Special Care in Dentistry最新文献

Aims: The aim of this systematic review was to analyze the efficacy, advantages and adverse effects of midazolam in outpatient pediatric dentistry.

Methods: This review was carried out in accordance with the PRISMA criteria. A systematic electronic search was conducted through MEDLINE/PubMed, Scopus, and the Cochrane Library databases up to September 2024. An advanced and reproducible search strategy was used to identify relevant studies. Articles were excluded if they focused solely on midazolam as a premedication for general anesthesia or elective surgery, involving patients with special diseases. Inclusion criteria required participants aged 0-16 years, patients with behavioral and/or cooperation disorders and undergoing simple dental restorative procedures under local anesthesia, such as fillings, pulp therapies, stainless steel crowns, or basic extractions. Patients with specific medical conditions, as well as those who were not monitored for vital signs during sedation, were excluded from the study. The risk of bias assessment was analyzed using the criteria set out in the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0.

Results: A total of 28 studies were included in the analysis, which were conducted across 11 countries and involved a total of 4374 children aged between 2 and 14 years. Most studies demonstrated a low risk of bias. Many of the participants were ASA I or II status and were assessed using behavioral scales, primarily the Frankl scale. Twelve adjunct drugs were combined with midazolam, and various administration routes were explored, including oral, intranasal, and buccal. Dosing protocols varied, as did fasting guidelines prior to sedation. Outcome measures included vital sign monitoring and behavioral assessments, most commonly via the Houpt and MOAA/S scales. Midazolam generally proved effective in reducing anxiety and improving cooperation, with reported benefits extending to future dental visits. Adverse effects were infrequently noted and typically mild, including nausea, vomiting, and paradoxical reactions.

Conclusions: Midazolam has been shown to be an effective and safe agent for moderate sedation in pediatric dental procedures when administered orally at a dose range of 0.3-0.5 mg/kg. The evidence suggests that it reliably reduces anxiety and improves cooperation. Supervision, preferably by an anesthesiologist, is recommended when combined with other drugs to ensure patient safety.

Aims: Systematically review the literature to answer the focused question: "What is the best way to facilitate pain communication for patients with intellectual disabilities (ID) in dental care?"

Methods: A systematic search strategy was conducted in five databases and gray literature. Studies evaluating pain communication in dental care for patients with ID were included. The risk of bias was assessed according to the Meta-Analysis of Statistics Assessment and Review Instrument.

Results: A total of 1525 studies were screened, and after applying exclusion criteria, 10 articles remained. The included studies were published between 2003 and 2021, with sample sizes ranging from 28 to 270 participants with developmental disabilities. The Dental Discomfort Questionnaire (DDQ) was the most commonly used tool in the studies. Most studies showed a low risk of bias.

Conclusion: The DDQ is the most validated tool for assessing dental pain in individuals with ID, though evidence in adults is limited. Other tools provide useful behavioral cues but may not clearly differentiate pain from discomfort or anxiety. The absence of a gold standard underscores the need for context-appropriate tool selection and clinician training to interpret nonverbal pain, enhancing diagnostic accuracy and promoting equitable care.

Introduction: Despite the existence of clear management protocols for patients treated with warfarin, direct-acting oral anticoagulants, and anti-thrombotic medications requiring dental extractions, guidelines for patients on injectable anticoagulants or heparins are limited. This absence of advice for dentists and doctors results in potential confusion about the safety of these dental procedures, impacting timely patient care.

Methods: A prospective, observational study was completed at two Australian hospital-based dental clinics to determine the frequency and severity of bleeding events, within the 48-h period, following dental extractions completed in heparinized patients.

Results: During the study period, 95 heparinized patients received a total of 185 dental extractions. Six patients had minor bleeding in the first 48 h after their procedure, representing a rate of 6.3%. All bleeding episodes were managed with direct pressure to the site with gauze. Bivariate analysis identified that patients treated with unfractionated heparin, compared to low-molecular-weight heparins, and extractions completed closer to the last dose of heparin had higher rates of post-extraction bleeding (p ≤ 0.01).

