Does Rubella Cause Autism: A 2015 Reappraisal?

Microbes and Mental Illness: Past, Present, and Future

A review of the association between microbes and mental illness is performed, including the history, relevant definitions, infectious agents associated with mental illnesses, complex interactive infections, total load theory, pathophysiology, psychoimmunology, psychoneuroimmunology, clinical presentations, early-life infections, clinical assessment, and treatment. Perspectives on the etiology of mental illness have evolved from demonic possession toward multisystem biologically based models that include gene expression, environmental triggers, immune mediators, and infectious diseases. Microbes are associated with a number of mental disorders, including autism, schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders, as well as suicidality and aggressive or violent behaviors. Specific microbes that have been associated or potentially associated with at least one of these conditions include Aspergillus, Babesia, Bartonella, Borna disease virus, Borrelia burgdorferi (Lyme disease), Candida, Chlamydia, coronaviruses (e.g., SARS-CoV-2), Cryptococcus neoformans, cytomegalovirus, enteroviruses, Epstein-Barr virus, hepatitis C, herpes simplex virus, human endogenous retroviruses, human immunodeficiency virus, human herpesvirus-6 (HHV-6), human T-cell lymphotropic virus type 1, influenza viruses, measles virus, Mycoplasma, Plasmodium, rubella virus, Group A Streptococcus (PANDAS), Taenia solium, Toxoplasma gondii, Treponema pallidum (syphilis), Trypanosoma, and West Nile virus. Recognition of the microbe and mental illness association with the development of greater interdisciplinary research, education, and treatment options may prevent and reduce mental illness morbidity, disability, and mortality.

[Autism spectrum disorder in adulthood]

Autism is a neurodevelopmental disorder that starts in early childhood and persists over the lifespan. A combination of genetic factors and environmental factors around birth contribute to its etiology. Autistic individuals show differences and difficulties in social interaction and communication as well as repetitive, stereotypical behavior and interests. The diagnostic procedure is complex and should be carried out in a specialized assessment unit. Diagnostic assessment is based on behavioral observation and a careful evaluation of developmental history. A wide range of potential differential diagnoses should be considered. Autistic adults have a higher risk of developing psychiatric disorders such as anxiety and depression. Psychotherapeutic treatment that is adapted to autism-related difficulties can be helpful. Co-occurring conditions should be treated in accordance with disorder-specific guidelines. Psychopharmacological treatment of co-occurring conditions is, in most cases, only recommended as an addition to behavioral interventions. Autistic people often experience difficulties in social participation, which can be targeted with sociotherapeutic interventions.

Changes in cytokine and cytokine receptor levels during postnatal development of the human dorsolateral prefrontal cortex

In addition to their traditional roles in immune cell communication, cytokines regulate brain development. Cytokines are known to influence neural cell generation, differentiation, maturation, and survival. However, most work on the role of cytokines in brain development investigates rodents or focuses on prenatal events. Here, we investigate how mRNA and protein levels of key cytokines and cytokine receptors change during postnatal development of the human prefrontal cortex. We find that most cytokine transcripts investigated (IL1B, IL18, IL6, TNF, IL13) are lowest at birth and increase between 1.5 and 5 years old. After 5 years old, transcriptional patterns proceeded in one of two directions: decreased expression in teens and young adults (IL1B, p = 0.002; and IL18, p = 0.004) or increased mean expression with maturation, particularly in teenagers (IL6, p = 0.004; TNF, p = 0.002; IL13, p < 0.001). In contrast, cytokine proteins tended to remain elevated after peaking significantly around 3 years of age (IL1B, p = 0.012; IL18, p = 0.026; IL6, p = 0.039; TNF, p < 0.001), with TNF protein being highest in teenagers. An mRNA-only analysis of cytokine receptor transcripts found that early developmental increases in cytokines were paralleled by increases in their ligand-binding receptor subunits, such as IL1R1 (p = 0.033) and IL6R (p < 0.001) transcripts. In contrast, cytokine receptor-associated signaling subunits, IL1RAP and IL6ST, did not change significantly between age groups. Of the two TNF receptors, the 'pro-death' TNFRSF1A and 'pro-survival' TNFRSF1B, only TNFRSF1B was significantly changed (p = 0.028), increasing first in toddlers and again in young adults. Finally, the cytokine inhibitor, IL13, was elevated first in toddlers (p = 0.006) and again in young adults (p = 0.053). While the mean expression of interleukin-1 receptor antagonist (IL1RN) was highest in toddlers, this increase was not statistically significant. The fluctuations in cytokine expression reported here support a role for increases in specific cytokines at two different stages of human cortical development. The first is during the toddler/preschool period (IL1B, IL18, and IL13), and the other occurs at adolescence/young adult maturation (IL6, TNF and IL13).

