Post-sedation events in children sedated for dental care.

Moderate oral sedation is used in pediatric dentistry for safe delivery of dental care to children. However, there is a paucity of data on the effects of pediatric dental sedations after discharge of children from the dental office. The purpose of this study was to evaluate and compare the incidence of adverse events occurring with meperidine and hydroxyzine versus midazolam alone 8 and 24 hours after sedation in pediatric dental patients. In this prospective study, a convenience sample of 46 healthy children presenting to a private pediatric dental practice for dental treatment needs was selected. A telephone survey of the parents of children sedated with either meperidine and hydroxyzine or midazolam alone was conducted 8 and 24 hours after the administration of sedation medications. Data analysis included descriptive statistics, frequency and proportion analysis, and Fisher exact test. Forty children were sedated with meperidine and hydroxyzine, and 6 who were sedated with midazolam. In both groups, 50% of the children slept in the car on the way home. Three children in the meperidine and hydroxyzine group vomited in the car. A significantly larger proportion of children in the meperidine and hydroxyzine group experienced prolonged sleep at home (P = .015). More children in the midazolam group exhibited irritability in the first 8 hours (P = .07). There were no statistical differences between the 2 groups with respect to incidence of pain, fever, vomiting, sleeping in the car, snoring, and difficulty in waking up. The lingering effects of orally administered sedation medications can lead to prolonged sleep, irritability, and vomiting in children after they have been discharged from the dental clinic. Most of these events occurred within the first 8 hours, but in some children the effects were seen up to 24 hours later.

Management of avulsed permanent incisors with closed apices and prolonged extraoral dry time.

This article reports the clinical management and outcome of two avulsed permanent incisors that were kept dry for 42 hours. Dental trauma guidelines were followed and clinically successful outcomes were seen until seven months of follow-up. The factors contributing to successful management of this case despite the extreme clinical circumstances were attributed to pulp extirpation prior to replantation, doxycycline soak, fluoride soak, and timely endodontic treatment. Recent advances and alternate treatment modalities reported in literature are evaluated in the discussion.

Tropospheric ozone assessment report: Global ozone metrics for climate change, human health, and crop/ecosystem research.

Assessment of spatial and temporal variation in the impacts of ozone on human health, vegetation, and climate requires appropriate metrics. A key component of the Tropospheric Ozone Assessment Report (TOAR) is the consistent calculation of these metrics at thousands of monitoring sites globally. Investigating temporal trends in these metrics required that the same statistical methods be applied across these ozone monitoring sites. The nonparametric Mann-Kendall test (for significant trends) and the Theil-Sen estimator (for estimating the magnitude of trend) were selected to provide robust methods across all sites. This paper provides the scientific underpinnings necessary to better understand the implications of and rationale for selecting a specific TOAR metric for assessing spatial and temporal variation in ozone for a particular impact. The rationale and underlying research evidence that influence the derivation of specific metrics are given. The form of 25 metrics (4 for model-measurement comparison, 5 for characterization of ozone in the free troposphere, 11 for human health impacts, and 5 for vegetation impacts) are described. Finally, this study categorizes health and vegetation exposure metrics based on the extent to which they are determined only by the highest hourly ozone levels, or by a wider range of values. The magnitude of the metrics is influenced by both the distribution of hourly average ozone concentrations at a site location, and the extent to which a particular metric is determined by relatively low, moderate, and high hourly ozone levels. Hence, for the same ozone time series, changes in the distribution of ozone concentrations can result in different changes in the magnitude and direction of trends for different metrics. Thus, dissimilar conclusions about the effect of changes in the drivers of ozone variability (e.g., precursor emissions) on health and vegetation exposure can result from the selection of different metrics.

The use of critical levels for determining plant response to ozone in Europe and in North America.

Critical levels to determine plant response to ozone (O3) have been used in Europe since the 1980s, utilizing the concentration-based AOT40 to relate plant response to ambient O3 exposure. More recently, there has been progress in Europe toward utilizing flux-based critical levels, because plant response is more closely related to O3 uptake than to the amount of O3 in ambient air. Flux-based critical levels are plant species specific; data for parameterization of flux-based critical levels models are lacking for most plant species. Although flux-based critical levels are now being used for a limited number of agricultural crops and tree species where data are available, the use of flux-based critical levels is limited by the lack of adequate consideration and incorporation of plant internal detoxification mechanisms in flux modeling. Critical levels have not been used in North America; however, recent interest in the U.S. and Canada for using critical loads for nitrogen and sulfur has generated interest in using critical levels for O3. A major obstacle for utilization of critical levels in North America is that ambient air quality standards for O3 in the U.S. and Canada are concentration based. It appears that cumulative exposure-based metrics, particularly when implemented with a quantification of peak concentrations and environmental variables, such as a drought index, are currently the most useful to relate O3 to vegetation response. Because data are unavailable to quantify detoxification potential of vegetation, effective flux models are not available to determine plant response to O3.

