Acceptability of fissure sealants from the child's perspective.

AIM: To seek children's opinions about the acceptability of resin fissure sealant placement. STUDY DESIGN: Service evaluation using a child-centred questionnaire issued to a prospective sample of consecutive hospital patients.Method Questionnaires were issued to children, aged 3 to 16 years, immediately after resin fissure sealant placement in the Paediatric Dentistry Department in Sheffield. Participants used a three-point faces scale for positive, neutral and negative responses, arranged as a Likert scale with minimal text, to rate their treatment experiences and satisfaction with the dental visit. RESULTS: Two hundred questionnaires were returned. Overall, 96% (n = 191) recorded a positive or neutral response for the ease at which they coped with the procedure, with most children positive about having fissure sealants placed again (66%; n = 132). Further analysis demonstrated that children who had fissure sealants on a previous occasion found them easier than those having them for the first time (p <0.05, chi-squared test). Almost half of all participants where ambivalent about the taste and feeling (46%; n = 92 and 55%; n = 110 respectively). The vast majority of children were satisfied with the explanations provided by their operator. CONCLUSION: Most participants found having resin fissure sealants placed an overall acceptable procedure, with patient acceptance improving with increased treatment experience.

Role of botulinum toxin A injection into the submandibular salivary glands as an assessment for the subsequent removal of the submandibular glands in the management of children with sialorrhoea.

Sialorrhoea is caused by an excessive production of saliva or a lack of muscular coordination at the initiation of the swallowing reflex during the voluntary phase. In children with neuromuscular disorders it can cause excoriation and social embarrassment. In adults, repeated injections of botulinum have been shown to be beneficial in the control of sialorrhoea, but in children, lack of cooperation necessitates general anaesthesia, and repeated injections would not be appropriate. We aimed to assess outcome after injection of botulinum into the submandibular glands to find out whether subsequent removal of the glands would reduce salivary flow to an acceptable level. We assessed 30 children with various neuromuscular disorders that caused a lack of muscular coordination when swallowing. Under general anaesthesia, they all had injection of 1 unit/kg/gland of botulinum toxin A (Dysport™, Ipsen Ltd., Slough, UK) into each submandibular gland either by bimanual palpation or under ultrasound guidance. They were reassessed at 6 weeks to find out whether the flow had reduced adequately or whether the mouth was too dry. Twenty-one had improved and of these, 20 went on to have the glands removed successfully with no neurological or surgical complications. The mouth of one patient had become too dry after injection and the parents declined further surgery. The remaining 9 did not improve noticeably and continued to be managed medically. Injection of botulinum into the submandibular glands gives a reliable assessment of how much the salivary flow will be reduced after the submandibular gland has been removed.

Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review.

Cryoanalgesia is a controversial adjunct to the management of chronic pain, but we know of no studies that have investigated its effect in the management of temporomandibular joint (TMJ) pain. In this five-year retrospective study we treated 17 patients who had severe pain that had failed to respond to all forms of conventional conservative treatment and were not appropriate for simple open operation. None had a clear indication for open operation on the joint or had too severe disease to warrant a simple procedure. Preliminary diagnostic injections of bupivacaine to the TMJ relieved the pain. We applied the cryoprobe in the region of the auriculotemporal nerve and TMJ capsule. There was a small but insignificant improvement in mean mouth opening together with a significant (p=0.000) improvement in visual analogue pain scores (VAS) from 6.8 (range 4-10) to 2.0 (range 0-7). Two patients had no change in their pain scores, and 2 had complete resolution of their pain. The mean number of pain-free months after treatment was 7 (IQR 3-15). Three patients had long-term pain relief, and 12 temporary relief; 6 of these subsequently had successful relief after total replacement of the TMJ. One patient had further cryoanalgesia, one was referred for specialist pain management, and one controlled the pain with nortriptyline. Of the 17 cases studied, 2 had temporary complications after cryoanalgesia. Cryoanalgesia is a useful adjunct to the management of intractable pain in the TMJ. Short-term pain relief can be achieved, and long-term relief is possible in some, deferring more complex and costly treatments.