Faculty Bibliography

PURPOSE: The purpose of this study was to investigate the efficacy of EMLA (eutectic mixture of local anesthetics, 2.5% lidocaine and 2.5% prilocaine) cream in reducing discomfort from pressure applied by rubber dam clamp. METHODS: A consecutive sample of 31 patients, ages 6 to 12 years who presented for sealants from September 2002 through March 2003, participated in this within-subjects controlled clinical study. The facial pain scale (FPS) measured discomfort of dental dam placement on first permanent molars on opposite sides of the mouth after EMLA and placebo application for 5 minutes on the gingiva surrounding each tooth. RESULTS: 18 subjects (58%) were female, and 13 (42%) were male. Twenty (65%) of the teeth studied were permanent maxillary first molars, and 11 (35%) were permanent mandibular first molars. Fourteen (44%) patients were 9 years old or younger, and 17 (56%) patients were over 9 years old. The mean FPS score for EMLA teeth of 0.47+/-0.27 was significantly lower than that for non-EMLA teeth of 0.64+/-0.24 (P<.001). EMLA vs non-EMLA FPS scores by age, gender, and arch were not significantly different. CONCLUSIONS: The EMLA cream was effective in reducing discomfort caused by the dental dam clamp.

PURPOSE: This study compared pain, acceptance, and preference associated with 2 topical anesthetics: benzocaine gel and lidocaine patch (DentiPatch). METHODS: Thirty patients aged 3 to 10 years participated in this within-subjects study. All children required identical or similar dental work bilaterally (restorations, extractions, endodontic procedures, or sealants). Subjects chose either DentiPatch or benzocaine gel at the first visit. The anesthetic the child did not choose was used at the second visit. The Whali-Wong scale was used to measure comfort before and after application of topical anesthetic and after injection, and the Sounds, Eyes, Motor (SEM) scale measured pain upon injection. RESULTS: At the first visit, 80% of subjects selected DentiPatch; 60% of subjects made their choice based on appearance. Younger children more than older children were influenced by appearance in their selection. After trying both topical anesthetics, 77% preferred DentiPatch; final preference and either age or gender were not significantly related. The gel had greater scores than the patch for the Sounds pain value and for the SEM scale composite score. CONCLUSIONS: The lidocaine patch was associated with some objective evidence of reduced pain compared to the gel and was preferred by most children.

This study measured parental anxiety before, during, and after elective dental procedures under general anesthesia using the Spielberger State-Trait Anxiety questionnaire. State anxiety started relatively high before the procedures, peaked immediately after induction using general anesthesia, and dropped during recovery to below the initial score. Parents, whose children were premedicated and fathers in general, had significantly higher anxiety immediately after induction. This study supports interventions to lower anxiety of the parents as well as that of children.

In this pilot study, the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma. The research followed a pretest-posttest crossover design wherein each subject served as her own control. Blinded examiners recorded respiratory excursion, peak expiratory flow rates, and subjective measures of asthma symptoms. Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures. Changes in peak expiratory flow rates and asthma symptoms were not statistically significant.

Many children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), but the impact of this on behavior at a dental visit has not been examined. This study compared the behaviors of children with and without ADHD during a dental recall visit. Forty-two children with and forty-two without ADHD (fifty-six boys and twenty-eight girls, ages 6.0 through 10.6 years of age) were selected from a chart review at a hospital dental clinic. Every child was observed in the dental chair before and during the dental visit. Tell-show-do was utilized with every patient. Each child was evaluated for compliance or resistance and was rated using the Frankl behavior rating scale. Behavior ratings of children with and without ADHD were not statistically different. This could indicate that children with and without ADHD behave similarly in the dental setting. Use of Tell-show-do and presence of a pediatric dentist trained in child psychology could have contributed to this similarity.

The goals of the study were to explore physicians' attitudes and opinions about palliative care and its implementation. Four focus groups composed of attending physicians were conducted by a professional facilitator at a community teaching hospital. The audio-tapes of the groups were carefully transcribed and analyzed according to rigorous qualitative methodology. Physicians perceived palliative care and pain control as important. Problems they perceived were a lack of education for physicians, residents, other health care professionals, and the general public; a lack of hospital support systems to implement palliative care appropriately, and a lack of knowledge and support regarding legal considerations. They believed that a palliative care unit was a reasonable tool to overcome many obstacles to good end-of-life care.