Pain and fear in connection to orthodontic extractions of deciduous canines

International Journal of Paediatric Dentistry 2010; 20: 193–200 Background. Interceptive extractions of deciduous canines are, from a patient perspective, poorly investigated. Aims. To describe pain, discomfort, and dental fear in connection to extractions of the deciduous canines, indicated as an orthodontic treatment procedure. Design. Thirty‐two Swedish children aged 7–9 years had all four deciduous canines extracted over three occasions. The children rated procedural and postoperative pain on visual analogue scales. Acceptance of injections and extractions was assessed by the treating dentists. Analgesic consumption and recovery time for drinking and eating was reported by parents. Dental fear was assessed using the Children’s Fear Survey Schedule questionnaire. Results. Procedural pain showed low median levels, although some individuals reported high values. Boys reported significantly more pain at appointments when two (as opposed to one) canines were extracted. Postoperative pain levels were low and use of analgesics sparse. Dental fear paralleled norm values and did not increase from pre‐ to post‐extraction. Conclusions. Pain management routines during extractions of this kind should be revised. Single tooth extractions seem to be preferable to extractions of two canines at the same appointment. Extraction of four deciduous canines should not cause major postoperative inconvenience; these extractions neither triggered nor increased dental fear.     

A randomized controlled proof-of-concept trial of digoxin and furosemide in adults with cutaneous warts

This is a study of the effect of two topically-applied (i.e. applied to the skin) drugs, digoxin and furosemide, on the healing of viral warts on the skin. It was performed by a group from the Netherlands and Pennsylvania, USA. The investigation is known as a proof of concept study, which is a preliminary experiment to show whether there is likely to be a benefit of a particular course of treatment. These two medicines are believed to improve healing rates of viral warts because they block the passage of potassium into cells, a process that is necessary for the growth of wart viruses in human skin. The team used a topically applied preparation containing the two medications and measured the size of warts, the presence of visible features on their surface and their disappearance; in addition, samples were taken for testing for the presence of wart virus. All the patients had warts that had not responded to other treatments. The study followed different groups of 20 patients who received either both medications combined, each singly or a placebo. This showed that after 6 weeks of daily treatment and a follow up of 14 weeks, only those patients who had received the treatment with both digoxin and furosemide together showed improvements, with some achieving elimination of the warts. This is an encouraging result, but the work should now be carried out on a larger number of patients with warts that have not been treated before as, although the new treatment led to greater improvement, the numbers of patients whose warts disappeared completely was small. There were no side effects associated with the treatment.     

Allergic characteristics of urban schoolchildren with atopic eczema in Ghana

Background Atopic eczema is an increasing clinical problem in Africa. Objective To determine allergic characteristics and to identify possible risk factors for eczema among schoolchildren in an urbanized area in Ghana. Patients and methods Schoolchildren aged 3–16 years with eczema were recruited. For each patient, one to three age‐ and sex‐matched controls were selected. All children completed a questionnaire and were skin prick tested with a panel of allergens. Blood was drawn to determine the total and allergen‐specific IgE. Conditional logistic regression models with the matching factors included in the model were used to calculate the odds ratios and to adjust for possible confounders. Results A total of 52 children with eczema (27 boys and 25 girls) and 99 controls were included. Levels of total IgE were found to be 9.1 (1.1; 78.4) times more often elevated in children with eczema. This association was mainly driven by elevated IgE levels against cockroach antigen. Children with eczema were found to have 2.0 (0.87; 4.7) times more often positive skin prick tests (SPT), but this association diminished to 1.2 (0.40; 3.6) after adjustment for total IgE levels. Frequent washing with soap was identified as a risk factor for the development of eczema among these children. Conclusion Schoolchildren with eczema in Ghana were characterized by elevated IgE levels especially against cockroach antigen. The association between eczema and positive SPT was much weaker suggesting immune hyporesponsiveness of the skin. After adjustment for IgE level, SPT were less suitable to distinguish children with and without eczema.