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.

Ethyl 6′-cyano-7′-(p-tolyl)-1′,6′,7′,7a′-tetrahydro-3′H-spiro[indeno[1,2-b]quinoxaline-11,5′-pyrrolo[1,2-c]thiazole]-6′-carboxylate

The title compound, C31H26N4O2S, crystallizes in a triclinic centrosymmetric lattice with two molecules in the unit cell. The five-membered thiazole and pyrrolidine rings adopt twisted and envelope conformations, respectively. The methoxyphenyl and indenoquinoxaline planes are oriented with a dihedral angle of 88.1 (1)° to each other. The crystal structure features C—H...N, C—H...O and C—H...S intermolecular interactions forming two R 2 2(16) ring motifs and a C(11) and two C 2 2(14) chain motifs. The –CH3 group of the ethyl side chain is disordered over two positions with site occupancies of 0.55 and 0.45.

6′-(3-Bromophenyl)-7′-nitro-1′,6′,7′,7a'-tetrahydro-3′H-spiro[indeno[1,2-b]quinoxaline-11,5′-pyrrolo[1,2-c]thiazole]

The title compound, C26H19BrN4O2S, crystallizes in a monoclinicC-centred lattice with eight molecules in the unit cell. The five-membered thiazole and pyrrolidine rings adopt envelope conformations and the bromophenyl and indenoquinoxaline planes are oriented at a dihedral angle of 61.6 (1)° to each other. The molecular structure features an intramolecular C—H...N interaction leading to anS(6) ring motif.C(9) andC(10) chains along thec- andb-axis directions form through C—H...Br and C—H...S contacts, respectively. In addition, C—H...O and C—H...N hydrogen bonds form inversion dimers withR22(10) andR22(14) motifs, respectively. One O atom is disordered over two positions (occupancy ratio 0.63:0.37).

7′-Nitro-6′-phenyl-1′,6′,7′,7a′-tetrahydro-spiro[indeno[1,2-b]quinoxaline-11,5′-pyrrolo[1,2-c][1,3]thiazole]

In the title compound, C26H20N4O2S, the thiazole and pyrrolidine rings adopt envelope conformations with the respective flap atoms being the N atom and the nitro-bearing C atom. The phenyl and indenoquinoxaline planes are oriented at an angle of 66.72 (1)° to each other. The molecular structure features two intramolecular interactions,viz. C—H...N and C—H...O. In the crystal, the molecules are connected through C—H...N and C—H...O interactions, forming ring motifs [twoR21(7),R22(14),R22(22) andR22(16)]. These ring motifs are connected through aC(9) motif chain.

In vivo scanning electron microscope assessment of enamel permeability in primary teeth with and without early childhood caries

BACKGROUND

Over the years, certain primary teeth have been shown to be highly sensitive to dental caries, while others have remained caries-free. It has been hypothesized that this may be attributed to differences in the permeability of the enamel surface.

AIM

The aim of the study was to evaluate the hypothesized differences in the permeability of primary tooth enamel in children with and those without Severe Early Childhood Caries (S-ECC) using scanning electron microscopy.

MATERIALS AND METHODS

Sixteen children between 3 and 6 years of age were randomly selected and divided into two groups: Group 1, children without S-ECC (n = 8), and Group 2, children with S-ECC (n = 8). In each child, 4 teeth (the maxillary right and left central and lateral incisors) were subjected to evaluation. An impression was made with polyvinylsiloxane impression material, and scanning electron microscopy was used to inspect the negative replicas for droplets.

RESULTS

The results indicated higher significance when individual regions (cervical, middle, and incisal thirds) in the two groups were evaluated and compared. Similarly, the overall results showed high statistical significance between S-ECC and non-S-ECC teeth.

CONCLUSION

There could be a positive relationship between the permeability of tooth enamel and the development of caries, which needs further research.

Supernumerary teeth: review of literature and decision support system

Supernumerary teeth are those which are additional or in excess of the normal number. They can be either single or multiple, unilateral or bilateral and can be present anywhere in the dental arch with predilection for the premaxilla. Supernumerary teeth are mostly classified on position and form. Timing of surgical intervention of supernumerary teeth has been controversial with various authors having different opinions. Hence a new decision support system is put forward which can help in the treatment planning of supernumerary teeth.

