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The purpose of this study was to examine case-specific perceptions associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The GDs were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Identical questions followed each vignette that were designed to assess five perceptions of the incident and whether the respondent would be likely to report the case. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), for a total of 288 (41.1%). A majority of respondents considered each vignette to be serious, but only a minority believed that they were required to report the neglect (7.3%) and the abuse (33.7%) vignettes. The percentages of likely reporters of the neglect (n = 28) and abuse (N = 103) vignettes were 9.7 and 36%, respectively. No significant differences were noted in the response patterns of GDs and PDs. Decisions to report child maltreatment described in the vignettes were associated with perceptions of 1) the seriousness of the incident, 2) the incident being defined as neglect or abuse, and 3) a requirement to report. The possibility that a maltreatment report would have a negative impact on the child was associated with a decision not to report. The perception that a report would have a negative impact on the family was common among likely reporters and nonreporters.

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The purpose of this study was to examine demographic factors associated with dentists' decisions to report hypothetical cases suggestive of child maltreatment. Surveys were mailed to 500 general dentists (GDs) in Georgia and all 200 pediatric dentists (PDs) in Georgia and Florida. The general dentists were chosen from a pool of 1500 by a stratified randomization scheme. Each survey contained two brief vignettes suggestive of, but not conclusive for, child neglect and abuse. Respondents were asked about their likelihood of reporting each vignette. General demographic questions were asked about the population served by the dentist, the year of dental degree and speciality certificate acquisition, and gender of the respondent. Further questions were asked about the individual's exposure to continuing education in child maltreatment, knowledge of legal requirements to report and the agency to which reports should be directed, and experience with suspected and filed cases. Responses were received from 185 GDs (37%) and 103 PDs (51.5%), a total of 288 (41.4%). PDs had more practitioners in larger communities and had more female respondents. PDs were more likely to answer yes to the questions about education/experience with child maltreatment. Factors associated with likely reporting of neglect were: 1) serving communities with populations < or = 100,000; 2) PDs acquiring specialty certificates after 1980; 3) being female; 4) exposure to continuing education; 5) having suspected cases in practice; and 6) having filed a maltreatment report. Factors associated with likely reporting of abuse were: 1) PDs acquiring specialty certification after 1980 and 2) self-reported recognition of the legal obligation to report.

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The purpose of this study was to examine the trends in numbers, demographic characteristics, and treatment history of pediatric dental patients under the care of dental students over the period 1980 through 1994. Data were collected for: exams, sealants, surfaces of amalgam, composite resin surfaces, pulpotomies, stainless steel crowns, and extractions. Correlations were done across the 15-year period to determine significant trends over time. During the 15-year period, the average number of patient visits required for each student to complete the requisite number of patients, declined from 45 appointments to complete 10 patients in 1980, to 35 visits to complete 13 patients in 1994. Over time, the numbers of amalgam surfaces, pulpotomies, extractions and stainless steel crowns decreased significantly, while the number of composite resin surfaces increased (P < 0.05). Based on a previous outcome assessment that indicated declining numbers of procedures performed between 1980 and 1985, the required number of patients treated per student was raised from 10 to 13, beginning with the 1986 class.

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The objective of this clinical study was to evaluate the long-term efficacy of placing sealed posterior composite restorations for arresting active caries. The tooth preparation for this bonded and sealed restoration was limited to placing a bevel in the enamel only, without the removal of the carious lesion. The radiographic and clinical performance of these ultraconservative sealed composite restorations placed over caries (CompS/C) was compared over a period of nine years with: 1) ultraconservative, localized sealed amalgam (AGS) restorations with no extension for prevention, and 2) traditional, unsealed amalgam restorations (AGU) with the usual extension for prevention outline form. Sealant retention with > 50 percent to 100 percent of the margins occurred in 64 percent of CompS/C and 82.5 percent of AGS restorations. After nine years the cumulative failure rates were 16 percent for CompS/C, 2.5 percent for AGS, and 17.1 percent for AGU restorations. Thus, the clinical performance of CompS/C restorations was slightly superior to that of the traditional AGU restorations. The AGS restorations were definitely superior to the traditional AGU restorations and to the CompS/C restorations in both children and adults alike. Complete sealant retention over CompS/C and AGS restorations was equivalent between children and adults (P = 0.14 and 0.74, respectively). A higher percentage of open margins in CompS/C restorations was seen, however, in children (17.4 percent) than adults (1.94 percent). This study has shown that Class I caries can be arrested by the CompS/C restoration.

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Rheumatoid arthritis (RA) is an inflammatory disease of the synovium which may lead to proliferative and degenerative changes in the body's joints, including the temporomandibular joint (TM Joint). Although the exact etiology of rheumatoid arthritis remains unknown, it is suspected that the disease is often initiated by an infectious organism, or by genetic and/or environmental factors. Juvenile rheumatoid arthritis (JRA) is a chronic disease of childhood with a spectrum of joint involvement and associated systemic and other organ involvement. Five percent of all rheumatoid arthritis patients are children. In the United States, approximately 150,000 children are affected by JRA. With upper limb involvement, routine oral hygiene procedures become difficult. Dental evaluations/screenings may not be included in the initial team assessment of these patients until the TM Joint is affected; however, prior to this time, the patient may have had years of poor oral hygiene which could contribute to severe decay and early tooth loss. This case report describes the oral health status of a child with polyarticular juvenile rheumatoid arthritis and the specific recommendations for dental management.

