RESUMOS INDEXADOS - Fonte Bireme

Título: Implementation of behaviour management techniques--how well accepted they are today.
Fonte: J Indian Soc Pedod Prev Dent; 21(2):70-4, 2003 Jun.
ISSN: 0970-4388
País de publicação: India
Idioma: eng
Resumo: Dynamic changes in society with working parents and smaller nuclear families have brought about a sea of changes in parental attitudes and anxieties towards their children. This has affected the perception and implementation of behaviour modification techniques by the dentist. Today, the significance of Tell Show Do technique and its efficiency in behaviour modification is questionable. Insistence of parents on conscious sedation is seen to be on the rise. This study aimed to assess the change in the utilization pattern of behaviour management techniques by pediatric dentists of Punjab in the past five years along with identification of change in parental attitude towards these techniques.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 59467-70-8 (Midazolam)

Autor: Paterson SA; Tahmassebi JF
Endereço: Department of Paediatric Dentistry, Leeds Dental Institute.
Título: Paediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry.
Fonte: Dent Update; 30(7):350-6, 358, 2003 Sep.
ISSN: 0305-5000
País de publicação: England
Idioma: eng
Resumo: Provision of General Anaesthesia is now limited and restricted to the hospital setting. Sedation for paediatric patients is an essential tool in anxiety management and is used as an adjunct to behaviour management. Inhalation sedation with nitrous oxide/oxygen sedation to reach a plane of relative analgesia may be administered easily and safely to children in general dental practice and is a potential alternative to general anaesthesia.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 1002

Autor: Peretz B; Glaicher H; Ram D
Endereço: Department of Pediatric Dentistry, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel. benny@cc.huji.ac.il
Título: Child-management techniques. Are there differences in the way female and male pediatric dentists in Israel practice?
Fonte: Braz Dent J; 14(2):82-6, 2003.
ISSN: 0103-6440
País de publicação: Brazil
Idioma: eng
Resumo: The purpose of this study was to assess differences in the management techniques used by Israeli female and male pediatric dentists. All 112 participants of the meeting of the Israeli Society of Dentistry for Children that was held in February 1999 received a questionnaire which sought information regarding age, sex, behavioral and pharmacological methods used to treat children, having a course in nitrous oxide, general anesthesia, and feelings towards pediatric patients. No differences between female and male dentists were found regarding most management techniques. The majority of dentists used tell-show-do, and gave presents at the end of the appointments. Hypnosis was the least used technique. Papoose board was more prevalent among male dentists than among female dentists. Most dentists reported having the parents present during treatment, and more male dentists used their assistance when restraint was needed. General anesthesia was significantly more prevalent among males than among females (p = 0.01). One-third of the dentists reported feeling aggression toward the pediatric patient. Although not statistically significant, more female dentists reported about feeling aggression than male dentists. Most dentists felt authority towards the pediatric patient. Our findings imply that female and male dentists use similar management techniques when treating children.

PMID: 12964649
Autor: Peretz B; Glaicher H; Ram D
Endereço: Department of Pediatric Dentistry, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel. benny@cc.huji.ac.il
Título: Child-management techniques. Are there differences in the way female and male pediatric dentists in Israel practice?
Fonte: Braz Dent J; 14(2):82-6, 2003.
ISSN: 0103-6440
País de publicação: Brazil
Idioma: eng
Resumo: The purpose of this study was to assess differences in the management techniques used by Israeli female and male pediatric dentists. All 112 participants of the meeting of the Israeli Society of Dentistry for Children that was held in February 1999 received a questionnaire which sought information regarding age, sex, behavioral and pharmacological methods used to treat children, having a course in nitrous oxide, general anesthesia, and feelings towards pediatric patients. No differences between female and male dentists were found regarding most management techniques. The majority of dentists used tell-show-do, and gave presents at the end of the appointments. Hypnosis was the least used technique. Papoose board was more prevalent among male dentists than among female dentists. Most dentists reported having the parents present during treatment, and more male dentists used their assistance when restraint was needed. General anesthesia was significantly more prevalent among males than among females (p = 0.01). One-third of the dentists reported feeling aggression toward the pediatric patient. Although not statistically significant, more female dentists reported about feeling aggression than male dentists. Most dentists felt authority towards the pediatric patient. Our findings imply that female and male dentists use similar management techniques when treating children.
Tipo de publicação: JOURNAL ARTICLE

PMID: 12739685
Autor: Ran D; Peretz B
Endereço: Department of Pediatric Dentistry, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel.
Título: Assessing the pain reaction of children receiving periodontal ligament anesthesia using a computerized device (Wand).
Fonte: J Clin Pediatr Dent; 27(3):247-50, 2003 Spring.
ISSN: 1053-4628
País de publicação: United States
Idioma: eng
Resumo: The purpose of the study was to compare the reaction of children, who received a local anesthesia to the upper incisors with a conventional buccal infiltration and a periodontal ligament injection (PDLi) with a computerized device (Wand); to assess the efficacy of the anesthesia and the reactions by children after treatment. Ninety-eight children aged 2 to 4 years participated in the study. All the children were sedated with hydroxyzine and nitrous oxide. Children were randomly assigned to receive either PDLi with the Wand or conventional infiltration. During the injection, a modified Behavioral Pain Scale was used. There were 21 girls and 23 boys between the ages of 2 to 4 years in the study group (mean age 3.9 +/- 1.3 years), and 16 girls and 29 boys (mean age 3.5 +/- 1.0 years) in the control group. No significant difference was found between boys and girls. More children reacted negatively, namely, crying, facial expressions and eyes squeezed, while receiving the conventional infiltrative injection, whereas children, who received the anesthetic solution using the Wand, reacted more positively. This difference was statistically significant. No significant difference regarding the efficacy of the anesthesia was observed in either technique. Eighty percent of the children who receive the conventional buccal infiltration scratched the nose or upper lip after the treatment, while none of the children, who received PDLi, showed signs of discomfort. Children displayed better behavior when they received local anesthesia with the Wand rather than with the conventional infiltration. The same efficacy of anesthesia was achieved with both techniques. Children did not show signs of discomfort after treatment with the Wand, whereas they did while receiv

PMID: 12779113
Autor: Takarada T; Kawahara M; Irifune M; Endo C; Shimizu Y; Maeoka K; Tanaka C; Katayama S
Endereço: Department of Dental Anesthesiology, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University Dental Hospital, Hiroshima, Japan. takarada@hiroshima-u.ac.jp
Título: Clinical recovery time from conscious sedation for dental outpatients.
Fonte: Anesth Prog; 49(4):124-7, 2002 Winter.
ISSN: 0003-3006
País de publicação: United States
Idioma: eng
Resumo: For dental outpatients undergoing conscious sedation, recovery from sedation must be sufficient to allow safe discharge home, and many researchers have defined "recovery time" as the time until the patient was permitted to return home after the end of dental treatment. But it is frequently observed that patients remain in the clinic after receiving permission to go home. The present study investigated "clinical recovery time," which is defined as the time until discharge from the clinic after a dental procedure. We analyzed data from 61 outpatients who had received dental treatment under conscious sedation at the Hiroshima University Dental Hospital between January 1998 and December 2000 (nitrous oxide-oxygen inhalation sedation [n = 35], intravenous sedation with midazolam [n = 10], intravenous sedation with propofol [n = 16]). We found that the median clinical recovery time was 40 minutes after nitrous oxide-oxygen sedation, 80 minutes after midazolam sedation, and 52 minutes after propofol sedation. The clinical recovery time was about twice as long as the recovery time described in previous studies. In a comparison of the sedation methods, clinical recovery time differed (P = .0008), being longer in the midazolam sedation group than in the nitrous oxide-oxygen sedation group (P = .018). These results suggest the need for changes in treatment planning for dental outpatients undergoing conscious sedation.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Anesthetics, Intravenous); 10024-97-2 (Nitrous Oxide); 2078-54-8 (Propofol); 59467-70-8 (Midazolam); 7782-44-7 (Oxygen)

