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Biomedical subjects

R E Primosch

Publications and source records attributed to R E Primosch.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Effect of nitrous oxide-oxygen inhalation with scavenging on behavioral and physiological parameters during routine pediatric dental treatment.

PURPOSE: The purpose of this study was to determine the influence of 40% nitrous oxide/60% oxygen inhalation with scavenging on the behavioral and physiological parameters during routine pediatric dental procedures. METHODS: Twenty-two subjects, aged 60-116 months, were randomized into a double blind, cross-over study design and administered alternately either 40% nitrous oxide/60% oxygen or 100% oxygen during two sequential restorative appointments. All subjects were monitored continuously for respiratory rate, pulse rate, and hemoglobin oxygen saturation using a combined capnograph and pulse oximeter. The subject's breath sound and behavior were recorded every minute along with vital signs. RESULTS: When compared to 100% oxygen inhalation, 40% nitrous oxide/60% oxygen inhalation produced significant reductions in adverse patient behavior, respiratory rate, and pulse rate, but did not affect percent hemoglobin oxygen saturation. Nitrous oxide inhalation had no effect on breath sound revealed by auscultation or on the occurrence of the apnea alarm displayed by the capnograph. CONCLUSIONS: This study demonstrated that the administration of 40% nitrous oxide/60% oxygen delivered via a scavenging nasal hood significantly improved patient behavior and altered physiological parameters commonly monitored during conscious sedation.

Administration, Inhalation↗
PubMedDate not supplied

Monitoring pediatric dental patients with nasal mask capnography.

PURPOSE: The purpose of this study was to evaluate the potential of using capnography to analyze respiratory samples taken from a scavenging nitrous oxide nasal hood during routine pediatric dental procedures. METHODS: Twenty-two subjects, aged 60-116 months, were administered alternately either 40% nitrous oxide/60% oxygen or 100% oxygen during two sequential restorative appointments. All subjects were monitored continuously for end-tidal carbon dioxide and respiratory rate using a capnograph whose sampling line was attached directly to the nitrous oxide nasal hood. The subject's breath sound, displayed behavior, type of dental procedure being performed, and presence of rubber dam isolation were recorded every minute throughout the two appointments. RESULTS: Values for end-tidal carbon dioxide and respiratory rate were displayed on the capnograph when administering either oxygen or a combination of nitrous oxide/oxygen inhalation through the nasal hood. These respiratory values were lowered significantly when comparing 40% nitrous oxygen-60% oxygen to 100% oxygen inhalation. They were not significantly altered by the type of breath sound, patient behavior, dental procedure, or presence of rubber dam isolation, with the exception of some dental procedures which significantly lowered end-tidal carbon dioxide. The apnea alarm on the capnograph occurred during 5% of the total treatment time, but its occurrence represented a 97% false positive rate. The occurrence of the apnea alarm was significantly associated with the type for breath sound, patient behavior, and dental procedure. When used in this manner, the capnograph was effective in alerting the practitioner to potential apneic events, but likely has limited value in monitoring valid end-tidal carbon dioxide levels due to limitations in the sampling technique. CONCLUSIONS: This study demonstrated the potential of the capnograph as a respiratory monitor for pediatric dental patients when the sampling line was attached to a scavenging nitrous oxide nasal hood.

Anesthesia, Dental↗
PubMedDate not supplied

Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anesthetic infiltration in children.

