Effectiveness of two visual-pedagogical methods for toothbrushing skills in autistic children: A randomized clinical trial.

AIM: This study aimed to compare the effectiveness of two visual pedagogy methods, video modeling and educational posters, on improving tooth-brushing autonomy in 10-12-year-old children with mild autism. METHODS: Sixty-four autistic children were randomly assigned to either the video or poster groups using the Rand function in Excel. Toothbrushing skills were divided into five stages: preparation, buccal, occlusal, lingual surfaces, and the end. These five stages comprised a total of 20 steps, with each step scored from 1 (not done at all) to 5 (done independently). The final score was calculated by averaging the scores of the five stages. The FONES method of toothbrushing was used for training. Follow-up assessments were conducted after 1 and 3 months. The data were analyzed using SPSS V26, including t-tests, Mann-Whitney U tests, and repeated-measures ANOVA. RESULTS: After 3 months, there were significant improvements in autonomy scores for both groups, with the video group showing greater benefits (4.37 ± 0.43) compared to the poster group (4.11 ± 0.49) (p = .03), with an effect size of η2 = .07. CONCLUSION: Both video and poster methods were effective in improving tooth-brushing skills, but video modeling was associated with a higher total autonomy score.

An In-Vitro Comparative Study of Fluoride Varnish and Two Calcium-Containing Fluoride Products on the Remineralization of Primary Teeth Enamel.

Objectives: To compare the effectiveness of fluoride varnish and two calcium-based fluoride products on the remineralization of primary teeth enamel. Materials and Methods: Surface-microhardness (SMH) of 36 extracted anterior primary teeth was measured by Vickers test (50gr/5 seconds) to provide a baseline for later comparisons. All teeth were immersed in demineralizing solution for 96 hours to create caries-like lesions and SMH was determined for the artificially-induced caries. The teeth were randomly assigned to three groups consisting of 5% fluoride varnish once daily/10 seconds, Clinpro™ 5000 toothpaste once daily/2 minutes, and Remin Pro cream once daily/3 minutes for 28 days. All specimens were kept in artificial saliva with pH cycling during the study period. After remineralization, SMH was evaluated for the last time. Data were analyzed by one-way ANOVA, Mauchly's sphericity, and RM-ANOVA with Bonferroni correction for inter-and- intra-group comparisons at the three stages of the study. Results: Neither the baseline SMH nor the SMH of the artificially created caries showed significant differences among the samples (P>0.05). The post-treatment SMH was highest in the Clinpro group (296.4±73.1kgf/mm2), followed by Remin Pro (283.8±119.3kgf/mm2), and varnish (270.9±78.3 kgf/mm2). There was no significant difference among the groups after treatment (P>0.05). We also did not observe a significant difference among the three different study stages (P>0.05). Conclusion: Within the limitations of this in-vitro study, daily application of low fluoride-calcium compound seems to be as effective as the professional use of fluoride varnish or high-content fluoride toothpaste in remineralizing initial caries of primary teeth.

Comparison of two Intranasal Sedatives, Midazolam versus Dexmedetomidine, in Children with High Dental Fear: a Randomized Clinical Trial.

Statement of the Problem: Pharmacologic management of uncooperative behavior is a growing trend in dentistry. Determining the most appropriate drug, route of administration, and proper candidate for sedation have been the goal of several investigations. Purpose: The aim of this study was to compare the sedative effect of intranasal (IN) sedation of midazolam (MDZ) in compare to dexmedetomidine (DEX) while taking into consideration the effect of dental fear, and psychological status on sedation success. Materials and Method: This double-blind randomized clinical trial included 92 uncooperative dental patients aged 4-6. Study participants were randomly assigned to receive either 0.2mg/kg IN MDZ or 1µg/kg DEX. Sedation was evaluated using the Houpt sedation rating scale. Vital signs were recorded before and during sedation. Prior to sedation, the level of dental fear was determined through children's fear survey schedule-dental subscale (CFSS-DS). Psychological characteristics were screened using the strengths and difficulties questionnaire (SDQ). Data were analyzed using T-test, Mann-Whitney, Chi-square, and repeated-measures analysis of variance (ANOVA). Results: Overall ratings of sedation and subscales of sleep, crying, and movement were comparable between groups (p> 0.05); however, more acceptable behavior (overall scores (4+5+6) was observed in MDZ group compared to DEX group (64% vs. 47.7%) (p= 0.007). All participants were found to have abnormal levels of dental fear (CFSS-DS≥38). However, according to SDQ, the study participants have mainly shown normal behavioral status. A significant association was found between dental fear and sedation success (MDZ, p= 0.001, DEX, p= 0.03), while similar findings were not observed for psychological characteristics (MDZ, p= 0.09 and p= 0.41; DEX, p= 0.71 and p= 0.53). Physiological parameters remained within normal limits in both groups. Conclusion: Sedation with IN MDZ resulted in overall behaviors, which were more satisfactory in highly fearful pediatric dental patients. Despite baseline uncooperative behaviors, the psychological status of study participants were close to average and were not associated with sedation failure.

Efficacy and Safety of Orally Administered Intravenous Midazolam Versus a Commercially Prepared Syrup.

