Database: EMBASE <: international biomedical and pharmaceutical literature, 1988 - Aug 2000. [Trial access until 3/2001. Feedback welcome to medical.library@umich.edu] Search Strategy (You Saved Citations 1-116 From Set 54): ----------------------------------------------------------------------------- 1 Dental cavity preparation/ 790 2 ((dental or cavit$3) adj5 (design$3 or outline$1 or form$1 995 or extension$1 or prepar:)).mp. 3 ((convention$2 or amalgam or silver or copper) adj3 1309 (prepar: or restor: or fill$3 or cavit$3)).mp. 4 ((conservative or ultraconservative or ultra-conservative) 71 adj5 (prepar: or restor: or fill$3 or cavit$3)).mp. 5 ((tunnel: or slot: or adhesive: or saucer:) adj5 (prepar: 280 or restor: or fill$3 or cavit$3)).mp. 6 ((resin or composite$1) adj5 (prepar: or restor: or fill$3 909 or cavit$3)).mp. 7 (air adj (abrasion: or abrad:) adj5 (prepar: or restor: or 0 fill$3 or cavit$3)).mp. 8 ((minimal or prevent:) adj5 (prepar: or restor: or fill$3 2174 or cavit$3)).mp. 9 (extension adj3 prevent:).mp. 159 10 Dental restoration, permanent/ 790 11 or/1-10 6549 12 Dental restoration failure/ 790 13 (restoration$1 or filling$1 or implant$1 or bridge$1 or 64753 crown$1 or inlay$1 or denture$1).mp. 14 (survival$1 or failure$1 or longevity or durability or 412291 success: or survival).mp. 15 ((restoration$1 or filling$1 or implant$1 or bridge$1 or 2260 crown$1 or inlay$1 or denture$1) adj5 (survival$1 or failure$1 or longevity or durability or success: or survival)).mp. 16 Survival analysis/ 22247 17 Prosthesis failure/ 2473 18 exp treatment outcome/ 83917 19 co.fs. 297204 20 exp cohort studies/ 7022 21 prognosis/ 61986 22 exp mortality/ 68797 23 exp morbidity/ 24280 24 (natural adj history).ti,ab. 9421 25 prognos$.ti,ab. 77742 26 course.ti,ab. 103748 27 predict$.ti,ab. 184430 28 exp "Outcome assessment (health care)"/ 83917 29 outcome$1.ti,ab. 142383 30 (inception adj cohort$1).ti,ab. 349 31 disease progression/ 28210 32 exp survival analysis/ 74069 33 Recurrence/ 15870 34 ((recurr: or secondary) adj caries).mp. 9 35 or/12,15-34 839087 36 exp Molar/ 760 37 molar$1.mp. 12572 38 exp Tooth, deciduous/ 148 39 Dentition, primary/ 426 40 Dentition, mixed/ 426 41 ((primary or deciduous or mixed) adj5 (tooth or teeth or 623 dent: or odont:)).mp. 42 "child"/ 169316 43 or/38-42 170115 44 (36 or 37) and 43 255 45 11 and 35 1766 46 limit 45 to (embryo < first trimester > or infant < to one 243 year > or child < unspecified age > or preschool child < 1 to 6 years > or school child < 7 to 12 years > or adolescent < 13 to 17 years >) 47 44 or 46 494 48 45 and 47 245 49 limit 48 to (human and english language) 205 50 exp dental care/ 6313 51 exp Dentistry/ 2199 52 dent:.mp. 20519 53 or/50-52 22634 54 49 and 53 116 55 from 54 keep 1-116 116 *************************** <1> UI - 2000259719 AU - Roe CR AU - Wiltse HE AU - Sweetman L AU - Alvarado LL IN - Dr. C.R. Roe, Institute of Metabolic Disease, Baylor University Medical Center, 3812 Elm St, Dallas, TX 75226; United States. TI - Death caused by perioperative fasting and sedation in a child with unrecognized very long chain acyl-coenzyme A dehydrogenase deficiency. SO - Journal of Pediatrics Vol 136(3) (pp 397-399), 2000. AB - An adopted 3 [half] -year-old girl with no prior medical problems died after a routine dental procedure. More than 2 years later, acylcarnitine analysis of dried blood found on her bedding revealed she had very long chain acyl- coenzyme A dehydrogenase (VLCAD) deficiency. Perioperative oral fasting, without intravenous administration of glucose, may be detrimental to children with certain metabolic and endocrine disorders. Newborn screening by tandem mass spectrometry will detect disorders of fatty acid oxidation such as VLCAD and allow early and preventive treatment. [References: 7] <2> UI - 2000228808 AU - Scheepers LD AU - Montgomery CJ AU - Kinahan AM AU - Dunn GS AU - Bourne RA AU - McCormack JP IN - Dr. L.D. Scheepers, Department of Anaesthesia, 4480 Oak Street, Vancouver, BC V6H 3V4; Canada. E-Mail: louissch@home.iatronet.net. TI - Plasma concentrations of flumazenil following intranasal administration in children. SO - Canadian Journal of Anaesthesia Vol 47(2) (pp 120-124), 2000. AB - Purpose: A pharmacokinetic study in children to determine plasma flumazenil concentrations after the intranasal administration of 40 mug.kg- 1. Methods: Following institutional approval and informed written consent, I I ASA physical status I-II patients, aged two to six years, undergoing general anesthesia for dental surgery were recruited. After induction, 40 mug.kg-1 flumazenil Anexate(TM), Roche, 0.1 mg.mL-1 (0.4 mL.kg-1)) were administered via a syringe as drops, prior to nasal intubation. Venous plasma samples were drawn prior to administration of flumazenil (t=0), and then at 2, 4, 6, 8, 10, 15, 20, 30, 40, 60, and 120 min thereafter. The plasma samples were immediately processed by the onsite laboratory and then stored at -70 [degree] C, before batch analysis via high performance liquid chromatography assay. Pharmacokinetic data calculations were performed using WinNonLin software (Scientific Consulting Inc.). Results: Eleven patients were studied, but data for one patient were discarded due to insufficient sampling. The median age was 4.3 yr (range 3 to 6), with a median weight of 18.9 kg (range 14.9 to 22.2). There were seven boys and three girls. Mean C(max) was 67.8 ng.mL-1 (SD 41.9), with T(max) at two minutes. The calculated half-life was 122 min (SD 99). Conclusion: The mean plasma concentrations of flumazenil attained were similar to those reported after intravenous administration, and may be sufficient to antagonize the side- effects of benzodiazepines. This route of administration may be useful when the intravenous route is not readily available. [References: 16] <3> UI - 2000198040 AU - Macmillan CSA AU - Wildsmith JAW IN - Dr. C.S.A. Macmillan, University Department of Anaesthesia, Ninewells Hospital and Medical Sch., Dundee DD1 9SY; United Kingdom. TI - A survey of paediatric dental anaesthesia in Scotland. SO - Anaesthesia Vol 55(6) (pp 581-586), 2000. AB - A postal survey of NHS hospital-based anaesthetists providing out-patient anaesthesia for dental procedures in children under 10 years of age was conducted in February 1999. Information was sought about quality of care and common practice in Scotland. The experience of the anaesthetists involved in such work was substantial, but the monitoring used did not meet current standards, with only 16% of respondents indicating use of a full range of standard devices. Separate recovery facilities were available to 99%, and all had access to a defibrillator, but the qualifications of dedicated assistant and recovery staff were lacking in 14 and 30%, respectively. Intravenous access was not obtained routinely after inhalational induction of anaesthesia by up to 71% (49%, never; 22%, sometimes). Systemic analgesia or local anaesthesia was used by 88%. Discharge times ranged from 10 min to 6 h. [References: 10] <4> UI - 2000133910 AU - Deehan S AU - Henderson D AU - Stewart K IN - Dr. K. Stewart, Department of Anaesthetics, St. John's Hospital at Howden, Livingston, West Lothian EH54 6PP; United Kingdom. TI - Intubation conditions and postoperative myalgia in outpatient dental surgery: A comparison of succinylcholine with mivacurium. SO - Anaesthesia & Intensive Care Vol 28(2) (pp 146-150), 2000. AB - Ninety-four patients undergoing elective outpatient third molar extraction were recruited into a double-blind, randomized, prospective trial comparing mivacurium (group M) with succinylcholine (Group S) for conditions for endotracheal intubation and the occurrence of postoperative myalgia. Anaesthesia was induced with fentanyl 1 mug.kg-1 and propofol 2.5 mg.kg-1 in all patients. Group S patients were given gallamine 20 mg while group M patients were given mivacurium 0.2 mg.kg-1. Manual ventilation was commenced and anaesthesia maintained with nitrous oxide 70% and isoflurane 1 to 2% in oxygen. After two minutes, group S patients were given succinylcholine 1.5 mg.kg-1 and group M patients 0.9% saline. Nasotracheal intubation was performed 30 seconds later. Intubating conditions in group M were significantly better than those in group S (P < 0.001). The incidence of postoperative conditions in group M were significantly better than those in group S (P = 0.09). We propose that mivacurium is a suitable neuromuscular blocker to use for endotracheal intubation in outpatient dental surgery. [References: 24] <5> UI - 2000112043 AU - Federici AB AU - Sacco R AU - Stabile F AU - Carpenedo M AU - Zingaro E AU - Mannucci PM IN - A.B. Federici, Haemophilia and Thrombosis Centre, Via Pace 9, 20122 MILANO; Italy. E-Mail: augusto.federici@unimi.it. TI - Optimising local therapy during oral surgery in patients with von Willebrand disease: Effective results from a retrospective analysis of 63 cases. SO - Haemophilia Vol 6(2) (pp 71-77), 2000. AB - Bleeding after dental extractions is very frequent in patients with von Willebrand disease (vWD) and in the past often necessitated transfusions with factor VIII/von Willebrand factor concentrates (vWFc). To evaluate the benefits of a standard local therapy on bleeding complications during oral surgery, 63 consecutive patients with vWD were analysed retrospectively. All types of vWD were included: type 1 (n = 31), type 2 (n = 22) and type 3 (n = 10). All the patients had dental extractions or periodontal surgery at the same hospital by the same oral surgeons. All cases had been given tranexamic acid (TA) before and for 7 days after surgery. As additional local therapy fibrin glue (FG) was used during surgery in several patients. Additional systemic therapies were: desmopressin (DDAVP, 0.3 mug kg-1)and fVIII/vWF concentrates (vWFc, 40 U kg-1) given as a single dose before surgery. The 29 subjects (46%) treated locally did not bleed. Among the remaining cases, 24 (38%) were given DDAVP as additional systemic therapy and 6 (9.5%) received vWFc. There was bleeding after surgery in only two cases who had been given local FG (type 2 B) or systemic vWFc (type 3), but bleeding was stopped with an additional local application of FG. Our data suggest that a standard local therapy with TA and FG with DDAVP can prevent bleeding complications during oral surgery in the majority of patients (84%) with vWD and reduce the need for concentrates, with all their possible complications and high costs. [References: 25] <6> UI - 2000044208 AU - Al Agram H AU - Paterson AW AU - Putnum GD IN - H. Al Agram, Department of Maxillofacial Surgery, City General Hospital, Carlisle CA1 2HG; United Kingdom. TI - Re: Edwards et al. Choice of anaesthetic and health care facility for third molar surgery. SO - British Journal of Oral & Maxillofacial Surgery Vol 37(6) (pp 509), 1999. <7> UI - 2000044205 AU - Parker JKA IN - J.K.A. Parker, Dept. of Oral Maxillofacial Surgery, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH; United Kingdom. TI - 'Specialist practitioner' in surgical dentistry: Preliminary report on a pilot scheme at East Surrey Hospital, Redhill, UK. SO - British Journal of Oral & Maxillofacial Surgery Vol 37(6) (pp 498-501), 1999. AB - This continuing pilot scheme was designed to assess whether minor oral operations could be done by a 'specialist practitioner' in surgical dentistry in hospital. The preliminary results indicate that patients benefit from the improved facilities and expertise that are available in the hospital, that the provision of treatment within the hospital is at a sufficiently 'local' level to meet their requirements, and that this increased quality of service can be provided at no greater cost to the NHS than treating them in a dental surgery. A large amount of the dentoalveolar surgery done (such as removal of third molars) is regarded as routine, but 'routine' is often mistakenly thought to mean 'simple' or 'easy'. Dentoalveolar surgery not only demands the highest quality of care and expertise but it also requires the necessary immediate support if medical or surgical complications arise. [References: 6] <8> UI - 1999423294 AU - Chuansumrit A AU - Sangkapreecha C AU - Hathirat P IN - Dr. A. Chuansumrit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok; Thailand. E-Mail: raajs@mahidol.ac.th. TI - Successful epistaxis control in a patient with Glanzmann thrombasthenia by increased bolus injection dose of recombinant factor VIIa [9]. SO - Thrombosis & Haemostasis Vol 82(6) (pp 1778), 1999. <9> UI - 1999403627 AU - Kahabuka FK AU - Willemsen W AU - Van T Hof M AU - Ntabaye MK AU - Plasschaert A AU - Frankenmolen F AU - Burgersdijk R IN - F.K. Kahabuka, Muhimbili Univ. Coll. Hlth. Sciences, Faculty of Dentistry, PO Box 65014, Dar es Salaam; Tanzania. TI - Oro-dental injuries and their management among children and adolescents in Tanzania. SO - East African Medical Journal Vol 76(3) (pp 160-162), 1999. AB - Objective: To investigate, by utilising patient records, the occurrence of the various types of dental trauma and the treatment provided among children aged one to seventeen years. Design: A retrospective survey of dental clinic records. Setting: Paedodontic clinic of the Faculty of Dentistry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. Subjects: Records of 130 dental patients aged one to seventeen years who were treated in 1995 and 1996. Main outcome measure: Types of injuries (periodontal, soft tissue, dental tissues). Types of treatment given in relation to type of injury. Evaluation of treatment provided by using European treatment standards. Results: Soft tissue injuries were recorded in 49% of the patients. Periodontal and dental tissue injuries were recorded in 34% and 8% of the patients respectively. While injured teeth were extracted in 30% of the cases, soft tissues were stitched in 70% and antibiotics were prescribed in 34% of the patients respectively. Evaluation of treatment provided showed that 31%, 