Case report: the Lesch-Nyhan syndrome.

BACKGROUND: The Lesch-Nyhan syndrome (LNS) is a rare x-linked excessive disorder of purine metabolism, caused by the congenital absence of hypoxanthine guanine phosphoribosyl transferase (HGPRT). CASE REPORT: In January 2000 a 2 year old boy was referred to a paediatric dental office in Landshut, Germany, because of severe and repeated lip chewing and aggressive tongue biting. A medical history revealed a normal pregnancy with no complications but a diagnosis of muscular hypotonia was made at four months of age. At 18 months a diagnosis of LNS was established through biochemical analysis and molecular examinations. The child displayed self-destructive behaviour, typical in children with LNS. Shortly thereafter the patient was supplied with arm cuffs for self-protection which were not tolerated and the self-mutilation continued. Eventually the extraction of all primary teeth was deemed necessary to prevent additional medical problems for this child. FOLLOW-UP: One year after the dental extractions the patient presented with no bite injuries but was now using his fingers to injure himself.

Reducing children's injection pain: lidocaine patches versus topical benzocaine gel.

PURPOSE: The purpose of this study was to compare the effectiveness of lidocaine patches and topical anesthetic gel in reducing injection pain in children. METHODS: Thirty-two children received bilateral greater palatine injections of 0.2 cc of 2% lidocaine with 1:100,000 epinephrine at the same visit. Injections followed a 15 minute application of DentiPatch (20% lidocaine) or a 1 minute application of topical anesthetic gel (Topex, 20% benzocaine). Each child completed a Faces Pain Scale and Visual Analog Scale after each injection and was asked which injection hurt more. Injections were videotaped and two independent evaluators, using the Sounds, Eyes, and Motor Scale, rated observed pain-related behavior. Inter-rater reliability was established at 96%. RESULTS: A significant difference was shown in observed pain-sounds favoring use of the DentiPatch (P < .003, Wilcoxon Sign Rank Test). Using Wilcoxon Sign Rank Test and paired t-tests, no significant differences were shown in either reported pain or observed pain-motor. CONCLUSIONS: A statistically significant decrease in observed verbal indicators of injection pain was found when the DentiPatch was used 20%: compared to a 1 minute application of topical anesthetic gel. However, no significant difference was found between the two study groups in either reported pain or observed pain-motor responses.

Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study.

The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian <1 percent Asian-American) was similar to that for the clinic in general. Reimbursement for dental care was primarily via Medicaid (91 percent) with <10 percent covered by insurance or payment by responsible parents. For one quarter of the children, the emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.

Bond strength of self-etching primers to enamel and dentin of primary teeth.

PURPOSE: The objective of this in vitro study was to evaluate the tensile bond strength of three self-etching primers to human primary enamel and dentin. METHODS: Forty (40) freshly extracted primary molars were sectioned bucco-lingually and embedded in self-curing acrylic resin with the facial or lingual surfaces exposed. The specimens were wet ground to 600 grit SiC paper to expose a flat enamel or dentin surface. The materials tested were: Prompt L-Pop (LP2, ESPE), Clearfil SE Bond (CSE, Kuraray America), Etch and Prime 3.0 (EP, Degussa) anda control, Prime and Bond NT (NT, Dentsply/Caulk). The adhesive systems were applied according to the manufacturers' instructions. An inverted, truncated cone of composite (Pertac II, ESPE) with a 2-mm bonding diameter was cured using a polytetrafluoroethylene jig. The specimens were debonded in tension using a universal testing machine (Instron) at a crosshead speed of 0.5 mm/min. RESULTS: Analysis of variance (ANOVA) showed significant differences existed between the four systems and two surfaces. To enamel of primary teeth, Prime and Bond NT had significantly higher bond strength (25.9 MPa) than when bonding with the three acidic primers Prompt L-Pop (18.5 MPa), Etch and Prime 3.0 (19.3 MPa) and Clearfil SE Bond (18.7 MPa). Complete bond failures occurred with Prompt L-Pop and Etch and Prime 3.0 to dentin of primary teeth. With a mean of 39 Mpa, the bond strength to dentin of primary teeth with Clearfil SE Bond was significantly higher than with Prime and Bond NT (12.5 MPa). CONCLUSIONS: The results of this in vitro study show that the four adhesive systems tested bonded effectively to enamel of primary teeth, but only CSE achieved adequate bond strengths to dentin of primary teeth.