Sigalit Blumer

Post-operative pain and use of analgesic agents in children following intrasulcular anaesthesia and various operative procedures

Aim To characterise post-operative pain (PDP) and use of analgesic agents in children.Methods The study consisted of 472 children, who received routine dental treatment. Teeth were anaesthetised by a computerised delivery system, either intrasulculary (CDS-IS) or by local infiltration (CDS-IF). Information regarding post-operative pain and use of analgesic agents was obtained by a telephone call within 24 hours after treatment.Results The overall incidence of PDP was 38%. 60.9% of the children who experienced PDP were given an analgesic agent. Incidence and severity of pain were significantly associated with type of dental procedure. The highest incidence was found after root canal treatment (62.5%) and preformed crowns (60.8%). A higher incidence of PDP was found in teeth with history of pain or abscess as compared to teeth with restoration or caries (p <0.01). Incidence of pain was not associated with restoration material, extension, depth or type (occlusal vs proximal) of restoration, multiple restoration, gender, mode of CDS anaesthesia, or effectiveness of anaesthesia during dental treatment. Analgesic drugs were given mainly after preformed crowns, root canal filling and extractions.Conclusions PDP and analgesic use in children is common, especially after root canal filling, preformed crowns and extractions. CDS-IS is not associated with increased PDP.

Effect of computerized delivery intraligamental injection in primary molars on their corresponding permanent tooth buds

OBJECTIVE To evaluate the prevalence of developmental disturbances in permanent teeth in which buds were exposed to intraligamental injection (ILI) delivered by a computer controlled local anaesthetic delivery (C-CLAD). METHODS The study population consisted of 78 children (age 4.1-12.8 years) who received ILI-C-CLAD to 166 primary molars. A structured form was designed to include information regarding age at treatment, gender, type of treated tooth, tooth location, type of dental treatment, and type of developmental disturbance(s) present in the associated permanent tooth. Teeth, which received regular anaesthesia or were not anaesthetized by local anaesthesia, served as controls. RESULTS Five children had developmental defects. In C-CLAD-ILI exposed teeth, one child had two hypomaturation defects. The corresponding primary teeth were extracted. No defects were found on the control side. In two children, hypoplastic defects were found only in the control teeth (one in each child). One suffered from a dentoalveolar abscess in the corresponding primary tooth. Diffuse hypomaturation defects were found in two children on both the C-CLAD-ILI exposed and control sides. CONCLUSION In the primary dentition, C-CLAD-ILI does not increase the danger of developmental disturbances to the underlying permanent dental bud.

Children's Responses to Sensory Stimuli and their Behavior in the Dental Office

OBJECTIVES To evaluate childrens behavior during dental examinations, their reactions to various selected sensory stimuli and the association between them. STUDY DESIGN Sixty-three children (28 boys and 35 girls) aged 5-12 years (mean age 7.9 ± 1.6 years) participated in the study. Their parents were asked to complete a questionnaire while in the dentists waiting room. The dentists evaluated the childrens behavior in the dental office using Frankls behavioral scale and noted the childrens reactions to the sensory stimuli of touch, noise, smell and backward tilting of the examination chair. RESULTS Most of the children cooperated during the dental examination. Lack of cooperation was associated with adverse reactions to all selected sensory stimuli. There was also an association between resistance to brushing teeth and adverse reaction to touch. Children who reacted negatively to sensory stimuli during dental examinations were more likely to have needed advanced management techniques during past dental treatment. CONCLUSIONS Childrens behavior during dental examinations is known to be affected by many factors, including age, previous experiences, anxiety and fear and others. This investigation demonstrates that it is also associated with their reactions to various sensory stimuli.

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

OBJECTIVE To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N2O-O2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. STUDY DESIGN 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. RESULTS Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N2O-O2 alone had a 6.1-fold greater risk of failure compared to N2O-O2+midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). CONCLUSIONS The GA mode yielded significantly greater success than the N2O-O2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N2O-O2. When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

Effect of Two Traditional Polyacrylic Acid Conditioners and 2% Chlorhexidine Digluconate on Cavosurface Microleakage of Glass Ionomer Restorations

OBJECTIVES A lack of appropriate adhesiveness is one of the biggest problems in restorative dentistry today and the main cause of microleakage. This is especially true in pediatric dentistry where moisture control is more difficult to achieve. Glass ionomer restorative materials increase adhesion and decrease microleakage given their chemical adhesion to the remaining tooth substance. Pretreatment improves the adhesion quality. The aim of this study was to assess the microleakage of Glass ionomer restorative materials following application of 20% polyacrylic acid, 10% polyacrylic acid or 2% chlorhexidine digluconate in Class V cavities. STUDY DESIGN Two Class V preparations were prepared on the buccal and lingual surfaces of 24 extracted human molars. The gingival wall was set below or above the CEJ. The teeth were divided into 2 groups. Group 1 was treated with 20% polyacrylic acid or 10% polyacrylic acid. Group 2 was treated with 10% polyacrylic acid or 2% chlorhexidine digluconate. Microleakage was evaluated using a light-reflecting stereomicroscope and stain penetration test. RESULTS Two percent chlorhexidine digluconate was as efficient as the other conditioners. No statistically significant differences were found among the three types of conditioners. Dye penetration was significantly greater into dentin than into enamel among all three conditioners in both groups (P<0.001). CONCLUSION Two percent chlorhexidine digluconate, with its known added advantages, can be used as a pretreatment conditioner in GI restorations.

