Fetal breathing movements in late diabetic pregnancy: relationship to fetal heart rate patterns and Braxton Hicks' contractions

Uterine contractions clustering based on electrohysterography

The uterine electromyogram, also named Electrohysterogram (EHG), is a non-invasive technique that has been used for pregnancy and labour monitoring as well as for research work on uterine physiology. This technique is well established in this field. There is however a vast unexplored potential in the EHG that is currently the subject of interdisciplinary research work involving different scientific fields such as medicine, engineering, physics and mathematics. In this paper, an unsupervised clustering method is applied to a previously obtained set of frequency spectral representations of the respective EHG signal contractions that were previously automatically detected and delineated. An innovative approach using the complete spectrum projection is described, rather than a set of relevant points. The feasibility of the method is established despite the concerns of possible computational burden incurred by the processing of the whole spectrum. Given the unsupervised nature of this classification, a validation procedure was performed whereas the obtained clusters were labelled through the correlation with the common knowledge about the most relevant uterine contraction types, as described in the literature. As a result of this study, a spectral description of the Alvarez contractions was obtained where it was possible to breakdown these important events in two different types according to their spectrum. Spectral estimates of Braxton-Hicks contractions were also obtained and associated to one of the clusters. This led to a full spectral characterization of these uterine events.

Large Follicular Odontogenic Keratocyst affecting Maxillary Sinus mimicking Dentigerous Cyst in an 8-year-old Boy: A Case Report and Review

Cyst with relatively high recurrence and having nature to invade the underlying tissue is “odontogenic keratocyst (OKC).” Radiographically, OKC can appear as different varieties, such as follicular, replacemental, extraneous, envelopmental, and collateral. Each radiographic variety of OKC varies in biological behavior, prognosis, recurrence, and therapeutic approaches.

Many studies done till date have not established any relationship between markers of proliferation and aggressiveness in regard to radiographic varieties of OKC. The present article reports a case of follicular OKC in an 8-year-old boy which was concluded as a dentigerous cyst by radiographic features.

How to cite this article: Madhireddy MR, Prakash AJ, Mahanthi V, Chalapathi KV. Large Follicular Odontogenic Keratocyst affecting Maxillary Sinus mimicking Dentigerous Cyst in an 8-year-old Boy: A Case Report and Review. Int J Clin Pediatr Dent 2018;11(4):349-351.

Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study

Aim

To compare and evaluate morphological changes and bacterial deposits in primary carious molars after caries excavation with Carie-Care, erbium-doped yttrium aluminum garnet (Er:YAG) laser, and round tungsten carbide bur.

Materials and methods

Thirty human carious primary molars extracted for therapeutic reasons were sectioned mesiodistally. These sectioned samples were allocated into three groups (20 samples each): group I: Carie Care, group II: Er:YAG laser, and group III: round tungsten carbide bur. After caries excavation, all samples were processed and examined under conventional light microscope to examine for bacterial deposits. Representative samples from each group were processed and analyzed to examine the morphology of caries-excavated tissue by scanning electron microscope (SEM). Statistical analysis was done using Fisher’s exact test, Kruskal–Wallis test, and Mann-Whitney U test.

Results

The Er:YAG laser showed best results with no smear layer followed by chemomechanically excavated surfaces with Carie-Care. Amount of bacterial deposits was observed to be more in group I while least in group II (p-value < 0.001). Mann-Whitney U test and Fisher’s exact test revealed that there was statistically significant difference among all the three groups.

Conclusion

Among the three different methods of caries excavation, Er:YAG laser was found to be more effective compared with Carie-Care and round tungsten carbide bur.

Clinical significance

Laser-induced caries excavation by Er:YAG laser and chemomechanical method of caries removal by Carie-Care can be considered as future of noninvasive pediatric and preventive dentistry.

How to cite this article: Prabhakar A, Lokeshwari M, Naik SV, Yavagal C. Efficacy of Caries Removal by Carie-Care and Erbium-doped Yttrium Aluminum Garnet Laser in Primary Molars: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2018;11(4):323-329.

Comparative Evaluation of the Fracture Resistance of Two Different Fiber-reinforced Composite Restorations with Particulate Filler Composite Restorations

Uncomplicated crown fractures are the most common form of traumatic dental injuries (TDIs) in children affecting their personal and social well-being.

Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors

Aim

Two eruption surgical techniques are commonly described for the treatment of upper impacted central incisors (ICIs): Open and closed. Currently, the closed-eruption surgical technique (CEST) is the most commonly used, as it allows for the best esthetic and periodontal results.

The aim of this study was to determine the effect of traction discontinuation on maxillary central incisor sulcal depth and alveolar bone ridge levels compared with contralateral incisors, when CEST is used.

Materials and methods

Our study involved 28 unilateral impacted maxillary central incisors treated by CEST. Thirteen teeth were subjected to traction interruption for a month at the time of emergence of the crown, while 15 teeth underwent continuous traction. One year after treatment, periapical digital X-rays, anterosuperior cone beam computerized tomography (CBCT) scanning, and periodontal probing of the ICIs and contralateral central incisors (CCIs) were performed. Student’s t-test was used to study whether a statistically significant difference between continuous and interrupted tractions takes place while using the CCI measurements as reference.

Results

There was a statistically significant difference between the two techniques only for the following measurements: Mesial probing (p-value 0.039352), labial bone level (p-value 2.58E-08), and palatal bone level (p-value 2.56E-06).

Limitations

A larger sample size and longer term follow-up are needed to draw more robust conclusions.

Conclusion

A temporary discontinuation during traction of the tooth appears to positively impact treatment outcome on ICIs.

Clinical significance

• The CEST leads to the best periodontal status for ICIs.

• The discontinuation of traction at the emergence of the tooth allows the supracrestal fibers to insert into the cement in a proper way.

How to cite this article: Sfeir E, Gholmieh M, Skaf Z, Mourad A. Alveolar Bone and Epithelial Attachment Status following Two Different Closed-eruption Surgical Techniques for Impacted Maxillary Central Incisors. Int J Clin Pediatr Dent 2018;11(4):317-322.

Clinical, Radiological, and Histological Assessment of Magnetic Nanoparticles as Pulpotomy Medicament in Primary Molars

Aim and objectives

Aim of the study was to evaluate the success of magnetic nanoparticles (MNPs) as pulpotomy medicament by clinical, radiologic, and histological assessment in primary molars.

Materials and methods

The sample included 30 primary molars from 25 children aged between 3 and 9 years requiring pulpotomy treatment. Pulpotomy was carried out with MNPs. The teeth were evaluated after a period of 3, 6, and 12 months clinically and with the aid of radiographs. After 1 year, 10 teeth were extracted for histological evaluation under field emission scanning electron microscope (FE-SEM; ZEISS, Model No. Supra 55vp).

Results

Of the samples, 98% showed clinical success rate with absence of pain, swelling, mobility, and abscess formation. After 3 months, 98% radiological success with absence of periodontal ligament widening, root resorption, and inter-radicular radiolucency was noted. Histological examination carried out under FE-SEM revealed a zone of odontoblastic proliferation at the interface between MNPs and odontoblastic layer of pulp and viable pulpal cells from the canal orifice till apical foramen.

