Objective To introduce a method to aid dental treatment for autistic children; midazolam oral sedation. Methods 10 autistic children who can not be managed under normal dental procedures were administrated oral midazolam (0.5mg/kg) before treatment. Once they were adequately sedated, dental treatment was carried out in outpatient. During the whole course, their finger oxygen saturation and heart rate were inspected. Painless methods were also applied. The duration of each treatment was controlled within 30min. When the procedure ended, the autistic children were inspected until recovery from sedation and then discharged with their parents. Results 10 children aged 4～10y totally underwent 17 visits to complete all dental treatment. The average ages were (6.00?1.89)y, body weight was (28.10?9.36) kg and Houpt scales were (4.71?0.77). They were all successfully sedated and managed and no severe complications were found. Conclusion The oral midazolam sedation showed satisfactory effects on this group of autistic children while studies of large samples are needed to draw a definite conclusion.

OBJECTIVETo evaluate the incidence of two-rooted mandibular premolar morphology using full-mouth periapical film series in a Chinese population, with particular emphasis on bilateral incidence, so as to provide a clinical anatomical basis for root canal treatment in mandibular premolars.

METHODSA total of 2015 patients who underwent dental treatment and had full mouth periapical radiographs at the Peking University School of Stomatology from April 2011 to April 2012 were enrolled in this study. Three experienced dentists reviewed the patients' periapical films and classified the root morphology of mandibular premolars bilaterally. The incidence of unilateral and bilateral double roots were recorded and calculated, including confirmed and suspected bucco-lingual root types.

RESULTSIn terms of the morphology of two-rooted mandibular first premolars, of the 2015 cases with complete root formation, two-rooted first premolars were detected in 120 cases, with a total number of 159 teeth. According to the number of teeth, the overall incidence of double roots was 4.03% (159/3972). In terms of the morphology of two-rooted mandibular second premolars, of the 2015 cases with complete root formation, two-rooted second premolars were detected in 24 cases, with a total number of 33 teeth. According to the number of teeth, the overall incidence of double roots was 0.85% (33/3880).

CONCLUSIONSThe roots of mandibular premolars display specific morphological patterns. Based on a large sample, we observed and calculated not only the occurrence rate of bucco-lingual and mesio-distal double roots in first and second mandibular premolars, but also the incidence of unilateral or bilateral double roots within the same mandible. These findings could provide useful information on the anatomical structure of mandibular premolars for endodontic, prosthodontic and surgical procedures, and could improve the quality of treatment and reduce complications.

Adolescent ; Adult ; Aged ; Bicuspid ; abnormalities ; Child ; Humans ; Mandible ; Middle Aged ; Periapical Tissue ; diagnostic imaging ; Radiography ; Tooth Root ; abnormalities

A 23-year-old man in remission from acute myeloblastic leukemia after allogeneic peripheral blood stem cell transplantation developed peripheral neuropathy presenting as sciatic and peroneal nerve deficits. Electrophysiological tests localized the lesions to the left sciatic and common peroneal nerve. Magnetic resonance imaging revealed nerve thickening and enhancement, while a positron emission tomography-computed tomography scan demonstrated increased fluorodeoxyglucose uptake tracking along the nerve, suggesting peripheral nerve infiltration. This report demonstrates an unusual presentation of acute leukemia relapse presenting as focal neuropathy

Asthma, often begins in childhood, can affect dental health. In return, dental treatment and dental anxiety can lead to an acute asthmatic attack. This article reviews the potential influence of asthma on dental treatment and dental medications and specifically describes the modes of dental conscious sedation in asthmatic patients.
Anesthesia, Dental ; methods ; Asthma ; etiology ; Dental Anxiety ; complications ; Humans

OBJECTIVETo evaluate the attention shift effect produced by a video-audio eyewear in pediatric dentistry.

METHODSTotally 40 children aged 4-7 years were equally randomized into fissure sealant group(group S) and caries filling group(group F). A self-control comparison method was used in each group: each child took two visits to finish the whole study, they received the dental treatment either with normal method(SC, FC) or with attention shift by wearing the video-audio eyewear (SI, FI) for each visit. The degree of pain, accomplishment of treatment, and co-operation were analyzed and compared.

RESULTSAll children were successfully managed in the whole course. The pain scores were not significantly different between SC group and SI group or between FC group and FI group (P0.05), while the Frankl scores were significantly different between SC group and SI group (P=0.04) and between FC group and FI group (P=0.03). Houpt scores were significantly different between SC group and SI group (P=0.04), but not between FC group and FI group (P=0.85). Most children (90% in group S) and (85% in group F) expressed the willingness to receive the video-audio eyewear if they were asked to do so again.

CONCLUSIONSThe video-audio eyewear provides satisfactory attention shift for children during dental treatment and increases their cooperation. However, it has little effect on pain relieving.

Attention ; Audiovisual Aids ; Child ; Child, Preschool ; Female ; Humans ; Male ; Pediatric Dentistry ; Play and Playthings

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament (PDL) injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis.
Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth:the premolar group (PM, n=38), first molar group (FM, n=66), and second molar group (SM, n=58). All the patients received computer-controlled PDL injection with 4%articaine and 1∶100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure.
Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups (92.1%, 53.0%, 93.1%, respectively;χ2=34.3, P<0.01). Both the PM and SM groups showed higher success rates than that of the FM group (v=1, χ2=16.73, P<0.01; v=1, χ2=24.5, P<0.01). No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups.
Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

OBJECTIVETo evaluate the sedative effect of continuous intravenous infusion of midazolam in treating severe dental phobia.

