Oral sedation in dentistry: evaluation of professional practice of oral hydroxyzine in the University Hospital of Rennes, France.

PURPOSE: Management of a child's anxiety early in their treatment is essential in dentistry. Sedative medications are used to overcome increased anxiety from previous appointments and to promote the cooperation of children during treatment. Hydroxyzine is currently prescribed to young patients as part of the first level of conscious sedation. The main objective was to evaluate the professional practice of oral hydroxyzine, when prescribed for children presenting anxiety during dental treatment procedure performed by students and senior practitioners. METHODS: A retrospective study of dental records and questionnaires was conducted at the Dental Care Centre of the University Hospital of Rennes, France. Parameters related to the prescription of hydroxyzine in children were evaluated as potential predictors of the dental session success, with adjustments on potential confounders. RESULTS: The therapeutic outcome was very encouraging with 78.3% of success during dental sessions under sedation with oral hydroxyzine. Anxiety levels before the dental procedure and the medication compliance of the child were the main predictors of success. On the other hand, lower age (< 6 years old) and longer treatments (such as pulpotomy) worsened the outcome. CONCLUSIONS: Careful analysis of the literature and results of this work showed the safety of hydroxyzine within the maximum dose authorized without adverse effects, compared to other molecules described and commonly used in dentistry. No adverse effects during dental procedure were noted. This allows for minimal sedation with efficiency for the great majority of pediatric treatment. This solution should be the first step in sedation to help practicing clinicians.

Fluoride: changes in knowledge and prescription habits of paediatricians for 11 years in Brittany, France.

AIMS: To assess via a questionnaire the changes in knowledge and prescription habits for systemic fluoride of physicians at maternal and infant protection centres (MIP) and paediatricians in private practice (PPP) in the Brittany region between 2003 and 2014. METHODS: In both 2003 and 2014, the same seven-question survey was mailed to PPP (110 in 2003 and 101 in 2014) and MIP (61 in 2003 and 71 in 2014). An eighth question was added in 2014 about French guidelines published in 2008 (AFSSAPS guidelines). RESULTS: The overall response rate was significantly higher in 2003 (69.0%) than in 2014 (54.7%). In 2014 systemic fluoride was still considered an effective means of caries prevention (79.8% vs. 98.7% in 2003) and systematic prescription of fluoride supplements was less common (39.4 vs. 87.0% in 2003). When prescribed, systemic fluoride was given after the first 6 months of a child's life in 2014 (79.8%) instead of within the first month of life (73.5%) in 2003. CONCLUSIONS: Paediatricians and MIP physicians in Brittany were significantly less prone to routinely prescribe systemic fluoride in 2014. Certain sources of fluoride were still not well known in 2014. Collaboration and information sharing between dentists and physicians is necessary.

Intraosseous anaesthesia in children with 4 % articaine and epinephrine 1:400,000 using computer-assisted systems.

AIM: To assess retrospectively the efficacy of computer-assisted intraosseous anaesthesia (CAIO) in children using an anaesthetic solution with a lower concentration of epinephrine (1:400,000). METHODS: In a retrospective study, CAIO was evaluated in healthy children and adolescents for restorative and endodontic treatments, uncomplicated tooth extractions or scalings using articaine 4 % plus epinephrine 1:400,000. Anaesthesia was performed in children who showed enough compliance (score of 0-3 according to modified behaviour Venham scale). Efficacy, amount of anaesthetic solution as well as need of a complementary injection was assessed. RESULTS: A total of 421 consecutive sessions were performed on 278 patients aged 7.1 ± 2.9 years with 518 teeth involved in the anaesthetic process and analysed process. When teeth to be anaesthetised were considered, the overall success rate was 97.2 %. In most of the cases, only 0.9 mL was needed to achieve anaesthesia. Permanent teeth needed significantly more anaesthetics than primary teeth. Sensitivity of the teeth anaesthetized reappeared in 5.7 % of cases after 30-60 min of treatment. CONCLUSIONS: These results suggest that CAIO with 4 % articaine and epinephrine diluted 1:400,000 can be an alternative to usual infiltration techniques or IO with epinephrine at a higher concentration for most of treatments in primary and permanent teeth. Further studies are needed to evaluate its efficacy in permanent teeth in case of endodontic treatment or extraction.

Computer-assisted intraosseous anaesthesia for molar and incisor hypomineralisation teeth. A preliminary study.

Anesthetizing MIH (Molar and Incisor Hypomineralisation) teeth is one of the major challenges in paediatric dentistry. Computer-assisted IO injection (CAIO) of 4% articaine with 1:200,000 epinephrine (Alphacaine, Septodont) has been shown to be an efficient way to anesthetize teeth in children. The aim of this study was to assess the efficacy of this method with MIH teeth. This preliminary study was performed using the Quick Sleeper system (Dental Hi Tec, Cholet, France) that allows computer-controlled rotation of the needle to penetrate the bone and computer-controlled injection of the anaesthetic solution. Patients (39) of the department of Paediatric Dentistry were included allowing 46 sessions (including 32 mandibular first permanent molars) to be assessed. CAIO showed efficacy in 93.5% (43/46) of cases. Failures (3) were due to impossibility to reach the spongy bone (1) and to achieve anaesthesia (2). This prospective study confirms that CAIO anaesthesia is a promising method to anesthetize teeth with MIH that could therefore be routinely used by trained practitioners.