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This clinical investigation assessed the retention of pit and fissure sealants with and without the use of a post-etching drying agent in pediatric dental patients. Twenty eight healthy patients with four fully erupted, non-carious first permanent molars participated. Sixteen males and 12 females, 5-12 years of age, each received four sealants, two with and two without a drying agent. Sealants were placed by three dental operators. Assignment for sealant application (with and without drying agent) was based on a computer-generated randomization table. Sealant application involved cleansing of the teeth with a non-fluoridated prophylaxis paste followed by rinsing 60 seconds with air/water spray, enamel conditioning with 40% phosphoric acid for 60 seconds, rinsing with air/water spray for 60 seconds, application of drying agent for 5 seconds, application of sealant material, and light curing for 60 seconds. Modified USPHS (Ryge) criteria were used to evaluate interfacial staining, secondary caries, marginal integrity, and surface texture. Sealant retention was evaluated as fully retained or lost (failed). All 28 participants returned for the 12-month recall visit. Four evaluators reported a 91% overall retention rate. Of the 56 teeth sealed without a drying agent, there was a 13% (n = 7) failure rate compared to 5% (n = 3) failure rate for the 56 teeth sealed with a drying agent. These results were not statistically significant (P > 0.05) based on the log-rank test.

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Preoperative transfusion of sickle cell anemia (SCA) patients prior to general anesthesia is considered a routine procedure to ensure adequate levels of normal adult hemoglobin A to prevent a sickle cell crisis. Blood transfusion risks have led some clinicians to question this procedure. A case report is presented in which a SCA patient developed a delayed hemolytic reaction from a transfusion given prior to dental treatment under general anesthesia. The controversy of transfusion in this patient group is presented.

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This study compares the efficacy of two drug regimens used for oral sedation in pediatric dental patients: chloral hydrate (50 mg/kg)/promethazine (1 mg/kg) and meperidine (1 mg/kg)/promethazine (1 mg/kg). Twenty-four pediatric dental patients, ASA Class I, were evaluated in this double-blind, randomized study. The patients ranged in age from 18 to 48 months. Each dental procedure under sedation was videotaped and rated independently by two raters. Intraoperative ratings of sleep, movement, crying, an overall behavior score for each treatment interval, and an overall behavior score for each sedation were also evaluated. No treatment was aborted for either regimen. In all cases, chloral hydrate/promethazine sedations had significantly better results for sleep (P = 0.0001), movement (P = 0.0168), crying (P = 0.0041), and overall behavior score (P = 0.0186) for the sedations compared to meperidine/promethazine sedations. Although chloral hydrate/promethazine sedations produced significantly better results, clinically, both drug regimens were equally effective.

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Oxygen saturation of arterial blood (SaO2) was assessed in children after discontinuing N2O/O2 sedation for dental procedures. Two post-treatment methods were used: breathing 100% O2 for 5 min after the procedure, and breathing room air for 5 min. Participants were 24 healthy children ages 41 to 113 months. Each child was treated twice and a crossover design was used. The mean length of procedures that were followed by O2 was 28.8 (+/- 10.9 SD) min; for those followed by room air, 28.3 (+/- 12.4 SD) min. SaO2 was monitored continuously by pulse oximetry and recorded at predetermined intervals before, during, and after N2O/O2 administration. When participants received post-treatment O2, the mean SaO2 at 1 min after N2O cessation (99.91 +/- 0.63 SD) and 5 min after cessation (99.94 +/- 0.17 SD) was statistically significantly higher than the pretreatment value of 99.28 (+/- 0.63 SD). When participants received post-treatment room air, the mean SaO2 1 min after N2O cessation (99.44 +/- 0.8) was also statistically significantly higher than the pretreatment mean (99.08 +/- 0.96). After 2 min, however, the mean SaO2 decreased and was statistically indistinguishable from the pretreatment level after 5 min (99.13 +/- 0.9 SD). Fluctuations in SaO2, though statistically significant, were less than 1%. Allowing children to breathe room air immediately after cessation of N2O/O2 inhalation did not reduce SaO2 below clinically acceptable levels. This study further documents the safety of N2O/O2 sedation, and gives the clinician additional information concerning the safe and effective administration of inhalation sedation. (Pediatr Dent 15:88-92, 1993).

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Oral sedation remains a common method for managing uncooperative and/or extremely fearful pediatric patients requiring dental treatment. The purpose of this retrospective review is to report on the adverse reactions associated with the use of two oral sedation drug regimens commonly employed in pediatric dental patients. Of a combined total of 73 different patient records, 112 sedation cases from the pediatric dental program at the University of Alabama School of Dentistry were reviewed for this report. The two drug regimens were (1) chloral hydrate/promethazine and (2) meperidine/promethazine. Documentation was taken from the sedation cases, which included the following: (1) age, (2) weight, (3) the drug regimen and dosages, (4) the use of nitrous oxide, (5) the effectiveness rating of each sedation, and (6) adverse reactions. The adverse reactions included emesis and oxygen desaturation (hypoxemia) the latter being determined by the use of a pulse oximeter. The results of the study revealed that approximately 48 percent of the sedation cases with pulse oximetry recordings experienced mild to moderate hypoxemia, and in 6.2 percent of the cases, emesis occurred. The review and statistical analysis of the sedation ratings using the nonparametric analog of the t-test indicated no significant difference of effectiveness between the two drug regimens. This study shows that oxygen desaturation occurs frequently in pediatric dental patients being treated with conscious oral sedation techniques and that the prevalence of adverse reactions was similar for the drug regimens evaluated.

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