Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial.

BACKGROUND: This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. MATERIALS AND METHODS: In this randomized, cross-over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included. Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross-over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients' anxiety and parents' satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon' s signed rank test and Paired t-tests with a P value set at 0.05. RESULTS: Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. CONCLUSION: Both of the drug combinations resulted in acceptable, efficient, and safe sedation outcomes.

Effect of platelet-rich plasma concentrations on the proliferation of periodontal cells: An in vitro study.

OBJECTIVE: The purpose of this study was to evaluate the effect of different concentrations of platelet-rich plasma (PRP) on the proliferation of undifferentiated periodontal ligament (PDL) fibroblasts. MATERIALS AND METHODS: The undifferentiated PDL fibroblasts were obtained from two healthy human premolar teeth and cultured in Dulbecco's modified Eagle's medium. Cell wells were divided into five groups. Experimental groups received 0.1%, 5%, or 50% PRP; the positive and negative control groups were cultured in fetal bovine serum (FBS) 12% and in a medium without FBS 12%, respectively. The plates were incubated at 37°C for 1, 2, 3, 4, and 7 days. PDL cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide proliferation assay. Statistical analysis of the data was accomplished using repeated measure ANOVA and Tukey's test. P < 0.05 was considered statistically significant. RESULTS: The 5% PRP had the greatest effect on undifferentiated fibroblast proliferation, which was significant on the 3rd day. There was no significant difference between 0.1% PRP and positive control during the first 3 days. The group with 50% PRP presented significantly lower proliferation, compared to other experimental and control groups. CONCLUSIONS: It may be concluded that the growth-stimulating effect of PRP is dose dependent with the best results in low concentrations.

Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety.

OBJECTIVE: Providing a safe and efficient dental treatment for a young patient is a challenge for the dentist and the child. The purpose of this study was to investigate the effectiveness, safety and acceptability of buccal midazolam in dental pediatric patients and to compare it with oral Midazolam. METHODS: Eighteen uncooperative healthy children aged 2.5-6 years were randomized to each of buccal midazolam (0.3mg/kg) or oral midazolam (0.5mg/kg) at the first visit, the alternative has been used at the second visit in a cross-over manner. The study took place at pediatric dentistry clinic of Shahed University, Tehran, from November 2011 to June 2012. The patients' vital signs and behavioral scores were recorded. The patient, the operator and the observer were blinded to the applied medication. Post operatively, patients' and parents' satisfaction were assessed by Visual Analogue Score and a questionnaire respectively. The P-value was set at 0.05 for significance level. FINDINGS: There were no significant differences in physiologic factors in the medication groups at time 0, 10, 20, 30 minutes and discharge. There was also no significant difference between the two groups in behavioral parameters. The majority of parents rated both sedative agents as "effective" or "very effective" and their children mostly were without anxiety or with minor anxiety. CONCLUSION: Buccal midazolam may be safely and efficiently used in sedation of pediatric dental patients.

Effect of Anticipatory Guidance Presentation Methods on the Knowledge and Attitude of Pregnant Women Relative to Maternal, Infant and Toddler's Oral Health Care.

OBJECTIVE: The prenatal period is the best time for health interventions. The aim of this study was to evaluate the effects of different methods of anticipatory guidance presentation on the change of knowledge and attitude of pregnant women regarding oral healthcare in the mother, infant and toddler. MATERIALS AND METHODS: In this quasi-experimental study, 90 pregnant women attended one health center in Zahedan, Iran; they were divided into direct intervention, indirect intervention and control groups. A self-reported questionnaire was completed before intervention. The guidance was presented to the direct intervention group, by PowerPoint and to the indirect group by pamphlet. Immediately after the intervention, the questionnaire was completed by intervention groups and two months later by all participants. Difference in the scores at start and end was calculated. Mann-Whitney, Kruskal-Wallis with Dunn's post hoc and Friedman with K-W post-hoc tests were used for statistical analysis. The data was analyzed using SPPS version 19 software at a significance level of 0.05. RESULTS: The change in scores of knowledge relevant to maternal, infant and toddler's oral health and attitude toward maternal oral healthcare had significant differences in the three studied groups (P>0.05), The changes of scores in the four mentioned variables in the intervention groups were significantly higher than controls. In comparison between the intervention groups, the change in score of knowledge about maternal oral healthcare was significantly higher in the direct intervention group (P=0.023). CONCLUSION: Anticipatory guidance presentation led to change in the score of knowledge about maternal, infant and toddler's oral health and attitude towards maternal oral health in comparison to no presentation. The direct presentation had superiority over indirect in increasing knowledge about maternal oral healthcare.

The effect of using different rinsing angles on the micro-tensile bond strength of the sealant to the etched enamel.