Impacts of air pollution and climate change on forest ecosystems--emerging research needs.

Outcomes from the 22nd meeting for Specialists in Air Pollution Effects on Forest Ecosystems "Forests under Anthropogenic Pressure--Effects of Air Pollution, Climate Change and Urban Development", September 10-16, 2006, Riverside, CA, are summarized. Tropospheric or ground-level ozone (O3) is still the phytotoxic air pollutant of major interest. Challenging issues are how to make O3 standards or critical levels more biologically based and at the same time practical for wide use; quantification of plant detoxification processes in flux modeling; inclusion of multiple environmental stresses in critical load determinations; new concept development for nitrogen saturation; interactions between air pollution, climate, and forest pests; effects of forest fire on air quality; the capacity of forests to sequester carbon under changing climatic conditions and coexposure to elevated levels of air pollutants; enhanced linkage between molecular biology, biochemistry, physiology, and morphological traits.

Air pollution, precipitation chemistry and forest health in the Retezat Mountains, Southern Carpathians, Romania.

In the Retezat Mountains concentrations of O3, NO2 and SO2 in summer season 2000-2002 were low and below toxicity levels for forest trees. While NH3 concentrations were low in 2000, the 2001 and 2002 concentrations were elevated indicating possibility for increased N deposition to forest stands. More than 90% of the rain events were acidic with pH values <5.5, contributing to increased acidity of soils. Crown condition of Norway spruce (Picea abies) and European beech (Fagus sylvatica) was good, however, defoliation described as >25% of foliage injured increased from 9.1% in 2000 to 16.1% in 2002. Drought that occurred in the southern Carpathians between fall 2000 and summer 2002 and frequent acidic rainfalls could cause the observed decline of forest condition. Both Norway spruce and European beech with higher defoliation had lower annual radial increments compared to the trees with low defoliation. Ambient O3 levels found in the Retezat did not affect crown condition of Norway spruce or European beech.

New international long-term ecological research on air pollution effects on the Carpathian Mountain forests, Central Europe.

An international cooperative project on distribution of ozone in the Carpathian Mountains, Central Europe was conducted from 1997 to 1999. Results of that project indicated that in large parts of the Carpathian Mountains, concentrations of ozone were elevated and potentially phytotoxic to forest vegetation. That study led to the establishment of new long-term studies on ecological changes in forests and other ecosystems caused by air pollution in the Retezat Mountains, Southern Carpathians, Romania and in the Tatra Mountains, Western Carpathians on the Polish-Slovak border. Both of these important mountain ranges have the status of national parks and are Man & the Biosphere Reserves. In the Retezat Mountains, the primary research objective was to evaluate how air pollution may affect forest health and biodiversity. The main research objective in the Tatra Mountains was to evaluate responses of natural and managed Norway spruce forests to air pollution and other stresses. Ambient concentrations of ozone (O(3)), sulfur dioxide (SO(2)), nitrogen oxides (NO(x)) as well as forest health and biodiversity changes were monitored on densely distributed research sites. Initial monitoring of pollutants indicated low levels of O(3), SO(2), and NO(x) in the Retezat Mountains, while elevated levels of O(3) and high deposition of atmospheric sulfur (S) and nitrogen (N) have characterized the Tatra Mountains. In the Retezat Mountains, air pollution seems to have little effect on forest health; however, there was concern that over a long time, even low levels of pollution may affect biodiversity of this important ecosystem. In contrast, severe decline of Norway spruce has been observed in the Tatra Mountains. Although bark beetle seems to be the immediate cause of that decline, long-term elevated levels of atmospheric N and S depositions and elevated O(3) could predispose trees to insect attacks and other stresses. European and US scientists studied pollution deposition, soil and plant chemistry, O(3)-sensitive plant species, forest insects, and genetic changes in the Retezat and Tatra Mountains. Results of these investigations are presented in a GIS format to allow for a better understanding of the changes and the recommendations for effective management in these two areas.

Primary tooth radicular resorption as a consequence of self-corrected ectopic eruption: 2 unusual cases.

Resorption of the distal root of primary second molars is a common consequence of ectopically erupting permanent first molars. Here, we report 2 unusual cases of primary molar root resorption caused by reversible (self-correcting) ectopic eruption of premolar and canine teeth. In both cases, severe pathological resorption of the mesial roots of primary molars was detected on routine dental radiographs, and the affected molars remained asymptomatic until exfoliation. The purpose of this paper was, using 2 case studies, to highlight the possibility of primary root resorption as a sequel of self-corrected ectopic eruption in locations not frequently diagnosed or reported.

Spontaneous regression of congenital epulis: a case report and review of the literature.

