Trends of conscious sedation in the Department of Pediatric Dentistry at the Dankook University Dental Hospital for 11 Years

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.

A Retrospective Study on the Effect of Pulp Treatment on the Exfoliation of Primary Teeth / 대한소아치과학회지

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.

Effects of Positive Psychological Resources on the Relationship Between Adverse Childhood Experiences and Depressive Symptoms in University Students / 우울ㆍ조울병

Background@#This study was conducted to examine the effect of adverse childhood experiences on depressive symptoms in university students and to verify whether positive psychological resources act as a protective factor for depression. @*Methods@#Data from 1,317 young adults aged 18-29 years who took part in the university-based cross-sectional survey were analyzed. All participants completed self-report questionnaires that included demographic variables, the Adverse Childhood Experience (ACE) Scale, the Patient Health Questionnaire-9, and the Positive Resources Test. @*Results@#The incidence of depression was 33.3% and was higher in women than in men. Based on the 10 ACE categories, 32.7% of the students reported one or more adverse childhood experiences, and 14.4% reported two or more forms of adverse childhood experiences. Students with depressive symptoms were likely to report more traumatic experiences in childhood and fewer positive psychological resources than those without depressive symptoms. Hierarchical regression analysis indicated that positive psychological resources moderated the relationship between adverse childhood experiences and depression. @*Conclusion@#Based on these results, professionals should consider identifying adverse childhood experiences early and provide active mental health service support, including positive psychological and social resources for individuals who have adverse experiences during childhood.

Difference in Bonding Strength of RMGIC according to Type of Hemostatic Agent in Primary Tooth / 대한소아치과학회지

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.

Antibacterial Effect on Enterococcus Faecalis and Physical Properties of Chitosan Added Calcium Hydroxide Canal Filling Material / 대한소아치과학회지

The aim of this study was to evaluate the antibacterial effect on Enterococcus Faecalis and physical properties of chitosan added calcium hydroxide canal filling material.Low, medium, high molecular weights of chitosan powder were mixed with calcium hydroxide canal filling material. Also, for each molecular weight group, 1.0, 2.0, 5.0 wt% of chitosan powder were added. An overnight culture of E. faecalis was adjusted to 1 × 106 CFU/ml. For test of antibacterial effect, three different molecular weights of 2.0 wt% chitosan and three different concentrations of high molecular weight chitosan were mixed with calcium hydroxide canal filling material. The absorbance of plates was analyzed using spectrophotometer at 570 nm with a reference wavelength of 600 nm. Physical properties such as flow, film thickness and radiopacity were examined according to ISO 6876 : 2012.All molecular weight type of chitosan containing material showed inhibitory effect against E. faecalis growth compared to non-chitosan added calcium hydroxide canal filling material group (p In conclusion, for reinforcement of antibacterial effect against E. faecalis and for favorable physical properties, 2.0 wt% of chitosan adding is recommended. Considering its antibacterial effect of chitosan, further studies are required for clinical application of chitosan in endodontics and pediatric dentistry.

Characterization of Odontoblasts in Supernumerary Tooth-derivedDental Pulp Stem Cells between Passages by Real-Time PCR / 대한소아치과학회지

The aim of this study is to compare the properties of odontoblast gene of early passage cells and late passage cells derived from impacted maxillary supernumerary teeth.Impacted supernumerary teeth with maxilla were extracted from 12 patients (8 males, 4 females) between 6 - 9 years old without medical history. Real-time polymerase chain reaction (PCR) was conducted to compare characterization of odontoblast cell in the 3rd and 10th passage, and between with bone inducing additive group and without additive group. Genes for odontoblasts characteristics are osteonectin (ONT), alkaline phosphatase (ALP), osteocalcin (OCN), dentin matrix protein 1 (DMP-1) and dentin sialophosphoprotein (DSPP). The level of gene expression was in a decreasing order of ONT, ALP, OCN, DMP-1 and DSPP in the 3rd passage, and in decreasing order of ONT, DMP-1, OCN, ALP, and DSPP in the 10th passage in the undifferentiation and differentiation group. The order of ONT, DMP-1, and OCN did not changed. ALP and DMP-1 were switched in order. ALP and DMP-1 may be used as important markers for differentiating between the 3rd passage and 10th passage cells. Considering that supernumerary tooth was extracted young age and the time required to cultured 10th passage was short, supernumerary tooth can be considered a useful donor site of dental pulp stem cells.