PMID: 12452982
Autor: Bryan RA
Endereço: Senior Clinician in Paediatric Dentistry, Harrow and Hillingdon Healthcare NHS Trust, Ruislip, UK.
Título: The success of inhalation sedation for comprehensive dental care within the Community Dental Service.
Comentários: Erratum In:Int J Paediatr Dent. 2003 Jan;13(1):71.
Fonte: Int J Paediatr Dent; 12(6):410-4, 2002 Nov.
ISSN: 0960-7439
País de publicação: England
Idioma: eng
Resumo: OBJECTIVES: To assess the outcomes of treatment with nitrous oxide/oxygen inhalation sedation (IS). To relate these to the age and previous dental experience of the child and the experience of the operator. To provide base-line information and identify training needs. METHODS: A retrospective examination of the clinical records of all children treated with IS within the Community Dental Service of Harrow and Hillingdon NHS Trust (HHHT) over a 3-month period was made. Personal details and previous dental experience were recorded. The outcome of the planned treatment was identified. RESULTS: Two hundred and eleven sets of records were reviewed from eight clinicians. The average age of the children was 7.2 years. Treatment plans were successfully completed in 83.9% of cases. Records showed that 18.5% of the children had previously had general anaesthesia (GA) for dental treatment, 27.5% had received IS and 5.2% had no previous dental experience. Of the 'failed' treatments, 50% were under 7 years of age and 31.3% were referred for GA. There was no difference in the proportion of failures in relation to the experience of the operator. CONCLUSION: This review shows that inhalation sedation with nitrous oxide/oxygen is a very successful adjunct to the clinical management of children within the Community Dental Service.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 12212869
Autor: Houpt M
Endereço: Department of Pediatric Dentistry, New Jersey Dental School, Newark, USA. houpt@umdnj.edu
Título: Project USAP 2000--use of sedative agents by pediatric dentists: a 15-year follow-up survey.
Fonte: Pediatr Dent; 24(4):289-94, 2002 Jul-Aug.
ISSN: 0164-1263
País de publicação: United States
Idioma: eng
Resumo: PURPOSE: A national survey of members of the American Academy of Pediatric Dentistry was conducted to provide a 15-year update of information regarding the use of sedative agents by pediatric dentists. METHODS: All 3,315 active members of the Academy were sent questionnaires regarding the frequency of their use of sedation and 1,778 responded. Practitioners were questioned regarding their use of sedative agents and the nature of their patients receiving sedation. In addition, they were questioned in regard to their use of restraints and reasons for change in their use of sedation during the past two years. RESULTS: In regard to the use of nitrous oxide alone, 47% of practitioners responded that they use nitrous oxide less than 11% of the time. In regard to other types of sedative agents, most practitioners use little, if any, sedation. Eighty-two percent use sedation for less than 11% of their patients. Of the 1,778 respondents, 1,224 used drugs other than nitrous oxide. In a typical three-month period, they performed 77,112 sedations. Of that number, 61,662 (80%) were administered by only 478 practitioners who use sedation on the average of once or greater each day. CONCLUSIONS: In comparison with previous surveys in 1985, 1991 and 1995, these results demonstrate an overall increased use of sedation by pediatric dentists. However, the increased use is due primarily to an increase in the numbers of practitioners who are heavier users of sedation (once or greater each day).
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 302-17-0 (Chloral Hydrate); 439-14-5 (Diazepam); 57-42-1 (Meperidine); 59467-70-8 (Midazolam); 60-87-7 (Promethazine); 68-88-2 (Hydroxyzine)

PMID: 12142869
Autor: Hulland SA; Freilich MM; Sàndor GK
Endereço: The Hospital for Sick Children, Toronto, Ontario, Canada.
Título: Nitrous oxide-oxygen or oral midazolam for pediatric outpatient sedation.
Fonte: Oral Surg Oral Med Oral Pathol Oral Radiol Endod; 93(6):643-6, 2002 Jun.
ISSN: 1079-2104
País de publicação: United States
Idioma: eng
Resumo: OBJECTIVE: A total of 1112 pediatric outpatient sedations, by either nitrous oxide-oxygen inhalation (N2O) or oral midazolam, administered over a 10-year period were reviewed. Patient responses and outcomes were evaluated to ascertain the safety of these sedation techniques. STUDY DESIGN: A total of 819 patients were included in this study. Patient health status, age, weight, behavior, treatment rendered, and length of treatment were recorded. Vital signs (heart rate, blood pressure, oxygen saturation) were recorded for the N2O group. Complications and successful completion of treatment were also noted. RESULTS: Both the N2O and midazolam groups demonstrated a low complication rate with a high rate of successful completion of treatment. Patients receiving N2O were somewhat older on average and underwent a greater number of surgical procedures than patients in the midazolam group. Vital signs recorded in the N2O group were observed to remain stable throughout treatment. CONCLUSIONS: The use of either oral midazolam or nitrous oxide-oxygen as single agents provides safe and effective conscious sedation in the pediatric outpatient population.
Tipo de publicação: EVALUATION STUDIES; JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 59467-70-8 (Midazolam)

PMID: 11874010
Autor: Eid H
Endereço: Tufts University School of Dental Medicine, Department of Pediatric Dentistry, Boston, MA 02111, USA.
Título: Conscious sedation in the 21st century.
Fonte: J Clin Pediatr Dent; 26(2):179-80, 2002 Winter.
ISSN: 1053-4628
País de publicação: United States
Idioma: eng
Resumo: Most (99%) patients treated at this university clinic do not need any form of sedation as rapport and behavioral management skills are more than sufficient and are safe. Those aged 1 to 5 years, who needed the use of oral sedation (Midazolam), showed 70% success. Those who needed nitrous oxide / oxygen ranged in age from 8 to 18 years and were later treated without any sort of conscious sedation after one or two sessions of nitrous oxide / oxygen sedation.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 59467-70-8 (Midazolam)

PMID: 11863151
Autor: Landes DP
Endereço: Department of Public Health, County Durham and Darlington Health Authority. david.landes@public-health.durham.ha.northy.nhs.uk
Título: The provision of general anaesthesia in dental practice, an end which had to come?
Fonte: Br Dent J; 192(3):129-31, 2002 Feb 9.
ISSN: 0007-0610
País de publicação: England
Idioma: eng
Resumo: 31 December 2001 was the final day on which a general anaesthetic could be given in a dental practice in UK. Henceforth all dental treatment requiring a general anaesthetic will have to take place in a hospital setting, which has immediate access to critical care facilities. This will mark the end of the association between dental practice and general anaesthesia which dates back to the very first recorded clinical procedure performed under general anaesthesia, when in 1844, Horace Wells an American dentist, had a tooth removed by his assistant using nitrous oxide in Hartford, Connecticut, USA.
Tipo de JOURNAL ARTICLE

PMID: 11748867
Autor: Szymanska J
Endereço: Instytut Medycyny Wsi, Jaczewskiego 2, P.O.Box 185, 20-950 Lublin, Poland.
Título: Environmental health risk of chronic exposure to nitrous oxide in dental practice.
Fonte: Ann Agric Environ Med; 8(2):119-22, 2001.
ISSN: 1232-1966
País de publicação: Poland
Idioma: eng
Resumo: Nitrous oxide may be used to alleviate dental anxiety and to diminish or eliminate dental pain. The benefit of nitrous oxide sedation is a cooperative and satisfied patient. By reducing the patient's perception of pain it allows them to relax and cooperate during dental procedures. However, the dental surgery personnel, chronically exposed to N2O, are at serious risk. The chronic effects of occupational exposure to nitrous oxide have long been the subject of debate. Safety standards have been established in the United States and Europe since many years. The potential detrimental action on the reproductive, neurological, haematological, hepatic and renal systems, plus the possibility of increased cancer risk have been the subject of active research, although absolute occupational effects are still uncertain. To provide a safer work-place for those at risk of exposure to waste anesthetic gases, preventive measures are recommended.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 11242733
Autor: Cotton KT; Seale NS; Kanellis MJ; Damiano PC; Bidaut-Russell M; McWhorter AG
Endereço: Department of Pediatric Dentistry, Baylor College of Dentistry, TX, USA.
Título: Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?
Comentários: Comment In:Pediatr Dent. 2001 Mar-Apr;23(2):98
Fonte: Pediatr Dent; 23(1):51-5, 2001 Jan-Feb.
ISSN: 0164-1263
País de publicação: United States
Idioma: eng
Resumo: PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 11709940
Autor: Alcaino EA
Endereço: Westmead Centre for Oral Health.
Título: Conscious sedation in paediatric dentistry: current philosophies and techniques.
Fonte: Ann R Australas Coll Dent Surg; 15:206-10, 2000 Oct.
ISSN: 0158-1570
País de publicação: Australia
Idioma: eng
Resumo: For years paediatric dentists have searched for the ideal sedative, that is, a drug that allows the safe control of a child's behaviour, provides adequate time to complete a procedure, and also has a quick recovery so that the patient may be discharged. Many drugs have been tried either alone or in combination, and unfortunately none has yet produced reliable results. This paper will review current philosophies in the use of conscious sedation in children. Currently, much interest has been focused on the use of midazolam, a short acting benzodiazepine. The safety of midazolam will be addressed, either when given alone or in combination with nitrous oxide. Midazolam appears to be a safe and effective drug when given in the appropriate doses. Its use in combination with nitrous oxide also appears to be effective, but certain precautions should be kept in mind. Careful patient selection, adequate informed consent, and specific clinical criteria appear to be vital for success. In general, the use of sedation in paediatric dentistry should be carried out by experienced operators in a well controlled environment.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Anti-Anxiety Agents); 0 (GABA Modulators); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 59467-70-8 (Midazolam)

