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Son G, Oh S, Lee J, Jun S, Kim J, Kim J, Lee J, Han M, Shin J. Trends in behavioral management techniques for dental treatment of patients with autism spectrum disorder: a 10-year retrospective analysis. J Dent Anesth Pain Med 2024; 24:187-193. [PMID: 38840652 PMCID: PMC11148413 DOI: 10.17245/jdapm.2024.24.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Background Patients with autism spectrum disorder (ASD) present challenges in dental treatment cooperation owing to deficits in communication skills and social interaction. Behavioral guidance, sedation, and general anesthesia may be employed to ensure the quality of dental care for individuals with ASD. This study aimed to examine the trends in dental treatment for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital, an oral health center for the disabled in the Gyeonggi region, over the past 10 years. Methods This study utilized the order communication system to gather data on sex, age, cooperation level, number of quadrants treated, and administration of sedation or general anesthesia for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital between January 2013 and December 2022. Results The total number of patients with ASD increased annually, possibly due to an increase in ASD prevalence and the hospital's designation as a center for disabled oral health. General anesthesia was predominant before 2017, with a shift towards N2O-O2 sedation. The most common age group for sedation or general anesthesia was 6-9 years, with a higher prevalence in males than in females. Notably, N2O-O2 and midazolam sedation resulted in better cooperation and fewer treated teeth than general anesthesia. Conclusion This study highlights the evolving trends in dental treatment for individuals with ASD, indicating a shift towards outpatient methods, particularly N2O-O2 sedation. The sex distribution aligns with national statistics, emphasizing a higher prevalence of ASD in males than in females. These findings underscore the need for further research to establish evidence-based guidelines for optimal dental care strategies tailored to the unique needs of individuals with ASD.
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Affiliation(s)
- Gahee Son
- Department of Pediatric Dentistry, Dankook University Jukjeon Dental Hospital, Yongin, Republic of Korea
| | - Sohee Oh
- Department of Pediatric Dentistry, Dankook University Jukjeon Dental Hospital, Yongin, Republic of Korea
| | - Jaehee Lee
- Department of Pediatric Dentistry, Dankook University Jukjeon Dental Hospital, Yongin, Republic of Korea
| | - Saeromi Jun
- Department of Pediatric Dentistry, Dankook University Jukjeon Dental Hospital, Yongin, Republic of Korea
| | - Jongbin Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Jongsoo Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Joonhaeng Lee
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Miran Han
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Jisun Shin
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Republic of Korea
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2
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Khan I. Anterior epistaxis and sedation. Br Dent J 2023; 235:233. [PMID: 37620458 DOI: 10.1038/s41415-023-6239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 08/26/2023]
Affiliation(s)
- I Khan
- Midlands Partnership NHS Foundation Trust, West Midlands, United Kingdom.
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Perez A, Gernandt S, Scolozzi P. The Use of Equimolar Mixtures of Nitrous Oxide and Oxygen in Oral Surgery-A Retrospective Study of Patients in a Swiss University Hospital Setting. J Clin Med 2023; 12:4117. [PMID: 37373810 DOI: 10.3390/jcm12124117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE The purpose of the study was to evaluate the success of procedural conscious sedation using inhaled equimolar nitrous oxide-oxygen (NOIS-EMONO) in patients undergoing routine dental and oral surgery procedures in a Swiss university hospital setting. MATERIALS AND METHODS The authors conducted a retrospective cohort study of patients that underwent NOIS-supported procedures between 2018 and 2022 at the oral surgery department of the University Hospital of Geneva (HUG), Switzerland. The primary outcome was the measurement of the procedure's success and efficacy as defined by the European Society of Anesthesiology. Secondary objectives included the analysis of the types of treatments performed, their indications, patient behavior, and the patient-clinician satisfaction score. RESULTS 55 patients were included in the study; 85% underwent surgical procedures, and the remaining 15% underwent restorative and preventive procedures. The overall treatment success rate was 98.2% and 97.9% for surgically treated patients. Out of the patients, 62% appeared relaxed, calm, and serene, while 16% expressed pain or fear during the procedure. Infiltrative administration of local anesthesia caused stress in 22% of patients. This portion was significantly lower in sub-cohorts who received local topical anesthetics (0%) or a combination of systemic and local topical analgesics (7%). Patients (75%) and clinicians (91%) were satisfied with the procedure. CONCLUSION Inhaled equimolar nitrous oxide-oxygen procedural sedation used during dental procedures and oral surgery results in high treatment success and satisfaction rates. The administration of additional topical anesthetics helps to reduce the anxiety and stress related to infiltrative anesthesia. Further dedicated studies and prospective trials are needed to confirm these findings.
