Clinical comparison of sealant and bonding systems in the restoration of fractured anterior teeth.

This study compared the clinical performance of the ultraviolet light-initiated fissure sealant and composite system (Nuva-Seal/Nuva-Fil) with a chemically activated system (Adaptic Bonding Agent/Adaptic). A total of 63 fractured permanent anterior teeth involving only enamel and dentin were restored. All teeth were isolated with rubber dams, and the acid etch technique was used. The degree of success was determined from an assessment of retention, marginal integrity, marginal staining, and color change. The restorations were evaluated at 3, 6, 12, 18, and 24 months postoperatively. Of the restorations, 93% were retained in both groups of patients after two years. Varying degrees of marginal problems (lack of marginal integrity or marginal staining) were directly attributable to the extension of the bonding medium and the composite in relation to the conditioned enamel and to each other. Repolishing of the margins should be considered at the time of the recall appointments to improve the quality of restoration.

Analgesic efficacy and safety of an intraoral lidocaine patch.

The effectiveness of intraoral II-docaine patches was tested by asking participants to rate the pain experienced after insertions of a 25-gauge needle. Needlesticks were performed at baseline and at various time points after patch placement. Each needlestick included contact with the periosteum. Lidocaine patches achieved significantly better analgesia than the placebo within 2.5 to five minutes after placement. Drug-related side effects were minimal and venous blood levels of lidocaine were low, averaging 10 to 14 times less than those achieved with a typical injection of lidocaine plus epinephrine. The authors conclude that the lidocaine patches used in this study are effective and safe in reducing needle insertion pain in adults.

Effects of nitrous oxide on diazepam sedation of young children.

This study was performed to test the hypothesis that nitrous oxide augments the effects of diazepam sedation of young children by reducing crying and movement and improving the overall quality of sedation. Twenty-four children (mean age of 32 months) were sedated on two occasions with two different treatment regimens. All subjects received a standard oral dose of 0.5 mg/kg of diazepam with and without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for the first 20 min followed by 100% oxygen for the balance of the procedure and, during the second visit, the reverse regimen was used. All subjects were restrained in a Papoose Board (Olympic Medical, Seattle, WA) with an auxiliary head restraint. Successful sedation, as evidenced by lack of crying or movement that interrupted treatment, occurred in 83% of administrations. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted, local anesthesia was administered, and the rubber dam was placed. When the evaluation of the overall sedation was compared with and without nitrous oxide, it was better with nitrous oxide 56% of the time, worse 13% of the time, and the same in the remaining 31% of the comparisons. It is concluded that nitrous oxide may slightly augment the effect of diazepam sedation of young children, but it does not do so uniformly for all children receiving sedation.

Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children.

This study investigated the prevalence of oral soft tissue lesions in children infected with HIV and the relationship of CD4 lymphocyte levels with the prevalence of those lesions. Sixty HIV-positive children enrolled in the Children's Hospital AIDS Program (age 5.8 +/- 3 years) were selected for study. Only five subjects (8%) had healthy gingiva and a low mean plaque index (22%). The remainder had gingivitis or periodontitis with relatively high plaque indices (47, 55, and 94%, respectively). A declining CD4 lymphocyte count (1357 to 35) was associated with an increasing severity of gingival disease.

A comparison of chloral hydrate and diazepam sedation in young children.

The purpose of this study was to compare a high and low dose of diazepam with chloral hydrate in the sedation of young children. Thirty healthy children between the ages of 20 and 48 months, with a mean age of 33.5 months, participated in the study. All children exhibited negative behavior during a screening visit and required at least two restorative appointments with the use of sedation. A dose of either 0.3 mg/kg or 0.6 mg/kg of diazepam at one visit and 50 mg/kg of chloral hydrate at another visit was administered in a double-blind manner. All children were restrained in a Papoose Board with auxiliary head restraint and received 50% nitrous oxide/oxygen during treatment. The degree of sleep, body movement, crying, pulse rate, respiratory rate, and blood oxygen saturation were monitored before and during the operative procedures. Vital signs remained essentially unchanged during treatment, except for transitory elevations of the pulse during periods of stimulation. There were no statistically significant differences among the three drug regimens with regard to movement and crying. Significantly more patients who received chloral hydrate were asleep than when either dose of diazepam was given during the first 60 min of treatment. The only side effect found was vomiting in one patient with both chloral hydrate and diazepam. It is concluded that the sedative effects of chloral hydrate and diazepam are similar when young children are sedated for dental treatment. The use of diazepam might be more advantageous because chloral hydrate produces more sleep during the first hour of treatment.

Effects of nitrous oxide on chloral hydrate sedation of young children.

This study was performed to test the hypothesis that nitrous oxide augments the effects of chloral hydrate sedation of young children. Twenty children with a mean age of 32 months were sedated on two occasions with two different treatment regimens. All subjects received a standard dose of 50 mg/kg of chloral hydrate with or without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for a period of 20 minutes followed by 100% oxygen and, during the other visit, the reverse concentrations were used. All subjects were restrained in a Papoose Board(*) with an auxiliary head restraint. Successful sedation, as evident by lack of crying or movement which interrupted treatment, occurred in 84% of administrations. During the first twenty minutes, subjects receiving nitrous oxide moved and cried significantly less than when they were treated without nitrous oxide. During the remainder of the appointment, there was no difference in behavior between the two treatment regimens. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted and local anesthesia was administered. It is concluded that nitrous oxide augments the effect of chloral hydrate sedation of young children, but does not do so uniformly for all children receiving sedation.

An evaluation of intraoral lidocaine patches in reducing needle-insertion pain.

Intraoral lidocaine patches have recently been approved by the US Food and Drug Administration for the production of topical anesthesia before superficial dental procedures and for the reduction of pain associated with local anesthetic injections. The results of this 5-center clinical study showed that lidocaine patches were significantly more efficacious than matching placebo patches in reducing the pain associated with 25-gauge needle insertions to the level of bone in the maxillary premolar region. Anesthetic onset occurred within 5 minutes and was present for the entire 15-minute period that the patches were in contact with the oral mucosa. In addition, the patches were safe and well tolerated by study participants. Other potential clinical applications of this novel delivery system are also discussed in this article.

Assessing chloral hydrate dosage for young children.

Results of this study demonstrate that a dose of 75 mg/kg of chloral hydrate supplemented by nitrous oxide is superior to the dose of 50 mg/kg, for behavior management of young children sedated for dental treatment.