Social factors associated with pediatric emergency department visits for caries-related dental pain.

PURPOSE: This study was performed to describe and relate sociodemographic factors and management of visits to a pediatric hospital emergency department for caries-related dental pain. METHODS: Retrospective chart review of cases with a verifiable chief complaint of caries-related dental pain in 1998, was conducted using established protocol and trained reviewers. RESULTS: Three hundred of 984 hospital ED dental emergencies met the study's selection criteria and 109 children were six years old or younger. Almost two-thirds (66%) came from single parent families. Fifty-eight percent were self-pay or covered by government programs and the rest had some insurance. African-American children were 45% of cases. Over 80% were from within Franklin County, OH. Only 4 children (1%) had been seen for the same tooth previously. Lower primary molars were most often affected. Race, insurance, parental marital status were not significantly related to follow-up attendance at the facility (P > 0.05). Those living outside Franklin County and under 5 years of age were more likely to attend follow-up appointments (P < 0.05). When compared to the catchment population of Franklin County, this ED sample had six times as many uninsured children, two and a half times more African-Americans, and came from single parent families four and a half times more often. CONCLUSIONS: Children seen in the ED were predominantly poor, from single-parent families, and disproportionately minority, and were different from the catchment area population. These social risk factors were not related to attendance at follow-up.

The effect of electronic dental anesthesia on behavior during local anesthetic injection in the young, sedated dental patient.

PURPOSE: The purpose of this study was to evaluate the effectiveness of the 3M Electronic Dental Anesthesia (EDA) finger electrode on reducing sedated patient responsiveness during local anesthesia administration. METHODS: Thirty patients between the ages of 24 to 48 months, ASA I, and in need of treatment of maxillary anterior teeth using local anesthesia were used in this study. Each of the patients received chloral hydrate (CH) and hydroxyzine (50 mg/kg and 2 mg/kg, respectively). The patients were divided randomly in two groups. The experimental group received activated electronic dental anesthesia (AEDA) while the control group had a nonactive EDA (NAEDA). Physiological parameters were recorded and behavior was videotaped and rated using the Ohio State University Behavior Rating Scale. A repeated-measures ANOVA, Student's tests, and descriptive statistics were used. RESULTS: The results indicated that the heart rate and diastolic blood pressure of both groups were significantly affected as a function of time and dental procedures. A significant effect in the percent change of heart rate between groups was noted during local anesthetic injection with the NAEDA group having an increased heart rate. There was a higher occurrence of movement in the NAEDA compared to the AEDA. CONCLUSION: The EDA appears to be beneficial in reducing the discomfort, as judged by behavioral and physiologic observations, associated with local anesthetic administration in young sedated dental patients.

Effect of dental treatment on the lung function of children with asthma.

In this preliminary study, the authors evaluated whether dental treatment can trigger a reaction in the hyperactive airways of children with asthma, thereby affecting lung function. They also examined the variables, if any, that predict a change in lung function in relation to dental treatment. They tested the lung function of 57 6- to 18-year-old subjects with histories of active asthma, using spirometry before, immediately after and 30 minutes after routine dental treatment. Results revealed a statistically significant decrease (P < .05) in lung function and a clinically significant decrease in lung function in approximately 15 percent of the subjects.

Comparison of temperaments of children with and without baby bottle tooth decay.

Several demographic studies have been done to identify children at risk for Baby Bottle Tooth Decay (BBTD). Discussions have described these children with Baby Bottle Tooth Decay as strong tempered, cranky, restless, and fussy. The parents of these children have acknowledged these behaviors. To determine whether there were differences in temperament, children with Baby Bottle Tooth Decay were compared with children without Baby Bottle Tooth Decay by assessing the nine temperament components described by the Toddler Temperament Scale (TTS) questionnaire. Parents completed the temperament questionnaire and ninety-two children between twelve and thirty-six months old were studied. Scores for the nine temperament components were tabulated and temperament difficulty was determined as defined by the authors of the toddler Temperament Scale. At-test comparison between the two groups revealed no significant difference for the nine temperament components. There was also no difference when comparing clusters of the nine components. The conclusion is that there is no difference in the temperaments between the group of children with Baby Bottle Tooth Decay and the comparison group of children without Baby Bottle Tooth Decay.

Nontraumatic dental emergencies in a pediatric emergency department.

The objectives of this study were to describe nontraumatic dental emergencies among children treated in a pediatric emergency department. The children studied received emergency treatment for a nontraumatic dental problem from December 1992 through November 1993. Among the 1,459 children treated for dental emergencies, 949 had a nontraumatic emergency (65%) and were enrolled in this study. Patients ranged in age from 1 month to 19 years, with a mean age of 6.9 years. Fifty-two percent of patients were male. The teeth were involved in 99% of cases. An abscess was present in 33% of patients; and among these patients, 26% also had a fistula. Pericoronitis was seen in 4% of patients, primary viral stomatitis in 1%, and an eruption hematoma in 0.5%. Caries is the etiology of the problem prompting the emergency department visit in 73% of patients, and baby bottle caries accounted for 18% of all cases of caries. Other etiologies included the late effects of trauma (8%), iatrogenic (7%), idiopathic (3%), and periodontal processes (2%). Tooth extraction was performed in 45% of patients. Findings of this large consecutive series provide a better understanding of this type of visit to the pediatric emergency department.

Relationship of tonsil size on an airway blockage maneuver in children during sedation.

