Comparison of odontogenic and nonodontogenic facial cellulitis in a pediatric hospital population.

Facial cellulitis in the pediatric hospital population can be classified as odontogenic and nonodontogenic. Emergency departments welcome timely diagnosis from consultants as cellulitis is associated with significant morbidity in children. The purpose of this retrospective study is to assist pediatric dentists in recognizing differences between odontogenic and nonodontogenic facial cellulitis and to determine whether odontogenic infections make up a major portion of facial swellings seen upon admission to the hospital. The completed medical records of 100 patients admitted to Children's Hospital of Pittsburgh from 1980-1989 with an ICD-9 diagnosis of facial cellulitis were reviewed. The types of cellulitis were differentiated using admission data. The information reviewed included age, sex, temperature, white blood cell count, location of facial infection, and season of the year. Odontogenic cellulitis comprised approximately 50% of the total hospital facial infections of the records reviewed during the 10-year period. Upon admission, patients with odontogenic and nonodontogenic facial cellulitis have similarities (season of onset during the year, febrile temperature, and location of infection) and differences (mean admission temperature, age at time of affliction, white blood cell count, and most commonly occurring microorganisms.

Teratoid cyst of the floor of the mouth.

Because the term 'dermoid' is frequently used in the literature, some authors believe that this term should be used for all congenital cysts of the floor of the mouth. Three subclasses of congenital floor of the mouth cysts are described in the literature: (1) epidermoid (simple) cysts, (2) dermoid (complex) cysts and (3) teratoid (complex) cysts. The teratoid cyst is the least common. Most of these cases present during the second and third decades of life, thus presentation during infancy is extremely rare. Surgical excision is the treatment of choice. We present a 2-month old male who underwent expedient surgical excision for progressive airway compromise secondary to a teratoid cyst of the floor of the mouth. Radiographic and histopathologic evidence, as well as a review of the literature is presented.

Pharmacokinetics and local responses to submucosal meperidine compared with other routes of administration.

The objective of this study was to determine the time course of the plasma levels of meperidine administered by various routes. Ten healthy adults received 0.8 mg/kg of meperidine given intravenous, submucosal, intramuscular, and 1.4 mg/kg orally in a randomized sequence at a minimum of one-week intervals. Blood samples were collected at 0, 10, 20, 30, 45, 60, 90, 120, 180, 240, 360, and 720 min. The plasma was separated by centrifugation at room temperature. Plasma samples were analyzed for unchanged meperidine by a high-pressure liquid chromatographic assay. Pharmacokinetic parameters were calculated according to standard techniques. Data analysis was accomplished using a 4 x 11 analysis of variance and the Scheffe test for multiple comparisons. Pain response and tissue changes also were assessed using 4-point scales. Significant interaction effects (P < 0.00001) were found between the administration route and the time intervals. The maximum observed concentration of meperidine for the IV and SM routes occurred at the first sample point at 10 min, for the IM route at 20 min, and for the PO route at 45 min. There were no significant differences between the IV and the SM routes at any time interval measured. Post hoc comparisons of the peak values demonstrated significant differences between the IM and PO values (1.4 mg/kg) when compared with the IV and SM routes (P < 0.01). SM route caused greater tissue response and pain reaction, however, the differences were not statistically significant.

High frequency jet ventilation in complete oral rehabilitation.

High frequency jet ventilation (HFJV) has been used recently as an alternative to conventional endotracheal intubation in bronchoscopy and laryngoscopy procedure. The objective of this study was to define the applicability of the system to dental procedures performed on healthy and medically compromised patients. A total of seventeen pediatric patients ranging in age from twenty-eight months to fourteen years were included. The results of this study indicate that this technique is most beneficial for non-extraction cases, especially those with coagulation disorders or significant airway abnormalities. Routine use of this technique is not generally recommended. The physical characteristics of the smaller diameter soft catheter used in HFJV exemplify the advantages of this technique.

Dose-responsive characteristics of meperidine sedation in preschool children.

Using double-blind conditions, 60 uncooperative and fearful preschool children (24-66 months) received intramuscular injections of meperidine 0.25, 0.50, 1.00 mg/lb or placebo prior to restorative dental treatment. Behavior was assessed by the dentist and an independent observer during five specific treatment procedures. Behavioral ratings found meperidine to be an effective sedative, with 0.50 mg/lb and 1.00 mg/lb being significantly more effective than placebo (P less than 0.05, Kruskal-Wallis). Children receiving 1.0 mg/lb of meperidine had significantly more nausea and vomiting than patients receiving lower doses of the drug (P less than 0.05, Chisquare). Physiologic monitoring demonstrated that the highest dose of meperidine was associated with transient drops in arterial oxygen saturation. Meperidine sedation was found to be more effective for older children (37-66 months) and for children initially rated as being only moderately uncooperative and fearful.

Dens invaginatus in a geminated central incisor: case report.