BACKGROUND: Attempts to enhance bond strength of the sealant have been among the most important sides of dental research. AIM: The purpose of the present study was to evaluate the effect of using different rinsing angles on the micro-tensile bond strength of the sealant to the etched enamel. SETTINGS AND DESIGN: Experimental study. MATERIALS AND METHODS: Sixty first-premolars were randomly assigned to six groups based on the rinsing angle applied (15°, 30°, 45°, 60°, 75°, and 90°). Following etching and rinsing, a 4-mm height build up of sealant material was created. Bonded specimens were sectioned into sticks (1 × 1 mm), which were subjected to micro-tensile bond strength, testing at a cross-head speed of 0.5 mm/min. STATISTICAL ANALYSIS USED: The data were analyzed by Kolmogorov-Smirnov and post-hoc Tukey test. RESULTS: The tensile bond strength in specimens rinsed at 90° were statistically higher compared to those rinsed at 15° and 30° (P < 0.05), and increasing the angle from 15° to 90° was correlated with a reduction in the number of specimens with adhesive failures. CONCLUSIONS: Rinsing the conditioned enamel surface at 90° may improve the bond strength and retention of the sealant.

Assessment of nickel release from stainless steel crowns.

OBJECTIVE: Adverse effects of dental materials, especially metals, have been an important issue in recent decades. PURPOSE OF STUDY: The purpose of this study was to determine the amount of nickel released from stainless steel crowns in artificial saliva. MATERIALS AND METHODS: In this in-vitro study, 270 stainless steel crowns were divided into five groups, each with nine subgroups. Each group (I to V) was comprised of four, five, six, seven and eight crowns, respectively. Each subgroup was placed in a polyethylene jar containing artificial saliva and held in an incubator at 37°C for four weeks. The amount of released nickel was determined on days 1, 7, 14, 21 and 28, using an atomic absorption spectrophotometer. Wilcoxon Signed-Rank and Kruskal-Wallis with Dunn's post hoc tests (SPSS software, v. 18) were used for statistical analysis at a significance level of 0.05. RESULTS: The mean level of nickel on day 1 was more than that of day 7; this difference was statistically significant for all groups (P < 0.05), except for group II (P = 0.086). Also, the mean difference of released nickel between the groups was significant on day 1 (P = 0.006) and was insignificant on day 7 (P = 0.620). The nickel levels were zero on days 14, 21, and 28. CONCLUSION: The amount of nickel was below the toxic level and did not exceed the dietary intake.

The effect of using different rinsing angles on the micro-tensile bond strength of the sealant to the etched enamel.

BACKGROUND AND OBJECTIVES: Attempts to enhance bond strength of the sealant have been among the most important sides of dental research. The purpose of the present study was to evaluate the effect of using different rinsing angles on the micro-tensile bond strength of the sealant to the etched enamel. MATERIALS AND METHODS: Sixty first-premolars were randomly assigned to six groups based on the rinsing angle applied (15°, 30°, 45°, 60°, 75° and 90°). Following etching and rinsing, a 4-mm height build-up of sealant material was created. Bonded specimens were sectioned into sticks (1 mm × 1 mm), which were subjected to micro-tensile bond strength, testing at a cross head speed of 0.5 mm/min. STATISTICAL ANALYSIS USED: The data were analyzed by Kolmogorov-Smirnov and post-hoc Tukey test. RESULTS: The tensile bond strength in specimens rinsed at 90° were statistically higher compared to those rinsed at 15° and 30° (P < 0.05) and increasing the angle from 15° to 90° was correlated with a reduction in the number of specimens with adhesive failures. CONCLUSIONS: Rinsing the conditioned enamel surface at 90° may improve the bond strength and retention of the sealant.

The Effect of Calcium Pre-Rinse on Salivary Fluoride After 900 ppm Fluoride Mouthwash: A Randomized Clinical Trial.

OBJECTIVE: Calcium fluoride deposit during fluoride application. Uptake and retention of fluoride by saliva depends generally on the concentration of calcium. In this study, the effect of calcium pre-rinse on salivary fluoride concentration after a 900 ppm fluoride mouthwash was investigated. MATERIALS AND METHODS: This cross-over double-blind randomized clinical trial was conducted in a girls' dormitory in Zahedan University of Medical Sciences, southeast Iran. In this study, 42 female dental students were chosen using simple randomization. During the first phase, 21 subjects (group A) used fluoride rinse (F regimen) and the remaining (group B) used calcium pre-rinse followed immediately by fluoride rinse (Ca + F regimen). In the second phase, participants rinsed using the mouthwashes not previously used. Prior to each phase prophylaxis was performed and no fluoridated product was used during a two-week interval between the phases. Salivary samples were taken immediately before (baseline), 1 and 12 hours after rinsing. The salivary fluoride concentration was determined using fluoride sensitive electrode. Repeated measures ANOVA was used for statistical analysis and the significance level was set at P<0.05. RESULTS: There was significant difference between fluoride concentrations at different time points (P< 0.001). Significant differences were observed when the different time points of two regimens were examined. In contrast to this, the baseline before using F regimen and the baseline before using Ca + F regimen did not show any significance (P= 0.070). CONCLUSION: Pre-rinsing with calcium before fluoride is recommended because of significant increases in salivary fluoride concentration.

