Scholars@Duke
Martha Ann Keels

Martha Ann Keels

Medical Associate Professor in the Department of Surgery
Surgery
keels001@duke.edu
Duke Box 3810, Durham, NC 27708
2711 North Duke Street, Durham, NC 27704

Selected Publications

Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report.

Journal Article Pediatrics · August 1, 2024 Ankyloglossia refers to a congenitally tight lingual frenulum that limits the motion of the tongue. Whether the release of a tight lingual frenulum in neonates improves breastfeeding is not clear. Because many of the symptoms of ankyloglossia overlap those ... Full text Link to item Cite

A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children.

Journal Article Acad Pediatr · July 2024 OBJECTIVE: To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. METHODS: Health an ... Full text Link to item Cite

Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations.

Journal Article J Am Dent Assoc · April 2024 BACKGROUND: The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory g ... Full text Link to item Cite

Predicting Dental Caries in Young Children in Primary Health Care Settings.

Journal Article J Dent Res · August 2023 Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening ... Full text Link to item Cite

Microbial Indicators of Dental Health, Dysbiosis, and Early Childhood Caries.

Journal Article J Dent Res · July 2023 Dental caries lesions are a clinical manifestation of disease, preceded by microbial dysbiosis, which is poorly characterized and thought to be associated with saccharolytic taxa. Here, we assessed the associations between the oral microbiome of children a ... Full text Link to item Cite

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association.

Journal Article J Am Dent Assoc · July 2023 BACKGROUND: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed r ... Full text Link to item Cite

Barriers to oral health care for transgender and gender nonbinary populations.

Journal Article J Am Dent Assoc · May 2023 BACKGROUND: Despite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people's experiences and expectations with regard to oral health care remain understudied. The authors exam ... Full text Link to item Cite

Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs.

Journal Article J Am Dent Assoc · February 2023 BACKGROUND: The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct resto ... Full text Link to item Cite

Concurrent validity of the short-form Family Impact Scale (FIS-8) in 4-year-old US children.

Journal Article BMC Pediatr · July 4, 2022 BACKGROUND: US data on the validity and reliability of the short-form Family Impact Scale (FIS-8; a scale for measuring the impact of a child's oral condition on his/her family) are lacking. METHODS: Cross-sectional analysis of data on four-year-old US chi ... Full text Link to item Cite

Primary Caregiver Retention and Perceptions of Retention Strategies in a 36-Month Prospective Childhood Caries Study.

Journal Article J Prim Care Community Health · 2022 INTRODUCTION/OBJECTIVES: This paper reports on participant retention from an ongoing prospective, multi-site cohort caries risk study involving parent/infant pairs. The objectives were to: (1) compare the retention rates at each intermediate contact (every ... Full text Link to item Cite

Teledentistry Implementation in a Private Pediatric Dental Practice During the COVID-19 Pandemic.

Journal Article Pediatr Dent · November 15, 2021 Purpose: (1) Implementation of teledentistry in a private pediatric practice during COVID-19 pandemic, (2) Evaluate dental care that was assessed and managed during the COVID-19 pandemic. Methods: Urgent dental care provided during the recommended defermen ... Link to item Cite

Tooth Eruption and Early Childhood Caries: A Multisite Longitudinal Study.

Journal Article Pediatr Dent · July 15, 2021 Purpose: The purpose of this study was to assess the relationship between the number of teeth present at 12 months and decayed, missing, or filled surfaces (dmfs) at 30 and 48 months. Methods: Data are from a longitudinal, multisite study with clinical den ... Link to item Cite

Child Nutrition Patterns Are Associated with Primary Dentition Dental Caries.

Journal Article Pediatric dentistry · May 2021 Purpose: Diet is a well-established, modifiable factor influencing dental caries risk. However, evidence regarding its association with distinct clinical patterns of dental caries is lacking. The purpose of this study was to identify the association ... Cite

Fluoride Use in Caries Prevention in the Primary Care Setting.

Journal Article Pediatrics · December 2020 Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in caries prevention. This clinical report aims to clarify the use of available fluori ... Full text Link to item Cite

Influence of Temperament As a Risk Indicator for Early Childhood Caries.

Journal Article Pediatr Dent · November 15, 2020 Purpose: To evaluate the association between temperament and caries. Methods: A total of 408 primary caregiver-child pairs were followed for 36 months; they completed the Early Childhood Behavior Questionnaire Very Short-Form (ECBQ-VSF) at age four years. ... Link to item Cite

Maturation of the Oral Microbiome in Caries-Free Toddlers: A Longitudinal Study.

Journal Article J Dent Res · February 2020 Understanding the development of the oral microbiota in healthy children is of great importance to oral and general health. However, limited data exist on a healthy maturation of the oral microbial ecosystem in children. Moreover, the data are biased by mi ... Full text Link to item Cite

Personalized Dental Caries Management in Children.

