Attitude and Practices of Paediatric Dentists towards Parental Guidance on Dental Trauma. A cross-sectional survey.

AIM: There is a lack of sufficient information about the protocols followed by paediatric dentists in informing parents about traumatic dental injuries as a part of anticipatory guidance. Hence, the aim of this study was to assess paediatric dentists' attitudes and practices about parental guidance regarding these injuries. MATERIALS: This was a cross-sectional survey conducted using a validated questionnaire emailed through Google form to approximately 2500 paediatric dentists in various world regions. The sampling method used was a list-based sampling frame followed by simple random sampling. Participants were recruited through national member societies of the International Association of Paediatric Dentistry, personal contacts and social media groups. Only paediatric dentists with at least three years of experience after their post-graduation were only included in the study. Their attitudes and practices towards parental education on dental trauma during the child's first and recalled dental visits were assessed as per their age, gender, country of post-graduation qualification and years of experience in the profession. Chi-Square test was used to evaluate the association between the paediatric dentist response and the continent of practice. Kruskal-Wallis H test was used to assess the level of significance within each variable in relation to the continent of practice. A 95% confidence interval with a significance level of α = 0.05 was used. CONCLUSION: The overall attitude and practice of paediatric dentists toward parental education on traumatic dental injuries were not satisfactory. Many paediatric dentists do not impart education on emergency care and dental trauma prevention in primary teeth. Parents should be informed about oral hygiene instructions and prevention-oriented interventions during the first visit and about managing traumatic dental injuries.

Dose-dependent effects of intravenous alprazolam on neuroendocrine, biochemical, cardiovascular, and behavioral parameters in humans.

Neuroendocrine, biochemical, cardiovascular, and behavioral parameters were assessed in seven normal volunteers for 2 h after intravenous administration of alprazolam (APZ). Three doses of APZ (0.003, 0.007, and 0.02 mg/kg) were administered to each subject in a random order with at least 4 days between infusions. Plasma growth hormone and sedation increased in a dose dependent manner after APZ, and there was a dose dependent change in the shape of the cortisol response to APZ. No dose-response relationships were evident for plasma ACTH and norepinephrine. These differences in dose-response relationships may reflect the involvement of multiple systems in controlling neuroendocrine, biochemical, and subjective responses to APZ infusion. The optimal dose of APZ needed to produce a neuroendocrine or behavioral change appears to differ depending on the parameter of interest.

Self-injurious behavior in the developmentally disabled: assessment techniques.

Self-injurious behavior (SIB) is a major cause of difficulty for the developmentally disabled person. Causes are varied, but medical, neurological, and psychiatric disorders should be considered before nonspecific approaches to treatment are chosen. A careful assessment should include a thorough medical and psychiatric evaluation as well as laboratory and diagnostic studies. Various assessment instruments are available to aid in the evaluation process and, to some extent, in the evaluation of the effectiveness of treatment for SIB.

Self-injurious behavior in the developmentally disabled: pharmacologic treatment.

The current status of pharmacological treatments of self-injurious behavior (SIB) and aggression in persons with mental retardation and autism was reviewed in the literature. Much of the existing literature is derived from anecdotal clinical experience, with a relative lack of well-controlled studies to determine the efficacy of different treatments. Although all psychotropics have been used to manage SIB and aggression, particularly promising are the data on the use of opioid antagonists like naltrexone. Beta-blockers may also have some role, but more controlled, systematic studies are needed. Use of neuroleptics is on the decline because of their adverse effects, such as tardive dyskinesia and possible impairment of cognitive functions. We assert that the behavioral problems of SIB and aggression are at times manifestations of different psychiatric syndromes. They present in a modified, atypical form in the developmentally disabled population because of cognitive limitations. Further understanding and classification of the psychopathology associated with this behavior is essential for its successful treatment.

ECT treatment does not enhance neuroendocrine responses to serotonergic challenge.

We prospectively investigated the effects of a course of electroconvulsive therapy (ECT) on neuroendocrine responses to serotonergic challenge in five depressed patients. Low dose intravenous chlorimipramine (CMI) challenge produced a modest release of prolactin and significant increases in plasma adrenocorticotrophic hormone (ACTH) and cortisol. Interestingly, ECT did not alter the neuroendocrine responses to serotonergic challenge despite clinical response in four of the five patients. If anything, the modest prolactin (PRL) response to CMI, rather than being enhanced, appeared to be abolished following ECT. Using confidence intervals, we estimate that there is less than a 5% probability of a 78% increase in prolactin response to CMI after ECT. To detect this, a sample size of greater than 35 would be needed. These findings suggest that neither ECT nor the clinical response in severely depressed patients is likely to produce consistent changes in neuroendocrine response to the acute serotonergic effects of CMI infusion. The lack of effect of ECT on prolactin response to serotonergic challenge might be explained by simultaneous enhancement of both serotonergic and dopaminergic neurotransmission.

Pharmacokinetic and dynamic correlates of intravenous alprazolam challenge.

The concentration-effect relationship of alprazolam plasma concentration and growth hormone changes was studied in six healthy volunteers by use of three different intravenous bolus doses of alprazolam (0.003, 0.007, and 0.02 mg/kg) in a random blind order. There was a linear increase in peak concentration (Cmax) and area under the curve (AUC) of alprazolam with increasing dose (r = 0.96). There was no significant correlation between alprazolam Cmax and effect on growth hormone measured as either maximum increase or maximum percentage change from baseline. There was, however, an overall positive correlation (r = 0.58) between the AUC values of alprazolam and growth hormone from 0 to 120 minutes, although the relative degree of increased AUC of growth hormone with increasing AUC of alprazolam varied greatly across individuals. The difficulties of interpreting the mechanisms underlying differential growth hormone responses even when concentration of stimulus is controlled are discussed.

Hypothalamic--pituitary--adrenal axis and monoamine transmitter activity in depression: a pilot study of central and peripheral effects of electroconvulsive therapy.

Central and peripheral measures of hypothalamic--pituitary--adrenal (HPA) axis and monoamine neurotransmitter activity were assessed in 8 depressed patients during a medication-free period and again after completion of a course of electroconvulsive therapy (ECT). Seven patients responded fully to ECT. At baseline there was corresponding activation of the HPA and noradrenergic systems, with apparent elevation in cerebrospinal fluid (CSF) concentrations of corticotropin-releasing hormone (CRH) in some patients. Neither CRH nor adrenocorticotropin (ACTH) in CSF changed significantly after ECT, with a mean 10% decline in CSF CRH. Urinary free cortisol (UFC) excretion was high both before and after treatment. Although peripheral noradrenergic hyperreactivity at baseline appeared to normalize with ECT, CSF concentrations of the principal norepinephrine metabolite, 3-methoxy-4-hydroxyphenyl-glycol (MHPG) were unaffected and remained correlated with CSF CRH. In contrast, there were increases in the CSF levels of the main metabolite of serotonin in half the patients.