Arturo Garrocho-Rangel

Effect of 4-Allyl-1-hydroxy-2-methoxybenzene (Eugenol) on Inflammatory and Apoptosis Processes in Dental Pulp Fibroblasts

Eugenol (mixed with zinc oxide powder) is widely used as direct capping material during pulp therapy in primary teeth. The aim of the present study was to evaluate the effect of eugenol on diverse genes involved in inflammatory and cell apoptosis processes. The regulatory effect of eugenol on the expression of inflammation and apoptotic genes was evaluated in dental pulp fibroblasts from extracted third molars, cultured under concentration of eugenol of 13 μM. Eugenol allowed the expression of inflammatory and apoptotic genes when compared with positive and negative controls. Eugenol is a proinflammatory agent when it is in direct contact with healthy tissues and behaves as an anti-inflammatory agent in tissues undergoing inflammatory/apoptotic processes, as in cases of pulp inflammation in primary teeth. These findings are relevant for dentistry, when considering the application of safer pulp treatments to grossly carious childrens teeth.

Intracanal irrigants for pulpectomy in primary teeth: a systematic review and meta‐analysis

OBJECTIVE To conduct a systematic review and meta-analysis to assess the findings on the clinical efficacy of intracanal irrigants employed during pulpectomy of primary teeth. METHODS A systematic search was performed in electronic databases and peer-reviewed paediatric dentistry journals to find relevant studies. Titles, abstracts, and full-text papers were located, screened, and assessed independently by two reviewers, and a meta-analysis was performed. RESULTS The search identified a total of 775 records; 46 were selected and reviewed in full text. After screening, seven studies met the eligibility criteria for inclusion. Three studies compared the 2% chlorhexidine and saline solutions, but no analysis could be performed because of the heterogeneity between these; two of the studies reported non-comparative methodologies and results when compared, and were not analysed. Finally, two studies compared a mixture of tetracycline isomer, an acid, and a detergent (MTDA) or oxidative potential water (OPW) to sodium hypochlorite (NaOCl), without showing significant heterogeneity; therefore, their combined outcomes were included. Both fixed and random mixed models resulted in a non-significant weighted mean difference between treatments, according to a forest plot. CONCLUSIONS More studies are required with adequate quality, as well as a full-result report, including summary measurements of both response variables and effect size, to determine the most effective irrigant agents for use in pulpectomies.

Moxifloxacin versus Clindamycin/Ceftriaxone in the management of odontogenic maxillofacial infectious processes: A preliminary, intrahospital, controlled clinical trial

Background The aim of this study was to compare the days of hospitalization length between patients treated with Moxifloxacin with that of patients treated with a Clindamycin/Ceftriaxone combination and additionally, to isolate and identify the oral pathogens involved in orofacial odontogenic infections. Material and Methods A pilot-controlled-clinical-trial was carried out on hospitalized patients with cervicofacial odontogenic abscesses or cellulitis, who were randomly asigned to two study groups: 1) patients who received Moxifloxacin, and 2) patients receiving Clindamycin/Ceftriaxone combination. Infiltrate samples were collected through transdermic or transmucosal punction and later cultured on a media specific for aerobic and anaerobic microorganisms. Mean hospitalization duration in days until hospital discharge and susceptibility assessment in rates were established. Results Mean hospitalization time in days of patients treated with Moxifloxacin was 7.0 ± 1.6 days, while in the Clindamycin/Ceftriaxone group, this was 8.4 ± 1.8 days, although significant difference could not be demonstrated (p=0.074). A total of 43 strains were isolated, all of these Gram-positive. These strains appeared to be highly sensitive to Moxifloxacin (97.5%) and Ceftriaxone (92.5%). Conclusions Moxifloxacin and Ceftriaxone appear to be potential convenient and rational alternatives to traditional antibiotics, for treating severe odontogenic infections, in conjunction with surgical extraoral incision, debridement, and drainage. Key words:Orofacial odontogenic infections, antimicrobial susceptibility, antimicrobial resistance.

Dentist attitudes and responsibilities concerning child sexual abuse. A review and a case report.

According to the World Health Organization, child abuse and neglect is “every kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. The aim of the present report is to inform about the most relevant aspects of child abuse and the characteristics of injuries to the head, neck, and orofacial regions, in addition to the suggested role of, and management by, the dentist for the evaluation of this condition, and also for reporting a case of a physically and sexually abused girl aged 5 years 8 months. Throughout the appointments, some type of abuse in this patient was suspected by the treating dentists at the clinic, mainly due to the initial behavior exhibited by the patient in the dental chair. Based on the clinical diagnostic an intensive preventive plan and restorative treatment was realized. The timely detection of the signs and symptoms of sexual abuse, often present in the orofacial region, place the pediatric dentist in a strategic situation, with the capacity to recognize, register, and later report those cases considered as suspect, including the dental treatment delivered and the intensive behavioral-psychological management, in order to achieve acceptation by the otherwise very anxious patient of the indicated restorative and preventive dental procedures. Key words:Child abuse, dentistry, behavior management.