PMID: 11218457
Autor: Patel B; Potter C; Mellor AC
Endereço: University of Manchester.
Título: The use of hypnosis in dentistry: a review.
Fonte: Dent Update; 27(4):198-202, 2000 May.
ISSN: 0305-5000
País de publicação: England
Idioma: eng
Resumo: Hypnosis is a valuable technique in patient management. With appropriate training, general dental practitioners can widen the treatment options they can offer to patients, especially those who are dentally anxious. This article provides a brief theoretical and historical overview, and a review of the literature pertaining to the clinical uses of hypnosis in dentistry.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 11203886
Autor: Ghezzi EM; Chávez EM; Ship JA
Título: General anesthesia protocol for the dental patient: emphasis for older adults.
Fonte: Spec Care Dentist; 20(3):81-92, 2000 May-Jun.
ISSN: 0275-1879
País de publicação: United States
Idioma: eng
Resumo: As the population ages, with increased retention of the natural dentition, there will be a greater responsibility for dental professionals to maintain the oral health of medically, behaviorally, cognitively, and physically impaired adults. Oral sedatives and nitrous oxide analgesia are frequently and successfully used for dental treatments in these patients. However, many compromised older adults cannot safely tolerate dental treatment with these sedative techniques in an outpatient setting. This paper describes the use of general anesthesia in a hospital environment, coordinated with medical and anesthesia specialists, that is a viable, safe, and effective treatment tool for providing comprehensive dental and oral surgical treatment for the older patient.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Analgesics); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide)

PMID: 11143733
Autor: Nakai Y; Milgrom P; Mancl L; Coldwell SE; Domoto PK; Ramsay DS
Endereço: Department of Pediatric Dentistry, University of Washington, Seattle, Box 357475, Seattle, WA 98195-7475, USA.
Título: Effectiveness of local anesthesia in pediatric dental practice.
Fonte: J Am Dent Assoc; 131(12):1699-705, 2000 Dec.
ISSN: 0002-8177
País de publicação: United States
Idioma: eng
Resumo: BACKGROUND: Pain control in dental treatment for children is very important. The purpose of this study is to describe the characteristics of local anesthetic use by pediatric dentists and to examine factors related to its effectiveness in children. METHODS: The authors observed 361 patients in 17 pediatric dental practices in Washington state while each child received restorative or surgical dental treatment. The authors recorded data concerning local anesthetic use and effectiveness. The children's mean age was 87 months, and 181 (50.1 percent) of the patients were girls. A pediatric dentist observer rated each child's anxiety before the initial injection of local anesthetic and the effectiveness of pain control during restorative treatment. The observing dentist asked the treating dentist about the effectiveness of pain control after completion of treatment. RESULTS: Forty-two of 361 children (11.6 percent) were observed to experience ineffective pain control. Fourteen of 17 dentists (82.4 percent) were observed to have at least one patient in whom pain control was ineffective. Lidocaine (2 percent with 1:100,000 epinephrine) was used by 15 of 17 dentists (88.2 percent) and in 312 of 361 cases (86.4 percent). The average amount of agent was one cartridge (36 milligrams of lidocaine). Children who were anxious, who had symptoms before treatment, and who underwent more invasive operative and endodontic procedures were more likely to experience ineffective pain control. CONCLUSIONS: The data suggest that painful treatment is relatively frequent even in specialized pediatric practice. Variability in general practice is likely to be greater. CLINICAL IMPLICATIONS: The incidence of ineffective pain control may be less if clinicians use methods to reduce anxiety and perioperative infection and symptoms.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Local); 10024-97-2 (Nitrous Oxide); 137-58-6 (Lidocaine); 51-43-4 (Epinephrine)

PMID: 10893816
Autor: Henderson KA; Matthews IP
Endereço: Health and Safety Unit, University of Wales College of Medicine, Heath Park, Cardiff.
Título: Environmental monitoring of nitrous oxide during dental anaesthesia.
Fonte: Br Dent J; 188(11):617-9, 2000 Jun 10.
ISSN: 0007-0610
País de publicação: ENGLAND
Idioma: eng
Resumo: AIM: The study was carried out to see if levels of nitrous oxide in dental theatres and community dental clinics were being controlled in accordance with the Control of Substances Hazardous to Health Regulations. SETTING: A multi-centre study looked at exposure levels in a dental teaching hospital and two community dental clinics in the South Wales area between 1997 and 1998. METHODS: A MIRAN infra-red spectrophotometer was used to measure static levels of nitrous oxide during general anaesthesia and conscious sedation. NIOSH method 6600 was used to collect personal samples of the individual administering the anaesthetic. RESULTS: The results showed compliance with the regulations when averaged out over an 8 hour time weighted average. However, over short periods of time peak concentrations of up to 1190 ppm were observed through static sampling, and up to 734 ppm through personal sampling. CONCLUSIONS: The results highlighted the need to provide adequate control measures such as anaesthetic gas scavenging, to reduce occupational exposure to dental staff in dental operating theatres and community dental clinics, therefore providing a safe working environment.
Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY
Nome de substância: 0 (Air Pollutants, Occupational); 0 (Anesthetics, Inhalation); 0 (Hazardous Substances); 10024-97-2 (Nitrous Oxide)
PMID: 10769857
Autor: Leelataweewud P; Vann WF; Dilley DC; Lucas WJ
Endereço: Department of Pediatric Dentistry, Mahidol University, Thailand. dtple@mahidol.ac.th
Título: The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients.
Fonte: Pediatr Dent; 22(2):125-33, 2000 Mar-Apr.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: PURPOSE: This study was performed to compare the effects of nitrous oxide/oxygen (N2O/O2) versus oxygen (O2) as adjuncts to an oral narcotic regimen for pediatric conscious sedation. METHODS: Using a randomized double-blind crossover design, 19 children (mean age 41 +/- 8.6 months) were sedated with chloral hydrate (50 mg/kg), meperidine (1.5 mg/kg) and hydroxyzine pamoate (25 mg) for two appointments. Patients were assigned randomly to receive 100% O2 at one visit and 50% N2O/O2 at the other. Physiologic parameters were measured in five-minute intervals, including respiratory rate, pulse rate (PR), oxyhemoglobin saturation (SpO2) and end-tidal carbon dioxide. Data analyses focused on true desaturations and apnea, level of sedation and sedation outcomes. RESULTS: There were no differences in PR, SpO2 and risk of desaturation between the inhalation agents. The level of sedation was deeper and the sedation outcomes were better in the N2O/O2 group. CONCLUSION: N2O/O2 deepened the sedation while improving its success with minimal alteration in physiologic parameters.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Oxyhemoglobins); 10024-97-2 (Nitrous Oxide); 7782-44-7 (Oxygen)

