Rubber Dam Clamp Research Articles

Assessment of treatment field isolation during scaling, root planing and rinsing

Aim: Intensive application of highly concentrated antimicrobials during scaling and root planing may be hazardous if swallowed in quantity. This study evaluates two dental isolation systems for fluid leakage in conjunction with a sham treatment of scaling and root planing. Materials and methods: Eight volunteers were randomly assigned to wear a conventional rubber dam (RD) and a combined suction and isolation device (IsoLite® system [IL]) alternatively on contralateral maxillary and mandibular quadrants. RD was cut between the canine and the first molar and was fixed on the first molar with a rubber dam clamp and with a tissue adhesive (Histoacryl) on the gingiva. IL was applied as recommended by the manufacturer. Ultrasonic instrumentation with corresponding irrigation water was used for 5 min as sham treatment, i.e. no actual therapy. The irrigation liquid was collected and the difference between the amount of liquid applied and that collected during treatment was determined. The volunteers then reported on their comfort during treatment. Results: Neither of the devices offered complete isolation. Mean leakage with both systems was generally low, i.e. approximately 10% (of the applied irrigant). More leakage was recorded in the maxilla than in the mandible, for both systems. Both devices were deemed moderately comfortable to wear. Conclusion: RD and IL isolated the working field to a similar degree. Since RD represents the highest isolation standard currently available, the use of IL must also be considered sufficient to prevent noxious amounts of antiseptic rinses from leaking into the mouth.

Dimensional comparison of rubber dam clamp prongs with cervical mesiodistal dimension of primary second molar

Background: The stability of the rubber dam (RD) basically depends on the selection of a properly fitting clamp corresponding to the tooth. There are significant differences in tooth size between various races. This implies that the commercially available RD clamps may fit well to teeth of one population but not to another. Aim: The aim of this study was to obtain standard measure of mesiodistal widths at the cervical level of primary second molars in Gujarat children and to compare them with commercial RD clamps commonly used in paediatric dentistry. Materials and Methods: A total of sixty children were selected on the basis of selection criteria. The mesiodistal widths of primary second molars were measured at the clinical cervical level for buccal and lingual sides, respectively, by a digital Vernier caliper. It was compared with mesiodistal with of RD clamps no. #14A, #7 and #13A/12A. Statistical tests independent sample t-test and single sample t-test were applied. Results: All clamps width show significant difference either buccal or lingual side with their respected teeth (P Conclusion: Cervical mesiodistal dimensions of primary mandibular molars were generally larger than those of primary maxillary molars. #14A and #7 can relatively fit to primary mandibular second molar and #13A/#12A for primary maxillary second molar.

Maxillary Incisor with Internal Resorption: Endodontic and Restorative Management.