Conclusion

Magnetic nanoparticles can be recommended as an effective pulpotomy medicament with hard tissue barrier formation and preservation of vitality of remaining radicular pulp.

How to cite this article: Konyala HR, Mareddy AR, Puppala N, Reddy NV, Mallela MK, Susheela KP. Clinical, Radiological, and Histological Assessment of Magnetic Nanoparticles as Pulpotomy Medicament in Primary Molars. Int J Clin Pediatr Dent 2018;11(4):283-287.

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia

Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper’s aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management.

How to cite this article: Prud’homme T, Roy E, Soueidan A, Fouassier M, Dajean-Trutaud S, Badran Z. Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann’s Thrombasthenia. Int J Clin Pediatr Dent 2018;11(4):344-348.

Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla

Aim

The purpose of this study was to evaluate the surgical options for supernumerary teeth (SNT) in the premaxillary region of children.

Materials and methods

A total of 69 patients with 82 partially or completely formed SNT in the anterior maxillary region were identified over a 3-year period. All selected patients were assessed for the number, location, and family history of SNT, damage to adjacent roots, and associated symptoms. The surgical approaches used for removal were recorded. Postoperative clinical sequelae (loss of vitality, periodontal problems, pain, bleeding, and enanthema) were evaluated.

Results

A total of 43, 30, and 9 SNT were extracted with palatal, buccal, and bicortical approaches respectively. Peri-odontal and vitality assessments revealed no problems in adjacent teeth at 6 months after surgery. Postoperative pain was within acceptable levels in all patients and subsided within 3 to 7 days. Mild postoperative bleeding occurred in eight patients. Enanthema subsided within 10 days in all patients.

Conclusion

Our results suggest that early diagnosis and appropriate surgical treatment of SNT are important to decrease the risk of clinical complications.

How to cite this article: Maddalone M, Rota E, Amosso E, Porcaro G, Mirabelli L. Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla. Int J Clin Pediatr Dent 2018;11(4):294-298.

Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study

Aim

To evaluate the microtensile bond strength of teeth restored with packable composite after removing caries with three chemomechanical caries removal agents (Carisolv, Papacarie and Carie-care) and also to analyze its effect on chemical composition of dentin using energy-dispersive X-ray (EDX) analysis.

Design

A total of 40 carious molars with 1 to 1.5 mm of remaining dentin were selected and divided into four groups of 20 each. Group I (control)—bur, group II—Carisolv, group III—Papacarie, group IV—Carie-care. A total of 15 samples from each group were restored with composite; 1 mm thick sections were made and were debonded under tensile load. Remaining five samples from each group were subjected to EDX for elemental analysis of dentin surface.

Results

No statistically significant difference in the bond strength values and Ca/P ratio was observed between control group and three chemomechanical agents tested in the study.

Conclusion

None of the chemomechanical agents tested in the study adversely affected the bond strength of composite resin to caries-affected dentin. Therefore, newer papain-based chemomechanical agent Carie-care can be considered as an equally effective economical alternative to commonly used agents Carisolv and Papacarie.

How to cite this article: Nair S, Nadig RR, Pai VS, Gowda Y. Effect of a Papain-based Chemomechanical Agent on Structure of Dentin and Bond Strength: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):161-166.

Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India

Aim

Oral habits during and beyond preschool age are one of the important etiological factors in developing malocclusion and other ill effects on orofacial structures. The objective of the present study was to know the prevalence of deleterious oral habits among 3- to 5-year-old preschool children in Bhubaneswar, Odisha, India.

Materials and methods

This cross-sectional study was conducted among preschool children, in the age group of 3 to 5 years in the city of Bhubaneswar, Odisha, India. To carry out this study, six private schools, two from each of the three electoral constituency, were selected using cluster sampling technique. A total of 500 students, studying in LKG and UKG and their respective mothers/caregivers were selected for the study as per the inclusion/exclusion criteria. Prevalence of different oral habits in children was calculated from the data obtained. Using Statistical Package for the Social Sciences (SPSS), version 17.0 software, Chi-square test was applied to compare the differences present between boys and girls and their significant values (p < 0.05).

Results

The result of this study showed a high prevalence of oral habits (36%) among preschool children in Bhubaneswar, Odisha, India. Lip biting was found to be the most prevalent habit (13.4%), followed closely by thumb sucking (12.8%), bruxism (12.8%), and mouth breathing (11%).

Conclusion

The study revealed a great dearth of a well-established dental education program for preschool children as well as their parents, caretakers, teachers, and pediatricians in order to provide an effective and timely care to the children.

How to cite this article: Dhull KS, Verma T, Dutta B. Prevalence of Deleterious Oral Habits among 3- to 5-year-old Preschool Children in Bhubaneswar, Odisha, India. Int J Clin Pediatr Dent 2018;11(3):210-213.

Foreign Body causing Displacement of Immature Fractured Apical Root Fragment: An Unusual Case Report

Trauma is a common cause of fractured teeth with exposed canals in growing children. These children use foreign bodies like stapler pin, lead pencil, nail, etc., to explore the canal of fractured tooth. Sometimes, these foreign objects may get stuck in the canal, which the children do not reveal to their parents because of fear. These foreign objects may act as a potential source of infection. We herewith present a case of a 12-year-old boy who presented with a stick lodged in the root canal of maxillary right lateral incisor along with the displaced fractured tooth segment at the apex and the associated management. How to cite this article: Moda A, Singla R, Agrawal PM. Foreign Body causing Displacement of Immature Fractured Apical Root Fragment: An Unusual Case Report. Int J Clin Pediatr Dent 2018;11(3):247-249.

A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study

Objectives

The objective of this in vitro study was to assess the surface hardness through Vickers hardness (VH) test of one conventional hybrid resin composites (Filtek Z350), compared with that of two bulk cure resin composites (SDR™, Tetric N Ceram®).

Materials and methods

Twenty specimens of each material were prepared in cylindrical aluminum molds with an internal diameter of 5 mm and depth of 4 mm, 10 (incremental curing) and 10 (bulk curing).

The surface of each specimen was covered with a transparent plastic matrix strip before light curing with conventional visible light for 40 seconds. The specimens thus obtained were stored in deionized water and transferred to an incubator at 37°C for 24 hours to simulate clinical conditions. After 24 hours, the microhardness of each specimen was measured using a Vickers indenter, with a load of 100 gm and dwell time of 15 seconds (HV 0.2/40).

The specimens were further subjected to VH test in an interval of 7, 30, and 90 days. The data were subjected to statistical analysis—Student’s t test, analysis of variance, and post hoc Tukey’s test.

Results

The present study showed that SDR™ in bulk curing showed consistently greater value of hardness and was comparable to traditional incremental cured Filtek Z350, highlighting the advantages of the new SDR technology.

How to cite this article: Sarma A, Nagar P. A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):183-187.

