Oral midazolam vs. intranasal dexmedetomidine plus oral midazolam for sedation of pediatric outpatients: a double-blinded randomized controlled trial.

BACKGROUND: Moderate to deep sedation is required for dental treatment of children with dental anxiety. Midazolam is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric sedation. OBJECTIVE: The aim of this trial was to compare the sedative efficacy of oral midazolam alone with that of intranasal dexmedetomidine plus oral midazolam during dental treatment of children with dental anxiety. DESIGN: In total, 83 children (aged 3-12 years) scheduled to undergo dental sedation were randomized to receive oral midazolam (0.5 mg/kg) and intranasal placebo, or oral midazolam (0.5 mg/kg) plus intranasal dexmedetomidine (2 µg/kg). The primary outcome was the rate of successful sedation for dental treatment. Secondary outcomes were the onset time and adverse events during and after treatment. Data analyses involved descriptive statistics and nonparametric tests. RESULTS: The rate of successful sedation was significantly higher in combination group (P = 0.007), although the sedation onset time was significantly longer in combination group (17.5 ± 2.4 min) than in monotherapy group (15.7 ± 1.8) (P = 0.003). No children required medical intervention or oxygen therapy for hemodynamic disturbances, and the incidences of adverse events had no significant difference between groups (P = 0.660). CONCLUSION: Combined treatment with oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (2 µg/kg) is more significantly effective for managing the behavior of non-cooperative children during dental treatment, compared to oral midazolam (0.5 mg/kg) alone. (Chinese Clinical Trial Registry: ChiCTR2100042300) TRIAL REGISTRATION: ChiCTR2100042300, Clinical trial first registration date: 17/01/2021.

Metagenomic analysis reveals ecological and functional signatures of oral phageome associated with severe early childhood caries.

OBJECTIVES: Severe early childhood caries (S-ECC) is highly prevalent, affecting children's oral health. S-ECC development is closely associated with the complex oral microbial microbiome and its microorganism interactions, such as the imbalance of bacteriophages and bacteria. Till now, little is known about oral phageome on S-ECC. Therefore, this study aimed to investigate the potential role of the oral phageome in the pathogenesis of S-ECC. METHODS: Unstimulated saliva (2 mL) was collected from 20 children with and without S-ECC for metagenomics analysis. Metagenomics sequencing and bioinformatic analysis were performed to determine the two groups' phageome diversity, taxonomic and functional annotations. Statistical analysis and visualization were performed with R and SPSS Statistics software. RESULTS: 85.7 % of the extracted viral sequences were predicted from phages, in which most phages were classified into Myoviridae, Siphoviridae, and Podoviridae. Alpha diversity decreased, and Beta diversity increased in the S-ECC phageome compared to the healthy group. The abundance of Podoviridae phages increased, and the abundance of Inoviridae, Herelleviridae, and Streptococcus phages decreased in the S-ECC group. Functional annotation revealed increased annotation on glycoside hydrolases and nucleotide metabolism, decreased glycosyl transferases, carbohydrate-binding modules, and biogenic metabolism in the S-ECC phageome. CONCLUSIONS: Metagenomic analysis revealed reduced Streptococcus phages and significant changes in functional annotations within the S-ECC phageome. These findings suggest a potential weakening of the regulatory influence of oral bacteria, which may indicate the development of innovative prevention and treatment strategies for S-ECC. These implications deserve further investigation and hold promise for advancing our understanding and management of S-ECC. CLINICAL SIGNIFICANCE: The findings of this study indicate that oral phageomes are associated with bacterial genomes and metabolic processes, affecting the development of S-ECC. The reduced modulatory effect of the oral phageome in counteracting S-ECC's cariogenic activity suggests a new avenue for the prevention and treatment of S-ECC.

Clinical Analysis of Approach Selection of Extraction of Maxillary Embedded Mesiodens in Children.

Objective: To analyze the relationship between the position of embedded mesiodens in maxilla and surgical approach in children and thus provide reference materials for surgical design. Methods: According to the preoperative cone-beam computed tomography (CBCT) examination, the location and surgical approach characteristics of 625 children aged 4-16 years old who presented with embedded mesiodens in maxilla and were diagnosed in our department from January 2016 to December 2021 were statistically analyzed. Results: There were 877 embedded mesiodens in 625 children. The selected cases were classified according to the axial angle relationship between mesiodens and adjacent normal teeth or tooth germs, including 84 cases of acute angle type (including the same direction) (13.4%), 66 cases of vertical type (10.6%), 114 cases of obtuse angle type (18.2%), 271 cases of inverted type (43.4%), and 90 cases of mixed type (14.4%). The palatal gingival margin approach was the most selected surgical approach for the cases of acute angle (including synclastic), obtuse angle, and inverted type, and the palatal gingival margin approach and the combined labial-palatal approach were the most selected surgical approach for the cases of vertical and mixed type. Conclusion: Palatal gingival margin approach was the most common surgical approach for various types of embedded mesiodens in maxilla in children. Surgeons should classify the case of mesiodens according to the preoperative imaging examination and design the surgical approach reasonably.