The prevalence of taurodontism in primary molar and correlation with permanent first molar / 대한구강보건학회지

Objectives@#The purpose of this study was to investigate the prevalence of permanent first molar taurodontism and identify the correlation between primary molars and permanent first molar taurodontism. @*Methods@#Among the 10,113 children who underwent panoramic radiography at a dental hospital from January 2010 to December 2019, 685 children (404 boys, 281 girls) were included in this study. @*Results@#Six children (0.8%) and 98 children (14.1%) showed taurodontism of the primary molars and permanent first molar, respectively. All of the children with taurodontism in the primary molars had at least one taurodontism in the permanent first molars. @*Conclusions@#Early diagnosis of taurodontism in primary molars might allow dentists to make treatment plans in accordance with tooth development.

Safety of chloral hydrate sedation in dental practice for children: an overview

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.

The prevalence of taurodontism in primary molar and correlation with permanent first molar / 대한구강보건학회지

Objectives@#The purpose of this study was to investigate the prevalence of permanent first molar taurodontism and identify the correlation between primary molars and permanent first molar taurodontism. @*Methods@#Among the 10,113 children who underwent panoramic radiography at a dental hospital from January 2010 to December 2019, 685 children (404 boys, 281 girls) were included in this study. @*Results@#Six children (0.8%) and 98 children (14.1%) showed taurodontism of the primary molars and permanent first molar, respectively. All of the children with taurodontism in the primary molars had at least one taurodontism in the permanent first molars. @*Conclusions@#Early diagnosis of taurodontism in primary molars might allow dentists to make treatment plans in accordance with tooth development.

Fracture Strength and Translucency of CAD/CAM Zirconia Crown for Primary Anterior Tooth / 대한소아치과학회지

The purpose of this study is to evaluate the validity of primary anterior zirconia crown made with Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) technology by analyzing fracture strength and translucency parameter.Zirconia crown was designed with CAD software, using 3D scanned data of #61 tooth model. Crown fabrication was performed with CAM machine using zirconia block. Zirconia crowns were divided into 3 groups according to thickness(0.3, 0.5, and 0.7 mm), and fracture strength was compared with 1.0 mm thickness of resin strip crown. The compressive force was applied with universal testing machine at 30° along the incisal edge at increments of 1 mm/min. For translucency evaluation, 0.3, 0.5, and 0.7 mm thickness of zirconia specimens were fabricated and translucency was measured with spectrophotometer.Among zirconia groups, there was a significant increase in fracture strength as thickness increased (p Thin primary anterior zirconia crown can be designed and fabricated according to individual needs by using CAD/CAM. Restoration with thin crown would reduce the amount of tooth reduction, risk of pulp exposure, and make more esthetic restoration possible.

Is it Impossible to Replace Chloral Hydrate in Dental Sedation of Pediatric Dentistry in Korea? / 대한소아치과학회지

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.

A Novel RUNX2 Mutation in a Korean Family with Cleidocranial Dysplasia / 대한소아치과학회지

Cleidocranial dysplasia (CCD) is an autosomal-dominant disease characterized by the delayed closure of cranial sutures, defects in clavicle formation, supernumerary teeth, and delayed tooth eruption. Defects in the Runt-related transcription factor 2 (RUNX2), a master regulator of bone formation, have been identified in CCD patients. The aim of this study was to identify the molecular genetic causes in a CCD family with delayed tooth eruption.The 23-year-old female proband and her mother underwent clinical and radiographic examinations, and all coding exons of the RUNX2 were sequenced. Mutational analysis revealed a single nucleotide deletion mutation (NM_001024630.4 : c.357delC) in exon 3 in the proband and her mother. The single C deletion would result in a frameshift in translation and introduce a premature stop codon [p.(Asn120Thrfs*24)]. This would result in the impaired function of RUNX2 protein, which may be the cause of delayed eruption of permanent teeth in the family.