A 34-year-old female patient reported with a chief complaint of cervical erosion and discoloration of upper maxillary central incisor with the history of trauma a week before. The patient said the tooth showed a pink spot on the crown at the cervical area 36 hours after the trauma, with no symptoms. Few days before she observed the erosion of the enamel at the same area, since it become a cavity in the next days. Radiographic examination showed the presence of an internal resorption at the crown,starting from the pulp chamber [Table/Fig-1]. No symptoms, no mobility, no pain on percussion were present and the vitality of the tooth were maintained (positive response to cold test). Prior to commencement of the procedure, treatment modality, cost benefit and risk were explained to the patient and appropriate consent was taken. [Table/Fig-1]: Initial radiograph with evidence of IRR at the crown. Local anaesthesia was administered. Enamel and dentine around the lesion were removed [Table/Fig-2] and a cervical restoration with composite resine was planned. At the same time the palatine access cavity was open with a diamond bur and all pulpal tissue was removed using Endoflare Ni-Ti rotary file (MicroMega, Besancon, France) and hand stainless-steel K files n.10 and n.15. The canal was irrigated with 5% sodium hypochlorite (NaOCl) to control the bleeding and to dissolve residual pulp tissue. So the restoration with composite resin (Filtek Supreme XTE, 3M Espe, Seefeld, Germany) of the coronal perforation was done, respecting all the protocols for adhesion. An intraoperative radiographic control of the restoration was done after removal of the rubber dam clamp, in order to control the fitting of the restoration [Table/Fig-3]. Then the rubber dam was replaced and root canal treatment was continued with the Revo-S Ni-Ti system (MicroMega, Besancon, France): all the sequence was done using SC1, SC2 and SC: the root canal was prepared at 25/.06. All the steps were done in presence of abundant irrigation with 5% NaOCl and 17% EDTA solutions. Irrigating solutions were frequently replaced. At the end of the treatment NaOCl was activated for 4 minutes using the Endo Activator(MailleferSimit Dental, Baillagues, Switzerland) and the whole root canal was filled with Calcium hydroxide (MM Paste, MicroMega, Besancon, France). A temporary restoration of the access cavity was placed and a radiograph was taken for control [Table/Fig-4]. [Table/Fig-5] shows the restored tooth immediately at the end of the treatment. [Table/Fig-2]: Intraoral view of the incisor after cleaning of coronal resoprtion with high- and low-speed burs: the root canal is visible through the cavity. [Table/Fig-3]: Radiographic control of composite resin restoration of the cervical cavity [Table/Fig-4]: Radiographic control of the temporary filling with Calcium hydroxide after initial treatment and removal of whole pulp tissue. [Table/Fig-5]: Aspect of the tooth after restoration with composite resin. The patient was recalled three weeks later for a second visit: no symptoms were present and the root canal treatment was finished. The root canal was irrigated with the copious amount of 5% NaOCl and the shaping was completed with Revo-S Apical 30 and 35 (MicroMega, Besancon, France). After verifying the complete removal of the Calcium hydroxide with the aid of the operating microscope, the final rinse with activated 5% NaOCl was done and the root canal was dried with paper points. The root canal obturation was done with the continuous wave technique [Table/Fig-6]: sealing of the apical third with warm gutta-percha compacted by the System B Heat source (Sybron Endo, Orange, CA, USA) and the MM Seal (MicroMega, Besancon, France) as sealer; backfilling obtained using Obtura II syringe (Spartan, Fenton, MO, USA). The patient was recalled one week later for the final obturation of the access cavity with composite resin (Filtek Supreme XTE, 3M Espe, Seefeld, Germany). [Table/Fig-6]: Radiographic control after obturation of the root canal. Radiographs were taken after two months [Table/Fig-7], after six months [Table/Fig-8] and after 12 months [Table/Fig-9]. The last control was done after two years [Table/Fig-10,​,11].11]. The tooth was asymptomatic and completely healed. No apical and peri-radicular lesions or signs of new resorption were visible. [Table/Fig-7]: A 2 months recall radiograph. [Table/Fig-8]: A 6 months recall radiograph. [Table/Fig-9]: A 12 months recall radiograph. [Table/Fig-10]: A 24 months recall radiograph. [Table/Fig-11]: Clinical and healthy aspect of the tooth after 24 months recall.

Recent advances in topical anesthesia

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

Rubber Dam Use during Post Placement Influences the Success of Root Canal–treated Teeth

IntroductionSalivary leakage after root canal therapy is of great concern and can lead to failure of the endodontic therapy. The aim of this study was to investigate whether the use of a rubber dam (RD) during post placement impacts the success of root canal–treated teeth. MethodsRetrospective chart reviews of 185 patients with an average recall of 2.7 years were assessed for the incidence of a new periapical lesion (periapical index score >2) after root canal therapy and post placement. The patients were divided into 2 groups based on the presence or absence of an RD clamp in the verification radiograph during post placement. ResultsTwenty-six patients (30 teeth) had a post placed with the use of an RD, and 159 patients (174 teeth) had a post placed without an RD. In the non-RD group, 128 (73.6%) teeth were considered successful at follow-up. In the RD group, 28 (93.3%) teeth were considered successful at follow-up. Based on the bivariate GEE model, the difference in success between these 2 groups was statistically significant (P = .035). ConclusionsThe use of an RD during prefabricated post placement provides a significantly higher success rate of root canal–treated teeth. Using an RD is already considered a standard of care for nonsurgical root canal therapy; in addition, using an RD during restorative procedures that involve open teeth should also become a standard of care.

