Postoperative dental morbidity in children following dental treatment under general anesthesia.

PubMed

Hu, Yu-Hsuan; Tsai, Aileen; Ou-Yang, Li-Wei; Chuang, Li-Chuan; Chang, Pei-Ching

2018-05-10

General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients

PubMed Central

Escanilla-Casal, Alejandro; Aznar-Gómez, Mirella; Viaño, José M.; Rivera-Baró, Alejandro

2014-01-01

This is a comparative study between two groups, one of healthy children and the other of children with cerebral palsy, which underwent dental treatment under general anesthesia at Hospital Sant Joan de Déu Barcelona. The purpose of the study was to compare and determine oral pathology, frequency, severity and postoperative complications in pediatric patients with and without an underlying disease which undergo a dental treatment under general anesthesia. Key words:General anesthesia, cerebral palsy, pediatric patients. PMID:24608223

The use of local anesthesia during dental rehabilitations: a survey of AAPD members.

PubMed

Townsend, Janice A; Martin, Ashla; Hagan, Joseph L; Needleman, Howard

2013-01-01

The purpose of this study was to document current practices among pediatric and general dentists who are members of the American Academy of Pediatric Dentistry (AAPD) regarding the use of local anesthesia (LA) on children undergoing dental rehabilitation under general anesthesia (GA). A survey was administered via e-mail to AAPD members to document the use of LA during dental rehabilitations under GA and the rationales for its use. A total of 952 of 5,599 members responded to this survey; 79 percent of respondents use LA at least part of the time during dental rehabilitations under GA. "Improved patient recovery" was the most commonly cited rationale for administering LA. Extraction of permanent and primary teeth were the two most common procedures cited for the use of LA, respectively. There is no consensus among the respondents on the use of local anesthesia during dental rehabilitation under general anesthesia, but the majority responded that it does play a role in their perioperative patient management.

Heart rate, salivary α-amylase activity, and cooperative behavior in previously naïve children receiving dental local anesthesia.

PubMed

Arhakis, Aristidis; Menexes, George; Coolidge, Trilby; Kalfas, Sotirios

2012-01-01

Psychosomatic indicators, such as heart rate (HR), salivary alpha amylase (sAA) activity, and behavior, can be used to determine stress. This study's aim was to assess the pattern of changes of salivary alpha amylase, heart rate, and cooperative behavior in previously naïve children receiving dental treatment under local anesthesia. Included were 30 children with no prior dental experience who needed 4 or more sessions of dental treatment involving local anesthesia. In each session, sAA, HR, and behavior were assessed before and during the application of local anesthesia and at the end of the treatment. The highest sAA value was always observed at the end of each session; overall, the value was lower in the fourth session. HR always increased during the local anesthesia, and did not vary across sessions. No significant relationship was found between child cooperation and either sAA or HR. In this sample, child cooperation may not be an accurate indicator of stress. Based on salivary alpha amylase activity changes, dental treatment involving local anesthesia in naïve children appeared to be less stressful after 3 sessions.

Survey of the sevoflurane sedation status in one provincial dental clinic center for the disabled.

PubMed

Park, Chang-Hyun; Kim, Seungoh

2016-12-01

Sevoflurane sedation in pediatric and disabled patients has the advantage of faster induction and recovery compared to general anesthesia, as well as minimum influence on the respiratory and cardiovascular functions, and airway protective reflexes. This study aimed to evaluate the clinical efficacy of sevoflurane sedation used in dental treatment at one provincial dental clinic center for the disabled. We investigated patients' gender, age, reasons for undergoing sedation, medication history prior to treatment, duration of anesthesia, treatment length, type of treatment, and yearly patterns, for 387 cases of dental treatment performed using sevoflurane sedation from January 2013 to October 2016. We analyzed 387 cases (215 male patients, 172 female patients). Male patients aged 20 year or older accounted for 39.0% of all patients, marking the highest proportion. Patient's lack of cooperation was the most common reason for performing dental sedation. Prosthetic treatment was the most frequently practiced, accounting for 174 treatment cases. The mean lengths of the entire treatment and of the dental procedure were 55.2 min and 39.8 min, respectively. Sevoflurane sedation has the advantage of fast anesthesia induction and recovery compared to general anesthesia; therefore, it can be used efficiently to induce anesthesia in pediatric and disabled patients during short dental procedures, enabling stable treatment of these patients.

TRICARE; Changes included in the John Warner National Defense Authorization Act for Fiscal Year 2007; authorization of anesthesia and other costs for dental care for children and certain other patients. Final rule.

PubMed

2007-09-25

This final rule implements section 702 of the John Warner National Defense Authorization Act for Fiscal Year 2007, Public Law 109-364. The rule provides coverage of contracted medical care with respect to dental care beyond that care required as a necessary adjunct to medical or surgical treatment. The entitlement of institutional and anesthesia services is authorized in conjunction with non-covered dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under. This final rule does not eliminate any contracted medical care that is currently covered for spouses and children. The entitlement of anesthesia services includes general anesthesia services only. Institutional services include institutional benefits associated with both hospital and in-out surgery settings. Patients with developmental, mental, or physical disabilities are those patients with conditions that prohibit dental treatment in a safe and effective manner. Therefore, it is medically or psychologically necessary for these patients to require general anesthesia for dental treatment.

Hypnosis and Local Anesthesia for Dental Pain Relief-Alternative or Adjunct Therapy?-A Randomized, Clinical-Experimental Crossover Study.

PubMed

Wolf, Thomas Gerhard; Wolf, Dominik; Callaway, Angelika; Below, Dagna; d'Hoedt, Bernd; Willershausen, Brita; Daubländer, Monika

2016-01-01

This prospective randomized clinical crossover trial was designed to compare hypnosis and local anesthesia for experimental dental pain relief. Pain thresholds of the dental pulp were determined. A targeted standardized pain stimulus was applied and rated on the Visual Analogue Scale (0-10). The pain threshold was lower under hypnosis (58.3 ± 17.3, p < .001), maximal (80.0) under local anesthesia. The pain stimulus was scored higher under hypnosis (3.9 ± 3.8) than with local anesthesia (0.0, p < .001). Local anesthesia was superior to hypnosis and is a safe and effective method for pain relief in dentistry. Hypnosis seems to produce similar effects observed under sedation. It can be used in addition to local anesthesia and in individual cases as an alternative for pain control in dentistry.

Hypnosis and dental anesthesia in children: a prospective controlled study.

PubMed

Huet, Adeline; Lucas-Polomeni, Marie-Madeleine; Robert, Jean-Claude; Sixou, Jean-Louis; Wodey, Eric

2011-01-01

The authors of this prospective study initially hypothesized that hypnosis would lower the anxiety and pain associated with dental anesthesia. Thirty children aged 5 to 12 were randomly assigned to 2 groups receiving hypnosis (H) or not (NH) at the time of anesthesia. Anxiety was assessed at inclusion in the study, initial consultation, installation in the dentist's chair, and at the time of anesthesia using the modified Yale preoperative anxiety scale (mYPAS). Following anesthesia, a visual analogue scale (VAS) and a modified objective pain score (mOPS) were used to assess the pain experienced. The median mYPAS and mOPS scores were significantly lower in the H group than in the NH group. Significantly more children in the H group had no or mild pain. This study suggests that hypnosis may be effective in reducing anxiety and pain in children receiving dental anesthesia.

Survey of the sevoflurane sedation status in one provincial dental clinic center for the disabled

PubMed Central

Park, Chang-hyun

2016-01-01

Background Sevoflurane sedation in pediatric and disabled patients has the advantage of faster induction and recovery compared to general anesthesia, as well as minimum influence on the respiratory and cardiovascular functions, and airway protective reflexes. This study aimed to evaluate the clinical efficacy of sevoflurane sedation used in dental treatment at one provincial dental clinic center for the disabled. Methods We investigated patients' gender, age, reasons for undergoing sedation, medication history prior to treatment, duration of anesthesia, treatment length, type of treatment, and yearly patterns, for 387 cases of dental treatment performed using sevoflurane sedation from January 2013 to October 2016. Results We analyzed 387 cases (215 male patients, 172 female patients). Male patients aged 20 year or older accounted for 39.0% of all patients, marking the highest proportion. Patient's lack of cooperation was the most common reason for performing dental sedation. Prosthetic treatment was the most frequently practiced, accounting for 174 treatment cases. The mean lengths of the entire treatment and of the dental procedure were 55.2 min and 39.8 min, respectively. Conclusions Sevoflurane sedation has the advantage of fast anesthesia induction and recovery compared to general anesthesia; therefore, it can be used efficiently to induce anesthesia in pediatric and disabled patients during short dental procedures, enabling stable treatment of these patients. PMID:28879316

The use of general anesthesia to facilitate dental treatment in adult patients with special needs.

PubMed

Lim, Mathew Albert Wei Ting; Borromeo, Gelsomina Lucia

2017-06-01

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.

Repeated General Anesthesia in a Patient With Noonan Syndrome.

PubMed

Asahi, Yoshinao; Fujii, Ryosuke; Usui, Naoko; Kagamiuchi, Hajime; Omichi, Shiro; Kotani, Junichiro

2015-01-01

Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial anomalies, short stature, chest deformity, congenital heart diseases, and other comorbidities. The challenges faced during anesthetic management of patients with NS could be due to congenital heart diseases, hemostatic disorders, and airway anomalies. Here we describe dental treatment under general anesthesia performed for a 28-year-old man with NS. He had characteristic features of NS along with mild pulmonary valve stenosis. Dental treatment under general anesthesia was performed successfully on 13 occasions with nasotracheal intubation under curve-tipped suction catheter guidance or insertion of a reinforced laryngeal mask airway. This case suggests that for patients with NS, who might present several challenges, dental anesthesiologists should consider the extent of the patient's disorders to enable them to perform dental treatment safely under general anesthesia.

Repeated General Anesthesia in a Patient With Noonan Syndrome

PubMed Central

Asahi, Yoshinao; Fujii, Ryosuke; Usui, Naoko; Kagamiuchi, Hajime; Omichi, Shiro; Kotani, Junichiro

2015-01-01

Noonan syndrome (NS) is an autosomal dominant disorder characterized by facial anomalies, short stature, chest deformity, congenital heart diseases, and other comorbidities. The challenges faced during anesthetic management of patients with NS could be due to congenital heart diseases, hemostatic disorders, and airway anomalies. Here we describe dental treatment under general anesthesia performed for a 28-year-old man with NS. He had characteristic features of NS along with mild pulmonary valve stenosis. Dental treatment under general anesthesia was performed successfully on 13 occasions with nasotracheal intubation under curve-tipped suction catheter guidance or insertion of a reinforced laryngeal mask airway. This case suggests that for patients with NS, who might present several challenges, dental anesthesiologists should consider the extent of the patient's disorders to enable them to perform dental treatment safely under general anesthesia. PMID:26061577

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients

PubMed Central

Spera, Allison L.; Saxen, Mark A.; Yepes, Juan F.; Jones, James E.; Sanders, Brian J.

2017-01-01

The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010–2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients. PMID:28858554

Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients.

PubMed

Spera, Allison L; Saxen, Mark A; Yepes, Juan F; Jones, James E; Sanders, Brian J

The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010-2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients.

75 FR 59329 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; 2011 Fiscal Year Update

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

... and other professional charges, including professional charges for anesthesia services and dental... charges for anesthesia services and dental services; pathology and laboratory charges; observation care...

Treatment Needs and Adverse Events Related to Dental Treatment under General Anesthesia for Individuals with Autism

ERIC Educational Resources Information Center

Rada, Robert E.

2013-01-01

Individuals with autism can be quite challenging to treat in a routine dental-office setting, especially when extensive dental treatment and disruptive behavioral issues exist. Individuals with autism may also be at higher risk for oral disease. Frequently, general anesthesia is the only method to facilitate completion of the needed dental…

[Long-term dental interventions in mentally retarded children under general anesthesia with sevoflurane].

PubMed

Sitkin, S I; Gasparian, A L; Ivanova, T Iu; Nesterova, E Iu; Drozdova, N I

2015-01-01

Dental procedures in mentally retarded children is challenging for both dentist and for anesthesiologist. The aim of the study was to evaluate the efficacy and safety of dental care procedures under general anesthesia with sevoflurane by means of laryngeal mask in mentally retarded children. The randomized controlled study included 65 mentally retarded children with ASA 2-3 who underwent dental treatment. All patients had multiple caries. The children were divided into two groups. The first group included 35 children with normal body weigh while the second one - 30 obese children. All patients received a rapid induction with sevoflurane with the subsequent installation of the laryngeal mask. In the second group the signs of hypoventilation recorded an average of 10 ± 4 minutes after induction of anesthesia, which was manifested in increasing Pсо₂greater than 50 mm Hg. In the first group, the signs of hypoventilation marked an average of 18 ± 3.5 minutes from the start of induction of anesthesia. All patients were transferred to the artificial lung ventilation through the LMA. By dental treatment under general anesthesia with sevoflurane and laryngeal mask all mentally retarded children had respiratory depression with increased levels of carbon dioxide greater than 50 mmHg, but obese children developed these signs of hypoventilation twice as fast. Conducting long dental treatment in mentally retarded children require artificial lung ventilation.

78 FR 59427 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.13, Fiscal Year 2014 Update

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-26

...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

76 FR 60136 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.8, 2012 Fiscal Year Update

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-28

...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

77 FR 55269 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.11, 2013; Fiscal Year Update

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

[Survey of pediatric sedation in Japan--results of questionnaire to universities of dentistry].

PubMed

Takeuchi, Lisa; Kuratani, Norifumi; Hoshijima, Hiroshi; Kikuchi, Hirosato

2010-12-01

Despite widespread use of sedation for stress management during dental treatment in adults, its prevalence of use for pediatric in patients Japan has not been clarified. We investigated here, the present situation of pediatric sedation by the questionnaire sent to the dental anesthesia departments of university hospitals in Japan. Postal survey was conducted of the dental anesthesia departments of university hospitals (29 institutions) throughout the country. Information was requested on hospital policy of indication and technique of pediatric sedation for dental treatment. The causes for avoiding pediatric sedation were also investigated. The response rate was 86.2% (25/29 institutions). Of these respondents, 16 institutions (64%, 16/25 institutions) employ sedation for pediatric dental treatment stress management. The cases performed were around 1-5 cases every month. However, the criteria for employment of pediatric sedation during dental treatment varied among institutes. They preferred to provide general endotracheal anesthesia for pediatric dental procedures, and tended to avoid sedation without airway security for children. The present survey suggests that pediatric sedation for stress management during dental treatment are employed in more than half of the dental university hospitals. However, there was little consensus regarding pediatric sedation during dental treatment among dental anesthesiologists in Japan.

Anesthetic Management by Laryngeal Mask Airway in a Patient With a History of Difficult Intubation Resulting in Dental Injuries

PubMed Central

Asahi, Yoshinao; Fujii, Ryosuke; Usui, Naoko; Kagamiuchi, Hajime; Omichi, Shiro; Kotani, Junichiro

2015-01-01

Disabled patients may face respiratory problems during general anesthesia because of head and neck anomalies. We describe a case of dental treatment under general anesthesia using a laryngeal mask airway in a disabled patient who faced difficulty in endotracheal intubation on several occasions, 5 of which resulted in dental injuries. PMID:25849470

Does audiovisual distraction reduce dental anxiety in children under local anesthesia? A systematic review and meta-analysis.

PubMed

Zhang, Cai; Qin, Dan; Shen, Lu; Ji, Ping; Wang, Jinhua

2018-03-02

To perform a systematic review and meta-analysis on the effects of audiovisual distraction on reducing dental anxiety in children during dental treatment under local anesthesia. The authors identified eligible reports published through August 2017 by searching PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Clinical trials that reported the effects of audiovisual distraction on children's physiological measures, self-reports and behavior rating scales during dental treatment met the minimum inclusion requirements. The authors extracted data and performed a meta-analysis of appropriate articles. Nine eligible trials were included and qualitatively analyzed; some of these trials were also quantitatively analyzed. Among the physiological measures, heart rate or pulse rate was significantly lower (p=0.01) in children subjected to audiovisual distraction during dental treatment under local anesthesia than in those who were not; a significant difference in oxygen saturation was not observed. The majority of the studies using self-reports and behavior rating scales suggested that audiovisual distraction was beneficial in reducing anxiety perception and improving children's cooperation during dental treatment. The audiovisual distraction approach effectively reduces dental anxiety among children. Therefore, we suggest the use of audiovisual distraction when children need dental treatment under local anesthesia. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The influence of location of local anesthesia and complexity/duration of restorative treatment on children's behavior during dental treatment.

PubMed

Davidovich, Esti; Wated, Alham; Shapira, Joseph; Ram, Diana

2013-01-01

The purpose of this study was to investigate whether the region of local anesthetic injection and the complexity and duration of restorative treatment were associated with children's behavior during and immediately after dental treatment. This study examined 90 children, divided into two age groups (2-3.5 years old and >3.5-5.5 years old), who underwent dental treatment while lightly sedated. The region of local anesthesia (maxillary infiltration or mandibular block), complexity and duration of treatment, and behavior during and after treatment were assessed. Children's behavior during and after dental treatment, within and between age groups, was not found to be associated with the region of local anesthesia or complexity of treatment. For both age groups, more children exhibited negative behaviors during treatment when procedures exceeded 30 minutes. For younger children, more negative behaviors were also observed after longer vs shorter procedures. Treatment duration, not the region of local anesthesia or complexity of treatment, was associated with children's behavior during and after dental procedures.

Acoustic method respiratory rate monitoring is useful in patients under intravenous anesthesia.

PubMed

Ouchi, Kentaro; Fujiwara, Shigeki; Sugiyama, Kazuna

2017-02-01

Respiratory depression can occur during intravenous general anesthesia without tracheal intubation. A new acoustic method for respiratory rate monitoring, RRa ® (Masimo Corp., Tokyo, Japan), has been reported to show good reliability in post-anesthesia care and emergency units. The purpose of this study was to investigate the reliability of the acoustic method for measurement of respiratory rate during intravenous general anesthesia, as compared with capnography. Patients with dental anxiety undergoing dental treatment under intravenous anesthesia without tracheal intubation were enrolled in this study. Respiratory rate was recorded every 30 s using the acoustic method and capnography, and detectability of respiratory rate was investigated for both methods. This study used a cohort study design. In 1953 recorded respiratory rate data points, the number of detected points by the acoustic method (1884, 96.5 %) was significantly higher than that by capnography (1682, 86.1 %) (P < 0.0001). In the intraoperative period, there was a significant difference in the LOA (95 % limits of agreement of correlation between difference and average of the two methods)/ULLOA (under the lower limit of agreement) in terms of use or non-use of a dental air turbine (P < 0.0001). In comparison between capnography, the acoustic method is useful for continuous monitoring of respiratory rate in spontaneously breathing subjects undergoing dental procedures under intravenous general anesthesia. However, the acoustic method might not accurately detect in cases in with dental air turbine.

Ventilation via Cut Nasotracheal Tube During General Anesthesia

PubMed Central

Asahi, Yoshinao; Omichi, Shiro; Adachi, Seita; Kagamiuchi, Hajime; Kotani, Junichiro

2013-01-01

Many patients with disabilities need recurrent dental treatment under general anesthesia because of high caries prevalence and the nature of dental treatment. We evaluated the use of a nasal device as a possible substitute for flexible laryngeal mask airway to reduce the risk of unexpected failure accompanying intubation; we succeeded in ventilating the lungs with a cut nasotracheal tube (CNT) with its tip placed in the pharynx. We hypothesized that this technique would be useful during dental treatment under general anesthesia and investigated its usefulness as part of a minimally invasive technique. A prospective study was designed using general anesthesia in 37 dental patients with disabilities such as intellectual impairment, autism, and cerebral palsy. CNT ventilation was compared with mask ventilation with the patient in 3 positions: the neck in flexion, horizontal position, and in extension. The effect of mouth gags was also recorded during CNT ventilation. The percentages of cases with effective ventilation were similar for the 2 techniques in the neck extension and horizontal positions (89.2–97.3%). However, CNT ventilation was significantly more effective than mask ventilation in the neck flexion position (94.6 vs 45.9%; P < .0001). Mouth gags slightly reduced the rate of effective ventilation in the neck flexion position. Most dental treatments involving minor oral surgeries were performed using mouth gags during CNT ventilation. CNT ventilation was shown to be superior to mask ventilation and is useful during dental treatment under general anesthesia. PMID:23506278

Significant Factors Related to Failed Pediatric Dental General Anesthesia Appointments at a Hospital-based Residency Program.

PubMed

Emhardt, John R; Yepes, Juan F; Vinson, LaQuia A; Jones, James E; Emhardt, John D; Kozlowski, Diana C; Eckert, George J; Maupome, Gerardo

2017-05-15

The purposes of this study were to: (1) evaluate the relationship between appointment failure and the factors of age, gender, race, insurance type, day of week, scheduled time of surgery, distance traveled, and weather; (2) investigate reasons for failure; and (3) explore the relationships between the factors and reasons for failure. Electronic medical records were accessed to obtain data for patients scheduled for dental care under general anesthesia from May 2012 to May 2015. Factors were analyzed for relation to appointment failure. Data from 3,513 appointments for 2,874 children were analyzed. Bivariate associations showed statistically significant (P<0.05) relationships between failed appointment and race, insurance type, scheduled time of surgery, distance traveled, snowfall, and temperature. Multinomial regression analysis showed the following associations between factors and the reason for failure (P<0.05): (1) decreased temperature and increased snowfall were associated with weather as reason for failure; (2) the African American population showed an association with family barriers; (3) Hispanic families were less likely to give advanced notice; and (4) the "additional races" category showed an association with fasting violation. Patients who have treatment under general anesthesia face specific barriers to care.

Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia.

PubMed

El Batawi, Hisham Yehia

2015-01-01

To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time.

Dental Treatment and Expenditures Under General Anesthesia Among Medicaid-Enrolled Children in North Carolina.

PubMed

Meyer, Beau D; Lee, Jessica Y; Casey, Mark W

2017-11-01

Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution. This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization. For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001). Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Evaluation of a Local Anesthesia Simulation Model with Dental Students as Novice Clinicians.

PubMed

Lee, Jessica S; Graham, Roseanna; Bassiur, Jennifer P; Lichtenthal, Richard M

2015-12-01

The aim of this study was to evaluate the use of a local anesthesia (LA) simulation model in a facilitated small group setting before dental students administered an inferior alveolar nerve block (IANB) for the first time. For this pilot study, 60 dental students transitioning from preclinical to clinical education were randomly assigned to either an experimental group (N=30) that participated in a small group session using the simulation model or a control group (N=30). After administering local anesthesia for the first time, students in both groups were given questionnaires regarding levels of preparedness and confidence when administering an IANB and level of anesthesia effectiveness and pain when receiving an IANB. Students in the experimental group exhibited a positive difference on all six questions regarding preparedness and confidence when administering LA to another student. One of these six questions ("I was prepared in administering local anesthesia for the first time") showed a statistically significant difference (p<0.05). Students who received LA from students who practiced on the simulation model also experienced fewer post-injection complications one day after receiving the IANB, including a statistically significant reduction in trismus. No statistically significant difference was found in level of effectiveness of the IANB or perceived levels of pain between the two groups. The results of this pilot study suggest that using a local anesthesia simulation model may be beneficial in increasing a dental student's level of comfort prior to administering local anesthesia for the first time.

Proposed Guideline Revisions for Dental Sedation and General Anesthesia: Why Target the Safest Level of Sedation?

PubMed

Dionne, Raymond A

2016-09-01

Recently proposed revisions to the American Dental Association's Guidelines for the Use of Sedation and General Anesthesia by Dentists, aimed at improving safety in dental offices, differentiate between levels of sedation based on drug-induced changes in physiologic and behavioral states. However, the author of this op-ed is concerned the proposed revisions may have far-reaching and unintended consequences.

Prognosis after treatment with multiple dental implants under general anesthesia and sedation in a cerebral palsy patient with mental retardation: A case report.

PubMed

Hong, Young-Joon; Dan, Jung-Bae; Kim, Myung-Jin; Kim, Hyun Jeong; Seo, Kwang-Suk

2017-06-01

Cerebral palsy is a non-progressive disorder resulting from central nervous system damage caused by multiple factors. Almost all cerebral palsy patients have a movement disorder that makes dental treatment difficult. Oral hygiene management is difficult and the risks for periodontitis, dental caries and loss of multiple teeth are high. Placement of dental implants for multiple missing teeth in cerebral palsy patients needs multiple rounds of general anesthesia, and the prognosis is poor despite the expense. Therefore, making the decision to perform multiple dental implant treatments on cerebral palsy patients is difficult. A 33-year-old female patient with cerebral palsy and mental retardation was scheduled for multiple implant treatments. She underwent computed tomography (CT) under sedation and the operation of nine dental implants under general anesthesia. Implant-supported fixed prosthesis treatment was completed. During follow-up, she had the anterior incisors extracted and underwent the surgery of 3 additional dental implants, completing the prosthetic treatment. Although oral parafunctions existed due to cerebral palsy, no implant failure was observed 9 years after the first implant surgery.

Advanced techniques and armamentarium for dental local anesthesia.

PubMed

Clark, Taylor M; Yagiela, John A

2010-10-01

Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis. Copyright © 2010 Elsevier Inc. All rights reserved.

Independent predictors of delay in emergence from general anesthesia.

PubMed

Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; Ishii-Maruhama, Minako; Egusa, Masahiko; Miyawaki, Takuya

2015-01-01

Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.

Independent Predictors of Delay in Emergence From General Anesthesia

PubMed Central

Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; Ishii-Maruhama, Minako; Egusa, Masahiko; Miyawaki, Takuya

2015-01-01

Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability. PMID:25849468

Assessment of Oral Status in Pediatric Patients with Special Health Care Needs receiving Dental Rehabilitation Procedures under General Anesthesia: A Retrospective Analysis.

PubMed

Solanki, Neeraj; Kumar, Anuj; Awasthi, Neha; Kundu, Anjali; Mathur, Suveet; Bidhumadhav, Suresh

2016-06-01

Dental problems serve as additional burden on the children with special health care needs (CSHCN) because of additional hospitalization pressure, they face for the treatment of various serious medical problems. These patients have higher incidence of dental caries due to increased quantity of sugar involved in the drug therapies and lower salivary flow in the oral cavity. Such patients are difficult to treat with local anesthesia or inhaled sedatives. Single-sitting dental treatment is possible in these patients with general anesthesia. Therefore, we conducted this retrospective analysis of oral health status of CSHCN receiving various dental treatments in a given population. A total of 200 CSHCN of age 14 years or less reporting in the pediatric wing of the general hospital from 2005 to 2014 that underwent comprehensive dental treatment under general anesthesia were included in the study. Patients with history of any additional systemic illness, any malignancy, any known drug allergy, or previous history of any dental treatment were excluded from the study. Complete mouth rehabilitation was done in these patients under general anesthesia following standard protocols. Data regarding the patient's disability, type, duration, and severity of disability was collected and analyzed. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Chi-square test, Student's t-test, and one-way analysis of variance were used to assess the level of significance. Statistically significant results were obtained while analyzing the subject's decayed missing filled/decayed extracted filled teeth indices divided based on age. Significant difference was observed only in cases where patients underwent complete crown placement even when divided based on type of disability. While analyzing the prevalence, statistically significant results were observed in patients when divided based on their age. In CSHCN, dental pathologies and caries indices are increased regardless of the type or extent of disability. Children with special health care needs should be given special oral health care, and regular dental checkup should be conducted as they are more prone to have dental problems.

Ophthalmologic complications after administration of local anesthesia in dentistry: a systematic review.

PubMed

Alamanos, Christos; Raab, Philipp; Gamulescu, Andreea; Behr, Michael

2016-03-01

The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic mechanisms, and the measures that offer patients a restitutio ad integrum. This systematic review adopted a structured protocol to access available publications and followed the PRISMA statement. Eighty-nine cases of patients experiencing ocular adverse events after administration of dental local anesthesia have been reported in the literature. Most of the complications manifested as double vision. Only 8% of the complications caused permanent functional damage, either as vision deficit or anisocoria. Complete permanent blindness was not reported. Ocular complications as a result of dental local anesthesia may be seen as rare occurrences with usually low intensity. However, visual function may become permanently impaired and serious medical conditions may obscure ocular dysfunction. Copyright © 2016. Published by Elsevier Inc.

Single-tooth anesthesia: pressure-sensing technology provides innovative advancement in the field of dental local anesthesia.

PubMed

Hochman, Mark N

2007-04-01

This article will review standard techniques for intraligamentary injection and describe the technology and technique behind a new single-tooth anesthesia system. This system and technique represents a technological advancement and a greater understanding of intraligamentary anesthesia.

Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

PubMed Central

El Batawi, Hisham Yehia

2015-01-01

Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. Results: The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Conclusions: Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time. PMID:25992332

Demand in Pediatric Dentistry for Sedation and General Anesthesia by Dentist Anesthesiologists: A Survey of Directors of Dentist Anesthesiologist and Pediatric Dentistry Residencies

PubMed Central

Hicks, C. Gray; Jones, James E.; Saxen, Mark A.; Maupome, Gerardo; Sanders, Brian J.; Walker, LaQuia A.; Weddell, James A.; Tomlin, Angela

2012-01-01

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade. PMID:22428968

Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

PubMed

Hicks, C Gray; Jones, James E; Saxen, Mark A; Maupome, Gerardo; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Tomlin, Angela

2012-01-01

This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

Second-Degree Atrioventricular Block Occurring After Tooth Extraction.

PubMed

Kamatani, Takaaki; Akizuki, Ayako; Kondo, Seiji; Shirota, Tatsuo

Although cardiac arrhythmias are occasionally associated with dental extractions and dental anesthesia, atrioventricular block is rarely seen during dental procedures. We report a rare case of type I second-degree atrioventricular block (Wenckebach phenomenon) occurring after bilateral extraction of impacted mandibular third molars under general anesthesia in a 16-year-old Japanese girl. Under consultation with a cardiovascular physician, we carefully monitored the patient's vital signs postoperatively, including blood pressure, oxygen saturation, and electrocardiogram, using a bedside monitor. Her postoperative course was uneventful. A 12-lead electrocardiogram the following day revealed no abnormality. In this case, we hypothesize that extubation of the nasotracheal tube or oral/pharyngeal suction might have triggered a vagal reflex that caused type I second-degree atrioventricular block. Our experience indicates that standard cardiovascular monitoring should be used for patients undergoing dental treatment under general anesthesia, even for young, healthy patients, to prevent and detect cardiovascular emergencies.

Using Mixed-Reality Technology to Teach Techniques for Administering Local Anesthesia

ERIC Educational Resources Information Center

Hanson, Kami M.

2011-01-01

The ability to perform local anesthesia on dental patients is an important clinical skill for a dental hygienist. When learning this procedure in an academic situation, students often practice on their peers to build their skills. There are multiple reasons why the peer practice is not ideal; consequently, educators have sought the means to…

Procedural mishaps with trephine-based intraosseous anesthesia.

PubMed

Small, Joel C; Witherspoon, David E; Regan, John D; Hall, Ellen

2011-01-01

Failure to achieve profound anesthesia during dental treatment can be a significant problem for dental clinicians, especially for endodontic procedures on teeth in the mandibular arch with irreversible pulpitis. A number of supplemental local anesthesia techniques exist, the most effective of which may be the intraosseous injection. Two cases are presented demonstrating the dangers associated with the use of the intraosseous anesthesia technique. While the technique can provide profound anesthesia in otherwise difficult to anesthetize cases, care must be taken during its administration. Both cases show the damage done to the root and overlying bone by the injudicious use of the trephine. It is incumbent on the clinician to fully consider the anatomy in the area prior to insertion of the trephine. Intraosseous anesthesia techniques are a valuable addition to the clinicians' armamentarium. However careless administration can result in problems of endodontic or periodontal nature that may be difficult to rectify.

Computer-controlled local anesthetic delivery for painless anesthesia: a literature review

PubMed Central

Kwak, Eun-Jung; Pang, Nan-Sim; Cho, Jin-Hyung; Jung, Bock-Young; Kim, Kee-Deog

2016-01-01

Local anesthesia is administered to reduce pain during dental treatments, but may itself cause pain and contribute to increased dental fear. Computer-controlled local anesthetic delivery (CCLAD) is one the method to reduce patient pain during local anesthesia; it is a device that slowly administers anesthetics by using a computerized device to control the injection speed. This literature review aims to provide an objective assessment of the usefulness of CCLAD for controlling pain by reviewing papers published to date that have used CCLAD. PMID:28879299

How safe is deep sedation or general anesthesia while providing dental care?

PubMed

Bennett, Jeffrey D; Kramer, Kyle J; Bosack, Robert C

2015-09-01

Deep sedation and general anesthesia are administered daily in dental offices, most commonly by oral and maxillofacial surgeons and dentist anesthesiologists. The goal of deep sedation or general anesthesia is to establish a safe environment in which the patient is comfortable and cooperative. This requires meticulous care in which the practitioner balances the patient's depth of sedation and level of responsiveness while maintaining airway integrity, ventilation, and cardiovascular hemodynamics. Using the available data and informational reports, the authors estimate that the incidence of death and brain injury associated with deep sedation or general anesthesia administered by all dentists most likely exceeds 1 per month. Airway compromise is a significant contributing factor to anesthetic complications. The American Society of Anesthesiology closed claim analysis also concluded that human error contributed highly to anesthetic mishaps. The establishment of a patient safety database for anesthetic management in dentistry would allow for a more complete assessment of morbidity and mortality that could direct efforts to further increase safe anesthetic care. Deep sedation and general anesthesia can be safely administered in the dental office. Optimization of patient care requires appropriate patient selection, selection of appropriate anesthetic agents, utilization of appropriate monitoring, and a highly trained anesthetic team. Achieving a highly trained anesthetic team requires emergency management preparation that can foster decision making, leadership, communication, and task management. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

PubMed

Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Antò, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

2017-01-01

Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

PubMed Central

D'Antò, Vincenzo; Fauxpoint, Gabriel; De Rosa, Sara; Vallogini, Giulia

2017-01-01

Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe. PMID:28293129

Transient Cardiac Arrest in Patient With Left Ventricular Noncompaction (Spongiform Cardiomyopathy)

PubMed Central

Yamazaki, Shinya; Ito, Hiroshi; Kawaai, Hiroyoshi

2011-01-01

Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid‐based anesthetic was performed, and recovery was smooth. In LVNC, opioid‐based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high‐risk patient. PMID:21410361

Transient cardiac arrest in patient with left ventricular noncompaction (spongiform cardiomyopathy).

PubMed

Yamazaki, Shinya; Ito, Hiroshi; Kawaai, Hiroyoshi

2011-01-01

Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid-based anesthetic was performed, and recovery was smooth. In LVNC, opioid-based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high-risk patient.

Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases.

PubMed

Corcuera-Flores, J-R; Delgado-Muñoz, J-M; Ruiz-Villandiego, J-C; Maura-Solivellas, I; Machuca-Portillo, G

2014-03-01

Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment.

Comparative Evaluation of Pediatric Patients with Mental Retardation undergoing Dental Treatment under General Anesthesia: A Retrospective Analysis.

PubMed

Ahuja, Ravish; Jyoti, Bhuvan; Shewale, Vinod; Shetty, Shridhar; Subudhi, Santosh Kumar; Kaur, Manpreet

2016-08-01

Behavioral management of patients forms one of the foremost components of pediatric dental treatment. Some children readily cooperate with dental treatment, while others require general anesthesia as a part of treatment protocol for carrying out various dental procedures. Hence, we evaluated the pediatric patients with and without mental retardation, who underwent dental treatment under general anesthesia. The present study analyzed the record of 480 pediatric patients reporting in the department of pedodontics from 2008 to 2014. Analysis of the records of the patients who underwent dental treatment under general anesthesia was done and all the patients were divided into two study groups depending upon their mental level. For the purpose of evaluation, the patients were also grouped according to their age; 4 to 7 years, 8 to 12 years, and 13 to 18 years. Measurement of decayed, missing, and filled teeth and scores for both deciduous and permanent dentition was done before and after the commencement of the dental treatment. Chi-square test and independent t-test were used for evaluating the level of significance. While comparing the patients in the two groups, maximum number of patients is present in the age group of 13 to 18 years. While comparing the indices' score between the two study groups in various age intervals, no statistically significant results were obtained. Restorative treatment and dental extractions were the most common dental treatments that were seen at a higher frequency in the intellectual disability study group. In patients with mental retardation, a higher frequency of restorative treatment and extractions occurs as compared to healthy subjects of similar age group. Therefore, they require special attention regarding maintenance of their oral health. Special attention should be given for maintaining the oral health of patients with special health care needs as compared to their physically and mentally normal counterparts.

Trigemino-gustatory interactions: a randomized controlled clinical trial assessing the effects of selective anesthesia of dental afferents on taste thresholds.

PubMed

Lecor, Papa Abdou; Touré, Babacar; Boucher, Yves

2018-03-01

This study aimed at analyzing the effect of the temporary removal of trigeminal dental afferents on electrogustometric thresholds (EGMt). EGMt were measured in 300 healthy subjects randomized in three groups, in nine loci on the right and left side (RS, LS) of the tongue surface before and after anesthesia. Group IAN (n = 56 RS, n = 44 LS) received intraosseous local anesthesia of the inferior alveolar nerve (IAN). Group MdN received mandibular nerve (MdN) block targeting IAN before its entrance into the mandibular foramen (n = 60, RS, and n = 40, LS); group MxN receiving maxillary nerve (MxN) anesthesia (n = 56 RS and n = 44 LS) was the control group. Differences between mean EGMt were analyzed with the Wilcoxon test; correlation between type of anesthesia and EGMt was performed with Spearman's rho, all with a level of significance set at p ≤ 0.05. Significant EGMt (μA) differences before and after anesthesia were found in all loci with MdN and IAN on the ipsilateral side (p < 0.05), but not with MxN. Anesthesia of the MdN was positively correlated with the increase in EGMt (p < 0.001). Selective anesthesia of IAN was positively correlated only with the increase in EGMt measured at posterior and dorsal loci of the tongue surface (p < 0.01). The increase in EGMt following IAN anesthesia suggests a participation of dental afferents in taste perception. Extraction of teeth may impair food intake not only due to impaired masticatory ability but also to alteration of neurological trigemino-gustatory interactions. PACTR201602001452260.

Drugs Used for Parenteral Sedation in Dental Practice

PubMed Central

Dionne, Raymond A.; Gift, Helen C.

1988-01-01

The relative efficacy and safety of drugs and combinations used clinically in dentistry as premedicants to alleviate patient apprehension are largely unsubstantiated. To evaluate the efficacy and safety of agents used for parenteral sedation through controlled clinical trials, it is first necessary to identify which drugs, doses, and routes of administration are actually used in practice. A survey instrument was developed to characterize the drugs used clinically for anesthesia and sedation by dentists with advanced training in pain control. A random sample of 500 dentists who frequently use anesthesia and sedation in practice was selected from the Fellows of the American Dental Society of Anesthesiology. The first mailing was followed by a second mailing to nonrespondents after 30 days. The respondents report a variety of parenteral sedation techniques in combination with local anesthesia (the response categories are not mutually exclusive): nitrous oxide (64%), intravenous conscious sedation (59%), intravenous “deep” sedation (47%), and outpatient general anesthesia (27%). Drugs most commonly reported for intravenous sedation include diazepam, methohexital, midazolam, and combinations of these drugs with narcotics. A total of 82 distinct drugs and combinations was reported for intravenous sedation and anesthesia. Oral premedication and intramuscular sedation are rarely used by this group. Most general anesthesia reported is done on an outpatient basis in private practice. These results indicate that a wide variety of drugs is employed for parenteral sedation in dental practice, but the most common practice among dentists with advanced training in anesthesia is local anesthesia supplemented with intravenous sedation consisting of a benzodiazepine and an opioid or a barbiturate. PMID:3250279

An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia.

PubMed

Song, Ki Un; Nam, Ok Hyung; Kim, Mi Sun; Choi, Sung Chul; Lee, Hyo-Seol

2015-12-01

Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.

21 CFR 522.558 - Dexmedetomidine.

Code of Federal Regulations, 2011 CFR

2011-04-01

... by intramuscular injection. (B) For use as a preanesthetic to general anesthesia, administer 125 µg... dental procedures; and as a preanesthetic to general anesthesia. (iii) Limitations. Federal law restricts...

21 CFR 522.558 - Dexmedetomidine.

Code of Federal Regulations, 2014 CFR

2014-04-01

... by intramuscular injection. (B) For use as a preanesthetic to general anesthesia, administer 125 µg... dental procedures; and as a preanesthetic to general anesthesia. (iii) Limitations. Federal law restricts...

21 CFR 522.558 - Dexmedetomidine.

Code of Federal Regulations, 2012 CFR

2012-04-01

... by intramuscular injection. (B) For use as a preanesthetic to general anesthesia, administer 125 µg... dental procedures; and as a preanesthetic to general anesthesia. (iii) Limitations. Federal law restricts...

21 CFR 522.558 - Dexmedetomidine.

Code of Federal Regulations, 2013 CFR

2013-04-01

... by intramuscular injection. (B) For use as a preanesthetic to general anesthesia, administer 125 µg... dental procedures; and as a preanesthetic to general anesthesia. (iii) Limitations. Federal law restricts...

General Anesthesia Time for Pediatric Dental Cases

PubMed Central

Forsyth, Anna R.; Seminario, Ana Lucia; Scott, JoAnna; Berg, Joel; Ivanova, Iskra; Lee, Helen

2012-01-01

Purpose The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children’s hospital over a 2-year period. Methods A cross-sectional review of a pediatric dental GA records was performed at Seattle Children’s Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed. Results The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (P<.001); number of teeth treated (P<.001); and dentist operator type (P=.005). Conclusions Overall, 73% of dental procedures under GA finished early or on time. Significant variables included patient age, medical status, treatment type and extent, and dentist operator type. Assessing factors that impact the time needed in GA may enhance efficiency for pediatric dental procedures. PMID:23211897

Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia.

PubMed

Cantekin, Kenan; Yildirim, Mustafa Denizhan; Cantekin, Isin

2014-01-01

This study's purpose was to investigate how young children's and parent/caregivers' oral health-related quality of life and children's dental fears were affected by dental rehabilitation under general anesthesia (DRGA). A consecutive clinical sample of dyads of parents/caregivers and their four- to six-year-old children who received DRGA were surveyed before and after DRGA. Parents/caregivers responded through a self-administered questionnaire [Early Childhood Oral Health Impact Scale (ECOHIS)], and children received a dentist-administered questionnaire [children's fear survey schedule-dental subscale (CFSS-DS)]. The final sample consisted of 311 children/caregiver dyads. One to six teeth were extracted in 91 percent of children. There was a 44 percent decrease in total ECOHIS scores following treatment (P<.001). Overall child impact section scores decreased 34 percent following treatment (P<.001), and family impact section scores decreased 65 percent (P<.001). CFSS-DS anxiety scores after dental treatment were significantly higher for 14 of 15 situations/conditions assessed (P<.001). There was a trend of higher CFSS-DS scores in children who received increasing numbers of extractions. Children's and parent/caregivers' quality of life improved after the children received dental rehabilitation under general anesthesia, and children's fears increased for all situations tested. The number of extractions the children received was associated with increased levels of fear.

Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases

PubMed Central

Corcuera-Flores, José R.; Delgado-Muñoz, José M.; Ruiz-Villandiego, José C.; Maura-Solivellas, Isabel

2014-01-01

Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment. Key words:Hospital dentistry, handicapped patient. PMID:24121922

[Children's intelligence quotient following general anesthesia for dental care: a clinical observation by Chinese Wechsler young children scale of intelligence].

PubMed

Xia, B; Wang, J H; Xiao, Y M; Liu, K Y; Yang, X D; Ge, L H

2016-04-18

It has been demonstrated that anesthetics exposure may lead to neurocognitive impairment in developing brain of animal models. However, for the limitation that the animal models cannot fully mimic the dose and duration in clinical settings especially for dental general anesthesia, the clinical significance of anesthetics exposure on developing central nervous system remains undetermined. Therefore, we conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia comparing to that before surgery. We conducted the current study in order to observe the fluctuation of intelligence quotient (IQ) after the administration of dental general anesthesia compared with that before surgery. Thirty two patients, ASA I, who were exposed to dental general anesthesia in Department of Pediatric Dentistry Peking University School and Hospital of Stomatology, aged 4 to 6.5 years, were enrolled in this prospective study. Patients with severe learning difficulties or communication disorders were excluded. Written and informed consent was obtained from each patients' family which was fully explained of the purpose and method of study. Their intelligence quotients were evaluated with the Chinese Wechsler young children scale of intelligence (Urban version) before and 2 weeks after dental anesthesia. They were treated by experienced pediatric dentists and the sevoflurane, propofol and nitrous oxide were used for general anesthesia by anesthetist. Articaine hydrochloride and epinephrine tartrate injections were used for their pulp treatment or extraction. The examiners and scorers for IQ had technical training in the test administration. All the patients were tested by the same examiner and with standardized guide language. Each subtest was scored according to the tool review. Verbal IQ and performance IQ consisted of relevant 5 subtests and full scale IQ. Statistical analyses were performed by SPSS 18.0. All the scores of subtests and 3 types of IQ were expressed as mean±standard deviation. Paired two-tailed t test was applied and P<0.05 was accepted as statistically significant. The results of intelligent assessment from 28 subjects were collected. The anesthetic time was (163.4±32.6) min and the number of treated teeth was 12.1±2.3, mean age (4.60±0.41) years; age range=4.04 to 5.44 years. Among the patients, there were 13 girls and 15 boys. There was no significant difference in gender distribution. The postoperative full IQ (128.46±10.85) was higher than that before surgery (124.64±11.46, P= 0.017). We found that the elevation of performance IQ, to a large extent, contributed to this change in full IQ (P= 0.007). Correspondingly, there was no statistical difference in the verbal IQ, which was 119.68±11.74 to 120.21±15.61 (P=0.854). Dental general anesthesia has no negative effect on the intelligence of preschool children, who were treated under general anesthesia by sevoflurane, propofol and nitrous oxide for 2 to 4 hours. The full IQ and performance IQ were slightly enhanced after treatment which can be explained by the memory effect.

An update on local anesthesia for pediatric dental patients

PubMed Central

Peedikayil, Faizal C.; Vijayan, Ajoy

2013-01-01

Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients. PMID:25885712

Hypnosis as a Valuable Tool for Surgical Procedures in the Oral and Maxillofacial Area.

PubMed

Montenegro, Gil; Alves, Luiza; Zaninotto, Ana Luiza; Falcão, Denise Pinheiro; de Amorim, Rivadávio Fernandes Batista

2017-04-01

Hypnosis is a valuable tool in the management of patients who undergo surgical procedures in the maxillofacial complex, particularly in reducing and eliminating pain during surgery and aiding patients who have dental fear and are allergic to anesthesia. This case report demonstrates the efficacy of hypnosis in mitigating anxiety, bleeding, and pain during dental surgery without anesthesia during implant placement of tooth 14, the upper left first molar.

[Classification of local anesthesia methods].

PubMed

Petricas, A Zh; Medvedev, D V; Olkhovskaya, E B

The traditional classification methods of dental local anesthesia must be modified. In this paper we proved that the vascular mechanism is leading component of spongy injection. It is necessary to take into account the high effectiveness and relative safety of spongy anesthesia, as well as versatility, ease of implementation and the growing prevalence in the world. The essence of the proposed modification is to distinguish the methods in diffusive (including surface anesthesia, infiltration and conductive anesthesia) and vascular-diffusive (including intraosseous, intraligamentary, intraseptal and intrapulpal anesthesia). For the last four methods the common term «spongy (intraosseous) anesthesia» may be used.

Keeping ether "en-vogue": the role of Nathan Cooley Keep in the history of ether anesthesia.

PubMed

Guralnick, Walter C; Kaban, Leonard B

2011-07-01

In this report, we explore the little known role of Dr Nathan Cooley Keep in the dissemination of ether anesthesia in Boston. Keep was a prominent Boston dentist who, for a short time, taught and employed both William Morton and Horace Wells. He used ether anesthesia for a variety of dental and other surgical procedures requiring pain control. Keep administered ether to anesthetize Henry Wadsworth Longfellow's wife during the delivery of their daughter. This was the first use of ether for obstetric anesthesia. Dr Keep was also the first Dean of the Harvard Dental School and convinced the Massachusetts General Hospital to appoint a dentist to the staff of the hospital for the first time. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Utility of Vibratory Stimulation for Reducing Intraoral Injection Pain.

PubMed

Erdogan, Ozgur; Sinsawat, Anatachai; Pawa, Sudeep; Rintanalert, Duangtawan; Vuddhakanok, Suchada

2018-01-01

Intraoral local anesthesia injection is often perceived as a painful and anxiety-causing dental procedure. Vibration stimulus is one of the nonpharmacologic methods used to reduce unwanted sensations of local anesthesia injection. This clinical study evaluated the effectiveness of a recently introduced vibratory stimulation device in intraoral local anesthesia administration. Thirty-two subjects underwent 2 maxillary local anesthesia injections in 2 different sessions: 1 with conventional techniques and 1 with the aid of a vibratory stimulation device (DentalVibe). The pain levels were evaluated with a visual analog scale and the Wong-Baker FACES Pain Rating Scale. The subjects were asked to choose the preferred method for future injections. The data were evaluated statistically. There were no significant differences between the 2 injection methods with regard to either pain evaluation method. The preference of the subjects regarding future injection technique was evenly distributed between the groups. The vibratory stimulation device used in this study did not provide any reduction in pain level associated with maxillary infiltration local anesthesia administration.

Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta-analysis of randomized, controlled trials.

PubMed

Sivaramakrishnan, Gowri; Sridharan, Kannan

2018-05-01

Alternatives to adrenaline with lignocaine local anesthesia, such as clonidine, have been trialed in various randomized, controlled trials. Therefore, the aim of the present systematic review was to compile the available evidence on using clonidine with lignocaine for dental anesthesia. Electronic databases were searched for eligible studies. A data-extraction form was created, extracted data were analyzed using non-Cochrane mode in RevMan 5.3 software. Heterogeneity between the studies were assessed using the forest plot, I 2 statistics (where >50% was considered to have moderate-to-severe heterogeneity), and χ 2 -test. Random-effects models were used because of moderate heterogeneity. Five studies were included for the final review. While clonidine was found to significantly shorten the onset of local anesthesia when measured subjectively, no significant difference was observed objectively. No significant difference was observed in the duration and postoperative analgesia. Stable hemodynamic parameters within the safe range were observed postoperatively when clonidine was used. Clonidine could be considered as an alternative to adrenaline in cases of contraindications to adrenaline, such as like cardiac abnormalities, hypertension, and diabetes. © 2017 John Wiley & Sons Australia, Ltd.

Phentolamine mesylate to reverse oral soft-tissue local anesthesia: A systematic review and meta-analysis.

PubMed

Prados-Frutos, Juan Carlos; Rojo, Rosa; González-Serrano, José; González-Serrano, Carlos; Sammartino, Gilberto; Martínez-González, José María; Sánchez-Monescillo, Andrés

2015-10-01

Knowing that patients desire reduced duration of local anesthesia, the authors performed a meta-analysis to evaluate the efficacy of phentolamine mesylate (PM) in reducing anesthesia duration and the occurrence of adverse effects. The authors searched studies in 4 electronic databases up to December 18, 2014. For each study, the methodological quality was assessed according to the Cochrane Collaboration's tool for assessing risk of bias. Randomized controlled trials (RCTs) that used PM met the inclusion criteria. Six RCTs met the inclusion criteria and were used to carry out a meta-analysis of the effectiveness of PM and a qualitative analysis of its adverse effects. The use of PM was more effective in reversing the anesthetic effect on the lower lip and tongue than was applying a placebo. Adverse effects reported in the studies were not statistically significant, the most frequent being headache, pain during injection, and postprocedure pain. Based on limited evidence, PM is effective in reducing the persistence of anesthesia duration on the lower lip and tongue, with infrequent adverse effects of little clinical significance. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

The use of intraosseous anesthesia in a patient with myositis ossificans progressiva.

PubMed

Webb, M D; Wilson, C

1996-01-01

The case of a pediatric patient with myositis ossificans progressiva in whom it became increasingly difficult to obtain local anesthesia is presented. Intraosseous anesthesia was successful in allowing pain-free dental treatment to be completed. This approach should be considered in other patients who have limited mouth-opening ability due to injury or disease.

Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

PubMed

Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

2014-01-01

Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

Preoperative Medical Evaluation: Part 1: General Principles and Cardiovascular Considerations

PubMed Central

Becker, Daniel E

2009-01-01

A thorough assessment of a patient's medical status is standard practice when dental care is provided. Although this is true for procedures performed under local anesthesia alone, the information gathered may be viewed somewhat differently if the dentist is planning to use sedation or general anesthesia as an adjunct to dental treatment. This article is the first of a 2-part sequence and will address general principles and cardiovascular considerations. A second article will address pulmonary, metabolic, and miscellaneous disorders. PMID:19769423

Dental Chairside Technique. Student's Manual.

ERIC Educational Resources Information Center

Apfel, Maura; Weaver, Trudy Karlene

This manual is part of a series dealing with skills and information needed by students in dental assisting. The individualized student materials are suitable for classroom, laboratory, or cooperative training programs. This student manual contains four units covering the following topics: local anesthesia; dental office emergencies; oral hygiene;…

Pediatric Admissions After Dental Care Under General Anesthesia: A Retrospective Study at a Tertiary Care Center.

PubMed

Lucy, Anna L; Gandhi, Roopa P; Gross, Lilyana; McNair, Bryan

2017-05-15

The purpose of this study was to identify factors associated with planned and unplanned pediatric hospital admissions following dental treatment under general anesthesia (DGA) in a tertiary care center. Dental and medical records of 100 subjects one to 20 years of age, with a known history of admission after DGA, were reviewed retrospectively for patient-, procedure-, and anesthesia-related factors as well as adverse events following DGA. During the review period (December 3, 2011 to June 30, 2015), 10,371 subjects underwent DGA, of which 100 subjects (less than one percent) required admission. A significant association was found between postoperative (PO) recovery time and unplanned admissions following DGA (P<0.001). Adverse post-operative events significantly associated with unplanned admissions included emesis (P=0.01) and hypoxia (P<0.001). Patients who were classified as having American Anesthesiology Association (ASA) III status were more frequently admitted following DGA. Adverse events such as emesis and hypoxia were significantly associated with patients with an unplanned admission.

Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: A preliminary study

PubMed Central

Beneito-Brotons, Rut; Peñarrocha-Oltra, David; Ata-Ali, Javier

2012-01-01

Objective: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. Design: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. Results: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia – the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia – the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. Conclusions: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia. Key words:Anesthesia, intraosseous, oral anesthesia, infiltrating, mandibular block, Quicksleeper®. PMID:22143722

Referral patterns and general anesthesia in a specialized paediatric dental service.

PubMed

Alkilzy, Mohammad; Qadri, Ghalib; Horn, Janina; Takriti, Moutaz; Splieth, Christian

2015-05-01

The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

YouTube: a new way of supplementing traditional methods in dental education.