A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale

Aim

Parental presence often provides unique challenge in dental operatory and is directly related to the quality dental treatment. The present study was done to investigate parent's ability to assess dental anxiety of their 6- to 10-year-old child and to determine how parent's and children's fear assessments correlate with each other.

Materials and methods

Prior to dental treatment, 94 child-parent combinations were included to complete Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire, and Frankl score was assigned to children during treatment by operator.

Results

Mean dental anxiety score reported by the children was 27.74, whereas by their parents was 39.64. There was a poor consistency of parents to predict their child dental fear (p < 0.05). Parents reported higher dental fear for their children.

Conclusion

Parents assessment of their child's fear may vary in accordance to factors, including their own dental fear. Such input may prevent dentists from establishing an accurate association with the child's patient.How to cite this article: Malhotra R, Gandhi K, Kumar D, Ahuja S, Kapoor R, Sahni A. A Comparative Study to evaluate Parent's Ability to assess Dental Fear in their 6- to 10-year-old Children using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2018;11(3):205-209.

Time and Eruption Sequence of Permanent Teeth in Hyderabad Children: A Descriptive Cross-sectional Study

Context

Eruption of teeth is influenced by various factors. Very few studies were carried out in the past on the eruption time of teeth in the Indian population.

Aim

The aim of the study is to determine the time and sequence, gender differences, pattern of symmetry in the eruption of permanent teeth in Hyderabad children.

Materials and methods

In this cross-sectional study, 1654 schoolchildren (806 girls and 848 boys) in the age group of 5 to 15 years from Hyderabad were examined for the status of eruption of permanent teeth.

Statistical analysis used

Results were subjected to probit’s regression analysis. The average age at eruption of permanent teeth, excluding third molars, was given as the mean [± standard deviation (SD)] in months for each gender. A table of percentiles of the eruption time was also determined.

Results

Unlike most of the earlier studies which showed that girls are ahead of boys in permanent teeth emergence, no such pattern was observed. No significant difference was found in the eruption of permanent teeth in right and left arches. Eruption of all the mandibular teeth, with the exception of right first premolar (44) in both the genders, was earlier than their maxillary counterparts. There was overall delay in the eruption of permanent teeth and significant delay in the eruption of lower canines in both genders.

Conclusion

The significant delay in the eruption of permanent mandibular canines is relevant for orthodontic treatment planning.

How to cite this article: Chaitanya P, Reddy JS, Suhasini K, Chandrika IH, Praveen D. Time and Eruption Sequence of Permanent Teeth in Hyderabad Children: A Descriptive Cross-sectional Study. Int J Clin Pediatr Dent 2018;11(4):330-337.

Papillon-Lefèvre Syndrome: A Rare Case Report of Two Brothers and Review of the Literature

Papillon-Lefèvre is an autosomal recessive syndrome that starts in early periods of childhood. Characteristic features include palmar plantar hyperkeratosis, aggressive periodontal disease, and a tendency for dry and chopped skin, thin and sparse hair. Patients show signs of premature tooth loss at the age of 2 to 4 years, which is then followed by the loss of permanent dentition during adolescence. The presence of both skin and oral lesions in this syndrome differentiates this unusual genodermatosis from other pathology of palmoplantar keratoderma (PPK). The etiopathogenesis of this syndrome is somewhat obscure; however, immunologic, genetic, and possible bacterial etiologies have been proposed. The dental practitioner is often the first to diagnose the disease, as there is a significant degree of periodontal breakdown that is involved at an early age. This report presents a clinical presentation of two brothers detected with Papillon-Lefèvre syndrome (PLS).

How to cite this article: Fageeh HN. Papillon-Lefèvre Syndrome: A Rare Case Report of Two Brothers and Review of the Literature. Int J Clin Pediatr Dent 2018;11(4):352-355.

Validity and Reliability of the Hindi Version of the Modified Child Perceptions Questionnaire 11 to 14

Introduction

The study was conceived to formulate a tool to evaluate child perceptions related to oral health in 11- to 14-year-olds tailor-made for Indian children in Hindi. The original child perceptions questionnaire (CPQ_11-14) was translated into Hindi and it was tested for validity and reliability.

Materials and methods

The original CPQ_11-14 was translated into Hindi and some questions were rephrased to suit the sociocultural situation in India. The domains of self-esteem and psychological well-being were added to the questionnaire to broaden the scope of parameters to thoroughly assess the impact on child perceptions toward oral health. The English and Hindi versions of the CPQ_11-14 were administered during the first visit to test for validity and the children were recalled after 1 week and administered the Hindi questionnaire again after 1 week to check for reliability.

Results

The results showed significant positive correlation between oral symptoms, decayed, missing and filled teeth (DMFT) functional limitation and malocclusion. The mean functional limitation score was found to be higher in subjects with malocclusion in both the English and Hindi questionnaires. The test-retest samples were evaluated using the paired t-test and showed no significant difference between the first and second administration which suggested good reliability.

Conclusion

The translated and modified Hindi CPQ_11-14 was found to be valid and highly reliable for use in India. The adaptation of the original questionnaire by modifying certain questions to suit the Indian condition was found to be culturally relevant.

How to cite this article: Kumar P, Mandanna DCM, Londhe SM, Sharma M. Validity and Reliability of the Hindi Version of the Modified Child Perceptions Questionnaire 11 to 14. Int J Clin Pediatr Dent 2018;11(4):271-276.

Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status

Aims and objectives

To determine and compare the effect of triphala, chlorhexidine gluconate, and garlic extract mouthwash on salivary Streptococcus mutans count and the oral hygiene status.

Materials and methods

Sixty children aged 9 to 12 years were randomly allocated into the study groups of triphala mouthwash, chlorhexidine mouthwash, garlic extracts mouth-wash, and distilled water mouthwash. Examination included decayed, missing, and filled teeth (dmft)/decayed, missing, filled surface (dmfs) and DMFT/DMFS, plaque index, and S. mutans count on days 1, 15, and 30.

Results

The results were statistically analyzed using Friedman test, Wilcoxon signed rank, repeated-measures analysis of variance (ANOVA), paired t-test, one-way ANOVA, post hoc Tukey’s honestly significant different (HSD), Kruskal–Wallis test, and Mann-Whitney test; all calculations were done by MEDCALC software 14.0.0 version.

Discussion

Streptococcus mutans count had significant reductions using different mouthwashes at 15 days, but the chlorhexidine group showed significant difference from the remaining three groups. Intergroup comparison for plaque index scores of triphala, chlorhexidine, and garlic groups was similar in preventing plaque build-up during the 15 days of mouthwash use.

Conclusion

All the three mouthwashes containing triphala, chlorhexidine gluconate, and garlic were comparably efficient in reducing the salivary S. mutans count as well as in limiting plaque score; however, chlorhexidine was the most effective in this aspect. In comparison of the two natural ingredients, Triphala is more effective in its antimicrobial effect.

How to cite this article: Padiyar B, Marwah N, Gupta S, Padiyar N. Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status. Int J Clin Pediatr Dent 2018;11(4):299-306.

