Parental Presence/Absence in the Dental Operatory as a Behavior Management Technique: A Review and Modified View.

INTRODUCTION: Parental presence/absence in the dental operatory (also called: Parent-in-parent-out technique) is an extremely controversial aspect of the nonpharmacological BMTs. Historically, dentists used to exclude parents from dental operatory to avoid their interference with the dentist's aptitude to build a rapport and relationship with the child, hence increasing the child management problems by disrupting treatment and making the dentist unfocused and uncomfortable. AIM: The purpose of this article is to review and emphasize on the importance of parental presence/absence in the dental operatory, especially in a certain age group, as a behavior management technique (BMT) in pediatric dentistry, and to present a modified view of this technique. RESULTS: This article reviews the current literature concerning behavior management in pediatric dentistry. It includes a medline database search and review of the comprehensive textbooks in pediatric dentistry. Some recommendations were based on the opinions of experienced researchers and clinicians. CONCLUSION: Parent-in-parent-out technique in dental operatory is advocated to gain emotional support and avoid the effect of traumatic separation, especially in younger children or special health-care needs patients. CLINICAL SIGNIFICANCE: The parent-in-parent-out technique in dental operatory is underused, or misused. This article clarifies the proper use of this technique along with a minor modification to it to make it more effective on young apprehensive dental patients.

Efficiency of Er:YAG utilization in accelerating deep bite orthodontic treatment.

BACKGROUND AND AIMS: The long duration of orthodontic treatment is a major patients' concern. A noninvasive method of accelerating tooth movement in a physiological manner is needed. The aim of the study was to evaluate the effects of Er:YAG laser application during orthodontic treatment of deep bite and to evaluate its analgesic effect during that movement. MATERIALS AND METHODS: A prospective randomized controlled clinical trial (RCT) was performed on 30 patients with deep bite. Sample was divided into two groups: (A), 15 patients (orthodontic treatment-control group) and (B), 15 patients (orthodontic treatment and Er:YAG Laser - laser group). The tooth movement was evaluated as the primary outcome variable by measuring angular and linear changes on three progress lateral cephalometeric radiographs (T1, T2 and T3); Lateral cephalograms were taken before treatment (T1), immediately after finishing the stage of leveling and alignment (T2) and after completion of the intrusion stage (T3).Laser parameters were 400 mJ/10 Hz/4 W and 400 mJ/15 Hz/6 W, depending on the handpiece used. The levels of pain and discomfort were evaluated and ranked according to a visual analog scale. Paired t-tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences. RESULTS: The main findings of the treatment were (1) significant positive difference in the rates of tooth intrusion movement on the experimental group compared with the control group at the baseline to T2 and T3 interval and the tooth movement rate was approximately 3 times faster in the experimental group. (2) The pain score in the experimental group was significantly lower compared with the control group on day 3 as on day 7. CONCLUSION: The application of Er:YAG laser is an effective mean to speed orthodontic tooth movement with a significant reduction in pain and discomfort after application.