Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study.

OBJECTIVES: The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively. MATERIALS AND METHODS: The 1-12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size. RESULTS: The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%. CONCLUSIONS: The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial. CLINICAL RELEVANCE: The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

The ability of pulp sensibility tests to evaluate the pulp status in primary teeth.

BACKGROUND. Accurate determination of the pulp status is the most important part of conservative pulp therapy. AIM. The aim of this study was to assess the ability of thermal and electrical pulp tests to assess the pulp status in primary teeth. DESIGN. Seventy-eight primary molar teeth in 36 children were investigated. Fifty-six teeth had unknown pulp status in need of endodontic treatment, and 22 were intact teeth with no signs of pulp disease. Cold, hot and electrical pulp testing (EPT) were performed on each tooth. The gold standard was established by direct inspection of the pulp after an access cavity had been made. The sensitivity, specificity, positive and negative predictive values for each test and different sequential combinations of pulp testing were calculated. Sequential combination test analysis was used for data analysis. RESULTS. The highest accuracy was found for EPT, followed by heat and cold tests. No significant difference was found between the accuracy of EPT and the heat test (P-values > 0.05); however, the accuracy of EPT was significantly higher than that of the cold test (P-value< 0.05). CONCLUSION. Based on this study, EPT can be used as a reliable test for diagnosing the pulp status in primary teeth.

Wear and repair of stainless steel crowns.

AIM: The purpose of this study was to determine the wear of stainless steel crowns (SSCs) in children, and compare the extent of microleakage in SSCs that had been repaired using either a cermet glass-ionomer cement (GIC) or a packable composite resin (CR). MATERIALS AND METHODS: For the first aim, the occlusal surface thickness of 31 harvested SSCs (21 primary first and 10 second molars) and 18 unused SSCs was measured, and then examined under scanning electron microscopy. For the second aim, standardised holes were prepared on the occlusal surfaces of 20 SSCs, and then repaired using either a cermet GIC or packable CR. After their repair, the extent of microleakage was determined using 0.5% basic fuchsin and stereomicroscopy. RESULTS: The thickness of all the harvested SCCs was 5.3 µm less than that of the unused SCCs (p<0.02), and there were no significant differences between the thickness and occlusal wear rates of harvested SSCs from the first and second primary molars. Although neither of the two repair materials completely prevented microleakage, the number of specimens in which microleakage occurred after repair with a cermet GIC was significantly lower than the number of specimens in which a packable CR was used (p<0.05). CONCLUSION: We concluded that the occlusal surfaces of SSCs for first and second primary molars display wear. Although perforated SSCs can be repaired using either a cermet GIC or a packable CR, less microleakage occurs in SSCs that were repaired with a cermet GIC than those with a packable CR.

Generalised hypomineralisation of enamel in oculodentodigital dysplasia: comprehensive dental management of a case.

Oculodentodigital dysplasia (ODDD) is a rare congenital disorder characterised by developmental abnormalities of the eye, dentition and digits of the hands and feet, with neurological symptoms reported in 30% of individuals. Dental anomalies associated with ODDD include enamel hypoplasia and subsequent caries, microdontia, missing teeth, amelogenesis imperfecta, pulp stones and delayed tooth development. Here, we describe the comprehensive dental management of a 3-year-old girl who presented with rapid deterioration of the primary dentition due to generalised enamel hypomineralisation. Conservative, comprehensive restorative management was performed under general anaesthesia. Within 6 months, further breakdown of the remaining unrestored enamel was noted. This case documents the challenges of conservative management in dental anomalies that are not well documented due to the extreme rarity of the disorder.

The practice and perception of pain assessment in US pediatric dentistry residency programs.

PURPOSE: The purpose of this study was to describe the current practice and perception of pain assessment in US accredited advanced pediatric dentistry residency programs, as reported by directors of these programs. METHODS: A questionnaire was sent out to 68 accredited US pediatric dentistry residency programs. Responses were statistically analyzed to find significant correlations between the actual practice of pain assessment and the perceived usefulness of pain assessment. RESULTS: Forty-four surveys (65% response rate) were completed and returned. Sixty-eight percent of program directors stated that pain is assessed at all types of appointments. A statistically significant correlation exists between program directors who regard pain assessment scales as useful and those who teach the use of such resources in their programs (chi-square = 3.73, P = .05). A statistically significant correlation exists between program directors who regard preoperative pain assessment as clinically beneficial and those who report a need to place more emphasis on pain assessment (chi-square = 6.22, P = .01). CONCLUSIONS: Pediatric dentistry residency program directors generally regard pain assessment as clinically beneficial in patient treatment. Implementing increased pain assessment teaching in pediatric dentistry residency programs could improve the confidence and skills of residents in assessing the pain of young children and those with special health care needs.

Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper).

BACKGROUND: Intraosseous (IO) anaesthesia has been shown to be effective in children. However, the pain associated with anaesthetic injections, and its acceptance by children, have never been studied. AIM: The aim of this study was to assess the pain associated with the IO injection of 4% articaine with 1 : 200 000 epinephrine using the computerized QuickSleeper' system in a population of children and adolescents. DESIGN: IO anaesthesia was performed on patients aged 10.4 +/- 2.6 years of age. The patients assessed their pain on a faces pain scale (FPS) and on a visual analogue scale (VAS). The operators were also asked to assess signs of patient pain/discomfort. RESULTS: No pain or mild discomfort was reported by, respectively, 81.8% (FPS) and 83.9% (VAS) of the patients. Some 58.9% of children with previous experience of dental anaesthesia reported that computerized IO anaesthesia was more comfortable than traditional infiltration methods. Operators noted signs of discomfort during penetration and injection in 18.3% and 25.3% of the patients, respectively. CONCLUSIONS: This study showed that the majority of children reported no pain or mild pain when anaesthetic was administered by computerized needle rotation and solution deposition. This technique holds promise for use by trained paediatric dentists.

Evaluation of the Root ZX apex locator in primary teeth.

PURPOSE: The purpose of this study was to evaluate the accuracy of the Root ZX electronic apex locator in determining canal length in primary incisors. METHODS: Root ZX was utilized to measure the canal lengths of 150 primary incisors in vivo. After the teeth were extracted, a standard ruler was used to measure the canal lengths to the nearest 0.5 mm. A paired t test was used to compare the lengths obtained in vivo with Root ZX and the lengths measured in vitro. RESULTS: In 98 (65%) of the canals, the length measured by Root ZX was determined to be equal to the length measured in vitro. Root ZX measurements were found to be less than in vitro measurements by 0.5 mm in 24 canals (16%), and were greater than in vitro measurements by 0.5 mm in 21 canals (14%). Root ZX measurements exceeded in vitro measurements by 1.0 to 1.5 mm in 5 canals (3%) and were less than in vitro measurements by 1.0 mm in 2 canals (1%). Paired t test analysis indicated no significant difference between the 2 measurement methods (P=.67). CONCLUSIONS: Root ZX can accurately assess the length of canals in primary incisors.

Impressions in cleft lip and palate--a novel two stage technique.

Though the field of presurgical orthopedics for the management of children with cleft Lip and Palate (CLAP) has made great advances over the past few decades, little is found in literature regarding the imressions required to fabricate these appliances. The purpose of this paper is to describe a novel two stage technique utilizing greenstick compound and addition silicone impression material to provide a safe, economical and accurate method for recording impressions in children with cleft lip and palate.

Assessment of the anesthetic effectiveness of anterior and middle superior alveolar injection using a computerized device versus traditional technique in children.

UNLABELLED: The study aims to evaluate the anesthetic effectiveness of the Anterior and Middle Superior Alveolar (AMSA) injection administered through a computer-controlled local anesthetic delivery system (CCLAD), and compare it with the traditional buccal and palatal injections used to anesthetize maxillary primary molars. MATERIALS AND METHODS: The sample included 80 primary maxillary molars, divided into 2 equal groups: Pulpotomy and extraction groups. Each group was divided equally into 4 subgroups: A. First molars anesthetized with the traditional technique, B. first molars anesthetized with the CCLAD, C. second molars anesthetized with the traditional technique, and D. second molars anesthetized with the CCLAD. The evaluation was done single blind using SEM scale. RESULTS: The AMSA injection with the CCLAD was found to be effective in anesthetizing maxillary primary molars in pulpotomy and extraction procedures. There was no significant difference between the two anesthetic techniques except in the step of gingival retraction buccally in, which the traditional injections were more effective than the CCLAD during extractions. No significant difference was found between first and second primary molars in the effectiveness of both techniques. CONCLUSION: The AMSA injection using CCLAD was found to be effective in children.

Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: A systematic review and MTC meta-analysis.

BACKGROUND: Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective. AIM: To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes. DESIGN: Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated. RESULTS: An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS: Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.

A randomised comparison of the single use LMA Flexible with the reusable LMA Flexible in paediatric dental day-case patients.