Knowledge, Attitude, and Practice of Mothers regarding Oral Hygiene of Primary School children in Chennai, Tamil Nadu, India

Introduction

Children depend on their parents and caretakers for maintenance of their oral health. Parents play a major role in both preventive and treatment regime in these children. This study was conducted with the aim of evaluating the influence of parental education on knowledge, attitude, and practice of mothers regarding oral health of primary schoolchildren in Chennai.

Materials and methods

A 15-item self-administered questionnaire was used among 465 parents of preschool children in Chennai, of which 432 mothers returned the filled questionnaire. The data collected were subjected to statistical analysis using frequency of responses and chi-square test (p < 0.01). Data were analyzed using statistical package.

Results

Of the 432 mothers who participated in the study, 150 (35%) have studied up to school level and 282 (65%) have completed diploma/degree. The knowledge of mothers regarding the knowledge of importance of oral health for general health is appreciable, but the awareness of proper brushing habit, treatment of caries, and importance of dental visits is less in mothers who have school education when compared with graduate mothers.

Conclusion

Mothers who are graduates are more aware of the importance of oral health in children, treatment of dental caries, and brushing technique than mothers with school education. Hence, it is essential that government and health care providers impart oral health knowledge to mothers, as they are the role-models for their children.

How to cite this article: Gurunathan D, Moses J, Arunachalam SK. Knowledge, Attitude, and Practice of Mothers regarding Oral Hygiene of Primary School children in Chennai, Tamil Nadu, India. Int J Clin Pediatr Dent 2018;11(4):338-343.

Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study

Introduction

Usually discomfort and pain are associated with dental work, especially for young patients. Pain control can be achieved by using anesthesia. Sight of injection can terrify any patient and if the patient is a child it is really difficult to convince them for injections. Alternatives to injections have been explored. Pediatric dentists are using anesthesia in the form of jelly and patch. Recently, the concept of mucosal vibration has been put forward to enhance the effectiveness of local anesthesia.

Aim

The aim of the present study was to compare and evaluate the effectiveness of lignocaine jelly and mucosal vibration in reducing pain during administration of local anesthesia in pediatric dental patients.

Materials and methods

Thirty children in the age group 6 to 11 years who required bilateral anesthesia for dental treatment in mandible were selected for this study. Pain was compared using Wilcoxon signed-rank test at the time of injection using Sound, Eye, Motor (SEM) scale as objective criteria and facial pain rating (FPR) scale as subjective criteria after administration of injection by a trained assistant who was blinded to the procedure.

Results

Local anesthetic injection along with mucosal vibration resulted in significantly less pain (p = 0.001) in comparison with the injections without the use of mucosal vibration.

Conclusion

The result shows that mucosal vibration can be used as an effective means to reduce the intensity of pain during local anesthetic injection in dentistry.

How to cite this article: Tandon S, Kalia G, Sharma M, Mathur R, Rathore K, Gandhi M. Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study. Int J Clin Pediatr Dent 2018;11(4):261-265.

Accelerating Treatment of Skeletal Class II Malocclusion using Fixed Twin Block Appliances

Background

Patients with class II malocclusion generally seek orthodontic treatment for esthetic concern. Various myo-functionl appliances can be used for the treatment of skeletal as well as the dental malocclusion in a growing patient. Among various functional appliances, twin block appliance is most commonly used due to better patient compliances. It redirects the mandibular growth to correct the maxillomandibular relationship, enhancing facial esthet ics. This article presents a modified design of the twin block appliance which is less bulky, more esthetic, can be used concurrently with fixed orthodontic appliance, and is easily accepted by uncooperative patients.

Case summary

An 11-year-old-boy, who presented himself with a skeletal class II malocclusion, was treated with simultaneous use of fixed twin block along with fixed orthodontic appliance to correct both the skeletal and dental malocclusion. The twin block design was modified to have a better compatibility with the fixed orthodontic appliance.

How to cite this article: Pattanaik S, Puvvula N, Mohammad N. Accelerating Treatment of Skeletal Class II Malocclusion using Fixed Twin Block Appliances. Int J Clin Pediatr Dent 2018;11(2):146-150.

A Case of Painless Excision

Soft tissue lesions of the oral cavity are seen in children at the dental office. This case report aims to showcase the ability of laser to treat recurrent soft tissue lesions in the oral cavity in a painless manner. This painless procedure provides relief to the child and parent who suffer from anxiety toward dental treatment.

How to cite this article: Suyash IA, Bhatia R. A Case of Painless Excision. Int J Clin Pediatr Dent 2018;11(2):135-140.

A Comparative Evaluation of Efficacy of Streptococcus mutans Counts in Saliva: An in vivo Study

Dental caries is a disease of multifactorial origin and Streptococcus mutans is considered as the chief pathogen responsible for its development. However, reduction in the number of pathogenic bacteria, particularly S. mutans, with the use of various preventive measures, can reduce dental caries to a significant level. Therefore, the present clinical study was undertaken to evaluate and compare the efficacy of toothbrushing, fluoride varnish, chlorhexidine mouthwash, and a probiotic (Yakult) in reducing the S. mutans counts in the saliva using Dentocult SM Strip Mutans kit in children. A total of 40 school students between the age group of 4 and 8 years were selected for the study and S. mutans count was taken on the first dental visit using Dentocult SM Strip Mutans test kit. After the initial scores of S. mutans were obtained, the children were divided into four groups and provided with different caries preventive regimen for 2 weeks. After 2 weeks, the scores of S. mutans were reevaluated for reduction in their counts, if any. The data thus collected were tabulated and statistically analyzed. All the groups showed a significant reduction in S. mutans counts with the highest reduction from the Fluor Protector varnish followed by chlorhexidine mouthwash, probiotic (Yakult), and toothbrushing.

How to cite this article: Sharma M, Pandit IK, Srivastava N, Gugnani N, Gupta M. A Comparative Evaluation of Efficacy of Streptococcus mutans Counts in Saliva: An in vivo Study. Int J Clin Pediatr Dent 2018;11(2):94-99.

Manuka Honey: A Potent Cariostatic Agent- An in vitro Study

Aim

The aim of the study was to test the antibacterial activity of manuka honey and compare its efficacy with another commercially available honey (Dabur honey) on the cariogenic bacteria on Streptococcus mutans and Lactobacillus.

Materials and methods

An in vitro study was carried out on 40 agar specimens; the samples were divided into two groups of 20 samples consisting of S. mutans and Lactobacil-lus respectively. The 20 samples in each group were further subdivided into four groups of five each, which were tested with 25% manuka honey, 100% manuka honey, 25% Dabur honey, and 100% Dabur honey for both Lactobacillus and S. mutans groups. The antibacterial activity was tested using the agar well diffusion method against S. mutans and Lacto-bacillus. Antibacterial activity was assessed by measuring the diameter of inhibition of zones surrounding the wells. The results obtained were statistically analyzed (one-way analysis of variance test, p-value).