52% and 17% of the teeth received the correct, wrong and unnecessary treatment respectively. Conclusion: Our observations correlate well with other reports. However, efforts on standardisation of treatment for oro-dental injuries should be undertaken. [References: 14] <10> UI - 1999385935 AU - Ng KP AU - Wang CY IN - K.P. Ng, Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur; Malaysia. TI - Alfentanil for intubation under halothane anaesthesia in children. SO - Paediatric Anaesthesia Vol 9(6) (pp 491-494), 1999. AB - Intubating conditions under halothane anaesthesia aided with alfentanil 20 mug . kg-1 were compared with suxamethonium 2 mg . kg-1 in 40 children presenting for day dental procedures. The condition of vocal cords, jaw relaxation and presence of movement and coughing were scored to give the overall intubating conditions. Successful intubation was achieved in 100% of the suxamethonium group and 94.7% of the alfentanil group. The cardiovascular response to intubation was attenuated in the alfentanil group. Some 43.7% of those receiving suxamethonium developed myalgia the day after surgery compared with 0% in the alfentanil group (P < 0.01). [References: 12] <11> UI - 1999381746 AU - Conrad SM AU - Blakey GH AU - Shugars DA AU - Marciani RD AU - Phillips C AU - White RP Jr AU - Kiyak HA IN - Dr. R.P. White Jr., Dept. of Oral/Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450; United States. TI - Patients' perception of recovery after third molar surgery. SO - Journal of Oral & Maxillofacial Surgery Vol 57(11) (pp 1288-1296), 1999. AB - Purpose: This study evaluated patients' perceptions of recovery after third molar surgery. Methods: Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health- Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center. Results: After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period. Conclusions: This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent. <12> UI - 1999347225 AU - Wagley C AU - Hackett C AU - Haug RH IN - Dr. C. Wagley, 5437 Mahoning Ave, Youngstown, OH 44515; United States. TI - The effect of preoperative ondansetron on the incidence of postoperative nausea and vomiting in patients undergoing outpatient dentoalveolar surgery and general anesthesia. SO - Journal of Oral & Maxillofacial Surgery Vol 57(10) (pp 1195-1200), 1999. AB - Purpose: The purpose of this investigation was to evaluate the efficacy of ondansetron in controlling postoperative nausea and vomiting (PONY) when used prophylactically in patients undergoing routine dentoalveolar surgery performed under general anesthesia. Patient and Methods: This was a prospective, double-blind, randomized, placebo-controlled evaluation. Fifty adult ASA I or II patients, requiring routine dentoalveolar surgery performed under general anesthesia, without a prior history of PONV, were randomly assigned to the experimental or control groups. Ondansetron (2.0 mL = 4.0 mg) or normal saline (2.0 mL) were administered intravenously before surgery. Age, gender, type of surgery, duration of surgery, anesthetic dosages, and PONV were evaluated. PONV was evaluated at time 0 (end of anesthesia) and at 30 and 60 minutes postoperatively. Nausea was evaluated using a visual analog scale (1, not nauseous; 5, about to vomit). Vomiting was assessed as ayes or no response. At 20 to 28 hours postoperatively, PONV was evaluated via a telephone call as ayes or no response, along with the number of episodes of nausea, vomiting, or both. Means and standard deviations were calculated for age, surgery, and anesthetics, and differences were assessed using an independent samples t-test. Differences for gender between the control and experimental groups were tested by a nonparametric chi-squared test. Differences between groups for nausea and vomiting were tested with a continuity correction chi-squared test. Differences were considered significant for a P < .05. Results: No significant differences (P < .05) were found between the PONV groups for gender, duration of procedure, or anesthetic dosages. Statistically significant differences were noted in age and the type of surgical procedures performed. No statistically significant differences (P < .05) were noted between groups for nausea or vomiting. Conclusion: Based on the results of this study, PONV occurred in approximately 20% of patients (20% for nausea, 8% for vomiting). With the types of anesthetic agents and techniques used in this investigation, there were no significant differences between ondansetron and placebo for prophylaxis against PONV. [References: 18] <13> UI - 1999343243 AU - Sziegoleit F AU - Sziegoleit A AU - Wetzel W-E IN - Prof. W.-E. Wetzel, Department of Pediatric Dentistry, Medical Center of Odontology, Schlangenzahl 14, D-35392 Giessen; Germany. E-Mail: willi-eckhard.wetzel@dentist.med.uni-giessen.de. TI - Effect of dental treatment and/or local application of amphotericin B to carious teeth on oral colonization by Candida. SO - Medical Mycology Vol 37(5) (pp 345-350), 1999. AB - Microbiological analyses of saliva and swabs were obtained from carious lesions of 54 children and adolescents with carious teeth, and of 49 boys and girls with healthy teeth. Candida species were isolated from the saliva of 36 (66.7%) subjects with active caries, but from the saliva of only one (2%) of the 49 caries-free subjects. Candida was detected in material removed from the carious lesion in 44 (81.5%) of the children with caries. Thirty patients with carious teeth and colonized by Candida were randomly divided into three groups of 10 individuals each, and either treated by complete dental restoration, by local application of amphotericin B or by a combination of dental treatment plus ampholericin B. The final microbiological control showed that thorough dental treatment alone eliminated fungi from the oral cavity in 90% of cases, whereas the local application of amphotericin B alone had a minimal effect on the candidal colonization of carious lesions. When, in addition to dental treatment, amphotericin B was applied, fungi were completely eliminated from the oral cavity of all subjects. [References: 18] <14> UI - 1999285651 AU - Roberts GJ IN - G.J. Roberts, Eastman Dental Institute, Oral Healthcare Sciences, University of London, 256 Gray's Inn Road, London WCIX 8LD; United Kingdom. TI - Dentists are innocent! 'Everyday' bacteremia is the real culprit: A review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. SO - Pediatric Cardiology Vol 20(5) (pp 317-325), 1999. AB - The literature related to three aspects of dental bacteremia has been reviewed in regard to postprocedure bleeding and bacteremia, intensity of bacteremia, and cumulative exposure to bacteremia from 'everyday' events. The data on postprocedure bleeding and bacteremia show that there is no relationship between bleeding and bacteremia. Significant bacteremia can occur in the absence of clinically discernible bleeding. The intensity of bacteremia in humans is significantly less than that used in experimental endocarditis models. It is unlikely that the intensity of bacteremia following dental procedures in children could readily lead to endocarditis. The cumulative exposure to bacteremia is significantly greater from everyday procedures when compared to dental operative procedures. It is far more likely that such everyday procedures are the cause of bacterial endocarditis because the cumulative exposure is often hundreds, thousands, or even millions of times greater than that occurring following surgical procedures such as extraction of teeth. The value of antibiotic prophylaxis prior to dental treatment is questioned. [References: 40] <15> UI - 1999221442 AU - Pinsker MC AU - Carroll NV IN - Dr. N.V. Carroll, School of Pharmacy, Virginia Commonwealth University, Box 980533, Richmond, VA 23298; United States. TI - Quality of emergence from anesthesia and incidence of vomiting with remifentanil in a pediatric population. SO - Anesthesia & Analgesia Vol 89(1) (pp 71-74), 1999. AB - We conducted a randomized trial to compare the incidence of vomiting and the quality of emergence from anesthesia associated with the use of remifentanil versus a nonopiate. It was expected that remifentanil would provide smoother emergence from anesthesia with a comparably low rate of vomiting. The study sample consisted of 115 pediatric patients undergoing dental restoration and extraction who were randomly assigned to the nonopiate or remifentanil groups based on their hospital admission numbers. The nonopiate patients received sufficient desflurane to prevent movement, typically 7%-9%. The remifentanil group received remifentanil 0.2 mug . kg- 1 . min-1 and enough desflurane to prevent movement, typically 3.2%- 3.6%. A trained postanesthesia care unit nurse, blinded to the anesthetic technique, assessed the quality of emergence and incidence of vomiting. Sixty-three patients received remifentanil and 52 received the nonopiate. The groups were not significantly different in either quality of emergence or incidence of vomiting. Remifentanil provided results comparable to a nonopiate with no increase in emesis. Implications: A randomized, controlled clinical trial of 115 patients undergoing dental restoration indicated that an anesthetic technique using remifentanil provided quality of emergence comparable to and no greater incidence of vomiting than a nonopiate technique. [References: 8] <16> UI - 1999218727 AU - Moss ME AU - Lanphear BP AU - Auinger P IN - Dr. M.E. Moss, Dept. of Community/Preventive Med., Univ. of Rochester Medical Center, Box 644, 601 Elmwood Ave, Rochester, NY 14642; United States. E-Mail: moss@prevmed.rochester.edu. TI - Association of dental caries and blood lead levels. SO - Journal of the American Medical Association Vol 281(24) (pp 2294-2298), 1999. AB - Context: Experiments show that dental caries rates are higher among lead-exposed animals, but this association has not been established in humans. Objective: To examine the relationship between blood lead levels and dental caries. Design: Cross-sectional survey conducted from 1988 to 1994 that included a dental examination and venipuncture blood lead assay. Setting and Participants: A total of 24901 persons aged 2 years and older who participated in the Third National Health and Nutrition Examination Survey, which assessed the health and nutritional status of children and adults in the United States. Main Outcome Measures: For children aged 2 to 11 years, the sum of decayed and filled deciduous or primary surfaces; for persons aged 6 years and older, the sum of decayed and filled permanent surfaces; for those 12 years and older, the sum of decayed, missing, and filled surfaces. Results: The log of blood lead level was significantly associated with the number of affected surfaces for both deciduous and permanent teeth in all age groups, even after adjusting for sociodemographic characteristics, diet, and dental care. Among children aged 5 to 17 years, a 0.24-mumol/L (5-mug/dL) change in blood lead level was associated with an elevated risk of dental caries (odds ratio, 1.8; 95% confidence interval, 1.32.5). Differences in blood lead level explained some of the differences in caries prevalence in different income levels and regions of the United States. We estimated the population attributable risk of lead exposure to be 13.5% and 9.6% of dental caries occurring in 5- to 17-year-olds exposed to the high and moderate levels, respectively. Conclusions: Environmental lead exposure is associated with an increased prevalence of dental caries in the US population. Findings may help explain the distribution of caries by income and region of the United States. [References: 25] <17> UI - 1999204746 AU - Von Arx T AU - Kurt B IN - Dr. T. Von Arx, Dept. of Oral/Maxillofacial Surgery, Kantonsspital, CH-6000 Luzern 16; Switzerland. E-Mail: vonarx@uthscsa.edu. TI - Root-end cavity preparation after apicoectomy using a new type of sonic and diamond-surfaced retrotip: A 1-year follow-up study. SO - Journal of Oral & Maxillofacial Surgery Vol 57(6) (pp 656-661), 1999. AB - Purpose: This study evaluated the outcome of periradicular surgery using a new set of retrotips for root-end cavity preparation. Patients and Methods: Forty-three patients who had 50 consecutively treated teeth with periradicular pathology were enrolled in this prospective study. After apicoectomy, root-end cavity preparation was performed, using diamond- surfaced retrotips driven by a sonic handpiece; EBA-cement was used as the root-end filling material. Healing assessment was based on clinical and radiographic criteria. Results: At the 1-year follow-up, 82% of the reexamined surgical cases presented with successful healing. Fourteen percent of the treated teeth were deemed as improved (partial healing), and 4% were classified as failures. Conclusion: The new retrotips were found to be ideal for root-end cavity preparation. They simplify the surgical approach to root ends where the working space is limited by restricted access. Root-ends prepared with this new sonoabrasive technique yielded excellent results at the 1-year follow-up examination. [References: 35] <18> UI - 1999093626 AU - Edwards DJ AU - Shepherd JP AU - Horton J AU - Brickley MR IN - Prof. J.P. Shepherd, Clinical Decisions Research Group, University Wales College of Medicine, Dept. Oral Surg. Medicine Pathology, Cardiff CF4 4XY; United Kingdom. TI - Impact of third molar removal on demands for postoperative care and job disruption: Does anaesthetic choice make a difference?. SO - Annals of the Royal College of Surgeons of England Vol 81(2) (pp 119-123), 1999. AB - A prospective cohort study was undertaken to investigate the influences of anaesthetic modality and surgical difficulty on social reintegration and demands on health services after third molar removal. The study was undertaken at the Oral and Maxillofacial Surgery Department, Cardiff Dental Hospital. Of 444 patients, 266 (60%) had