Facial Dog Bite Injuries of a 19-Month-Old Child: A Case Report.

It is estimated that 4.5 million Americans are bitten by dogs each year, and half of those are children. One in five dog bites results in injuries that require some form of medical attention. Children between 5 and 9 years of age are the most affected age group for this type of injury. A 19-month-old boy was admitted to the emergency department of Children's Hospital of Michigan for treatment of injuries due to a dog attack. Injuries were limited to the face of the child. Dental injuries included avulsion of upper lateral incisors, severe luxation of upper central incisors, and fracture of the facial alveolus bone. Surgical management of facial wounds was accomplished through irrigation, debridement and suturing. Dental treatment included extraction of central incisors and suturing soft tissues.

Comparison of articaine and lidocaine in the pediatric population.

The purpose of this paper was to review the use of articaine in the pediatric dental population. Literature on use of articaine in comparison to lidocaine was reviewed. Many dental procedures on primary molars can be successfully accomplished with infiltration of articaine alone, which would significantly reduce the duration of soft tissue anesthesia, and subsequently may reduce the incidence of the undesirable post-treatment self-inflicted injuries associated with inferior alveolar nerve block (IAN). Articaine is well-tolerated and safe to use in the pediatric dental patient after 4 years of age.

Space maintenance in the primary and mixed dentitions.

Loss of space in the primary dentition is considered one of the main causes of malocclusion in the permanent dentition. The purpose of this paper is to review ond summarize the indications and use of space maintainers in primary and mixed dentitions as preventive measures of future malocclusion. Two main types of space maintainers are used to maintain the space in primary ond mixed dentitions: fixed and removable appliances. Band and loop is the appliance of choice when a primary maxillary or mandibular first molar is prematurely lost. With the premature loss of a second primary molar, Nance or transpalatal (TPA) appliances can be used on the maxillary arch and the lower lingual holding arch (LLHA) for the mandibular arch.

Raman spectroscopy of xylitol uptake and metabolism in Gram-positive and Gram-negative bacteria.

Visible-wavelength Raman spectroscopy was used to investigate the uptake and metabolism of the five-carbon sugar alcohol xylitol by Gram-positive viridans group streptococcus and the two extensively used strains of Gram-negative Escherichia coli, E. coli C and E. coli K-12. E. coli C, but not E. coli K-12, contains a complete xylitol operon, and the viridans group streptococcus contains an incomplete xylitol operon used to metabolize the xylitol. Raman spectra from xylitol-exposed viridans group streptococcus exhibited significant changes that persisted even in progeny grown from the xylitol-exposed mother cells in a xylitol-free medium for 24 h. This behavior was not observed in the E. coli K-12. In both viridans group streptococcus and the E. coli C derivative HF4714, the metabolic intermediates are stably formed to create an anomaly in bacterial normal survival. The uptake of xylitol by Gram-positive and Gram-negative pathogens occurs even in the presence of other high-calorie sugars, and its stable integration within the bacterial cell wall may discontinue bacterial multiplication. This could be a contributing factor for the known efficacy of xylitol when taken as a prophylactic measure to prevent or reduce occurrences of persistent infection. Specifically, these bacteria are causative agents for several important diseases of children such as pneumonia, otitis media, meningitis, and dental caries. If properly explored, such an inexpensive and harmless sugar-alcohol, alone or used in conjunction with fluoride, would pave the way to an alternative preventive therapy for these childhood diseases when the causative pathogens have become resistant to modern medicines such as antibiotics and vaccine immunotherapy.

High-flow arteriovenous malformations of the mandible and the maxilla: report of 2 cases.

Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.

The use of in situ simulation to evaluate teamwork and system organization during a pediatric dental clinic emergency.

INTRODUCTION: The purpose of this exercise was to use in situ simulation training to assess a pediatric dental clinic's emergency response protocol, specifically evaluating overall team and system process effectiveness as well as clinical performance. METHODS: Two high-fidelity simulation scenarios were developed to evaluate an existing clinic-wide multidisciplinary emergency code response for a freestanding pediatric dentistry clinic. Participants included all clinic faculty, trainees (dental residents), and staff (dental assistant and clerks). Each scenario was based on a routine patient care issue experienced by the clinicians in practice. The scenarios were executed in a regular patient care room with all clinical faculty and staff. A facilitated group debrief occurred after each scenario to identify areas of vulnerability and process failures. Key issues were recorded and evaluated by the investigators to determine potential causes and solutions. RESULTS: Primary areas of vulnerability identified included (1) team communication, (2) equipment availability, (3) dosing errors, and (4) role assignment. Failure to stock needed equipment and ineffective use of a preexisting radio system was noted. Participants reported that they learned from the experience and that they would revisit the current system and address these issues. Implementation of mandatory simulation training was the most immediate outcome from the experience. CONCLUSIONS: In situ simulations can be leveraged to evaluate critical teamwork processes and system-based operations, both of which can impact dental team function during adverse patient events.