Factors Involved in Caries Experience of Dentally-fearful Patients

Background: The aim of this study was to investigate the factors that associate the decayed, missing due to caries, and filled teeth (DMFT) index of patients with dental anxiety during dental treatment discontinuation.Methods: A total of 110 patients who complained of fear and anxiety toward dental treatments and who re-visited following treatment discontinuation were enrolled in the study. Patient and dental data considered to be related to caries were digitally collected from medical and dental records. The decayed (D), missing (M), and filled (F) scores, and the DMFT index before and after discontinuation were compared using Wilcoxon signed-rank tests, and the associated factors were evaluated using the Poisson and multiple regression analyses.Results: The D score and DMFT index augmented significantly during the discontinuation period, and the F score reduced. There was no significant change in the M score. The change in the D score was associated by the pre-discontinuation D score and the number of experiences of intravenous sedation, and the change in the F score was associated by the duration of treatment discontinuation, the DMFT index before discontinuation, and the number of experiences of intravenous sedation. The upsurge in the DMFT index was associated by the experience of intravenous sedation, the D and M scores, and the DMFT index before discontinuation.Conclusion: Discontinuation of dental treatment was proven to be associated with the incidence of caries in dentally-fearful patients

The denyning of patient’s appeal for additional local anesthesia is related to post-traumatic stress disorder symptoms about dental treatment.

The aim of this study was to identify traumatic dental events that are related to post-traumatic stress disorder (PTSD) symptoms.At a dental clinic, first-time visitors were given a questionnaire that asked patients to indicate whether they felt fear in differentdental situations. Patients’ dental anxiety was assessed using the short version of the Dental Anxiety Inventory (S-DAI).Patients’ trauma from dental treatments was assessed using the Impact of Event Scale-Revised (IES-R). Scores indicated that16.5% of patients suffered from PTSD symptoms. A weak positive correlation was observed between S-DAI scores and IES-Rscores. In a logistic regression analysis, “Not being able to get an anesthetic injection despite reporting pain during treatment”had independent effects on the PTSD symptom group. Our results suggest that a past experience with a dentist who denied apatient’s appeal for additional local anesthesia is related to the patient’s PTSD symptoms about dental treatment

Reliability and validity of the short version of the Dental Anxiety Inventory (S-DAI) in a Japanese population

Aim: The aim of this study was to establish the reliability and validity of the Japanese version of the short version of the Dental Anxiety Inventory (S-DAI).Methods: The Japanese translated versions of the S-DAI and Dental Fear Survey (DFS) were administered to patients and attendants who were visiting a general dental office.Results: One hundred and sixty-seven participants (response rate = 90.3%) filled out two questionnaires assessing dental anxiety (The Japanese S-DAI and DFS). Cronbach’s α for the reliability of the Japanese S-DAI in the present sample was 0.908. In the Japanese S-DAI, factor analysis revealed one factor with an eigenvalue >1. The Japanese S-DAI correlated with the DFS (r=0.812, p<0.001).Conclusions: The Japanese version of the S-DAI appears reliable and demonstrates cross-cultural validity. It may be a valuable tool for quantifying dental fear in Japanese populations

Management of gingival hyperplasia associated with sore mucositis in an acute leukemia patient

Gingival enlargement is a prominent symptom in patients with myelomonocytic leukemia (AML-M4) and acute monocytic leukemia (AML-M5). Poor oral hygiene may aggravate the condition. However, patients are apt to avoid oral care out of fear of the pain and hemorrhage associated with the myelopoietic disorder. Here we report a case of a patient with AML-M4 in whom oral care intervention from an early stage improved the quality of life by relieving the pain associated with mucositis and gingival overgrowth aggravated by preceding periodontal lesions

The effect of midazolam administration for the prevention of emergence agitation in pediatric patients with extreme fear and non-cooperation undergoing dental treatment under sevoflurane anesthesia, a double-blind, randomized study

