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Background@#Anxiety and fear in children's dental care are major impediments to successful dental care. High-quality dental treatment can be achieved using various behavioral control methods; however, conscious sedation using drugs can be used if behavioral control is difficult, owing to excessive fear and anxiety. This study aimed to examine the trends in conscious sedation implemented in pediatric dentistry at the Dankook University Dental Hospital over the past 11 years. @*Methods@#This study included 6,438 cases of dental treatment under conscious sedation conducted over 11 years between January 2011 and December 2021 in the Department of Pediatric Dentistry at Dankook University Dental Hospital. @*Results@#Over the past 11 years, the number of dental treatments under sedation has increased. In the case of inhalation sedation using nitrous oxide, the rate of increase was approximately twice every year, and the use of midazolam gradually decreased. The average age of children who underwent sedation was 5.11 years, and the rate of sedation treatment in children aged 5 years tended to increase. This is related to the trend of changes in drugs used. In a sex-based survey, sedation treatment rate was higher in males than that in females. @*Conclusion@#Appropriate selection of sedatives can reduce the frequency of general anesthesia and minimize complications through efficient and safe dental treatments. Trend analysis of sedation by year will help provide guidelines for the appropriate selection of sedation for dental treatment of children and patients with disability.
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The aim of this study was to retrospectively analyze the effects of pulp treatment on exfoliation of primary teeth and its related factors. In this study, 167 teeth of 97 patients aged 6 months to 12 years who were treated with pulp treatment at Dankook Dental Hospital were selected, and information related to pulp treatment and tooth loss was collected. The included subjects were 72 primary anterior teeth (43.1%) and 95 primary posterior teeth (56.9%), of which 56 were males (57.7%) and 41 females (42.3%). The mean follow-up period was 106.1 ± 38.7 months, and the mean age at pulp treatment was 34.8 ± 15.4 months for primary anterior teeth and 69.1 ± 25.1 months for primary posterior teeth. Unilaterally pulpectomized teeth were significantly exfoliated earlier than the same tooth on the opposite side (p 0.05). Pulpectomized teeth were lost earlier, an average of 7.8 months for primary anterior teeth and 8.5 months for primary posterior teeth. Early loss of the primary tooth can lead to space loss and premature eruption of the successor, so this can be considered when planning or performing treatment of the primary tooth.
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Objective@#Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. @*Materials and Methods@#From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. @*Results@#Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient’s age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient’s age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. @*Conclusion@#Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.
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The purpose of this study was to evaluate the effect of a hemostatic agent containing aluminum chloride on the shear bond strength of resin-modified glass ionomer cement (RMGIC) to the dentin of primary teeth.Thirty-six extracted non-carious human primary teeth were collected in this study. Dentin surfaces were cut and polished. The specimens were randomly divided into 4 groups; group I: RMGIC without conditioning; group II: polyacrylic acid (PAA), RMGIC; group III: aluminum chloride, RMGIC; group IV: aluminum chloride, PAA, RMGIC.All teeth were thermocycled between 5.0℃ and 55.0℃ for 5000 cycles. Fifteen specimens from each group were subjected to shear bond strength test and 3 specimens from each group were inspected using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy.The mean shear bond strength of each group was as follows: 4.04 ± 0.88 MPa in group I, 8.29 ± 1.40 MPa in group II, 1.39 ± 0.47 MPa in group III, 6.24 ± 2.76 MPa in group IV. There were significant differences among all groups (p In conclusion, aluminum chloride decreased the shear bond strength of RMGIC to dentin, regardless of PAA conditioning.
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The purpose of this study was to compare the effect of the hemostatic agent containing aluminum chloride with hemostatic agent containing ferric sulfate on the shear bond strength of resin-modified glass ionomer cement(RMGIC) to dentin in primary tooth.Twenty extracted non-carious human primary teeth were collected in this study. The specimens were cut to expose dentin and polished. The specimens were randomly seperated into 3 groups for treatment; group I: polyacrylic acid(PAA), RMGIC; group II: aluminum chloride, PAA, RMGIC; group III: ferric sulfate, PAA, RMGICTen specimens from each group were subjected to shear bond strength test. The mean shear bond strength of each group was as follows: 10.07 ± 1.83 MPa in Group I, 7.62 ± 0.78 MPA in group II, 5.23 ± 0.78 MPa in group III. There were significant differences among all groups(p In conclusion, both aluminum chloride hemostatic agent and ferric sulfate hemostatic agent decreased the shear bond strength of RMGIC to dentin. And ferric sulfate hemostatic agent decreased the shear bond strength of RMGIC more than the aluminium chloride hemostatic agent.
