SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Dental treatment for a 15-year-old patient with Nicolaides-Baraitser Syndrome, under intravenous sedation with midazolam: a case report
Author(s): J. Coomar 

Abstract: 

A 15-year-old male with Nicolaides-Baraitser Syndrome (NCBRS), presented for a routine examination complaining of lower left tooth pain. NCBRS is a very rare genetic condition caused by mutations in the SMRCA2 gene, affecting chromatin remodelling where patients can exhibit delayed eruption of permanent teeth, spaced dentition and hypodontia.¹ He also has a severe learning disability, heart murmur, ADHD, psoriasis, asthma (mild), scoliosis and limited speech.

He exhibited severe crowding, an anterior open bite, multiple retained deciduous teeth, a fractured upper left central incisor and a grossly carious upper right deciduous second molar. An orthodontic opinion was sought and the extraction of all deciduous teeth was advised. After discussing treatment options with his parent, intravenous sedation was chosen due to the patient’s challenging co-operation for extractions. The treatment was completed over three appointments under intravenous sedation, with an operative score of three and a general anaesthetic was avoided.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: The use of inhalation sedation to manage delayed eruption of permanent teeth, hypodontia and caries in a child patient
Author(s): A. Heewa, A.K. Lamba, H. Syed,  R. Kaur, R. Whatling

Abstract: 

A ten-year-old medically healthy male, was referred to The Royal London Hospital’s Paediatric Dental Department due to delayed eruption of upper central incisors. Clinical and radiographic examination confirmed the diagnosis of carious first permanent molars, hypodontia of the LR5 and delayed eruption of multiple permanent teeth.

Following attendance at a joint orthodontic paediatric clinic, three first permanent molars (UR6, UL6 and LL6) were extracted, whilst the remaining lower right first permanent molar (LR6) was fissure sealed. Soft tissue exposure was advised and performed on seven unerupted permanent teeth (UR1, UL1, UL3, UL4, UL5, LL4 and LL5). Successful treatment appointments have been achieved with inhalation sedation. Inhalation sedation as an adjunct to chairside treatment under local anaesthetic has allowed treatment to be completed, without the need for general anaesthetic.

If you have a query relating to this article please email: digest@saad.org.uk

Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title: Dexmedetomidine: pharmacology and use as a sedative agent
Author(s): C. Richards

Abstract: 

With the recent introduction of remimazolam into conscious sedation for dentistry there is a natural interest in the possibility of other drugs suitable for sedation in the field. This review explores the drug dexmedetomidine, an alpha adrenoceptor agonist first approved for use in intensive care units for short term sedation on intubated patients. It has sedative, analgesic, anxiolytic and antihypertensive properties. Interest was first sparked in dexmedetomidine as it was merited for having minimal impact on respiration, in comparison to midazolam which causes respiratory depression.

This review explores the literature of the pharmacodynamic and pharmacokinetic properties, followed by evaluation of the five available randomised control trials in the literature that compare midazolam with dexmedetomidine for procedural sedation in dentistry.

Overall, although dexmedetomidine seems to be associated with improved patient satisfaction and operator satisfaction with patients more relaxed during treatment, the limitations of being unable to use this drug as an operator sedation technique and the potential significant cardiovascular changes mean that dexmedetomidine is unlikely to ever become a drug of choice for intravenous conscious sedation in dentistry.

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Articles from Digest 40(1)

SAAD Digest
March 2024
Volume: 40
Issue: 1

Title:

Author(s):

Abstract: 

Articles from Digest 40(1)