Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study.

Aim: EMONO is an equimolar mixture of oxygen and nitrous oxide. Studies investigating its anxiolytic effect mostly used behavioral scales for assessing anxiolysis in children during dental care. Observing this effect objectively in a pediatric population could be very interesting. Materials and methods: We conducted a prospective uncontrolled monocentric pilot study to assess the equimolar mixture of oxygen and nitrous oxide (EMONO) anxiolytic effect in children during dental care by monitoring heart rate (HR) variation. Results: A statistically significant difference could be highlighted between the HR before the dental care and after 5 minutes of EMONO inhalation, illustrating the anxiolytic effect of EMONO in an objective way. HR variation also suggests that the effect of EMONO seems to prevent a return to the initial level of stress, even during anesthesia. Conclusion: All of the data in the literature confirm the essential role of nitrous oxide in pediatric dental care. Demonstrating the effectiveness of EMONO by objective criteria is necessary. Trial registration: Clinical Trials Unique Protocol ID: RC17_0275. How to cite this article: Clouet R, Dajean-Trutaud S, Grall-Bronnec M, et al. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023;16(2):270-275.

Post-operative discomforts in children after extraction of primary teeth.

OBJECTIVES: This prospective observational study aimed to evaluate discomfort after extraction of deciduous teeth under local anesthesia. The primary objective was to describe the prevalence of post-extraction pain (PEP), post-extraction bleeding (PEB), post-extraction biting injury (PEBI), and analgesic usage in children. The secondary objective was to define whether it is possible to determine a profile of patients or a type of extraction procedure predictive to PEP, administration of analgesics, PEB, or PEBI. METHODS: One hundred and twenty-five children, aged 3-13 years, with indications of at least one deciduous tooth extraction, were included. Immediately after extraction, information concerning the patient and the extraction were collected. Eighteen to 32 hr after extraction, parents were called by phone to request reports concerning the onset and intensity of PEP assessed using the Wong-Baker Faces (WBF) scale, the administration of paracetamol (acetaminophen) to their children, and the appearance of PEB and/or PEBI. RESULTS: Of the children, 37.3% reported PEP (WBF ≥2), but 23.3% of these children did not receive any analgesic drugs to help relieve pain. Pain appeared before 3 hr after extraction in 69% of the children. Higher incidences of PEP and usage of analgesics were found both in the group of children with unfavorable socioeconomic level compared to favorable level and in the group with pre-operative pain compared to no pre-operative pain (p < .05). CONCLUSIONS: About a third of the children reported pain after extraction, but the instructions for pain relief were not followed by all parents. The socioeconomic level of the young patient and the pain felt during the extraction were important predictors of discomfort. Therefore, our study could help the dentist to provide information on predicted post-operative discomfort and to allow suitable care depending on the patient's profile or procedure.

The MEOPAeDent trial protocol-an observational study of the Equimolar Mixture of Oxygen and Nitrous Oxide (EMONO) effects in paediatric dentistry.

BACKGROUND: Many studies were conducted to assess the benefit/risk ratio of EMONO (Equimolar Mixture of Oxygen and Nitrous Oxide) in France before it was authorized for use outside the hospital setting in 2009. The main objective of this project is to evaluate the effects sought and felt by children when EMONO is used in paediatric dentistry. The secondary objectives are to (i) evaluate the appreciation of EMONO by the children, (ii) characterize children who experience both analgesia and anxiolysis, (iii) evaluate children's appetite for EMONO and characterize children with a high appetite and (iv) evaluate the impact of the difference in practice among the French dental service university hospitals on anxiety. The maintenance of a framework for the safe use of this drug, whose place in dental care is fundamental, is essential. Twelve of the 16 French dental service university hospitals agreed to participate in this study. METHODS: MEOPAeDent is an observational, descriptive, transversal study that aims to evaluate the effects sought and felt by children when EMONO is used in paediatric dentistry. Subjects requiring dental care under EMONO are recruited by 12 French dental service university hospitals. Patients aged from 3 to 15 years are recruited for the study when they visit a dental service of a French university hospital requiring dental care under EMONO. The investigator collects the necessary data from the child's medical records, from his own observations and from questions posed to the child and his/her parents. A survey is completed at the first and final sessions of dental care under EMONO. DISCUSSION: This study will provide an evaluation of the effects of EMONO on the French paediatric population in need of dental care as well as evaluate the appetite for the use of this substance. The results will first be used to provide additional data that is essential to monitor the use of a product with an authorization to use it outside of hospitals from 2009 in France, confirm its safety for use and justify its framework of application. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03453411 registered 2 March 2018.

Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry.