PMID: 10769856
Autor: Primosch RE; Buzzi IM; Jerrell G
Endereço: University of Florida, College of Dentistry, Department of Pediatric Dentistry, Gainesville. rprimosch@dental.ufl.edu
Título: Monitoring pediatric dental patients with nasal mask capnography.
Fonte: Pediatr Dent; 22(2):120-4, 2000 Mar-Apr.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: PURPOSE: The purpose of this study was to evaluate the potential of using capnography to analyze respiratory samples taken from a scavenging nitrous oxide nasal hood during routine pediatric dental procedures. METHODS: Twenty-two subjects, aged 60-116 months, were administered alternately either 40% nitrous oxide/60% oxygen or 100% oxygen during two sequential restorative appointments. All subjects were monitored continuously for end-tidal carbon dioxide and respiratory rate using a capnograph whose sampling line was attached directly to the nitrous oxide nasal hood. The subject's breath sound, displayed behavior, type of dental procedure being performed, and presence of rubber dam isolation were recorded every minute throughout the two appointments. RESULTS: Values for end-tidal carbon dioxide and respiratory rate were displayed on the capnograph when administering either oxygen or a combination of nitrous oxide/oxygen inhalation through the nasal hood. These respiratory values were lowered significantly when comparing 40% nitrous oxygen-60% oxygen to 100% oxygen inhalation. They were not significantly altered by the type of breath sound, patient behavior, dental procedure, or presence of rubber dam isolation, with the exception of some dental procedures which significantly lowered end-tidal carbon dioxide. The apnea alarm on the capnograph occurred during 5% of the total treatment time, but its occurrence represented a 97% false positive rate. The occurrence of the apnea alarm was significantly associated with the type for breath sound, patient behavior, and dental procedure. When used in this manner, the capnograph was effective in alerting the practitioner to potential apneic events, but likely has limited value in monitoring valid end-tidal carbon dioxide levels due to limitations in the sampling technique. CONCLUSIONS: This study demonstrated the potential of the capnograph as a respiratory monitor for pediatric dental patients when the sampling line was attached to a scavenging nitrous oxide nasal hood.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 10509336
Autor: Carr KR; Wilson S; Nimer S; Thornton JB
Endereço: Postgraduate Pediatric Dentistry Program Section of Pediatric Dentistry, Ohio State University, USA.
Título: Behavior management techniques among pediatric dentists practicing in the southeastern United States.
Fonte: Pediatr Dent; 21(6):347-53, 1999 Sep-Oct.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: PURPOSE: This study identifies those techniques most often utilized by pediatric dentists practicing in the Southeastern United States. It also assesses how the utilization pattern may have changed within the last five years, and identifies those factors that may have influenced the changes as perceived by the practicing dentists. METHODS: A questionnaire was mailed to 528 pediatric dentists who were members of the American Academy of Pediatric Dentistry, or The Southeastern Society of Pediatric Dentistry, or both. RESULTS: The response rate after one mailing and one reminder was 64%. The majority of dentists utilized less aversive behavior management techniques (e.g., parents in the operatory and nitrous oxide oxygen) and had decreased or discontinued use of such controversial techniques as Hand-Over-Mouth-Exercise (HOME) and Hand-Over-Mouth-With-Airway Restriction (HOMAR). The majority of dentists reported that their reasons for changes in the utilization pattern for most techniques were parental influences and legal and ethical concerns. CONCLUSIONS: Chi square analysis indicated significant differences (P < 0.05) in the frequency of use of behavior management techniques and age of practitioner, American Board of Pediatric Dentistry status, type of specialty training, and type of practice.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide
PMID: 10457643
Título: Control of nitrous oxide in dental operatories. National Institute for Occupational Safety and Health.
Fonte: Appl Occup Environ Hyg; 14(4):218-20, 1999 Apr.
ISSN: 1047-322X
País de publicação: ENGLAND
Idioma: eng
Tipo de publicação: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
Nome de substância: 0 (Air Pollutants); 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 10360204
Autor: Ram D; Mamber E; Chosack A; Fuks AB
Endereço: Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel.
Título: The effect of metoclopramide and hydroxyzine in sedation of infants undergoing dental treatment.
Fonte: ASDC J Dent Child; 66(1):49-52, 13, 1999 Jan-Feb.
País de publicação: UNITED STATES
Idioma: eng
Resumo: The purpose of the present study was to determine whether the administration of 5 mg of the anti-emetic drug metoclopramide (MTP) would improve the effectiveness of 3.7 mg/kg of hydroxyzine (HYZ) in dental treatment of young patients. Thirty uncooperative children, with a mean age of twenty-nine months, and needing at least two restorative visits, participated in this study. The patients were assigned randomly to receive either 3.7 mg/kg HYZ or the same drug in conjunction with MTP; alternate regimens were administered at the two appointments. All the children received 50 percent nitrous oxide, and were restrained in a Papoose Board with a head holder. The following parameters were evaluated at baseline (before initiation of treatment), and at five-minute intervals throughout the procedure: degree of alertness, crying and movement. Evaluation of the overall behavior at each session was performed by one investigator, who was blind to the drug regimen the child had received, utilizing a separate rating scale. The results were submitted to statistical analysis. No differences were observed in the behavior of the children receiving both regimens. Successful sedation, as assessed by lack or minimal crying and/or movement was observed in all the treatment visits, with both regimens (mean score 4.4 for HYZ + MTP and 4.6 for HYZ). In the few occasions, however, where the restorative sessions were longer (45 to 60 minutes), more children fell asleep after receiving protocol A (pramin + hydroxyzine), suggesting a possible trend to improve effectiveness in these situations. No adverse effects were observed, and all the treatments were successfully completed. Although no significant differences could be observed in treatments lasting up to a half hour, the addition of MTP could help in sedations lasting longer than a half hour.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Antiemetics); 0 (Drug Combinations); 10024-97-2 (Nitrous Oxide); 364-62-5 (Metoclopramide); 68-88-2 (Hydroxyzine)

PMID: 10331139
Autor: Yagiela JA
Endereço: Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, USA.
Título: Office-based anesthesia in dentistry. Past, present, and future trends.
Fonte: Dent Clin North Am; 43(2):201-15, v, 1999 Apr.
ISSN: 0011-8532
País de publicação: UNITED STATES
Idioma: eng
Resumo: The history of office-based anesthesia dates back to the discovery of nitrous oxide and ether in the 1840s. In recent years, advances in intravenous anesthetic techniques and the rising costs of hospital-based services have combined to promote the practice of ambulatory anesthesia. Dental patients who may benefit from office-based anesthesia include patients undergoing stressful procedures, fearful patients, medically or behaviorally challenged patients, young children, and patients with a history of gagging or local anesthesia problems. The future of office-based anesthesia in dentistry appears bright. Its development, however, will be influenced by organized dentistry, medical anesthesia, and other groups interested in pain and anxiety control, and state legislatures reacting to public demands for both safe and cost-effective anesthesia care.
Tipo de publicação: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 10803155
Autor: Quarnstrom F
Endereço: Faculty of Dentistry, University of British Columbia.
Título: Nitrous oxide safety: how safe is it for staff? What can be done to make it safer?
Fonte: Dent Today; 18(12):70-2, 74-7, 1999 Dec.
ISSN: 8750-2186
País de publicação: UNITED STATES
Idioma: eng
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Air Pollutants, Occupational); 10024-97-2 (Nitrous Oxide)

PMID: 10633513
Autor: Primosch RE; Buzzi IM; Jerrell G
Endereço: University of Florida, College of Dentistry, Department of Pediatric Dentistry, Gainesville, USA.
Título: Effect of nitrous oxide-oxygen inhalation with scavenging on behavioral and physiological parameters during routine pediatric dental treatment.
Fonte: Pediatr Dent; 21(7):417-20, 1999 Nov-Dec.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: PURPOSE: The purpose of this study was to determine the influence of 40% nitrous oxide/60% oxygen inhalation with scavenging on the behavioral and physiological parameters during routine pediatric dental procedures. METHODS: Twenty-two subjects, aged 60-116 months, were randomized into a double blind, cross-over study design and administered alternately either 40% nitrous oxide/60% oxygen or 100% oxygen during two sequential restorative appointments. All subjects were monitored continuously for respiratory rate, pulse rate, and hemoglobin oxygen saturation using a combined capnograph and pulse oximeter. The subject's breath sound and behavior were recorded every minute along with vital signs. RESULTS: When compared to 100% oxygen inhalation, 40% nitrous oxide/60% oxygen inhalation produced significant reductions in adverse patient behavior, respiratory rate, and pulse rate, but did not affect percent hemoglobin oxygen saturation. Nitrous oxide inhalation had no effect on breath sound revealed by auscultation or on the occurrence of the apnea alarm displayed by the capnograph. CONCLUSIONS: This study demonstrated that the administration of 40% nitrous oxide/60% oxygen delivered via a scavenging nasal hood significantly improved patient behavior and altered physiological parameters commonly monitored during conscious sedation.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide); 7782-44-7 (Oxygen)