PubMed

Mukhopadhyay, Sanjana; Kruger, Estie; Tennant, Marc

2014-11-01

Higher education in many disciplines has undergone a dramatic change with the incorporation of electronic means to enhance student learning. YouTube is an open-access online website that has gained tremendous popularity in recent years as it allows users to upload videos for social and educational purposes. The aim of this study was to assess whether dentally relevant videos would be utilized as a freely available tool to aid learning. Forty videos, mainly in the area of dental anatomy and local anesthesia, were uploaded and made available for a period of eighteen months from March 2012 to September 2013. The videos were watched a total of nearly 71,000 times, with the anatomy channels accounting for 58,000 views. Most of the viewers were from the United States and Australia, with an ever-increasing number of viewers from developing countries. This study suggests that YouTube can be used as an adjunct tool to supplement dental education due to it being easily accessible online. It provides many sources of information that can be accessed by those working in or preparing for the dental profession, whether students, practitioners, or those in geographically isolated areas.

Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia.

PubMed

Ridell, Karin; Borgström, Margareta; Lager, Elisabeth; Magnusson, Gunilla; Brogårdh-Roth, Susanne; Matsson, Lars

2015-01-01

This study evaluated oral health-related quality-of-life (OHRQoL) in children and families before and after dental treatment under general anesthesia because of severe caries or molar-incisor hypomineralization (MIH). A consecutive sample of the parents/caregivers of children (3-14 years) in need of treatment under general anesthesia participated in the study. The children were divided into two groups: 3-6 years and 7-14 years. The 49-item questionnaire that was administered before and after general anesthesia comprised the Child Oral Health Quality of Life-components of the Parental-Caregivers Perception Questionnaire (P-CPQ), the Family Impact Scale (FIS) and two global questions concerning oral health and general well-being. The P-CPQ domains were Oral symptoms, Functional limitations, Emotional well-being and Social well-being. The FIS items assessed impact on family life. In both age groups, a significant decrease (p < 0.001) occurred in overall P-CPQ and the Oral symptoms, Functional limitations and Emotional limitations domains of the P-CPQ. Mean values for the Social well-being domain decreased significantly in the older (p < 0.05) but not the younger age group. Mean values for FIS decreased significantly in the younger (p < 0.001) and the older (p < 0.05) age groups. Dental treatment of severe caries or MIH, performed under general anesthesia, had an immediate effect on the oral health-related quality-of-life in the children in this study and a positive impact on the family situation.

Diplopia after inferior alveolar nerve block: case report and related physiology.

PubMed

You, Tae Min

2015-06-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.

Diplopia after inferior alveolar nerve block: case report and related physiology

PubMed Central

2015-01-01

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management. PMID:28879264

Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

PubMed Central

Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

2014-01-01

Introduction Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. Aim: To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. Methods A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. Results 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Conclusion Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population. PMID:25328594

Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia.

PubMed

Saraghi, Mana

2015-01-01

Intravenous fluids are administered in virtually every parenteral sedation and general anesthetic. The purpose of this article is to review the physiology of body-water distribution and fluid dynamics at the vascular endothelium, evaluation of fluid status, calculation of fluid requirements, and the clinical rationale for the use of various crystalloid and colloid solutions. In the setting of elective dental outpatient procedures with minor blood loss, isotonic balanced crystalloid solutions are the fluids of choice. Colloids, on the other hand, have no use in outpatient sedation or general anesthesia for dental or minor oral surgery procedures but may have several desirable properties in long and invasive maxillofacial surgical procedures where advanced hemodynamic monitoring may assess the adequacy of intravascular volume.

Specific conditions of distress in the dental situation.

PubMed

Hentschel, U; Allander, L; Winholt, A S

1977-01-01

The general feeling of distress in the dental situation has been studied in 60 female dental patients and correlated to the following variables: Experimentally evaluated sensitivity to pain, self-rating and the dentist's rating of sensitivity to pain, the pain-threshold value in the teeth, the need of local anesthesia, extraversion-introversion, neuroticism, and some percept-genetic psychological measures of adaptive behavior. The subjects have also answered a questionnaire for grading their distress in regard to different aspects of the treatment-situation, which were combined into eight groups using factor analysis and then correlated to the general distress. The variables having a significant relation to distress in the dental situation were: the dentist's rating of the patient's sensitivity, the need of anesthesia, four groups of treatment-components and two of the percept-genetic measures. There was also a certain relation to the pain threshold in the teeth.

Effect of Oral Midazolam Premedication on Children's Co-operation Before General Anesthesia in Pediatric Dentistry.

PubMed

Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

2014-09-01

Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events.

Taking the mystery out of endodontics, Part 6. Painless anesthesia for the "hot" tooth.

PubMed

Weathers, A

1999-12-01

Much of what we were taught in dental school is no longer valid. In this article, I've examined some of the myths surrounding what I have dubbed the "inferior" inferior alveolar nerve block. Using the X-tip anesthesia system, it is now possible to achieve total, instant and profound anesthesia of the "hot" tooth, without the problems formerly associated with intraosseous injections.

Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: a preliminary study.

PubMed

Beneito-Brotons, Rut; Peñarrocha-Oltra, David; Ata-Ali, Javier; Peñarrocha, María

2012-05-01

To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia--the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia--the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia.

An emphasis on the wide usage and important role of local anesthesia in dentistry: A strategic review.

PubMed

Singh, Preetinder

2012-03-01

Local anesthesia forms the major part of pain-control techniques in dentistry. The prevention and elimination of pain during dental treatment has benefited patients, their doctors and dental hygienists, enabling the dental profession to make tremendous therapeutic advances that would otherwise have been impossible. Introduced in the late 1940s, the amide local anesthetics represent the most used drugs in dentistry. Local anesthetics also represent the safest and most effective drugs in all of medicine for the prevention and management of pain. They are also accompanied by various adverse effects which should be well known and be able to be controlled by the clinician. The article reviews the types of agents used as local anesthetics and their effects on the human body.

42 CFR 485.639 - Condition of participation: Surgical services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... surgery or dental medicine; or (3) A doctor of podiatric medicine. (b) Anesthetic risk and evaluation. (1... the risk of anesthesia. (3) Before discharge from the CAH, each patient must be evaluated for proper anesthesia recovery by a qualified practitioner, as specified in paragraph (c) of this section. (c...

42 CFR 485.639 - Condition of participation: Surgical services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... surgery or dental medicine; or (3) A doctor of podiatric medicine. (b) Anesthetic risk and evaluation. (1... the risk of anesthesia. (3) Before discharge from the CAH, each patient must be evaluated for proper anesthesia recovery by a qualified practitioner, as specified in paragraph (c) of this section. (c...

42 CFR 485.639 - Condition of participation: Surgical services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... surgery or dental medicine; or (3) A doctor of podiatric medicine. (b) Anesthetic risk and evaluation. (1... the risk of anesthesia. (3) Before discharge from the CAH, each patient must be evaluated for proper anesthesia recovery by a qualified practitioner, as specified in paragraph (c) of this section. (c...

Different Aspects of General Anesthesia in Pediatric Dentistry: A Review.

PubMed

Ramazani, Nahid

2016-04-01

Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Besides criteria for case selection of dental GA, some degree of dental practitioner's judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

Pain and anxiety control: an online study guide.

PubMed

2008-05-01

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will cover pain theories and dentin hypersensitivity, referred pain, oral pain not of dental origin, barodontalgia, local anesthetics, long-acting local anesthetics, intrapulpal anesthesia, intraligamentary anesthesia, intraosseous anesthesia, inferior alveolar nerve block anesthesia, Gow-Gates anesthesia technique, Vazirani-Akinosi anesthesia technique, second-division block anesthesia technique, endodontic postoperative pain, effect of occlusal adjustment on endodontic pain, paresthesia associated with periradicular pathosis, analgesics, sedation, and endodontic flare-ups.

[Results of 30 children treated under dental general anesthesia in pediatric dentistry].

PubMed

Chen, Xu; Liu, Yao; Jin, Shi-fu; Zhang, Qian; Jin, Xuan-yu

2008-12-01

To determine the age and sex characteristics of the children and type of dental procedures performed under dental general anesthesia (DGA) and to assess the results after six months to one year's follow-up. A sample of 30 patients treated under dental general anesthesia (DGA) during 2006-2007 in the Department of Pediatric Dentistry of China Medical University was reviewed. All the teeth were treated one time. The dental procedures performed included caries restoration, indirect pulp capping, pulpotomy, root canal therapy (RCT) and dental extraction. Oral prophylaxis and topical fluoride applications were performed on all teeth. Pit and fissure sealing was performed on all healthy premolars and molars. SPSS10.0 software package was used for statistical analysis. Chi-square test was used to analyze the difference of the sex distribution in different age group and the difference of dental procedures performed between the primary teeth and the permanent teeth. The age of the patients ranged from 19 months to 14 years. The mental retardation patients accounted for 10% and mental healthy patients accounted for 90% of the sample studied. Males were more than females with the ratio about 2 to 1 in each age group. The dental procedures performed were caries restoration (18.67%), indirect pulp capping (23.26%), pulpotomy (0.77%), RCT (29.16%), dental extractions (2.05%) and fissure sealants (26.09%). The percentage of RCT was higher than that of caries restoration in the primary teeth, whereas the result was opposite as for the permanent teeth as indicated by Chi-square test (X(2)=11.630, P=0.001). New dental caries was not found except 2 patients who suffered from dysnoesia and were not cooperative to have regular examination. Fillings were lost in 3 cases, with 3 anterior teeth and 2 posterior teeth after RCT. All the children could cooperate except two mental retardation patients during the follow-up visit. Caries restoration and RCT are the most frequently performed procedures in pediatric patients using DGA. This indicates the need to design and implement integrate control and prevention programs for special pediatric patients. DGA is a safe and effective behavior management technique to treat uncooperative children.

Pediatric dental sedation: challenges and opportunities

PubMed Central

Nelson, Travis M; Xu, Zheng

2015-01-01

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques. PMID:26345425

Pediatric dental sedation: challenges and opportunities.

PubMed

Nelson, Travis M; Xu, Zheng

2015-01-01

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

Surgical Procedures in Predoctoral Periodontics Programs.

ERIC Educational Resources Information Center

Radentz, William H.; Caffesse, Raul G.

1991-01-01

A survey of 58 dental school periodontics departments revealed the frequency of predoctoral dental students performing surgery, the frequency of specific procedures, the degree of participation or performance of students, incidence of preclinical surgical laboratories in the curricula, and materials and anesthesia used. A wide range in…

Oral manifestations and dental management of a child with Zellweger syndrome.

PubMed

Lertsirivorakul, Jinda; Wongswadiwat, Malinee; Treesuwan, Panta

2014-01-01

Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media.

PubMed

Isong, Inyang A; Rao, Sowmya R; Holifield, Chloe; Iannuzzi, Dorothea; Hanson, Ellen; Ware, Janice; Nelson, Linda P

2014-03-01

Dental care is a significant unmet health care need for children with autism spectrum disorders (ASD). Many children with ASD do not receive dental care because of fear associated with dental procedures; oftentimes they require general anesthesia for regular dental procedures, placing them at risk of associated complications. Many children with ASD have a strong preference for visual stimuli, particularly electronic screen media. The use of visual teaching materials is a fundamental principle in designing educational programs for children with ASD. To determine if an innovative strategy using 2 types of electronic screen media was feasible and beneficial in reducing fear and uncooperative behaviors in children with ASD undergoing dental visits. We conducted a randomized controlled trial at Boston Children's Hospital dental clinic. Eighty (80) children aged 7 to 17 years with a known diagnosis of ASD and history of dental fear were enrolled in the study. Each child completed 2 preventive dental visits that were scheduled 6 months apart (visit 1 and visit 2). After visit 1, subjects were randomly assigned to 1 of 4 groups: (1) group A, control (usual care); (2) group B, treatment (video peer modeling that involved watching a DVD recording of a typically developing child undergoing a dental visit); (3) group C, treatment (video goggles that involved watching a favorite movie during the dental visit using sunglass-style video eyewear); and (4) group D, treatment (video peer modeling plus video goggles). Subjects who refused or were unable to wear the goggles watched the movie using a handheld portable DVD player. During both visits, the subject's level of anxiety and behavior were measured using the Venham Anxiety and Behavior Scales. Analyses of variance and Fisher's exact tests compared baseline characteristics across groups. Using intention to treat approach, repeated measures analyses were employed to test whether the outcomes differed significantly: (1) between visits 1 and 2 within each group and (2) between each intervention group and the control group over time (an interaction). Between visits 1 and 2, mean anxiety and behavior scores decreased significantly by 0.8 points (P = .03) for subjects within groups C and D. Significant changes were not observed within groups A and B. Mean anxiety and behavior scores did not differ significantly between groups over time, although group A versus C pairwise comparisons showed a trend toward significance (P = .06). These findings suggest that certain electronic screen media technologies may be useful tools for reducing fear and uncooperative behaviors among children with ASD undergoing dental visits. Further studies are needed to assess the efficacy of these strategies using larger sample sizes. Findings from future studies could be relevant for nondental providers who care for children with ASD in other medical settings.

[Intravenous Sedation and Repeated "the Same Day General Anesthesia" for a School-age Boy with Dandy-Walker Syndrome and Dentinogenesis].

PubMed

Hitosugi, Takashi; Tsukamoto, Masanori; Fujiwara, Shigeki; Yokoyama, Takeshi

2016-03-01

Dandy-Walker syndrome (DWS) is characterized by perfect or partial defect of the cerebellum vermis and cystic dilatation of the posterior fossa communicating with the fourth ventricle. Common clinical signs are mental retardation, cerebellar ataxia, and those of increased intracranial pressure (ICP). Associated congenital anomalies are craniofacial, cardiac, renal, and skeletal abnormalities. We experienced a case of intravenous sedation and six times of "the same day" general anesthesia for a school-aged boy (10-13 years old) with DWS and hypodentinogenesis. The patient underwent an examination and dental treatments. We had to pay attention to airway management tracheal tube selection and control of ICP. In addition, we should prevent tooth injuries through mishaps during tracheal intubations, since all-tooth-hypoplasia with fragile dental crowns was strongly suggested in this case. Detailed postoperative care is also required for general anesthesia afflicted with DWS.

Effect of a training model in local anesthesia teaching.

PubMed

Brand, Henk S; Baart, Jacques A; Maas, N Eline; Bachet, Irmke

2010-08-01

The aim of this study was to evaluate the preclinical use of a training model in local anesthesia teaching on the subsequent clinical administration of a local anesthetic. Sixty-five dental students gave their first injection to a fellow dental student: twenty-two students after previous experience on a training model and forty-three without this training. After the injection, the opinions of both the student who performed the injection and the recipient were explored by questionnaires. Use of a training model did not affect the self-reported opinion of the students who performed the injection. However, the recipients of the injection considered students who exercised on the training model significantly more confident and calm, and reported a near-significant decrease in level of pain during insertion of the needle and feeling of a tingling lip. These results suggest that use of preclinical training models in local anesthesia teaching may have beneficial effects.

Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic.

PubMed

Boynes, Sean G; Riley, Amah E; Milbee, Sarah; Bastin, Meghan R; Price, Maylyn E; Ladson, Andrea

2013-08-01

This study sought to identify and quantify complications with local anesthetic administration and reversal on consecutive patients seen for comprehensive dental care in a school-based, portable dental clinic, and includes data on the patients seen by the participating portable dental providers. In 923 dental visits where local anesthetic was administered, a standardized form was used to gain further information and identify any complications; this was accompanied by a questionnaire for the student's teacher, in order to quantify the student's distraction and disruption ratings following the dental visit. After statistical analysis of the 923 consecutive cases, the overall complication rate was 5.3%. All of the complications were considered to be mild or moderate, and there were no severe event reports. The complications encountered most frequently (n = 49) were associated with self-inflicted soft tissue injury. The results of this study indicate that comprehensive care with local anesthesia delivered by a school-based portable dental clinic has a low risk of complications. Whereas safe administration of dental care is achievable with or without phentolamine mesylate as a local anesthetic reversal agent, its use was determined to improve safety outcomes. Three factors appeared to directly increase the incidence of complications: the administration of an inferior alveolar nerve block, attention deficit disorder, and obesity. Teacher evaluations demonstrated that children receiving care by a portable dental team were able to reorient back to classwork and were not disruptive to classmates.

Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

PubMed Central

Ramazani, Nahid

2016-01-01

Context Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes. PMID:27307962

Modeling of recovery profiles in mentally disabled and intact patients after sevoflurane anesthesia; a pharmacodynamic analysis.

PubMed

Shin, Teo Jeon; Noh, Gyu-Jeong; Koo, Yong-Seo; Han, Dong Woo

2014-11-01

Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). End-tidal sevoflurane concentration associated with 50% probability of ROC (C₅₀) and γ value were lower in the mentally disabled patients (C₅₀=0.37 vol %, γ=16.5 in mentally intact patients, C₅₀=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C₅₀ for ROC and γ value to pharmacodynamic model. A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients.

Modeling of Recovery Profiles in Mentally Disabled and Intact Patients after Sevoflurane Anesthesia; A Pharmacodynamic Analysis

PubMed Central

Shin, Teo Jeon; Noh, Gyu-Jeong; Koo, Yong-Seo

2014-01-01

Purpose Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Materials and Methods Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). Results End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and γ value were lower in the mentally disabled patients (C50=0.37 vol %, γ=16.5 in mentally intact patients, C50=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and γ value to pharmacodynamic model. Conclusion A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients. PMID:25323901

Advances in local anesthesia in dentistry.

PubMed

Ogle, Orrett E; Mahjoubi, Ghazal

2011-07-01

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia. Copyright © 2011 Elsevier Inc. All rights reserved.

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note

PubMed Central

2017-01-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics. PMID:28879340

Application of augmented reality for inferior alveolar nerve block anesthesia: A technical note.

PubMed

Won, Yu-Jin; Kang, Sang-Hoon

2017-06-01

Efforts to apply augmented reality (AR) technology in the medical field include the introduction of AR techniques into dental practice. The present report introduces a simple method of applying AR during an inferior alveolar nerve block, a procedure commonly performed in dental clinics.

[Local anesthesia in dentistry. Additional techniques].

PubMed

Makkes, P C; Bouvy-Berends, E C; Rupreht, J

1996-05-01

Patients with insufficient coping abilities can yet be dentally treated by practising several additional techniques. Behaviour management should always be the starting point of all dental treatment strategies. In the end the administration of well selected drugs should lead, via anxiolysis, sedation or general anaesthesia, to a painfree and optimal treatable patient.

Cultivating a "chairside manner": dental hypnosis, patient management psychology, and the origins of behavioral dentistry in America, 1890-1910.

PubMed

Andrick, John M

2013-01-01

Discussions regarding the use of hypnotism in dentistry featured prominently in dental journals and society proceedings during the decades around the turn of the twentieth century. Many dentists used hypnotic suggestion either as the sole anesthetic for extractions or in conjunction with local and general anesthetics for excavation and cavity filling. With the heralding of humanitarian dentistry and improved local anesthesia around 1905, a number of dentists advocated using suggestion psychology to calm nervous patients and increase their comfort and satisfaction levels while undergoing dental procedures. The practice of hypnotic suggestion with local and general anesthesia in providing patients with increasingly painless procedures constituted the earliest variety of behavioral dentistry, a discipline not fully developed until the closing decades of the twentieth century. Hypnosis and suggestion became driving forces for psychological applications in the formative years of behavioral dentistry. © 2013 Wiley Periodicals, Inc.

Quality and accuracy of electronic pre-anesthesia evaluation forms.

PubMed

Almeshari, Meshari; Khalifa, Mohamed; El-Metwally, Ashraf; Househ, Mowafa; Alanazi, Abdullah

2018-07-01

Paper-based forms have been widely used to document patient health information for anesthesia; however, hospitals are now switching to electronic patient file documentation for anesthesia. The aim of this study is to compare the quality of paper-based and electronic pre-anesthesia assessment forms. The research conducted in this study was quasi-experimental using a pretest-posttest design without a control group. The study was conducted at King Abdulaziz Medical City, Riyadh (KAMC-RD) during November 2015. Paper-based forms were converted into electronic forms, and the paper-based pre-anesthesia forms were used during the first two weeks of the data collection period while electronic forms were completed in the last two weeks. The quality of each (electronic vs. paper) was evaluated with respect to missing items, errors, and unreadable items. The sample size included all 15 anesthetists working in the pre-anesthesia clinic at KAMC-RD. The anesthetists completed 25 pre-anesthesia forms daily during a five-day week schedule. A total of 500 patient forms were completed during the study (250 paper-based and 250 electronic forms). Anesthetists' satisfaction with the electronic pre-anesthesia form was also measured using a questionnaire. The electronic form shows significantly higher quality in all assessment categories (missing items, errors, and unreadable items; X² (2, N = 500) = 171.64, p < 0.001). The satisfaction survey found 81.65% of the anesthetists were satisfied with the electronic pre-anesthesia form for all questions. Our study demonstrates that the electronic pre-anesthesia form has better data quality, meets the expectations of anesthetists and aids to decrease missing key preoperative information. This type of approach is imperative for the safety of perioperative patients. Copyright © 2018. Published by Elsevier B.V.

Visualizing the Comorbidity Burden in Children with Autism Spectrum Disorder Receiving Dental Treatment Under General Anesthesia.

PubMed

Mathu-Muju, Kavita R; Li, Hsin-Fang; Nam, Lisa H; Bush, Heather M

2016-01-01

The purposes of this study were to: (1) describe the comorbidity burden in children with autism spectrum disorder (ASD) receiving dental treatment under general anesthesia (GA); and (2) characterize the complexity of these concurrent comorbidities. A retrospective chart review was completed of 303 children with ASD who received dental treatment under GA. All comorbidities, in addition to the primary diagnosis of ASD, were categorized using the International Classification of Diseases-10 codes. The interconnectedness of the comorbidities was graphically displayed using a network plot. Network indices (degree centrality, betweenness centrality, closeness centrality) were used to characterize the comorbidities that exhibited the highest connectedness to ASD. The network plot of medical diagnoses for children with ASD was highly complex, with multiple connected comorbidities. Developmental delay, speech delay, intellectual disability, and seizure disorders exhibited the highest connectedness to ASD. Children with autism spectrum disorder may have a significant comorbidity burden of closely related neurodevelopmental disorders. The medical history review should assess the severity of these concurrent disorders to evaluate a patient's potential ability to cooperate for dental treatment and to determine appropriate behavior guidance techniques to facilitate the delivery of dental care.

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics

PubMed Central

Syed, Faizaan; Uffman, Joshua C; Tumin, Dmitry; Flaitz, Catherine M; Tobias, Joseph D; Raman, Vidya T

2018-01-01

Purpose Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia). We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. Methods We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. Results Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7) or separately (n=27). No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: −58, +10 minutes; P=0.115) and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: −16, +48 minutes; P=0.307). The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394) did not differ between the groups. No postoperative complications were noted in either group. Conclusion These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or significant changes in postoperative outcomes. PMID:29628777

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics.

PubMed

Syed, Faizaan; Uffman, Joshua C; Tumin, Dmitry; Flaitz, Catherine M; Tobias, Joseph D; Raman, Vidya T

2018-01-01

Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia). We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7) or separately (n=27). No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: -58, +10 minutes; P =0.115) and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: -16, +48 minutes; P =0.307). The need for overnight stay (C: 4 of 7, S: 20 of 27; P =0.394) did not differ between the groups. No postoperative complications were noted in either group. These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or significant changes in postoperative outcomes.

An Evaluation of Permit L Local Anesthesia within Dental Hygiene Practice in Massachusetts.

PubMed

Soal, Katherine A; Boyd, Linda; Jenkins, Susan; November-Rider, Debra; Rothman, Andrew

2016-06-01

The purpose of this descriptive study was to assess data pertinent to the Permit L local anesthesia license among practicing dental hygienists in Massachusetts, providing an overview of characteristics, practice behaviors, barriers for obtaining the permit and self-perceived competency. A convenience sample of dental hygienists (n=6,167) identified through a publically available data base were invited to participate in a web-based survey. The survey consisted of demographic and Permit L specific questions. Items regarding opinions were rated using a 5-point Likert scale while frequencies and percentiles were used to evaluate demographics and practice-based information. Spearman's Rank correlation was performed to determine association between variables. A 10% (n=615) response rate was attained with (n=245) non-Permit L holders and (n=370) Permit L holders. Respondents reported significant differences in demographics and opinions between non-Permit L holders and Permit L holders (p<0.01) and between those certified through continuing education or curriculum based programs (p<0.01). Significant relationships were found in demographics (p<0.01) and practice (p<0.05) items in relation to the length of time the Permit L has been held. Themes from the data and comments indicate multiple factors influencing obtaining or not obtaining the Permit L. The results of this study provide an overview of Permit L local anesthesia administration that is generally comparable to previous studies and offers new insights into why some Massachusetts dental hygienists choose not to pursue certification. This study highlights the potential to increase the prevalence of the Permit L, address barriers to pursuing the Permit L, and further evaluate self-perceived barriers. Copyright © 2016 The American Dental Hygienists’ Association.

Descriptive study of perioperative analgesic medications associated with general anesthesia for dental rehabilitation of children.

PubMed

Carter, Laura; Wilson, Stephen; Tumer, Erwin G

2010-01-01

The purpose of this retrospective chart review was to document sedation and analgesic medications administered preoperotively, intraoperatively, and during postanesthesia care for children undergoing dental rehabilitation using general anesthesia (GA). Patient gender, age, procedure type performed, and ASA status were recorded from the medical charts of children undergoing GA for dental rehabilitation. The sedative and analgesic drugs administered pre-, intra-, and postoperatively were recorded. Statistical analysis included descriptive statistics and cross-tabulation. A sample of 115 patients with a mean age of 64 (+/-30) months was studied; 47% were females, and 71% were healthy. Over 80% of the patients were administered medications primarily during pre- and intraoperative phases, with fewer than 25% receiving medications postoperatively. Morphine and fentanyl were the most frequently administered agents intraoperatively. The procedure type, gender, and health status were not statistically associated with the number of agents administered. Younger patients, however, were statistically more likely to receive additional analgesic medications. Our study suggests that a minority of patients have postoperative discomfort in the postanesthesia care unit; mild to moderate analgesics were administered during intraoperative phases of dental rehabilitation.

A comparative evaluation of 4% articaine and 2% lidocaine in mandibular buccal infiltration anesthesia: A clinical study

PubMed Central

Maruthingal, Sunith; Mohan, Dennis; Maroli, Ramesh Kumar; Alahmari, Ali; Alqahtani, Ahmed; Alsadoon, Mohammed

2015-01-01

Background: To compare 4% articaine and 2% lidocaine local anesthetics in achieving pulpal anesthesia of the lower first permanent molar teeth objectively, and to assess and compare lip and lingual mucosa numbness subjectively. Materials and Methods: All subjects received 1.7 ml of any one anesthetic in the mucobuccal fold adjacent to mandibular first molar teeth; the same individuals received the second infiltration at least 1 week after the first. Later, comparisons for pulpal anesthesia, lip and lingual mucosa numbness between these two anesthetics solutions were made. Results: Articaine showed significant results with P = 0.006 in achieving pulpal anesthesia objectively, when compared with lidocaine. Articaine also showed very high significant results subjectively with P = 0.0006 in achieving lip numbness, when compared with lidocaine. But the results in achieving lingual mucosa numbness with articaine subjectively was not significant with P = 0.01, when compared with lidocaine. Conclusion: Endodontic and operative treatments are one of the most common oral non-surgical procedures done under local anesthesia. The diversity of anesthetic substances currently available on the market requires dental professionals to assess the drug both by its pharmacokinetic and also by its clinical characteristics during dental treatments. Our study used 4% articaine, which is available in the market, for comparison with 2% lidocaine. Further studies are required to use an equal concentration of solutions to achieve more accurate results. PMID:26759799

Special Care Dentistry in a Patient with Prader-Willi Syndrome through the Use of Atraumatic Restorative Treatment under General Anesthesia.

PubMed

Roman-Torres, Caio Vinícius Gonçalves; Kussaba, Sérgio Takashi; Bantim, Yasmin Comoti Vita; de Oliveira, Roberta de Barros Antunes Almeida

2017-01-01

Prader-Willi syndrome described in 1956 has a genetic origin, affecting both genders, varying in presence and intensity from individual to individual. A precocious diagnosis, before the manifestation of symptoms, has brought some improvement in the quality of life of the carriers in the last years. The objective of this case report was to describe the treatment realized in a 3-year-old boy who presented grade II obesity, difficulty of locomotion, hypotonia, and history of cardiopathy. A dental treatment under general anesthesia was defined, allowing an oral adequation in a single section, in which it was planned the extraction of the element 74 and atraumatic restorative treatment (ART) technique in the other teeth. The precocious intervention in this 3-year-old patient by the therapy realized with ART under general anesthesia was done with success, avoiding unnecessary extractions, preserving dental elements, and maintaining the oral cavity in adequate function.

[Practical advices in choosing local anesthesia tools in dentistry. Management of carpule's quality in local anesthesia in dentistry].

PubMed

Kuzin, A V

2014-01-01

The equipment for local anesthesia is described in this article. Practical recommendations for the selection of the injection needle length, size, bevel type is given. Using dental needle for local anesthesia should be guided by the "one injection - one needle" rule, as a needle tends to deform by even the slightest contact with jawbone. Some of the shortcomings of carpule quality may be detected before use: signs of cup corrosion, the presence of sediment, air bubbles, rubber plunger disposition. In the case of such defects being identified all the package should not be used. The use of such carpule in clinical practice is unsafe.

REMIFENTANIL VS FENTANYL DURING DAY CASE DENTAL SURGERY IN PEOPLE WITH SPECIAL NEEDS: A COMPARATIVE, PILOT STUDY OF THEIR EFFECT ON STRESS RESPONSE AND POSTOPERATIVE PAIN.

PubMed

Sklika, Eirini; Kalimeris, Konstantinos; Perrea, Despina; Stavropoulos, Nikolaos; Kostopanagiotou, Georgia; Matsota, Paraskevi

2016-06-01

People with special needs undergoing dental surgery frequently require general anesthesia. We investigated the effect of remifentanil vs fentanyl on stress response and postoperative pain in people with special needs undergoing day-case dental surgery. Forty-six adult patients with cognitive impairment undergoing day-case dental surgery under general anesthesia were allocated to receive intraoperatively either fentanyl 50 μg iv bolus (group F, n = 23) or continuous infusion of remifentanil 0.5-1 μg/kg/min (group R, n = 23). Iintraoperative hemodynamic parameters were recorded and serum inflammatory mediators [tumor necrosis factor-α, substance-P], stress hormons (melatonin, cortisol) and β-endorphin were measured. Postoperative pain was assessed during the first postoperative 12 hours with the Wong-Baker faces pain-rating scale. Demographics were similar in two groups. The two groups did not differ regarding their effects on inflammatory mediators, stress hormons and postoperative pain scores. However, the use of remifentanil prevented intraoperative increases of arterial blood pressure and heart rate. Remifentanil and fentanyl did not affect differently stress and inflammatory hormones during day-case dental surgery, although remifentanil may render intraoperative management of hemodynamic responses easier. Both opioids are equally efficient for postoperative pain management following dental surgery in people with special needs.

Success rates of the first inferior alveolar nerve block administered by dental practitioners.

PubMed

Kriangcherdsak, Yutthasak; Raucharernporn, Somchart; Chaiyasamut, Teeranut; Wongsirichat, Natthamet

2016-06-01

Inferior alveolar nerve block (IANB) of the mandible is commonly used in the oral cavity as an anesthetic technique for dental procedures. This study evaluated the success rate of the first IANB administered by dental practitioners. Volunteer dental practitioners at Mahidol University who had never performed an INAB carried out 106 INAB procedures. The practitioners were divided into 12 groups with their advisors by randomized control trials. We recorded the success rate via pain visual analog scale (VAS) scores. A large percentage of the dental practitioners (85.26%) used the standard method to locate the anatomical landmarks, injecting the local anesthetic at the correct position, with the barrel of the syringe parallel to the occlusal plane of the mandibular teeth. Further, 68.42% of the dental practitioners injected the local anesthetic on the right side by using the left index finger for retraction. The onset time was approximately 0-5 mins for nearly half of the dental practitioners (47.37% for subjective onset and 43.16% for objective onset), while the duration of the IANB was approximately 240-300 minutes (36.84%) after the initiation of numbness. Moreover, the VAS pain scores were 2.5 ± 1.85 and 2.1 ± 1.8 while injecting and delivering local anesthesia, respectively. The only recorded factor that affected the success of the local anesthetic was the administering practitioner. This reinforces the notion that local anesthesia administration is a technique-sensitive procedure.

Intraligamentary--intraosseous anesthesia. A radiographic demonstration.

PubMed

Garfunkel, A A; Kaufman, E; Marmary, Y; Galili, D

1983-10-01

Intraligamentary dental anesthesia has become a widely accepted technique. The periodontal ligament seems to provide easy access to the tooth apex. In the present study, radiopaque material was injected into baboon monkeys. Serial radiographs during incremental injections showed clouding of the crestal bone. The material was seen gradually advancing through the alveolar bone crest, apically. The spread was noticed through the marrow spaces, unexpectedly avoiding the PDL route.

Analysis of physiological responses associated with emotional changes induced by viewing video images of dental treatments.

PubMed

Sekiya, Taki; Miwa, Zenzo; Tsuchihashi, Natsumi; Uehara, Naoko; Sugimoto, Kumiko

2015-03-30

Since the understanding of emotional changes induced by dental treatments is important for dentists to provide a safe and comfortable dental treatment, we analyzed physiological responses during watching video images of dental treatments to search for the appropriate objective indices reflecting emotional changes. Fifteen healthy young adult subjects voluntarily participated in the present study. Electrocardiogram (ECG), electroencephalogram (EEG) and corrugator muscle electromyogram (EMG) were recorded and changes of them by viewing videos of dental treatments were analyzed. The subjective discomfort level was acquired by Visual Analog Scale method. Analyses of autonomic nervous activities from ECG and four emotional factors (anger/stress, joy/satisfaction, sadness/depression and relaxation) from EEG demonstrated that increases in sympathetic nervous activity reflecting stress increase and decreases in relaxation level were induced by the videos of infiltration anesthesia and cavity excavation, but not intraoral examination. The corrugator muscle activity was increased by all three images regardless of video contents. The subjective discomfort during watching infiltration anesthesia and cavity excavation was higher than intraoral examination, showing that sympathetic activities and relaxation factor of emotion changed in a manner consistent with subjective emotional changes. These results suggest that measurement of autonomic nervous activities estimated from ECG and emotional factors analyzed from EEG is useful for objective evaluation of subjective emotion.

Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions.

PubMed

Galeotti, Angela; Garret Bernardin, Annelyse; D'Antò, Vincenzo; Ferrazzano, Gianmaria Fabrizio; Gentile, Tina; Viarani, Valeria; Cassabgi, Giorgio; Cantile, Tiziana

2016-01-01

Aim . To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods . 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score. Results . 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment. Conclusions . Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions

PubMed Central

Galeotti, Angela; Garret Bernardin, Annelyse; D'Antò, Vincenzo; Viarani, Valeria; Cassabgi, Giorgio

2016-01-01

Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score. Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment. Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia. PMID:27747238

Reaction of 5 and 6 year olds to dental injection after viewing the needle: pilot study.

PubMed

Maragakis, G M; Musselman, R J; Ho, C C

2006-01-01

The aim was to evaluate the practice of hiding the needle prior to dental anesthesia administration to children. Fourteen 5 and 6 year olds received dental treatment in two sessions. The needle was shown in one session and hidden in the other. Eleven children were cooperative and 3 uncooperative irrespective of approach. The children's behavior correlated with fears expressed by the mothers. Our initial fndintgs do not support the practice of hiding the needle.

A new hypothesis of cause of syncope: trigeminocardiac reflex during extraction of teeth.

PubMed

Arakeri, Gururaj; Arali, Veena

2010-02-01

Transient Loss Of Consciousness (TLOC) or vasovagal syncope is well known phenomenon in dental/maxillofacial surgery. Despite considerable study of vasovagal syncope, its pathophysiology remains to be fully elucidated. After having encountered a case of trigeminocardiac reflex after extraction of maxillary first molar we observed and studied 400 extractions under local anesthesia to know the relation between trigeminocardiac reflex and syncope. We make hypothesis that trigeminocardiac reflex which is usually seen under general anesthesia when all sympathetic reflexes are blunted can also occur under local anesthesia during extractions of maxillary molars (dento-cardiac reflex) and mediate syncope.

Ophthalmologic complications after intraoral local anesthesia.

PubMed

von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

2014-01-01

The first ophthalmologic complication in conjunction with a dental anesthesia was reported in 1936. The objective of the present study was a detailed analysis of case reports about that topic. After conducting a literature search in PubMed this study analyzed 108 ophthalmologic complications following intraoral local anesthesia in 65 case reports with respect to patient-, anesthesia-, and complication- related factors. The mean age of the patients was 33.8 years and females predominated (72.3%). The most commonly reported complication was diplopia (39.8%), mostly resulting from paralysis of the lateral rectus muscle. Other relatively frequent complications included ptosis (16.7%), mydriasis (14.8%) and amaurosis (13%). Ophthalmologic complications were mainly associated with block anesthesia of the inferior alveolar nerve (45.8%) or the posterior superior alveolar nerve (40.3%). Typically, the ophthalmologic complications in conjunction with intraoral local anesthesia had an immediate to short onset, and disappeared as the anesthesia subsided. The increased number of ophthalmologic complications after intraoral local anesthesia in females may suggest a gender effect. Double vision (diplopia) is the most frequently described complication, which is usually completely reversible like the other reported ophthalmologic complications.

Local anesthesia selection algorithm in patients with concomitant somatic diseases.

PubMed

Anisimova, E N; Sokhov, S T; Letunova, N Y; Orekhova, I V; Gromovik, M V; Erilin, E A; Ryazantsev, N A

2016-01-01

The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

The Local Pharmacokinetics of 3H-Ropivacaine and 14C-Lidocaine After Maxillary Infiltration Anesthesia in Rats

PubMed Central

Kimi, Hiromi; Yamashiro, Mikiko; Hashimoto, Shuichi

2012-01-01

The effects of infiltration anesthesia with ropivacaine on the dental pulp are considered to be weak. This may be partly associated with its permeation into the oral tissue. With the objective of investigating the local pharmacokinetics of ropivacaine and lidocaine following infiltration anesthesia, we injected 3H-ropivacaine or 14C-lidocaine to the palatal mucosa in rats, measured distributions of radioactivity in the maxilla, and compared the local pharmacokinetics of these agents. The animals were sacrificed at various times and the maxillas were removed. The palatal mucosa and maxillary nerve were resected, and the bone was divided into 6 portions. We measured radioactivity in each tissue and calculated the level of each local anesthetic (n  =  8). Lidocaine diffused to the surrounding tissue immediately after the injection, whereas ropivacaine tended to remain in the palatal mucosa for a longer period. Lidocaine showed a higher affinity for the maxillary bone than ropivacaine. There was a correlation between the distribution level of local anesthetics in the maxillary bone and that in the maxillary nerve. The lower-level effects of infiltration anesthesia with ropivacaine on the dental pulp may be because ropivacaine has a high affinity for soft tissue, and its transfer to bone is slight. PMID:22822994

[Considerations on local-regional anesthesia for ambulatory tooth extractions in patients with heart disease].

PubMed

Debernardi, G; Borgogna, E

1975-01-01

Ambulatory dental extraction was performed on 150 patients with various forms of heart disease. No serious complications were noted with an anaesthetic without vasoconstriction (plain 3% carbocaine). The prior history was carefully studied and pressure values were determined. It is felt that heart disease does not form an absolute contraindication to ambulatory dental extraction.

The Effect of Heart Disease on Anesthetic Complications During Routine Dental Procedures in Dogs.

PubMed

Carter, Jennifer E; Motsinger-Reif, Alison A; Krug, William V; Keene, Bruce W

Dental procedures are a common reason for general anesthesia, and there is widespread concern among veterinarians that heart disease increases the occurrence of anesthetic complications. Anxiety about anesthetizing dogs with heart disease is a common cause of referral to specialty centers. To begin to address the potential effect of heart disease on anesthetic complications in dogs undergoing anesthesia for routine dental procedures, we compared anesthetic complications in 100 dogs with heart disease severe enough to trigger referral to a specialty center (cases) to those found in 100 dogs without cardiac disease (controls) that underwent similar procedures at the same teaching hospital. Medical records were reviewed to evaluate the occurrence of anesthetic complications. No dogs died in either group, and no significant differences were found between the groups in any of the anesthetic complications evaluated, although dogs in the heart disease group were significantly older with higher American Society of Anesthesiologists scores. Midazolam and etomidate were used more frequently, and alpha-2 agonists used less frequently, in the heart disease group compared to controls. This study suggests dogs with heart disease, when anesthetized by trained personnel and carefully monitored during routine dental procedures, are not at significantly increased risk for anesthetic complications.

Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?

PubMed

Silay, E; Candirli, C; Taskesen, F; Coskuner, I; Ceyhanli, K T; Yildiz, H

2013-01-01

The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures. In our study, 58 and 47 American Society of Anesthesiologists (ASA)-1 pediatric patients, aged 2-12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians. The oxygen saturation level was significantly lower (GA: 99.0 ± 0.30, CS: 98.4 ± 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases where they used CS. Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, could be performed successfully under CS. In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.

Relief of Injection Pain During Delivery of Local Anesthesia by Computer-Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial.

PubMed

Chang, Hyeyoon; Noh, Jiyoung; Lee, Jungwon; Kim, Sungtae; Koo, Ki-Tae; Kim, Tae-Il; Seol, Yang-Jo; Lee, Yong-Moo; Ku, Young; Rhyu, In-Chul

2016-07-01

Pain from local anesthetic injection makes patients anxious when visiting a dental clinic. This study aims to determine differences in pain according to types of local anesthetizing methods and to identify the possible contributing factors (e.g., dental anxiety, stress, and sex). Thirty-one patients who underwent open-flap debridement in maxillary premolar and molar areas during treatment for chronic periodontitis were evaluated for this study. A randomized, split-mouth, single-masked clinical trial was implemented. The dental anxiety scale (DAS) and perceived stress scale (PSS) were administered before surgery. Two lidocaine ampules for each patient were used for local infiltration anesthesia (supraperiosteal injection). Injection pain was measured immediately after local infiltration anesthesia using the visual analog pain scale (VAS) questionnaire. Results from the questionnaire were used to assess degree of pain patients feel when a conventional local anesthetic technique (CNV) is used compared with a computer-controlled anesthetic delivery system (CNR). DAS and PSS did not correlate to injection pain. VAS scores were lower for CNR than for CNV regardless of the order in which anesthetic procedures were applied. VAS score did not differ significantly with sex. Pearson coefficient for correlation between VAS scores for the two procedures was 0.80, also indicating a strong correlation. Within the limitations of the present study, relief from injection pain is observed using CNR.

Inferior alveolar nerve block: Alternative technique

PubMed Central

Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

2012-01-01

Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

Inferior alveolar nerve block: Alternative technique.

PubMed

Thangavelu, K; Kannan, R; Kumar, N Senthil

2012-01-01

Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages.

Integration of the enterprise electronic health record and anesthesia information management systems.

PubMed

Springman, Scott R

2011-09-01

Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system-wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS. Copyright © 2011 Elsevier Inc. All rights reserved.

The use of intraosseous anesthesia among endodontists: results of a questionnaire.

PubMed

Bangerter, Chad; Mines, Pete; Sweet, Mark

2009-01-01

The purpose of this study was to investigate the use of supplemental intraosseous (IO) anesthesia among endodontists in the United States. The study also looked at the types of anesthetic solutions commonly used for IO anesthesia and in which diagnostic conditions IO anesthesia is used. A Web-based survey of 2,528 active members of the American Association of Endodontists was sent out by e-mail. Data from 833 respondents were collected with a response rate of 33%. It was discovered that 94.77% of the respondents used some form of IO anesthesia, with the periodontal ligament injection (PDL) being the most commonly administered (49.78%). Symptomatic irreversible pulpitis is the pulpal diagnosis for which respondents most often use some form of IO anesthesia (61.99%), and 2% lidocaine with epinephrine 1:100,000 is the most common anesthetic solution used in IO anesthesia (37.62%). Although more than half of the respondents use some form of IO anesthesia more than twice a week, newer IO anesthesia delivery systems such as Stabident (Fairfax Dental, San Francisco, CA) and X-Tip (Dentsply International, Johnson City, TN) are used less often than the PDL injection.

Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children.

PubMed

Shilpapriya, Mangalampally; Jayanthi, Mungara; Reddy, Venumbaka Nilaya; Sakthivel, Rajendran; Selvaraju, Girija; Vijayakumar, Poornima

2015-01-01

Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "gate control" theory of Melzack and Wall. The present study was carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Thirty patients aged 6-12 years old of both the genders with Frankel's behavior rating scale as positive and definitely positive requiring bilateral local anesthesia injections for dental treatment were included in the split-mouth cross over design. Universal pain assessment tool was used to assess the pain with and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001) compared to the injections without the use of vibe. The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.

Anesthetic management of comprehensive dental restoration in a child with glutaric aciduria type 1 using volatile sevoflurane.

PubMed

Teng, Wei-Nung; Lin, Su-Man; Niu, Dau-Ming; Kuo, Yi-Min; Chan, Kwok-Hon; Sung, Chun-Sung

2014-10-01

Glutaric aciduria type 1 (GA1) is a rare, inherited mitochondrial disorder that results from deficiency of mitochondrial glutaryl-CoA dehydrogenase. Most patients develop neurological dysfunction early in life, which leads to severe disabilities. We present a 37-month-old girl with GA1 manifested as macrocephaly and hypotonia who received comprehensive dental restoration surgery under general anesthesia with sevoflurane. She was placed on specialized fluid management during a preoperative fasting period and anesthesia was administered without complications. All the physiological parameters, including glucose and lactate blood levels and arterial blood gas were carefully monitored and maintained within normal range perioperatively. Strategies for anesthetic management should include prevention of pulmonary aspiration, dehydration, hyperthermia and catabolic state, adequate analgesia to minimize surgical stress, and avoidance of prolonged neuromuscular blockade. We administered general anesthesia with sevoflurane uneventfully, which was well tolerated by our patient with GA1. Additionally, communication with a pediatric geneticist and surgeons should be undertaken to formulate a comprehensive anesthetic strategy in these patients. Copyright © 2014. Published by Elsevier B.V.

Internet resources for dental anesthesia.

PubMed Central

Rosenberg, M.; Reed, K. L.

1999-01-01

The extraordinary growth of the Internet has created a revolutionary leap in the ability of health professionals to easily communicate and access information. These resources are readily available to the public as well, and an understanding of these sources is important in determining the validity of the content. A few Internet sites of interest to dentists interested in anesthesia and pain control are presented to demonstrate the depth and breadth of these resources via the Internet. PMID:10551057

Effect of hydralazine on duration of soft tissue local anesthesia following dental treatment: a randomized clinical trial.

PubMed

Fakheran Esfahani, Omid; Pouraboutaleb, Mohammad Fazel; Khorami, Behnam

2015-01-01

Prolonged numbness following routine dental treatments can cause difficulties in speaking and swallowing and may result in inadvertent biting of soft tissues. Local injection of vasodilator agents may represent a solution to this problem. The aim of this study was to evaluate the effect of submucosal injection of hydralazine hydrochloride (HCl) on the duration of oral soft tissue anesthesia after routine dental treatment. This randomized, single-blinded, controlled clinical trial included 50 patients who received inferior alveolar nerve block (2% lidocaine with 1:100,000 epinephrine) for simple restorative treatment. Upon completion of the dental treatment, patients randomly received a hydralazine HCl or sham injection in the same site as the local anesthetic injection. The reversal time to normal sensation of soft tissues (lips, tongue, and perioral skin) was evaluated and reported every 5 minutes by the patients, who followed an assessment protocol that they were taught in advance of treatment. Median recovery times in the hydralazine group and the sham group were 81.4 (SD, 3.6) and 221.8 (SD, 6.3) minutes, respectively. Based on Kaplan-Meier survival analysis, the duration of soft tissue anesthesia in the 2 groups was significantly different (P < 0.0001). By 1 hour after the reversal injection, 76% of subjects receiving hydralazine HCl had returned to normal intraoral and perioral sensation, but none of the subjects in the sham group reported normal sensation. Based on these results, submucosal injection of hydralazine HCl can be considered a safe and effective method to reduce the duration of local anesthetic-induced soft tissue numbness and the related functional problems.

The effect of general anesthesia for ambulatory dental treatment on children in Chongqing, Southwest China.

PubMed

Chao, Zhang; Gui Jin, Huang; Cong, Yu

2017-01-01

The incidence of early childhood caries shows a significant increasing trend. Often, children younger than 6 years need additional help to finish the dental treatment. Therefore, general anesthesia (GA) could help to provide a successful environment for pediatric dental treatment. The aim of this study was to assess the effect of dental treatment under general anesthesia (DGA) on the patients' oral health in Chongqing, Southwest China using the P-CPQ and the FIS questionnaires. We collected the hospital's records of the children who received DGA from 2013 to 2014 and the questionnaires answered by their parents or caregivers before and after the treatment. Then the data were integrated and analyzed to assess the effect of DGA on the children and their family, the incidence of the complications during or after DGA, and the satisfaction of their parents. We collected 659 patients' records including 55.4% boys and 44.6% girls. There were 443 children younger than 4 years, and 216 children older than 4 years. The main reason why they chose DGA was the patients' fear for the treatment (95.1%). The mean cost of DGA almost reached a half (61.5%) or a third (15.3%) of the family's monthly earning. The mean P-CPQ score and FIS score significantly decreased after DGA. The highest incidence of complications was emergence agitation, headache, and nausea/vomiting. The incidence of emergence agitation and headache was related to the operation time. The majority of families reported a high degree of satisfaction. Children's oral health-related quality of life after DGA improved significantly. Meanwhile DGA showed a positive effect on the whole family and majority of families reported a high degree of satisfaction to it. © 2016 John Wiley & Sons Ltd.

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

PubMed

Antunes, Denise Espíndola; Viana, Karolline Alves; Costa, Paulo Sucasas; Costa, Luciane Rezende

2016-10-24

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.

Impact of dental treatment under general anesthesia on the oral health-related quality of life of adolescents and adults with special needs.

PubMed

Chang, Juhea; Patton, Lauren L; Kim, Hae-Young

2014-12-01

This study aimed to assess the perception of the family's primary caregiver on the oral health-related quality of life (OHRQoL), and the impact on family dynamics, of dental treatment under general anesthesia (GA) in adolescent and adult patients with intellectual and developmental disabilities (IDD) and neurocognitive disorders. Self-administered questionnaires were completed, before dental treatment, by 116 primary family caregivers of patients who received dental treatment under GA, and 102 (88%) of these caregivers completed the same questionnaires within 4 wk after treatment. The Child Oral Health Impact Profile (COHIP) and the Family Impact Scale (FIS) were shortened to a 14-item COHIP (COHIP-14) and a 12-item FIS (FIS-12) based on the limitations of patients' communication. The COHIP-14 and FIS-12 scores and each subscale improved after treatment. The baseline scores varied based on certain characteristics of the patients, such as age, disabilities, medications, caregivers, meal types, cooperation levels, and treatment needs. The postoperative improvement in OHRQoL was significant in the patients who were older than 30 yr of age, originally eating soft meals, displaying no or very low levels of cooperation, or receiving endodontic treatment. Based on the primary caregiver perceptions, the OHRQoL of adolescents and adults with IDD and neurocognitive disorders was improved by dental treatment under GA. © 2014 Eur J Oral Sci.

Training Adults and Children with an Autism Spectrum Disorder to Be Compliant with a Clinical Dental Assessment Using a TEACCH-Based Approach

ERIC Educational Resources Information Center

Orellana, Lorena M.; Martínez-Sanchis, Sonia; Silvestre, Francisco J.

2014-01-01

The specific neuropsychological and sensory profile found in persons with autism spectrum disorders complicate dental procedures and as a result of this, most are treated under general anesthesia or unnecessary sedation. The main goal of the present study was to evaluate the effectiveness of a short treatment and education of autistic and related…

Practice Patterns of Dentist Anesthesiologists in North America.

PubMed

Young, Andrew S; Fischer, Michael W; Lang, Nicholas S; Cooke, Matthew R

2018-01-01

This study provides trends in the discipline of dental anesthesiology. A questionnaire-based survey was sent to 338 members of the American Society of Dentist Anesthesiologists to evaluate practice patterns. One focus of the study was modality of sedation/anesthesia used for dentistry in North America. Age, gender, years in practice, and geographic region of practice were also obtained. Data gathered from the returned questionnaires were entered into an Excel spreadsheet and then imported into JMP Statistical Discovery Software (v12.2 Pro) for descriptive analysis. A total of 112 surveys were completed electronically and 102 surveys were returned via post, for a total response rate of 63.3% ( N = 214). Data from this survey suggested a wide variation of therapeutic practices among dentist anesthesiologists in North America. Of the surveyed dentist anesthesiologists, 58.7% (SE = 4.2%) practice as mobile providers, 32.2% (SE = 3.1%) provide care in an academic environment, and 27.7% (SE = 2.8%) function as operator/anesthetists. The majority of anesthesia is provided for pediatric dentistry (47.0%, SE = 4.2%), oral and maxillofacial surgery (18.5%, SE = 3.9%), and special needs (16.7%, SE = 3.6%). Open-airway (58.7%, SE = 5.5%) sedation/anesthesia was the preferred modality of delivery, compared with the use of advanced airway (41.3%, SE = 4.6%). The demographics show diverse practice patterns of dentist anesthesiologists in multiple regions of the continent. Despite concerns regarding specialty recognition, reimbursement difficulties, and competition from alternative anesthesia providers, the overall perceptions of dentist anesthesiologists and the future of the field seem largely favorable.

Articaine: a review of its use for local and regional anesthesia

PubMed Central

Snoeck, Marc

2012-01-01

Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations. PMID:22915899

Access to dental care-parents' and caregivers' views on dental treatment services for people with disabilities.

PubMed

Prabhu, Neeta T; Nunn, June H; Evans, D J; Girdler, N M

2010-01-01

The goal of this study was to elicit the views of patients or parents/caregivers of patients with disabilities regarding access to dental care. A questionnaire was generated both from interviews with patients/parents/caregivers already treated under sedation or general anesthesia as well as by use of the Delphi technique with other stakeholders. One hundred thirteen patients from across six community dental clinics and one dental hospital were included. Approximately, 38% of the subjects used a general dental practitioner and 35% used the community dental service for their dental care, with only 27% using the hospital dental services. Overall waiting time for an appointment at the secondary care setting was longer than for the primary care clinics. There was a high rate of parent/caregiver satisfaction with dental services and only five patients reported any difficulty with travel and access to clinics. This study highlights the need for a greater investment in education and training to improve skills in the primary dental care sector.

Surgery Considerations for Adults and Children

MedlinePlus

... may be posed by complicating factors such as dental problems (skeletal fragility makes dentitia prone to fracture), cleft palate, joint stiffness or heart valve disease. Anesthesia personnel also need to be aware of ...

A Vibration Device to Control Injection Discomfort.

