• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.91-103
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• 2017

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.7-13
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• 2019

The aim of this study was to clarify the barriers of dental treatment for special needs patients felt by dentists and to determine the dentist-related factors contributing to the obstacles in treatment planning and decision making. Questionnaires were distributed and responded by dentists working at five public-based special care clinics in South Korea. Factors divided into three parts (dentist demographics, clinical factors, and educational and administrational factors) were assessed and analyzed for correlations between dentist-related factors and dentist-felt burdens for special care treatment. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 34 dentists responded to the questionnaires. Almost all dentists had obstacles in the treatment of special needs patients in terms of the patients' lack of cooperation (94.1%), proxy communication with caregivers (94.1%), payment reward system (63.6%), deficient workforce (67.7%), and others. The longer dentists had been practicing for special needs patients, the more they were dissatisfied with the reward system and a longer time was spent for communication with patients and their caregivers (p<0.05). For specialists, more obstacles were experienced in treatment planning due to a deficiency in the clinical information obtained from their patients compared to general practitioners (p<0.05). A total of 82.4% of the respondents approved of mandatory educational programs for special care dentists. There were practitioner-based factors related to the amount of obstacles felt by special care dentists. To overcome the treatment barrier of special needs patients, in-depth education and training are required in special care dentistry.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.1
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• pp.27-30
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• 2016

A salivary stone on mouth floor was removed in a 10-year-old girl with cerebral palsy and epilepsy. If left untreated, sialolithiasis can lead to inflammation of whole salivary gland with severe pain and inflammation that spread to other side of salivary gland causing damaging of teeth, abscess, and nerve disorders. Special needs patients have difficulty to express their pain or discomfort. To overcome communication problem and offer appropriate treatment in proper time, a careful and comprehensive clinical examination including soft tissue and tooth should be prioritized in special needs patients visiting the dental clinic.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.2
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• pp.68-77
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• 2014

An opportunity for dental students to come into contact with individuals with disabilities is insufficient. Therefore, prejudice and negative attitudes towards persons with disabilities persist. Working under the assumption that educating dental students regarding people with disabilities will bring about positive awareness, we conducted this study. We investigated the changes in the recognition of the issues and needs of people with disabilities before and after special care dentistry class of students of dental college that will include an experience in a dental clinic with a disabled person. Seventy-two Kyung Hee University School of Dentistry third-year dental students attended the special care dentistry class in one semester and they took the same survey was before and after the class. In the questionnaire, we used the disability factor scale (DFS) that Siller has proposed. The authoritarian virtuousness factor getting lower to a significant level after receiving an education. This means that after the education, the respondents realize that how hard to adapt the disabilities. After receiving an education, the rejection of intimacy factor score significantly get higher than before they took the class. This means that after the training, positive attitudes towards those with disabilities were better than those towards the opposite sex. We were able to confirm a positive change in the recognition for persons with disabilities through the special care dentistry class. Our study shows that educating dental students on the how to take care of individuals with disabilities can bring about a positive change in the attitudes students may have regarding them.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.6 no.2
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• pp.77-83
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• 2010

This article discusses the issues of benefit and risk associated with outpatient general anesthesia and deep sedation for the special need dental patients. The purpose of administering anesthesia for patients with special needs is to provide effect dental treatment. But there are many complications such as sore throat, nausea and vomiting, airway trauma, airway obstruction and hypoxic brain damages, etc. In order to decrease incidence of complication, before general anesthesia meticulous patient evaluation is much important. But, there are a number of factors that make it difficult to accurately assess the anesthetic risk for many people with special needs. These include limited medical workups, uncooperative behavior, and difficulties in postoperative cares, etc. But Judging from several years experience of many contries, it appears that the incidence of mortalities for people with special needs in dental setting is minimal and the incidence of morbidity is limited. In the long run, the delivery of general anesthesia and deep sedation for people with special needs can be considered a very safe and successful procedure.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.527-545
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• 2021

The aim of this systematic review was to determine the success rate of nitrous oxide-oxygen procedural sedation (NOIS) in dentistry. A systematic digital search was conducted for publications or reports of randomized controlled trials evaluating the clinical performance of NOIS. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who met the inclusion and exclusion criteria accordingly. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool (RoB 2). A total of 19 articles (eight randomized clinical trials with parallel intervention groups and 11 crossover trials), published between May 1988 and August 2019, were finally selected for this review. The studies followed 1293 patients reporting NOIS success rates, with a cumulative mean value of 94.9% (95% CI: 88.8-98.9%). Thirteen trials were conducted on pediatric populations (1098 patients), and the remaining six were conducted on adults (195 patients), with cumulative efficacy rates of 91.9% (95% CI: 82.5-98.1%) and 99.9% (95% CI: 97.7-100.0%), respectively. The difference was statistically significant (P = 0.002). Completion of treatment and Section IV of the Houpt scale were the most used efficacy criteria. Within the limitations of this systematic review, the present study provides important information on the efficacy rate of NOIS. However, further well-designed and well-documented clinical trials are required and there is a need to develop guidelines for standardization of criteria and definition of success in procedural sedation. Currently, completion of treatment is the most used parameter in clinical practice, though many others also do exist at the same time. To maximize NOIS efficacy, clinicians should strictly consider appropriate indications for the procedure.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.2
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• pp.145-150
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• 2016

