Behavior Of Pediatric Patients Research Articles

Sedation in pediatric patients undergoing dental treatment: case reports

Anxiety, fear and phobia of dental treatment are present in a large part of the population. As an effective method to control anxiety, sedation is currently present in dental offices, acting in a positive way in dental care procedures. In pediatric dentistry, the fear regarding consultation is mainly caused by the fact that the environment is new and unknown, and sometimes it is necessary to use sedative drugs, so that the care is efficient, fast and safe. This study is a case report involving two pediatric patients with dental treatment phobia who underwent sedation performed in an outpatient clinic under the supervision of an anesthesiologist. We conclude that drug sedation is a technique that should be considered in cases where there was no success in behavioral management to control aversive behavior in pediatric patients with phobia and the incorporation of this technique enables safe and effective dental care.

Behavior management in pediatric patients towards dentistry

Anxiety in pediatric patients is often found in dental practice. It is triggered by several components such as encountering unfami-liar adults, unfamiliar sounds and feelings, having to lie down for treatment, discomfort, and even pain. So that the need for be-havior management in pediatric patients in dental procedures. This case discusses the behavior management of a 6-year-old child who is accompanied by his mother and will undergo dental restoration treatment (ART). It is known that the child has a his-tory of unpleasant dental treatment and traumatizes the child in dental treatment. During the treatment process in dealing with the child's attitude, a combination of several behavior management techniques was applied such as tell-show-do, use of second lang-uage, and the presence of parents, where the application of these techniques succeeded in influencing the child's attitude which at the first appointment was negative to become positive at the second appointment and definitely positive at the third appoint-ment. It is concluded that it is important for dentists to analyze the proper technique in dealing with the behavior of pediatric patients so that dental treatment can run well and effectively.

Does the Behavior of Pediatric Patients towards Dental Treatment Influence the Pattern of Adjacent (Sound, Decayed, and Filled) Proximal Surfaces in Primary Molars?

This retrospective study aimed to investigate the influence of patient behavior toward dental treatment on the presence of adjacent (sound, decayed, or filled) proximal surfaces in the primary molars. The study included a records review of 2226 pediatric patients. Records were eligible if the patients were in primary or mixed dentition, and if they included a complete set of bitewings and periapical intraoral radiographs of all their primary molars. Four calibrated reviewers used intraoral radiographs to record the sound, decayed, and filled proximal distal surfaces of the first primary molars and the mesial surfaces of the second primary molars. Demographical variables were reported from patients’ medical records including gender, age, medical history, nationality, and patient behavior. Patients’ behaviors were evaluated using Frankl’s Behavior Rating Scale. The Pearson correlation was used to test the association between the sound, decayed, and filled distal surfaces of the first primary molars and the mesial surface of the second primary molar. High correlations of ≥0.6 were further tested in simple and multiple linear regression models to test the influence of patients’ behaviors on these correlations after adjusting for demographical factors. All tests were performed at 5% significance level A. A total of 1194 records met the inclusion criteria and were analyzed. There was a high positive correlation between the sound, decayed, and filled distal surfaces of the first primary molar and similar surfaces on the mesial of the second primary molars (0.66, 0.61, and 0.60, respectively). Compared to cooperative patients, the adjusted estimate of the mean decayed mesial surface of the second primary molar increased significantly for non-cooperative patients by 0.1 (95% CI = 0.16–0.53). On the contrary, the adjusted estimate of the mean sound mesial surfaces of the second primary molars decreased significantly by 0.09 for non-cooperative patients, compared to those who were cooperative (95% CI = −0.52–−0.15). Patient cooperation did not significantly influence the mean of the filled mesial surfaces of the second primary molars (adjusted B = 0.01, 95% CI = −0.05–0.09). Educating parents and clinicians about the influence of children’s behaviors on oral health is highly encouraged to improve treatment outcomes and reduce the progression of dental caries. The implementation of specific behavior management techniques is also important to reduce dental fear and anxiety.

Behavior of Children toward Various Dental Procedures.