PubMed

Shaefer, Jeffry R; Lee, Stephanie J; Anderson, Nina K

2017-06-01

Pain from local anesthesia injections can be reduced by distraction and counter-stimulation techniques. This study investigated the DentalVibe® Injection Comfort System (third-generation, DV3), developed to lessen anesthesia pain through pulsed vibration, a form of counter-stimulation. The aim of the study was to evaluate both the efficacy of DV3 in reducing pain and discomfort from intraoral long buccal (LB) and inferior alveolar nerve (IAN) injections and the time needed to achieve complete anesthesia during an IAN block. The study enrolled 60 subjects, 30 men and 30 women, aged 21 to 32 years, who rated both injection pain on a visual analog scale and discomfort, unpleasantness, and difficulty in enduring the injection on a modified symptom severity index. Each subject received bilateral LB injections and an IAN block. Using block design, the third-generation DV (DV3) was randomly assigned to either the first or second LB injection and to 30 subjects on their third injection, the IAN block. No topical anesthesia was applied. Subjects receiving DV3 reported significantly less pain, discomfort, unpleasantness, and difficulty in enduring LB and IAN injections (P < .05), regardless of whether DV3 was used on the first or second LB injection. Time to complete anesthesia was not significantly different (P > .05) when DV3 was used on IAN block injections. The DV3 significantly (P < .02) reduced pain/discomfort from anesthetic injections in this pilot study, in which many subjects were either dental or medical students familiar with performing and enduring injections. More studies are warranted on layperson populations.

Characteristics and dental experiences of autistic children in Saudi Arabia: cross-sectional study.

PubMed

Murshid, Ebtissam Z

2011-12-01

The purpose of this study is to report base line information about characteristics, and dental experiences of a group of autistic children in three major cities of Saudi Arabia. Most of the children (76.2%) included in the study were diagnosed with autism before the age of 5 years. More than half of the children (53.7%) had no previous dental experience while 33% were treated under general anesthesia. The American Academy of Pediatrics' recommendations should be applied in Saudi Arabia to help improve the average age of diagnosis and make a positive effect on children with autism and their families. Regular visits to dental clinics should be recommended to all families with autistic children to reduce dental disease.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brodsky, J.B.; Cohen, E.N.; Brown, B.W.

Information was sought on wives of dentists or female dental assistants who underwent surgery during their pregnancies to determine the effects of anesthesia and surgery on fetal outcome. Occupational exposure to inhalation anesthetics either directly (dental assistants) or indirectly (wives of exposed male dentists) was associated with a significant increase in spontaneous abortion rate over a comparison group during both trimesters. Anesthesia for surgery was also associated with increased fetal loss when administered during the first or second trimesters. The number of congenital abormalities in children born to women who had surgery during pregnancy was not increased. For women surgicallymore » exposed to anesthetics and occupationally exposed as well, either directly or indirectly, the risk of spontaneous abortion increased almost threefold above control lvels. The authors conclude that elective surgery should be deferred during early pregnanacy to minimize potential fetal loss.« less

Association Between Severe Dental Caries and Child Abuse and Neglect.

PubMed

Sillevis Smitt, Henk; de Leeuw, Jenny; de Vries, Tjalling

2017-11-01

In their maxillofacial practice, the authors have encountered some children with severe dental caries whose teeth had to be removed; many later appeared to be abused children. The authors hypothesized that in the group of children who underwent multiple tooth extractions for caries under general anesthesia, a larger percentage would be found to be abused compared with the normal population. The authors identified children who underwent multiple tooth extractions under general anesthesia in a well-defined region in the Netherlands in 2005 and 2006. Subsequently, they sought these children in the database of the Dutch national organization against domestic violence and child abuse (Veilig Thuis) in 2015. Of the total group of 376 children, 205 (55%) underwent the procedure because of caries during this period. Child abuse and neglect was established by Veilig Thuis in 47 of these children (23%; 95% confidence interval, 20-26), whereas the procedure occurred before the child abuse was established in 27. There appears to be a strong association between severe dental caries and child abuse and neglect. Hence, severe dental caries could be regarded as an early symptom of child abuse and neglect. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil.

PubMed

Santos, Jacqueline Silva; Valle, Déborah Andrade; Palmier, Andréa Clemente; do Amaral, João Henrique Lara; de Abreu, Mauro Henrique Nogueira Guimarães

2015-02-01

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia.

PubMed

Blumer, Sigalit; Costa, Liora; Peretz, Benjamin

To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N 2 O-O 2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N 2 O-O 2 alone had a 6.1-fold greater risk of failure compared to N 2 O-O 2 +midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). The GA mode yielded significantly greater success than the N 2 O-O 2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N 2 O-O 2 . When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

Differences in pediatric dental services under general anesthesia for Medicaid and military dependent children.

PubMed

Johnson, M B; Cappelli, D P; Bradshaw, B S; Mabry, J C

2010-01-01

This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method. Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests. The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02). This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.

Strategies to manage patients with dental anxiety and dental phobia: literature review

PubMed Central

Appukuttan, Deva Priya

2016-01-01

Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought. PMID:27022303

Dental disorders in brown howler monkeys (Alouatta guariba clamitans) maintained in captivity.

PubMed

Dias Neto, Ramiro das Neves; Fecchio, Roberto Silva; Rahal, Sheila Canevese; Teixeira, Carlos Roberto; Gioso, Marco Antônio; Pereira, Camila Trevisan; Santos, Maria Augusta Adami Pereira Dos; Milanelo, Liliane

2016-04-01

The aim of this study was to investigate dental disorders of brown howler monkeys maintained in captivity. The hypothesis is that the identification and diagnosis of the lesions may contribute to control and prevention. Sixteen intact brown howler monkeys (Alouatta guariba clamitans), eight females and eight males, weighing from 3.9 to 6.8 kg, were studied. Under general anesthesia, the teeth were evaluated by visual inspection, probing, palpation, and intra-oral radiographic exam. The findings were registered on a dental chart specific for primates. Of the 16 monkeys evaluated in the present study, 94% (n = 15) had some type of dental disorder. The lesions observed were dental calculus (88%), dental wear (81%), missing teeth (38%), gingivitis (19%), gingival recession (6%), dental fracture (19%), pulp exposure (19%), and dental staining (25%). Alouatta guariba clamitans maintained in captivity have a high rate of dental problems. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Efficiency of teeth local anesthesia by articaine-containing formulation with adrenaline and clonidine in pediatric dentistry].

PubMed

Mel'nikova, A V; Shugaĭlov, I A; Garus, Ia N

2014-01-01

The study evaluated duration and depth of the local infiltration anesthesia by articaine with different combinations of epinephrine and clonidine : articaine (4%) + epinephrine (1: 200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1: 400 000) + clonidine (1:100, 000) in pediatric dental practice. It was revealed that the replacement of the vasoconstrictor epinephrine on clonidine associated with reduced depth and duration of analgesia. This increased efficiency is provided by inclusion of epinephrine (1:200 000), and clonidine (1:100 000) into anesthetic solution, which provided statistically significant increase in depth and duration of anesthesia.

A clinical evaluation of comprehensive dental treatment for children under general anesthesia.

PubMed

Su, H L; Chen, P S

1992-12-01

The purpose of this study is to evaluate the comprehensive dental treatment for children under general anesthesia. From 1989 to 1991, 57 children with mean age of 3 years 2 months were treated, followed up with a minimal of 1 year. This procedure allows the dentition to be restored in one visit. Further care including preventive options and behavior shaping was provided on a 3-6 months recall schedule. The reasons for general anesthesia are that these children were either unable to accept treatment because of handicaps, extreme fear or young age. Their mean number of decayed tooth was 15 (Standard Deviation, SD = 5) and nearly three quarters of the children were under 6 years old. The most frequent treatment procedures were the extraction of teeth, composite resin restoration and Ni-Cr crown restoration. The Ni-Cr crown (1.7% failure rate) was more successful than the amalgam and composite resin restoration (9.7% failure rate). Pedo-strip crown had the highest failure rate (22%) for anterior teeth restoration. Nineteen children needed retreatment with conventional behavior guide. Six children had new caries and required further treatment. Thirty eight children returned for regular recall during the minimal 1 year follow-up period.

Duration of Action of Bupivacaine Hydrochloride Used for Palatal Sensory Nerve Block in Infant Pigs

PubMed Central

Holman, Shaina Devi; Gierbolini-Norat, Estela M.; Lukasik, Stacey L.; Campbell-Malone, Regina; Ding, Peng; German, Rebecca Z.

2015-01-01

Summary Bupivacaine hydrochloride is frequently used in veterinary dental procedures to reduce the amount of general anesthesia needed and to reduce post-procedural pain. The aim of this study was to develop a novel method to test local anesthetic duration in mammals. Six infant pigs were placed under deep/surgical anesthesia with 3 % isoflurane and oxygen while 0.5 ml of 0.5 % bupivacaine hydrochloride was injected to block the two greater palatine and the nasopalatine nerves. They were then maintained under light anesthesia with 0.5–1.0 % isoflurane. Beginning 15-minutes after the injection, 7 sites in the oral cavity were stimulated using a pointed dental waxing instrument, including 3 sites on the hard palate. The response, or lack of response, to the stimulus was recorded on video and in written record. The bupivacaine hydrochloride injections lasted 1 to 3-hours before the animals responded to the sensory stimulation with a reflexive movement. This study provides evidence that bupivacaine used to anesthetize the hard palate has a relatively short and variable duration of action far below what is expected based on its pharmacokinetic properties. PMID:25185333

[Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations].

PubMed

von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

2014-01-01

The present article reviews the different types of ophthalmologic complications following administration of intraoral local anesthesia. Since the first report by Brain in 1936, case reports about that topic have been published regularly in the literature. However, clinical studies evaluating the incidence of ophthalmologic complications after intraoral local anesthesia are rarely available. Previous data point to a frequency ranging from 0.03% to 0.13%. The most frequently described ophthalmologic complications include diplopia (double vision), ptosis (drooping of upper eyelid), and mydriasis (dilatation of pupil). Disorders that rather affect periorbital structures than the eye directly include facial paralysis and periorbital blanching (angiospasm). Diverse pathophysiologic mechanisms and causes have been reported in the literature, with the inadvertent intravascular administration of the local anesthetic considered the primary reason. The agent as well as the vasopressor is transported retrogradely via arteries or veins to the orbit or to periorbital structures (such as the cavernous sinus) with subsequent anesthesia of nerves and paralysis of muscles distant from the oral cavity. In general the ophthalmologic complications begin shortly after administration of the local anesthesia, and disappear once the local anesthesia has subsided.

Epidermolysis bullosa, dental and anesthetic management: a case report.

PubMed

Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza

2014-09-01

Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.

Recent advances in topical anesthesia

PubMed Central

2016-01-01

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain. PMID:28879311

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block.

PubMed

Corrêa, Cléber Gimenez; Machado, Maria Aparecida de Andrade Moreira; Ranzini, Edith; Tori, Romero; Nunes, Fátima de Lourdes Santos

2017-01-01

This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Expanded function allied dental personnel and dental practice productivity and efficiency.

PubMed

Beazoglou, Tryfon J; Chen, Lei; Lazar, Vickie F; Brown, L Jackson; Ray, Subhash C; Heffley, Dennis R; Berg, Rob; Bailit, Howard L

2012-08-01

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices.

Effectiveness of computer-assisted anesthetic delivery system (sta™) in dental implant surgery: a prospective study

PubMed Central

GRASSI, F.R.; RAPONE, B.; SCARANO CATANZARO, F.; CORSALINI, M.; KALEMAJ, Z.

2017-01-01

SUMMARY Objectives. This prospective cohort study aimed to investigate effectiveness of Computerized Local Anesthesia (CLA) on oral implantology through estimation of pain and discomfort and total quantity of injected anesthetic. Methods. Forty-five consecutive patients whose treatment plan included immediate or late dental implants were included in this study. The main inclusion criteria comprised: previous implant intervention under conventional anesthesia (CA) during the past 3 years and no previous treatment of pain relief. All patients reported on a 0–10 scale on previous experience with CA, and new experience with CLA. The same CLA system, namely Single Tooth Anesthesia (STA) was used for all patients with half of the quantity normally used for CA. Data on quantity of anesthetic and reported ratings were collected and described. Potential associations and determinant variables were analysed through correlation analysis and regression models. Results. Out of 45 patients, 27 received post-extractive implant surgery whereas the rest 18 implant surgery on healed sites. The reported pain from STA (mean 1.6, SD 0.7) showed important difference as compared to CA (7.9, SD 1.2; z=5.873; p<0.0001). The comfort perceived during the STA ranged from 7 to 10 (mean 9.5, SD 0.79). A second injection with half of the initial dose was necessary in three cases only. Conclusions. STA system proved to be effective during interventions of dental implantology, by markedly reducing patients’ pain and discomfort and the total quantity of necessary anesthetic. PMID:29682255

Contribution of Dentist Anesthesiologists to Dental Anesthesiology Research

PubMed Central

Ganzberg, Steven; Rashid, Robert G.; Davidian, Edward

2011-01-01

In order to determine if dentist anesthesiologists (DAs) actively contribute to research in the field of anesthesiology, and thus contribute new knowledge to the field, an extensive literature search was accomplished. DAs make up only 1.5% of dentists who actively contribute to anesthesia research but account for 10% of publications. To determine if the impact of DA research was similar to the American Dental Association (ADA) recognized specialties, h-indices of noted researchers in other specialties were compared to the h-indices of noted DA researchers. The results show that the impact of top DA researchers in dental anesthesiology is similar to the impact of top dental specialty researchers, despite lack of academic departments in dental schools where a large percentage of dental research is completed. Dentist anesthesiologists actively contribute to the research in anesthesiology for dentistry and thus, actively contribute to new knowledge in the field. PMID:21410360

Water fluoridation and costs of Medicaid treatment for dental decay--Louisiana, 1995-1996.

PubMed

1999-09-03

Treatment costs for dental decay in young children can be substantial, especially if extensive dental procedures and general anesthesia in a hospital operating room (OR) are needed. Because caries in the primary dentition disproportionately affect children from low-income households, the cost for care frequently is reimbursed by state Medicaid programs. To determine whether the average treatment cost for Medicaid-eligible children in Louisiana differed by community fluoridation status, the Louisiana Department of Health and Hospitals (LDHH) and CDC analyzed Medicaid dental reimbursements and Medicaid eligibility records from July 1995 through June 1996 for children aged 1-5 years. Findings suggest that Medicaid-eligible children in communities without fluoridated water were three times more likely than Medicaid-eligible children in communities with fluoridated water to receive dental treatment in a hospital OR, and the cost of dental treatment per eligible child was approximately twice as high.

Oral health-related quality of life in pediatric patients under general anesthesia: A prospective study.

PubMed

Li, Lanlan; Wang, Hongwei; Han, Xueping

2017-01-01

Our goal was to evaluate how dental treatments under general anesthesia (GA) affect the quality of life by a prospective pair-matched design. Pediatric patients, who had received dental treatments under GA, were enrolled and were asked to complete the Early Childhood Oral Health Impact Scale (ECOHIS) before the treatment and 1 month after the treatment. To shield the observed impacts, a pair-matched control group was performed. Patients in the control group were also required to complete the ECOHIS at these different points in time. In both groups, the items of troubled sleep and oral/dental pain scored highest, whereas avoiding smiling or laughing and avoiding talking scored lowest before the treatment. The total mean score in the 2 groups was 13.1 and 13.7, respectively, and there was no significant statistical difference (P > 0.05). However, the total mean score was 1.9 in the experimental group after the treatment and smaller compared with the control group (1.9 vs. 4.7, P < 0.001). The majority of the items in both groups had an apparent effect size and the total mean effect in the experimental group was greater than that in the control group (85.5% vs. 65.7%, P < 0.001). Therefore, dental treatment under GA could provide better quality of life restoration compared with treatment over multiple visits.

[A dissociative patient].

PubMed

de Jongh, A; Abkhezr, S; Broers, D L M

2009-08-01

A 45-year-old woman attended a centre for special dental care. Initially, it seemed that the patient suffered from an extreme form of dental anxiety. However, the fact that she displayed 'dissociations' suggested that she had a severe psychiatric disorder, in this case Dissociative Identity Disorder. The key feature of this condition is a dysfunction of the normal integrative functions of identity, memory and consciousness. In such instances it is recommended to contact a psychologist or psychiatrist and the referring care provider to consider the consequences of the psychiatric condition regarding informed consent, treatment plan and actual treatment. Because it was not likely that the patient would respond to an intervention specifically aimed to reduce anxiety in the dental setting, dental treatment under general anesthesia was the best suited option.

Dental Management of a Pediatric Patient with Moyamoya Syndrome: A Rare Clinical Entity.

PubMed

Ko, Brittany L; Unkel, John H

2018-01-01

Moyamoya disease (MMD) is a rare cerebrovascular disorder involving progressive constriction of the internal carotid artery and its branches. The disease has a particularly aggressive course in very young patients, and early surgical intervention is often necessary to prevent permanent neurological damage. MMD patients have an increased risk of stroke development, which may be provoked by pain or anxiety. Currently, no reports of pediatric patients with MMD exist in the dental literature. The purpose of this paper was to discuss the dental management of a two-year-old with moyamoya disease who presented with early childhood caries and dental fear, offering recommendations for dental providers with emphasis on stroke prevention, collaboration with the medical team, anesthesia considerations for patients with increased stroke risk, and the challenges to maintain the oral health of a patient undergoing complex medical treatment.

Methemoglobin Levels in Generally Anesthetized Pediatric Dental Patients Receiving Prilocaine Versus Lidocaine

PubMed Central

Gutenberg, Lauren L.; Chen, Jung-Wei; Trapp, Larry

2013-01-01

The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3–6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1 : 100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure. PMID:24010987

The effect of nerve section on the incidence and distribution of gap junctions in the odontoblast layer of the cat.

PubMed

Holland, G R

1987-08-01

Gap junctions are numerous in the odontoblast layer of the dental pulp and may link sensory axons to odontoblasts. If these junctions do link axons and odontoblasts, they, together with the axons, should disappear after cutting the pulpal nerves centrally. Under general anesthesia the inferior alveolar nerve on one side of two young adult cats was sectioned. Under general anesthesia the animals were perfused with fixative 56 hours later and the coronal dental pulp prepared for electron microscopy. Ultrathin sections were examined from the level of the pulpal cornu and levels approximately one, two, and three mm below this. The incidence of cell processes and gap junctions was measured at different distances from the pulp predentin junction, and operated and control sides compared. The odontoblast layer at the level of the cornu differed from elsewhere in having, on the control side, a greater density of cell processes and gap junctions and in having clearly recognizable axons approaching to within 5 to 10 micron of the predentin. The only statistically significant changes after nerve section occurred in this layer and consisted of a decline in the incidence of cell processes and of gap junctions that link one cell process to another. There was no significant difference between the operated and control sides in the number of gap junctions linking cell processes to recognizable cell bodies. The odontoblast layer in the pulpal cornu contained substantial numbers of unsheathed axons, many presumably en route to the dentin. These axons may participate in gap junctions that link them to other cell processes, possibly even other axons.(ABSTRACT TRUNCATED AT 250 WORDS)

Discovery of Modern Anesthesia: A Counterfactual Narrative about Crawford W. Long, Horace Wells, Charles T. Jackson, and William T. G. Morton.

PubMed

Desai, Manisha S; Desai, Sukumar P

2015-12-01

The discovery of anesthesia occurred during a narrow time span in the mid-19th century, but there is no agreement about who deserves credit for this important American contribution to medicine. Based mostly on an examination of primary sources, we explore how formal and informal interactions between the principals affected their careers, lives, and attribution of credit for the discovery of anesthesia. There should be no controversy as to which individual deserves credit for the discovery of anesthesia if credit is ascribed for specific contributions. We suggest that credit for the discovery of anesthesia be divided among 4 individuals who played specific roles. Crawford W. Long first used ether as an anesthetic during surgery, Horace Wells introduced nitrous oxide for pain relief during dental surgery, and William T. G. Morton gave the first public demonstration of ether anesthesia and spread the word about its efficacy. Charles T. Jackson suggested the use of ether as an anesthetic agent to Morton. We also assert that had these individuals not known one another, the discovery of anesthesia would have proceeded in approximately the same timeframe, but Wells, Morton, and Jackson would have enjoyed more productive careers as well as longer, more peaceful lives.

Acute pulmonary hemorrhage during isoflurane anesthesia in two cats exposed to toxic black mold (Stachybotrys chartarum).

PubMed

Mader, Douglas R; Yike, Iwona; Distler, Anne M; Dearborn, Dorr G

2007-09-01

Acute pulmonary hemorrhage developed during isoflurane anesthesia in 2 Himalayan cats undergoing routine dental cleaning and prophylaxis. The cats were siblings and lived together. In both cats, results of pre-operative physical examinations and laboratory testing were unremarkable. Blood pressure and oxygen saturation were within reference ranges throughout the dental procedure. Approximately 15 to 20 minutes after administration of isoflurane was begun, frothy blood was noticed within the endotracheal tube. Blood was suctioned from the endotracheal tube, and the cats were allowed to recover from anesthesia. 1 cat initially responded to supportive care but developed a second episode of spontaneous pulmonary hemorrhage approximately 30 hours later and died. The other cat responded to supportive care and was discharged after 4 days, but its condition deteriorated, and the cat died 10 days later. Subsequently, it was discovered that the home was severely contaminated with mold as a result of storm damage that had occurred approximately 7 months previously. Retrospective analysis of banked serum from the cats revealed satratoxin G, a biomarker for Stachybotrys chartarum, commonly referred to as "toxic black mold." Findings highlight the potential risk of acute pulmonary hemorrhage in animals living in an environment contaminated with mold following flood damage.

Intraosseous anesthesia: implications, instrumentation and techniques.

PubMed

Kleber, Christopher H

2003-04-01

The author reviews historical methods and the instruments used to bring about intraosseous anesthesia, or IOA; discusses the criteria for successful use of the intraosseous injection, or IOI, technique; and provides recommendations. Articles from before 1990 consisted of subjective reports of patient types and procedures performed using IOI as a primary technique. Studies published after 1990 yielded subjective findings on indications for expanded clinical use. The author discusses the expansion of the role of IOI relative to integrated local anesthetic delivery systems. The literature and studies verify the efficacy of IOI as a supplemental or primary technique. The author recommends anesthetics and infusion sites, and reports on the patients' perceptions of comfort. IOI can be used as a supplemental or primary technique to bring about local anesthesia in routine dental procedures. It can be used as a supplemental technique with mandibular nerve blocks to enhance deep pulpal anesthesia. It can be used as a primary technique so that patients do not experience numb lips or tongues postoperatively. Dentists can appreciate the immediate onset of anesthesia and reduced dosage levels of anesthetics associated with using IOI.

Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

PubMed Central

Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

2016-01-01

Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation. PMID:27041847

[Clinical and physiological rationale for use of clonidine with articaine and adrenaline for local anesthesia in pediatric dentistry].

PubMed

Mel'nikova, A V; Shugaĭlov, I A

2014-01-01

The study evaluated the effect of local anesthesia with articaine in different combinations with epinephrine and clonidine (articaine (4%) + epinephrine (1:200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1:400 000) + clonidine (1:100 000)), on a number of physiological parameters in pediatric dental practice that characterize cardiovascular system, patient's degree of adaptation to a stressful situation and efficacy of analgesia. It is shown that in terms of impact on the cardiovascular system and stress adaptation indicators anesthesia including combination of epinephrine (1: 200 000) and clonidine (1: 100 000) in the anesthetic solution is the safest. Furthermore, this method ensures the most appropriate analgesic effect.

Oral findings and dental treatment in a patient with Dandy-Walker syndrome: a case report.

PubMed

Kusumoto, Yasuka; Shinozuka, Osamu

2014-01-01

Dandy-Walker syndrome (DWS) is congenital disease characterized by hypoplasia of the cerebellum, the formation of cysts that communicate with the fourth ventricle of the posterior cranial fossa, and hydrocephalus. In addition to various other complications, cleft lip/palate, facial retrognathia, a high-arched palate, and maldentition occur at an increased frequency in patients with DWS. However, few studies have reported the dental manifestations of DWS. Herein, we report the clinical manifestations, oral findings, and dental management of a DWS patient who was treated under general anesthesia. Poor oral hygiene, gingivitis, and several congenital dental abnormalities (e.g., generalized microdontia, conical tooth, transposition, and congenitally missing teeth) were observed. This report is the first to describe the oral findings and dental treatment of DWS. Our findings emphasize the importance of a multidisciplinary approach in the diagnosis and treatment of DWS. © 2013 Special Care Dentistry Association and Wiley Periodicals, Inc.

Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions.

PubMed

Diz Dios, P; Tomás Carmona, I; Limeres Posse, J; Medina Henríquez, J; Fernández Feijoo, J; Alvarez Fernández, M

2006-09-01

We evaluated the efficacies of oral prophylactic treatment with amoxicillin (AMX), clindamycin (CLI), and moxifloxacin (MXF) in the prevention of bacteremia following dental extractions (BDE). Two hundred twenty-one adults who required dental extractions under general anesthesia were randomly assigned to a control group, an AMX group, a CLI group, and an MXF group (the individuals in the drug treatment groups received 2 g, 600 mg, and 400 mg, respectively, 1 to 2 h before anesthesia induction). Venous blood samples were collected from each patient at the baseline and 30 s, 15 min, and 1 h after the dental extractions. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were processed in a BACTEC 9240 instrument. Subculture and the further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalences of BDE in the control group, AMX group, CLI group, and MXF group were 96, 46, 85, and 57%, respectively, at 30 s; 64, 11, 70, and 24%, respectively, at 15 min; and 20, 4, 22, and 7%, respectively, at 1 h. Streptococcus spp. were the most frequently identified bacteria in all groups (44 to 68%), with the lowest percentage being detected in the AMX group (44%). AMX and MXF prophylaxis showed high efficacies in reducing the prevalence and duration of BDE, but CLI prophylaxis was noneffective. As a consequence, MXF prophylaxis is a promising antibiotic alternative for the prevention of BDE when beta-lactams are not indicated.

Comparative Efficacies of Amoxicillin, Clindamycin, and Moxifloxacin in Prevention of Bacteremia following Dental Extractions

PubMed Central

Diz Dios, P.; Tomás Carmona, I.; Limeres Posse, J.; Medina Henríquez, J.; Fernández Feijoo, J.; Álvarez Fernández, M.

2006-01-01

We evaluated the efficacies of oral prophylactic treatment with amoxicillin (AMX), clindamycin (CLI), and moxifloxacin (MXF) in the prevention of bacteremia following dental extractions (BDE). Two hundred twenty-one adults who required dental extractions under general anesthesia were randomly assigned to a control group, an AMX group, a CLI group, and an MXF group (the individuals in the drug treatment groups received 2 g, 600 mg, and 400 mg, respectively, 1 to 2 h before anesthesia induction). Venous blood samples were collected from each patient at the baseline and 30 s, 15 min, and 1 h after the dental extractions. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were processed in a BACTEC 9240 instrument. Subculture and the further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalences of BDE in the control group, AMX group, CLI group, and MXF group were 96, 46, 85, and 57%, respectively, at 30 s; 64, 11, 70, and 24%, respectively, at 15 min; and 20, 4, 22, and 7%, respectively, at 1 h. Streptococcus spp. were the most frequently identified bacteria in all groups (44 to 68%), with the lowest percentage being detected in the AMX group (44%). AMX and MXF prophylaxis showed high efficacies in reducing the prevalence and duration of BDE, but CLI prophylaxis was noneffective. As a consequence, MXF prophylaxis is a promising antibiotic alternative for the prevention of BDE when beta-lactams are not indicated. PMID:16940094

The nitrous oxide "dream" of Cora Gray: a dental anesthesia story of 1884.

PubMed

Christen, Arden G; Christen, Joan A

2014-01-01

In the September 1884 issue of Frank Leslie's Popular Monthly magazine, a fictional dramatic short story was published concerning the dental use of nitrous oxide. Entitled, "Cora Gray," it was written by the well-known American journalist and poet John Whittaker Watson (1815-1848), who authored hundreds of sentimental, tragic and dramatic poems, serials and stories concerning the destitute lives and deaths of downtrodden young women of that time. His greatest poetic effort, "Beautiful Snow," (1869) tells of a young prostitute who freezes to death in a snow bank. Watson, born in New York City, was educated at the University of New York, where he studied medicine. He also developed and used his skills as an engraver, journalist and writer. Watson obviously based his imaginative narrative on his medical knowledge of nitrous oxide and its physical and psychological side effects when inhaled. The story centers around the dreamlike romantic experiences of a 19-year-old female dental patient while she is under the effects of this gas. It explicitly depicts the administration of nitrous oxide and the resulting erotic visions and hallucinations that the young patient experiences. We make reference to other cautionary scientific writings from the late 1800s, in order to point out and clarify the potentially negative repercussions of nitrous oxide when administered to female dental patients without the presence of a third party. The ethics and propriety of anesthesia administration remain as perennial questions in dentistry to this day.

Correlation between provider computer experience and accuracy of electronic anesthesia charting A pilot study and performance improvement project

DTIC Science & Technology

2017-03-20

information management systems (AIMS), a subset of electronic medical records (EMR) (Stonemetz & Dutton, 2014). By contrast, about 75 percent of anesthesia...of distraction caused by the anesthesia information management system (AIMS). Peterfreund et al. (2011) attributed their 92% increase in... information into an Excel spreadsheet, coded by the participant research identification number. Using the Innovian Case Manager application, the

Continuous Positive Airway Pressure Prevents Hypoxia in Dental Patient with Obstructive Sleep Apnea Syndrome under Intravenous Sedation.

PubMed

Kasatkin, Anton A; Reshetnikov, Aleksei P; Urakov, Aleksandr L; Baimurzin, Dmitrii Y

2017-01-01

Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

Oral health status of children with special health care needs receiving dental treatment under general anesthesia at the dental clinic of Taipei Veterans General Hospital in Taiwan.

PubMed

Chen, Chia-Yu; Chen, Ya-Wei; Tsai, Tzong-Ping; Shih, Wen-Yu

2014-04-01

Oral health is crucial to individual growth and development. However, oral health care is often overlooked in children with special health care needs (CSHCN). We investigated current oral health status and unmet dental needs of CSHCN in Taiwan. We performed a retrospective study of consecutive CSHCN cases receiving first-time comprehensive dental treatment under general anesthesia at Taipei Veterans General hospital from 2001 to 2010. We retrieved clinical data including age, sex, types, and severity of disability, caries experience index [decayed, extracted, and filled teeth (deft) index for primary dentition/decayed, missing, and filled teeth (DMFT) index for permanent dentition], malocclusion, and treatment modalities from medical charts for analysis. The correlation between different groups of CSHCN regarding the deft/DMFT indices and treatment modalities was analyzed statistically. Our study included 96 children, ranging in age from 2.4 years to 14.3 years (mean age 6.8 ± 3.3 years). The deft/DMFT index was significantly higher in the younger age group (2-6 years; 13.8 ± 4.3) compared with the older group (> 6 years; 10.5 ± 5.3; p < 0.001). The mean number of total treated teeth was 14.2 ± 3.8, and no differences existed among disability groups (p = 0.528) and age groups (p = 0.992). For the treatment modality, the number of pulp therapies with crown restoration was higher in the younger age group than in the older group. At the time of the study, 53 CSHCN had reached their full permanent dentition. We observed significantly more malocclusion of full permanent dentition in the older age group (91%) than in the younger group (35%; p < 0.001). Unmet dental needs and caries experience indices remain high in CSHCN, regardless of the types and severity of disability. However, the younger the age at which CSHCN received their first dental treatment, the more effective the dental rehabilitation was. Parental education regarding early dental intervention and a preventive approach for enhanced oral care is mandatory. Copyright © 2014. Published by Elsevier B.V.

Effects of epinephrine on lidocaine pharmacokinetics and blood volume in the dental pulp.

PubMed

Hashimoto, Shuichi; Yamashiro, Mikiko; Fujita, Kyohei; Yasuda, Asako; Sunada, Katsuhisa

2014-09-01

Epinephrine potentiates and prolongs the efficacy of local anesthetics by reducing blood flow. We investigated the effect of epinephrine on the pharmacokinetics of lidocaine and the pulpal blood volume after maxillary infiltration anesthesia in rats. We measured the (14)C-radioactivity and (14)C-distribution in the maxilla and the dental pulp after the injection of 2% (14)C-lidocaine with or without 10 μg/mL epinephrine (n = 7) into the palatine mucosa proximal to the first molar. The blood volume in the pulp was measured using (99m)Tc-pertechnetate (n = 5). When lidocaine was injected together with epinephrine, the lidocaine became widely distributed throughout the maxilla and was observed mainly in the first molar pulp. The lidocaine amount in the dental pulp at 10-60 minutes was more than 2 times higher than that after the injection of lidocaine alone. The relative pulpal blood volume after 20 minutes decreased to 63.1% of the value after the injection of lidocaine alone. We found that lidocaine had infiltrated into the molar pulp after infiltration anesthesia. Furthermore, our results suggested that epinephrine augmented the retention of lidocaine in the pulp. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A conceptual model of parental behavior change following a child's dental general anesthesia procedure.

PubMed

Amin, Maryam S; Harrison, Rosamurd L

2007-01-01

The purpose of this study was to investigate parents' challenges to long-term maintenance of healthy behaviors following their child's dental general anesthesia (GA). Twenty-six in-depth interviews were conducted with parents of children younger than 6 years of age who had dental treatment under GA. The interviews were scheduled at various time periods following the surgery. Compared were the responses of: (1) "relapse" families, whose child had new cavities at the 6-month recall; and (2) "no relapse" families, who were caries-free at recoil. A grounded theory approach to data analysis was used. "Relapse" parents: (1) valued baby teeth differently; (2) perceived their child to be less susceptible to new cavities; and (3) expressed lower self-efficacy for controlling their child's oral health compared to "no relapse" parents. They also appeared to be: (1) in earlier stages of change; (2) less receptive to advice from others, including professionals; and (3) more permissive regarding their child's desires. "Relapse" parents did not seem to have any immediate plans to change their "home-care" behaviors. GA did not appear to affect long-term preventive behaviors for all parents. Readiness to change seemed to be an important predictor of whether parents adopted and maintained preventive behaviors to improve their child's oral health.

Advances in dental local anesthesia techniques and devices: An update

PubMed Central

Saxena, Payal; Gupta, Saurabh K.; Newaskar, Vilas; Chandra, Anil

2013-01-01

Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available. PMID:24163548

Side effects and complications of intraosseous anesthesia and conventional oral anesthesia

PubMed Central

Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha, Miguel

2012-01-01

Objective: To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. Material and method: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Conclusions: Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques. Key words:Intraosseous anesthesia, oral anesthesia, mandibular block, heart rate, adrenalin, complications. PMID:22143716

Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report.

PubMed

Weintraub, Ari Y; Deutsch, Ellen S; Hales, Roberta L; Buchanan, Newton A; Rock, Whitney L; Rehman, Mohamed A

2017-06-01

Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.

Inadvertent injection of formalin mistaken for local anesthetic agent: report of a case.

PubMed

Arakeri, Gururaj; Brennan, Peter A

2012-05-01

Chemical facial cellulitis, while commonly seen in domestic accidents or attempted suicide, is uncommon in the dental office and hence rarely addressed in the dental literature. We present an unusual case of chemical facial cellulitis caused by inadvertent injection of formalin into the soft tissues of the oral cavity, which was mistaken for local anesthesia solution. This report comprises the immediate symptoms, possible root cause, and management of the difficult situation. We also provide some guidelines to avoid such unfortunate events. Copyright © 2012 Elsevier Inc. All rights reserved.

Management of dental complications in a child with rhabdomyosarcoma.

PubMed

Jalali, Golnaz; Unkel, John H; Reed, James A

2012-01-01

Radiotherapy treatment options can cause adverse dental sequelae, including xerostomia, dental radiation caries, abnormal tooth development, and osteoradionecrosis (ORN). Hyperbaric oxygen (HBO) therapy can be used prophylactically or therapeutically to treat or reduce the risk of ORN. The purpose of this paper was to describe a case involving a 5-year-old male with rhabdomyosarcoma of the left temporal fossa and a history of radiation therapy who presented with gross radiation caries and xerostomia. Full-mouth extractions of all primary teeth were performed under general anesthesia, with the patient receiving HBO therapy before and after the surgery. The child was monitored postoperatively, and healing occurred with minimal post-operative complications. Based on his results, it can be concluded that hyperbaric oxygen therapy is an effective supplement to consider when treating children who have undergone radiation therapy and require dental care.

Using elements of hypnosis prior to or during pediatric dental treatment.

PubMed

Peretz, Benjamin; Bercovich, Roly; Blumer, Sigalit

2013-01-01

Most dental practitioners are familiar with pediatric patients expressing dental fear or anxiety. Occasionally, the dentist may encounter a situation where all behavioral techniques fail, while, for some reason, premedication or general anesthesia are contraindicated or rejected by the patient or his/her parents and a different approach is required. Hypnosis may solve the problem in some cases. The purpose of this study was to review the literature about techniques that use elements of hypnosis and hypnotic techniques prior to or during pediatric dental treatment. There is a limited amount of literature regarding the use of hypnosis and hypnotic elements in pediatric dentistry. Induction techniques, reframing, distraction, imagery suggestions, and hypnosis are identified, although mostly anecdotally, while there are very few structured controlled studies. Nevertheless, the advantages of using hypnotic elements and hypnosis in pediatric dentistry are evident.

An ex vivo comparison of pressures within dental pulp space using conventional anesthetic technique versus needle-mounted obturator.

PubMed

Grubbs, S Lee; Alley, Larry W; Eleazer, Paul D

2014-07-01

The intrapulpal (IP) injection technique is 1 of several ways of obtaining profound anesthesia. There is evidence to suggest that pressure is the primary factor in obtaining anesthesia using IP injection. This is an ex vivo comparison of pressures within dental pulp space using the conventional anesthetic technique versus a needle-mounted obturator technique. Twenty extracted anterior and premolar teeth were accessed with a high-speed 169L bur. A saline-filled tube connected to a digital pressure gauge was attached to the apical 10 mm of each tooth in a fixed mount. One operator performed all the injections under moderate pressure. Each tooth was injected twice; first, the tooth was given an IP injection with a normal setup, and then the same tooth was given an IP injection with the modified obturator syringe. The pressure at the apex was recorded for each tooth. A paired sample t test was completed to determine statistical significance. The pressure generated was considerably higher for the obturator group in every tooth when compared with the normal group (P < .001). IP injection with the obturator resulted in increased pressure at the apex of each tooth. This pressure increase may allow for increased anesthesia when IP injections are indicated. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Development of Chronic Mandibular Osteomyelitis in a Miniswine Model

DTIC Science & Technology

1993-01-01

endotracheal intubation was then accomplished and medullary cavity to control bleeding and to produce anesthesia maintained with N,0/O,/Forane (ANA- some...Dis 122:410, 1970 experimental animal in dental research. Arch Oral Biol 7:17, 5. Norden CW, Shinners E, Niederriter K: Clindamycin treatment 1962 of

Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center

PubMed Central

Abu Younis, Mohammed H; Abu Hantash, Ra'ed O

2011-01-01

Aims: The objectives of this study were to find out the frequency, clinical picture, and risk factors of dry socket at the Dental Teaching Center of Al-Quds University in Palestine. Methods and Materials: Two previously used questionnaires were accomplished in this study over a one year period. The first questionnaire was completed for every patient who had one or more permanent teeth extracted in the Dental Surgery Clinic. The other one was completed for every patient suffered a postoperative pain and was diagnosed with dry socket. Results: There were 1305 dental extractions performed in 805 patients. The overall frequency of dry socket was 3.2%. The incidence of dry socket following non-surgical extractions was 1.7% while it was 15% following surgical extractions (P< 0.005). The incidence of dry socket was significantly higher in smokers (12%) than in non-smokers (4%) (P < 0.005), however, there is a strong association between the amount of smoking and the incidence of dry socket (P < 0.002). The incidence of dry socket was significantly higher in the single extraction cases (13%) than in the multiple extraction cases (5%) (P = 0.005). Age, sex, medical history, extraction site, amount of local anesthesia and experience of operator play no role in the occurrence of dry socket. Conclusion: Smoking, surgical trauma and single extractions are considered predisposing factors in the occurrence of dry socket. On the other hand, factors like: age, sex, medical history, extraction site, amount of anesthesia, and operator experience have no effect on the observation of dry socket. PMID:21559187

The caries experience and behavior of dental patients with autism spectrum disorder.

PubMed

Loo, Cheen Y; Graham, Richard M; Hughes, Christopher V

2008-11-01

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. The authors conducted a study to evaluate the demographics, caries experience and behavior of patients with ASD and compare these characteristics with those of patients without ASD (unaffected patients). The authors reviewed patients' charts and identified a group of 395 patients with ASD and a group of 386 unaffected patients. They obtained the following patient data for analysis: primary diagnosis, age, sex, residence (home versus institution or group home), presence of seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behavior or pica), medications, caries prevalence, caries severity and behavior. The ASD group had a male:female ratio of 4:1, and patients had a diagnosis of autism, pervasive developmental disorder-not otherwise specified or Asperger syndrome. Sex distribution was equal in the unaffected group, which was younger and had a higher decayed, missing and filled teeth (DMFT) score than did the ASD group. When the authors controlled for age and sex, they noted a statistically significant association between ASD and dental caries prevalence. A significantly higher percentage of patients with ASD than unaffected patients were uncooperative and required dental treatment to take place under general anesthesia. Caries prevalence and severity in patients with ASD were not associated with institutionalization, presence of seizure disorder or additional diagnosis. People with ASD were more likely to be caries-free and had lower DMFT scores than did their unaffected peers. Significantly more patients with ASD than unaffected patients were uncooperative and required general anesthesia to undergo dental treatment.

Side effects and complications of intraosseous anesthesia and conventional oral anesthesia.

PubMed

Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María-José; Peñarrocha-Diago, María; Peñarrocha, Miguel

2012-05-01

To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques.

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

PubMed Central

Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

2012-01-01

Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA – the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes – the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. Key words: Anesthesia, intraosseous, oral anesthesia, Stabident®, infiltrative, mandibular block. PMID:22143700

Dental caries area of rat molar expanded by cigarette smoke exposure.

PubMed

Fujinami, Y; Nakano, K; Ueda, O; Ara, T; Hattori, T; Kawakami, T; Wang, P-L

2011-01-01

Passive smoking is the involuntary inhalation of cigarette smoke (CS) and has an adverse impact on oral health. We examined the effect of CS exposure on caries risk and experimental dental caries. Experimental dental caries was induced in rat maxillary molars which were inoculated orally with Streptococcus mutans MT8148 and maintained on a cariogenic diet (diet 2000) and high sucrose water during the experimental period. CS-exposed rats were intermittently housed in an animal chamber with whole-body exposure to CS until killed. Whole saliva was collected before CS exposure (day 0) and for 30 days after the start of CS exposure. Saliva secretion was stimulated by administration of isoproterenol and pilocarpine after anesthesia. Maxillary molars were harvested on day 31. The increase in body weight of the CS-exposed rats was less than that of the control rats. Salivary flow rate, concentration of S. mutans in the stimulated saliva and caries activity score did not significantly differ between 0 and 30 days after the start of CS exposure. Histological examination of the caries-affected area on maxillary molars 30 days after CS exposure showed expansion compared to control rats. In the electron probe microanalysis, no differences were observed between the mineral components of the CS-exposed teeth and the control teeth. These results suggest that CS exposure expands the caries-affected area in the maxillary molars of the rat. Copyright © 2011 S. Karger AG, Basel.

Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study.

PubMed

Sitilci, T; Demirgan, S; Akcay, C; Kahraman, N; Koseoglu, B G; Erdem, M A; Cankaya, A B

2017-04-01

We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following categories: Demographic features, American Society of Anesthesiologists (ASA) classification, Mallampati score, type of anesthetic drug used during the operation, type of intubation used, any difficulties with tracheal intubation, presence of systemic diseases, and recovery times after ending general anesthesia. A total of 348 patients were selected from the Department of Maxillofacial Surgery and the Department of Pedodontics who underwent surgery with general anesthesia. Medical histories of all patients were taken, and their electrocardiography, chest X-rays, complete blood count, and blood clotting tests were checked during a preoperative assessment. Mallampati evaluations were also performed. Patients were grouped into ASA I, II, or III according to the ASA classification and were treated under general anesthesia. There was no significant difference between normal and intellectually disabled patients in terms of gender, Mallampati scores, intubation difficulties, mean anesthetic period, time to discharge, or postoperative nausea and vomiting. Epilepsy and genetic diseases in intellectually disabled patients were significantly more common than in non-ID (NID) patients. However, the frequency of diabetes and chronic obstructive pulmonary disease in NID patients was significantly higher than in the intellectually disabled patients. Dental treatment of intellectually disabled patients under general anesthesia can be performed just as safely as that with NID patients.

Updates of Topical and Local Anesthesia Agents.

PubMed

Boyce, Ricardo A; Kirpalani, Tarun; Mohan, Naveen

2016-04-01

As described in this article, there are many advances in topical and local anesthesia. Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The modern-day dentist has the responsibility of knowing the variety of products on the market and should have at least references to access before, during, and after treatment. This practice ensures proper care with topical and local anesthetics for the masses of patients entering dental offices worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

[Dental care during pregnancy].

PubMed

Luc, Egea; Coulibaly, Nadin; Demoersman, Julien; Boutigny, Hervé; Soueidan, Assem

2012-01-01

to understand and analyze knowledge and practices of dentists regarding dental care during pregnancy using a questionnaire which focuses on the knowledge of the relationship between oral infections and complications of pregnancy, the attitude of practitioners on the implementation of dental care during pregnancy and the training of practitioners. 53.9% of pregnant women are not referred by an obstetrician. Only 59.8% of practitioners believe that dental anesthesia is not contraindicated, and most practitioners believe that the best time for care is the second trimester or after pregnancy. During pregnancy, practitioners realize the motivation for hygiene (90.7%), drainage of an abscess (82.2%), scaling (76.1%), the placement of a splint (74.1%), the treatment of caries (70%), and the removable prosthesis (67.2%). these results indicate the existence of a gap between the care of pregnant women and the state of the art in dental science, despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second and third trimester. Moreover, the results highlight the need to reinforce the initial training of dental students, but also to develop the training for practitioners in this field.

COMPLICATIONS OF ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANESTHESIA IN TUBE-FED CHILDREN: A RETROSPECTIVE ANALYSIS.

PubMed

Nguyen, Trang D; Freilich, Marshall M; Macpherson, Bruce A

2016-06-01

To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding. A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events. During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s. Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space

PubMed Central

Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-01-01

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents. PMID:26918101

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space.

PubMed

Bector, Aditi; Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-11-05

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents.

Oral Health Education in Children before Dental Treatment under General Anesthesia.

PubMed

Valéra, Marie-Cécile; Aragon, Isabelle; Monsarrat, Paul; Vaysse, Fréderic; Noirrit-Esclassan, Emmanuelle

The aim of this study was to evaluate the attitude of parents towards the oral health of their children before oral rehabilitation under general anesthesia (GA). Children receiving dental treatment under GA between November 2013 and July 2014 in the Pediatric Dentistry Department (University Hospital Center, Toulouse, France) were enrolled in an oral health preventive program. An anonymous questionnaire was self-administered by the parents during the pre-operative session. The sample comprised 67 children with a mean age of 4.8 years. 48 % of the parents had difficulties in maintaining the oral hygiene of their child. Two thirds of them reported a lack of cooperation. An adult cleaned the child's teeth in 43% of the cases. 14% of the study population brushed their teeth twice a day or more. In addition, half of the parents reported that they modified food consumption or teeth cleaning habits of their children since the initial consultation. This study suggests a low compliance of parents and children with the recommendations on oral hygiene and food consumption given at the initial visit and demonstrates the feasibility of a preventive program in this population.

Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment

PubMed Central

Noorani, Hina; Shivaprakash, PK

2014-01-01

ABSTrACT Objective: Objectives of our studies were to predict dental fear in a child patient depending on salivary alpha amylase (sAA) level before and after dental treatment and to evaluate correla­tion of later with behavior of child patient during dental treatment. Materials and methods: Seventy-seven children between age of 5 and 12 years were divided in three groups. Group 1 consisted of 25 school children who did not undergo any dental treatment. Groups 2 and 3 underwent dental treatment without and with local anesthesia respectively. Groups 2 and 3 were administered child fear survey schedule-dental subscale (CFSS-DS) questionnaire before treatment. Salivary samples were collected for sAA estimation in groups 2 and 3 children before and after completion of dental treatment and behavior during treatment was noted using Frankel behavior rating scale. Group 1 acted as control in which salivary sample was collected in absence of dental stress. Results: When groups 2 and 3 were combined, pretreatment sAA level had a statistically significant (p = 0.0094) correlation with CFSS-DS scores. Conclusion: Alpha amylase can be used as a screening tool to predict level of dental fear in a child patient. How to cite this article: Noorani H, Joshi HV, Shivaprakash PK. Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment. Int J Clin Pediatr Dent 2014;7(1):19-23. PMID:25206232

A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital.

PubMed

Chen, Yung-Pan; Hsieh, Chun-Yi; Hsu, Wen-Ting; Wu, Fu-Ya; Shih, Wen-Yu

2017-04-01

General anesthesia (GA) as a pediatric dental procedure is a well-established method of behavior management. However, studies of pediatric dentistry under GA have mostly focused on handicapped patients, and various retrospective studies in Taiwan have mainly reviewed only a limited number of years. The purpose of the present study was to report trends in pediatric dental treatment performed under GA over the past 10 years. A retrospective review of the hospital records of patients receiving dental treatment under GA from 2006 until 2015 was performed. The patients were divided into three age groups: < 3 years, 3-6 years, and > 6 years. A range of information including basic patient characteristics and types of dental treatment was identified and then analyzed. A total of 791 cases (< 3 years old: 65 cases, 3-6 years old: 492, > 6 years old: 235; 549 male, 242 female) were treated under GA. The case number was found to have increased from 94 during 2006-2007 to 238 during 2014-2015, with the increase being especially pronounced among those aged 3-6 years (2006-2007: 49, 2014-2015: 165). The most common treatments (extraction, restoration, and pulp therapy) were associated with multiple dental caries (684, 86.4%). The < 3-years-old group was characterized by the highest decayed, extracted, and filled surface and decayed, missing, and filled surface indices; the highest mean number of treated teeth; and the highest mean number of treated teeth by composite resin fillings. The 3-6-years-old group had the highest number of primary teeth extractions. The > 6-years-old group had the lowest mean number of treated teeth by stainless-steel crowns (SSCs) and fewest cases treated with pulp therapy. From 2011 onwards, the number of primary tooth extractions significantly increased, while in 2013, there was a crossover whereby the SSC count surpassed the composite resin filling count. Over the past 10 years, there has been an increased use of GA for pediatric dental treatments, in particular, in cases with multiple dental caries. In addition, there has also been an increasing trend towards extraction of primary teeth and the use of SSCs. Copyright © 2017. Published by Elsevier Taiwan LLC.

Assessment of Thiel-Embalmed Cadavers as a Teaching Tool for Oral Anatomy and Local Anesthesia.

PubMed

Lone, Mutahira; McKenna, Joseph P; Balta, Joy Y; O'Mahony, Siobhain M; Cryan, John F; Downer, Eric J; Toulouse, André

2017-04-01

The aim of this study was to determine whether Thiel-embalmed cadavers would provide a useful anatomy teaching tool for topics that cannot be approached using formalin-fixed cadavers such as oral cavity examination and maxillary anesthesia. The suitability of Thiel-embalmed bodies for performing oral examinations was assessed by asking first-year dental and dental hygiene students at a dental school in Ireland to identify oral structures on a classmate and on a Thiel-embalmed body. The study was conducted in 2016. The ease of location was compared in the two settings, and their quality was assessed on the cadavers. The suitability of Thiel-embalmed cadavers to teach maxillary anesthesia was assessed by students' performing mock injections at five adjacent sites daily for five consecutive days, followed by inspection of the gingival surface by experienced anatomists and dentists. Data were obtained from 57 students, but only the 54 forms that were fully completed were analyzed, for an overall response rate of 85.7%. The results showed that most oral structures were more difficult to locate on cadavers. The texture and appearance of features in the cadavers were rated at a midpoint between realistic and unrealistic. The relative inexperience of the participants, the accumulation of fixative in the oral cavity, and discoloration were mentioned as potential confounding factors. Visual analysis of images obtained following repeated injections revealed no deterioration of the tissue. Importantly, the puncture marks appeared to reduce over time, suggesting that the gingival tissue maintains some elasticity following Thiel fixation. These findings suggest that Thiel-embalmed cadavers may be a useful tool to provide students more time to localize and study aspects of the oral cavity. Likewise, the recoiling capacity of gingival tissue suggests that Thiel-embalmed cadavers may provide an ideal tool for teaching injection technique of local anesthetics.

Evaluation of a mandatory quality assurance data capture in anesthesia: a secure electronic system to capture quality assurance information linked to an automated anesthesia record.

PubMed

Peterfreund, Robert A; Driscoll, William D; Walsh, John L; Subramanian, Aparna; Anupama, Shaji; Weaver, Melissa; Morris, Theresa; Arnholz, Sarah; Zheng, Hui; Pierce, Eric T; Spring, Stephen F

2011-05-01

Efforts to assure high-quality, safe, clinical care depend upon capturing information about near-miss and adverse outcome events. Inconsistent or unreliable information capture, especially for infrequent events, compromises attempts to analyze events in quantitative terms, understand their implications, and assess corrective efforts. To enhance reporting, we developed a secure, electronic, mandatory system for reporting quality assurance data linked to our electronic anesthesia record. We used the capabilities of our anesthesia information management system (AIMS) in conjunction with internally developed, secure, intranet-based, Web application software. The application is implemented with a backend allowing robust data storage, retrieval, data analysis, and reporting capabilities. We customized a feature within the AIMS software to create a hard stop in the documentation workflow before the end of anesthesia care time stamp for every case. The software forces the anesthesia provider to access the separate quality assurance data collection program, which provides a checklist for targeted clinical events and a free text option. After completing the event collection program, the software automatically returns the clinician to the AIMS to finalize the anesthesia record. The number of events captured by the departmental quality assurance office increased by 92% (95% confidence interval [CI] 60.4%-130%) after system implementation. The major contributor to this increase was the new electronic system. This increase has been sustained over the initial 12 full months after implementation. Under our reporting criteria, the overall rate of clinical events reported by any method was 471 events out of 55,382 cases or 0.85% (95% CI 0.78% to 0.93%). The new system collected 67% of these events (95% confidence interval 63%-71%). We demonstrate the implementation in an academic anesthesia department of a secure clinical event reporting system linked to an AIMS. The system enforces entry of quality assurance information (either no clinical event or notification of a clinical event). System implementation resulted in capturing nearly twice the number of events at a relatively steady case load. © 2011 International Anesthesia Research Society

[To finish with fear of dental care].

PubMed

Bohl, J B; Bracconi, M; Herve, C; Pirnay, P

2015-06-01

The patient facing the dentist knows fear, anxiety. The symbolism of the mouth and teeth from childhood is an entirely specific nature of the human body. The terrifying image of dental treatment and dentist that has long been stigmatized through painting, literature, theater and cinema can change today. Many therapeutic options to the management of anxiety in dental phobia; anesthesia, conscious sedation, combined with a soothing cabinet, a caring dentist, targeted use of medications or milder alternative methods; homeopathy, herbal medicine, acupuncture, psychotherapy, places the patient's interests at the center of the caregiving relationship. But this treatment panel is also offered him the difficulty of the choice. This exercise without systematization, according to the patient with competence and kindness. Some patients may be sent or processed in collaboration with other health professionals.

Electroacupuncture-Assisted Craniotomy on an Awake Patient.

