CXCL14 and MCP1 are potent trophic factors associated with cell migration and angiogenesis leading to higher regenerative potential of dental pulp side population cells.

INTRODUCTION: The release of trophic factors from mesenchymal stem cells (MSCs) is critical for tissue regeneration. A systematic investigation of the regenerative potential of trophic factors from different MSCs, however, has not been performed. Thus, in the present study, the regenerative potential of conditioned medium (CM) from dental pulp, bone marrow, and adipose tissue-derived CD31(-) side population (SP) cells from an individual source was compared in an ectopic tooth transplantation model. METHODS: The tooth root transplantation in an ectopic site model was used for investigation of the regenerative potential and trophic effects in vivo. Either pulp CD31(-) SP cell populations (1×10(6) cells) at the third to fourth passage or 5 µg/ml of CM from dental pulp, bone marrow, and adipose stem cells from four different individuals were injected into the root with collagen TE. Each root was transplanted subcutaneously in 5-week-old severe combined immunodeficiency mice. Each root with surrounding tissue was harvested for histology on days 7, 21, and 28 and for Western blot analysis and real-time reverse transcription-polymerase chain reaction (RT-PCR) analysis on day 28. Furthermore, the trophic factors responsible for the regenerative potential were identified as the upregulated genes present in pulp CD31(-) SP cells when compared with the genes in both bone marrow and adipose CD31(-) SP cells by using microarray analysis, real-time RT-PCR, and Western blot analysis. RESULTS: Transplantation of pulp CM yielded increased volume of pulp regeneration, more bromodeoxyuridine (BrdU)-positive migrated cells, and fewer caspase 3-positive cells in the regenerated pulp compared with the others. Pulp CM also demonstrated significantly increased cell migration, anti-apoptosis, and angiogenesis in C2C12 cells. Higher expression of CXCL14 and MCP1 in pulp SP cells suggested candidate trophic factors. The stimulatory effects on both migration and angiogenesis of CXCL14 and MCP1 were demonstrated in vitro. In the regenerated tissue, BrdU-positive migrated cells expressed CXCR4 and CCR2, receptors for CXCL14 and MCP1, respectively. CONCLUSIONS: The higher regenerative potential of pulp SP cells may be due to potent trophic factors, including CXCL14 and MCP1, which promote migration and angiogenesis.

The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose.

The purpose of this study was to determine the sedative effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. Twenty-one patients, aged 4 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were sedated with 0.2 mg/kg midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. After administering the midazolam, each patient was allowed to rest before initiating the dental procedures. Behavioral patterns during the various procedures were rated on a behavioral rating scale of 1-7. Each patient served as his or her own control, comparing behavior with or without intranasal midazolam. The results showed a marked improvement in behavioral patterns after administration of intranasal midazolam. Ratings on a scale of 1-7 were noted as "markedly effective" and "effective" for 69.2% of those patients who received infiltration injection anesthesia, 93.8% under rubber dam, 76.2% during cavity preparation, 84.2% for restoration placement and 87.5% during pulpotomy procedures. The majority of patients were discharged within 150 minutes of intranasal instillation. Further studies are indicated to ascertain the most appropriate dose of intranasally administered midazolam.

The sedative effects of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2: optimal concentration of intranasal midazolam.

In a previous paper, we reported on the effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. The purpose of this study was to compare the clinical and possible adverse effect of doses of 0.2 mg/kg and 0.3 mg/kg midazolam, administered intranasally, and to determine the most appropriate concentration for the drug when administered by this route. Patients were assessed by a behavioral test which consisted of a scale from 1-7 with 3 ranges: markedly effective (1-3), effective (4-5) or ineffective (6-7). Forty-three mentally handicapped patients, aged 5 to 20 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were stratified by age and randomly assigned in a double blind manner to two groups, receiving either 0.2 mg/kg or 0.3 mg/kg midazolam administered intranasally. Group 1, consisting of 22 patients, average age 11 years 8 months, received 0.2 mg/kg. Group 2 consisted of 21 patients, average age 13 years 8 months, each of whom was administered 0.3 mg/kg intranasal midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. Subsequent to intranasal administration of midazolam, no patient rejected the nasal mask nor refused to inhale nitrous oxide/oxygen. The induction of nitrous oxide/oxygen sedation and oral examination were effected smoothly in every case in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Intranasal administration of midazolam: pharmacokinetic and pharmacodynamic properties and sedative potential.

