A case report of haemophilia: a review of haemophilia and oral health implications

Haemophilia is an inherited haematological disorder that can result in prolonged bleeding in patients. Dental procedures such as extractions and periodontal surgery can be associated with post-operative bleeding; therefore, patients with the diagnosis of haemophilia must have proper medical management. In this article, we aim to illustrate the importance of: having the appropriate knowledge to manage a patient with haemophilia suspected by the dental team; the need for proper medical management; and referral of patients with symptoms of a bleeding disorder.

Comparing Behavior Outcomes with Rubber Dam or IsoVac Isolation in Patients Undergoing Moderate Sedation

Purpose: To evaluate the behavior of moderately sedated pediatric patients treated using rubber dam (RD) or IsoVac isolation.<br/>Methods: A retrospective chart review was completed for patients who underwent restorative procedures under moderate sedation. Behavioral and Frankl scores were evaluated to determine which isolation technique (RD or IsoVac) resulted in better behavior outcomes.<br/>Results: A total of 112 charts were reviewed from October 2019 to May 2021. Fifty- one patients were treated with RD isolation and 61 with IsoVac. Behavioral and Frankl scores were analyzed and showed that RD isolation was associated with better behavior at the time of placement as well as a better overall sedation Frankl score in comparison to IsoVac (P <0.05).<br/>Conclusions: This study showed an association between RD isolation and better behavior during moderate sedation when compared to the IsoVac.

Developing a Classification System for Prioritizing Pediatric Dental Patients Needing Treatment under General Anesthesia

PURPOSE

The aim of this study was to explore a classification system for children requiring full-mouth dental rehabilitation (FMDR) in the operating room (OR) and its association with adverse events.

METHODS

Patients treated at a pediatric dental residency clinic and determined to need FMDR in the OR were classified on initial examination, based on the extent of caries, pain and the presence of a dental abscess. On the treatment date, parents were given a questionnaire concerning adverse events that occurred while waiting for treatment. Χ2 tests of independence were used to determine associations between classification (OR code) and the occurrence of adverse events. The Pearson's r test was used to determine relations among adverse events and wait time.

RESULTS

The study included 82 patients (age range 2-10 years, mean 4.73 years, median 4 years). The average wait time was 55.6 days. The most common OR classification was caries in the outer third of dentin without pain or abscess, and the most common adverse event was difficulty eating or drinking. The OR code category most closely associated with negative outcomes was the presence of a dental abscess, followed by caries depth, then pain. Wait time was not associated with the occurrence of adverse events.

CONCLUSIONS

These data provide evidence to support the need for a classification system for children requiring FMDR in the OR. Dental abscess, caries depth and pain were associated with adverse events.

Effectiveness of Intranasal Dexmedetomidine with Nitrous Oxide Compared to Other Pediatric Dental Sedation Drug Regimens

Purpose: The purpose of this study was to compare the effectiveness of intranasal dexmedetomidine (DEX), oral midazolam (MID), and oral midazolam combined with oral hydroxyzine (MIDHYD) with nitrous oxide when used for sedation during pediatric dental procedures. Methods: The charts of 146 patients who underwent dental procedures using moderate sedation with DEX, MID, or MIDHYD, all with nitrous oxide, from January 2014 to December 2019, were reviewed retrospectively. Sedations were evaluated for effectiveness based on sedation level and behavior using a modified University of Michigan Sedation Scale and behavior using the American Academy of Pediatric Dentistry sedation behavior scale. Procedures planned and completed were evaluated for each sedation regimen. Results: Overall, the effectiveness was not statistically different between sedation regimens (P=0.71). More stainless steel crowns were planned and completed with DEX, more resins were planned and completed with MIDHYD, and more extractions were planned and completed with MID. The onset of action and working time were found to be statistically significant between sedation regimens; DEX had the longest working time. Conclusions: This retrospective study found that intranasal dexmedetomidine with nitrous oxide showed no statistical difference in effectiveness, compared with oral midazolam or oral midazolam combined with oral hydroxyzine and nitrous oxide, in moderate sedation for pediatric dental procedures. The majority of stimulating time-consuming procedures were completed in the DEX sedation regimen.

