Neurobehavior in fetal life

Behavioral-state development and sleep-state differentiation during early ontogenesis

Sleep is a key process in neurodevelopment and essential for the maturation of fundamental brain functions. Premature birth can disturb the initial steps of sleep maturation, which may contribute to the impairment of neurodevelopment. It is thus fundamental to understand the maturation of the various sleep states and the quality of cerebral function in each vigilance state, as well as the development of sleep cyclicity, in at-risk neonatal infants, particularly those born premature. The objective of this review is to provide a precise description of sleep states and cycles and their rhythmic organization in premature and term newborns according to their gestational age. Technical aspects of polysomnography, which requires a high level of expertise in neonates, are also described. Principles of the visual interpretation of polysomnography, including the simultaneous analysis of behavioral (spontaneous motricity and eye movements), polysomnographic parameters (electro-oculogram, electrocardiogram, respiration), and electroencephalography patterns are presented. The neurophysiology of sleep ontogenesis and its interaction with brain maturation are discussed, highlighting the crucial role of sleep states and their duration in premature newborns. In particular, the involvement of myoclonic twitches in functional connectivity in sensorimotor development is discussed. Indeed, sleep quality, determined by combined polysomnographic parameters, reflects either normal or pathological developmental processes during the neonatal period. The fundamental place of neurophysiological explorations in the early detection of sleep disorders is discussed, as well as their potential consequences on neurodevelopmental care to improve the prevention of neurodevelopmental impairment.

Association of differential symptoms of stress to hair cortisol and cortisone concentrations among pregnant women in Kenya

Objectives: The purpose of this study was to characterize the stress experienced by pregnant women in Kenya and assess the relationship between perceived stress and stress-related biomarkers of cortisol and cortisone.Background: Kenyan women are exposed to multiple stressors that may result in chronic stress. However, antenatal stress has not been examined and characterized in Kenya; nor has the relationship between pregnant women's self-reported stress and stress biomarkers been established.Methods: One hundred and fifty women were recruited between 22 and 28 weeks gestation. Participants completed the Perceived Stress Scale (PSS) and a sociodemographic questionnaire. Hair samples were obtained for analysis of cortisol and cortisone. Factor analysis was used to extract unique clusters of stress symptoms from items in the PSS. Regression models were computed to examine relationships of stress to cortisone and cortisol, controlling for obstetric risk.Results: Mean age of the women was 25 years (SD = 5, ±16-41). Their degree of perceived stress and cortisol/cortisone concentrations both indicated moderate levels of stress. There was no association between general perceived stress and either hair cortisol or cortisone. However, factor analysis of the PSS identified three clusters of stress symptoms and one cluster - a woman's negative frame of mind regarding life and inefficacy in handling its problems - was associated with higher levels of cortisone (β= -.231, p = 0.011).Conclusions: Specific stress symptoms may have unique relationships to specific biomarkers and be more useful in assessment than general perceived stress. Assays of both hair cortisol and cortisone might enable a more comprehensive assessment of glucocorticoid activity and better prediction of health risks from stress.Lay summaryUnderstanding stress among rural pregnant Kenyan women may help in addressing risks during pregnancy that lead to adverse birth outcomes. Findings suggest that a woman's tendency to think negatively about life and to doubt her ability to handle life's problems are symptoms of stress that may contribute to higher levels of stress hormones. Assessing women's specific symptoms of stress and different stress hormones during pregnancy may more effectively identify women who need intervention to reduce their health risk.

A video polysomnographic study of spontaneous smiling during sleep in newborns

The objective of the present study was to confirm the link between spontaneous smiling and active sleep in newborns, and to identify the role of the cortex in the generation of spontaneous smiles. A total of 12 healthy newborns born at term and three infants with major congenital abnormalities (two with hydranencephaly and one with a left hemispherectomy) were evaluated by video and polysomnography during a 3-hr sleep period. Smiles were graded and their association with isolated rapid eye movements and grouped rapid eye movements was analysed. In all, 383 smiles were recorded of which 377 occurred during active sleep. Smiles were shown to be significantly associated with active sleep (p < .0001) and with grouped rapid eye movements (p < .0001). Bilateral smiles were more frequent than asymmetrical smiles. Among asymmetrical smiles, left-sided smiles were more frequent than right-sided smiles (p < .0001). Maternal stimulation during active sleep did not increase smiles. Smiling was absent during active sleep only in the infant with total hydranencephaly in whom nearly all cortical tissue was absent. In conclusion, smiling occurs in healthy newborns, almost exclusively in active sleep and is associated with grouped rapid eye movements. In infants with major congenital abnormalities, smiling is abolished only when nearly all of the cerebral cortex is absent. These results support the hypothesis of the role of active sleep in the stimulation of neuronal circuits responsible for spontaneous smiling and emphasise the importance of cortical areas in newborn smiling.

Multi-center results on the clinical use of KANET

An extensive review of the literature on the diagnostic and clinical accuracy of Kurjak's antenatal neurodevelopmental test (KANET) and the summarized results of the multi-center study involving 10 centers revealed that four-dimensional ultrasonography (4D US) has become a powerful tool and KANET a valuable test that empowers the clinicians worldwide to evaluate the fetal behavior in a systematic way and contribute to the detection of fetuses that might be at high risk for neurological impairments and in particular cerebral palsy (CP). After 10 years of clinical use, many published papers and multi-center studies, hundreds of trained physicians and numerous tests performed all over the world, KANET has proven its value and has been showing encouraging results so far. The aim of this paper is to show the results from the studies done so far and to reveal the clinical value of the KANET. We expect that data from the larger ongoing collaborative study, the short- and long-term postnatal follow-up will continue to improve our knowledge. Ultimately, we all strive to prevent the CP disorders, autism spectrum disorder (ASD) and other neurological impairments and we are convinced that KANET might be helpful in the realization of this important aim.

Correlation between human nervous system development and acquisition of fetal skills: An overview

Understanding the association between fetal nervous system structure and functioning should be an important goal in neurodevelopmental sciences, especially when considering the emerging knowledge regarding the importance of prenatal onset. Intrauterine development of the human central nervous system consists of specific processes: neurogenesis, neuronal migration, synaptogenesis, and myelination. However, as extensively shown by the neurobehavioral studies in the last century, the development of the central nervous system involves both structure and functioning. It is now recognised that the developing motor and sensory systems are able to function long before they have completed their neural maturation and that the intrauterine experience contributes to neurobehavioral development. This review analyzes the recent literature, looking at the association between the human nervous system maturation and fetal behavior. This article will follow the development and skill acquisition of the anatomical nervous system across the three trimesters of the gestation period.

Clinical study of fetal neurobehavior by the KANET test

Fetal neurology is evolving as an area of great interest in prenatal diagnosis and fetal medicine. The identification and diagnosis of brain damage prenatally has been a great challenge in obstetrics for many years. Investigations of fetal behavior in comparison with morphological studies led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of the fetal central nervous system (CNS). Four-dimensional (4D) ultrasound has greatly improved the assessment of the quality of the fetal spontaneous movements, and enabled a better evaluation of fetal behavior. The assessment of normal neurobehavioral development by 4D ultrasound provided the opportunity to investigate functional characteristics of the fetus that could predict neurological developmental dysfunction. Some studies have already been carried out to evaluate this new methodology in the observation of fetal behavior during different stages of gestation, in an attempt to better understand the relationships between the maturation of the CNS of the fetus and its implications on its behavior pattern. We present a review of literature on fetal behavior by 4D ultrasound.

