Martha Wells

Comparison of mandibular cortical thickness and QCT‐derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia: a retrospective study

OBJECTIVE To examine whether panoramic radiograph-determined mandibular cortical thickness correlated with quantitative computed tomography-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia (ALL). METHODS We identified patients treated for ALL at St. Jude Childrens Research Hospital, seen in the After Completion of Therapy (ACT) Clinic between January of 2006 and January of 2014 who had QCT-derived BMD and panoramic radiographs obtained within 1 month of each other. Panoramic radiographs were independently scored by a pediatric radiologist, two pediatric dentists, and a general dentist using the Klemetti technique. We used the Spearmans rank correlation test and the multivariate regression model to investigate the effect of evaluator experience on results. RESULTS The study cohort comprised 181 patients with 320 paired studies: 112 (62%) male, 112 (71%) were white. Median age at ALL diagnosis was 6.4 (range, 0-18.8) years. Median age at study was 11.9 (range, 3.3 to 29.4) years. The median average BMD was 154.6 (range, 0.73-256) mg/cc; median QCT Z-score (age and gender adjusted) was -0.875 (range, -5.04 to 3.2). We found very weak association between panoramic radiograph score and both QCT-BMD average (P = 0.53) and QCT Z-score (P = 0.39). Results were not influenced by level of reader experience. CONCLUSIONS The Klemetti technique of estimating BMD does not predict BMD deficits in children and young adult survivors of ALL, regardless of reviewer expertise. Alternative methods are needed whereby dental healthcare providers can identify and refer patients at risk for BMD deficits for detailed assessment and intervention.

A Retrospective Study of 248 Pediatric Oral Sedations Utilizing the Combination of Meperidine and Hydroxyzine for Dental Treatment

UNLABELLED Oral sedation for pre-cooperative and anxious pediatric patients is an important tool for the pediatric dentist. Few studies have examined the sedation regimen of meperidine and hydroxyzine. OBJECTIVES The primary goal of this study was to evaluate the overall safety and effectiveness of the meperidine/hydroxyzine drug combination. Secondary goals included detecting potential factors that alter sedation effectiveness. STUDY DESIGN Two hundred and forty eight electronic health records of pediatric patients (131 females, 117 males) who received meperidine/hydroxyzine sedations in a university setting were evaluated. Pediatric dental residents rated each case according to the Frankl behavioral scale and for effectiveness. Numerous factors were analyzed to evaluate their significance on overall effectiveness. Factors examined included age at time of treatment, gender, ASA status, Frankl score at various points during treatment, sextant of treatment, operator experience, dosage, use of nitrous oxide, and any complications encountered during treatment, both major and minor. RESULTS Over 81% of sedations were considered effective or very effective. Statistically significant findings included age of patient, pre-sedation behavior, and willingness to take the medication. Less than 5% of sedations were aborted due to behavior. Only one major complication was found, which was not related to the sedation. CONCLUSIONS Meperidine combined with hydroxyzine is a safe and effective sedation regimen for uncooperative or pre-cooperative children during dental treatment.