Subcutaneous Midazolam with and without Ketamine for Sedation In Children Undergoing Dental Treatment: A Pilot Study.

AIM The objective of this study was to evaluate the efficacy of subcutaneous (SC) sedation using midazolam with and without ketamine in non-cooperative pediatric patients undergoing dental treatment. STUDY DESIGN A prospective, randomized, controlled, double-blind, crossover pilot clinical trial was carried out in 13 children, aged between 17-46 months, ASA l, Frankl 1. Two sedation schemes were administered SC: Midazolam alone (M), and a combination of Midazolam-Ketamine (MK). Both regimens were administered to the same patient in two consecutive treatment sessions, in accordance with a random assignment. Overall behavior, movement, and crying were assessed according to the modified Houpt scale. Heart rate, blood pressure, blood oxygen saturation, and possible side effects were also monitored. RESULTS The percentage of non-crying children was always higher in the treatment with MK compared with the treatment with M, but without a significant statistical difference. Regarding variable body movement, the percentage of children without movement was higher in the MK group, although only up to minute 10; no significant differences were found at 20, 30, and 40 minutes, and from minute 40, body movement was lower in the M group. CONCLUSIONS Midazolam alone and the midazolam-ketamine combination administered subcutaneously resulted in a safe and efficient pharmacological method for providing moderate sedation to non-cooperative pediatric patients undergoing dental treatment.

Pain Management Associated with Posttraumatic Unilateral Temporomandibular Joint Anterior Disc Displacement: A Case Report and Literature Review

The aim of the present article is to review the etiological risk factors and the general and oral management of anterior disc displacement with reduction caused by a chin trauma, and to describe the diagnostic process and the treatment provided to an affected 7-year-old girl. The patient also experienced frequent and severe cephaleas, which may be related to cervical vertebrae deviation. The patient was successfully treated with an intraoral occlusal splint and analgesics. Pediatric dentists must always be aware of the early signs and symptoms of temporomandibular joint disorders in their patients, especially in cases of orofacial trauma history, with the aim of providing an opportune resolution and preventing its progression later in life. Occlusal splints are strongly recommended for the treatment of anterior disc displacement with reduction in children and adolescents.

Dental Management of a Young Child Affected by Galactosialidosis and a Gigantic Abdominal Growth

Galactosialidosis (GS) is a rare form of lysosomal storage disease that involves a broad spectrum of skeletal and soft tissue abnormalities. We report here on a 4-year 7-month-old boy with mild mental retardation, exhibiting multiple caries cavities and associated infectious foci and macroglossia. A huge abdominal enlargement due to peritoneal ascites was evident. Behavioral management and patient positioning on the dental chair represented a true challenge. The patient was treated under general anesthesia. However, life-threatening postoperative complications occurred because of the impossibility of extubating the patient. A very careful preanesthetic assessment is crucial in children affected by general conditions associated with airway anomalies, such as GS.

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

This new perspective article was performed to investigate the evidence from published dental literature about the prophylactic extraction of asymptomatic (or disease-free) impacted third molars (ITM) in adolescents and young adults. This clinical procedure is common until today and has been the origin of controversy among the dental community worldwide. However, evidence-based data from well-conducted clinical studies and systematic reviews are not sufficient to justify the routine prophylactic extraction of ITM. Active surveillance at regular intervals has been proposed as a better management strategy. As a conclusion, surgical removal of ITM is only justified in the presence of specific pathosis, independently of the patient’s age.

Fundamentals in Biostatistics for Investigation in Pediatric Dentistry: Part II –Biostatistical Methods

The main purpose of the second part of this series was to provide the reader with some basic aspects of the most common biostatistical methods employed in health sciences, in order to better understand the validity, significance and reliability of the results from any article on Pediatric Dentistry. Currently, as mentioned in the first paper, Pediatric Dentists need basic biostatistical knowledge to be able to apply it when critically appraise a dental article during the Evidence-based Dentistry (EBD) process, or when participating in the development of a clinical study with dental pediatric patients. The EBD process provides a systematic approach of collecting, review and analyze current and relevant published evidence about oral health care in order to answer a particular clinical question; then this evidence should be applied in everyday practice. This second report describes the most commonly used statistical methods for analyzing and interpret collected data, and the methodological criteria to be considered when choosing the most appropriate tests for a specific study. These are available to Pediatric Dentistry practicants interested in reading or designing original clinical or epidemiological studies.

Dental Management of a Child with Incidentally Detected Hemophilia: Report of a Clinical Case

Children with hemophilia (A or B) are at risk for bleeding episodes, which rank from mild mucosal/soft tissues bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to an 8.10-year-old patient suffering from uncontrolled bleeding after a surgical procedure to expose both permanent upper central incisors, in which hemophilia was a pure incidental finding. Additionally, diverse precautions to be considered during the dental clinical treatment of hemophilic children are discussed.