Aspiración de cuerpo extraño durante la consulta dental en pediatría: Reporte de un caso / Foreign body aspiration in dental office: Founded suspicion for late diagnosis. Case presentation and literature review

Dentro de la práctica clínica en pediatría existen situaciones en las que el diagnóstico oportuno de una enfermedad involucra la meditación de situaciones insospechadas; en niños muy pequeños el interrogatorio indirecto bien realizado y detallado se convierte en herramienta fundamental para su tratamiento. En un evento de aspiración de cuerpo extraño existen indicadores específicos para tener sospecha de que estamos ante un caso; sin embargo, no todos los pacientes presentan signos y síntomas clásicos, por lo que la experiencia del clínico es vital. Se presenta el caso de un niño de veintiún meses de edad que broncoaspiró una corona de acero cromo en un consultorio dental; ésta no fue identificada sino hasta 60 días después del accidente. Es importante que los clínicos encargados de la salud bucal de los niños estén capacitados para auxiliar a sus pacientes ante un evento de aspiración de cuerpo extraño, tanto de forma inmediata como mediata, teniendo una conducta responsable ante la sospecha fundamentada de que ocurrió un accidente de esta naturaleza.

Within the scope of pediatric medical practice, certain situations arise where timely diagnosis of a condition implies facing unforeseen situations. Clinical history is clearly paramount for the correct and precise handling of any patient, even more so for very young patients from whom obtained data can be frequently imprecise. With respect to foreign body aspiration accidents, there are specific indicators which substantiate a suspicion of that case. Nevertheless, not all cases are typical, therefore, experience of the clinical operator is essential. The present study presents the case of a one year and nine months old patient who broncho-aspirated a chrome-steel crown in a dental practice, and the situation was only diagnosed 60 days later. The present diagnosis was emitted at once when the patient arrived at the National Pediatrics Institute. To that aim, a thorax X-ray was taken. The present case can be considered a paradigm. It supports the idea that the oral cavity of very young patients must be treated by qualified specialists, and that such care must be given in centers which can guarantee the patient's safety. A foreign body can remain in the bronchii for a long time, without directly endangering the patient's life. Nevertheless, this situation would introduce the patient into a dangerous chronicity, therefore, emergency room physicians should be aware of the possibility of a substantiated suspicion of foreign body aspiration. These cases, after suitable history research and auscultation could have been avoided, and thus avoid a serious chronic situation in these patients.

Video self-instruction for police officers in cardiopulmonary resuscitation and automated external defibrillators.

INTRODUCTION: Police officers often serve as first responders during out-of-hospital cardiac arrests (OHCA). Current knowledge and attitudes about resuscitation techniques among police officers are unknown. Hypothesis/problem This study evaluated knowledge and attitudes about cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) among urban police officers and quantified the effect of video self-instruction (VSI) on these outcomes. METHODS: Urban police officers were enrolled in this online, prospective, educational study conducted over one month. Demographics, prior CPR-AED experience, and baseline attitudes were queried. Subjects were randomized into two groups. Each group received a slightly different multiple-choice test of knowledge and crossed to the alternate test after the intervention, a 10-minute VSI on CPR and AEDs. Knowledge and attitudes were assessed immediately before and after the intervention. The primary attitude outcome was entering "very likely" (5-point Likert) to do chest compressions (CC) and use an AED on a stranger. The primary knowledge outcomes were identification of the correct rate of CC, depth of CC, and action in an OHCA scenario. RESULTS: A total of 1616 subjects responded with complete data (63.6% of all electronic entries). Randomization produced 819 participants in group 1, and 797 in group 2. Groups 1 and 2 did not differ significantly in any background variable. After the intervention, subjects "very likely" to do CC on a stranger increased by 17.2% (95% CI, 12.5%-21.8%) in group 1 and 21.2% (95% CI, 16.4%-25.9%) in group 2. Subjects "very likely" to use an AED on a stranger increased by 20.0% (95% CI, 15.3%-24.7%) in group 1 and 25.0% (95% CI, 20.2%-29.6%) in group 2. Knowledge of correct CC rate increased by 59.0% (95% CI, 55.0%-62.8%) in group 1 and 64.8% (95% CI, 60.8%-68.3%) in group 2. Knowledge of correct CC depth increased by 44.8% (95% CI, 40.5%-48.8%) in group 1 and 54.4% (95% CI, 50.3%-58.3%) in group 2. Knowledge of correct action in an OHCA scenario increased by 27.4% (95% CI, 23.4%-31.4%) in group 1 and 27.2% (95% CI, 23.3%-31.1%) in group 2. CONCLUSION: Video self-instruction can significantly improve attitudes toward and knowledge of CPR and AEDs among police officers. Future studies can assess the impact of VSI on actual rates of CPR and AED use during real out-of-hospital cardiac arrests.

