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

Evaluation of The Effect of Fluoride Gel and Varnish on The Demineralization Resistance of Enamel: An in Vitro

Background and Aim : Fluoride has an important role in the prevention of caries. This study assessed the efficacy of three types of topical fluoride: fluoride varnish, APF gel (sultan), APF gel (Kimia) in protecting the enamel from demineralization in an in vitro environment .  Materials and Methods : Sixty human caries-free premolars where randomly assigned into four groups of 15 specimens. The control group was washed with deionized/distilled water. Weekly gel (Kimia) was treated with APF gel (1/23%) for 2 minutes weekly, weekly gel (Sultan) was treated with APF gel (1/23%) for 60 seconds weekly, weekly varnish fluoride was treated with Durashield (2/26%). Specimens were then placed in a cycle of demineralization (pH= 4.3) for 6 hours and remineralization (pH= 7) for 17 hours. This pH- cycle was repeated for 3 weeks (21days). The teeth were sectioned buccolingually and evaluated under polarized light microscope. Then the depth of each lesion was measured from the deepest demineralization point of the lesion. The data were analyzed using Kruskal-Wallis and Dunn test for pairwise comparison . Results : The control group had the deepest lesions (mean depth, 140±37micrometer). The varnish group had the shallowest lesions (mean depth, 60±37 micrometer) with a 75.3% reduction percent. However, there was no significant difference in the depth of demineralization between all fluoride treated groups. The difference between fluoride groups and the control group were significant. Conclusion : Treatment of the enamel of permanent teeth with various topical fluorides significantly inhibited demineralization, but there was no significant difference between varnish or gel application

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.

Effect of Self-Etching and Single-Bottle Bonding Systems On Shear Bond Strength of Fissure sealant to Primary and Permanent Enamel

Background and Aim: Application of self-etching bonding systems to primary and permanent teeth has increased due to the simplicity of work and fewer steps. This experimental study aimed to compare the effect of conventional acid etching and single-bottle and self-etching bonding systems on shear bond strength (SBS) of light-cured fissure sealant to primary and permanent enamel .   Materials and Methods: In this experimental study, the smoothest unprepared proximal enamel surfaces of 30 primary molars (groups 2, 4 and 6) and 30 permanent premolar teeth (groups 1, 3 and 5) were divided into 6 groups of 10. Groups 1 and 2 (control) were acid-etched and received light-cured fissure sealant (Concise 3M-ESPE). Groups 3 and 4 (SB) were subjected to acid etching + Single Bondadhesive + fissure sealant. Groups 5 and 6 (PLP) received self-etching bonding system (Prompt L-Pop, 3M, ESPE) + fissure sealant. Specimens were then subjected to 500 thermal cycles with the dwell time of 30 seconds. Shear bond strength was determined using Universal Testing Machine (Zwick, Germany). Mode of fracture was determined under stereomicroscope and data were analyzed using ANOVA, (between-subjects effect) and LSD .   Results: SBS was not significantly different between the control and PLP or SB and PLP groups (P>0.05). However, the difference in SBS between the control and SB groups was statistically significant (P=0.022). The SBS in primary teeth was less than in permanent teeth in all groups (P<0.05 ).   Conclusion: Self-etching bonding system (PLP), similar to conventional acid etching technique, provides adequate bond between the light-cured fissure sealant and unprepared enamel. Application of Single Bond Adhesiveeffectively increased the fissure sealant bond strength

Comparison of various concentrations of tricalcium phosphate nanoparticles on mechanical properties and remineralization of fissure sealants.

The aim of this study was to investigate the mechanical properties (flexural strength, micro-shear bond strength) and remineralizing potential of fissure sealants by adding various concentrations of β-tricalcium phosphate nanoparticles.This in-vitro study consisted of five experimental groups containing prepared nano-fisssure sealants (1-5 wt.% β-TCP nanoparticles) and two control groups containing a prepared and a commercial fissure sealant. Flexural/micro-shear bond strength values were measured using Zwick test machine. Cavities on sixty healthy premolar teeth were filled with the fissure sealants containing 0-5 wt.% of nano β-TCP. The samples were assessed for remineralization under scanning electron microscopy (SEM) and EDAX. Kolmogorov-Smirnov test, One-way ANOVA and Tukey's Post Hoc analysis/HSD were used to analyze the data.There was no significant difference between the flexural strengths/elastic modulus of the 0-5 wt.% nano β-TCP groups (p>0.05). The average flexural strength/elastic modulus of the prepared fissure sealant group (0%) was significantly higher than the commercial fissure sealant group (Clinpro) (p0.05). Examining the samples under SEM showed a significant increase in thickness of the intermediate layer with increasing concentrations of β-TCP nanoparticles (

Pomegranate juice (punica granatum): a new storage medium for avulsed teeth.

There is evidence indicating that pomegranate juice contains many of the essential properties necessary to retain cell viability and cell proliferation. These properties indicate that pomegranate juice is a suitable storage medium for avulsed teeth. However, this idea has not yet been tested. In this study, the capacity of pomegranate juice (PJ) as a storage medium for retaining avulsed teeth was evaluated.PDL fibroblasts were obtained from healthy human premolars and cultured in Dulbecco's Modified Eagle's Medium (DMEM). Cultured cells were subjected to different concentrations of pomegranate juice (PJ), 1% Hank's balanced salt solution (HBSS) and tap water for 1, 3, 6 and 24 hours. PDL cell viability was assessed by the neutral red uptake assay.The results indicated that 7.5% PJ was the most effective solution for maintaining PDL cell viability amongst all the experimental solution's and time intervals (