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Affiliation(s)
- Alexandre Perez
- Unit of Oral Surgery and Implantology, Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Hôpitaux Universitaires de Genève, 1211 Genève, Switzerland
| | - Steven Gernandt
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Hôpitaux Universitaires de Genève, 1211 Genève, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, Hôpitaux Universitaires de Genève, 1211 Genève, Switzerland
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4
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Khan I. Postoperative Epistaxis Following Dental Treatment With Nitrous Oxide/Oxygen Sedation. Anesth Prog 2023; 70:75-79. [PMID: 37379092 PMCID: PMC10328194 DOI: 10.2344/anpr-70-01-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/16/2023] [Indexed: 06/29/2023] Open
Abstract
A 12-year-old Caucasian male undergoing a dental extraction for a grossly carious mandibular molar under inhalational sedation with nitrous oxide/oxygen experienced an episode of anterior epistaxis postoperatively that was controlled well with local measures. Epistaxis following inhalational sedation with nitrous oxide/oxygen in the dental setting is a very rare complication but has been previously reported in the literature. This case report provides a review of the existing literature regarding cases of epistaxis associated with inhalational sedation using nitrous oxide/oxygen and discusses the potential etiology of epistaxis associated with inhalational sedation. Patients at higher risk of epistaxis should be properly informed of the risks prior to inhalational sedation with nitrous oxide/oxygen, and dentists should also be familiar with epistaxis management in the dental setting.
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Affiliation(s)
- Ishfaq Khan
- Honorary Clinical Lecturer, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, UK
- Senior Dental Surgeon, Midlands Partnership University NHS Foundation Trust, University of Portsmouth, UK
- Postgraduate Student, Dental Academy, University of Portsmouth, UK
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5
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Garret-Bernardin A, Festa P, Matarazzo G, Vinereanu A, Aristei F, Gentile T, Piga S, Bendinelli E, Cagetti MG, Galeotti A. Behavioral Modifications in Children after Repeated Sedation with Nitrous Oxide for Dental Treatment: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4037. [PMID: 36901046 PMCID: PMC10002368 DOI: 10.3390/ijerph20054037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Sedation with nitrous oxide (N2O) has been widely used as a viable alternative to general anesthesia to perform dental treatments in uncooperative or anxious children. The purpose of this retrospective study is to assess if repeated sedations with N2O can improve collaboration of uncooperative children. The medical records of 650 children, aged between 3 and 14 years, who underwent at least two sedations, were consulted. Differences in the Venham score during the first sedation and subsequent sedations were collected. After removal incomplete records, 577 children's records (309 males and 268 females) were analyzed. The Venham score decreased both during each sedation and with repeated sedations (p < 0.01 for both comparisons). In particular, a significant reduction of the Venham score was observed at the first contact with the dentist, with a mean score ranging from 1.56 ± 1.46 to 1.16 ± 1.37, comparing the first and the second sedation, and from 1.65 ± 1.43 to 1.06 ± 1.30, comparing the first with the third sedation (p < 0.01). The reduction in the Venham score was recorded in both healthy and physically impaired patients, and it was significantly greater in older children than in younger children (p < 0.01). In conclusion, uncooperative children with or without physical impairments can be successfully treated with N2O sedation in order to increase their confidence in dental procedures.