their third molars removed. The main outcome measures included anaesthetic modality, surgical difficulty (WHARFE scores), utilisation of health services, effects on work, school and home life. In all, 101 (40%) patients were treated under local anaesthesia (LA) +/- intravenous (iv) sedation and 165 (60%) under general anaesthesia (GA); 81 (49%) as inpatients and 84 (51%) as day cases. Of these patients, 38 (14%) returned to the hospital and 74 (28%) utilised primary care services postoperatively in addition to a standard review appointment. Patients treated under GA made more demands on primary care services (chi2 = 6.41, df = 2, P < 0.05) and took more time away from work (P < 0.05). Patients underestimated the time they needed to recover. There was similar disruption to job, college and home life. There were no links between disruption and particular anaesthetic modalities and surgical difficulty. [References: 24] <19> UI - 1998376708 AU - Bonow RO AU - Carabello B AU - De Leon AC Jr AU - Edmunds LH Jr AU - Fedderly BJ AU - Freed MD AU - Gaasch WH AU - McKay CR AU - Nishimura RA AU - O'Gara PT AU - O'Rourke RA AU - Rahimtoola SH IN - Dr. R.O. Bonow, American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596; United States. TI - Guidelines for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of patients with valvular heart disease). SO - Circulation 03 NOV 1998Vol 98(18) (pp 1949-1984), 1998. <20> UI - 1998309781 AU - Leonard AG AU - Kneafsey B AU - McKenna S AU - Johnston CD AU - Burden DJ AU - Stevenson M IN - Dr. D.J. Burden, School of Clinical Dentistry, Queen's University of Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BP; United Kingdom. E-Mail: d.burden@qub.ac.uk. TI - A retrospective comparison of craniofacial form in Northern Irish children with unilateral cleft lip and palate. SO - Cleft Palate-Craniofacial Journal Vol 35(5) (pp 402-407), 1998. AB - Objective: This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Molsted et al, 1992). Design: Retrospective analysis. Patients: All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987. Main Outcome Measures: Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results: The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships. Conclusions: No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Eurocleft's center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers. [References: 14] <21> UI - 1998247595 AU - Bhatt-Mehta V AU - Rosen DA IN - V. Bhatt-Mehta, F5203, 200 East Hospital Drive, Ann Arbor, MI 48109-0225; United States. TI - Sedation in children: Current concepts. SO - Pharmacotherapy Vol 18(4) (pp 790-807), 1998. AB - Sedation in children poses a great challenge, with the main concern one of safety. The importance of providing adequate sedation to children was realized only in the last decade and a half, and relevant data are severely lacking. Use of potent sedative agents is not without risk. Children are given sedative agents in a wide variety of settings by practitioners with different degrees of experience with the drugs and management of adverse effects. Controversial issues must be addressed in this area, and appropriate tools developed to measure sedation and individualize treatment based on the drugs' pharmacokinetic and pharmacodynamic properties. [References: 119] <22> UI - 1998198654 AU - Larson M AU - Hellquist R AU - Jakobsson OP IN - M. Larson, Eastman Institutet, Dalagatan 11, SE-113 24 Stockholm; Sweden. TI - Dental abnormalities and ectopic eruption in patients with isolated cleft palate. SO - Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery Vol 32(2) (pp 203-212), 1998. AB - The aim of this study was to evaluate the influence of cleft size and surgical treatment on the development of permanent teeth in patients with isolated cleft palate. The series comprised 109 children with isolated cleft palate, 70 girls and 39 boys, including 14 patients with Robin sequence. The patients were grouped according to the sagittal extent of the palatal cleft, measured on dental casts obtained before the primary palate surgery. Forty-six children were treated by one-stage palatoplasty, and 63 in two stages. The dentition was studied on orthopantomograms taken at 5, 8, 11, and 14 years of age. Congenitally missing permanent teeth (third molars excluded) were found in 33 subjects (30%). Children with large clefts had significantly more missing teeth than children with small clefts. The tooth most usually missing was the mandibular second premolar, followed by the maxillary lateral incisor, and the upper second premolar. The incidence of dental malformation was 23%, mostly mild forms. Ectopic eruption of the upper first permanent molars was seen in 23 (45%) of the subjects with large clefts, and in 18 (31%) of those with small clefts. The surgical method did not significantly affect the direction of the eruption. There is a correlation between cleft size and hypodontia, dental deformity, and ectopic eruption. Children with Robin sequence had almost the same incidence of hypodontia, malformed teeth, and ectopic eruption as children with large clefts. There was no correlation between surgical method and ectopic eruption of the maxillary first permanent molars. [References: 48] <23> UI - 1998123175 AU - Parworth LP AU - Frost DE AU - Zuniga JR AU - Bennett T AU - Candelaria LM IN - Dr. J.R. Zuniga, Dept. of Oral/Maxillofacial Surg., North Carolina Univ. Sch. of Dent., CB 7450, Chapel Hill, NC 27514-7450; United States. TI - Propofol and fentanyl compared with midazolam and fentanyl during third molar surgery. SO - Journal of Oral & Maxillofacial Surgery Vol 56(4) (pp 447-453), 1998. AB - Purpose: The purpose of this study was to measure the safety and efficacy of propofol combined with fentanyl as sedative agents during third molar outpatient surgery. Patients and Methods: A double-blind, prospective, randomized clinical trial involving 57 patients undergoing removal of third molars under intravenous sedation between November 1994 and December 1995 was performed. Patients randomly received either proporal and fentanyl (P + F, th = 24) or midazolam and fentanyl (M + F, M = 33). Patient demographics, Corah anxiety scores, and physiologic parameters were determined preoperatively. All medications were titrated to the same clinical end point for sedation. Intraoperative physiologic parameters, cooperation, alertness, and pain scores were assessed. Postoperative recovery and degree of amnesia also were determined. Results: There were no significant differences in either patient demographics or surgical characteristics between groups. The P + F group was significantly less cooperative than the M + F group. Pain during injection of propofol was a significant adverse side effect. Both groups experienced a small percentage of apneic episodes, but mechanical ventilation was never required. There were no differences in recovery between groups as measured by the Treiger dot test and psychomotor recovery scores. The degree of anterograde amnesia was greater for the M + F group, although the difference was not statistically significant. Sedation was rated good to excellent by the patient, surgeon, and observer, and there were no statistically significant differences between groups. Conclusion: Propofol appears to be a safe and efficacious drug for use during outpatient oral surgical procedures. [References: 28] <24> UI - 1998084683 AU - Fleming C AU - Lucke T AU - Forsyth A AU - Rees S AU - Lever R AU - Wray D AU - Aldridge R AU - MacKie R IN - C. Fleming, University Department of Dermatology, Western Infirmary, Glasgow G11 6NT; United Kingdom. TI - A controlled study of gold contact hypersensitivity. SO - Contact Dermatitis Vol 38(3) (pp 137-139), 1998. AB - 1203 patients attending for routine patch testing at 3 hospitals and 105 volunteers were tested with 0.5% and 0.05% gold sodium thiosulfate (GST). 38 patients (3.2%) and 5 volunteers (4.8%) had positive patch tests to GST. There were no significant differences between volunteers and patients with respect to age, sex, atopy or exposure to gold in dental restorations, jewellery or through occupation. There were no significant differences in prevalence of GST hypersensitivity in the 3 hospitals, or between patients and controls. This is the 1st controlled study of hypersensitivity to GST, and suggests that routine patch testing to gold is of limited clinical benefit. [References: 13] <25> UI - 1998079554 AU - Barcroft BD AU - Shen TJ AU - Lew DB IN - Dr. D.B. Lew, Crippled Children's Fdn Research Ctr, Univ. Tennessee-Memphis College Med., Department of Pediatrics, 50 North Dunlap Street, Memphis, TN 38103; United States. TI - Ulcerative contact gingivitis due to the nickel component of stainless steel crowns. SO - Pediatric Asthma Allergy & Immunology Vol 11(4) (pp 221-226), 1997. AB - While contact dermatitis to nickel is common, contact mucositis to the nickel component of dental devices rarely occurs. A 2-year old boy with multiple nursing bottle decay underwent restorative treatment with stainless steel crowns. One month later, he developed gingival inflammation that progressed to severe ulcerative contact gingivitis. Patch tests revealed that he was sensitized to nickel. After a battery of prescreening patch tests to the materials for restorative treatment, the patient was successfully treated with composite resin crowns. [References: 20] <26> UI - 1998061645 AU - Kazdin AE AU - Weisz JR IN - A.E. Kazdin, Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT 06520-8205; United States. TI - Identifying and developing empirically supported child and adolescent treatments. SO - Journal of Consulting & Clinical Psychology Vol 66(1) (pp 19-36), 1998. AB - Child and adolescent therapy outcome research findings attest to the efficacy of a variety of treatments. This article illustrates promising treatments for selected internalizing (anxiety and depression), externalizing (oppositional, and antisocial behavior), and other (obesity and autism) conditions, and for other aims (preparation for medical and dental procedures). Studies in these areas illustrate worthwhile characteristics that can help inform the search for empirically supported treatments. These characteristics include randomized controlled trials, well-described and replicable treatments, tests with clinical samples, tests of clinical significance, broad-based outcome assessment including measures of real- world functioning, and others. Continued research progress will depend on greater attention to magnitude and maintenance of therapeutic change, long- term follow-up, moderators and mediators of change, and development and testing of treatment in conditions relevant to clinical practice. [References: 175] <27> UI - 1998059497 AU - Taubert KA AU - Dajani AS IN - Dr. K.A. Taubert, Department of Science and Medicine, American Heart Association, 7272 Greenville Ave., Dallas, TX 75231; United States. TI - Preventing bacterial endocarditis: American Heart Association guidelines. SO - American Family Physician 01 FEB 1998Vol 57(3) (pp 457-468), 1998. AB - The American Heart Association recently revised its guidelines for the prevention of bacterial endocarditis. These guidelines are meant to aid physicians, dentists and other health care providers, but they are not intended to define the standard of care or to serve as a substitute for clinical judgment. In the guidelines, cardiac conditions are stratified into high-, moderate- and negligible-risk categories based on the potential outcome if endocarditis develops. Procedures that may cause bacteremia and for which prophylaxis is recommended are clearly specified. In addition, an algorithm has been developed to more clearly define when prophylaxis is recommended in patients with mitral valve prolapse. For oral and dental procedures, the standard prophylactic regimen is a single dose of oral amoxicillin (2 g in adults and 50 mg per kg in children), but a follow-up dose is no longer recommended. Clindamycin and other alternatives are recommended for use in patients who are allergic to penicillin. For gastrointestinal and genitourinary procedures, the prophylactic regimens have been simplified. The new recommendations are meant to more clearly define when prophylaxis is or is not recommended, to improve compliance, to reduce cost and the incidence of gastrointestinal side effects, and to approach more uniform worldwide recommendations. [References: 29] <28> UI - 1998037045 AU - Zuniga JR AU - Meyer RA AU - Gregg JM AU - Miloro M AU - Davis LE AU - McDonald AR IN - Dr. J.R. Zuniga, Oral and Maxillofacial Surgery, School of Dentistry, Campus Box 7450, Chapel Hill, NC 27599-7450; United States. TI - The accuracy of clinical neurosensory testing for nerve injury diagnosis. SO - Journal of Oral & Maxillofacial Surgery Vol 56(1) (pp 2-8), 1998. AB - Purpose: The accuracy of the clinical neurosensory test to diagnose trigeminal nerve injuries has never been statistically evaluated. The purpose of this study was to determine the statistical efficacy of the clinical neurosensory test using surgical findings as the 'gold' standard, and to determine whether a correlation existed between the sensory impairment score obtained by preoperative testing and the degree of nerve injury found at surgery. Materials and Methods: A multisite, randomized, prospective, blinded, clinical trial was conducted on 130 patients with inferior alveolar nerve (IAN) and lingual nerve (LN) injuries. Preoperatively, patients were provided a sensory impairment score using a three-level drop-out clinical neurosensory test (NST), and blind comparisons were made with the surgical findings postoperatively. Results: The positive predictive and negative predictive values for LN-injured patients were 95% and 10094, respectively. The positive predictive and negative predictive values for IAN patients were 77% and 60%, respectively. There were statistically significant differences in the