Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study.

There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study

Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Combined oral midazolam-ketamine better than midazolam alone for sedation of young children: a randomized controlled trial.

BACKGROUND. There is a lack of clinical trials on paediatric dental sedation. AIM. We investigated whether young children's behaviour improves during dental treatment with oral ketamine/midazolam compared with midazolam alone or no sedation. DESIGN. Healthy children under 36 months of age, presenting early childhood caries were randomly assigned to receive protective stabilization plus: combined oral midazolam (0.5 mg/kg) and ketamine (3 mg/kg) (MK), or oral midazolam (1.0 mg/kg) (MS), or no sedative (PS). One observer scored children's behaviour using the Ohio State University Behavior Rating Scale (OSUBRS) at determined points in a dental exam (no sedative) and treatment session. Data were analysed using nonparametric bivariate tests. RESULTS. Forty-one children were included. In the dental exam session, the sum of OSUBRS scores was similar for the three groups (P = 0.81). In the treatment session, the MK produced more cooperative behaviour than MS and PS (P = 0.01), longer sessions (P = 0.04), and a pattern of homogeneous OSUBRS scores from the reception area (before sedative administration) to the end of the session (P = 0.06). No immediate and post-discharge side effects were observed in groups MK and MS. CONCLUSIONS. The combination of oral midazolam and ketamine is efficacious for guiding the behaviour of children under 3 years old.

Efeito dos vernizes Cervitec® e Fluorniz® na redução de estreptococos mutans da saliva. Estudo longitudinal em bebês / Cervitec® and Fluorniz® varnishes effect in salivary mutans streptococci. A longitudinal study in infant and toddlers

Introdução - O objetivo do presente trabalho foi comparar, durante seis meses, a efetividade de dois vernizes - Cervitec® (Vivadent/Vivacare - Schaan/Liechtenstein, lote 916204) e Fluorniz® (S.S. White Artigos Dentários Ltda. Rio de Janeiro) - na redução dos níveis salivares de estreptococos mutans em lactentes de 12 a 18 meses, comparados a um grupo controle. Material e Métodos - Foram selecionados 21 pares mãe-bebê, sendo que as mães receberam adequação do meio bucal e os bebês receberam acompanhamento trimestral seguindo o protocolo do grupo (F, C ou P) no qual foram, aleatoriamente, enquadrados. Resultados - Coletas de saliva dos bebês foram realizadas antes das aplicações por um período de seis meses e analisadas microscopicamente para contagem das colônias de estreptococos mutans . Conclusão - Apenas o grupo flúor apresentou uma redução estatisticamente significante na contagem de estreptococos mutans da saliva após seis meses de estudo.

Introduction - The purpose of this study was to compare, during 6 months, the effect of two varnishes - Cervitec® (Vivadent/Vivacare - Schaan/Liechtenstein, lot 916204) and Fluorniz® (S.S. White Artigos Dentários Ltda. Rio de Janeiro) - in decreasing the levels of mutans streptococci in saliva in suckling babies with 12-18 months. Material and Methods - Twenty one pairs mother-baby were selected; the mothers received restorative care and the babies received trimestral consults, according to the group that they belong to. Results - Saliva samples were collected from the babies and the colonies of mutans streptococci were counted. Conclusion - Just the fluor group show a reduced, significant, in the number of streptococcus mutans in saliva.

Tratamento restaurador atraumático (ART): estágio atual e perspectivas / Atraumatic restorative treatment (Art): current stage and perspectives

O Tratamento Restaurador Atraumático (ART) é uma abordagem de tratamento da cárie que consiste na remocäo da estrutura dentária cariada usando somente instrumento manuais e na restauraçäo imediata do preparo cavitário com material obturador adesivo (cimento de ionômero de vidro), dispensando o uso de anestesia e energia elétrica. A simplicidade da técnica possibilita a sua utilizaçäo em populaçöes menos favorecidas e sem acesso aos cuidados odontológicos. O objetivo do presente estudo é revisar a literatura sobre o estágio atual e as perspectivas do ART, abordando a aplicabilidade da técnica, a eficácia das restauraçöes e as necessidades de pesquisa sobre o tema. O interesse pela utilizaçäo do ART tem sido crescente. Estudos realizados em diversos países, principalmente da Africa e Asia, têm demonstrado que a técnica pode ser considerada atraumática para o dente e para o paciente e apresenta boa aceitaçäo pelos usuários. O percentual de sucesso das restauraçöes de uma face em dentes permanentes tem sido satisfatório após 3 anos. As necessidades de pesquisa incluem principalmente estudos com tempo de proservaçäo mais longos, estudos em dentes decíduos e restauraçöes envolvendo mais de uma superfície, além do desenvolvimento de materiais restauradores mais adequados ao ART