Persistent Palatal Ulcerations. A Potential Manifestation of Juvenile Systemic Lupus Erythematosus.

Oral ulcerations in children and adolescents is a common occurrence and affects about 20-30% of this population. This case report describes a unique and serious autoimmune condition that presented with distinct oral findings that significantly supported the differential diagnosis of Juvenile Systemic Lupus Erythematosus in a 15 year-old female. Pediatric and general dentists should familiarize themselves with the condition to facilitate diagnosis with collaborative efforts with the medical team.

Effect of continuous versus interrupted administration of nitrous oxide-oxygen inhalation on behavior of anxious pediatric dental patients: a pilot study.

OBJECTIVE: The purpose of this study was to determine the effect of interrupted administration of nitrous oxide (N2O) inhalation, after obtaining profound local anesthesia, on the behavior of mild to moderately anxious pediatric patients during routine restorative dentistry. STUDY DESIGN: Healthy children, 5 to 8 years old, requiring nitrous oxide/oxygen inhalation sedation and bilateral mandibular restorative treatment performed in two sequential appointments under local anesthesia were recruited for this study. After profoundness of the local anesthesia was confirmed, the subject was randomly assigned to either Protocol A (50% N2O/50% O2) or Protocol B (100% O2) and restorative dental care was completed. On the second appointment, the subject was assigned to the alternate protocol. RESULTS: Hemoglobin oxygen saturation remained constant with no episodes of oxygen desaturation recorded. There were no statistically significant differences (P > .05) in pulse rate or behavior change noted between the two protocols. CONCLUSION: The implication of this pilot study was significant in consideration of the desire to minimize chronic exposure to ambient nitrous oxide and its potential health hazards to the dental team. These findings challenge the traditional practice of N2O maintenance throughout the dental appointment.

Esthetic restorative options for pulpotomized primary molars: a review of literature.

OBJECTIVE: The goal of this manuscript was to review the existing literature in regards to esthetic options to restore pulpotomized primary molars. STUDY DESIGN: A pubmed literature search has been performed and all relevant studies were assessed. RESULTS: Two laboratory, 3 restrospective and 4 prospective clinical studies were found, reviewed and analyzed. CONCLUSIONS: Based on the limited information available, we concluded that tooth colored and bonded restorations showed promising results as alternative materials to replace stainless steel crowns after pulpotomies in primary molars. Hybrid composites tend to perform better than compomers. Resin modified glass ionomer cements demonstrated excellent marginal seal and retention. More long-term follow up studies are necessary until more definitive recommendations can be made.

The incidence of adverse reactions following 4% septocaine (articaine) in children.

PURPOSE: The purpose of this study was to report the incidence of adverse events following the use of 4% Septocaine in children. METHODS: A prospective study was carried out on children attending university-based pediatric dental clinics for restorative core under local anesthesia. Data collection included patient demographics, medical history, amount and site of injection, and treatment complexity. Follow-up telephone interviews were conducted with the parents at 3, 5, 24, and 48 hours regarding prolonged paresthesia, soft tissue injury, and pain. RESULTS: Two hundred sixty-four 2 to 14 year-olds were recruited for the study. Complete interview information was obtained from 204 patients. Prolonged paresthesia at 3 hours postinjection was reported for 40% of the population and at 5 hours for 11%. Soft tissue injury occurred in 14% of the patients at 3 hours and was found to be highest among children younger than 7 years old. The lip was the most commonly affected site for accidental injury and it was not related to injection site. Twenty percent reported postprocedural pain at 3 and 5 hours post-treatment. CONCLUSIONS: Since prolonged numbness appears to be the most frequent adverse event and occurred primarily in children younger than 7 years old, parents need to be informed and reassured accordingly.

Evaluation of the effect of nitrous oxide and hydroxyzine in controlling the behavior of the pediatric dental patient.

This study evaluated and compared the effect of three different sedation combinations on the young dental patient: hydroxyzine alone, hydroxyzine with nitrous oxide, and nitrous oxide alone. Nineteen uncooperative children with mean age of 37 months needing at least three restorative visits were selected for this study. Crying, alertness, and general behavior were evaluated during the dental procedure. The combination of hydroxyzine and nitrous oxide was more effective than the others for the majority of the sessions in terms of controlling crying and alertness. The results in the present study indicate that the sedative effect of hydroxyzine on children's behavior is enhanced by the addition of nitrous oxide.