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Affiliation(s)
- Annelyse Garret-Bernardin
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Paola Festa
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Giorgio Matarazzo
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Arina Vinereanu
- Department of Pedodontics, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 032799 Bucharest, Romania
| | - Francesco Aristei
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Tina Gentile
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Elena Bendinelli
- Department of Surgery and Translational Medicine, University of Florence, 50121 Firenze, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Angela Galeotti
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
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Salerno C, Cirio S, Zambon G, D’Avola V, Parcianello RG, Maspero C, Campus G, Cagetti MG. Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1779. [PMID: 36767145 PMCID: PMC9914902 DOI: 10.3390/ijerph20031779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
This systematic review and meta-analysis was aimed to investigate the conscious sedation efficiency in patients with intellectual disability undergoing dental treatment (PROSPERO CRD42022344292). Four scientific databases were searched by ad-hoc prepared strings. The literature search yielded 731 papers: 426 were selected, 42 were obtained in full-text format, and 4 more were added after hand searching. Fourteen studies were finally included, 11 of which were included in the meta-analysis (random effect model). A high heterogeneity in the drugs used and route of administration was retrieved. Success rate, occurrence of side effects, and deep sedation occurrence were combined to give an overall efficiency of each drug. N2O/O2 reported the highest efficiency (effect size = 0.90; p < 0.01) and proved to be more efficient when used alone. Nine papers reported a success rate of sedation of 80% or more. The prevalence of side effects (6 studies) ranged from 3% to 40%. Enteral and parenteral benzodiazepines showed the same overall efficiency (effect size = 0.86). No meta-analysis has yet been conducted to define the most effective and safest way to achieve conscious sedation in patients with intellectual disability; nitrous oxide appears to be the best choice to perform conscious sedation in patients with intellectual disability undergoing dental treatment.
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Affiliation(s)
- Claudia Salerno
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Giulia Zambon
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Valeria D’Avola
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Roberta Gaia Parcianello
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
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7
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Conscious Sedation in Dentistry for the Management of Pediatric Patients with Autism: A Narrative Review of the Literature. CHILDREN 2022; 9:children9040460. [PMID: 35455504 PMCID: PMC9026963 DOI: 10.3390/children9040460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
Abstract
(1) Background: the variety of autism spectrum disorder makes the definition of guidelines for dental care a challenging task. The aim of this review was to evaluate the literature concerning the use of conscious sedation for dental treatments in pediatric autistic patients. (2) Methods: we searched MEDLINE/PubMed, EMBASE, Cochrane databases in order to identify pertinent studies. The search strategy was based on these areas of interest: autistic spectrum disorder, pediatric patients, dentistry, tranquilizing agents, and conscious sedation. (3) Results: the search yielded 177 non-duplicated articles, of which 24 articles were retrieved for full text review, and 2 were found to address our review aim. The first paper was a retrospective study that included 83 autistic patients sedated either with an oral premedication combined with nitrous oxide/oxygen inhalation or with nitrous oxide/oxygen inhalation alone; the second article was a prospective trial on the effectiveness of 0.3 mg/kg of oral diazepam with 0.5 mg/kg of oral midazolam in 13 sedated uncooperative autistic patients. (4) Conclusions: this review highlights the insufficiency of studies that can provide concrete indications for the dental treatment in conscious sedation of pediatric patients with autism. New studies are needed to better define the appropriate drugs, dosages, sedation level and evaluate patient cooperation.
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8
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Kuroiwa K, Harano N, Shigeyama-Tada Y, Ono K, Watanabe S. Effects of inhalation sedation with nitrous oxide on intraoral senses. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Alshihri AA, Al-Askar MH, Aldossary MS. Barriers to Professional Dental Care among Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:2988-2994. [PMID: 33089446 DOI: 10.1007/s10803-020-04759-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
Abstract
Aims were to: (1) investigate the parental difficulties toward their ASD children dental care and, (2) analyze factors influencing their access to such services. Questionnaires were completed by 142 mothers of ASD children. Children aged between 2.5 and 14 years old, with 3.9:1 male to female ratio. 68.3% perceived difficulties in finding dental care. Most barriers were: Cost (75.4%), finding a dentist to treat ASD child (74.6%), and behavior of their ASD child (45.1%). There was no difference among age and "difficulty finding dental care" (p = 0.429). Having medical insurance and previous bad experience showed significant effects on the difficulty in finding dental care (p < 0.05). Children with ASD and their parents encounter various barriers to dental services.
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Affiliation(s)
- Abdulmonem A Alshihri
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mansour H Al-Askar
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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10
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Rabach I, Peri F, Minute M, Aru E, Lucafò M, Di Mascio A, Cozzi G, Barbi E. Sedation and analgesia in children with cerebral palsy: a narrative review. World J Pediatr 2019; 15:432-440. [PMID: 31098933 DOI: 10.1007/s12519-019-00264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications. DATA SOURCES We reviewed the available literature to highlight the specific risk factors and area of criticism, that should be further improved. We searched the Cochrane Library, Medline, Pubmed from 1987 to September 2018 using key words such as 'cerebral palsy and children and pain' or 'sedation and cerebral palsy and children'. RESULTS While different pain scales are useful in recognizing pain expressions, anxiety scales are not available. Moreover, studies on non-pharmacological techniques do not always have comparable results. Several risk factors, from anatomic abnormalities to liver and kidney functioning, should be kept in mind before proceeding with sedation. CONCLUSIONS Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy (pharmacological and non-pharmacological) should be used in different settings.
