This study was designed to evaluate the efficacy and safety of intranasal sufentanil/midazolam [S/M] and ketamine/madazolam [K/M] for sedation and analgesia in preschool children that require dental surgery [extractions].<br /> <br /> Fifty children [ASA 1] aged 5 &ndash / 7 years, requiring six or more dental extractions under general anaesthesia, were allocated to two groups of 25 children to receive either ketamine 5 mg/kg or sufentanil 20&mu / g intranasally, 20 minutes before induction of surgery in this randomised double-blind study. All the children in both groups in addition concurrently received nasal midazolam 0,3 mg/kg. For induction of anaesthesia, sevoflurane in nitrous oxide and oxygen, was used.<br /> <br /> S/M was accepted significantly better as a nasal pre-medication [p&lt / 0.05]. Both groups were equally sedated and a smooth mask induction of anaesthesia was experienced in the majority of children. Recovery of children in both groups were similar / 82% of the S/M group were fully recovered 120 minutes post-operatively versus 80% in the K/M group [p&gt / 0,05]. Effective postoperative analgesia for multiple extractions was provided. For pain evaluation, children were divided into two groups, a non-responder group where all pain values over time were more than 40 and a responder group where pain values were equal to, or less than 40. Seventy two percent of children in the S/M group were responders as to fifty two percent in the K/M group [p&gt / 0,05]. No adverse respiratory, cardiovascular or other effects were recorded. This study showed that intranasal administration of sufentanil /midazolam or ketamine/midazolam, provides safe and effective sedation and analgesia in children aged 5&ndash / 7 years undergoing multiple dental extractions.

The controversy surrounding the role of malocclusion and orthodontic treatment in temporomandibular joint (TMJ) dysfunction led to this study. The purpose of this study was to establish the prevalence and compare the status of signs and symptoms of TMJ dysfunction in four groups of adolescents and young adults. The groups consisted of 14 persons with normal occlusions, 23 with untreated malocclusions, 20 with malocclusions currently undergoing treatment, and 18 with treated malocclusions. The Helkimo index was used to collect the TMJ dysfunction data. The results showed that the untreated malocclusion group had the most number of persons with signs and symptoms of dysfunction, but the differences between the groups in the distribution of persons according to the anamnestic and clinical dysfunction indices were not statistically significant. There were also no statistically significant differences in the distribution of signs and symptoms between boys and girls. According to anamnesis, the most frequently reported symptoms were joint sounds and headaches or neckaches occurring more than twice a week. Amongst the clinical signs and symptoms, the<br /> most commonly occurring were joint sounds on auscultation and muscle tenderness on palpation. In light of the small study sample and the absence of any substantial differences between the four groups, the role of malocclusion and orthodontic treatment in the aetiology of TMJ dysfunction remains obscure.

<p>The aim of this study was to determine whether the presence or absences of the root canal seal had any influence on the retrograde sealing ability of MTA (mineral trioxide aggregate).</p>

<p>There are several categories of dental problems in children that cannot be treated optimally in the office settings and are best managed in the hospital theatre. The ability to treat children in the hospital environment in order to provide comprehensive dental care using general anaesthesia(GA) is a valuable option to the paediatric dentist, despite some degree of risk to the patient. General anaesthesia provides optimum conditions for restorative treatment such as maximum contamination control, immobilization of the patient, efficiency and effectiveness, and elimination of reflexes.</p>

<p>This thesis covered the fast track assessment of the referred dental patient for conscious sedation in a day clinic. The assessment took in consideration patient information, medical history, anatomical observations, treatment required, phobic aspects and patient expectations.</p>

No description available.