PMID: 9728094
Autor: Girdler NM; Sterling PA
Endereço: Department of Sedation, University of Newcastle Dental School, Newcastle upon Tyne, UK.
Título: Investigation of nitrous oxide pollution arising from inhalational sedation for the extraction of teeth in child patients.
Fonte: Int J Paediatr Dent; 8(2):93-102, 1998 Jun.
ISSN: 0960-7439
País de publicação: ENGLAND
Idioma: eng
Resumo: OBJECTIVES: (i) TO test whether the exposure of dental staff to nitrous oxide during inhalational sedation with nitrous oxide/oxygen for extractions in children complies with specified occupational exposure standards, and (ii) to assess the atmospheric nitrous oxide concentration at one site close to the breathing zone of the operator/sedationist and to determine which patient- and sedation-related factors affect the level of nitrous oxide pollution. DESIGN: Prospective study. SETTING: Dental hospital sedation department, Newcastle Dental Hospital, UK. SAMPLE AND METHODS: 20 inhalational sedation clinics each of 2 hours duration were evaluated, during which a total of 60 children aged 4-15 years had extractions carried out. Nitrous oxide was administered via a nose mask from a Quantiflex MDM inhalational sedation machine and active scavenging was used throughout. Exposure of dental staff was measured using personal dosimetry. Atmospheric nitrous oxide pollution at one fixed point, close to the breathing zone of the operator/sedationist, was assessed using infra-red gas analyser. RESULTS: Mean exposure of the operator/sedationist to nitrous oxide during a single treatment clinic was 211 ppm, for the close support nurse 77 ppm and for the second nurse 67 ppm. Expressed as an 8 hour time-weighted average, the mean exposures were 39 ppm for the operator/sedationist, 17 ppm for the close support nurse and 15 ppm for the second nurse. The atmospheric nitrous oxide concentration varied during the clinics, with a maximum concentration of 538 ppm an a minimum that exceeded 100 ppm. There was a 71 minute delay following discharge of the last patient before atmospheric levels fell to zero. During sessions the degree of atmospheric pollution was inversely related to patient age (rc = -0.61, P < 0.05). There was a positive correlation between atmospheric pollution at the single point and the maximum percentage of nitrous oxide administered to each patient (rc = 0.57, P < 0.05). CONCLUSIONS: In this study, staff exposure to nitrous oxide complied with the national occupational exposure standard but there was still considerable atmospheric nitrous oxide pollution during inhalational sedation for paediatric exodontia.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Air Pollutants, Occupational); 10024-97-2 (Nitrous Oxide)

PMID: 9641092
Autor: Peretz B; Gluck GM
Endereço: Department of Pediatric Dentistry, Hebrew University, Hadassah Faculty of Dental Medicine, Jerusalem, Israel. benny@cc.huji.ac.il
Título: Children's sense of pleasure from nitrous oxide therapy during dental visits.
Fonte: J Clin Pediatr Dent; 22(3):199-202, 1998 Spring.
ISSN: 1053-4628
País de publicação: UNITED STATES
Idioma: eng
Resumo: The purpose of the present study was to measure feelings of pleasure by children who were undergoing dental treatment under nitrous oxide therapy during consecutive treatment sessions, and at a six-month follow-up visit. Fifty-two children between the ages of 3 and 5 years (mean age 4.3 +/- 1.06) children, who required two or more operative treatment visits participated in the study. At the conclusion of the initial treatment and after sufficient time for the effects of the nitrous oxide therapy to subside, patients were asked about their feelings from the gas. At subsequent visits, patients were asked the same questions at the beginning of each treatment session. The same was done at the beginning of a six-month follow-up visit. In general, there was a decrease in pleasure among those who experienced three or more visits. Extraction, in addition to operative treatment, did not result in a decrease in the sense of pleasure from nitrous oxide therapy. A similar response was observed in the recall visits when the reactions of the children were compared with the reactions at the last dental appointment. It is concluded that the sense of pleasure is strengthened through the second visit, but that the sense of pleasure and ability to cope is overwhelmed by the inconvenience of the dental treatment at the third visit.
Tipo de publicação: JOURNAL ARTICLE

PMID: 9515417
Autor: Clark MS; Renehan BW; Jeffers BW
Endereço: University of Colorado, School of Dentistry, Department of Surgical Dentistry, Denver 80262, USA.
Título: Clinical use and potential biohazards of nitrous/oxide oxygen.
Fonte: Gen Dent; 45(5):486-91, 1997 Sep-Oct.
ISSN: 0363-6771
País de publicação: UNITED STATES
Idioma: eng
Resumo: This article examines the worldwide literature for information regarding the potential adverse effects of nitrous oxide on chronically exposed personnel. This research convincingly demonstrates the lack of substantiation for these concerns. Biologically correlated standards for exposure still need to be established. Nitrous oxide has never been implicated to be harmful in any way to the patient.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Air Pollutants, Occupational); 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 9171486
Autor: Dunning DG; McFarland K; Safarik M
Endereço: College of Dentistry, Department of Dental Practice Management, University of Nebraska Medical Center, Lincoln 68583-0740, USA.
Título: Nitrous-oxide use. II. Risks, compliance, and exposure levels among Nebraska dentists and dental assistants.
Fonte: Gen Dent; 45(1):82-6, 1997 Jan-Feb.
ISSN: 0363-6771
País de publicação: UNITED STATES
Idioma: eng
Resumo: This study measured nitrous oxide (N2O) exposure levels of 70 dentists and their dental assistants, and related these results to minutes of N2O use, compliance with N2O use guidelines, and risk of exposure. Dentists and dental assistants averaged, respectively, 97 and 59 parts per million (ppm) in N2O exposure, much higher than the recommended 25 to 50 ppm. Estimated peaks of exposure averaged 1,415 and 986 respectively for the two groups. Dentists exposure levels were significantly higher than those of dental assistants in both measures. Correlations revealed a significant link between compliance and estimated maximum exposure, and between minutes of use and 40-hour exposure readings. The variables most predictive of 40-hour N2O exposure were: minutes of use, frequency of use, number of operatories equipped, education of staff members on N2O health risks and exposure control, and operation of scavenging systems with the recommended liters/minute. This study established a feasible methodology for long-term, field-based epidemiological studies on N2O exposure, and identified some key variables related to 40-hour exposures and estimated maximum exposure.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 9066223
Título: Nitrous oxide in the dental office. ADA Council on Scientific Affairs; ADA Council on Dental Practice.
Fonte: J Am Dent Assoc; 128(3):364-5, 1997 Mar.
ISSN: 0002-8177
País de publicação: UNITED STATES
Idioma: eng
Resumo: Nitrous oxide continues to be a valuable agent for the control of pain and anxiety. However, chronic occupational exposure in dental offices not using scavenging systems may be associated with possible deleterious neurological and reproductive effects. This report outlines recommendations for controlling nitrous oxide exposure that were made by an expert panel convened by the ADA.
Tipo de publicação: GUIDELINE; JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 9066222
Autor: Howard WR
Endereço: Department of Allied Health and Human Services, Western Kentucky University, Bowling Green 42101-3576, USA.
Título: Nitrous oxide in the dental environment: assessing the risk, reducing the exposure.
Comentários: Erratum In:J Am Dent Assoc 1997 Jun;128(6):700
Fonte: J Am Dent Assoc; 128(3):356-60, 1997 Mar.
ISSN: 0002-8177
País de publicação: UNITED STATES
Idioma: eng
Resumo: This article identifies the potential sources of nitrous oxide in the dental environment and reviews the harmful effects of chronic exposure to nitrous oxide. The author suggests methods of controlling nitrous oxide concentrations to approximate the recommended levels in the dental care environment.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 9515393
Autor: Dunning DG; McFarland K; Safarik M
Endereço: University of Nebraska Medical Center, College of Dentistry, Department of Dental Practice Management, Lincoln 68583-0740, USA.
Título: Nitrous-oxide use. I. Risk of potential exposure and compliance among Nebraska dentists and dental assistants.
Fonte: Gen Dent; 44(6):520-3, 1996 Nov-Dec.
ISSN: 0363-6771
País de publicação: UNITED STATES
Idioma: eng
Resumo: Patterns of nitrous-oxide (N,O) use among Nebraska dentists and dental assistants are reported. More than 800 respondents answered questions relating to risk of N,O exposure and compliance with N,O standards in the dental office: 73 percent of these dental practices using N,O have a state-registration permit. Dentists and dental assistants (from registered and unregistered practices) reported risk of exposure differently. Important compliance issues emerged (the average compliance rate was 9 on a scale of 17). Most N,O users have scavenging systems, but they are not properly operated. Few dental practices test for leaks or conduct N,O-monitoring tests. By complying with the recommendations for N,O administration, dental-care workers can minimize their risk of exposure.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Air Pollutants, Occupational); 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous Oxide)

