No abstract

The management of adult dental patients with congenital bleeding disorders has caused a considerable number of problems to the dental profession. There is a need to simplify the process and identify what can be safely carried out on a 'shared care' basis in General Dental Practice or the Community Dental Service. Particular problems are discussed with special reference to those requiring hospital care. The Scottish Oral Health Group for Medically Compromised Patients has developed this clinical guidance in conjunction with the Scottish Haemophilia Directors. It is important that dental care is easily available for this group of patients, especially those living at some distance from the regional centres. The aim is to simplify planning dental care for this group of patients and remove a number of myths concerning their management. The hospital departments, both medical and dental, must be available for advice and to arrange for treatment that is inappropriate outside a specialist hospital.

Drinking through a straw positioned toward the back of the mouth may reduce the erosive potential of soft drinks.

Chemomechanical removal of dental caries has considerable potential in the treatment of patients with management problems, especially in paediatric dentistry. The aim of this study was to assess the acceptance and success of the technique in young nervous patients. A group of 20 patients, aged between 4 and 10 years with a high level of dental anxiety was selected. The study achieved a success rate of over 90% in acceptance of cavity preparation by this procedure followed by placement of a restoration. The length of time required for cavity preparation was comparable with conventional methods. The need for local anaesthesia was reduced or eliminated and the children did not complain of any pain during the procedure. It is concluded that chemomechanical caries removal in vivo in primary teeth is an effective alternative to conventional mechanical caries removal and is advantageous in patients who have a phobia to the dental handpiece and/or injections.

Summary. A prospective study has been performed of factors influencing postoperative pain in a cohort of children undergoing dental extractions under general anaesthesia. Postoperative pain was assessed immediately after recovery from anaesthesia and also by using a visual linear analogue scale which was completed by the parent hourly for the first 10 hours and then at 24 hours. Analgesic use was also recorded. The most significant factor influencing postoperative pain was the relationship of the accompanying adult to the child; children attending with their mothers were more likely to complain of postoperative pain (P<005). The results also suggested that the age of the patient and the extraction of primary rather than permanent teeth were influencing factors, although they did not reach statistical significance. Pain was reported by 57.5% of the children immediately after treatment. It would seem that the greatest need for postoperative analgesia is immediately after the dental procedure, especially in young children undergoing multiple extractions. Résumé. Une étude prospective a été entreprise pour connaitre les facteurs influençant la douleur post‐opératoire chez des enfants ayant eu des extractions sous anesthésie générale. La douleur post‐opératoire a été notée immédiatement après l'intervention et à l'aide d'une échelle visuelle linéaire analogique, remplie par les parents, toutes les heures, pendant les dix premières heures et vingt‐quatre heures après. L'utilisation d'antalgiques a également été notée. Le facteur le plus significatif, influençant la douleur postopératoire, était la relation avec la personne accompagnant l'enfant. Les enfants accompagnés de leur mére étaient ceux qui se plaignaient le plus de douleurs post‐opératoires (P<0,05). Les résultats suggérent que l'âge de l'enfant et que l'extraction de dents temporaires plus que celles de dents définitives seraient des facteurs favorisant bien que sans difference significative. Des douleurs ont été notées, immédiatement après l'intervention, chez 56,5% des enfants. Le besoin le plus important d'antalgiques serait immédiatement après l'intervention pour extractions multiples chez les jeunes enfants. Zusammenfassung. Diese Studie versucht herauszufinden, welche Faktoren beeinflussen den postoperativen Schmerz von Kindern, bei welchen Extraktionen in Vollnarkose durchgeführt wurden. Der postop. Schmerz wurde sofort nach dem Erwachen bestimmt. Ein visueller linearanaloge Skala wurde dazu cerwendet durch die Eltern, für die ersten 10 Stunden und nach 24 Stunden. Ebenso wurden die verabreichten Schmerzmittel registriert. Der signifikanteste Faktor, welcher den postop. Schmer beeinflusst war die Beziehung der Begleitperson zum Kind, wenn dies die Mutter war so erhöhten sich die Beschwerden des Kindes (PL 0,05). Die Resultate zeigten auch dass das Alter, und ob ein Milchzahn oder ein bleibender Zahn gezogen wurde, Einflusshatten, aber dies ohne statistische Signifikanz. Schmerz empfanden 57% der Kinder sofort nach der Behandlung. Es scheint das dann d...