PURPOSE: The purpose of this investigation was to compare the pain responses of children during local anesthetic infiltration at bilateral palatal sites prepared with the topical application of benzocaine 20% oral adhesive (Orabase-B) versus benzocaine 20% gel (Hurricaine) or EMLA 5% oral adhesive (EMLA 5% cream in Orabase Plain). METHODS: Forty subjects, aged 7-15 years old, received bilateral palatal injections following topical application of anesthetic agents applied in a randomized, crossover design. Pain responses were compared based upon subject self-report using a visual analogue scale (VAS), changes in the subject's heart rate, and operator assessment using a modified Children's Hospital of Eastern Ontario Pain Scale (CPS) that rated behavioral changes in children. Following the injections, the subjects were asked to choose which agent was preferred based on comfort and taste acceptance. RESULTS: All the agents tested were equivalent in injection pain response comparisons, but Hurricaine had a slight advantage in expressed subject preference and taste acceptance over the other topical anesthetic agents tested. CONCLUSIONS: The selection of EMLA 5% oral adhesive over other commercially available products containing benzocaine 20% is not recommended for palatal site preparation in children. The lack of demonstrated superiority in efficacy and subject preference, the necessity to custom mix the cream into an oral adhesive paste, the extended duration of time required for onset of action, the greater potential for complications associated with systemic absorption, and product cost preclude the use of EMLA 5% oral adhesive as an intraoral topical anesthetic agent.

Adolescent↗
PubMedDate not supplied

Outcomes assessment an intervention strategy to improve parental compliance to follow-up evaluations after treatment of early childhood caries using general anesthesia in a Medicaid population.

Young children from low-income families are at risk for the development of early childhood caries (ECC) that can progress to severe oral disease. Treatment of this condition often requires extensive rehabilitation using general anesthesia in an ambulatory care facility. These children, presenting with neglected oral health, frequently face major obstacles to accessing dental care in a timely manner. Recently, several retrospective studies reported poor follow-up compliance (return for recall evaluations) in children treated for ECC using general anesthesia (GA). The purpose of this study was to provide a prospective analysis of an intervention strategy aimed at improving follow-up compliance in this population. Results of the analysis suggested that the insertion of an additional pre-operative consultation appointment failed to improve significantly compliance to follow-up evaluations or change parental dental health knowledge and preventive practices. Patient variables studied also failed to discriminate influences on predicting compliant behavior. Although retreatment (relapse) was prevalent among those patients who complied with follow-up evaluations, a statistically significant improvement in plaque, gingival, and mutans streptococci scores were demonstrated, following the degree of aggressive restorative treatment typically provided using general anesthesia. These findings are contrary to those reported from conventional restorative therapy and might reflect a beneficial outcome of an aggressive restorative approach. Further investigation is required to identify an intervention strategy that improves follow-up compliance and reduces the costly ravages of dental neglect in young children from low-income families.

Anesthesia, Dental↗
PubMedDate not supplied

Factors associated with administration route when using midazolam for pediatric conscious sedation.

Midazolam conscious sedation records of pediatric dental patients, one to six years of age, were reviewed retrospectively to: 1) examine the factors associated with the use of oral and nasal routes of administration and their effect on displayed behavior during dental treatment and 2) determine whether a child's compliance with oral administration is predictive of the intraoperative behavior displayed during dental treatment. Two hundred and fifty-seven conscious sedation records for 222 pediatric dental patients sedated with orally or nasally administered midazolam for dental treatment at the University of Florida were reviewed. Data collected included the patient's age, gender, route of administration, dose, compliance with oral administration, appointment type (planned vs. emergency), previous sedation experience with midazolam, operator vs. parent administration of the medication, use of papoose board and nitrous oxide/oxygen inhalation, types of procedures performed (restorations only, extractions only, or both), length of treatment rendered, and preoperative and intraoperative behavioral assessments of the child. The collected data were analyzed with Statview software using ANOVA and Chi-square analyses. There was a statistically significant difference (p < 0.001) between oral and nasal administration for the parameters of age, procedure length, appointment type, procedures performed, previous sedation experience and use of the papoose board and nitrous oxide/oxygen inhalation. While there was no statistically significant influence of chronological age on the preoperative Frankl behavior ratings, there was a statistically significant mean age difference with respect to the administrator of the medication (parent vs. operator), papoose board use, N2O/O2 use and previous sedation experience. Forty-five percent of the subjects were willing to accept oral administration of the medication, however, there was no statistically significant difference (p = 0.114) between the child's compliance to accept the medication and the intraoperative Frankl behavioral ratings displayed during dental treatment. In this review of midazolam conscious sedation records of pediatric dental patients. 1) route of administration was significantly influenced by several patient and procedural variables, resulting in different behavioral outcomes and 2) compliance with oral administration was not predictive of behavior displayed during treatment.