Antenatal ultrasound value in risk calculation for Autism Spectrum Disorder: A systematic review to support future research

There is a growing research interest on the antenatal features of children with neurodevelopmental disorders. Indeed, it has been proved that the neurodevelopment is, at least partly, affected by processes occurring in fetal life and that the early neurodevelopmental disorders identification is essential to optimize long-term outcomes. This systematic review aims to summarize findings on antenatal ultrasound data, which are or might be considered early risk indexes of postnatal social impairments. We conducted systematic searches in Pubmed and PsychINFO databases to identify studies including fetal ultrasound measurements and postnatal neurodevelopmental outcome assessment. The bibliographic search included 3203 articles but after the assessment of the eligibility conducted by two independent researchers, only 26 studies were selected. Some alterations in ultrasound antenatal measurements (such as biophysical data, nuchal thickness and enlargement of cerebral ventricles) have been associated to autism spectrum disorder. However, data are still limited, controversial and not specific. Reported data are here discussed to strongly support studies on fetuses at high risk for autism spectrum disorder.

In vitro Evaluation of Stainless Steel Crowns cemented with Resin-modified Glass Ionomer and Two New Self-adhesive Resin Cements

AIMS

To assess and compare the retentive strength of two dual-polymerized self-adhesive resin cements (RelyX U200, 3M ESPE & SmartCem2, Dentsply Caulk) and a resin-modified glass ionomer cement (RMGIC; RelyX Luting 2, 3M ESPE) on stainless steel crown (SSC).

MATERIALS AND METHODS

Thirty extracted teeth were mounted on cold cured acrylic resin blocks exposing the crown till the cemento-enamel junction. Pretrimmed, precontoured SSC was selected for a particular tooth. Standardized tooth preparation for SSC was performed by single operator. The crowns were then luted with either RelyX U200 or SmartCem2 or RelyX Luting 2 cement. Retentive strength was tested using Instron universal testing machine. The retentive strength values were recorded and calculated by the formula: Load/Area.

STATISTICAL ANALYSIS

One-way analysis of variance was used for multiple comparisons followed by post hoc Tukey's test for groupwise comparisons. Unpaired t-test was used for intergroup comparisons.

RESULTS

RelyX U200 showed significantly higher retentive strength than rest of the two cements (p < 0.001). No significant difference was found between the retentive strength of SmartCem2 and RelyX Luting 2 (p > 0.05).

CONCLUSION

The retentive strength of dual-polymerized self-adhesive resin cements was better than RMGIC, and RelyX U200 significantly improved crown retention when compared with SmartCem2 and RelyX Luting 2.

HOW TO CITE THIS ARTICLE

Pathak S, Shashibhushan KK, Poornima P, Reddy VVS. In vitro Evaluation of Stainless Steel Crowns cemented with Resin-modified Glass Ionomer and Two New Self-adhesive Resin Cements. Int J Clin Pediatr Dent 2016;9(3):197-200.

Autotransplantation of a Strange Positioned Impacted Central Incisor in a surgically Prepared Socket: A Miracle Esthetic Concept

Esthetics is a prime concern for a young lady. Any anomaly in the anterior tooth may create anxiety and depression. This anxiety and depression may hamper her married life and overall personality. This case report reveals an unerupted right central incisor situated in a strange position, creating space in the maxillary anterior region and giving an unesthetic appearance. Autotransplantation is a method of choice for a strangely positioned impacted central incisor in a new appropriate site. This method offers a new treatment option for some clinical situations if orthodontic approach is not possible. It permits tooth movement to a distant or the opposite side of the same dental arch as well as to the opposite jaw. This procedure also offers potential benefits of reestablishment of normal alveolar process development, esthetics, functions, and arch integrity. This procedure has the potential to become a viable alternative treatment plan for young patients of low socioeconomic status, allowing the reestablish-ment and restoration of a missing tooth and their functions. This article discusses methods of auto-reimplantation of a tooth in a fresh surgically prepared socket, its biological principle, and establishment of functions, esthetics, and phonetics.

SCN8A Epileptic Encephalopathy: Detection of Fetal Seizures Guides Multidisciplinary Approach to Diagnosis and Treatment

BACKGROUND

SCN8A mutations are rare and cause a phenotypically heterogeneous early onset epilepsy known as early infantile epileptic encephalopathy type 13 (EIEE13, OMIM #614558). There are currently no clear genotype-phenotype correlations to help guide patient counseling and management.

PATIENT DESCRIPTION

We describe a patient with EIEE13 (de novo heterozygous pathogenic mutation in SCN8A - p.Ile240Val (ATT>GTT)) who presented prenatally with maternally reported intermittent, rhythmic movements that, when observed on ultrasound, were concerning for fetal seizures. Ultrasound also revealed abnormal developmental states. With maternal administration of levetiracetam, the rhythmic fetal movements stopped. After birth, the patient developed treatment-refractory multi-focal epilepsy confirmed by electroencephalogram. Neuroimaging revealed restricted diffusion in the superior cerebellar peduncles, a finding not reported previously in EIEE13.

CONCLUSION

This is the first report of EIEE13 associated with clinical prenatal-onset seizures. Ultrasonography can be useful for identifying fetal seizures, which may be treatable in utero. Ideally, the clinical approach to fetal seizures should involve a multidisciplinary team spanning the pre- and postnatal course to expedite early diagnosis and optimize management, as illustrated by this patient.

A Comparative Analysis of Different Finishing and Polishing Devices on Nanofilled, Microfilled, and Hybrid Composite: A Scanning Electron Microscopy and Profilometric Study

The continuous development of esthetically acceptable adhesive restorative material has made a variety of tooth-colored materials available for clinical use. The advent of visible light polymerizing resin and the use of finer filler particles permit resin composites to be polished to higher degree. The effect of polishing systems on surface finish has been reported to be material-dependent, and the effectiveness of these systems was mostly product-dependent. Hence, the purpose of this study was to evaluate the efficiency of finishing and polishing systems on the surface roughness of nanofilled, microfilled, and hybrid composite restorative materials available in the market.

HOW TO CITE THIS ARTICLE

Yadav RD, Raisingani D, Jindal D, Mathur R. A Comparative Analysis of Different Finishing and Polishing Devices on Nanofilled, Microfilled, and Hybrid Composite: A Scanning Electron Microscopy and Profilometric Study. Int J Clin Pediatr Dent 2016;9(3):201-208.

Comparative Evaluation of Shear Bond Strength of Various Glass Ionomer Cements to Dentin of Primary Teeth: An in vitro Study

Aim

To evaluate and compare shear bond strength of various glass ionomer cements (GICs) to dentin of primary teeth.

Materials and methods

Sample size taken for the study was 72 deciduous molars with intact buccal or lingual surfaces. Samples were randomly divided into three groups, i.e., groups A, B, and C and were restored with conventional type II GIC, type II light cure (LC) GIC, and type IX GIC respectively. Thermocycling was done to simulate oral conditions. After 24 hours, shear bond strength was determined using Instron Universal testing Machine at crosshead speed of 0.5 mm/ minute until fracture. Results were tabulated and statistically analyzed.

