Evaluation of the sedative effect of intranasal versus intramuscular ketamine in 2-6-year-old uncooperative dental patients.

BACKGROUND: Conscious sedation has gained more popularity these days, with different routes of drug administration having various advantages and disadvantages. Among all, ketamine is one of the most commonly used drugs in children. OBJECTIVES: The aim of the present study was to compare 2 different routes of ketamine administration - intranasal (IN) vs. intramuscular (IM) - in 2-6-year-old uncooperative children needing dental treatment. MATERIAL AND METHODS: This single-blind, crossover clinical trial was conducted on a group of 26 uncooperative children aged 2-6 years, who required at least 2 similar dental treatment visits. The patients were randomly assigned into 2 groups: group I - IN ketamine at their 1st session and IM ketamine at the 2nd session; and group II - exactly the opposite sequence. The sedative efficacy of the 2 techniques was assessed by 2 independent pediatric dentists based on the Houpt sedation rating scale. The data was analyzed using the Wilcoxon test, the repeated measures analysis of variance (ANOVA) and the least significant difference (LSD) test. RESULTS: The participants showed reduced crying and movement with improved sleepiness at the 3 time points examined when IM administration was performed as compared to IN sedation (p < 0.05). The overall behavior scores were higher for the IM route as compared to the IN route at all tested time points (p < 0.05). The operating dentist and the parents believed that the IM route was significantly more effective (p < 0.05). The children in the IN session reached equilibrium faster than those in the IM session (p < 0.05). No significant statistical differences were noted between the groups with regard to various physiological parameters investigated at different time intervals. CONCLUSIONS: Intramuscular ketamine was more satisfactory and effective than the IN route when sedating uncooperative children for dentistry.

Using implants for prosthodontic rehabilitation of a 4-year-old with ectodermal dysplasia.

Ectodermal dysplasia (ED) is an inherited disorder that affects ectodermally derived organs, such as teeth. Pathogenesis is thought to involve an altered epithelium-mesenchymal interaction. ED patients have oligodontia (or sometimes anodontia) in addition to other abnormalities involving the skin, sweat glands, or hair. Many different subtypes have been introduced in the literature. This article describes the case of a 4-year-old patient who, after being diagnosed with ED, was put on a treatment plan that involved mandibular implants, reshaping of the maxillary primary central incisors, and prosthetic dental rehabilitation. Due to the child's rapid growth, both dentures were changed 9 months post-treatment. Two years post-treatment, the maxillary denture was changed again and the child was placed under close supervision.

Assessing the sedative effect of oral vs submucosal meperidine in pediatric dental patients.

BACKGROUND: THE GOAL OF THIS INVESTIGATION WAS TO COMPARE THE BEHAVIORAL AND PHYSIOLOGICAL EFFECTS OF THREE SEDATIVE DRUG REGIMENS: oral meperidine (OM), submucosal meperidine (SM) and oral midazolam (M) in healthy pediatric patients. MATERIALS AND METHODS: This study sample consisted of thirty children aged 24-72 months (mean = 41.1) exhibiting definitely negative behavior. Three sedative regimens including: Oral meperidine/hydroxyzine, oral midazolam/hydroxyzine and submucosal meperidine/oral hydroxyzine were administered randomly during three consecutive appointments with a crossover design. Houpt behavioral scale was employed for evaluating the sedation effect of each regimen by a calibrated independent Pediatric dentist. Physiologic parameters were also recorded including blood oxygen saturation and pulse rate. Data was analyzed using Wilcoxon-signed ranked test, Mc-Nemar, GEE Logistic regression, Friedman, Fisher exact and Cochran tests for significance. RESULTS: Overall success rates were 50%, 46.7% and 26.7% for submucosal meperidine, oral meperidine and oral midazolam, respectively (P = 0.03). The probability of achieving a success in behavior control was more in 48-72 month olds. Child's age and drug type were the two main predictors of altered behavior. Evaluating the differences between the effects of three tested regimens on recorded physiological parameters showed no significant differences. CONCLUSION: All three regimens were proved safe within the limits of the current study. Meperidine sedation in both routes was considered to be more effective. Although there was less sleep and more head/oral resistance in midazolam group, the difference between groups was not significant.

Stimulatory effect of low-level laser therapy on root development of rat molars: a preliminary study.

Several studies suggest a biomodulatory influence of low-level laser irradiation in the inflammatory and reparative processes of dental tissues. The aim of this study was to investigate the stimulatory effect of 808-nm laser irradiation on root development of rat molars and also to evaluate the histological reaction of pulp and periapical tissues. Twenty-four 30-day-old Wistar male rats were randomly assigned to three-time and five-time laser therapy groups. After initial x-ray, using mammography equipment, laser energy was applied at a wavelength of 808 nm (2 J/cm(2), 100 mW, 20 s) to the midroot area of the lower molars of one side of mouth at repeated intervals of the 48 h. The animals were killed 1 day after the final treatment, and root length development of the experimental samples was compared to contra-lateral non-irradiated molars using mammography. The histological reaction of the pulp and periapical tissue was evaluated under light microscopy. Root development was more advanced in irradiated groups than in the non-irradiated controls (p < 0.001). No significant differences, however, could be found between the root development changes in the three-time and five-time laser therapy groups (p > 0.05). Histological findings showed that the occurrence of secondary cement formation was significantly higher in the irradiation groups compared to the controls (p = 0.003). However, there were no statistically significant differences for the frequencies of pulp hyperemia, periodontal ligament fiber organization, or lamina dura remodeling between the groups (p > 0.05). Under the conditions used in this study, 808-nm low-level laser accelerates the rat molar root development in the presence of favorable histological reactions.

Comparison of neutrophil apoptosis, α-defensins and calprotectin in children with and without severe early childhood caries.

