Dental Caries Experience among Children and Adolescents with Cleft Lip and/or Palate: An Umbrella Review

Aim and objective

To assess the systematic reviews and meta-analyses investigating the dental caries experience in children with cleft lip and/or palate (CL/P).

Study design and methodology

A systematic search was carried out from MEDLINE Via PubMed, JBI Database of Systematic Reviews and Implementation Reports, EMBASE, OVID, Cochrane Database of Systematic Review, and Epistemonikos databases. Two independent reviewers carried out the collection and analysis of the study data. Methodological quality was assessed by ROBIS (Risk of bias assessment in systematic review) tool.

Review results

An initial search of electronic databases yielded a total of 25 relevant reviews, of which only three systematic reviews were taken into consideration for qualitative synthesis. The total number of unique primary studies among the three included systematic reviews were 25, of which overlap of the studies was calculated using citation matrix. The corrected covered area (CCA) was estimated to be 0.26. Based on the ROBIS tool, only one systematic review reported with low risk of bias.

Conclusion

Individuals with CL/P report more decayed, missing, or filled teeth/surfaces than those without CL/P in primary, mixed, and permanent dentition. Future studies should focus on the factors which could modify the caries risk of an individual with CL/P.

Clinical significance

This umbrella review offers a more reliable and balanced view regarding the dental caries experience among individuals with cleft lip and/or palate. This paper also highlights the important role of pediatric dentist in multidisciplinary health care team in implementing first dental visit and anticipatory guidance to consider early diagnosis and specific preventive interventions for Early Childhood Caries (ECC) in individuals with CL/P.

How to cite this article

Abirami S, Panchanadikar NT, Muthu MS, et al. Dental Caries Experience among Children and Adolescents with Cleft Lip and/or Palate: An Umbrella Review. Int J Clin Pediatr Dent 2022;15(S-2):S261-S268.

Feeding At Sleep Time (FeAST) Scale: Assessing Risk for Developing Early Childhood Caries in South Indian Toddlers

PURPOSE

The Feeding At Sleep Time (FeAST) scale was developed and validated to assess sleep time feeding practices for children younger than three years. The purpose of this study was to describe the process of scoring and find an optimum clinical cutoff score for early childhood caries (ECC) using receiver operating characteristics (ROC) analysis, thereby enabling researchers and clinicians to assess risk for devel- oping ECC.

METHODS

The FeAST scale was administered to mothers of 527 toddlers, aged 12 to 36 months, attending four outpatient depart- ments. The score was calculated based on subconstructs of combined breast-feeding (CBR) and combined bottle-feeding (CBO), and suitable cutoff points were identified using ROC analysis.

RESULTS

The study established a cutoff score greater than 14 for the CBR construct and a cutoff score greater than 11 for the CBO construct of the FeAST scale to determine a child's risk for developing ECC. The area under the curve (AUC), which measures the overall performance of a scale, has yielded statistically significant values (P<0.001) with fair (0.707) and good (0.788) perform- ance for the CBR and CBO constructs, respectively.

CONCLUSION

The Feeding at Sleep Time scale, based on receiver operating characteristics analysis, can potentially be used by clinicians and researchers to screen toddlers at risk of developing early childhood caries.

Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding

Background

Glanzmann thrombasthenia is a rare bleeding disorder due to defects in the glycoprotein Ilb/IIIa complex present on the platelet membrane. The most common mode of treatment for this disorder is platelet transfusion. However, scientific evidence does state that repeated transfusions could lead to auto immunization making transfusions ineffective.

Aim and objective

To describe the use of a novel technique of soft splint with tranexamic acid paste to stop oral bleeding in a patient with Glanzmann thrombasthenia (GT).

Case description

A 7-year-old female patient with a known history of GT was referred to the pediatric department. The chief complaint of the patient revealed a history of spontaneous bleeding from the oral cavity. The patient required multiple teeth extractions due to severely carious teeth. History revealed that the patient was admitted to the hospital (casualty) three times within 1 month due to a similar complaint leading to hypovolemic shock. Several transfusion procedures were done to stop the spontaneous bleeding. To stop the intraoral bleeding without transfusions, a novel method of using a soft splint with tranexamic acid paste (500 mg tablet crushed and mixed with saline) in the area of spontaneous bleeding was employed with a successful follow-up of 7 months.