Results

It was found that the shear bond strength was highest in group B (LC GIC) 9.851 ± 1.620 MPa, followed by group C (type IX GIC) 7.226 ± 0.877 MPa, and was lowest in group A (conventional GIC) 4.931 ± 0.9735 MPa.

Conclusion

Light cure GIC was significantly better than type IX GIC and conventional GIC in terms of shear bond strength.

How to cite this article

Somani R, Jaidka S, Singh DJ, Sibal GK. Comparative Evaluation of Shear Bond Strength of Various Glass Ionomer Cements to Dentin of Primary Teeth: An in vitro Study. Int J Clin Pediatr Dent 2016;9(3):192-196.

A Comparative Evaluation of the Efficacy of Different Caries Excavation Techniques in reducing the Cariogenic Flora: An in vivo Study

Background

Caries excavation is a noninvasive technique of caries removal with maximum preservation of healthy tooth structure.

Aim

To compare the efficacy of three different caries excavation techniques in reducing the count of cariogenic flora.

Materials and methods

Sixty healthy primary molars were selected from 26 healthy children with occlusal carious lesions without pulpal involvement and divided into three groups in which caries excavation was done with the help of (1) carbide bur; (2) polymer bur using slow-speed handpiece; and (3) ultrasonic tip with ultrasonic machine. Samples were collected before and after caries excavation for microbiological analysis with the help of sterile sharp spoon excavator. Samples were inoculated on blood agar plate and incubated at 37°C for 48 hours. After bacterial cultivation, the bacterial count of Streptococcus mutans was obtained.

Statistical analysis

All statistical analysis was performed using SPSS 13 statistical software version. Kruskal-Wallis analysis of variance, Wilcoxon matched pairs test, and Z test were performed to reveal the statistical significance.

Results

The decrease in bacterial count of S. mutans before and after caries excavation was significant (p < 0.001) in all the three groups.

Conclusion

Carbide bur showed most efficient reduction in cariogenic flora, while ultrasonic tip showed almost comparable results, while polymer bur showed least reduction in cariogenic flora after caries excavation.

How to cite this article

Hassan AF, Yadav G, Tripathi AM, Mehrotra M, Saha S, Garg N. A Comparative Evaluation of the Efficacy of Different Caries Excavation Techniques in reducing the Cariogenic Flora: An in vivo Study. Int J Clin Pediatr Dent 2016;9(3):214-217.

Evaluation of Role of Myofibroblasts in Oral Cancer: A Systematic Review

Aim

To conduct a systematic review on the role of myofibroblasts in progression of oral cancer. The myofibroblast is essential for the integrity of the mammalian body by virtue of its role in wound healing, but it also plays a negative role due to their role in promoting tumor development.

Settings and design

Systematic review.

Materials and methods

Bibliographic searches were conducted in several electronic databases using all publications in PubMed, PubMed central, EMBASE, CancerLit, Google scholar, and Cochrane CCTR between 1990 and June 2015.

Results

The search of all publications from various electronic databases revealed 1,371 citations. The total number of studies considered for systematic review was 43. The total number of patients included in the studies was 990.

Conclusion

Myofibroblasts are a significant component in stroma of oral cancer cases, though not identified in all cases. This systematic review shows that clinical, pathological, and immunohistochemistry tests have correlated the presence of high myofibroblast count in oral cancer cell stroma.

Key Messages

Myofibroblasts play a significant role in oral cancer invasion and progression. Various studies have demonstrated their association with oral cancer. This review tends to highlight their role in the pathogenesis of oral cancer over the decade.

How to cite this article

Sekhon HK, Sircar K, Kaur G, Marwah M. Evaluation of Role of Myofibroblasts in Oral Cancer: A Systematic Review. Int J Clin Pediatr Dent 2016;9(3):233-239.

Mandibular Dentigerous Cyst in a 10-Year-Old Child

Dentigerous cyst is the most common odontogenic cyst. It is characterized by a unilocular radiolucent lesion that encloses permanent tooth buds or, under certain circumstances, displaced tooth buds. Buccal bony expansion and a missing tooth is the most common clinical feature. Various treatment modalities have been mentioned in the literature for management of dentigerous cysts. This article presents a left mandibular dentigerous cyst in a 10-year-old boy. Marsupialization was the treatment of choice and a denturelike space maintainer was provided. Long-term follow-up revealed good healing of the bony lesion.

Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study

Introduction

Vital pulp therapy is a major contributor in the preservation of primary dentition after caries affliction. Introduction of mineral trioxide aggregate (MTA) has revolutionized such treatment.

Aim

The aim of our study was to evaluate and correlate the effects of MTA clinically and radiographically on pulpotomized primary molars till their exfoliation or extraction followed by histological evaluation.

Study design

This is an observational study.

Materials and methods

A total of 25 teeth were selected from 5- to 8-year-old children requiring pulp therapy on the basis of inclusion and exclusion criterion. The teeth were treated by conventional pulpotomy technique under aseptic conditions using MTA and were immediately restored with stainless steel crown. The teeth were assessed postoperatively till 36 months. The exfoliated or extracted teeth were examined histologically.

Results

The pulpotomized teeth were vital with no adverse clinical findings during the observation period. After 3 months, one tooth showed internal resorption, but the same was not observed after 12 months. Pulp canal obliteration was seen in three cases. At the end of the study, five teeth were exfoliated and one tooth was extracted for maintaining arch symmetry. The histological examination of extracted tooth revealed the presence of healthy pulp and the area of true calcification. Remaining exfoliated teeth presented dentin bridge formation.

Statistics

Frequencies and percentages were used for descriptive statistics. Fisher’s exact tests were used to see the difference between clinical and radiological findings. The probability value was fixed at 5% level of significance.

Conclusion

The response of pulp in primary teeth to MTA was favorable in all cases from clinical and radiographic perspective, and histological evaluation confirmed the observation.

How to cite this article

Godhi B, Tyagi R. Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study. Int J Clin Pediatr Dent 2016;9(3):222-227.

Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices

Introduction

Dentifrices are available in different formulations and more commonly a single dentifrice is used by whole family; be it an adult or child. However, concerns over high fluoride in pediatric formulations coupled with inability of the children to spit have led to recommendations to minimize fluoride ingestion during toothbrushing by using a small amount of toothpaste by children and incorporating minimal quantity of fluoride in the toothpastes. Literature is scarce on the remineralization potential of popularly known Indian pediatric dentifrices; hence, pediatric dentifrices containing lesser concentration of fluoride have been marketed relatively recently for the benefit of children without posing a threat of chronic fluoride toxicity at the same time.

Aim and objectives

The present study was undertaken to evaluate and compare the remineralization potential of three commercially available Indian pediatric dentifrices with different compositions on artificially induced carious lesions in vitro through scanning electron microscopy (SEM).

Materials and methods

The present in vitro study was conducted on 45 sound extracted primary molar surfaces divided into three groups (15 each). Artificial demineralization was carried out, followed by remineralization using dentifrice slurry as per the group allocation. All the samples were studied for remineralization using SEM and the results statistically compared.