Administration, Intranasal↗
PubMedDate not supplied

A survey of local anesthetic usage in pediatric patients by Florida dentists.

Local anesthetic toxicity in the child dental patient is a concern of the dental profession. A survey of 117 Florida dentists was conducted to determine their local anesthetic practices in treating children. Results indicated that a fifth of the respondents might use local anesthetic levels that could cause potential CNS toxicity in the smaller and younger children they treat. It is the responsibility of the dental profession to recognize the differences in treating this group of patients, and the serious consequences that might occur when maximum recommended levels of local anesthetic are exceeded.

Age Factors↗
PubMedDate not supplied

The effects of various dental procedures and patient behaviors upon nitrous oxide scavenger effectiveness.

This prospective study of 36 children, ages 44-93 months, receiving nitrous oxide-oxygen under standardized conditions during routine dental procedures was conducted to determine what influence eight selected dental procedures and three patient behaviors had on ambient nitrous oxide (N2O) levels in the dentist's breathing zone. Half the children received nitrous oxide-oxygen via a scavenging nasal mask. An infrared spectrophotometer analyzed the ambient N2O level continuously throughout the procedure and the time-weighted average (TWA) for consecutive 15-sec intervals was recorded by a microprocessor. A video camera was used to synchronize the coded dental procedures and patient behaviors to the TWA ambient N2O levels recorded. The results demonstrated that scavenging significantly reduced the dentist's exposure to ambient N2O (P less than 0.05, nonscavenged mean = 284.7 ppm; scavenged mean = 36.6 ppm), but the mean TWA N2O concentration remained significantly higher, P less than 0.05, than the 25-ppm level recommended by the National Institute for Occupational Safety and Health (NIOSH). Supplemental oral evacuation was the only dental procedure capable of reducing ambient N2O to below NIOSH's recommendation when scavenging was employed. The administration of local anesthesia consistently created a significant increase in ambient N2O levels. Patient behaviors of talking, crying, and movement also resulted in significant increases from baseline ambient N2O levels.

Air Pollutants, Occupational↗
PubMedDate not supplied

Clinical effectiveness of 1 and 2% lidocaine in young pediatric dental patients.

Clinical effectiveness of the double-blind administration of 1 and 2% lidocaine solutions was evaluated for restorative and surgical procedures on primary molars of children 4.5 to 10.5 years old. This effectiveness was measured by changes in the child's heart rate, the child's self report of pain, and the operator's assessment of the anesthesia's effectiveness. Although the incidence of anesthetic failure was higher for the 1% solution (31.3%) than for the 2% solution (11.1%), no statistically significant difference between the solutions was found. During the performance of pulpotomies and extractions, a higher failure rate was recorded for the 1% solution (62.5%) than for the 2% solution (28.6%), but these differences were not statistically significant. For minor restorative procedures, the 1% solution was equally successful in achieving anesthesia. The results suggested that 1% lidocaine should be used when multiple minor procedures are performed and potential toxicity in the young dental patient is a concern.

Anesthesia, Dental↗
PubMedDate not supplied

Orofacial trauma and mouth-protector wear among high school varsity basketball players.