Conclusion

Soft splint with the tranexamic acid paste can serve as an effective method of treatment for patients with spontaneous oral bleeding due to medical conditions like GT.

Clinical relevance

This case report highlights the need for awareness among all the healthcare providers about the importance of regular dental visits. The healthcare providers also need to emphasize the same to all patients with medical conditions to avoid such life-threatening situations.

How to cite this article

Bhavyaa R, Vignesh KC, Muthu MS, et al. Glanzmann Thrombasthenia: Use of the Soft Splint with Tranexamic Acid Paste to Reduce Spontaneous Oral Bleeding. Int J Clin Pediatr Dent 2021;14(4):580–585.

Early Childhood Caries and Iron Deficiency Anaemia: A Systematic Review and Meta-Analysis

Identification of the association between Early Childhood Caries (ECC) and Iron Deficiency Anaemia (IDA) will aid paediatricians and paediatric dentists to enhance health promotion measures to reduce the related morbidity in children. This systematic review aims to determine an evidence-based association between ECC and IDA. A systematic search was carried out from MEDLINE via PubMed, EMBASE, LILACS, Cochrane Oral Health Group's Specialized Register, CINAHL via EBSCO, Web of Science, and Scopus up to May 2020. Hand searching and grey literature screening were also conducted. Cross-sectional, case-control, and cohort studies in English language which assessed the association was included. Two reviewers independently assessed the study quality and extracted the outcome data. A total of 1,434 studies were identified. Fourteen studies qualified for qualitative review and 7 of them for a meta-analysis. In comparison with children not affected by ECC, those affected had an increased likelihood of IDA (OR = 6.07 [3.61, 10.21]). The meta-analysis showed no statistical difference when comparing blood parameters (Hb, MCV, and serum ferritin) in children with and without ECC. This systematic review demonstrates an association between ECC and increased odds of IDA rather than it being the cause for IDA. Further longitudinal studies with robust methodology are required to determine an evidence-based association.

Proximal enamel thickness of the permanent teeth: A systematic review and meta-analysis

INTRODUCTION

This systematic review aimed to identify, evaluate, and provide a synthesis of the available literature on the proximal enamel thickness (PET) of permanent teeth.

METHODS

The eligibility criteria were studies that assessed the PET of the permanent teeth. A search of studies in Medline (via PubMed), the Cochrane Library, Scopus, Web of Science, Embase, and Lilacs databases that measured PET was conducted until August 31, 2020. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias for systematic reviews involving cross-sectional studies. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. PET data generated from the systematic review were summarized by random-effects inverse-generic meta-analysis.

RESULTS

From 1388 potentially eligible studies, 11 were considered for systematic review and meta-analysis. The measurement of PET was done with radiographs, microscopes, microtomographs, or profilometers. In total, 4019 mesial and distal surfaces involving 2118 teeth were assessed. All included studies showed low to moderate risk of bias, whereas GRADE revealed that the level of evidence was low. Greater mesial and distal enamel thickness was observed for the premolars and molars, whereas it was least for the mandibular central incisors. The least difference of 0.02 mm (95% confidence interval [CI], -0.07 to 0.11 and -0.06 to 0.09, respectively) between mesial and distal sides was observed for the maxillary and mandibular second molars, whereas the maximum difference of 0.12 mm (95% CI, 0.07-0.17 and 0.07-0.16, respectively) was observed for the maxillary central incisors and maxillary first premolars. The meta-analysis indicated a moderate level of heterogeneity (I² of 45%). The funnel plot revealed minimal publication bias.

CONCLUSIONS

The summary effect of the meta-analysis revealed that the thickness of the enamel on the distal aspect was greater than on the mesial aspect by an average of 0.10 mm (95% CI, 0.09-0.12). This finding would be of relevance to all disciplines of dentistry and especially for the clinician planning interproximal reduction, a procedure that is routinely done for clear aligner therapy.

