Oxygen Saturation and Pulse Rate Change in Children during Sedation with Oral Midazolam and Nitrous Oxide.

OBJECTIVE: We aimed to examine if changes in oxygen saturation and pulse rate of pediatric patients during conscious sedation with midazolam and nitrous oxide are associated with child's behavior, midazolam dose, the type and duration of the treatment and demographic parameters. STUDY DESIGN: This study was a retrospective chart review of consecutive pediatric patients, aged 2.5-12.5 years, who had undergone conscious sedation for dental treatment with oral midazolam (with or without nitrous oxide) between January 2011 and September 2015 at the Department of Pediatric Dentistry of Tel Aviv University. Oral midazolam was administered according to the patients' weight, either at 0.4 mg/kg, 0.5 mg/kg or at a maximum dose of 10 mg. In all cases pulse rate and oxygen saturation were monitored every 15 minutes during treatment, Results: 147 sedation sessions (82 of females and 65 of males) were included in the study. Sedation was successful in 80% of cases. Children with poor behavior scores had statistically significant different mean saturation levels, albeit within normal range, during the treatment (p<0.012) as well as a clinically significant higher mean pulse rate (p=0.0001), compared to children with good or excellent behavior scores. Treatment duration, the type of dental procedure or the patients' weight were not correlated with the change in oxygen saturation or pulse rate during the treatment. CONCLUSIONS: Poor behavior of pediatric patients does not affect oxygen saturation, but it increases the pulse rate of children under sedation with midazolam and nitrous oxide.

Inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height.

PURPOSE: The purpose of this study was to examine inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of infraoccluded teeth. METHODS: A total of 402 periapical radiographs of infraoccluded primary mandibular molars were reviewed. Infraocclusion, alveolar bone height, and tipping of adjacent teeth were measured. RESULTS: Infraocclusion was most prevalent among primary mandibular first molars. The amount of infraocclusion was most profound among primary mandibular second molars (2.79±1.25). The shortest distal alveolar crest (reflected by the highest distance between the cementoenamel junction and bone crest) was observed among infraoccluded primary mandibular first molars (0.9±0.92). The permanent mandibular first molar and the primary mandibular first molar demonstrated the maximum tipping mesially and distally. CONCLUSIONS: Infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of the infraoccluded teeth are inter-related.

Using elements of hypnosis prior to or during pediatric dental treatment.

Most dental practitioners are familiar with pediatric patients expressing dental fear or anxiety. Occasionally, the dentist may encounter a situation where all behavioral techniques fail, while, for some reason, premedication or general anesthesia are contraindicated or rejected by the patient or his/her parents and a different approach is required. Hypnosis may solve the problem in some cases. The purpose of this study was to review the literature about techniques that use elements of hypnosis and hypnotic techniques prior to or during pediatric dental treatment. There is a limited amount of literature regarding the use of hypnosis and hypnotic elements in pediatric dentistry. Induction techniques, reframing, distraction, imagery suggestions, and hypnosis are identified, although mostly anecdotally, while there are very few structured controlled studies. Nevertheless, the advantages of using hypnotic elements and hypnosis in pediatric dentistry are evident.