Guide for the mentoring dentist: the admissions office perspective.

There is no better way to give back to dentistry--which has given us so much as dentists--than to mentor a young person into the profession. With the size of the applicant pool dramatically increasing over the past 10 years (73.6 percent), the challenge of the admissions process has increased as well. To put it simply, the "line" of those desiring dentistry as a profession has become quite long. In 2010, based upon data from the Texas Medical and Dental Schools Application Service, the ratio of dental applicants to positions exceeded the ratio of applicants to medical school positions! We haven't seen ratios like this since the late 1970's. This guide will aid mentoring dentists in the process of helping their mentees to be successful as applicants, dental students and, ultimately, dental practitioners.

A controlled clinical trial to evaluate the safety and whitening efficacy of a 9.5% hydrogen peroxide high-adhesion whitening strip in a teen population.

PURPOSE: To compare the efficacy and safety outcomes of two tooth-whitening systems. METHODS: 44 subjects, 12-17 years of age, participated in the study and were divided into two balanced groups. 15 subjects received 6.5% hydrogen peroxide professional whitening strip treatment and 29 subjects received 9.5% hydrogen peroxide high-adhesion whitening strips to wear for 30 minutes twice a day. Teeth were bleached for 20 days with the 9.5% hydrogen peroxide strips and 21 days with the 6.5% hydrogen peroxide strips. Digital image analysis measured color in b*, L*, and a* color spaces, where b* indicated yellowness, L* indicated lightness, and a* indicated redness at days 8, 11 and 22 for both the maxillary and mandibular arches. Oral examinations and interviews were used to ascertain any adverse events that may have occurred during treatment. RESULTS: 36 subjects completed the study. At each post-baseline visit, both of the treatment groups had statistically significant (P < 0.02) mean color improvement from baseline for b*, L* and a*. The 9.5% hydrogen peroxide strips group provided statistically greater reduction in yellowness (deltab*) relative to the 6.5% hydrogen peroxide strips group for each visit of in the maxillary arch (P < 0.02) and for Day 8 and Day 22 in the mandibular arch (P < 0.02). In addition, the 9.5% hydrogen peroxide high-adhesion strip group provided statistically greater improvement in lightness (deltaL*) relative to the 6.5% hydrogen peroxide strip group for each visit in the maxillary arch (P < or = 0.007) and for the final visit in the mandibular arch (P = 0.002). 18 subjects (62%) in the 9.5% hydrogen peroxide high-adhesion strip group reported adverse events compared to 8 subjects (53%) in the 6.5% hydrogen peroxide polyethylene strip group. Minor and transient tooth sensitivity and oral irritation were the most common adverse events.

Dental education economics: challenges and innovative strategies.

This article reviews current dental education economic challenges such as increasing student tuition and debt, decreasing funds for faculty salaries and the associated faculty shortage, and the high cost of clinic operations and their effect on the future of dentistry. Management tactics to address these issues are also reviewed. Despite recent efforts to change the clinical education model, implementation of proposed faculty recruitment and compensation programs, and creation of education- corporate partnerships, the authors argue that the current economics of public dental education is not sustainable. To remain viable, the dental education system must adopt transformational actions to re-engineer the program for long-term stability. The proposed re-engineering includes strategies in the following three areas: 1) educational process redesign, 2) reduction and redistribution of time in dental school, and 3) development of a regional curriculum. The intent of these strategies is to address the financial challenges, while educating adequate numbers of dentists at a reasonable cost to both the student and the institution in addition to maintaining dental education within research universities as a learned profession.

Randomized controlled trial of professional at-home tooth whitening in teenagers.