BACKGROUND: Among different categories of sedative agents, benzodiazepines have been prescribed for more than three decades to patients of all ages. The effective and predictable sedative and amnestic effects of benzodiazepines support their use in pediatric patients. Midazolam is one of the most extensively used benzodiazepines in this age group. Oral form of drug is the best accepted route of administration in children. OBJECTIVES: The purpose of this study was to compare the efficacy and safety of a commercially midazolam syrup versus orally administered IV midazolam in uncooperative dental patients. Second objective was to determine whether differences concerning sedation success can be explained by child's behavioral problems and dental fear. PATIENTS AND METHODS: Eighty eight uncooperative dental patients (Frankl Scales 1,2) aged 3 to 6 years, and ASA I participated in this double blind, parallel randomized, controlled clinical trial. Midazolam was administered in a dose of 0.5 mg/kg for children under the age 5 and 0.2 mg/kg in patients over 5 years of age. Physiologic parameters including heart rate, respiratory rate, oxygen saturation and blood pressure were recorded. Behavior assessment was conducted throughout the course of treatment using Houpt Sedation Rating Scale and at critical moments of treatment (injection and cavity preparation) by North Carolina Scale. Dental fear and behavioral problems were evaluated using Child Fear Schedule Survey-Dental Subscale (CFSS-DS), and Strength and Difficulties Questionnaire (SDQ). Independent t-test, Chi-Square, and Pearson correlation were used for statistical analysis. RESULTS: Acceptable overall sedation ratings were observed in 90% and 86% of syrup and IV/Oral group respectively; Chi-Square P = 0.5. Other domains of Houpt Scale including: sleep, crying and movement were also not significantly different between groups. Physiological parameters remained in normal limits during study without significant difference between groups. CONCLUSIONS: "Orally administered IV midazolam" preparation can be used as an alternative for commercially midazolam syrup.

Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial.

Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of "commercially midazolam syrup" versus "orally administered IV midazolam dosage form (extemporaneous midazolam (EF))" in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2-0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good) was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup.

Assessing the sedative effect of oral vs submucosal meperidine in pediatric dental patients.

BACKGROUND: THE GOAL OF THIS INVESTIGATION WAS TO COMPARE THE BEHAVIORAL AND PHYSIOLOGICAL EFFECTS OF THREE SEDATIVE DRUG REGIMENS: oral meperidine (OM), submucosal meperidine (SM) and oral midazolam (M) in healthy pediatric patients. MATERIALS AND METHODS: This study sample consisted of thirty children aged 24-72 months (mean = 41.1) exhibiting definitely negative behavior. Three sedative regimens including: Oral meperidine/hydroxyzine, oral midazolam/hydroxyzine and submucosal meperidine/oral hydroxyzine were administered randomly during three consecutive appointments with a crossover design. Houpt behavioral scale was employed for evaluating the sedation effect of each regimen by a calibrated independent Pediatric dentist. Physiologic parameters were also recorded including blood oxygen saturation and pulse rate. Data was analyzed using Wilcoxon-signed ranked test, Mc-Nemar, GEE Logistic regression, Friedman, Fisher exact and Cochran tests for significance. RESULTS: Overall success rates were 50%, 46.7% and 26.7% for submucosal meperidine, oral meperidine and oral midazolam, respectively (P = 0.03). The probability of achieving a success in behavior control was more in 48-72 month olds. Child's age and drug type were the two main predictors of altered behavior. Evaluating the differences between the effects of three tested regimens on recorded physiological parameters showed no significant differences. CONCLUSION: All three regimens were proved safe within the limits of the current study. Meperidine sedation in both routes was considered to be more effective. Although there was less sleep and more head/oral resistance in midazolam group, the difference between groups was not significant.

Dental Fear and Concomitant Factors in 3-6 Year-old Children.

BACKGROUND AND AIMS: Dental fear/anxiety as a barrier in accessing oral health care is poorly investigated in Iranian children. The aims of this study were to evaluate the prevalence of dental fear and behavior management problems, as well as to examine the relationship between dental fear/anxiety and probable concomitant factors. MATERIALS AND METHODS: Mothers of 200 children aged 3-6 were participated in this descriptive-analytic study, and completed the CFSS-DS, SDQ, Chora and Spielberger questionnaires for both child and parents' general and dental anxiety in this descriptive- analytic study. Behavior was evaluated according to Frankl scale. Statistical approaches included T-test, chi-sq, and Pearson Linear correlation. RESULTS: The mean score of dental fear was 32.15 ± 10 and the prevalence was 22.2%. Significant correlations were found between child's dental fear, general fear and behavior management problems; however, no relationship was found between child's dental fear and parental dental or general fear. CONCLUSION: According to results of this study dental fear/anxiety seems to be more conditional and related to child's temperament than parental impact. Parental evaluation of dental fear can be used as a predictor of child's dental behavior.

Treatment of bilateral macrostomia (lateral lip cleft): case report.

BACKGROUND: Macrostomia as a rare facial deformity is classified among facial clefts. It originates from failure in union of maxillary and mandibular prominences of first brachial arch during 7(th) embryonic week. CASE PRESENTATION: We report a case of bilateral macrostomia (bilateral lip cleft) in a female newborn as a sole entity without other skeletal and facial deformities. The cleft was repaired by a simple linear triangular flap using extra oral landmarks to locate lip commissures. Patient was followed through a six-month period. Acceptable results were gained in mouth appearance as well functional aspects. CONCLUSION: Commissural repair through a linear flap can result in minimal visible scar with satisfying results in both esthetics and functional aspects.