BACKGROUND: The infectious nature of severe early-childhood caries (S-ECC) points to the possible participation of immunologic host responses including neutrophils and their antimicrobial products. OBJECTIVES: The aim of this study was to determine the neutrophil apoptosis, α-defensins (HNP1-3) and calprotectin levels in the saliva of preschool children and the association with S-ECC. METHODS: Oral examinations were performed on 87 children aged 3-5 years and non stimulated whole saliva samples were collected. Thirty of these subjects were considered S-ECC children, 30 with moderate caries (MC) and 27 were caries free (CF). To detect apoptosis, cell staining was done with Annexin-V-Fluos and propidium iodide, and they were analyzed by fluorescent microscopy. The concentration of α-defensins and calprotectin were assessed using ELISA. RESULTS: There were no statistical differences between groups considering the HNP1-3 or calprotectin salivary levels (p=0.06 and p=0.23, respectively). The HNP1-3 and calprotectin levels were negatively correlated and the correlation was significant in MC group (p=0.03). Lower levels of apoptotic neutrophils were obtained from CF subjects as compared with S-ECC children (p=0.03). CONCLUSIONS: Our findings establish that apoptotic mechanisms could be implicated in the immunity responses associated with S-ECC. We cannot yet determine if the level of salivary α-defensins or calprotectin is predictive of S-ECC.

Periodontal manifestation of leukocyte adhesion deficiency type I.

Progressive periodontal disease in leukocyte adhesion deficiency children may lead to severe systemic infections and even death. A five-year-old Iranian male child with leukocyte adhesion deficiency I was first seen in December 2005 at the Pediatric Dentistry Department of Shahid Beheshti Medical University and diagnosed with periodontitis as a manifestation of systemic disease. The treatment approach was based on assessing plaque index, oral prophylaxis, periodic supra and subgingival scaling, in addition to strict oral hygiene instruction with a chlorhexidine prescription and restoration of decayed teeth. The patient attended two dental visits at a one month interval. At the second session, an improvement was seen in the plaque index. Gingival inflammation and bleeding were decreased. Unfortunately he did not regularly attend treatment sessions and at the following examination, progression of periodontitis and bone destruction occurred. The present case emphasizes the need for cooperation between medical and dental professionals, parents and the pediatric patient in order to achieve treatment goals in controlling oral infection in these patients.

Dentin dysplasia type I: a case report and review of the literature.

INTRODUCTION: Dentin dysplasia is a rare hereditary disturbance of dentin formation characterized by defective dentin development with clinically normal appearing crowns, severe hypermobility of teeth and spontaneous dental abscesses or cysts. Radiographic analysis shows obliteration of all pulp chambers, short, blunted and malformed or absent roots and peri-apical radiolucencies of non carious teeth. CASE PRESENTATION: We present a case of dentin dysplasia type I in a 12-year-old Iranian boy, and the clinical, radiographic and histopathologic findings of this condition and treatment are described. CONCLUSIONS: There are still many inconclusive issues in the diagnosis and management of patients with dentin dysplasia. The diagnostic features of this rare disturbance will remain incompletely defined until additional cases have been described. Early diagnosis of the condition and initiation of effective regular dental treatments may help these patients to prevent or delay loss of dentition.

Histopathological evaluation of pulpotomy with Er,Cr:YSGG laser vs formocresol.

The purpose of this study was to histologically investigate whether pulpotomy with Er,Cr:YSGG laser is an acceptable alternative for formocresol. Pulpotomy of 48 dog's primary canine teeth was performed with formocresol or Er,Cr:YSGG laser. Histological evaluations on hematoxylin and eosin-stained pulp tissues were made by an optical microscope 7 or 60 days later. Statistical analysis was performed with Fisher's exact test, Mann-Whitney U test, and Student's t test. Seven days after pulpotomy, samples treated with laser had significantly favorable histological features in the following measures: continuity of odontoblastic layer (P<0.001), presence of hemorrhage (P<0.008), amount of inflammation (P<0.002), tissue necrosis (P<0.001), internal resorption (P<0.002), level of vascularization (P<0.002), and size of abscess (P<0.041). Similar results were observed 60 days after pulpotomy, except that the differences were not mostly significant due to natural exfoliation of 16 teeth. In conclusion, Er,Cr:YSGG laser system is an acceptable alternative for formocresol in pulpotomy of deciduous teeth.

Contamination of dental unit water and air outlets following use of clean head system and conventional handpieces.

BACKGROUND AND AIMS: Dental handpiece is a source of contamination because it is in constant touch with the oral cavity. Sterilization does not seem to be sufficient to prevent penetration of microorganisms into air and water lines of the unit, because negative pressure developed by valves (which are placed in water outlets) and post shut-off inertial rotation of handpiece result in water and debris being sucked into air and water outlets of dental unit. The aim of this study was to compare dental unit contamination following use of clean head system handpieces and conventional handpieces. MATERIALS AND METHODS: Twenty-two dental units in the Department of Pediatric Dentistry in Shahid Beheshti Faculty of Dentistry were used for the purpose of this study. A 1.5×108 cfu/mm3 concentration of Staphylococcus epidermis (SE) was used to contaminate the air and water outlets of dental units. Ten clean head system handpieces and 10 conventional handpieces were used for 30 seconds in the above-mentioned suspension. Microbial samples were collected from the air and water lines. Culturing and colony counting procedures were carried out. Data was analyzed by t-test; a value of p<0.01 was considered significant. RESULTS: Results demonstrated a significantly lower SE contamination in water outlets following the use of clean head system (p<0.01). CONCLUSION: A lower tendency of clean head system handpieces to transmit SE compared to conventional system makes them a better choice for infection control.