Iontocaine

A quick look at some of what is happening in the world of research that can affect your practice, your patients and you

The British Medical Journal (1998;317:820) reports that studies examining the prevalence of tooth erosion in children points to children with asthma as being at particularly high risk. Erosion of tooth enamel not only predisposes cavity formation, but causes sensitivity. Further investigation into that statistic explores two possible contributing factors. First, people with asthma tend to have a higher incidence of gastroesophageal reflux, which has been shown to increase erosion of tooth enamel, not only in children but in adult asthmatics, as well.

The other possibility is the medications inhaled by asthmatics. Going on the assumption that the pH of inhaled products might be a considerable risk factor, analysis showed a marked difference between aerosols and powder formulations. Though the higher pH of aerosol formulations makes them less likely culprits, the more acidic powder formulations are obvious contributors to enamel erosion, which begins at a pH of 5.5.

Though spacer devices tend to minimize the problem by delivering doses beyond the teeth, children should be advised to rinse their mouths with water after each dose of powder formulations and to brush at least twice daily with a fluoride toothpaste.

Evidence presented at the American Academy of Otolaryngology Head and Neck Surgery meeting in San Antonio, Texas, indicates that recent increases in the incidence of serious complications secondary to pediatric ear infections are due to bacterial resistance to antibiotics. Analysis of hospital records shows a dramatic increase in the incidence of mastoiditis secondary to ear infection, which has been almost nonexistent since the advent of antibiotics. With 80 percent of otic pathogens now resistant to penicillin, overuse and inappropriate use of antibiotics are blamed for the problem.

Dr. Patrick Antonelli, a University of Florida otolaryngologist, recommends that antibiotics be prescribed to children with greater reserve. Though resolution without antibiotics usually requires a bit longer, most ear infections will clear up without antibiotic therapy. He suggests that breastfeeding, avoiding exposure to tobacco smoke and day care in groups of less than six children can help minimize the incidence of pediatric ear infections, and emphasizes the importance of compliance throughout the entire course when antibiotics must be prescribed. (Source: Doctor's Guide To The Internet: http://www.pslgroup.com/dg/afede.htm)

The Lancet (Sept. 11, 1998) reports that encephalitis in children secondary to viral influenza infection is largely unrecognized and even disputed. But, research in Japan utilized polymerase chain reaction to detect recent infection with the flu virus in children hospitalized for acute encephalopathy or encephalitis and confirmed infection in 70 percent. Six-out-of-seven infected children suffered convulsions, the initial sign of spread to the CNS, within two days of initial temperature elevation. The study highlights the particular jeopardy of young children who get the flu and suggests that early vaccination might reduce the incidence of such serious complications.

Morbidity and Mortality Weekly Report (1998:47:756-759) reports that outbreaks of the flu are not restricted to what is widely considered the "flu season" of November through April. In fact, summer outbreaks have occurred nine times between 1993 and 1997, and the Centers for Disease Control blames world travel, tracing one recent outbreak to vacationers returning home from Panama and another among cruise ship passengers to Southern hemisphere viruses. Such outbreaks provide valuable data for forecasting problematic strains for fall and winter.

An article in The Archives of Disease in Childhood (1998:79;3) blames smoking during pregnancy for attention deficit disorder, gastrointestinal disorders, sleep problems, language problems and deficits in motor skills and perception. Of 113 6-year-olds, 52 presented such problems and were twice as likely to have had mothers who smoked during pregnancy.

With the success of [EMLA.sup.TM] cream for topical anesthesia prior to injections in children, Astra is introducing the [EMLA.sup.TM] Anesthetic Disc. The new adhesive patch releases lidocaine and prilocaine that penetrate the skin for local anesthesia, not only for injections but for sutures and even minor surgical procedures. Recommended only for use in clinics and emergency facilities, onset of action requires about an hour; severe side effects are possible if left on for more than 3 hours. The discs should not be used on mucous membranes.

Numby [Stuff.sup.TM], lomed's lidocaine product (called [Iontocaine.sup.TM]), uses iontophoresis to enhance dermal penetration to produce local anesthesia within about 10 minutes. The drug delivery system uses a low-level electric current from a battery-powered dose controller to produce numbness up to a depth of 10 millimeters prior to needle insertions. It is currently being used in hospitals for vascular access and in minor surgical procedures in children; a recent study reported in The Journal of Pediatrics confirms its effectiveness in these applications. (Source: Reuters Health Information: http://www. medscape.com/reuters/thu/t09161f html)

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