The impact of race on tooth formation.

The subjects consisted of 650 children (American white 245, Chinese 202, Japanese 203) from five to twelve years old, who came to the Department of Growth & Development, University of California, San Francisco. Mandibular first molar development was determined by inspecting panoramic radiographs and assigning a rating according to Kullman's method, which classifies tooth formation into seven stages according to growth and development. The samples in each age-stage were evaluated by their means values. Tooth formation was significantly more advanced in the American white children than in the Chinese or Japanese at all stages. The significance of the difference between Chinese and Japanese children was not identified. Tooth formation was shown to be highly correlated with chronological age, with a coefficient of more than 0.7 in all racial groups.

Intranasal administration of midazolam: pharmacokinetic and pharmacodynamic properties and sedative potential.

This study investigated the pharmacodynamic effects and sedative potential of midazolam administered by the intranasal route to adult volunteers. A double-blind, randomized, controlled study was carried out on seventeen healthy, male volunteers to study plasma level changes, sedative effects and variations in vital signs following intranasal administration of 0.2 mg/kg and 0.3 mg/kg doses of midazolam. Eight subjects received 0.2 mg/kg midazolam, seven received 0.3 mg/kg. Each subject rested for 15-20 minutes after placement of vital sign monitors and venipuncture needles before administration of midazolam. Behavior during the rest period was designated as the control so that each subject acted as his own control. Each subject's behavior was assessed on a scale of 1 (asleep) to 8 (excited). Plasma concentrations of midazolam were analyzed using venous blood samples from each of three randomly selected subjects for each of the two doses. Vital signs, monitored continuously, included electrocardiogram, heart rate, blood pressure, respiratory rate and oxygen saturation (SPO2). Plasma concentration of midazolam in both groups maintained adequate sedation levels with each group sustaining favorable sedation conditions from 15-20 minutes to 55-60 minutes. Individual variations of midazolam plasma concentration within the 0.3 mg/kg group were greater than those of the 0.2 mg/kg group. Normal vital sign variations due to the nasal instillation of midazolam were observed in both groups. Some minor respiratory depression was observed in the 0.2 mg/kg group. One instance of severe respiratory depression was observed in the higher dose group. Although both doses of midazolam were effective, no benefit was observed using a dose of 0.3 mg/kg. Indeed, a 0.3 mg/kg intranasal dose of midazolam may actually produce severe respiratory depression.

Damage to the primary dentition resulting from thumb and finger (digit) sucking.

It is estimated that approximately 50 percent of infants at one year of age suck a thumb or finger. The number decreases rapidly by ages four to five years. The average age for spontaneous cessation of the habit is 3.8 years of age. Anterior open bite is the most frequent malocclusion reported with digit sucking. In this study the authors investigated the influence of thumb and finger-sucking in the anterior and posterior sections of the primary dentition in three age-groups: three, four, and five years. The study population included 930 subjects. Data for the non-oral-habit group were compared with the data for the thumb and/ or finger-sucking group. At all ages the frequencies of open-bite and maxillary protrusion for the thumb and finger-sucking group were higher than the non-oral-habit group. The frequencies did not appear age-related. There appeared to be an increased tendency to a permanent malocclusion in children who continued after four years of age.

A study of the sedative effect of home-administered oral diazepam for the dental treatment of children.

This study investigated the effects of oral diazepam administered at home to fearful child patients prior to dental treatment. Twenty-five healthy, uncooperative children, mean age 3 years 8 months (+/- 1 year 3 months), requiring at least three visits for the treatment of dental caries, were studied. Each child's behaviour was assessed during three treatment sessions: (i) control, with no diazepam or placebo; (ii) with diazepam; and (iii) with a placebo. Each child acted as his/her own control, being initially assigned to the control session. Subsequently each was randomly assigned to receive either diazepam or placebo for the second session and the other for the third session. The diazepam and placebo were administered by the parents at home approximately 60 minutes before treatment. Each patient's behaviour was assessed on a scale of 1 (definitely positive) to 4 (definitely negative) by two calibrated examiners who were blind to the medications given and independent of the treatment. Vital signs were monitored at 5-minute intervals. Behaviour was significantly better with diazepam than with the placebo or with neither. No significant differences were observed between the placebo and control sessions. At no time were any adverse effects noted, such as vomiting or respiratory depression. It was concluded that oral administration of 0.3 mg/kg diazepam at home by the parent is an effective and safe technique for preoperative sedation of fearful child patients.

