Effectiveness of buccal administration of dexmedetomidine and ketamine combination in paediatric dental sedation: A randomized controlled clinical trial.

BACKGROUND: Pain and anxiety can be considerable obstacles while treating paediatric dental patients. Moderate sedation is needed to treat uncooperative patients. AIM: This study aimed to compare the effectiveness of buccal administration of dexmedetomidine-ketamine combination versus dexmedetomidine. DESIGN: Fifty-six uncooperative children were randomly assigned into two groups: Group I received buccal dexmedetomidine (2 µg/kg) and ketamine (2 mg/kg) (DEX-KET), whereas Group II received buccal dexmedetomidine (4 µg/kg) (DEX). The effects of drugs were evaluated based on changes in vital signs, onset and duration of sedation, sedation level, analgesia, ease of treatment and procedural adverse effects. RESULTS: There were no significant differences in vital signs or sedation onset between the two groups. DEX-KET group showed shorter recovery time than DEX group (p < .0001). There were no statistically significant differences between both groups regarding sedation level at optimum sedation and during operative procedure (p = .064, p = .069 respectively). The ease of treatment was significantly better in DEX-KET group than in DEX group (p = .048). Procedural side effects and analgesic effects of the sedative drugs were comparable between both groups. CONCLUSION: The combination of dexmedetomidine and ketamine delivered buccally provided a better method of delivering care to uncooperative children with more rapid recovery than dexmedetomidine.

Efficacy of buccal versus intranasal route of administration of midazolam spray in behavior management of preschool dental patients.

OBJECTIVE: To assess the efficacy of aerosolized midazolam, introduced through buccal versus intranasal mucosa in managing uncooperative children undergoing dental treatment. METHOD AND MATERIALS: A crossover randomized controlled clinical trial included 36 children aged 3 to 5 years, rated I or II according to the Frankl scale and ASA I or II. Each child fulfilled the requirement of having a dental condition that needed treatment in two dental settings. They were randomly assigned to one of two groups; either buccal or intranasal aerosolized midazolam was administered at the first visit. The alternate route was implemented with a 1-week washout period in the second visit. Drug acceptance and time until optimum sedation were measured. Crying, sleeping, head resistance, and child overall behavior were assessed using modified Houpt scale. RESULTS: In total, 34 patients (95 %) were drowsy on optimum sedation. There was a statistically higher acceptance of buccal midazolam (P < .001). Onset of optimum sedation was more rapid for the intranasal group, with a mean of 15.50 ± 4.226 minutes (P < .001), while in the buccal group the mean was 22.97 ± 4.582 minutes. No statistical differences were recorded between the two groups in all behavior rating scales, except for crying where the intranasal group was statistically higher (P = .010). Regarding the overall behavior, there was no significant difference recorded between the two groups (P = .204). CONCLUSION: Aerosolized buccal midazolam was more tolerated by the patients. However, intranasal aerosolized midazolam had a more rapid onset of sedation. Both buccal and intranasal administrations of aerosolized midazolam are safe and effective.

Antimicrobial Effect of Propolis Administered through Two Different Vehicles in High Caries Risk Children: A Randomized Clinical Trial.

OBJECTIVE: To investigate the effect of two methods of propolis administration on plaque accumulation and microbial count as well as patient acceptance of each vehicle. STUDY DESIGN: A randomized clinical trial with two parallel arms was used with a sample of 60 high caries risk children 6-8 years old. Children were divided randomly into two groups. Group I: Children who received propolis chewing gum and instructed to chew it twice daily for at least twenty minutes, for two weeks. Group II: children who received propolis mouthwash and instructed to rinse twice daily for one minute. A plaque index was recorded and a plaque sample was collected from all participants at base line and after two weeks of treatment. All participants were asked to rate the preparation they received during treatment period on a Visual Analogue Scale chart. RESULTS: Data showed that propolis had a significant effect on reducing plaque scores and colony counts in both vehicles. There was no significant difference between both vehicles neither on plaque reduction nor on microbial count. However children preferred the gum formula. CONCLUSION: Propolis in both vehicles reduced plaque accumulation and microbial count which recommends its use as an antimicrobial agent in different vehicles.

Comparison between Positive Dental Images and Neutral Images in Managing Anticipatory Anxiety of Children.

OBJECTIVE: To evaluate the impact of positive images versus neutral images on child behavior during dental treatment and their dental anxiety after dental treatment. STUDY DESIGN: Sixty, 4 to 6 year old healthy pediatric dental patients, indicated for pulpotomy and stainless steel crown restorations, were divided randomly into two equal groups. Group I (experimental group viewed positive dental images and group II (control group) viewed neutral cartoon images prior to treatment. Behavior was assessed using Frankl rating scale in all four treatment phases: seating, local anesthesia administration, pulpotomy and overall rating. Patient's anxiety was determined according to Venham Picture Test (VPT) before and after dental procedure. RESULTS: Behavior rating using the Frankl scale showed a statistically significant difference in the two groups in the overall rating (P= 0.003, 0.001 respectively). No statistically significant difference was found between both groups in any of the treatment phases (P= 0.288, 0.060, 0.719 respectively) and between the mean VPT scores before and after procedures (P=0.95, 0.93 respectively. CONCLUSION: Viewing neutral or positive dental images did not have an effect on child's anticipatory anxiety level. However, it is an effective method of improving the behavior in children.

Joubert Plus Syndrome with Self-Mutilation: A Case report.

BACKGROUND: Joubert syndrome is a very rare condition with dismal prognosis. It is characterized by several abnormalities including molar tooth sign on MRI. When coupled with mega cisterna magna- a feature of the Dandy Walker syndrome- it is categorized as Joubert plus syndrome. CASE REPORT: A 16 month old male child with Joubert syndrome was referred to the Pediatric Dentistry Department Clinic, Faculty of Dentistry Alexandria University, complaining of severe tongue and lower lip injury due to self-mutilation. He required multiple teeth extractions under general anesthesia to prevent further tongue and lip mutilation. CONCLUSION: Joubert plus syndrome is a very rare occurring condition. Because self-mutilation is sometimes fatal, a treatment plan tailored to each patient's need is mandatory. A multidisciplinary approach is recommended.

Root maturation and dentin-pulp response to enamel matrix derivative in pulpotomized permanent teeth.

The success of pulpotomy of young permanent teeth depends on the proper selection of dressing materials. This study aimed to evaluate the histological and histomorphometric response of dentin-pulp complex to the enamel matrix derivative (Emdogain(®) gel) compared to that of calcium hydroxide when used as a pulp dressing in immature young permanent dogs' teeth. Dentin-like tissues bridging the full width of the coronal pulp at the interface between the injured and healthy pulp tissues were seen after 1 month in both groups. With time, the dentin bridge increased in thickness for calcium hydroxide but disintegrated and fully disappeared for Emdogain-treated group. Progressive inflammation and total pulp degeneration were only evident with Emdogain-treated group. The root apices of Emdogain-treated teeth became matured and closed by cementum that attached to new alveolar bone by a well-oriented periodontal ligament. In young permanent dentition, Emdogain could be a good candidate for periodontium but not dentino-pulpal complex regeneration.