Results

All three dentifrices tested showed remineralization; although insignificantly different from each other but significantly higher compared to the demineralizing surface.

Conclusion

One can use pediatric dentifrices for preventing dental caries and decelerating lesion progression with an added advantage of lower fluoride toxicity risk.

How to cite this article

Kapoor A, Indushekar KR, Saraf BG, Sheoran N, Sardana D. Comparative Evaluation of Remineralizing Potential of Three Pediatric Dentifrices. Int J Clin Pediatr Dent 2016;9(3):186-191.

Evaluation and Comparison of the Antibacterial Activity against Streptococcus mutans of Grape Seed Extract at Different Concentrations with Chlorhexidine Gluconate: An in vitro Study

INTRODUCTION

Streptococcus mutans has been implicated as primary microorganisms which cause dental caries in humans. There has been an increased interest in the therapeutic properties of some medicinal plants and natural compounds which have demonstrated antibacterial activities. Grape is one of the plants of this group which contains tannin and polyphenolic compound.

AIM

To evaluate and compare antibacterial activity of grape seed extract at different concentrations with chlorhexidine gluconate against S. mutans.

MATERIALS AND METHODS

Grape seeds were extracted with ethanol/water ratio of 70:30 volume/volume. The extracts were filtered through Whatman No. 1 filter paper until it becomes colorless. Streptococcus mutans strains were taken. To check the antimicrobial properties of grape seed extract at different concentration and chlorhexidine gluconate, they were added to S. mutans strain and incubated for 48 hours than colony-forming units/mL were checked.

RESULTS

Grape seed extract at higher concentration were found to be more potent against S. mutans. Chlorhexidine gluconate was found to have most potent antibacterial action compared to all different concentrations of grape seed extract.

CONCLUSION

Grape seed extract as a natural antimicrobial compound has inhibitory effect against S. mutans.

HOW TO CITE THIS ARTICLE

Swadas M, Dave B, Vyas SM, Shah N. Evaluation and Comparison of the Antibacterial Activity against Streptococcus mutans of Grape Seed Extract at Different Concentrations with Chlorhexidine Gluconate: An in vitro Study. Int J Clin Pediatr Dent 2016;9(3):181-185.

Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review

Objective

The objective of this systematic review is to analyze the various treatment modalities and sequelae of intruded anterior primary teeth.

Materials and methods

Electronic search in PubMed, Cochrane, and Science Direct databases was done. Hand search was performed using the reference list of chosen articles from electronic search. Three reviewers analyzed the articles independently, assessed the quality of the studies, and derived data.

Results

Ten case series were identified from the electronic and hand search. No randomized control studies were available. In the observational studies treatment of intruded primary teeth ranged from conservative management, which includes waiting for spontaneous re-eruption as well as repositioning to invasive procedure, such as extraction.

Conclusion

Spontaneous eruption is a treatment option of intruded primary teeth in absence of damage to a permanent tooth. Surgical repositioning of intruded primary teeth has also shown as a viable alternative treatment modality. Extraction to be performed if complications develop.

How to cite this article

Gurunathan D, Murugan M, Somasundaram S. Management and Sequelae of Intruded Anterior Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2016;9(3):240-250.

Prevalence of Early Childhood Caries in Children of West Godavari District, Andhra Pradesh, South India: An Epidemiological Study

Aim

To determine the prevalence of early childhood caries (ECC) and its risk factors in children of West Godavari district, Andhra Pradesh.

Study design

A sample of 1,897 children between 24 and 71 months of age based on stratified cluster random sampling were clinically examined for dental caries using mouth mirror under day light. The parents/caregivers of each child were interviewed with a structured questionnaire. Data was analyzed using independent sample Student’s t-test and chi-square test.

Results

Out of the total 1,897 children, 796 were affected with ECC showing an overall prevalence of 41.9%, with boys showing a higher prevalence rate of 44.8% compared to girls (39.9%). Statistically significant correlations were found between ECC and consumption of sugary snacks (p < 0.0001) and mouth rinsing habit (p < 0.001).

Conclusion

A higher prevalence of ECC was observed and most of the teeth were not restored.

How to cite this article

Koya S, Ravichandra KS, Arunkumar VA, Sahana S, Pushpalatha HM. Prevalence of Early Childhood Caries in Children of West Godavari District, Andhra Pradesh, South India: An Epidemiological Study. Int J Clin Pediatr Dent 2016;9(3):251-255.

Sealing Ability of Nano-ionomer in Primary Teeth: Anex vivoStudy

Introduction

Microleakage is an important consideration in primary dentition because the floor of the cavity preparation may be close to the pulp. The added insult to the pulp caused by seepage of irritants around the restoration and through the thin dentin may produce irreversible pulp damage.

Aim

The objective of this study was to evaluate and compare the sealing ability of three light cured (LC) resin-modified glass-ionomer cements (RMGICs) in primary anterior teeth.

Materials and methods

Class V cavity was prepared on the labial surface of extracted primary anterior teeth which were then grouped and restored with Ketac N100, Fuji II LC, or Vitremer. Dye penetration test with methylene blue stain was used to record the microleakage. Depth of dye penetration was recorded in millimeters at the incisal and gingival margin using computer software.

Results

The depth of dye penetration at the incisal margin in the three groups was comparable, but at the gingival margin, Vitremer showed the least dye penetration, followed by Fuji II LC, and Ketac N100. The depth of dye penetration at the gingival margin was higher than the incisal margins in all the three groups.

Conclusion

Among the three RMGICs, Vitremer can be considered as the material of choice for restoring class V cavities in primary anterior teeth. Periodic recall and recare is necessary when any of the three materials are used in clinical practice.

How to cite this article

Siddiqui F, Karkare S. Sealing Ability of Nano-ionomer in Primary Teeth: An ex vivo Study. Int J Clin Pediatr Dent 2016;9(3):209-213.

Acidogenic Potential of Plain Milk, Milk with Sugar, Milk with Cornflakes and Milk Cornflakes with Sugar: A Comparative Study

Aim

To compare the acidogenic potential of plain milk, milk with sugar, milk with cornflakes, and milk cornflakes with sugar by assessing the salivary pH.

Materials and methods

The study was carried out on 40 school children of 8 to 12 years; 20 boys and 20 girls were randomly selected. The salivary pH was assessed before and after the consumption of milk; milk and sugar; milk and cornflakes; and milk, sugar, and cornflakes. Baseline unstimulated saliva was collected in sterile plastic tube and the pH was recorded. The change in the salivary pH from the respective groups after consuming the test meal was recorded as follows: (1) after 5 minutes; (2) after 10 minutes; (3) after 15 minutes; (4) after 30 minutes; (5) 120 minutes. Statistical analysis was done using Statistical Package for the Social Sciences 18.0 (SPSS).

Results

The average baseline salivary pH among all the groups was 7.26. A fall in pH at 5 minutes was seen in all the four groups. However, at different time intervals 5, 10, 15, 30, and 120 minutes, the pH values between the groups showed a significant difference at p < 00.7, 0.005, 0.001, 0.010, and 0.028 respectively.