PubMed

Sidhu, Amritpal; Murgahayah, Trushna; Narayanan, Vairavan; Chandran, Hari; Waran, Vicknes

2017-01-01

Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk. Copyright © 2016 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period.

PubMed

Mallineni, Sreekanth Kumar; Yiu, Cynthia Kar Y

The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (<6years, 6-12 years, >12 years). One-way ANOVA was used to evaluate the effect of "age group" on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (p<0.05). No significant difference in post-operative recovery time was observed among the three age groups (p>0.05). The <6 years group received significantly less preventive, but more restorative procedures (p<0.05). Significantly fewer extractions were performed in the 6-12 years group (p<0.05). The use of composite restorations was significantly higher in the <6 years group; while amalgam restorations were more frequently used in the >12 years group (P<0.05). Stainless steel crowns were more frequently employed in SNP under 12 years of age (p<0.05). Intra-examiner reliability was good (k=0.94). Most of the dental procedures performed under GA on SNP were restorative procedures. For children less than 6 years of age, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.

Need and Demand for Sedation or General Anesthesia in Dentistry: A National Survey of the Canadian Population

PubMed Central

Chanpong, B; Haas, D. A; Locker, D

2005-01-01

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population. PMID:15859442

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.

PubMed

Chanpong, B; Haas, D A; Locker, D

2005-01-01

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Impact of Dental Rehabilitation on Oral Health-related Quality-of-life in Healthy Children and Those with Special Health Care Needs.

PubMed

Farsi, Deema J; Farsi, Nada J; El-Housseiny, Azza A; Turkistani, Jihan M; Farsi, Najat M

2018-04-01

Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent-child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date. Keywords: Children with special health care needs, Dental caries, Early childhood oral health impact scale, General anesthesia, Oral health-related quality-of-life.

Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing - A split-mouth clinical trial.

PubMed

Chintala, Kalyan; Kumar, Sandhya Pavan; Murthy, K Raja V

2017-01-01

Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP) and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group) or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group). Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. No difference was observed in visual analog scale (P > 0.05) and verbal rating scale (P > 0.05) pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47%) was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05). Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.

Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia.

PubMed

Peñarrocha-Oltra, D; Ata-Ali, J; Oltra-Moscardó, M-J; Peñarrocha-Diago, M-A; Peñarrocha, M

2012-03-01

To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA - the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes - the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%)(p=0.0032). The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments.

Development and validation of the Pediatric Anesthesia Behavior score--an objective measure of behavior during induction of anesthesia.

PubMed

Beringer, Richard M; Greenwood, Rosemary; Kilpatrick, Nicky

2014-02-01

Measuring perioperative behavior changes requires validated objective rating scales. We developed a simple score for children's behavior during induction of anesthesia (Pediatric Anesthesia Behavior score) and assessed its reliability, concurrent validity, and predictive validity. Data were collected as part of a wider observational study of perioperative behavior changes in children undergoing general anesthesia for elective dental extractions. One-hundred and two healthy children aged 2-12 were recruited. Previously validated behavioral scales were used as follows: the modified Yale Preoperative Anxiety Scale (m-YPAS); the induction compliance checklist (ICC); the Pediatric Anesthesia Emergence Delirium scale (PAED); and the Post-Hospitalization Behavior Questionnaire (PHBQ). Pediatric Anesthesia Behavior (PAB) score was independently measured by two investigators, to allow assessment of interobserver reliability. Concurrent validity was assessed by examining the correlation between the PAB score, the m-YPAS, and the ICC. Predictive validity was assessed by examining the association between the PAB score, the PAED scale, and the PHBQ. The PAB score correlated strongly with both the m-YPAS (P < 0.001) and the ICC (P < 0.001). PAB score was significantly associated with the PAED score (P = 0.031) and with the PHBQ (P = 0.034). Two independent investigators recorded identical PAB scores for 94% of children and overall, there was close agreement between scores (Kappa coefficient of 0.886 [P < 0.001]). The PAB score is simple to use and may predict which children are at increased risk of developing postoperative behavioral disturbance. This study provides evidence for its reliability and validity. © 2013 John Wiley & Sons Ltd.

Visceral mast cell tumor in a captive black jaguar (Panthera onca).

PubMed

de Castro, Márcio Botelho; Werther, Karin; Godoy, Guilherme Sellera; Borges, Vivian Palmeira; Alessi, Antonio Carlos

2003-03-01

Little is known about neoplasia in the jaguar (Panthera onca), the largest American feline. A captive black jaguar was diagnosed at necropsy with a mastocytic form of visceral mast cell tumor similar to that which occurs in domestic cats. This animal had no previous clinical disease and died during anesthesia for a routine dental treatment.

A survey of the intravenous sedation status in one provincial dental clinic center for the disabled in Korea

PubMed Central

Seok, Ujeong; Ji, Sangeun; Yoo, Seunghoon; Kim, Jongsoo; Kim, Seungoh

2016-01-01

Background The objective of the present study was to examine the status of patients who had received dental treatment under intravenous (IV) sedation at Chungnam Dental Clinic for the Disabled in Korea from its inception to the present time, and to review the analysis results. Methods Retrospective analysis was performed on 305 cases of patients who had received dental treatments under IV sedation between January 2011 and May 2016. The analysis examined the patient's sex, age, primary reason for IV sedation, duration of anesthesia and dental treatment, type of dental treatment performed, number of clinical departments involved in the dental treatment and level of multidisciplinary cooperation, and annual trends. Results Most dental treatments using intravenous sedation were performed on medically disabled patients or dentally disabled patients with an extreme gag reflex or dental phobia. The mean duration of IV sedation was 72.5 min, while the mean duration of treatment was 58.0 min. The types of dental treatments included surgical treatment (n = 209), periodontal treatment (n = 28), prosthodontic treatment (n = 28), restorative treatment (n = 23), implant surgery (n = 22), endodontic treatment (n = 9), reduction of temporomandibular joint dislocation (n = 1), and treatment of traumatic injuries (n = 1), with treatments mostly performed on adult patients. Conclusions With increasing demand for minimally painful treatment, cases using IV sedation are on an upward trend and are expected to continue to increase. PMID:28879305

Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients

PubMed Central

Siddiqui, Talha Mufeed; Khan, Rabia; Batool, Kanza

2016-01-01

The aim of the study was to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cross-sectional study was conducted to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cluster-sampling technique was used and 200 dental surgeons from six different dental institutions were selected. A self-constructed questionnaire was distributed to the dental surgeons that comprised 20 closed-ended questions. The data was entered and analyzed for frequency and percentages by using Statistical Package for the Social Sciences (SPSS) version 19. The results showed that 76 (38%) dental surgeons took the responsibility of managing pediatric patient when given; 68 (34%) dental surgeons allowed the parents in the clinic; 111 (55.5%) dental surgeons are of the view that colorful and fun environment in dental clinic make the child at ease; 59 (29.5%) always demonstrate the dental procedure to the child to eradicate imaginary fears; 94 (47.0%) dental surgeons preferred the child to be treated in general anesthesia (GA) to avoid difficult behavior of the child; 135 (67.5%) dental surgeons did not show syringe needle or any instrument to the child. All the members of dental profession must be aware of patient perceptions, preferences, and fear to meet patient’s needs. Dental studies should include guidelines and techniques to train the upcoming dentists for excellent practice in pediatric dentistry. How to cite this article Wali A, Siddiqui TM, Khan R, Batool K. Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients. Int J Clin Pediatr Dent 2016;9(4):372-378. PMID:28127171

Dental fear and oral health and family characteristics of Finnish children.

PubMed

Rantavuori, Kari; Lahti, Satu; Hausen, Hannu; Seppä, Liisa; Kärkkäinen, Sakari

2004-08-01

Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. The subject groups were aged 3, 6, 9, 12, and 15 years in two middle-sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Dental fear was higher among 12- and 15-year-old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12-year-olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six- and 12-year-olds who had experienced caries were more likely to report dental fear than were caries-free children. Among 6-year-olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.

PubMed

Nair, Bala G; Newman, Shu-Fang; Peterson, Gene N; Wu, Wei-Ying; Schwid, Howard A

2010-11-01

Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized. Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system. In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010. Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved.

Vasoconstrictors in local anesthesia for dentistry.

PubMed Central

Sisk, A. L.

1992-01-01

Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects: a decrease in the peak plasma concentration of the local anesthetic agent, increase in the duration and the quality of anesthesia, reduction of the minimum concentration of anesthetic needed for nerve block, and decrease of blood loss during surgical procedures. The addition of a vasoconstrictor to a local anesthetic may also have detrimental effects. A review of the literature indicates that vasoconstrictor concentrations in local anesthetics marketed for dental use in the United States are not always optimal to achieve the purposes for which they are added. In most cases, a reduced concentration of vasoconstrictor could achieve the same goal as the marketed higher concentration, with less side-effect liability. PMID:8250339

When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry.

PubMed

Kleinhauz, M; Eli, I

1993-01-01

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.

A randomized control trial comparing the visual and verbal communication methods for reducing fear and anxiety during tooth extraction.

PubMed

Gazal, Giath; Tola, Ahmed W; Fareed, Wamiq M; Alnazzawi, Ahmad A; Zafar, Muhammad S

2016-04-01

To evaluate the value of using the visual information for reducing the level of dental fear and anxiety in patients undergoing teeth extraction under LA. A total of 64 patients were indiscriminately allotted to solitary of the study groups following reading the information sheet and signing the formal consent. If patient was in the control group, only verbal information and routine warnings were provided. If patient was in the study group, tooth extraction video was showed. The level of dental fear and anxiety was detailed by the patients on customary 100 mm visual analog scales (VAS), with "no dental fear and anxiety" (0 mm) and "severe dental distress and unease" (100 mm). Evaluation of dental apprehension and fretfulness was made pre-operatively, following visual/verbal information and post-extraction. There was a substantial variance among the mean dental fear and anxiety scores for both groups post-extraction (p-value < 0.05). Patients in tooth extraction video group were more comfortable after dental extraction than verbal information and routine warning group. For tooth extraction video group there were major decreases in dental distress and anxiety scores between the pre-operative and either post video information scores or postoperative scores (p-values < 0.05). Younger patients recorded higher dental fear and anxiety scores than older ones (P < 0.05). Dental fear and anxiety associated with dental extractions under local anesthesia can be reduced by showing a tooth extraction video to the patients preoperatively.

The impact of cardiovascular drugs on the efficacy of local anesthesia in dentistry.

PubMed

Milosavljevic, Мarko J; Jankovic, Slobodan M

2016-12-01

Drugs used chronically by patients with diseases of the cardiovascular system (group C of the ATC classification) may act on adrenergic receptors and/or certain ion channels, which gives them the potential to interact with the action of local dental anesthetics. The aim of the study was to investigate the effect of systemically administered chronic cardiovascular medication (oral route) on the efficacy of intraoral local anesthesia in patients with diseases of the cardiovascular system. This was a prospective cohort study which analyzed the efficacy of local terminal anesthesia (onset of anesthesia, duration anesthetized area) in the upper jaw of 70 patients: 40 patients on medication for cardiovascular system disorders and 30 patients who were not using these drugs (the control group). The following cardiovascular drugs were used: beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, vasodilatators, diuretics, angiotensin receptor blockers, antiarrhythmics, statins and alfa blockers. The onset of anesthesia on the vestibular side was faster in those taking cardiovascular drugs (40.50±19.87 s) than the control patients (58.93±31.07 s; P = 0.004) and duration of anesthesia on this side was shorter. Although the difference was not significant, it was evident that on vestibular and palatal side the anesthetized area was more rapidly reduced in the patients taking cardiovascular drugs. The duration of cardiovascular therapy also had a significant impact on the anesthetized area. Drugs acting on cardiovascular system may influence the effect of local anesthetics used in dentistry, possibly through interaction with autonomic receptors and ion channels.

Surgical removal of coronal fragment of tooth embedded in lower lip and esthetic management of fractured crown segment.

PubMed

Avinash, Alok; Dubey, Alok; Singh, Rajeev Kumar; Prasad, Swati

2014-01-01

Dental fractures of the permanent maxillary anterior teeth are relatively frequent accidents during childhood. The Efficient diagnosis and treatment of dental injury are important elements in clinical dentistry. This article describes a case of trauma in permanent right central maxillary incisors with tooth fragments embedded in the lower lip. Thorough clinical examination followed by soft tissue radiographs confirmed the presence of a fractured incisal fragment, which was surgically retrieved under local anesthesia. Direct composite restoration was placed. After finishing and polishing, an esthetic and natural-looking restoration was achieved; this completely satisfied the functional and esthetic expectation of the patient and dental team. How to cite this article: Avinash A, Dubey A, Singh RK, Prasad S. Surgical Removal of Coronal Fragment of Tooth Embedded in Lower Lip and Esthetic Management of Fractured Crown Segment. Int J Clin Pediatr Dent 2014;7(1):65-68.

Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach.

PubMed

Orellana, Lorena M; Martínez-Sanchis, Sonia; Silvestre, Francisco J

2014-04-01

The specific neuropsychological and sensory profile found in persons with autism spectrum disorders complicate dental procedures and as a result of this, most are treated under general anesthesia or unnecessary sedation. The main goal of the present study was to evaluate the effectiveness of a short treatment and education of autistic and related communication-handicapped children-based intervention program (five sessions) to facilitate a 10-component oral assessment in children (n = 38, aged 4-9 years) and adults (n = 34, aged 19-41) with autism spectrum disorder (with or without associated intellectual disability). The assessment ranges from entering into the examination room to the evaluation of the dental occlusion. There were statistically significant differences in the number of components reached and in compliance before and after the training program.

Survey of oral and maxillofacial surgeons' offices in Virginia: anesthesia team characteristics.

PubMed Central

Campbell, Robert L.; Fritz, Gabriel; Campbell, Jeffrey R.

2004-01-01

This survey assesses whether oral and maxillofacial surgeons in the state of Virginia are prepared for inspection of their offices. A survey asking pertinent questions on the availability of specific equipment and the educational qualifications of the anesthesia care team was developed and sent to 155 offices. Seven questions were asked regarding the availability of nurses, types of life support training, (formal or informal), the surgeons and anesthesia care personnel, and the presence of a defibrillator. Questionnaires were short and simple to encourage compliance with the study guidelines. A total of 128 (82.6%) questionnaires were returned. Only 42 of 128 (32.8%) offices employed nurses, and 6 of the 42 nurses were not considered as part of the anesthesia care team. Only 36 of 128 (28.1%) of the offices had assistants with formal anesthesia assistant course training from the American Association of Oral and Maxillofacial Surgeons (AAOMS) or the American Dental Society of Anesthesiology (ADSA). However, 93% of the assistants who participated in the anesthesia had current basic life support training (BLS) training, and 74% of the surgeons had current advanced cardiac life support (ACLS) training. The AAOMS Office Emergency Manual was present in 118 of 128 offices (92.2%), and 124 of 128 offices (96.9%) had defibrillators. The survey suggests that the surgeons are well prepared from the standpoint of having a defibrillator present and the AAOMS Office Emergency Manual available as a template for the team to use in order to answer questions that the inspection team may ask of the primary anesthesia care provider and surgeon. The majority of the surgeons had current ACLS certification, and the office anesthesia assistants had current BLS training. Most of the assistants did not have formal course training, which indicates that on-the-job training is probably the norm. Less than one third of the offices had nurses. PMID:15675260

Central Anticholinergic Syndrome due to Hypoxia-Induced Bradycardia in a Child with Difficult Intubation Undergoing Complete Dental Restoration: A Case Report.

PubMed

Gharavifard, Mohamad; Razavi, Majid; Ghandehari Motlagh, Mehdi; Ziyaeifard, Mohsen

2014-09-01

Central anticholinergic syndrome (CAS) following general anesthesia (GA) is a well known syndrome in children and adults. Many cases of CAS have been previously reported in the literature. However, there are only two reports of post resuscitation CAS after administration of small doses of atropine. Hereby, we report a case of CAS in a child undergoing complete dental restoration under GA after receiving a small dose of atropine to reverse hypoxia induced bradycardia. Intraoperative events such as hypoxia or cardiac arrest may play a role as triggers for CAS. However, we cannot establish a causal relationship between the occurrence of CAS and such critical events.

Endodontic applications of a short pulsed FR Nd:YAG dental laser: photovaporization of extruded pulpal tissue following traumatic fractures of two maxillary central incisors--a clinical trial repor

NASA Astrophysics Data System (ADS)

Gregg, Robert H., II

1992-06-01

Historically, many techniques have been attempted in the search for a satisfactory and consistent treatment of inflamed, painful, hyperemic pulpal tissue. Present techniques attempting to achieve profound local anesthesia in such tissue, have not been satisfactory. Local anesthesia techniques acceptable to the patient with painful hyperemic pulpal tissue, has eluded previous technology. The subsequent treatment of hyperemic tissue without sufficient anesthesia primarily involves undesirable invasive mechanical/surgical procedures. Described in this clinical trial is a technique using free running (FR) pulsed, Nd:YAG laser energy to ablate soft tooth pulpal tissue--a technique employed after conventional endodontic methods failed. A free running pulsed, FR Nd:YAG dental laser was successfully used at 20 pulses per second and 1.25 watts to photovaporize endodontic pulpal tissue (pulpectomy) to allow a conventional endodontic file to extirpate the remaining soft tissue remnants and access the root apex. Also described in this paper is the 'hot-tip' effect of contact fiber laser surgery. This clinical trial achieved the immediate, short term objective of endodontic soft tissue removal via photovaporization, without pain reported by the patient. The pulsed FR Nd:YAG dental laser used as described in this clinical report appears to be a very safe and very effective technique; offers a treatment alternative to traditional therapy that suggests high patient acceptance; and is significantly less stressful for the doctor and staff than traditional treatment options. Long-term, controlled scientific and clinical studies are necessary to establish the safety and efficacy of both the helium-neon energy for visualization and the low-watt pulsed FR Nd:YAG energy for photovaporization of soft endodontic pulpal tissue within the root canal. Research is especially needed to understand the effects of a low-watt, pulsed FR, Nd:YAG laser on the activity of osteoclasts and odontoclasts and identify risks for developing external and/or internal resorption after intracanal application of pulsed FR Nd:YAG laser energy.

Implementation of an Anesthesia Information Management System (AIMS)

PubMed Central

Douglas, James R.; Ritter, Melody J.

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges. PMID:21734847

Implementation of an Anesthesia Information Management System (AIMS).

PubMed

Douglas, James R; Ritter, Melody J

2011-01-01

During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. The AIMS facilitates chart entries such as drug doses and case narratives. Benefits of an AIMS include improved legibility of the anesthesia record and greater efficiency in documentation efforts. Use of the AIMS assists the practitioner with decision support logic, such as the timing of antibiotic administration and the inclusion of legally required documentation. Upon case completion, the AIMS data are immediately available to other information systems, such as billing and medical records. Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.

Perceived Dentist and Dental Hygienist Task Distribution After Dental and Dental Hygiene Students' Team Intervention.

PubMed

Reinders, Jan J; Krijnen, Wim P; Stegenga, Boudewijn; van der Schans, Cees P

2017-04-01

Attitudes of dental students regarding the provision of treatment tend to be dentist-centered; however, facilitating mixed student group formation could change such perceptions. The aim of this study was to investigate the perceived scope of practice of dental and dental hygiene students and whether their perceptions of task distribution between dentists and dental hygienists would change following an educational intervention consisting of feedback, intergroup comparison, and competition between mixed-group teams. The study employed a pretest-posttest single group design. Third-year dental students and second-year dental hygiene students at a university in The Netherlands were randomly assigned to intraprofessional teams (four or five members) and received team-based performance feedback and comparison. The intervention was finalized with an award ceremony for the best intraprofessional team. Before and after the intervention, students completed a questionnaire measuring their perceived distribution of ten tasks between dentists and dental hygienists. A total of 38 dental students and 32 dental hygiene students participated in the intervention-all 70 of those eligible. Questionnaires were completed by a total 88.4% (n=61) of the participants: 34 dental (89.5%) and 27 dental hygiene students (84.4%). Dental and dental hygiene students had similar perceptions regarding teeth cleaning (prophylaxis) (p=0.372, p=0.404) and, after the intervention, preventive tasks (p=0.078). Following the intervention, dental students considered four out of ten tasks as less dentist-centered: radiograph for periodontal diagnosis (p=0.003), local anesthesia (p=0.037), teeth cleaning (p=0.037), and periodontal treatment (p=0.045). Dental hygiene students perceived one task as being less dentist-centered after the intervention: radiograph for cariologic diagnosis (p=0.041). This study found that these dental and dental hygiene students had different opinions regarding the scope of practice for dentistry and dental hygiene. The number of redistributed tasks after the intervention was especially substantial among the dental students, although the amount of change per task was minimal. Half of all tasks were perceived as less dentist-centered as a result of the intervention.

[Clinical evaluation of Engström's electrically controlled ELSA for low flow closed circuit anesthesia].

PubMed

Igarashi, M; Nakae, Y; Ichimiya, N; Watanabe, H; Iwasaki, H; Namiki, A

1993-02-01

Many anesthesiologists are now interested in low flow, closed circuit anesthesia from an economical and environmental point of view. In order to evaluate clinically a newly developed electronically controlled anesthesia machine Engström's ELSA, we compared low flow, closed circuit anesthesia on 38 ASA I-II patients using ELSA, with high flow anesthesia on 12 ASA I-II patients using a conventional anesthesia machine. The results were as follows; 1. We could perform safe and economical low flow, closed circuit anesthesia using ELSA's injection vaporizer and accurate monitoring devices for O2, N2O, CO2 and concentrations of various volatile anesthetic agents. 2. Under low flow anesthesia, isoflurane consumption was 5.3 +/- 1.1 ml.h-1 x Vol.%-1 (mean +/- SE) with ELSA, which is about one fourth of the high flow anesthesia consumption (22.6 +/- 2.1 ml.h-1 x Vol.%-1 (mean +/- SE). 3. Low flow closed circuit anesthesia could maintain significantly higher temperature and humidity compared with high flow anesthesia. 4. Under low flow anesthesia of more than 7hrs, color of soda lime becomes blue, but this does not affect FIO2 nor PaCO2, and the method is clinically safe for patients.

Four common herbs seen in dental practice: properties and potential adverse effects.

PubMed

Shankland, Wesley E

2009-04-01

The use of herbal supplements in North America is steadily growing and raises concerns about safety, efficacy, and how they affect safe patient care. The most notable and direct health risks associated with herbal supplements include hypertension, prolonged bleeding, and the potential for drug-herb interactions, which is of particular concern for patients undergoing anesthesia, both general and local anesthesia. In this article, four of the most commonly used herbs today in North America will be discussed: garlic, gingko, ginseng, and ginger. The pharmacology, benefits, and possible side effects of these herbs will be presented. Awareness of the rising use of herbs is important to prevent, recognize, and treat potential problems that can arise from herbal preparations taken alone or in conjunction with prescription medications.

A Procedural Electroencephalogram Simulator for Evaluation of Anesthesia Monitors.

PubMed

Petersen, Christian Leth; Görges, Matthias; Massey, Roslyn; Dumont, Guy Albert; Ansermino, J Mark

2016-11-01

Recent research and advances in the automation of anesthesia are driving the need to better understand electroencephalogram (EEG)-based anesthesia end points and to test the performance of anesthesia monitors. This effort is currently limited by the need to collect raw EEG data directly from patients. A procedural method to synthesize EEG signals was implemented in a mobile software application. The application is capable of sending the simulated signal to an anesthesia depth of hypnosis monitor. Systematic sweeps of the simulator generate functional monitor response profiles reminiscent of how network analyzers are used to test electronic components. Three commercial anesthesia monitors (Entropy, NeuroSENSE, and BIS) were compared with this new technology, and significant response and feature variations between the monitor models were observed; this includes reproducible, nonmonotonic apparent multistate behavior and significant hysteresis at light levels of anesthesia. Anesthesia monitor response to a procedural simulator can reveal significant differences in internal signal processing algorithms. The ability to synthesize EEG signals at different anesthetic depths potentially provides a new method for systematically testing EEG-based monitors and automated anesthesia systems with all sensor hardware fully operational before human trials.

Photoelectron spectroscopic study on the electronic structures of the dental gold alloys and their interaction with L-cysteine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ogawa, Koji; Takahashi, Kazutoshi; Azuma, Junpei

The valence electronic structures of the dental gold alloys, type 1, type 3, and K14, and their interaction with L-cysteine have been studied by ultraviolet photoelectron spectroscopy with synchrotron radiation. It was found that the electronic structures of the type-1 and type-3 dental alloys are similar to that of polycrystalline Au, while that of the K14 dental alloy is much affected by Cu. The peak shift and the change in shape due to alloying are observed in all the dental alloys. It is suggested that the new peak observed around 2 eV for the L-cysteine thin films on all themore » dental alloys may be due to the bonding of S 3sp orbitals with the dental alloy surfaces, and the Cu-S bond, as well as the Au-S and Au-O bonds, may cause the change in the electronic structure of the L-cysteine on the alloys.« less

Use of bispectral index system (BIS) to Monitor Enteral Conscious (moderate) sedation during general dental procedures.

PubMed

Donaldson, Mark; Goodchild, Jason H

2009-12-01

Although dental board regulations for the provision of in-office enteral conscious (oral) sedation vary widely with respect to training and pharmacologic strategies, they agree on the use of drugs that are inherently safe, the use of pulse oximetry and the availability of emergency equipment, including pharmacologic antagonists. Patient safety is of greatest concern and is best addressed by appropriate selection of patients, adequate training of personnel and appropriate monitoring of patients. Readings from bispectral index system (BIS) monitors, which use electroencephalographic signals, correlate accurately with depth of sedation during nondissociative general anesthesia of adults and children in the operating room setting. The usefulness of such monitoring as an adjunct to other forms of monitoring of in-office enteral sedation in the dental setting may represent the next important application of this tool, adding a further level of safety for the patient and another level of predictability for the practitioner. This paper reviews the current evidence supporting this new technique, presenting data from 20 procedures in which BIS monitoring during in-office enteral sedation was employed in a community dental practice.

Cardiovascular diseases in dental practice. Practical considerations.

PubMed

Margaix Muñoz, María; Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Sarrión, Gracia

2008-05-01

Coronary heart disease is the principal cause of death in the industrialized world. Its most serious expression, acute myocardial infarction, causes 7.2 million deaths each year worldwide, and it is estimated that 20% of all people will suffer heart failure in the course of their lifetime. The control of risk cardiovascular factors, including arterial hypertension, obesity and diabetes mellitus is the best way to prevent such diseases. The most frequent and serious cardiovascular emergencies that can manifest during dental treatment are chest pain (as a symptom of underlying disease) and acute lung edema. Due to the high prevalence and seriousness of these problems, the dental surgeon must be aware of them and should be able to act quickly and effectively in the case of an acute cardiovascular event. In patients with a history of cardiovascular disease, attention must center on the control of pain, the reduction of stress, and the use or avoidance of a vasoconstrictor in dental anesthesia. In turn, caution is required in relation to the antiplatelet, anticoagulant and antihypertensive medication typically used by such patients.

PRENATAL DENTAL CARE: EVALUATION OF PROFESSIONAL KNOWLEDGE OF OBSTETRICIANS AND DENTISTS IN THE CITIES OF LONDRINA/PR AND BAURU/SP, BRAZIL, 2004

PubMed Central

Zanata, Régia Luzia; Fernandes, Karen Barros Parron; Navarro, Patrícia Silva Lopes

2008-01-01

The purpose of this study was to assess the current knowledge and recommendations of obstetricians and dentists as to the dental care to pregnant patients in the cities of Londrina/PR and Bauru/SP, Brazil. Questionnaires were distributed to professionals of both cities, arguing on the following issues: oral health during pregnancy; contact between prenatal care and dental care providers; prenatal fluoride supplementation; selection of therapeutic agents for local anesthesia, pain control and treatment of infection; and dental procedures that can be performed during each trimester. Data were analyzed by frequency of responses and statistical analyses were carried out using X2 (type of workplace/service) and t test (time since graduation), significant if p<0.05. Seventy-nine obstetricians and 37 dentists responded the questionnaires. Most physicians referred the patient to dental care only when a source of dental problem was mentioned, limiting the adoption of a preventive approach. Forty-three percent of dentists and 34% of obstetricians did not know the potential contribution of periodontal infection as a risk factor for preterm low birth-weight babies. There was divergence from scientific literature as to the recommendation of local anesthetics (dentists and obstetricians), prenatal fluoride supplementation (obstetricians) and dental radiographs (dentists). The findings of this survey with dentists and obstetricians showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care. PMID:19089217

Anatomy of the pterygomandibular space - clinical implication and review.

PubMed

Lipski, Marcin; Lipska, Weronika; Motyl, Sylwia; Gladysz, Tomasz; Iskra, Tomasz

2013-01-01

The aim of this study was to present review of the pterygomandibular space with some referrals to clinical practice, specially to the methods of lower teeth anesthesia. Pterygomandibular space is a clinically important region which is commonly missing in anatomical textbooks. More attention should be paid to it both from theoretical and practical point of view, especially in teaching the students of first year of dental studies.

Observed child and parent toothbrushing behaviors and child oral health

PubMed Central

COLLETT, BRENT R.; HUEBNER, COLLEEN E.; SEMINARIO, ANA LUCIA; WALLACE, ERIN; GRAY, KRISTEN E.; SPELTZ, MATTHEW L.

2018-01-01

Background Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking. Aim To examine associations between parent–child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS). Design One hundred children ages 18–60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia. Results Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age. Conclusions Parents’ child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions. PMID:26148197

Comparison of success rate and onset time of two different anesthesia techniques

PubMed Central

Haghighat, Abbas; Hasheminia, Dariush; Samandari, Mohammad-Hasan; Safarian, Vajihe; Davoudi, Amin

2015-01-01

Background Using local anesthetic is common to control the pain through blocking the nerve reversibly in dental procedures. Gow-Gates (GG) technique has a high success rate but less common. This study aimed to compare the onset time and success rate in GG and standard technique of inferior alveolar nerve block (IANB). Material and Methods This descriptive, single blind study was consisted of 136 patients (59 males and 77 females) who were randomly received GG or IANB for extraction of mandibular molar teeth. Comparisons between the successes of two anesthetic injection techniques were analyzed with Chi-square test. Incidence of pulpal anesthesia and soft tissue anesthesia were analyzed with Kaplan-Meier method. Mean onset times of pulpal anesthesia, soft tissue and lip numbness were analyzed with Log-Rank test. Comparisons were considered significant at P≤0.05 by using SPSS software ver.15. Results The incidence of pulpal anesthesia in the IANB group (canine 49.3%, premolar 60.3%) were not significantly different from the GG group (canine 41.3%, premolar 74.6%) (P=0.200 and P=0.723). The success rate in the IANB group (80.82%) was not significantly different from the GG group (92.02%) (P=0.123). Furthermore, onset time of lip and buccal soft tissue numbness in GG group (3.25, 4.96 minutes) was quite similar to IANB group (3.22, 4.89 minutes) (all Pvalues >0.05). Conclusions Although this study demonstrated higher clinical success rate for GG than IANB technique, no significant differences in success rates and onset time were observed between two techniques. Key words: Anesthesia, Inferior alveolar nerve, nerve block, success rate. PMID:25858085

Are anesthesia start and end times randomly distributed? The influence of electronic records.

PubMed

Deal, Litisha G; Nyland, Michael E; Gravenstein, Nikolaus; Tighe, Patrick

2014-06-01

To perform a frequency analysis of start minute digits (SMD) and end minute digits (EMD) taken from the electronic, computer-assisted, and manual anesthesia billing-record systems. Retrospective cross-sectional review. University medical center. This cross-sectional review was conducted on billing records from a single healthcare institution over a 15-month period. A total of 30,738 cases were analyzed. For each record, the start time and end time were recorded. Distributions of SMD and EMD were tested against the null hypothesis of a frequency distribution equivalently spread between zero and nine. SMD and EMD aggregate distributions each differed from equivalency (P < 0.0001). When stratified by type of anesthetic record, no differences were found between the recorded and expected equivalent distribution patterns for electronic anesthesia records for start minute (P < 0.98) or end minute (P < 0.55). Manual and computer-assisted records maintained nonequivalent distribution patterns for SMD and EMD (P < 0.0001 for each comparison). Comparison of cumulative distributions between SMD and EMD distributions suggested a significant difference between the two patterns (P < 0.0001). An electronic anesthesia record system, with automated time capture of events verified by the user, produces a more unified distribution of billing times than do more traditional methods of entering billing times. Copyright © 2014 Elsevier Inc. All rights reserved.

Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors.

PubMed

Nair, Bala G; Peterson, Gene N; Newman, Shu-Fang; Wu, Wei-Ying; Kolios-Morris, Vickie; Schwid, Howard A

2012-06-01

Continuation of perioperative beta-blockers for surgical patients who are receiving beta-blockers prior to arrival for surgery is an important quality measure (SCIP-Card-2). For this measure to be considered successful, name, date, and time of the perioperative beta-blocker must be documented. Alternately, if the beta-blocker is not given, the medical reason for not administering must be documented. Before the study was conducted, the institution lacked a highly reliable process to document the date and time of self-administration of beta-blockers prior to hospital admission. Because of this, compliance with the beta-blocker quality measure was poor (-65%). To improve this measure, the anesthesia care team was made responsible for documenting perioperative beta-blockade. Clear documentation guidelines were outlined, and an electronic Anesthesia Information Management System (AIMS) was configured to facilitate complete documentation of the beta-blocker quality measure. In addition, real-time electronic alerts were generated using Smart Anesthesia Messenger (SAM), an internally developed decision-support system, to notify users concerning incomplete beta-blocker documentation. Weekly compliance for perioperative beta-blocker documentation before the study was 65.8 +/- 16.6%, which served as the baseline value. When the anesthesia care team started documenting perioperative beta-blocker in AIMS, compliance was 60.5 +/- 8.6% (p = .677 as compared with baseline). Electronic alerts with SAM improved documentation compliance to 94.6 +/- 3.5% (p < .001 as compared with baseline). To achieve high compliance for the beta-blocker measure, it is essential to (1) clearly assign a medical team to perform beta-blocker documentation and (2) enhance features in the electronic medical systems to alert the user concerning incomplete documentation.

A randomized trial of automated electronic alerts demonstrating improved reimbursable anesthesia time documentation.

PubMed

Freundlich, Robert E; Barnet, Caryn S; Mathis, Michael R; Shanks, Amy M; Tremper, Kevin K; Kheterpal, Sachin

2013-03-01

To investigate whether alerting providers to errors results in improved documentation of reimbursable anesthesia care. Prospective randomized controlled trial. Operating room (OR) of a university hospital. Anesthesia cases were evaluated to determine whether they met the definition for appropriate anesthesia start time over 4 separate, 45-day calendar cycles: the pre-study period, study period, immediate post-study period, and 3-year follow-up period. During the study period, providers were randomly assigned to either a control or an alert group. Providers in the alert cohort received an automated alphanumeric page if the anesthesia start time occurred concurrently with the patient entering the OR, or more than 30 minutes before entering the OR. Three years after the intervention period, overall compliance was analyzed to assess learned behavior. Baseline compliance was 33% ± 5%. During the intervention period, providers in the alert group showed 87% ± 6% compliance compared with 41% ± 7% compliance in the control group (P < 0.001). Long-term follow-up after cessation of the alerts showed 85% ± 4% compliance. Automated electronic reminders for time-based billing charges are effective and result in improved ongoing reimbursement. Copyright © 2013 Elsevier Inc. All rights reserved.

Development of a module for point-of-care charge capture and submission using an anesthesia information management system.

PubMed

Reich, David L; Kahn, Ronald A; Wax, David; Palvia, Tanuj; Galati, Maria; Krol, Marina

2006-07-01

The use of electronic charge vouchers in anesthesia practice is limited, and the effects on practice management are unreported. The authors hypothesized that the new billing technology would improve the effectiveness of the billing interface and enhance financial practice management measures. A custom application was created to extract billing elements from the anesthesia information management system. The application incorporates business rules to determine whether individual cases have all required elements for a complete and compliant bill. The metrics of charge lag and days in accounts receivable were assessed before and after the implementation of the electronic charge voucher system. The average charge lag decreased by 7.3 days after full implementation. The total days in accounts receivable, controlling for fee schedule changes and credit balances, decreased by 10.1 days after implementation, representing a one-time revenue gain equivalent to 3.0% of total annual receipts. There are additional ongoing cost savings related to reduction of personnel and expenses related to paper charge voucher handling. Anesthesia information management systems yield financial and operational benefits by speeding up the revenue cycle and by reducing direct costs and compliance risks related to the billing and collection processes. The observed reductions in charge lag and days in accounts receivable may be of benefit in calculating the return on investment that is attributable to the adoption of anesthesia information management systems and electronic charge transmission.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sponseller, Patricia, E-mail: sponselp@uw.edu; Pelly, Nicole; Trister, Andrew

Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course.

Utilization of Dental General Anaesthesia for Children

PubMed Central

Karim, Zarina Abdul; Musa, Normaizura; Noor, Siti Noor Fazliah Mohd

2008-01-01

Dental treatment under general anaesthesia may be needed for some children and adolescents due to medical or behaviour problem. The objective of the study is to identify the type of treatment that has been carried out under GA in Hospital Universiti Sains Malaysia (HUSM). A retrospective record review study from hospital records of dental patients (under 18 years old) receiving dental treatment under GA from 2003 until 2007 were retrieved from the database. Information such as the reason for GA, and the type of treatment provided was recorded in data sheet. The data were analyzed using SPSS 12.0.1 for Windows. It was checked and verified for errors. A total of 349 cases were treated of which 43.6% had medical problems. Patients were mostly diagnosed to have rampant caries (77.1%) and some of them have behavioural problems (34.4%). Treatment pattern in deciduous dentition revealed more extraction (97.8%) as compared to restoration (75.7%) whereas in permanent dentition more restoration was done (24.3%) as compared to extraction (2.2%). Majority of the restorations were done using Glass Ionomer Cements (47.5%). Biopsy (4.3%) contributed mainly to the surgery (24.1%) done during GA. General anesthesia is necessary when dental disease is interfering with health and general well-being of patient and it can facilitated dental treatment allowing dentists to benefit from improved treatment conditions and provide a higher quality of care. PMID:22570587

Impact of early childhood caries and its treatment under general anesthesia on orofacial function and quality of life : A prospective comparative study.

PubMed

Collado, V; Pichot, H; Delfosse, C; Eschevins, C; Nicolas, E; Hennequin, M

2017-05-01

Early Childhood Caries (ECC) has become a major public health concern worldwide, mostly affecting children from disadvantaged families in increasingly severe forms. This condition has been frequently reported to alter children's nutrition, growth and general development. It negatively impacts their quality of life, through painful episodes and severe eating difficulties. While this period is crucial for oral praxes development, the impact of dental state on oro-facial functions is poorly documented. This study evaluated the impact of ECC and its treatment under general anesthesia on oro-facial functions and quality of life in pre-school children. The dysfunction and quality of life scores from 25 children with ECC were evaluated before treatment (T0), one month (T1) and three months after treatment (T2), using the Nordic Orofacial Test-Screening (NOT-S) and the Early Childhood Oral Health Impact Scale (ECOHIS), respectively, in comparison with 16 caries-free children. The number and extent of inter-arch dental contacts were also observed. The pre-operative higher NOT-S score observed in children with ECC decreased to reach the control level at T2. The mastication item was the most affected in the ECC group throughout the study. Their mean ECOHIS score also significantly decreased post-operatively and differences remaining between both groups were no longer clinically relevant. In addition, in children with ECC, values of functional inter-arch surfaces tended to increase over the follow-up period. Oro-facial functions and quality of life, altered by ECC, could be restored through a conservative treatment approach. Relations between dental state, orofacial functions and particularly chewing, and nutrition should be investigated further.

Implementation and Use of Anesthesia Information Management Systems for Non-operating Room Locations.

PubMed

Bouhenguel, Jason T; Preiss, David A; Urman, Richard D

2017-12-01

Non-operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Potent Inhalational Anesthetics for Dentistry

PubMed Central

Satuito, Mary; Tom, James

2016-01-01

Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings. PMID:26866411

Ocular complications associated with local anesthesia administration in dentistry.

PubMed

Boynes, Sean G; Echeverria, Zydnia; Abdulwahab, Mohammad

2010-10-01

The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol. Copyright © 2010 Elsevier Inc. All rights reserved.

In vivo evaluation of the effects of hydraulic calcium silicate dental cements on plasma and liver aluminium levels in rats.

PubMed

Demirkaya, Kadriye; Can Demirdöğen, Birsen; Öncel Torun, Zeynep; Erdem, Onur; Çetinkaya, Serdar; Akay, Cemal

2016-02-01

Our aim was to test whether the presence of three hydraulic calcium silicate dental cements--MTA Angelus, MTA Fillapex, and Theracal LC--in the dental extraction socket of an in vivo model, would affect the levels of aluminium (Al) in the plasma and liver. Following anesthesia, the right upper incisor of each male Wistar albino rat was extracted and polyethylene tubes filled with MTA Angelus, MTA Fillapex, or Theracal LC were inserted into the depth of the extraction socket and gingival tissue was sutured. The rats were killed 7, 30, or 60 d after the operation. Blood and liver samples were obtained from the rats before they were killed, and the levels of Al were measured by atomic absorption spectrometry. Plasma Al levels were higher in the rats in which the mineral trioxide aggregate (MTA) cements were implanted, especially MTA Angelus and MTA Fillapex, compared with control rats. In liver samples, however, the differences in Al level were not statistically significant. Our results show that Al might have been released into the circulation from the three dental cements tested, especially MTA Angelus and MTA Fillapex. Further research should be carried out on the possible biological effects of Al liberated from dental cements. © 2015 Eur J Oral Sci.

Perfusion Electronic Record Documentation Using Epic Systems Software.

PubMed

Riley, Jeffrey B; Justison, George A

2015-12-01

The authors comment on Steffens and Gunser's article describing the University of Wisconsin adoption of the Epic anesthesia record to include perfusion information from the cardiopulmonary bypass patient experience. We highlight the current-day lessons and the valuable quality and safety principles the Wisconsin-Epic model anesthesia-perfusion record provides.

Dental caries in rural Alaska Native children--Alaska, 2008.

PubMed

2011-09-23

In April 2008, the Arctic Investigations Program (AIP) of CDC was informed by the Alaska Department of Health and Social Services (DHSS) of a large number of Alaska Native (AN) children living in a remote region of Alaska who required full mouth dental rehabilitations (FMDRs), including extractions and/or restorations of multiple carious teeth performed under general anesthesia. In this remote region, approximately 400 FMDRs were performed in AN children aged <6 years in 2007; the region has approximately 600 births per year. Dental caries can cause pain, which can affect children's normal growth and development. AIP and Alaska DHSS conducted an investigation of dental caries and associated risk factors among children in the remote region. A convenience sample of children aged 4-15 years in five villages (two with fluoridated water and three without) was examined to estimate dental caries prevalence and severity. Risk factor information was obtained by interviewing parents. Among children aged 4-5 years and 12-15 years who were evaluated, 87% and 91%, respectively, had dental caries, compared with 35% and 51% of U.S. children in those age groups. Among children from the Alaska villages, those aged 4-5 years had a mean of 7.3 dental caries, and those aged 12-15 years had a mean of 5.0, compared with 1.6 and 1.8 dental caries in same-aged U.S. children. Of the multiple factors assessed, lack of water fluoridation and soda pop consumption were significantly associated with dental caries severity. Collaborations between tribal, state, and federal agencies to provide effective preventive interventions, such as water fluoridation of villages with suitable water systems and provision of fluoride varnishes, should be encouraged.

A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6-11-year-old children during local anesthesia administration-a novel approach.

PubMed

Melwani, Anjana M; Srinivasan, Ila; Setty, Jyothsna V; D R, Murali Krishna; Pamnani, Sunaina S; Lalitya, Dandamudi

2018-02-01

The sight of dental injection can bring about severe anxiety in children. Therefore, an alternative method that is convenient, effective, and keeps the needle hidden making it child friendly is necessary. The objective of the study was to compare the efficacy of a camouflaged syringe and conventional syringe on behavior and anxiety in 6-11-year-old children during local anesthesia administration. The study was a randomized, crossover clinical study including 30 children. Children were separated into two groups. Group 1 consisted of 15 children aged 6-8 years while group 2 consisted of 15 children aged 9-11 years. This study involved two sessions wherein all the children were injected using conventional and camouflaged syringes in separate sessions. Their behavior was assessed using the Faces, Legs, Activity, Cry, Consolability (FLACC) behavior pain scale and anxiety was assessed by measuring changes in pulse rate. Patient and operator preferences were compared. The results showed a lower mean change in pulse rate and FLACC scores in the camouflaged group, suggesting a positive behavior and lesser anxiety with camouflaged syringes than with conventional syringes. The use of camouflaged syringes for anesthesia was demonstrated to be effective in improving the behavior of children and decreasing their anxiety, and is therefore recommended as an alternative to the use of conventional syringes for local anesthesia.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis.

PubMed

Sood, Ravi; Hans, Manoj-Kumar; Shetty, Shashit

2014-12-01

This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient's subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis.

Comparison of anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis

PubMed Central

Sood, Ravi; Shetty, Shashit

2014-01-01

Objectives: This study was done to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in mandibular posterior teeth. Material and Methods: Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics, K.D. Dental College, randomly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine. After the patient’s subjective assessment of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale. Results: The pulpal anesthesia success for articaine (76%) was slightly more than with lidocaine (58%) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine (88%) was slightly more than that of lidocaine (82%) although the difference between the two solutions was not statistically significant. Conclusions: Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block. Key words:Anesthesia, articaine, lignocaine, pulpitis. PMID:25674319

Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

PubMed

Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

PubMed Central

Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

Practical applications of the diode in dental practice

NASA Astrophysics Data System (ADS)

Moldoveanu, Lucia E.; Odor, Alin A.

2016-03-01

Introduction: The use of lasers has become a practice in modern periodontology and it is a fact that the use of diodes in the dental office can bring a real benefit in periodontal surgery. Material and method: These case reports describe few of various soft tissue procedures that were performed with diode laser 940 nm (Epic 10, Biolase Inc., USA). Discussions: There are a few immediate benefits of the intervention: the "periodontal bandage" belongs to the patient, the procedure is painless, performed under a superficial anesthesia and the psychological impact on the patient, as well as the acceptance, are superior to conventional methods of dentistry. Conclusions: Diode lasers at the level of periodontium have become a significant part of the dentistry, reducing the patient's stress and giving satisfaction to practitioners as well.

Diode Laser Clinical Efficacy and Mini-Invasivity in Surgical Exposure of Impacted Teeth.

PubMed

Migliario, Mario; Rizzi, Manuela; Lucchina, Alberta Greco; Renò, Filippo

2016-11-01

The gold standard to arrange impacted teeth in the dental arch is represented by a surgical approach followed by orthodontic traction force application. In the literature, many surgical approaches are proposed to reach such a scope. The aim of the present study is to demonstrate how laser technique could positively assist surgical approaches.Study population was composed by 16 patients undergoing orthodontic treatment of 20 impacted teeth. In 10 patients (population A) surgical exposure of the impacted teeth was performed using a 980 nm diode laser, while in the other 10 patients (population B), surgical incision was performed using a traditional lancet.Only 3 patients of the population A needed local anesthesia for surgical procedure while the remaining 7 patients reported only faint pain during surgery. Two patients referred postsurgical pain (numerical rating scale average value = 2) and needed to take analgesics. None of the patients showed other postsurgical side effects (bleeding, edema).All population B patients needed infiltrative anesthesia and referred postsurgical pain (numerical rating scale average value >4) treated with analgesics. Moreover, in such population, 4 patients referred lips edema while 4 showed bleeding and 6 needed surgical sutures of soft tissues.The lack of side effects of laser surgical approach to expose impacted teeth must persuade dental practitioners to choose such a clinical approach to closed surgical approach every time it is possible.

Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs.

PubMed

Glassman, Paul; Caputo, Anthony; Dougherty, Nancy; Lyons, Ray; Messieha, Zakaria; Miller, Christine; Peltier, Bruce; Romer, Maureen

2009-01-01

Many people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."

Observed child and parent toothbrushing behaviors and child oral health.

PubMed

Collett, Brent R; Huebner, Colleen E; Seminario, Ana Lucia; Wallace, Erin; Gray, Kristen E; Speltz, Matthew L

2016-05-01

Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking. To examine associations between parent-child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS). One hundred children ages 18-60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia. Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age. Parents' child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Medical providers' dental information needs: a baseline survey.

PubMed

Acharya, Amit; Mahnke, Andrea; Chyou, Po-Huang; Rottscheit, Carla; Starren, Justin B

2011-01-01

Articulation of medical and dental practices has been strongly called for based on the many oral-systemic connections. With the rapid development and adoption of electronic health records, the feasibility of integrating medical and dental patient data should be strongly considered. The objective of this study was to develop an initial understanding of the medical providers' core dental information needs and opinion of integrated medical-dental electronic health record (iEHR) environment in their workflow. This was achieved by administering a 13 question survey to a group of 1,197 medical care providers employed by Marshfield Clinic in Wisconsin, United States. The survey received a response rate of 35%. The responses were analyzed based on provider 'Role' and 'Specialty'. The majority of the respondents felt the need for patient's dental information to coordinate or provide effective medical care. An integrated electronic health record environment could facilitate this holistic patient care approach.

Ethics and the electronic health record in dental school clinics.

PubMed

Cederberg, Robert A; Valenza, John A

2012-05-01

Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States

PubMed Central

Schroeder, Dixie; Schwei, Kelsey; Chyou, Po-Huang

2017-01-01

This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low. PMID:29229631

[Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

PubMed

Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

2015-04-01

Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

Various Strategies for Pain-Free Root Canal Treatment

PubMed Central

Parirokh, Masoud; V. Abbott, Paul

2014-01-01

Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia. PMID:24396370

Assessing the current state of dental informatics in saudi arabia: the new frontier.

PubMed

Al-Nasser, Lubna; Al-Ehaideb, Ali; Househ, Mowafa

2014-01-01

Dental informatics is an emerging field that has the potential to transform the dental profession. This study aims to summarize the current applications of dental informatics in Saudi Arabia and to identify the challenges facing expansion of dental informatics in the Saudi context. Search for published articles and specialized forum entries was conducted, as well as interviews with dental professionals familiar with the topic. Results indicated that digital radiography/analysis and administrative management of dental practice are the commonest applications used. Applications in Saudi dental education included: web-based learning systems, computer-based assessments and virtual technology for clinical skills' teaching. Patients' education software, electronic dental/oral health records and the potential of dental research output from electronic databases are yet to be achieved in Saudi Arabia. Challenges facing Saudi dental informatics include: lack of IT infrastructure/support, social acceptability and financial cost. Several initiatives are taken towards the research in dental informatics. Still, more investments are needed to fully achieve the potential of various application of informatics in dental education, practice and research.

[Financial and medicolegal impact of dental trauma].

PubMed

Bernasinski, M; Lepousé, C; Bankole, E; Rouche, O; Milloncourt, L; Leon, A

2012-03-01

Dental injuries are among the most common complications of general anesthesia. Yet few studies have assessed the costs and factors that involve the responsibility of the anesthetist. A retrospective study was conducted at the university hospital of Reims on 46 cases of dental injuries directly related to anaesthesia. Ten patients made a claim for compensation. Two of them have received compensation following a medical expertise, which revealed for the first patient a possible alternative to general anaesthesia, and the second, hardware failure of intubation. The Administrative Court was entered once in 9 years. The global insurance-cost amounts to 4476 euros for all patients. The review of all cases of anaesthesia shows clearly that the dental claims are associated with a significant under clinical evaluation of dental status and criteria for difficult intubation during the anaesthesia. The information to the patient on this risk is not obvious from reading the anaesthesia records. No mouth guard was used. This work proves that the statements of caution are the most common and a minority of dental trauma lead to a claim. Claims are due to the high cost of dental care repair. The proportion of patients receiving benefits is extremely low. Medical expertise is an essential part of the evaluation of medical responsibilities. No compensation was paid without expertise. The lack of physical examination and information are contrary to our professional obligations and may involve our responsibility. The lack of patient information is not generated for compensation to the extent that the consequences of failure are easily dental weighed against the benefits of the entire medical-surgical procedure that the patient has agreed. Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Antibiotic prophylaxis for children with sickle cell disease: a survey of pediatric dentistry residency program directors and pediatric hematologists.

PubMed

Tate, Anupama Rao; Norris, Chelita Kaye; Minniti, Caterina P

2006-01-01

The purposes of this study were to: (1) investigate the current clinical practice regarding the use of antibiotic prophylaxis by pediatric dentistry residency program directors and pediatric hematologists for children with sickle cell disease (SCD) requiring dental treatment; and (2) evaluate the perceived relative risk of bacteremia following specific dental procedures, as defined by pediatric dentistry residency program directors and pediatric hematologists. A written survey depicting various clinical scenarios of SCD children requiring common dental procedures was mailed to directors of pediatric dental advanced education programs and distributed to pediatric hematologists attending the 2003 Annual Sickle Cell Disease Association of America conference in Washington, DC. Surveys were returned by 60% (N=34/57) of the pediatric dentistry residency program directors. The surveys were obtained from 51% of pediatric hematologists at the meeting (N=72/140). At least 50% of all respondents recommended prophylaxis for the following clinical situations: dental extractions, treatment under general anesthesia, and status post splenectomy. The perceived risk of infectious complication was highest for extractions, followed by restorative treatment and tooth polishing. Dental residency program directors were more likely (71%, N=24/34) to recommend additional antibiotic therapy for patients taking penicillin prophylaxis if they required an invasive oral surgical procedure. Conversely, only 38% (N=25/66) of pediatric hematologists recommended additional antibiotic therapy (P=.001). Eighty-six percent of dental residency program directors (N=25/29) chose amoxicillin for prophylaxis whereas only 62% of pediatric hematologists (N=36/58) recommended amoxicillin. (P<.05). There is a lack of consensus on the appropriate use of antibiotic prophylaxis in SCD children undergoing dental treatments. Further research and risk/benefit assessment is needed to create a unified approach.

Perspectives on Canadian core fellowship training in pediatric anesthesia: a survey of graduate fellows.

PubMed

O'Leary, James D; Crawford, Mark W

2015-10-01

Educators in anesthesia have an obligation to ensure that fellowship programs are training anesthesiologists to meet the highest standards of performance in clinical and academic practice. The objective of this survey was to characterize the perspectives of graduates of Canadian core fellowship programs in pediatric anesthesia (during a ten-year period starting in 2003) on the adequacies and inadequacies of fellowship training. We conducted an electronic survey of graduates from eight departments of pediatric anesthesia in Canada who completed one-year core fellowship training in pediatric anesthesia from 2003 to 2013. A novel survey design was implemented, and the content and structure of the design were tested before distribution. Data were collected on respondents' demographics, details of training and practice settings, perceived self-efficacy in subspecialty practices, research experience, and perspectives on one-year core fellowship training in pediatric anesthesia. Descriptive statistics and 95% confidence intervals were determined. The survey was sent to 132 anesthesiologists who completed core fellowship training in pediatric anesthesia in Canada. Sixty-five (49%) completed and eligible surveys were received. Most of the anesthesiologists surveyed perceived that 12 months of core fellowship training are sufficient to acquire the knowledge and critical skills needed to practice pediatric anesthesia. Subspecialty areas most frequently perceived to require improved training included pediatric cardiac anesthesia, chronic pain medicine, and regional anesthesia. This survey reports perceived deficiencies in domains of pediatric anesthesia fellowship training. These findings should help guide the future development of core and advanced fellowship training programs in pediatric anesthesia.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study.