METHODS31 patients with severe dental phobia were enrolled and all of them had good communication with dentists. Two teeth in each patient were assigned to control group and experiment group seperately. The control group received root canal therapy. The experiment group were sedated by intravenous midazolam and received root canal therapy. The treat dependence and behavior therapy efficacy were evaluated. The vital signs and side effects during treatment were noted.

RESULTSContinuous intravenous infusion of midazolam showed a significant good sedative effect on patients with severe dental phobia. There were statistical difference in the Houpt score and the Frankl score between experiment group and control group (z = -4.846, P = 0.000; z = -4.907, P = 0.000). The total dose of midazolam was (9.58 +/- 3.76) mg, and mean infusion rate was (0.28 +/- 0.06) mg x kg(-1) x h(-1). The blood pressure, heart rate and respiration of experiment group were depressed. But these changes didn't interfere with the completion of the whole treatment. No severe side effects were detected.

CONCLUSIONThe single use of midazolam as an intravenous sedation agent has satisfactory effect on patients with severe dental phobia.

Blood Pressure ; Conscious Sedation ; Dental Anxiety ; Heart Rate ; Humans ; Hypnotics and Sedatives ; Infusions, Intravenous ; Male ; Midazolam

OBJECTIVETo evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam.

METHODSOne hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind, randomized, controlled study. Patients in intervention group (n = 50) were given midazolam dissolved in glucose solution and patients in control group (n = 50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points.

RESULTSUnder basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P < 0.05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P < 0.05), but coefficient of variation did show significant difference in both groups.

CONCLUSIONContinuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.

Aged ; Blood Pressure ; drug effects ; physiology ; Diastole ; drug effects ; Humans ; Hypertension ; prevention & control ; Hypnotics and Sedatives ; pharmacology ; therapeutic use ; Infusions, Intravenous ; Midazolam ; pharmacology ; therapeutic use ; Systole ; drug effects ; Tooth Extraction ; methods

OBJECTIVETo evaluate the effect of midazolam alone on sedation in young children for dental restorative care.

METHODSForty children, aged 5 to 10 years with a mean age of 7.3 years, participated in this study. Twenty-one patients were assigned to intervention group received 0. 5 mg/kg of oral midazolam 20 minutes prior to the beginning of dental treatment, and 19 patients in control group received placebo liquid 20 minutes before treatment All patients received painless local anesthetic injection and were restrained with children's board and bands. Blood pressure (BP), heart rate (HR), oxygen saturation, treatment compliance scores of the Ramsay scale, the Briekopf and Buttner scale, Frankl scale, and the Houpt scale were recorded. Each procedure was taped and all the data were evaluated every 5 minutes by an anesthetist or experienced dentist who was unaware of the drug given to the child.

RESULTSHR in intervention group (82.5 +/- 5.1 bpm) was much lower than that in control group (95.2 +/- 8.9 bpm; F = 31.20, P < 0.001). Intervention group had a significantly lower systolic BP level (94.8 +/- 5.6 mm Hg) than control group (98.5 +/- 5.5 mm Hg; F = 4.34, P = 0.04), but the diastolic BP (63.0 +/- 3.5 mm Hg) was not significantly lower than control group (65.5 +/- 4.8 mm Hg; F = 3.31, P = 0.07). Children in intervention group showed more compliance. The patients' scores of the Ramsay scale, Briekopf and Buttner scale, Frankl scale, and Houpt scale in intervention group (1.37 +/- 0.96, 1.37 +/- 0.83, 1.32 +/- 0.67, and 2.32 +/- 1.49, respectively) were significantly lower than those in control group (3.71 +/- 1.23, 2.71 +/- 0.96, 2.71 +/- 0.90, and 4.71 +/- 1.19; F = 44.66, 22.36, 30.39, and 31.88, respectively, all P < 0.001).

CONCLUSIONSOral midazolam alone is safe and produces effective sedation for the dental treatment of young children. Oral midazolam application should be generally preferred because it is more easily accepted by pediatric patients.

Administration, Oral ; Anti-Anxiety Agents ; therapeutic use ; Blood Pressure ; drug effects ; Child ; Child Behavior ; drug effects ; Child, Preschool ; Conscious Sedation ; Dental Anxiety ; drug therapy ; Dental Caries ; surgery ; Double-Blind Method ; Heart Rate ; drug effects ; Humans ; Hypnotics and Sedatives ; administration & dosage ; Midazolam ; administration & dosage ; Patient Compliance

Angioma serpiginosum is an uncommon, acquired vascular nevoid disorder with capillary dilation and proliferation in the papillary dermis. The eruptions are asymptomatic and characterized by grouped, erythematous to violaceous, serpiginous and punctate macules. The condition usually appears in females during adolescence on unilateral lower extremities and the buttocks. We report a rare case with a late onset and atypical distribution of lesions in a 48-year-old female patient who had groups of punctate lesions on her left foot for four to five years. Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis. Inflammation and extravasation of red blood cells were not found. According to the clinical and pathological findings, we established a diagnosis of angioma serpiginosum. She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.
Female ; Foot Diseases/diagnosis/surgery ; Humans ; Lasers, Dye/therapeutic use ; Middle Aged ; Skin/blood supply/pathology/surgery ; Skin Diseases, Vascular/*diagnosis/surgery ; Telangiectasis/*diagnosis/surgery ; Treatment Outcome