Behavior management techniques among pediatric dentists practicing in the southeastern United States.

PURPOSE: This study identifies those techniques most often utilized by pediatric dentists practicing in the Southeastern United States. It also assesses how the utilization pattern may have changed within the last five years, and identifies those factors that may have influenced the changes as perceived by the practicing dentists. METHODS: A questionnaire was mailed to 528 pediatric dentists who were members of the American Academy of Pediatric Dentistry, or The Southeastern Society of Pediatric Dentistry, or both. RESULTS: The response rate after one mailing and one reminder was 64%. The majority of dentists utilized less aversive behavior management techniques (e.g., parents in the operatory and nitrous oxide oxygen) and had decreased or discontinued use of such controversial techniques as Hand-Over-Mouth-Exercise (HOME) and Hand-Over-Mouth-With-Airway Restriction (HOMAR). The majority of dentists reported that their reasons for changes in the utilization pattern for most techniques were parental influences and legal and ethical concerns. CONCLUSIONS: Chi square analysis indicated significant differences (P < 0.05) in the frequency of use of behavior management techniques and age of practitioner, American Board of Pediatric Dentistry status, type of specialty training, and type of practice.

The incidence, classification, etiology, and embryology of oral clefts.

There are numerous problems encountered among individuals with a cleft lip and/or cleft palate. Addressing these problems necessitates a multidisciplinary approach, requiring a team of experts to facilitate care for these individuals. Dentists play a vital role on the team. An orthodontist, pediatric dentist, oral maxillofacial surgeon, and prosthodontist usually represent the dental members of the team. The success of this team depends on expertise within each discipline but also depends on each member having a broad base of knowledge in general about oral clefts. An understanding of other disciplines and how they approach the treatment of oral clefts is important for each team member. Also, each team representative should appreciate the need to understand the causes of oral clefts, how clefts develop in utero, how various populations are affected, and how to recognize and classify an oral cleft. It is difficult to communicate effectively within the team if we fail to recognize the importance of expanding our knowledge to include other aspects of oral clefts beyond treatment perspectives. This article provides the orthodontist with basic information as it relates to the etiology of oral clefts (ie, genetics, teratogens, and medical conditions), the demographics and incidence of oral clefts, the embryology and classification of clefts.

Apples & oranges: a look at cultural diversity.

Both assimilating into another culture and developing an understanding of our own culture require a process of several stages. With the goal of assisting in the cultural awareness training of home care staff, the author offers some academic theories concerning cultural transitions.

Preanesthesia transfusion and sickle cell anemia patients: case report and controversies.

Preoperative transfusion of sickle cell anemia (SCA) patients prior to general anesthesia is considered a routine procedure to ensure adequate levels of normal adult hemoglobin A to prevent a sickle cell crisis. Blood transfusion risks have led some clinicians to question this procedure. A case report is presented in which a SCA patient developed a delayed hemolytic reaction from a transfusion given prior to dental treatment under general anesthesia. The controversy of transfusion in this patient group is presented.

The assessment of two oral sedation drug regimens in pediatric dental patients.

Oral sedation remains a common method for managing uncooperative and/or extremely fearful pediatric patients requiring dental treatment. The purpose of this retrospective review is to report on the adverse reactions associated with the use of two oral sedation drug regimens commonly employed in pediatric dental patients. Of a combined total of 73 different patient records, 112 sedation cases from the pediatric dental program at the University of Alabama School of Dentistry were reviewed for this report. The two drug regimens were (1) chloral hydrate/promethazine and (2) meperidine/promethazine. Documentation was taken from the sedation cases, which included the following: (1) age, (2) weight, (3) the drug regimen and dosages, (4) the use of nitrous oxide, (5) the effectiveness rating of each sedation, and (6) adverse reactions. The adverse reactions included emesis and oxygen desaturation (hypoxemia) the latter being determined by the use of a pulse oximeter. The results of the study revealed that approximately 48 percent of the sedation cases with pulse oximetry recordings experienced mild to moderate hypoxemia, and in 6.2 percent of the cases, emesis occurred. The review and statistical analysis of the sedation ratings using the nonparametric analog of the t-test indicated no significant difference of effectiveness between the two drug regimens. This study shows that oxygen desaturation occurs frequently in pediatric dental patients being treated with conscious oral sedation techniques and that the prevalence of adverse reactions was similar for the drug regimens evaluated.

Oral hygiene levels and periodontal disease prevalence among residents with mental retardation at various residential settings.

This pilot study compared oral hygiene levels and periodontal disease prevalence among residents with mental retardation in a large traditional state institution, a small regional facility, and community group homes. Plaque scores and periodontal disease levels were high in all groups. However, there was a significant difference (P less than 0.05) among the group home residents, who had lower scores, than the other groups. These results indicate that preventive dental programs are necessary in new residential settings for individuals with mental retardation.

The effect of fluoride in phosphoric acid on enamel fluoride uptake and the tensile bond strength of an orthodontic bonding resin.

Decalcification that occurs adjacent to bonded orthodontic brackets is of great concern to orthodontists. Among the many procedures suggested to overcome this problem is the addition of fluoride to the phosphoric acid (H3PO4) etching solution. The purposes of this study were to determine the loss of fluoride from the acidic etching solutions, to evaluate the effect of various fluoride concentrations in H3PO4 on the tensile bond strength of an orthodontic bonding resin, to determine the amount of total and bound fluoride acquired by etched enamel, and to evaluate the effect of these etching solutions on enamel by scanning electron microscopy. Solutions of 50 m/m% H3PO4 containing 0 and approximately 0.01, 0.04, 0.08, 0.2, 0.4 and 0.9% fluoride were prepared. The fluoride concentrations in the etching solutions remained stable up to 3 months after preparation. The tensile bond strengths of the bonding resin to the etched enamel surfaces were not significantly different. Enamel acquired the greatest amount of total fluoride from H3PO4 solutions containing 0.215% fluoride while the bound fluoride acquired by enamel from the fluoride-containing etching solutions was not significantly different. The addition of fluoride to H3PO4 did not impede the etching effect on enamel.