Effect of a needle-free system versus traditional anesthesia on pain perception during palatal injections in children.

BACKGROUND: Needle-free injection systems can contribute to the prevention of needle-related pain during palatal infiltration anesthesia (PIA) in children. Research on this topic in children is required. AIM: The purpose of this clinical study was to evaluate the effectiveness and patient preference of a needle-free system versus traditional anesthesia (TA) on pain perception during PIA in children. DESIGN: The study was designed as a randomized, controlled crossover clinical study with 48 children aged 6-12 years requiring dental treatment with PIA in bilateral maxillary primary molars. TA was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions. Then, patient preference was recorded. The pain perception during PIA was evaluated using the Wong-Baker FACES Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The data were analyzed for statistical significance (p < .05). RESULTS: There were statistically significant differences between the TA and the CIS according to the PRS and FLACC Scale scores. On both scales, significantly higher pain ratings were observed in the TA group during PIA (p < .001). There was a statistically significant difference in terms of patient preference (p < .001). Although 77.1% (n = 37) of the children preferred the CIS, 22.9% (n = 11) preferred the TA. Moreover, patient preference for the CIS was significantly higher in older children (p < .01). CONCLUSIONS: The application of a needle-free system during PIA ensured a decrease in pain perception in children.

Effectiveness of an educational cartoon animation on the knowledge of children about traumatic dental injuries.

BACKGROUND/AIM: Although children are frequently exposed to traumatic dental injuries (TDIs), their knowledge and attitude regarding the emergency management of TDIs are largely insufficient. The aim of this study was to determine the knowledge of children about TDIs utilizing a questionnaire before and after watching a custom animated instructional video. MATERIAL AND METHODS: The study was conducted with 332 children aged 8 to 13 years. The children were asked to complete a 3-part questionnaire that included socio-demographic data, past experiences related to TDIs, and knowledge of the emergency management of TDIs. An educational video containing evidence-based information about the management of TDIs was shown to the children. They then completed the questionnaire again immediately after viewing the video and 1 week later. The data were analyzed using Friedman's two-way ANOVA by ranks test, McNemar's test, and the Mann-Whitney U-test. RESULTS: The children's scores increased significantly following the viewing of the video (p = .0001). Prior to watching the animation, children who had previously received dental trauma education had considerably higher scores than their peers (p = .004). The animation was considered to be beneficial by 96.7% of the children. Prior to watching the animation, 49.1% of the children believed they could help their friends in the event of dental trauma, and after viewing the animation, this rate increased to 86.4%, but decreased to 77.1% after 1 week (p < .001). CONCLUSIONS: After watching the video, the children's scores improved dramatically and their self-confidence in helping their friends in the event of dental trauma increased.

Effect of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of Mozart's music on the learning of toothbrushing behavior in children with high and low dental anxiety levels. MATERIALS AND METHODS: A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8-12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart's music). In the Mozart's music subgroups, children were exposed to Mozart's Sonata for 7 min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart's music. The periodontal measurements were repeated after 15 days. Three-factor variance analysis was used to analyze the data. RESULTS: There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07). CONCLUSIONS: Listening to Mozart's music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart's music did not have a positive effect in the group with low dental anxiety. CLINICAL RELEVANCE: The use of Mozart's music may be beneficial in oral hygiene education for children with high dental anxiety levels.

The effects of pediatric dentifrices with different types of fluoride on the color change of restorative materials.

