• Journal of the korean academy of Pediatric Dentistry
• /
• v.37 no.2
• /
• pp.240-245
• /
• 2010

Neurofibromatosis type 1, an autosomal dominant disorder with prevalence of 1 per 3000 people, has clinical features of cafe au lait spots in skin, multiple neurofibroma and dysplasia in skeletal, endocrinal, and blood vessel systems. Actual intraoral neurofibromas are known to occur in 25% of patients. A 9 year-old girl diagnosed with type 1 neurofibromatosis visited our hospital with chief complaint of gingival swelling. Gingival enlargement in lower anterior region existed and cafe au lait spots were confirmed in patient' skin. Enlarged gingival tissue were excised under local anesthesia. Neurofibroma was confirmed with biopsy. Clinical examination after months showed fine recovery without any evidence of recurrence. Due to its possibility of recurrence, periodic follow-up will be needed.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.25 no.4
• /
• pp.710-716
• /
• 1998

It is one of difficulties to control children who show definitely negative behavior in dental clinic. In such a case, the pharmacologic management has been used to provide quality care, minimize the extremes of disruptive behavior, promote a positive psychologic response to treatment and patient welfare and safety. Deep sedation can be defined as a controlled, pharmacologically-induced state of depressed consciousness from which the patient is not easily aroused which may be accompanied by a partial loss of protective reflexes. In this retrospective report, the sedation records of 200 pediatric dental patients of ASA Class I & II who were not successfully treated under conscious sedation were used for analysis. Most frequently used regimen of deep sedation was the co-medication of midazolam(0.3mg/kg), enflurane(1.0-2.0 vol%) and 50-70% $N_2O_2$. The average age and weight of the patients was 4.6 yr (S.D: 2.72) and 18.7kg(S.D: 6.35) respectively. The average operative time was 52 minutes and midazolam (0.1-0.2cc) was additionally administered intranasally to prolong the operative time as needed. The episodes of untoward side effects were reported during and/or after the procedure in 58 patients. Serious adverse reactions such as cyanosis or laryngospasm were even reported in 7 patients but without mortality. Deep sedation is a very effective way of completing the dental treatments for those who failed to respond well to the conscious sedation. This technique has many practical advantages over general anesthesia case but the demands for the rigid monitoring criteria limit its use in general practice setting. The continuous efforts to improve the safety of the medication and the technique are required for the benefits of the patients and parent.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.23 no.3
• /
• pp.717-728
• /
• 1996

The effects of electro-acupuncture on the pain threshold and the amplitude of dEMG(di-gastric EMG) evoked by the noxious electric stimulation on teeth and gingiva in dogs were studied. Experiments were carried out with 10 dogs weighing 5-8kg. Each animal was anestheticed with Entobar given intraperitoneally in an initial dose of 30mg/kg. Maintenance dose of 5mg/kg/hr was given through a cannula, in the femoral vein, as required to keep up light anesthesia. Bipolar stimulating wire electrodes, 0.1mm in diameter, insulated except for tips, were inserted into the upper canine and palatal gingiva. Rectangular aluminium plate electrodes (15$\times$5mm) were placed on acupuncture points, called Yin-Hsiang, located at both sides of the upper jaw. Rectangular biphasic current pulses of 2Hz, with a $250{\mu}sec$ duration, were delivered for 15 minutes. The dEMG activities were recorded from the anterior belly of the digastric muscle(one of the jaw opening muscles) using bipolar wire electrodes. The magnitude of the jaw opening reflex at different intensties of electro-acupuncture(1volt 4volt and 10volt) was estimated by averaging the 30 superimposed dEMGs recorded on an oscilloscope and audiomonitor. Data were analysed statistically with ANOV A and paired t-test. The obtained results were as follows: 1. Pain thresholds were increased 7.7 %, 15.4 %, 17.3 % in the teeth and 11.1 %, 19.0 %, 25.4 % in the gingiva as the intensities of electro-acupuncture increased incrementally. 2. Amplitudes of dEMG were decreaed 8.3%, 22.4%, 27.4% in the teeth and 9.8%, 36.5%, 42.2 % in the gingiva as the intensities of electro-acupuncture increased incrementally. 3. Inhibition of pain responses by the electroacupuncture was more effective in the gingiva than in the teeth.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.32 no.4
• /
• pp.589-594
• /
• 2005

With the progress of medical treatment techniques of bleeding control, dental care of the patient with hemophilia has become more convenient. So many surgical treatments can be performed with out-patient. 2 cases of intraoral surgical treatment of children, one with hemophilia 3, sever, the other with hemophilia A, severe. While the former was treated under general anesthesia, the latter was treated under local anaesthesia. There are principles : 1. When a patient with hemophilia need dental treatment, the dentist must consult to his physician, pediatrician, or hematologist before dental treatment. 2. When the dentist make a treatment plan, there should be consideration of the general condition, cooperation of the patient and risk of the treatment needed. 3. Minimize the number of times of coming for dental treatment so that reduce the times that need replacement therapy of coagulation factor. And during the treatment, dentist should care for infection and bleeding.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.39 no.2
• /
• pp.161-165
• /
• 2012