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder (ASD) is a group of heterogeneous, multi-factorial, neurodevelopmental disorders resulting from genetic and environmental factors interplay. Infection is a significant trigger of autism, especially during the critical developmental period. There is a strong interplay between the viral infection as a trigger and a result of ASD. We aim to highlight the mutual relationship between autism and viruses. We performed a thorough literature review and included 158 research in this review. Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism, especially for specific viral infections such as Rubella, Cytomegalovirus, Herpes Simplex virus, Varicella Zoster Virus, Influenza virus, Zika virus, and severe acute respiratory syndrome coronavirus 2. Viral infection directly infects the brain, triggers immune activation, induces epigenetic changes, and raises the risks of having a child with autism. At the same time, there is some evidence of increased risk of infection, including viral infections in children with autism, due to lots of factors. There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism. In addition, children with autism are at increased risk of infection, including viruses. Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism. Immune modulation of children with autism should be considered to reduce the risk of infection.

Developmental outcomes in children born to women with possible subclinical rubella exposures during pregnancy

This study investigated outcomes of children born to women who seroconverted to rubella immune during pregnancy. In a prior 2012-2013 study of 296 women who were rubella nonimmune, 26 (8.8%) seroconverted to rubella immune during pregnancy. These same women and their now 8-9 years-old children were queried as to the children's developmental health. After removing exclusions and those lost to follow-up, the total response rate was 115/204 (56.4%). Three sets of twins in the nonimmune group increased the total to 118. The seroconversion group had more autism (12.5% vs. 3.9%, p = 0.19), ADHD (37.5% vs. 18.6%, p = 0.10), and any developmental disability (43.8% vs. 31.4%, p = 0.39) but none showed a statistical difference between the two groups. Compared to Autism and Developmental Disabilities Monitoring data, the seroconversion group had a greater prevalence of autism (odds ratio [OR] 6.07, p = 0.051, nonsignificant); and to data derived from the National Health Interview Survey, a nonsignificant higher odds of autism (OR 5.57, p = 0.060), higher odds of ADHD (OR 5.65, p = 0.0027) and of any developmental disability (OR 3.59, p = 0.014). The nonimmune group also demonstrated a statistically significant increase for both ADHD and any developmental disability, but not for autism.

Maternal immune activation as an epidemiological risk factor for neurodevelopmental disorders: Considerations of timing, severity, individual differences, and sex in human and rodent studies

Epidemiological evidence suggests that one's risk of being diagnosed with a neurodevelopmental disorder (NDD)-such as autism, ADHD, or schizophrenia-increases significantly if their mother had a viral or bacterial infection during the first or second trimester of pregnancy. Despite this well-known data, little is known about how developing neural systems are perturbed by events such as early-life immune activation. One theory is that the maternal immune response disrupts neural processes important for typical fetal and postnatal development, which can subsequently result in specific and overlapping behavioral phenotypes in offspring, characteristic of NDDs. As such, rodent models of maternal immune activation (MIA) have been useful in elucidating neural mechanisms that may become dysregulated by MIA. This review will start with an up-to-date and in-depth, critical summary of epidemiological data in humans, examining the association between different types of MIA and NDD outcomes in offspring. Thereafter, we will summarize common rodent models of MIA and discuss their relevance to the human epidemiological data. Finally, we will highlight other factors that may interact with or impact MIA and its associated risk for NDDs, and emphasize the importance for researchers to consider these when designing future human and rodent studies. These points to consider include: the sex of the offspring, the developmental timing of the immune challenge, and other factors that may contribute to individual variability in neural and behavioral responses to MIA, such as genetics, parental age, the gut microbiome, prenatal stress, and placental buffering.

Pathogenic Infections during Pregnancy and the Consequences for Fetal Brain Development

Pathogens comprised of viruses, bacteria, gut microbiome, and parasites are a leading cause of ever-emerging diseases in humans. Studying pathogens for their ability to cause diseases is a topic of critical discussion among scientists and pharmaceutical centers for effective drug development that diagnose, treat, and prevent infection-associated disorders. Pathogens impact health either directly by invading the host or by eliciting an acute inflammatory immune response. This paradigm of inflammatory immune responses is even more consequential in people who may be immunocompromised. In this regard, pregnancy offers an altered immunity scenario, which may allow the onset of severe diseases. Viruses, such as Influenza, HIV, and now SARS-CoV-2, associated with the COVID-19 pandemic, raise new concerns for maternal and fetal/neonatal health. Intrauterine bacterial and parasitic infections are also known to impact pregnancy outcomes and neonatal health. More importantly, viral and bacterial infections during pregnancy have been identified as a common contributor to fetal brain development defects. Infection-mediated inflammatory uterine immune milieu is thought to be the main trigger for causing poor fetal brain development, resulting in long-term cognitive impairments. The concept of in utero programming of childhood and adult disorders has revolutionized the field of neurodevelopment and its associated complications. Recent findings in mice and humans clearly support the idea that uterine immunity during pregnancy controls the health trajectory of the child and considerably influences the cognitive function and mental health. In this review, we focus on the in utero programming of autism spectrum disorders (ASD) and assess the effects of pathogens on the onset of ASD-like symptoms.