Phase III, randomized, double-blind, placebo-controlled trial of topical 2 % lidocaine for the prevention and treatment of oral mucosal pain in children

The aim of this study was to assess the efficacy in pain reduction of topical 2 % lidocaine compared to a placebo cream in children with oral mucosal lesions due to trauma or aphthous ulcers or in the prevention of clamp placement pain. The design was a double-blind, randomized, placebo-controlled, four-center trial on 64 patients. Pain intensity and relief were measured using a 100-mm visual analog scale (VAS). One-tailed Student's t test and ANOVA were used for statistical analyses. Independent of the pain origin, application of 2 % lidocaine cream led to a mean reduction in VAS pain intensity of 19.7 mm ± 18.3, which was significantly greater than that obtained with the placebo cream (p = .025). Analyses showed a statistically significant efficacy of the 2 % lidocaine cream (p < .0001). Its efficacy was not associated to any local or systemic adverse drug reaction, as reported by the patients. As the most important population represented in our patients was children whom a rubber dam clamp was placed, we also specifically analysed this population, and we were able to demonstrate a significantly greater efficacy of the 2 % lidocaine cream on the pain caused by the rubber dam clamp placement in comparison to the placebo cream (p < .005). A significant reduction in pain intensity occurred after application of 2 % lidocaine cream, and the effect was significantly greater than that obtained with the placebo cream. Considering the study's limitations, this product appears safe for use in children. For painful benign lesions of the oral mucosa (trauma or aphthous ulcers) or for preventing painful iatrogenic procedures such as rubber dam clamp placement, it is essential to treat or prevent pain onset, especially in the pediatric population for whom a painful experience could end in refusal of dental care. Application of a topical anesthetic in this specific situation is of particular interest, as is defining its efficacy and safety.

Does Operatory Field Isolation Influence the Performance of Direct Adhesive Restorations

To evaluate the influence of different adhesive strategies (etch-and-rinse and self-etching adhesives) and type of field isolation (absolute or relative) on the clinical performance of restorations of noncervical carious lesions (NCCLs). One hundred forty NCCLs were selected from 38 patients, according to previously established inclusion/exclusion criteria, and assigned to one of four groups (n = 35): etch-and-rinse/rubber-dam (ERR), etch-and-rinse/cotton roll (ERC), self-etching/rubber-dam (SER) and self-etching/cotton roll (SEC). The adhesive systems used were: Adper Single Bond 2 (3M ESPE) and Adper SE Plus (3M ESPE), with restorations made using a composite resin (Z350, 3M ESPE). Using the USPHS modified criteria, 140 restorations were evaluated by two calibrated examiners at 5 different times: immediately after placement, at 7 days, and 2, 6, and 12 months. In order to evaluate the presence of gingival recession after the use of the #212 rubber-dam clamp, the clinical crowns of the teeth from groups ERR and SER were measured at six different periods (baseline, immediately, and at 7 days, 2, 6, and 12 months). Data were subjected to McNemar's, chi-square, and Student's t-tests. Both adhesive strategies reduced tooth sensitivity beyond the second period of evaluation (7 days); tooth sensitivity disappeared after the third period of evaluation (2 months). There were no statistically significant differences between the adhesive techniques or isolation techniques, except for a Bravo score for marginal discoloration in group SEC at 6 months, which was significantly different from the other groups. The rubber-dam isolation technique was more uncomfortable for the patient and resulted in short-term gingival recession. No significant differences were found between the types of isolation or adhesive strategy in this clinical evaluation, with the exception of 2 restorations in group SEC that showed marginal discoloration, possibly due to inadequate enamel etching by the self-etching adhesive. Class V restorations perform equally well placed with or without rubber-dam.

Canal Projection - A Technique for the Management of Badly Mutilated Teeth: Case Reports

Isolating a severely broken down tooth is a considerable challenge. Due to insufficient tooth structure either the rubber dam placement becomes difficult or the dam leaks. Coronal bonded build-up can simplify the endodontic phase and strengthen the tooth, decreasing the possibility of further damage to the tooth due to the rubber dam clamp or mastication. The canal projection technique allows for isolation of the individual canals bringing them to the cavosurface margin. This offers adequate visualization and convenience for instrumentation as straight line access is achieved and also provides a strong core and coronal seal of the operative field. In these case reports management of badly broken down teeth was done by canal projection technique using plastic delivering tips and hypodermic needles as projectors. Composite core build up was done, which helped in rubber dam placement.

