Technical communication: the effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices.

A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. We assessed occupational exposure to anesthetic drugs during pediatric general anesthesia in dental offices and assessed the effectiveness of the "double mask." Nine freestanding dental offices had measurements of anesthetic waste gas levels taken before and immediately after implementation of a double-mask system. Levels of nitrous oxide decreased from a median of 40.0 parts per million (ppm; interquartile range [IQR] = 23.0-46.0 ppm, n = 9) to 3.0 ppm, (IQR = 2.3-4.7 ppm, n = 9, P = 0.0055) and exceeded 25 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10-7.00 ppm, n = 9) to 0 ppm (IQR = 0-0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental "high-volumes" suctions (high-volume evacuators producing approximately 12 m(3)/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.

Use of coolant for high-speed tooth preparation: a survey of pediatric dentistry residency program directors in the United States.

PURPOSE: To determine current teaching policies regarding the use of coolant type during tooth preparation with high-speed hand-pieces in pediatric dental residency programs in the US. METHODS: A 17-question survey was electronically mailed to 63 program directors with one follow-up. Multiple-choice questions asked about school and program teaching of cavity preparation with or without water coolant, including hypothetical clinical situations. RESULTS: Fifty-two (83%) program directors returned the survey. Fifty-two percent taught both dry and water coolant methods, 6% taught dry cutting exclusively, and 42% did not teach the dry method and always used water coolant. Dry techniques were used primarily for special needs patients with poor swallow reflexes (50%) and for young children undergoing sedation (41%). Air coolant was taught more frequently in programs in the Midwest (77%) and South (85%) vs. the Northeast (32%) and West (50%) (P<.01). Forty-four percent of combined programs and 60% of hospital programs taught water spray use exclusively, while all university programs taught the dry cutting technique (P<.01). CONCLUSIONS: A majority of program directors teach the use of air coolant alone for high-speed preparation of teeth. University and combined programs were more likely to teach the method compared with hospital based ones.

Validation of an age-modified caries risk assessment program (Cariogram) in preschool children.

OBJECTIVES: (i) To validate caries risk profiles assessed with a computer program against actual caries development in preschool children, (ii) to study the possible impact of a preventive program on the risk profiles, and (iii) to compare the individual risk profiles longitudinally. MATERIAL AND METHODS: Caries risk was assessed in 125 two-year-old children invited to participate in a 2-year caries-preventive trial with xylitol tablets. At 7 years of age, 103 were available for follow-up, 48 from the former intervention group and 55 from the control group. At baseline and after 5 years, 7 variables associated with caries were collected through clinical examinations and questionnaires, and scored and computed with a risk assessment program (Cariogram). RESULTS: Children assessed as having a "low chance (0-20%) of avoiding caries" had significantly higher caries at 7 years of age compared to children with a lower risk in the control group (p<0.05) but not in the intervention group. Overall predictive accuracy and precision, however, were moderate in both groups. Less than half of the children remained in the same risk category at both ages, despite a largely unchanged consumption pattern of sugar. The majority of the children who changed category displayed a lowered risk at 7 years. The intervention program seemed to impair the predictive abilities of Cariogram. CONCLUSION: A modified Cariogram applied on preschool children was not particularly useful in identifying high caries risk patients in a low-caries community.

Evaluating the Quality of Multiple Choice Question in Paediatric Dentistry Postgraduate Examinations.

OBJECTIVES: This study aimed to evaluate the quality of multiple choice question (MCQ) items in two postgraduate paediatric dentistry (PD) examinations by determining item writing flaws (IWFs), difficulty index (DI) and cognitive level. METHODS: This study was conducted at Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Virtual platform-based summative versions of the general paediatric medicine (GPM) and prevention of oral diseases (POD) examinations administered during the second semester of the 2017-2018 academic year were used. Two PD faculty members independently reviewed each question to assess IWFs, DI and cognitive level. RESULTS: A total of 185 single best answer MCQs with 4-5 options were analysed. Most of the questions (81%) required information recall, with the remainder (19%) requiring higher levels of thinking and data explanation. The most common errors among IWFs were the use of "except" or "not" in the lead-in, tricky or unfocussed stems and opportunities for students to use convergence strategies. There were more IWFs in the GPM than the POD examination, but this was not statistically significant (P = 0.105). The MCQs in the GPM and POD examination were considered easy since the mean DIs (89.1% ± 8.9% and 76.5% ± 7.9%, respectively) were more than 70%. CONCLUSION: Training is an essential element of adequate MCQ writing. A general comprehensive review of all programme's MCQs is needed to emphasise the importance of avoiding IWFs. A faculty development programme is recommended to improve question-writing skills in order to align examinations with programme learning outcomes and enhance the ability to measure student competency through questions requiring higher level thinking.