Periradicular disease (PRD), a localised chronic pathologic inflammatory reaction in response to continuous microbial stimuli from necrotic, infected dental root canals, represents a substantial health care burden. The efficacy of available therapies is sub-optimal and identification of new therapeutic targets is essential. Elucidation of functional interactions between PRD cell populations and tissue matrix and between PRD lesion and cells within the surrounding dentoalveolar bone matrix is prerequisite to this. I hypothesise that the cytokine milieu is central in orchestrating these interactions. I generated a novel human explant tissue culture system to investigate the pathogenesis of PRD. I aimed: (1) to investigate the expression of multiple cytokines, but particularly IL-18, within the human lesion and to elucidate their likely biological contribution towards PRD; (2) to investigate the presence of and functional interactions between inflammatory mediators within human PRD that influence bone homeostasis; and (3) to phenotype the contribution of the PRD fibroblast. Four hundred and fifty patients were recruited after obtaining informed consent. PRD tissue was obtained for investigations, of which 310 specimens were examined in a novel explant culture system. Endogenous cytokine release was readily detected in vitro confirming significant inflammatory activity within chronic PRD and facilitating a detailed analysis for the first time of the complex interactions between cytokine activities in PRD.

The aim of these studies was to research different aspects of the pathogenesis and therapeutic features of recurrent aphthous stomatitis. In support of the involvement of viruses in the aetiology of recurrent aphthous stomatitis, the nested PCR and assays of ELISA and IFA were employed. Results of PCR investigations showed that HHV-6 DNA was present in 29 per cent of aphthous lesions. Using ELISA, specific IgG antibodies against HHV-6 were detected in 96.7 per cent of all serum samples with no significant difference between aphthous patients, oral lichen planus or control subjects. Specific IgM antibodies against HHV-6 were found in a higher prevalence rate in aphthous samples compared with the two other groups: a significant difference of p=0.01 was found between sera of aphthous patients compared with healthy controls. HCMV and VZV DNA were not detected in aphthous samples. Also serological findings did not show any significant increase in the prevalence of specific IgG antibodies against these two viruses. Serum IgM antibodies against HCMV were positive in a small number of samples with no difference between groups and IgM antibody against VZV was not positive in any serum samples. These data fail to show that recurrent aphthous stomatitis can be a manifestation of VZV or HCMV infection or reactivation. However, the possibility of involvement of HHV-6 is raised by the present studies. The possible involvement of Mycobacterium paratuberculosis was examined by the nested PCR investigations. Although mycobacterial DNA was detected only in four biopsy samples of aphthous patients and in none of the oral lichen planus patients or controls, this difference was not significant and more research is necessary to confirm such involvement.