Accidental Ingestion of Instruments in Pediatric Dental Patients: Report of Three Cases

Very young children are at risk of swallowing or aspirating numerous household things. This risk is enhanced during dental procedures of these children as they tend to be very unco-operative due to their age and lack of maturity to understand the importance of the treatment. Use of physical barriers, sedation or general anesthesia is not practically possible in every child scheduled for dental treatment. Dentist must be able to manage emergency situations in which patients accidentally swallow dental instruments or materials during treatment and procedures. This article presents ingestion of dental objects in 3 children and attempts to discuss the management and prevention of such mishaps. 1 young children, and especially peaks in children aged six months to three years. In adults, it occurs accidentally more commonly among those with psychiatric disorder, mental retardation, and altered consciousness associated with 2 intravenous sedation. Swallowing of dental materials and devices may lead to serious complication during dental treatment. Any object routinely placed into or removed from the oral cavity during dental or surgical procedures can be aspirated or swallowed. These items can include teeth, restorations, restorative materials, instruments, implant parts, 3-7 rubber dam clamps, gauze packs and impression materials. The incidence of aspiration or swallowing of foreign bodies of dental origin varies considerably in the literature. Tamura 8 et al (1996) in a review reported the range being 3.6-27.7 % of all foreign bodies. The majority of foreign bodies that reach the gastrointestinal tract pass spontaneously. However, 10-20% of cases require nonsurgical intervention, while 1% or less may require surgery. Patients swallowing foreign bodies are usually asymptomatic but symptoms may arise later. Foreign body aspiration or ingestion may cause damage to gastric mucosa, septic abscess, intestinal perforations, partial or complete airway obstruction, post obstructive pneumonia, respiratory distress, pnuemothorax or 9-11 haemorrhage. If these cases are not properly managed and 12 timely intervention is not carried out, it can be lethal. Therefore, pediatric as well as general dental practitioners should be aware of a protocol of management and prevention of swallowing or aspiration of dental objects.

Rubber Dam Clamp Trauma, Root Canal Therapy, and Osteonecrosis of the Jaw

Rubber Dam Clamp Trauma, Root Canal Therapy, and Osteonecrosis of the Jaw

Rubber Dam Clamp Trauma During Endodontic Treatment: A Risk Factor of Bisphosphonate-Related Osteonecrosis of the Jaw?

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has become one of the most prominent enigmas in the medical community since the first descriptions emerged in 2003. The exact pathogenesis remains obscure, but many heories regarding BRONJ prevail. Although BRONJ is ofen assumed to primarily be a bone condition, it has been ypothesized that the soft tissue of the oral mucosa could lay a significant role in BRONJ. In most cases, dentoalveolar surgical procedures have preceded the manifestation of BRONJ. Trauma and illfitted dentures are also thought to trigger the onset of BRONJ. However, cases that have occurred spontaneously with no identifiable precipitating event have been reported. To date, few reports have been published of BRONJ precipitated by conservative or endodontic procedures. The purpose of the present study is to report a case with an interesting evolution in which endodontic treatment was the precipitating factor of BRONJ. We have discussed the influence of mucosal, periodontal, and alveolar bone trauma caused by the rubber dam clamp position during conservative treatment as a risk factor for BRONJ.

ラバーダム装着から除去後に至るまでのＮｄ：ＹＡＧレーザーによる疼痛緩和効果に関する経時的変化

The purpose of this study was to compare the pain-relieving effects of pulsed Nd:YAG laser irradiation with topical anesthetic application during placement of a rubber dam clamp.Twenty-two students, aged 22 to 31 years (mean 24.05), who had not experienced either endodontic or cervical restorative treatment of first permanent molars, participated in this study. In this study, the same tooth for the same patient was tested three times every week. The following were the conditions of each site: 1) control site: no pretreatment before placement of the rubber dam clamp, 2) topical anesthetic site: application of topical anesthetic 60 seconds before placement of the rubber dam clamp and wash-out by three-way syringe water, 3) Nd:YAG laser irradiation site: Nd:YAG laser irradiation before placement of the rubber dam clamp. The irradiation conditions were 120 mJ, 1.2 W, 10 pps, and irradiation time was 30 sec twice. The efficacy of pain-relief was assessed by visual analogue scale (VAS) at the start, before placement of the rubber dam clamp, after placement of the rubber dam clamp, and until 20 minutes at 2-minute intervals. The clamp was removed 14 minutes after the start. Pain-relieving effects were also examined by questionnaire.The VAS levels of both placement and removal of the rubber dam clamp were high for all sites. On placement of the rubber dam clamp, the VAS level with Nd:YAG laser irradiation was statistically significantly lower than with no preparation (P<0.05: Wilcoxon signed-ranks test). During placement of the rubber dam clamp, the VAS level with Nd:YAG laser irradiation and topical anesthetic application were statistically significantly lower than with no preparation (P<0.05: Wilcoxon signed-ranks test).