ABSTRACTIntroductionDental treatment is known to trigger anxiety and fear even in fully grown adults, especially if administration of local anesthesia with a syringe is indicated. This study is aimed to evaluate whether procedures like an extraction and pulpectomy could trigger fear and anxiety in a pediatric patient and also the response of pediatric patients to other treatment modalities. Their perception toward receiving dental treatment as a whole is also evaluated. The effect of conditioning of the environment and the dentist (extractions done in second or third appointments) and its effect in decreasing the anxiety is also evaluated. The aim of the study is to evaluate the behavior of pediatric patients aged 7–17 years in response to various treatment procedures at Saveetha Dental College.Materials and methodsThe behavior of 50 children reporting to Saveetha Dental College, categorized according to the Frankl's behavior rating scale, was recorded before, during, and posttreatment.ResultsChildren undergoing extractions and pulpectomies showed the most uncooperative behavior. Sixty percent of patients undergoing extraction and 45% of patients undergoing the pulp therapy showed negative behavior (rating 2) during treatment.ConclusionInvasive procedures like extractions and pulpectomies were procedures that brought out negative behavior in pediatric patients, especially during treatment.How to cite this articleSivakumar P, Gurunathan D. Behavior of Children toward Various Dental Procedures. Int J Clin Pediatr Dent 2019;12(5):379–384.

Attitude of general dental practitioners to pediatric patients and preventive dentistry

Background: Dental education shapes the attitudes and professional behavior of dentists when treating pediatric patients. We evaluated the extent to which general dental practitioners (GDPs) in private and public hospitals were willing to treat pediatric patients as well as their attitude to preventive dentistry. Materials and Methods: A web-based questionnaire comprising 18 questions was E-mailed to 600 GDPs across Turkey. Descriptive statistics and the Pearson Chi-squared test were used for statistical analysis. Results: The response rate was 63.6% (n = 382). Of the 382 GDPs, 40 were unwilling to treat pediatric patients, whereas 74 stated that they treated such patients rarely. The GDPs were most unwilling to treat pediatric patients under 4 years of age (35.1%). The most frequent reason cited for unwillingness to treat was the uncooperative behavior of pediatric patients (77.2%). Of the GDPs, 51.6% and 56.8% preferred topical fluoride and fissure sealant, respectively, as preventive measures. Conclusions: GDPs are unwilling to treat pediatric patients due to their lack of cooperation. To overcome this, theoretical and practical training in pediatric dentistry behavior management techniques should be promoted.

Reducing the pain of intravenous injections in preschool children

Peripheral intravenous catheter insertion is a significant source of stress for preschoolers during hospitalization. An average of about 85% of pediatric patients at our general pediatric unit are preschoolers. An average 71% of these exhibit severe pain-related behavior during intravenous insertions. The factors influencing this pain experience may include inappropriate administration of analgesics by nurses, non-pharmacologic pain management, and inappropriate clinical settings. This project worked to develop a strategy to reduce the incidence of severe injection pain in preschool children from 71.0% to 36.0% and to achieve a capacity improvement target of 50%. We implemented the following: 1) arranged a relevant training program for pediatric nurses; 2) revised hospital standards for pediatric intravenous insertions; and 3) enhanced analgesic administration and non-pharmacologic pain management through creating child-friendly clinical settings and providing interactive toys. After implementing the above mentioned interventions, the incidence of severe pain-related behavior in pediatric patients decreased from 71.0% to 19.7%, a result that greatly exceeded expectations. This project demonstrated an effective approach to reducing severe intravenous-insertion pain in preschoolers and increasing pediatric care quality.

Techniques for Controlling the Behavior of Pediatric Patients - Review of Literature

Introducao: E comum na pratica clinica odontologica infantil, manifestacoes de medo e ansiedade do paciente, que, quando nao controladas pelo cirurgiao-dentista, podem causar danos aos mecanismos emocionais da crianca e comprometimento da qualidade do atendimento odontologico. Estas situacoes podem ser minimizadas por meio da construcao de uma relacao de confianca com o profissional mediante a aplicacao de conhecimentos de psicologia infantil, possibilitando um melhor entendimento do comportamento da crianca em tratamento odontologico e facilitando a orientacao e abordagem dos pais nesta ocasiao. E oportuno, pois, que o cirurgiao-dentista conheca e institua estrategias adequadas de controle do comportamento na clinica infantil, favorecendo o estabelecimento de um ambiente propicio para se obter sucesso nos procedimentos clinicos propostos. Objetivo: Revisar, por meio de pesquisa bibliografica nas bases de dados MEDLINE e BBO, na literatura nacional de periodicos e livros especializados, bem como no protocolo sobre orientacoes de controle de comportamento de pacientes infantis da Academia Americana de Odontopediatria (AAPD), as principais tecnicas nao farmacologicas de auxilio do controle do comportamento na clinica infantil (comunicacao verbal, dizer - mostrar - fazer, controle de voz, comunicacao nao verbal, reforco positivo, distracao, presenca ou ausencia dos pais e contencao fisica). Conclusao: Verificou-se que a adocao de uma abordagem adequada da crianca possibilita o atendimento odontologico atraves de tecnicas nao farmacologicas, assim como estimula uma relacao profissional paciente favoravel a promocao da saude bucal do paciente infantil.

