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In caring for critically ill patients in the prehospital setting, rapid, definitive airway management is a high-risk, crucial procedure.All helicopter emergency medical services (HEMS) providers must proficiently and safely perform this procedure.Little information is available about the preference and efficacy of video laryngoscopy (VL) compared with direct laryngoscopy (DL).Additionally, there is a paucity of research investigating which method of intubation is more successful in the HEMS setting. The objective of this study was to delineate factors that contribute to provider decision regarding the method of orotracheal intubation and compare the frequency of use for each method.

An anonymous online survey was distributed to all providers in a single HEMS program.The survey results were deidentified and blinded to the researchers.

The survey was sent to 40 HEMS providers; 29 responded, and 119 total intubations were reported.Method familiarity and patient condition were the most commonly cited reasons for choosing both DL and VL for intubation.DL accounted for 15 intubation attempts, whereas 104 attempts were completed by VL.

For both laryngoscopy techniques, the top reasons cited for selecting an intubation technique were being comfortable with that technique and patient presentation. Further investigation with chart review would help confirm the reported data.
For both laryngoscopy techniques, the top reasons cited for selecting an intubation technique were being comfortable with that technique and patient presentation. Further investigation with chart review would help confirm the reported data.
Decisions about children's oral health care are made by parents. Parents' dental insurance, dental service use, and perceived affordability all influence their children's oral health care.

Using data from the 2016 National Health Interview Survey, the authors constructed a database of 4,396 nationally representative US children and their linked household adults. The authors assessed the relationship between children's and parents' use of dental services, private and public dental insurance, and deferral of oral health care owing to cost. To adjust for factors that may influence outcomes independently, the authors performed multivariate analyses to consider child, parent, and household characteristics.

Children have 2 times the risk of lacking a dental visit in a year if the parent has none, 7 times the risk of reportedly lacking dental coverage if the parent has none, and nearly 10 times the risk of having care deferred owing to cost if the parent finds oral health care unaffordable. Affordability risk factors for children include older age and minority race, whereas protective factors include public insurance, parents with higher educational attainment, and female-led households. Increased oral health care use by children was associated with states that provide more extensive adult Medicaid dental benefits.

Greater parental dental service use, dental coverage, and ability to afford care benefit their children's use of oral health care.

Policies by employers and government that expand quality private and public coverage for adults hold strong promise to improve oral health care for both parents and their children.
Policies by employers and government that expand quality private and public coverage for adults hold strong promise to improve oral health care for both parents and their children.
Bottled water has become the most consumed beverage in the United States. The authors aimed to inform the dental profession about the potential anticaries benefits of some bottled waters and to provide information about their possible contributions to fluoride, calcium, magnesium, sodium, and potassium intakes.

The authors chose a convenience sample by purchasing all different bottled waters from the main supermarkets operating in Indianapolis, Indiana. 1-Methyl-3-nitro-1-nitrosoguanidine ic50 The authors analyzed the fluoride content using a fluoride ion-specific electrode and metal concentrations using atomic absorption spectroscopy. They used dietary reference intakes to calculate hypothetical intakes of all minerals.

The authors identified 92 different bottled waters. Fluoride concentrations were generally low (mean, 0.11 parts per million [ppm]; median, 0.04 ppm). Only 2 waters contained more than 0.7 ppm fluoride (0.95 ppm and 1.22 ppm). Metal concentrations varied considerably among waters. Calcium concentrations ranged from less than 0.1 through 360 ppm (mean, 26.9 ppm; median, 5.2 ppm), which were greater than those of magnesium (range, < 0.01-106 ppm; mean, 7.5 ppm; median, 1.9 ppm), sodium (range, < 0.01-109 ppm; mean, 11.1 ppm; median, 2.9 ppm), and potassium (range, < 0.01-43 ppm; mean, 3.6 ppm; median, 1.2 ppm). Overall, most bottled waters do not contribute to adequate intakes of fluoride, potassium, or sodium or to recommended dietary allowances for calcium and magnesium. Nonetheless, some waters can provide meaningful contributions to fluoride, calcium, and magnesium intake.

The fluoride concentration in 90 of the 92 studied bottled waters is insufficient to contribute to caries prevention. Only a few bottled waters can be considered health-promoting.

Dental professionals should consider the mineral content of water consumed by their patients during caries risk assessment.
Dental professionals should consider the mineral content of water consumed by their patients during caries risk assessment.
The authors aimed to assess whether 4% articaine is a safe and effective local anesthetic (LA) for mandibular third-molar extractions.

The authors searched MEDLINE (PubMed), Cochrane Library, Scopus, and Web of Science databases to identify randomized clinical trials that fulfilled the eligibility criteria. Risk of bias was evaluated using the Cochrane risk-of-bias assessment tool. The authors performed a meta-analysis of safety and efficacy variables comparing 4% articaine with different LAs.

The authors assessed 482 articles but only 14 randomized clinical trials met the inclusion criteria for review. No statistically significant differences were found among the selected LAs regarding safety. Four percent articaine required fewer reinjections than 2% lidocaine and had a shorter onset time than 2% lidocaine, 0.5% bupivacaine, and 4% lidocaine. Four percent articaine had a longer anesthesia effect than 2% lidocaine and 2% mepivacaine, but a shorter anesthesia effect than 0.5% bupivacaine.

Use of 4% articaine for mandibular third-molar extraction is a safe choice that requires fewer reinjections and has a shorter onset time than other aminoamide-type LAs.
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