[Effect of aqueous extracts of Scutellaria baicalensis Georgi and Radix paeoniae Alba on the serum IgG1 and IgG2a of the periodontitis mice].

OBJECTIVE: To examine the effect of aqueous extracts of Scutellaria baicalensis Georgi and Radix paeoniae Alba on periodontitis mice and compare the results of the two herbs for the treatment of the periodontitis mice. METHODS: Sixty-four SPF 12-week-old male Kunming mice were selected and randomly divided into four groups:Control group(C); Experimental periodontitis group (P):the peridontitis models in Kunming mice were prepared by wrapping silk ligature and inoculating with putative periodontopathic bacteria; Scutellaria baicalensis Georgi treatment group (SG): periodontitis was induced by the same method described above, the mice were gavaged with Scutellaria baicalensis Georgi; Radix paeoniae Alba treatment group (RG): periodontitis was induced by the same method described above, the mice were gavaged with Radix paeoniae Alba.Four mice were sacrificed at each time point of the end of 4, 6, 8 and 10 weeks in each group. The histopathological changes of periodontal tissue were observed under microscope with HE staining. The level of serum IgG1 and IgG2a was measured by enzyme-linked immunosorbent assay (ELISA) . RESULTS: A serious inflammatory response, alveolar progressive absorption and a large number of osteoclasts were observed in the experimental periodontitis group.However, in SG and RG, the inflammation of the periodontal tissue was decreased and tissue repair was significant. The level of serum IgG2a in SG (6 week:0.934 ± 0.006, 8 week:0.743 ± 0.009, 10 week: 0.674 ± 0.008) and RG (6 week: 1.023 ± 0.032, 8 week: 0.851 ± 0.032, 10 week:0.790 ± 0.009) was significantly decreased after the mice were gavaged with the two herbs(P < 0.01). The level of serum IgG2a in SG was significantly lower than that of RG (P < 0.01). The level of serum IgG1 in SG (6 week: 0.314 ± 0.006, 8 week: 0.344 ± 0.004, 10 week: 0.367 ± 0.006) and RG (6 week: 0.287 ± 0.005, 8 week: 0.303 ± 0.058, 10 week: 0.336 ± 0.006) were significantly increased (P < 0.01). The level of serum IgG1 in SG was significantly higher than that of RG (P < 0.01). CONCLUSIONS: Both the aqueous extracts of Scutellaria baicalensis Georgi and Radix paeoniae Alba showed therapeutic effect on periodontitis in mice.Scutellaria baicalensis Georgi was more effective than Radix paeoniae Alba.

Bone graft in the shape of human mandibular condyle reconstruction via seeding marrow-derived osteoblasts into porous coral in a nude mice model.

PURPOSE: The purpose of this study was to develop a tissue-engineered bone graft model in the shape of a human mandibular condyle. MATERIALS AND METHODS: Natural coral with a pore size of 150 to 220 microm and porosity of about 36% was molded into the shape of a human mandibular condyle. Culture-expanded rabbit marrow mesenchymal stem cells were induced by recombinant human bone morphogenetic protein-2 (rhBMP2) to improve osteoblastic phenotype. Then marrow-derived osteoblasts were seeded into natural coral at a density of 2 x 10(8)/mL and incubated in vitro for 3 days before implantation. The cell-coral complexes were implanted subcutaneously into the backs of nude mice and incubated in vivo for 2 months before harvesting. Implantation of coral alone acted as control. The specimens were processed for gross inspection, radiographic examination, and histologic and scanning electronic microscopic observation. RESULTS: The results showed that new bone grafts in the shape of a human mandibular condyle were successfully developed 2 months after implantation and maintained the initial shape of the natural coral scaffold. New bone could be observed histologically on the surface and in the pores of natural coral in all specimens in the cell-seeding group (6 of 6), whereas in the control group there was no evidence of osteogenesis process (0 of 4). CONCLUSION: This study suggests the feasibility of using porous coral as scaffold material transplanted with marrow-derived osteoblasts to restore bone graft in the shape of human mandibular condyle and shows the potential of using this method for the reconstruction of bone defects.