distribution of age, duration of injury, cause of injury, presence of neuropathic pain, presence of trigger pain, and degree of injury between the IAN and LN patient populations. There was a statistically significant positive relationship found between the sensory impairment score and the degree of nerve injury. Conclusions: The NST is a clinically useful method to diagnose IAN and LN injuries. However, the NST results are less efficient for IAN injuries than LN injuries, and have a high incidence of false-positive (23%) and false-negative (40%) results when testing patients with IAN injuries. The different rates of statistical efficiency between the two groups of patients may be attributable to differences in prevalence and biologic covariates. [References: 17] <29> UI - 1998036312 AU - Yoshimura Y AU - Obara S AU - Mikami T AU - Matsuda S IN - Y. Yoshimura, Department Oral Maxillofacial Surg., Shimane Medical University, Shimane 693; Japan. TI - Calcifying epithelioma (pilomatrixoma) of the head and neck: Analysis of 37 cases. SO - British Journal of Oral & Maxillofacial Surgery Vol 35(6) (pp 429-432), 1997. AB - Objective: To review all cases of pilomatrixoma (calcifying epithelioma) of the head and neck published in Japanese dental journals 1977-1994. Design: Retrospective review. Setting: University hospital, Japan. Subjects: 37 Patients with 38 tumours, mean age 23 years, female:male ratio 2.4:1. Interventions: Enucleation alone (n = 29, 78%), excision including covering skin (n = 7, 19%), or excision including superficial lobe of parotid (n = 1, 3%). Main outcome measure: Presentation, site, recurrence, and histological features. Results: Two patients had multiple tumours (5%). Most of the tumours were firm nodules covered with normal skin varying in size from 5 to 30 mm. The most common site was the preauricular region; 22 (58%) were in the anterior part. The follow up period ranged from 7 to 43 months during which there was only one recurrence. Tumours were encapsulated and solid composed of either shadow and basophilic cells or shadow cells alone, and the stroma contained varying amounts of calcification, ossification, and keratinization. Conclusions: The diagnosis should be suspected when the mass is adherent to the skin but not fixed to the underlying tissue. It is difficult to distinguish between benign and malignant tumours by imaging methods alone, so the recommended treatment must be complete excision including adherent skin. [References: 41] <30> UI - 1997375149 AU - Punjabi AP AU - Plaisier BR AU - Haug RH AU - Malangoni MA AU - Maloney PL IN - Dr. R.H. Haug, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109-1998; United States. TI - Diagnosis and management of blunt carotid artery injury in oral and maxillofacial surgery. SO - Journal of Oral & Maxillofacial Surgery Vol 55(12) (pp 1388-1396), 1997. AB - Purpose: Traumatic occlusion of the internal carotid artery (ICA) is a rare complication of maxillofacial trauma or surgery. This investigation evaluated patient demographics, diagnostic methods, and effective therapeutic modalities associated with blunt carotid injury (BCI). Patients and Methods: This was a retrospective analysis of patient records with an ICD-9-CM diagnosis of carotid injury conducted at MetroHealth Medical Center during the 24-month period between August 1993 and July 1995. Carotid injuries attributable to penetrating trauma were excluded. Age, gender, cause of injury, Glasgow Coma Scale score, Injury Severity Score, type and location of injury, concomitant injury, diagnostic methods, treatment modalities, and outcome were identified, recorded, and analyzed. Results: During the 24- month period, 12 patients (seven males and five females) suffered BCI. These patients were divided into two groups based on cause of the problem. In group I, there were 3,214 blunt trauma patients admitted during the 2-year study, of which 10 patients had BCI, representing 0.31% of blunt trauma patients, and 1.2% of patients with head injuries. Seven patients presented with hemiplegia, two with cranial nerve palsy, and one with perceptual neglect. Ninety percent of the patients had associated injuries. Two patients had surgical intervention, three received anticoagulation, and five had only supportive care. Four of the 10 patients died, four had moderate neurologic deficits, and two survived with only minor neurologic deficits. In group II, two patients developed BCI after surgery. A 52-year-old woman had a carotid injury after right total temporomandibular joint replacement, and a 48-year- old man who underwent surgical removal of a third molar became hemiplegic postoperatively. The first patient recovered after anticoagulation, whereas the second patient, who received only supportive care, has severe neurologic deficits. Conclusions: BCI is an uncommon entity. It is usually recognized when a patient develops an unexplained neurologic deficit, most often hemiplegia, subsequent to trauma or surgery of the head, face, or neck. In the early stages, the diagnosis can be missed by carotid ultrasound or computed tomography. The injury is unrelated to Glasgow Coma Scale score. Symptoms may not develop for days after injury in 50% of patients. Anticoagulation appears to be the most beneficial therapeutic modality. <31> UI - 1997375148 AU - Dodson TB AU - Kaban LB AU - Donoff RB IN - Dr. T.B. Dodson, Emory Clinic, 1365B Clifton Rd, NE, Atlanta, GA 30322; United States. TI - Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature. SO - Journal of Oral & Maxillofacial Surgery Vol 55(12) (pp 1380-1387), 1997. AB - Purpose: Management of trigeminal nerve injuries continues to challenge oral and maxillofacial surgeons. The purpose of this review article is to apply the principles of evidence-based medicine (E-BM) to determine the optimal operative technique for managing defects involving the inferior alveolar (IAN) or lingual nerves when direct (ie, primary) repair is not feasible. Methods: To address the research purpose, the four steps of the E- BM critical appraisal process were applied: 1) identify the clinical problem, 2) efficiently search the literature, 3) select relevant articles and apply rules of evidence, and 4) apply the findings to patient care. Parameters for the literature search included using Medline to identify English language articles, publication dates from 1986 through 1996, and studies involving human subjects. Results: The studies reviewed showed that the clinical literature on operative management of trigeminal nerve injuries is sparse, preoperative and postoperative neurosensory examinations are poorly documented, and the data are derived completely from reports using case series methods. Given these limitations, the available literature suggests that 1) tension-free, primary (direct) suture repair of an injured nerve, if possible, provides optimal results; 2) if direct repair is not possible, autogenous nerve grafts should be used for acute injuries, for example, immediate nerve repair after tumor resection or at the time of acute repair after traumatic injury; and 3) if direct repair is not possible, autogenous nerve grafts or hollow conduits (entubulization) to bridge the defect are equally successful for delayed reconstruction of gaps of 3 cm or smaller. Conclusions: Based on the weakness of the current literature, recommendations for future research include 1) better standardization and documentation of sensory deficits resulting from nerve injuries and their recovery, 2) using multicenter studies to accumulate large samples of patients rapidly, 3) using case series or prospective cohort study designs to assess the value of operative management of nerve injuries, and 4) progressing to randomized clinical trials to ascertain the optimal operative management of nerve injuries. <32> UI - 1997375147 AU - Litman RS AU - Kottra JA AU - Berkowitz RJ AU - Ward DS AU - Wilson S IN - Dr. R.S. Litman, Box 604, Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY 14642; United States. E-Mail: RLitman@anes.rochester.edu. TI - Breathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam premedication. SO - Journal of Oral & Maxillofacial Surgery Vol 55(12) (pp 1372-1379), 1997. AB - Purpose: The combination of midazolam and nitrous oxide is commonly used to achieve sedation and analgesia during pediatric oral procedures, yet there are few, if any, data that illustrate the ventilatory effects of N2O in children, especially when used in combination with additional central nervous system (CNS) depressants. It was hypothesized that the addition of N2O inhalation to oral midazolam premedication would enhance the sedative effects of the midazolam and add analgesia without causing significant respiratory depression. The purpose of this study was to test this hypothesis. Materials and Methods: Thirty-four healthy children about to undergo restorative dental treatment under general anesthesia were premedicated with oral midazolam, 0.7 mg/kg, and were then exposed to 40% N2O for 15 minutes after a 5-minute control period. The effect of adding N2O on SpO2, respiratory rate, P(ET)CO2, VT, and V(T)/T(I) was examined and the levels of consciousness (conscious vs deep sedation) before and during N2O inhalation were determined. Results: During the course of the study, no child developed hypoxemia (SpO2 < 92%) nor clinically significant upper airway obstruction. Four children who did not develop hypoventilation (defined as P(ET)CO2 > 45 mm Hg) during the control period did so after initiation of N2O. Overall, there were no significant differences in SpO2, P(ET)CO2, V(T), or V(T)/T(I) between the control and study periods. However, respiratory rates were significantly higher in the first 10 minutes of N2O inhalation when compared with the control period. Before starting N2O administration, 14 children were not clinically sedated, 19 children met the criteria for conscious sedation, and one child met the criteria for deep sedation. At the end of 15 minutes of N2O inhalation, 12 children were not clinically sedated, 17 children met the definition of conscious sedation, three were deeply sedated, and one child had no response to IV insertion, implying a state of general anesthesia. There were no differences in sedation scores between the control and study periods (P = .6). Overall, seven children had an increase in their sedation score while breathing N2O, four had a decrease in their sedation score, and 22 had no change. Conclusions: The addition of 40% N2O to oral midazolam, 0.7 mg/kg, did not result in clinically meaningful respiratory depression nor upper airway obstruction, but did, in some children, cause an increase in the level of sedation beyond simple conscious sedation. <33> UI - 1997357617 AU - Garcia AG AU - Sampedro FG AU - Rey JG AU - Torreira MG IN - Dr. A.G. Garcia, Facultad de Odontologia, Enterrios, s/n, Santiago de Compostela; Spain. TI - Trismus and pain after removal of impacted lower third molars. SO - Journal of Oral & Maxillofacial Surgery Vol 55(11) (pp 1223-1226), 1997. AB - Purpose: This study evaluated trismus and pain after removal of impacted lower third molars and investigated whether these responses were related to difficulty of surgery. Patients and Methods: A consecutive series of 104 patients, all of whom underwent removal of an impacted lower third molar under local surgery, was studied. Difficulty of surgery was evaluated on a modified version of the Parant scale: I, extraction with forceps only; II, extraction by ostectomy; III, extraction by ostectomy and coronal section; IV, complex procedures. Trismus was evaluated in terms of maximum interincisal distance (MID) 1 and 5 days after surgery. Pain was evaluated on the basis of reported analgesic use 1 and 5 days after surgery. Results: Among group I subjects, mean day 1 MID did not differ significantly (P > .05) from mean presurgery MID, whereas mean day 1 MID in groups II, III, and IV was significantly lower than before surgery. In groups II, III, and IV, mean day 5 MID remained lower than before surgery. The proportion of group I patients using analgesics was significantly lower on both days 1 and 5 than the proportion of patients using analgesics in groups II, III, and IV. In all groups, the proportion of patients using analgesics dropped significantly between days 1 and 5. Conclusion: Trismus is less severe after simple (forceps-only, grade I) extractions than after surgical extractions (grades II to IV). However, trismus severity after surgical extraction does not depend on difficulty of surgery. Pain, as revealed by reported analgesic use, is likewise less severe after simple extractions. Regardless of extraction type, pain declines between days 1 and 5 postsurgery. [References: 12] <34> UI - 1997325108 AU - Berge TI IN - T.I. Berge, Dept. of Oral Surgery/Oral Medicine, Faculty of Dentistry, University of Bergen, Bergen; Norway. TI - Pattern of self-administered paracetamol and codeine analgesic consumption after mandibular third-molar surgery. SO - Acta Odontologica Scandinavica Vol 55(5) (pp 270-276), 1997. AB - Pattern of analgesic consumption after unilateral mandibular third- molar surgery was investigated in an open study in 201 patients. All patients were supplied with six analgesic tablets containing 500 mg paracetamol and 30 mg codeine. Instructions for use were given. A mean consumption of 4.9 tablets over the 1st week and 3.6 tablets the day of operation was found. Eight (4%) patients indicated inadequate or no effect of the medication. The remaining patients were able to control pain, to a level of one-third of maximum pain, by using from one to five tablets. One hundred and thirty-two (68%) patients followed instructions with regard to start of medication. No difference in mean tablet consumption was found between compliant patients and those who delayed the intake of the first analgesic dose by more than 1 h. Predictor analysis showed the most powerful predictors to