouraging parental involvement in oral care for children with DS may lower their risk for oral disease. Continued support is needed to ensure dental school education includes training for the treatment and management of patients with DS. [ABSTRACT FROM AUTHOR]

Store-operated Ca 2+ entry (SOCE) channels are highly selective Ca 2+ channels activated by the endoplasmic reticulum (ER) sensors STIM1 and STIM2. Their direct interaction with the pore-forming plasma membrane ORAI proteins (ORAI1, ORAI2, and ORAI3) leads to sustained Ca 2+ fluxes that are critical for many cellular functions. Mutations in the human ORAI1 gene result in immunodeficiency, anhidrotic ectodermal dysplasia, and enamel defects. In our investigation of the role of ORAI proteins in enamel, we identified enamel defects in a patient with an ORAI1 null mutation. Targeted deletion of the Orai1 gene in mice showed enamel defects and reduced SOCE in isolated enamel cells. However, Orai2 -/- mice showed normal enamel despite having increased SOCE in the enamel cells. Knockdown experiments in the enamel cell line LS8 suggested that ORAI2 and ORAI3 modulated ORAI1 function, with ORAI1 and ORAI2 being the main contributors to SOCE. ORAI1-deficient LS8 cells showed altered mitochondrial respiration with increased oxygen consumption rate and ATP, which was associated with altered redox status and enhanced ER Ca 2+ uptake, likely due to S-glutathionylation of SERCA pumps. Our findings demonstrate an important role of ORAI1 in Ca 2+ influx in enamel cells and establish a link between SOCE, mitochondrial function, and redox homeostasis., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis., Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry., Results: Radiographic analysis showed significantly greater ( P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly ( P < .05) wider coronal sutures and greater sutural area compared to controls., Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis.

Objective :  Studies described in this paper were designed to test the hypothesis that an increase in nonviral, plasmid-encoded Tgf-β3 production, localized to the rat posterior frontal suture, prevents programmed suture fusion. Design :  We developed a gene delivery system based on a dense collagen gel to deliver nonviral plasmids that encode for Tgf-β3. Studies were performed to test the ability of this system to rescue rat cranial suture fusion in vitro and in vivo. Immunohistochemical studies were conducted to characterize the possible mechanisms by which increased production and presence of Tgf-β3 protein interferes with suture fusion. Results :  Posterior frontal sutures in the Tgf-β3 plasmid-treated group exhibited 77% to 85% less bony bridging than the collagen control and untreated groups after 15 days in culture. In animals treated with Tgf-β3 plasmid or Tgf-β3 protein, there was a significant reduction in suture fusion in the middle region of the posterior frontal sutures when compared with control groups. In this region the Tgf-β3 plasmid-treated group revealed 70% to 75% less bony bridging than control groups in vivo. Conclusions :  Collagen gel can be formulated to provide release of nonviral plasmid DNA that results in cell transfection and elevated Tgf-β3 protein production. Tgf-β3 is an important regulator of suture fusion, and an increase in plasmid-encoded Tgf-β3 protein is effective in inhibiting programmed suture fusion in rats.

Objectives: Craniosynostosis affects 1 in 2000 to 3000 live births and may result in craniofacial and neural growth disturbances. Histological data have shown that thick collagenous bundles are present in the sutural ligament, which may tether the osteogenic fronts, resulting in premature fusion. The hormone relaxin has been shown to disrupt collagen fiber organization, possibly preventing craniosynostosis by relaxing the sutural ligament and allowing osteogenic fronts to separate normally and stay patent. This study tested this hypothesis with a rabbit model of delayed-onset coronal suture synostosis., Methods: A total of 18 New Zealand White rabbits with craniosynostosis were randomly assigned to one of three groups: sham control, protein control (BSA), relaxin treatment. After initial diagnosis, sham surgery, BSA, or relaxin was delivered to the fusing coronal suture in a slow-release (56-day) collagen vehicle. Longitudinal radiographs and body weights were collected at 10, 25, 42, and 84 days of age, and sutures were harvested for histology., Results: Relaxin-treated animals had more disorganized intrasuture content than control groups. These specimens also appeared to have relatively wider sutures ectocranially. There were no significant differences in relaxin-treated animals for all craniofacial growth measures, or suture separation compared with controls., Conclusions: These data do not support our initial hypothesis that the use of relaxin may rescue sutures destined to undergo premature suture fusion. These findings suggest that collagen fiber arrangement may not be important for suture fusion. This protein therapy would not be clinically useful for craniosynostosis.