Facial injury is less common in childhood than adulthood. However, it is still a significant cause of morbidity and presentation in hospital emergency departments. The pattern, time trends, and key socio-demographic determinants of facial injuries in Scottish adults admitted to hospital have previously been reported but this is not the case in the paediatric population and the question of whether such injuries are equally distributed across all socio-economic groups has not been answered. In contrast to the epidemiology of facial injuries in the paediatric population, traumatic dental injuries in children and adolescents have become one of the most frequent forms of treatment in dental practice. This suggests that traumatic dental injuries are common in childhood and are a significant cause of morbidity and presentation in hospital emergency departments. The relationship between socio-economic circumstances and the commonest dental disease (dental caries) in Scotland is well established and children resident in the most deprived areas experience more dental disease. However, this relationship with regard to dental injuries in Scotland has not yet been established. In the same way, many answers to questions regarding the sequelae and prognosis of pulpal and endodontic treatment among traumatised teeth remain unclear. Furthermore, numerous studies have been published examining the long term variables that might have an effect on treatment outcomes of avulsed teeth, but none have yet been able to estimate the long term prognosis of avulsed and replanted teeth. Two studies presented in this thesis are largely the result of population based studies investigating the epidemiology of facial and dental injuries in relation to individual demographics. An additional two studies explore the occurrence of paediatric dental trauma and its general treatment outcomes with a specific focus on estimation of the long term prognosis of avulsed and replanted teeth. To establish the epidemiology of paediatric facial injuries in children and adolescents requiring in-patient hospital admission in Scotland and to report the pattern, time trends, and key socio-demographic determinants of paediatric facial injury in Scotland, a descriptive epidemiological population-based study of the incidence of facial injuries in Scotland (2001-2009) was undertaken. Poisson regression models were employed to assess trends. There were 45,388 (4.7 per 1000 population) facial injury cases registered (2001-2009). 60% of injuries were due to non-intentional causes, 15% to motor vehicle incidents, and 9% to assault. 4.5% were alcohol related. The incidence decreased over time from 5.5/1000 in 2001 to 4.0/1000 in 2009. The risk ratio (RR) for males was 1.98 times greater than females (p < 0.001). RR varied significantly between Health Board areas from 0.68 (Dumfries and Galloway) to 1.76 (Grampian) (p < 0.001). There was a significant association between facial injury and deprivation (p<0.001); SIMD 1 (most deprived) had the highest incidence (6.3 per 1000 population; RR =1.89). The findings of this study provide evidence of a continuing increase in the burden of facial injuries in males especially for those who are living in areas of social deprivation, and in certain geographical areas of Scotland. A population-based investigation was undertaken to investigate the pattern and time trends of dental injuries and their socio-demographic determinants among primary one (P1) children in Scotland. Records of Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) and National Dental Inspection Programme (NDIP) for the period 1993 to 2007 were retrieved from the Dental Health Services Research unit - Dundee. Annual incidences of dental injuries were calculated by age, gender, Health Board and DEPCAT (Carstairs deprivation categories). 68,354 P1 children were examined and only 405 (0.6%) had suffered dental injuries (5.9 per 1000 population). There was a significant decrease in incidence over time (1993 figures were three times greater than 2007). Virtually the same incidence rates were recorded for the two genders. However incidence varied significantly between Health Boards (p<0.001); the highest rate being reported in Dumfries (14.2 per 1000 population), which was 11 times greater than Ayrshire (1.3 per 1000 population). There was no significant association between risk of dental injuries and deprivation; in DEPCAT 1 (most affluent) the incidence rate was 6.4 per 1000 population, while in DEPCAT 7 (most deprived) the incidence rate was 5.7 per 1000 population. The findings of this study provide evidence that the incidence of dental injuries had significantly decreased between 1993 and 2007; gender and deprivation level had no effect on the incidence and risk of dental injuries. A retrospective investigation was undertaken to study the sequelae of non-surgical root canal treatment in traumatised anterior permanent teeth of patients referred to a secondary referral centre. The department dental trauma database was used to randomly identify patients who had sustained dental trauma to their permanent anterior teeth between 1994 and 2008 which required pulpal intervention. A data extraction form was designed and completed for each tooth, and then the data was transcribed and processed. The association between treatment outcomes and clinical variables was studied. 100 permanent anterior teeth (72 patients) were studied. Dental trauma was frequent in the age group 9-11yrs (53.9%). Upper central incisors were the most common teeth involved (43.8%). The male: female ratio was 2:1 with an average age at the time of trauma of 10.31 yrs (SD 2.16 yrs). Home and immediate home environs were the commonest location (18%) while falls (34.8%) and injuries during sport/play (34.8%) were the commonest causes. The commonest injuries in this randomly selected group were enamel-dentine fracture with pulp exposure (34.8%) and avulsion (28%). 66.3% received a first treatment intervention less than 24 hours following the injury. Root canal treatment was the most frequent treatment provided, especially for dental avulsion cases (100%). Treatment outcomes were split into three categories: Success (53.4%); Short-term success but long-term failure (35.6%); and Failure (11%). Significantly fewer failures occurred with: developing roots compared to completed roots (P=0.05); a good quality temporary filling (P<0.003); no mobility (P<0.001); and less than one hour extra alveolar dry time (P =0.02). No significance was reached with regard to: condition of root canal (P=0.095); extra alveolar time (EAT) (P=0.191); and type of storage medium (P=0.43). To assess and identify early clinical variables that are most predictive of treatment outcomes for avulsed and replanted permanent anterior teeth and to develop a model that will allow estimation of treatment outcome based on these variables, a retrospective study was designed and undertaken, where the dental trauma database was used to randomly identify patients who had sustained dental trauma on their permanent teeth leading to avulsion between 1998 and 2007. A data extraction form was designed and completed for each tooth. Demographic, diagnostic and treatment information recorded in the patient’s records, in addition to radiographs, were viewed and then transcribed and processed. The significance for each early clinical variable was assessed using a univariate logistic regression model. Only significant variables (P ≤ 0.05) were considered eligible for the prediction model and a c-index was then constructed for their respective predictive power. 213 patients who had received treatment for avulsed and replanted teeth between 1998 and 2007 were studied and only 105 fulfilled the criteria for evaluation.