Dentinogenesis imperfecta associated with osteogenesis imperfecta.

This paper presents a case with dentinogenesis imperfecta (DI) associated with osteogenesis imperfecta. Systemic and dental manifestations of OI and its medical and dental treatments are discussed in this paper. A 5-year-old child with the diagnosis of OI was referred to the Dental School of Shaid Beheshti University of Medical Sciences. On clinical examination yellow/brown discoloration of primary teeth with the attrition of the exposed dentin and class III malocclusion was observed. Enamel of first permanent molars was hypoplastic. Radiographic examinations confirmed the diagnosis of DI. A histological study was performed on one of the exfoliating teeth, which showed abnormal dentin. Primary teeth with DI were more severely affected compared to permanent teeth; enamel disintegration occurred in teeth with DI, demonstrating the need for restricts recalls for these patients.

Molar incisor hypomineralization: a study of prevalence and etiology in a group of Iranian children.

OBJECTIVE: The aim of this study was to investigate the prevalence of molar incisor hypomineralization (MIH) and its relationship with systemic conditions in a group of Iranian children. METHODS: The study population comprised of 433 7-9 year olds, from four schools in Zahedan, Iran. Subjects were evaluated clinically by one examiner, and at a separate session, their mothers completed a coded medical history questionnaire. Hypo-mineralized molars and incisors were recorded based on DDE (developmental defects of enamel) index and DMFT (number of decayed, filled and missing teeth) was determined. Statistical analyses were performed using Chi-square and independent sample t-tests. FINDINGS: Fifty-five (12.7%) children showed MIH. The overall mean number of affected teeth was 0.2. The mean value of DMFT in MIH children was greater than in normal children. Demarcated opacities were the most frequent (76%) enamel defect. Mother's and child's medical problems during prenatal, perinatal and post natal period were significantly remarkable in MIH children. CONCLUSION: The prevalence of MIH in a group of Iranian children was 12.7%. Prenatal, perinatal and post natal medical conditions were more prevalent in children affected by MIH.

Microleakage of stainless steel crowns placed on intact and extensively destroyed primary first molars: an in vitro study.

PURPOSE: The purpose of this investigation was to evaluate the effect of residual tooth structure on the microleakage of stainless steel crowns cemented with glass ionomer on primary maxillary and mandibular first molars. METHODS: Thirty extracted primary molars were divided into 2 groups: group 1 included intact teeth; and group 2 included extensively carious samples. Each tooth received standard preparation, and each crown was luted with G-CEM on its specific specimen. Teeth were loaded vertically and transferred to distilled water. After thermocycling and immersing in methylene blue solution, the teeth were sectioned and examined microscopically for microleakage. Data were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests. RESULTS: All specimens (intact and damaged teeth) had microleakage, although most of these presented only minimum microleakage. No statistically significant differences were found in the microleakage of sound and extensively carious teeth on either the buccal (P=.62) or lingual (P=.65) side. Buccal (P=.73) and lingual (P=.63) surfaces showed similar microleakage scores in primary maxillary and mandibular molars. CONCLUSIONS: There was no significant difference in the microleakage of sound or extensively carious teeth and primary maxillary or mandibular first molars.

The Prevalence of Bruxism and Correlated Factors in Children Referred to Dental Schools of Tehran, Based on Parent's Report.

OBJECTIVE: Bruxism is defined as the habitual nonfunctional forceful contact between occlusal tooth surfaces. The aim of this study was to determine the prevalence of bruxism and correlated factors in children referred to dental schools of Tehran, based on Parent's report. METHODS: This cross-sectional descriptive study was conducted on 600 4-12 year-old children with a mean age of 7.4±2.4 years, who were referred to four dental schools in Tehran. After collecting information with questionnaire filled out by parents, χ(2), Fisher Test, Mann-Whitney and t-Test were used to analyze the data. FINDINGS: The prevalence of bruxism was 26.2%. Bruxism begun in average at the age of 4.9±2 years. Also it occurred 2.6 times more in children who had a family history of bruxism (father-mother), compared to children who didn't have such a history. 87% of children with bruxism had a history of distressing events in their life, and 13% of children with bruxism did not report any history of distressing events in their life. In this study most common oral habit was nail biting. In study of parasomnias, drooling was the most, and snoring the least reported sleep disorder. Bruxism in children with drooling was twice more than in other children. The prevalence of bruxism in children with temporomandibular disorder was 63.6% and in children without TMD was 24.7%. CONCLUSION: Based on Parent's report, 26.2% of children showed bruxism and there was a significant relation between bruxism and mother's job, family history, distressing event in life, parasomnias, especially drooling and sleep walking, TMD, hyperactivity, depression, acrophobia and lygophobia.