be preoperative depth of the third molar and moderate or heavy smoking. Thirteen per cent explanatory power of all predictors together was found. [References: 31] <35> UI - 1997292572 AU - Pelagalli J AU - Gimbel CB AU - Hansen RT AU - Swett A AU - Winn II DW AU - Van Valen M IN - M. Van Valen, Premier Laser Systems, 3 Morgan, Irvine, CA 92618; United States. TI - Investigational study of the use of Er:YAG laser versus dental drill for caries removal and cavity preparation - Phase I. SO - Journal of Clinical Laser Medicine & Surgery Vol 15(3) (pp 109-115), 1997. AB - Objective: We determined that the Er:YAG pulsed 2.94 micron radiation was successful in the removal of caries, cavity preparation, and etching prior to acid etching. Summary Background Data: The laser group was compared to a control group in which the high-speed drill was employed. Parameters measured included histological evaluation of the pulp, scanning electron microscopy of the surface morphology of the tooth, dye penetration studies, bond strength measurements, and rating of the laser's ability to remove caries and form the preparation. Methods: We collectively evaluated 60 patients with 106 teeth in both the laser and control groups over a 1-year period. Teeth were treated in vivo and then extracted immediately, at 2 days, 1 month, and up to 1-year to assess pulpal healing, surface morphology, and the quality of the preparation, restoration, and pain. Results: The dental laser was shown to be equal or better than the drill in the tested procedures of caries removal, cavity preparation, and etching prior to acid etching. The scanning electron microscopy revealed no microfracturing, open dentinal tubules, and effective etching with the laser having a mean of 2.7 with an optimum rating of 3. The histological testing confirmed that the pulp was not compromised using the laser with scores of 0 for hemmorhage, 0.47 for hyperemia, and 0.12 for inflammation on a scale of 0 to 3 where 0 is no effect. Conclusions: The FDA has recently cleared the Er:YAG to remove all classes of caries, form the cavity preparation, and modify the enamel and dentin prior to acid etching. In this Phase I study conducted as part of the clinical trials, there were no complications and no tooth was compromised. Patients were consistently treated without anesthesia with the same or better results than the drill as confirmed by scanning electron microscopy and histological studies. [References: 17] <36> UI - 1997258529 AU - Jones CM AU - Taylor GO AU - Whittle JG AU - Evans D AU - Trotter DP IN - Dr. C.M. Jones, Wigan and Bolton Health Authority, Bryan House, 61 Standish Gate, Wigan WN1 1AH; United Kingdom. TI - Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: Analysis of data from British dental surveys. SO - British Medical Journal Vol 315(7107) (pp 514-517), 1997. AB - Objective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for. Design: Ecological study based on results from the NHS dental surveys in 5 year olds in 1991-2 and 1993-4 and Jarman underprivileged area scores from the 1991 census. Setting: Electoral wards in three areas: Hartlepool (naturally fluoridated), Newcastle and North Tyneside (fluoridated), and Salford and Trafford (non-fluoridated). Subjects: 5 year old children (n = 10,004). Intervention: Water fluoridation (artificial and occurring naturally). Main outcome measure: Ward tooth decay score (score on the 'decayed, missing, and filled tooth index' for each electoral ward). Results: Multiple linear regression showed a significant interaction between Jarman score for ward, mean number of teeth affected by decay, and both types of water fluoridation. This confirms that the more deprived an area, the greater benefit derived from fluoridation, whether natural or artificial (R2 = 0.84, P < 0.001). At a Jarman score of zero (national mean score) there was a predicted 44% reduction in decay in fluoridated areas, increasing to a 54% reduction in wards with a Jarman score of 40 (very deprived). The area with natural fluoridation (at a level of 1.2 parts per million-higher than levels in artificially fluoridated areas) had a 66% reduction in decay, with a 74% reduction in wards with a Jarman score of 40. Conclusion: Tooth decay is confirmed as a disease associated with social deprivation, and the more socially deprived areas benefit more from fluoridation. Widespread water fluoridation is urgently needed to reduce the 'dental health divide' by improving the dental health of the poorer people in Britain. [References: 21] <37> UI - 1997212957 AU - Dajani AS AU - Taubert KA AU - Wilson W AU - Bolger AF AU - Bayer A AU - Ferrieri P AU - Gewitz MH AU - Shulman ST AU - Nouri S AU - Newburger JW AU - Hutto C AU - Pallasch TJ AU - Gage TW AU - Levison ME AU - Peter G AU - Zuccaro G Jr IN - Dr. A.S. Dajani, American Heart Association, Public Information, 7272 Greenville Avenue, Dallas, TX 75231-4596; United States. E-Mail: pubauth@amhrt.org. TI - Prevention of bacterial endocarditis: Recommendations by the american heart association. SO - Circulation Vol 96(1) (pp 358-366), 1997. AB - Objective: To update recommendations issued by the American Heart Association last published in 1990 for the prevention of bacterial endocarditis in individuals at risk for this disease. Participants: An ad hoc writing group appointed by the American Heart Association for their expertise in endocarditis and treatment with liaison members representing the American Dental Association, the Infectious Diseases Society of America, the American Academy of Pediatrics, and the American Society for Gastrointestinal Endoscopy. Evidence: The recommendations in this article reflect analyses of relevant literature regarding procedure-related endocarditis, in vitro susceptibility data of pathogens causing endocarditis, results of prophylactic studies in animal models of endocarditis, and retrospective analyses of human endocarditis cases in terms of antibiotic prophylaxis usage patterns and apparent prophylaxis failures. MEDLINE database searches from 1936 through 1996 were done using the root words endocarditis, bacteremia, and antibiotic prophylaxis. Recommendations in this document fall into evidence level III of the US Preventive Services Task Force categories of evidence. Consensus Process: The recommendations were formulated by the writing group after specific therapeutic regimens were discussed. The consensus statement was subsequently reviewed by outside experts not affiliated with the writing group and by the Science Advisory and Coordinating Committee of the American Heart Association. These guidelines are meant to aid practitioners but are not intended as the standard of care or as a substitute for clinical judgment. Conclusions: Major changes in the updated recommendations include the following: (1) emphasis that most cases of endocarditis are not attributable to an invasive procedure; (2) cardiac conditions are stratified into high-, moderate-, and negligible-risk categories based on potential outcome if endocarditis develops; (3) procedures that may cause bacteremia and for which prophylaxis is recommended are more clearly specified; (4) an algorithm was developed to more clearly define when prophylaxis is recommended for patients with mitral valve prolapse; (5) for oral or dental procedures the initial amoxicillin dose is reduced to 2 g, a follow-up antibiotic dose is no longer recommended, erythromycin is no longer recommended for penicillin-allergic individuals, but clindamycin and other alternatives are offered; and (6) for gastrointestinal or genitourinary procedures, the prophylactic regimens have been simplified. These changes were instituted to more clearly define when prophylaxis is or is not recommended, improve practitioner and patient compliance, reduce cost and potential gastrointestinal adverse effects, and approach more uniform worldwide recommendations. [References: 66] <38> UI - 1997202950 AU - Appiah-Anane S AU - Appiah-Anane MG IN - S. Appiah-Anane, Garston Dental Clinic, Moss Street, Liverpool L19 2NA; United Kingdom. TI - Protection of the lingual nerve during operations on the mandibular third molar: A simple method. SO - British Journal of Oral & Maxillofacial Surgery Vol 35(3) (pp 170-172), 1997. AB - The object of the study was to assess the incidence of lingual nerve sensory loss during removal of impacted mandibular third molar teeth, and the effect of retention of the lingual plate on the incidence. The subjects were 395 patients, of whom 362 completed the study. Removal of 504 impacted wisdom teeth with retention of the lingual plate was performed. Results showed that 381 (76%) of the teeth were partially erupted and the remaining 123 were unerupted. In 497 (99%) bone had to be removed, and of these 376 (76%) required division of the tooth before removal (75% of the entire series). The only complication was transient paraesthesia in one patient which settled within a month. The study concludes that retention of the lingual plate gives optimum protection to the lingual nerve during removal of impacted wisdom teeth. [References: 10] <39> UI - 1997190859 AU - Forrest JB AU - Heitlinger EL AU - Revell S IN - Dr. J.B. Forrest, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ont. L8N 3Z5; Canada. TI - Ketorolac for postoperative pain management in children. SO - Drug Safety Vol 16(5) (pp 309-329), 1997. AB - Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) with potent analgesic effects and a relatively low incidence of adverse effects. Numerous clinical trials of postoperative pain treatment in children have shown that ketorolac is as effective as the major opioid analgesics, such as morphine, and more effective than codeine. The pharmacokinetics of ketorolac differ in children compared with adult patients after surgery. In children, the volume of distribution (Vd) of ketorolac is increased by as much as 2-fold relative to that in adults. The plasma clearance (CL) of ketorolac is also higher in children, probably because of lower binding to plasma proteins. However, the elimination half-life (t [quarter] beta) of ketorolac is similar in children and adults because t [quarter] beta is directly proportional to Vd but inversely proportional to CL. These pharmacokinetic differences indicate that a higher relative dosage is required in children, but the dosage interval is similar in children and adults. Ketorolac can be administered intravenously, intramuscularly or orally. The intravenous route is preferred during the immediate postoperative period, until the patient can tolerate oral medication. Intramuscular injections are not recommended in children, unless the intravenous route is unavailable. The recommended intravenous dosage of ketorolac in children is 0.5 mg/kg, followed either by bolus injections of 1.0 mg/kg every 6 hours or an intravenous infusion of 0.17 mg/kg/h. The maximum daily dosage is 90 mg, and the maximum duration of treatment is 48 hours. The recommended oral dosage is 0.25 mg/kg to a maximum of 1.0 mg/kg/day, with a maximum duration of 7 days. Older children may require somewhat lower dosages, while infants and young children may require slightly higher dosages to achieve the same level of pain relief. Ketorolac is not recommended for use in infants aged < 1 year. Unlike opioid analgesics, ketorolac does not depress ventilation, and is not associated with nausea and vomiting, urinary retention or sedation. When combined with an opioid, ketorolac exhibits marked opioid-sparing effects, allowing a lower dosage of opioid to be used. Clinical studies in children and adults show that the synergistic action of ketorolac and opioids improves the degree and quality of pain relief, and reduces the incidence of opioid-related adverse effects such as respiratory depression, nausea/vomiting and ileus. Recovery of bowel function after abdominal surgery occurs sooner in ketorolac- compared with opioid-treated patients. Ketorolac reversibly inhibits cyclo-oxygenase, and decreases the hypersensitisation of tissue nociceptors that occurs with surgery. It also has reversible antiplatelet effects, which are attributable to the inhibition of thromboxane synthesis. Bleeding time is usually slightly increased, but in most patients it remains within normal values. There is conflicting evidence of the potential for increased surgical-site bleeding after tonsillectomy but, for other types of paediatric surgery, numerous clinical studies have confirmed that ketorolac is not associated with increased bleeding. Thus, ketorolac is well suited for the treatment of postoperative pain in children, either alone or in combination with opioids or local anaesthetics, because of its analgesic potency and relatively low incidence of adverse effects. [References: 113] <40> UI - 1997184512 AU - Takahashi T AU - Fukuda M AU - Yamaguchi T AU - Kochi S AU - Chiapasco M IN - Dr. T. Takahashi, Div. of Dentistry and Oral Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita City, 010 Akita; Japan. TI - Use of endosseous implants for dental reconstruction of patients with grafted alveolar clefts. SO - Journal of Oral & Maxillofacial Surgery Vol 55(6) (pp 576-584), 1997. AB - Purpose: The purpose of this study was to investigate the clinical application of endosseous implants placed into grafted alveolar clefts and to evaluate the short-term outcome. Patients and Methods: Nineteen patients (6 males and 13 females; mean age, 17.9 years; range, 9.7 to 33.6 years at first implant surgery), including 11 with unilateral cleft lip and palate, and eight with unilateral cleft lip and alveolus, were studied. All patients except for one who underwent periosteoplasty received grafts of autogenous particulate cancellous bone and marrow (PCBM) obtained from the ilium. After bone bridge formation, orthodontic treatment and preparation for implant placement were performed. Results: A total of 21 implants were placed in the bone-grafted alveoli of the 19 patients. The