Peter K. Domoto

The use of nitrous oxide in the treatment of children: results of a controlled study

The sequential analysis of behavior has begun to show that the behavior of the dentist is a major influence on the fear-related behaviors of children, even when N2O is used. The moment-to-moment behaviors of the dentist influence the childs behaviors. Certain behaviors of dentists, such as distraction, appear to be effective especially when the N2O is being administered.

Pharmacokinetics of oral triazolam in children

The purpose of this study was to determine the pharmacokinetic behavior of triazolam in children. Nine healthy children, aged 6 to 9 years, received oral triazolam (0.025 mg/kg suspended in Kool-Aid, Kraft General Foods, Chicago, IL) before dental treatment. Plasma triazolam concentrations were measured by gas chromatography/mass spectrophotometry at approximately 5, 15, 30, 45, 60, 90, 120, 180, and 240 minutes. A one-compartment model with first-order absorption and varying parameters was used, and estimated concentration curves were obtained for each subject. The observed peak plasma concentration was 8.5 +/- 3.0 ng/mL (mean +/- SD). The observed time to peak plasma concentration was 74 +/- 25 minutes. Elimination half-life was 213 +/- 144 minutes. Substantial recovery from signs and symptoms of clinical sedation required 180 to 240 minutes. The long duration of effect and relatively slow elimination should be noted by clinicians concerned with patient safety.

The Estimation of Caries Prevalence in Small Areas

National surveys have been effective for the estimation of caries prevalence in broad regions of the US. However, it is unclear if data from such surveys can be used to estimate prevalences in small areas such as states or counties because of small sample sizes within individual areas. In this study, we applied specialized statistical methods to the estimation of small-area caries measures using data from an oral health survey conducted in the State of Washington. Dental exams to assess caries and the presence of sealants and fluorosis were performed on 2921 third-grade students in 84 public schools selected by a stratified random sample from all 39 counties in the state. Statistical methods for small-area estimation were used to estimate disease and sealant utilization measures for each of the counties. Adjustment was made for covariates measured at the school level, including ethnicity and the proportion of children in the Federally sponsored school lunch program. Substantial variability in disease and sealant utilization between counties was found. The estimated number of decayed and filled surfaces per child was 4.7 (inter-county range, 2.4 to 7.4). The estimated number of surfaces of untreated decay was 1.2 per child overall (range, 0.5 to 3.1). Thirty percent of the children had restorative treatment needs (range, 15 to 54%). The prevalence of sealants on one or more permanent molars was estimated to be 34% (range, 19 to 46%). Overall, only 8% of children showed evidence of fluorosis. The results demonstrate the usefulness of small-area estimation methods for oral health surveys.

Inhalation of 30% nitrous oxide impairs people's learning without impairing people's judgments of what will be remembered.

Many hypotheses have been proposed to account for the effects of nitrous oxide on memory, with one emerging possibility being that it has a global effect on memory-related functioning. This possibility was explored by examining the effects of nitrous oxide on memory performance and on the accuracy of peoples judgments about their memory performance. Participants inhaled 30% nitrous oxide or a placebo gas while items were studied and while judgments were made about the likelihood of recall for each item. Next, all participants inhaled the placebo during paired-associate recall. Although administration of nitrous oxide during study impaired recall, it did not affect the predictive accuracy of the metacognitive judgments. These results provide pharmacological evidence for a distinction between memory and metamemory.