Correction of class III malocclusion using modified tandem appliance-two case reports

Skeletal discrepancies in growing children can have great physical and psychological impact on their appearance. These deformities require orthopedic correction at an appropriate age to avoid future extensive management. Managing a midfacial deficiency or true mandibular prognathism is perhaps the most challenging situation for the clinician. Many orthopedic appliances like chin cup, facemask, and so on have been advocated to correct class III malocclusion. The major problems with these appliances are physical appearance, skin irritation from the anchorage pads and hence, less patient compliance. We present management of class III malocclusion in two children with modified tandem appliance (MTA), which is an intraoral appliance, with no extraoral anchorage, and has better patient compliance and cooperation.

Single-rooted primary first molars

Knowledge regarding the morphological variations in roots and root canals aids in successful dental treatment. However, literature regarding dysmorphology of roots in primary dentition is sparse. The purpose of this article is to present a case of bilateral primary mandibular first molars with an unusual morphology of single root. Review of literature regarding variations in root number in primary dentition has been discussed in this article. The etiology for occurrence of such variations has also been briefly reviewed.

Continuous assessment of undergraduate students at a dental college in India

The purpose of this retrospective study was to evaluate the quantitative assessment of a structured essay and standardized oral examination and its correlation to the final-year graduating exam in the Department of Pediatric Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, India. The records of 531 students from 2005 to 2009 were collected. Students were categorized based on their "completion" and "grading" in a structured essay and standardized oral examination, which is a continuous assessment of dental students in the college. The grades obtained by continuous assessment were compared to students' final-year examination scores. The assessment showed that students who completed all tasks and had desirable performance in their written assessment and standardized oral examination also scored better on their final examination. Therefore, the continuous assessment by written assessment and standardized oral examination had a direct relationship to students' performance on the final examination and is useful for evaluation.

In vivo evaluation of the color of anterior primary teeth

PURPOSE

The purpose of this study was to evaluate the color of anterior primary teeth.

METHODS

A total of 449 teeth (including central and lateral incisors) belonging to 78 3- to 6-year-olds were evaluated. A spectroscope was used to determine tooth color. Each tooth's overall shade and the respective shades in the cervical, middle, and incisal thirds were measured, and data collected was subjected to statistical analysis.

RESULTS

D2 was found to be the most common shade of primary teeth. Comparing B1, D2, and C1 shades using a chi-square test showed statistically significant (P<.001) differences among children.

CONCLUSIONS

D2 was the most common shade of primary anterior teeth in children.

Unusual dens evaginatus on maxillary premolars: a case report

Dens evaginatus is a developmental anomaly that can be defined as a tubercle from the surface of an affected tooth. It is composed of enamel and dentin usually enclosing pulp tissue. It is a rare dental anomaly commonly seen on premolars. A 12-year-old boy reported for the management of dental caries. He had bilateral occurrence of dens evaginatus on maxillary second premolars. The tubercle on the right side was unusually long without occlusal interference with the opposing primary mandibular second molar. Carious teeth were restored and the tubercle was left untreated. Management of dens evaginatus is determined by various factors which are discussed in decision-support system. Pulpal complication due to caries or fracture of tubercle can occur; hence it should be periodically monitored.

Development of repaglinide loaded solid lipid nanocarrier: selection of fabrication method

Repaglinide solid lipid nanoparticles (RG-SLN) were fabricated using stearic acid as lipid. Pluronic F68 (PLF68) and soya lecithin were used as a stabilizer. SLNs were prepared by modified solvent injection and ultrasonication methods. SLNs prepared with modified solvent injection method have larger particle size (360+/-2.5nm) than prepared with ultrasonication method (281+/-5.3nm). The zeta potential of the prepared formulations by these two methods varied from - 23.10 +/-1.23 to -26.01 +/-0.89 mV. The maximum entrapment efficiency (62.14 +/-1.29%) was obtained in modified solvent injection method. The total drug content was nearly same (98%) in both the methods. In vitro release studies were performed in phosphate buffer (pH 6.8) with 0.5% sodium lauryl sulphate (SLS) using dialysis bag diffusion technique. The cumulative drug release was 30% and 50% within 2 hrs in modified solvent injection and ultrasonication method, respectively. This indicates that RG-SLN prepared from modified injection method released the drug more slowly than SLNs prepared with ultrasonication method. Differential scanning calorimetry indicates that repaglinide (RG) entrapped in the solid lipid nanoparticles (SLN) exist in an amorphous or molecular state. Repaglinide loaded solid lipid nanoparticles prepared with both methods were of spherical shape as observed by transmission electron microscopy (TEM). These results suggest that modified solvent injection method is more suitable for preparation of repaglinide SLNs using stearic acid.