Intra‐oral stabilisation of the reinforced tracheal tubes using the surgical suture

We read with interest Janakiraman and Rassam’s paper, which suggests many different methods for fixing reinforced tracheal tubes using adhesive tape [1]. However, they ignore some disadvantages of the extra-oral tape fixation of the ETT, particularly when operations involve middle and lower face, and intra-oral sites [2]. First, surgical access to these regions is handicapped by the tape covering and distracting the skin. Second, blood, saliva, sweat, and disinfectant fluid interfere with reliable adhesion of the tape. The operative procedure and frequent reposition of the head may also further jeopardize the security of tracheal tubes. Third, the common adhesive tapes have been shown to have poor adhesion to the reinforced tracheal tube [3]. Fourth, the adhesive tape can not adequately secure an tracheal tube in patients with facial hair, burns or trauma and is not used in those with allergy to adhesive materials. To overcome these problems, several methods of securing the tracheal tube have been described: anchoring the tracheal tube with circum-mandibular wire or a standard dental arch bar, using a dental rubber dam clamp, or screw fixation to the maxilla by drilling [4, 5]. We report another simple intra-oral dental fixation method of the reinforced tracheal tube using the surgical suture. After intubation is successfully complete, a size seven surgical suture with a length of about 30–40 cm is placed on the cervix of a stable tooth via interdental space of its two sides (Fig. 4a) and fixed firmly on the tooth by a ligature (Fig. 4b). Then the suture is wound round the reinforced tracheal tube twice (Fig. 4c) and tightly tied a knot to secure the tube (Fig. 4d). When the surgical sites are middle and lower face or perioral region, a maxillary or mandibular central incisor should be selected and the tube is fixed in median line (Fig. 5a and 5b). If intra-oral surgery is performed, a lateral incisor is best selected and the tube is secured in angle of mouth to avoid its interference to surgical access (Fig. 5c). In patients who are at a high risk of biting the tube during the surgery, both a bite block and a tube should be stabilised together to prevent perforation and obstruction of the reinforced tracheal tube from biting [6] (Fig. 5d). The procedure for the intra-oral dental fixation of a reinforced tracheal tube. (a) Suture is placed on the cervix of a stable tooth via interdental space of its two sides and (b) fixed firmly on the tooth by a ligature. (c) The suture is then wound round the reinforced ETT and d. tightly knotted to secure the tube. (a) The reinforced tracheal tube was secured on the maxillary central incisor using the suture in a patient who received the skin expander embedment in the perioral region. (b) The tube was fixed on the mandibular central incisor using the suture in a patient who received maxillary and nasal surgery. (c) The tube was mounted on the maxillary lateral incisor using the suture in a patient who received an intraoral surgery. (d) Both a bite block and a tube were secured together on the central incisor of upper mandible using the suture in a patient who may bite during surgery. We have used this technique in 3000 patients over the last 10 years, and consider that this method has the following advantages: (1) it can provide reliable tube fixation without undesirable tube displacement or accident extubation; (2) it may avoid the problems of the extra-oral tape fixation and is easier to perform for the anaesthetist compared with the other methods previously reported [4, 5]; (3) it is non-invasive and there is no risk of damaging the oral mucosa and facial skin; (4) the surgeon has a good view of the operative region. However, it is must emphasized that only healthy teeth should be selected. This method is evidently unsuitable for edentulous patients.

The Information Processing of Visual Perception in Recognizing the Figure of Rubber Dam Clamp

The Information Processing of Visual Perception in Recognizing the Figure of Rubber Dam Clamp

Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection

Management of vertically fractured tooth or a perforation frequently poses problem during endodontic management. Such teeth often need a pre-endodontic restoration prior to initiation of root canal therapy to aid in the placement of rubber dam clamp. This paper describes a simple method of placement of a pre-endodontic restoration using the canal projection technique using hollow metallic needles as sleeves.