This study investigated the pharmacodynamic effects and sedative potential of midazolam administered by the intranasal route to adult volunteers. A double-blind, randomized, controlled study was carried out on seventeen healthy, male volunteers to study plasma level changes, sedative effects and variations in vital signs following intranasal administration of 0.2 mg/kg and 0.3 mg/kg doses of midazolam. Eight subjects received 0.2 mg/kg midazolam, seven received 0.3 mg/kg. Each subject rested for 15-20 minutes after placement of vital sign monitors and venipuncture needles before administration of midazolam. Behavior during the rest period was designated as the control so that each subject acted as his own control. Each subject's behavior was assessed on a scale of 1 (asleep) to 8 (excited). Plasma concentrations of midazolam were analyzed using venous blood samples from each of three randomly selected subjects for each of the two doses. Vital signs, monitored continuously, included electrocardiogram, heart rate, blood pressure, respiratory rate and oxygen saturation (SPO2). Plasma concentration of midazolam in both groups maintained adequate sedation levels with each group sustaining favorable sedation conditions from 15-20 minutes to 55-60 minutes. Individual variations of midazolam plasma concentration within the 0.3 mg/kg group were greater than those of the 0.2 mg/kg group. Normal vital sign variations due to the nasal instillation of midazolam were observed in both groups. Some minor respiratory depression was observed in the 0.2 mg/kg group. One instance of severe respiratory depression was observed in the higher dose group. Although both doses of midazolam were effective, no benefit was observed using a dose of 0.3 mg/kg. Indeed, a 0.3 mg/kg intranasal dose of midazolam may actually produce severe respiratory depression.

Damage to the primary dentition resulting from thumb and finger (digit) sucking.

It is estimated that approximately 50 percent of infants at one year of age suck a thumb or finger. The number decreases rapidly by ages four to five years. The average age for spontaneous cessation of the habit is 3.8 years of age. Anterior open bite is the most frequent malocclusion reported with digit sucking. In this study the authors investigated the influence of thumb and finger-sucking in the anterior and posterior sections of the primary dentition in three age-groups: three, four, and five years. The study population included 930 subjects. Data for the non-oral-habit group were compared with the data for the thumb and/ or finger-sucking group. At all ages the frequencies of open-bite and maxillary protrusion for the thumb and finger-sucking group were higher than the non-oral-habit group. The frequencies did not appear age-related. There appeared to be an increased tendency to a permanent malocclusion in children who continued after four years of age.

A study of the sedative effect of home-administered oral diazepam for the dental treatment of children.

This study investigated the effects of oral diazepam administered at home to fearful child patients prior to dental treatment. Twenty-five healthy, uncooperative children, mean age 3 years 8 months (+/- 1 year 3 months), requiring at least three visits for the treatment of dental caries, were studied. Each child's behaviour was assessed during three treatment sessions: (i) control, with no diazepam or placebo; (ii) with diazepam; and (iii) with a placebo. Each child acted as his/her own control, being initially assigned to the control session. Subsequently each was randomly assigned to receive either diazepam or placebo for the second session and the other for the third session. The diazepam and placebo were administered by the parents at home approximately 60 minutes before treatment. Each patient's behaviour was assessed on a scale of 1 (definitely positive) to 4 (definitely negative) by two calibrated examiners who were blind to the medications given and independent of the treatment. Vital signs were monitored at 5-minute intervals. Behaviour was significantly better with diazepam than with the placebo or with neither. No significant differences were observed between the placebo and control sessions. At no time were any adverse effects noted, such as vomiting or respiratory depression. It was concluded that oral administration of 0.3 mg/kg diazepam at home by the parent is an effective and safe technique for preoperative sedation of fearful child patients.

[Dental treatment and the prognosis for handicapped children].

We analysed a survey made on oral examinations at the first visit, the kind of dental treatment and the prognosis. The subjects were 77 handicapped children who received dental treatment at the pedodontic clinic of the Aichi-Gakuin University Dental Hospital and periodic examinations after the completion of dental treatment. The average age of the subjects was 7.4 (2.11 to 16.7 years old). (1) At the first visit, the mean number of untreated decayed teeth was 7.1 for the group of children who received dental treatment without general anesthesia, and 12.0 for the group of children who received dental treatment with general anesthesia. And the rate of untreated decayed teeth was 40.1% of the deciduous and 21.0% of the permanent teeth for the group of children who had received dental treatment without general anesthesia, and 65.5% of the deciduous and 34.2% of the permanent teeth for the group of children who had received dental treatment with general anesthesia. (2) For the group of children who received dental treatment without general anesthesia, restoration was performed on 62.5% of the deciduous and 87.5% of the permanent teeth; the remaining 37.5% of the deciduous and 12.5% of the permanent teeth were extracted. Endodontic treatment was performed on 20.6% of the deciduous and 8.9% of the permanent teeth. (3) For the group of children who received dental treatment with general anesthesia, restoration was performed on 57.0% of the deciduous and 95.1% of the permanent teeth; the remaining 42.9% of the deciduous and 4.9% of the permanent teeth were extracted. Endodontic treatment was performed on 25.3% of the deciduous teeth and 12.2% of the permanent teeth. (4) In the case of restorative treatment, the highest incidence was in metal crowns on the deciduous teeth, and amalgam fillings in the permanent teeth for the groups of children who received dental treatment with or without general anesthesia. In the case of endodontic treatment, the highest incidence was in pulp amputation for the groups of children who received dental treatment with or without general anesthesia. (5) During the past year of completed dental treatment, unsuccessful cases were 5.4% for the restorative treatment and 0% for the endodontic treatment for the group of children who received dental treatment without general anesthesia; unsuccessful cases were 14.1% for the restorative treatment and 4.1% for the endodontic treatment for the group of children who received dental treatment with general

[The behavior of mothers during dental treatment for their handicapped children. 1. Relationship between mothers' behavior and child patients' factors].