PubMed

Busato, Paloma; Garbín, Raíssa Rigo; Santos, Catielma Nascimento; Paranhos, Luiz Renato; Rigo, Lilian

2017-01-01

Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care. Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil. Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used. 40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%). Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

Accuracy of digital arm and wrist manometers: clinical implications for the dental hygienist.

PubMed

Furgeson, Danielle; Mickels-Foster, Nancy

2013-10-01

Utilization of digital manometers chairside is fast becoming a standard of care in dental hygiene education. It is imperative to ensure accurate blood pressure measurements regardless of modality to avoid medical emergencies in the dental chair. This study sought to determine the accuracy of the automated digital arm and wrist cuffs utilized by students in the University of Maine at Augusta, Bangor Campus Dental Health Programs' dental hygiene clinic. After institutional review board approval, 121 subjects were recruited, with 21 excluded for a total of 100 subjects. Subjects were randomly assigned to different test modalities upon check-in. Initial blood pressure measurements were taken with a calibrated aneroid control device by a principal investigator. A second measurement was taken with the randomized arm or wrist manometer 5 minutes later. Investigators were blinded to the modality of test manometer and measurements obtained from the second reading. All readings were taken according to manufacturers' instructions to ensure technique consistency. Data indicated lower readings for each modality from the control for both systolic and diastolic measurements. The differences in the systolic and diastolic readings for the wrist modality were significantly lower than the control with (p= 0.000) and (p=0.000), respectively. Automated digital manometers should be used with caution as a screening tool in the dental setting, particularly when administration of pharmacological agents such as local anesthesia may be used during the course of treatment. These automated modalities should not be used for patients with cardiac or hypertensive conditions.

Better informed in clinical practice - a brief overview of dental informatics.

PubMed

Reynolds, P A; Harper, J; Dunne, S

2008-03-22

Uptake of dental informatics has been hampered by technical and user issues. Innovative systems have been developed, but usability issues have affected many. Advances in technology and artificial intelligence are now producing clinically useful systems, although issues still remain with adapting computer interfaces to the dental practice working environment. A dental electronic health record has become a priority in many countries, including the UK. However, experience shows that any dental electronic health record (EHR) system cannot be subordinate to, or a subset of, a medical record. Such a future dental EHR is likely to incorporate integrated care pathways. Future best dental practice will increasingly depend on computer-based support tools, although disagreement remains about the effectiveness of current support tools. Over the longer term, future dental informatics tools will incorporate dynamic, online evidence-based medicine (EBM) tools, and promise more adaptive, patient-focused and efficient dental care with educational advantages in training.

DFT-MD simulations of shocked Xenon

NASA Astrophysics Data System (ADS)

Magyar, Rudolph J.; Mattsson, Thomas R.

2009-03-01

Xenon is not only a technologically important element used in laser technologies, jet propulsion and dental anesthesia, but it is also arguably the simplest material in which to study the metal-insulator transition at high pressure. Because of its closed shell electronic configuration, Xenon is often assumed to be chemically inert, interacting almost entirely through the van der Waals interaction, and at liquid density, is typically modeled well using Leonard-Jones potentials. However, such modeling has a limited range of validity as Xenon is known to form compounds at normal conditions and likely exhibits considerably more chemistry at higher densities when hybridization of occupied orbitals becomes significant. In this talk, we present DFT-MD simulations of shocked liquid Xenon with the goal of developing an improved equation of state. The relative importance of the van der Waals interaction compared to other Coulomb interactions is considered, and estimates of the relative accuracy of various density functionals are quantified. Sandia is a multiprogram laboratory operated by Sandia Corporation, a Lockheed Martin Company, for the United States Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.

Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial.

PubMed

Kämmerer, P W; Schneider, D; Palarie, V; Schiegnitz, E; Daubländer, M

2017-01-01

The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen. The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine. For mandibular tooth extraction, articaine 2 % may be used as alternative as well.

[Development and clinical evaluation of an anesthesia information management system].

PubMed

Feng, Jing-yi; Chen, Hua; Zhu, Sheng-mei

2010-09-21

To study the design, implementation and clinical evaluation of an anesthesia information management system. To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. With the system, kinds of patient data could be collected, stored, analyzed and archived, kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provide clinical proof.

Preventive and invasive treatment in special needs patients: a German retrospective study.

PubMed

Rothmaier, Katrin; Bücher, Katharina; Metz, Isabel; Pitchika, Vinay; Hickel, Reinhard; Heinrich-Weltzien, Roswitha; Kühnisch, Jan

2017-05-01

Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d 3/4 mft/0.9 D 3/4 MFT) than in ODC (2.5 d 3/4 mft /0.9 D 3/4 MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

PubMed

Staberg, Marie; Norén, Jörgen G; Johnson, Mats; Kopp, Svenny; Robertson, Agneta

2014-01-01

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

Factors involved in dental surgery fires: a review of the literature.

PubMed

VanCleave, Andrea M; Jones, James E; McGlothlin, James D; Saxen, Mark A; Sanders, Brian J; Walker, LaQuia A

2014-01-01

Surgical fires are well-characterized, readily preventable, potentially devastating operating room catastrophes that continue to occur from 20 to 100 times per year or, by one estimate, up to 600 times per year in US operating rooms, sometimes with fatal results. The most significant risk factors for surgical fires involve (a) the use of an ignition source, such as laser or electrocautery equipment, in or around an oxygen-enriched environment in the head, neck, and upper torso area and (b) the concurrent delivery of supplemental oxygen, especially via nasal cannula. Nonetheless, while these 2 conditions occur very commonly in dental surgery, especially in pediatric dental surgery where sedation and anesthesia are regularly indicated, there is a general absence of documented dental surgical fires in the literature. Barring the possibility of underreporting for fear of litigation, this may suggest that there is another mechanism or mechanisms present in dental or pediatric dental surgery that mitigates this worst-case risk of surgical fires. Some possible explanations for this include: greater fire safety awareness by dental practitioners, incidental ventilation of oxygen-enriched environments in patient oral cavities due to breathing, or suction used by dental practitioners during procedures. This review of the literature provides a background to suggest that the practice of using intraoral suction in conjunction with the use of supplemental oxygen during dental procedures may alter the conditions needed for the initiation of intraoral fires. To date, there appear to be no published studies describing the ability of intraoral suctioning devices to alter the ambient oxygen concentration in an intraoral environment. In vivo models that would allow examination of intraoral suction on the ambient oxygen concentration in a simulated intraoral environment may then provide a valuable foundation for evaluating the safety of current clinical dental surgical practices, particularly in regard to the treatment of children.

Effectiveness of Self-Hypnosis on the Relief of Experimental Dental Pain: A Randomized Trial.

PubMed

Wolf, Thomas Gerhard; Wolf, Dominik; Below, Dagna; d'Hoedt, Bernd; Willershausen, Brita; Daubländer, Monika

2016-01-01

This randomized, controlled clinical trial evaluates the effectiveness of self-hypnosis on pain perception. Pain thresholds were measured, and a targeted, standardized pain stimulus was created by electrical stimulation of the dental pulp of an upper anterior tooth. Pain stimulus was rated by a visual analogue scale (VAS). The pain threshold under self-hypnosis was higher (57.1 ± 17.1) than without hypnotic intervention (39.5 ± 11.8) (p < .001). Pain was rated lower on the VAS with self-hypnosis (4.0 ± 3.8) than in the basal condition without self-hypnosis (7.1 ± 2.7) (p < .001). Self-hypnosis can be used in clinical practice as an adjunct to the gold standard of local anesthesia for pain management, as well as an alternative in individual cases.

Unilateral Vision Loss after a Dental Visit

PubMed Central

Khattab, Mohammed H.; Wiegand, Annette; Storch, Marcus; Hoerauf, Hans; Feltgen, Nicolas

2018-01-01

Intraoral local anesthetics are widely used for performing painless dental treatments; however, in some cases, they may cause ocular complications such as meiosis, diplopia, nystagmus, ophthalmoplegia, ptosis, and amaurosis. Mostly, the symptoms disappear after several hours; rarely, they have a prolonged character. We describe the case of a 38-year-old young man who had reduced vision in the left eye 5 days after having received intraoral local anesthesia. A diagnosis of cilioretinal artery occlusion with optic disc swelling was made. Ten weeks later, the patient's visual acuity had increased to 20/20, and the swelling of the optic disc had subsided. Although various possible mechanisms for ocular complications after intraoral local anesthetic administration were suggested in the literature, the exact etiology remains unclear. In this case, inadvertent intravascular injection is believed to be the cause. PMID:29681838

A survey of user acceptance of electronic patient anesthesia records

PubMed Central

Jin, Hyun Seung; Lee, Suk Young; Jeong, Hui Yeon; Choi, Soo Joo; Lee, Hye Won

2012-01-01

Background An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administered to anesthesiologists, trainees, and nurses during February 2011 and the responses were collected anonymously during March 2011. Results A total of 28 anesthesiologists, 27 trainees, and 47 nurses responded to this survey. Most participants involved in this survey were satisfied with AIMS (96.3%, 82.2%, and 89.3% of trainees, anesthesiologists, and nurses, respectively) and preferred AIMS over handwritten anesthesia records in 96.3%, 71.4%, and 97.9% of trainees, anesthesiologists, and nurses, respectively. However, there were also criticisms of AIMS related to user-discomfort during short, simple or emergency surgeries, doubtful legal status, and inconvenient placement of the system. Conclusions Overall, most of the anesthetic practitioners in this hospital quickly accepted and prefer AIMS over the handwritten anesthetic records in the OR. PMID:22558502

Characteristics of patients with autistic disorder (AD) presenting for dental treatment: a survey and chart review.

PubMed

Klein, U; Nowak, A J

1999-01-01

A group of 43 patients with AD (mean age, 13.5; SD, 5.9 yrs) was identified from the University Hospital School Pediatric Dentistry Clinic. We reviewed the patients' charts to obtain demographic data, dental findings, and the management techniques used for treatment. The patients were divided into groups according to Frankl's categories of behavior, ranging from definitely negative to positive. Descriptive data are provided for each group. Commonly used communications and pharmacological management techniques, as well as physical restraints, enabled us to treat all the patients in the traditional dental setting, when simple procedures were planned. Treatment under general anesthesia in the operating room was necessary in 37% of all patients when comprehensive care was required or difficult procedures were carried out. A questionnaire was also sent out to the caregivers to gather data on patients' nutrition and eating/chewing habits. In the sample surveyed, two-thirds of the individuals reportedly exhibited a normal eating pattern, while 14% pouched food. Soft, sweet, or sticky foods were preferred by 41% of the patients.

Accidental aspiration in a patient with Parkinson's disease during implant-supported prosthesis construction: a case report.

PubMed

Deliberador, Tatiana Miranda; Marengo, Gláucia; Scaratti, Rodrigo; Giovanini, Allan Fernando; Zielak, João César; Baratto Filho, Flares

2011-01-01

This article reports on a case history of an elderly patient with Parkinson's disease (PD) who sought treatment at a private dental office. His chief complaint was "difficulty in eating due to an illfitting prosthesis." Laboratory tests and oral radiographs were made. The surgical placement of an implant was done and, subsequently, an implant-supported prosthesis was fitted for the patient. During the impression for the construction of the implant-supported prosthesis, the patient accidentally aspirated the implant screwdriver. The object was found in the lower right lobe of the bronchus, and its removal was necessary in a hospital using bronchoscopy under general anesthesia. Patients with PD are considered at risk of aspirating and/or ingesting dental instruments. Short treatment periods are recommended, preferably during the morning, when the medication prescribed for PD is most effective. When treating patients who have a risk for aspirating and ingesting small objects, it is important to treat them in a more vertical position, and small-sized objects should be secured with dental floss to aid retrieval. © 2011 Special Care Dentistry Association and Wiley Periodicals, Inc.

Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

PubMed

Davidovich, E; Pessov, Y; Baniel, A; Ram, D

2015-01-01

To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

Development of a mobile device optimized cross platform-compatible oral pathology and radiology spaced repetition system for dental education.

PubMed

Al-Rawi, Wisam; Easterling, Lauren; Edwards, Paul C

2015-04-01

Combining active recall testing with spaced repetition increases memory retention. The aim of this study was to evaluate and compare students' perception and utilization of an electronic spaced repetition oral pathology-radiology system in dental hygiene education and predoctoral dental education. The study employed an open-source suite of applications to create electronic "flashcards" that can be individually adjusted for frequency of repetition, depending on a user's assessment of difficulty. Accessible across multiple platforms (iOS, Android, Linux, OSX, Windows) as well as via any web-based browser, this framework was used to develop an oral radiology-oral pathology database of case-based questions. This system was introduced in two courses: sophomore oral pathology for dental students and sophomore radiology for dental hygiene students. Students were provided free software and/or mobile tablet devices as well as a database of 300 electronic question cards. Study participants were surveyed on frequency and extent of use. Perception-based surveys were used to evaluate their attitudes towards this technology. Of the eligible students, 12 of 22 (54.5%) dental hygiene and 49 of 107 (45.8%) dental students responded to the surveys. Adoption rates and student feedback were compared between the two groups. Among the respondents, acceptance of this technology with respect to educational usefulness was similar for the dental and dental hygiene students (median=5 on a five-point scale; dental hygiene interquartile range (IQR)=0; dental IQR=1). Only a minority of the survey respondents (25% dental, 33% dental hygiene) took advantage of one of the main benefits of this technology: automated spaced repetition.

Dental Hygienist-Led Chronic Disease Management System to Control Early Childhood Caries.

PubMed

Ng, Man Wai; Fida, Zameera

2016-06-01

Management of the complex chronic disease of early childhood caries requires a system of coordinated health care interventions which can be led by a dental hygienist and where patient self-care efforts are paramount. Even after receiving costly surgical treatment under general anesthesia in the operating room, many children develop new and recurrent caries after only 6-12 months, a sequela that can be prevented. This article describes the chronic disease management (CDM) of dental caries, a science-based approach that can prevent and control caries. In this article, we (1) introduce the concept of CDM of dental caries, (2) provide evidence that CDM improves oral health outcomes, and (3) propose a dental hygienist-led team-based oral health care approach to CDM. Although we will be describing the CDM approach for early childhood caries, CDM of caries is applicable in children, adolescents, and adults. Early childhood caries disease control requires meaningful engagement of patients and parents by the oral health care team to assist them with making behavioral changes in the unique context of their families and communities. The traditional dentist/hygienist/assistant model needs to evolve to a collaborative partnership between care providers and patients/families. This partnership will be focused on systematic risk assessment and behaviorally based management of the disease itself, with sensitivity toward the familial environment. Early pilot study results demonstrate reductions in the rates of new caries, dental pain, and referral to the operating room compared with baseline rates. Dental hygienists are the appropriate team members to lead this approach because of their expertise in behavior change and prevention. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Maxillary segmental distraction in children with unilateral clefts of lip, palate, and alveolus.

PubMed

Zemann, Wolfgang; Pichelmayer, Margit

2011-06-01

Alveolar clefts are commonly closed by a bone grafting procedure. In cases of wide clefts the deficiency of soft tissue in the cleft area may lead to wound dehiscence and loss of the bony graft. Segmental maxillary bony transfer has been mentioned to be useful in such cases. Standard distraction devices allow unidirectional movement of the transported segment. Ideally the distraction should strictly follow the dental arch. The aim of this study was to analyze distraction devices that were adapted to the individual clinical situation of the patients. The goal was to achieve a distraction strictly parallel to the dental arch. Six children with unilateral clefts of lip, palate, and alveolus between 12 and 13 years of age were included in the study. The width of the cleft was between 7 and 19 mm. Dental cast models were used to manufacture individual distraction devices that should allow a segmental bony transport strictly parallel to the dental arch. Segmental osteotomy was performed under general anesthesia. Distraction was started 5 days after surgery. All distracters were tooth fixed but supported by palatal inserted orthodontic miniscrews. In all patients, a closure of the alveolar cleft was achieved. Two patients required additional bone grafting after the distraction procedure. The distraction was strictly parallel to the dental arch in all cases. In 1 case a slight cranial displacement of the transported maxillary segment could be noticed, leading to minor modifications of the following distractors. Distraction osteogenesis is a proper method to close wide alveolar clefts. Linear segmental transport is required in the posterior part of the dental arch, whereas in the frontal part the bony transport should run strictly parallel to the dental arch. An exact guided segmental transport may reduce the postoperative orthodontic complexity. Copyright © 2011 Mosby, Inc. All rights reserved.

The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments

PubMed Central

Kaviani, Nasser; Ashrafi, Sanaz; Jabbarifar, Seyed Ebrahim; Ghaffari, Elham

2015-01-01

Statement of the Problem Some children do not show an appropriate cooperation with their dentist. A number of them cannot be managed by local anesthesia and the usual techniques used to control behaviors, so further steps are required to control their pain and anxiety. Pharmaceutical control is recommended through sedation or general anesthesia. Purpose This study was aimed to evaluate two groups of drugs in intravenous sedation method. Materials and Method In this clinical trial intervention study, patients were randomly divided into two groups of 18 and 20 and each group received either intravenous midazolam-ketamine or midazolam-fentanyl. During the procedure, 0.25mg midazolam was administered to both groups if needed. The scores of intraoperative sedation and operation conditions were evaluated and recorded by dental sedation teacher groups (DSTG) system in the 10th, 20th, 30th and 40th minutes of the operation. The results were analyzed by SPSS (version 16) using independent T-test, Wilcoxon, Mann-Whitney and Pearson Chi-Square tests as appropriated. Results There was no significant difference between the two groups in sedation period (p= 0.55), recovery time (p= 0.18), Frankl score (p= 0.83(, score of intraoperative sedation and operating conditions (p> 0.05), and sedation complications (p= 0.612). In addition, no complication occurred in recovery. Conclusion There was no significant difference between the two drug groups; both were appropriate in controlling children’s behavior. PMID:26106632

Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia?

PubMed

Chang, Juhea; Kim, Hae-Young

2014-11-01

The aim of this study was to correlate the caries-related variables of special needs patients to the incidence of new caries. Data for socio-demographic information and dental and general health status were obtained from 110 patients treated under general anesthesia because of their insufficient co-operation. The Cariogram program was used for risk assessment and other caries-related variables were also analyzed. Within a defined follow-up period (16.3 ± 9.5 months), 64 patients received dental examinations to assess newly developed caries. At baseline, the mean (SD) values of the DMFT (decayed, missing and filled teeth) and DT (decayed teeth) for the total patients were 9.2 (6.5) and 5.8 (5.3), respectively. During the follow-up period, new caries occurred in 48.4% of the patients and the mean value (SD) of the increased DMFT (iDMFT) was 2.1 (4.2). The patients with a higher increment of caries (iDMFT ≥3) showed significantly different caries risk profiles compared to the other patients (iDMFT <2) (p < 0.05). Close correlations existed between the caries increment and several caries-related variables; baseline DMFT, insufficient self-tooth-brushing and malocclusion were greatly associated with new caries development. Caries risk assessment could predict the incidence of future caries in hospital-based dentistry. Past caries experience and inadequate oral hygiene maintenance were largely related to caries development in special needs patients.

An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study.

PubMed

Setty, Madhavi; Montagnese, Thomas A; Baur, Dale; Aminoshariae, Anita; Mickel, Andre

2014-09-01

Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Intraoperative non-record-keeping usage of anesthesia information management system workstations and associated hemodynamic variability and aberrancies.

PubMed

Wax, David B; Lin, Hung-Mo; Reich, David L

2012-12-01

Anesthesia information management system workstations in the anesthesia workspace that allow usage of non-record-keeping applications could lead to distraction from patient care. We evaluated whether non-record-keeping usage of the computer workstation was associated with hemodynamic variability and aberrancies. Auditing data were collected on eight anesthesia information management system workstations and linked to their corresponding electronic anesthesia records to identify which application was active at any given time during the case. For each case, the periods spent using the anesthesia information management system record-keeping module were separated from those spent using non-record-keeping applications. The variability of heart rate and blood pressure were also calculated, as were the incidence of hypotension, hypertension, and tachycardia. Analysis was performed to identify whether non-record-keeping activity was a significant predictor of these hemodynamic outcomes. Data were analyzed for 1,061 cases performed by 171 clinicians. Median (interquartile range) non-record-keeping activity time was 14 (1, 38) min, representing 16 (3, 33)% of a median 80 (39, 143) min of procedure time. Variables associated with greater non-record-keeping activity included attending anesthesiologists working unassisted, longer case duration, lower American Society of Anesthesiologists status, and general anesthesia. Overall, there was no independent association between non-record-keeping workstation use and hemodynamic variability or aberrancies during anesthesia either between cases or within cases. Anesthesia providers spent sizable portions of case time performing non-record-keeping applications on anesthesia information management system workstations. This use, however, was not independently associated with greater hemodynamic variability or aberrancies in patients during maintenance of general anesthesia for predominantly general surgical and gynecologic procedures.

[Comparison of long-term dental treatment effects of children treated under general anesthesia and passive restraint].

PubMed

Zhou, F; Xia, B; Zhang, S; Ma, W L; Xiao, Y M; Ge, L H

2017-02-09

Objective: To compare the long-term dental treatment effects, oral health habits and oral-health-related qualities of life of children treated under general anesthesia (GA) and passive restraint (PR), respectively. Methods: Twenty seven 2 to 4-year-old children treated under GA and thirty four children treated under PR were recruited in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. Up to 2 years after the treatment, a follow up assessment was conducted. The data of general information, dental plaque level and the unplanned treatments were recorded and analyzed. The questionnaire of oral health habits and early childhood oral health impact scale (ECOHIS) for each child was also completed and analyzed. The survival rate and median survival time of the deciduous teeth were calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: Twenty-five children under GA and 32 under PR were finally included, with a total of 1 098 deciduous teeth. The postoperative dental plaque indicesin both GA and PR groups had significantly improved than that of before the treatments ( P= 0.019, P< 0.001). The oral health habits had also improved, and the improvement in PR group was more obvious than that in GA group. Totally 128 teeth (27.0%) appeared unplanned treatments in GA group and 232 teeth (37.2%) in PR group during the follow-ups. The new caries and recurrent caries in PR group were significantly more than that in GA group ( P< 0.001, P= 0.012). No significant differences were found between the two groups in restoration failure, secondary caries and endodontic diseases ( P= 0.129, P= 0.822, P= 0.642). However, the time of occurrence of endodontic disease and secondary caries in GA group were significantly longer than that in PR group ( P< 0.01, P< 0.001). The median survival time of teeth in GA group was 1 018 days comparing to 944 days in PR group. The difference was statistically significant ( P< 0.05). The survival rate was associated with such factors as decayed-missing-filled tooth (dmft), anterior or posterior teeth, feeding frequency, brushing habits and behavior management techniques. Conclusions: The long-term dental treatment effects of children treated under GA was significantly better than that of PR group. Continuous reinforcement of proper dietary and oral hygiene habits might help in maintaining the long-term treatment effect.

45 CFR 162.1102 - Standards for health care claims or equivalent encounter information transaction.

Code of Federal Regulations, 2014 CFR

2014-10-01

....) (ii) Dental health care claims. The ASC X12 Standards for Electronic Data Interchange Technical Report... Care Claim: Dental (837) ASC X12 Standards for Electronic Date Interchange Technical Report Type 3... care claims. The ASC X12 Standards for Electronic Data Interchange Technical Report Type 3—Health Care...

Death related to dental treatment: a systematic review.

PubMed

Reuter, Nathan G; Westgate, Philip M; Ingram, Mark; Miller, Craig S

2017-02-01

The aim of this study was to identify factors associated with death in relation to dental care. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Dental and Oral Sciences Source, Web of Science, and the Cochrane database were searched, and the references of all retrieved articles were analyzed. Studies were included if death had occurred within 90 days of the dental appointment, and if the patient's age, procedure, and information regarding cause or time of death were provided. Factors associated with death were assessed by multivariate analyses and logistic regression. Fifty-six publications, including retrospective studies and case reports/series that reported 148 fatalities, were analyzed. On average, 2.6 deaths were reported per year. The leading cause of deaths was anesthesia/sedation/medication-related complications (n = 70). Other causes were cardiovascular events (n = 31), infection (n = 19), airway-respiratory complications (n = 18), bleeding (n = 5), and others (n = 5). Age (P < .0001), disease severity (P < .02), disease stability (P < .006), dental provider characteristics (P < .05), level of consciousness/sedation (P < .02), and drug effects (P < .03) had significant associations with death. Reports of death were rare; however, specific risk factors associated with dentistry were identified. A better understanding of these factors is important for the development of guidelines that help prevent fatalities in dentistry. Copyright © 2016 Elsevier Inc. All rights reserved.

Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation

PubMed Central

Shin, Sooil

2017-01-01

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR. PMID:28879331

Nanorobots: Future in dentistry

PubMed Central

Shetty, Neetha J.; Swati, P.; David, K.

2013-01-01

The purpose of this paper is to review the phenomenon of nanotechnology as it might apply to dentistry as a new field called nanodentistry. Treatment possibilities might include the application of nanotechnology to local anesthesia, dentition renaturalization, the permanent cure for hypersensitivity, complete orthodontic realignment in a single visit, covalently bonded diamondized enamel, and continuous oral health maintenance using mechanical dentifrobots. Dental nanorobots could be constructed to destroy caries-causing bacteria or to repair tooth blemishes where decay has set in, by using a computer to direct these tiny workers in their tasks. Dental nanorobots might be programed to use specific motility mechanisms to crawl or swim through human tissue with navigational precision, to acquire energy, to sense and manipulate their surroundings, to achieve safe cytopenetration, and to use any of a multitude of techniques to monitor, interrupt, or alter nerve-impulse traffic in individual nerve cells in real time. PMID:23960556

Dental treatment in patients with severe gag reflex using propofol-remifentanil intravenous sedation.

PubMed

Shin, Sooil; Kim, Seungoh

2017-03-01

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.

Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions

PubMed Central

Gazal, Giath; Alharbi, Rashdan; Fareed, Wamiq Musheer; Omar, Esam; Alolayan, Albraa Badr; Al-Zoubi, Hassan; Alnazzawi, Ahmad A.

2017-01-01

Objective: To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions. Materials and Methods: Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm). Results: There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P < 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P <0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth. Conclusions: BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth. PMID:28442952

Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study

PubMed Central

Sunada, Katsuhisa

2015-01-01

Background Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. Methods Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. Results The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). Conclusions The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain. PMID:28879260

Advantages of anterior inferior alveolar nerve block with felypressin-propitocaine over conventional epinephrine-lidocaine: an efficacy and safety study.

PubMed

Shinzaki, Hazuki; Sunada, Katsuhisa

2015-06-01

Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.

Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults.

PubMed

Hersh, Elliot V; Moore, Paul A; Papas, Athena S; Goodson, J Max; Navalta, Laura A; Rogy, Siegfried; Rutherford, Bruce; Yagiela, John A

2008-08-01

The authors conducted two multicenter, randomized, double-blinded, controlled Phase III clinical trials to study the efficacy and safety of phentolamine mesylate (PM) in shortening the duration and burden of soft-tissue anesthesia. The study involved 484 subjects who received one of four commercially available local anesthetic solutions containing vasoconstrictors for restorative or scaling procedures. On completion of the dental procedure, subjects randomly received a PM or a sham injection (an injection in which a needle does not penetrate the soft tissue) in the same site as the local anesthetic injection. The investigators measured the duration of soft-tissue anesthesia by using standardized lip- and tongue-tapping procedures every five minutes for five hours. They also evaluated functional measures and subject-perceived altered function, sensation, appearance and safety. Median recovery times in the lower lip and tongue for subjects in the PM group were 70 minutes and 60 minutes, respectively. Median recovery times in the lower lip and tongue for subjects in the sham group were 155 minutes and 125 minutes, respectively. Upper lip median recovery times were 50 minutes for subjects in the PM group and 133 minutes for subjects in the sham group. These differences were significant (P < .0001). Recovery from actual functional deficits and subject-perceived altered function, sensation and appearance also showed significant differences between the PM and the sham groups. PM was efficacious and safe in reducing the duration of local anesthetic- induced soft-tissue numbness and its associated functional deficits. Clinicians can use PM to accelerate reversal of soft-tissue anesthesia and the associated functional deficits.

A novel lidocaine hydrochloride ophthalmic gel for topical ocular anesthesia

PubMed Central

Shah, HR; Reichel, E; Busbee, BG

2010-01-01

Topical anesthetics play an important role in the practice of ophthalmology, both for procedures in the office and in the operating room. The need for safe, long-acting topical ocular anesthetic agents is ongoing, and has been highlighted by the increase of intravitreal administration of pharmacologic agents. Current practices for ocular anesthesia include subconjunctival injection of 2% aqueous lidocaine, topical 2% lidocaine drops and topical 0.5% tetracaine. Tetracaine is not yet FDA approved, and is associated with corneal epithelial toxicity and delayed epithelial healing after multiple administrations. Lidocaine jelly (2%) preparations have been reported to be beneficial in several systemic procedures, including those of the upper airway, dental, urogenital, and gastrointestinal. It has been theorized, and recent studies support the idea, that gel formulations of lidocaine may enhance anesthetic effect, and therefore be superior to anesthetic solutions for topical cataract surgery. The viscous nature of gel formulations is thought to lengthen contact time, resulting in better anesthesia at lower drug concentrations. Furthermore, several studies suggest that lidocaine is bactericidal and bacteriostatic, and may have a supplementary role in preventing and treating surgical site infections. Akten™, lidocaine 3.5% gel (Akorn, Buffalo Grove, IIlinois) was FDA approved for all ophthalmic procedures in October 2008. This gel is a preservative-free, lidocaine-based anesthetic gel consisting of 35 mg/mL of lidocaine hydrochloride. We describe the properties, including chemical structure, indications, evidence of support, use, adverse effects, and precautions, which we believe enable Akten to provide superior anesthesia, while minimizing side effects. PMID:22915870

The awareness and attitudes of students of one indian dental school toward information technology and its use to improve patient care.

PubMed

Jathanna, Vinod R; Jathanna, Ramya V; Jathanna, Roopalekha

2014-01-01

Many obstacles need to be overcome if digital and electronic technologies are to be fully integrated in the operation of dental clinics in some countries. These obstacles may be physical, technical, or psychosocial barriers in the form of perceptions and attitudes related to software incompatibilities, patient privacy, and interference with the patient-practitioner relationship. The objectives of the study are to assess the perceptions of Indian dental students of one school toward the usefulness of digital technologies in improving dental practice; their willingness to use digital and electronic technologies; the perceived obstacles to the use of digital and electronic technologies in dental care setups; and their attitudes toward Internet privacy issues. The study population consisted of 186 final year undergraduate dental students from the A. B. Shetty Memorial institute of Dental Sciences, Rajiv Gandhi University of Health Sciences, Mangalore, India. Survey data were analyzed descriptively . Most students indicated that information technology enhances patient satisfaction, the quality of dental record, diagnosis, treatment planning, and doctor-doctor communication. Cost of equipment and need for technical training were regarded as major obstacles by substantial proportions of respondents. Most dental students at our school feel that the information technology will support their decision making in diagnoses and devising effective treatment plans, which in turn increase patient satisfaction and quality of care. Students also perceived that lack of technical knowledge and the high cost of implementation are major barriers to developing information technology in India.

Collaborative teaching models for health professionals.

PubMed

Falk-Kessler, Janet; Macrae, Nancy; Dyer, Jean

2005-01-01

Multidisciplinary faculty collaboration within the health professions educational system is explored. The definitions for the concepts of intradisciplinary, multidisciplinary, interdisciplinary and transdisciplinary faculty teams are provided along with the strengths and weaknesses of collaborative teaching and course development across various health profession programs. Examples of these teaching models are described using case studies to illustrate collaborative course development by faculty from Occupational Therapy, Nursing, Physician Assistant, Social Work and Dental Hygiene, Nurse Anesthesia, and Health Services Management programs offered at the University of New England in Portland, Maine, United States of America.

The National Anesthesia Clinical Outcomes Registry.

PubMed

Liau, Adrian; Havidich, Jeana E; Onega, Tracy; Dutton, Richard P

2015-12-01

The Anesthesia Quality Institute (AQI) was chartered in 2008 by the American Society of Anesthesiologists to develop the National Anesthesia Clinical Outcomes Registry (NACOR). In this Technical Communication, we will describe how data enter NACOR, how they are authenticated, and how they are analyzed and reported. NACOR accepts case-level administrative, clinical, and quality capture data from voluntarily participating anesthesia practices and health care facilities in the United States. All data are transmitted to the AQI in summary electronic files generated by billing, quality capture, and electronic health care record software, typically on a monthly basis. All data elements are mapped to fields in the NACOR schema in accordance with a publicly available data dictionary. Incoming data are loaded into NACOR by AQI technologists and are subject to both manual and automated review to identify systematically missing elements, miscoding, and inadvertent corruption. Data are deidentified in compliance with Health Insurance Portability and Accountability Act regulations. The database server of AQI, which houses the NACOR database, is protected by 2 firewalls within the American Society of Anesthesiologists' network infrastructure; this system has not been breached. The NACOR Participant User File, a deidentified case-level dataset of information from NACOR, is available to researchers at participating institutions. NACOR architecture and the nature of the Participant User File include both strengths and weaknesses.

Electronic Dental Records System Adoption.

PubMed

Abramovicz-Finkelsztain, Renata; Barsottini, Claudia G N; Marin, Heimar Fatima

2015-01-01

The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community.

Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network

PubMed Central

Schleyer, Titus; Song, Mei; Gilbert, Gregg H.; Rindal, D. Brad; Fellows, Jeffrey L.; Gordan, Valeria V.; Funkhouser, Ellen

2012-01-01

Objectives Determine the: (1) extent of computer use for managing clinical information among practitioner-investigators in The Dental Practice-Based Research Network (DPBRN); (2) type of patient information kept electronically; and (3) willingness to reuse electronic dental record (EDR) data for research. Methods Web-based survey of 991 U.S. and Scandinavian practitioner-investigators. Results 729 (74%) practitioner-investigators responded. Seventy-four percent of US solo and 78.7% of group practitioners used a computer to manage clinical information, and 14.3% and 15.9%, respectively, were paperless. U.S. practitioners stored appointments, treatment plans, completed treatment and images most often electronically, and the periodontal chart, diagnoses, medical history, progress notes and chief complaint least often. Over 90% of Scandinavian practitioners stored all information electronically. Fifty-one percent of all respondents were willing to re-use EDR data for research and 63% preferred electronic forms for data collection. Conclusion The results of this study demonstrate that the trend towards increased adoption of EDRs in the US is continuing, potentially making more data in electronic form available for research. Respondents appear to be willing to reuse EDR data for research and collect data electronically. Clinical implications The rising adoption of EDRs may offer increased opportunities for reusing electronic data for quality assurance and research. PMID:23283926

Electron microscopy of octacalcium phosphate in the dental calculus.

PubMed

Kakei, Mitsuo; Sakae, Toshiro; Yoshikawa, Masayoshi

2009-12-01

The purpose of this study was to morphologically demonstrate the presence of octacalcium phosphate in the dental calculus by judging from the crystal lattice image and its rapid transformation into apatite crystal, as part of our serial studies on biomineral products. We also aimed to confirm whether the physical properties of octacalcium phosphate are identical with those of the central dark lines observed in crystals of ordinary calcifying hard tissues. Electron micrographs showed that crystals of various sizes form in the dental calculus. The formation of each crystal seemed to be closely associated with the organic substance, possibly originating from degenerated microorganisms at the calcification front. Many crystals had an 8.2-A lattice interval, similar to that of an apatite crystal. Furthermore, some crystals clearly revealed an 18.7-A lattice interval and were vulnerable to electron bombardment. After electron beam exposure, this lattice interval was quickly altered to about half (i.e. 8.2 A), indicating structural conversion. Consequently, a number of apatite crystals in the dental calculus are possibly created by a conversion mechanism involving an octacalcium phosphate intermediate. However, we also concluded that the calcification process in the dental calculus is not similar to that of ordinary calcifying hard tissues.

Scanning Electron Microscopic Evaluation of Several Resharpening Techniques.

DTIC Science & Technology

1982-08-19

AD-AI20 320 ARMY INST OF DENTAL RESEARCH WASHINGTON OC F/6 6/5 SCANNING ELECTRON MICROSCOPIC EVALUATION OF SEVERAL RESHARPENIN-ETC(U) UNLASSIFIE D...NIT NUMBERS US Army Institute of Dental Research Walter Reed Army Medical Center N/A Washington, DC 20012 it. CONTROLLING OFFICE NAME AND ADORESS I...several resharpening techniques by Donald J. DeNucci, DDS, MS and Carson L. Mader, DMD, MSD United States Army Institute of Dental Research Walter Reed

Efficacy of Ketamine in Pediatric Sedation Dentistry: A Systematic Review.

PubMed

Oh, Samuel; Kingsley, Karl

2018-05-01

Ketamine has been used as a safe and effective sedative to treat adults and children exhibiting high levels of anxiety or fear during dental treatment. Pediatric dentistry often involves patients with high levels of anxiety and fear and possibly few positive dental experiences. Patient management can involve behavioral approaches, as well as the use of sedation or general anesthesia with a variety of agents, including midazolam, diazepam, hydroxyzine, meperidine, and ketamine. The aim of this study was to investigate the clinical efficacy of ketamine use in pediatric sedation dentistry through systematic review and analysis. A systematic review of publications between 1990 and 2015 was conducted using PubMed and MEDLINE databases maintained by the US National Library of Medicine and the National Institutes of Health. The keywords used were (ketamine) AND (dental OR dentistry) AND (sedation). The abstract and title of all potential publications were then screened for clinical trials and to remove non-English articles, non-human or animal trials, and other non-dental or non-relevant studies. A total of 1,657 citations were initially identified, reviewed, and screened, eventually resulting in inclusion of 25 clinical trials in this systematic review. Nineteen studies evaluated ketamine effects in pediatric dental sedation using oral (non-invasive) administration, three involved subcutaneous or intramuscular injection, and three were completed intravenously. Evidence analysis of these trials revealed the majority (n = 22/25) provided strong, positive evidence for the use of ketamine (alone or in combination) to reduce dental anxiety and behavioral non-compliance with the remainder suggesting equivocal results. Additional endpoints evaluated in some studies involved dosage, as well as time to achieve sedation effect. The use of ketamine (alone or in combination) can provide safe, effective, and timely sedation in pediatric patients regardless of the route of administration.

Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records.

PubMed

Ramoni, Rachel B; Asher, Sheetal R; White, Joel M; Vaderhobli, Ram; Ogunbodede, Eyitope O; Walji, Muhammad F; Riedy, Christine; Kalenderian, Elsbeth

2016-06-01

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

Prevalence of Gastroesophageal Reflux in Cats During Anesthesia and Effect of Omeprazole on Gastric pH.

PubMed

Garcia, R S; Belafsky, P C; Della Maggiore, A; Osborn, J M; Pypendop, B H; Pierce, T; Walker, V J; Fulton, A; Marks, S L

2017-05-01

Gastroesophageal reflux (GER) is poorly characterized in anesthetized cats, but can cause aspiration pneumonia, esophagitis, and esophageal stricture formation. To determine whether pre-anesthetic orally administered omeprazole increases gastric and esophageal pH and increases serum gastrin concentrations in anesthetized cats, and to determine the prevalence of GER using combined multichannel impedance and pH monitoring. Twenty-seven healthy cats undergoing elective dental procedures. Prospective, double-masked, placebo-controlled, randomized clinical trial. Cats were randomized to receive 2 PO doses of omeprazole (1.45-2.20 mg/kg) or an empty gelatin capsule placebo 18-24 hours and 4 hours before anesthetic induction. Blood for measurement of serum gastrin concentration was collected during anesthetic induction. An esophageal pH/impedance catheter was utilized to continuously measure esophageal pH and detect GER throughout anesthesia. Mean gastric pH in the cats that received omeprazole was 7.2 ± 0.4 (range, 6.6-7.8) and was significantly higher than the pH in cats that received the placebo 2.8 ± 1.0 (range, 1.3-4.1; P < .001). Omeprazole administration was not associated with a significant increase in serum gastrin concentration (P = .616). Nine of 27 cats (33.3%) had ≥1 episode of GER during anesthesia. Pre-anesthetic administration of 2 PO doses of omeprazole at a dosage of 1.45-2.20 mg/kg in cats was associated with a significant increase in gastric and esophageal pH within 24 hours, but was not associated with a significant increase in serum gastrin concentration. Prevalence of reflux events in cats during anesthesia was similar to that of dogs during anesthesia. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Review article: practical current issues in perioperative patient safety.

PubMed

Eichhorn, John H

2013-02-01

This brief review provides an overview and, importantly, a context perspective of relevant current practical issues in perioperative patient safety. The dramatic improvement in anesthesia patient safety over the last 30 years was not initiated by electronic monitors but, rather, largely by a set of behaviours known as "safety monitoring" that were then made decidedly more effective by extending the human senses through electronic monitoring, for example, capnography and pulse oximetry. In the highly developed world, this current success is threatened by complacency and production pressure. In some areas of the developing/underdeveloped world, the challenge is implementing the components of anesthesia practice that will bring safety improvements to parallel the overall current success, for instance, applying the World Federation of Societies of Anaesthesiologists (WFSA) "International Standards for A Safe Practice of Anaesthesia". Generally, expanding the current success in safety involves many practical issues. System issues involve research, effective reporting mechanisms and analysis/broadcasting of results, perioperative communication (including "speaking up to power"), and checklists. Monitoring issues involve enforcing existing published monitoring standards and also recognizing the risk of danger to the patient from hypoventilation during procedural sedation and from postoperative intravenous pain medications. Issues of clinical care include medication errors in the operating room, cerebral hypoperfusion (especially in the head-up position), dangers of airway management, postoperative residual weakness from muscle relaxants, operating room fires, and risks specific in obstetric anesthesia. Recognition of the issues outlined here and empowerment of all anesthesia professionals, from the most senior professors and administrators to the newest practitioners, should help maintain, solidify, and expand the improvements in anesthesia and perioperative patient safety.

Dental Caries Experience in Texan Children with Cleft Lip and Palate.

PubMed

Sunderji, Sabrina; Acharya, Bhavini; Flaitz, Catherine; Chiquet, Brett

2017-09-15

The purpose of this study was to assess the caries experience in the primary dentition of children born with cleft lip and palate (CLP). A retrospective chart review was conducted on subjects between two and six years old recruited from a university-based pediatric dentistry residency clinic. The number of dental visits and professional fluoride applications, the plaque index and treatment modality, and the presence/location of caries, white spot lesions, and enamel hypoplastic lesions were compared between CLP patients and healthy age- and gender-matched controls. Descriptive statistics, Student's t test, Mann-Whitney U test, and regression analysis were completed. A total of 183 charts were reviewed. Compared to healthy children, CLP children had increases in number of dental visits (P<0.001), decayed-missing-filled surfaces (dmfs; P<0.001), decayed-missing-filled teeth (dmft; P<0.001), enamel hypoplastic lesions (P=0.003), treatment completed under general anesthesia (P<0.001), plaque score (P<0.001), and caries increment between baseline and most recent oral examination (P=0.003). Regression analysis revealed a positive association between age and dmft scores within the CLP group (P=0.018). The caries experience of unilateral and bilateral CLP cases was the same (P>0.05). Children with cleft lip and palate are at a greater risk of enamel hypoplasia and dental caries. No significant caries experience difference was found between unilateral or bilateral CLP cases.

Medical care providers' perspectives on dental information needs in electronic health records.

PubMed

Acharya, Amit; Shimpi, Neel; Mahnke, Andrea; Mathias, Richard; Ye, Zhan

2017-05-01

The authors conducted this study to identify the most relevant patient dental information in a medical-dental integrated electronic health record (iEHR) necessary for medical care providers to inform holistic treatment. The authors collected input from a diverse sample of 65 participants from a large, regional health system representing 13 medical specialties and administrative units. The authors collected feedback from participants through 11 focus group sessions. Two independent reviewers analyzed focus group transcripts to identify major and minor themes. The authors identified 336 of 385 annotations that most medical care providers coded as relevant. Annotations strongly supporting relevancy to clinical practice aligned with 18 major thematic categories, with the top 6 categories being communication, appointments, system design, medications, treatment plan, and dental alerts. Study participants identified dental data of highest relevance to medical care providers and recommended implementation of user-friendly access to dental data in iEHRs as crucial to holistic care delivery. Identification of the patients' dental information most relevant to medical care providers will inform strategies for improving the integration of that information into the medical-dental iEHR. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

The effect of music distraction on pain, anxiety and behavior in pediatric dental patients.

PubMed

Aitken, Jennifer Creem; Wilson, Stephen; Coury, Daniel; Moursi, Amr M

2002-01-01

The purpose of this study was to determine if audio distraction could decrease patient anxiety, pain and disruptive behavior during pediatric dental procedures. Forty-five children between the ages of 4 to 6 years had two visits each involving restorative dentistry with local anesthesia in a mandibular quadrant. Visit #1 was a baseline session for all patients. During visit #2, the children were assigned to either an upbeat music group, a relaxing music group or a no music group. Variables measured were: (1) parent-reported anxiety via the Modified Corah Anxiety Scale, (2) self-reported anxiety via the Venham picture scale, (3) heart rate, (4) behavior via the North Carolina Behavior Rating Scale and (5) pain via a visual analogue scale. No significant differences were found among the three groups during experimental visit #2 across any variables. A majority of patients (90%) stated that they enjoyed the music and would like to listen to it during their next visit. Audio distraction was not an effective means of reducing anxiety, pain or uncooperative behavior during pediatric restorative dental procedures. However, patients did enjoy listening to the music during their visits.

Parental attitudes regarding behavior guidance of dental patients with autism.

PubMed

Marshall, Jennifer; Sheller, Barbara; Mancl, Lloyd; Williams, Bryan J

2008-01-01

The purposes of this study were to evaluate: (1) parents' ability to predict dental treatment cooperation by their autistic child; (2) behavior guidance techniques (BGTs) used during treatment; and (3) parental attitudes regarding basic and advanced BGTs. Data were collected from 85 parent/autistic child pairs and their dentists using surveys and treatment records. Parents most accurately predicted if their child would permit an examination in the dental chair (> or = 88%) and would cooperate for radiographs (> or = 84%). BGTs utilized most often (> 50%) were positive verbal reinforcement (PVR), tell-show-do (TSD), mouthprops, and rewards. In general, basic BGTs were more acceptable (> 81%) than advanced BGTs (>54%). The most acceptable techniques (>90%) in order were: PVR, TSD, distraction, rewards, general anesthesia, hand-holding by parent, and mouth-props. When parents evaluated only BGTs used for their child, all BGTs, including a stabilization device, were highly acceptable (> 91%), except for staff restraint (74%). Parents were accurate in predicting cooperation for some procedures. The most acceptable and efficacious BGTs in order were: PVR, TSD, distraction, rewards, and hand-holding by parent. Parental perceptions of BGTs were influenced by whether or not they had been used for their child.

Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery.

PubMed

Broussard, David M; Couch, Michael C

2011-10-01

This study was designed to answer the question of whether the experience level of the resident on his/her first month of adult cardiothoracic anesthesiology has an impact on operating room efficiency in a large academic medical center. Traditionally, the resident's 1st month of cardiac anesthesia had been reserved for the clinical anesthesia (CA)-2 year of training. This study analyzed the impact on operating room efficiency of moving the 1st month of cardiac anesthesia into the CA-1 year. The authors hypothesized that there would be no difference in anesthesia preparation times (defined as the interval between "in-room" and "anesthesia-ready" times) between CA-1 and CA-2 residents on their 1st month of cardiac anesthesia. This study was retrospective and used an electronic anesthesia information management system database. This study was conducted on care provided at a single 450-bed academic medical center. This study included 12 residents in their 1st month of cardiac anesthesia. The anesthesia preparation time (defined as the interval between "in-room" and "anesthesia-ready" times) was measured for cases involving residents on their first month of cardiac anesthesia. Anesthesia preparation times for 6 CA-1 resident months and 6 CA-2 resident months (100 adult cardiac procedures in total) were analyzed (49 for the CA-1 residents and 51 for the CA-2s). There were no differences in preparation time between CA-1 and CA-2 residents as a group (p = 0.8169). The CA-1 residents had an unadjusted mean (±standard error) of 51.1 ± 3.18 minutes, whereas the CA-2 residents' unadjusted mean was 50.2 ± 2.41 minutes. Adjusting for case mix (valves v coronary artery bypass graft surgery), the CA-1 mean was 49.1 ± 5.22 minutes, whereas the CA-2 mean was 49.1 ± 4.54 minutes. These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia. Copyright © 2011 Elsevier Inc. All rights reserved.

Current applications of big data in obstetric anesthesiology.

PubMed

Klumpner, Thomas T; Bauer, Melissa E; Kheterpal, Sachin

2017-06-01

The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers.

PubMed

Whitworth, John Martin; Kanaa, Mohammad Dib; Corbett, Ian Porter; Meechan, John Gerald

2007-10-01

This randomized, double-blind trial tested the null hypothesis that speed of deposition has no influence on the injection discomfort, efficacy, distribution, and duration of pulp anesthesia after incisive/mental nerve block in adult volunteers. Thirty-eight subjects received incisive/mental nerve blocks of 2.0 mL lidocaine with 1:80,000 epinephrine slowly over 60 seconds or rapidly over 15 seconds at least 1 week apart. Pulp anesthesia was assessed electronically to 45 minutes after injection. Injection discomfort was self-recorded on visual analogue scales. Overall, 48.7% of volunteers developed pulp anesthesia in first molars, 81.8% in bicuspids, and 38.5% in lateral incisors. The mean duration of pulp anesthesia was 19.1 minutes for first molars, 28.5 minutes for bicuspids, and 19.0 minutes for lateral incisors. Speed of injection had no significant influence on anesthetic success or duration of anesthesia for individual teeth. Slow injection was significantly more comfortable than rapid injection (P < .001). The null hypothesis was supported, although slow injection was more comfortable.

Use of Electronic Versus Print Textbooks by Chilean Dental Students: A National Survey.

PubMed

Aravena, Pedro Christian; Schulz, Karen; Parra, Annemarie; Perez-Rojas, Francisco; Rosas, Cristian; Cartes-Velásquez, Ricardo

2017-03-01

Electronic textbooks have become available in recent decades as replacements or alternatives for print versions. The aim of this descriptive cross-sectional study was to evaluate the use of electronic versus print textbooks by Chilean dental students. The target population was students from 14 Chilean dental schools. The questionnaire was adapted and translated to Spanish from a previous survey used in a similar study. It consisted of the following variables: preferred type, type used, frequency of use, source, electronic devices used to read, and disposal after use. The use of textbooks was analyzed and compared by gender and course (p≤0.05). The final sample consisted of 3,256 students (21.38±2.5 years of age, 50.8% women). Most of the participants reported using both types of texts, with most (63.9%) preferring print over electronic texts, including significantly more women (p<0.001) and first-year students (p<0.001). Most of the participants (82.8%), more women (p<0.001), and with variations over years of study (p<0.001) reported that they printed out their electronic texts, and 91.8% kept their printed material. Most of the students used electronic books on a daily basis (47.3%) or at least twice a week (30.7%). The main source of electronic textbooks was the Internet (43.8%). A personal computer was the most widely used device for reading electronic texts (95.0%), followed by a cell phone (46.4%) and a tablet (24.5%). Overall, these Chilean dental students preferred print over electronic textbooks, despite having available electronic devices.

Legal issues of the electronic dental record: security and confidentiality.

PubMed

Szekely, D G; Milam, S; Khademi, J A

1996-01-01

Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor.

An ontology-based method for secondary use of electronic dental record data.

PubMed

Schleyer, Titus Kl; Ruttenberg, Alan; Duncan, William; Haendel, Melissa; Torniai, Carlo; Acharya, Amit; Song, Mei; Thyvalikakath, Thankam P; Liu, Kaihong; Hernandez, Pedro

2013-01-01

A key question for healthcare is how to operationalize the vision of the Learning Healthcare System, in which electronic health record data become a continuous information source for quality assurance and research. This project presents an initial, ontology-based, method for secondary use of electronic dental record (EDR) data. We defined a set of dental clinical research questions; constructed the Oral Health and Disease Ontology (OHD); analyzed data from a commercial EDR database; and created a knowledge base, with the OHD used to represent clinical data about 4,500 patients from a single dental practice. Currently, the OHD includes 213 classes and reuses 1,658 classes from other ontologies. We have developed an initial set of SPARQL queries to allow extraction of data about patients, teeth, surfaces, restorations and findings. Further work will establish a complete, open and reproducible workflow for extracting and aggregating data from a variety of EDRs for research and quality assurance.

Effects of Hypotensive Anesthesia on Reducing Intraoperative Blood Loss, Duration of Operation, and Quality of Surgical Field During Orthognathic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PubMed

Lin, Susie; McKenna, Samuel J; Yao, Chuan-Fong; Chen, Yu-Ray; Chen, Chit

2017-01-01

The objective of this study was to evaluate the efficacy of hypotensive anesthesia in reducing intraoperative blood loss, decreasing operation time, and improving the quality of the surgical field during orthognathic surgery. A systematic review and meta-analysis of randomized controlled trials addressing these issues were carried out. An electronic database search was performed. The risk of bias was evaluated with the Jadad Scale and Delphi List. The inverse variance statistical method and a random-effects model were used. Ten randomized controlled trials were included for analysis. Our meta-analysis indicated that hypotensive anesthesia reduced intraoperative blood loss by a mean of about 169 mL. Hypotensive anesthesia was not shown to reduce the operation time for orthognathic surgery, but it did improve the quality of the surgical field. Subgroup analysis indicated that for blood loss in double-jaw surgery, the weighted mean difference favored the hypotensive group, with a reduction in blood loss of 175 mL, but no statistically significant reduction in blood loss was found for anterior maxillary osteotomy. If local anesthesia with epinephrine was used in conjunction with hypotensive anesthesia, the reduction in intraoperative blood loss was increased to 254.93 mL. Hypotensive anesthesia was effective in reducing blood loss and improving the quality of the surgical field, but it did not reduce the operation time for orthognathic surgery. The use of local anesthesia in conjunction with hypotensive general anesthesia further reduced the amount of intraoperative blood loss for orthognathic surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of regional anesthesia on the success rate of external cephalic version: a systematic review and meta-analysis.

PubMed

Goetzinger, Katherine R; Harper, Lorie M; Tuuli, Methodius G; Macones, George A; Colditz, Graham A

2011-11-01

To estimate whether the use of regional anesthesia is associated with increased success of external cephalic version. We searched MEDLINE, EMBASE, the Cochrane Library, and clinical trial registries. Electronic databases were searched from 1966 through April 2011 for published, randomized controlled trials in the English language comparing regional anesthesia with no regional anesthesia for external cephalic version. The primary outcome was external cephalic version success. Secondary outcomes included cesarean delivery, maternal discomfort, and adverse events. Pooled risk ratios (relative risk) were calculated using a random-effects model. Heterogeneity was assessed using the Cochran's Q statistic and quantified using the I Z method. Six randomized controlled trials met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared with intravenous or no analgesia (59.7% compared with 37.6%; pooled relative risk 1.58; 95% confidence interval [CI] 1.29-1.93). This significant association persisted when the data were stratified by type of regional anesthesia (spinal compared with epidural). The number needed to treat with regional anesthesia to achieve one additional successful external cephalic version was five. There was no evidence of statistical heterogeneity (P=.32, I Z=14.9%) or publication bias (Harbord test P=.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia with intravenous or no analgesia (48.4% compared with 59.3%; pooled relative risk 0.80; 95% CI 0.55-1.17). Adverse events were rare and not significantly different between the two groups. Regional anesthesia is associated with a higher success rate of external cephalic version.