Fixation of an Oral Tracheal Tube to the Maxilla in Maxillofacial Surgery

To the Editor: Securing the orotracheal tube is a challenge in maxillofacial surgery. Blood, saliva, and disinfectant solutions interfere with tape adhesion (1). Surgeons frequently reposition the head, further jeopardizing the security of the orotracheal tube. Several methods of securing oral endotracheal tubes have been described: anchoring the endotracheal tube with circummandibular wire (2) or a standard dental arch bar (3), affixing wire between the endotracheal tube and the cervix of a stable tooth (4), using a dental rubber dam clamp (5) or screw fixation to the maxilla (6). We report another method of affixing an oral tracheal tube in a case of midfacial fracture. A 25-yr-old man sustained maxillofacial injury from a motor vehicle accident. Clinical and radiological examination revealed bilateral Lefort Type 2 fracture of the midface, naso-orbito-ethmoidal complex fracture, and fracture of the mandible at the parasymphysis. The patient was scheduled to undergo open reduction and internal fixation of his maxilla, mandible with nasal bone manipulation and stabilization. Airway examination showed an adequate mouth opening with avulsed maxillary central incisors and right lateral incisor. After we induced general anesthesia and neuromuscular blockade, we intubated the trachea with a 38F flexometallic tube. We drilled a hole above the maxillary central incisors’ socket in the thick alveolar bone and threaded a 6-mm intermaxillary fixation screw into the hole. We secured the endotracheal tube to the screw using 26-gauge dental wire (Fig. 1). This permitted proper alignment of the teeth, and completion of the surgery without risk of extubation. At the end of the procedure, we reversed the neuromuscular blockade, extubated the trachea, and removed the maxillary screw, without any complication.Figure 1.: Endotracheal tube secured to the screw drilled in maxillary central incisors’ socket.Suman Arora, MD Navanit G. Nagdeve, MD, DNB Jeetinder Kaur Makkar, MD, DNB Department of Anaesthesia and Intensive Care Ramesh Kumar Sharma, MS, MCh Department of Plastic Surgery Post Graduate Institute of Medical Education and Research Chandigarh, India [email protected]

Clinical Evaluation of Prototype Rubber-dam Clamps for Deciduous Molar Teeth

Clinical Evaluation of Prototype Rubber-dam Clamps for Deciduous Molar Teeth

In vivo fracture of a new rubber-dam clamp.

This study was carried out to investigate the reasons for fracture of a new rubber-dam clamp used for the first time. The fractured surfaces of the broken clamp were studied with optical microscopy. Characteristic surface patterns of tensile fracture were identified. Cracks originated from the groove of letter D mechanically engraved on the inner surface of the clamp bow, and developed with high velocity (unstable crack growth rate) leading to catastrophic fracture. This behaviour was attributed to the residual stresses introduced by the labelling technique due to local thermal alterations. The labelling technique used to number clamps may be implicated with catastrophic failure. Dentists should be aware that even new clamps can fracture. It is important that clamps are secured to prevent inhalation of metal fragments, should catastrophic failure occur.

SUBACUTE BACTERIAL ENDOCARDITIS: CONSIDERATIONS FOR THE PEDIATRIC PATIENT

The American Heart Association&apos;s recommendations for prescribing antibiotic prophylaxis against bacterial endocarditis were last revised in 1997.1 Each revision of these recommendations has decreased the recommended antibiotic dosage. There is confusion regarding the need for antibiotics for prophylaxis in a pediatric patient with excellent oral hygiene (but not for the placement of a rubber dam clamp). Toxic and adverse reactions to these medications lead to questions about risks vs. gains from this protocol.

Evaluation of electronic dental anesthesia in children

Objective. The purpose of this study was to determine the effectiveness and acceptance of electronic dental anesthesia in comparison with local anesthesia in restorative procedures in children. Study design. Twenty-eight children, aged 6 to 12 years, participated in the study. Each patient had symmetric teeth requiring class I cavity preparations. One tooth was treated with electronic dental anesthesia; the antimere tooth was treated with local anesthesia. The tooth and the method were selected at random, and the two restorations were performed at the same appointment. Pain was assessed by means of two pain scales, the color scale and the sound, eye, and motor scale. Behavior was assessed through use of the North Carolina Behavior Rating Scale. The ratings of pain and behavior were made at 4 separate intervals (after rubber dam clamp placement, with the handpiece operating adjacent to the tooth, during penetration of the dentin-enamel junction of the tooth, and 5 minutes postoperatively). The recorded values for the steps of the restorations completed with electronic dental anesthesia and local anesthesia were analyzed by means of χ 2 analysis to determine any statistically significant difference between the techniques at a level of P < .05. Results. Although the success rate of electronic dental anesthesia was less than that of local anesthesia, there was no significant difference between the two methods. On the other hand, 53.6% of the patients preferred electronic dental anesthesia, whereas 35.7% preferred local anesthesia. Conclusions. In restorative dental care in children, electronic dental anesthesia appears to be beneficial in reducing discomfort, as judged from behavioral observations and self-reports. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:418-23)