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Affiliation(s)
- Ingrid Rabach
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Francesca Peri
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy. .,University of Trieste, Trieste, Italy.
| | - Marta Minute
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | | | - Marianna Lucafò
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Giorgio Cozzi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy.,University of Trieste, Trieste, Italy
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Buhre W, Disma N, Hendrickx J, DeHert S, Hollmann MW, Huhn R, Jakobsson J, Nagele P, Peyton P, Vutskits L. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice. Br J Anaesth 2019; 122:587-604. [PMID: 30916011 DOI: 10.1016/j.bja.2019.01.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022] Open
Abstract
Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.
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Affiliation(s)
- Wolfgang Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, University of Maastricht, Maastricht, the Netherlands
| | - Nicola Disma
- Department of Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Jan Hendrickx
- Department of Anesthesiology, Onze-Lieve-Vrouwziekenhuis Hospital Aalst, Aalst, Belgium
| | - Stefan DeHert
- Department of Anesthesiology and Perioperative Medicine, University Hospital Ghent, Ghent, Belgium
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), AMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ragnar Huhn
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jan Jakobsson
- Department of Anesthesiology and Intensive Care, Institution for Clinical Science, Karolinska Institute, Danderyds University Hospital, Danderyd, Sweden
| | - Peter Nagele
- Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, IL, USA
| | - Philip Peyton
- Department of Anaesthesia, Austin Health, and Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals Geneva, Genève, Switzerland
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12
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Camoin A, Dany L, Tardieu C, Ruquet M, Le Coz P. Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network. Disabil Health J 2018; 11:412-419. [DOI: 10.1016/j.dhjo.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/29/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
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13
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M Baeder F, F Silva D, Cl de Albuquerque A, Tbr Santos M. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2018; 10:384-390. [PMID: 29403234 PMCID: PMC5789144 DOI: 10.5005/jp-journals-10005-1470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/22/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Individuals with cerebral palsy (CP) often present with oral alterations that impact oral health and require dental treatment. Aim This study aimed to evaluate the use of conscious sedation with nitrous oxide (N2O) to control stress during dental treatment in individuals with CP using as parameters: Venham score (VS), heart rate (HR), and respiratory rate (RR). Materials and methods A total of 77 CP patients >3 years of age with a mean age of 11.8 (± 6.4) years were evaluated in a rehabilitation center. Stress control was measured at the following time points: T1 (presedation), T2 (induction), T3 (sedated patient), and T4 (end). Student's t-test, the Chi-squared test, analysis of variance (ANOVA), and the McNemar test were used. The significance level was 5%. Results Sedation ranged between 10 and 60% N2O, with an average of 35.6% (± 10.4). The RR did not vary among the times (p = 0.12). The HR and VS varied significantly between times (p < 0.001), as significantly higher values of HR were observed at T1. Conclusion Conscious sedation with N2O during dental care controls stress in CP patients, as verified by a decrease in HR, and does not promote respiratory depression. Higher concentrations of N2O are recommended for CP patients with tachycardia. Clinical significance Sedation modifies behavior during dental procedures, facilitating patient collaboration.How to cite this article: Baeder FM, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2017;10(4):384-390.
