Oral midazolam-grapefruit juice drug interaction.

Oral midazolam is a frequently used sedative in pediatric dentistry. Although an oral form of midazolam is now commercially available, some practitioners continue to use the IV midazolam as an oral medication. If the injectible form of midazolam is administered orally, its bitter taste requires the use of a flavoring agent. Grapefruit juice is contraindicated for this purpose as it inhibits cytochrome P450 (CYP) 3A4. CYP 3A4 is located in the intestine and liver. Inhibition of this cytochrome results in delayed absorption and reduced first pass effect on midazolam. This results in increased blood plasma levels of midazolam of 56% and increased midazolam bioavailability of 35%. This can result in excessive levels of sedation for the pediatric patient. Grapefruit juice is therefore contraindicated for use with oral midazolam.

Pulse oximetry evaluation of vitality in primary and immature permanent teeth.

Present methods of assessing pulp vitality (electric and thermal testing) are of limited use with children, often resulting in false positive or false negative results. Pulse oximetry is a proven, atraumatic method of measuring vascular health by evaluating oxygen saturation (SaO2). This pilot study explores the use of a modified pulse oximetry ear probe to assess pulpal vascular oxygen saturation in primary and immature permanent teeth. Pulse oximetry readily differentiated between known vital and nonvital teeth. Vital teeth consistently provided SaO2 values that were lower than the values recorded on the patients' fingers. Further study of the SaO2 changes in traumatized teeth, with a probe designed specifically for teeth, is warranted by these initial results. Although additional research is indicated, pulse oximetry is already an objective, atraumatic clinical alternative to the present electrical and thermal methods of assessing pulp vitality in children's teeth.

Dental findings in Saethre-Chotzen syndrome (acrocephalosyndactyly type III): report of case.

Saethre-Chotzen syndrome is characterized primarily by facial and digital anomalies. This case report describes multiple dental anomalies in a patient with Saethre-Chotzen, not reported in previous descriptions of the syndrome. These features are teeth with broad, bulbous crowns, thin, narrow tapering roots, and diffuse pulp stones in the pulp chambers of all posterior teeth. These dental findings, along with being associated with the syndrome, may influence dental care for these patients.

Neonatal sublingual traumatic ulceration (Riga-Fede disease): reports of cases.

Neonatal sublingual traumatic ulcerations (Riga-Fede disease) can present as mild to severe ulcerations. The associated pain can interfere with infant nursing and nutrition. The preferred, conservative treatment consists of smoothing rough incisal edges, or placing round smooth composites over the incisal edges. Acute ulcerations, and a need for definite, rapid healing, may require extraction of the neonatal teeth.

Hypothalamic hamartoma in oral-facial-digital syndrome type VI (Váradi syndrome).

Oral-facial-digital syndrome (OFDS) type VI (Váradi syndrome) is an autosomal recessive trait of orofacial anomalies, cerebellar dysgenesis, and polysyndactyly. Developmental anomalies of the posterior fossa, including cerebellar hypoplasia and variants of the Dandy-Walker complex, are the most common central nervous system malformations reported in patients with this syndrome. We report hypothalamic hamartoma, supernumerary maxillary incisor, and precocious puberty in a boy with OFDS type VI. We propose that hypothalamic hamartoma is an occasional manifestation of OFDS type VI.

Chemoradiation therapy: effect on dental development.

Chemoradiation therapy used on pediatric oncology patients often causes dental developmental anomalies that affect future dental care. Defects noted include tooth and root agenesis, root thinning and shortening, and localized enamel defects. Histologically, these defects appear as osteoid-like niches in the developing dentin which alter the overlying enamel. Odontogenic cell sensitivity is dependent upon the position on the cell cycle and the mitotic activity at the time of chemoradiation therapy. Knowledge of the stage of dental development at the time of oncology treatment and the type of therapy allows the clinician to predict dental effects of the chemoradiation. Representative cases illustrate the clinical manifestations of chemoradiation on the developing dentition.

Enhancement of antimicrobial properties of cavity varnish: a preliminary report.

Bacterial contamination beneath amalgam restorations has been a problem in restorative dentistry. Cavity varnish improves the marginal seal but possesses no antibacterial properties, and chlorhexidine gluconate is a known antimicrobial substance. This study investigated the efficacy of a chlorhexidine gluconate/cavity varnish mixture against Streptococcus mutans, S. salivarius, and Escherichia coli. The in vitro results indicated that the addition of chlorhexidine gluconate to cavity varnish improved its antimicrobial properties.

Association between primary dentition wear and clinical temporomandibular dysfunction signs.

Dental wear facets often are considered indicators of temporomandibular dysfunction (TMD). Dental wear facets are common in children, but their association with TMD signs is unknown. A reproducible, clinical evaluation of TMD signs for young children shows no statistically significant association between primary dentition wear facets and clinical signs of TMD (P less than or equal to 0.05). Wear facets in young children do not appear to warrant TMD evaluation or treatment.

Ingestion of dental mirror fragments: report of case.

A case is reported in which one treated pediatric patient gave his plastic, disposable dental mirror to a 2.5-year-old sibling, who while playing chewed on the mirror and the mirrored glass surface broke in the child's mouth. After thorough examination including x-rays, the patient was released with no further complications. Potentially severe injuries could have occurred, resulting in legal liabilities.