Simultaneous occurrence of gemination and dens invaginatus in the same tooth is reported. Combined surgical and non surgical endodontic therapy was completed, with satisfactory results.

Intrusion of the mandibular condyle into the middle cranial fossa: report of a case in an 11-year-old girl.

Intrusion of the head of the condyle into the middle cranial fossa is a rare but highly significant result of trauma to the mandible. Various treatment modalities for this type of injury have been reported in the literature. This case report concerns the intrusion of the left mandibular condyle into the middle cranial fossa in an 11-year-old girl. Five days after the original injury, severe limitation of opening was noted, as was a significant overjet and posterior open bite. A CT scan revealed intrusion of the left condyle into the middle cranial fossa. Treatment consisted of closed reduction with intermaxillary fixation. At the 10-month follow-up, full range of motion was possible with only minimal deviation.

Effects of Cyclosporin A on gingival status following liver transplantation.

Cyclosporin A, since its introduction, has drastically reduced the morbidity and mortality rates associated with organ transplants. One side-effect of CSA is gingival hyperplasia. This study investigated the effects of CSA given in conjunction with a low dose of steroids on the gingival status of pediatric patients following liver transplantation. A total of 21 such patients were compared with 23 healthy children, matched for age and sex. Data collected included CSA serum levels, gingival width, pocket depth, gingival index and modified plaque index. Using mean total values, there was a significant difference for plaque index, gingival index, pocket depth and gingival width. There was no significant correlation between CSA serum levels and any of the dental factors measured. The experimental group exhibited a statistically significant increase in all dental measurements--an increase that may be due--at least in part--to the higher plaque index in this population.

Emergency care in pediatric dentistry.

The emergency room records of 1,456 children who were treated at Children's Hospital of Pittsburgh with any oral complaint, during a single calendar year, were reviewed with the data entered into a computer. The data were tabulated and statistically analyzed. Trauma (676 visits) was responsible for 46 percent of the total visits, with boys representing a significantly higher percentage of trauma visits than girls (440 vs 236). The total number of trauma visits was also significantly higher for the youngest age-group (birth to three years). Soft-tissue injuries represented a substantially higher percentage of trauma cases (58 percent), compared with dental injuries (35 percent) and bony injuries (3 percent). Emergency dental services are a viable part of emergency services in major population centers; emergency care is an essential component of overall dental services.

Effects of variable alphaprodine dose levels on arterial blood gases in rhesus monkeys.

The administration of alphaprodine submucosally in doses of 0.5, 1.0, and 1.5 mg/kg to ketaminized rhesus monkeys resulted in Po(2) levels significantly lower than those observed for controls (ketamine only) at the 10 min level. There was a significant increase in Po(2) levels between the 10 and 20 min intervals, thereafter, Po(2) levels returned toward normal and were not statistically different from baseline. Higher alphaprodine doses (1.0 and 1.5 mg/kg) resulted in a non-significant increase in Pco(2) values. Monitoring Po(2) levels during sedation seems preferable to monitoring Pco(2) in view of the findings of this study.

The effects of primary molar ankylosis on root resorption and the development of permanent successors.

This study investigated the association of ankylosed primary molars with subsequent clinical problems, and found a significant association between the delay in root resorption of the first and second ankylosed primary molars and the delay in root formation of their permanent successors.

Cephalometric study of American black children with sickle-cell disease.

The effects of sickle-cell disease on skeletal maturation are well documented. The objective of this study was to investigate the possible effects of sickle-cell disease on the growth of the dentofacial complex. The results of this study indicated that: The sickle-cell group seems to have a more protrusive maxilla and a more forward growth tendency of the mandible. The group also exhibited significantly retruded maxillary and mandibular incisors.

Pulpal pathology in relation to discoloration of primary anterior teeth.

Discoloration is the most common sequela to trauma in the primary dentition (Hargreaves, et al, 1981). The significance of this phenomenon has not been properly investigated. The purpose of this study is to investigate histologically pulpal changes in discolored primary anterior teeth following trauma. Twenty-three healthy children ranging in age from one year, eleven months to six years, seven months were included. The sample included teeth with no evidence of abscess formation clinically or radiographically, no history of pain, and no mobility. All teeth had a minimum of three-quarter root length. Shade matching was determined by the same operator, utilizing a Vita Lumin shade guide. Each tooth was anesthetized, isolated, disinfected, then opened. Pulp tissues were extirpated and placed in formalin. Histologic evaluation was performed maintaining a double-blind system of identification. Three major problem areas were evaluated: necrosis, acute inflammation, and chronic inflammation. Each was graded on a four-point scale. Total pulpal necrosis occurred in eleven of the twenty-three specimens. Seven specimens showed complete autolysis. Eight specimens showed dystrophic calcification with associated partial necrosis and inflammation. No healthy specimens were found. There was no apparent correlation between the shade of discoloration and the histologic status of the pulps examined. All discolored teeth showed significant histopathological changes.