Predictable sedation: Safe administration of oral Midazolam and nitrous oxide gas for paediatric patients in the general dental practice

Behaviour management for anxious paediatric dental patients is challenging. Solutions include education and sedation. Various drugs have been used to effectively sedate paediatric patients during treatment. The aim of this study was to review literature on the sedation of paediatric patients. The study specifically looked at those reviews covering the combination of two sedation methods in case of more challenging paediatric patients. The study undertook a literature review focused on studies using nitrous oxide, Midazolam, or a combination of the two substances. An electronic search was done on EBSCOhost to source articles published from 1979 to 2019. A deeper form of sedation can be achieved for paediatric patients when using a combination of nitrous oxide, oxygen and a hypnotic agent such as Midazolam. Dealing with the anxiety levels of paediatric patients is a challenge for dental health providers. Two of the main strategies used to deal with anxious children are behaviour management and sedation. A critical review of journal articles on the use of nitrous oxide and oxygen in combination with Midazolam was therefore undertaken. The findings suggest that, in order to achieve a deeper form of sedation, the combination of nitrous oxide, oxygen and Midazolam works well to reduce discomfort, anxiety and/or pain in paediatric patients

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without  periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical interventio

A comparison between the band-and-loop space maintainer with a loop-design fibre-reinforced composite space maintainer

The band-and-loop space maintainer (BLSM) is a non-invasive device commonly used to maintain space after the early loss of a single deciduous tooth until the permanent tooth erupts. Unfortunately, however, these devices are difficult to fabricate, require laboratory work and are expensive. Clinically, they tend to fracture, bend or debond under occlusal forces and they are not considered aesthetic. These obvious limitations and challenges warrant the investigation of new materials and device designs for the treatment of premature single tooth loss. The fibre-reinforced composite space maintainer (FRCSM) has many advantages and has been suggested as an alternative to the BLSM. This study considers the clinical failure rates and reasons for failure for a loop-design FRCSMs, as placement techniques have not yet been standardised. The aim of the study was to comparatively investigate the in vivo failure rates (as well as the reasons for failures) of the loop-design FRCSM and the metal BLSM over a 6 month period. The data collected could be useful in the development of more successful FRCSMs. A total of 20 space maintainers were placed – 10 BLSMs and 10 loop-design FRCSMs. For each BLSM placement, an orthodontic band was fitted around the anchor tooth and an alginate impression was taken. This impression, with the band in position, was sent to the dental laboratory for fabrication of the device. At a second appointment, the BLSM was fitted and cemented with glass ionomer cement. For each FRCSM placement, a unidirectional glass fibre bundle was positioned in a continuous loop design extending from the buccal to the lingual surface of the anchor tooth. The fibre bundle was secured in position with a flowable composite, light-cured, and subsequently finished and polished. Monthly follow-up appointments were scheduled over a six-month period and parents/ patients were instructed to report immediately for an emergency appointment if any problem or failure occurred between these arranged appointments. This ensured that the timing of (and reasons for) the failures of both types of device were accurately recorded. With respect to the BLSM, the main reason for device failure was bending of the wire and subsequent impingement on the soft tissue. With respect to the FRCSM, the main reasons for device failure were debonding at the enamel-composite interface and fibre loop fracture. Within the six month follow-up period, both space maintainer types exhibited a 50% failure rate, but 30% of the failed FRCSMs could be repaired chairside whilst the failed BLSMs had to be refabricated in the laboratory. Although the results of this study do not show a significant statistical difference between the failure rates of the two space maintainer types tested (p=0.53), the FRCSM performed well clinically in that it was more easily repairable and remained clinically effective even in cases where the device broke. From the data gathered during this study, it is recommended that further research be done on the effectiveness of the loop-design FRCSM when it is bonded to permanent teeth, and on whether this device would prove more successful if mechanical retention were enhanced when bonding the device to deciduous tooth enamel. Whilst this study has generated valuable new clinical information, the FRCSM cannot yet be confidently recommended as a reliable alternative to the BLSM. Further research on this topic (based on a larger sample size and with a longer follow-up period) is necessary.Dissertation (MSc Dentistry)--University of Pretoria, 2017.Community DentistryMSc DentistryUnrestricte

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

INTRODUCTION : Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without peri-apical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. CASE DESCRIPTION : A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone All of the lesion. CONCLUSION : Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention.https://www.sada.co.za/the-sadjam2022Odontolog

Facilitating technology-enhanced external examination moderation during the Covid-19 pandemic