Anesthesia Practice in Pediatric Radiation Oncology: Mayo Clinic Arizona's Experience 2014-2016.

PubMed

Khurmi, Narjeet; Patel, Perene; Koushik, Sarang; Daniels, Thomas; Kraus, Molly

2018-02-01

Understanding the goals of targeted radiation therapy in pediatrics is critical to developing high quality and safe anesthetic plans in this patient population. An ideal anesthetic plan includes allaying anxiety and achieving optimal immobilization, while ensuring rapid and efficient recovery. We conducted a retrospective chart review of children receiving anesthesia for radiation oncology procedures from 1/1/2014 to 7/31/2016. No anesthetics were excluded from the analysis. The electronic anesthesia records were analyzed for perianesthetic complications along with efficiency data. To compare our results to past and current data, we identified relevant medical literature covering a period from 1984-2017. A total of 997 anesthetic procedures were delivered in 58 unique patients. The vast majority of anesthetics were single-agent anesthesia with propofol. The average duration of radiation treatment was 13.24 min. The average duration of anesthesia was 37.81 min, and the average duration to meet discharge criteria in the recovery room was 29.50 min. There were seven instances of perianesthetic complications (0.7%) and no complications noted for the 80 CT simulations. Two of the seven complications occurred in patients receiving total body irradiation. The 5-year survival rate for pediatric cancers has improved greatly in part due to more effective and targeted radiation therapy. Providing an anesthetic with minimal complications is critical for successful daily radiation treatment. The results of our data analysis corroborate other contemporary studies showing minimal risk to patients undergoing radiation therapy under general anesthesia with propofol. Our data reveal that single-agent anesthesia with propofol administered by a dedicated anesthesia team is safe and efficient and should be considered for patients requiring multiple radiation treatments under anesthesia.

Dental Students' Preference with Regard to Tactile or Visual Determination of Injection Site for an Inferior Alveolar Nerve Block in Children: A Crossover Randomized Clinical Trial.

PubMed

Ramazani, Nahid; Iranmanesh, Seyed Masoud

2016-01-01

Instruction of local anesthesia injection in an important part of dental education curricula. This study was performed to compare dental students' preference with regard to tactile or visual determination of injection site for an inferior alveolar nerve block (IANB) in children. This crossover randomized clinical trial was conducted on dental students of Zahedan Dental School who took the first practical course of pediatric dentistry in the first academic semester of 2013-14 (n=42). They were randomly divided into two groups. During the first phase, group I was instructed to find the needle insertion point for an IANB via tactile method and group II was instructed to do it visually. In the second phase, the groups received instructions for the alternate technique. Both instructions were done using live demonstrations by the same instructor and immediately after instruction the learners practiced an IANB using the taught method. A five-point Likert scale questionnaire was then filled out by the students. The preference score was determined by calculating the mean of item scores. Data were analyzed using Mann-Whitney U and Wilcoxon Singed Rank tests in SPSS 19 at P=0.05 level of significance. Thirty-eight students completed the study. By using the visual method to perform an IANB, students gained a significantly higher mean preference score (P=0.020). There was a significant difference in the preference of male students (P=0.008). Instruction of IANB by visual identification of needle insertion point is more desirable by students.

Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder: A case report

PubMed Central

Castellanos-Cosano, Lizett; Corcuera-Flores, José-Ramón; Mesa-Cabrera, María; Cabrera-Domínguez, José; Torres-Lagares, Daniel; Machuca-Portillo, Guillermo

2017-01-01

Background Paranoid schizophrenia is a mental illness that involves no observable anatomical alteration. Main characteristic affects the personality of the individual, as well as areas of his own psychology. Case Report A 33-year-old man with paranoid schizophrenia and obsessive-compulsive disorder in treatment with Haloperidol, Oxcarbazepine, Olanzapine and Seroquel is presented. Dental exploration showed widespread decay mostly cervical with numerous root fragments, agenesis of lateral incisors, impacted wisdom teeth, missing teeth and malocclusion. Treatment plan included restoration of teeth decay, extractions of root fragments and implant-supported prostheses in bilateral upper lateral incisors for aesthetics reason. A previous consultation with a psychiatric specialist was performed and no contraindication were observed. A preliminary radiological examination was performed previous dental treatment and implant placement. Due to patient refusal to replace dental abscenses with implants, inform consent was signed up from his parents. After local anesthesia, first implant was placed at upper right lateral positions (Straumann Bone Level Ø 3.3 mm, length 10 mm). Two weeks later a second implant was placed at upper left lateral position (Straumann Bone Level Ø 3.3 mm, length 12 mm). The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. The prosthesis was placed after a 3-month period of osseointegration. Conclusions Implant placement can be considered a suitable option for people with mental disorders. A previous consultation with psychiatric specialists for conducting a good patient management is necessaire. Key words:Paranoid schizophrenia, obsessive-compulsive disorder, dental implants. PMID:29302292

Oral Sedation Postdischarge Adverse Events in Pediatric Dental Patients

PubMed Central

Huang, Annie; Tanbonliong, Thomas

2015-01-01

The study investigated patient discharge parameters and postdischarge adverse events after discharge among children who received oral conscious sedation for dental treatment. This prospective study involved 51 patients needing dental treatment under oral conscious sedation. Each patient received one of various regimens involving combinations of a narcotic (ie, morphine or meperidine), a sedative-hypnotic (ie, chloral hydrate), a benzodiazepine (ie, midazolam or diazepam), and/or an antihistamine (ie, hydroxyzine HCl). Nitrous oxide and local anesthesia were used in conjunction with all regimens. After written informed consent was obtained, each guardian was contacted by phone with specific questions in regard to adverse events following the dental appointment. Out of 51 sedation visits, 46 were utilized for analysis including 23 boys and 23 girls ranging from 2 years 2 months to 10 years old (mean 5.8 years). 60.1% of patients slept in the car on the way home, while 21.4% of that group was difficult to awaken upon reaching home. At home, 76.1% of patients slept; furthermore, 85.7% of patients who napped following the dental visit slept longer than usual. After the appointment, 19.6% exhibited nausea, 10.1% vomited, and 7.0% experienced a fever. A return to normal behavior was reported as follows: 17.4% in <2 hours, 39.1% in 2–6 hours, 28.3% in 6–10 hours, and 15.2% in >10 hours. Postdischarge excessive somnolence, nausea, and emesis were frequent complications. The time to normality ranged until the following morning demonstrating the importance of careful postdischarge adult supervision. PMID:26398124

Noxious stimuli do not determine reflex cardiorespiratory effects in anesthetized rabbits.

PubMed

Raimondi, G; Legramante, J M; Iellamo, F; Frisardi, G; Cassarino, S; Peruzzi, G

1996-12-01

The main purpose of this study is to examine whether the stimulation of an exclusively pain-sensing receptive field (dental pulp) could determine cardiorespiratory effects in animals in which the cortical integration of the peripheral information is abolished by deep anesthesia. In 15 anesthetized (alpha-chloralose and urethan) rabbits, low (3-Hz)- and high-frequency (100-Hz) electrical dental pulp stimulation was performed. Because this stimulation caused dynamic and static reflex contractions of the digastric muscles leading to jaw opening jaw-opening reflex (JOR); an indirect sign of algoceptive fiber activation], experimentally induced direct dynamic and static contractions of the digastric muscle were also performed. The low- and high-frequency stimulation of the dental pulp determined cardiovascular [systolic arterial pressure (SAP): -21.7 +/- 4.6 and 10.8 +/- 4.7 mmHg, respectively] and respiratory [pulmonary ventilation (VE): 145.1 +/- 44.9 and 109.3 +/- 28.4 ml/min, respectively] reflex responses similar to those observed during experimentally induced dynamic (SAP: -17.5 +/- 4.2 mmHg; VE: 228.0 +/- 58.5 ml/min) and static (SAP: 5.8 +/- 1.5 mmHg; VE: 148.0 +/- 75.3 ml/min) muscular contractions. The elimination of digastric muscular contraction (JOR) obtained by muscular paralysis did away with the cardiovascular changes induced by dental pulp stimulation, the effectiveness of which in stimulating dental pulp receptors has been shown by recording trigeminal-evoked potentials in six additional rabbits. The main conclusion was that, in deeply anesthetized animals, an algesic stimulus is unable to determine cardiorespiratory effects, which appear to be exclusively linked to the stimulation of ergoreceptors induced by muscular contraction.

Capacity of dental equipment to interfere with cardiac implantable electrical devices.

PubMed

Lahor-Soler, Eduard; Miranda-Rius, Jaume; Brunet-Llobet, Lluís; Sabaté de la Cruz, Xavier

2015-06-01

Patients with cardiac implantable electrical devices should take precautions when exposed to electromagnetic fields. Possible interference as a result of proximity to electromagnets or electricity flow from electronic tools employed in clinical odontology remains controversial. The objective of this study was to examine in vitro the capacity of dental equipment to provoke electromagnetic interference in pacemakers and implantable cardioverter defibrillators. Six electronic dental instruments were tested on three implantable cardioverter defibrillators and three pacemakers from different manufacturers. A simulator model, submerged in physiological saline, with elements that reproduced life-size anatomic structures was used. The instruments were analyzed at differing distances and for different time periods of application. The dental instruments studied displayed significant differences in their capacity to trigger electromagnetic interference. Significant differences in the quantity of registered interference were observed with respect to the variables manufacturer, type of cardiac implant, and application distance but not with the variable time of application. The electronic dental equipment tested at a clinical application distance (20 cm) provoked only slight interference in the pacemakers and implantable cardioverter defibrillators employed, irrespective of manufacturer. © 2015 Eur J Oral Sci.

Measuring up: Implementing a dental quality measure in the electronic health record context.

PubMed

Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F

2016-01-01

Quality improvement requires using quality measures that can be implemented in a valid manner. Using guidelines set forth by the Meaningful Use portion of the Health Information Technology for Economic and Clinical Health Act, the authors assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure to determine the percentage of children who received fluoride varnish. The authors defined how to implement the automated measure queries in a dental electronic health record. Within records identified through automated query, the authors manually reviewed a subsample to assess the performance of the query. The automated query results revealed that 71.0% of patients had fluoride varnish compared with the manual chart review results that indicated 77.6% of patients had fluoride varnish. The automated quality measure performance results indicated 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. The authors' findings support the feasibility of using automated dental quality measure queries in the context of sufficient structured data. Information noted only in free text rather than in structured data would require using natural language processing approaches to effectively query electronic health records. To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation to support near-term automated calculation of quality measures. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

A comparison of two intraosseous anesthetic techniques in mandibular posterior teeth.

PubMed

Gallatin, Juliane; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2003-11-01

A number of studies have evaluated the Stabident (Fairfax Dental, Miami) intraosseous anesthesia technique. A second intraosseous technique--the X-tip system (X-tip Technologies, Lakewood, N.J.)--has been introduced, but no scientific studies have yet compared its effectiveness to that of the Stabident system. The authors undertook a study to compare the two systems' anesthetic outcomes in primary intraosseous injections in mandibular posterior teeth. The authors, using a crossover design, randomly administered a primary Stabident intraosseous injection and a primary X-tip intraosseous injection, at two separate appointments, to 41 subjects. Subjects were asked if they perceived an increase in heart rate with the intraosseous injections. The research team blind-tested each subject's first molar, second molar and second premolar with a pulp tester at two-minute cycles for 60 minutes after the injection. Anesthesia was considered successful when two consecutive pulp tester readings of 80 were obtained. Anesthetic success rates for the Stabident technique and the X-tip technique, respectively, were 93 percent and 93 percent for the first molar; 95 percent and 95 percent for the second molar; and 81 percent and 83 percent for the second premolar, with no significant differences (P > .05) between the two techniques. For both intraosseous techniques, onset of pulpal anesthesia occurred within the first two minutes, but the duration of anesthesia declined steadily over the 60 minutes. Eighty-five percent of the subjects had a perceived increase in heart rate with the Stabident injection and 93 percent with the X-tip injection, with no significant differences (P > .05) between the techniques. The two primary intraosseous injection techniques were similar regarding anesthetic success, onset, duration and perceived heart rate increases.

On the bulk degradation of yttria-stabilized nanocrystalline zirconia dental implant abutments: an electron backscatter diffraction study.

PubMed

Ocelík, V; Schepke, U; Rasoul, H Haji; Cune, M S; De Hosson, J Th M

2017-08-01

Degradation of yttria-stabilized zirconia dental implants abutments due to the tetragonal to monoclinic phase transformation was studied in detail by microstructural characterization using Electron Back Scatter Diffraction (EBSD). The amount and distribution of the monoclinic phase, the grain-size distribution and crystallographic orientations between tetragonal and monoclinic crystals in 3 mol.% yttria-stabilized polycrystalline zirconia (3Y-TZP) were determined in two different types of nano-crystalline dental abutments, even for grains smaller than 400 nm. An important and novel conclusion is that no substantial bulk degradation of 3Y-TZP dental implant abutments was detected after 1 year of clinical use.

A survey of collection development for United States Medical Licensing Examination (USMLE) and National Board Dental Examination (NBDE) preparation material.

PubMed

Hendrix, Dean; Hasman, Linda

2008-07-01

The research sought to ascertain medical and dental libraries' collection development policies, evaluation methods, purchase decisions, and issues that relate to print and electronic United States Medical Licensing Examination (USMLE) and National Board Dental Examination (NBDE) preparation materials. The investigators surveyed librarians supporting American Association of Medical Colleges (AAMC)-accredited medical schools (n = 58/125) on the USMLE and librarians supporting American Dental Association (ADA)-accredited dental schools (n = 23/56) on the NBDE. The investigators analyzed the data by cross-tabulating and filtering the results using EFM Continuum web survey software. Investigators also surveyed print and electronic USMLE and NBDE preparation materials from 2004-2007 to determine the number of publications and existence of reviews. A majority of responding AAMC libraries (62%, n = 58) provide at least 1 electronic or online USMLE preparation resource and buy an average of 11.6 print USMLE titles annually. Due to a paucity of NBDE print and electronic resources, ADA libraries bought significantly fewer print resources, and only 1 subscribed to an electronic resource. The most often reported evaluation methods for both populations were feedback from medical or dental students, feedback from medical or dental faculty, and online trials. Some AAMC (10%, n = 58) and ADA libraries (39%, n = 23) libraries reported that no evaluation of these materials occured at their libraries. From 2004-2007, publishers produced 45 USMLE preparation resources (total n = 546) to every 1 NBDE preparation resource (total n = 12). Users' needs, institutional missions and goals, financial status, and official collection policies most often underlie decisions to collect or not collect examination preparation materials. Evaluating the quality of examination preparation materials can be problematic due to lack of published reviews, lack of usability testing by libraries, and librarians' and library users' unfamiliarity with the actual content of examinations. Libraries must integrate faculty and students into the purchase process to make sure examination preparation resources of the highest quality are purchased.

Effect of introduction of a new electronic anesthesia record (Epic) system on the safety and efficiency of patient care in a gastrointestinal endoscopy suite-comparison with historical cohort.

PubMed

Goudra, B; Singh, P M; Borle, A; Gouda, G

2016-01-01

Use of electronic medical record systems has increased in the recent years. Epic is one such system gaining popularity in the USA. Epic is a private company, which invented the electronic documentation system adopted in our hospital. In spite of many presumed advantages, its use is not critically analyzed. Some of the perceived advantages are increased efficiency and protection against litigation as a result of accurate documentation. In this study, retrospective data of 305 patients who underwent endoscopic retrograde cholangiopancreatography (wherein electronic charting was used - "Epic group") were compared with 288 patients who underwent the same procedure with documentation saved on a paper chart ("paper group"). Time of various events involved in the procedure such as anesthesia start, endoscope insertion, endoscope removal, and transfer to the postanesthesia care unit were routinely documented. From this data, the various time durations were calculated. Both "anesthesia start to scope insertion" times and "scope removal to transfer" times were significantly less in the Epic group compared to the paper group. Use of Epic system led to a saving of 4 min of procedure time per patient. However, the mean oxygen saturation was significantly less in the Epic group. In spite of perceived advantages of Epic documentation system, significant hurdles remain with its use. Although the system allows seamless flow of patients, failure to remove all artifacts can lead to errors and become a source of potential litigation hazard.

Preliminary fabrication and characterization of electron beam melted Ti-6Al-4V customized dental implant.

PubMed

Ramakrishnaiah, Ravikumar; Al Kheraif, Abdulaziz Abdullah; Mohammad, Ashfaq; Divakar, Darshan Devang; Kotha, Sunil Babu; Celur, Sree Lalita; Hashem, Mohamed I; Vallittu, Pekka K; Rehman, Ihtesham Ur

2017-05-01

The current study was aimed to fabricate customized root form dental implant using additive manufacturing technique for the replacement of missing teeth. The root form dental implant was designed using Geomagic™ and Magics™, the designed implant was directly manufactured by layering technique using ARCAM A2™ electron beam melting system by employing medical grade Ti-6Al-4V alloy powder. Furthermore, the fabricated implant was characterized in terms of certain clinically important parameters such as surface microstructure, surface topography, chemical purity and internal porosity. Results confirmed that, fabrication of customized dental implants using additive rapid manufacturing technology offers an attractive method to produce extremely pure form of customized titanium dental implants, the rough and porous surface texture obtained is expected to provide better initial implant stabilization and superior osseointegration.

Clinical Application of Cone Beam Computed Tomography of the Rabbit Head: Part 2—Dental Disease

PubMed Central

Riggs, G. G.; Cissell, Derek D.; Arzi, Boaz; Hatcher, David C.; Kass, Philip H.; Zhen, Amy; Verstraete, Frank J. M.

2017-01-01

Domestic rabbits are increasing in popularity as household pets; therefore, veterinarians need to be familiar with the most common diseases afflicting rabbits including dental disease. Current diagnostic approaches include gross oral examination, endoscopic oral examination, skull radiography, and computed tomography (CT). Cone beam computed tomography (CBCT), a new oral and maxillofacial imaging modality that has the capability to produce high-resolution images, has not yet been described for use in evaluating dental disease in rabbits. A total of 15 client-owned rabbits had CBCT, oral examination, dental charting, and dental treatment performed under general anesthesia. Images were evaluated using transverse and custom multiplanar (MPR), 3D, and panoramic reconstructed images. The CBCT findings were grouped into abnormalities that could be detected on conscious oral examination vs. abnormalities that could not be detected by conscious oral examination. Potential associations between the two categories were examined by pairwise Fisher’s exact test with statistical significance determined by P < 0.05. The most common findings identified on CBCT images were periodontal ligament space widening (14/15), premolar and molar malocclusion (13/15), apical elongation (13/15), coronal elongation (12/15), inflammatory tooth resorption (12/15), periapical lucency (11/15), moth-eaten pattern of osteolysis of the alveolar bone (9/15), ventral mandibular border contour changes (9/15), and missing teeth (8/15). Of the CBCT abnormalities likely to be observed on oral examination, coronal elongation (detectable on oral examination) was significantly associated with apical elongation (P = 0.029). There were no other significant associations between CBCT findings that are also clinically detectable and CBCT findings that are not be detectable on oral examination. This suggests that pathology often exists that is not apparent upon oral examination. This study establishes the common CBCT findings associated with dental disease in rabbits and demonstrates the feasibility of this technology to diagnose and plan treatment in dental disorders in this species. PMID:28194401

Exploring Dental Providers’ Workflow in an Electronic Dental Record Environment

PubMed Central

Schwei, Kelsey M; Cooper, Ryan; Mahnke, Andrea N.; Ye, Zhan

2016-01-01

Summary Background A workflow is defined as a predefined set of work steps and partial ordering of these steps in any environment to achieve the expected outcome. Few studies have investigated the workflow of providers in a dental office. It is important to understand the interaction of dental providers with the existing technologies at point of care to assess breakdown in the workflow which could contribute to better technology designs. Objective The study objective was to assess electronic dental record (EDR) workflows using time and motion methodology in order to identify breakdowns and opportunities for process improvement. Methods A time and motion methodology was used to study the human-computer interaction and workflow of dental providers with an EDR in four dental centers at a large healthcare organization. A data collection tool was developed to capture the workflow of dental providers and staff while they interacted with an EDR during initial, planned, and emergency patient visits, and at the front desk. Qualitative and quantitative analysis was conducted on the observational data. Results Breakdowns in workflow were identified while posting charges, viewing radiographs, e-prescribing, and interacting with patient scheduler. EDR interaction time was significantly different between dentists and dental assistants (6:20 min vs. 10:57 min, p = 0.013) and between dentists and dental hygienists (6:20 min vs. 9:36 min, p = 0.003). Conclusions On average, a dentist spent far less time than dental assistants and dental hygienists in data recording within the EDR. PMID:27437058

What Are They Thinking? Dental Assisting Students' Feelings about E-Books

ERIC Educational Resources Information Center

Parsons, Kimberly M.

2014-01-01

Electronic textbook usage is increasing within higher education while use of traditional textbooks is declining. While some research concerning student preference for textbook type provides insight into student choices, there is a gap in the literature regarding use of electronic textbooks within dental assisting programs. The purpose of this…

Comparison of e-mail communication skills among first- and fourth-year dental students.

PubMed

Oakley, Marnie; Horvath, Zsuzsa; Weinberg, Seth M; Bhatt, Jaya; Spallek, Heiko

2013-11-01

As e-mail and other forms of electronic communication increase in popularity, it is important for dental schools to consider a curriculum that prepares their graduates to understand and apply effective electronic communication strategies to their patients. Reflecting this shift in communication behavior, the American Medical Association has developed specific e-mail communication guidelines. Some behavioral examples in these guidelines include protecting patients' protected health information (PHI), ensuring proper record keeping, and using professional, courteous, and understandable language. In this study, a sample of first- and fourth-year dental students (n=160) at the University of Pittsburgh School of Dental Medicine participated in an assignment assessing their patient-provider e-mail communication skills. A rubric was used to evaluate and compare the data between dental student classes. The results reveal a generalized lack of compliance with several of these guidelines by both classes (e.g., failure to protect PHI), despite efforts to expose students to these concepts in the curriculum. In an effort to train emerging dentists to function in a rapidly changing technological environment, these findings suggest a need for growth and development of curricula and perhaps guidelines/recommendations for behavioral competencies regarding dental students' use of electronic communication in the patient care environment.

The Dental Practitioner's Role in Emergency Health Services

PubMed Central

McCabe, C. Aberdeen E.

1967-01-01

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada's 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada's 6396 dentists could supply 30% reinforcement. The dentist's training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties. PMID:6015739

Testing of Anesthesia Machines and Defibrillators in Healthcare Institutions.

PubMed

Gurbeta, Lejla; Dzemic, Zijad; Bego, Tamer; Sejdic, Ervin; Badnjevic, Almir

2017-09-01

To improve the quality of patient treatment by improving the functionality of medical devices in healthcare institutions. To present the results of the safety and performance inspection of patient-relevant output parameters of anesthesia machines and defibrillators defined by legal metrology. This study covered 130 anesthesia machines and 161 defibrillators used in public and private healthcare institutions, during a period of two years. Testing procedures were carried out according to international standards and legal metrology legislative procedures in Bosnia and Herzegovina. The results show that in 13.84% of tested anesthesia machine and 14.91% of defibrillators device performance is not in accordance with requirements and should either have its results be verified, or the device removed from use or scheduled for corrective maintenance. Research emphasizes importance of independent safety and performance inspections, and gives recommendations for the frequency of inspection based on measurements. Results offer implications for adequacy of preventive and corrective maintenance performed in healthcare institutions. Based on collected data, the first digital electronical database of anesthesia machines and defibrillators used in healthcare institutions in Bosnia and Herzegovina is created. This database is a useful tool for tracking each device's performance over time.

Measuring Up: Implementing a Dental Quality Measure in the Electronic Health Record Context

PubMed Central

Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F

2015-01-01

Background Quality improvement requires quality measures that are validly implementable. In this work, we assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure (percentage of children who received fluoride varnish). Methods We defined how to implement the automated measure queries in a dental electronic health record (EHR). Within records identified through automated query, we manually reviewed a subsample to assess the performance of the query. Results The automated query found 71.0% of patients to have had fluoride varnish compared to 77.6% found using the manual chart review. The automated quality measure performance was 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. Conclusions Our findings support the feasibility of automated dental quality measure queries in the context of sufficient structured data. Information noted only in the free text rather than in structured data would require natural language processing approaches to effectively query. Practical Implications To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation in order to support near-term automated calculation of quality measures. PMID:26562736

Electronic health records: a valuable tool for dental school strategic planning.

PubMed

Filker, Phyllis J; Cook, Nicole; Kodish-Stav, Jodi

2013-05-01

The objective of this study was to investigate if electronic patient records have utility in dental school strategic planning. Electronic health records (EHRs) have been used by all predoctoral students and faculty members at Nova Southeastern University's College of Dental Medicine (NSU-CDM) since 2006. The study analyzed patient demographic and caries risk assessment data from October 2006 to May 2011 extracted from the axiUm EHR database. The purpose was to determine if there was a relationship between high oral health care needs and patient demographics, including gender, age, and median income of the zip code where they reside in order to support dental school strategic planning including the locations of future satellite clinics. The results showed that about 51 percent of patients serviced by the Broward County-based NSU-CDM oral health care facilities have high oral health care needs and that about 60 percent of this population resides in zip codes where the average income is below the median income for the county ($41,691). The results suggest that EHR data can be used adjunctively by dental schools when proposing potential sites for satellite clinics and planning for future oral health care programming.

Anesthetic management during a cesarean section in a patient with cleidocranial dysplasia: a case report.

PubMed

Nishio, Yumiko; Hiraki, Teruyuki; Taniguchi, Hiroko; Ushijima, Kazuo

2018-01-01

Cleidocranial dysplasia is a type of skeletal dysplasia, which is primarily characterized by delayed ossification of skeletal structures. It causes facial and oral abnormalities, resulting in difficult airway management and neuraxial anesthesia. The patient was a 24-year-old primipara (height 138 cm, weight 42 kg) with a hypoplastic right clavicle, patent fontanelles, dental malalignment, and a high palate. She was diagnosed with cleidocranial dysplasia at birth, although gene examination has not been performed. The fetus was confirmed to have short limbs and large fontanelles during an examination performed at 28 weeks gestation, suspected to have cleidocranial dysplasia. The mother was scheduled for a cesarean section at 37 weeks and 1 day due to cephalopelvic disproportion. Preoperative radiography and magnetic resonance imaging revealed no vertebral and spinal abnormalities, which allowed combined spinal-epidural analgesia (CSEA) to be performed. The surgery was safely concluded under CSEA with no intraoperative respiratory or circulatory problems. Patients with cleidocranial dysplasia exhibit facial, oral abnormalities, and often vertebral abnormalities. Imaging assessments before neuraxial anesthesia and careful preparation for airway management are required.

An ontology-based method for secondary use of electronic dental record data

PubMed Central

Schleyer, Titus KL; Ruttenberg, Alan; Duncan, William; Haendel, Melissa; Torniai, Carlo; Acharya, Amit; Song, Mei; Thyvalikakath, Thankam P.; Liu, Kaihong; Hernandez, Pedro

A key question for healthcare is how to operationalize the vision of the Learning Healthcare System, in which electronic health record data become a continuous information source for quality assurance and research. This project presents an initial, ontology-based, method for secondary use of electronic dental record (EDR) data. We defined a set of dental clinical research questions; constructed the Oral Health and Disease Ontology (OHD); analyzed data from a commercial EDR database; and created a knowledge base, with the OHD used to represent clinical data about 4,500 patients from a single dental practice. Currently, the OHD includes 213 classes and reuses 1,658 classes from other ontologies. We have developed an initial set of SPARQL queries to allow extraction of data about patients, teeth, surfaces, restorations and findings. Further work will establish a complete, open and reproducible workflow for extracting and aggregating data from a variety of EDRs for research and quality assurance. PMID:24303273

Survival of dental implants in patients with Down syndrome: A case series.

PubMed

Limeres Posse, Jacobo; López Jiménez, Julian; Ruiz Villandiego, José C; Cutando Soriano, Antonio; Fernández Feijoo, Javier; Linazasoro Elorza, Maialen; Diniz Freitas, Márcio; Diz Dios, Pedro

2016-12-01

The need for tooth replacement in individuals with Down syndrome (DS) is explained by the high prevalence of dental agenesis and by the premature loss of teeth through severe periodontal disease. Dental implants may be the dental procedure of choice in some of these patients. The purpose of this clinical study was to analyze dental implant survival in a series of patients with DS. This was a multicenter, retrospective, observational study. Information on patients was gathered using a standardized questionnaire designed specifically for this study, including personal details, oral health status, information on the surgical and prosthetic phases, and follow-up visits. The questionnaire was sent to centers registered with the research network of the Spanish Society of Special Needs Dentistry (SEOENE). Patients with DS aged 18 years or older were included in the study if they had at least 1 dental implant and the corresponding prosthesis and had been followed up for at least a year. The study population was formed of 25 adult patients (13 men and 12 women) aged between 19 and 60 years. The interventions were performed by 5 different dental surgeons, usually under general anesthesia or deep sedation (n=17 patients). A total of 73 implants were inserted, 30 in the maxilla and 43 in the mandible, most commonly in the anterior region (n=51). The mean time to loading the implants was 4.1 ±1.3 months after surgery (range, 1 to 7 months). All patients completed prosthetic rehabilitation; the most frequent design used was the single fixed prosthesis (n=13 patients). A total of 17 (23.2%) implants failed in 8 (32%) patients; the majority (n=14 implants) failed in the postsurgical period before implant loading. The distribution by patients was 1 implant failure in 6 patients, 3 failures in 1 patient, and 8 failures in 1 patient. Dental implant survival is lower in individuals with DS than in the general population. The reasons for early implant failure in these patients have still not been clearly identified. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

PubMed

Pourkazemi, Maryam; Erfanparast, Leila; Sheykhgermchi, Sanaz; Ghanizadeh, Milad

2017-01-01

Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children. In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21. The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth. According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars' buccal mucosa is not anesthetized. How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.

Evaluating a Dental Diagnostic Terminology in an Electronic Health Record

PubMed Central

White, Joel M.; Kalenderian, Elsbeth; Stark, Paul C.; Ramoni, Rachel L.; Vaderhobli, Ram; Walji, Muhammad F.

2011-01-01

Standardized treatment procedure codes and terms are routinely used in dentistry. Utilization of a diagnostic terminology is common in medicine, but there is not a satisfactory or commonly standardized dental diagnostic terminology available at this time. Recent advances in dental informatics have provided an opportunity for inclusion of diagnostic codes and terms as part of treatment planning and documentation in the patient treatment history. This article reports the results of the use of a diagnostic coding system in a large dental school’s predoctoral clinical practice. A list of diagnostic codes and terms, called Z codes, was developed by dental faculty members. The diagnostic codes and terms were implemented into an electronic health record (EHR) for use in a predoctoral dental clinic. The utilization of diagnostic terms was quantified. The validity of Z code entry was evaluated by comparing the diagnostic term entered to the procedure performed, where valid diagnosis-procedure associations were determined by consensus among three calibrated academically based dentists. A total of 115,004 dental procedures were entered into the EHR during the year sampled. Of those, 43,053 were excluded from this analysis because they represent diagnosis or other procedures unrelated to treatments. Among the 71,951 treatment procedures, 27,973 had diagnoses assigned to them with an overall utilization of 38.9 percent. Of the 147 available Z codes, ninety-three were used (63.3 percent). There were 335 unique procedures provided and 2,127 procedure/diagnosis pairs captured in the EHR. Overall, 76.7 percent of the diagnoses entered were valid. We conclude that dental diagnostic terminology can be incorporated within an electronic health record and utilized in an academic clinical environment. Challenges remain in the development of terms and implementation and ease of use that, if resolved, would improve the utilization. PMID:21546594

Tablet e-Logbooks: Four Thousand Clinical Cases and Complications e-Logged by 14 Nondoctor Anesthesia Providers in Nepal.

PubMed

Shah, Shristi; Ross, Oliver; Pickering, Stephen; Knoble, Stephen; Rai, Indra

2017-10-01

To meet the need for essential surgery across rural Nepal, anesthesia at district level is delivered by nondoctor anesthetists. They require support to maintain confidence and competence, and upgraded professional registration to secure their status. To meet these needs, a distance-blended learning course was pioneered and delivered. A core course requirement was to log all clinical cases; these were logged on a new e-logbook. Fourteen nondoctor anesthesia providers working in 12 different districts across Nepal were enrolled in the 1-year course. The course is based on self-completion on a tablet loaded with new learning modules, a resource library, and a case logbook. Continuous educational mentoring was provided by anesthesiologists by phone and email. The logbook included preanesthesia assessment and interventions, American Society of Anesthesiologists (ASA) grading, types of cases and anesthesia given, monitors used, complications, outcomes and free text remarks. Cases were uploaded monthly to a database, and mentors reviewed all logbook entries. The 14 nondoctor anesthesia providers were widely distributed across the country in district, zonal, community, and mission hospitals, and had different levels of clinical experience and caseloads. Logbooks and uploads were regularly completed without difficulty; 1% cases were entered incompletely with no case details provided. A total of 4143 cases were recorded. Annual caseload per nondoctor anesthesia provider ranged from 50 to 788, the majority of which were under spinal anesthesia; 34% of the total cases were cesarean deliveries, of which 99% received spinal anesthesia. Fifty gastrointestinal laparotomies (1% total) were recorded. Ninety-one percent of cases were ASA I, 0.8% ASA III/IV. Pulse oximetry was used in 98% of cases. Complications were recorded in 6% of cases; the most common were circulation problems (69%) including hypotension and occasional bradycardia after spinal anesthesia. Airway complications were usually under ketamine anesthesia requiring basic airway maneuvers; 4 difficult intubations were recorded under general anesthesia. Anesthesia outcomes were good with overall mortality of 0.1% (total 4 cases). Causes of death included severe preeclampsia, sepsis postlaparotomy, and patients with multiorgan failure for minor procedure. The tablet-based electronic anesthesia logbook was successfully used to record cases, complications, and outcomes across rural Nepal. The nondoctor anesthesia providers had trust and confidence in recording outcomes. It remains to be tested whether an e-logbook would be routinely completed outside of a specific training course. Such a logbook could be incorporated into all continuous professional development programs for rural nondoctor anesthetists.

Dental management of pediatric patients affected by pulmonary atresia with ventricular septal defect: A scoping review.

PubMed

Garrocho-Rangel, A; Echavarría-García, A-C; Rosales-Bérber, M-A; Flores-Velázquez, J; Pozos-Guillén, A

2017-07-01

Congenital Heart Diseases (CHD) involves a wide range of pathological conditions, such as Pulmonary Atresia with Ventricle Septal Defect (PA/VSD). This disorder leads to the systemic circulation of oxygen-poor blood (cyanosis), with associated features and consequences in the oral cavity. Using scoping review methodology for screening and article selection, the primary objectives of this paper were as follows: first, to pose a research question; second, to identify relevant studies in order to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data, and finally, to collate, summarize, and report the results from the most important articles on the dental management of children affected with PA/VSD. Relevant articles (Randomized Controlled Trials [RCT], reviews, observational studies, and clinical case reports) published over a 10-year period were identified and retrieved from four Internet databases: PubMed; Embase/Ovid; Cochrane Library, and Google Scholar. By title and abstract screening and after removing duplicates, 24 articles were finally included in the present scoping review. According to the extracted data, the following are the most important clinical issues to be considered when treating children with PA/VSD in the dental setting: prevalence of dental caries; prevention of dental disease (oral hygiene and diet); bacteremia and infective endocarditis risk, and child behavior control and treatment under general anesthesia. Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of children with PA/VSD, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their good quality of life.

Noise level measurement, a new method to evaluate effectiveness of sedation in pediatric dentistry.

PubMed

Sabouri, A Sassan; Firoozabadi, Farshid; Carlin, Drew; Creighton, Paul; Raczka, Michelle; Joshi, Prashant; Heard, Christopher

2014-12-01

Pediatric dentists perform moderate sedation frequently to facilitate dental treatment in uncooperative children. Assessing the depth and quality of sedation is an important factor in the clinical utilization of moderate sedation. We aimed to determine if the level of noise, created by the children who are undergoing moderate sedation during dental procedures, could be used as a nonsubjective measurement of the depth of sedation and compare it to the Ohio State Behavior Rating Score (OSBRS). Following Institutional Review Board approval and after receiving informed consent, we studied 51 children with a mean age of 4.2 years and average weight of 18.5 kg, who were undergoing restorative or extractive dental procedures, requiring moderate sedation. Sedation efficacy was assessed using OSBRS at several stages of the procedure. The noise level was measured by using a NoisePRO logging device to record the noise level at a rate of every second throughout the procedure. The depth of sedation assessed by OSBRS during the operative procedure was significantly correlated with noise level. The act of administering the local anesthesia and the operative procedure itself were two phases of the encounter that were significantly associated with higher OSBRS as well as noise levels. Measurement of noise level can be used as an effective guide to quantify the depth of sedation at different stages of the dental procedure. It is a nonsubjective and continuous measurement, which could be useful in clinical practice for the administration of moderate sedation during dental procedures. By using noise level analysis we are able to determine successful, poor, and failed sedation outcome. Copyright © 2014. Published by Elsevier B.V.

Dental Students’ Preference with Regard to Tactile or Visual Determination of Injection Site for an Inferior Alveolar Nerve Block in Children: A Crossover Randomized Clinical Trial

PubMed Central

Iranmanesh, Seyed Masoud

2016-01-01

Objectives: Instruction of local anesthesia injection in an important part of dental education curricula. This study was performed to compare dental students’ preference with regard to tactile or visual determination of injection site for an inferior alveolar nerve block (IANB) in children. Materials and Methods: This crossover randomized clinical trial was conducted on dental students of Zahedan Dental School who took the first practical course of pediatric dentistry in the first academic semester of 2013–14 (n=42). They were randomly divided into two groups. During the first phase, group I was instructed to find the needle insertion point for an IANB via tactile method and group II was instructed to do it visually. In the second phase, the groups received instructions for the alternate technique. Both instructions were done using live demonstrations by the same instructor and immediately after instruction the learners practiced an IANB using the taught method. A five-point Likert scale questionnaire was then filled out by the students. The preference score was determined by calculating the mean of item scores. Data were analyzed using Mann-Whitney U and Wilcoxon Singed Rank tests in SPSS 19 at P=0.05 level of significance. Results: Thirty-eight students completed the study. By using the visual method to perform an IANB, students gained a significantly higher mean preference score (P=0.020). There was a significant difference in the preference of male students (P=0.008). Conclusions: Instruction of IANB by visual identification of needle insertion point is more desirable by students. PMID:27536327

Career satisfaction of Pennsylvanian dentists and dental hygienists and their plans to leave direct patient care.

PubMed

Vick, Brandon

2016-03-01

The aim of this study is to explore a number of practice-related dynamics between dentists and dental hygienists, including their career dissatisfaction, plans to leave direct patient care, hiring difficulties, and full-time work. Data come from the 2013 Pennsylvania Health Workforce Surveys, a sample of 5,771 dentists and 6,023 dental hygienists, and logistic regression is used to estimate the relationships between outcome areas - dissatisfaction, plans to leave patient care, and hiring/job outcomes - and a number of explanatory variables, including demographic and practice characteristics. Dentists working in practices that employ hygienists have lower odds of reporting overall dissatisfaction and of leaving patient care in the next 6 years than those that do not employ hygienists. Dental hygienists that work full-time hours across two or more jobs have higher odds of dissatisfaction than those who work full-time in one job only. Part-time work in a single hygienist job is associated with higher odds of leaving the career, relative to having a single, full-time job. Results suggest that employment of dental hygienists is associated with lower career dissatisfaction and extended careers for dentists. However, a number of dentist characteristics are associated with difficulty hiring hygienists, including rural practice, nonwhite race, and solo ownership. Only 37.5 percent of hygienists work in a single, full-time job, an outcome related to lower dissatisfaction and extended careers for hygienists. Characteristics associated with this job outcome include having an associate degree, having a local anesthesia permit, and not working for a solo practice. © 2015 American Association of Public Health Dentistry.

Paperless anesthesia: uses and abuses of these data.

PubMed

Anderson, Brian J; Merry, Alan F

2015-12-01

Demonstrably accurate records facilitate clinical decision making, improve patient safety, provide better defense against frivolous lawsuits, and enable better medical policy decisions. Anesthesia Information Management Systems (AIMS) have the potential to improve on the accuracy and reliability of handwritten records. Interfaces with electronic recording systems within the hospital or wider community allow correlation of anesthesia relevant data with biochemistry laboratory results, billing sections, radiological units, pharmacy, earlier patient records, and other systems. Electronic storage of large and accurate datasets has lent itself to quality assurance, enhancement of patient safety, research, cost containment, scheduling, anesthesia training initiatives, and has even stimulated organizational change. The time for record making may be increased by AIMS, but in some cases has been reduced. The question of impact on vigilance is not entirely settled, but substantial negative effects seem to be unlikely. The usefulness of these large databases depends on the accuracy of data and they may be incorrect or incomplete. Consequent biases are threats to the validity of research results. Data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate misleading research findings for the purpose of manipulating public opinion and swaying policymakers. There remains a fear that accessibility of data may have undesirable regulatory or legal consequences. Increasing regulation of treatment options during the perioperative period through regulated policies could reduce autonomy for clinicians. These fears are as yet unsubstantiated. © 2015 John Wiley & Sons Ltd.

Er:YAG and Nd:YAG laser in treatment of patients with contraindications of conventional dental and maxillofacial surgery

NASA Astrophysics Data System (ADS)

Smucler, Roman; Mazanek, Jiri

2000-03-01

In clinical praxis we must treat patients with some relative or absolute contraindications every day. Need of hospitalization, antibiotics, hemostyptics and complex examinations makes dentoalveolar and maxillofacial surgery in those cases quite expensive. Combination of Nd:YAG and Er:YAG laser gives us new possibilities. We can help some untreatable patients or transfer care from hospital to dental office. We have been trying to solve contraindications for laser therapy five years. In the center of our work are disorders of blood coagulation, immunity and metabolism. Nd:YAG laser is very useful in coagulation and vaporization of dental gum hypertrophies, benign and malign tumors in case of chronic anticoagulation therapy and immunosupress / in combination for example- after heart transplantation /. Special chapter is the care of patients with disseminated tumors. Er:YAG laser large solve big lesions because of minimal invasivity of course but for small benign tumors are recidives is ideal. Better and quicker healing make new standard of patients' cooperation. Generally fashionable and more comfortable laser treatment minimize need of general anesthesia. After five years we use complex laser therapy in our routine. Aim of our new work is to find ideal combination of cutting lasers to minimize classical complications of laser surgery / carbonization, long and secondary healing /.

Hypoplasia-associated Severe Early Childhood Caries – A Proposed Definition

PubMed Central

Caufield, P.W.; Li, Y.; Bromage, T.G.

2012-01-01

We propose a new classification of severe early childhood caries (S-ECC): hypoplasia-associated severe early childhood caries (HAS-ECC). This form of caries affects mostly young children living at or below poverty, characterized by structurally damaged primary teeth that are particularly vulnerable to dental caries. These predisposing developmental dental defects are mainly permutations of enamel hypoplasia (EHP). Anthropologists and dental researchers consider EHP an indicator for infant and maternal stresses including malnutrition, a variety of illnesses, and adverse birthing conditions. Differentiation of HAS-ECC from other forms of early childhood caries is warranted because of its distinct etiology, clinical presentation, and eventual management. Defining HAS-ECC has important clinical implications: Therapies that control or prevent other types of caries are likely to be less effective with HAS-ECC because the structural integrity of the teeth is compromised prior to their emergence into the oral cavity. By the time these children present to the dentist, the treatment options often become limited to surgical management under general anesthesia. To prevent HAS-ECC, dentists must partner with other health providers to develop interventions that begin with pregnant mothers, with the aim of eliminating or ameliorating the covariates accompanying poverty, including better pre- and post-natal care and nutrition. PMID:22529242

Displacement of a Broken Dental Injection Needle Into the Perivertebral Space.

PubMed

Sahin, Bayram; Yildirimturk, Senem; Sirin, Yigit; Basaran, Bora

2017-07-01

Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment.This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance.

Trauma due to Self-aggression in Patient with Waardenburg Syndrome associated with Congenital Anomalies.

PubMed

Marta, Sara Nader; Kawakami, Roberto Yoshio; Sgavioli, Claudia Almeida Prado Piccino; Correa, Ana Eliza; D'Árk de Oliveira El Kadre, Guaniara; Carvalho, Ricardo Sandri

2016-08-01

Waardenburg syndrome (WS) is an inherited autosomal dominant genetic disorder presenting variable penetrance and expressivity, with an estimated prevalence of 1:42,000. Clinical characteristics of WS include lateral displacement of the internal eye canthus, hyperplasia of the medial portion of the eyebrows, prominent and broad nasal base, congenital deafness, pigmentation of the iris and skin, and white forelock. A 24-year-old male patient, previously diagnosed with WS, was referred to the Special Needs Dental Clinic of Sacred Heart University, Bauru, Brazil. Parents reported that the patient was experiencing self-mutilation, particularly in the oral region. He presented multiple congenital anomalies, including anophthalmia, mental retardation, low-set ears, and leg deformities. Clinical oral examination revealed hypodontia, abnormalities in dental morphology, extensive dental caries, periodontal disease, and fistulae. Extensive scars on the tongue, lips, and hands caused by self-mutilation were also observed. In accordance with his family and neurologist, full-mouth extraction under general anesthesia was performed, especially considering his severe self-aggressive behavior and the necessity to be fed with soft-food diet due to his inability to chew. After the surgical procedure, a significant reduction in the patient's irritability and gain of weight were reported in the follow-ups of 30, 60, and 180 days.

A Survey of Collection Development for United States Medical Licensing Examination (USMLE) and National Board Dental Examination (NBDE) Preparation MaterialEC

PubMed Central

Hendrix, Dean; Hasman, Linda

2008-01-01

Objective: The research sought to ascertain medical and dental libraries' collection development policies, evaluation methods, purchase decisions, and issues that relate to print and electronic United States Medical Licensing Examination (USMLE) and National Board Dental Examination (NBDE) preparation materials. Methods: The investigators surveyed librarians supporting American Association of Medical Colleges (AAMC)–accredited medical schools (n = 58/125) on the USMLE and librarians supporting American Dental Association (ADA)–accredited dental schools (n = 23/56) on the NBDE. The investigators analyzed the data by cross-tabulating and filtering the results using EFM Continuum web survey software. Investigators also surveyed print and electronic USMLE and NBDE preparation materials from 2004–2007 to determine the number of publications and existence of reviews. Results: A majority of responding AAMC libraries (62%, n = 58) provide at least 1 electronic or online USMLE preparation resource and buy an average of 11.6 print USMLE titles annually. Due to a paucity of NBDE print and electronic resources, ADA libraries bought significantly fewer print resources, and only 1 subscribed to an electronic resource. The most often reported evaluation methods for both populations were feedback from medical or dental students, feedback from medical or dental faculty, and online trials. Some AAMC (10%, n = 58) and ADA libraries (39%, n = 23) libraries reported that no evaluation of these materials occured at their libraries. Conclusions: From 2004–2007, publishers produced 45 USMLE preparation resources (total n = 546) to every 1 NBDE preparation resource (total n = 12). Users' needs, institutional missions and goals, financial status, and official collection policies most often underlie decisions to collect or not collect examination preparation materials. Evaluating the quality of examination preparation materials can be problematic due to lack of published reviews, lack of usability testing by libraries, and librarians' and library users' unfamiliarity with the actual content of examinations. Libraries must integrate faculty and students into the purchase process to make sure examination preparation resources of the highest quality are purchased. PMID:18654641

Students' Knowledge, Opinions, and Behaviors Concerning Dental Informatics and Computer Applications.

ERIC Educational Resources Information Center

Lang, W. Paul; And Others

1992-01-01

A survey of 95 first-year and 91 fourth-year dental students concerning informatics and computer applications in dentistry investigated knowledge of terms and concepts related to hardware, software, electronic communication, and dental applications; opinions concerning use of the technology; and extent of experience in 4 areas of use. (MSE)

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain.

PubMed

Parirokh, Masoud; Yosefi, Mohammad Hosein; Nakhaee, Nouzar; Abbott, Paul V; Manochehrifar, Hamed

2015-05-01

Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Dental Wear: A Scanning Electron Microscope Study

PubMed Central

Levrini, Luca; Di Benedetto, Giulia

2014-01-01

Dental wear can be differentiated into different types on the basis of morphological and etiological factors. The present research was carried out on twelve extracted human teeth with dental wear (three teeth showing each type of wear: erosion, attrition, abrasion, and abfraction) studied by scanning electron microscopy (SEM). The study aimed, through analysis of the macro- and micromorphological features of the lesions (considering the enamel, dentin, enamel prisms, dentinal tubules, and pulp), to clarify the different clinical and diagnostic presentations of dental wear and their possible significance. Our results, which confirm current knowledge, provide a complete overview of the distinctive morphology of each lesion type. It is important to identify the type of dental wear lesion in order to recognize the contributing etiological factors and, consequently, identify other more complex, nondental disorders (such as gastroesophageal reflux, eating disorders). It is clear that each type of lesion has a specific morphology and mechanism, and further clinical studies are needed to clarify the etiological processes, particularly those underlying the onset of abfraction. PMID:25548769

Salivary protein polymorphisms and risk of dental caries: a systematic review.

PubMed

Lips, Andrea; Antunes, Leonardo Santos; Antunes, Lívia Azeredo; Pintor, Andrea Vaz Braga; Santos, Diana Amado Baptista Dos; Bachinski, Rober; Küchler, Erika Calvano; Alves, Gutemberg Gomes

2017-06-05

Dental caries is an oral pathology associated with both lifestyle and genetic factors. The caries process can be influenced by salivary composition, which includes ions and proteins. Studies have described associations between salivary protein polymorphisms and dental caries experience, while others have shown no association with salivary proteins genetic variability. The aim of this study is to assess the influence of salivary protein polymorphisms on the risk of dental caries by means of a systematic review of the current literature. An electronic search was performed in PubMed, Scopus, and Virtual Health Library. The following search terms were used: "dental caries susceptibility," "dental caries," "polymorphism, genetics," "saliva," "proteins," and "peptides." Related MeSH headings and free terms were included. The inclusion criteria comprised clinical investigations of subjects with and without caries. After application of these eligibility criteria, the selected articles were qualified by assessing their methodological quality. Initially, 338 articles were identified from the electronic databases after exclusion of duplicates. Exclusion criteria eliminated 322 articles, and 16 remained for evaluation. Eleven articles found a consistent association between salivary protein polymorphisms and risk of dental caries, for proteins related to antimicrobial activity (beta defensin 1 and lysozyme-like protein), pH control (carbonic anhydrase VI), and bacterial colonization/adhesion (lactotransferrin, mucin, and proline-rich protein Db). This systematic review demonstrated an association between genetic polymorphisms and risk of dental caries for most of the salivary proteins.

Perianesthetic and Anesthesia-Related Mortality in a Southeastern United States Population: A Longitudinal Review of a Prospectively Collected Quality Assurance Data Base.

PubMed

Pollard, Richard J; Hopkins, Thomas; Smith, C Tyler; May, Bryan V; Doyle, James; Chambers, C Labron; Clark, Reese; Buhrman, William

2018-05-21

Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database. Following institutional review board approval, data from 2011 to 2016 were obtained from the QA database of a large, community-based anesthesiology group practice. The physician practice covers 233 anesthetizing locations across 20 facilities in 2 US states. All detected cases of perianesthetic death were extracted from the database and compared to the patients' electronic medical record. These cases were further examined by a committee of 3 anesthesiologists to determine whether the death was anesthesia related (a perioperative death solely attributable to either the anesthesia provider or anesthetic technique), anesthetic contributory (a perioperative death in which anesthesia role could not be entirely excluded), or not due to anesthesia. A total of 785,467 anesthesia procedures were examined from the study period. A total of 592 cases of perianesthetic deaths were detected, giving an overall death rate of 75.37 in 100,000 cases (95% CI, 69.5-81.7). Mortality judged to be anesthesia related was found in 4 cases, giving a mortality rate of 0.509 in 100,000 (95% CI, 0.198-1.31). Mortality judged to be anesthesia contributory were found in 18 cases, giving a mortality of 2.29 in 100,000 patients (95% CI, 1.45-3.7). A total of 570 cases were judged to be nonanesthesia related, giving an incidence of 72.6 per 100,000 anesthetics (95% CI, 69.3-75.7). In a large, comprehensive database representing the full range of anesthesia practices and locations in the Southeastern United States, the rate of perianesthestic death was 0.509 in 100,000 (95% CI, 0.198-1.31). Future in-depth analysis of the epidemiology of perianesthetic deaths will be reported in later studies.

Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children.

PubMed

Bansal, Neha; Saha, Sonali; Jaiswal, Jn; Samadi, Firoza

2014-05-01

The present study was taken up to clinically evaluate and compare effectiveness of transcutaneous electrical nerve stimulator (TENS) and comfort control syringe (CCS) in various pediatric dental procedures as an alternative to the conventional method of local anesthesia (LA) administration. Ninety healthy children having at least one deciduous molar tooth indicated for extraction in either maxillary right or left quadrant in age group of 6 to 10 years were randomly divided into three equal groups having 30 subjects each. Group I: LA administration using conventional syringe, group II: LA administration using TENS along with the conventional syringe, group III: LA administration using CCS. After LA by the three techniques, pain, anxiety and heart rate were measured. The observations, thus, obtained were subjected to statistical analysis using analysis of variance (ANOVA), student t-test and paired t-test. The mean pain score was maximum in group I followed by group II, while group III revealed the minimum pain, where LA was administered using CCS. Mean anxiety score was maximum in group I followed by group II, while group III revealed the minimum score. Mean heart rate was maximum in group I followed in descending order by groups II and III. The study supports the belief that CCS could be a viable alternative in comparison to the other two methods of LA delivery in children. How to cite this article: Bansal N, Saha S, Jaiswal JN, Samadi F. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. Int J Clin Pediatr Dent 2014;7(2):71-76.

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review.

PubMed

Facco, Enrico; Zanette, Gastone

2017-01-01

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum ) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

PubMed Central

Facco, Enrico; Zanette, Gastone

2017-01-01

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite. PMID:28744243

Electronic textbooks as a professional resource after dental school.

