Adverse Events in Pediatric Dental Practice: Survey of Pediatric Dentists in the United States.

Purpose: To survey pediatric dentists in the United States regarding adverse events during dental care for children. Methods: A self-administered, anonymous online survey was sent to American Academy of Pediatric Dentistry members (N equals 6,327) using REDCap® software (between October and December 2019). The questionnaire (all items with radio-button numerical categories) included five items surveying pediatric adverse event occurrence and seven demographic items. Annualized occurrences of adverse events in US pediatric dental practices were extrapolated from the data collected. Results: The survey response was 11 percent (n equals 704), with 91 percent of respondents reporting that at least one child experienced an adverse event during dental treatment. The two most prevalent adverse events, each reported by 82 percent of respondents, were self-inflicted trauma to soft tissues after local anesthesia and nausea and vomiting, with annualized estimates of 7,816 and 7,003, respectively. Major adverse events (respiratory depression, cardiovascular depression, neurological damage, death) during pediatric dental treatment were reported by 14 percent of respondents (annualized estimate equals 443). "Wrong" errors (wrong tooth/wrong procedure/wrong patient) were reported by 24 percent of respondents (annualized estimate equals 600). Conclusions: Adverse events during pediatric dental care are of noticeable concern with some (wrong tooth/wrong procedure/wrong patient errors) that can be procedurally mitigated.

Pharmacotherapy for the Pediatric Dental Patient.

Dental caries continues to be a common public health issue, affecting children worldwide. In order to provide safe and effective dental care to children, practitioners must possess a fundamental understanding of pharmacological principles and how they differ in pediatric patients versus adult patients. This article will review pediatric pharmacokinetic and pharmacodynamic changes, with emphasis on commonly prescribed medications in dental practice, including local anesthetics, antibiotics, and analgesics. These medications must be dose-adjusted appropriately when used in pediatric patients to avoid significant adverse effects and toxicity.

Retinoid X Receptor-selective Signaling in the Regulation of Akt/Protein Kinase B Isoform-specific Expression.

The differentiation and fusion of myoblasts into mature myotubes are complex processes responding to multiple signaling pathways. The function of Akt/PKB is critical for myogenesis, but less is clear as to the regulation of its isoform-specific expression. Bexarotene is a drug already used clinically to treat cancer, and it has the ability to enhance the commitment of embryonic stem cells into skeletal muscle lineage. Whereas bexarotene regulates fundamental biological processes through retinoid X receptor (RXR)-mediated gene expression, molecular pathways underlying its positive effects on myogenesis remain unclear. In this study, we have examined the signaling pathways that transmit bexarotene action in the context of myoblast differentiation. We show that bexarotene promotes myoblast differentiation and fusion through the activation of RXR and the regulation of Akt/PKB isoform-specific expression. Interestingly, bexarotene signaling appears to correlate with residue-specific histone acetylation and is able to counteract the detrimental effects of cachectic factors on myogenic differentiation. We also signify an isoform-specific role for Akt/PKB in RXR-selective signaling to promote and to retain myoblast differentiation. Taken together, our findings establish the viability of applying bexarotene in the prevention and treatment of muscle-wasting disorders, particularly given the lack of drugs that promote myogenic differentiation available for potential clinical applications. Furthermore, the model of bexarotene-enhanced myogenic differentiation will provide an important avenue to identify additional genetic targets and specific molecular interactions that we can study and apply for the development of potential therapeutics in muscle regeneration and repair.