INTRODUCTION: Congenital epulis is a rare lesion found on the alveolar process of a newborn child, diagnosed soon after birth. The lesion has a site predilection for the anterior maxillary alveolar process and a 9:1 sex predilection for females. Once diagnosed the traditional management of the lesion has been surgical excision under general anesthesia. CASE PRESENTATION: The purpose of this case report is to describe spontaneous regression of congenital epulis in a three week old healthy African American female child. She presented with a 1.5 cm bilobed sessile nodular lesion in the region of the right maxillary cuspid. The clinical impression was congenital epulis. Since the lesion was not interfering with feeding and respiration, a conservative approach was taken. The child was followed-up for 18 months, during which the lesion progressively regressed. CONCLUSIONS: Conservative management prevented unnecessary surgery and anesthesia exposure in a neonate.

Evaluation of storage and filtration protocols for alpine/subalpine lake water quality samples.

Many government agencies and other organizations sample natural alpine and subalpine surface waters using varying protocols for sample storage and filtration. Simplification of protocols would be beneficial if it could be shown that sample quality is unaffected. In this study, samples collected from low ionic strength waters in alpine and subalpine lake inlets and outlets in the western United States were used to evaluate (1) effects of refrigerated storage time on the chemistry of unfiltered samples, and (2) differences in sample filtration protocols. No analytes exhibited significant changes when stored less than 48 h. Six analytes (pH, sodium, ammonium, potassium, chloride, sulfate) exhibited statistically significant (but small) changes when storage time exceeded 48 h. Two analytes (calcium, nitrate) were significantly higher when samples were field filtered than when filtered in the laboratory, but the differences were also small. For waters similar to those in this test, unfiltered refrigerated samples may be stored up to 48 h without compromising sample quality. The small differences between field and lab filtration do not justify the expense, training, and contamination risk of field filtration.

Air quality at a snowmobile staging area and snow chemistry on and off trail in a Rocky Mountain subalpine forest, Snowy Range, Wyoming.

A study was begun in the winter of 2000-2001 and continued through the winter of 2001-2002 to examine air quality at the Green Rock snowmobile staging area at 2,985 m elevation in the Snowy Range of Wyoming. The study was designed to evaluate the effects of winter recreation snowmobile activity on air quality at this high elevation site by measuring levels of nitrogen oxides (NO( x ), NO), carbon monoxide (CO), ozone (O(3)) and particulate matter (PM(10) mass). Snowmobile numbers were higher weekends than weekdays, but numbers were difficult to quantify with an infrared sensor. Nitrogen oxides and carbon monoxide were significantly higher weekends than weekdays. Ozone and particulate matter were not significantly different during the weekend compared to weekdays. Air quality data during the summer was also compared to the winter data. Carbon monoxide levels at the site were significantly higher during the winter than during the summer. Nitrogen oxides and particulates were significantly higher during the summer compared to winter. Nevertheless, air pollutants were well dispersed and diluted by strong winds common at the site, and it appears that snowmobile emissions did not have a significant impact on air quality at this high elevation ecosystem. Pollutant concentrations were generally low both winter and summer. In a separate study, water chemistry and snow density were measured from snow samples collected on and adjacent to a snowmobile trail. Snow on the trail was significantly denser and significantly more acidic with significantly higher concentrations of sodium, ammonium, calcium, magnesium, fluoride, and sulfate than in snow off the trail. Snowmobile activity had no effect on nitrate levels in snow.

Estimating CO(2) flux from snowpacks at three sites in the Rocky Mountains.

Soil surface CO(2) flux (F(s)) is the dominant respiratory flux in many temperate forest ecosystems. Snowpacks increase this dominance by insulating the soil against the low temperature to which aboveground components are exposed. However, measurement of F(s) in winter may be impeded by snow cover. Likewise, developing annual F(s) models is complicated by seasonal variation in root and microbial metabolism. We compared three methods of measuring sub-snow F(s): (1) dynamic chamber measurements at the upper snowpack surface (F(snow)), (2) dynamic chamber measurements at the soil surface via snowpits (F(soil)), and (3) static estimates based on measured concentrations of carbon dioxide ([CO(2)]) and conductance properties of the snowpack (F(diffusional)). Methods were compared at a mid-elevation forest in northeastern Washington, a mid-elevation forest in northern Idaho, and a high-elevation forest and neighboring meadow in Wyoming. The methods that minimized snowpack disturbance, F(diffusional) and F(snow), yielded similar estimates of F(s). In contrast, F(soil) yielded rates two to three times higher than F(snow) at the forested sites, and seven times higher at the subalpine meadow. The ratio F(soil)/F(snow) increased with increasing snow depth when compared across all sites. Snow removal appears to induce elevated soil flux as a result of lateral CO(2) diffusion into the pit. We chose F(snow) as our preferred method and used it to estimate annual CO(2) fluxes. The snowpack was present for 36% of the year at this site, during which time 132 g C m(-2), or 17% of the annual flux, occurred. We conclude that snowpack CO(2) flux is quantitatively important in annual carbon budgets for these forests and that the static and dynamic methods yield similar and reasonable estimates of the flux, as long as snowpack disturbance is minimized.