OXIS Contacts as a Risk Factor for Approximal Caries: A Retrospective Cohort Study

Purpose: The purpose of the present study was to evaluate the individual susceptibility of four different types of OXIS contact areas (open [O], point [X], straight [I], and curved [S]) to approximal caries in children. Methods: A retrospective cohort study was performed using clinical photographs and cone-beam computed tomography images of children, available from January 1, 2014, to August 31, 2015, showing the presence of at least one caries-free contact area between the primary molars. A single calibrated examiner scored 1,102 selected contacts using OXIS criteria from the occlusal view and subsequently evaluated the same contacts with a minimum follow-up period of one year for the presence of approximal caries. Results: Of the 1,102 contacts, 259 (23.5 percent) were found to be carious or restored due to approximal caries. Multivariate logistic regression analysis showed that only the type of contact played a significant role in caries prevalence (P<0.05). The odds ratios of OXIS contacts for the development of approximal caries were: S contact-147.4 (95 percent confidence interval [95% CI] equals 19.7 to 1101.7); I contact-24.5 (95% CI equals 3.4 to 177.9); X contact-1.1 (95% CI equals 1.0 to 12.5); and O contact-1.00 (reference). Conclusions: Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology. The broad contact areas, namely, I and S types, are at greater risk for approximal caries in primary molars than O and X contacts.

Prevalence and correlation of OXIS contacts using Cone Beam Computed Tomography (CBCT) images and photographs

BACKGROUND

The contact areas in between primary teeth are broader, flatter, and located further cervically when compared with the contact areas of permanent molars.

AIM

We investigated the prevalence of interproximal contact area types of primary molars using CBCT images in children aged 3-10 years. Our second objective was to correlate OXIS contact areas when observed with CBCT images and clinical photographs.

DESIGN

A retrospective cross-sectional study was performed with 367 CBCT images of children, aged 3-10 years, obtained from Children's Dental Centre, South Korea. The type of contacts in between primary molars was scored at various levels, specifically, occlusal, middle, and cervical thirds, according to OXIS criteria. Following this, the same patient's records were checked for the presence of clinical photographs and scored according to the same criteria. Prevalence was stated as percentages along with numbers. Chi-square test was applied to determine association of contact areas across genders and arches. The correlation between the two methods was done by Cohen's Kappa correlation test.

RESULTS

The prevalence of the OXIS contacts obtained from CBCT images was as follows: I (79.7%), followed by X (10.0%), S (6.6%), and, finally, O (3.7%). The overall score of all the 1343 contact areas matched with the score observed at the occlusal third. All included contacts were of O (open) type at cervical third, and 1,231 contacts were of O (open) type at the middle third. Significant results were observed with respect to arches (P < .001). The correlation between the two methods was found to be 0.958.

CONCLUSIONS

The contact area observed at the occlusal level determined the overall type of contact based on OXIS criteria. Thus, reports in the literature concluded that contact areas are broad, flat, and extend further gingivally should be revised. The study also concluded almost perfect agreement between CBCT images and clinical photographs.

Embracing Psychological Ownership in Dental Education: A Potential Game Changer

Psychological ownership (PO) is conceptually defined as the state in which individuals feel as though the target of ownership or a piece of it is "theirs" (i.e., "It is MINE!"). Theoretical dimensions of PO are promotion oriented (self-efficacy, self-identity, belongingness, accountability, autonomy, and responsibility) and prevention oriented (territoriality). This paper describes the application of PO in dental education and assists us to establish or master numerous aforementioned skills during the learning process in dental school. This PO system will facilitate a gradual transition of students from the dental school environment to private practice smoothly without any apprehensions.

Morphological variations and prevalence of aberrant traits of primary molars

BACKGROUND

Morphological variations in tooth structure exhibit as metric and non-metric traits which play an important role in dental anthropology.

AIM

The purpose of this study was to determine the prevalence of morphometric traits and mean crown dimensions of primary molars in children.

SUBJECTS AND METHODS

This cross-sectional study was carried out in 4256 sectional dye casts of caries-free children aged 2.5-4 years from Puducherry. Two calibrated examiners graded the non-metric traits utilising the Arizona State University Dental Anthropological System classification and measured the crown dimensions in primary molars. The results are expressed in the form of numbers and percentages.

