Haluk Bodur

Premedication with melatonin vs midazolam in anxious children.

Aim:  Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N2O/O2) sedation for dental treatment.

Accuracy of two different apex locators in primary teeth with and without root resorption

The objective of this study was to assess the accuracy of two frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan) in primary teeth with and without root resorption in vitro. For this study, 90 sound extracted primary teeth (60 molars and 30 incisors; 93 roots with visible resorption and 51 roots without) were selected. A total of 144 root canals were included. After access preparation, root canal lengths were measured visually. The teeth were embedded in an alginate model developed specifically for testing apex locators. Electronic length was determined with two different frequency apex locators, Root ZX (Morita, Kyoto, Japan) and Endex (Osada, Tokyo, Japan). Statistical evaluation was performed using Mann–Whitney U and Wilcoxon W tests (p < 0.05). Results revealed that both apex locator devices did not show similar values to visual length measurements with statistically significant differences in primary teeth with root resorption (p < 0.05). For the teeth without root resorption, Endex showed similar values to visual length measurements with no statistically significant differences (p > 0.05), but Root ZX values were different than visual length and the differences were statistically significant (p < 0.05). There were no significant differences between the two apex locators considering the presence of root resorption. The two frequency apex locators can be recommended for use in root canal therapy for primary teeth with and without root resorption, only if electrical determination of root canal length is supported with other diagnostic measures.

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen.

Background and objective In paediatric dentistry, when anxiety, fear of dental procedures or behavioural impairment precludes the conduct of dental treatments, sedation procedures are required. However, sedation at the desired level might not be achieved despite administration of various agents. The present study aimed to evaluate the effectiveness of oral premedication with different agents on children scheduled for dental treatment under nitrous oxide/oxygen (N2O/O2) sedation. Methods The present research was approved by the Ethics Committee of Gazi University Faculty of Medicine. Sixty children aged between 5 and 8 years, ASA I or II, having no mental or motor retardation, requiring at least two-visit dental treatment, having no sedation or general anaesthesia experience, and incompliant with dental treatment (Frankl Behaviour Scale≥3), were enrolled into the study after obtaining informed parental consent. The children were then randomly assigned to one of four groups. The treatment regimen according to the study groups was as follows: oral administration of 1 mg kg−1 hydroxyzine hydrochloride suspension (Atarax) 1 h preoperatively (group I, n = 15), oral administration of 0.7 mg kg−1 midazolam (Dormicum) 15 min preoperatively (group II, n = 15), oral administration of 3 mg kg−1 ketamine (Ketalar) with 0.25 mg kg−1 midazolam (Dormicum) 15 min preoperatively (group III, n = 15), and no oral premedication administration [group IV (controls), n = 15]. Peripheral oxygen saturation (SpO2) and heart rate were monitored with a pulse oximeter during treatment. The sedation level was monitored with the bispectral index. Following premedication, 40% N2O and 60% O2 was administered to all groups by means of a nasal mask. Sedation depth was evaluated using the Ramsay Sedation Scale and data were recorded at 5 min intervals. Sedation success and other sedation-related events were recorded. Results The evaluation of the findings of this study revealed that treatment procedures were completed without any serious complications. Achievement of sedation in terms of satisfactory/mid-level satisfactory/unsatisfactory was as follows: 13.3/53.3/33.3% in group I; 54/20/26% in group II; 33.3/33.3/33.3% in group III, and 6.7/60/33.3% in group IV, respectively. Ramsay Sedation Scale results revealed that the most effective medication was 0.7 mg kg−1 midazolam. Conclusion It is concluded that 0.7 mg kg−1 midazolam is more effective than 0.25 mg kg−1 midazolam with 3 mg kg−1 ketamine and 1 mg kg−1 hydroxyzine hydrochloride in terms of oral premedication prior to N2O/O2 sedation in children scheduled for dental treatments.

Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success

Background:  Midazolam is one of the most frequently used agents for sedation in pediatric dentistry. The injectable form of midazolam can also be given orally. However, its bad taste has negative effects on ingestion of the drug. In this study, we aimed to evaluate the effect of drinks which were added to mask the bitter taste of midazolam for drug acceptance and sedation.

In vitro comparison of digital and conventional bitewing radiographs for the detection of approximal caries in primary teeth exposed and viewed by a new wireless handheld unit

OBJECTIVES The aim of this study was to compare the diagnostic quality of a new wireless handheld unit (ADX4000; Dexcowin Co. Ltd, Korea) on conventional bitewings and its LCD screen for the detection of approximal caries in primary teeth. METHODS In total, 108 approximal surfaces of primary teeth were examined in vitro by 3 observers. Conventional films were viewed under subdued lighting conditions on a conventional view box. Digital 3.5 inch images were displayed on the built-in monitor of the ADX4000 and digital 17 inch images were viewed on a 17 inch monitor. The true caries diagnosis was based on histological assessment of the approximal surfaces after sectioning the primary teeth. Receiver operating characteristic (ROC) curve (A(z)) analysis was used to assess the diagnostic quality of imaging modalities. RESULTS The areas under the ROC curves ranged from 0.786 (digital 17 inch) to 0.813 (digital 3.5 inch). No statistically significant differences were found between the three modalities for detecting approximal caries. CONCLUSIONS It was concluded that the diagnostic quality of conventional film and digital images, which were exposed and viewed by a new wireless handheld unit, was comparable.

Salivary and Urinary Fluoride Levels after 1-Month Use of Fluoride-Releasing Removable Appliances

Forty children aged 8-10 years participated in this study. Half (n =20) of them used orthodontic appliances which contained fluoride-releasing devices embedded in the lingual surface of the appliance and the other half used orthodontic appliances prepared from a fluoride-releasing acrylic polymer. Prior to the adjustment of appliances and after 1, 7, 14, 21 and 30 days salivary and urinary samples were collected and the fluoride concentrations were determined. The mean fluoride release was highest during the first week. However, the values decreased considerably after that and the curves for the two groups became parallel. The results indicate that fluoride-releasing removable appliances could be useful for a prolonged release of low concentrations of fluoride without any systemic effect.