PubMed

Bates, Michael L; Strother, Elizabeth A; Brunet, Darlene P; Gallo, John R

2012-05-01

In two previous studies of dental students' attitudes about the VitalSource Bookshelf, a digital library of dental textbooks, students expressed negative opinions about owning and reading electronic textbooks. With the assumption that dentists would find the digital textbooks useful for patient care, the authors surveyed recent graduates to determine if their attitude toward the VitalSource Bookshelf had changed. A brief survey was sent to 119 alumni from the classes of 2009 and 2010 of one U.S. dental school. Forty-seven (39.5 percent) completed the questionnaire. Eighteen respondents (48.3 percent) reported using the e-textbooks often or sometimes. The twenty-nine dentists who said they have not used the collection since graduation reported preferring print books or other online sources or having technical problems when downloading the books to a new computer. Only five respondents selected the VitalSource Bookshelf as a preferred source of professional information. Most of the respondents reported preferring to consult colleagues (37.8 percent), the Internet (20 percent), or hardcopy books (17.8 percent) for information. When asked in an open-ended question to state their opinion of the Bookshelf, nineteen (42.2 percent) responded positively, but almost one-third of these only liked the search feature. Six respondents reported that they never use the program. Twenty-two said they have had technical problems with the Bookshelf, including fifteen who have not been able to install it on a new computer. Many of them said they have not followed up with either the dental school or VitalSource support services to overcome this problem. Our study suggests that dentists, similar to dental students, dislike reading electronic textbooks, even with the advantage of searching a topic across more than sixty dental titles.

Electronic curriculum implementation at North American dental schools.

PubMed

Hendricson, William D; Panagakos, Fotinos; Eisenberg, Elise; McDonald, James; Guest, Gary; Jones, Pamela; Johnson, Lynn; Cintron, Laura

2004-10-01

Electronic curriculum, or E-curriculum, refers to computer-based learning including educational materials available on CD or DVD, online courses, electronic mechanisms to search the literature, email, and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible classrooms. In spite of enthusiasm about the potential for E-curriculum to enhance dental education, there is minimal guidance in the literature to assist schools with implementation. The study objectives were: 1) identify U.S. and Canadian dental schools that have initiated mandatory laptop programs and assess cost, faculty development issues, extent of curricular use, problems, and qualitative perceptions; 2) determine the extent to which twenty-two other E-curriculum resources were available and used at North American dental schools; and 3) identify factors that influenced E-curriculum implementation. A twenty-six item questionnaire, known as the Electronic Curriculum Implementation Survey (ECIS), was mailed to all sixty-six North American dental schools (ten Canadian and fifty-six U.S. schools) during 2002-03 with a response rate of 100 percent. Twenty-five of the twenty-six ECIS questions employed a menu-driven, forced choice format, but respondents could provide amplifying comments. Fifty-three questionnaires were completed by associate deans for academic affairs, three by deans, and ten by instructional technology (IT) managers, IT committee chairs, or directors of dental informatics departments. The survey found that E-curriculum implementation among North American dental schools is following the classic innovation pattern in which a few early adopting institutions proceed rapidly while the majority of potential adopters make modifications slowly. Fourteen U.S. dental schools have established mandatory laptop programs for students. Ten of these laptop programs were created in the past two years; respondents reported numerous growing pains but were generally pleased with their progress. Other E-curriculum capabilities were incorporated into courses more frequently at laptop schools than the fifty-two non-laptop schools including websites, online course evaluations, and instructor use of email to communicate with students. Few dental schools use online courses, and at most schools, few faculty have received training in online instructional techniques. Virtually all North American dental schools have provided substantial instructional technology resources to their faculty, but use of twenty-two components and capabilities of E-curriculum was limited, especially at schools without laptop programs. Various faculty-related issues were reported as implementation barriers including lack of time, skill, and incentive to develop educational software. We conclude that many North American dental schools, especially those with laptop programs, are functioning at the "learn by doing" phase of initial implementation in a four-stage innovation adoption model. E-curriculum planners should pay close attention to implementation problems that occur at this stage where many innovation efforts break down.

Anesthesia-Related and Perioperative Cardiac Arrest in Low- and High-Income Countries: A Systematic Review With Meta-Regression and Proportional Meta-Analysis.

PubMed

Koga, Fernando A; El Dib, Regina; Wakasugui, William; Roça, Cairo T; Corrente, José E; Braz, Mariana G; Braz, José R C; Braz, Leandro G

2015-09-01

The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5-1.0] in the 1990s-2010s, P < 0.001; and 8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P < 0.001, respectively). In low-HDI countries, anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P = 0.14), whereas perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P = 0.03).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the 2 time periods.

Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery.

PubMed

Tom, James

2016-01-01

The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias.

Management of Patients With Cardiovascular Implantable Electronic Devices in Dental, Oral, and Maxillofacial Surgery

PubMed Central

Tom, James

2016-01-01

The prevalence of cardiovascular implantable electronic devices as life-prolonging and life-saving devices has evolved from a treatment of last resort to a first-line therapy for an increasing number of patients. As these devices become more and more popular in the general population, dental providers utilizing instruments and medications should be aware of dental equipment and medications that may affect these devices and understand the management of patients with these devices. This review article will discuss the various types and indications for pacemakers and implantable cardioverter-defibrillators, common drugs and instruments affecting these devices, and management of patients with these devices implanted for cardiac dysrhythmias. PMID:27269668

Standard Health Level Seven for Odontological Digital Imaging

PubMed Central

Abril-Gonzalez, Mauricio; Portilla, Fernando A.

2017-01-01

Abstract Background: A guide for the implementation of dental digital imaging reports was developed and validated through the International Standard of Health Informatics–Health Level Seven (HL7), achieving interoperability with an electronic system that keeps dental records. Introduction: Digital imaging benefits patients, who can view previous close-ups of dental examinations; providers, because of greater efficiency in managing information; and insurers, because of improved accessibility, patient monitoring, and more efficient cost management. Finally, imaging is beneficial for the dentist who can be more agile in the diagnosis and treatment of patients using this tool. Materials and Methods: The guide was developed under the parameters of an HL7 standard. It was necessary to create a group of dentists and three experts in information and communication technologies from different institutions. Discussion: Diagnostic images scanned with conventional radiology or from a radiovisiograph can be converted to Digital Imaging and Communications in Medicine (DICOM) format, while also retaining patient information. The guide shows how the information of the health record of the patient and the information of the dental image could be standardized in a Clinical Dental Record document using international informatics standard like HL7-V3-CDA document (dental document Level 2). Since it is an informatics standardized document, it could be sent, stored, or displayed using different devices—personal computers or mobile devices—independent of the platform used. Conclusions: Interoperability using dental images and dental record systems reduces adverse events, increases security for the patient, and makes more efficient use of resources. This article makes a contribution to the field of telemedicine in dental informatics. In addition to that, the results could be a reference for projects of electronic medical records when the dental documents are part of them. PMID:27248059

Standard Health Level Seven for Odontological Digital Imaging.

PubMed

Abril-Gonzalez, Mauricio; Portilla, Fernando A; Jaramillo-Mejia, Marta C

2017-01-01

A guide for the implementation of dental digital imaging reports was developed and validated through the International Standard of Health Informatics-Health Level Seven (HL7), achieving interoperability with an electronic system that keeps dental records. Digital imaging benefits patients, who can view previous close-ups of dental examinations; providers, because of greater efficiency in managing information; and insurers, because of improved accessibility, patient monitoring, and more efficient cost management. Finally, imaging is beneficial for the dentist who can be more agile in the diagnosis and treatment of patients using this tool. The guide was developed under the parameters of an HL7 standard. It was necessary to create a group of dentists and three experts in information and communication technologies from different institutions. Diagnostic images scanned with conventional radiology or from a radiovisiograph can be converted to Digital Imaging and Communications in Medicine (DICOM) format, while also retaining patient information. The guide shows how the information of the health record of the patient and the information of the dental image could be standardized in a Clinical Dental Record document using international informatics standard like HL7-V3-CDA document (dental document Level 2). Since it is an informatics standardized document, it could be sent, stored, or displayed using different devices-personal computers or mobile devices-independent of the platform used. Interoperability using dental images and dental record systems reduces adverse events, increases security for the patient, and makes more efficient use of resources. This article makes a contribution to the field of telemedicine in dental informatics. In addition to that, the results could be a reference for projects of electronic medical records when the dental documents are part of them.

Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration.

PubMed

Ramírez-Carrasco, A; Butrón-Téllez Girón, C; Sanchez-Armass, O; Pierdant-Pérez, M

2017-01-01

Background and Objective . Anxiety/pain are experiences that make dental treatment difficult for children, especially during the time of anesthesia. Hypnosis is used in pediatric clinical situations to modify thinking, behavior, and perception as well as, recently, in dentistry; therefore the aim of this study was to evaluate the effectiveness of hypnosis combined with conventional behavior management techniques during infiltration anesthetic. Methods . Anxiety/pain were assessed with the FLACC scale during the anesthetic moment, as well as heart rate variability and skin conductance before and during the anesthetic moment, between the control and experimental group. Results . A marginal statistical difference ( p = 0.05) was found in the heart rate between baseline and anesthetic moment, being lower in the hypnosis group. No statistically significant differences were found with the FLACC scale or in the skin conductance ( p > 0.05). Conclusion . Hypnosis combined with conventional behavior management techniques decreases heart rate during anesthetic infiltration showing that there may be an improvement in anxiety/pain control through hypnotic therapy.

Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration

PubMed Central

Ramírez-Carrasco, A.; Butrón-Téllez Girón, C.; Sanchez-Armass, O.

2017-01-01

Background and Objective. Anxiety/pain are experiences that make dental treatment difficult for children, especially during the time of anesthesia. Hypnosis is used in pediatric clinical situations to modify thinking, behavior, and perception as well as, recently, in dentistry; therefore the aim of this study was to evaluate the effectiveness of hypnosis combined with conventional behavior management techniques during infiltration anesthetic. Methods. Anxiety/pain were assessed with the FLACC scale during the anesthetic moment, as well as heart rate variability and skin conductance before and during the anesthetic moment, between the control and experimental group. Results. A marginal statistical difference (p = 0.05) was found in the heart rate between baseline and anesthetic moment, being lower in the hypnosis group. No statistically significant differences were found with the FLACC scale or in the skin conductance (p > 0.05). Conclusion. Hypnosis combined with conventional behavior management techniques decreases heart rate during anesthetic infiltration showing that there may be an improvement in anxiety/pain control through hypnotic therapy. PMID:28490941

Supporting the Emergence of Dental Informatics with an Online Community

PubMed Central

Spallek, H.; Irwin, J. Y.; Schleyer, T.; Butler, B. S.; Weiss, P. M.

2008-01-01

Dental Informatics (DI) is the application of computer and information science to improve dental practice, research, education, and program administration. As an emerging field, dental informatics faces many challenges and barriers to establishing itself as a full-fledged discipline; these include the small number of geographically dispersed DI researchers as well as the lack of DI professional societies and DI-specific journals. E-communities have the potential to overcome these obstacles by bringing researchers together at a resources hub and giving them the ability to share information, discuss topics, and find collaborators. In this paper, we discuss our assessment of the information needs of individuals interested in DI and discuss their expectations for an e-community so that we can design an optimal electronic infrastructure for the Dental Informatics Online Community (DIOC). The 256 survey respondents indicated they prefer electronic resources over traditional print material to satisfy their information needs. The most frequently expected benefits from participation in the DIOC were general information (85% of respondents), peer networking (31.1%), and identification of potential collaborators and/or research opportunities (23.2%). We are currently building the DIOC electronic infrastructure: a searchable publication archive and the learning center have been created, and the people directory is underway. Readers are encouraged to access the DIOC Website at www.dentalinformatics.com and initiate a discussion with the authors of this paper. PMID:18271498

The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures.

PubMed

Keles, Sultan; Kocaturk, Ozlem

2017-01-01

The aim of this study was to detect the effect of 1  μ g/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group ( n = 50) received 1  μ g/kg DEX in apple juice, and the control group ( n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded. The data were analyzed using chi-square test, Fisher's exact test, Student's t -test, and analysis of variance in SPSS. RSS scores were significantly higher in the DEX group than group C at 15, 30, and 45 min ( p < 0.05). More children (68% easy separation, 74% satisfactory mask acceptance) in the DEX group showed satisfactory ease of parental separation and mask acceptance behavior ( p < 0.05). There was no significant difference in the PAEDS scores and mean hemodynamic parameters of both groups. Oral DEX administered at 1  μ g/kg provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children but was not effective in preventing emergence delirium. The trial was registered (Protocol Registration Receipt NCT03174678) at clinicaltrials.gov.

Occurrence of paresthesia after dental local anesthetic administration in the United States.

PubMed

Garisto, Gabriella A; Gaffen, Andrew S; Lawrence, Herenia P; Tenenbaum, Howard C; Haas, Daniel A

2010-07-01

Several studies have suggested that the likelihood of paresthesia may depend on the local anesthetic used. The purpose of this study was to determine if the type of local anesthetic administered had any effect on reports of paresthesia in dentistry in the United States. The authors obtained reports of paresthesia involving dental local anesthetics during the period from November 1997 through August 2008 from the U.S. Food and Drug Administration Adverse Event Reporting System. They used chi(2) analysis to compare expected frequencies, on the basis of U.S. local anesthetic sales data, with observed reports of oral paresthesia. During the study period, 248 cases of paresthesia occurring after dental procedures were reported. Most cases (94.5 percent) involved mandibular nerve block. The lingual nerve was affected in 89.0 percent of cases. Reports involving 4 percent prilocaine and 4 percent articaine were 7.3 and 3.6 times, respectively, greater than expected (chi(2), P < .0001) on the basis of local anesthetic use by U.S. dentists. These data suggest that paresthesia occurs more commonly after use of 4 percent local anesthetic formulations. These findings are consistent with those reported in a number of studies from other countries. Until further research indicates otherwise, dentists should consider these results when assessing the risks and benefits of using 4 percent local anesthetics for mandibular block anesthesia.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

PubMed Central

Yosefi, Mohammad Hosein; Nakhaee, Nouzar

2015-01-01

Objectives Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. Materials and Methods Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. Results At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. Conclusions There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment. PMID:25984478

Electronic laboratory quality assurance program: A method of enhancing the prosthodontic curriculum and addressing accreditation standards.

PubMed

Moghadam, Marjan; Jahangiri, Leila

2015-08-01

An electronic quality assurance (eQA) program was developed to replace a paper-based system and to address standards introduced by the Commission on Dental Accreditation (CODA) and to improve educational outcomes. This eQA program provides feedback to predoctoral dental students on prosthodontic laboratory steps at New York University College of Dentistry. The purpose of this study was to compare the eQA program of performing laboratory quality assurance with the former paper-based format. Fourth-year predoctoral dental students (n=334) who experienced both the paper-based and the electronic version of the quality assurance program were surveyed about their experiences. Additionally, data extracted from the eQA program were analyzed to identify areas of weakness in the curriculum. The study findings revealed that 73.8% of the students preferred the eQA program to the paper-based version. The average number of treatments that did not pass quality assurance standards was 119.5 per month. This indicated a 6.34% laboratory failure rate. Further analysis of these data revealed that 62.1% of the errors were related to fixed prosthodontic treatment, 27.9% to partial removable dental prostheses, and 10% to complete removable dental prostheses in the first 18 months of program implementation. The eQA program was favored by dental students who have experienced both electronic and paper-based versions of the system. Error type analysis can yield the ability to create customized faculty standardization sessions and refine the didactic and clinical teaching of the predoctoral students. This program was also able to link patient care activity with the student's laboratory activities, thus addressing the latest requirements of the CODA regarding the competence of graduates in evaluating laboratory work related to their patient care. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Evidence-based dentistry: a clinician's perspective.

PubMed

Bauer, Janet; Spackman, Sue; Chiappelli, Francesco; Prolo, Paolo; Stevenson, Richard

2006-07-01

Evidence-based dentistry is a discipline that provides best, explicit-based evidence to dentists and their patients in shared decision-making. Currently, dentists are being trained and directed to adopt the role of translational researchers in developing evidence-based dental practices. Practically, evidence-based dentistry is not usable in its current mode for the provision of labor-intensive services that characterize current dental practice. The purpose of this article is to introduce a model of evidence-based dental practice. This model conceptualizes a team approach in explaining problems and solutions to change current dental practice. These changes constitute an evidence-based dental practice that involves the electronic chart, centralized database, knowledge management software, and personnel in optimizing effective oral health care to dental patients.

Anesthetic management of Costello syndrome: a case report.

PubMed

Williams, Christol

2014-04-01

Costello syndrome is a rare genetic disorder with an estimated 300 medical cases worldwide. Typical features that characterize this syndrome include short stature, macrocephaly, developmental delay, loose skin folds, distinctive coarse facial features, and multiorgan system anomalies. The following case report discusses the anesthetic management for a 3-year-old boy undergoing general anesthesia for a scheduled dental restoration, hydrocelectomy, inguinal hernia repair, and bilateral myringotomy with placement of pressure equalization tubes. A scarcity of literature for the anesthetic management of Costello syndrome (also known as faciocutaneoskeletal syndrome) exists. Utilizing an overview of the pertinent literature, clinical practice recommendations are suggested for the anesthetic implications of managing a pediatric patient with this rare syndrome.

Four impacted fourth molars in a young patient: a case report

PubMed Central

CLEMENTINI, M.; OTTRIA, L.; PANDOLFI, C.; AGRESTINI, C.; BARLATTANI, A.

2013-01-01

Summary The occurrence of supernumerary teeth is a relatively uncommon dental anomaly and it’s rare for patients to have impacted fourth molars in all quadrant. Aim of this work is to describe the presence of bilateral fourth molars in the maxilla and the mandible in a young male patient aged 22 years came to our hospital with acute pericoronal infection around unerupted third inferior molars. Routine radiographic examination revealed impacted inferior third molars but also unerupted bilateral upper and inferior fourth molars. The acute infection was treated by local measures and the patient was subsequently admitted for removal of third and fourth impacted upper and lower molars under general anesthesia. PMID:23741604

Comparison of alphabetical versus categorical display format for medication order entry in a simulated touch screen anesthesia information management system: an experiment in clinician-computer interaction in anesthesia.

PubMed

Marian, Anil A; Dexter, Franklin; Tucker, Peter; Todd, Michael M

2012-05-29

Anesthesia information management system (AIMS) records should be designed and configured to facilitate the accurate and prompt recording of multiple drugs administered coincidentally or in rapid succession. We proposed two touch-screen display formats for use with our department's new EPIC touch-screen AIMS. In one format, medication "buttons" were arranged in alphabetical order (i.e. A-C, D-H etc.). In the other, buttons were arranged in categories (Common, Fluids, Cardiovascular, Coagulation etc.). Both formats were modeled on an iPad screen to resemble the AIMS interface. Anesthesia residents, anesthesiologists, and Certified Registered Nurse Anesthetists (n = 60) were then asked to find and touch the correct buttons for a series of medications whose names were displayed to the side of the entry screen. The number of entries made within 2 minutes was recorded. This was done 3 times for each format, with the 1st format chosen randomly. Data were analyzed from the third trials with each format to minimize differences in learning. The categorical format had a mean of 5.6 more drugs entered using the categorical method in two minutes than the alphabetical format (95% confidence interval [CI] 4.5 to 6.8, P < 0.0001). The findings were the same regardless of the order of testing (i.e. alphabetical-categorical vs. categorical - alphabetical) and participants' years of clinical experience. Most anesthesia providers made no (0) errors for most trials (N = 96/120 trials, lower 95% limit 73%, P < 0.0001). There was no difference in error rates between the two formats (P = 0.53). The use of touch-screen user interfaces in healthcare is increasingly common. Arrangement of drugs names in a categorical display format in the medication order-entry touch screen of an AIMS can result in faster data entry compared to an alphabetical arrangement of drugs. Results of this quality improvement project were used in our department's design of our final intraoperative electronic anesthesia record. This testing approach using cognitive and usability engineering methods can be used to objectively design and evaluate many aspects of the clinician-computer interaction in electronic health records.

Comparison of alphabetical versus categorical display format for medication order entry in a simulated touch screen anesthesia information management system: an experiment in clinician-computer interaction in anesthesia

PubMed Central

2012-01-01

Background Anesthesia information management system (AIMS) records should be designed and configured to facilitate the accurate and prompt recording of multiple drugs administered coincidentally or in rapid succession. Methods We proposed two touch-screen display formats for use with our department’s new EPIC touch-screen AIMS. In one format, medication “buttons” were arranged in alphabetical order (i.e. A-C, D-H etc.). In the other, buttons were arranged in categories (Common, Fluids, Cardiovascular, Coagulation etc.). Both formats were modeled on an iPad screen to resemble the AIMS interface. Anesthesia residents, anesthesiologists, and Certified Registered Nurse Anesthetists (n = 60) were then asked to find and touch the correct buttons for a series of medications whose names were displayed to the side of the entry screen. The number of entries made within 2 minutes was recorded. This was done 3 times for each format, with the 1st format chosen randomly. Data were analyzed from the third trials with each format to minimize differences in learning. Results The categorical format had a mean of 5.6 more drugs entered using the categorical method in two minutes than the alphabetical format (95% confidence interval [CI] 4.5 to 6.8, P < 0.0001). The findings were the same regardless of the order of testing (i.e. alphabetical-categorical vs. categorical - alphabetical) and participants’ years of clinical experience. Most anesthesia providers made no (0) errors for most trials (N = 96/120 trials, lower 95% limit 73%, P < 0.0001). There was no difference in error rates between the two formats (P = 0.53). Conclusions The use of touch-screen user interfaces in healthcare is increasingly common. Arrangement of drugs names in a categorical display format in the medication order-entry touch screen of an AIMS can result in faster data entry compared to an alphabetical arrangement of drugs. Results of this quality improvement project were used in our department’s design of our final intraoperative electronic anesthesia record. This testing approach using cognitive and usability engineering methods can be used to objectively design and evaluate many aspects of the clinician-computer interaction in electronic health records. PMID:22643058

Long-term neuroplasticity of the face primary motor cortex and adjacent somatosensory cortex induced by tooth loss can be reversed following dental implant replacement in rats.

PubMed

Avivi-Arber, Limor; Lee, Jye-Chang; Sood, Mandeep; Lakschevitz, Flavia; Fung, Michelle; Barashi-Gozal, Maayan; Glogauer, Michael; Sessle, Barry J

2015-11-01

Tooth loss is common, and exploring the neuroplastic capacity of the face primary motor cortex (face-M1) and adjacent primary somatosensory cortex (face-S1) is crucial for understanding how subjects adapt to tooth loss and their prosthetic replacement. The aim was to test if functional reorganization of jaw and tongue motor representations in the rat face-M1 and face-S1 occurs following tooth extraction, and if subsequent dental implant placement can reverse this neuroplasticity. Rats (n = 22) had the right maxillary molar teeth extracted under local and general anesthesia. One month later, seven rats had dental implant placement into healed extraction sites. Naive rats (n = 8) received no surgical treatment. Intracortical microstimulation (ICMS) and recording of evoked jaw and tongue electromyographic responses were used to define jaw and tongue motor representations at 1 month (n = 8) or 2 months (n = 7) postextraction, 1 month postimplant placement, and at 1-2 months in naive rats. There were no significant differences across study groups in the onset latencies of the ICMS-evoked responses (P > 0.05), but in comparison with naive rats, tooth extraction caused a significant (P < 0.05) and sustained (1-2 months) decreased number of ICMS-defined jaw and tongue sites within face-M1 and -S1, and increased thresholds of ICMS-evoked responses in these sites. Furthermore, dental implant placement reversed the extraction-induced changes in face-S1, and in face-M1 the number of jaw sites even increased as compared to naive rats. These novel findings suggest that face-M1 and adjacent face-S1 may play a role in adaptive mechanisms related to tooth loss and their replacement with dental implants. © 2015 Wiley Periodicals, Inc.

What Is Elective Surgery? (For Parents)

MedlinePlus

... or not your insurance will cover the entire cost of the operation, the hospitalization, the prescriptions, and any other associated ... Electronic Health Records Health Insurance Basics Finding Low-Cost Medical ... Like to Have Surgery? Health Care: What Do You Know? Anesthesia Basics ...

Processing and Development of Nano-Scale HA Coatings for Biomedical Application

DTIC Science & Technology

2005-01-01

thickness of the film has been processed and tested as a more effective orthopedic/ dental implant coating. The present study aims to increase the service...life of an orthopedic/ dental implant by creating materials that form a strong, long lasting, bond with the Ti substrate as well as juxtaposed bone... dental replacement surgery may quickly return to a normal active lifestyle. Cross-sectional transmission electron microscopy analysis displayed that the

Anatomy of an anesthesia information management system.

PubMed

Shah, Nirav J; Tremper, Kevin K; Kheterpal, Sachin

2011-09-01

Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records. Copyright © 2011 Elsevier Inc. All rights reserved.

Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth.

PubMed

Kämmerer, P W; Adubae, A; Buttchereit, I; Thiem, D G E; Daubländer, M; Frerich, B

2018-04-01

The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth. In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed. ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected. ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth. ILA can be recommended for routine dental extractions.

Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children?

PubMed Central

Erfanparast, Leila; Sheykhgermchi, Sanaz; Ghanizadeh, Milad

2017-01-01

Introduction Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children. Study design In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21. Results The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth. Conclusion According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars’ buccal mucosa is not anesthetized. How to cite this article: Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372. PMID:29403231

Self-reported information needs of anesthesia residency applicants and analysis of applicant-related web sites resources at 131 United States training programs.

PubMed

Chu, Larry F; Young, Chelsea A; Zamora, Abby K; Lowe, Derek; Hoang, Dan B; Pearl, Ronald G; Macario, Alex

2011-02-01

Despite the use of web-based information resources by both anesthesia departments and applicants, little research has been done to assess these resources and determine whether they are meeting applicant needs. Evidence is needed to guide anesthesia informatics research in developing high-quality anesthesia residency program Web sites (ARPWs). We used an anonymous web-based program (SurveyMonkey, Portland, OR) to distribute a survey investigating the information needs and perceived usefulness of ARPWs to all 572 Stanford anesthesia residency program applicants. A quantitative scoring system was then created to assess the quality of ARPWs in meeting the information needs of these applicants. Two researchers independently analyzed all 131 ARPWs in the United States to determine whether the ARPWs met the needs of applicants based on the scoring system. Finally, a qualitative assessment of the overall user experience of ARPWs was developed to account for the subjective elements of the Web site's presentation. Ninety-eight percent of respondents reported having used ARPWs during the application process. Fifty-six percent reported first visiting the Stanford ARPW when deciding whether to apply to Stanford's anesthesia residency program. Multimedia and Web 2.0 technologies were "very" or "most" useful in "learning intangible aspects of a program, like how happy people are" (42% multimedia and Web 2.0 versus 14% text and photos). ARPWs, on average, contained only 46% of the content items identified as important by applicants. The average (SD) quality scores among all ARPWs was 2.06 (0.59) of 4.0 maximum points. The mean overall qualitative score for all 131 ARPWs was 4.97 (1.92) of 10 points. Only 2% of applicants indicated that the majority (75%-100%) of Web sites they visited provided a complete experience. Anesthesia residency applicants rely heavily on ARPWs to research programs, prepare for interviews, and formulate a rank list. Anesthesia departments can improve their ARPWs by including information such as total hours worked and work hours by rotation (missing in 96% and 97% of ARPWs) and providing a valid web address on the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) (missing in 28% of ARPWs).

Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children

PubMed Central

Saha, Sonali; Jaiswal, JN; Samadi, Firoza

2014-01-01

ABSTRACT Aim: The present study was taken up to clinically evaluate and compare effectiveness of transcutaneous electrical nerve stimulator (TENS) and comfort control syringe (CCS) in various pediatric dental procedures as an alternative to the conventional method of local anesthesia (LA) administration. Materials and methods: Ninety healthy children having at least one deciduous molar tooth indicated for extraction in either maxillary right or left quadrant in age group of 6 to 10 years were randomly divided into three equal groups having 30 subjects each. Group I: LA administration using conventional syringe, group II: LA administration using TENS along with the conventional syringe, group III: LA administration using CCS. After LA by the three techniques, pain, anxiety and heart rate were measured. Statistical analysis: The observations, thus, obtained were subjected to statistical analysis using analysis of variance (ANOVA), student t-test and paired t-test. Results: The mean pain score was maximum in group I followed by group II, while group III revealed the minimum pain, where LA was administered using CCS. Mean anxiety score was maximum in group I followed by group II, while group III revealed the minimum score. Mean heart rate was maximum in group I followed in descending order by groups II and III. Conclusion: The study supports the belief that CCS could be a viable alternative in comparison to the other two methods of LA delivery in children. How to cite this article: Bansal N, Saha S, Jaiswal JN, Samadi F. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. Int J Clin Pediatr Dent 2014;7(2):71-76. PMID:25356003

A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems.

PubMed

Simpao, Allan F; Tan, Jonathan M; Lingappan, Arul M; Gálvez, Jorge A; Morgan, Sherry E; Krall, Michael A

2017-10-01

Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies were identified by searches of the electronic databases Medline and EMBASE. Two reviewers screened studies based on title, abstract, and full text. Studies that were similar in intervention and desired outcome were grouped into CDS categories. Three reviewers graded the evidence within each category. The final analysis included 25 articles on CDS as implemented within AIMS. CDS categories included perioperative antibiotic prophylaxis, post-operative nausea and vomiting prophylaxis, vital sign monitors and alarms, glucose management, blood pressure management, ventilator management, clinical documentation, and resource utilization. Of these categories, the reviewers graded perioperative antibiotic prophylaxis and clinical documentation as having strong evidence per the peer reviewed literature. There is strong evidence for the inclusion of near real-time and point-of-care CDS in AIMS to enhance compliance with perioperative antibiotic prophylaxis and clinical documentation. Additional research is needed in many other areas of AIMS-based CDS.

Operating room metrics score card-creating a prototype for individualized feedback.

PubMed

Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Urman, Richard D

2014-11-01

The balance between reducing costs and inefficiencies with that of patient safety is a challenging problem faced in the operating room suite. An ongoing challenge is the creation of effective strategies that reduce these inefficiencies and provide real-time personalized metrics and electronic feedback to anesthesia practitioners. We created a sample report card structure, utilizing existing informatics systems. This system allows to gather and analyze operating room metrics for each anesthesia provider and offer personalized feedback. To accomplish this task, we identified key metrics that represented time and quality parameters. We collected these data for individual anesthesiologists and compared performance to the overall group average. Data were presented as an electronic score card and made available to individual clinicians on a real-time basis in an effort to provide effective feedback. These metrics included number of cancelled cases, average turnover time, average time to operating room ready and patient in room, number of delayed first case starts, average induction time, average extubation time, average time to recovery room arrival to discharge, performance feedback from other providers, compliance to various protocols, and total anesthetic costs. The concept we propose can easily be generalized to a variety of operating room settings, types of facilities and OR health care professionals. Such a scorecard can be created using content that is important for operating room efficiency, research, and practice improvement for anesthesia providers.

Dental unit waterlines disinfection using hypochlorous acid-based disinfectant

PubMed Central

Shajahan, Irfana Fathima; Kandaswamy, D; Srikanth, Padma; Narayana, L Lakshmi; Selvarajan, R

2016-01-01

Objective: The purpose of the study was to investigate the efficacy of a new disinfectant to disinfect the dental unit waterlines. Materials and Methods: New dental unit waterlines were installed in 13 dental chairs, and biofilm was allowed to grow for 10 days. Disinfection treatment procedure was carried out in the 12 units, and one unit was left untreated. The dental unit waterlines were removed and analyzed using the scanning electron microscope (SEM) (TESCAN VEGA3 SBU). Result: On examination, SEM images showed that there was no slime layer or bacterial cells seen in any of the 12 cut sections obtained from the treated dental waterlines which mean that there was no evident of biofilm formation. Untreated dental unit waterlines showed a microbial colonization with continuous filamentous organic matrix. There was significant biofilm formation in the control tube relative to the samples. Conclusion: The tested disinfectant was found to be effective in the removal of biofilm from the dental unit waterlines. PMID:27563184

Drug wastage contributes significantly to the cost of routine anesthesia care.

PubMed

Weinger, M B

2001-11-01

To complement previous studies that employed indirect methods of measuring anesthesia drug waste. Prospective, blinded observational study. Operating rooms of a single university hospital. Anesthesia providers practicing in this setting who were completely unaware of the conduct of the study. All opened and unused or unusable intravenous (IV) anesthesia drugs left over at the end of each workday were collected over a randomly selected typical 2-week period. 166 weekday cases were performed. Thirty different drugs were represented in the 157 syringes and 139 ampoules collected. Opioid waste as well as opened vials that became outdated were counted in the tally. Based on actual hospital drug acquisition costs, $1,802 of drugs were wasted during this 2-week period ($300/OR), amounting to an average cost per case of $10.86. On a cost basis, six drugs accounted for three quarters of the total wastage: phenylephrine (20.8%), propofol (14.5%), vecuronium (12.2%), midazolam (11.4%), labetalol (9.1%), and ephedrine (8.6%). Because incompletely used syringes or vials that were discarded in the trash were not measured in this analysis, the results may underestimate the total cost of drug wastage at this institution by up to 40%. The results of this study are similar to those of previous studies that employed electronic record keeping techniques to calculate drug waste. Intravenous drugs that are prepared but unused may be a significant cost of intraoperative anesthesia care. Methods to reduce the amount of drug wasted are proposed.

Cumulative Effect of Repeated Brief Cerebral Ischemia

DTIC Science & Technology

1991-12-14

in this process. Rats were prepared for experiment under halothane anesthesia with trach; ostomy , ligation of both subclavian arteries, cannulation of...did, beyond ordinary surgical morbidity and electronic recording problems. All have finally been mastered, and we are hopeful that the mastery will be

Measuring and Improving the Quality of Preprocedural Assessments.

PubMed

Manji, Farah; McCarty, Kelsey; Kurzweil, Vanessa; Mark, Eden; Rathmell, James P; Agarwala, Aalok V

2017-06-01

Preprocedural assessments are used by anesthesia providers to optimize perioperative care for patients undergoing invasive procedures. When these assessments are performed in advance by providers who are not caring for the patient during the procedure, there is an additional layer of complexity in ensuring that the workup meets the needs of the primary anesthesia care team. In this study, anesthesia providers were asked to rate the quality of preprocedural assessments prepared by other providers to evaluate anesthesia care team satisfaction. Quality ratings for preprocedural assessments were collected from anesthesia providers on the day of surgery using an electronic quality assurance tool from January 9, 2014 to October 21, 2014. Users could rate assessments as "exemplary," "satisfactory," or "unsatisfactory." Free text comments could be entered for any of the quality ratings chosen. A reviewer trained in clinical anesthesia categorized all comments as "positive," "constructive," or "neutral" and conducted in-depth chart reviews triggered by 67 "constructive" comments submitted during the first 3 months of data collection to further subcategorize perceived deficiencies in the preprocedural assessments. In May 2014, providers were asked to participate in a midpoint survey and provide general feedback about the preprocedural process and evaluations. 37,611 procedures requiring anesthesia were analyzed. Of the 17,522 (46.6%) cases with a rated preprocedural assessment, anesthesia providers rated 3828 (21.8%) as "exemplary," 13,454 (76.8%) as "satisfactory," and 240 (1.4%) as "unsatisfactory." The monthly proportion of "unsatisfactory" ratings ranged from 3.1% to 0% over the study period, whereas the midpoint survey showed that anesthesia providers estimated that the number of unsatisfactory evaluations was 11.5%. Preprocedural evaluations performed on inpatients received significantly better ratings than evaluations performed on outpatients by the preadmission testing clinic or phone program (P < .0001). The most common reason given for "unsatisfactory" ratings was a perception of "missing information" (49.2%). Chart reviews revealed that inadequate documentation was in reality the most common deficiency in preprocedural evaluations (35 of 67 reviews, 52.2%). The overwhelming majority of preprocedural assessments performed at our institution were considered satisfactory or exemplary by day-of-surgery anesthesia providers. This was demonstrated by both the case-by-case ratings and midpoint survey. However, the perceived frequency of "unsatisfactory" evaluations was worse when providers were asked to reflect on the quality of preprocedural evaluations generally versus rate them individually. Analysis of comments left by providers allowed us to identify specific and actionable areas for improvement. This method can be used by other institutions to identify systemic deficiencies in the preprocedural evaluation process.

Connecting to success: practice management on the Net.

PubMed

Freydberg, B K

2001-08-15

Profound changes in the way dental practices manage data, patient records, and communication are beginning to unfold. Sooner than most of us can imagine, secured patient medical and dental records will reside on the Internet. Additionally, communication between health care providers and patients will become virtually 100% electronic. As the Application Service Provider (ASP) dental models mature, practices will transition from paper to "paperless" to "web-based" management and clinical systems. This article examines and explains these future frontiers.

The Effect of Titanium Surface Roughness on Growth, Differentiation, and Protein Synthesis of Cartilage and Bone Cells

DTIC Science & Technology

1996-05-01

at San Antonio Supervising Professors: Barbara D. Boyan, Ph.D. David L. Cochran, D.D.S., Ph.D. Placement of endosseous dental implants requires the...titanium substratum was chosen for these studies since most medical and dental implants are fabricated from titanium The titanium was cut into uniform...electron microscopy to evaluate the histomorphometry of the implant-bone interface of various titanium and ceramic dental implants placed in dog mandibles

Effect of audiovisual eyeglasses during local anesthesia injections in 5- to 8-year-old children.

PubMed

Asvanund, Yuwadee; Mitrakul, Kemthong; Juhong, Ratana-on; Arunakul, Malee

2015-06-01

To evaluate the effectiveness of audiovisual (AV) eyeglasses on pain reduction during local anesthetic injection in children who are 5 to 8 years old. Forty-nine healthy, cooperative children with bilateral carious molars requiring treatment under local anesthesia were recruited in this crossover study. Treatments were done in two visits, 1 to 4 weeks apart. Subjects were randomly divided into two groups according to the sequence of AV eyeglasses used. Group I received the injection without wearing AV eyeglasses in the first visit and then wearing AV eyeglasses in a second visit. Group II was vice versa. Self-reporting pain using the Faces Pain Scale-Revised (FPS-R), face, legs, activity, crying, and consolability scale (FLACC), and heart rate (HR), were measured to assess the injection pain. No significant differences in sex (P = .132) and treatment arch (P = .779) were observed between the two groups using a chi-square test at P < .05. There were no significant differences in age (P = .341, t test at P ≤ .05) and previous dental experience (P = .19, Fisher's exact test at P ≤ .05) between the two groups. Pain scores were lower when the patients had their injection while wearing AV eyeglasses in both groups. No subject reported a maximum score on the pain rating scale when wearing AV eyeglasses, while 14% of the subjects reported so when not wearing the eyeglasses. AV eyeglasses significantly reduced FLACC scores (P = .03) and HR (P = .005) when compared with not wearing the eyeglasses (Mann-Whitney U test at P ≤ .05). AV eyeglasses successfully reduced pain, physical distress, and HR during local anesthesia injection.

Does Use of an Electronic Health Record with Dental Diagnostic System Terminology Promote Dental Students’ Critical Thinking?

PubMed Central

Reed, Susan G.; Adibi, Shawn S.; Coover, Mullen; Gellin, Robert G.; Wahlquist, Amy E.; AbdulRahiman, Anitha; Hamil, Lindsey H.; Walji, Muhammad F.; O’Neill, Paula; Kalenderian, Elsbeth

2015-01-01

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students’ critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013–17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry. PMID:26034034

Does use of an electronic health record with dental diagnostic system terminology promote dental students' critical thinking?

PubMed

Reed, Susan G; Adibi, Shawn S; Coover, Mullen; Gellin, Robert G; Wahlquist, Amy E; AbdulRahiman, Anitha; Hamil, Lindsey H; Walji, Muhammad F; O'Neill, Paula; Kalenderian, Elsbeth

2015-06-01

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.

Evaluation of irradiation effects of near-infrared free-electron-laser of silver alloy for dental application.

PubMed

Kuwada-Kusunose, Takao; Kusunose, Alisa; Wakami, Masanobu; Takebayashi, Chikako; Goto, Haruhiko; Aida, Masahiro; Sakai, Takeshi; Nakao, Keisuke; Nogami, Kyoko; Inagaki, Manabu; Hayakawa, Ken; Suzuki, Kunihiro; Sakae, Toshiro

2017-08-01

In the application of lasers in dentistry, there is a delicate balance between the benefits gained from laser treatment and the heat-related damage arising from laser irradiation. Hence, it is necessary to understand the different processes associated with the irradiation of lasers on dental materials. To obtain insight for the development of a safe and general-purpose laser for dentistry, the present study examines the physical effects associated with the irradiation of a near-infrared free-electron laser (FEL) on the surface of a commonly used silver dental alloy. The irradiation experiments using a 2900-nm FEL confirmed the formation of a pit in the dental alloy. The pit was formed with one macro-pulse of FEL irradiation, therefore, suggesting the possibility of efficient material processing with an FEL. Additionally, there was only a slight increase in the silver alloy temperature (less than 0.9 °C) despite the long duration of FEL irradiation, thus inferring that fixed prostheses in the oral cavity can be processed by FEL without thermal damage to the surrounding tissue. These results indicate that dental hard tissues and dental materials in the oral cavity can be safely and efficiently processed by the irradiation of a laser, which has the high repetition rate of a femtosecond laser pulse with a wavelength around 2900 nm.

Incidence and Determinants of Dental Implant Failure: A Review of Electronic Health Records in a U.S. Dental School.

PubMed

Hickin, Matthew Parker; Shariff, Jaffer A; Jennette, Philip J; Finkelstein, Joseph; Papapanou, Panos N

2017-10-01

The aim of this study was to use electronic health care records (EHRs) to examine retrospectively the incidence of and attributes associated with dental implant failures necessitating implant removal in a large cohort of patients treated in the student clinics of a U.S. dental school over three and a half years. EHRs were searched for all patients who received dental implants between July 1, 2011, and December 31, 2014. Characteristics of patients and implants that were actively removed due to irrevocable failure of any etiology ("failure cohort") during this period were compared to those of all other patients who received dental implants during the same time frame ("reference cohort"). Differences in the frequency distribution of various characteristics between the failure and reference cohorts were compared. Of a total 6,129 implants placed in 2,127 patients during the study period, 179 implants (2.9%) in 120 patients (5.6%) were removed. In the multivariate analysis, presence of a removable (OR=2.86) or fixed temporary prosthesis (OR=3.71) was statistically significantly associated with increased risk for implant failure. In contrast, antibiotic coverage (pre- and post-surgery OR=0.16; post-surgery only OR=0.38) and implants of certain manufacturers were associated with lower risk of implant failure. In this sizeable cohort of patients receiving care in dental student clinics, the review of EHRs facilitated identification of multiple variables associated with implant failure resulting in removal; however, these findings do not suggest causative relationships. The adopted analytical approach can enhance quality assurance measures and may contribute to the identification of true risk factors for dental implant failure.

Effectiveness of benzocaine in reducing deep cavity restoration and post-extraction stress in dental patients.

PubMed

Al-Samadani, Khalid H; Gazal, Giath

2015-11-01

To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA). A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS). Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with "no pain" (0 mm) and "unbearable pain" (100 mm). There were statistically significant differences between the mean stress scores for patients in the benzocaine and normal saline groups post-operatively (p=0.002). There were significant differences between the mean pain scores for patients in the post buccal injection (p=0.001), post palatal injection (p=0.01), and the post inferior alveolar nerve block groups (p=0.02). Buccal, palatal, and inferior alveolar nerve block injections were more painful for patients in the normal saline group than the benzocaine group. This investigation has demonstrated that post-operative stress associated with deep cavity restoration and dental extractions under LA can be reduced by the application of topical anesthetic (20% benzocaine) at the operative site for intra-oral injections.

Effectiveness of benzocaine in reducing deep cavity restoration and post-extraction stress in dental patients

PubMed Central

Al-Samadani, Khalid H.; Gazal, Giath

2015-01-01

Objectives: To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA). Methods: A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS). Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm). Results: There were statistically significant differences between the mean stress scores for patients in the benzocaine and normal saline groups post-operatively (p=0.002). There were significant differences between the mean pain scores for patients in the post buccal injection (p=0.001), post palatal injection (p=0.01), and the post inferior alveolar nerve block groups (p=0.02). Buccal, palatal, and inferior alveolar nerve block injections were more painful for patients in the normal saline group than the benzocaine group. Conclusion: This investigation has demonstrated that post-operative stress associated with deep cavity restoration and dental extractions under LA can be reduced by the application of topical anesthetic (20% benzocaine) at the operative site for intra-oral injections. PMID:26593169

Pediatric ambulatory care sensitive conditions: Birth cohorts and the socio-economic gradient.

PubMed

Roos, Leslie L; Dragan, Roxana; Schroth, Robert J

2017-09-14

This study examines the socio-economic gradient in utilization and the risk factors associated with hospitalization for four pediatric ambulatory care sensitive conditions (dental conditions, asthma, gastroenteritis, and bacterial pneumonia). Dental conditions, where much care is provided by dentists and insurance coverage varies among different population segments, present special issues. A population registry, provider registry, physician ambulatory claims, and hospital discharge abstracts from 28 398 children born in 2003-2006 in urban centres in Manitoba, Canada were the main data sources. Physician visits and hospitalizations were compared across neighbourhood income groupings using rank correlations and logistic regressions. Very strong relationships between neighbourhood income and utilization were highlighted. Additional variables - family on income assistance, mother's age at first birth, breastfeeding - helped predict the probability of hospitalization. Despite the complete insurance coverage (including visits to dentists and physicians and for hospitalizations) provided, receiving income assistance was associated with higher probabilities of hospitalization. We found a socio-economic gradient in utilization for pediatric ambulatory care sensitive conditions, with higher rates of ambulatory visits and hospitalizations in the poorest neighbourhoods. Insurance coverage which varies between different segments of the population complicates matters. Providing funding for dental care for Manitobans on income assistance has not prevented physician visits or intensive treatment in high-cost facilities, specifically treatment under general anesthesia. When services from one type of provider (dentist) are not universally insured but those from another type (physician) are, using rates of hospitalization to indicate problems in the organization of care seems particularly difficult.

Integrating student feedback during "Dental Curriculum Hack-A-thon".

PubMed

Saffari, Shawheen S; Frederick Lambert, R; Dang, Lucy; Pagni, Sarah; Dragan, Irina F

2018-05-02

The future of dental education is at crossroads. This study used the parameter of the 2016 Dental Curriculum Hack-a-Thon to assess intra- and inter-institutional agreement between student and faculty views regarding dental curriculums to determine if there is an impact in student perceptions towards dental education from before and after the event. This exploratory, cross-sectional study involved two surveys, with Survey 1 being distributed among four faculty-student pairs of the four participating dental schools answering 14 questions. Survey 2 assessed the views of 20 participating dental students through 26 questions in a pre- and post- event survey design. Descriptive statistics were used to explore differences in perceptions towards dental education across both instrument surveys. The results revealed valuable student insights regarding intra- and inter-institutional agreement relevant for the change in dental curriculum that needs to occur. Survey 2 revealed that mandatory attendance in didactic courses, electronic based examination preferences, and the preference of preclinical courses being held in the first and second years of a four-year dental curriculum were of particular importance to student participants. The results of this study indicate that exposure and participation in subjects pertaining to dental education can be influential on student preferences and opinions on how dental education should be delivered in a four-year curriculum.

Nitrous Oxide and the Inhalation Anesthetics

PubMed Central

Becker, Daniel E; Rosenberg, Morton

2008-01-01

Nitrous oxide is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably, but it may be combined with other inhalation and/or intravenous agents in deep sedative/general anesthestic techniques. However, as a single agent, it has impressive safety and is excellent for providing minimal and moderate sedation for apprehensive dental patients. To gain a full appreciation of the pharmacology, physiologic influences, and proper use of nitrous oxide, one must compare it with other inhalation anesthetics. The purpose of this CE article is to provide an overview of inhalation anesthetics in general and to address nitrous oxide more specifically in comparison. PMID:19108597

Electronic dental records: start taking the steps.

PubMed

Bergoff, Jana

2011-01-01

Converting paper patient records charts into their electronic counterparts (EDRs) not only has many advantages, but also could become a legal requirement in the future. Several steps key to a successful transition includes assessing the needs of the dental team and what they require as a part of the implementation Existing software and hardware must be evaluated for continued use and expansion. Proper protocols for information transfer must be established to ensure complete records while maintaining HIPAA regulations regarding patient privacy. Reduce anxiety by setting realistic dead-lines and using trusted back-up methods.

Efficacy of Intravenous Acetaminophen in Periimplantation Pain of Cardiac Electronic Devices: A Randomized Double-Blinded Study.

PubMed

Mollazadeh, Reza; Eftekhari, Mohammad Reza; Eslami, Masoud

2017-06-01

Although intravenous acetaminophen has been administered to reduce postoperative pain, it has not been used during cardiac implantable electronic devices (CIEDs) implantation. This was a randomized double-blinded interventional study. Thirty-two patients who were referred for new CIED implantation during July 2012 until April 2013 randomly received placebo or 1 g of intravenous acetaminophen. All patients were treated with local anesthesia. Pain score during incision, pocket creation, and in the recovery room, and the patients' need for analgesics during the 6 hours after the procedure were recorded in both groups. Seventeen and 15 patients received acetaminophen and placebo, respectively. Pain scores in patients treated with acetaminophen were significantly lower (4.4 vs 2.9, P = .004), and they received less analgesics (17% vs 60%, P = .014). Intravenous administration of acetaminophen is effective for pain relief in patients undergoing CIED implantation and decreases the need for postoperative analgesics. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia.

PubMed

Rudie, Maxwell N; Milano, Michael M; Roberts, Michael W; Divaris, Kimon

2018-05-11

The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

Substantivity of hypochlorous acid-based disinfectant against biofilm formation in the dental unit waterlines

PubMed Central

Shajahan, Irfana Fathima; Kandaswamy, Deivanayagam; Lakshminarayanan, L.; Selvarajan, R.

2017-01-01

Objective: The purpose of the study was to examine the substantivity of a new disinfectant against biofilm formation in the dental unit waterlines. Materials and Methods: Twenty dental units were selected for the study and divided into two groups: Group A (dental unit waterlines treated with the disinfectant) and Group B (untreated dental unit waterlines). Biofilm formation was monitored in both groups by removing the one dental unit waterline from each group for the period of 10 days. One inch of the dental unit waterline tube was cut at random site, and the inner lumen of the cut sections was analyzed using the scanning electron microscope (SEM) (TESCAN VEGA3 SBU). Results: On examination, SEM images showed that there was no slime layer or bacterial cells seen in cut section for the period of 7 days in the treated dental waterlines, which means that there is no evident of biofilm formation. In the untreated dental unit waterline cut section, slime layer was observed from day 1. Conclusion: Disinfectant solution was proved to be effective for 7 days against biofilm formation. This technique could be used as a valid method for disinfection of dental unit waterlines. PMID:28761244

Mitochondrial dysfunction in myocardium obtained from clinically normal dogs, clinically normal anesthetized dogs, and dogs with dilated cardiomyopathy.

PubMed

Sleeper, Meg M; Rosato, Bradley P; Bansal, Seema; Avadhani, Narayan G

2012-11-01

To compare mitochondrial complex I and complex IV activity in myocardial mitochondria of clinically normal dogs, clinically normal dogs exposed to inhalation anesthesia, and dogs affected with dilated cardiomyopathy. Myocardial samples obtained from 21 euthanized dogs (6 clinically normal [control] dogs, 5 clinically normal dogs subjected to inhalation anesthesia with isoflurane prior to euthanasia, 5 dogs with juvenile-onset dilated cardiomyopathy, and 5 dogs with adult-onset dilated cardiomyopathy). Activity of mitochondrial complex I and complex IV was assayed spectrophotometrically in isolated mitochondria from left ventricular tissue obtained from the 4 groups of dogs. Activity of complex I and complex IV was significantly decreased in anesthetized dogs, compared with activities in the control dogs and dogs with juvenile-onset or adult-onset dilated cardiomyopathy. Inhalation anesthesia disrupted the electron transport chain in the dogs, which potentially led to an outburst of reactive oxygen species that caused mitochondrial dysfunction. Inhalation anesthesia depressed mitochondrial function in dogs, similar to results reported in other species. This effect is important to consider when anesthetizing animals with myocardial disease and suggested that antioxidant treatments may be beneficial in some animals. Additionally, this effect should be considered when designing studies in which mitochondrial enzyme activity will be measured. Additional studies that include a larger number of animals are warranted.

Color related to ceramic and zirconia restorations: a review.

PubMed

Vichi, Alessandro; Louca, Chris; Corciolani, Gabriele; Ferrari, Marco

2011-01-01

The requirement to achieve natural looking restorations is one of the most challenging aspects of dentistry, and the shade matching of dental restorations with the natural dentition is a difficult task due to the complex optical characteristics of natural teeth. Dental porcelain is considered the reference material for prosthetic rehabilitation, but it is not easy to handle and aesthetic excellence is quite difficult to obtain. For these reasons, shade matching with dental porcelain is often considered to be more artistic than scientific. Shade matching is considered unpredictable due to several variables that may influence the final appearance of a restoration. In order to improve this situation, over the last decade new shade guides and instruments have been developed and the aesthetic aspects of dental porcelain have been further investigated. In this review some aspects of color selection and color reproduction have been examined. Color selection has advanced through the development of new shade guides and electronic shade taking devices, although visual assessment has still not been entirely replaced by electronic instruments. Color reproduction with dental porcelain has improved thanks to advances in the performance and knowledge of dental porcelain, but is still not easy to achieve. The difficulties of achieving good aesthetics with PFM restorations and the desire for metal free solutions have resulted in the increased use of zirconia. The unique optical properties of zirconia have introduced new opportunities for achieving superior aesthetics, however further research is required with this material. Copyright © 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Does milling one-piece titanium dental implants induce osteocyte and osteoclast changes?

PubMed

Russe, P; Pascaretti-Grizon, F; Aguado, E; Goyenvale, E; Filmon, R; Baslé, M-F; Chappard, D

2011-06-01

One-piece dental implants avoid adverse effects sometimes associated with the traditional implant-abutment interface and may provide a suitable alternative to two-piece implants; however, one-piece implants often need in situ milling, which may exacerbate cell apoptosis from excessive heat at the bone-implant interface and induce secondary crestal bone loss. Twelve implants were placed in the metaphyses of two sheep under general anesthesia. Six implants were milled with a diamond bur while the other six implants remained intact. Animals were euthanized after four days, and bone blocks were harvested. Bone samples were studied without decalcification. Osteocytes were stained with Hoechst 33342 and osteoclasts by the TRAcP reaction. Both cell types, in the cortical and trabecular bone around the implant's cervical region, were counted utilizing morphometric methods. Values were compared to areas at a distance from the cervical region. No difference was observed between milled and unmilled implants, which suggested that the amount of generated heat did not provoke osteocyte loss or induce osteoclastogenesis. Intraoral abutment preparations did not increase cellular apoptosis at the bone-implant interface after four days in the ovine model. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Photogrammetry Impression Technique: A Case History Report.

PubMed

Sánchez-Monescillo, Andrés; Sánchez-Turrión, Andrés; Vellon-Domarco, Elena; Salinas-Goodier, Carmen; Prados-Frutos, Juan Carlos

2016-01-01

The aim of this report is to present photogrammetry as a reliable step in the fabrication of a full-arch immediate rehabilitation. A 59-year-old man attended the department seeking dental rehabilitation for the sequelae of severe oral health neglect. The mandibular teeth suffered from advanced periodontal disease and the patient wore a maxillary complete denture. An irreversible hydrocolloid impression of the mandibular arch was made, poured in stone, and digitally scanned to create the first stereolithography (STL) file. All teeth with the exception of two retained as landmarks were extracted, and seven implants were placed under local anesthesia and their positions recorded using photogrammetry. Maxillary and mandibular dental arch alginate impressions were made, poured in laboratory stone, and scanned. A provisional restoration was placed 7 hours after surgery using the STL files to determine the best-fit line. Radiographic and clinical follow-up after 1 year showed a favorable evolution of the implants. No screw loosening or other mechanical or biologic complications were observed. The case history using the described system suggests certain advantages over conventional techniques. More research is needed to assess the possible benefits associated with photogrammetry when making implant-supported restorations.