RESULTS

Of the eight non-metric traits studied, metaconule (30.17%), Cusp of Carabelli (90.6%), and deflecting wrinkle (87.41%) in second primary molars, and distal trigonid crest (93.06%) and parastyle (3.48%) in first primary molars, seemed to have higher prevalence, and the overall crown dimensions were found to be smaller in comparison with those in other populations.

CONCLUSION

This study highlights the prevalence of aberrant dental traits in primary molars in a population. The study describes, for the first time, the existence of these traits in first primary molars, adding anthropological significance of primary dentition in various other populations.

Use of Puzzles as an Effective Teaching-Learning Method for Dental Undergraduates

Introduction

Passive teaching in the form of didactic lecture is the usual mode of disseminating knowledge in dental colleges in India. An innovative way to address the diverse learners learning style at the undergraduate level is much sought after in dental education. Puzzles in the form of crossword and word search are structural, self-learning educational tools that review and reinforce knowledge and concepts acquired during the lecture.

Objectives

To evaluate the effectiveness of crossword and word search puzzles as an active teaching learning method for dental undergraduates.

Materials and methods

This is an open, randomized parallel group interventional study conducted with the final BDS students in the Department of Pediatric and Preventive Dentistry of Sri Ramachandra Institute of Higher Education and Research. Two modules of the “must know” category of the curriculum were selected. The class was divided into two groups (interventional and control) using computerized random generator. Learners in both the groups were exposed to didactic lectures, but the activity of solving the puzzles was undertaken only by the interventional group learners. Questionnaire in the form of MCQ was given at the end of the activity to both the groups, and results were evaluated.

Results

Mann–Whitney U test between interventional (Group I) learners revealed an average mean score of 4.2, 6.1, 9.3, and 6 out of 10 in the post-activity test when compared to 2.9, 6.6, 4.6, and 5.1 of the control (Group II) students and was statistically significant in three of four sessions.

Conclusion

Our study revealed that puzzles can be used as an effective active learning tool to reinforce lecture material for dental undergraduates.

How to cite this article

Nirmal L, MS Muthu, Prasad M. Use of Puzzles as an Effective Teaching–Learning Method for Dental Undergraduates. Int J Clin Pediatr Dent 2020;13(6):606–610.

Intra-arterial Instillation of a Nociceptive Agent Modulates Cardiorespiratory Parameters Involving 5-HT3 and TRPV1 Receptors in Anesthetized Rats

BACKGROUND

Since long back, it has been a matter of discussion regarding the role of peripheral blood vessels in the regulation of cardiorespiratory (CVR) system.

OBJECTIVE

The role of 5-HT3 and TRPV1 receptors present on perivascular nerves in elicitation of CVR reflexes was examined after intra-arterial instillation of bradykinin in urethane anesthetized rats.

MATERIALS AND METHODS

Femoral artery was cannulated retrogradely and was utilized for the instillation of saline/agonist/antagonist and recording of blood pressure (BP), using a double ported 24G cannula. BP, respiration and ECG were recorded for 30 min after bradykinin (1 μM) in the absence or presence of antagonists.

RESULTS

Instillation of bradykinin produced immediate hypotensive (40%), bradycardiac (17%), tachypnoeic (45%) and hyperventilatory (96%) responses of shorter latencies (5-8 s) favoring the neural mechanisms in producing the responses. In lignocaine (2%) pretreated animals, bradykinin- induced hypotensive (10%), bradycardiac (1.7%), tachypnoeic (13%) and hyperventilatory (13%) responses attenuated significantly. Pretreatment with ondansetron (100 μg/kg), 5-HT3-antagonist attenuated the hypotensive (10%), bradycardiac (1.7%), tachypnoeic (11%) and hyperventilatory (11%) responses significantly. Pretreatment with capsazepine (1 mg/kg), transient receptor potential vanilloid 1- antagonist blocked the hypotensive (5%), bradycardiac (1.2%), tachypnoeic (6%) and hyperventilatory (6%) responses significantly.

