The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments.

STATEMENT OF THE PROBLEM: Some children do not show an appropriate cooperation with their dentist. A number of them cannot be managed by local anesthesia and the usual techniques used to control behaviors, so further steps are required to control their pain and anxiety. Pharmaceutical control is recommended through sedation or general anesthesia. PURPOSE: This study was aimed to evaluate two groups of drugs in intravenous sedation method. MATERIALS AND METHOD: In this clinical trial intervention study, patients were randomly divided into two groups of 18 and 20 and each group received either intravenous midazolam-ketamine or midazolam-fentanyl. During the procedure, 0.25mg midazolam was administered to both groups if needed. The scores of intraoperative sedation and operation conditions were evaluated and recorded by dental sedation teacher groups (DSTG) system in the 10(th), 20(th), 30(th) and 40(th) minutes of the operation. The results were analyzed by SPSS (version 16) using independent T-test, Wilcoxon, Mann-Whitney and Pearson Chi-Square tests as appropriated. RESULTS: There was no significant difference between the two groups in sedation period (p= 0.55), recovery time (p= 0.18), Frankl score (p= 0.83(, score of intraoperative sedation and operating conditions (p> 0.05), and sedation complications (p= 0.612). In addition, no complication occurred in recovery. CONCLUSION: There was no significant difference between the two drug groups; both were appropriate in controlling children's behavior.

Evaluation of factors influencing child abuse leading to oro-facial lesions in Isfahan, Iran: A qualitative approach.

BACKGROUND: Since child abuse and neglect are serious conditions which can potentially lead to inappropriate dental health, we conducted this qualitative study to define the factors influencing child abuse and neglect, which lead to oro-facial lesions. MATERIALS AND METHODS: Qualitative semi-structured interviews were conducted by social services employees. Purposive sampling was used to recruit participants to capture a range of experiences such as the physical abuse, sexual abuse, role of family in child abuse, age, and gender. RESULTS: Participants demonstrated a range of perceptions which lead to child abuse including hitting on the head and slapping. Often subsidiary to this view, several factors were mentioned that occasionally influenced child abuse. These factors appeared to be idiosyncratic but could be drawn together into three categories: Cultural lacks which includes poverty, cruelty of parents and addiction, psychological disorders, and separation in the family which was seen in most of the children. CONCLUSION: This study has identified a variety of factors influencing the incidence of child abuse. Therefore, dentists should meticulously pay attention to children who have these risk factors in order to discover child abuse events. Quantitative research would reveal the extent of these factors. Dentists' knowledge of their roles in managing cases suffering from abuse might need to be assessed to see if dentists need further education in this important area.

Evaluation of orofacial lesions relating child abuse, Esfahan, Iran: A quantitative approach.

BACKGROUND: Family violence, including child abuse, neglect, and domestic violence, is a public health problem. The aim of this study was to provide data on prevalence and factors of Orofacial lesions relating child abuse in Iran to lend evidence to support preventing child abuse. MATERIALS AND METHODS: The overall approach was a case-note review of children having child abuse note, recording by personnel of social services. Research ethical approval was sought from the Central social service organization. This study was conducted in Isfahan, Iran (2011). RESULT: The mean age of children, when abuse had been occurred was 8 years (SD = 1.68), and there were approximately an equal number of boys and girls. Children had a high physical experience (66.1%).Of these children, at least 60% sustained trauma to the face and mouth. Emotional abuse was 77.1%, neglect was 64.1%, and lower experience of sexual abuse which was 4.1%. There was a strong relationship between gender and abuser which shows girls have been affected by stepfathers (P = 0.001). CONCLUSION: Preliminary data suggest that there are strong evidence regarding the incidence of child abuse relating orofacial lesions which dentists should be aware of them. Future trials may draw on these useful baseline data to help their study design.

Effect of fluoridated dentifrices on surface microhardness of the enamel of deciduous teeth.