Intrauterine Viral Infections: Impact of Inflammation on Fetal Neurodevelopment

Intrauterine viral infections during pregnancy by pathogens such as Zika virus, Cytomegalovirus, Rubella and Herpes Simplex virus can lead to prenatal as well as postnatal neurodevelopmental disorders. Although maternal viral infections are common during pregnancy, viruses rarely penetrate the trophoblast. When they do cross, viruses can cause adverse congenital health conditions for the fetus. In this context, maternal inflammatory responses to these neurotropic pathogens play a significant role in negatively affecting neurodevelopment. For instance, intrauterine inflammation poses an increased risk of neurodevelopmental disorders such as microcephaly, schizophrenia, autism spectrum disorder, cerebral palsy and epilepsy. Severe inflammatory responses have been linked to stillbirths, preterm births, abortions and microcephaly. In this review, we discuss the mechanistic basis of how immune system shapes the landscape of the brain and how different neurotropic viral pathogens evoke inflammatory responses. Finally, we list the consequences of neuroinflammation on fetal brain development and discuss directions for future research and intervention strategies.

A k-mer based approach for classifying viruses without taxonomy identifies viral associations in human autism and plant microbiomes

Viruses are an underrepresented taxa in the study and identification of microbiome constituents; however, they play an essential role in health, microbiome regulation, and transfer of genetic material. Only a few thousand viruses have been isolated, sequenced, and assigned a taxonomy, which limits the ability to identify and quantify viruses in the microbiome. Additionally, the vast diversity of viruses represents a challenge for classification, not only in constructing a viral taxonomy, but also in identifying similarities between a virus' genotype and its phenotype. However, the diversity of viral sequences can be leveraged to classify their sequences in metagenomic and metatranscriptomic samples, even if they do not have a taxonomy. To identify and quantify viruses in transcriptomic and genomic samples, we developed a dynamic programming algorithm for creating a classification tree out of 715,672 metagenome viruses. To create the classification tree, we clustered proportional similarity scores generated from the k-mer profiles of each of the metagenome viruses to create a database of metagenomic viruses. The resulting Kraken2 database of the metagenomic viruses can be found here: https://www.osti.gov/biblio/1615774 and is compatible with Kraken2. We then integrated the viral classification database with databases created with genomes from NCBI for use with ParaKraken (a parallelized version of Kraken provided in Supplemental Zip 1), a metagenomic/transcriptomic classifier. To illustrate the breadth of our utility for classifying metagenome viruses, we analyzed data from a plant metagenome study identifying genotypic and compartment specific differences between two Populus genotypes in three different compartments. We also identified a significant increase in abundance of eight viral sequences in post mortem brains in a human metatranscriptome study comparing Autism Spectrum Disorder patients and controls. We also show the potential accuracy for classifying viruses by utilizing both the JGI and NCBI viral databases to identify the uniqueness of viral sequences. Finally, we validate the accuracy of viral classification with NCBI databases containing viruses with taxonomy to identify pathogenic viruses in known COVID-19 and cassava brown streak virus infection samples. Our method represents the compulsory first step in better understanding the role of viruses in the microbiome by allowing for a more complete identification of sequences without taxonomy. Better classification of viruses will improve identifying associations between viruses and their hosts as well as viruses and other microbiome members. Despite the lack of taxonomy, this database of metagenomic viruses can be used with any tool that utilizes a taxonomy, such as Kraken, for accurate classification of viruses.