Purpose: This study aimed to evaluate the effects of dentifrices with different fluoride content on color change of restorative materials commonly used in pediatric dentistry. Materials and methods: Three restorative materials (glass hybrid [Equia Forte (EF)], glass carbomer [GCP Glass Fill (GCP)] and compomer [Dyract XP (DXP)]) were used to prepare 120 disc shaped specimens by using a Teflon ring. Four dentifrice groups were created as Sodium Fluoride (NaF), Amine Fluoride (AmF), Stannous Fluoride (SnF2) and no-fluoride (n=40). Simulated tooth brushing was performed for each specimen by applying 6720 strokes for 6 months. Color changes [CIEDE2000 (Δ𝐸00)] were calculated by using generalized linear model procedure and the data were subjected to two-way analysis of variance. Results: The highest color changes for NaF and AmF dentifrice groups were observed in the GCP restorative material (p<0.05). The color changes of restorative materials tested with SnF2 dentifrice group were statistically different (p<0.05) in each restorative material and Δ𝐸00 values were observed as GCP> EF>DXP. SnF2 dentifrice provided better color stability for all restorative materials when compared to NaF and AmF dentifrices; although, this was not statistically significant. GCP underwent significant discoloration values when brushed with all types of dentifrices. Conclusion: Although the glass carbomers caused significant color change, the compomers seem to be more resistant to the color change when brushed with all types of dentifrices. The fluoride content of dentifrices is crucial for the color change of restorative materials.

Anthropogenic marine litter on the north coast of Cyprus: Insights into marine pollution in the eastern Mediterranean.

The eastern Mediterranean is a region that has been relatively understudied with regards to anthropogenic marine litter despite potential for environmental and social costs. Here, coastal marine litter accumulation was assessed at eight beach locations along the coast of Northern Cyprus. Monthly surveys were performed between January 2017 and January 2019. All items ≥ 2.5 cm in diameter within the same 250 m2 plot were collected and processed. A total of 59,556 separate items were collected with a total mass of 697 kg. At the worst affected site (Ronnas Bay) litter accumulation averaged 1114 items and 11.9 kg per month. Plastic and polystyrene litter accounted for 82% (622.71 kg) of all litter types by mass and 96% (57,231) by frequency. Plastic bags, plastic pieces, drinks containers, caps/lids were the four most abundant forms of plastic by mass and by frequency. This suggests dumping/poor domestic waste governance as the main driver of marine litter in the region.

Effect of Emotional State of Nurses Working in Intensive Care on Their Attitudes Toward Death.

The purpose of this study is to investigate the effect of the emotional state of the nurses working in intensive care unit on their attitudes toward death. The study was conducted with the participation of 100 nurses working in intensive care units between July and December 2017. A positive statistically significant correlation was found between the nurses' status of approaching emotions and subscales of Death Attitude Profile (p < .05). It was observed that there was a positive significant correlation between the emotional avoidance scores and neutral acceptance and approach acceptance (r = .281), escape acceptance (r = .335), and fear of death and death avoidance (r = .490) scores (p < .05).

The Effects of Motivational Methods Applied During Toothbrushing on Children's Oral Hygiene and Periodontal Health.

Purpose: The purpose of this study was to evaluate the effect of different motivational methods on children's oral hygiene and periodontal health. Methods: A prospective, controlled, single-blinded, randomized clinical trial was conducted with 60 six- to 12-year-olds who were randomly assigned to toothbrushing with an hourglass timer, music video, or control group. All three groups were divided into two equal subgroups: those using a manual toothbrush and those using a powered toothbrush. The plaque index (PI) and gingival index (GI) were measured in each group. The data obtained were analyzed using three-factor variance analysis. Results: A statistically significant decrease was observed in PI and GI values in all groups (P<0.05). The highest decrease in PI values was observed in the group brushing with a music video and a powered toothbrush (51.8 percent), whereas the least decrease was observed in the control group using a powered toothbrush (26.1 percent). The differences were not statistically significant among the groups. Conclusions: A significant decrease in plaque index and gingival index values was obtained in all groups compared to baseline values. Although the additional motivational methods used during toothbrushing contributed to improved plaque removal and toothbrushing efficiency, no statistically significant differences were found among the groups.