Impressions in cleft lip and palate--a novel two stage technique.

Though the field of presurgical orthopedics for the management of children with cleft Lip and Palate (CLAP) has made great advances over the past few decades, little is found in literature regarding the imressions required to fabricate these appliances. The purpose of this paper is to describe a novel two stage technique utilizing greenstick compound and addition silicone impression material to provide a safe, economical and accurate method for recording impressions in children with cleft lip and palate.

Instrumentación rotatoria comparada con instrumentación manual para terapias pulpares en odontopediatría / Instrumentação rotatória comparada com instrumentação manual para terapia pulpar em odontopediatria / Rotary instrumentation compared manual instrumentation for pulp therapy in pediatric dentistry

Introducción: En la terapia pulpar, se han producido avances que no solo están relacionados con los biomateriales empleados sino también con las técnicas utilizadas para la instrumentación; de allí que al optimizar estas últimas se contribuya al aumento de la calidad de la terapéutica en este campo. Objetivo: examinar la evidencia disponible sobre la instrumentación rotatoria comparada con la instrumentación manual para terapias pulpares en odontopediatría. Métodos: Se aplicaron los criterios de informes PRISMA- ScR. Para la búsqueda de los artículos se utilizaron las bases de datos pubmed/Medline, Elsevier, Epistemonikos, Scielo.org, Redalyc.org; Imbiomed y Google académico, Artículos en idioma inglés y español, publicados desde enero 2017 a junio de 2022. Se seleccionaron 15 artículos que cumplieron con los criterios de inclusión establecidos para la revisión. Resultados: 60,0 % de los estudios reportaron que la instrumentación rotatoria tuvo una mejor calidad de obturación que la manual; 40,0% informaron no encontrar diferencias estadísticamente significativas entre ambas técnicas. El 100% de los estudios indicaron que hubo reducción significativa del tiempo de instrumentación de las limas rotatorias en comparación con las manuales. Conclusión: las evidencias señalan que tanto la instrumentación rotatoria como la instrumentación manual son eficaces para garantizar la calidad de la obturación de los conductos radiculares y el tiempo de instrumentación es más corto con la instrumentación rotatoria, este aspecto es muy importante en Odontopediatría ya que reduce el tiempo del tratamiento y contribuye a que el niño sea más cooperador y los tratamientos sean más eficaces.

Introdução: Na terapia pulpar, houve avanços que não estão relacionados apenas aos biomateriais utilizados, mas também às técnicas utilizadas para instrumentação; portanto, a otimização destes últimos contribuirá para um aumento na qualidade da terapia neste campo. Objetivo: Examinar as evidências disponíveis sobre instrumentação rotativa em comparação com instrumentação manual para terapia de polpa em odontologia pediátrica. Métodos: Foram aplicados os critérios de relatório PRISMA-SCR. Os bancos de dados pubmed/Medline, Elsevier, Epistemonikos, Scielo.org, Redalyc.org, Imbiomed e google artigos acadêmicos, em inglês e espanhol publicados de janeiro de 2017 a junho de 2022 foram usados para pesquisar artigos. Foram selecionados 15 artigos que cumpriam os critérios de inclusão estabelecidos para a revisão. Resultados: 60,0 % dos estudos relataram que a instrumentação rotativa tinha melhor qualidade de obturação do que a instrumentação manual; 40,0 % relataram não encontrar diferença estatisticamente significativa entre as duas técnicas. 100% dos estudos indicaram que houve uma redução significativa no tempo de instrumentação dos arquivos rotativos em comparação com os arquivos manuais. Conclusão: As evidências indicam que tanto a instrumentação rotativa quanto a manual, estão sendo eficazes para garantir a qualidade da obturação dos canais radiculares e que o tempo de instrumentação é menor com a instrumentação rotativa. Este aspecto é muito importante na odontologia pediátrica, pois reduz o tempo de tratamento e contribui para que a criança seja mais cooperativa e os tratamentos sejam mais eficazes