BACKGROUND: Many studies were conducted to assess the benefit/risk of equimolar mixture of oxygen and nitrous oxide (EMONO), but evaluating the appetite associated to its use is now getting very little attention in the literature. The purpose of this study was to investigate the effects present, felt, and sought during care by the child related with the 50% nitrous oxide/oxygen (EMONO) sedation used in pediatric dentistry. MATERIALS AND METHODS: All patients in consultation with the Dental Service of Nantes hospital and in need of EMONO were included in the study. In this prospective single-center study, the effects present, felt, and sought during care by the child and the assessment of EMONO appreciation were recorded. The presence of clear signs that the child was trying to extend the duration of the EMONO use was also sought. RESULTS: Only 62% of the patients were presented with an anxiolytic effect, and 40% relative analgesia. Both effects were associated in 33% of children. Over the 76 patients assessed, 12 attempted to extend the duration of the EMONO use (16%). After a bivariate statistical analysis, none of the variables appeared significantly associated with the extension of the EMONO use duration. CONCLUSION: The significant proportion of patients who have prolonged the EMONO use seems to indicate a real attraction for nitrous oxide. This is the first study to evaluate nitrous oxide appreciation on a child. HOW TO CITE THIS ARTICLE: Prud'homme T, Allio A, Dajean-Trutaud S, et al. Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry. Int J Clin Pediatr Dent 2019;12(5):429-436.

Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review.

Neurofibromatosis type 1 (NF1) is a clinically heterogeneous neurocutaneous genetic disorder that manifests in the form of coffee-milk spots on the skin, Lish nodules, lentigines on the underarms and on the inguinal region, and neurofibromas. Orofacial manifestations of NF1 are common. Through a review of the literature, bone lesions, orthodontic and dental abnormalities, periodontal manifestations, and caries related to NF1 will be explored. In this study, we present a clinical case of a patient with neurofibroma in the oral cavity and infraocclusion of primary molars, as well as his dental management. HOW TO CITE THIS ARTICLE: Wotjiuk F, Hyon I, Dajean-Trutaud S, et al. Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review. Int J Clin Pediatr Dent 2019;12(6):577-581.

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia.

Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann's thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper's aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management. How to cite this article: Prud'homme T, Roy E, Soueidan A, Fouassier M, Dajean-Trutaud S, Badran Z. Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia. Int J Clin Pediatr Dent 2018;11(4):344-348.

Twenty-nine-month follow-up of a paediatric zirconia dental crown.

The aim of this paper is to present the long-term follow-up of one paediatric zirconia crown on a deciduous molar. Preformed crowns are part of the armamentarium in paediatric dentistry. In recent years, aesthetic alternatives to preformed metal crowns have been developed, first preveneered crowns and then zirconia crowns. This paper describes the restoration of a primary molar with a zirconia crown (EZ-Pedo, Loomis, California, USA) in an 8-year-old boy. In this clinical case, the protocol for the implementation and maintenance of zirconia crowns is detailed. The patient was followed up for 29 months until the natural exfoliation of his primary molar. The adaptation of the zirconia crown, the gingival health and the wear on the opposing tooth were considered. In this case, the paediatric zirconia crown allowed sustainable functional restoration while restoring a natural appearance of the tooth.

Different applicabilities of the etch-bleach-seal technique for treating opacities on permanent incisor damage by molar incisor hypomineralisation in three young patients.

Enamel opacity on anterior teeth can be prejudicial for the aesthetic appearance of affected patients. Patients with molar incisor hypomineralisation, for example, present opacities that can range from discrete white mottling to extensive yellow-brown discolourations. They can request a treatment to improve their aesthetic conditions. Many techniques have been considered to manage this condition. Wright developed a technique called etch-bleach-seal, which showed promising results for the management of anterior enamel opacities. The aims of this report are to present this technique and to analyse its benefits and inconveniences.

[Extra-oral signs to look for in patients exhibiting oral warning signs of genetic diseases]. / Signes extra-oraux à rechercher face à des signes bucco-dentaires d'alerte de maladies d'origine génétique.

This article is aimed at defining guidelines for dental surgeons to manage patients with warning signs of rare genetic diseases. Anomalies of tooth development may occur as an isolated condition or in association with other symptoms in syndromes. In many cases, dental anomalies may be the first manifestations of a genetic disease. The dentist can contribute to the diagnosis, and hence to an early treatment of this syndrome. When one or more dental anomalies are found, practitioners should refer patients to a genetic clinic or a specialized reference center to diagnose genetic diseases. Therefore, we provide, for the first time, a table of extra-oral signs that dental surgeons can look for in patients exhibiting heritable dental developmental anomalies.

Evaluation of the ability of laser Doppler flowmetry for the assessment of pulp vitality in general dental practice.

OBJECTIVES: In this study we investigated pulpal blood flow (PBF) values and moving blood cell velocity (MBCV) curves recorded by laser Doppler flowmetry (LDF) for pulpal vitality diagnosis in general dental practice and to compare MBCV curves to standard diagnostic tests in traumatology. STUDY DESIGN: LDF tests performed with the PeriFlux System 5000 were applied to vital and nonvital (endodontic treatment) teeth of healthy students (n = 52) and on 24 luxated teeth of patients. RESULTS: The PBF values were not reproducible and no statistically significant differences were observed between vital and nonvital teeth. MBCV curves in contrast could distinguish between the 2 tooth types. Tests on luxated teeth showed that while 62.5% of MBCV curves correlated with conventional vitality tests, only 12.5% of MBCV curves could help in vital diagnosis. CONCLUSION: When applied to luxated teeth, the MBCV curve appeared to be accurate when the standard vitality tests indicated a nonvital diagnosis.