The teaching of Class I and II restorations in primary molars: a survey of North American dental schools.

PURPOSE: The purpose of this study was to obtain an overview of materials and restoratives techniques taught for Class I and Class II restorations in primary molars in different pediatric dentistry departments in North America. METHODS: A form with response alternatives was mailed to 63 dental schools in the United States and Canada. The forms were addressed to the chairman/undergraduate program director of the department of pediatric dentistry. Questions regarding the restorative materials taught, indications and contraindications for the use of tooth-colored materials and the type of cavity preparation indicated for those materials were among the topics assessed. RESULTS: Eighty-six percent of the dental schools responded to the survey. Amalgam continues to be the material of choice for Class I and II restorations in primary molars, although hybrid composites and compomers are gaining some popularity. When tooth-colored materials were indicated, the slot-type of cavity preparation was the preferred one. CONCLUSIONS: The diversity in teaching may reflect uncertainty related to requirements for optimal restorations of primary teeth. Data from dental schools of other countries may be important to obtain to establish universally accepted criteria and standards for restorative techniques of primary teeth.

Periodontal health at first permanent molars adjacent to primary molar stainless steel crowns.

The present investigation was designed to study the effect of stainless steel crowns (SSC), placed on second primary molars, on the periodontal tissues of neighbouring first permanent molars. 36 children (9-12 years old) with an SSC on a second primary molar on one side of the mouth only, were selected for the study. A clinical and radiographic examination was performed at the mesial surface of the first permanent molar, adjacent to the SSC, and at the corresponding area on the contralateral side of the mouth. The clinical examination included gingival and plaque index scores and probing depth measurements. In the radiographic examination, the marginal bone level was assessed. No statistically significant differences in plaque index scores, gingival index scores and probing pocket depth were noted between the mesial surface of first permanent molars and the contralateral control area. Nor were any significant differences in bone level seen. The present findings suggest that the presence of a well-adapted SSC on a second permanent molar does not affect the periodontal health of the neighbouring first permanent molar.

Assessment of a 2 percent buffered glutaraldehyde solution in pulpotomized primary teeth of schoolchildren.

This investigation was undertaken, clinically and radiographically, to assess the effect of glutaraldehyde as a pulp medicament in pulpotomized cariously exposed primary molars. Fifty-three primary molars of thirty-two second-grade children were evaluated after being treated by pulpotomy utilizing a 2 percent buffered glutaraldehyde solution. Failures were observed in 5.7 percent of the teeth at the six-month evaluation and increased with time: 9.6 percent after 12 months; and 18 percent after 25 months. Internal resorption was observed in six teeth; external resorption was found in only one tooth. Pulp canal obliteration, which was not listed as a failure, was observed in one tooth after 6 months, yielding a total of twenty teeth at the final examination. In thirty-eight pulpotomized teeth (82.6 percent), the resorption rate was similar to their antimeres; in another seven, root resorption was faster; and only one pulpotomized tooth resorbed more slowly than its antimere. The relatively high failure rate in the present study does not justify recommending a 2 percent buffered glutaraldehyde solution as a substitute to formocresol.

Marginal leakage of Class II glass-ionomer-silver restorations, with and without posterior composite coverage: an in vitro study.

The aims of this in vitro investigation were: 1) to assess marginal leakage around three types of class II restorations, using: a) a composite resin with a glass ionomer lining; b) a glass ionomer cerment with composite resin coverage; c) a glass ionomer cermet without composite resin coverage and 2) to study the effect of thermocycling on marginal defects, by means of radiographs and SEM micrographs of the margins. Fifty-eight class II cavities were prepared in extracted primary molars. The teeth were divided into three groups and restored as follows: Group A--Ketac Bond (liner) and P-30; Group B--Ketac Silver and P-30(sandwich); Group C--Ketac Silver only. The restored teeth were thermocycled and marginal leakage was assessed from the degree of dye penetration on the sections. Dye penetration at the occlusal margins increased in the sequence A less than B less than C. The differences between group C and Groups A and B were statistically significant. Severe penetration of the dye was observed at the cervical margins with no statistically differences between the groups. Deterioration of margins due to thermocycling was observed for all groups, but these defects were not evident on the radiographs. Ketac Silver with and without composite coverage did not prevent marginal leakage when utilized in class II restorations in vitro.

Long-term follow-up of conservative treatment of severely traumatized maxillary incisors.

We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.