Special Health Care Needs (SHCN) patients need regular follow-up because of high incidence and severity of oral disease. The aim of this study was to evaluate the dental treatment outcomes of SHCN patients according to follow-up patterns. SHCN patients who were treated under general anesthesia (GA) at Kyung Hee University Dental Hospital from 2006 to 2014 were included in this study. The final samples comprised of 53 patients that were divided into regular (33 patients) and irregular (20 patients) follow-up groups according to their follow-up patterns. The type of dental treatment after GA during the follow-up periods were compared. In the irregular group, aggressive treatment including endodontic, prosthetic treatment, and extraction were predominant, compared with the regular group (p < 0.05). In addition, all patients who had dental treatment under GA in follow-up periods were in the irregular group (p < 0.05). In conclusion, the results of this study provide the importance of regular follow-ups with SHCN patients and emphasize responsibilities of dentists for educating patients and their guardians.

• Journal of the korean academy of Pediatric Dentistry
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• v.10 no.1
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• pp.97-105
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• 1983

The author made a periodontal survey on 2,000 Korean adolescents in Seoul special city and Kyoungki-Do, to detect periodontal conditions and treatment needs. The obtained results were as follows: 1. 1.20% of adolescents had healthy periodontal tissues. 2. 11.95% showed only the gingival bleeding on probing, 66.55% had the calculus. 3. The proportions of adolescents with pocket depths about 4 to 5mm and over 6mm were 19.95% and 0.35% respectively. 4. Periodontal treatment need proportion showed 98.80% in oral hygiene instruction and 86.65% in oral prophylaxis; mean number of sextants affected was 2.96. 5. 0.35% was needed complex periodontal treatment. 6. In the sex and regional distribution, girls were slightly higher than boys in periodontal treatment needs and seoul than Kyoungki-Do; but the difference was not significant statistically.(p<0.05) 7. In the age distribution, periodontal treatment needs did not increase evidently with age; but comparing those for 15 years old with 19, the latter was slightly higher than the former.(p<0.05)

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.71-80
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• 2021

Background: The options for stabilization appliance therapy for masticatory muscle pain include soft occlusal and hard stabilization appliances. A previous study suggested that hard stabilization appliance therapy was effective for patients with local myalgia who developed long facets on their occlusal appliances. The objective of this study was to identify patients in whom a soft occlusal appliance should be used to treat masticatory muscle pain by analyzing the type of muscle pain present and patient factors that influenced the effectiveness of this treatment. Methods: The study included 42 patients diagnosed with local myalgia or myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders Diagnostic Decision Tree. The analysis of patient factors included variables believed to be associated with temporomandibular disorders. First, a temporary screening appliance was used for 2 weeks to assess each patient for bruxism during sleep. Soft appliance therapy was then started. For each patient, the effectiveness of the appliance was evaluated according to the intensity of tenderness during muscle palpation and the treatment satisfaction score at one month after starting treatment. Results: Data from 37 of the 42 patients were available for analysis. Twenty-five patients reported satisfaction with the appliance. In logistic regression analysis, the odds ratio for reduction of facet length was 1.998. Nineteen patients showed at least a 30% improvement in the visual analog scale score. The odds ratio for local myalgia was 18.148. Conclusion: Soft appliance therapy may be used in patients with local myalgia. Moreover, patients who develop short facets on the appliance surface are likely to be satisfied with soft appliance therapy. Soft appliance therapy may be appropriate for patients with local myalgia who develop short facets on their occlusal appliance.

• Journal of Periodontal and Implant Science
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• v.51 no.6
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• pp.409-421
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• 2021

Purpose: The aim of this study was to compare the prevalence and bacterial load of 6 main periodontal pathogens between pairs of periodontal patients with and without type 2 diabetes mellitus. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans genotypes were also investigated. Methods: Twenty patients affected by chronic periodontitis and type 2 diabetes were retrospectively selected and matched to 20 patients without diabetes on the basis of the degree and severity of periodontal disease. Microbiological data of subgingival biofilms were analysed and compared for the examined pathogens: A. actinomycetemcomitans, P. gingivalis, Prevotella intermedia, Treponema denticola, Fusobacterium nucleatum, and Tannerella forsythia. Results: The pairs were balanced in terms of demographic and clinical parameters, except for bleeding on probing and suppuration. In the microbiological test sites (4 for each patient), the mean probing pocket depth was 6.34±1.63 mm in patients with diabetes and 6.41±1.78 mm in patients without diabetes. No significant difference between pairs in the prevalence of P. gingivalis or the distribution of its genotypes was recorded. Patients with diabetes had a significantly greater amount of total bacterial load, P. gingivalis, T. denticola, T. forsythia, and F. nucleatum (P<0.05). Moreover, patients with diabetes had a higher number of sites with a greater cell count than patients without diabetes. When compared to the total bacterial load, only T. forsythia maintained its relative load in patients with diabetes (P=0.001). Conclusions: This retrospective matched study supports the hypothesis that microbiological differences exist among periodontal patients with and without diabetes mellitus.