Children with special health care needs are at increased risk for oral diseases. The purpose of this article was to discuss: nutritional and oral health factors routinely observed in most chronic childhood disorders; dietary modifications associated with select systemic disorders and how they may impact oral health in children; and the following factors common to chronic disorders associated with diet modifications-decreased appetite and increased nutritional risk; frequency of food intake; parental overindulgence; long-term use of cariogenic medications; and xerostomia. Characteristics of childhood disorders that require dietary modifications (congenital heart disease, cystic fibrosis, cancer, AIDS/HIV, diabetes mellitus, and phenylketonuria) are summarized. In addition, healthy dietary modifications and oral health recommendations are suggested. Implementation of these recommendations can assist the dentist and dental team as they join physicians and nutritionists in delivering the best possible care to children with special health care needs.

Background: Postoperative resynostosis is a common clinical finding. It has been suggested that an overexpression of transforming growth factor (TGF)-beta2 may be related to craniosynostosis and may contribute to postoperative resynostosis. Interference with TGF-beta2 function with the use of neutralizing antibodies may inhibit resynostosis. The present study was designed to test this hypothesis., Methods: New Zealand White rabbits with bilateral coronal suture synostosis were used as suturectomy controls (group 1, n = 9) or given suturectomy with nonspecific, control immunoglobulin G antibody (group 2, n = 9) or suturectomy with anti-TGF-beta2 antibody (group 3, n = 11). At 10 days of age, a 3 x 15-mm coronal suturectomy was performed. The sites in groups 2 and 3 were immediately filled with 0.1 cc of a slowly resorbing collagen gel mixed with either immunoglobulin G (100 mug per suture) or anti-TGF-beta2 (100 mug per suture). Three-dimensional computed tomography scan reconstructions of the defects were obtained at 10, 25, 42, and 84 days of age, and the sutures were harvested for histomorphometric analysis., Results: Computed tomography scan data revealed that the suturectomy sites treated with anti-TGF-beta2 showed significantly (p < 0.05) greater areas through 84 days of age compared with controls. Histomorphometry also showed that suturectomy sites treated with anti-TGF-beta2 had patent suturectomy sites and more fibrous tissue in the defects compared with sites in control rabbits and had significantly (p < 0.001) less new bone area (by approximately 215 percent) in the suturectomy site., Conclusions: These data support the initial hypothesis that interference with TGF-beta2 function inhibited postoperative resynostosis in this rabbit model. They also suggest that this biologically based therapy may be a potential surgical adjunct to retard postoperative resynostosis in infants with craniosynostosis.

Postoperative resynostosis and secondary craniofacial growth abnormalities are common sequelae after craniofacial surgery. It has been suggested that an overexpression of transforming growth factor-beta2 (Tgf-beta2) may be related to craniosynostosis and contribute to postoperative resynostosis. Interference with Tgf-beta2 function using neutralizing antibodies may inhibit resynostosis and improve postoperative craniofacial growth; the present study was designed to test this hypothesis. Twenty-nine New Zealand white rabbits with bilateral coronal suture synostosis were used: 1) suturectomy controls (n=9); 2) suturectomy with nonspecific, control IgG antibody (n=9); and 3) suturectomy with anti-Tgf-beta2 antibody (n=11). At 10 days of age, a 3 mm x 15-mm coronal suturectomy was performed. The sites in groups 2 and 3 were immediately filled with 0.1 cc of a slow resorbing collagen gel mixed with either IgG (100 microg/suture) or anti-Tgf-beta2 (100 microg/suture). Three-dimensional computed tomography scan reconstructions of the skulls and cephalographs were obtained at 10, 25, 42, and 84 days of age. Computed tomography scan data revealed patent suturectomy sites and significantly (P<0.05) greater intracranial volumes by 84 days of age in rabbits treated with anti-Tgf-beta2 compared with controls. Cephalometric analysis revealed significant (P<0.05) differences in craniofacial, cranial vault, and cranial base growth by 84 days of age in rabbits treated with anti-Tgf-beta2 compared with controls. These data support the initial hypothesis that interference with Tgf-beta2 function inhibited postoperative resynostosis and improved cranial vault growth in this rabbit model. Thus, this biologically based therapy may be a potential surgical adjunct in the treatment of infants with craniosynostosis.

The birth prevalence of craniosynostosis (premature suture fusion) is 300-500 per 1,000,000 live births. Surgical management involves the release of the synostosed suture. In many cases, however, the suturectomy site rapidly reossifies, further restricts the growing brain and alters craniofacial growth. This resynostosis requires additional surgery, which increases patient morbidity and mortality. New findings in bone biology and molecular pathways involved with suture fusion, combined with novel tissue engineering techniques, may allow the design of targeted and complementary therapies to decrease complications inherent in high-risk surgical procedures. This paper selectively reviews recent advances in i) identifying genetic mutations and the aetiopathogenesis of a number of craniosynostotic conditions; ii) cranial suture biology and molecular biochemical pathways involved in suture fusion; and iii) the design, development and application of various vehicles and tissue engineered constructs to deliver cytokines and genes to cranial sutures. Such biologically based therapies may be used as surgical adjuncts to rescue fusing sutures or help manage postoperative resynostosis.