Conclusion

The fall in pH in all the groups was not significant to a limit of critical pH. Milk when added with sugar and/or cornflakes as a meal did not pose a threat as there was not significant decrease in pH.

How to cite this article

Bhat SS, Hegde SK, Bhat VS, Ramya KM, Jodalli PS. Acidogenic Potential of Plain Milk, Milk with Sugar, Milk with Cornflakes, and Milk Cornflakes with Sugar: A Comparative Study. Int J Clin Pediatr Dent 2016;9(3):218-221.

Gorlin-Goltz Syndrome: A Rare Case Report of a 11-Year-Old Child

Gorlin-Goltz Syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is an autosomal dominant trait caused due to mutations in the patched tumor suppressor gene (PTCH) gene found on the long arm of chromosome 9. The syndrome is characterized by the presence of odontogenic keratocysts (OKCs), basal cell carcinomas, and skeletal malformations. Early diagnosis of the syndrome can be done by pedodontist as OKC is one of the early manifestations of the syndrome. Early diagnosis and treatment is important for long-term prognosis of the syndrome by reducing the severity of cutaneous carcinomas and deformities due to jaw cyst. The present case describes an 11-year-old patient with some typical features of NBCCS, which were diagnosed through its oral and maxillofacial manifestations. This case emphasizes the importance of pedodontist in early recognition of the syndrome.

HOW TO CITE THIS ARTICLE

Tandon S, Chauhan Y, Sharma M, Jain M. Gorlin-Goltz Syndrome: A Rare Case Report of a 11-Year-Old Child. Int J Clin Pediatr Dent 2016;9(3):264-268.

Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration

Ewing's sarcoma (ES) is an uncommon aggressive bone malignancy that mainly affects children and adolescents. Mandible involvement is quite rare and usually represents metastasis from another skeletal site. Combined therapy including wide surgical resection and preoperative and postoperative chemotherapy has been demonstrated as the mainstay of therapeutic approach. As improved therapeutic modalities have significantly increased survival over the last decades, functional and esthetic reconstruction of the postmandibulectomy defect is usually necessary for patient's total rehabilitation. We report a case of ES of the mandible with special consideration to the postresection spontaneous structural and functional regeneration of the mandible.

HOW TO CITE THIS ARTICLE

Chatzistefanou I, Kabesi S, Paraskevopoulos K, Koliouskas D, Antoniades K. Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration. Int J Clin Pediatr Dent 2016;9(3):273-277.

Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India

INTRODUCTION

An earlier epidemiological study by these authors revealed fluorosis at very low levels of fluoride concentrations in drinking water.

AIM

The objective of present study was to investigate risk factors of dental fluorosis in permanent teeth in the villages of northern Karnataka, India.

MATERIALS AND METHODS

The present survey was carried out in three villages of Hungund Taluk, Bagalkot District, Karnataka, India, with the fluoride concentration of 0.136, 0.381, and 1.36 ppm. Children aged between 9 and 15, with permanent teeth, were examined for dental fluorosis using Dean's index, as per WHO criteria. Required relevant information regarding risk factors was obtained through a questionnaire.

STATISTICAL ANALYSIS

Data entry and analysis were performed using SPSS for Windows 16.0. Comparison of means of different indices by the three groups was performed using ANOVA and t-test (p < 0.05). Bivariate analysis was performed to identify significant risk factors that affected prevalence and severity of dental fluorosis. Those variables showing a statistically significant association (p < 0.05) on χ2 were entered into multiple logistic regressions to assess their independent effects.

RESULTS

In this study, we analyzed risk factors for both prevalence and severity of fluorosis. From multiple logistic regression analysis, only fluoride concentration in drinking water was found significant with prevalence of fluorosis and only nutritional status showed significant association with severity of fluorosis.

CONCLUSION

Presence or absence of dental fluorosis in permanent teeth was significantly associated with fluoride concentration in drinking water. Once present, its severity was determined by nutritional status of the children - malnourished children exhibiting severe form of fluorosis.

HOW TO CITE THIS ARTICLE

Mahantesha T, Dixit UB, Nayakar RP, Ashwin D Ramagoni NK, Ellore VPK. Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India. Int J Clin Pediatr Dent 2016;9(3):256-263.

Goldenhar Syndrome: A Case Report with Review

Goldenhar syndrome is a rare condition which is characterized by a multitude of anomalies involving craniofacial structures, vertebrae, internal organs and usually occurs unilaterally. The etiology of this syndrome is unclear since it varies genetically and is linked to a plethora of reasons. Herein, we report a case of Goldenhar syndrome with hemifacial microsomia and microtia along with systemic involvement which was clinically and radio-graphically assessed. Many classical signs of the syndrome were present in the patient along with few rare ones. The various aspects of this rare disease have been discussed with emphasis on timely diagnosis and multidisciplinary approach to manage it.

HOW TO CITE THIS ARTICLE

Goswami M, Bhushan U, Jangra B. Goldenhar Syndrome: A Case Report with Review. Int J Clin Pediatr Dent 2016;9(3):278-280.

Primary Oral Health Care in India: Vision or Dream?

The contemporary approach to dental caries management in children focuses on prevention than treatment. Pediatricians, general dentists and pediatric dentists must be involved in a detailed preventive program, which includes prenatal counselling, treatment of expectant mothers at risk for dental caries, infant oral health care and the establishment of the dental home, so that dental disease can be prevented in infants, starting at a young age. Various health care system and organizations in India must join together to promote oral health care for all the children and specially focused toward children from disadvantaged background and children with special health care needs.

HOW TO CITE THIS ARTICLE

Suresh KS, Kumar P, Javanaiah N, Shantappa S, Srivastava P. Primary Oral Health Care in India: Vision or Dream? Int J Clin Pediatr Dent 2016;9(3):228-232.

Does ethnicity have an effect on fetal behavior? A comparison of Asian and Caucasian populations

AIM

This study aimed to evaluate the ethnic difference in fetal behavior between Asian and Caucasian populations.

METHODS

Fetal behavior was assesed by Kurjak's antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 28 and 38 weeks of gestation. Eighty-nine Japanese (representative of Asians) and seventy-eight Croatian (representative of Caucasians) pregnant women were studied. The total value of KANET score and values of each parameter (eight parameters) were compared.

RESULTS

The total KANET score was normal in both populations, but there was a significant difference in total KANET scores between Japanese (median, 14; range, 10-16) and Croatian fetuses (median, 12; range, 10-15) (P<0.0001). When individual KANET parameters were compared, we found significant differences in four fetal movements (isolated head anteflexion, isolated eye blinking, facial alteration or mouth opening, and isolated leg movement). No significant differences were noted in the four other parameters (cranial suture and head circumference, isolated hand movement or hand to face movements, fingers movements, and gestalt of general movements).

CONCLUSION

Our results suggest that ethnicity should be considered when evaluating fetal behavior, especially during assessment of fetal facial expressions. Although there was a difference in the total KANET score between Japanese and Croatian populations, all the scores in both groups were within normal range. Our results indicate that ethnical differences in fetal behaviour do not affect the total KANET score, but close follow-up should be continued in some borderline cases.