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Affiliation(s)
- Fernando M Baeder
- Professor, Department of Dentistry, Universidade Cruzeiro do Sul, Sao Paulo, Brazil
| | - Daniel F Silva
- Professor, Department of Dentistry, Faculdades Integradas de Patos Paraiba, Brazil
| | - Ana Cl de Albuquerque
- Professor, Department of Dentistry, Universidade Federal de Campina Grande, Paraiba, Brazil
| | - Maria Tbr Santos
- Professor, Department of Dentistry, Universidade Cruzeiro do Sul, Sao Paulo, Brazil
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14
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Mac Giolla Phadraig C, Griffiths C, McCallion P, McCarron M, Donnelly-Swift E, Nunn J. Pharmacological behaviour support for adults with intellectual disabilities: Frequency and predictors in a national cross-sectional survey. Community Dent Oral Epidemiol 2018; 46:231-237. [DOI: 10.1111/cdoe.12365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- C. Mac Giolla Phadraig
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - C. Griffiths
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
| | - P. McCallion
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
- School of Social Work; Temple University; Philadelphia PA USA
| | - M. McCarron
- School of Nursing and Midwifery; Trinity College Dublin; Dublin Ireland
| | - E. Donnelly-Swift
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
| | - J. Nunn
- Department of Child and Public Dental Health; Dublin Dental University Hospital; Dublin Ireland
- School of Dental Science; Trinity College Dublin; Dublin Ireland
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Molina GF, Faulks D, Mazzola I, Cabral RJ, Mulder J, Frencken JE. Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability. Clin Oral Investig 2017; 22:461-467. [PMID: 28547182 DOI: 10.1007/s00784-017-2134-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.
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Affiliation(s)
- Gustavo F Molina
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina.
| | - Denise Faulks
- Service d'Odontologie, CHU Clermont-Ferrand, Université Clermont Auvergne, CROC EA4847, Clermont-Ferrand, France
| | - Ignacio Mazzola
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina
| | - Ricardo J Cabral
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina
| | - Jan Mulder
- Department of Functional Dentition and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jo E Frencken
- Department of Functional Dentition and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
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Rozas NS, Sadowsky JM, Jeter CB. Strategies to improve dental health in elderly patients with cognitive impairment. J Am Dent Assoc 2017; 148:236-245.e3. [DOI: 10.1016/j.adaj.2016.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
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Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7289310. [PMID: 27747238 PMCID: PMC5056242 DOI: 10.1155/2016/7289310] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/06/2016] [Indexed: 12/31/2022]
Abstract
Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score. Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment. Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.
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Gandhi RP, Klein U. Autism spectrum disorders: an update on oral health management. J Evid Based Dent Pract 2014; 14 Suppl:115-26. [PMID: 24929596 DOI: 10.1016/j.jebdp.2014.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
UNLABELLED Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient. BACKGROUND With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders. METHODS The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations. CONCLUSIONS A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD.
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Affiliation(s)
- Roopa P Gandhi
- Department of Pediatric Dentistry, Children's Hospital Colorado and University of Colorado School of Dental Medicine, Aurora, CO, USA.
| | - Ulrich Klein
- Department of Pediatric Dentistry, Children's Hospital Colorado and University of Colorado School of Dental Medicine, Aurora, CO, USA
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Blaizot A, Trentesaux T, Hervé C, Hamel O. Décisions thérapeutiques buccodentaires chez des patients en situation de handicap intellectuel. Éléments de réflexions éthiques apportés par les aidants. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.etiqe.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Petrovic B, Markovic D, Peric T. Evaluating the population with intellectual disability unable to comply with routine dental treatment using the International Classification of Functioning, Disability and Health. Disabil Rehabil 2012; 33:1746-54. [PMID: 21859419 DOI: 10.3109/09638288.2010.546934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to investigate the use of general anaesthesia (GA) among patients with intellectual disability (ID) in relation to the International Classification of Functioning (ICF). METHOD Twenty-seven ICF codes related to the tolerance of the dental treatment were chosen. The sample consisted of 100 children with ID divided into two groups (50 patients in whom routine dental treatment had been accomplished and 50 patients who had been treated under GA). Differences between the groups were analysed using the chi-square test, bivariate correlation and multiple logistic regression analysis. RESULTS The GA group showed higher levels with regard to the following codes: b117--intellectual function, b2801--pain in head and neck, d310--communication, d530--toileting, d540--dressing, e310--immediate family, e5400--transportation services and e5850--education and training services. The severity of ID significantly correlated with the 'Activities and Participation' codes. Three predictors of GA treatment were identified: 'Pain in head and neck' (p < 0.001), 'Transportation services, systems and policies' (p < 0.05) and 'Education and training services, systems and policies' (p < 0.05). CONCLUSIONS The use of GA increases with the severity of ID. Acute and painful conditions result in more frequent use of GA. Unfavourable environmental factors present barrier to routine dental management.
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Affiliation(s)
- Bojan Petrovic
- Department for Paediatric and Preventive Dentistry, Faculty of Medicine, Dentistry Clinic of Vojvodina, Novi Sad, Serbia.