CONCLUSION

In conclusion, presence of a nociceptive agent in the local segment of an artery evokes vasosensory reflex responses modulating CVR parameters involving TRPV1 and 5-HT3 receptors present on the perivascular sensory nerve terminals in anesthetized rats.

Development of a Competency-Based Curriculum for undergraduate education in Pediatric Dentistry: A systematic approach

The changing paradigm of dental education in India has led its way to the development of Competency-Based Curriculum (CBC). This article describes the process of developing CBC in the specialty of Pediatric Dentistry under the initiative of Dental Council of India. Rationale behind CBC development is to bring uniform system of education for improving oral health outcomes of the society in long term. The process of CBC development was a collaborative teamwork, planned meticulously with predefined outline, tasks and timelines. Workflow involved identification of curricular content, defining program goals, outlining competencies, assigning them domains / levels of clinical competence, priority, educational strategies, assessment practices, integration and numbers needed for certification in selected competencies. Early clinical exposure was introduced in CBC. The final content was validated and submitted to the Council. CBC output can be summarized as competencies with fair share of all domains, levels, prioritization and integration. It is characterized by flexibility for choosing educational strategies and assessment practices. It opens up ways for global competition. However, it still has some inherent weaknesses like diverging learning paths, time constraints and number chasing. CBC can further have more academic flexibility and develop toward an outcome-based approach. Faculty preparedness and acceptability shall be the biggest challenges in CBC implementation besides resources' availability, support from leadership and acceptability from our primary stakeholders, our learners. CBC is the beginning of evidence-based delivery of education in dentistry. An effective implementation of CBC in current form would result in increased numbers of competent oral healthcare professionals for the society.

Interproximal contact areas of primary molars based on OXIS classification - a two centre cross sectional study

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is "What is the prevalence OXIS contact areas of primary molars in the populations studied?". Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The 'O' and 'X' types of contacts were observed more in Center 1, whereas 'I' and 'S' contacts were observed more in Center 2.

Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years

Aim

To measure the influence of rotatory pediatrics postings for dental residents on the outpatient census of the pediatric dentistry department. The secondary aims were to assess the change in trend toward the number of preschool children visiting the department before and after the initiation of pediatrics posting and also to find the percentage of children affected with caries among children visiting the pediatricians.

Materials and methods

Retrospectively, the census of the pediatric dentistry department was calculated from 2010 to 2016. The number of preschool children who visited the pediatric dentistry department during this period was determined. From the pediatrics posting records, the dental status of the children, the number screened, the number referred, and the number reported to dentistry following referral were tabulated. Descriptive statistics and Chi-square tests were performed.

Results

After the initiation of pediatrics postings for residents, the outpatient census has increased by 26%. There was a significant increase in the number of preschool children visiting the pediatric dentist. About 57.09% of children screened in the pediatrics department had dental disease.

Conclusion

There is an increase in the patient flow of the pediatric dentistry department with a greater number of preschool children visiting the pediatric dentist after initiation of the pediatrics postings for residents. More than half the children visiting pediatricians had dental disease requiring professional care.

Clinical significance

Pediatrics postings for residents can be used in teaching centers as an opportunity to spread awareness and increase the number of preschool children visiting pediatric dentists, thereby increasing prevention and early intervention of early childhood caries.

How to cite this article

Mohan A, Muthu MS, Ramachandran P, et al. Impact of Pediatric Dentistry Residents Posted in Pediatrics Department: A Retrospective Assessment of 6 Years. Int J Clin Pediatr Dent 2021;14(1):84–87.