Lowe syndrome, also known as oculocerebrorenal syndrome, is a rare genetic disorder involving eyes, kidney, brain and musculoskeletal system, and occurs predominantly in males. The patient with Lowe syndrome is characterized with congenital cataracts, glaucoma, prominent forehead, thin and sparse hair, mental and growth retardation, muscular hypotonia, renal dysfunction, and metabolic bone disease. We have experienced a 10-year-old boy with Lowe syndrome who had poor oral hygiene and trouble for teeth brushing. To manage his behavior and systemic metabolic disorder, sedation was performed during dental care. Excessive calculus formation in this patient is caused by both medication and lack of ability to maintain oral hygiene. The dental management of those patients has to be focused on prevention due to difficulties in dental treatment and dangers of general anesthesia for the Lowe syndrome.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.22 no.3
• /
• pp.217-224
• /
• 2019

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.1
• /
• pp.114-118
• /
• 2009

Sialolithiasis is the formation of calcific concretions within the ductal system of major or minor salivary glands. The submandibular gland is most involved because of its high viscosity of the saliva and the long, curved duct. It may occur at any age but, it is most common in middle-aged adults and rare in childhood. Clinical symptoms in sialolithiasis are variable but, swelling is the most common, followed by the pain. Clinical examination and radiographic examination(panoramic and mandibular occlusal radiographs, sialography, intraoral-, extraoral- ultrasound, CT scan, MRI and sialoendoscopy) can help to confirm a diagnosis and localize a stone. The treatment is surgical intervention, either removal of the sialolith or sialoadenectomy. However, non-invasive techniques including shock-wave lithotripsy, $CO_2$ laser and endoscopic treatment used in selected cases. A 5-Year-old girl referred from private practice for evaluation of a yellowish mass on the floor of the mouth. She complained that it had became three times bigger than four months ago when it was found for the first time and she had some pain on submandibular gland area occasionally. On physical examination, a firm and yellowish mass could be seen at the orifice of the submandibular duct. Diagnosis is the submandibular sialolithiasis in the anterior Wharton`s duct. Under local anesthesia, stone was removed.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.41 no.1
• /
• pp.18-26
• /
• 2014

Deep sedation is considered for the dental treatment of pediatric or disabled patients who have severe anxiety or involuntary movement. Deep sedation using sevoflurane inhalation in emergency dental practice, therefore, is also preferred for fast induction and recovery. This survey consists of 121 people with pediatric or disabled patients who underwent dental treatment under deep sedation using sevoflurane inhalation from January 2013 to October 2013. Patients who were scheduled for deep sedation were classified into a non-emergency sevoflurane sedation group, whereas patients who underwent emergency sedation due to trauma and patients with disabled characteristics itself were classified into an emergency sevoflurane sedation group. Of 121 patients studied, 95 patients received dental care under non-emergency sedation, 26 patients received dental care under emergency sevoflurane sedation. The two groups were analyzed according to: gender; age; primary reason for sedation; duration of sedation; treatment time; induction methods; treatment information; and departments. Non-emergency sevoflurane sedation in pediatric or disabled patients was safe and effective for controlling the behavior. Emergency sevoflurane sedation was a useful method for younger pediatric patients with traumatic injury who need simple, short time emergency treatment. Deep sedation using sevoflurane inhalation not only will reduce the use of general anesthesia gradually but also will be a useful method to emergency treatment for pediatric or disabled patients.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.28 no.1
• /
• pp.166-170
• /
• 2001

Rubinstein-Tabyi syndrome(RTS) is a congenital multisystem dysmorphic syndrome with many non-specific features, making diagnosis occasionally difficult. The major features of this syndrome include mental retardation, characteristic facial appearance, short stature, microcephaly, and broad thumbs and halluces. This syndrome was first described by Rubinstein and Tabyi in 1963, and many studies have been continued about this syndrome, but specific pathogenesis of the Rubinstein-Tabyi syndrome phenotype is still not clear. High arched palate, micrognathia and multiple caries etc have been reported in Rubinstein-Tabyi syndrome. In this report, a 6-year and 5-month-old boy visited at our department due to multiple dental caries, who showed broad thumbs, mental and physical development retardation, and characteristic facial appearance including both ptosis and ear deformity. This patient was diagnosed as a Rubinstein-Tabyi syndrome, and treated the multiple dental caries under general anesthesia. This study was aimed to observe the relationship between medical and dental characteristics.

• The Journal of Pediatrics of Korean Medicine
• /
• v.19 no.1
• /
• pp.173-183
• /
• 2005

Background and objective : Postoperative nausea and vomiting(PONV) are frequent complications of general anesthesia in children. High cost and associated side effects of antiemetic drugs, have increased interest in nonpharmacological methods for treatment of PONV. The aim of this study was to report the effect of acupuncture for prevention of PONV in children. Material and Method : Randomized clinical trials retrieved by a search of articles indexed on the Medline and NDSL database. Key words to search were 'PONV', 'POV', 'acupuncture', 'children', 'pediatric'. Results : Eleven articles were selected and six of them showed significant effectiveness of acupuncture in preventing PONV in children. Acupuncture methods were needle acupuncture acupressure, electro-acupuncture, laser acupuncture, acupuncture point injection. The main acupuncture point was P6(Neiguan). Conclusion : The effectiveness of acupuncture for prevention of PONV in children has been shown in some, but not all trials. Further studies are needed.