Prevalence and treatment costs of infant caries in Northern California.

To determine the prevalence of infant caries in low-socioeconomic-status children and to analyze the costs of their treatment, we retrospectively evaluated 357 children, ages eight months to seven years, who were treated during 1992 at a university-associated medical center in Northern California. Infant caries was diagnosed by several different standards, and prevalence varied according to the diagnostic criteria employed: 27 percent by the presence of any labiolingual lesion on the maxillary incisors; 32 percent by the presence of at least two carious maxillary incisors; 27 percent by the presence of at least three carious maxillary incisors; and 36 percent by a dmft > or = 5. Prevalence was higher among boys than girls (37 percent versus 27 percent), and highest in the group ages 3-4 years (43 percent). The cost of dental treatment increased with deft and ranged from $408 for deft 2-5 to $1725 for deft 16-20. Many patients failed to comply with recommended treatment for reasons of cost. Our results showed that (1) the prevalence of infant caries varies depending upon the clinical criteria used for diagnosis; (2) the cost of rehabilitating primary dentition increases in proportion to the number of teeth involved; and (3) low-income patients avoid treatment of infant caries for a variety of reasons related to the cost involved.

Inverted impaction of second premolar: two case reports.

This report documents two patients with inversion and impaction of the second premolar tooth. Family and personal histories of both patients were unremarkable with no abnormalities in general growth and development nor any history of trauma. Patient 1 was a 10-year-old female with inversion and impaction of the mandibular right second premolar. Fifteen months previously, pre-operative radiographic examination prior to extraction of the mandibular right second primary molar revealed a normal direction and eruptive pattern of the tooth in question. However, following extraction of the mandibular right second primary molar, the developing succedaneous premolar was seen to be inverted. This was suggestive of inversion resulting from an iatrogenic force during tooth extraction. The second patient was a 9-year-old male with inversion and impaction of the maxillary right second premolar. Radiographic examination 3 months prior to the initial visit at our hospital showed an existing inversion of this tooth. This pointed to a developmental abnormality in the location of the original tooth bud.

Clinical evaluation of a light-cured glass ionomer lining cement.

This study was a clinical evaluation of a light-cured glass ionomer lining material (Fuji Lining LC) applied to prepared cavities in 45 primary teeth of children aged 3-5 years. The overall assessment, based on clinical and radiographic findings, was 'good' in 42 cases and 'fair' in the other three cases. The material had no effect on the shade of the composite resin restorative material that was used. The findings indicate that Fuji Lining LC has significant value in clinical practice.

Factors associated with the use of screening mammography in a primary care setting.

Despite consensus recommendations the use of screening mammography remains low. We examined physician and patient related variables associated with requests to undergo screening mammography in a primary care setting, in order to assess current barriers to screening mammography at the level of the physician-patient interaction. A sample of 261 women over the age of 50, whose primary care was provided by resident physicians in a large, urban, academic medical center were examined. Data concerning patients and physicians demographic and clinical characteristics were abstracted. The data were analyzed by Chi-square and stepwise logistic regression. Forty-five percent of the patients were offered screening mammography within the study year and 53% were offered mammography over the preceding two years. Variables significantly associated with a request for screening included a previous history of breast disease (p < .001) and the severity of the patient's overall medical condition. Patients with an overall medical condition rated as mild were more likely to be requested to undergo screening than patients rated as moderately or severely ill (p < .01). Patients with higher educational levels were also more likely to be offered screening (P = .06). First year postgraduate (PGY 1) physicians requested more mammograms than PGY 2 or PGY 3 physicians (P < .05). A multivariable model utilizing logistic regression confirmed the association of the significant variables above with screening requests. Physicians were more likely to request mammography in patients at higher risk for developing breast cancer and less likely to request it in patients who had co-morbid illness. Increasing physician understanding of the importance and benefits of mammography and further investigation of strategies to ensure physician compliance with mammography recommendations are necessary to increase utilization.

The sedative effects of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2: optimal concentration of intranasal midazolam.