Results

The results showed that 25% of manuka honey has statistically significant (p ≤ 0.001) antibacterial effect than 25% of Dabur honey on both Streptococcus and Lactobacillus species, and manuka honey with 100% concentration showed a statistically significant (p ≤ 0.001) antibacterial effect than 100% Dabur honey on the same species of bacteria. 100% of both the honeys showed statistically significant (p ≤ 0.001) antibacterial effect than 25% concentrations of the same on S. mutans and Lactobacillus.

Conclusion

Manuka honey had more antibacterial activity than Dabur honey on S. mutans and Lactobacillus bacteria in the in vitro study. This effect was dependent on the concentration of honey used.

How to cite this article: Beena JP, Sahoo P, Konde S, Raj SN, Kumar NC, Agarwal M. Manuka Honey: A Potent Cariostatic Agent—An in vitro Study. Int J Clin Pediatr Dent 2018;11(2):105-109.

Perception of Indian Dental Surgeons regarding Molar Incisor Hypomineralization

Aim

To determine the perception of Indian dental professionals about prevalence, severity, and etiological factors of molar incisor hypomineralization (MIH).

Materials and methods

An online survey was mailed to dental professionals encompassing various questions regarding etiology, diagnosis, prevalence, and management of MIH.

Results

More than 90% of the respondents encounter teeth with hypomineralization in their practice, with less than half of them encountering such teeth on a monthly basis. Among these more than one-third find it difficult to manage one or the other aspect of MIH. The etiology was found to be varying as per the respondents.

Conclusion

Molar incisor hypomineralization is a common condition encountered by dental professionals with no apparent consensus regarding the anticipated prevalence, severity, and etiology of this condition. Knowledge of clinicians' level of perception could be an incentive for pediatric dentists to become more acquainted with MIH by conducting research into its different aspects.How to cite this article: Upadhyay S, Kumar G, Dhillon JK, Gill NC. Perception of Indian Dental Surgeons regarding Molar Incisor Hypomineralization. Int J Clin Pediatr Dent 2018;11(2):116-121.

Customized Hybrid Bluegrass Appliance: An Innovative Technique

Oral habits in the form of thumb sucking and tongue thrusting are commonly learned patterns of behavior seen in preschool children and they are associated with anxiety, fear, hunger, oral pressure, and sleep. Chronic practice can cause dentoalveolar, perioral problems, and atypical root resorption (ARR) of anterior primary teeth. The ARR is provoked by the thumb sucking habit, and leads to early loss of anterior primary teeth. The early loss of anterior tooth may result in speech and masticatory problems, and psychological disturbance to the child. Hence, pediatric dentists play a crucial role in giving necessary information to parents and guardians. Starting from counseling to appliance therapy, various treatment modalities have been reported in the literature. One of them is bluegrass appliance; it is a nonpunitive habit reminder therapy. The present case report describes a customized hybrid bluegrass appliance designed to eliminate thumb sucking and tongue thrusting habit, and to perform as an esthetic functional space maintainer. How to cite this article: Mohammad Z, Bagalkotkar A, Mishra A, Veerala G. Customized Hybrid Bluegrass Appliance: An Innovative Technique. Int J Clin Pediatr Dent 2018;11(2):141-145.

Liver Cancer in Nepal

Hepatocellular carcinoma (HCC) is highly incidental in South Asian countries. Nepal, however, has low incidence for HCC owing to low prevalence for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Nepal lacked national cancer registry until 2003. Though there has been some effort in having one, the current registry incorporates twelve centers and may not properly represent the total cancer burden in the country. Serology for HBV and HCV is seen to be positive in nearly 25 to 30% and 5 to 10% of HCCs respectively. Clinical characteristics of HCCs in Nepal have been discussed in this mini-review and it features poor performance status and advanced stage at presentation, making only a small fraction of these subjects eligible for curative treatment options. Most of the standard treatment modalities are available in Nepal and appear to be reasonably affordable as compared with other developed nations.

How to cite this article: Shrestha A. Liver Cancer in Nepal. Euroasian J Hepato-Gastroenterol 2018;8(1):63-65.

Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases

Introduction

The term multiple primary tumor (MPT) is used to describe cases where two or more primary tumors show no histopathological similarities in between. Multiple primary tumor cases have begun to increase in recent years as a result of the increase in life expectancy because of the increase in life standards and progress in diagnostic methods. In this study, MPT cases with periampullary tumors that underwent Whipple procedure were discussed in the light of literature data.

Materials and methods

The patient files of 223 cases with periampullary tumors that underwent Whipple procedure in our hospital during the last 6 years were examined retrospectively. More than one primary tumor was detected in 21 patients.

Results

Periampullary carcinomas were detected as a second primary tumor in 18 patients. First primary tumor was periampullary carcinoma in 3 patients that underwent Whipple procedure. After the Whipple procedure, 5 patients died due to early complications in the first 30 days and 6 patients died due to metastases and additional problems that developed during follow-up.

Discussion

The incidence of MPT has been reported as 0.7 to 14.5% in the literature. Most of them are multiple primary case presentations. In patient management, it is recommended that each tumor should be evaluated independently of its own characteristics, and treatment and follow-up should be planned accordingly.

Conclusion

The MPT cases are increasing. The possibility of MPT as well as metastasis should be kept in mind during the evaluation of tumor foci seen during diagnosis and follow-up of patients. The characteristics of each tumor, survival, and prognosis should be evaluated separately and the most appropriate treatment should be offered to the patient. It is recommended that synchronic primary tumors which are considered to be surgically resectable without metastasis should be removed in the same session.How to cite this article: Dilek ON, Ozsay O, Karaisli S, Gür EÖ, Er A, Haciyanli SG, Kar H, Dilek FH. Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases. Euroasian J Hepato-Gastroenterol 2018;8(1):1-5.

Reviewing of Research Finding of Hepatitis B Virus Infection in Lao People's Democratic Republic

The seroprevalence of hepatitis B virus (HBV) surface antigen (HBsAg)-positive blood donors was 8.7%. The prevalence among males (9.7%) was higher than among females (6.2%). The prevalence of antihepatitis C virus (HCV)-positive blood donors was 1.1%, with no significant differences between males (1.1%) and females (1.0%). Annual positive rates for HBsAg and anti-HCV donors during the years 2003 to 2005 did not differ significantly. In Lao People’s Democratic Republic (PDR), HBV is highly endemic. However, blood donations are only screened for HBsAg, leaving a risk of transmission by HBsAg-negative occult infected donors. Here, we characterized first-time blood donors to assess prevalence of HBV infections and occult infected donors. Despite hepatitis B vaccination at birth and at 6, 10, and 14 weeks of age, HBV infection continues to be endemic in Lao PDR. We carried a cross-sectional serological study in infants, preschool children, school pupils, and pregnant women to determine their burden of disease, risk of infection, and vaccination status. The prevalence of HBsAg carriage in pregnant women is a relevant marker for the risk of mother-to-child HBV transmission. This study aimed to assess the changes in prevalence of HBV infection among pregnant women attending Mahosot Prenatal Clinic (Vientiane).