Due to the Covid-19 pandemic and associated travel restrictions, the physical presence of international external examiners was a challenge when assessing the exit level outcomes of the MSc (Dent) in Paediatric Dentistry at the University of the Western Cape. External moderation of final examinations ensure an acceptable standard, coverage of content as specified by the programme outcomes and eliminates bias during assessment. Internationalization of the moderation andexamination process allows countries to compare and maintain international standards and graduate attributes expected for professional qualifications.Qualifications requiring assessment of skills often rely on ObjectiveStructured Clinical Examinations, Objective Structured Practical Examinations and simulated cases in combination with an oral examination, which requires the presence of all examiners to assess the student. This paper describes how the final examination in this MSc (Dent) degree was adapted and conducted in order to overcome the challenges of the Covid-19 pandemic, to maintain the academic integrity and rigour of the programme. A narrative essay-style approach was adopted, which reflects on the challenges and opportunities created by Covid-19. The adapted assessment method proved to be an effective alternative to the more traditional assessment approaches employed pre-Covid

Macrodontia and Dens Invaginatus - Review of the literature and a case report

Disturbances in histodifferentiation and morphodifferentiation may include genetic or environmental factors. These disturbances often lead to dental anomalies. This paper reviews the aetiology, clinical and radiographic appearance, diagnosis and treatment options for macrodontia and dens invaginatus respectively. A rare case is presented in which the two anomalies occurred directly next to each other in the anterior dentition of a young boy. The diagnostic process and management are reported with a detailed explanation of the use of modern diagnostic aids and equipment. The procedure of apexification is also described in detail as both anterior teeth were still immature when they turned necrotic. A 2-year follow up reported the successful treatment resolution of infection and associated symptoms, as well as restoration of function and aesthetics

Minimally invasive management of a labial talon cusp : clinical review and case report

This case report presents the management of a rare occurrence of a labial talon cusp on a permanent maxillary lateral incisor. The buccal projection was reduced with a minimally invasive approach, with the aim of avoiding pulpal exposure during tooth preparation and thereby maintaining the vitality of the pulp. A direct resin veneer was placed to mask the remaining projection and to address the aesthetic concerns of the patient.https://www.sada.co.za/the-sadjOdontologyOral Pathology and Oral Biolog

Apexogenesis treatment with mineral trioxide aggregate : long-term follow-up of two cases

Apexogenesis is the treatment of choice for traumatized or carious teeth which, at the time of exposure, have a vital pulp and open apex. This article describes two cases of permanent teeth with carious exposures, treated with direct pulp capping procedures using mineral trioxide aggregate (MTA). METHODS : Radiographic and clinical examination, including testing reaction to cold, showed that both teeth were immature and in a stage of reversible pulpitis. The caries was identified using caries detector dye and removed using a rotary bur. Sodium hypochlorite solution was applied to the exposed pulp to achieve haemostasis. MTA paste was then placed on the pulp exposure and surrounding dentine. In the first case, the MTA was covered with a glass-ionomer restorative material; in the second case, the MTA was covered with a glass-ionomer cement and restored with composite resin. RESULTS : Radiographic and clinical examinations on the initial and longterm follow-up visits showed that root development continued and apices formed. The teeth remained vital and functional, and no further endodontic intervention was necessary. CONCLUSION : Under the conditions of this study, MTA proved to be a reliable pulp-capping material on direct carious exposures in immature permanent teeth using a one-visit protocol.https://www.sada.co.za/the-sadjam2019Odontolog

Macrodontia and dens invaginatus - review of the literature and a case report

Disturbances in histodifferentiation and morphodifferentiation may include genetic or environmental factors. These disturbances often lead to dental anomalies. This paper reviews the aetiology, clinical and radiographic appearance, diagnosis and treatment options for macrodontia and dens invaginatus respectively. A rare case is presented in which the two anomalies occurred directly next to each other in the anterior dentition of a young boy. The diagnostic process and management are reported with a detailed explanation of the use of modern diagnostic aids and equipment. The procedure of apexification is also described in detail as both anterior teeth were still immature when they turned necrotic. A 2-year follow up reported the successful treatment resolution of infection and associated symptoms, as well as restoration of function and aesthetics.https://www.sada.co.za/the-sadjam2022Odontolog

The attitudes and perceptions towards the Covid-19 vaccine among dental staff at the University of the Western Cape, South Africa

Despite the well-known increased risk of exposure to the Covid-19 virus in a dental setting, vaccination rates among staff members are low. This information, as well as the possible associations to demographic profiles, may be useful for authorities to adequately address specific concerns and uncertainties. To determmine the attitudes and perceptions towards the COVID-19 vaccine among dental staff at the UWC Oral Health Centers. A cross-sectional design was used. An anonymous, online, validated questionnaire was used to collect the data. Majority (91.4%) of the participants had received the Covid-19 vaccine while just over 12% stated that they would not take the booster vaccination. Significant associations between the level of education and the attitudes and perceptions of staff were found. While the majority had a positive attitude towards the Covid-19 vaccine, specific concerns and uncertainties were identified and will need to be addressed in order to improve vaccination rates among staff member