Microstructural factors may play a role in the osseointegration of calcium phosphates. In this paper, direct microstructural interactions between crystalline calcium phosphates and the biological milieu are reported. Degradation via exposure to osteoblast culture closely resembles in vivo interactions with subcutaneous tissues in a bovine model at early time periods. That these interactions were common to both experiments constitutes one of the few known examples of in vitro-in vivo correspondence. Interestingly, the degradation of phase pure hydroxyapatite (HA) in vitro was more rapid than that of biphasic HA in vivo. In both cases, grain extraction/pullout was frequently observed. This suggests a connection to smaller-scale observations of epitaxial CHA nucleation and growth on pre-existing HA grains. A microstructure in which the grain boundary is dissolving/corroding can apparently be disassembled by forces transmitted through biological structures. These observations are distinct from those of simple non-biological solutions and prove that biological environments can interact with the material beneath the ceramic-cell/ceramic-tissue interface. Many often ignored microstructural factors-grain size, shape, grain boundary strength and the presence of impurity phases-may in fact control degradation. We also suggest that even relatively modest initial grain sizes will, in combination with the mild/absent foreign body response to calcium phosphates, result in lengthy in vivo particle resistence., (Copyright 2003 Wiley Periodicals, Inc. J Biomed Mater Res 68A: 61-70, 2004)

Craniosynostosis results in cranial deformities and increased intracranial pressure, which pose extensive and recurrent surgical management problems. Developmental studies in rodents have shown that low levels of transforming growth factor-beta 3 (Tgf-beta 3) are associated with normal fusion of the interfrontal (IF) suture, and that Tgf-beta 3 prevents IF suture fusion in a dose-dependent fashion. The present study was designed to test the hypothesis that Tgf-beta 3 can also prevent or "rescue" fusing sutures in a rabbit model with familial craniosynostosis. One hundred coronal sutures from 50 rabbits with delayed-onset, coronal suture synostosis were examined in the present study. The rabbits were divided into five groups of 10 rabbits each: 1) sham controls, 2) bovine serum albumin (BSA, 500 ng) low-dose protein controls, 3) low-dose Tgf-beta 3 (500 ng), 4) high-dose BSA (1,000 ng) controls, and 5) high-dose Tgf-beta 3 (1,000 ng). At 10 days of age, radiopaque amalgam markers were implanted in all of the rabbits on either side of the coronal suture to monitor sutural growth. At 25 days of age, the BSA or Tgf-beta 3 was combined with a slow-absorbing collagen vehicle and injected subperiosteally above the coronal suture. Radiographic results revealed that high-dose Tgf-beta 3 rabbits had significantly greater (P < 0.05) coronal suture marker separation than the other groups. Histomorphometric analysis revealed that high-dose Tgf-beta 3 rabbits also had patent coronal sutures and significantly (P < 0.01) greater sutural widths and areas than the other groups. The results suggest that there is a dose-dependent effect of TGF-beta 3 on suture morphology and area in these rabbits, and that the manipulation of such growth factors may have clinical applications in the treatment of craniosynostosis., (Copyright 2003 Wiley-Liss, Inc.)

Objective: To determine whether antibody perturbation of Tgf-beta, delivered in a collagen gel, could inhibit cranial suture fusion., Design: Attachment and proliferation of osteoblasts cultured on a collagen gel with or without anti-Tgf-beta2 antibody were determined by AlamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, collagen gel with and without anti-Tgf-beta2 antibody was injected subperiosteally over the posterior frontal suture of postnatal day 15 rat calvariae. A quantitative analysis of suture fusion was used to measure suture bridging in histological serial sections at various time points., Results: Attachment and proliferation for cells cultured on collagen gel with anti-Tgf-beta2 antibody were similar to collagen gel controls. Although proliferation was lower than on tissue culture plastic, cells treated with anti-Tgf-beta2 antibody maintained an osteoblastic morphology. After 7, 10, and 15 days in organ culture, anti-Tgf-beta2 antibody treatment caused a reduction in the percent bridging of posterior frontal sutures, compared with controls. Sutures exposed to anti-Tgf-beta2 antibody and fibroblast growth factor-2 concurrently did not show an inhibition of bony bridging., Conclusions: These results support previous reports suggesting a role for Tgf-beta2 in cranial suture fusion. In cell culture the collagen gel, both with and without anti-Tgf-beta2 antibody, promoted similar osteoblast attachment, proliferation, and osteoblastic morphology. In organ culture anti-Tgf-beta2 antibody was delivered in a bioactive state via a collagen gel to inhibit cranial suture fusion. Also, the results suggest that the inductive effect of fibroblast growth factor-2 is not dependent on Tgf-beta2 activity. Together, these results provide further support for the role of Tgf-beta2 in cranial suture fusion.