In this study we compared the performance of the single use flexible laryngeal mask airway (LMA Flexible) with the original reusable LMA Flexible in paediatric dento-alveolar day-case surgery. The aim of the study was to determine whether these two supraglottic airway devices were clinically equivalent when used for simple dental extractions in children under general anaesthesia. This randomised comparative trial in 100 healthy children used first attempt airway insertion success as its primary outcome measure. Secondary outcomes included the adequacy of ventilation, incidence of airway obstruction and the requirement for device manipulation and the incidence of adverse airway outcomes during recovery from anaesthesia. No difference was found between the devices in first attempt insertion success rate (94% with reusable LMA Flexible and 90% with single use LMA Flexible, p = 0.358), and ease of insertion was also similar (p = 0.5). Both devices performed equally well during surgery, with no significant differences in episodes of intra-operative airway compromise (p = 0.387), and both the single use and reusable LMA Flexible displayed excellent recovery characteristics, with no occurrences of emergence airway obstruction. No blood was discovered within the inner LMA tube shaft in either device, implying that both protected against tracheobronchial soiling. We conclude therefore that the single use LMA Flexible is an acceptable alternative to the reusable LMA Flexible.

Prevention of traumatic dental lesions: cognitive research on the role of mouthguards during sport activities in paediatric age.

AIM: This study reports a personal contribution and the analysis of the most recent literature on prevention of dentoalveolar traumas, and the lack of knowledge and use of protective oral devices in children (7-12 years old) practicing sports. Different oral protection devices will be illustrated, and among them the types more suitable for the investigated age group. MATERIALS AND METHODS: Recently we conducted a survey on a sample of 300 children between 8 and 11 years of age practicing basketball, to assess the frequency of oral traumas, correlated predisposing factors, level of knowledge of mouthguards and possible frequency of use of such devices. RESULTS: From the survey it emerged that only 30 subjects knew about mouthguards (15 of them received the information from their dentist) and none of them received information from the coach or within the sport club. Furthermore, only 3 subjects (1% of the sample) wore a mouthguard during practice. Our study and other literature contributions highlight the total lack of information of the practitioners, especially the young ones, and the unconcern for these problems by the organisations (clubs) where sports are practiced. A cycle of 2 brief conferences about orofacial trauma prevention and use of mouthguard was administered. Regarding the type of mouthguard more suitable to adolescent athletes, the semi-individual types of new generation seem to be the best choice, since they can be refitted multiple times in order to adapt to the dental and skeletal growth. Conclusion We can conclude reasserting the absolute need of providing information about the risks of orofacial trauma related with basketball and other contact sport activities, and to promote the use of mouthguards as a primary protective measure among athletes, which will considerably reduce the social costs associated with such trauma occurrences.

[Post-academic dental specialties. 11. Discomfort during atraumatic restorative treatment (ART) versus conventional restorative treatment]. / Beroepsdifferentiatie in de tandheelkunde. 11. Ongemak tijdens atraumatic restorative treatment (ART) versus conventionele behandelmethode.

Although Atraumatic Restorative Treatment (ART) claims to be a patient-friendly method of treatment, little scientific proof of this is available. The aim of this study, therefore, was to acquire a reliable measurement of the degree of discomfort which children experience during dental treatment performed according to the ART approach and during the conventional method. A number of 403 Indonesian schoolchildren were randomly divided into 2 groups. In each child, one class II restoration was carried out on a deciduous molar either by means of ART or the use of rotary instruments (750 rpm). Discomfort scores were determined both by physiological measurements (heart rate) and behavioral observations (Venham scale). Venham scores showed a marked difference between the 2 groups, whereas heart rate scores only differed significantly during deep excavation. A correlation was found between Venham scores and heart rate measurements. Sex, initial anxiety and performing dentist were shown to be confounding variables. In conclusion it can be said that children treated according to the ART approach experience less discomfort than those treated with rotary instruments.

Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments.

Atraumatic Restorative Treatment, ART, is a method of minimal caries intervention that uses only hand instruments. The aim of the present study was to explore a possible difference between the extent of discomfort experienced during dental treatment according to the ART approach and a method using rotary instruments. The study was performed in Indonesia. A total of 403 children were randomly divided in two groups. In each child, one class II restoration in a deciduous molar was made. One group received treatment using rotary instruments (750 r.p.m.). The other group was treated according to the ART approach. Glass ionomer cement was used for restoration in both groups. Discomfort scores were determined using both physiological measurements (heart rate) and behavioral observations (Venham) on specific moments during the treatment. Venham scores showed a marked difference between the two groups at most time points. Heart rate measurements were different at deep excavation. Also, a clear relation between Venham scores and heart rate measurements could be found at all time points. Confounding could be shown for operating dentist, gender of the patient and initial anxiety, not for age. No effect modification could be shown. It can be concluded that children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instruments.