Abstract: Ecological influences, observational caries epidemiological trends and associated socioeconomic and geographic dental health inequalities at five years of age in Scotland, 1993/94-2007/08 Introduction: In recent years many national Governments have called for health improvements at the population level and at the same time reductions in health inequalities. To date, dental epidemiology has concentrated mainly on tracking trends in dental health. Methodologies relating to dental health inequalities are, however, not well established. Within Scotland, over the past decade, children’s oral health improvement programmes have been established at national level. Preceding and concurrent with these developments, similar initiatives have been implemented within Greater Glasgow NHS Board. This is Scotland's largest NHS Board with the highest proportion of Scotland’s socio-economic status (SES) deprived population. Recent reports from the National Dental Inspection Programme (NDIP) for five-year-olds show improvements in dental health. The above conditions provide the opportunity to explore dental trends in more detail at geographic level within Scotland and to investigate dental health inequality methodologies within the context of health improvement programmes and overall improvements in dental health. Aim: To examine caries epidemiology data and apply and appraise a range of tests of health inequality to data from Primary 1 (P1) five-year-old children in Scotland during the period 1993/94-2007/08, against a background of health improvement programmes. Furthermore, to apply the selected inequalities tests to the caries data for a) Scotland as a whole and b) the geographic subgroups: 1] Glasgow (GGHB) and 2] the remainder of Scotland, outwith Glasgow (Not-Glasgow). Methods: Secondary analyses were performed on eight successive cross-sectional NDIP five-year-olds' caries datasets, 1993/94 to 2007/08. These permitted both SES and geographic trends in mean d3mft and % dmft=0 to be plotted for the areas: Scotland, GGHB and Not-Glasgow. The metrics selected to model dental health inequalities were: the Significant Caries Index (SIC) and modified SIC10, the Receiver Operator Curve (ROC), the Gini coefficient, the Concentration Curve (CC), Koolman and Doorslaer's transformed Concentration Index (CI), the Slope Index of Inequality (SII), the Relative Index of Inequality (RII) and the Population Attributable Risk (PAR). Odds Ratios and Meta-analyses using Generalised Linear Modelling assessed statistical-inference for dental health and inequality trends. Results: Overall, usable data was retrieved for 68,398 five-year-old subjects (n=18,174 from GGHB; n=50,224 from Not-Glasgow). In Scotland as a whole, marked SES gradients in caries prevalence and caries burden were related to the DepCat score of children’s home postcode. Between the start and endpoints of the study, the simple absolute SES inequality in mean d3mft between the most affluent and most deprived groups decreased (p<0.02), whilst mean d3mft reduced across the entire SES spectrum. Relative to the baseline year (1993), by 2007, the Odds Ratios for d3mft>0 in Scotland decreased (p<0.0001) to 0.43 (95%CI, 0.40-0.46). Although Scotland's simple absolute SES related dental health inequality (DHI) decreased for mean d3mft (p<0.02), there were no improvements in simple relative SES DHIs over this time period. Simple absolute and simple relative geographic inequalities in weighted %d3mft=0 and mean d3mft were seen when GGHB was compared with Not-Glasgow data. These geographic inequalities metrics tended to increase from 1993/94 until 1999/00. However, by 2007/08 reductions in simple absolute geographic inequality were observed, with marginal improvements in simple relative geographic inequality compared to baseline. Additionally, simple absolute and relative geographic inequality in SIC scores decreased overall against