Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case.

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration.

Background and Objective. Anxiety/pain are experiences that make dental treatment difficult for children, especially during the time of anesthesia. Hypnosis is used in pediatric clinical situations to modify thinking, behavior, and perception as well as, recently, in dentistry; therefore the aim of this study was to evaluate the effectiveness of hypnosis combined with conventional behavior management techniques during infiltration anesthetic. Methods. Anxiety/pain were assessed with the FLACC scale during the anesthetic moment, as well as heart rate variability and skin conductance before and during the anesthetic moment, between the control and experimental group. Results. A marginal statistical difference (p = 0.05) was found in the heart rate between baseline and anesthetic moment, being lower in the hypnosis group. No statistically significant differences were found with the FLACC scale or in the skin conductance (p > 0.05). Conclusion. Hypnosis combined with conventional behavior management techniques decreases heart rate during anesthetic infiltration showing that there may be an improvement in anxiety/pain control through hypnotic therapy.

Colonization levels of Streptococcus mutans between mother and infant: a postnatal prospective cohort study.

OBJECTIVE: To investigate the possible association between maternal S. mutans levels and those of the infant during the period between birth and 5 months and evaluate possible risk factors in the S mutans colonization. STUDY DESIGN: A prospective cohort study was carried out comprising 62 infants and their mothers, selected at the time of childbirth. For each infant, a sample swab was taken at 0, 15, 30, 90, and 150 days postpartum; on the same days, a sample was obtained from the mothers. TYCSB medium was employed for identifying the microorganism, which was later confirmed by Gram staining, the catalase activity test, and the API strep test. RESULTS: The final total sample consisted of 60 infants, from which S. mutans was detected in only 2 (3%) at the 150th day of oral sample collection. Of the sample of 60 mothers, 54 exhibited colonization levels. CONCLUSIONS: In the studied sample pairs up to 150 days, it was not possible to demonstrate the presence of a direct relationship between maternal S. mutans oral levels.