PMID: 8930683
Autor: Peretz B; Katz J; Zilburg I; Shemer J
Endereço: Department of Pediatric Dentistry, Hadassah Faculty of Dental Medicine, Jerusalem, Israel.
Título: Treating dental phobic patients in the Israeli Defense Force.
Fonte: Int Dent J; 46(2):108-12, 1996 Apr.
ISSN: 0020-6539
País de publicação: ENGLAND
Idioma: eng
Resumo: The present study reports the results of the Israeli Defense Force clinic for dental phobic patients 14 months after its establishment. Thirty four soldiers (26 men, 8 women) attended the clinic, their ages ranged from 19 to 46 years. The patients were asked to complete Corah's Dental Anxiety Scale (DAS), prior to their first and each subsequent visit to the clinic. A full dental examination, including radiographs, was carried out on each patient, and the DMFT was recorded. The Tell, Show, Do, technique (21 patients), the use of nitrous oxide/oxygen sedation (5), behavioural relaxation techniques (4), and hypnosis (1) were used. Most patients required four sessions or more for treatment. The mean DAS total scores significantly decreased after each visit, as did the mean scores for each question. The mean DMFT, and the D component, were higher than the scores reported previously in Israeli soldiers, suggesting an association between dental phobia, avoidance of dental treatment and higher dental disease. Alleviating anxiety by rational explanation may not be sufficient in all phobic patients.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 10024-97-2 (Nitrous O

PMID: 8857656
Autor: Wilson S
Endereço: Postgraduate Pediatric Dentistry Program & Research, Ohio State University, College of Dentistry, USA.
Título: A survey of the American Academy of Pediatric Dentistry membership: nitrous oxide and sedation.
Fonte: Pediatr Dent; 18(4):287-93, 1996 Jul-Aug.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: Issues concerning the use of nitrous oxide (N2O) and sedative agents by pediatric dentists in relation to recent changes in sedation guidelines of the American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) are relatively unexplored. A 48-item questionnaire addressing demographics, N2O equipment, N2O use, safety, and personnel was mailed to 2,650 active AAPD members in the United States and Canada. The 1,758 (66.3%) responses were reviewed and descriptive statistics were obtained using SPSS/PC+ statistics package. Results suggest that respondents were representative of the demographics of the AAPD membership. The majority of respondents (89%) used N2O, with a central delivery system being most popular. The majority (74%) did not use any monitors when using N2O alone; 10% did not use monitors when N2O was used in combination with other sedative agents. A majority (59%) did not use a time-based recording of physiological parameters. In conclusion, a mixed impression was found about practitioners' use of N2O and sedative agents, suggesting wide variability in practitioner habits related to pharmacologic patient management.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Combined); 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide)

PMID: 8784916
Autor: Houpt MI; Kupietzky A; Tofsky NS; Koenigsberg SR
Endereço: Department of Pediatric Dentistry, University of Medicine & Dentistry of New Jersey, Newark, USA.
Título: Effects of nitrous oxide on diazepam sedation of young children.
Fonte: Pediatr Dent; 18(3):236-41, 1996 May-Jun.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: This study was performed to test the hypothesis that nitrous oxide augments the effects of diazepam sedation of young children by reducing crying and movement and improving the overall quality of sedation. Twenty-four children (mean age of 32 months) were sedated on two occasions with two different treatment regimens. All subjects received a standard oral dose of 0.5 mg/kg of diazepam with and without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for the first 20 min followed by 100% oxygen for the balance of the procedure and, during the second visit, the reverse regimen was used. All subjects were restrained in a Papoose Board (Olympic Medical, Seattle, WA) with an auxiliary head restraint. Successful sedation, as evidenced by lack of crying or movement that interrupted treatment, occurred in 83% of administrations. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted, local anesthesia was administered, and the rubber dam was placed. When the evaluation of the overall sedation was compared with and without nitrous oxide, it was better with nitrous oxide 56% of the time, worse 13% of the time, and the same in the remaining 31% of the comparisons. It is concluded that nitrous oxide may slightly augment the effect of diazepam sedation of young children, but it does not do so uniformly for all children receiving sedation.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Anesthetics, Inhalation); 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 439-14-5 (Diazepam)

PMID: 8776198
Autor: Crouch KG; Johnston OE
Endereço: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, Cincinnati, Ohio 45226, USA.
Título: Nitrous oxide control in the dental operatory: auxiliary exhaust and mask leakage, design, and scavenging flow rate as factors.
Fonte: Am Ind Hyg Assoc J; 57(3):272-8, 1996 Mar.
ISSN: 0002-8894
País de publicação: UNITED STATES
Idioma: eng
Resumo: Two new local exhaust systems, intended primarily to control patient mouth emissions of N2O, were installed in a dental operatory, and resulting exposure concentrations to dental personnel were observed. The exposures were found to be typically unaffected by the presence and operation of these new controls. Laboratory testing on a head form, in conjunction with the operatory observations, established that mask leakage due to poor fit was the primary cause of N2O emissions. An improved mask fit and the addition of a slotted skirt around the outer mask shell individually resulted in greatly reduced leakage rates in the laboratory tests. Also, exhaust systems placed on the chin, on the chest, or in the mouth proved effective in capturing mouth emissions simulated by a breathing machine and head form.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 8695586
Autor: Murtomaa H; Milgrom P; Weinstein P; Vuopio T
Endereço: Department of Public Health Dentistry, University of Helsinki, Finland.
Título: Dentists' perceptions and management of pain experienced by children during treatment: a survey of groups of dentists in the USA and Finland.
Fonte: Int J Paediatr Dent; 6(1):25-30, 1996 Mar.
ISSN: 0960-7439
País de publicação: ENGLAND
Idioma: eng
Resumo: Dentists' perceptions and management of the pain experienced by children during treatment were examined in surveys of 198 American and 230 Finnish dentists. Two pain management areas were studied: communication and the use of anaesthetics and sedation. Neither group of dentists routinely questioned children about pain, but encouraging the child to report pain during treatment was more common; the USA dentists asked about pain more often than the Finnish dentists, whereas the Finnish dentists more often encouraged children to report pain. Finnish dentists were much less likely to use local anaesthetics during restorative treatment of either primary or permanent teeth than USA dentists. Neither group of dentists routinely prescribed nitrous oxide sedation, or premedication, or post-operative pain medications. Regarding the dentists' perceptions of pain experienced by children during dental treatment, neither group rated dental treatment procedures as particularly painful or unpleasant. Most dentists found the pain reports of children credible, yet a sizeable minority (up to 67% of the USA dentists and 21% of the Finnish dentists) did not find them strongly credible. There was little relationship between the dentists' pain management behaviour and their perceptions of the pain experienced by their patients.
Tipo de publicação: JOURNAL ARTICLE