a background of SIC improvements in both GGHB & Not-Glasgow (Meta-analysis, p<0.01, respectively). By 2007/08, relative to 1993/94, Odds Ratios for d3mft>0 in the geographic subgroups GGHB and Not-Glasgow decreased, respectively (p<0.0001), to 0.31 (95%CI, 0.26-0.38) and 0.46 (95%CI, 0.43-0.50). There was evidence of a 'Glasgow (dental health) Effect', whereby GGHB children’s dental health was poorer than in Not-Glasgow during the period 1993 to 1999, after controlling for confounding factors (p<0.01). This ‘Glasgow Effect’ was no longer evident by 2007. Modelling caries data using the complex inequality metrics has given further insights into different dimensions of geographic and SES-related dental health inequalities. For example, in each area from 1993/94-2007/08, the full SIC10 distributions showed respective decreases in complex absolute DHI in affected individuals in population deciles (irrespective of SES). Simultaneously, Scotland's SII indicated that complex absolute SES inequalities decreased (p<0.02). Furthermore, in Glasgow the %PAR decreased by 24 percentage points, itself impacting on Scotland's decreased PAR. However, the RII and transformed CI indicated that complex relative SES DHI increased in each area over the period of study. The ROC, CC & RII plots were comparatively stable over time for Scotland, compared to trends in the GGHB subgroup. There was evidence of some variation in DHI, and the Gini-coefficient (for individual DHI) was counter-intuitive. Discussion: Analysis and interpretation of simple and complex absolute and relative DHI outcomes are not straightforward against a background of population dental health improvements across the SES spectrum. If equivalent absolute dental health improvements are achieved in the best and poorest d3mft groups, as %d3mft>0 and mean d3mft diminish in the denominator group it is increasingly difficult to achieve improvement in relative inequalities. Nonetheless, tests suggest that simple absolute geographic DHI in Scotland's P1's weighted %d3mft=0 and mean d3mft have improved, while simple relative geographic inequality has not deteriorated over the interval 1993-2007. Further insights were obtained from examination of the cross-sectional distributions of SIC10. These showed improvements in complex absolute individual inequality across all population deciles with d3mft>0, over time, at each geographic level. Moreover, comparison of the geographic SIC10 scores for the worst affected deciles demonstrated reductions in simple absolute and relative geographic DHI in five-year-olds' d3mft morbidity for those with the poorest dental health outcomes in 2007 vs. 1993. Furthermore, Scotland's complex absolute SES-related DHI has decreased over time when assessed by SII. Improvements in complex absolute SES-related DHI have occurred more readily than improvements in complex relative SES-related DHI. Conclusions: For the first time, these multiple tests of inequality have been applied to Scotland’s and Glasgow’s child caries datasets. Generally, caries epidemiology trends occurred slowly and smoothly, however, DHI trends from this same data tended to fluctuate (especially in the geographic subgroups). The apparent lack of consonance of the various inequalities metrics demonstrates that measurement, understanding and interpretation of population DHI trends are complicated and require knowledge of the underlying epidemiology trends. Nonetheless, with the exception of the Gini, all results provided useful information which aid understanding of DHI. The complex measures such as the SII and RII had the advantage of using all the available d3mft information within the DepCat domains and weighting results for SES within the denominator populations. Furthermore, in Scotland as a whole, the SIC10 distribution, SII and RII appear to exhibit stable DHI trends, against the background populations' dental health improvements.