Current methods of sedation in dental patients - a systematic review of the literature.

OBJECTIVE: The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. STUDY DESIGN: A systematic literature review of the PubMed MEDLINE database was carried out using the key words "conscious sedation," "drugs," and "dentistry." A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. RESULTS: A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs. CONCLUSIONS: Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective.

Melatonin expression in periodontal disease.

BACKGROUND AND OBJECTIVE: It was the purpose of this study to examine the relationship between periodontal diseases and melatonin level. MATERIAL AND METHODS: Forty-six patients with periodontal disease, together with 26 age- and gender-matched healthy controls, were included. Periodontal status was assessed using the Community Periodontal Index. Plasma and salivary melatonin levels were determined using specific commercial radioimmunoassays, whereas lymphocyte subpopulations (e.g. CD3, CD4, CD8, C19 and natural killer cells) were analyzed using flow cytometry. RESULTS: Patients with periodontal disease had significantly (p < 0.001) lower plasma (9.46 +/- 3.18 pg/mL) and saliva (2.55 +/- 0.99 pg/mL) melatonin levels than healthy control patients (14.33 +/- 4.05 and 4.22 +/- 0.87 pg/mL, respectively). A biphasic relationship was observed between plasma melatonin levels and Community Periodontal Indices. The plasma melatonin level was reduced in patients with a lower Community Periodontal Index value (1 or 2) and increased in patients with a higher Community Periodontal Index value (3 or 4). Salivary melatonin parallels the changes of plasma melatonin. The higher the Community Periodontal Index, the older the patient and the higher the total lymphocyte counts. CD4 concentrations also increased as the disease worsened. CONCLUSION: The results obtained from this study suggest that melatonin could act as a protective function in fighting periodontal infection. However, further studies in this area are encouraged.

Hereditary blood coagulation disorders: management and dental treatment.

Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.

Antibiotic prophylaxis in dental patients with body prostheses.

Antibiotic administration before performing dental treatments, with the purpose of preventing the possible risks associated with bacteremia, has received much support but also considerable criticism. Advances in surgery have led dental professionals to deal with patients carrying body prostheses of different kinds - thus giving rise to situations in relation to dental management that require careful evaluation. In this context, when deciding whether or not to provide antibiotic prophylaxis, the dental professional must also be able to adequately assess other aspects such as oral status, the dental treatment required, the type of body implant involved, the potential risk of infection in relation to the prosthesis, associated secondary pathologies, the type of antibiotic indicated and its spectrum of action, as well as the dosage, side effects and economical cost of the antibiotic administered.

La profilaxis antiiótica en pacientes odontológicos portadores de prótesis corporales / Antibiotic prophylaxis in dental patients with body prostheses

La utilización de antibióticos de forma previa a la realización de tratamientos odontológicos con el fin de preservar a los pacientes de posibles riesgos derivados de la aparición de bacterihemias, ha sido una actuación con grandes apoyos y grandes detractores. Conforme ha pasado el tiempo el avance en la cirugía nos va permitiendo el ver pacientes con prótesis corporales de diferente índole que crea situaciones, a la hora de realizar el tratamiento dental, que deben de ser muy bien evaluadas por el profesional. Éste debe conocer y valorar a la hora de tomar la decisión de si administrar o no una dosis profiláctica de antibióticos, otros aspectos, como el estado oral, tratamiento dental a realizar, tipo de prótesis corporal, grado de riesgo de infección en relación a dicha prótesis, patologías secundarias asociadas, tipo de antibiótico a utilizar y espectro bacteriano que cubre, así como sus dosis, sus efectos colaterales y coste económico (AU)

Free interleukin-2 receptors in children with trisomy 21 (Down's syndrome) and different levels of periodontal disease.

AIMS: To investigate levels of free interleukin-2 (IL-2) receptors in relation to differing levels of CIPD in children with trisomy 21 (Down's syndrome). DESIGN: Cross-sectional study of soluble IL-2 receptors in serum samples. SAMPLE AND METHOD: Eighty children aged 10-13 years were included; 40 children with Down's syndrome and with varying levels of CIPD and 40 control children without Down's syndrome and without periodontitis. Serum samples were analysed using an enzyme-linked immunosorbent assay (ELISA) with two monoclonal antibodies. RESULTS: In children with Down's syndrome and periodontitis, serum IL-2 receptor levels were significantly higher than in control subjects.

Spanish dental students knowledge of oral malignancy and premalignancy.

BACKGROUND: In view of the gradual rise in oral malignancy in Europe, there is an increased need for undergraduate dental students to have some appropriate training in the recognition of the signs and symptoms of oral Premalignancy and malignancy, and be aware of the appropriate early management of patients with such oral lesions. The present study outlines the results of a pilot study to determine the knowledge and awareness of a cohort of undergraduate dental students in Spain regarding the management of oral premalignancy and malignancy. METHOD: In March 1997 a self-administered questionnaire (SAQ) addressing student's knowledge, opinions, and related aspects of screening and detection of oral malignancy and premalignancy, was mailed to 200 undergraduate dental students in two Spanish Universities. The present report details the responses of this cohort of undergraduates. Statistical analysis of the data was performed using the chi(2) test and the results were considered significant when P < 0.05. RESULTS: 37.0% of the respondents were male and 63.0% female. Almost all of the respondents (99.0%) had attended general dental congresses and 81.5% had attended specific courses on oral malignancy and premalignancy. Only 20% of undergraduate students had witnessed at least one patient with oral malignancy. Squamous cell carcinoma (SCC) was the most frequently observed (94.4%) oral tumour. 79% of the respondents had examined or witnessed at least one patient with a potentially malignant lesion. Leukoplakias were the most commonly observed (80.0%) premalignant lesions. 5th year students were more likely to have performed a biopsy than 4th year students (P < 0.05), particularly male students (P < 0.005). 40.0% of respondents believed that the lower lip was the most common site of an oral cancer; almost half realised that a tumour could have a speckled appearance. 79% to 82% of the respondents indicated that tobacco and alcohol were the principal causes of oral SCC, but 34.6% suggested that HIV disease was a risk factor for oral SCC. Almost all respondents routinely recorded the tobacco or alcohol consumption of patients and would offer advice to patients regarding modification of these habits. 64.0% of undergraduates suggested that clinical screening at intervals of 6 to 12 months was an effective means of diagnosing oral premalignant and malignant lesions, and almost all considered oral health promotion to be an effective means of reducing oral cancer mortality. CONCLUSIONS: Undergraduate dental students in Spain have limited clinical experience or knowledge of related aspects of oral premalignant and malignant lesions, and they may fail to recognise appropriate signs and symptoms and aetiological factors of such disease.

[The neurophysiological study of diabetic polyneuritis. Apropos 100 cases]. / Estudio neurofisiológico en la polineuritis diabética. A propósito de 100 casos.

Alterations in nervous transmission might be an early feature of diabetic peripheral polyneuropathy, even in the subclinical stage. We performed a study on 100 diabetic patients. Those with possible endogenous or exogenous causes of neuropathy were not included. We studied the motor distal latency of right peroneal and cubital nerve and the sensory distal latency of median nerve by the use of electromyogram. The neuropathy incidence was 34.3%. One of the results was that conduction in males was slower than in the female control group; this disappeared in diabetic patients.