Evaluation of Anatomic Features and Assessment Tools to Determine Treatment of Ankyloglossia

Purpose: To evaluate the use of lingual frenotomy assessment tools and the anatomical features most commonly used by dentists and otolaryngologists to determine if a frenotomy was indicated.<br/>Methods: A nine-question survey was distributed to American Academy of Pediatric Dentistry members and otolaryngologists in the American Medical Association. The survey consisted of three categories: (1) demographics; (2) use of a standardized assessment tool; and (3) assessing anatomical features for frenotomy. Three different cases of ankyloglossia were given to assess which anatomical features were used to determine if a frenotomy was needed.<br/>Results: Subjects included 404 practitioners. The most common frenotomy assessment tool utilized was the Hazelbaker assessment tool, followed by the LATCH and Bristol tongue assessment tools. The anatomical features used by most responders in determining if a frenotomy was indicated were the appearance of the tongue when lifted, tongue protrusion, frenulum length, and frenulum type.<br/>Conclusions: Many practitioners believe frenotomies for ankyloglossia are indicated when there is a functional impairment and an anatomical component. This study suggests that the general appearance of the tongue when lifted is the most common anatomical feature used for assessing the need for a frenotomy.

A Retrospective Evaluation of the Safety Profile of Dexmedetomidine and Nitrous Oxide for Pediatric Dental Sedation

Purpose: The purpose of this study was to compare the safety of three different sedation regimens for pediatric dental procedures to examine the safety of intranasal dexmedetomidine paired with nitrous oxide (N₂O). Methods: This was a retrospective chart review of 149 three-to six-year-old healthy patients who underwent sedation to complete dental treatment. Forty-nine patients received intranasal dexmedetomidine with nitrous oxide (DEXNO), 47 received oral midazolam with nitrous oxide (MIDNO), and 53 received oral midazolam and oral hydroxyzine with nitrous oxide (MIDHYXNO). Demographic data, procedural times, vital signs, and adverse events were recorded. Results: No patients in any of the three groups experienced major adverse events. All groups experienced some degree of hypotension. One of the 49 DEXNO cases experienced bradycardia intraoperatively. No cases required clinical intervention. Conclusion: This pilot study suggested that intranasal dexmedetomidine with nitrous oxide is a safe sedation regimen for pediatric procedures, comparable to combinations of oral midazolam with nitrous oxide and oral midazolam and oral hydroxyzine with nitrous oxide.

Perinatal Oral Health Education and Compliance with the First Dental Visit

Purpose: The purpose of this study was to determine which mode of education given to mothers of newborns resulted in the greatest compliance for establishing an age one dental visit and identify reasons why mothers do not bring their child for their first dental visit.<br/> Methods: Several modes of education presented information to mothers: (1) written literature provided by a nurse; (2) a nurse verbally presenting and providing literature; (3) a resident verbally presenting and providing literature; and (4) control-no education. The chi-square test of homogeneity was utilized to determine if there was a difference in compliance to make an age one dental appointment.<br/> Results: The retained sample consisted of 277 children evaluated between 2014 and 2018. There was no statistical difference between the educational methods regarding compliance to make an age one dental visit (P >0.05). There was a significant difference between marital status (P =0.0005), with 95 percent of single mothers likely to schedule the visit.<br/> Conclusion: No particular maternal educational method resulted in greater compliance with scheduling an age one dental visit. Single mothers were more likely to schedule the visit. The primary reason for not visiting was a lack of primary care provider recommendations.

Discrepancies Between Dental Parent-Derived Health Histories and Medical Electronic Health Records

Purpose: Many dentists utilize health history forms completed by patients' parents/guardians to obtain medical histories. It is unknown if parent-derived health histories are consistent with histories completed by health care providers. The purpose of this study was to compare patient medical electronic health records (EHRs) with parent-/guardian-derived dental health histories in order to identify, quantify, and compare discrepancies of patient medical conditions, medications, and allergies. Methods: Two-hundred randomly selected patient dental charts and corresponding EHRs were reviewed retrospectively from a preexisting patient pool. The number of conditions, medications, and allergies in the dental chart and on the patient's accompanying EHRs were quantified and recorded. Results: Discrepancies between the two records were present for 97.5 percent of patient charts. All charts without discrepancies were for those patients who did not have any past medical history, take any medications, or have any allergies. Chart discrepancies often included conditions involving the head, cardiac, and respiratory systems. Conclusion: It is important for dentists not to rely solely on parent-derived information or medical records. At the initial encounter, dentists should request a history from the patient's physician and review it with the parents for accuracy. Updates should be obtained at each appointment to obtain an accurate medical history. (Pediatr Dent 2019;41(5):371-5).