A Trend of Treatment in Department of Pediatric Dentistry for 10 Years / 대한소아치과학회지

The purpose of this study is to analyze the changes in patient distribution and practice pattern resulted from changes of socioeconomic circumstances. From January 2008 to December 2017, information about patient distribution and practice pattern was collected and reviewed.Both the number of new patients and revisiting patients increased. The average age of new patients showed a declining trend. Children aged between 0 and 6 had the majority. In case of restorative treatment, the use of composite resin decreased, whereas resin modified glass ionomer increased. As to pulp treatment of primary tooth, the proportion of pulpectomy increased significantly, but decreased in pulpotomy. The results showed an increase in the treatments under sedation and general anesthesia and with the use of midazolam and nitric oxide increased after 2014.

Characterization of Human Dental Pulp Cells from Supernumerary Teeth by Using Flow Cytometry Analysis / 대한소아치과학회지

The aim of this study was to analyze cells from human dental pulp tissue of impacted supernumerary teeth as stem cells with flow cytometry. Human dental pulp cells from 15 supernumerary teeth were identified their characteristics as stem cells by expression of mesenchymal stem cell markers through flow cytometry analysis at passage 3 and passage 10. Cluster of differentiation (CD) 73, CD 90, CD 34, CD 45 and STRO-1 cell surface markers were used to figure out characteristics of dental pulp stem cells from supernumerary teeth. At passage 3, the cell population showed positive expression of CD 73, CD90 and STRO-1, lacked expression of CD 34 and CD 45. At passage 10, CD 73, CD 90 and STRO-1 showed positive expression while CD 34 and CD 45 showed negative expression. This study indicated that dental pulp stem cells of supernumerary teeth had the properties of mesenchymal stem cells at both early and late passage. Impacted supernumerary teeth could be considered as a noble source of stem cells because of rapid growth and maintaining characteristics of stem cells until late passage.

Gene Expression of Supernumerary Dental Pulp Related to the Subculture Speed: A Pilot Study / 대한소아치과학회지

The purpose of this study was to investigate the odontoblast gene expression related to the subculture speed of supernumerary dental pulp stem cells (sDPSCs). The stem cell is undifferentiated cells which has the ability to differentiate into various cells. Specific stimulation or environment induces cell differentiation, and these differentiation leads to bone or muscle formation.20 sDPSCs were obtained from 20 children under aseptic condition. During the culture through the 10th passage, the third passage cells which showed short subculture period and 10th passage cells which showed long subculture period were earned. Each cell was divided into differentiated group and non-differentiated group. Quantitative real-time polychain reaction (q-RT-PCR) was performed for each group. The genes related to odontoblast differentiation, Alkaline Phosphatase (ALP), Osteocalcin (OCN), Osteonectin (ONT), Dentin sialophosphoprotein (DSPP) and Dentin matrix acidic phosphoprotein 1 (DMP-1), were measured.Differentiated cells showed more gene expression levels. Undifferentiated cells showed higher gene expression level in 10th passages but differentiated cells showed higher gene expression level in 3rd passages. Cells that showed faster subculture period showed relatively lower gene expression level except for OCN and DSPP.

Intraosseous anesthesia using a computer-controlled system during non-surgical periodontal therapy (root planing): Two case reports

Local anesthesia is administered to control pain, but it may induce fear and anxiety. Root planing is a non-surgical periodontal therapy; however, when it is performed in an extensive manner, some tissue removal is inevitable. Notably, this removal may be so painful that local anesthesia is required to be administered to the area scheduled for the treatment. Although patients tend to accept root planing easily, they frequently express a fear of local anesthesia. Intraosseous anesthesia (IA) is an intraosseous injection technique, whereby local anesthetic is injected into the cancellous bone supporting the teeth. A computer-controlled IA system (CIAS) exhibits multiple benefits, such as less painful anesthesia, reduced soft tissue numbness, and the provision of palatal or lingual, as well as buccal, anesthesia via single needle penetration. In this report, we present two cases of root planing that were performed under local anesthesia, using a CIAS.

