Anxiolytic activity of chloral hydrate and hydroxyzine.

The combination of chloral hydrate and hydroxyzine is given frequently to anxious pediatric dental patients. In order to observe and quantify the anxiolytic effects of these drugs given alone and in combination, highly explorative male C57/black mice were tested using the light/dark test box after injecting subhypnotic doses for increased transitions between the light and dark side of the test box. Fifty-one mice were subjected individually to a 10-min test in the box for dose responses following the i.p. administration of 32-, 64-, and 132-mg/kg doses of chloral hydrate; 1-, 4-, 7-, and 10-mg/kg doses of hydroxyzine; or a combination of each of these doses of hydroxyzine and chloral hydrate. The automated test box recorded the number of times a mouse crossed between the two chambers. Doses of chloral hydrate 132 mg/kg and hydroxyzine 1 mg/kg resulted in significantly increased transitions. None of the combinations studied produced significantly increased transitions when compared with the effective doses identified for each individual drug. The paradigm did not support the hypothesis that the anxiolytic effects of chloral hydrate and hydroxyzine are additive or synergistic.

Management of aspiration and swallowing incidents: a review of the literature and report of case.

This article has reviewed aspiration and swallowing incidents in a dental environment with particular emphasis on the young child and the medically, physically and mentally handicapped patient. A thorough review of prevention, signs and symptoms, management and documentation of these incidents has been presented. This review was presented to reaffirm the potential of these incidents and strives to educate the practitioner who treats these special populations. The case report applies reported guidelines for noting signs and symptoms, management and documentation. This case report also affirms the need to check all dental instruments before their use, as a safeguard against possible failure. Current policy for infection control maintains strict guidelines for asepsis. With the increasing use of steam autoclaving and cleansing products, an increased rate of failure may be seen in some instruments. Manufacturers should be contacted for instrument care and sterilization recommendations, as well as projected longevity of the instrument, if their sterilization procedures are followed. The economic implications of replacing instruments because of the protocol for maintaining asepsis will undoubtedly contribute to the rising cost of care. Prevention has been the goal of dentistry for decades and dental emergencies are not excluded. Preparation for such incidents will prevent many incidents and allow for proper patient management should they occur.

Dentist-implemented contingent escape for management of disruptive child behavior.

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.

Evaluation of behavior management technology dissemination in pediatric dentistry.

A survey of the behavior management practices of pediatric dentistry diplomates was conducted. One hundred sixty respondents reported the frequency of use of 15 different management practices. Results show preference for traditional management practices, such as hand-over-mouth, tell-show-do, sedation, and restraint, over newer technology such as live modeling, filmed modeling, contingent distraction, or contingent rewards. Respondents reported management difficulties with nearly one in four children seen and reported the need for alternative, safe, effective management techniques. Reasons are discussed for reliance on traditional management techniques and methods for increasing exposure to newer management technology.