BACKGROUND: Surface microhardness is a physical property which access the effect of chemical and physical agents on hard tissues of teeth, and a useful way to examine the resistance of fluoride treated enamel against caries. The purpose of this study was to evaluate microhardness of enamel following pH-cycling through demineralization and remineralization using suspensions of dentifrices with different fluoride contents. METHODS: In this in vitro study 56 enamel blocks of primary incisors were soaked in demineralizing solution and four dentifrices suspensions including: Crest 1100 ppm F (NaF), Crest 500 ppm F (NaF), Pooneh 500 ppm F (NaF,) and Pooneh without fluoride. The means and percentage changes of surface microhardness in pre-demineralization, after demineralization and remineralization stages in four groups were measured. The findings of four groups in three stages were compared by, ANOVA, Tukey and paired t-tests. (α=0.05) RESULTS: Average surface microhardness changes of Crest 1100 ppm F, was higher than Crest 500 ppm F, Pooneh 500 ppm F, and Pooneh without fluoride. The percentages of surface microhardness recovery for Crest 1100 ppm F, Crest 500 ppm F, Pooneh 500 ppm F, and Pooneh without fluoride were 45.4, 35.4, 28.6, and 23.7 respectively. Demineralization treatment decreased the surface microhardness of enamel (P<0.05) and the surface microhardness recovery in all groups were significant (P<0.0001). CONCLUSION: Surface microhardness of enamel after remineralization by Crest 1100 ppm F was higher than Crest 500 ppm F, Pooneh 500 ppm F, and Pooneh without fluoride.

Implementation of clinical practice guidelines in dental settings.

OBJECTIVE: This study aimed to determine the knowledge and application of current expert recommendations on antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) both in the United Kingdom and Iran. METHODS: The study used a 3-part postal questionnaire survey of dentists in the United Kingdom (n=467) and Iran (n=200) covering demographic data, antimicrobial prophylaxis prescribing habits for adults treated under local analgesia, and sources of information about recommended schedules and changes in dentists' prophylaxis regimens. RESULTS: Most UK dentists (87%) reported following the British National Formulary guidelines (BNF) on AP. Seventy-five percent of Iranian dentists follow the guidelines of the American Heart Association (AHA). A significant proportion of practitioners prescribed the correct antibiotic regimens for patients who are nonallergic or allergic to penicillin in the United Kingdom, but in Iran the knowledge of and compliance with the available guidelines regarding antibiotic regimens was poor. Although dentists were familiar with the dental procedures that could place their patients at risk, and more than 80% prescribed prophylaxis for patients with "prosthetic heart valves" and "previous bacterial endocarditis," they also considered AP for patients with medical conditions not known to be at risk. For the UK dentists, the most common source of information on AP is medical and dental journals, whereas for Iranian dentists, academic meetings, colleagues, and textbooks were cited as sources of information on AP. Furthermore, 80% of participants in both countries would like to attend further courses about this topic. CONCLUSION: Generally, dentists in the United Kingdom were more familiar with the current expert recommendations on AP than dentists in Iran; however, dentists in both countries tended to overprescribe. This could contribute to the problem of antimicrobial resistance. Educational initiatives aimed at implementing updated recommendations and continuous assessment of dental practice might reverse this trend.

Association of parental stress and early childhood caries.

BACKGROUND: Little research has been carried out on whether the parental stress affects children's oral health in general and dental caries in particular. This study aimed to investigate the association between parental stress and early childhood caries (ECC). METHODS: A cross-sectional study was designed that included 250 children of 4-6 year-old; 127 ones attended the pediatric department of Isfahan School of Dentistry who had early childhood caries and a comparison group of 123 caries free children attended five kindergartens and pre-schools in Isfahan city. Clinical examinations were conducted to evaluate the caries status. The parents of the two study groups completed the self-administrated long form of the Parenting Stress Index questionnaire. Details of their socio-demographic status were gathered too. The collected data were analyzed by SPSS version 11.5. The nonparametric Mantel-Haenszel test for correlation statistics was used to determine bivariate associations between total parenting stress and their domains scores in the two groups; i.e., those with early childhood caries and the caries free group. RESULTS: Mean score of PSI in the early childhood caries and caries free group were 286.66 ± 66.26 and 273.87 ± 31.03, respectively. There was not any significant relationship between total parental stress and ECC. The scores of the following domains of PSI demonstrated significant differences between ECC and CF groups: child reinforcement, child distractibility, child deficit attention, life stress and relationship with spouse (P = 0.01, 0.01, 0.001, 0.005 respectively). CONCLUSION: Findings of this study did not show any significant association between total parenting stress score and prevalence of early childhood caries.