Characteristics of Supernumerary Tooth-derived Pulp Cells during Long-term Culture / 대한소아치과학회지

This study was conducted to investigate the characteristics of subculture times in the early, middle, and late passages by measuring the time under subculture until it was judged that the supernumerary tooth-derived pulp stem cells (sDPSCS) were no longer proliferating. Three supernumerary teeth from two healthy six-years old boys were extracted and stem cells were obtained from the pulp tissue. This was called SNT1 (supernumerary tooth 1), SNT2, and the supernumerary tooth from another child was named SNT3. SNT1 and 2 were subcultured at the same time and SNT3 was subcultured a little faster. The mean time of complete subculture was 3.6 ± 1.1 days. Total passages were cultured up to 23.3 ± 0.6 and took 83 days. These were divided into three groups based on the passage. The increase rate of time taken in subculture between group I and group II was 11.9%, but the rate between group II and group III was 28.6%, which was 2.4 times increased. The time taken between passages during long-term subculture up to 22 passages shows a regressive pattern y = 0.1169x + 2.25 and y = 0.1169x + 2.0. In conclusion, the passage time of SPSCs increased in late passages, and it shows a similar pattern.

Benzocaine, Methemoglobinemia and Methylene Blue / 대한소아치과학회지

The aim of this review is to introduce about the issue of benzocaine and methemoglobinemia. Through blocking the pain during dental treatment, fear and anxiety of patients will be reduced. Thus, anesthetic agent containing benzocaine is commonly used while controlling the pain of patients during treatment. However, on May 28, 2018, the Ministry of Food and Drug Safety reported a medication safety report about restricting the use of benzocaine-containing agents in infants under 24 months and children. Also, they recommended a cautious use to adolescents and adults to prevent methemoglobinemia (MHb). This report was published due to an advice from Food and Drug Administration (FDA) on May 23, 2018. When using agents containing benzocaine, dentists must consider the probability of MHb and prepare for early diagnosis and appropriate action. Since 1930s, methylene blue is known to cure MHb patients. Therefore, the proper use of methylene blue for emergencies and diagnosis methods for early diagnosis of MHb should be familiar to dentists planning for the use of topical anesthetic agents. Dentists should be trained for emergency situation of MHb caused by the use of benzocaine.

Comparison of Gene Expression from Supernumerary Dental Pulp and Periodontal Ligament Stem Cells / 대한소아치과학회지

The purpose of this study is to compare the properties of dental pulp and periodontal ligament stem cells from extracted supernumerary teeth by quantitative real-time PCR.Impacted supernumerary teeth in the maxillary anterior region were extracted. Dental pulp and periodontal ligament cells were collected from extracted supernumerary teeth on the same day. After isolation and culture of cells, compare characterization of them by using qRT-PCR. Primer sequences for odontoblasts are ONT, ALP, OCN, DMP-1 and DSPP.On dental pulp group, ONT has the largest quantity of gene expression, followed by OCN, ALP, DMP-1 and DSPP. On periodontal ligament group, ONT has the largest quantity of gene expression, followed by OCN, ALP, DSPP and DMP-1. Analysis of quantitative gene expression data using relative quantification showed that the expression of all genes decreased in periodontal ligament cells.Dental pulp and periodontal ligament stem cells from supernumerary teeth have the properties of odontoblasts. Considering that properties, supernumerary teeth were considered a useful donor site of dental pulp and periodontal ligament stem cells.

A Retrospective Statistical Study on Sedation Cases in Department of Pediatric Dentistry at Dankook University Dental Hospital for 5 Years / 대한소아치과학회지

Recently, sedation is routinely used in children who lacked cooperation in pediatric dental clinics. The purpose of this study is to analyze dental treatment cases in department of pediatric dentistry at Dankook University Dental Hospital associating with sedation during 5 years.From January 2011 to December 2015, information about dental treatment cases in department of pediatric dentistry was collected and reviewed. The information gathered included patient gender, age, sedation type, sedative agents, date of operation, and type of procedure.The proportion of treatment cases with conscious sedation for total treatment cases continued to decline until 2014. On the other hand, the incidence of general anesthesia increased gradually. The frequency of midazolam administration and nitrous oxide inhalation sedation increased recently. The use of conscious sedation was significantly decreased when the age of patient was 3 years or older. The frequency of general anesthesia was similar in all age groups. There was a tendency to perform treatment with deeper sedation when the patient was male than female, and when the pulp treatment was performed together with the restorative treatment than not performed. The frequency of re-treatment within 90 days after restoration treatment decreased as the depth of sedation increased.