A previous report suggested that airway compromise without self-correction may occur in pediatric dental patients sedated with chloral hydrate (CH) and nitrous oxide (N2O) and may be interpreted as "deep" sedation. The purpose of this institutionally approved study was to determine 1) the association between the size of the tonsils and 2) the degree of expired carbon dioxide (CO2) and oxygen saturation (SaO2) changes to simulated airway obstruction using the Moore head-tilt maneuver for 30 sec or less. Thirty healthy children (ASA I), aged 22-40 months, were evaluated for tonsil size and sedated with CH (50 mg/kg) and hydroxyzine (2 mg/kg) and supplemented with N2O. Pulse oximetry and capnography were used to monitor the child. During the restorative phase when the patient appeared asleep, the head was rolled forward with the chin touching the chest for a period of 30 sec. Changes in SaO2 and CO2 waveform were observed during this period. The results indicated that seven children who had enlarged tonsils had blocked airways (as determined by capnography) lasting approximately 15 sec. The remaining children did not have enlarged tonsils and continued to exchange air appropriately. O2 levels did not change during this period. The results suggest that the likelihood of airway blockage increases with enlarged tonsils. In children without airway blockage, ventilation occurs unimpeded, and attempts to readjust the head may not occur. The association between airway blockage and patient responsiveness is discussed in relation to sedation levels.

Epidemiology of dental trauma treated in an urban pediatric emergency department.

STUDY OBJECTIVE: To describe the epidemiology of traumatic dental injuries to children treated in an urban pediatric emergency department (ED). DESIGN: A descriptive study of a consecutive series of patients. SETTING: The ED of a large, academic children's hospital. PARTICIPANTS: Children presenting to the ED with dental trauma from December 1992 to November 1993. RESULTS: Of 1459 children treated for dental emergencies, 541 had dental trauma (37%) and were enrolled in this study. Patients ranged in age from five months to 18 years. Fifty-nine percent of patients were less than seven years of age, and 59% of patients were male. Falls caused 63% of injuries, followed by being struck (17%), and motor vehicle crashes (2%). Injuries to the soft tissues included lacerations (32%), swelling (8%), abrasions (7%), and contusions (6%). Injuries to hard dental structures included tooth fractures (33%), luxations (18%), concussions (12%), avulsions (8%), and jaw fractures (1%). Tooth luxation and concussion were more common among children less than seven years of age, and fractures to the tooth crown with dentin exposure (Ellis class II) were seen most often among children with permanent dentition (chi 2 = 41.4, P < 0.005). The central incisors were the teeth most frequently traumatized. CONCLUSION: Findings of this large consecutive series provide a useful description of the epidemiology of this common type of pediatric trauma for pediatric emergency care providers.

A comparison of opinions from parents of disabled and non-disabled children on behavior management techniques used in dentistry.

The purposes of this study were to compare the acceptance of pediatric dental behavioral management techniques by 40 parents of children with disabilities with that of 40 parents whose children were not disabled and to determine the effect of prior information on the level of acceptance for both groups of parents. An instrument containing a demographic questionnaire and using a visual analog scale asked parents to indicate acceptance level of hand-over mouth, sedation, restraint using Papoose board, and general anesthesia for either a check-up/cleaning, dental filling, or treatment of a toothache. One half of each parent group received a written description and rationale for the behavior management technique prior to rating acceptance, and the other half did not. Although differences were found between parents of the disabled and non-disabled and between those informed and not informed, only one technique and procedure (restraint for check-up/cleaning) was significantly different for acceptability (p < or = 0.05), and that was between uninformed parents of non-disabled children and informed parents of disabled children. We conclude that having a disabled child or receiving a prior rational for pediatric behavior management techniques was not significantly related to differences in acceptance of the techniques for the procedures described.

Prevalence of dental caries in USAF family members age 3-15.

This study was undertaken to determine the caries prevalence and restorative needs of United States Air Force (USAF) family members ages 3-15. Examinations were performed on 1802 USAF children at five bases. Indexes recorded were: Decayed, Missing, Filled Surfaces (DMFS) for permanent teeth; decayed, filled surfaces (dfs) for primary teeth; and a Dental Restorative Treatment Need Index. Results indicate an increase in the dfs and DMFS index with age, with more caries present in young children located overseas. No significant differences between children of officers and enlisted members were found. A higher dfs and DMFS index was found in other racial families as compared to blacks or whites. This study's overall population sample had a higher dfs index but lower DMFS index than the 1986-87 NIDR survey showed.

The effect of tetracycline on the incidence of postextraction alveolar osteitis.

Four hundred twenty-four mandibular third molar extractions of varied surgical difficulty were evaluated for the occurrence of alveolar osteitis. In 219 of these sockets, tetracycline powder was placed immediately after the tooth was removed. This resulted in a significant reduction in the incidence of alveolar osteitis from 28.7% to 14.6%. There was also a positive correlation between the rate of alveolar osteitis and the increasing depth of the impaction and the degree of surgical difficulty.

Gustatory lacrimation in association with the branchio-oto-renal syndrome.

Branchio-oto-renal (BOR) syndrome is a developmental complex presenting with various combinations of ear pits, branchial cleft cysts, deafness and renal anomalies, which is inherited as an autosomal dominant trait. This report describes a father and 2 children with BOR syndrome in which gustatory lacrimation (GL) was also present in 2 of them. GL is considered to be a rare, non-hereditary type of anomalous, cranial nerve-end organ innervation. Since lacrimal stenosis, which can clinically mimic GL, is also a feature of the BOR syndrome, future reports require lacrimal reflex testing and duct patency evaluation to define this variation in the BOR phenotype.