Acupuncture Reduces Pain and Autonomic Distress During Injection of Local Anesthetic in Children: A Pragmatic Crossover Investigation.

OBJECTIVES: Stimulation of acupoint LI4 has been shown to result in analgesic effects in patients experiencing acute pain. We aimed to study the effectiveness of LI4 stimulation for pain relief in children receiving an injection of a local anesthetic (LA). MATERIALS AND METHODS: Children scheduled for dental treatment using LA received bilateral acupuncture at LI4 using indwelling fixed needles. During the treatment, the parents of the patients stimulated the needles by massage. Two different treatment regimes were compared: a standardized LA injection given 5 minutes after acupuncture, and an LA injection without acupuncture. The order of treatment was randomized, with the 2 treatments performed in a crossover manner on different days. Pain intensity during LA injection, assessed by the patient with the Verbal Rating Scale or Faces Pain Scale (0 to 10), was used as the primary endpoint. Parent-assessed and dentist-assessed pain intensity and agitation, heart rate, and the patients' satisfaction with the therapy were also recorded. RESULTS: Data were obtained from 49 patients (22 female; mean age 10 y). Patients reported less pain when acupuncture was used: mean 2.3 (95% confidence interval, 1.5-3.1) versus 3.9 (95% confidence interval, 3.0-4.7); P<0.001. The patients' heart rate remained low throughout the dental treatment after LI4 stimulation, when compared with treatment without acupuncture (P<0.05). LI4 stimulation was safe and increased satisfaction levels in both the patients and their parents, when compared with LA injection alone (P<0.05). DISCUSSION: Stimulation of acupoint LI4 reduces pain and autonomic distress in children during LA injection in dental procedures.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

Assessment of occlusion after placement of stainless steel crowns in children - a pilot study.

Many stainless steel crowns (SSCs) disrupt the occlusion in children, but stabilisation appears to occur within a short period post-placement. The extent and mechanism of these short-term occlusal changes in children are unknown. This study sought to determine whether placement of a SSC changes the maximum intercuspation position (MIP) in children, whether the MIP returns to normal within 4 weeks and whether local anaesthesia had an effect on the child's ability to achieve MIP. The T-Scan(®) III was used for the measurement of occlusal contacts. Reliability and reproducibility of the system was determined using a calibration exercise where MIP recordings were taken of eleven children not undergoing any dental treatment. For the main study, the percentage of total occlusal force on each tooth was recorded in 20 children preoperatively, after local anaesthesia, after SSC placement and 4 weeks postoperatively. There was no significant difference in MIP (P = 0·435) preoperatively and post-administration of local anaesthesia. There was a significant difference between the preoperative force on a tooth and the reading after crown placement (P = 0·0013, Wilcoxon test). By 4 weeks, there was no significant difference overall between post-SSC placement and the preoperative value for the tooth (P = 0·3). Administration of local anaesthesia did not affect the ability of a child to attain MIP. Maximum intercuspation position was disturbed by the placement of a SSC in seven of 20 cases. When MIP was disturbed, in most cases, it returned to preoperative status within 4 weeks of crown placement.

Farmacología en atención estomatológica en menores de 19 años / Presence of Pharmacology in stomatologic care in children aged under 19

Se presenta una revisión bibliográfica actualizada basada en evidencias científicas del uso de antimicrobianos, antiinflamatorios, analgésicos, antisépticos bucales y medicina natural y tradicional en estomatología, realizada por Medline, Doyma y otras fuentes bibliográficas. Se reporta que más de la mitad de la población mundial consume en un momento de su vida algunos de estos fármacos, indicados por diferentes patologías de orígenes infecciosos, inflamatorios, incluso como tratamiento prevenivos y preoperatorios. La edad pediátrica constituye un grupo de difícil manejo terapéutico dada la inmadurez física, fisiológica (sistema pulmonar, cardiovascular, inmunológico y metabólico) y emocional, lo que exige que el uso de estas drogas requieren un conocimiento actualizado por parte del personal médico. En tal sentido, presentamos una revisión con el objetivo de exponer lo más actual sobre el uso de antibióticos, antiinflamatorios, analgésicos y antisépticos bucales en cuanto a farmacología para estomatólogos generales que brindan atención a menores de 19 años con afecciones estomatológicas(AU)

A updated bibliographic review is presented based on scientific evidences on use of antimicrobials, anti-inflammatory, analgesics agents, oral antiseptics and natural and folk medicine in Stomatology, performed by Medline Doyma, and other bibliographic sources. Authors reports that more than half of world population, in any moment of its life, has been a consumer of these drugs, prescribed from different pathologies of infectious, inflammatory nature, even as a preventive preoperative treatment. Pediatric age is a difficult therapeutic management group due to physical, physiological ( pulmonary, cardiovascular, immunologic, and metabolic system) and emotional immaturity, requiring that medical staff must to have a updated knowledge on use of these drugs. In this context, we presented a revision to expose the more updated features on use of antibiotics, anti-inflammatory, and oral antiseptics, as for a Pharmacology for general stomatologists giving care to children ages under 19 presenting with stomatologic affections(AU)

A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities.

An investigation was undertaken of morbidity after outpatient general anaesthesia for comprehensive dental care in a group of paediatric patients over a 1-year period. Data were collated from the patient's hospital notes and from the response to a questionnaire sent to parents/carers. Clinical data were obtained for 55 cases (age range 3-17 years) for whom parents/carers had returned questionnaires. There were 27 intellectually and/or physically impaired patients, the other 28 being anxious or phobic. After discharge, 44% of all parents/carers reported symptoms post-operatively in their child, the prevalence being similar in both groups. The symptoms were nausea/vomiting (20%), unexpected drowsiness (13%) and the need for pain relief at home (13%). Dental procedures were routine restorations (42%), or a combination of restoration, extractions and preventive care for the remainder. Only four patients had extractions only. One teenager had to be admitted for persistent nausea and vomiting, despite prophylactic measures. In conclusion, post-operative morbidity appears to be low after outpatient general anaesthesia for dental procedures, and is no greater in patients with disabilities.