Background: Sevoflurane is generally the preferred anesthetic agent for general anesthesia in pediatric patients, due to its rapid induction and recovery characteristics. However, it has been recognized that a major complication is emergence agitation when awakening from general anesthesia. The aim of this study was to evaluate the occurrence rate of emergence agitation in the operating room and postoperative recovery area following intraoperative administration of midazolam to pediatric patients under general anesthesia. Patients and methods: One hundred and twenty pediatric patients undergoing dental treatment under sevoflurane anesthesia were enrolled in this study. The patients were divided into three groups (n=40 each in the 0.1 mg/kg midazolam, 0.05 mg/kg midazolam, and control with saline groups). Midazolam or saline was injected intravenously approximately 30 minutes before the end of the dental treatment. We used the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and drowsiness at emergence phase in the operating room. We also used the Pediatric Anesthesia Emergence Delirium Scale (PAED) to assess the level of agitation and delirium at the full recovery phase from anesthesia in the recovery area. Results:At the emergence phase, the incidence of emergence agitation in the 0.1 mg/kg midazolam group was significantly lower than in the other groups (p=0.0010). At the recovery phase, there was no significant difference among the three groups. The odds ratio between PAED score and RASS score was 4.0 using logistic regression analysis. The odds ratio between PAED score and Disability was 2.5. Conclusion: Administration of a single dose of 0.1 mg/kg midazolam dose significantly decreases the incidence of severe emergence agitation at the emergence after sevoflurane anesthesia, but not at the recovery phase. Furthermore, the evaluation of sedative and agitation condition using RASS score at emergence from anesthesia is useful to predict occurrence of agitation in the recovery phase

Effects of midazolam on acquisition and extinction of conditioned taste aversion memory in rats.

Some intravenous anesthetic agents such as midazolam are known to induce anterograde and retrograde amnesia. We analyzed the effect of midazolam by the conditioned taste aversion (CTA) acquisition and retention. After the rats were offered 0.1% sodium saccharin (Sac) as conditioned stimulus (CS), an intraperitoneal (i.p.) injection of several concentrations (5-30mg/kg) of midazolam was followed by an i.p. injection of 0.15M LiCl (2% of body weight) as unconditioned stimulus (US). The rats, which acquired CTA by every CS-US paradigm, strongly avoided Sac on the 1st test day after conditioning and maintained the avoidance for 3 days. We have already reported that Sac intake abruptly increased on the 2nd test day and the almost complete extinction occurred on the 3rd test day after conditioning by injection of subhypnotic dose of propofol before LiCl-injection. In contrast, we found that subhypnotic dose of midazolam suppressed not only CTA acquisition, but also CTA retention. On the other hand, an alpha2-adrenergic blocker, yohimbin (1mg/kg) suppressed only the CTA retention. These results suggest that the subhypnotic doses of midazolam firstly affect the acquisition mechanism of the CTA memory (CTAM), resulting the suppression of the retention of CTAM

Nasal high flow improves ventilation during propofol sedation: A randomized cross-over study in healthy volunteers

Objective: Hypoventilation and carbon dioxide (CO2) retention are common during sedation. The current study investigated the ventilation responses to nasal high flow (NHF) during sedation with propofol. Methods: NHF of 30 L/min and 60 L/min with room air was applied during wakefulness and sedation in 10 male volunteers. Ventilation was monitored by respiratory inductance plethysmography, transcutaneous partial pressure of CO2 (TcCO2), and SpO2. Results: During sedation, NHF of 30 L/min and 60 L/min reduced the TcCO2 by 2.9 ± 2.7 mmHg (p = 0.025) and by 3.6 ± 3.4 mmHg (p = 0.024) without affecting SpO2 and reduced the mean respiratory rate by 3 ± 3 breaths/min (p = 0.011) and by 4 ± 3 breaths/min (p = 0.003), respectively. Conclusion: During sedation with propofol, NHF without supplemental oxygen attenuated CO2 retention and reduced the respiratory rate. The findings show that NHF can improve ventilation during sedation, which may reduce the risk of complications related to hypoventilation

Management of post-hyperventilation apnea during dental treatment under monitored anesthesia care with propofol

Although hyperventilation syndrome generally carries a good prognosis, it is associated with the risk of developing severe symptoms, such as post-hyperventilation apnea with hypoxemia and loss of consciousness. We experienced a patient who suffered from post hyperventilation apnea. A 17-year-old female who suffered from hyperventilation syndrome for several years developed post-hyperventilation apnea after treatment using the paper bag rebreathing method and sedative administration during a dental procedure. We subsequently successfully provided her with monitored anesthesia care with propofol. Monitored anesthesia care with propofol may be effective for the general management of patients who have severe hyperventilation attacks and post-hyperventilation apnea. This case demonstrates that appropriate emergency treatment should be available for patients with hyperventilation attacks who are at risk of developing post-hyperventilation apnea associated with hypoxemia and loss of consciousness