Physiologic Effects of Intra-nasal Sedation with Midazolam and Ketamine in 3-6 Years old Uncooperative Children

Objective: Several medications have been used for sedation in children in dentistry and intra-nasal route has been reported to be an efficient way regarding patient cooperation. The aim of the present study was to compare the changes in physiologic parameters following intra-nasal midazolam and ketamine administration.Methods: In this randomized cross-over double-blind trial, 17 uncooperative 3-6 years old children requiring at least two dental treatments were selected randomly and received intra-nasal ketamine (0.5 mg/kg) and midazolam (0.2 mg/kg) prior to the treatment using the other drug in the next visit. Physiologic parameters including blood pressure, heart rate, respiratory rate and O2 saturation were measured and compared during the different time intervals using two way repeated measure ANOVA.Results: The patients showed higher blood pressure and heart rate following ketamine administration compared to midazolam (p<0.001). No significant difference was found between the drugs at different time intervals regarding respiratory rate and O2 saturation. (p>0.05)Conclusion: In spite of significant differences between midazolam and ketamine regarding heart rateand blood pressure, both drugs can b e used as effective sedative medications without treatment interruption in children

Comparison of nano-hydroxyapatite and sodium fluoride mouthrinse for remineralization of incipient carious lesions.

Dental caries is an infectious disease that can be prevented in several ways. The aim of this study was to compare the efficacy of sodium fluoride mouthrinse and nano- hydroxyapatite (nano-HA) for the remineralization of incipient caries.After obtaining different concentrations of nano-HA (0-2-5-10%), 60 sound premolars fixed in acrylic blocks were coated with nail polish except for one surface. Ten teeth (control group) were stored in distilled water and the remaining 50 samples were demineralized by immersion in 13 ml of 0.1 M lactic acid and 0.2% poly acrylic acid for 48 hours. Their microhardness was then measured and compared to that of the control group. Next, the 50 test teeth were randomly divided into 5 groups of group1 (negative), group 2 (2% nano-HA), group 3 (5% nano-HA), group 4(10% nano-HA) and group 5 (0.2 NAF mouthrinse). The microhardness of the teeth was measured after 12 hours of immersion in the above-mentioned solutions. Data were analyzed using repeated measures analysis of variance (ANOVA).Microhardness of all samples decreased significantly after immersion in the demineralization solution and increased following immersion in nano-HA and NAF mouthrinses; however, this increase was not statistically significant (P=0.711).Nano-HA and NAF mouthrinses can greatly enhance remineralization and increase tooth microhardness

Effect of Intranasal Sedation Using Ketamine and Midazolam on Behavior of 3-6 Year-Old Uncooperative Children in Dental Office: A Clinical Trial

Objectives: The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments.  Materials and Methods: In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg) or midazolam (0.2mg/kg) prior to treatment. The other medication was used in the next visit. The children’s behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA. Results: The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002); movement of children decreased with fewer incidence of treatment interruption (P=0.001) while their sleepiness increased (P=0.003). Despite higher success of sedation with ketamine compared to midazolam, no significant differences were found between the two regarding patients’ overall behavior (P>0.05). The patients had higher heart rate and blood pressure with ketamine; however, no significant difference was found regarding respiratory rate and oxygen saturation (P>0.05).  Conclusions: Ketamine (0.5mg/kg) led to fewer movements, less crying and more sleepiness compared to midazolam (0.2mg/kg). No significant differences were found between the two drugs regarding children’s overall behavior and sedation efficiency. Both drugs demonstrated positive efficacy for sedation of children during dental treatments.

Incidence Assessment of MTHFR C677T and A1298C Polymorphisms in Iranian Non-syndromic Cleft Lip and/or Palate Patients

Background and aims. The aim of the present study is to determine the incidence of MTHFR C677 T and A1298C muta-tions in Iranian patients with cleft lip and/or cleft palate. Materials and methods. We screened 61 Iranian patients with cleft lip and/or cleft palate for mutations in the two alleles of MTHFR gene associated with cleft lip and/or palate: A1298C and C677T, using Polymerase Chain Reaction following by RFLP. Results. The 677T and 1298C homozygote genotypes showed a frequency of 36.1% and 11.4%, respectively. Combined genotype frequencies in newborns having oral clefts showed that the highest genotype was 677TT/1298AA (22.9%) and 677TT/1298CC genotypes were not observed. Conclusion. The results showed that 65.6% of all patients had at least one T mutant allele in C677T and 58.9% C mutant allele for A1298C. According to the frequencies of homozygosity of mutant alleles, it could be said that MTHFRgenotype of 677TT shows a greater role in having oral clefts