Conclusions: Dental extractions can be completed safely for patients on injectable anticoagulants when careful local hemostatic measures are used. Based on the low rates and minor nature of post-extraction bleeding, interruption or change to dosing of heparin therapy is unnecessary to facilitate these invasive dental procedures.

Objectives: This study aims to determine the prevalence of self-reported tooth grinding among older adult patients at a dental school and to examine the associations between tooth grinding and various demographic and clinical factors.

Methods: Data were retrieved from the electronic patient database at the University of Iowa College of Dentistry. Descriptive statistics and bivariate analyses were used to explore associations between tooth grinding and various demographic and clinical factors. Multivariable logistic regression was used to identify factors that were significantly associated with tooth grinding.

Results: Out of 12,550 adults aged 65 years or older, 1598 (12.7%) who responded to the tooth grinding question were included in the analysis, with 853 (53.4%) reporting tooth grinding. Multivariable logistic regression analysis revealed that gender and drug addiction were significantly associated with tooth grinding, with males and those with a history of drug addiction having higher odds.

Conclusions: In this large sample of older adults, self-reported tooth grinding had a high prevalence, with males and those with a history of drug addiction having significantly higher odds of experiencing it.

Aims: This study aimed to compare the effects of virtual reality (VR) and nitrous oxide (N₂O) sedation on anxiety and stress in patients with dental anxiety.

Methods and results: Eight patients with dental anxiety (five women; mean age, 41 years) with scores ≥ 19 on the Japanese version of the Modified Dental Anxiety Scale underwent three interventions: VR (natural landscapes and ambient music), N₂O (30% N₂O/70% oxygen), and no intervention (control). Autonomic nervous activity, including low frequency (LF), high frequency (HF), and the LF/HF ratio, was measured. VR significantly reduced LF and LF/HF levels compared to those of the control (p < 0.05), suggesting lower sympathetic nervous system activity, whereas N₂O had no effect (p = 0.88, 0.46, respectively). VR and N₂O increased HF levels compared to those of the control (p < 0.05), reflecting enhanced parasympathetic activity. Subjective anxiety was lower for VR and N₂O interventions (p < 0.05). VR immersion ratings indicated that most participants experienced moderate-to-high immersion levels.

Conclusion: VR is an effective, noninvasive option for managing dental anxiety, suggesting greater reductions in sympathetic-related markers than those of control and, in some analyses, N₂O, in this small crossover sample. Its accessibility and lack of pharmacological side effects support its integration into patient-centered care, particularly for mild-to-moderate dental anxiety.

Aim: To examine the association of family-centered care (FCC) with oral health indicators among children with special health care needs (CSHCN).

Methods: Data includes the CSHCN population from the 2017 to 2019 National Survey of Children's Health (NSCH). Four parent- and caregiver-reported binary oral health outcomes were assessed: preventive dental visits (PDVs), cavities, condition of teeth, and oral health problems. The primary independent variable was parent- and caregiver-perceived FCC. Multivariable logistic models were used to investigate the association of FCC with oral health indicators.

Results: Of 16 338 CSHCNs, a high proportion (83.29%) received FCC. Receipt of FCC was positively associated with better oral health outcomes among CSHCN. Compared to those who did not receive FCC, CSHCN who received FCC had 56% higher odds of having one or more PDV (adjusted odds ratio: 1.56, 95% Confidence Interval: 1.15-2.10), were 1.90 times more likely to have teeth rated as excellent or very good, had 82% greater odds of having no cavities, and 1.91 times higher odds of having no reported oral health problems.

Conclusions: FCC plays a critical role in maintaining oral health among CSHCNs. Its broader implementation is a potential solution to reduce disparities in oral health among CSHCN and across the pediatric population.