Journal Article Dent Clin North Am · October 2019 This article reviews dental caries management in children. The goal is to help clinicians recognize common patterns of dental caries in primary dentition and make appropriate decisions regarding management of carious lesions in children, taking into accoun ... Full text Link to item Cite

Dental Caries Risk Varies Among Subgroups of Children with Special Health Care Needs.

Journal Article Pediatr Dent · September 15, 2019 Purpose: Currently, caries risk assessment tools consider all children with special health care needs in tandem. The purpose of this study was to test this assumption by examining caries risk among and within five distinct groups of children, most with spe ... Link to item Cite

Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups.

Journal Article J Dent Res · January 2019 Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a ... Full text Link to item Cite

Management of After-Hours Pediatric Dental Emergencies Among Pediatric and General Dentists.

Journal Article Pediatr Dent · September 15, 2018 Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management o ... Link to item Cite

Management of after-hours pediatric dental emergencies among pediatric and general dentists

Journal Article Pediatric Dentistry · September 1, 2018 Purpose: Assess how pediatric dentists (PD) and general practitioners (GP) manage after-hours pediatric dental emergencies according to perceived urgency. Methods: A survey was e-mailed to PD and GP in North Carolina. Participants responded to management o ... Cite

Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases.

Journal Article Genet Med · April 2018 PurposeTo describe examples of missed pathogenic variants on whole-exome sequencing (WES) and the importance of deep phenotyping for further diagnostic testing.MethodsGuided by phenotypic information, three children with negative WES underwent targeted sin ... Full text Open Access Link to item Cite

Fluoride Use in Health Care Settings: Association with Children's Caries Risk.

Journal Article Adv Dent Res · February 2018 Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or appl ... Full text Link to item Cite

Dental Emergency Practice Characteristics Among North Carolina Pediatric and General Dentists.

Journal Article Pediatr Dent · March 15, 2017 PURPOSE: The purpose of this study was to assess after-hours practice characteristics of pediatric dentists (PDs) and general dentists (GDs) and determine how patients-of-record obtain after-hours emergency dental care. METHODS: A 29-item survey was electr ... Link to item Cite

De Novo Truncating Variants in ASXL2 Are Associated with a Unique and Recognizable Clinical Phenotype.

Journal Article Am J Hum Genet · October 6, 2016 The ASXL genes (ASXL1, ASXL2, and ASXL3) participate in body patterning during embryogenesis and encode proteins involved in epigenetic regulation and assembly of transcription factors to specific genomic loci. Germline de novo truncating variants in ASXL1 ... Full text Link to item Cite

A policy review of after-hours emergency dental care responsibilities.

Journal Article J Public Health Dent · September 2016 OBJECTIVES: To examine professional guidelines and/or requirements of state and national dental organizations regarding the responsibility of dentists for after-hours emergency care. METHODS: Guidelines of national dental professional organizations, specia ... Full text Link to item Cite

Coordinated Pediatric and Periodontal Dental Care of a Child with Down syndrome.

Journal Article Pediatr Dent · 2015 The purpose of this report was to describe the management of an eight-year-old Bulgarian male with Down syndrome presenting with periodontitis as a manifestation of systemic disease in the early mixed dentition. Treatment involved full-mouth mechanical deb ... Link to item Cite

Maintaining and improving the oral health of young children.

Journal Article Pediatrics · December 2014 Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries for the youngest of children has not decreased over ... Full text Link to item Cite

Management of dental trauma in a primary care setting.

Journal Article Pediatrics · February 2014 The American Academy of Pediatrics and its Section on Oral Health have developed this clinical report for pediatricians and primary care physicians regarding the diagnosis, evaluation, and management of dental trauma in children aged 1 to 21 years. This re ... Full text Link to item Cite

Oral health opinions and practices of pediatricians: updated results from a national survey.

Journal Article Acad Pediatr · 2014 BACKGROUND: Professional guidelines and state Medicaid policies encourage pediatricians to provide oral health screening, anticipatory guidance, and fluoride varnish application to young patients. Because oral health activities are becoming more common in ... Full text Link to item Cite

Oral health and pediatricians: results of a national survey.

Journal Article Acad Pediatr · 2009 OBJECTIVE: Pediatricians have regular opportunities to perform screening dental examinations on young children and to educate families on preventive oral health. We sought to assess pediatricians' current attitudes and practices related to oral health of c ... Full text Link to item Cite

Preventive oral health intervention for pediatricians.

Journal Article Pediatrics · December 2008 This policy is a compilation of current concepts and scientific evidence required to understand and implement practice-based preventive oral health programs designed to improve oral health outcomes for all children and especially children at significant ri ... Full text Link to item Cite

Perceptions of oral health training and attitudes toward performing oral health screenings among graduating pediatric residents.