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The purpose of this study was to compare the effect of sodium fluoride(NaF) varnish and potassium iodide(KI) on remineralization efficacy of silver diamine fluoride(SDF) by measuring microhardness and evaluating surface morphology by scanning electron microscope(SEM).Artificial caries lesions were induced on extracted primary molars and vickers microhardness was measured. Specimens were randomly separated into 4 groups for treatment. The specimens in group I were treated with SDF, group II with NaF varnish after SDF, group III with KI after SDF and group IV with distilled water. After 8 days of pH cycling, vickers microhardness was measured and difference before and after treatment was calculated. For SEM, 2 samples were evaluated respectively after enamel polishing, lesion formation and after pH cycling.Group III showed highest increase in microhardness. Group I showed higher increase in microhardness than Group II but without statistical difference. Group IV showed lowest increase in microhardness value among 4 groups.On SEM image, group I, II and III showed smoother and less irregular surface compared to group IV. Amorphous crystal pellicles were observed in group III.In conclusion, SDF, SDF and NaF, SDF and KI groups showed smoother surface and increase in microhardness suggesting the possibility that remineralization effect might take place in oral conditions. In addition, in limited conditions of this study, applying NaF varnish after SDF did not increase the remineralization efficacy of SDF while KI significantly increased the remineralization efficacy of SDF. However, additional study considering various conditions that might affect demineralization and remineralization in clinical situations need to be conducted.
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Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords “dental sedation,” “chloral hydrate,” and “children or adolescent,” 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.
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The aim of the study is to compare the fluoride release and recharge properties of glass ionomer cements and ‘alkasite’.Specimens of two glass ionomer cements (Fuji Ⅸ GP and Riva Self Cure), ‘alkasite’ restorative material (Cention N) and composite resin (FiltekTM Z350XT) were prepared. The fluoride release of each specimen was measured for 28 days. Thereafter, 1.23% acidulated phosphate fluoride (APF) gel was applied to experimental groups. No treatment was performed on control groups. The fluoride release was measured for additional 7 days to evaluate the fluoride recharge properties of each materials.The fluoride release was highest in Riva Self Cure, followed by Fuji Ⅸ GP, Cention N (p < 0.05). Fluoride release of Cention N was measured to be approximately 49% of Fuji Ⅸ GP’s. After the application of 1.23% APF gel, increases in fluoride release were observed in Riva Self Cure, Fuji Ⅸ GP and Cention N (p < 0.05). Fluoride recharge was observed in Cention N as well as in glass ionomer cements. Further studies are required to evaluate the anti-cariogenic properties of Cention N at clinical conditions.
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Chloral hydrate (CH) has been used in sedation for over 100 years. CH was first synthesized in 1832, the sedative properties were observed in 1861. Because of its easy synthesis, its use was widespread since 1869. There is a record of the use of CH in children as early as 1894. Recently there have been many controversies about safety of CH. Because of the low cost and relatively safe experience CH has still been used for dental sedation in children. After the US FDA recommendation in 2006, US pharmaceutical companies no longer produce commercial CH. However, CH has been used in the form of suspensions prepared from raw materials in many areas of the United States, and reports of adverse events related to death have continued.CH is the most commonly used drug for sedation in Korea, and there have been some reports of side effects.Dexmedetomidine, propofol and midazolam were introduced as an alternative for CH. There are various limitations in using them in the pediatric dentistry area and there are many things to consider.The purpose of this review is to analyze the complications of CH and status of use in Korea, and to introduce alternatives to CH.
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The aim of this study was to compare compressive strength and microhardness of recently introduced alkasite restorative materials with glass ionomer cement and flowable composite resin. For each material, 20 samples were prepared respectively for compressive strength and Vickers microhardness test. The compressive strength was measured with universal testing machine at crosshead speed of 1 mm/min. And microhardness was measured using Vickers Micro hardness testing machine under 500 g load and 10 seconds dwelling time at 1 hour, 1 day, 7 days, 14 days, 21 days and 35 days. The compressive strength was highest in composite resin, followed by alkasite, and glass ionomer cement. In microhardness test, composite resin, which had no change throughout experimental periods, showed highest microhardness in 1 hour, 1 day, and 7 days measurement. The glass ionomer cement showed increase in microhardness for 7 days and no difference was found with composite resin after 14 days measurement. For alkasite, maximum microhardness was measured on 14 days, but showed gradual decrease.