Lamotrigine for Pediatric Patients with Epilepsy

The antiepileptic drug lamotrigine has been assessed in various seizure types and epilepsy syndromes in children and is indicated in the USA and other countries for adjunctive treatment of epilepsy in patients as young as 2 years. This paper reviews data on the pharmacokinetics, efficacy and safety of lamotrigine in pediatric patients. Data from clinical trials and experience in clinical practice demonstrate that lamotrigine is effective for a range of seizure types, including generalized seizures (including absence) and partial seizures. Observations primarily from open-label studies are consistent with the possibility that lamotrigine is effective in several pediatric epilepsy syndromes, including infantile spasms and juvenile myoclonic epilepsy as well as Rett’s syndrome, a neurogenetic disorder that is often associated with epilepsy. The safety and tolerability profiles of lamotrigine in pediatric patients are consistent with those in adults. The risk of rash with lamotrigine can be reduced by adhering to current dosing recommendations. Lamotrigine-associated improvements in mood, cognition and behavior could be particularly useful in pediatric patients given the high rate of behavioral and mental abnormalities in children with epilepsy. Randomized, double-blind, placebo-controlled studies on the effects of lamotrigine on mood, cognition and behavior in pediatric patients are warranted. The safety and efficacy of lamotrigine as monotherapy in pediatric patients also warrant further investigation.

Long-Term Effects of Risperidone in Children With Autism Spectrum Disorders: A Placebo Discontinuation Study

The short-term benefit of risperidone in ameliorating severe disruptive behavior in pediatric patients with autism spectrum disorders is well established; however, only one placebo-controlled, long-term study of efficacy is available. Thirty-six children with an autism spectrum disorder (5-17 years old) accompanied by severe tantrums, aggression, or self-injurious behavior, started 8-week open-label treatment with risperidone. Responders (n = 26) continued treatment for another 16 weeks, followed by a double-blind discontinuation (n = 24; two patients discontinued treatment because of weight gain) consisting of either 3 weeks of taper and 5 weeks of placebo only or continuing use of risperidone. Relapse was defined as a significant deterioration of symptoms based on clinical judgment and a parent questionnaire. Risperidone was superior to placebo in preventing relapse: this occurred in 3 of 12 patients continuing on risperidone versus 8 of 12 who switched to placebo (p = .049). Weight gain, increased appetite, anxiety, and fatigue were the most frequently reported side effects. This study indicates the effectiveness of risperidone during a period of several months, reducing disruptive behavior in about half of the children with autism spectrum disorders. The results provide a rationale for the continuing use of risperidone beyond 6 months, although considerable weight gain can limit the use of this agent.

FDA’s drug safety initiative: Resolutions or more questions?

The storm of controversy surrounding the safety of antidepressants and nonsteroidal antiinflammatory drugs (NSAIDs) is part of a normal cycle that hits FDA every few years, Steven K. Galson, acting director of the Center for Drug Evaluation and Research (CDER), told agency employees, industry stakeholders, and news reporters during a May 20 webcast. Galson and other top FDA officials defended the agency’s actions in dealing with postmarketing reports of cardiovascular events associated with the use of cyclooxygenase-2 (COX-2)-selective NSAIDs, specifically Merck’s rofecoxib, or Vioxx, and Pfizer’s valdecoxib, sold as Bextra—both no longer on the market—and an increased risk of suicidal thoughts and behavior in pediatric patients using antidepressants. A cloud of controversy has loomed over FDA throughout the past year after lawmakers and other critics condemned the agency for being too slow to warn the public about risks linked to NSAIDs and antidepressants. John K. Jenkins, director of FDA’s Office of New Drugs, maintained that regulators in 2002 “thought we were going through the process of making sure that the public was aware” of the risks of using rofecoxib after FDA asked Merck to add information to the drug’s labeling reflecting the findings of the Vioxx Gastrointestinal Outcomes Research study, which found an increased risk of serious cardiovascular events.