How to cite this article: Ounavong A. Reviewing of Research Finding of Hepatitis B Virus Infection in Lao People’s Democratic Republic. Euroasian J Hepato-Gastroenterol 2018;8(1):75-76.

Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka

Nonalcoholic fatty liver disease (NAFLD) is becoming one of the most important causes for chronic liver disease and also hepatocellular carcinoma (HCC) in Sri Lanka. This tendency is also recognized worldwide. More than half of the middle-aged and elderly adults in urban Sri Lanka have ultrasonic evidence of NAFLD. The NAFLD is also identified in population from rural areas of Sri Lanka and also in children. Nonalcoholic steatohepatitis (NASH) cirrhosis is the most common cause of referral for liver transplantation in Sri Lankans. The NASH is also the most common cause for rejecting potential donors for liver transplantation in Sri Lanka. Patients who underwent liver transplantation for cryptogenic cirrhosis developed evidence of NASH following liver transplantation. Recent evidence suggests that there is a genetic component to NAFLD. PNPLA3, a single gene polymorphism linked to the short arm of chromosome 22, is associated with the severity of NAFLD. The presence of this genetic polymorphism appears to carry higher risk of patients with NAFLD developing NASH with fibrosis cirrhosis and hepatocellular carcinoma. In a large population-based study from Sri Lanka, there was a tendency to develop NAFLD associated with this genetic polymorphism. In a population-based study, NAFLD was identified as an independent risk factor for development of diabetes. This association is recognized worldwide now. Most patients with HHC in Sri Lanka developed it on a back ground of cryptogenic cirrhosis. At the same time, the prevalence of the markers for hepatitis B and C was rare in Sri Lankan patients with HCC.

How to cite this article: Dassanayake AS. Nonalcoholic Fatty Liver Disease: Identifying the Disease Burden in Sri Lanka. Euroasian J Hepato-Gastroenterol 2018;8(1):69-72.

The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia

Introduction

Liver involvement is common in hematological malignancies, but the incidence and pattern of liver injury vary among the different types. The aims of our study were to determine the incidence and clinical course of acute hepatitis and the important factors for its development in patients with leukemia after chemotherapy.

Materials and methods

All patients with the diagnosis of leukemia who were treated at the Department of Hematology between January 2008 and January 2013 were included in the study. A detailed medical history, clinical and laboratory findings, treatment modalities, complications, and clinical course were recorded retrospectively.

Results

A total of 124 patients (64 females) with the diagnosis of leukemia were included in the study. The mean age was 45.2 years (16-89 years) and mean follow-up time was 29.7 months (0.25-192 months). A total of 43 (34.6%) patients had acute hepatitis after chemotherapy. Pattern of liver injury was hepatocellular in 31 patients, cholestasis in 2, and mix in 10 patients. Age (p = 0.001), hepatitis B surface antigen (HBsAg, p = 0.007), acute leukemia (p < 0.001), positive blood culture (p = 0.004), the amount of transfused red blood cell (p = 0.001), and amount of transfused platelets (p = 0.002) were significantly different under univariate analysis between the acute hepatitis group and the nonacute hepatitis group. Under multivariate analysis, only acute lymphoblastic leukemia (ALL) was identified as independent predictive factor for development of acute hepatitis after starting chemotherapy.

Conclusion

Acute and self-limited hepatitis develops in the substantial proportion of patients with leukemia. The most important factor for development of acute hepatitis is the type of leukemia.

How to cite this article: Kaya M, Akdogan R, Uçmak F, Ayyildiz MO, Karakus A, Kaplan MA. The Incidence and Predictive Factors in the Development of Acute Hepatitis in Patients with Leukemia. Euroasian J Hepato-Gastroenterol 2018;8(1):31-37.

Cross-validation Studies of a Novel Low-cost Hepatitis B Virus Quantitative Polymerase Chain Reaction System

Aim

This research focused on the results of the cross-validation program related with the performance of a Cuban novel low-cost real-time quantitative polymerase chain reaction (qPCR) assay for hepatitis B virus (HBV) quantification developed by the Therapeutic Vaccine against Hepatitis B Department, Vaccines Division, Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba.

Materials and methods

Dilution series with the plasmid standard at concentrations of 900,000 to 0.09 copies/reaction (c/r) were made for each PCR instrument. The mean cycles threshold (Ct) values and PCR efficiency were compared among the cyclers. Hepatitis B virus-positive serum samples were used for the calculation of reproducibility of the HBV assay. Biotecon Diagnostics (BCD) also ordered the oligo sequences from a second supplier and compared the PCR performance to those provided from the CIGB.

Results

All PCR cyclers were able to detect concentrations up to 0.09 c/r. However, below the concentration of 9 c/r, the variation of results increased within and between the cyclers. The PCR efficiency showed satisfying results. The overall coefficient of variation (CV) cycler values were 1.29 and 0.91% for M6 and M19 respectively. No significance was observed between the different primer suppliers.

Conclusion

The HBV assay was performed with a good concordance between the five real-time instruments from different suppliers. The HBV assay was also performed with a high reproducibility for samples with a high and a low viral load. The HBV assay is robust against different primer suppliers.

How to cite this article: Aguiar J, Silva JA, García G, Guillén G, Aguilar JC. Cross-validation Studies of a Novel Low-cost Hepatitis B Virus Quantitative Polymerase Chain Reaction System. Euroasian J Hepato-Gastroenterol 2018;8(1):38-41.

Postobstructive Cyst Formation in Pancreatic Duct affecting Surgical Approach

How to cite this article: Ezer A, Parlakgumus A. Postobstructive Cyst Formation in Pancreatic Duct affecting Surgical Approach. Euroasian J Hepato-Gastroenterol 2018;8(1):99-100.

Evaluation of Chemokines in the Gingival Crevicular Fluid of Children with Down Syndrome

AIM

The goal of the study was to detect the presence of macrophage inflammatory protein (MIP)-1α and MIP-1β and to estimate their levels in gingival crevicular fluid (GCF) of children with Down syndrome.

MATERIALS AND METHODS

MIP-1α and MIP-1β levels were estimated in GCF samples of 20 healthy and 20 Down syndrome individuals. Gingival status was assessed by measuring the gingival index (GI), plaque index (PI), clinical attachment level (CAL), and probing pocket depth (PPD).The GCF samples were obtained from the subjects and MIP-1α and MIP-1β levels were quantified by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The mean MIP-1α concentrations in healthy and Down syndrome individuals were 209 and 1411 pg/μL respectively, and MIP-1α levels were 342 and 1404 pg/μL respectively.The levels of MIP-1α and MIP-1β in the GCF of subjects with Down syndrome were significantly higher than in the healthy individual, and statistically significant differences were present among the two groups.

CONCLUSION

The GCF showed dynamic changes according to the severity of periodontal disease, and the levels of MIP-1α and MIP-1β had a strong relationship with clinical parameters. The MIP-1α and MIP-1β can therefore be considered as novel biomarkers in the biological mechanism underlying the patho-genesis of periodontal disease.How to cite this article: Reddy VK, Kommineni NK, Padakandla P, Togaru H, Indupalli JP, Nanga SP. Evaluation of Chemokines in the Gingival Crevicular Fluid of Children with Down Syndrome. Int J Clin Pediatr Dent 2018;11(4):288-293.