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Glanzmann’s thrombasthenia (GT) is a rare, autosomal recessive inherited congenital disorder, characterized by impaired blood coagulation due to platelet dysfunction. It was first reported by the pediatrician Glanzmann in 1918. GT affects both males and females, and it is more common in regions of the Middle East, India, and France, where intermarriage is common. It has an incidence of about 1 in 1,000,000 people. In South Korea, according to the Division of Rare Diseases, Korea Centers for Disease Control and Prevention, around 200 cases have been reported in 2018. Clinical symptoms include petechia, ecchymosis, epistaxis, and gingival bleeding. The spontaneous loss of deciduous teeth can result in excessive bleeding with that blood transfusion should be considered. Preventing hemorrhages and hemostasis are most important factors in dental treatment. Local bleeding can be controlled by compression, but platelet transfusion can be required by prolonged bleeding. Pediatric dentists can minimize the gingival bleeding by control of the oral hygiene to prevent gingivitis and dental caries. The importance of oral hygiene and periodic recall check-up should be emphasized. During dental treatment, the examination and the treatment plan of patient should be modified to prevention of hemorrhages carefully. A 6-year-old girl with GT was referred for the treatment of dental caries, and resin restoration was performed under nitrous oxide inhalation sedation. After treatment, compression was required for the bleeding control.
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OBJECTIVE: This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.METHODS: Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.RESULTS: Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.CONCLUSION: Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.
Subject(s)
Humans , Angiography , Brain Death , Brain , Cerebral Arteries , Cerebral Veins , Heart Arrest , Hypothermia , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: The sectioned images of a cadaver head made from the Visible Korean project have been used for research and educational purposes. However, the image resolution is insufficient to observe detailed structures suitable for experts. In this study, advanced sectioned images with higher resolution were produced for the identification of more detailed structures. METHODS: The head of a donated female cadaver was scanned for 3 Tesla magnetic resonance images and diffusion tensor images (DTIs). After the head was frozen, the head was sectioned serially at 0.04-mm intervals and photographed repeatedly using a digital camera. RESULTS: On the resulting 4,000 sectioned images (intervals and pixel size, 0.04 mm³; color depth, 48 bits color; a file size, 288 Mbytes), minute brain structures, which can be observed not on previous sectioned images but on microscopic slides, were observed. The voxel size of this study (0.04 mm³) was very minute compared to our previous study (0.1 mm³; resolution, 4,368 × 2,912) and Visible Human Project of the USA (0.33 mm³; resolution, 2,048 × 2,048). Furthermore, the sectioned images were combined with tractography of the DTIs to elucidate the white matter with high resolution and the actual color of the tissue. CONCLUSION: The sectioned images will be used for diverse research, including the applications for the cross sectional anatomy and three-dimensional models for virtual experiments.
Subject(s)
Female , Humans , Anatomy, Cross-Sectional , Brain , Cadaver , Diffusion , Diffusion Tensor Imaging , Head , White MatterABSTRACT
Although many imaging modalities can play some roles in the diagnosis of vertebral artery dissection (VAD), digital subtraction angiography (DSA) remains the gold standard method, with the highest detection rate and ability to assist in planning for endovascular treatment. However, this tool is often avoided in children because its invasive nature and it exposes them to radiation. High resolution magnetic resonance imaging (HR-MRI) have been suggested to be a reliable and non-invasive alternative, but it has never been discussed in children in whom vertebral artery dissection is a rare condition. In this report, we evaluate a case of a 2-year-old child who initially presented with cerebellar symptoms, and was early diagnosed with vertebral artery dissection using HR-MRI and was successfully treated.
Subject(s)
Child , Child, Preschool , Humans , Angiography, Digital Subtraction , Diagnosis , Magnetic Resonance Imaging , Methods , Vertebral Artery Dissection , Vertebral ArteryABSTRACT
OBJECTIVE: To prospectively evaluate the diagnostic performance of computer-aided diagnosis (CAD) for detection of thyroid cancers via ultrasonography (US). MATERIALS AND METHODS: This study included 50 consecutive patients with 117 thyroid nodules on US during the period between June 2016 and July 2016. A radiologist performed US examinations using real-time CAD integrated into a US scanner. We compared the diagnostic performance of radiologist, the CAD system, and the CAD-assisted radiologist for the detection of thyroid cancers. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CAD system were 80.0, 88.1, 83.3, 85.5, and 84.6%, respectively, and were not significantly different from those of the radiologist (p > 0.05). The CAD-assisted radiologist showed improved diagnostic sensitivity compared with the radiologist alone (92.0% vs. 84.0%, p = 0.037), while the specificity and PPV were reduced (85.1% vs. 95.5%, p = 0.005 and 82.1% vs. 93.3%, p = 0.008). The radiologist assisted by the CAD system exhibited better diagnostic sensitivity and NPV than the CAD system alone (92.0% vs. 80.0%, p = 0.009 and 93.4% vs. 88.9%, p = 0.013), while the specificities and PPVs were not significantly different (88.1% vs. 85.1%, p = 0.151 and 83.3% vs. 82.1%, p = 0.613, respectively). CONCLUSION: The CAD system may be an adjunct to radiological intervention in the diagnosis of thyroid cancer.