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  • Missed cases have been reported who

    2019-04-22

    Missed cases have been reported who had an initially elevated C5DC concentration that normalized on a repeated sample. Such a result may be caused by secondary carnitine depletion. To avoid carnitine depletion, we propose that the carnitine loading test be used to assist diagnosis of GA-1. Although, so far, we have not identified any missed patients, our study did reveal that the carnitine loading test brought about a significant elevation of C5DC in GA-1 patients. We believe this should help to reduce false negative results caused by secondary carnitine depletion.
    Acknowledgements
    Introduction When pediatric dentistry is considered, most dentists seem to have a preconception that involves uncooperative and emotional children who strongly resist having dental treatment. This mindset results in dentists being unwilling to spend time treating uncooperative children. The American Academy of Pediatric Dentistry recognizes that dental care is medically necessary for the purpose of preventing and eliminating orofacial disease, eradicating infection, abolishing pain, restoring the form and function of dentition, and correcting facial disfiguration or dysfunction. Behavior guidance techniques, both nonpharmacological and pharmacological, can be used to alleviate anxiety, nurture a positive dental attitude, and perform quality oral health care on infants, children, adolescents, and persons with special health care needs; all in a safe and efficient manner. In order to reduce the anxiety that children may experience, some nonpharmacological approaches to behavior management are available; these include “tell–show–do”, positive reinforcement, physical restraint, voice control, and hand-over-mouth. However, these techniques were not completely effective when used with some dental phobia patients due to either age or psychological factors; this is also the case when patients lack the ability to cooperate with the dentist due to physiological factors. Furthermore, in recent years, as the ha tag has become lower and the importance of human rights has increased, many parents show antipathy towards negative approaches to behavior management, and the use of such approaches may even give rise to medical disputes. Investigations targeting the parents of pediatric dental patients have demonstrated that parents were more accepting of voice control, physical restraint, and hand-over-mouth in 1984 than medical sedation or general anesthesia (GA); but by 1991, parents found medical sedation more acceptable, as well as negative behavior management; however GA still remained unacceptable; by 2005, both medical sedation and GA had become more acceptable than negative behavior management. In most cases, GA allows the dentist to complete the treatment rather than delay care because a patient\'s anxieties and fears about treatment make him or her uncooperative. By reducing the anxiety of patients and their movement through the use of GA, tectonic plates is possible for dentists to offer significantly improved dental care. GA results in total relaxation, and recall of the procedure is minimized; this allows the successful treatment of even the most dental-phobic patient. In the long run, the use of GA to treat healthy and fearful children results in the best outcome for the patient. Despite the fact that the use of GA and sedation in pediatric dental treatment is common in European countries and North America, Taiwanese parents regard such approaches as not customary, and they find it hard to accept them. Therefore, most cases in which GA and sedation are used for children involve patients with special health care needs, and healthy children in Taiwan are still mostly treated using nonpharmacological approaches to behavior management. Nevertheless, quality of care may be significantly compromised due to uncontrolled movement by children with behavior problems. Dental treatment under GA at Taipei Veterans General Hospital (VGHTPE) started in the 1980s, and from this point onwards, it was available when treating patients in many districts of Northern Taiwan. While it provides treatment of the highest quality, information on this treatment method and studies on its use remain scarce. Furthermore, such studies of pediatric dentistry under GA in Taiwan that are available have mostly focused on children with special health care needs, and any retrospective studies were limited to only a few years. Therefore, the objective of this study was to provide baseline information regarding trends in pediatric dental treatment performed under GA at VGHTPE over the past 10 years. The information collected by this study should be very useful when planning the future use of GA in pediatric dentistry.