STUDIES IN FETAL BEHAVIOR: REVISITED, RENEWED, AND REIMAGINED

Among the earliest volumes of this monograph series was a report by Lester Sontag and colleagues, of the esteemed Fels Institute, on the heart rate of the human fetus as an expression of the developing nervous system. Here, some 75 years later, we commemorate this work and provide historical and contemporary context on knowledge regarding fetal development, as well as results from our own research. These are based on synchronized monitoring of maternal and fetal parameters assessed between 24 and 36 weeks gestation on 740 maternal-fetal pairs compiled from eight separate longitudinal studies, which commenced in the early 1990s. Data include maternal heart rate, respiratory sinus arrhythmia, and electrodrmal activity and fetal heartrate, motor activity, and their integration. Hierarchical linear modeling of developmental trajectories reveals that the fetus develops in predictable ways consistent with advancing parasympathetic regulation. Findings also include:within-fetus stability (i.e., preservation of rank ordering over time) for heart rate, motor, and coupling measures; a transitional period of decelerating development near 30 weeks gestation; sex differences in fetal heart rate measures but not in most fetal motor activity measures; modest correspondence in fetal neurodevelopment among siblings as compared to unrelated fetuses; and deviations from normative fetal development in fetuses affected by intrauterine growth restriction and other conditions. Maternal parameters also change during this period of gestation and there is evidence that fetal sex and individual variation in fetal neurobehavior influence maternal physio-logical processes and the local intrauterine context. Results are discussed within the framework of neuromaturation, the emergence of individual differences, and the bidirectional nature of the maternal-fetal relationship.We pose a number of open questions for future research. Although the human fetus remains just out of reach, new technologies portend an era of accelerated discovery of the earliest period of development

Fetal facial expression in response to intravaginal music emission

This study compared fetal response to musical stimuli applied intravaginally (intravaginal music [IVM]) with application via emitters placed on the mother’s abdomen (abdominal music [ABM]). Responses were quantified by recording facial movements identified on 3D/4D ultrasound. One hundred and six normal pregnancies between 14 and 39 weeks of gestation were randomized to 3D/4D ultrasound with: (a) ABM with standard headphones (flute monody at 98.6 dB); (b) IVM with a specially designed device emitting the same monody at 53.7 dB; or (c) intravaginal vibration (IVV; 125 Hz) at 68 dB with the same device. Facial movements were quantified at baseline, during stimulation, and for 5 minutes after stimulation was discontinued. In fetuses at a gestational age of >16 weeks, IVM-elicited mouthing (MT) and tongue expulsion (TE) in 86.7% and 46.6% of fetuses, respectively, with significant differences when compared with ABM and IVV (p = 0.002 and p = 0.004, respectively). There were no changes from baseline in ABM and IVV. TE occurred ≥5 times in 5 minutes in 13.3% with IVM. IVM was related with higher occurrence of MT (odds ratio = 10.980; 95% confidence interval = 3.105–47.546) and TE (odds ratio = 10.943; 95% confidence interval = 2.568–77.037). The frequency of TE with IVM increased significantly with gestational age (p = 0.024). Fetuses at 16–39 weeks of gestation respond to intravaginally emitted music with repetitive MT and TE movements not observed with ABM or IVV. Our findings suggest that neural pathways participating in the auditory–motor system are developed as early as gestational week 16. These findings might contribute to diagnostic methods for prenatal hearing screening, and research into fetal neurological stimulation.

Antenatal and Postnatal Assessment of Neurobehavior: Which One should be used?

It is obvious that this environment is quite different from one man is experiencing after birth, but, although different, intrauterine environment is ideal at that stage of human development. There is a question of the environmental discontinuity between intrauterine conditions characterized by existence of microgravity (baby astronaut hypothesis), and extrauterine life with gravity as developmental condition sine qua non. The human brain is one of the organs which is very sensitive to environmental changes affecting its growth and development. The brain of very tiny prematurely born babies is unable to follow the genetically determined growth pattern in extrauterine environment, even when postnatal nutrition and nurturing of the babies according to our best knowledge are appropriate. Is this fact of any significance to make distinction between normal and abnormal neurodevelopment pre- and postnatally is still unclear?

Kurjak antenatal neurodevelopmental test (KANET) using four-dimensional ultrasound (4D US) has been introduced using ten parameters and after attempt of standardization only eight parameters remained for neurodevelopmental assessment of low- and high-risk fetuses. We believe that at present level of knowledge, KANET test could be considered as a good test for the detection of fetuses with high neurological risk, without the possibility to define reliable long-term neurodevelopmental outcome. This is also hardly possible based on postnatal neurological assessment with 27 different postnatal tests. They were primarily neurobehavioral or neuromotor assessments that were suitable for use with preterm infants, and were discriminative, predictive or evaluative.

There was a high willingness of clinician to find postnatal neurodevelopmental test which could be predictive for short- term and long-term outcome of low and high-risk infants.

Although, there are many tests available for prenatal and postnatal assessment of neurodevelopment, none of them is reliable in the prediction of neurodevelopmental outcome in low-risk population, while many could be used with fairly acceptable predictivity in high-risk population. Although, many studies have been conducted in order to solve this problem, still there is a space for improvement. In postnatal period we are dealing with infant in front of the clinician with direct observation, while pretnatally we are dealing with quite different environment and less mature brain.

How to cite this article

Stanojevic M. Antenatal and Postnatal Assessment of Neurobehavior: Which One should be used? Donald School J Ultrasound Obstet Gynecol 2015;9(1):67-74.

Recent Results of the Clinical Application of Kanet Test

Many investigations led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of fetal central nervous system (CNS), and may make possible to distinguish between normal and abnormal brain development as well as prenatal diagnosis of neurological impairment. The arrival of three- and four-dimensional ultrasound (3D/4D US) made possible to study fetal behavioral patterns. Kurjak's antenatal neurodevelopmental test (KANET) is the first prenatal test based on 3D/4D ultrasound examination of the fetus, that could be used for the evaluation and prediction of fetal neurological status. Here, we present our review of literature on KANET around the world and summarized results of this promising prenatal neurological screening test.

How to cite this article

Neto RM, Kurjak A. Recent Results of the Clinical Application of Kanet Test. Donald School J Ultrasound Obstet Gynecol 2015;9(4):420-425.

Development of the stratum corneum

In 2015, Professor Ronald (Ronnie) Marks will celebrate his 80th birthday and the 35th year since assuming the Chair of Dermatology at the University of Wales College of Medicine in Cardiff, Wales. Ronnie's long and prolific career is well deserving of a celebratory Festschrift. Among his many accomplishments, Marks was an early champion of quantitative measurements and the application of bioengineering methods to clinical skin science, with particular focus on stratum corneum biology and the measurement of skin appearance. Appealing to Ronnie's wry sense of humour, I would characterize his career in the words of the native Welshman, Dylan Thomas, who published an unfinished novel in 1955 entitled Adventures in the Skin Trade. Ronnie Marks has been a quintessential and imaginative adventurer in the 'skin trade', and he continues to forge new trails for others to follow. The areas highlighted below are emblematic of Ronnie's varied research interests and his impact on stimulating experimental questions for me and future investigators of epidermal differentiation and stratum corneum development.

4D ultrasound study of fetal facial expressions at 20-24 weeks of gestation

OBJECTIVE

To assess the frequency of fetal facial expressions at 20-24 weeks of gestation using four-dimensional (4D) ultrasonography and to determine whether there was any correlation between facial expression and gestational age (20-34 weeks).

