Are there any limits to the dental treatment of children?

AIM: The objective of this paper is to describe and discuss the most commonly occurring limits in care provision between a dentist and a child, i.e. provider and recipient. METHODS: The study was conducted online in the form of an anonymous questionnaire survey. We were looking for dentists to answer two basic modeled situations during the treatment of deciduous teeth (filling and extraction) in 4-year-old and 8-year-old children. Each modeled situation had 9 possible clinical scenarios. The age was chosen to factor the cooperation of a preschool- and a school-age child. CONCLUSION: The experience gained through clinical practice and the number of treated children show to be fundamental for the treatment of child's deciduous teeth and for the selection of a treatment method. Dentists acquire sufficient knowledge through their education in the faculties of medicine. The limit is the child itself, therefore it is desirable to build specialised centres for their treatment.

Dental fear/anxiety in Czech preschoolers: relationship to gender, age, location of residence, dental status and previous treatment experience.

AIM: Dental fear/anxiety (DFA) may considerably complicate treatment in paediatric dentistry. This cross-sectional study aimed to assess DFA in Czech preschoolers aged 3-6 years and its relationship to gender, age, location of residence, dental status and previous treatment. METHODS: The study involved 460 children from preschools in four location types selected according to the WHO criteria for oral health surveys. DFA was assessed using the Venham picture test (VPT, score range 0-8) prior to the evaluation of dental status using the dmfs (decayed, missing, filled surface) index. The significance level was set to 5%. CONCLUSION: DFA is common in Czech preschoolers. Higher levels of DFA were found in females, children aged 3-4 years, children from rural areas, children with a higher dmfs index and children who had a tooth extracted.

Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry.

Midazolam is a short acting sedative with small number of adverse effects. Administered orally, it is currently the most common form of conscious sedation in children. The objective of this paper is to describe effect of midazolam administered to children during dental treatment on their vital signs, and to monitor changes in children's behavior. We described values of vital signs and behavior in 418 sedations conducted in 272 children between 1-12 years of age. To achieve the following results, we used data from 272 all first-time sedations. After administration of midazolam arterial blood pressure and blood oxygen saturation decreased by values which were not clinically significant. The heart rate increased, with values staying within the limits of physiological range. The speed of onset of midazolam's clinical effects depends on age and dose. The lower age and dose correlated with the higher behavior score. The effectiveness of midazolam treatment is 97.8 %. Unwillingness of child to receive midazolam is predictor for disruptive behavior during sedation. 1.8 % of all sedation cases showed paradoxical reactions. The administration of midazolam in dose of 0.5 mg per 1 kg of child's body weight is safe and could be recommended for dental treatment in pediatric dentistry.

The role of stress hormones in dental management behavior problems.

Dental management behavior problems are thought to be both multifactorial and multidimensional, consisting of physiological, behavioral and cognitive components. The stress response to pain or even the anticipation of distress initiates activation of the hypothalamic-pituitary-adrenal axis and causes an increase of cortisol and catecholamines. The literature on the role of hormones in dental management behavior problems comprises about one hundred papers, which have mainly been focused on this activation of the HPA axis in various situations in dental care. They have generally used salivary cortisol as a marker of the activity of the HPA axis, sometimes combined with salivary alpha amylase. Here we summarize the literature data on the role of stress hormones in dental management behavior problems.