OXIS contact areas of primary molars - a two center cross-sectional study

Background: Contact areas in primary teeth are known to be broader, flatter and situated farther gingivally than permanent teeth. The purpose of this study was to assess the prevalence of OXIS contact areas between primary molars using die models of children from two different ethnic populations. The research question of the present study is "What is the prevalence OXIS contact areas of primary molars in the populations studied?". Methods: A cross-sectional study was planned in a representative sample of 200 caries-free contact areas among children aged 3-6 years in two centers, Ajman and Puducherry. Data collection was performed from sectional or full-arch die stone models. The contacts were assessed according to OXIS classification by a single calibrated examiner at Center 2. Prevalence was expressed as numbers and percentages. The Chi-square test was applied to determine the association of OXIS contacts across genders and arches. Results: The prevalence of O, X, I, and S contacts were 19%, 22.5%, 53%, and 5.5% in Center 1 and 6%, 1.5%, 75.5%, and 17% in Center 2, respectively. Significant results (p=0.005) were obtained in Center 1 when inter-arch comparison was performed and between the centers with respect to type of contact. No significant difference was obtained with respect to gender and OXIS contact areas. Conclusions: The present study confirmed OXIS contacts in both the centers. The 'O' and 'X' types of contacts were observed more in Center 1, whereas 'I' and 'S' contacts were observed more in Center 2.

A Comparative Evaluation of Fracture Toughness of Composite Resin vs Protemp 4 for Use in Strip Crowns: An In Vitro Study

Aim

The aim of this study was to compare the fracture toughness of pedo shade packable composite resin (Z100, 3M ESPE, St. Paul, USA) vs Protemp 4 (3M ESPE, Seefeld, Germany) when used inside a strip crown to restore primary incisors.

Materials and methods

Thirty-six exfoliated noncarious human primary central and lateral incisors were randomly divided into two equal groups. The teeth were prepared to standardized dimensions to receive a strip crown. All the teeth were etched, rinsed, and dried following which bonding agent was applied and light cured. In group I, pedo shade packable composite resin (Z100, 3M ESPE, St. Paul, USA) was packed into strip crowns, placed on the prepared tooth, and light cured. In group II, the strip crowns were filled with Protemp 4 (3M ESPE, Seefeld, Germany), placed on the prepared tooth, and left to autopolymerize for 10 minutes. The strip crowns were removed, and the teeth were tested using the universal testing machine until fracture. Fracture toughness of the two groups was recorded and analyzed statistically using Student's “t” test.

Results

The mean force required to fracture strip crowns restored with Protemp 4 (416.89 ± 124.58 N) was higher when compared with pedo shade packable composite resin (338.27 ± 130.99 N). However, statistical analysis did not show a significant difference in the fracture toughness between the two groups (p = 0.074), based on Student's “t” test results.

Conclusion

The fracture toughness of teeth restored with Protemp 4 was comparable with pedo shade packable composite resin when used inside a strip crown.

Clinical significance

The use of Protemp 4 is a possible alternative to pedo shade packable composite resin in restoring the primary anterior teeth, when used inside the strip crowns. The data also showed that the fracture toughness of Protemp 4 was comparable with pedo shade packable composite resin.

How to cite this article

Vignesh KC, Kandaswamy E, Muthu MS. A Comparative Evaluation of Fracture Toughness of Composite Resin vs Protemp 4 for Use in Strip Crowns: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):57–60.

OXIS Classification of Interproximal Contacts of Primary Molars and Its Prevalence in Three- to Four-Year-Olds

Purpose: The purpose of this study was to investigate the prevalence of different interproximal contact areas of primary molars, as described in the OXIS classification, in a group of three- to four-year-old caries-free children. Methods: This cross-sectional study was carried out with a representative sample of 4,476 contact areas of 1,119 caries-free school children. A single calibrated examiner performed a type III examination to assess the type of contact area between primary molars, as seen from the occlusal view. The contacts were scored as O (open contact), X (point contact), I (straight contact), and S (curved contact) using OXIS classification. The prevalence of the types was expressed in the form of numbers and percentages. The findings were subjected to chi-square and McNemar's tests. Results: The most common contact type was I (75.5 percent), followed by S (15.3 percent), O (5.8 percent), and X (3.3 percent). Significant differences were obtained (P<0.001) when the inter- arch comparison was performed for all except the X type of contact. Further, 401 (35.8 percent) children had more than one type of contact in dif- ferent quadrants. Conclusions: The present study highlights the existence of four different types of interproximal contact areas, O, X, I, and S, in caries-free three- to four-year-olds.

Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries

BACKGROUND

Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC).

