Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety.Materials and methods.A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt’s scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test.Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004).Conclusion.. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children.

Background: Charcoal toothpastes can whiten teeth through abrasion. The purpose of this study was to determine the level of whitening and abrasiveness of charcoal toothpastes in permanent teeth. Materials and Methods: In this in vitro study, 30 premolars were polished, sectioned, mounted, and stored for 5 days in a coffee solution at 37°C. The color and surface profile of the teeth were measured by spectrophotometry and a profilometric device, respectively. The specimens were divided into 3 groups of 10 and were brushed 2000 times (equivalent to 3 times a day for 1.5 months) in a brushing machine using 20 g of each toothpaste (Bencer, Beverly, and Colgate) mixed with 40 ml of distilled water. The color and surface profile were remeasured. Bonferroni test and repeated measures analysis of variance (ANOVA) were used to examine the abrasion. One-way ANOVA was used to assess the whitening. Results: The three toothpastes caused changes in the surface profile (P = 0.0001). ΔE was equal to 3.3 (within the acceptable range) in all groups (95% confidence interval). There was no significant difference in abrasion (P > 0.05) and color change (P = 0.884) among toothpastes. Conclusion: The results of this study showed that all the three used toothpastes have the abrasive and whitening effect on the samples significantly. The differences between the toothpastes were not significant.

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This study aimed to elaborate a case with several complications and recommended some suggestions for dental management of these individuals. Case Presentation: Ehlers-Danlos syndrome (EDS) is a relatively rare condition involving a group of patients with inherited connective tissue disorders. Main manifestations of this condition are fragile and hyperextensible skin as well as joint mobility. A 6.5 year-old-girl referred with clinical presentation of frequent unexplained bruises leading to the characteristic clinical features of ED syndrome. Gentle and atraumatic approach in every way is the key in medical and dental management of such patients as minimum pressure could still lead to severe bruises even during a simple dental examination. Conclusions: All clinical findings were directly related to the features described for EDS. There are occasions when dentists would be the first health professionals to see these individuals at a young age; knowing the classic signs of EDS could help in identifying and managing them properly.

Objectives:This study aimed to assess the microshear bond strength (MSBS) of Scotchbond Universal adhesive, used in self-etch and etch-and-rinse modes, to primary and permanent dentin at 24 hours and six months.Materials and Methods:A total of 88 composite micro-cylinders were divided into eight groups (n=11) as follows: (A) Etch-and-rinse, 24 hours, primary dentin; (B) Self-etch, 24 hours, primary dentin; (C) Etch-and-rinse, six months, primary dentin; (D) Self-etch, six months, primary dentin; (E) Etch-and-rinse, 24 hours, permanent dentin; (F) Self-etch, 24 hours, permanent dentin; (G) Etch-and-rinse, six months, permanent dentin; (H) Self-etch, six months, permanent dentin. The MSBS was measured by a testing machine at a crosshead speed of 0.5 mm/minute. Data were analyzed using three-way analysis of variance (ANOVA).Results:The mean MSBS was 12.3±2.3 MPa in A, 18.8±4.1 MPa in B, 11.9±3.7 MPa in C, 16±2.9 MPa in D, 19.1±2.7 MPa in E, 22.8±4.1 MPa in F, 16.2±2.6 MPa in G, and 17.2±4.4 MPa in H. In the self-etch mode, the MSBS was significantly higher than that in the etch-and-rinse mode (P<0.001). The MSBS in permanent teeth was significantly higher than primary teeth (P<0.001). At six months, the MSBS significantly decreased in all groups (P<0.001).Conclusion:The micro-shear bond strength of Scotchbond Universal adhesive decreases over time and depends on the type of tooth and the mode of application of the adhesive.