most frequently used length was 15 mm. In five patients with insufficient alveolar bone height, a chin bone onlay graft was combined with simultaneous implant insertion. The follow-up period ranged from 1 year to almost 3 years after implant placement, and the clinical outcome was excellent in all except one patient. In this short-term study, the overall survival rate was 90.5%. Conclusion: The grafted alveoli were well suited to the placement of endosseous implants, and this treatment was shown to be a viable option for the dental reconstruction of alveolar clefts. However, the interdental alveolar bone height was insufficient for implant installation in a few patients. Further longitudinal studies are required to determine the optimal timing between secondary bone grafting and implant placement. [References: 27] <41> UI - 1997184509 AU - Lupori JP AU - Van Sickels JE AU - Holmgreen WC AU - Jackson L IN - Dr. J.E. Sickels, Dept. of Oral/Maxillofacial Surgery, Univ. of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78284-7823; United States. TI - Outpatient orthognathic surgery: Review of 205 cases. SO - Journal of Oral & Maxillofacial Surgery Vol 55(6) (pp 558-563), 1997. AB - Purpose: This article reviews the evolution of outpatient orthognathic surgery from 1988 to 1995 at the University of Texas Health Science Center at San Antonio. Patients and Methods: A total of 328 patients had orthognathic surgery from 1988 to 1995. Two hundred and five (124 females, 81 males) were treated on an outpatient basis in the surgical suite of the dental school. Procedures included bilateral sagittal split osteotomies (BSSO), Le Fort I osteotomies (LFI), horizontal mandibular osteotomies (HMO), rapid palatal expansions (RPE), and combinations of the above. Additional procedures such as submental liposuction, blepharoplasty, dorsoseptorhinoplasty, and otoplasty were performed on 22 patients. Patient age ranged from 13 to 64 years, (average age 25). Results: Ninety-four (46%) of the patients were discharged the day of surgery. One hundred and two (51%) were admitted for 23-hour observation, and five (2.4%) were admitted for longer than the 23- hour observation period. Anesthesia time over 4:28 significantly correlated with admission for observation status. There was no significant difference between LFI and BSSO in relation to admission for observation status. Conclusions: The number and complexity of orthognathic procedures increased dramatically over the study period. The length of anesthesia time, but not the specific procedure, correlated significantly with admission to observation status. There were few unexpected complications, with considerable cost reduction and convenience for the patients. [References: 17] <42> UI - 1997171565 AU - Shorten GD AU - Braude BM IN - G.D. Shorten, Dept. of Anesthesia/Critical Care, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215; United States. TI - Pulmonary aspiration of gastric contents after a priming dose of vecuronium. SO - Paediatric Anaesthesia Vol 7(2) (pp 167-169), 1997. AB - A case is presented of a 16-year-old girl with ectodermal dysplasia for whom dental surgery under general anaesthesia was planned. Following a priming dose of vecuronium, and immediately after injection of sodium thiopentone (5 mg . kg-1) pulmonary aspiration of gastric contents occurred. It is hypothesized that, because of the rapid speed of onset of neuromuscular blocking agents on the laryngeal muscles, that partial laryngeal paralysis was present at the time of induction of anaesthesia and that this was responsible in part for the episode of pulmonary aspiration. [References: 8] <43> UI - 1997163679 AU - Zurita S AU - Costa C AU - Watts D AU - Indacochea S AU - Campos P AU - Sanchez J AU - Gotuzzo E IN - S. Zurita, IMTAH, Universidad Peruana Cayetano Heredia, Lima; Peru. TI - Prevalence of human retroviral infection in Quillabamba and Cuzco, Peru: A new endemic area for human T cell lymphotropic virus type 1. SO - American Journal of Tropical Medicine & Hygiene Vol 56(5) (pp 561-565), 1997. AB - An epidemiologic study was conducted to determine the prevalence of retroviral infections among people of Quechua origin in Cuzco and Quillabamba, Peru. The study volunteers included individuals at low and at high risk for retroviral infections. Each volunteer was interviewed to obtain clinical and epidemiologic data, and to identify risk behaviors for infection. The serum was tested for human immunodeficiency virus type 1 (HIV- 1) and human T cell lymphotropic virus types 1/2 (HTLV-1/2) by standard enzyme-linked immunosorbent and Western blot assays. Among a total of 370 volunteers enrolled in the study, 276 were women and 94 were men whose ages ranged between 15 and 49 years. Infection with HTLV-1 was demonstrated in 5.1% (19 of 370), and one of these, a homosexual, was also positive for HIV- 1; none had HTLV-2. Overall, the rate of HTLV-1 infection was 5.3% (5 of 94) for males and 5% (14 of 276) for females. Among the low risk group of 211 healthy pregnant women, five (2.3%) were positive for HTLV-1. The rate of HTLV-1 infection in this group was significantly correlated with a history of dental surgery, as well as other surgical procedures, and a history of jaundice. Among the volunteers who practiced risk behavior(s) for retroviral infections, the positive rates for HTLV-1 were 13.7% (7 of 51) for female sex workers, 6.2% (3 of 48) for homosexuals and/or bisexuals, 8.5% (4 of 47) for patients with sexually transmitted diseases (STDs), and 0.0% (0 of 13) for promiscuous heterosexual males. In female sex workers, HTLV-1 infection was found to be significantly associated with age, a history of STDs or genital ulcers, sexual intercourse during menses, and vaginal douching (P < 0.05). A low prevalence of HIV-1 infection indicates that the virus has not yet spread significantly in these areas. [References: 38] <44> UI - 1997076541 AU - Sumi Y AU - Hattori H AU - Hayashi K AU - Ueda M IN - Dr. Y. Sumi, Division of Dental and Oral Surgery, Komaki-City Hospital, 1-20, Jyo-fusi, Komaki-City 485; Japan. TI - Ultrasonic root-end preparation: Clinical and radiographic evaluation of results. SO - Journal of Oral & Maxillofacial Surgery Vol 54(5) (pp 590-593), 1996. AB - Purpose: This study evaluated the results of periradicular surgery performed using ultrasonic root-end preparation. Patients and Methods: The course of healing during observation periods ranging from 6 months to 3 years was examined in 157 teeth. Results: One hundred forty-five teeth were successfully treated, for a success rate of 92.4%. Conclusion: It was concluded that the ultrasonic root-end preparation technique for periradicular surgery is a simple procedure that provides excellent results. [References: 10] <45> UI - 1997073645 AU - Roelofse JA AU - Joubert JJDV AU - Roelofse PGR AU - Lieblich SE IN - Dr. J.A. Roelofse, Faculty of Dentistry, University of Stellenbosch, Tygerberg 7505; South Africa. TI - A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. SO - Journal of Oral & Maxillofacial Surgery Vol 54(7) (pp 838-846), 1996. AB - Purpose: The safety and efficacy of a new sedation technique for children having dental procedures under local anesthesia were evaluated. Materials and Methods: One hundred children between the ages of 2 and 7 years who required sedation for dental procedures were administered either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) or midazolam alone (1 mg/kg) rectally 30 minutes before removal to the dental chair. Pulse rate, respiratory rate, arterial pressure, oxygen saturation, adverse reactions, postoperative recovery, and behavior were recorded. Results: Satisfactory sedation and anxiolysis were achieved with both drugs used in the study. When evaluating postoperative recovery, statistically significantly more children receiving midazolam alone were fully awake on admission to the recovery room and 30 minutes later. Results of physiologic monitoring, behavioral ratings, and adverse effects are reported. Excessive salivation occurred in 26% of children receiving the combination of drugs, compared with 14% receiving midazolam alone. Seven (14%) of the children receiving the combination of drugs hallucinated, compared with 21 (42%) receiving midazolam alone. Both drug groups had reliably good anxiolysis and sedation without loss of respiratory drive or protective airway reflexes. Conclusion: The use of a combination of midazolam and ketamine or midazolam alone is a safe, effective, and practical approach to managing children for minor dental procedures under local anesthesia. With this technique, advanced airway management proficiency is recommended. [References: 21] <46> UI - 1997071180 AU - Splinter WM AU - Komocar L IN - Dr. W.M. Splinter, Department of Anaesthesia, Children's Hosp. of Eastern Ontario, 401 Smyth Rd., Ottawa, Ont. K1H 8L1; Canada. TI - Nitrous oxide does not increase vomiting after dental restorations in children. SO - Anesthesia & Analgesia Vol 84(3) (pp 506-508), 1997. AB - The effect of nitrous oxide on postoperative vomiting was evaluated in 330 children who underwent outpatient dental restorations. There were two groups in this single blind, randomized, controlled study. One group received nitrous oxide during their anesthetic, while the non nitrous oxide group did not receive nitrous oxide at any time. Anesthesia was induced by inhalation with halothane or with propofol intravenously. The incidence of vomiting for 24 h after surgery was recorded. Overall, the incidence of vomiting was similar, with 30%, of the control patients and 35%, of the nitrous-treated patients vomiting after their anesthetic. However, in-hospital vomiting was less in the control group: 15% vs 24%, control versus nitrous oxide, P = 0.03. In conclusion, nitrous oxide does not alter postoperative vomiting after halothane anaesthesia for dental restorations in children. [References: 10] <47> UI - 1996303433 AU - Gupta SK AU - Gupta RC AU - Seth AK AU - Gupta A IN - A-31 B Anita Colony,Bajaj Nagar, Jaipur 302015; India. TI - Reversal of fluorosis in children. SO - Acta Paediatrica Japonica Vol 38(5) (pp 513-519), 1996. AB - Large populations consume fluoride-contaminated water, especially in developing countries. The toxic effects of fluorosis take three forms: clinical, skeletal and dental. Research thus far indicates that the manifestations of fluorosis are irreversible. However, it has been observed that the ingestion of calcium, vitamin C or vitamin D, individually, is effective in protection from fluoride toxicity to a certain extent. Therefore, a double blind control trial was conducted to examine the effect of a combination of calcium, vitamin D3 and ascorbic acid supplementation in fluorosis-affected children. In the present study, 25 children were selected from an area consuming water containing 4.5 p.p.m. of fluoride. All the children were in the age group 6-12 years and weighed 18-30 kg. They were graded for clinical, radiological and dental fluorosis and relevant biochemical parameters. Grade I skeletal fluorosis and all grades of the manifestation of dental and clinical fluorosis were observed. The children were given ascorbic acid, calcium and vitamin D3 well below the toxic dosages in a double blind manner using lactose as a placebo. Follow up revealed a significant improvement in dental, clinical and skeletal fluorosis and relevant biochemical parameters in these children. Thus, the study indicated that fluorosis can be reversed, at least in children, by a therapeutic regimen that is fairly cheap, simple and easily available and without any side effects. <48> UI - 1996188302 AU - Friedman G IN - 7330 Yonge Street,Thornhill, Ont. L4J 1V8; Canada. TI - Facial nerve paralysis of dental origin in children. SO - Pediatric Neurology Vol 14(4) (pp 342-344), 1996. AB - Dental causes of facial nerve paralysis are rare and have not been previously reported in children. Two children are described with facial nerve paralysis of dental origin. The underlying mechanism of action and pathogenesis are discussed. <49> UI - 1996165530 AU - Heard CMB AU - Caldicott LD AU - Fletcher JE AU - Selsby DS IN - Department of Anesthesiology, Children's Hospital of Buffalo, 219 Bryant St.,Buffalo, NY 14222; United States. TI - Fiberoptic-guided endotracheal intubation via the laryngeal mask airway in pediatric patients: A report of a series of cases. SO - Anesthesia & Analgesia Vol 82(6) (pp 1287-1289), 1996. <50> UI - 1996147564 AU - Lundberg T AU - Isaksson S IN - Dept Oral and Maxillofacial Surgery, Lanssjukhuset,S-301 85 Halmstad; Sweden. TI - A clinical follow-up study of 278 autotransplanted teeth. SO - British Journal of Oral & Maxillofacial Surgery Vol 34(2) (pp 181-185), 1996. AB - This open study was undertaken to investigate the outcome of autotransplanted teeth over a 6-year period. The subjects were 296 patients who underwent autotransplantation in the 6-year period September 1986-August 1992 and outcome was measured by considering root formation, occlusion, endodontal and periodontal complications. 