Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients.

PURPOSE: The purpose of this retrospective study was to compare the effects of oral administration of a combination of chloral hydrate (CH) 25 mg/kg, hydroxyzine (H) 1 mg/kg, and meperidine (M) 1 mg/kg to midazolam 0.65 mg/kg using 50% nitrous oxide (N2O) on behavioral and physiological parameters of young children sedated for dental procedures. Factors associated with sedation effectiveness were identified, including age, preoperative behavior, and type of procedure. METHODS: Records of 116 sedation sessions of 66 healthy, uncooperative children ages 24 to 60 months at The University of Iowa Centers for Disabilities and Development were reviewed. Patients received 1 of the 2 regimens. Intraoperative behavior was rated using a dichotomous scale. Physiological variables including heart rate and oxygen saturation were recorded at baseline and at 10-minute intervals of the session. Data were analyzed using SPSS Version 9. RESULTS: Overall, 81 % of sessions were rated successful. Sedation sessions using CH+H+M combination had significantly higher success rate (P<.01, odds ratio=3.38, 95% confidence interval= 1.06 to 7.15) compared to sessions with midazolam. Sedation success was not associated with age, preoperative behavior, or type of dental procedure performed. Physiological variables were within the normal range for both regimens, although midazolam regimen recorded higher heart rates. CONCLUSIONS: CH+H+M combination using 25 mg/kg CH resulted in significantly more effective sedation sessions compared to midazolam. Both regimens used 50% N2O and were found to be safe.

The prevalence of periodontal disease measures in elderly adults, aged 79 and older.

From 1996-98, we examined 449 adults (mean age 85 years) from the 1982 Iowa 65+ Rural Health Study, in the field using headlight, mirror, and periodontal probe. Ninety-six of the 342 dentate subjects were excluded from the follow-up examination due to contraindications to probing, and 10 could not be assessed due to refusals, fatigue or other reasons. For all remaining subjects (n=236), attachment loss, defined as recession plus probing depth, was determined at four sites per tooth. Ninety-one percent of the subjects had at least one site with 4+ mm of attachment loss, 45% had one or more sites with attachment loss of 6+ mm, and 15% had 8+ mm of attachment loss. Moderate periodontal disease is prevalent among very old dentate adults while advanced periodontal disease is much less prevalent, suggesting that most periodontal treatment needed by this age group can be provided by general dentists and dental hygienists rather than periodontists.

The impact of the Iowa S-SCHIP program on access, health status, and the family environment.

OBJECTIVES: To determine the effect of the Iowa Separate State Child Health Insurance Program (S-SCHIP) on need for services, utilization and access to care, child health status, and the family environment. METHODOLOGY: A longitudinal pretest-posttest panel survey was used to evaluate differences in children's access to health care, health status, and family environment at the beginning of the program and after 1 year. Written surveys with telephone follow-up calls were used to collect the data. Pre- and postquestionnaire results for 463 children were matched and compared using the McNemar test for correlated proportions and the Wilcoxon signed rank test. Approximately 71% of families responded to both surveys. PRINCIPAL FINDINGS: Similar rates of perceived need for each of 6 service areas were found after being in the program for a year as before. Unmet need was significantly reduced among those needing services: medical care (27% before, 6% after), specialty care (40% before, 13% after), dental care (30% before, 10% after), vision care (46% before, 12% after), behavioral and emotional care (42% before, 18% after), and prescription medications (21% before, 13% after). Overall health status was rated significantly better (ie, excellent: 37% before, 42% after). Ninety-five percent of families reported a reduction in family stress, and there was significantly less worry about the ability to pay for their child's health care (92% before, 57% after). The activities of fewer children were limited because of potential health care costs. CONCLUSIONS: The Iowa S-SCHIP program improved access to care and the family environment for children enrolled during the first year without a change in perceived need for services.