Gabapentin-Associated Aggression

Back to table of contents Previous article Next article LetterFull AccessGabapentin-Associated AggressionNarsimha R. Pinninti, M.D., , and Deepak S. Mahajan, M.D., Narsimha R. PinnintiSearch for more papers by this author, M.D., Department of Psychiatry, SOM-UMDNJ, Cherry Hill, NJ, and Deepak S. MahajanSearch for more papers by this author, M.D., Philadelphia, PAPublished Online:1 Aug 2001AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: Gabapentin is an effective adjunctive mood stabilizer.1 There are case reports of aggression and hyperactivity when gabapentin was added to existing antiepileptic medication2 or used as a monotherapy in children.3 In adults, hostility, but not aggressive behavior, is reported to occur in at least 1% of patients treated with gabapentin.4 We report two cases where introduction of gabapentin was associated with aggressive behavior.Case ReportsCase 1. A 38-year-old man was admitted for the third time to our facility with a diagnosis of bipolar disorder, manic phase with psychotic symptoms. There was no history of rapid cycling, comorbid substance abuse, or physical aggression. His symptoms were partially responsive to a combination of lithium carbonate 1,650 mg/day (level of 0.7 mEq/l), olanzapine 25 mg/day, and lorazepam 2 mg bid. Gabapentin was started in a dose of 300 mg tid and increased to 1,200 mg/day by day 3. By day 4, the patient became very irritable and physically aggressive. He attacked a nurse, and mechanical restraints were used to control his behavior. He did not receive any additional medication at this time. The patient later recognized this behavior as out of character for him. Gabapentin was stopped while all other medications were continued. Within a day, his irritability decreased and aggressive behavior stopped completely. No further incidents of aggression were noted throughout the rest of his hospital stay.Case 2. A 51-year-old man with a diagnosis of bipolar disorder was admitted for the fourth time to our facility in a manic phase with mixed affective features. He had no history of psychotic symptoms, substance abuse, or aggression. On a combination of sodium valproate 2 g/day and risperidone 4 mg/day (to which the patient had responded well on previous admission) he became very withdrawn, spending 12 hours a day in bed, but denied depressive symptoms. When a reduction in sodium valproate to 1 g did not improve his condition, a decision was made to switch mood stabilizers. Gabapentin was started in a dose of 300 mg bid, and sodium valproate was stopped. Within 48 hours, the patient developed new symptoms of hostility, verbal aggression, and command auditory hallucinations and destroyed property by breaking the commode in his room. The patient clearly attributed these new symptoms to gabapentin. Gabapentin was stopped and sodium valproate reinstated in a dose of 1g per day. Within 48 hours, hostility, aggressive behavior, and hallucinations stopped. No further aggressive behavior was noted throughout his hospital stay.CommentAggression in the above two cases could be an aspect of mania, or it could be gabapentin-related. The absence of prior aggression, the temporal relation to instituting gabapentin, the cessation of aggression soon after stopping gabapentin, and the ego-dystonic nature of the aggressive behavior indicate an association between gabapentin and aggression. To our knowledge, there are no published case reports of aggression with gabapentin in adult patients. More than 100 cases of hostility and aggression have been reported to the manufacturer in the past 5 years (personal communication, Parke-Davis, 2000). With increasing use of gabapentin in psychiatry, this possible adverse effect should be kept in mind.References1 Ferrier IN: Lamotrigine and gabapentin: alternative in treatment of bipolar disorder. Neuropsychobiology 1998; 38:192-197Crossref, Medline, Google Scholar2 Wolf SM, Shinnar S, Kang H, et al: Gabapentin toxicity in children manifesting as behavioral changes. Epilepsia 1996: 36:1203-1205Google Scholar3 Tallian KB, Nahata MC, Lo W, et al: Gabapentin-associated aggressive behavior in pediatric patients with seizures. Epilepsia 1996; 37(suppl):501-502Google Scholar4 Neurontin (gabapentin). Physician's Desk Reference, 55th edition. Montvale, NJ, Medical Economics Co, 2001, p 2460Google Scholar FiguresReferencesCited byDetailsCited byEffect of gabapentin on sleep-deprivation-induced disruption of prepulse inhibition27 June 2020 | Psychopharmacology, Vol. 63BMJThe Psychopharmacology of Aggressive BehaviorJournal of Clinical Psychopharmacology, Vol. 32, No. 2The Consultant Pharmacist, Vol. 22, No. 12Gabapentin-Induced Paradoxical Exacerbation of Psychosis in a Patient with Schizophrenia1 December 2002 | The Canadian Journal of Psychiatry, Vol. 47, No. 10 Volume 13Issue 3 August 2001Pages 424-424 Metrics PDF download History Published online 1 August 2001 Published in print 1 August 2001