18 patients were excluded because of inadequate notes or radiographs (n = 3) or because they were lost to follow-up (n = 15). The groups were divided into open apex and closed apex, and duration of follow up was 6 months-5 years. Aplasia was the indication for operation in 158 (77%) of the open apex group but only 10 (14%) of the closed apex group, whereas caries and associated disease was the most common in the latter (n = 45, 61% compared with 20, 10%). There were 24 complete failures, 12 in each group (p < 0.01). Only 7 teeth in total developed full roots, and 159 showed incomplete growth. In the open apex group 112 teeth were in occlussal contact and 4 were extracted for severe infraocclusion. In the closed apex group there were 10 cases of mild infraocclusion, none of which required treatment. There were 7 cases of pulp necrosis in the open apex group, 4 of which required extraction. Two teeth in the closed apex group were extracted for endodontic reasons. Only 1 tooth (in the closed apex group) had to be extracted for periodontal reasons, Autotransplantation is a reliable method with a good prognosis for donor teeth with both open and closed apexes. The technique is applicable whatever the aetiology of the agenesis, and is worthy of consideration should there be a suitable donor tooth. <51> UI - 1996132624 AU - Purday JP AU - Reichert CC AU - Merrick PM IN - Anaesthetics Department, Frenchay Hospital,Bristol BS16 1LE; United Kingdom. TI - Comparative effects of three doses of intravenous ketorolac or morphine on emesis and analgesia for restorative dental surgery in children. SO - Canadian Journal of Anaesthesia Vol 43(3) (pp 221-225), 1996. AB - Purpose: The optimal dose of intravenous ketorolac tromethamine (ketorolac), a non-steroidal anti-inflammatory drug has not been determined in children. There are only limited published data on the use of intravenous ketorolac for paediatric analgesia. This study compares the analgesic and emetic effect of three different doses of ketorolac with morphine in paediatric dental surgical out-patients. Methods: Following institutional approval and parental consent, 120 ASA I or II children, age 2-10 yr were randomized to four groups and received ketorolac 0.75, 1.0, and 1.5 mg . kg-1 or morphine 0.1 mg . kg-1 iv at induction of a standardized anaesthetic. At 15 and 30 min after arrival in the recovery room a blinded observer assessed pain using the Objective Pain Score (OPS). Twenty-four hours after surgery a telephone interview was carried out with a parent at home. Results: There were no differences in demographic data, anaesthesia time, recovery and day-care unit time, OPS and postoperative analgesic requirements in the four groups. Postoperative vomiting in the first 24 hr occurred more frequently in the morphine group than in the other groups (P < 0.0166). No patient had excessive surgical bleeding. Conclusions: Ketorolac, in all doses studied (0.75, 1.0 and 1.5 mg . kg-1) was as effective an analgesic as morphine 0.1 mg . kg-1 given intravenously at induction to children having restorative dental surgery. Its use was associated with a significant reduction in the incidence of postoperative vomiting. <52> UI - 1995339732 AU - Davis PJ AU - McGowan Jr FX AU - Landsman I AU - Maloney K AU - Hoffmann P IN - Department of Anesthesiology, University of Pittsburgh, 3705 Fifth Avenue at DeSoto Street,Pittsburgh, PA 15213-2583; United States. TI - Effect of antiemetic therapy on recovery and hospital discharge time: A double-blind assessment of ondansetron, droperidol, and placebo in pediatric patients undergoing ambulatory surgery. SO - Anesthesiology Vol 83(5) (pp 956-960), 1995. AB - Background: Postoperative nausea and vomiting continue to be a significant problem for pediatric ambulatory surgery patients. Although ondansetron has been demonstrated to be effective in the prophylactic treatment of postoperative nausea and vomiting (surrogate end point) no one has demonstrated a benefit of antiemetic therapy on patient recovery, postanesthesia care unit length of stay, and hospital length of stay (nonsurrogate end points). In a double-blind manner, the effects of ondansetron, droperidol, and placebo on the incidence of emesis, postanesthesia care unit stay, and hospital discharge time were evaluated in children undergoing dental surgery. Methods: The subjects were 102 children aged 2-8 years undergoing complete dental restoration. All patients received midazolam before undergoing inhalational induction of anesthesia with N2O/O2 and halothane. Anesthesia was maintained with N2O/O2 and alfentanil. Patients were then randomized to receive ondansetron (0.1 mg/kg), droperidol (75 mug/kg), or placebo (normal saline) in a double-blind fashion. At the conclusion of the anesthesia, a trained nurse observer assessed patient recovery and recorded the time patients met specified criteria for postanesthesia care unit and hospital discharge as well as episodes of emesis in the hospital and at home during the first 24 hr after surgery. Results: Ninety-five patients completed the study. The three antiemetic groups were similar with respect to age, weight, length of surgery, dose of alfentanil, and route of preanesthetic medication. The 24-hr incidence of emesis was significantly less with ondansetron (9%) than with placebo (35%) or droperidol (32%). Ondansetron-treated patients had significantly shorter hospital stays than droperidol-treated patients, but recovery parameters were similar between the ondansetron-and placebo-treated patients. Conclusions: Ondansetron is an effective prophylactic antiemetic agent for children undergoing dental surgery. Compared with droperidol, ondansetron decreases the length of hospital stay, but compared to placebo, there were no differences in the patient recovery parameters. <53> UI - 1995347800 AU - Arboleda M AU - Castilho MC AU - Fonseca JCF AU - Albuquerque BC AU - Saboia RC AU - Yoshida CFT IN - Inst Colombiano Medicina Tropical, Hospital General de Medellin 4 piso, Ka 48 No 32-102,Medellin; Colombia. TI - Epidemiological aspects of hepatitis B and D virus infection in the northern region of Amazonas, Brazil. SO - Transactions of the Royal Society of Tropical Medicine & Hygiene Vol 89(5) (pp 481-483), 1995. AB - The State of Amazonas in the Brazilian Amazon region is an area of high prevalence of hepatitis B and D virus (HBV and HDV) infection. The aim of this study was to identify epidemiological patterns and risk factors of HBV and HDV infections in Barcelos, in the basin of the Negro river. A random sample (798 in all) of the total population in the urban area and in 2 rural villages was surveyed. A standardized questionnaire was used and blood samples were tested by enzyme-linked immunosorbent assay: 1.63% had hepatitis B surface antigen, 12.9% had anti-hepatitis B surface antibody and 21.4% had anti-hepatitis B core antigen. The overall prevalence of HBV infection was 24.6%. Anti-hepatitis D was present in 5 subjects, all of them non-natives, and hepatitis B e antigen in 2. A positive association between history of dental treatment with an unqualified dental surgeon was found (P<0.05). These results suggest a low prevalence of HVB and HDV infection, in contrast with other parts of the Amazon area. <54> UI - 1995330984 AU - Keese E AU - Schmelzle R IN - Mund-Kiefer-Gesichtschirurgie, Universitat Hamburg, Martinistr 52,20246 Hamburg; Germany. TI - New findings concerning early bone grafting procedures in patients with cleft lip and palate. SO - Journal of Cranio-Maxillo-Facial Surgery Vol 23(5) (pp 296-301), 1995. AB - The following paper reports on our investigations of long-term results of 177 primary bone grafting procedures carried out in the period from 1959 to 1969. In an assessment of possible influential factors (multivariate statistical analysis), neither age at operation, dental hygiene, cleft form, aplasia or loss of teeth near cleft nor the surgeon was found to influence the success of the primary bone grafting procedure. The only significant correlation we found was that between cleft width and Bergland Index. In small clefts up to 4 mm wide, Bergland Index IV was not recognized. However, no cleft larger than 8 mm developed a Bergland Index I. Our results lead to the conclusion that primary bone grafting in wide clefts should not be performed as a single-stage procedure. We presume that, in wide clefts, a two-stage primary bone grafting procedure would likely have led to better long-term results. <55> UI - 1995253935 AU - Heaton PAJ AU - Humphries N IN - Taranaki Base Hospital,New Plymouth 4620; New Zealand. TI - Primary sternal osteomyelitis. SO - Pediatric Infectious Disease Journal Vol 14(8) (pp 722-723), 1995. <56> UI - 1995197133 AU - Bauters M AU - Himpe D AU - Van Gerven M AU - Schoorens J AU - Theunissen W IN - Department of Anesthesia, Middelheim Hospital,Antwerp; Belgium. TI - Dental surgery: Postoperative analgesia with diclofenac and/or methylprednisolone. SO - Acta Anaesthesiologica Belgica Vol 46(1) (pp P.50), 1995. <57> UI - 1995101786 AU - Lake APJ IN - Ysbyty Glan Clwyd,Rhyl, Clwyd LL18 5UJ; United Kingdom. TI - Propofol as sole agent for paediatric day case dental surgery [8]. SO - Anaesthesia Vol 50(3) (pp 269-271), 1995. <58> UI - 1995030146 AU - Roelofse JA AU - De Joubert VJJ IN - Faculty of Dentistry, University of Stellenbosch,Tygerberg; South Africa. TI - Preinduction of anesthesia with rectal midazolam [1]. SO - Anesthesia Progress Vol 41(2) (pp 62-63), 1994. <59> UI - 1995009535 AU - Schultze-Mosgau S AU - Schmelzeisen R AU - Frolich JC AU - Schmele H AU - Hargreaves KM IN - KPMKG, Medizinische Hochschule Hannover, Konstanty-Gutschow-Str. 8,30625 Hannover; Germany. TI - Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. SO - Journal of Oral & Maxillofacial Surgery Vol 53(1) (pp 2-8), 1995. AB - Purpose: To test a combination treatment of ibuprofen and methylprednisolone for pain and swelling. Methods: The efficacy of 32 mg methylprednisolone on pain and swelling when given 12 hours before and after surgery in combination with 400 mg ibuprofen three times a day given immediately on the day of the operation and on the two subsequent days following removal of impacted third molars was investigated in a placebo- controlled, intraindividual double-blind study. Results: After use of ibuprofen/methylprednisolone, ultrasonic examination showed a reduction in swelling of 56% (P < .001) compared with the placebo group; measurement with a tape measure showed a 58% (P < .001) reduction in swelling. The visual analog scale showed a reduction of 67.7% in postoperative pain in comparison with placebo. Conclusion: The combination of ibuprofen and methylprednisolone has good analgesic and antiinflammatory action. <60> UI - 1994377270 AU - Samsudin AR AU - Mason DA IN - Dept. Oral and Maxillofacial Surgery, St. Luke's Hospital,Bradford BD5 0NA; United Kingdom. TI - Symptoms from impacted wisdom teeth. SO - British Journal of Oral & Maxillofacial Surgery Vol 32(6) (pp 380-383), 1994. AB - A study of patients referred for wisdom teeth removal was carried out, to investigate symptoms prior to consultation and during the period on the waiting list for surgery. The reasons for treatment of asymptomatic wisdom teeth were investigated. Pain was the main indication for surgery in 73.7% of patients waiting for consultation. 168 patients waiting for consultation consumed a total of 271 courses of antibiotics, averaging 1.6 courses of antibiotics per patient. The antibiotic consumption increased to an average of 2.5 courses per patient in 94 patients waiting for operation. 67 out of 423 patients had an average of three lost working days due to symptoms from wisdom teeth. The long waiting list for consultation and treatment added further to the discomfort. The extent of symptoms from wisdom teeth may be underestimated. <61> UI - 1994316920 AU - Vriens JPM AU - Freihofer HPM IN - Dept Oral and Maxillofacial Surgery, University Hospital Nijmegen, PO Box 9101,6500 HB Nijmegen; Netherlands. TI - Autogenous transplantation of third molars in irradiated jaws: A preliminary report. SO - Journal of Cranio-Maxillo-Facial Surgery Vol 22(5) (pp 297-300), 1994. AB - Our experience with third molar autotransplants in 2 patients, into an area irradiated at an early age, is described and discussed. It is shown that such autotransplantations are possible. <62> UI - 1994292997 AU - Moore WJ AU - Underwood S IN - Harvard Medical School, Department of Anaesthesia, New England Deaconess Hospital, 185 Pilgrim Road,Boston, MA 02215; United States. TI - Propofol as sole agent for paediatric day-case dental surgery. A randomised study comparing an intravenous propofol infusion with 100% inspired oxygen versus a nitrous oxide/oxygen/halothane maintenance technique. SO - Anaesthesia Vol 49(9) (pp 811-813), 1994. AB - After intravenous induction of anaesthesia with propofol (4 mg.kg-1) 80 unpremedicated children admitted for day-case dental extractions were randomly allocated to receive either an intravenous propofol infusion whilst breathing 100% oxygen or inhalational nitrous oxide oxygen and halothane for maintenance of anaesthesia. In both groups the quality of anaesthesia was acceptable to both anaesthetist and surgeon. Recovery times and postoperative analgesia requirements did not differ significantly between the two groups. No child vomited. Propofol appears to be suitable for use as a sole agent in paediatric day case dental surgery. <63> UI - 1994254508 AU - Hoffman GR AU - Staples G AU - Moloney FB IN - Department of Maxillofacial Surgery, Princess Alexandra Hospital,Brisbane, QLD; Australia. TI - Cephalometric alterations following facial advancement surgery: 1. Statistical evaluation. A review of aesthetic evaluation of the face and an attempt to assess treatment validity. SO - Journal of Cranio-Maxillo-Facial Surgery Vol 22(4) (pp 214-219), 1994. AB - Simultaneous maxillary and mandibular advancement surgery, with or without chin advancement, was performed to correct combined mid and lower dento-facial deficiency, the diagnosis of the deformity in this study being based purely on a clinical analysis. The purpose of this investigation was to test the validity of the diagnosis, surgical treatment objective, and subsequent surgical result by comparing pre- and postoperative cephalometric data with 'Class I dento-skeletal parameters', derived from three different analyses. Lateral cephalometric radiographs were obtained from patients who had undergone 'facial advancement surgery'. The radiographs were subjected to cephalometric analysis in an attempt both to quantify and qualify the skeletal and dental changes that had taken place, following surgical correction of 'horizontal facial deficiency'. A statistical analysis was then used to assess postoperative change to normal, and how