PMID: 8695592
Autor: Shaw AJ; Meechan JG; Kilpatrick NM; Welbury RR
Endereço: Department of Child Dental Health, University of Newcastle upon Tyne, England.
Título: The use of inhalation sedation and local anaesthesia instead of general anaesthesia for extractions and minor oral surgery in children: a prospective study.
Fonte: Int J Paediatr Dent; 6(1):7-11, 1996 Mar.
ISSN: 0960-7439
País de publicação: ENGLAND
Idioma: eng
Resumo: One hundred and thirty-three children aged 4-17 years were treated to assess the viability of operating a regular inhalation sedation service for extractions and minor oral surgery in children. The study evaluated treatment success, assessed parents' and children's satisfaction, and compared the cost of inhalation sedation with that of existing general anaesthesia services. Eighty-four per cent of the children had been referred for orthodontic extractions. Treatment was successfully completed for 120 of the patients; 201 permanent and 130 primary teeth were extracted and six minor surgical procedures were performed. Postal questionnaire assessment of the parents' and children's views showed that 97% were satisfied with the treatment provided. Of those parents who had previous experience of general anaesthesia, 79% stated that inhalation sedation was 'better' or 'much better' than general anaesthesia. It was estimated that the cost of providing treatment under inhalation sedation was considerable less than under general anaesthesia. It was concluded that it is viable to offer a regular inhalation sedation service for orthodontic extractions in children because it is clinically successful, acceptable to children and their parents, and cost-effective.
Tipo de publicação: JOURNAL ARTICLE

PMID: 8668567
Autor: Kupietzky A; Holan G; Shapira J
Endereço: Hebrew University--Hadassah School of Dental Medicine, Department of Pediatric Dentistry, Jerusalem, Israel.
Título: Intranasal midazolam better at effecting amnesia after sedation than oral hydroxyzine: a pilot study.
Fonte: Pediatr Dent; 18(1):32-4, 1996 Jan-Feb.
ISSN: 0164-1263
País de publicação: UNITED STATES
Idioma: eng
Resumo: Providing amnesia about a surgery is a desired side effect of a medication. This study compares anterograde amnesic effects of midazolam with hydroxyzine in children undergoing dental treatment with those drugs plus nitrous oxide, using a recall test. Thirty ASAI children 24-28 months, were shown a Standard-Binet intelligence scale-memory for objects subtest before entering treatment room. Twenty-lone randomly determined children received 3.7 mg/kg hydroxyzine 45 min before treatment or 0.2 mg/kg intranasal midazolam in two succeeding appointments, alternatively. Recall in the 30-subject treatment group was 90%. Recall in the 21-subject treatment group was 71% for hydroxyzine and 29% for midazolam. Midazolam was more effective in creating amnesia than hydroxyzine in this study.
Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Nome de substância: 0 (Hypnotics and Sedatives); 10024-97-2 (Nitrous Oxide); 59467-70-8 (Midazolam); 68-88-2 (Hydroxyzine)

PMID: 9601236
Autor: Henry RJ; Borganelli GN
Endereço: Department of Pediatric Dentistry, University of Texas, USA.
Título: High-volume aspiration as a supplemental scavenging method for reducing ambient nitrous oxide levels in the operatory: a laboratory study.
Fonte: Int J Paediatr Dent; 5(3):157-61, 1995 Sep.
ISSN: 0960-7439
País de publicação: ENGLAND
Idioma: eng
Resumo: Occupational exposure to low levels of nitrous oxide (N2O) have been associated with adverse health effects. The National Institute for Occupational Safety and Health has established a threshold guideline of 25 ppm N2O. The purpose of this laboratory study was to determine the effectiveness of a high-volume dental aspirator as a supplemental device to reduce ambient N2O levels in the operatory. The investigation evaluated four experimental groups that were assigned based on whether or not the aspirator was used and on the rate at which operatory ventilation was established (5 or 10 room air exchanges per hour). Ambient N2O levels were monitored at 30 cm from the nasal hood using an infrared spectrophotometer. The room air exchange rate was measured with a flow hood and then manipulated to the desired ventilation rate. N2O levels were detected with a spectrophotometer and data were recorded with a microprocessor that continuously collected data. The results demonstrated that both utilization of supplemental oral aspiration and increased operatory ventilation significantly reduced ambient N2O levels. It was concluded that a high-volume aspirator, when used in conjunction with the normal scavenging system, can significantly reduce ambient N2O levels to within the guidelines established by the National Institute for Occupational Safety and Health.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 9601236
Autor: Henry RJ; Borganelli GN
Endereço: Department of Pediatric Dentistry, University of Texas, USA.
Título: High-volume aspiration as a supplemental scavenging method for reducing ambient nitrous oxide levels in the operatory: a laboratory study.
Fonte: Int J Paediatr Dent; 5(3):157-61, 1995 Sep.
ISSN: 0960-7439
País de publicação: ENGLAND
Idioma: eng
Resumo: Occupational exposure to low levels of nitrous oxide (N2O) have been associated with adverse health effects. The National Institute for Occupational Safety and Health has established a threshold guideline of 25 ppm N2O. The purpose of this laboratory study was to determine the effectiveness of a high-volume dental aspirator as a supplemental device to reduce ambient N2O levels in the operatory. The investigation evaluated four experimental groups that were assigned based on whether or not the aspirator was used and on the rate at which operatory ventilation was established (5 or 10 room air exchanges per hour). Ambient N2O levels were monitored at 30 cm from the nasal hood using an infrared spectrophotometer. The room air exchange rate was measured with a flow hood and then manipulated to the desired ventilation rate. N2O levels were detected with a spectrophotometer and data were recorded with a microprocessor that continuously collected data. The results demonstrated that both utilization of supplemental oral aspiration and increased operatory ventilation significantly reduced ambient N2O levels. It was concluded that a high-volume aspirator, when used in conjunction with the normal scavenging system, can significantly reduce ambient N2O levels to within the guidelines established by the National Institute for Occupational Safety and Health.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 9468935
Autor: Waters BG
Título: Providing dental treatment for patients with cardiovascular disease.
Fonte: Ont Dent; 72(6):24-6, 28-32, 1995 Jul-Aug.
ISSN: 0300-5275
País de publicação: CANADA
Idioma: eng
Resumo: The appropriate management of dental patients with cardiovascular disease is contingent on appropriate assessment and evaluation. Baseline vital signs, a good medical history and medical evaluation are all essential for the safe delivery of care. All patients with cardiovascular disease can be managed using the following guidelines: 1. Properly assess the patient. This should include an assessment by the dentist and also a medical consultation if required. 2. Establish what medications the patient is taking along with the dose and timing and note any potential drug interactions and side effects. 3. Use short appointments (less than one hour), preferably in the morning. 4. Premedication should be considered to alleviate anxiety. The intraoperative use of nitrous oxide and oxygen is also a reasonable strategy for patients with cardiovascular disease, particularly those with ischemic heart disease. 5. Effective local anesthesia is important in order to avoid undue stress during the appointment as long as the guidelines for the administration of epinephrine are followed. The use of epinephrine impregnated gingival displacement cord should be strictly avoided in patients with cardiovascular disease. 6. For patients with angina pectoris, a fresh supply of nitroglycerin should be available at the time of the appointment. Prophylactic nitroglycerin has been shown to be effective in the prevention of both hypertension and angina pectoris during dental treatment. The appointment should be terminated early if the patient becomes overly anxious. In the event of cardiovascular symptoms during dental treatment, all work should be stopped. Emergency measures should be instituted if necessary. Preparations for emergencies should be undertaken by all dentists. The treatment of patients with cardiovascular disease is relatively simple if the proper steps are taken. The use of blood pressure measurements on all patients will help to screen for undiagnosed hypertension and all patients who are potentially hypertensive should be referred for medical evaluation. A preventive approach to the treatment of these patients will serve to prevent untoward outcomes and provide safe and simple delivery of dental care for cardiovascular patients.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL

PMID: 8602430
Autor: Croll TP
Endereço: Department of Pediatric Dentistry, University of Pennsylvania, School of Dental Medicine, USA.
Título: Electronic anesthesia for primary molar restoration in a 27-month-old child: a case report.
Fonte: Quintessence Int; 26(8):549-51, 1995 Aug.
ISSN: 0033-6572
País de publicação: GERMANY
Idioma: eng
Resumo: Injection of local anesthetic is not the only method of achieving complete control of pain sensation during restorative dentistry for very young patients. Transcutaneous electronic nerve stimulation, also known as electronic anesthesia, can be used solely or in combination with nitrous oxide-oxygen inhalation or auditory diversion with music to assure the comfort and safety of some youngsters. This article documents placement of a Class I resin-modified glass-ionomer restoration in a severely carious maxillary primary first molar of a 27-month-old girl. Electronic anesthesia and nitrous oxide-oxygen inhalation were used in lieu of an anesthetic injection.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 7556795
Autor: Goupil MT
Endereço: Department of Oral and Maxillofacial Surgery, University of Connecticut, School of Dental Medicine, Newington, USA.
Título: Occupational health and safety emergencies.
Fonte: Dent Clin North Am; 39(3):637-47, 1995 Jul.
ISSN: 0011-8532
País de publicação: UNITED STATES
Idioma: eng
Resumo: When considering potentials emergencies in the dental office, one usually first thinks about potential drug reactions or adverse response to underlying systemic diseases. The rare, but potential, emergencies arising from the office environment itself also exist. Toxic reactions to various chemicals found in the office must be considered also. Adequate ventilation helps prevent the long-term consequences of breathing nitrous oxide and chemclave exhaust. Care must be taken in obtaining complete medical histories. Identify patients with communicable diseases such as TB. The potential for transmission of these infections to office staff and other patients exists. Health histories must include the ability to identify patients with latex sensitivity. The increased use of latex products among health care workers has resulted in a higher incidence of latex sensitivity. The office staff must be prepared to recognize and quickly treat anaphylactic reactions. A latex-free environment must be provided for high-risk patients. Even with the use of universal precautions, blood contamination exposures and needle sticks will still occur. Protect office staff against hepatitis through the administration of a hepatitis prevention vaccine. Establish a protocol in advance for handling blood exposure incidents. Update the patient history to determine potential risk. The exposed individual must receive counseling as to the potential risk of HIV infection. If there is a potential risk of HIV contamination, the exposed individual must be offered the opportunity to initiate prophylactic chemotherapy within 1 hour of exposure. Even though occupational health and safety emergencies are rare, they must be considered and planned for. Contingency plans, such as providing a latex-free environment, must be available for preventing emergencies. The office staff must be prepared to treat immediate emergencies such as anaphylaxis and caustic material spills. Arrangements must be available to quickly handle exposure to communicable infections.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 0 (Air Pollutants, Occupational); 0 (Hepatitis B Vaccines)

PMID: 7546474
Autor: Stach DJ
Endereço: Department of Dental Hygiene, School of Dentistry, University of Colorado Health Sciences Center, Denver 80262, USA.
Título: Nitrous oxide sedation: understanding the benefits and risks.
Fonte: Am J Dent; 8(1):47-50, 1995 Feb.
ISSN: 0894-8275
País de publicação: UNITED STATES
Idioma: eng
Resumo: Nitrous oxide and oxygen is widely used for conscious sedation in dental offices. It can have benefits for patients who experience dental anxiety or are medically compromised and gain from the oxygen enrichment and stress reduction. Clinicians benefit when patients are cooperative and satisfied. There are a few patients for whom nitrous oxide would not be an optimum therapy. Chronic occupational exposure to low levels of nitrous oxide has several reproductive and health risks. Reducing the ambient concentrations is important.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 7900720
Autor: Rowland AS; Baird DD; Shore DL; Weinberg CR; Savitz DA; Wilcox AJ
Endereço: Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC.
Título: Nitrous oxide and spontaneous abortion in female dental assistants.
Fonte: Am J Epidemiol; 141(6):531-8, 1995 Mar 15.
ISSN: 0002-9262
País de publicação: UNITED STATES
Idioma: eng
Resumo: The relation between anesthetic gas exposure and spontaneous abortion remains unresolved. We examined the effect of nitrous oxide on spontaneous abortion among female dental assistants. Questionnaires were sent to 7,000 dental assistants aged 18-39 years who were registered in California in 1987; 4,856 (69%) responded. Analysis was based on 1,465 respondents whose most recent pregnancy was conceived while working full time. Women were asked how many hours a week they worked with nitrous oxide during this pregnancy and whether the excess gas was scavenged (vented). Relative risk of spontaneous abortion (through week 20) was calculated using a person-week model. This allowed women with current pregnancies (13%) or induced abortions (10%) to be included for appropriate time periods of risk. A total of 101 pregnancies (7%) ended as spontaneous abortions. An elevation in risk of spontaneous abortion was seen among women who worked with nitrous oxide for 3 or more hours per week in offices not using scavenging equipment (relative risk = 2.6, 95% confidence interval 1.3-5.0, adjusted for age, smoking, and number of amalgams prepared per week), but not among those using nitrous oxide in offices with scavenging equipment. This relation changed little when analyses were restricted to confirmed pregnancies or examined for several types of potential bias. Scavenging equipment appears to be important in protecting the reproductive health of women working with nitrous oxide.

PMID: 7873315
Autor: Donaldson D; Meechan JG
Endereço: Department of Oral Medical and Surgical Sciences, Faculty of Dentistry, University of British Columbia, Canada.
Título: The hazards of chronic exposure to nitrous oxide: an update.
Fonte: Br Dent J; 178(3):95-100, 1995 Feb 11.
ISSN: 0007-0610
País de publicação: ENGLAND
Idioma: eng
Resumo: This paper reviews the potential occupational hazards associated with chronic exposure to nitrous oxide. The evidence that chronic exposure to the gas produces problems related to reproduction in dental personnel is convincing. Recent evidence suggests that scavenging systems decrease the adverse effects which nitrous oxide has on fertility of dental surgery assistants. However, even in the presence of scavenging systems trace levels of the gas can exceed recommended minimum levels.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL
Nome de substância: 10024-97-2 (Nitrous Oxide)

PMID: 7614284
Autor: Ilkhanipour K; Juels CR; Langdorf MI
Endereço: Department of Medicine, University of California Irvine Medical Center, USA.
Título: Pediatric pain control and conscious sedation: a survey of emergency medicine residencies.
Comentários: Comment In:Acad Emerg Med. 1995 Mar;2(3):240-1
Fonte: Acad Emerg Med; 1(4):368-72, 1994 Jul-Aug.
ISSN: 1069-6563
País de publicação: UNITED STATES
Idioma: eng
Resumo: OBJECTIVE: To determine the availability and relative use of pediatric analgesia and sedation at sites of U.S. emergency medicine residency training programs. METHODS: A mail/telephone survey of residency directors at 80 U.S. emergency medicine residencies regarding resident experience with pediatric analgesia and sedation for painful procedures conducted during November 1991. RESULTS: Sixty of 80 surveys (75%) were completed and available for analysis. Emergency medicine faculty supervised conscious sedation and analgesia in 87% of responding programs, while pediatrics faculty and pediatrics-emergency medicine fellows supervised in the remainder. Ninety-three percent of the programs had sedating agents available in the emergency department; only four programs needed to have drugs brought from the pharmacy. Thirty-four programs (57%) had formal protocols for the administration of these drugs. Seventy-seven percent of the programs had airway resuscitation equipment at the bedside, while only 63% brought resuscitation drugs. However, 60% of the programs reported complications of sedation, including respiratory depression, prolonged sedation, agitation, and vomiting. The most commonly used agents were midazolam (82%), meperidine alone (68%) and with promethazine and chlorpromazine (67%), and chloral hydrate (67%). Only 25% of the programs used nitrous oxide, and 30% used ketamine. CONCLUSIONS: Emergency medicine residencies generally have available agents for pain control and conscious sedation in children, although the agents used vary widely. Appropriate instruction by trained faculty should enhance resident experience with pediatric pain control and sedation.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância: 0 (Analgesics)

PMID: 7811656
Autor: Fukuta O; Braham RL; Yanase H; Kurosu K
Endereço: University of California, San Francisco, 94143-0438.
Título: The sedative effects of intranasal midazolam ad