Association between Viral Infections and Risk of Autistic Disorder: An Overview

Autism spectrum disorder (ASD) is a neurodevelopmental condition of the central nervous system (CNS) that presents with severe communication problems, impairment of social interactions, and stereotypic behaviours. Emerging studies indicate possible associations between viral infections and neurodegenerative and neurobehavioural conditions including autism. Viral infection during critical periods of early in utero neurodevelopment may lead to increased risk of autism in the offspring. This review is aimed at highlighting the association between viral infections, including viruses similar to COVID-19, and the aetiology of autism. A literature search was conducted using Pubmed, Ovid/Medline, and Google Scholar database. Relevant search terms included "rubella and autism", "cytomegalovirus and autism", "influenza virus and autism", "Zika virus and autism", "COVID-19 and autism". Based on the search terms, a total of 141 articles were obtained and studies on infants or children with congenital or perinatal viral infection and autistic behaviour were evaluated. The possible mechanisms by which viral infections could lead to autism include direct teratogenic effects and indirect effects of inflammation or maternal immune activation on the developing brain. Brain imaging studies have shown that the ensuing immune response from these viral infections could lead to disruption of the development of brain regions and structures. Hence, long-term follow up is necessary for infants whose mothers report an inflammatory event due to viral infection at any time during pregnancy to monitor for signs of autism. Research into the role of viral infection in the development of ASD may be one avenue of improving ASD outcomes in the future. Early screening and diagnosis to detect, and maybe even prevent ASD are essential to reduce the burden of this condition.

Infections, inflammation, and risk of neuropsychiatric disorders: the neglected role of "co-infection"

Neuropsychiatric disorders (NPDs) have multiple etiological factors, mainly genetic background, environmental conditions and immunological factors. The host immune responses play a pivotal role in various physiological and pathophysiological process. In NPDs, inflammatory immune responses have shown to be involved in diseases severity and treatment outcome. Inflammatory cytokines and chemokines are involved in various neurobiological pathways, such as GABAergic signaling and neurotransmitter synthesis. Infectious agents are among the major amplifier of inflammatory reactions, hence, have an indirect role in the pathogenesis of NPDs. As such, some infections directly affect the central nervous system (CNS) and alter the genes that involved in neurobiological pathways and NPDs. Interestingly, the most of infectious agents that involved in NPDs (e.g., Toxoplasma gondii, cytomegalovirus and herpes simplex virus) is latent (asymptomatic) and co-or-multiple infection of them are common. Nonetheless, the role of co-or-multiple infection in the pathogenesis of NPDs has not deeply investigated. Evidences indicate that co-or-multiple infection synergically augment the level of inflammatory reactions and have more severe outcomes than single infection. Hence, it is plausible that co-or-multiple infections can increase the risk and/or pathogenesis of NPDs. Further understanding about the role of co-or-multiple infections can offer new insights about the etiology, treatment and prevention of NPDs. Likewise, therapy based on anti-infective and anti-inflammatory agents could be a promising therapeutic option as an adjuvant for treatment of NPDs.

Rubella Virus Infection, the Congenital Rubella Syndrome, and the Link to Autism

Rubella is a systemic virus infection that is usually mild. It can, however, cause severe birth defects known as the congenital rubella syndrome (CRS) when infection occurs early in pregnancy. As many as 8%-13% of children with CRS developed autism during the rubella epidemic of the 1960s compared to the background rate of about 1 new case per 5000 children. Rubella infection and CRS are now rare in the U.S. and in Europe due to widespread vaccination. However, autism rates have risen dramatically in recent decades to about 3% of children today, with many cases appearing after a period of normal development ('regressive autism'). Evidence is reviewed here suggesting that the signs and symptoms of rubella may be due to alterations in the hepatic metabolism of vitamin A (retinoids), precipitated by the acute phase of the infection. The infection causes mild liver dysfunction and the spillage of stored vitamin A compounds into the circulation, resulting in an endogenous form of hypervitaminosis A. Given that vitamin A is a known teratogen, it is suggested that rubella infection occurring in the early weeks of pregnancy causes CRS through maternal liver dysfunction and exposure of the developing fetus to excessive vitamin A. On this view, the multiple manifestations of CRS and associated autism represent endogenous forms of hypervitaminosis A. It is further proposed that regressive autism results primarily from post-natal influences of a liver-damaging nature and exposure to excess vitamin A, inducing CRS-like features as a function of vitamin A toxicity, but without the associated dysmorphogenesis. A number of environmental factors are discussed that may plausibly be candidates for this role, and suggestions are offered for testing the model. The model also suggests a number of measures that may be effective both in reducing the risk of fetal CRS in women who acquire rubella in their first trimester and in reversing or minimizing regressive autism among children in whom the diagnosis is suspected or confirmed.

Associations between autistic-like traits and polymorphisms in NFKBIL1

OBJECTIVE

The immune system has been suggested to be associated with neuropsychiatric disorders; for example, elevated levels of cytokines and the inflammation-related transcription factor nuclear factor kappa-B (NF-κB) have been reported in individuals with autism spectrum disorder (ASD). The aim of this study was to investigate possible associations between autistic-like traits (ALTs) and single nucleotide polymorphisms (SNPs) in NFKB1 (encoding a subunit of the NF-κB protein complex) and NF-κB inhibitor-like protein 1 (NFKBIL1).