The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of pain control between a needle-free system and topical anesthesia applied prior to inferior alveolar nerve block (IANB). MATERIALS AND METHODS: The present study was designed as a randomized controlled cross-over clinical study on 60 children (aged 6 to 12 years) requiring dental treatment with IANB in bilateral mandibular molars. As pre-anesthesia, topical anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions before IANB. The injection pain during IANB, at both the needle insertion and solution deposition phases, was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). The data were analyzed using the Wilcoxon signed-rank test, Spearman correlation, and Mann-Whitney U test. RESULTS: There were statistically significant differences between TA and CIS in subjective and objective pain evaluations during both the needle insertion and solution deposition. The use of a needle-free system in pre-anesthesia yielded a significant decrease in subjective and objective pain scores (p < 0.001). No statistical difference was found between TA and CIS in terms of patient preference, but patient preference for CIS was significantly higher in older patients (p < 0.01). CONCLUSIONS: It was determined that the use of a needle-free system in pre-anesthesia yielded a decrease in injection pain of IANB. CLINICAL RELEVANCE: Pediatric dentists should be aware of the new injection system in order to decrease the level of injection pain.

Multidisciplinary Treatment Approach for Perforated Internal Root Resorption: Three-Year Follow-Up.

Internal root resorption (IRR) is described as a resorptive defect of the internal aspect of the root caused by odontoclastic activity associated chiefly with chronic pulp inflammation and trauma. An important variation to consider is the presence of a root perforation, although it is rare. This paper defines the use of CBCT in the diagnosis and combined nonsurgical and surgical multidisciplinary management and follow-up of a maxillary central incisor with perforating IRR in a 9-year-old female patient. At 3-year follow-up, clinical and radiographic findings of the case were satisfactory.

Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia.

OBJECTIVES: Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA. MATERIALS AND METHODS: Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl's Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children's Fear Survey Schedule-Dental Subscale (completed by the children's parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated. RESULTS: The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA. CONCLUSIONS: Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.

Effects of Two Different Anesthetic Solutions on Injection Pain, Efficacy, and Duration of Soft-Tissue Anesthesia with Inferior Alveolar Nerve Block for Primary Molars.

OBJECTIVES: The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS). STUDY DESIGN: The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests. RESULTS: Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively. CONCLUSIONS: Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.

Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial.

PURPOSE: The purpose of this study was to compare the use of a traditional syringe (TS) and the DentalVibe (DV) Injection Comfort System on the pain of needle insertion and injection of supraperiosteal (SP) anaesthesia into the mandibles and maxillas of children aged 6-12 years. METHODS: The study was a randomised, controlled, crossover clinical trial, comprising 60 children requiring an operative procedure with SP anaesthesia on both their mandibular and maxillary molars, bilaterally. One of the molars was treated with a TS, and the contralateral tooth was treated with the DV for both arches. On each visit, subjective and objective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Face, Leg, Activity, Cry, Consolability Scale. Patients were asked which technique they preferred. The data were analysed using Wilcoxon signed-rank test, Spearman's correlation test, and Mann-Whitney U-test. RESULTS: No statistically significant differences were noted between TS and DV for pain during injection and needle insertion for supraperiosteal anaesthesia in either the maxillary and mandibular operative procedures. CONCLUSIONS: Children experienced similar pain during SP anaesthesia administered with a TS and the DV, regardless of gender and jaw differences. DV was less preferred over the traditional procedure in children.

Design of meloxicam and lornoxicam transdermal patches: Preparation, physical characterization, ex vivo and in vivo studies.

Transdermal patches of meloxicam (MX) and lornoxicam (LX) were aimed to be prepared in order to overcome their side effects by oral application. The strategy was formulation of optimized films to prepare transdermal patches by determination of physical properties and investigation of drug-excipient compatibility. As the next step, in vitro drug release, assesment of anti-inflammatory effect on Wistar Albino rats, ex vivo skin penetration and investigation of factors on drug release from transdermal patches were studied. Hydroxypropyl methylcellulose (HPMC) was concluded to be suitable polymer for formulation of MX and LX transdermal films indicating pharmaceutical quality required. MX and LX transdermal patches gave satisfactory results regarding to the edema inhibition in the assessment of anti-inflammatory effect. MX was found out to be more effective compared to LX on relieving of edema and swelling. These results were supported by data obtained from ex vivo penetration experiments of drug through rat skin. Indicative parameters like log P, molecular weight and solubility constraint on penetration rate of drugs also indicated good skin penetration. Transdermal patches of MX and LX can be suggested to be used especially for the immediate treatment of inflammated area since it displays anti-inflammatory effect, soon.