This investigation surveyed the prevalence and types of orofacial injuries among 1020 Florida high school basketball players during one season; it also examined the prevalence and types of mouth protectors used and their influence on sustained injuries. The results demonstrated a relatively high prevalence of players (31 percent) reporting orofacial trauma suffered during the organized playing of basketball. Most players reporting orofacial trauma indicated they received multiple injuries during the season. Only a small percentage (4.2 percent) of the basketball players surveyed reported use of mouth protectors and this use was exclusively voluntary. Those players not wearing mouth protectors reported an approximately seven-fold increase in orofacial injuries; most involved trauma to the soft tissue. Many objections were cited to the use of mouth protectors by the players, which must be overcome if compliance with future mandatory wear is recommended. Results of this survey suggest that further investigation into orofacial injuries among basketball players should be pursued.

Adolescent↗
PubMedDate not supplied

Comparison of preoperative ibuprofen, acetaminophen, and placebo administration on the parental report of postextraction pain in children.

Previous investigations demonstrated that administering a preoperative analgesic can reduce postextraction pain in adults. Studies also have shown that ibuprofen was superior in alleviating postextraction pain when compared with acetaminophen. The purpose of this study was to compare the efficacy of the preoperative administration of ibuprofen, acetaminophen, and placebo in reducing postextraction pain in children. Sixty children, aged 2-10 years, requiring primary teeth extractions, were selected to participate in the study. Patients were assigned in a blind, random fashion to one of the three pretreatment drug groups. Parental report of their child's pain and use of analgesics during the immediate 7-hr postoperative period was elicited by telephone the day after the extraction procedure. Thirty-five percent of the patients were reported by their parents to experience postextraction pain. Of those patients, 52% received postoperative analgesics for pain relief (18% of the total). Although there was a trend toward reduced postextraction pain reported by the parents, the preoperative administration of neither analgesic was found to be statistically superior by chi-square analysis to placebo administration.

Acetaminophen↗
PubMedDate not supplied

An evaluation of oral and nasal midazolam for pediatric dental sedation.

Midazolam is a new short-acting benzodiazepine which is more potent than diazepam. Reports on its use in young pediatric dental patients is lacking in the literature. The purpose of this study was to evaluate the sedative qualities of midazolam via the oral and nasal routes in 100 recalcitrant pediatric dental patients between 1.5 and 6 years of age. One half of the patients received oral midazolam at a dose of 0.5 mg/kg administered with 25 mg hydroxyzine pamoate suspension as a vehicle. The other half received nasal midazolam at a dose of 0.2 mg/kg. Nitrous oxide-oxygen inhalation and local anesthesia were used in all cases. The results indicated that a satisfactory level of sedation was achieved in approximately two thirds of the cases. Complications were rare, and not of clinical significance. There was no significant difference in the frequency of success or complications reported between the oral and nasal routes. The results of the present study support the need for future investigations to determine optimal pediatric dosages and regimens for each route.

Administration, Intranasal↗
PubMedDate not supplied

Variables influencing hemoglobin oxygen desaturation in children during routine restorative dentistry.

Pulse oximetry to monitor oxygen saturation during pediatric dental sedations has revolutionized the early detection of hypoxemia. Previous sedation studies confirmed the occurrence of hemoglobin oxygen desaturation when sedative agents are administered in conjunction with nitrous oxide. The purpose of this study was to monitor the hemoglobin oxygen saturation levels of nonmedicated pediatric patients during routine restorative procedures to study the effect of nitrous oxide, chronologic age, tonsil size, and lidocaine dose. Two identical pulse oximeters and probes were attached to a patient's right and left feet to validate the occurrence of oxygen desaturations. The results revealed that 20.3% of the patients demonstrated at least one occurrence of oxygen desaturation during the routine dental procedure. Administration of nitrous oxide had no effect on the prevalence of oxygen desaturation. Although chronologic age, tonsil size, and lidocaine dose did not exert a statistically significant influence when analyzed independently, when combined they were related statistically (P < 0.0001) to the occurrence of oxygen desaturation as defined by the parameters of the study. These data suggest that some of the oxygen desaturations recorded during routine restorative appointments may result from probe error and a combination of patient-related variables.

Age Factors↗