Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol.

PURPOSE: The purpose of this pilot investigation was to study the efficacy, physiologic responses, and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted. METHODS: Using a time-based sedation record, the physiologic responses of 153 healthy children, age range 23 months to 14.5 years, were measured after they had received midazolam (Versed), nalbuphine (Nubain), and droperidol (Inapsine), each administered intravenously, and nitrous oxide and oxygen administered by nasal mask, while each child received comprehensive restorative or surgical dental care. Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines. Heart rate and rhythm, blood pressure, respiratory rate, hemoglobin oxygen saturation, end-tidal CO2, level of sedation, and behavioral responses were recorded preoperatively, at 5 minute intervals during treatment and in recovery until discharge. Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual. RESULTS: For each child, the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment. There were no sedation failures. Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation (P < 0.001, ANOVA). There were no episodes of intraoperative vomiting, hypotension, cardiac arrhythmias, respiratory depression requiring respiratory support, or dysphoria during treatment, in the recovery period, or after discharge. CONCLUSION: This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment.

Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection.

The criteria for diagnosis of HIV-related oral lesions in adults are well established, but corresponding criteria in the pediatric population are not as well defined. The Collaborative Workgroup on the Oral Manifestations of Pediatric HIV infection reached a consensus, based upon available data, as to the presumptive and definitive criteria to diagnose the oral manifestations of HIV infection in children. Presumptive criteria refer to the clinical features of the lesions, including signs and symptoms, whereas definitive criteria require specific laboratory tests. In general, it is recommended that definitive criteria be established whenever possible. Orofacial manifestations have been divided into three groups: 1) those commonly associated with pediatric HIV infection; 2) those less commonly associated with pediatric HIV infection; and 3) those strongly associated with HIV infection but rare in children. Orofacial lesions commonly associated with pediatric HIV infection include candidiasis, herpes simplex infection, linear gingival erythema, parotid enlargement, and recurrent aphthous stomatitis. In contrast, orofacial lesions strongly associated with HIV infection but rare in children include Kaposi's sarcoma, non-Hodgkin's lymphoma, and oral hairy leukoplakia. Treatment recommendations, specific for this age group, have been included for some of the more common HIV-related orofacial manifestations.

Description and epidemiology of nursing caries.

Nursing caries is a virulent form of tooth decay that affects the primary dentition of infants and preschool children. The purpose of this paper is to review the scientific literature to describe the clinical characteristics of this disease and to report on its prevalence in various locations and populations around the world. A Medline search was completed using the key words below. All English-language articles that reported on the prevalence of caries involving the primary maxillary incisors in preschool children in association with feeding habits were included in the review. Nursing caries is associated with ad libitum bottle feeding, particularly at naptime or nighttime, and has been reported in children who engage in demand breastfeeding. A substantial body of literature from numerous countries now exists that documents the prevalence of nursing caries. In developed countries the prevalence is reported to vary between 1 percent and 12 percent. However, in developing countries and within disadvantaged populations in developed countries, the prevalence has been reported to be as high as 70 percent in the preschool population. A universally accepted definition for nursing caries does not exist and methods used to define the condition, establish study populations, and collect prevalence data vary widely among studies. This review provides a detailed clinical description of nursing caries, reviews the characteristics of children who may be at risk for nursing caries, and reviews the prevalence data for nursing caries for countries that have reported it, and suggests directions for research into nursing caries etiology and prevalence.

A survey of dentists and the services they provide to disabled people in the Province of Manitoba.

Persons with disabilities occasionally report that dentists are reluctant to provide them with either dental care or necessary services. There is very little information about the kinds of services that Canadian dentists provide to disabled people. To answer this question, a mail survey, following Dillman's Total Design Method, was undertaken in Manitoba. Questionnaires were mailed to all dentists licensed to practise in Manitoba in 1990. A total of 342 surveys were returned, representing a 62 per cent response rate. In all, 259 (76 per cent) of respondents reported regularly providing dental care to disabled people of all ages who were afflicted by a broad range of disabling conditions. The private dental office was the primary location in which this dental care was provided, but 65 dentists (25 per cent) reported providing dental care in hospitals or other institutions such as nursing homes. Forty per cent of the dentists who reported treating disabled people were willing to accept referrals of new patients with disabilities. Dentists reported providing a full range of dental services to disabled people, and using similar modes of pain control for both disabled and non-disabled patients. The primary mechanism of payment was social assistance programs. Dentists reported that they received adequate compensation (defined as their usual and customary fee) in only 50 per cent of the cases in which they provided dental care to disabled patients. However, 27 per cent of the respondents reported always receiving their customary fee, and 52 per cent indicated that they would be willing to attend continuing education courses offered in the area of special patient care.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective analysis of the costs associated with the treatment of nursing caries in a remote Canadian aboriginal preschool population.

Nursing caries is a specific form of rampant dental caries affecting the majority of preschool aboriginal children who live in the Province of Manitoba, Canada. Since the majority of these individuals live in remote regions of the province access to dental treatment is difficult, resulting in long delays in the provision of treatment and, most likely, significant morbidity associated with dental pain and oral infection. Travel to distant centres for treatment under general anesthesia by pediatric dentists has become the usual method by which treatment is provided to the majority of affected children. We believed that this was an expensive method of providing these necessary services and our purpose was to document all costs associated with the treatment of nursing caries in this population. We analyzed the records of 884 children who were treated for nursing caries between 1980 and 1988 in Manitoba and collected data for costs in the following categories: travel, lodging, medical, dental, hospital and nursing. Our results show that the remote band groups had significantly higher costs (P < 0.001) than groups which were located closer to treatment centres. The costs which accounted primarily for this significant difference were travel and medical costs associated with hospitalization and the administration of general anesthesia. Our results support the need for the redeployment of resources on the basis of regional need and the development of community-based preventive programs and treatment programs which will significantly reduce the incidence of nursing caries in preschool Canadian aboriginal children.

Effect of NaF and pH on the growth and glycolytic rate of recently isolated strains of oral Lactobacillus species.

Twenty-eight fresh and seven type strains of Lactobacillus species were tested for their ability to grow and metabolize glucose in the presence of fluoride. While there was variation between the test organisms, freshly isolated strains were generally more fluoride-tolerant than were the type strains, and a group of seven strains would grow well at pH 4.5 with 5.3 mm NaF. Glucose metabolism by representative strains of this latter group required average fluoride concentrations of 204, 64, and 9.3 mM to inhibit glycolysis completely at pH 7.0, 6.0, and 5.0, respectively. These values are ten times higher than those required to inhibit glucose metabolism by Streptococcus mutans.