OBJECTIVES

To assess the effects of interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life, for preventing ECC (from birth to six years of age).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 14 January 2019), Cochrane Pregnancy and Childbirth Group's Trials Register (to 22 January 2019), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 14 January 2019), MEDLINE Ovid (1946 to 14 January 2019), Embase Ovid (1980 to 14 January 2019) and CINAHL EBSCO (1937 to 14 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing one or more interventions with pregnant women, mothers, or other caregivers of infants in the first year of life (intervention types included clinical, oral health education/promotion such as hygiene education, breastfeeding and other dietary advice, and policy or health service), versus standard care or placebo or another intervention. For inclusion, trials had to report at least one caries outcome.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial eligibility, extracted data, assessed risk of bias, and assessed certainty of evidence using the GRADE approach.

MAIN RESULTS

We included 17 RCTs (4 cluster-randomised), involving 23,732 caregivers (mainly mothers) and their children. Eleven RCTs assessed four oral health education/promotion interventions against standard care: child diet advice, child diet and feeding practice advice, breastfeeding promotion and support, and oral hygiene with child diet and feeding practice advice. Six trials assessed clinical interventions in mother's dentition, four trials chlorhexidine (CHX, a commonly prescribed antiseptic agent) or iodine-NaF application and prophylaxis versus placebo, and two trials xylitol against CHX or CHX + xylitol. At most, three trials (maximum of 1148 children and 130 mothers) contributed data to any comparison. For many trials, risk of bias was judged unclear due to lack of methodological details reported, and there was high risk of attrition bias in some trials. None of the included trials indicated receiving funding that is likely to have influenced their results. The trials were performed in high-, middle- and low-income countries. In nine trials, participants were socioeconomically disadvantaged. For child diet and feeding practice advice versus standard care, we observed a probable 15 per cent reduced risk of caries presence in primary teeth with the intervention (RR 0.85, 95% CI 0.75 to 0.97; 3 trials; 782 participants; moderate-certainty evidence), and there may be a lower mean dmfs (decayed, missing, filled primary surfaces) score (MD -0.29, 95% CI -0.58 to 0; 2 trials; 757 participants; low-certainty evidence); however, we are uncertain regarding the difference between the groups in mean dmft (decayed, missing, filled teeth) score (MD -0.90, 95% CI -1.85 to 0.05; 1 trial; 340 participants; very low-certainty evidence). For breastfeeding promotion and support versus standard care, we observed that there may be little or no a difference between groups in the risk of caries presence in primary teeth (RR 0.96, 95% CI 0.89 to 1.03; 2 trials; 1148 participants; low-certainty evidence), or mean dmft score (MD -0.12, 95% CI -0.59 to 0.36; 2 trials; 652 participants; low-certainty evidence). Dmfs was not reported for this comparison. We are uncertain whether child diet advice only compared with standard care reduces risk of caries presence in primary teeth (RR 1.08, 95% CI 0.34 to 3.37; 1 trial; 148 participants; very low-certainty evidence). Dmfs and dmft were not reported for this comparison. For oral hygiene, child diet and feeding practice advice versus standard care, we observed little or no reduced risk of caries presence in primary teeth (RR 0.91, 95% CI 0.75 to 1.10; 2 trials; 365 participants; low-certainty evidence), and are uncertain regarding difference between the groups in mean dmfs score (MD -0.99, 95% CI -2.45 to 0.47; 1 trial; 187 participants; very low-certainty evidence) and dmft score (MD -0.30, 95% CI -0.96 to 0.36; 1 trial; 187 participants; very low-certainty evidence). We observed there may be little or no difference in risk of caries presence in primary teeth between antimicrobial and placebo treatment in mother's dentition (RR 0.97, 95% CI 0.80 to 1.19; 3 trials; 479 participants; very low-certainty evidence). No trials assessing this comparison reported dmfs or dmft. For xylitol compared with CHX antimicrobial treatment, we observed there may be a lower mean dmft score with xylitol (MD -2.39; 95% CI -4.10 to -0.68; 1 trial, 113 participants; low-certainty evidence); however, we are uncertain regarding the difference between groups in caries presence in primary teeth (RR 0.62, 95% CI 0.27 to 1.39; 1 trial, 96 participants; very low-certainty evidence). Neither trial evaluating this comparison reported dmfs. No trials assessed a health policy or service intervention.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that providing advice on diet and feeding to pregnant women, mothers or other caregivers with children up to the age of one year probably leads to a slightly reduced risk of early childhood caries (ECC). The remaining evidence is low to very low certainty and is insufficient for determining which, if any, other interventions types and features may be effective for preventing ECC. Large, high-quality RCTs of oral health education/promotion, clinical, and policy and service access interventions, are warranted to determine effects and relative effects of different interventions and inform practice. We have identified 12 studies currently in progress. Those designing future studies should describe the intervention components, setting and participants, consider if and how effects are modified by intervention features and participant characteristics, and adopt a consistent approach to measuring and reporting ECC.

