Professional dental prophylaxis increases salivary cortisol in children with dental behavioural management problems: a longitudinal study.

BACKGROUND: Dental procedures may cause stress and increase the salivary cortisol levels. It is important to known if apparently simple procedures such as professional dental prophylaxis at low speed (DP) are stressful for children with dental behaviour management problems (DBMP) to help with behaviour guidance strategies. This longitudinal study aimed to evaluate if DP changes a physiological marker of stress (salivary cortisol) in children with DBMP who were referred to dental treatment under sedation. METHODS: One paediatric dentist carried out a DP with rubber cup and pumice followed by dental examination in 39 children aged 2-5 years, prior to the dental sedation appointment. Children's saliva was collected at three different moments: upon waking (UW), on arrival at the dental office reception area (RA) and 25 min after the dental prophylaxis (DP). The saliva samples were analysed using an enzyme immunoassay kit. The Wilcoxon test was used in paired comparison (P < 0.05). RESULTS: Salivary cortisol levels decreased from UW (0.34; 0.15-0.54) to RA (0.14; 0.08-0.56) (P = 0.019) and increased from RA to DP (0.25; 0.06-1.48) (P = 0.008). Higher salivary cortisol levels were observed at DP when compared to RA in children who did not have previous dental treatment (P = 0.007), had toothache (P = 0.006), presented some protest behaviour during DP (P = 0.008), or needed protective stabilisation by parents for the dental examination (P = 0.005). CONCLUSIONS: Paediatric dentists should be aware that even simple procedures such as professional dental prophylaxis are related to stress in young children.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study.

AIMS: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. MATERIALS AND METHODS: Anonymized billing data of 842 patients reporting to a university children's dental over three years (March 2017-2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. RESULTS: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. CONCLUSION: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

Intranasal sedation using ketamine and midazolam for pediatric dental treatment (NASO): study protocol for a randomized controlled trial.

BACKGROUND: Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children. METHODS: We have designed a three-armed, parallel RCT to assess intranasal sedation using ketamine/midazolam in terms of the following measures: efficacy, safety, and cost-effectiveness. Two- to 6-year-old healthy children, referred for dental treatment in a dental sedation center in Brazil due to uncooperative behavior and requiring restorative dental procedures, will be recruited. Each child will be randomly assigned to one of the three groups: A - Intranasal administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.2 mg/kg, maximum 5.0 mg); B - Oral administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.5 mg/kg, maximum 20 mg); and C - Oral administration of midazolam (1.0 mg/kg, maximum 20 mg). The primary outcome is the child's behavior assessed through an observational scale using digital videos of the restorative dental treatment under sedation. The secondary outcomes are as follows: acceptance of sedative administration; memory of intraoperative events; the child's stress; adverse events; the child's pain during the procedure; the parent's, dentists', and child's perceptions of sedation; and economic analysis. Measures will be taken at baseline and drug administration and during and after the dental procedure. The necessary sample size was estimated to be 84 children after a blinded interim analysis of the first 30 cases. DISCUSSION: This study will provide data that can substantially add to science and pediatric dentistry as it examines the effect of sedative regimes from different perspectives (outcomes). TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02447289 . Registered on 11 May 2015, named "Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO)."

Espectroscopia Atômica Identifica Diferenças nos Parâmetros de Elementos Traço na Saliva de Pacientes Portadores de Fibrose Cística / Atomic Spectroscopy Identifies Differences in Trace Element Parameters in the Saliva of Patients with Cystic Fibrosis

Objetivo: Determinar elementos traço na saliva de indivíduos com fibrose cística.Métodos: Trinta e cinco indivíduos com fibrose cística e trinta e nove indivíduos saudáveis participaram deste estudo. A distribuição de 24 elementos traço na saliva total estimulada foi avaliada por espectrometria de massa com plasma de argônio acoplado indutivamente (ICP-MS), espectrometria de emissão óptica com plasma de argônio acoplado indutivamente (ICP-OES) e espectrometria de absorção atômica (AAS).Resultados: Verificou-se uma diferença significativa na distribuição de elementos traço na saliva de indivíduos com fibrose cística quando comparado a indivíduos sem a doença. Sódio; Potássio; Vanádio; Cromo; Arsênio e Selênio apresentaram valores estatisticamente diferentes entre os grupos, enquanto Alumínio, Boro, Bário, Cadmo, Cobre, Ferro, Mercúrio, Magnésio, Manganês, Níquel, Titânio, Estrôncio e Zinco não apresentaram diferenças significativas entre os grupos. As análises estatísticas indicaram que os elementos Sódio e Potássio apresentaram maiores teores, enquanto que os elementos traço Vanádio, Cromo, Selênio e Arsênio apresentaram menores teores nos indivíduos com fibrose cística.Conclusões: A espectroscopia atômica mostrou um potencial considerável no desenvolvimento de metodologia destinada a detectar a fibrose cística neonatal. A saliva deve ser considerada como material biológico para análise de diagnóstico

Objective: To determine trace elements in the saliva of individuals with cystic fibrosis.Method: Thirty-five individuals with cystic fibrosis and thirty-nine healthy individuals participated in this study. The distribution of 24 trace elements in stimulated whole saliva was evaluated by inductivelycoupled plasma mass spectrometry (ICP-MS), inductively coupled plasma optical emission spectrometry (ICP-OES) and atomic absorption spectrometry (AAS).Results: There was a statistically significant difference in the distribution of trace elements in the saliva of individuals with cystic fibrosis compared with individuals without the disease. Sodium, potassium, vanadium, chromium, arsenic and selenium presented significantly different values between the groups, while no significant differences was found between the groups for aluminum, boron, barium, cadmium, copper, iron, mercury, magnesium, manganese, nickel, titanium, strontium and zinc. Statistical analyses indicated higher contents of the trace elements sodium and potassium and lower contents of the trace elements vanadium, chromium, selenium and arsenic in the individuals with cystic fibrosis.Conclusion: Atomic spectroscopy showed a considerable potential in the development of a methodology to detect a neonatal cystic fibrosis. The saliva should be considered as biological material for diagnostic analysis