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Hennequin M, Collado V, Faulks D, Koscielny S, Onody P, Nicolas E. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clin Oral Investig 2011; 16:633-42. [DOI: 10.1007/s00784-011-0550-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
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Zier JL, Rivard PF, Krach LE, Wendorf HR. Effectiveness of sedation using nitrous oxide compared with enteral midazolam for botulinum toxin A injections in children. Dev Med Child Neurol 2008; 50:854-8. [PMID: 19046178 DOI: 10.1111/j.1469-8749.2008.03069.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This randomized, double-blind, placebo-controlled study compared the efficacy of inhaled nitrous oxide (N(2)O) with enteral midazolam for sedation of children with cerebral palsy (CP) undergoing botulinum toxin A (BoNT-A) injections. Fifty children (29 males, 21 females; mean age 8y 2mo [SD 4y 5mo]; range 1-16y) were randomized to sedation with N(2)O (n=25) or midazolam (n=25). Groups were similar in type of CP (diplegia, 11; triplegia, three; quadriplegia, 16; hemiplegia, 16; other, three) and Gross Motor Function Classification System level (Level I, 4; II, 24; III, 4; IV, 13; V, 5). Both groups were equally sedated at time of injection (p=0.661), but those in the midazolam group were more sedated at time of discharge (p<0.001). N(2)O was more effective in reducing pain compared with midazolam as measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale (p=0.010), parental estimate of pain (p=0.009), and nursing estimate of pain (p=0.007). Parents in the N(2)O group rated it better than prior sedation with midazolam for BoNT-A injections (p=0.031). Physicians and nurses reported no difference in ease of procedure between the groups. One child in the midazolam group and eight in the N(2)O group had adverse effects, all of which resolved promptly. N(2)O appears to be an effective means of sedation for children undergoing outpatient BoNT-A injections.
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Affiliation(s)
- Judith L Zier
- Gillette Children's Specialty Healthcare, St Paul, MN, USA.
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Collado V, Nicolas E, Faulks D, Tardieu C, Manière MC, Droz D, Onody P, Hennequin M. Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course. BMC CLINICAL PHARMACOLOGY 2008; 8:3. [PMID: 18547418 PMCID: PMC2438323 DOI: 10.1186/1472-6904-8-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 06/11/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conscious sedation is used in dentistry to improve access and quality of care in patients who have difficulty coping with treatment. The aim of this prospective study was to describe a postgraduate training course in conscious sedation for dentists, with specific evaluation of the safe and effective administration of a 50% nitrous oxide in oxygen premix. METHODS 45 practitioners were trained between 2002 and 2004. They carried out 826 sessions of inhalation sedation in 662 patients. The clinical competency of this group was compared with an expert group. RESULTS There was no difference between trainees and experts in ability to complete the planned dental treatment under sedation (89.6% vs 93.2%). Trainees were less successful than experts for patients with intellectual disability (87.4% vs 94.2%, p < 0.01). For both groups, the degree of cooperation improved between initial induction and each perioperative step (Wilcoxon test, p < 0.01). However, for trainees, Venham behaviour scores varied with the type of patient (Kruskal Wallis test, p < 0.001). No major adverse effects were recorded. Trainees reported more minor adverse effects than experts (13% vs. 5.3% respectively, Fisher exact test, p < 0.001) CONCLUSION The trainee practitioners provided effective and safe inhalation sedation. This challenges the current French restriction of the 50% nitrous oxide in oxygen premix to the hospital setting. Further emphasis is required on the teaching of behaviour management skills for patients with intellectual disability.
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Affiliation(s)
- Valérie Collado
- Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France
| | - Denise Faulks
- Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France
| | - Corinne Tardieu
- Faculté d'Odontologie and Service d'Odontologie, Hôpital la Timone, 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Marie-Cécile Manière
- Faculté d'Odontologie et Hôpital Civil, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - Dominique Droz
- Faculté d'Odontologie, Département d'Odontologie pédiatrique, 96 Avenue de Lattre de Tassigny, 54004 NANCY Cedex, France
| | - Peter Onody
- Air Liquide Santé International, 10 rue Cognacq-Jay, 75341 Paris Cedex 7, France
| | - Martine Hennequin
- Univ Clermont1, EA 3847, UFR d'Odontologie, and CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, F-63003, Clermont-Ferrand, France
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