METHODS

The facial expressions of 23 healthy fetuses were examined using 4D ultrasound at 20-24 weeks. Each fetus was recorded continuously for 15 minutes. The frequencies of mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking were assessed and the data combined with those expressions observed at 25-34 weeks of gestation in two previous studies (n = 34) to determine the correlation between gestational age and each of the facial expressions.

RESULTS

Mouthing was significantly more frequent than the other six facial expressions at 20-24 weeks (P < 0.05). Yawning was significantly more frequent than smiling, scowling, and blinking (P < 0.05), and sucking was significantly more frequent than smiling, scowling, and blinking (P < 0.05). The frequency of yawning, smiling, tongue expulsion, scowling, and blinking increased with gestational age (P < 0.05). Mouthing movement and sucking frequencies remained constant between 20 and 34 weeks.

CONCLUSION

Frequencies of complicated facial expressions such as smiling and scowling may increase with advancing gestation owing to the development of the fetal brain and central nervous system.

Assessment of fetal behavior using four-dimensional ultrasonography: current knowledge and perspectives

In the last decades, the development of real-time ultrasonography has allowed the direct view of the fetus in the uterus, as well as assessing its activity. The advent of three-dimensional ultrasonography (3D) at the end of the 80s initiated a new era in diagnostic imaging for Obstetrics, dramatically increasing the possibility of studying the fetus. Recently, a new technique allowing the 3D image to be transformed into real-time was introduced: the four-dimensional (4D) ultrasonography. It allows the continuous monitoring of fetal face and other surface areas, such as the extremities. Some studies have already assessed this new methodology for fetal behavior observation during different stages of pregnancy, trying to understand better the relationship between fetal central nervous system maturation and the implications for its behavior. In this article, the authors review the current use of 4D ultrasonography in the assessment of fetal behavior, and discuss the possibilities of the technique to show the neurological development of the fetus, by means of watching movement and facial expressions. They also highlight the potential applicability of this new method in this new research area of fetal medicine.

Management of Traumatic Injury to Maxillary Central Incisors associated with Inverted Mesiodens: A Case Report

Maxillary incisors are the most frequently injured teeth in the primary and permanent dentition. Stage of adolescence show a significant number of dental injuries as they engage in contact sports. Children with accident prone profile, i.e. class II division I or class I type II malocclusion are more prone for injuries because of the proclined maxillary incisors. Supernumerary teeth are those that are additional to the normal complement. They occur in single or multiple, unilateral or bilateral in either of the jaws. This paper reports the presence of an inverted supernumerary tooth in the right maxillary central incisor region with trauma involving both maxillary central incisors and also the management of the supernumerary tooth and traumatized teeth in a 14-year-old boy.

How to cite this article: Pavuluri C, Nuvvula S. Management of Traumatic Injury to Maxillary Central Incisors associated with Inverted Mesiodens: A Case Report. Int J Clin Pediatr Dent 2013;6(1):30-32.

Crouzon's Syndrome: A Case Report

Crouzon's syndrome (CS) is a rare autosomal dominant condition with multiple mutations of the fibroblast growth factor receptor (FGFR2) gene, which accounts for 4.8% of all cases of craniosynostosis. It is characterized by premature closure of cranial sutures, cranial deformities, midface hypoplasia, relative mandibular prognathism, hypertelorism, proptosis, strabismus and short upper lip, crowding of teeth, pseudocleft or sometimes cleft palate and other associated abnormalities. The CS can vary in severity from mild presentation to severe forms involving multiple cranial sutures. We report a case of CS in 11-year-old boy. How to cite this article: Kumar GR, Jyothsna M, Ahmed SB, Lakshmi KS, Crouzon's Syndrome: A Case Report. Int J Clin Pediatr Dent 2013;6(1):33-37.

Effect of Propolis on Streptococcus mutans Counts: An in vivo Study

Propolis, a natural antibiotic, is a resinous substance that honey bees (Apis mellifera) produce. The main chemical classes present in propolis are flavonoids, phenolics and other various aromatic compounds.

Aim: To evaluate the antibacterial action of propolis on the concentration of Streptococcus mutans colonizing the oral cavity of children.

Materials and methods: Thirty children performed the rinses, with no other changes in their oral hygiene and dietary habits. Saliva was collected at two time points: Before using the product, 1 hour after the rinse.

Results: Paired t-test was used for analysis of the results. A reduction in the concentration of Streptococcus mutans was observed in samples collected after use of the extract. There was a reduction in Streptococcus mutans count when compared to samples obtained in baseline. Significant reductions were seen at the end of 1 hour. The result was statistically significant. There were no side effects in soft and hard tissues of mouth.

Conclusion and clinical implication: The propolis possesses in vivo antimicrobial activity against Streptococcus mutans present in the oral cavity and might be used as a measure to prevent dental caries.

How to cite this article: Hegde KS, Bhat SS, Rao A, Sain S. Effect of Propolis on Streptococcus mutans Counts: An in vivo Study. Int J Clin Pediatr Dent 2013;6(1):22-25.

Oral melanoacanthoma of a rare intraoral site: case report and review of literature

Oral melanoacanthoma is rare pigmented mucosal lesion that presents most commonly on the buccal mucosa, characterized by sudden appearance and rapid radial growth, thus clinically mimicking malignant melanoma. It was originally described as a mixed tumor of melanocytes and keratinocytes, but appears to be a reactive process; formed in areas prone to trauma, and regressing after the removal of trauma or incomplete excision. The clinical appearance of oral melanoacanthoma is nondiagnostic, and biopsy is mandatory to rule out malignancy. We report a case of melanoacanthoma of a rarer oral mucosal site in a 12-year-old Asian male. A brief review of the current literature is also presented.

How to cite this article: Rohilla K, Ramesh V, Balamurali PD, Singh N. Oral Melanoacanthoma of a Rare Intraoral Site: Case Report and Review of Literature. Int J Clin Pediatr Dent 2013;6(1):40-43.

Iron deficiency in young children: a risk marker for early childhood caries

Aim:

Evaluate the coexistence of iron deficiency and early childhood caries.

Evaluate whether iron deficiency can be considered as a risk marker for early childhood caries.

Estimate the incidence of iron deficiency in children with early childhood caries.

To evaluate and compare the iron status of children with and without severe early childhood caries.

Materials and methods: Sixty children of age 2 to 6 years in whom blood investigations are advised by pediatricians are selected for the study and are divided into early childhood caries (ECC) and control groups according to the def index. After obtaining the informed consent from parent, blood investigations are carried out in these children for the estimation of iron status.

Results: All the values depicting the iron status are found to be decreased in the clinical trial group (ECC group) and they are statistically significant.

Conclusion: Iron deficiency is observed definitely in children having ECC.

How to cite this article: Koppal PI, Sakri MR, Akkareddy B, Hinduja DM, Gangolli RA, Patil BC. Iron Deficiency in Young Children: A Risk Marker for Early Childhood Caries. Int J Clin Pediatr Dent 2013;6(1):1-6.