In a previous paper, we reported on the effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. The purpose of this study was to compare the clinical and possible adverse effect of doses of 0.2 mg/kg and 0.3 mg/kg midazolam, administered intranasally, and to determine the most appropriate concentration for the drug when administered by this route. Patients were assessed by a behavioral test which consisted of a scale from 1-7 with 3 ranges: markedly effective (1-3), effective (4-5) or ineffective (6-7). Forty-three mentally handicapped patients, aged 5 to 20 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were stratified by age and randomly assigned in a double blind manner to two groups, receiving either 0.2 mg/kg or 0.3 mg/kg midazolam administered intranasally. Group 1, consisting of 22 patients, average age 11 years 8 months, received 0.2 mg/kg. Group 2 consisted of 21 patients, average age 13 years 8 months, each of whom was administered 0.3 mg/kg intranasal midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. Subsequent to intranasal administration of midazolam, no patient rejected the nasal mask nor refused to inhale nitrous oxide/oxygen. The induction of nitrous oxide/oxygen sedation and oral examination were effected smoothly in every case in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacologic patient management in pediatric dentistry: an update.

This paper reviews the issue of sedation in pediatric dentistry in the light of recent controversies and rapidly increasing legal, professional and governmental regulations. Consideration is given to "Guidelines for safe administration of pharmacologic agents in dental practice". The various avenues of drug administration are reviewed with specific comment on recent approaches. Many of the older pharmacologic agents used for pediatric sedation are falling into disfavor. Chloral hydrate, in particular, would seem to be heading toward its demise. The benzodiazepines appear to have a very promising future as sedative agents. When administered and monitored appropriately, they have a wide margin of safety. Consideration is given to research and development into agents that reverse the action of sedative drugs. It is emphasized that contemporary electronic monitoring equipment in no way diminishes the necessity for sound and expert clinical judgment, supplemented by such simple devices as the precordial stethoscope and observation and communication in the form of simple commands.

The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose.

The purpose of this study was to determine the sedative effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. Twenty-one patients, aged 4 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were sedated with 0.2 mg/kg midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. After administering the midazolam, each patient was allowed to rest before initiating the dental procedures. Behavioral patterns during the various procedures were rated on a behavioral rating scale of 1-7. Each patient served as his or her own control, comparing behavior with or without intranasal midazolam. The results showed a marked improvement in behavioral patterns after administration of intranasal midazolam. Ratings on a scale of 1-7 were noted as "markedly effective" and "effective" for 69.2% of those patients who received infiltration injection anesthesia, 93.8% under rubber dam, 76.2% during cavity preparation, 84.2% for restoration placement and 87.5% during pulpotomy procedures. The majority of patients were discharged within 150 minutes of intranasal instillation. Further studies are indicated to ascertain the most appropriate dose of intranasally administered midazolam.

The detection of alcohol problems in a primary care clinic.

The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p < 0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.

Psychological studies of emotional changes in children undergoing dental treatment. 1. Changes in plethysmogram.

This study was designed to examine the influence of children's personality traits and parents' child-rearing attitudes on children's internal behaviors before and after treatment. As an indicator of emotional changes, polygraph data and particularly plethysmograms were compared with psychological analysis data of children's personality traits and parental child-rearing attitudes. The subjects were 40 children with slightly carious primary molars, who were out-patients at Aichi-Gakuin University Dental Hospital. The results show that the emotional changes of children undergoing dental procedures are, in fact, observed at the resting pre-treatment stage, and that they are influenced by various factors, including parental child-rearing attitudes and children's personality traits. More over, in the resting post-treatment stage, these factors impinge upon children's emotions in a more complicated manner.

Physician practice profiles--a valuable information system for HMOs.

Authors Warren Betty, M.D., et. al., describe how the Staten Island Medical Group computerized the data entry functions necessary for a workable physician audit and feedback program and how the program has been successful in some settings in bringing about lower utilization levels.

Audit and feedback as a cost-effective strategy.

Despite more than a decade of cost containment initiatives, medical care costs continue to rise at levels that concern both policy makers and third-party payers. Various explanations can be offered for this apparent lack of success. A crucial factor in the opinion of the authors, Robert Braham, M.D., and Hirsch Ruchlin, Ph.D., is the way in which cost containment is approached. Braham and Ruchlin describe how their organization successfully tackled this concern.