the proportion of patients so defined varied by method. All patients had optimal improvements in aesthetics, and in dental occlusion. Dento-skeletal changes remained stable at 12 months post surgery. In spite of these successes, the results of this investigation showed that no greater than 50% of preoperative abnormal measurements per patient were normalised by surgery. <64> UI - 1994176963 AU - Saour JN AU - Ali HA AU - Mammo LARF AU - Sieck JO IN - Department of Medicine (MBC-46), K. Faisal Specialist Hosp./Res. Ctr., P.O. Box 3354,Riyadh 11211; Saudi Arabia. TI - Dental procedures in patients receiving oral anticoagulation therapy. SO - Journal of Heart Valve Disease Vol 3(3) (pp 315-317), 1994. AB - Over a 10-year period a uniform management plan for patients receiving long term oral anticoagulation therapy for prosthetic heart valves and needing dental procedures was instituted. Those undergoing dental extraction or gum hygiene in the presence of gross gum pathology (Group A) had their oral anticoagulation discontinued two days prior to the procedure which was carried out only if the INR was 1.5 or less on the day of the procedure. Patients who needed dental fillings or gum hygiene in the absence of gross gum pathology (Group B) continued their anticoagulation therapy and had these procedures completed provided the INR was 3.0 or less. The main outcome measured were valve thrombosis, thromboembolism and excessive bleeding requiring hospitalization and/or blood transfusion. In Group A, 240 procedures were carried out; 212 dental extractions and 28 dental hygiene in the presence of gross gum pathology. They had a brief period of under- anticoagulation (3-7 days) to an INR of 1.5 or less. In Group B, 156 procedures were performed. No patient developed valve thrombosis or thromboembolism. Two patients, both in Group A needed hospitalization for observation but no blood transfusion. This management plan was easy to implement. Patients needed one extra visit to the anticoagulation clinic within one week of the procedure. It was both safe and effective. <65> UI - 1994183121 AU - Abrams R AU - Morrison Jr JE AU - Villasenor A AU - Hencmann D AU - Da Fonseca M AU - Mueller W IN - Children's Hospital, Department of Pediatric Dentistry, 1056 E. 19th Avenue,Denver, CO 80218; United States. TI - Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures. SO - Anesthesia Progress Vol 40(3) (pp 63-66), 1993. AB - Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three mediations - ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 mug/kg - intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. Each child was injected locally with up to one dental cartridge of 2% lidocaine with 1:100,000 epinephrine before dental extractions. A sedation score was recorded using a scale where 1 = hysterical/untreatable, 5 = ideal sedation, and 10 = obtunded and desaturated, requiring airway management assistance. Midazolam administration resulted in acceptable sedation (mean score: 4) with no desaturations below 90% as measured by pulse oximetry and a mean recovery room observation time of only 3 +/- 2 min (+/-SD). Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 mug/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 mug/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min). We conclude that midazolam and ketamine are acceptable, if not ideal, for short procedures of approximately 10 min duration but that sufentanil, at a dose of 1.5 mug/kg, has unacceptable side effects and is unsuitable for this pediatric outpatient population. Despite the success with the lower dosage of sufentanil, the closeness of the dosages in this pilot study of young children argues against it use pending further investigation. <66> UI - 1994125041 AU - Herrstrom P AU - Hogstedt B IN - Hertig Knut Health Centre, Bryggaregatan 1,S-302 43 Halmstad; Sweden. TI - Allergic diseases, dental health, and socioeconomic situation of Swedish teenagers: Allergy, dental health, and social situation. SO - Scandinavian Journal of Primary Health Care Vol 12(1) (pp 57-61), 1994. AB - Objective - To study the association between allergic diseases (eczema, allergic rhino-conjunctivitis, and asthma), dental health, and the socioeconomic situation of Swedish teenagers. Design - Cross-sectional survey with a questionnaire for allergic symptoms and parents' occupation (for socioeconomic classification); current dental status from the Public Dental Service. Bronchial reversibility test. Telephone inquiry of asthma cases. Setting - Primary care and a school in the centre of a middle-sized Swedish town (approx. 80,000 inhabitants). Participants - 137 pupils of both sexes, 13 - 15 years old. Main outcome measures - Number of reported cases with allergic disease and outcome of bronchial reversibility test in relation to social class. Number of validated cases of asthma. Number of filled tooth surfaces in healthy and diseased cases. Results - Socioeconomic situation was found to associate with dental health, i.e. more fillings in lower social classes (P=0.01), and with allergic disease, i.e. asthma and rhino- conjunctivitis (P=0.05). Individuals from the upper social classes seemed prone to overreport asthmatic symptoms, whereas teenagers in the lower classes did the opposite, as indicated by five cases of pathologic values after bronchial reversibility tests in individuals who did not report asthmatic symptoms. Conclusion - The study indicates that socioeconomic situation associates significantly with both dental health and allergic disease. No association was found between dental health and allergic diseases. <67> UI - 1994125032 AU - Herrstrom P AU - Hogstedt B IN - Hertig Knut Health Centre, Bryggaregatan 1,S-302 43 Halmstad; Sweden. TI - Dental restorative materials and the prevalence of eczema, allergic rhino- conjunctivitis, and asthma in schoolchildren: Dental amalgam and allergy in schoolchildren. SO - Scandinavian Journal of Primary Health Care Vol 12(1) (pp 3-8), 1994. AB - Objective - To study the association between allergic diseases (eczema, allergic rhino-conjunctivitis, and asthma) and different types of dental restorative materials (amalgam, composite, and glass ionomer) in Swedish schoolchildren. Design - Cross-sectional survey with a questionnaire asking for symptoms of allergic disease during the previous year. This information was combined with current dental status (number and type of filled tooth surfaces). Setting - Primary care and a school in the centre of a middle- sized Swedish town (approx. 80,000 inhabitants). Participants - 348 pupils of both sexes 13 - 15 years old. Outcome measures - The occurrence of allergic disease in pupils with and without dental fillings of different types. The mean number and type of filled tooth surfaces in diseased and healthy pupils. Results - 44% of the pupils had no amalgam fillings. This group of children reported significantly more often asthmatic symptoms than the group with amalgam (P=0.02). The asthmatic children had a lower mean number of amalgam surfaces than the other pupils (P=0.002) and also a lower mean number of filled tooth surfaces of all types. Conclusion - The results of this study do not support the theory that amalgam fillings increase the prevalence of allergic diseases or allergic reactivity as such in schoolchildren. Neither do composite and glass ionomer seem to cause such complications. <68> UI - 1994099760 AU - Rodrigo MRC AU - Tong CKA IN - Department of Anaesthetics, Faculty of Dentistry, University of Hong Kong,Hong Kong; Hong Kong. TI - A comparison of patient and anaesthetist controlled midazolam sedation for dental surgery. SO - Anaesthesia Vol 49(3) (pp 241-244), 1994. AB - Thirty healthy Hong Kong Chinese patients between the ages of 15 and 31 years with bilaterally impacted lower third molar teeth, scheduled for surgical removal were studied. All the patients presented twice (for the right and left sides) and received, on separate occasions, patient or anaesthetist-controlled midazolam sedation allocated using a randomised, crossover design. Both techniques provided reliable sedation with verbal contact maintained, minimal changes in respiratory and cardiovascular function, good operating conditions and a high degree of patient satisfaction. The majority of patients (67%) thought they could sedate themselves better on a subsequent visit and were confident that they could do this more satisfactorily than the anaesthetist. An almost equal number preferred patient (n = 12) or anaesthetist (n = 13) controlled sedation, with the remainder having no preference. The total dose of midazolam was very similar in the two groups, 5.3 (SD 2.4) mg and 5.0 (SD 1.1) mg for patient and anaesthetist controlled sedation respectively. <69> UI - 1994082399 AU - Roelofse JA AU - Van der Bijl P IN - Dept. of Oral Medicine/Periodontics, Faculty of Dentistry, University of Stellenbosch,Tygerberg 7505; South Africa. TI - Cardiac dysrhythmias associated with intravenous lorazepam, diazepam, and midazolam during oral surgery. SO - Journal of Oral & Maxillofacial Surgery Vol 52(3) (pp 247-250), 1994. AB - The incidence and nature of cardiac dysrhythmias occurring during intravenous sedation with lorazepam, diazepam, and midazolam for oral surgery were studied. Sixty American Society of Anesthesiologists (ASA) I patients of both sexes between the ages 17 and 32 years were randomly allocated to three groups. Groups received either intravenous lorazepam (.05 mg/kg), diazepam (.25 mg/kg), or midazolam (.1 mg/kg) prior to the oral surgical procedure. Electrocardiograms were made before medication and thereafter throughout the entire procedure. Of the 60 patients studied, 16 (26.7%) exhibited dysrhythmias during the surgical procedure. If sinus dysrhythmias were excluded as a cause of abnormal rhythms, only six patients (10%) exhibited dysrhythmias during surgery. No atrial or ventricular premature beats were recorded for the lorazepam group. In the diazepam group five of the patients (25%) exhibited dysrhythmias; 15% were mainly unifocal ventricular premature beats. Only one patient in the midazolam group exhibited unifocal ventricular premature beats. <70> UI - 1994055283 AU - Mauriello Jr JA AU - Hargrave S AU - Yee S AU - Mostafavi R AU - Kapila R IN - Department of Ophthalmology, Doctors Office Center, UMD-New Jersey Medical School, 90 Bergen St.,Newark, NJ 07103-2499; United States. TI - Infection after insertion of alloplastic orbital floor implants. SO - American Journal of Ophthalmology Vol 117(2) (pp 246-252), 1994. AB - Ten patients developed infections after alloplastic implantation (nine silicone, one gelatin film [Gelfilm] implant) for orbital floor fracture repair. Infection resulted from the following: (1) dental surgery, (2) upper respiratory infection, (3) inferior extrusion of a retained implant into the maxillary sinus with a fistulous tract into the inferior conjunctival fornix, (4) rhinoplasty, (5) snorting cocaine and other drugs, (6) postoperative infection after orbital floor repair, and (7) medial implant migration resulting in chronic dacryocystitis. In all ten patients, implants were removed because of orbital abscess, recurrent infection, or chronic low- grade infections. Microbiologic culture of removed implants disclosed Staphylococcus aureus, S. epidermidis, Serratia marcescens, and Pseudomonas aeruginosa as the offending organisms. The main complication of infection included severe cicatricial ectropion of the lower eyelid in three patients. The final globe position was not adversely affected by implant removal performed from five months to 20 years after insertion. Guidelines for prevention and management of orbital implant infections based on these ten patients are presented. <71> UI - 1994040892 AU - Csillag GD IN - 9 Raglan Street North,Ballarat, Vic. 3350; Australia. TI - Failure of an intra-oral wound to heal. Case report. SO - Australian Dental Journal Vol 38(5) (pp 351-353), 1993. AB - Failure to treat the soft tissue component of dentoalveolar wounds may complicate wound healing mechanisms, retarding the rate of healing and increasing the risk of infection. A case is presented of a five-year-old with an intra-oral wound which, left untreated for eleven days, failed to resolve. <72> UI - 1994029477 AU - Clark DC IN - Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall,Vancouver, BC V6T 1Z3; Canada. TI - Appropriate uses of fluorides for children: Guidelines from the Canadian workshop on the evaluation of current recommendations concerning fluorides. SO - Canadian Medical Association Journal Vol 149(12) (pp 1787-1793), 1993. AB - Objective: To prevent fluorosis caused by excessive fluoride ingestion by revising recommendations for fluoride intake by children. Options: Limiting fluoride ingestion from fluoridated water, fluoride supplements and fluoride dentifrices. Outcomes: Reduction in the prevalence of dental fluorosis and continued prevention of dental caries. Evidence: Before the workshop, experts prepared comprehensive literature reviews of fluoride therapies, fluoride ingestion and the prevalence and causes of dental fluorosis. The papers, which were peer-reviewed, revised and circulated to the workshop participants, formed the basis of the workshop discussions. Values: Recommendations to limit fluoride intake were vigorously debated before being adopted as the consensus opinion of the workshop group. Benefits, harms and costs: Decrease in the prevalence of dental fluorosis with continuing preventive effects of fluoride use. The only significant cost would be in preparing new, low-concentration fluoride products for distribution. Recommendations: Fluoride supplementation should be limited to children 3 years of age and older in areas where there is less than 0.3 ppm of fluoride in the water supply. Children in all areas should use only a 'pea-sized' amount of fluoride dentifrice no more than twice daily under the supervision of an adu