• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.2
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• pp.96-100
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• 2016

Metachromatic leukodystrophy (MLD) is a progressive and degenerative neurological disease caused by a deficiency of the catabolic enzyme arylsulfatase A. Deficiency of arylsulfatase A results in accumulation of sulfatide in the white matter of the peripheral and central nervous system and it occurs demyelination as a result. The patient gradually goes through mental and motor failure. General symptoms of MLD include gait disturbance, mental deterioration, muscle rigidity and impaired swallowing. Inheritance of the disease is autosomal recessive. We report a dental caries treatment of a 3-year old boy with MLD. The patient underwent hematopoietic stem cell transplantation (HSCT) to slow the progression of the disease. He was suffered from difficulties of mastication and swallowing from the degenerative neurological symptom. He was ingesting food by both oral feeding and tubal feeding after he took percutaneous endoscopic gastrostomy (PEG). The cause of multiple caries was mainly presumed as patient's prolonged time of meal. The treatment was performed under general anesthesia considering patient's incompliance. Severely affected lower primary molars were treated with pulp treatment and restored with stainless steel crown. Others were restored with composite resin. There were no postoperative complications. MLD is life threatening progressive disease and also has an impact on unfavorable condition for oral health. Routine home oral care and periodic professional dental care should be emphasized to the caregiver of patient considering the susceptibility of dental caries. Not only the medical care, but periodic dental office visit would benefit the quality of life of the patient.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.45-49
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• 2019

Bartter syndrome is an inherited renal tubular disorder characterized by hypokalemia, hypochloremic metabolic alkalosis, hyperreninemia, hyperprostaglandinism, and normal blood pressure. Bartter syndrome is classified by neonatal and classic type. Clinical manifestation of Bartter syndrome considered in dental treatment include tendency to dehydration, vomiting and erosion, attrition and abrasion of the teeth. A 2-year-4 month old boy with Bartter syndrome type III was referred to the Seoul National University Dental Hospital for dental evaluation and treatment. He showed hypokalemic hypochloremic metabolic alkalosis and had been treated with indomethacin and potassium chloride. He had hypocalcified teeth with or without multisurface caries lesions in all dentition and the erosion of maxillary teeth was detected. Dental procedure under general anesthesia was scheduled due to multiple caries and his medical condition. The dental procedure was successfully performed. This case suggests that electrolyte imbalances need to be treated prior to dental treatment and complete coverage restoration is necessary to protect the eroded teeth. An appropriate management plan for the patients with Bartter syndrome should include considerations of the need for close interaction with the pediatrician for pre- and post-operative care. General anesthesia may be recommendable to manage the patients having multiple caries with Bartter syndrome.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.329-336
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• 2021

Background: In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children. Methods: Sixty children aged 6-10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion. The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05. Results: The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant. Conclusion: Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.6
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• pp.521-530
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• 2020

Purpose: Malnutrition is a common feature in critically ill children. Enteral nutrition (EN) is the main strategy to nutritionally support critical ill children, but its use can be hindered by the development of intolerance. The study aimed to assess the effectiveness and safety of amoxicillin/clavulanate (A/C) to treat EN intolerance. Methods: We retrospectively evaluated patients admitted to the pediatric intensive care unit from October 2018 to October 2019. We conducted a case-control study: in the first 6 months (October 2018-April 2019) we implemented the nutritional protocol of our Institution with no drug, whereas in the second half (May 2019-October 2019) we employed A/C for 1 week at a dose of 10 mg/kg twice daily. Results: Twelve cases were compared with 12 controls. At the final evaluation, enteral intake was significantly higher than that at baseline in the cases (from 2.1±3.7 to 66.1±27.4% of requirement, p=0.0001 by Wilcoxon matched-pairs signed rank test) but not in the controls (from 0.2±0.8 to 6.0±14.1% of the requirement, p=NS). Final gastric residual volume at the end of the observation was significantly lower in the cases than in the controls (p=0.0398). The drug was well tolerated as shown by the similar safety outcomes in both cases and controls. Conclusion: Malnutrition exposes critically ill children to several complications that affect the severity of disease course, length of stay, and mortality; all may be prevented by early EN. The development of intolerance to EN could be addressed with the use of A/C. Future prospective clinical trials are needed to confirm these conclusions.

• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.1
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• pp.75-88
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• 2023

The aim of this retrospective study was to evaluate the demographic characteristics of pediatric dental patients who underwent dental treatment under general anesthesia (DTGA) at the Seoul National University Dental Hospital from January 2011 through December 2020 and compare the patterns of repeated DTGA between dental patients with severe disabilities (DSD) and non-DSD (healthy or medically compromised patients without DSD). There were 1,857 DTGAs among 1,719 patients (mean age = 5.1 years; males = 59.3%; ASA 2 or above = 52.9%; DSD = 26.8%). Overall, 6.6% of patients underwent repeated DTGA, and the rate of repeated DTGA over a 10-year period was 7.4%. ASA 2 or above (p < 0.0001) and DSD (p < 0.0001) were more likely to undergo repeated DRGA compared to ASA 1 and non-DSD. At both GA1 and GA2, DSD received significantly more restorative treatment on permanent teeth than non-DSD (p = 0.002, p < 0.0001, respectively). There has been an increasing demand for DTGA in pediatric dentistry over the last 10 years. Regular check-ups and preventive oral health care are necessary for pediatric dental patients with severe disabilities to reduce the possibility of repeated DTGA.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.3 no.2
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• pp.80-86
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• 2007

A critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical/dental staff after implementation of a critical pathway for dental treatment of disabled children under general anesthesia and its cost effectiveness. Ten patients who underwent dental treatment under general anesthesia were included in the CP group between August and December 2006. The pre-CP group included 20 patients who underwent the same procedure from February 2003. The satisfaction of parent of child patient and medical staff members were compared between two groups. The parents' satisfaction was significantly improved after the implementation of CP and medical/dental staff members were highly satisfied with the usefulness of the critical pathway. In conclusion, the critical pathway for the dental treatment of disabled treatment under general anesthesia can highly improve the satisfaction of parents and medical/ dental staff members.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.277-285
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• 2018

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. $Carie-care^{TM}$, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of $Carie-care^{TM}$ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes. A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: 'chemo-mechanical caries removal agent', 'dental caries', 'Carie-care', 'chemo-mechanical caries removal', 'chemo-mechanical caries excavation', other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review. This review showed that $Carie-care^{TM}$ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is needed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.309-313
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• 2018

Oronasal fistulae (ONF) could remain after surgery in some patients with cleft palate. ONF ultimately requires intraoral surgery, which may lead to perioperative airway obstruction. Tongue flap surgery is a technique used to repair ONF. During the second surgery for performing tongue flap division, the flap transplanted from the tongue dorsum to the palate of the patient acts as an obstacle to airway management, which poses a great challenge for anesthesiologists. In particular, anesthesiologists may face difficulty in airway evaluation and patient cooperation during general anesthesia for tongue flap division surgery in pediatric patients. The authors report a case of airway management using a flexible fiberoptic bronchoscope during general anesthesia for tongue flap division surgery in a 6-year-old child.

• Journal of The Korean Dental Society of Anesthesiology
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• v.2 no.2 s.3
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• pp.114-117
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• 2002

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.7 no.2
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• pp.119-122
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• 2011

Achondroplasia is one of the most common types of dwarfism and is inherited as an autosomal dominant trait. Clinical features of achondroplasia include disproportionate short stature with normal trunk length, shortening of the extremities, bowing of the lower extremities, short stubby trident hands, spinal stenosis and lumbar lordosis. Characteristic craniofacial features include macrocephaly, prominent forehead, depressed nasal bridge, maxillary hypoplasia, otolaryngeal system dysfunction, and foramen magnum stenosis. These characteristics may lead to number of complications including hydrocephalus, apnea, upper-airway obstruction, otitis media, sinusitis and dental malocclusion. Apart from these features, the affected children have good general health and normal intelligence. Dentists should be aware of the clinical characteristics of achondroplasia and the complications that may arise as a result of this disorder. This case report is to present dental treatment of a patient with achondroplasia under general anesthesia and discuss special considerations.