Dental postoperative pain management in children

Misconceptions about the need for pain management in pediatric patients have been shown to be wrong. We now understand that children feel pain and respond to pain medication in much the same way as adults. With this new understanding, practitioners must recognize all the factors that affect the feeling of pain. Pain can be variable and each patient brings a unique set of characteristics to be evaluated. The first objective should be to assess the patient's previous treatment history, medical condition, extent of treatment needed, and age. An effective pain management protocol begins with preoperative pain and anxiety control, with the use of agents such as nitrous oxide and local anesthetics. Postoperative pain medication should be given at the correct dosage and time intervals for the appropriate duration. With our commitment to pain management in children, these protocols should easily translate into improved clinical practice.     

Dental and anaesthetic management of children with dystrophic epidermolysis bullosa

Background.  Epidermolysis bullosa (EB) is a genetic disease associated with fragility and bullous lesions of the skin and mucous membranes. There are various patterns of inheritance and histopathology. The disease is associated with systemic and oral manifestations, among which may be dental decay necessitating oral rehabilitation. General anaesthesia is frequently required for oral rehabilitation in children with dystrophic EB. Paediatric dentists should be aware of the implications of dystrophic EB for dental and anaesthetic management.
Case report.  Two siblings with moderate to severe systemic and oral manifestations of dystrophic EB requiring extensive oral rehabilitation for rampant decay are described, including special anaesthetic techniques required for airway management and maintenance of skin integrity.
Conclusion.  Dystrophic EB is a rare genetic disorder in which vesiculobullous lesions occur with erosions and scarring of cutaneous and extracutaneous surfaces in the oral cavity. Poor oral hygiene results from efforts to avoid mucosal trauma, resulting in decay. The comprehensive care of children with dystrophic EB impacts not only dental management but anaesthesia administration as well.     

Dental behavior management problems in Swedish children

Abstract – 4505 Swedish children aged 4-11 yr were surveyed regarding dental behavior management problems (BMP) and dental health. Dental charts were retrieved from clinics in the Public Dental Service in Göteborg. and data were then compiled regarding BMP, action against BMP, caries, fillings, use of local anesthetics, and number of missed appointments. Behavior management problems were found in 10.5% of the children, and were more common in the younger children, among children who missed appointments, and in children who received restorative treatment without local anesthetics. The BMP children had more carious and fewer filled surfaces. In 43.4% of the cases with BMP the strategy chosen was postponement of dental treatment or no measure taken.     

Dental management of children undergoing liver transplantation.

The number of pediatric liver transplantations undertaken in the US has increased dramatically in recent years. As the survival of liver recipients continues to improve, the dentist will need to be familiar with the management of these patients. This article describes the indications for pediatric liver transplantation, the types of liver transplants, the clinical features of liver disease, and the medical and dental management of children before and after liver transplantation.     

Reported latex allergy in dental patients

OBJECTIVE: The purpose of this study was to alert doctors of dental surgery to the possibility of latex sensitivity in both outpatients and inpatients. STUDY DESIGN: The study involved 2 groups: group A was composed of 21 subjects with a history of immediate reaction in dental environment; group B was composed of 24 healthy individuals. Patients underwent skin prick tests with common inhalant allergens, with latex cross-reacting foods, with a commercial extract of non-ammoniated latex, and the incremental challenge test with local anesthetics. Specific IgE to latex and to latex cross-reacting foods were measured with the fluorescent enzyme immunoassay. RESULTS: All patients in group A and none in group B were latex-allergic. Subjects who were latex-allergic were significantly more likely to be atopic and had positive IgE test to cross-reactive foods. CONCLUSIONS: Dentists and people working in a dental surgery environment must obtain detailed patient history to help identify individuals at risk of latex allergy or those actually allergic to latex. If an allergy exists, equipment used should be made of alternative materials.     

Natural rubber latex allergy and dental practice

Natural rubber latex (NRL) allergy is a significant clinical problem with potentially life-threatening complications. Oral health care professionals must be able to screen for NRL allergy and refer patients or staff to a specialist for definitive diagnosis. Protocol for its management must be developed and incorporated into daily practice. Practitioners must be able to recognize and treat NRL exposure emergencies. Knowledge of the availability of substitute products and an adequate fresh stock of such products in dental practice can minimise the risk of adverse NRL sensitivity.     

Dental management for children with chronic renal failure undergoing hemodialysis therapy.

Patients with chronic renal failure who are undergoing hemodialysis therapy demonstrate problems of significant importance for dental treatment. A case is presented in which secondard hyperparathyroidism, resulting from renal failure and hemodialysis, was noted in a child. Other relationships between renal failure, hemodialysis, and dental care were also presented.     

Screening for latex allergy with a questionnaire: comparison with latex skin testing in a group of dental professionals

BACKGROUND: Latex allergy has emerged as an important cause of allergic reactions particularly in health workers. Due to the lack of a standardized extract for objective skin testing a screening questionnaire was developed. METHODS: At the 1995 Australian Dental Association Conference, all attendees were invited to complete a questionnaire and undergo skin testing to assess the level of latex allergy in this population and to assess the performance of the questionnaire as a screening test for latex allergy. RESULTS: The questionnaire had high specificity but poor sensitivity compared to skin testing with latex extract. CONCLUSION: This study compares at risk individuals identified by a screening questionnaire with those identified by objective skin testing. A questionnaire designed to screen for latex allergy was reliable for identifying those with low risk while overestimating those at risk of true latex allergy, demonstrating the need for objective testing with reliable allergens.     

Dental management of patients with hypertension

About 50 million people in the United States have hypertension. Many epidemiologists feels it is the number one public health problem in developed countries. Although asymptomatic early on, untreated hypertension leads to cardiovascular disease, strokes, renal failure, and blindness. Dentists no doubt treat patients with hypertension and its sequelae in their practice. This article summarizes the current thinking on the diagnosis and treatment of this condition, emphasizing dental implications. The article presents common oral and systemic side effects of antihypertensive medications, and discusses how dentists can help treat hypertension through the fabrication of devices useful in reducing obstructive sleep apnea.     

Dental management of patients with diabetes

Diabetes is a disease of metabolism resulting from impaired insulin secretion, varying degrees of insulin resistance, or both. Management of the diabetic dental patients must take into consideration the impact of dental disease and dental treatment on the management of diabetes as well as an appreciation for the comorbidities that accompany long-standing diabetes. Those comorbidities include obesity, hypertension, and dyslipidemia. Central to the management of diabetes is the intensive regulation of plasma glucose along with management of comorbidities comprising the "metabolic syndrome." Management of the diabetic dental patient should focus on periodontal health and the delivery of comprehensive dental care with minimal disruption of metabolic homeostasis and recognition of diabetic comorbidities.     

Dental care of children with hemophilia

Hemophilia, the most common of the inherited bleeding disorder, is the result of a deficiency of clotting factor. Its characteristic is easy to bleed, prolong bleeding, and difficult to stop bleeding. In order to give dental treatment to the patient with this disease, consultation with the patient's physician is necessary. In addition, dentist should know the prevention and control of hemorrhage after treatment.