Use of "Surface Analyzer" to evaluate the Effect of Two Polishing Systems on Surface Texture of Four Newer Composites

Composites polymerized with a clear matrix on the surface will leave a resin-rich surface layer that is easily abraded in the oral environment, exposing unpolished, rough, inorganic filler material. The purpose of this study was to evaluate the polishing effect of two different polishing systems: One-step (PoGo) system and Sof-Lex (multistep) system on four different resin composites: Synergy D6, Clearfil APX Esthetics, Filtek Z 350 XT, Ceram X Mono. After polishing, the specimens were analyzed for average surface roughness using a two-dimensional surface profilometer. How to cite this article: Garg S, Goel M, Verma S, Mahajan N, Kaul B, Garg V. Use of "Surface Analyzer" to evaluate the Effect of Two Polishing Systems on Surface Texture of Four Newer Composites. Int J Clin Pediatr Dent 2018;11(4):266-270.

Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude

Introduction

To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures.

Materials and methods

Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, cross-sectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland-Altman plots were used to assess reliability of measurements and their differences at the two altitudes.

Results

The mean age of patients was 41.7 (28-66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically sig -nificant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 μm, p = 0.496).

Conclusion

Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.How to cite this article: Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018;12(1):40-44.

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma

Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechia! angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic-GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery. How to cite this article: Alaghband P, Rodrigues IAS, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018;12(1):45-49.

Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder, characterized by extremely short attention span, impulsivity with resultant behavioral problems. They are prone to trauma and frequent dental injuries. The behavioral issues, cognitive deficits, and short attention span pose a challenge to the dental health team. Management of these children requires several modifications in approach at all levels of prevention and treatment. This study reviews all the pertinent oral health issues in these children and also presents the case report of a 14-year-old boy diagnosed with ADHD.

How to cite this article: Sinha S, Praveen P, Rani SP, Anantharaj A. Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report. Int J Clin Pediatr Dent 2018;11(3):254-259.

Salivary Cortisol and Alpha-amylase-Biomarkers of Stress in Children undergoing Extraction: An in vivo Study

Aim

The anxiety of dental procedure evokes physiological response in the human body similar to fear. The level of cortisol and alpha-amylase in saliva can be considered as one of the major biomarkers of stress and anxiety. Our study was aimed to correlate the stress and anxiety with the levels of salivary cortisol (SC) and salivary alpha-amylase (SAA) in patients undergoing routine dental extraction.

Materials and methods

The levels of SC and SAA were assessed pre- and postextraction in the salivary samples of 20 children.

Results

The values of cortisol and alpha-amylase showed a significant increase postextraction.

Conclusion

Salivary cortisol and SAA can be considered an important and noninvasive tool for assessment of anxiety, such as dental extraction, in children.

Clinical significance

Increase in the stress levels of a child in the dental operatory procedures like tooth extraction suggests the use of some behavior modification and shaping techniques by dentists to overcome the anxiety of the child before commencement of the procedure. This can aid in better cooperation of the child during treatment as well as helps in internal motivation toward future dental treatment.

How to cite this article: Chaturvedi Y, Chaturvedy S, Marwah N, Chaturvedi S, Agarwal S, Agarwal N. Salivary Cortisol and Alpha-amylase—Biomarkers of Stress in Children undergoing Extraction: An in vivo Study. Int J Clin Pediatr Dent 2018; 11(3):214-218.

Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis

Introduction

The principal goal of dentistry is to maintain and improve the quality of life of the dental patients. As many of these objectives require the replacement or alterations of the existing tooth structure, the main challenge for centuries has been the development and selection of biocompatible materials that can withstand the unique conditions of the oral environment.

Finite element analysis (FEA) is a modern technique of numerical stress analysis that has become a solution to the task of predicting failure due to unknown stresses by showing problem areas in a material and allowing designers to see all of theoretical stresses within.

Aims and objectives

To evaluate and compare the effect of various temperature changes on the stress distribution, in class II mesial-occlusal-distal (MOD) cavity when restored with different restorative materials, using the finite element method (FEM).

Materials and methods

Using FEA, various thermal stresses generated in class II MOD lesion using different restorative materials were studied.

Results

The computer-generated models of intact tooth and teeth restored with the different restorative materials were designed, and thermal stress at different temperatures was observed when subjected to the thermal loads of 5°C, 20°C, 36°C, and 55°C. From the results of the study, it can be concluded that glass ionomer cement (GIC) performed best, followed by intact tooth, composite resin, silver amalgam, and zinc oxide eugenol cement.

Conclusion

Restoration of class II MOD lesions with materials of lower modulus of elasticity and lower coefficient of thermal expansion will enable better stress distribution.

How to cite this article: Srivastava B, Devi NN, Gupta N, Singh R. Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis. Int J Clin Pediatr Dent 2018;11(3):167-170.

Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals

Introduction

Dissolution of the enamel in the form of erosion has increased due to shift in eating habits toward carbonated drinks like soft drink and chocolates.

Aim

The purpose of this study was to evaluate changes in the salivary pH after intake of different eatables and beverages in children at different time intervals.

Study design

Using standard salivary tests, this study was conducted as a case-control study. Fifty children between ages of 8 and 12 years having strict vegetarian diet were included in the study.

Materials and methods

Oral prophylaxis was done and salivary buffer capacity for stimulated saliva was measured. Before the saliva collection, each of the children was informed not to eat or drink anything for up to 2 hours just before the appointment.

Results

On pairwise evaluation, all the differences were found to be significant statistically except between baseline vs 30 minutes. Maximum mean difference was calculated and observed between baseline and immediately after intake of fruit juice and immediate after 30 minutes, 0.953 and 0.963 respectively, while minimum difference was calculated and observed between baseline and 30 minutes after intake of fruit juice (0.010).

Conclusion

Maximum drop was seen in cold drink when compared with fruit juice. The maximum pH increase was observed in cream biscuits with 7.63 ± 0.20. It was observed that in all the groups, the pH gradually got back to near normal levels due to the buffering mechanism of saliva.How to cite this article: Pachori A, Kambalimath H, Maran S, Niranjan B, Bhambhani G, Malhotra G. Evaluation of Changes in Salivary pH after Intake of Different Eatables and Beverages in Children at Different Time Intervals. Int J Clin Pediatr Dent 2018;11(3):177-182.

Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India

Introduction

Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children. Obesity and oral health are associated as both share some common risk factors.

Aim

The specific aim of the study was to determine the correlation, if there is any, between obesity and oral health in children.