Antibiofilm Potential of Silver Sulfadiazine-Loaded Nanoparticle Formulations: A Study on the Effect of DNase-I on Microbial Biofilm and Wound Healing Activity

Biofilm resistance is one of the severe complications associated with chronic wound infections, which impose extreme microbial tolerance against antibiotic therapy. Interestingly, deoxyribonuclease-I (DNase-I) has been empirically proved to be efficacious in improving the antibiotic susceptibility against biofilm-associated infections. DNase-I hydrolyzes the extracellular DNA, a key component of the biofilm responsible for the cell adhesion and strength. Moreover, silver sulfadiazine, a frontline therapy in burn wound infections, exhibits delayed wound healing due to fibroblast toxicity. In this study, a chitosan gel loaded with solid lipid nanoparticles of silver sulfadiazine (SSD-SLNs) and supplemented with DNase-I has been developed to reduce the fibroblast cytotoxicity and overcome the biofilm-imposed resistance. The extensive optimization using the Box-Behnken design (BBD) resulted in the formation of SSD-SLNs with a smooth surface as confirmed by scanning electron microscopy and controlled release (83%) for up to 24 h. The compatibility between the SSD and other formulation excipients was confirmed by Fourier transform infrared, differential scanning calorimetry, and powder X-ray diffraction studies. Developed SSD-SLNs in combination with DNase-I inhibited around 96.8% of biofilm of Pseudomonas aeruginosa as compared to SSD with DNase-I (82.9%). In line with our hypothesis, SSD-SLNs were found to be less toxic (cell viability 90.3 ± 3.8% at 100 μg/mL) in comparison with SSD (Cell viability 76.9 ± 4.2%) against human dermal fibroblast cell line. Eventually, the results of the in vivo wound healing study showed complete wound healing after 21 days' treatment with SSD-SLNs along with DNase-I, whereas marketed formulations SSD and SSD-LSNs showed incomplete healing after 21 days. Data in hand suggest that the combination of SSD-SLNs with DNase-I is an effective treatment strategy against the biofilm-associated wound infections and accelerates wound healing.

Prevalence of Early Childhood Caries in India - A Systematic Review

Early Childhood Caries (ECC) is a serious public health problem in developed as well as developing nations, with high prevalence among children around the world. This systematic review of the national literature was undertaken to document the prevalence of Early Childhood Caries. Studies evaluating the prevalence of Early Childhood Caries (ECC) in the Indian population were investigated. The method under evaluation was the use of a caries experience index to calculate the prevalence of ECC. An extensive literature search was done in the following databases: PubMed, IndMED and Cochrane upto June 2016. A modified version of the Newcastle-Ottawa Scale for cross-sectional studies was used for assessment of the quality of the studies. A systematic literature search yielded 503 publications from the various databases searched. Based on the inclusion and exclusion criteria, the final number of included studies were 54. Among the included studies, 19 studies were carried out in the state of Karnataka. Analysis of all the included studies revealed the overall prevalence of ECC in India to be 49.6%. Andhra Pradesh was found to have the highest prevalence of ECC at 63%, and the lowest prevalence was reported in Sikkim (41.92%). This review has reported a high prevalence of ECC in India. None of the states reported prevalence below 40%. The government should identify ECC as a national priority which requires significant attention.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Interproximal contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact interproximal contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of children aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types, O,X, I and S.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of patients aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types.