Objective: Craniosynostosis has been associated with fibroblast growth factors (FGFs) and their receptors. The purpose of this study was to quantitatively determine the effect of FGF2 on rat calvarial osteoblasts and a rat cranial suture formation model., Design: Fetal rat calvarial osteoblasts were cultured with and without FGF2. Cell attachment and proliferation was determined by alamar Blue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, postnatal day 15 rat calvariae with dura mater were placed in serum-free media with and without FGF2. A unique quantitative analysis of suture fusion was developed by obtaining measurements of suture bridging in histological serial sections at progressive stages of fusion., Results: Attachment for cells treated with FGF2 was similar to control. In contrast, proliferation was higher for cells treated with FGF2 while maintaining an osteoblastic morphology. After 5 days in organ culture, FGF2-treated posterior frontal sutures showed a dramatic increase in fusion, compared with untreated controls. This increased fusion was maintained throughout days 7 and 10 in culture. Also, fusion was enhanced on the dural side of the suture, as is normally observed in vivo, and the normal tissue architecture was maintained., Conclusions: These results indicate that FGF2 can promote rat osteoblast attachment and normal cell morphology as well as induce cell proliferation. In calvarial organ culture, FGF2 treatment produced an enhanced suture fusion. These results provide further support for a critical role for FGF2 in cranial suture development. These studies also present a new quantitative approach to evaluating the effect of suture-perturbing growth factors on cranial suture fusion.

Postnatal expansion of the intramembranous bones of the craniofacial skeleton occurs as bone growth at sutures. Loss of the bone growth site occurs when the suture fails to form, or when the newly formed sutures become ossified, resulting in premature obliteration. Previous experiments demonstrated that removal of dura mater from fetal rat coronal sutures, or neutralizing transforming growth factor-beta 2 (Tgf-beta2) activity using antibodies resulted in premature obliteration of the suture in vitro. Conversely, addition of Tgf-beta3 to coronal sutures in vitro rescued them from osseous obliteration. To examine whether Tgf-beta3 rescues sutures from obliteration in vivo, a collagen gel was used as a vehicle to deliver Tgf-beta3 to the normally fusing rat posterior interfrontal (IF) suture. Surgery was done on postnatal day 9 (P9) rats, in which collagen gels containing 0, 3, or 30 ng Tgf-beta3 were placed above the IF suture, underneath the periosteum for 2 weeks. By P24, 75-100% of animals in control unoperated, sham-operated, and collagen gel-only groups had fused IF sutures. In contrast, 40% of sutures exposed to 3 ng Tgf-beta3 remained open, while sutures exposed to 30 ng Tgf-beta were similar to controls. By immunohistochemistry, sutures rescued from obliteration by Tgf-beta3 had the same Tgf-beta receptor type II (Tbetar-II) distribution as controls. However, Tgf-beta3-treated sutures had altered Tgf-beta2 and Tbetar-I distribution compared to controls., (Copyright 2002 Wiley-Liss, Inc.)

The DentiPatch lidocaine transoral delivery system (Noven Pharmaceuticals) is indicated for mild topical anesthesia of mucosal membranes in the mouth. The DentiPatch is a mucoadhesive patch containing 46.1 mg of lidocaine (20% concentration). Current studies in adults report that DentiPatch application produces very low plasma concentrations of lidocaine. However, it is not known what plasma levels are obtained when the same dosage is used in children. The purpose of this study was to determine whether the plasma lidocaine concentrations generated by the DentiPatch are within a safe range for children. The sample in this study was 11 children aged 2-7 years requiring general anesthesia for comprehensive dental care. A lidocaine DentiPatch was placed on the buccal mucosa above the maxillary incisors for 5 minutes. Blood samples were drawn before placing the DentiPatch and at various time intervals after removing it. Blood samples were analyzed by fluorescence polarization immunoassay to determine the plasma concentrations of lidocaine and its major metabolite, monoethylglycinexylidide. The lidocaine and monoethylglycinexylidide absorbed from the DentiPatch did not reach toxic plasma levels in children. However, plasma concentrations were much higher than in adults and were high enough to require inclusion in the calculation of total lidocaine administered to a pediatric patient.

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.