Materials and methods

A cross-sectional survey was conducted in five districts of West Bengal, India. A total of 1,227 school-going children of 6 to 12 years were examined from the districts of Howrah, Hooghly, West Midnapore, South 24-parganas, and North 24-parganas. Following indices were analyzed: Decayed-missing-filled teeth (DMFT), decayed, extracted, filled teeth (deft), simplified oral hygiene index (OHI-S). Depending on their nutritional status, subjects were categorized as being normal weight, overweight, and obese. Logistic regression analysis were applied to the study to find out the association between the above-mentioned dental indices and independent variables: Gender and nutritional status.

Result

A positive association was found between obesity and oral health status in children.

Conclusion

Considering the results of this study, it was concluded that obesity is related to oral hygiene status of children. In order to improve oral hygiene status in children, dietary modifications need to be done.

How to cite this article: Halder S, Kaul R, Angrish P, Saha S, Bhattacharya B, Mitra M. Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India. Int J Clin Pediatr Dent 2018;11(3):233-237.

Pediatric Dental Appointments No-show: Rates and Reasons

Aim

To determine the frequency and reasons of missed and canceled pediatric dental appointments and identifying the factors associated with it among the patients visiting the pediatric dental clinic of the dental college in Navi Mumbai, Maharashtra, India. To assess the parents' perception regarding the treatment of their children and to explore the merit of different management strategies regarding the missed appointments.

Materials and methods

Self-administered questionnaires were handed over to the parents in the waiting area, whose children were undergoing treatment in the pediatric dental clinic. Questionnaire included questions pertaining to the sociodemo-graphic characteristics, methods of remembering appointments, and satisfaction with the overall past clinic experience.

Results

Of the 294 surveyed sample, 52.0% stated that they have missed an appointment. Highest percentage of the patients had missed due to parents' forgetfulness and patient's exams; 52.0% relied on their memory to remember their appointments, and 44.5% used their diaries and mobiles as a means of reminders. For canceling an appointment, most of them stated that patient was unwell and parents' commitments toward other work led to an increase in rates of no-shows. Socioeconomic status and the methods of remembering the appointment date were found to be significantly correlated with missing an appointment among the surveyed sample (p < 0.05); 48.3% said that they would want a call from the dentist a day prior to their appointment as a reminder.

Conclusion

Around one half of the patients attending the pediatric dental clinic missed their appointments. Patients most likely to fail to keep an appointment was the one who was young, remembered appointment via memory, came from a high socioeconomic class, most of them were males, and had previously broken appointments, while patients preferred receiving a call from the dentist as a reminder aide.

Clinical significance

Missing appointment creates a series of problems. Firstly, it deprives another patient the opportunity of getting treated. Secondly, it contributes to the development of long waiting list for dental services. Thirdly, it affects the patient's treatment time and may cause increase in the dental emergencies leading to a disruption in the doctor-patient relationship and behavioral management problems.How to cite this article: Bhatia R, Vora EC, Panda A. Pediatric Dental Appointments No-show: Rates and Reasons. Int J Clin Pediatr Dent 2018;11(3):171-176.

"Mind" in Betel-quid Use and Related Disorders

Oral squamous cell carcinoma is characterized by a unique predisposing state called oral potentially malignant disorders (OPMDs). Wide variety of carcinogenic insult in the form of detrimental habits can contribute to the causation of variety of OPMDs.1,2.

Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study

Aim

To study the prevalence of orofacial manifestations in leukemic children undergoing treatment and to correlate these manifestations with various stages of chemotherapy.

Materials and methods

A prospective noninvasive study comprising 43 acute lymphocytic leukemic pediatric patients at various stages of therapy. They were examined on day of their each blood examination, and lesions were recorded on a self-designed pro forma. A total of 133 observations were recorded by a single observer. The treatment was divided into the phase of induction, consolidation, maintenance, and relapse.

Results

The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 10.1. There were 24 males and 19 females in this study, aged between 3 and 13 years. The common oral lesions seen were dental caries, lymphadenopathy (86.04%), pallor (65.11%), ulcers (13.95%), mucositis (16.27%), gingival enlargement, hemorrhages (20.93%), candidiasis, herpes simplex virus (HSV) infection, xerostomia (44.18%), paresthesia, and tooth mobility. Herpes simplex virus infection was seen only during induction and consolidation phases. Ulcers were seen during all phases of therapy.

Clinical significance

Orofacial manifestations may be seen as the first sign of leukemia and a dentist may play a significant role in the diagnosis of the disease per se. This study highlights not only about commonly occurring lesions but also their variation during various phases of therapy. To the best of our knowledge, no study has such an extensive reporting of orofacial manifestations of acute lymphocytic leukemia (ALL) patients under treatment.

How to cite this article: Aggarwal A, Pai KM. Orofacial Manifestations of Leukemic Children on Treatment: A Descriptive Study. Int J Clin Pediatr Dent 2018;11(3):193-198.

Nonsyndromic Gingival Fibromatosis: A Rare Case Report

Hereditary gingival fibromatosis (HGF) is an uncommon gingival disease of attached gingiva, which is manifested as localized or generalized form. The HGF inheritance is transmitted through both autosomal dominant and recessive modes. Here, we are discussing a rare case report of an 8-year-old child with gingival fibromatosis in mixed dentition, which caused damage to his speech, mastication, and esthetics and led to significant change in his facial profile.

The patient noticed that the gingival enlargement was simultaneous with deciduous dentition eruption and gradually covered entire dentition. Gingival enlargement covered all teeth anteriorly and posteriorly and only occlusal surfaces were visible. The enlarged tissue was resected by the external bevel gingivectomy under general anesthesia arch wise.

The postoperative healing was satisfactory, uneventful, and there was significant change in patient’s esthetics. Patient has been kept on regular recall visits.

How to cite this article: Gandhi M, Tandon S, Sharma M, Vijay A. Nonsyndromic Gingival Fibromatosis: A Rare Case Report. Int J Clin Pediatr Dent 2018;11(3):250-253.

Comparative Evaluation of Microhardness by Common Drinks on Esthetic Restorative Materials and Enamel: An in vitro Study

Aim

This study was aimed to evaluate effects of various beverages on microhardness of esthetic restorative materials.

Materials and methods

A total of 160 disk-like specimens were prepared with 40 specimens each using nanocomposite resin, nano-ionomer, compomer, and conventional composite resin as experimental groups. Forty primary teeth were prepared and mounted in acrylic to be used as control group. Microhardness of the restorative materials was measured using Vickers microhardness tester at baseline and after immersion in various beverages. The difference between the two readings was evaluated within different groups.

Results

In general, low pH beverages adversely affected the properties of the tested materials. Microhardness of tested materials was significantly decreased after immersion in various beverages with the exception of Yakult. After the immersion period, the enamel showed the maximum loss in microhardness followed by nano-ionomer.

Conclusion

Low pH beverages were the most aggressive media for enamel, nano-ionomer and compomer, but in contrast, composite resin was relatively less affected. Probiotic drink appeared relatively benign toward the tested materials.

How to cite this article: Gupta R, Madan M, Dua P, Saini S, Mangla R, Kainthla T, Dupper A. Comparative Evaluation of Microhardness by Common Drinks on Esthetic Restorative Materials and Enamel: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):155-160.