A randomized controlled clinical trial was conducted to compare two professional at-home tooth whitening systems in a teenage population. Informed consent and child assent were obtained from 60 teenagers aged 12-17 (mean age = 14.8). After baseline measurements, subjects were randomized to one of two groups, using either 14% hydrogen peroxide whitening strips or 10% carbamide peroxide in a custom bleaching tray. Strips were used for 30 minutes twice daily, while the tray was worn overnight. Treatment took place for 14 days sequentially, first on the maxillary arch and then on the mandibular arch; all use was unsupervised. Efficacy was measured objectively by L*a*b* color change from digital images obtained at baseline and end of treatment, using combined color measures for both arches. Both professional whitening systems had significant (p < 0.0001) reductions in yellowness (Deltab*) and increased lightness (DeltaL*) after two weeks of treatment on each arch. At the end of treatment, Deltab* or DeltaL* did not differ significantly between the groups (p > 0.28). Tooth sensitivity and mild oral irritation represented the most common adverse events, with only one subject discontinuing treatment as a result. Teenagers who used either bleaching method for two weeks experienced significant tooth whitening without serious adverse events.

Mechanics of ambulation with standard and spring-loaded crutches.

OBJECTIVE: To compare kinetic measures and spatiotemporal variables assessed during walking with standard axillary crutches and spring-loaded crutches. DESIGN: A repeated-measures design in which healthy subjects walked with both standard and spring-loaded crutches. SETTING: Biomechanics research laboratory. PARTICIPANTS: Ten healthy young adult volunteers participated. Only female volunteers between 154.9 and 175.3 cm in stature were selected to fit the size of the crutches used. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome measures were kinetic variables such as ground reaction force, rate of force rise, and impulse and spatiotemporal variables such as stride length, stride time, and percentage of stride spent in stance. RESULTS: The rate of ground reaction force rise and impulse of the ground reaction force (both P<.001) were reduced by 33% and 13% to 26%, respectively, but the peak ground reaction force was slightly greater (P=.001) with spring-loaded crutches. The stride time was increased with spring-loaded crutches (P=.005), but the stride length did not differ significantly (P=.465). CONCLUSIONS: The use of spring-loaded crutches altered the mechanics of crutch gait in ways that are likely to reduce overuse injury in crutch users. Further study of spring-loaded crutches is warranted, especially with respect to their energetic efficiency.

Hábitos orales de succión y tratamientos utilizados en los pacientes atendidos en el área de odontología infantil y ortodoncia de la Facultad de Odontología de La Universidad de El Salvador / Oral sucking habits and treatments used in patients treated in the area of children's dentistry and orthodontics of the Faculty of Dentistry of the University of El Salvador

La succión es un reflejo innato, que con el paso del tiempo, el infante va abandonando y sustituyendo por actividades más maduras. Hay niños que no dejan atrás este patrón infantil y se convierte en un hábito deletéreo, el cual debe de ser eliminado de la manera menos traumática, para así evitar malformaciones óseo-dentarias. Por lo tanto, nuestro objetivo es identificar y clasificar los diferentes tipos de hábitos orales de succión según género y edad; así como también enumerar los tratamientos más utilizados en los pacientes con hábitos orales de succión, atendidos en el área de Odontología Infantil y Ortodoncia de la Facultad de Odontología de la Universidad de El Salvador (FOUES) en el período de 2003 ­ 2005. Materiales y métodos: La investigación que se desarrollo es de tipo Epidemiológica Descriptiva. Los datos se obtuvieron de una muestra de 225 expedientes clínicos correspondientes a pacientes con edades de 3.0 ­ 12.0 años atendidos en el área de Odontología Infantil y Ortodoncia de la FOUES entre los años 2003- 2005. Las variables en el estudio fueron: género, edad, tipos de hábitos y tratamientos más utilizados. Los datos fueros procesados en el programa Statistical Product for Service Solutions 11.0 (SPSS). Resultados: La frecuencia presentada de hábitos es de 25.8%; el género femenino fue el más afectada con un 60.3%; el rango de edad más afectado es de 6.0 ­ 8.11 años con 44.8%; el hábito más frecuente es succión digital con 58.6%; el rompe hábito más utilizado es la rejilla fija con 40%.

Sucking is an innate reflex, which over time, the infant is abandoning and replacing with more mature activities. There are children who do not leave this childhood pattern behind and it becomes a deleterious habit, which must be eliminated in the least traumatic way, in order to avoid bone-dental malformations. Therefore, our objective is to identify and classify the different types of oral sucking habits according to gender and age; as well as list the treatments most used in patients with oral sucking habits, attended in the area of ​​Children's Dentistry and Orthodontics of the Faculty of Dentistry of the University of El Salvador (FOUES) in the period 2003 - 2005. Materials and methods: The research that was developed is of the Descriptive Epidemiological type. The data were obtained from a sample of 225 clinical records corresponding to patients aged 3.0 - 12.0 years treated in the Children's Dentistry and Orthodontics area of ​​FOUES between the years 2003-2005. The variables in the study were: gender, age , types of habits and treatments most used. The data were processed in the Statistical Product for Service Solutions 11.0 (SPSS) program. Results: The frequency of habits presented is 25.8%; the female gender was the most affected with 60.3%; the most affected age range is 6.0 - 8.11 years with 44.8%; the most frequent habit is finger sucking with 58.6%; the most used habit breaker is the fixed grid with 40%.