Clinical evaluation of the measuring accuracy of ROOT ZX in primary teeth.

OBJECTIVE: The aim of this study was to assess the accuracy of an electronic device (Root ZX; Morita, Tokyo, Japan) for measuring the root canal length in primary teeth. STUDY DESIGN: The pulp tissue was removed from 71 nonrestorable teeth scheduled to be extracted under general anesthesia, and the root canals (n = 105) were irrigated (H(2)O(2), 3%; NaOCl, 1%). Subsequently, the length was determined clinically with the electronic device prior to extraction. Treatments were performed by 2 dentists (42 and 63 root canals). After extraction, the real length was recorded and the 2 measurements were compared. RESULTS: Measurements were affected significantly by the dentists (P < .01; chi(2)). However, regression analysis revealed sufficient accuracy of the device, with a tendency to estimate the root canal length just short (x = -0.98 +/- 1.75 mm) of the apex. These results were not influenced by tooth type, root canal type, status of the periapex, or clinical condition (P > .05; chi(2)). CONCLUSION: Root ZX can be strongly recommended for clinical implementation of endodontics in primary teeth, particularly when treating fidgety children.

A comparison of the efficacy and safety of an electric and a manual children's toothbrush.

Effective plaque control of the primary dentition can be particularly difficult to achieve because of problems with motivation and manual dexterity in some children. This study compared plaque control efficacy of a new electric toothbrush designed specifically for use by children with a children's manual brush. Results showed that in a pediatric population aged between 8 and 12 years, the electric brush achieved significantly greater plaque removal from both primary and permanent dentition.

Lasers in pediatric and adolescent dentistry.

The advent of lasers has offered new possibilities for improved service for pediatric dentistry patients and their parents. The removal of tissues without anesthesia is a common benefit. Almost symptomless postoperative experiences are in marked contrast to conventional methods. Whether performing cavity preparations or remodeling gingival architecture, the acceptance from a young patient is a gratification as well as a practice builder. Because many children may experience laser treatment as their first contact with dentistry, there is a possibility that a new generation of patients will grow up with a different attitude toward dentistry. Parents are enthusiastic about being able to offer their children the advantages of laser care.

Focused care of pediatric patients in the dental office.

No dental text can adequately prepare the practitioner with the necessary expertise to treat all presentations or office complications that may arise in the therapy of children. There are times when consultation with the child's parent and pediatrician may answer necessary treatment-related questions. Most chronic conditions do not prevent needed treatment interventions. Any acute illness or exacerbation of a chronic disease should be cleared by the primary care physician before commencing dental treatment. The mainstay of safe practice requires that the dentist to maintain a basic level of understanding of what constitutes an emergency and that office staff receive basic training and are adequately supplied with emergency equipment. Dentists are cautioned to consult their state board or dental society as well as their insurance carrier as to what constitutes necessary emergency equipment in the office and to what level they are responsible for providing emergency care to their patients. There is a great difference within the dental field just as there is with medical specialties. All practitioners, however, are liable for any acts of consignment, and although the intention is not to dissuade anyone from providing assistance in an emergency, supportive care and an immediate call of 911 to activate the local EMS are important. In addition, maintaining a familiarity with the local hospital and emergency department capabilities as well as travel time and distance is also important. Routine reviews and updates on life-saving interventions and resuscitations are good general practice and will save lives.

Electric toothbrushes--for whom are they designed?

Powered toothbrushes were first introduced on a large scale in the early 1960s. However, because of a clear lack of superiority compared with manual brushes, and problems with mechanical breakdowns, their sales decreased significantly. However, recommendation for their use continued in special populations with dexterity and cognition problems. The 1990s ushered in an era of new technology, and studies began to suggest superiority of some powered brushes, particularly those using oscillating-rotating or counter-rotational actions. Some studies have shown interproximal cleansing abilities superior to those of manual brushes and yielding results similar to those achieved with the use of a manual brush and floss. Both controlled and open-labeled studies have suggested that electric brushes improve gingival health with patients who routinely used manual brushes prior to using these new powered brushes, and safety has been clearly established. In recommending powered toothbrushes, practitioners should familiarize themselves with the products available, with the clinical studies supporting their benefits compared with manual brushes, their safety and ease of use, and the patient's economic status.