Mothers' perceptions of their child's enrollment in a randomized clinical trial: poor understanding, vulnerability and contradictory feelings.

PubMed

Carvalho, Adriana Assis; Costa, Luciane Rezende

2013-12-10

Little is known about the views of mothers when their children are invited to participate in randomized clinical trials (RCTs) investigating medicines and/or invasive procedures. Our goal was to understand mothers' perceptions of the processes of informed consent and randomization in a RCT that divided uncooperative children into three intervention groups (physical restraint, sedation, and general anesthesia) for dental rehabilitation. This is a qualitative study based on semi-structured interviews with mothers accompanying children under 3 years old presenting severe early childhood caries. Their responses were analyzed using content analysis. We identified one major theme from 15 mothers' responses - "Understanding of, attitudes toward, and feelings about consenting to participate in a RCT involving advanced behavior guidance techniques and about randomization" - that was derived from the following subcategories: confusion in defining techniques, questions after signing the consent form, lack of knowledge about the techniques, acceptance or questioning of the drawing, sharing responsibility with the child during the drawing, and feelings of faith in God, fear, powerlessness to choose, and relief from or an increase in pressure. Despite mothers' misunderstanding, vulnerability, and contradictory feelings, they were willing to overlook their thoughts in order to complete their children's dental treatment.

Surface Damage on Dental Implants with Release of Loose Particles after Insertion into Bone.

PubMed

Senna, Plinio; Antoninha Del Bel Cury, Altair; Kates, Stephen; Meirelles, Luiz

2015-08-01

Modern dental implants present surface features of distinct dimensions that can be damaged during the insertion procedure into bone. The aims of this study were (1) to quantify by means of roughness parameters the surface damage caused by the insertion procedure of dental implants and (2) to investigate the presence of loose particles at the interface. Three groups of dental implants representing different surface topographies were inserted in fresh cow rib bone blocks. The surface roughness was characterized by interferometry on the same area before and after the insertion. Scanning electron microscopy (SEM)-back-scattered electron detector (BSD) analysis was used to identify loose particles at the interface. The amplitude and hybrid roughness parameters of all three groups were lower after insertion. The surface presenting predominance of peaks (Ssk [skewness] > 0) associated to higher structures (height parameters) presented higher damage associated to more pronounced reduction of material volume. SEM-BSD images revealed loose titanium and aluminum particles at the interface mainly at the crestal cortical bone level. Shearing forces during the insertion procedure alters the surface of dental implants. Loose metal particles can be generated at bone-implant interface especially around surfaces composed mainly by peaks and with increased height parameters. © 2013 Wiley Periodicals, Inc.

Integrating tobacco dependence counseling into electronic dental records: a multi-method approach.

PubMed

Rush, William A; Schleyer, Titus K L; Kirshner, Michael; Boyle, Raymond; Thoele, Merry Jo; Lenton, P A; Asche, Steve; Thyvalikakath, Thankam; Spallek, Heiko; Durand, Emily C; Enstad, Chris J; Huntley, Charles L; Rindal, D Brad

2014-01-01

Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentistry has not adopted or developed effective interventions to deal with tobacco dependence. With the expanded use of electronic dental records, the authors identified an opportunity to incorporate standardized expert support for tobacco dependence counseling during the dental visit. Using qualitative results from observations and focus groups, a decision support system was designed that suggested discussion topics based on the patient's desire to quit and his or her level of nicotine addiction. Because dental providers are always pressed for time, the goal was a three-minute average intervention interval. To fulfill the provider's need for an easy way to track ongoing interventions, script usage was recorded. This process helped the provider track what he or she had said to the patient about tobacco dependence during previous encounters and to vary the messages. While the individual elements of the design process were not new, the combination of them proved to be very effective in designing a usable and accepted intervention. The heavy involvement of stakeholders in all components of the design gave providers and administrators ownership of the final product, which was ultimately adopted for use in all the clinics of a large dental group practice in Minnesota.

Evaluation of enamel by scanning electron microscopy green LED associated to hydrogen peroxide 35% for dental bleaching

NASA Astrophysics Data System (ADS)

Monteiro, Juliana S. C.; de Oliveira, Susana C. P. S.; Zanin, Fátima A. A.; Santos, Gustavo M. P.; Sampaio, Fernando J. P.; Gomes Júnior, Rafael Araújo; Gesteira, Maria F. M.; Vannier-Santos, Marcos A.; Pinheiro, Antônio Luiz B.

2014-02-01

Dental bleaching is a frequently requested procedure in clinical dental practice. The literature is contradictory regarding the effects of bleaching agents on both morphology and demineralization of enamel after bleaching. The aim of this study was to analyze by SEM the effect of 35% neutral hydrogen peroxide cured by green LED. Buccal surfaces of 15 pre-molars were sectioned and marked with a central groove to allow experimental and control groups on the same specimen. For SEM, 75 electron micrographs were evaluated by tree observers at 43X, 220X and 1000X. Quantitative analysis for the determination of the surface elemental composition of the samples through X-ray microanalysis by SEM was also performed. The protocol tested neither showed significant changes in mineral composition of the samples nor to dental enamel structure when compared to controls. SEM analysis allowed inferring that there were marked morphological differences between the enamel samples highlighting the need for the use of the same tooth in comparative morphological studies. The tested protocol did not cause morphological damage the enamel surface when compared to their respective controls.

Considerations for use of dental photography and electronic media in dental education and clinical practice.

PubMed

Stieber, Jane C; Nelson, Travis; Huebner, Colleen E

2015-04-01

Photography and electronic media are indispensable tools for dental education and clinical practice. Although previous research has focused on privacy issues and general strategies to protect patient privacy when sharing clinical photographs for educational purposes, there are no published recommendations for developing a functional, privacy-compliant institutional framework for the capture, storage, transfer, and use of clinical photographs and other electronic media. The aims of this study were to research patient rights relating to electronic media and propose a framework for the use of patient media in education and clinical care. After a review of the relevant literature and consultation with the University of Washington's director of privacy and compliance and assistant attorney general, the researchers developed a privacy-compliant framework to ensure appropriate capture, storage, transfer, and use of clinical photography and electronic media. A four-part framework was created to guide the use of patient media that reflects considerations of patient autonomy and privacy, informed consent, capture and storage of media, and its transfer, use, and display. The best practices proposed for capture, storage, transfer, and use of clinical photographs and electronic media adhere to the health care code of ethics (based on patient autonomy, nonmaleficence, beneficence, justice, and veracity), which is most effectively upheld by a practical framework designed to protect patients and limit institutional liability. Educators have the opportunity and duty to convey these principles to students who will become the next generation of dentists, researchers, and educators.

Stability of tapered and parallel-walled dental implants: A systematic review and meta-analysis.

PubMed

Atieh, Momen A; Alsabeeha, Nabeel; Duncan, Warwick J

2018-05-15

Clinical trials have suggested that dental implants with a tapered configuration have improved stability at placement, allowing immediate placement and/or loading. The aim of this systematic review and meta-analysis was to evaluate the implant stability of tapered dental implants compared to standard parallel-walled dental implants. Applying the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software. A total of 1199 studies were identified, of which, five trials were included with 336 dental implants in 303 participants. Overall meta-analysis showed that tapered dental implants had higher implant stability values than parallel-walled dental implants at insertion and 8 weeks but the difference was not statistically significant. Tapered dental implants had significantly less marginal bone loss compared to parallel-walled dental implants. No significant differences in implant failure rate were found between tapered and parallel-walled dental implants. There is limited evidence to demonstrate the effectiveness of tapered dental implants in achieving greater implant stability compared to parallel-walled dental implants. Superior short-term results in maintaining peri-implant marginal bone with tapered dental implants are possible. Further properly designed RCTs are required to endorse the supposed advantages of tapered dental implants in immediate loading protocol and other complex clinical scenarios. © 2018 Wiley Periodicals, Inc.

Validation of a Behavioral Ethogram for Assessing Postoperative Pain in Guinea Pigs (Cavia porcellus)

PubMed Central

Dunbar, Misha L; David, Emily M; Aline, Marian R; Lofgren, Jennifer L

2016-01-01

Although guinea pigs (Cavia porcellus) have been used in research for more than a century and remain the most prevalent USDA-covered species, little has been elucidated regarding the recognition of clinical pain or analgesic efficacy in this species. We sought to assess pain in guinea pigs by using newer, clinically relevant methods that have been validated in other rodent species: the behavioral ethogram and cageside proxy indicator. In this study, 10 male guinea pigs underwent electronic von Frey testing of nociception, remote videorecording of behavior, and cageside assessment by using time-to-consumption (TTC) of a preferred treat test. These assessments were performed across 2 conditions (anesthesia only and castration surgery under anesthesia) at 3 time points (2, 8, and 24 h after the event). The anesthesia only condition served to control for the nonpainful but potentially distressing components of the surgical experience. Compared with those after anesthesia only conditions, subtle body movements were increased and nociceptive thresholds were decreased at 2 and 8 h after surgery. At 24 h, neither subtle body movement behaviors nor nociceptive thresholds differed between the 2 conditions. In contrast, TTC scores did not differ between the anesthesia only and surgery conditions at any time point, underscoring the challenge of identifying pain in this species through cageside evaluation. By comparing ethogram scores with measures of nociception, we validated select behaviors as pain-specific. Therefore, our novel ethogram allowed us to assess postoperative pain and may further serve as a platform for future analgesia efficacy studies in guinea pigs. PMID:26817977

Developmental defects of enamel and dental caries in the primary dentition: A systematic review and meta-analysis.

PubMed

Costa, Francine S; Silveira, Ethieli R; Pinto, Gabriela S; Nascimento, Gustavo G; Thomson, William Murray; Demarco, Flávio F

2017-05-01

This systematic review and meta-analysis evaluated the association between developmental defects of enamel and dental caries in the primary dentition. Electronic searches were performed in PubMed, Web of Knowledge, Scopus and Scielo for the identification of relevant studies. Observational studies that examined the association between developmental defects of enamel and dental caries in the deciduous dentition were included. Additionally, meta-analysis, funnel plots and sensitivity analysis were employed to synthesize the available evidence. Multivariable meta-regression analysis was performed to explore heterogeneity among studies. A total of 318 articles were identified in the electronic searches. Of those, 16 studies were included in the meta-analysis. Pooled estimates revealed that children with developmental defects of enamel had higher odds of having dental caries (OR 3.32; 95%CI 2.41-4.57), with high heterogeneity between studies (I 2 80%). Methodological characteristic of the studies, such as where it was conducted, the examined teeth and the quality of the study explained about 30% of the variability. Concerning type of defect, children with hypoplasia and diffuse opacities had higher odds of having dental caries (OR 4.28; 95%CI 2.24-8.15; OR1.42; 95%CI 1.15-1.76, respectively). This systematic review and meta-analysis demonstrates a clear association between developmental defects of enamel and dental caries in the primary dentition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Influence of the height of the external hexagon and surface treatment on fatigue life of commercially pure titanium dental implants.

PubMed

Gil, Francisco Javier; Aparicio, Conrado; Manero, Jose M; Padros, Alejandro

2009-01-01

This study evaluated the effect of external hexagon height and commonly applied surface treatments on the fatigue life of titanium dental implants. Electropolished commercially pure titanium dental implants (seven implants per group) with three different external hexagon heights (0.6, 1.2, and 1.8 mm) and implants with the highest external hexagon height (1.8 mm) and different surface treatments (electropolishing, grit blasting with aluminium oxide, and acid etching with sulfuric acid) were tested to evaluate their mechanical fatigue life. To do so, 10-Hz triangular flexural load cycles were applied at 37 degrees C in artificial saliva, and the number of load cycles until implant fracture was determined. Tolerances of the hexagon/abutment fit and implant surface roughness were analyzed by scanning electron microscopy and light interferometry. Transmission electron microscopy and electron diffraction analyses of titanium hydrides were performed. First, the fatigue life of implants with the highest hexagon (8,683 +/- 978 load cycles) was more than double that of the implants with the shortest hexagons (3,654 +/- 789 load cycles) (P < .02). Second, the grit-blasted implants had the longest fatigue life of the tested materials (21,393 +/- 2,356 load cycles), which was significantly greater than that of the other surfaces (P < .001). The compressive surface residual stresses induced when blasting titanium are responsible for this superior mechanical response. Third, precipitation of titanium hydrides in grain boundaries of titanium caused by hydrogen adsorption from the acid solution deteriorates the fatigue life of acid-etched titanium dental implants. These implants had the shortest fatigue life (P < .05). The fatigue life of threaded root-form dental implants varies with the height of the external hexagon and/or the surface treatment of the implant. An external hexagon height of 1.8 mm and/or a blasting treatment appear to significantly increase fatigue life of dental implants.

Incoming dental students' expectations and acceptance of an electronic textbook program.

PubMed

Brunet, Darlene P; Bates, Michael L; Gallo, John R; Strother, Elizabeth A

2011-05-01

Since 2005, the Louisiana State University Health Sciences Center School of Dentistry has required the VitalSource Technologies, Inc. Bookshelf as the textbook program for all dental students. In a 2008 survey, four classes of dental students expressed dissatisfaction with most features of the bookshelf. With the expectation that incoming students would be more accustomed and amenable to digital textbooks and to further determine student attitudes toward electronic textbooks, we developed two surveys for first-year dental students in the class of 2013. The sixty-five first-year students received a survey (S1) one week before they were introduced to the e-textbook program. Questions centered on their undergraduate experience with e-books and their expectations of studying with an electronic textbook collection. In the second survey (S2), sent nine months later, the questions focused on students' opinion of the VitalSource Bookshelf. Forty-five students (69.2 percent) completed the S1 survey. Of those, thirty-six (80 percent) responded that they never used e-textbooks in college. Of the nine students who responded that they used e-books, only two liked them without reservations. The response rate to S2 increased to fifty students (77 percent). After using VitalSource for nine months, thirty-three students (66 percent) indicated a preference for reading print textbooks, compared to forty-seven students (57.3 percent) of the four classes surveyed in 2008. Although we expected incoming dental students to have had previous experience with e-textbooks, only nine students had used e-books in college courses. Few students indicated preference for e-textbooks, and over half of the group was undecided. After experience with VitalSource for first-year courses, students indicated that they like VitalSource for the ability to search for specific topics across the entire collection of dental books, but not for reading large amounts of text.

Technology diffusion of anesthesia information management systems into academic anesthesia departments in the United States.

PubMed

Stol, Ilana S; Ehrenfeld, Jesse M; Epstein, Richard H

2014-03-01

Anesthesia information management systems (AIMS) are electronic health records that automatically import vital signs from patient monitors and allow for computer-assisted creation of the anesthesia record. When most recently surveyed in 2007, it was estimated that at least 16% of U.S. academic hospitals (i.e., with an anesthesia residency program) had installed an AIMS. At least an additional 28% reported that they were in the process of implementing, or searching for an AIMS. In this study, we updated the adoption figures as of May 2013 and examined the historical trend of AIMS deployment in U.S. anesthesia residency programs from the perspective of the theory of diffusion of technologic innovations. Questionnaires were sent by e-mail to program directors or their identified contact individuals at the 130 U.S. anesthesiology residency programs accredited as of June 30, 2012 by the Accreditation Council for Graduate Medical Education. The questionnaires asked whether the department had an AIMS, the year of installation, and, if not present, whether there were plans to install an AIMS within the next 12 months. Follow-up e-mails and phone calls were made until responses were obtained from all programs. Results were collected between February and May 2013. Implementation percentages were determined using the number of accredited anesthesia residency programs at the start of each academic year between 1987 and 2013 and were fit to a logistic regression curve using data through 2012. Responses were received from all 130 programs. Eighty-seven (67%) reported that they currently are using an AIMS. Ten programs without a current AIMS responded that they would be installing an AIMS within 12 months of the survey. The rate of AIMS adoption by year was well fit by a logistic regression curve (P = 0.90). By the end of 2014, approximately 75% of U.S. academic anesthesiology departments will be using an AIMS, with 84% adoption expected between 2018 and 2020. Historical adoption of AIMS has followed Roger's 1962 formulation of the theory of diffusion of innovation.

Influencing Anesthesia Provider Behavior Using Anesthesia Information Management System Data for Near Real-Time Alerts and Post Hoc Reports.

PubMed

Epstein, Richard H; Dexter, Franklin; Patel, Neil

2015-09-01

In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia providers (i.e., anesthesiologists, anesthesia residents, and nurse anesthetists). Multiple studies have shown that anesthesia clinical decision support (CDS) improves adherence to protocols and increases financial performance through facilitation of billing, regulatory, and compliance documentation; however, improved clinical outcomes have not been demonstrated. We inform developers and users of feedback systems about the multitude of concerns to consider during development and implementation of CDS to increase its effectiveness and to mitigate its potentially disruptive aspects. We discuss the timing and modalities used to deliver messages, implications of outlier-only versus individualized feedback, the need to consider possible unintended consequences of such feedback, regulations, sustainability, and portability among systems. We discuss statistical issues related to the appropriate evaluation of CDS efficacy. We provide a systematic review of the published literature (indexed in PubMed) of anesthesia CDS and offer 2 case studies of CDS interventions using AIMS data from our own institution illustrating the salient points. Because of the considerable expense and complexity of maintaining near real-time CDS systems, as compared with providing individual reports via e-mail after the fact, we suggest that if the same goal can be accomplished via delayed reporting versus immediate feedback, the former approach is preferable. Nevertheless, some processes require near real-time alerts to produce the desired improvement. Post hoc e-mail reporting from enterprise-wide electronic health record systems is straightforward and can be accomplished using system-independent pathways (e.g., via built-in e-mail support provided by the relational database management system). However, for some of these enterprise-wide systems, near real-time data access, necessary for CDS that generates concurrent alerts, has been challenging to implement.

Laboratory evaluation of anti-biofilm agents for use in dental unit waterlines.

PubMed

Meiller, T F; Kelley, J I; Baqui, A A; DePaola, L G

2001-01-01

Dental unit waterline biofilm has been recognized as a potential point of contamination and a risk to patients with any level of immunocompromise. Biofilm in dental unit waterlines, once established, has proven formidable to efforts in disinfection/disruption. This project compared standardized evaluation techniques by assessing the efficacy of a variety of agents that have been reported or suggested as useful in surface disinfection and/or antiseptic protocols. The zones of inhibition, minimum inhibitory/bactericidal concentrations and use-dilution with stainless steel carrier replicates tests assessed the disinfection of planktonic organisms using standardized microbial testing procedures. The disruption and/or disinfection of planktonic and biofilm organisms within naturally occurring dental unit waterlines were evaluated by culture and scanning electron microscopy. The six commercially available antimicrobial agents used to assess the techniques were bleach (sodium hypochlorite), Cavicide, glutaraldehyde, Listerine Antiseptic, Peridex and Sterilex Ultra. Comparisons between the results for each technique evaluated were determined for each product. All six agents demonstrated antimicrobial efficacy at the working concentrations designated by the manufacturers. Biofilm matrix elimination evaluated by scanning electron microscopy found virtually 0% elimination by glutaraldehyde to an estimated 90% elimination by Sterilex Ultra and bleach after one treatment. Treatment with Cavicide, Listerine Antiseptic and Peridex resulted in negligible elimination of the biofilm matrix. For comparability, the use of standardized testing techniques to evaluate a disinfection agent's efficacy against dental unit waterline contamination is essential. This project demonstrates a model system for evaluating disinfection agents potentially useful in the management of dental unit waterline biofilm, and should assist in educating the dental clinician in the appraisal of existing and future product claims.

Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice

PubMed Central

Ramoni, Rachel B.; Walji, Muhammad F.; Kim, Soyun; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Skourtes, Eugene; Yansane, Alfa; White, Joel M.; Kalenderian, Elsbeth

2015-01-01

Background Attitudes and views are critical to the adoption of innovation. While there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members towards the adoption of such a terminology. Methods A survey was developed using validated questions identified through literature review. Domain experts’ input allowed for further modifications. The final survey was administered electronically to 814 team members at a multi-office practice based in the Pacific Northwest. Results Response proportion was 92%. The survey had excellent reliability (Cronbach alpha coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs towards using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. Conclusions Dental providers and staff in one multi-office practice showed positive attitudes towards the use of a diagnostic terminology, specifically they believed it would improve communication between the dentist and patient as well as among providers, while expressing some concerns if using standardized dental diagnostic terms helps clinicians to deliver better dental care. Practical Implications As the dental profession is advancing towards the use of standardized diagnostic terminologies, successful implementation will require that dental team leaders prepare their dental teams by gauging their attitude toward the use of such a terminology. PMID:26025826

Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting.

PubMed

Asan, Onur; Ye, Zhan; Acharya, Amit

2013-09-01

The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits. The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers. The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit. The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit. A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.

Surgical and prosthetic considerations to rehabilitate an ocular defect using extraoral implants: a clinical report.

PubMed

de Negreiros, Wagner Araujo; Verde, Marcus Aurelio Rabelo Lima; da Silva, Antonio Materson; Pinto, Lecio Pitombeira

2012-04-01

This clinical report shows the use of extraoral implants to rehabilitate an ocular defect, focusing the surgical and prosthetic procedures. Using local anesthesia and a surgical template obtained from the diagnostic wax ocular pattern, two cylinder dental implants were strategically placed in the lateral aspect of the right infraorbital region. Four months later, an acrylic framework including two spherical magnets was made using plastic UCLA abutments. After casting laboratory steps, a customized silicon prosthetic appliance was fabricated from the diagnostic wax ocular pattern and attached to the Co-Cr framework, observing its profile and seating aspects. The patient was satisfied with the treatment result, due to the retention, esthetics, and adhesive-free method to anchor his ocular prostheses. © 2012 by the American College of Prosthodontists.

Surgery upregulates high mobility group box-1 and disrupts the blood-brain barrier causing cognitive dysfunction in aged rats.

PubMed

He, Hui-Juan; Wang, Yi; Le, Yuan; Duan, Kai-Ming; Yan, Xue-Bin; Liao, Qin; Liao, Yan; Tong, Jian-Bin; Terrando, Niccolò; Ouyang, Wen

2012-12-01

Postoperative cognitive dysfunction (POCD) is a growing and largely underestimated problem without defined etiology. Herein, we sought to determine the relationship between cognitive decline, blood-brain barrier (BBB) permeability, and inflammation, namely high mobility group box-1 (HMGB1), after surgery in aged rats. Aged rats were randomly assigned as surgery group (n = 45, splenectomy under general anesthesia), anesthesia (n = 45, 2% isoflurane for 2 h), and naïve control (n = 15). Markers of inflammation were measured in plasma and brain. Blood-brain barrier ultrastructure and permeability were measured by transmission electron microscope (TEM) and IgG immunohistochemistry. Cognitive function was assessed in a reversal learning version of the Morris water maze (MWM). Surgical trauma under general anesthesia caused distinct changes in systemic and central proinflammatory cytokines. Levels of HMGB1 and the receptor for advanced glycation end products (RAGE) were significantly upregulated in the hippocampus of operated animals. Immunohistochemistry and TEM showed BBB disruption induced by surgery and anesthesia. These molecular changes were associated with cognitive impairment in latency with the MWM up to postoperative day 3. HMGB1 and RAGE signaling appear pivotal mediators of surgery-induced cognitive decline and may contribute to the changes in BBB permeability after peripheral surgical trauma. © 2012 Blackwell Publishing Ltd.

Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism.

PubMed

Lange, Elizabeth M S; Toledo, Paloma; Stariha, Jillian; Nixon, Heather C

2016-08-01

The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism. We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013. We then hand searched the electronic medical record for qualifying patients with heights < 148 cm and a diagnosis of dwarfism. The extracted data included patient demographics and obstetric and anesthetic information. We identified 13 women with dwarfism who had 15 Cesarean deliveries in total. Twelve of the women had disproportionate dwarfism, and ten of the 15 Cesarean deliveries were due to cephalopelvic disproportion. Neuraxial anesthesia was attempted in 93% of deliveries. The dose chosen for initiation of neuraxial anesthesia was lower than the typical doses used in parturients of normal stature. Neuraxial anesthetic complications included difficult neuraxial placement (64%), high spinal (7%), inadequate surgical level (13%), and unrecognized intrathecal catheter (7%). The data collected suggest that females with a diagnosis of dwarfism may have difficult neuraxial placement and potentially require lower dosages of local anesthetic for both spinal and epidural anesthesia to achieve adequate surgical blockade.

Gynecologists’ knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes

PubMed Central

Hashim, Raghad; Akbar, Madiha

2014-01-01

Objectives: A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health care during pregnancy and the association of periodontal disease with adverse pregnancy outcomes. Materials and Methods: A questionnaire consisting of 16 questions was designed and pilot tested. One hundred and fifty gynecologists practicing in the private sector of United Arab Emirates (UAE) were approached to voluntarily participate and fill up the questionnaire during February–March 2014. Data retrieved were entered into Excel database and analyzed using SPSS. Results: Of the 150 gynecologists approached, 108 filled the questionnaire, yielding a response rate of 72%. The majority (95.4%) acknowledged a connection between oral health and pregnancy and 75.9% agreed that periodontal disease can affect the outcome of pregnancy. Moreover, most of the gynecologists (85.2%) advised their pregnant patients to visit the dentist during pregnancy. Almost three-quarter of the participants (73%) regarded dental radiographs to be unsafe during pregnancy and more than half (59.3%) considered administration of local anesthesia to be unsafe during pregnancy. Conclusion: The present study demonstrated that gynecologists have a relatively high degree of knowledge with respect to the relationship of periodontal disease to pregnancy outcome. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and the medical community, and misconceptions regarding the types of dental treatments during pregnancy should be clarified. PMID:25625074

Fracture resistance of dental nickel-titanium rotary instruments with novel surface treatment: Thin film metallic glass coating.

PubMed

Chi, Chih-Wen; Deng, Yu-Lun; Lee, Jyh-Wei; Lin, Chun-Pin

2017-05-01

Dental nickel-titanium (NiTi) rotary instruments are widely used in endodontic therapy because they are efficient with a higher success rate. However, an unpredictable fracture of instruments may happen due to the surface characteristics of imperfection (or irregularity). This study assessed whether a novel surface treatment could increase fatigue fracture resistance of dental NiTi rotary instruments. A 200- or 500-nm thick Ti-zirconium-boron (Ti-Zr-B) thin film metallic glass was deposited on ProTaper Universal F2 files using a physical vapor deposition process. The characteristics of coating were analyzed by scanning electron microscopy, transmission electron microscopy, and X-ray diffractometry. In cyclic fatigue tests, the files were performed in a simulated root canal (radius=5 mm, angulation=60°) under a rotating speed of 300rpm. The fatigue fractured cross sections of the files were analyzed with their fractographic performances through scanning electron microscopy images. The amorphous structure of the Ti-Zr-B coating was confirmed by transmission electron microscopy and X-ray diffractometry. The surface of treated files presented smooth morphologies without grinding irregularity. For the 200- and 500-nm surface treatment groups, the coated files exhibited higher resistance of cyclic fatigue than untreated files. In fractographic analysis, treated files showed significantly larger crack-initiation zone; however, no significant differences in the areas of fatigue propagation and catastrophic fracture were found compared to untreated files. The novel surface treatment of Ti-Zr-B thin film metallic glass on dental NiTi rotary files can effectively improve the fatigue fracture resistance by offering a smooth coated surface with amorphous microstructure. Copyright © 2016. Published by Elsevier B.V.

Permeability of latex gloves after contact with dental materials.

PubMed

Richards, J M; Sydiskis, R J; Davidson, W M; Josell, S D; Lavine, D S

1993-09-01

The use of latex examination gloves in the dental office has become the standard of care. However, the effectiveness of gloves as a barrier after coming into contact with specific dental materials is still uncertain. To examine the effects of dental materials is still uncertain. To examine the effects of dental materials on latex, 100 latex examination glove finger tips were divided into 10 groups. Each group was manipulated in a different dental material for 15 minutes. Permeability was detected by the passage of herpes virus across the latex membrane, rinsed from the inner glove surface and titrated onto Vero cells. Significant virus leakage was discovered in gloves treated with acrylic monomer, chloroform, and orange solvent. Little virus leakage was noted in bleach, soap, and 30% phosphoric acid etchant treated gloves, and no virus leakage was found with composite resin, ethanol, formocresol, and water treated gloves. These data were supported with scanning electron micrographs taken of the treated glove samples and comparing with the controls. When certain dental materials are manipulated while wearing gloves, irreversible damage to the material occurs and may increase the practitioner's exposure to pathogens.

Perceptions of uncivil student behavior in dental education.

PubMed

Ballard, Richard W; Hagan, Joseph L; Townsend, Janice A; Ballard, Mary B; Armbruster, Paul C

2015-01-01

Students and faculty members in the health professions classroom are expected to exhibit professional behaviors that are conducive to maintaining a positive learning environment, but there is little published research concerning incivility in the area of dental education. The aim of this study was to evaluate differences in perceptions of incivility between dental faculty and students, between students in different courses of study, and between students in different years of dental study. The study utilized an anonymous electronic survey of all dental faculty and administrators and all dental, dental hygiene, and dental laboratory technology students at a single institution. The survey instrument contained questions concerning perceived uncivil behavior in the classroom and clinical settings. Response rates were 54% for faculty and administrators and ranged from 60% to 97% for students in various years and programs. The results were analyzed based on gender, course of study, year of study, and ethnicity. Significant differences were found regarding perceptions of civil behaviour between faculty and students, male and female students, the year of study, and the course of study. These differences point to the need for further research as well as administrative leadership and faculty development to define guidelines in this area in order to ensure a positive learning environment.

Prevalence of dental caries in overweight school going children of 12-15 years in and around Jaipur city, Rajasthan, India

PubMed

Choudhary, Rahul; Sharma, Rajesh; Bhat, Manohar; Satish V; Khairwa, Abhishek; Solanki, Jitender

2017-01-01

Dental caries and obesity are both multifactorial disease with a complex etiology and both are associated with dietary habits. Prevalence of dental caries and an association between body mass index (BMI) and dental caries among school children The present was done on 1500 school going children to assess the prevalence of dental caries in 12-15 year old overweight children. Weight and height were measured in light clothing and without shoes using an electronic weighing scale. Subjects’ heights were measured using a stadiometre. Subjects were examined on an upright chair in adequate natural daylight and dental caries was measured by using DMF index. Chi-square test was used to analyze and compare qualitative data whereas unpaired ‘t’ test was used to analyze and compare quantative data Amongst 1500 children, 156 were found to be overweight, 443 were normal weight. When mean BMI between overweight and normal weight were compared a highly significant difference was observed. When DMFT of overweight and normal weight were compared no significant difference was observed Dental caries was observed more in females as compared to males and no significant difference was observed between dental caries and weight gain

Characterization of the bioactive and mechanical behavior of dental ceramic/sol-gel derived bioactive glass mixtures.

PubMed

Abbasi, Zahra; Bahrololoum, Mohammad E; Bagheri, Rafat; Shariat, Mohammad H

2016-02-01

Dental ceramics can be modified by bioactive glasses in order to develop apatite layer on their surface. One of the benefits of such modification is to prolong the lifetime of the fixed dental prosthesis by preventing the formation of secondary caries. Dental ceramic/sol-gel derived bioactive glass mixture is one of the options for this modification. In the current study, mixtures of dental ceramic/bioactive glass with different compositions were successfully produced. To evaluate their bioactive behavior, prepared samples were immersed in a simulated body fluid at various time intervals. The prepared and soaked specimens were characterized using Fourier transform infrared spectroscopy, X-ray diffractometry and scanning electron microscopy. Since bioactive glasses have deleterious effects on the mechanical properties of dental ceramics, 3-point bending tests were used to evaluate the flexural strength, flexural strain, tangent modulus of elasticity and Weibull modulus of the specimens in order to find the optimal relationship between mechanical and bioactive properties. Copyright © 2015 Elsevier Ltd. All rights reserved.

Adoption of dental innovations

PubMed Central

Ramoni, Rachel B.; Etolue, Jini; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Yansane, Alfa; White, Joel M.; Walji, Muhammad F.; Kalenderian, Elsbeth

2017-01-01

Background Standardized dental diagnostic terminologies (SDDxTs) were introduced decades ago. Their use has been on the rise, accompanying the adoption of electronic health records (EHRs). One of the most broadly used terminologies is the Dental Diagnostic System (DDS). Our aim was to assess the adoption of SDDxTs by US dental schools by using the Rogers diffusion of innovations framework, focusing on the DDS. Methods The authors electronically surveyed clinic deans in all US dental schools (n = 61) to determine use of an EHR and SDDxT, perceived barriers to adoption of an SDDxT, and the effect of implementing an SDDxT on clinical productivity. Results The response rate was 57%. Of the 35 responses, 91% reported using an EHR to document patient care, with 84% using axiUm, and 69% reported using an SDDxT to document patient diagnoses; 41% used the DDS. Fifty-four percent of those who did not use an SDDxT had considered adopting the DDS, but 39% had not, citing barriers such as complexity and compatibility. Conclusions Adoption of an SDDxT, particularly the DDS, is on the rise. Nevertheless, a large number of institutions are in the Rogers late majority and laggards categories with respect to adoption. Several factors may discourage adoption, including the inability to try out the terminology on a small scale, poor usability within the EHR, the fact that it would be a cultural shift in practice, and a perception of unclear benefits. However, the consolidation of the DDS and American Dental Association terminology efforts stands to encourage adoption. PMID:28364948

Knowledge and confidence of a convenience sample of australasian emergency doctors in managing dental emergencies: results of a survey.

PubMed

Samaei, Hossein; Weiland, Tracey Joy; Dilley, Stuart; Jelinek, George Alexander

2015-01-01

Background. We aimed to determine Australasian Specialist Emergency Physicians' and Emergency Physicians in Training (Trainees') level of knowledge of common dental emergencies. We also explored confidence in managing dental emergencies; predictors of confidence and knowledge; and preferences for further dental education. Methods. A questionnaire was distributed electronically (September 2011) and directly (November 2011) to Fellows and Trainees of the Australasian College for Emergency Medicine. It explored demographics, confidence, knowledge of dental emergencies, and educational preferences. Results. Response rate was 13.6% (464/3405) and college members were proportionally represented by region. Fewer than half (186/446; 42%) had received dental training. Sixty-two percent (244/391, 95% CI 57.5-67.1) passed (>50%) a knowledge test. More than 60% incorrectly answered questions on dental fracture, periodontal abscess, tooth eruption dates, and ulcerative gingivitis. Forty percent (166/416) incorrectly answered a question about Ludwig's Angina. Eighty-three percent (360/433) were confident in the pharmacological management of toothache but only 26% (112/434) confident in recognizing periodontal disease. Knowledge was correlated with confidence (r = 0.488). Interactive workshops were preferred by most (386/415, 93%). Conclusions. The knowledge and confidence of Australasian Emergency Physicians and Trainees in managing dental emergencies are varied, yet correlated. Interactive training sessions in dental emergencies are warranted.

Use of Digital Technology and Support Software Programs in the Private Dental Offices in Nevada

ERIC Educational Resources Information Center

Fattore-Bruno, LaDeane

2009-01-01

The purpose of this survey research was to determine the diffusion of digital radiography, the electronic oral health record (EOHR), digital intraoral photography, and diagnosis and clinical decision-making support software into the dental offices of Nevada. A cross-sectional survey design was utilized with a random sample of 600 Nevada dentists.…

A critical discussion of the benefits of e-health in population-level dental research.

PubMed

Lam, Raymond; Kruger, Estie; Tennant, Marc

2013-01-01

Population-level research is an essential area of health with the potential to affect quality of life and the broader economy. There are excellent epidemiological studies that have improved health services, but traditional research requires a considerable investment. Although electronic technology has changed the practice of many industries with improved efficiency, its application to health is relatively new. Termed 'e-health', this emerging area has been defined by the World Health Organization as the use of information technology to support many aspects of health such as in administration and scientific information. However, not all professionals are convinced of its use. This paper presents a novel application of this emerging area to describe the benefit in data collation and research to support one of the most pressing issues in public health: oral health and policy. Using the Chronic Disease Dental Scheme as an example, a critical discussion of its benefit to population-level research is presented. The Chronic Disease Dental Scheme method of electronic administration has been shown to enhance research and to complement existing progress in health data linkage. e-Health is an invaluable tool for population-level dental research.

Views of Dental Providers on Primary Care Coordination at Chairside: A Pilot Study.

PubMed

Northridge, Mary E; Birenz, Shirley; Gomes, Danni M; Golembeski, Cynthia A; Greenblatt, Ariel Port; Shelley, Donna; Russell, Stefanie L

2016-06-01

There is a need for research to facilitate the widespread implementation, dissemination and sustained utilization of evidence-based primary care screening, monitoring and care coordination guidelines, thereby increasing the impact of dental hygienists' actions on patients' oral and general health. The aims of this formative study are to explore dental hygienists' and dentists' perspectives regarding the integration of primary care activities into routine dental care, and assess the needs of dental hygienists and dentists regarding primary care coordination activities and use of information technology to obtain clinical information at chairside. This qualitative study recruited 10 dental hygienists and 6 dentists from 10 New York City area dental offices with diverse patient mixes and volumes. A New York University faculty dental hygienist conducted semi-structured, in-depth interviews, which were digitally recorded and transcribed verbatim. Data analysis consisted of multilevel coding based on the Consolidated Framework for Implementation Research, resulting in emergent themes with accompanying categories. The dental hygienists and dentists interviewed as part of this study do not use evidence-based guidelines to screen their patients for primary care sensitive conditions. Overwhelmingly, dental providers believe that tobacco use and poor diet contribute to oral disease, and report using electronic devices at chairside to obtain web-based health information. Dental hygienists are well positioned to help facilitate greater integration of oral and general health care. Challenges include lack of evidence-based knowledge, coordination between dental hygienists and dentists, and systems-level support, with opportunities for improvement based upon a theory-driven framework. Copyright © 2016 The American Dental Hygienists’ Association.

Cone beam computed tomography in dental education: a survey of US, UK, and Australian dental schools.

PubMed

Parashar, Vijay; Whaites, Eric; Monsour, Paul; Chaudhry, Jahanzeb; Geist, James R

2012-11-01

Cone beam computed tomography (CBCT) is an excellent three-dimensional (3D) imaging modality. Traditional dental education has focused on teaching conventional (2D) imaging. The aims of this survey-based study were therefore to evaluate the incorporation of CBCT teaching in both the predoctoral/undergraduate (D.D.S./D.M.D./B.D.S.) and postgraduate/residency specialty training curricula in dental schools in the United States, the United Kingdom, and Australia. A nine-question survey form was electronically mailed to fifty-seven schools in the United States, sixteen schools in the United Kingdom, and seven schools in Australia. Fifty U.S. dental schools (89 percent), ten U.K. dental schools (62.5 percent), and one Australian dental school (14 percent) presently have CBCT equipment. The majority of responding schools do not include instruction in higher level use of this technology for undergraduate/predoctoral students, raising questions as to whether these students are adequately trained on qualification. Larger numbers of schools reported providing this training to residents in specialty programs. A similar trend was noticed in U.S., British, and Australian dental education. If general dentists are to be permitted to purchase and use CBCT equipment, inclusion of CBCT in dental education is an absolute requirement to prepare future dental practitioners to apply 3D imaging appropriately for diagnosis and treatment planning.

Postoperative Pain in Children After Dentistry Under General Anesthesia

PubMed Central

Wong, Michelle; Copp, Peter E.; Haas, Daniel A.

2015-01-01

The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4–6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics. PMID:26650492

Comparison of periodontal ligament injection and inferior alveolar nerve block in mandibular primary molars pulpotomy: a randomized control trial.

PubMed

Haghgoo, Roza; Taleghani, Ferial

2015-05-01

Inferior alveolar nerve block is a common technique for anesthesia of the primary mandibular molars. A number of disadvantages have been shown to be associated with this technique. Periodontal ligament (PDL) injection could be considered as an alternative to inferior alveolar nerve block. The aim of this study was to evaluate the effectiveness of PDL injection in the anesthesia of primary molar pulpotomy with mandibular block. This study was performed using a sequential double-blind randomized trial design. 80 children aged 3-7 years old who required pulpotomy in symmetrical mandibular primary molars were selected. The teeth of these children were anesthetized with periodontal injection on one side of the mandible and block on the other. Pulpotomy was performed on each patient during the same appointment. Signs of discomfort, including hand and body tension and eye movement, the verbal complaint and crying (SEM scale), were evaluated by a dental assistant who was blinded to the treatment allocation of the patients. Finally, the data were analyzed using the exact Fisher test and Pearson Chi-squared exact test. Success rate was 88/75 and 91/25 in the PDL injection and nerve block groups, respectively. There was no statistically significant difference between the two techniques (P = 0.250). Results showed that PDL injection can be used as an alternative to nerve block in pulpotomy of the mandibular primary molars.

Postoperative Pain in Children After Dentistry Under General Anesthesia.

PubMed

Wong, Michelle; Copp, Peter E; Haas, Daniel A

2015-01-01

The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning.

PubMed

Hards, Andrea; Davies, Sharon; Salman, Aliya; Erik-Soussi, Magda; Balki, Mrinalini

2012-09-01

Successful resuscitation of a pregnant woman undergoing cardiac arrest and survival of the fetus require prompt, high-quality cardiopulmonary resuscitation. The objective of this observational study was to assess management of maternal cardiac arrest by anesthesia residents using high-fidelity simulation and compare subsequent performance following either didactic teaching or electronic learning (e-learning). Twenty anesthesia residents were randomized to receive either didactic teaching (Didactic group, n = 10) or e-learning (Electronic group, n = 10) on maternal cardiac arrest. Baseline management skills were tested using high-fidelity simulation, with repeat simulation testing one month after their teaching intervention. The time from cardiac arrest to start of perimortem Cesarean delivery (PMCD) was measured, and the technical and nontechnical skills scores between the two teaching groups were compared. The median [interquartile range] time to PMCD decreased after teaching, from 4.5 min [3.4 to 5.1 min] to 3.5 min [2.5 to 4.0 min] (P = 0.03), although the change within each group was not statistically significant (Didactic group 4.9 to 3.8 min, P = 0.2; Electronic group 3.9 to 2.5 min, P = 0.07; Didactic group vs Electronic group, P = 1.0). Even after teaching, only 65% of participants started PMCD within four minutes. Technical and nontechnical skills scores improved after teaching in both groups, and there were no differences between the groups. There are gaps in the knowledge and implementation of resuscitation protocols and the recommended modifications for pregnancy among residents. Teaching can improve performance during management of maternal cardiac arrest. Electronic learning and didactic teaching offer similar benefits.

Radiology Reporting System Data Exchange With the Electronic Health Record System: A Case Study in Iran.

PubMed

Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh

2015-03-18

In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Dental technology over 150 years: evolution and revolution.

PubMed

Feuerstein, Paul

2014-01-01

A patient entering a dental office is often greeted and then checked in through the practice management system's digital appointment book. The provider is notified by an electronic signal that is visual, audible, or both. The patient is led to the treatment area and sits in a dental chair which is adjusted to the individual's size and position for the treatment, and the light is positioned. Sometimes a radiograph is taken, local anesthetic is delivered, and a handpiece--air turbine or electric--is used for the procedure. How different is this process today from a dentist treating a patient in 1864?

Synthesis and Characterization of a Polyimide-Epoxy Composite for Dental Applications

NASA Astrophysics Data System (ADS)

Yang, An; Xu, Chun

2018-03-01

Epoxy (EP) resins have been employed in dentistry for years, but their intrinsic brittleness demands a reinforcement to make them an ideal dental material that combines strength, toughness, and aesthetics. In this study, an EP resin was reinforced with a low-molecular-weight polyimide (PI). The PI/EP composites were subjected to three-point bending tests and examined by the scanning electron microscopy. It was found that blending PI with EP in proper proportions strengthened EP without sacrificing its toughness. The PI/EP composite could be employed in dentistry as the matrix of fiber-reinforced dental root canal posts.

Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital.

PubMed

Brenn, B Randall; Choudhry, Dinesh K; Sacks, Karen; Como-Fluehr, Sandra; Strain, Robert

2016-09-01

Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity. Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database. There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention. An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

PubMed Central

Fa, Bernadette Alvear; Cuny, Eve

2016-01-01

A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was “excellent,” “clinically acceptable,” or “clinically unacceptable.” Data were collected to determine if the patient perceived the modified retraction technique as “comfortable” or “correctable when addressed” to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator. PMID:27973940

Implants in disabled patients: A review and update

PubMed Central

Romero-Pérez, María J.; Mang-de la Rosa, María R.; López-Jimenez, Julián; Fernández-Feijoo, Javier

2014-01-01

The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. Key words:Implants, disabled, sedation. PMID:24608221

Treatment modalities for caries management, including a new resin infiltration system.

PubMed

Kugel, Gerard; Arsenault, Peter; Papas, Athena

2009-10-01

Seemingly against all odds, dental caries still affects most people in the US. While fluoridated products, school-based screening and cleaning programs, better patient education, and professional and chemotherapeutic interventions have all impacted certain populations, caries is still the most prevalent chronic childhood disease and continues to affect a high percentage of adolescents, young and middle-aged adults, and seniors. Much research has proven that dental caries is not just an occasional cycle of cavitation but a complex and infectious disease process. Historically, addressing the caries challenge has relied on prevention and restoration, with no intermediary means to stop lesion progression. Recently, a technique called caries infiltration was introduced that fills the noncavitated pores of an incipient lesion with a low-viscosity resin by capillary action, creating a barrier that blocks further bacterial diffusion and lesion development. This microinvasive method for stabilizing early lesions requires no drilling or anesthesia and does not alter the tooth's anatomic shape. In cases of white spot lesions in the esthetic zone, it also eliminates opaqueness and blends with surrounding natural teeth. This article presents an overview of caries prevention initiatives and a case demonstrating the new caries infiltration technique. Combined with shifting the focus to caries risk assessment, this promising technology may prove to be a significant addition to the profession's caries treatment armamentarium.

Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs.

PubMed

Peddle, Gordon D; Drobatz, Kenneth J; Harvey, Colin E; Adams, Allison; Sleeper, Meg M

2009-01-01

To identify risk factors potentially associated with the development of bacterial endocarditis in dogs and determine whether periodontal disease and surgical procedures (oral and nonoral) were associated with bacterial endocarditis. Retrospective case-control study. 76 dogs with (cases) and 80 dogs without (controls) bacterial endocarditis. Medical records were reviewed for information on signalment, physical examination findings, recent medical history, and results of echocardiography, clinicopathologic testing, and necropsy. None of the dogs with endocarditis had a history of undergoing any dental or oral procedure in the 3 months prior to the diagnosis of endocarditis, and no significant difference was found between groups with regard to the prevalence of oral infection. Dogs with endocarditis were significantly more likely to have undergone a nonoral surgical procedure that required general anesthesia in the preceding 3 months or to have developed a new heart murmur or a change in intensity of an existing heart murmur. Preexisting cardiac dis-ease (congenital or acquired) was not found to be a risk factor. Results did not provide any evidence of an association between bacterial endocarditis in dogs and either dental or oral surgical procedures or oral infection. Findings suggested that the routine use of prophylactic antimicrobial administration in dogs undergoing oral procedures needs to be reevaluated.

Consumer products and activities associated with dental injuries to children treated in United States emergency departments, 1990-2003.

PubMed

Stewart, Gregory B; Shields, Brenda J; Fields, Sarah; Comstock, R Dawn; Smith, Gary A

2009-08-01

Describe the association of consumer products and activities with dental injuries among children 0-17 years of age treated in United States emergency departments. A retrospective analysis of data from the National Electronic Injury Surveillance System, 1990-2003. There was an average of 22 000 dental injuries annually among children <18 years of age during the study period, representing an average annual rate of 31.6 dental injuries per 100 000 population. Children with primary dentition (<7 years) sustained over half of the dental injuries recorded, and products/activities associated with home structures/furniture were the leading contributors. Floors, steps, tables, and beds were the consumer products within the home most associated with dental injuries. Outdoor recreational products/activities were associated with the largest number of dental injuries among children with mixed dentition (7-12 years); almost half of these were associated with the bicycle, which was the consumer product associated with the largest number of dental injuries. Among children with permanent teeth (13- to 17-year olds), sports-related products/activities were associated with the highest number of dental injuries. Of all sports, baseball and basketball were associated with the largest number of dental injuries. To our knowledge, this is the first study to evaluate dental injuries among children using a national sample. We identified the leading consumer products/activities associated with dental injuries to children with primary, mixed, and permanent dentition. Knowledge of these consumer products/activities allows for more focused and effective prevention strategies.

Comparison of Ropivacaine 0.75 % and Lignocaine 2 % with 1:200,000 Adrenaline in Dental Extractions: Single Blind Clinical Trial.

PubMed

Bansal, Vishal; Kumar, Deval; Mowar, Apoorva; Bansal, Avi

2018-06-01

The aim of this study was to evaluate the efficacy, safety and clinical acceptability of the local anaesthetic agent ropivacaine 0.75 % in comparison with lignocaine 2 % with adrenaline 1:200,000 in minor oral surgical procedures. Forty-seven patients, who required bilateral extractions in a single arch, were included in this study. One hundred and sixty-six extractions were performed and all the patients were administered nerve blocks/infiltration. Pre and postoperative pulse, blood pressure, random blood sugar, electrocardiogram and partial oxygen pressure were recorded at specified time intervals. Pain score by visual analogue scale, onset of action and depth of anesthesia were also observed. Duration of anaesthesia was assessed by feeling of numbness and first sign of pain. Statistical analysis revealed insignificant difference between both the groups in terms of pulse, blood pressure, random blood sugar, and partial oxygen pressure. The depth of anesthesia was evaluated by pain, comfort during the procedure with visual analog scale and showed no significant difference between the two groups. The onset of action for maxillary infiltration was 33.29 ± 9.2 (ropivacaine), 32.12 ± 6.8 s (2 % lignocaine with adrenaline 1:200,000) and for pterygomandibular nerve block was 181.0 ± 87.5 (ropivacaine), 32.12 ± 6.8 s (2 % lignocaine with adrenaline 1:200,000). Duration of anesthesia when compared was 411.7 ± 66.11 min (ropivacaine) and 107.87 ± 16.54 (2 % lignocaine with adrenaline 1:200,000). On maxillary buccal vestibule infiltration it was also observed that in ropivacaine group there was no requirement of palatal infiltration suggestive of good diffusion property. Ropivacaine is a safe, clinically acceptable long acting local anaesthetic agent with added advantage of effective diffusion property. SDC/MISC/2013/239.

Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems.

PubMed

Epstein, Richard H; Dexter, Franklin; Hofer, Ira S; Rodriguez, Luis I; Schwenk, Eric S; Maga, Joni M; Hindman, Bradley J

2018-02-01

Perioperative hypothermia may increase the incidences of wound infection, blood loss, transfusion, and cardiac morbidity. US national quality programs for perioperative normothermia specify the presence of at least 1 "body temperature" ≥35.5°C during the interval from 30 minutes before to 15 minutes after the anesthesia end time. Using data from 4 academic hospitals, we evaluated timing and measurement considerations relevant to the current requirements to guide hospitals wishing to report perioperative temperature measures using electronic data sources. Anesthesia information management system databases from 4 hospitals were queried to obtain intraoperative temperatures and intervals to the anesthesia end time from discontinuation of temperature monitoring, end of surgery, and extubation. Inclusion criteria included age >16 years, use of a tracheal tube or supraglottic airway, and case duration ≥60 minutes. The end-of-case temperature was determined as the maximum intraoperative temperature recorded within 30 minutes before the anesthesia end time (ie, the temperature that would be used for reporting purposes). The fractions of cases with intervals >30 minutes between the last intraoperative temperature and the anesthesia end time were determined. Among the hospitals, averages (binned by quarters) of 34.5% to 59.5% of cases had intraoperative temperature monitoring discontinued >30 minutes before the anesthesia end time. Even if temperature measurement had been continued until extubation, averages of 5.9% to 20.8% of cases would have exceeded the allowed 30-minute window. Averages of 8.9% to 21.3% of cases had end-of-case intraoperative temperatures <35.5°C (ie, a quality measure failure). Because of timing considerations, a substantial fraction of cases would have been ineligible to use the end-of-case intraoperative temperature for national quality program reporting. Thus, retrieval of postanesthesia care unit temperatures would have been necessary. A substantive percentage of cases had end-of-case intraoperative temperatures below the 35.5°C threshold, also requiring postoperative measurement to determine whether the quality measure was satisfied. Institutions considering reporting national quality measures for perioperative normothermia should consider the technical and logistical issues identified to achieve a high level of compliance based on the specified regulatory language.

Anesthetic Management of Narcolepsy Patients During Surgery: A Systematic Review.

PubMed

Hu, Sally; Singh, Mandeep; Wong, Jean; Auckley, Dennis; Hershner, Shelley; Kakkar, Rahul; Thorpy, Michael J; Chung, Frances

2018-01-01

Narcolepsy is a rare sleep disorder characterized by excessive daytime sleepiness, sleep paralysis, and/or hypnagogic/hypnopompic hallucinations, and in some cases cataplexy. The response to anesthetic medications and possible interactions in narcolepsy patients is unclear in the perioperative period. In this systematic review, we aim to evaluate the current evidence on the perioperative outcomes and anesthetic considerations in narcolepsy patients. Electronic literature search of Medline, Medline in-process, Embase, Cochrane Database of Systematic Reviews databases, international conference proceedings, and abstracts was conducted in November 2015 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. A total of 3757 articles were screened using a 2-stage strategy (title-abstract followed by full text). We included case studies/series, cohort studies, and randomized controlled trials of narcolepsy patients undergoing surgical procedures under anesthesia or sedation. Preoperative narcolepsy symptoms and sleep study data, anesthetic technique, and perioperative complications were extracted. Screening of articles, data extraction, and compilation were conducted by 2 independent reviewers and any conflict was resolved by the senior author. A total of 19 studies including 16 case reports and 3 case series were included and evaluated. The majority of these patients received general anesthesia, whereas a small percentage of patients received regional anesthesia. Reported complications of narcolepsy patients undergoing surgeries were mainly related to autonomic dysregulation, or worsening of narcolepsy symptoms intra/postoperatively. Narcolepsy symptoms worsened only in those patient populations where the preoperative medications were either discontinued or reduced (mainly in obstetric patients). In narcolepsy patients, use of depth of anesthesia monitoring and total intravenous technique may have some advantage in terms of safety profile. Several patients undergoing neurosurgery involving the hypothalamus or third or four ventricles developed new-onset narcolepsy. We found a paucity of prospective clinical trials in this patient population, as most of the studies were case reports or observational studies. Continuation of preoperative medications, depth of anesthesia monitoring, use of multimodal analgesia with short-acting agents and regional anesthesia techniques were associated with favorable outcomes. Obstetric patients may be at greater risk for worsening narcolepsy symptoms, possibly related to a reduction or discontinuation of medications. For neurosurgical procedures involving the hypothalamus or third and fourth ventricle, postoperative considerations should include monitoring for symptoms of narcolepsy. Future studies are needed to better define perioperative risks associated with anesthesia and surgery in this population of patients.