A comparative study of color stability and fluoride release from glass ionomer cements combined with chlorhexidine

Background: Restoring carious teeth is one of the major treatment needs of young children. Glass ionomer cement (GIC) systems had become the most important dental restorative and luting materials for use in preschoolers, children and teenagers. Several attempts in developing GIC with antibacterial effects by addition of bactericides, such as chlorhexidine, have been reported.

Aim: Aim of the study was to evaluate and compare the color and fluoride ion release of conventional and resin-modified GICs in combination with 1.25 and 2.5% chlorhexidine diacetate.

Materials and methods: The control groups consisted of conventional GIC and resin-modified GIC. The experimental groups consisted of conventional and resin-modified GIC groups, consisting of 1.25 and 2.5% chlorhexidine. A total of six groups were included with each group being allotted 20 specimens for the evaluation of color stability and 10 specimens each were allotted for the evaluation of fluoride release.

Color and fluoride release were recorded using spectrophoto-meter and fluoride selective electrode respectively at 24 hours 7 days and 1 month.

Results: Resin-modified GIC groups showed less color stability and better fluoride release at the end of the study compared to conventional GIC groups.

Conclusion: There was no significant change in color and fluoride release between 1.25 and 2.5% conventional GIC and also between 1.25 and 2.5% resin-modified GIC combined with chlorhexidine diacetate at the end of the study. Conventional GIC showed better color stability and less fluoride release compared to resin-modified GIC.

How to cite this article: Prabhakar AR, Pattanshetti K, Sugandhan S. A Comparative Study of Color Stability and Fluoride Release from Glass Ionomer Cements Combined with Chlorhexidine. Int J Clin Pediatr Dent 2013;6(1):26-29.

Internal and external root resorption management: a report of two cases

The response of the dentoalveolar apparatus to infection is characterized by inflammation which may result in tooth resorption. Depending upon the type of resorption and etiology, different treatment regimens have been proposed. The following two cases demonstrate internal and external inflammatory root resorption arrest by conventional nonsurgical endodontic therapy combined with calcium hydroxide-iodoform dressing, mineral trioxide aggregate (MTA) and flowable gutta-percha system.The patient has been regularly recalled every 6 months and radiographically the apical lesion showed signs of healing and arrest of root resorption after 1 year and 6 months. How to cite this article: Hegde N, Hegde MN. Internal and External Root Resorption Management: A Report of Two Cases. Int J Clin Pediatr Dent 2013;6(1):44-47.

Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale

Fear of dental treatment in children has been recognized as a source of serious health problems and it may persist into adolescence, which may lead to a disruptive behavior, during dental treatment. In order to prevent this psychometric method namely the dental subscale of the children's fear survey schedule (CFSS-DS) is a well-known psychometric scale that was developed by Cuthbert and Melamed in 1982 for assessing dental fear in children. The present study was to evaluate dental fear in children during first dental visit using CFSS-DS between three different age group 4 and 6 years, 7 and 9 years, 10 and 14 years children to select fearful and nonfearful children from a larger reference population and to estimate the dental fear children. Total 600 children show CFSS-DS of 27.17 ± 5.3385, 307 were girls (51.17%) and they showed CFSS-DS of 27.50 ± 5.060 and 293 were boys (48.83%) and they show CFSS-DS 26.84 ± 5.617. This shows that there were no significant difference in fear between boys and girls. In 4 to 6 years show total CFSS-DS 28.78 ± 5.742, 7 to 9 years show that mean and standard deviation of CFSS-DS 27.81 ± 4.783, 10 to 14 years show that mean and standard deviation of CFSS-DS 25.93 ± 5.586. Fear scores were highest for ‘injections', ‘choking', ‘noise of dentist drilling', ‘dentist drilling which was not significant between boy's and girl's but item, ‘having somebody look at you’ showed that significant differences in fear scores between boys and girls in present study. The present study concluded that dental fear decreased as age increased. Total fear scores also exhibited no strong overall sex difference or age by sex interaction.

d> Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2013;6(1):12-15.

Four-dimensional HDlive rendering image of fetal facial expression: a pictorial essay

BACKGROUND

Our objective was to present our experience of fetal facial expressions reconstructed employing the four-dimensional (4D) HDlive rendering mode.

METHODS

A total of 23 normal fetuses at 18-36 weeks' gestation were studied using the 4D HDlive rendering mode.

RESULTS

The 4D HDlive rendering mode provided extraordinarily realistic features of the fetal face. In particular, blinking, mouthing, swallowing, yawning, tongue expulsion, and sucking were clearly noted. Moreover, various realistic fetal emotional expressions such as smiling-like and crying-like movements were recognized. The 4D HDlive rendered images of fetal facial expressions seem to be more readily discernible than those obtained by conventional 4D ultrasonography.

CONCLUSION

Observation of facial expressions using the 4D HDlive rendering mode is considered to reflect the normal and abnormal neurological development of the fetus. Therefore, the 4D HDlive rendering mode may assist in evaluation of fetal brain function, and offer potential advantages relative to conventional 4D ultrasonography.

Agenesis of multiple primary teeth and

Agenesis of multiple primary teeth is rare. A 6-year-old girl visited our department, in the absence of any other systemic abnormalities, on clinical and radiographic evaluation, it was revealed that she had only 6 primary teeth in her mouth. Maxillary and mandibular removable partial dentures were fabricated for prosthodontic rehabilitation. At the 6 months follow-up nutrition of the patient as well as self-confident appearance was improved. How to cite this article: Nirmala SVSG, Gokhale N, Sivakumar N, Quadar MA. Agenesis of Multiple Primary Teeth and Its Rehabilitation: A Case Report. Int J Clin Pediatr Dent 2013; 6(1):55-57.

Langerhans cell histiocytosis: an illusion of hope

INTRODUCTION

Langerhans cell histiocytosis (LCH) is a rare atypical cellular disorder characterized by clonal proliferation of Langerhans cells leading to myriad clinical presentations and variable outcomes. It usually occurs in children and young adults. It can be present with local and systemic manifestation involving skin, bone, mucosal tissues and internal organs.

AIMS AND OBJECTIVES

The stomatologist plays an important role in management of the disease by keeping in mind the various oral manifestations of the disease.

CASE REPORT

Of a child with disseminated LCH with multiorgan involvement who presented with failure to thrive, osteolytic bony lesions and extensive cutaneous eruptions.

CONCLUSION

Early diagnosis and awareness is necessary to treat the patients. How to cite this article: Desai VD, Priyadarshinni SR, Varma B, Sharma R. Langerhans Cell Histiocytosis: An Illusion of Hope. Int J Clin Pediatr Dent 2013;6(1):66-70.

Foreign body in root canals of two adjacent deciduous molars: a case report

Children often tend to have the habit of inserting foreign objects in the oral cavity unknowingly for relief of dental pain. Sometimes, children do not reveal to their parents due to fear. These foreign objects may act as a potent source of infection and painful condition. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body and the difficulty involved in its retrieval. Here is a case report, where foreign object was accidentally lodged in the carious deciduous molars by a child. How to cite this article: Dhull KS, Acharya S, Ray P, Dhull RS. Foreign Body in Root Canals of Two Adjacent Deciduous Molars: A Case Report. Int J Clin Pediatr Dent 2013;6(1):38-39.