Orofacial considerations for pediatric, adult, and elderly victims of abuse.

Health care providers must take the time to educate themselves about domestic violence, its signs and symptoms, and the proper care of victims of child, spouse, or elder abuse. It is not enough to treat the immediate injuries without offering necessary and appropriate intervention on behalf of the victim. No one deserves to be beaten, sexually abused, or emotionally mistreated. If abuse is suspected, report it to the proper authorities. By focusing attention on this major health problem, physicians can provide a leadership role in using health care response to reduce the incidence of abuse and, ultimately, to save lives.

Comparative pharmacokinetics of submucosal vs. intravenous flumazenil (Romazicon) in an animal model.

PURPOSE: This study was performed to determine the bioavailability and local tissue toxicological safety of flumazenil (Romazicon) when administered by oral submucosal (SM) as opposed to intravenous (i.v.) injection. METHODS: Six dogs each received SM flumazenil (0.2 mg), and their serum was collected at predetermined time intervals (0-2 h) and frozen (-70 degrees C). Seven days later, the dogs received an identical dose of i.v. flumazenil, and serum samples were again collected, as above. Comparative quantitation of flumazenil levels (i.v. vs. SM) was made using a sensitive HPLC assay (UV detection). Direct/local drug toxicity was visually scored by unbiased raters of color photographs (test and control mucosa) taken at 1, 2, and 7 days following SM flumazenil injection. An oral pathologist examined slides processed from control and treatment tissues (hematoxylin and eosin staining) taken (punch biopsy) 1 week following SM injection to compare with direct clinical scores. RESULTS: Serum flumazenil levels reached a plateau (8.5 +/- 1.5 ng/mL, mean +/- SD) within 4 min of SM drug injection and declined thereafter to -2 ng/mL by 2 h. Bioavailability of SM flumazenil was 101 +/- 14%, based upon measuring the area under the serum concentration-time curves over 1.5 h (AUC 0-1.5 h, SM vs. i.v. drug). Thus, serum drug levels following SM drug administration were broadly comparable to those obtained during the elimination phase of corresponding i.v. drug delivery. Regarding drug tissue toxicity, no evidence of direct drug toxicity was observed by unbiased raters of color photographs (test and control mucosa) taken at 1, 2, and 7 days following SM flumazenil injection. Following pathologic review, no difference was seen in the degree of inflammation between treatment and control tissue. CONCLUSION: At the quantity and concentration used, SM drug flumazenil administration appears to be both a safe and a viable alternative to bolus i.v. drug delivery and worthy of further investigation.

Preservation of the dentition following removal of a central giant cell granuloma: a case presentation.

Clinical and radiographic presentation of a child with central giant cell granuloma in the early mixed dentition and a suggested conservative management technique for preserving the developing dentition is presented.

Viral infections of the oral mucosa in children: a clinical review.

The oral cavity is a microcosm of the world around us, exposed to a variety of microorganisms present in the local environment. Some of these microorganisms establish a permanent presence in the oral tissues, which serve as a suitable growth medium. These locations include soft and hard tissue, areas of high and low oxygen content, flowing secretions and dryness, and flat or grooved surfaces. Most of the normal oral flora does not cause disease; some even provide a protective benefit. However, occasionally one or more groups become pathologic, producing a disease that may have serious consequences for the host. Many of the pathologic microorganisms are viruses, and children are particularly prone to such infections, since their immune systems are still in the development stage. The learning objective of this article is to review the viral infections of the oral mucosa in children, including varicella, herpes zoster, mononucleosis, and herpangina.

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.

Toothbrushing ability is related to age in children.

Methods to assess toothbrushing ability vary. The purpose of this study was to determine whether age could be a predictor for toothbrushing ability in children. This study evaluated the brushing patterns of 122 children utilizing the horizontal scrub technique. The results obtained suggest that a child's age is a reasonable predictor for toothbrushing ability.