Dental Anxiety Among Israeli Postgraduate Pediatric Dental Students and their Instructors

OBJECTIVE To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety. STUDY DESIGN Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on socio demographic information, dental anxiety scale (DAS) and dental fear survey (DFS). RESULTS The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentists office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar. CONCLUSIONS Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.

Preemptive Analgesia by Paracetamol, Ibuprofen or Placebo in Pediatric Dental Care: A Randomized Controlled Study

OBJECTIVE To compare postoperative pain among children who received an oral dose of paracetamol, ibuprofen or a placebo, prior to tooth extractions. STUDY DESIGN Thirty minutes prior to dental treatment, children received a liquid dosage, fruit flavored and orange colored, of paracetamol, ibuprofen, or a placebo. Data accessed included childrens dental history, their behavior, and their feeling of pain or anxiety according to Wong-Baker FACES: before treatment, following local anesthesia, and following treatment. Parents were interviewed by telephone regarding their childrens need for a postoperative analgesia (paracetamol or ibuprofen), and their feeling of pain at four and 24 hours posttreatment. RESULTS Parents reported administering paracetamol or nurofen following the dental procedure to 9/43 (21%), 2/33 (6%) and 12/29 (41%) of the children in the preemptive paracetamol, ibuprofen, and placebo groups, respectively. For the 3 groups, mean pain assessment were similar: around the middle of the Wong-Baker FACES scale at baseline, slightly higher following local anesthesia, and low (pain-free) at four and 24 hours postoperative. CONCLUSION Children who received paracetamol or ibuprofen prior to tooth extractions were less likely to need an analgesic following treatment, compared to children who received a placebo.

The Prevalence of ADHD Patients among Pediatric Dentists in Israel and Knowledge of Dental and Behavioral Aspects of Treating Them

OBJECTIVE There are no clear guidelines for managing the dental treatment of children with attention deficit hyperactivity disorder (ADHD). The use of sedation in combination with chronic ADHD medication use is also not well defined. This study surveyed the prevalence of ADHD children, management techniques and knowledge of pharmacologic therapies of these children among Israeli dentists. STUDY DESIGN A specially designed questionnaire was distributed to all Israeli dentists attending a national conference in 2016. RESULTS Of the 160 dentists who attended the conference, 96 completed the survey (60% response rate), and they included 46 (51%) pediatric dental specialists and 50 (49%) general dental practitioners. The medications Ritalin and Concerta were most familiar to the respondents (98.9%). Eighty-seven (91.1%) of the practitioners responded that their ADHD patients take their usual doses of any drug for treating ADHD symptoms, regardless of whether or not the dentists intended to use sedatives. The practitioners invented their own behavior management techniques with varying degrees of success. CONCLUSIONS There are no specific guidelines for the most effective pharmacologic protocol (co-administration of ADHD drugs and dental sedatives) or behavior management techniques for the provision of optimal dental care to children with ADHD.

Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a pediatric dental setting: a prospective randomized study

BACKGROUND Efficacy of pre-emptive analgesia compared to preventive regimen, managing postoperative pain is still controversial. AIM Evaluating the efficacy of intravenous (IV) paracetamol as pre-emptive analgesia compared to preventive post-treatment administration in pediatric dental setting. DESIGN In a prospective trial, 60 noncooperative children of ASA I, II aged 3-10 years who underwent dental rehabilitation under general anesthesia were randomly divided into two groups. Pre-emptive group (n = 30) received 15 mg/kg of IV paracetamol before the start of treatment. Preventive group (n = 30) received 15 mg/kg of paracetamol at the end of treatment. Analgesic efficacy was measured by visual analog scale of faces (VASOF), percentage of children received postoperative analgesia. RESULTS The VASOF results in the pre-emptive group were significantly lower compared to the preventive group at 4, 8, 12, and 24 h (0.0146, 0.0188, 0.0085, and 0.0001, respectively). Less children in the pre-emptive group received supplemental fentanyl postoperatively compared to the preventive group (27.6%, 58.6%, respectively, P = 0.0170). Time to first rescue dose of fentanyl postoperatively in the pre-emptive group was later than in the preventive group (P = 0.0432). CONCLUSIONS Administration of IV paracetamol pre-emptively provides lower pain scores, and a decreased percentage of children required pain relief and less amount of postoperative opioids, compared to preventive administration.

Supernumerary Teeth in the Maxillary Anterior Region: The Dilemma of Early Versus Late Surgical Intervention

Supernumerary teeth are the most common developmental dental anomalies in the maxillary anterior region causing interference to the developing permanent incisors resulting in poor dental and facial esthetics. Two different opinions regarding the timing for surgical removal of the supernumerary teeth are presented. In this case report, three brothers with supernumerary teeth in the maxillary anterior region are presented, their surgical and orthodontic management and outcome are discussed.