Introduction: In pulp therapy, there have been advances that are not only related to the biomaterials used but also to the techniques used for instrumentation; hence, optimizing the latter contributes to increasing the quality of therapeutics in this field. Objective: to examine the available evidence on rotary instrumentation vs. manual instrumentation for pulp therapy in pediatric dentistry. Methods: PRISMA-ScR reporting criteria were applied. For the search of the articles, the pubmed/medline, Elsevier, Epistemonikos, Scielo.org, Redalyc.org databases were used; Imbiomed and academic google, Articles in English and Spanish, published from January 2017 to June 2022. Fifteen articles were selected that met the criteria established for the review. Results: 60.0% of the studies reported that the rotary instrumentation had a better obturation quality than the manual one; 40.0% reported not finding statistically significant differences between both techniques. 100% of the studies indicated that there was a significant reduction in the instrumentation time of rotary files compared to manual files. Conclusion: the evidence indicates that both rotary and manual instrumentation are effective in guaranteeing the quality of root canal filling and that the instrumentation time is shorter with rotary instrumentation, this aspect being very important in pediatric dentistry since the patient the child spends less time in the chair, which contributes to his being more cooperative and the treatment time is reduced.

Laboratory-made space maintainers: a 7-year retrospective study from private pediatric dental practice.

PURPOSE: The purpose of this study was to report survival times and problems encountered with laboratory made space maintainers placed over 7 years by one pediatric dentist. METHODS: Charts were reviewed for 235 patients with fixed space maintainers placed between January 1, 1997, and December 31, 2003, and followed to December 31, 2005. Problems encountered and appliance lifetimes were recorded and assessed. Failures were recorded as: (1) cement loss; (2) solder breakage; (3) split bands; (4) eruption interference; (5) bent wire; (6) complete loss; or (7) not specified. Appliance outcomes, transferred patients, and those lost to follow-up were recorded. RESULTS: A total of 323 appliances were followed, with: (a) 93 (29%) successes; (b) 110 (34%) still in service; and (c) 104 (32%) known failures. Of the latter, most (62%) were from cement loss (60%) and 13 (12%) were totally lost. No statistically significant differences were noted between types of appliances, gender, and types of failure, except for the fact that bands and loops exhibited more cement loss (P=.045). Mean pooled survival times were between 26 and 27 months.. Of the 104 failures: (a) 34 (33%) were no longer needed (being considered clinically successful); (b) 57 (55%) were recemented; and (c) 13 (12%) were remade. Sixteen appliances were lost to follow-up or transferred. CONCLUSION: A total of 63% of all space maintainers lasted their anticipated lifetimes or were still in use.

[Post-academic dental specialties. 11. Discomfort during atraumatic restorative treatment (ART) versus conventional restorative treatment]. / Beroepsdifferentiatie in de tandheelkunde. 11. Ongemak tijdens atraumatic restorative treatment (ART) versus conventionele behandelmethode.

Although Atraumatic Restorative Treatment (ART) claims to be a patient-friendly method of treatment, little scientific proof of this is available. The aim of this study, therefore, was to acquire a reliable measurement of the degree of discomfort which children experience during dental treatment performed according to the ART approach and during the conventional method. A number of 403 Indonesian schoolchildren were randomly divided into 2 groups. In each child, one class II restoration was carried out on a deciduous molar either by means of ART or the use of rotary instruments (750 rpm). Discomfort scores were determined both by physiological measurements (heart rate) and behavioral observations (Venham scale). Venham scores showed a marked difference between the 2 groups, whereas heart rate scores only differed significantly during deep excavation. A correlation was found between Venham scores and heart rate measurements. Sex, initial anxiety and performing dentist were shown to be confounding variables. In conclusion it can be said that children treated according to the ART approach experience less discomfort than those treated with rotary instruments.