The purpose of this study was to find out factors which determine whether or not mothers of handicapped children chose to be with their children while receiving dental care. The subjects were 46 pairs consisting of a handicapped child and his or her mother who came to the pedodontic clinic of Aichi-Gakuin University Dental School. Such factors of the patients as the various abilities of the patients, their behavior and other items were surveyed with a behavior evaluation. These factors are considered to be related to determining the behavior of the mothers. The results of the survey are summarized as follows: 1. Patients whose mothers chose to be with them tended to be slightly inferior in basic language use and mouth rinsing ability, when compared with patients whose mothers chose to stay in the waiting room. 2. Patients who were autistic more often had mothers who chose to be with them than patients with other disabilities. 3. Patients whose mothers chose to be with them got higher Behavior Evaluation Scores in all dental care situations so that they tended not to adapt to dental care, when compared with patients whose mothers chose to stay in waiting room. 4. From the analyses of Quantification Type II, a height correlation ratio was obtained in the distinction efficiency of the mothers' behavior. Also the behavior of the mothers could be predicted by the factors of the children. 5. There were four factors present in those handicapped children which are considered to have determined their behavior of the mothers: the kind of disability, verbal expression ability, mouth rinsing ability and adaptation to dental care.

[Clinical effects of training in behavior management on handicapped patients in dentistry].

Behavior-therapeutic training was applied to patients who were not cooperative in dental surroundings and could not be managed for dental treatment. The training was continued from the first to the final visit and also at periodical checkups. The clinical effects of training were evaluated. The subjects were 150 handicapped child patients who visited the pedodontic clinic of Aichi-Gakuin University. The patients were classified into two groups according to the degree of cooperation regarding dental treatment during the first visit; 1) the slightly uncooperative group and 2) the uncooperative group. The results were as follows: 1. Training applied prior to actual dental treatment caused 48.7 per cent of the patients to accept routine dental treatment. 2. When N2O/O2 inhalation sedation was added to the training, 79.0 per cent of the slightly uncooperative group were able to accept dental treatment under conseious situation, and 46.0 per cent of the uncooperative group were able to accept it. 3. Continuous training caused 60.7 per cent of all patients to become cooperative. 4. Continuous training was effective with 95.3 per cent of the patients who experienced N2O/O2 sedation, 76.8 per cent of the patients who experienced general anesthesia and 71.2 per cent of the patients who experienced routine dental treatment.

[Behavior of mothers during dental treatment for their handicapped children. 1. Relationship between the mothers' behavior and the image to dental environment and self-consciousness].

The purpose of this study was to find out factors by which mothers of handicapped children chose whether to be with their children while receiving dental treatment or not. The questionnaires from mothers of 42 handicapped children were examined. Factors on the part of the mothers such as their views on the dental environment, their egogram, and the reasons of the mothers' behavior were surveyed. The results of this study were summarised as follows: 1. Both the group of the mothers with their children in the operating room and the group of the mothers not with their children had views of slightly good for a dentist, her child, and a dental operating room. These views were examined by the Semantic Differential Method. 2. Both types of mothers had views of slightly bad for dental treatment. 3. The group of mothers not with their children tended to have a good view of her child and a dental operating room, when compared with the group of mothers with their children. 4. From the analyses of the egogram of the Tokyo university' test, an AC (Adapted Child) was drawed as the factor, in relation to mothers' behavior. 5. The reasons why the mothers chose to be with their children were as follows: the children would have no anxiety, the mothers were apprehensive for their children, the children were not able to speak, and so forth. 6. The reasons why the mothers chose to stay in waiting room were as follows: there will be no reliance on the mothers and child will not be become spoiled, and they should do everything by themselves, children can manage to be treated alone, and so forth.

[The image on dental environment in mothers. A comparison of handicapped and normal children's mother].

The purpose of the present study was to investigate the image on the dental environment of the mothers of handicapped and normal children. To investigate the image on dental environment, the Semantic Differential Method was applied to mothers of 42 handicapped and 35 normal children. They rated 4 items--'dentist', 'my child', 'dental treatment' and 'dental operating room'--on the adjective-scales 12 pairs. The results of this study were summarized as follows: 1. In comparing the mean of the rating score, it observed that the mothers of handicapped children have a more positive image than the mothers of normal children. This tendency appeared more clearly at 'dental treatment' and 'dental operating room'. 2. By principal factor analysis and varimax rotation, 2 factors were extracted from every 4 items. 3. Factor scores at factor 1 and factor 2 of the mothers of handicapped children were different from those of the mothers of normal children. The mothers of handicapped children had views that a dental treatment is ease and acceptable, and that a dental operating room is comfortable and safe.