Effectiveness and safety of tooth bleaching in teenagers.

PURPOSE: The purpose of this study was to compare the efficacy and safety outcomes of a currently marketed, peroxide-containing, tray-based, tooth-whitening system to a peroxide-containing, "trayless" tooth-whitening system. METHODS: Fifty-seven subjects, 12 to 17 years of age, participated in this study and were divided into 2 balanced groups. Twelve subjects received custom trays with 10% carbamide peroxide gel that they were instructed to wear overnight. Forty-five subjects received 10% hydrogen peroxide polyethylene strips to wear for 30 minutes twice a day. Teeth were bleached for 2 weeks. Digital image analysis measured color in B, L, and A color spaces, where B indicated yellowness, L indicated lightness, and A indicated redness. Oral examinations and interviews were used to ascertain any adverse events that may have occurred during treatment. RESULTS: Fifty-one patients completed this study. Both whitening systems yielded significant (P<.001) color improvement, as evidenced by decreased yellowness, increased lightness, and decreased redness. Groups did not differ significantly (P>.39) regarding color improvement for B, L, or A on either the maxillary or mandibular teeth. Twelve subjects (27%) in the polyethylene strip group reported adverse events compared to 5 subjects (42%) in the tray-delivered group. Minor and transient tooth sensitivity and oral irritation were the most common adverse events. CONCLUSIONS: Both the daytime strip and overnight tray groups significantly (P<.0001) whitened teeth; there were no significant differences between the 2 groups in any of the color parameters; both whitening systems were well tolerated, and most adverse events were mild in severity.

Fluoride release and caries inhibition associated with a resin-modified glass-ionomer cement at varying fluoride loading doses.

PURPOSE: To measure, over time, the release of fluoride from a resin-modified glass-ionomer cement, loaded with different levels of fluoride, then to evaluate the adjacent dentin demineralization inhibition relative to these fluoride levels. MATERIALS AND METHODS: (Phase I) 25 standardized discs were fabricated from a non-fluoridated resin-based composite (control), resin-modified glass-ionomer cement and resin-modified glass-ionomer cement loaded with sodium fluoride at 1%, 2% and 3% by weight fluoride. Fluoride release was evaluated over 30 days. (Phase II) 50 restorations, from the materials listed in Phase I, were placed as Class V restorations in teeth, the teeth were acid-challenged, then dentin margins adjacent to restoration margins were evaluated for demineralization. RESULTS: As sodium fluoride additions increased, fluoride release increased. Evaluation of demineralization indicated the resin-modified glass-ionomer cement inhibited adjacent demineralization in a direct relationship with sodium fluoride concentration where 3% fluoride exhibited significantly less adjacent demineralization than all other groups; 2% and 1% fluoride exhibited significantly less adjacent demineralization than the non-loaded resin-modified glass-ionomer cement and non-fluoridated resin-based composite control (P< 0.05).

Dental plaque removal with two battery-powered toothbrushes.

PURPOSE: To compare the plaque removal efficacy of a positive control power toothbrush (Colgate Actibrush) to an experimental power toothbrush (Crest SpinBrush) following a single use. MATERIALS AND METHODS: This study was a randomized, controlled, examiner-blind, 4-period crossover design which examined plaque removal with the two toothbrushes following a single use in 39 completed subjects. Plaque was scored before and after brushing using the Turesky Modification of the Quigley-Hein Index. RESULTS: Baseline plaque scores averaged 2.18 and 2.16 for the experimental toothbrush and control toothbrush treatment groups, respectively. With respect to all surfaces examined, the experimental toothbrush delivered an adjusted (via analysis of covariance) mean difference between baseline and post-brushing plaque scores of 0.66 while the control toothbrush delivered an adjusted mean difference of 0.43. This represents an increase of 55% plaque removal relative to the control power toothbrush. The difference between brushes was statistically significant (P < 0.001). With respect to buccal and lingual surfaces, the experimental toothbrush delivered very consistent results relative to the control toothbrush. The differences between brushes were also statistically significant (P < 0.001).