Effectiveness of two nitrous oxide scavenging nasal hoods during routine pediatric dental treatment.

PURPOSE: This study compared the effectiveness of 2 nasal hoods (Porter/Brown and Accutron) in reducing waste nitrous oxide gas during conscious sedation for routine pediatric dental treatment. METHODS: Thirty children, ages 3 to 8 years (mean=5.4 +/- 1.2 years), participated in this study. Fifteen randomly selected children started with the Porter/Brown mask, which was then switched to the Accutron mask, and the other 15 children used the reverse order of masks. Four measurements of ambient nitrous oxide were recorded with a Miran 205B Portable Ambient Air Analyzer 5 minutes after each of the following: (1) administration of nitrous oxide; (2) placement of the rubber dam; (3) change of the nasal hood; and (4) reduction of the vacuum. Samples were taken 8 inches above the nose of the patient and in the room 5 feet away from the patient. RESULTS: Nitrous oxide levels were significantly lower (P<.05) with the Porter/Brown system (31 +/- 40 ppm for the patient and 8 +/- 10 ppm for the room) compared with the Accutron system (375 +/- 94 ppm for the patient and 101 +/- 37 ppm for the room). When the suction was reduced, there was an increase in nitrous oxide levels with the Porter/Brown nasal hood (169 +/- 112 ppm for the patient and 28 +/- 18 ppm for the room), whereas the levels with the Accutron nasal hood remained high (368 +/- 107 ppm for the patient and 121 +/- 50 ppm for the room). CONCLUSIONS: This study demonstrated that removal of waste nitrous oxide was greater with the Porter/Brown device and that recommended suction levels must be used for optimum effectiveness.

Lasers in pediatric and adolescent dentistry.

The advent of lasers has offered new possibilities for improved service for pediatric dentistry patients and their parents. The removal of tissues without anesthesia is a common benefit. Almost symptomless postoperative experiences are in marked contrast to conventional methods. Whether performing cavity preparations or remodeling gingival architecture, the acceptance from a young patient is a gratification as well as a practice builder. Because many children may experience laser treatment as their first contact with dentistry, there is a possibility that a new generation of patients will grow up with a different attitude toward dentistry. Parents are enthusiastic about being able to offer their children the advantages of laser care.

Efficacy of a computerized local anesthesia device in pediatric dentistry.

PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system in reducing pain during injections when compared with a traditional delivery system (i.e., syringe). METHODS: Subjects consisted of 57 patients between the ages of 5 and 13 needing operative dentistry using local anesthesia. Patients were randomly assigned to either the computerized or traditional anesthesia delivery system. Inferior alveolar block injections, palatal, and buccal infiltrations were the only injections administered throughout this study. Pain behavior was videotaped and coded throughout the study. Pain perceptions were rated using a 10 point visual analogue rating scale. Subjects were also asked to rate their overall satisfaction and approval of the dentist and the treatment received. RESULTS: Results of multivariate analysis of variance indicated that there were no significant differences between the computerized and the traditional method of administering local anesthesia when comparing pain ratings and pain behavior. Average pain ratings for the computerized method were 4.5 while the average ratings for the traditional method were 3.6. In addition, all subjects reported overall satisfaction with their dental treatment and that they would be willing to return in the future. CONCLUSIONS: A computerized anesthesia injection method was found to be comparable to the traditional method of anesthesia injection.

Using a dental operating microscope in a pediatric dental practice.

It often is suggested that using a dental operating microscope on children cannot work because of their inability to sit still. Not only is this premise incorrect, but also using the microscope can improve the ergonomics of practicing dentistry and, in some cases, reduce the potential for head and neck strain.

Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry.

Provision of General Anaesthesia is now limited and restricted to the hospital setting. Sedation for paediatric patients is an essential tool in anxiety management and is used as an adjunct to behaviour management. Inhalation sedation with nitrous oxide/oxygen sedation to reach a plane of relative analgesia may be administered easily and safely to children in general dental practice and is a potential alternative to general anaesthesia.