Journal Article Pediatrics · August 2008 BACKGROUND: There is a lack of access to oral health services for American children. Some propose that pediatricians be trained to deliver preventive screening and education to families until they access a dental home. However, little is known about the cu ... Full text Link to item Cite

Guidelines issues workshop report.

Journal Article Pediatr Dent · 2007 The workshop on guidelines met to review the aspects of the symposium related to oral health policies and guidelines proffered by the American Academy of Pediatric Dentistry (AAPD) and other organizations. Workgroup recommendations were reported regarding: ... Link to item Cite

Policies and guidelines outside the American Academy of Pediatric Dentistry: influencing oral health care for persons with special health care needs.

Journal Article Pediatr Dent · 2007 Organizations other than the American Academy of Pediatric Dentistry (AAPD) have produced policies and guidelines regarding oral health care for persons with special health care needs (PSHCN). These organizations may be classified as: (1) educational group ... Link to item Cite

Oral conditions.

Journal Article Pediatr Rev · January 2007 Full text Link to item Cite

Caries experience associated with attention-deficit/hyperactivity disorder.

Journal Article J Clin Pediatr Dent · 2005 UNLABELLED: The purpose of this cross-sectional study was to examine whether children with attention-deficit/hyperactivity disorder (ADHD) had a total caries experience that was equivalent to children without the disorder. METHODS: The test sample included ... Link to item Cite

Oral health risk assessment timing and establishment of the dental home.

Journal Article Pediatrics · May 2003 Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation's children. Early childhood dental caries occurs in all racial and socioeconomic groups; how ... Full text Link to item Cite

Fluorosis development in seven age cohorts after an 11-month break in water fluoridation.

Journal Article J Dent Res · January 2003 This study used an 11-month break in water fluoridation to identify the time when developing incisors are most sensitive to fluorosis development. The study was based in Durham, NC, where an interruption to water fluoridation occurred between September, 19 ... Full text Link to item Cite

Fluorosis prevalence after an 11-month interruption in water fluoridation.

Journal Article JOURNAL OF DENTAL RESEARCH · March 1, 2002 Link to item Cite

Early childhood caries: analysis of psychosocial and biological factors in a high-risk population.

Journal Article Caries Res · 2001 The influences that link social factors and caries development are not well understood, although mediation by stress has been suggested. The association between caregiver stress and early childhood caries (ECC), in particular, remains unclear. The purpose ... Full text Link to item Cite

Caries prevalence decreases after water fluoridation cessation

Journal Article Journal of Evidence-Based Dental Practice · January 1, 2001 Subjects. The subjects were 1696 children born between March 1985 and September 1990 who were, at the time of examination, in kindergarten through grade 5 in Durham, N.C. Exposure. An approximate 11-month break in water fluoridation between September 1990 ... Full text Cite

Pediatric oral pathology. Soft tissue and periodontal conditions.

Journal Article Pediatr Clin North Am · October 2000 Pediatric patients can present with various intraoral lesions that require accurate diagnosis, treatment or reassurance, and possible referral for a dental evaluation. Periodic review of oral soft-tissue pathology can help the medical team to easily recogn ... Full text Link to item Cite

The effects of a break in water fluoridation on the development of dental caries and fluorosis.

Journal Article J Dent Res · February 2000 Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study partici ... Full text Link to item Cite

Fluoride supplement prescribing and dental referral patterns among academic pediatricians.

Journal Article Pediatrics · January 1998 OBJECTIVE: To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical cen ... Full text Link to item Cite

Caries effects from an 11-month break in water fluoridation: interim results.

Journal Article JOURNAL OF DENTAL RESEARCH · January 1, 1998 Link to item Cite

Fluorosis effects from an 11-month break in water fluoridation; interim results.

Journal Article JOURNAL OF DENTAL RESEARCH · January 1, 1998 Link to item Cite

A national survey of women dentists.

Journal Article J Am Dent Assoc · December 1991 Full text Link to item Cite

Influence of paternal age, smoking, and alcohol consumption on congenital anomalies.

Journal Article Teratology · October 1991 The potential effects of paternal exposures on fetal development are of great public and scientific concern, yet few epidemiologic studies have examined this association. Single live births from 1959 to 1966 among 14,685 Kaiser Foundation Health Plan membe ... Full text Link to item Cite

AN ETIOLOGIC STUDY OF CLEFT-PALATE IN HUMANS

Journal Article AMERICAN JOURNAL OF EPIDEMIOLOGY · October 1, 1991 Link to item Cite

The Ca, Pi, F, and proline content of developing bovine enamel under GBHA-stained and unstained bands.

Journal Article J Dent Res · June 1988 The surface enamel of fetal bovine teeth was stained with GBHA to indicate the position of bands of smooth-ended and ruffle-ended ameloblasts relative to the developing enamel. The boundaries of the bands were scored, under a dissecting microscope, and the ... Full text Link to item Cite