The use of restraint in the treatment of paediatric dental patients: old and new insights.

OBJECTIVE: This article reviews aspects of the restraint strategies in paediatric dentistry that have been reviewed in recent years and point out those strategies that remain controversial as well as questionable. METHODS: Studies that evaluated demographic and cultural factors that influence dentists' use of restraint, discussion of the rationale behind the use of restraint, the role of parents, informed consent, use of restraints at the undergraduate and at the postgraduate level, and some ethical questions were selected. CONCLUSIONS: Practice location, caries prevalence, and the educational backgrounds of the dentist played a role in the selection of behavioural strategies. Use of these techniques varied depending on the age of the dentist and the dental school from which the dentist had graduated. Parents are one leg of the child/dentist/parent triangle and therefore have a role to play in the determination of treatment strategies. Dentists must select techniques that help to instill a positive dental attitude in the child by performing treatment effectively and efficiently. Dentists must inform parents of all aspects of the applied strategy and must have their approval.

Behavior and toothbrushing of young Israeli adolescents.

The purpose of the present study was to assess the toothbrushing behavior of Israeli adolescents attending a pediatric dental clinic, with regard to the maxillary anterior region. One hundred twenty-three adolescents (57 boys, 66 girls, mean age 12.45 +/- 1.76), participated in this study. The amount of plaque extending from the gingival line incisally was measured. Brushing characteristics and daily habits were recorded. In 87 patients, 4 mm or more of plaque were measured on the labial surfaces of the maxillary central incisors, while thirty-six patients demonstrated less than 4 mm plaque. Patients who brushed the maxillary and mandibular incisors separately showed significantly less plaque than patients who brushed them simultaneously. Brushing the maxillary and the mandibular incisors separately was significantly more prevalent in the thirteen-to-seventeen-year-olds, and among girls. Also, significantly more girls brushed twice per day, and for more than three seconds on each incisor.

Reframing--reappraising an old behavioral technique.

Successful reframing converts notions of unpleasantness to notions that are acceptable to the parties involved. However, the basic precursor to successful reframing is that the message conveyed must be consistent with the individuals 'meta' way of thinking and consistent with concepts of reality.

Assessing an active distracting technique for local anesthetic injection in pediatric dental patients: repeated deep breathing and blowing out air.

The aim of the study was to assess the effect of an active distraction technique that included the repeated breathing and blowing out of air on the pain behavior and facial display of children receiving local anesthesia injections prior to dental treatment. Fifty children between the ages of 3 and 7 years and who were undergoing dental treatment in a pediatric dental clinic were selected for this study. The children were randomly assigned to an intervention group or to a control group. The intervention group of 25 children was told to repeatedly breathe deeply before and during the administration of the injection and to blow the air out. The 25 control group children were given the injection in the slow manner without the repeated breathing and air blowing. Children in the intervention group demonstrated significantly less eyelid squeezing (P = 0.04). Also, more children in the intervention group than in the control group significantly expressed their wish to have the same technique used during the second visit (p = 0.033). Children in the intervention group generally demonstrated less hand and torso movements, less eyebrow bulging, and expressed less pain than in the control group. Boys significantly reported less pain after the injection. The results of this study indicate some advantages of distraction techniques (deep breaths and blowing air) prior to and during the administration of a local anesthetic injection in children.

Children's sense of pleasure from nitrous oxide therapy during dental visits.

The purpose of the present study was to measure feelings of pleasure by children who were undergoing dental treatment under nitrous oxide therapy during consecutive treatment sessions, and at a six-month follow-up visit. Fifty-two children between the ages of 3 and 5 years (mean age 4.3 +/- 1.06) children, who required two or more operative treatment visits participated in the study. At the conclusion of the initial treatment and after sufficient time for the effects of the nitrous oxide therapy to subside, patients were asked about their feelings from the gas. At subsequent visits, patients were asked the same questions at the beginning of each treatment session. The same was done at the beginning of a six-month follow-up visit. In general, there was a decrease in pleasure among those who experienced three or more visits. Extraction, in addition to operative treatment, did not result in a decrease in the sense of pleasure from nitrous oxide therapy. A similar response was observed in the recall visits when the reactions of the children were compared with the reactions at the last dental appointment. It is concluded that the sense of pleasure is strengthened through the second visit, but that the sense of pleasure and ability to cope is overwhelmed by the inconvenience of the dental treatment at the third visit.

Valuing dental practice.

Because new dentists are finding that initiating dental practices has become more problematic, the issues of practice purchase and valuation have become more salient. The purchase of a practice, although expensive, decreases the amount of time required before the dentist can experience a profit. This article discusses issues related to valuing, reviews some of the strategies related to the purchase of a practice, and recommends an objective approach to establishing fair market value.

Double-blind study of prednisolone and papase as inhibitors of complications after oral surgery.

Both prednisolone and papase are effective in reducing the oral surgical sequelae of trismus and pain, although prednisolone apparently is the more potent drug. The countervailing case for the routine use of prednisolone includes the relatively serious complications produced in some patients.

A community health center dental program in Boston, U.S.A.

In 1970, a community-based and federally funded dental program was established in Boston. The multiple objectives of this program included the following: provision of dental treatment; education of schoolchildren in dental health; support for community measures of prevention such as water fluoridation; support of job training programs in dental assisting for community residents; employment of community people; and sensitization and training in community health for dental students and auxiliaries. The program provided a number of dental services at a reasonable benefit-cost ratio of 0.87. Other endeavors included the development of a dental health program with community schools and the involvement of dental students in the delivery of care and in screening for children with dental treatment needs.