METHODS

The study was conducted in a cohort from the general population: The Child and Adolescent Twin Study in Sweden (CATSS, n = 12 319, 9-12 years old). The subjects were assessed by the Autism-Tics, ADHD, and Other Comorbidities Inventory. Five SNPs within the two genes were genotyped (NFKBIL1: rs2857605, rs2239707, rs2230365 and rs2071592; NFKB1: rs4648022).

RESULTS

We found significant associations for two SNPs in NFKBIL1: rs2239707 showed a significant distribution of genotype frequencies in the case-control analysis both for all individuals combined and in boys only, and rs2230365 was significantly associated with the ALTs-module language impairment in boys only. Furthermore, we found nominal association in the case-control study for rs2230365, replicating earlier association between this SNP and ASD in an independent genome-wide association study.

CONCLUSION

The shown associations between polymorphisms in NFKBIL1 and ALTs are supporting an influence of the immune system on neuropsychiatric symptoms.

The contribution of environmental exposure to the etiology of autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition of heterogeneous etiology. While it is widely recognized that genetic and environmental factors and their interactions contribute to autism phenotypes, their precise causal mechanisms remain poorly understood. This article reviews our current understanding of environmental risk factors of ASD and their presumed adverse physiological mechanisms. It comprehensively maps the significance of parental age, teratogenic compounds, perinatal risks, medication, smoking and alcohol use, nutrition, vaccination, toxic exposures, as well as the role of extreme psychosocial factors. Further, we consider the role of potential protective factors such as folate and fatty acid intake. Evidence indicates an increased offspring vulnerability to ASD through advanced maternal and paternal age, valproate intake, toxic chemical exposure, maternal diabetes, enhanced steroidogenic activity, immune activation, and possibly altered zinc-copper cycles and treatment with selective serotonin reuptake inhibitors. Epidemiological studies demonstrate no evidence for vaccination posing an autism risk. It is concluded that future research needs to consider categorical autism, broader autism phenotypes, as well as autistic traits, and examine more homogenous autism variants by subgroup stratification. Our understanding of autism etiology could be advanced by research aimed at disentangling the causal and non-causal environmental effects, both founding and moderating, and gene-environment interplay using twin studies, longitudinal and experimental designs. The specificity of many environmental risks for ASD remains unknown and control of multiple confounders has been limited. Further understanding of the critical windows of neurodevelopmental vulnerability and investigating the fit of multiple hit and cumulative risk models are likely promising approaches in enhancing the understanding of role of environmental factors in the etiology of ASD.

Zika Virus as a Possible Risk Factor for Autism Spectrum Disorder: Neuroimmunological Aspects

The recent outbreak of the Zika virus (ZIKV) and the discovery that perinatal Zika exposure can lead to the Congenital Zika Syndrome has promoted a call for prevention measures. Due to the increased number of babies born with microcephaly, structural brain abnormalities, and neurological alterations in regions affected by ZIKV, investigations were carried out in order to better understand this process. The maternal immune system directly influences the fetal central nervous system, and complications during pregnancy have been associated with neurodevelopmental disorders. Autism spectrum disorder (ASD), a neurodevelopmental disorder commonly manifested in the first years of life, is a disease with multifactorial etiology and is manifested typically by social and communication impairments, as well as stereotyped behaviors. Brain abnormalities, including both anatomically and functionally, can be observed in this disorder, suggesting delays in neuronal maturation and altered brain connectivity. It is known that some viral congenital infections, such as rubella, and cytomegalovirus can interfere with brain development, being associated with brain calcification, microcephaly, and ASD. Here, we reviewed a range of studies evaluating the aspects concerning brain development, immunological status during pregnancy, and neuroimmunomodulation in congenital viral infections, and we discuss if the fetal brain infection caused by ZIKV could predispose to ASD. Finally, we suggest a mechanism encompassing neurological and immunological pathways that could play a role in the development of ASD in infants after ZIKV infection in pregnancy.

Neonatal and regressive forms of autism: Diseases with similar symptoms but a different etiology

Autistic Spectrum Disorder (ASD) can be a debilitating, life-long neurocognitive disease. ASD is caused by genetic and epigenetic factors and largely unknown and poorly understood environmental triggers. Signs and symptoms of ASD often appear in the first year of life while the disease strikes other infants who had previously been developing normally at around 2years of age. Ozonoff and her colleagues recently suggested that there are three different pathways or trajectories for the development of ASD in infants 6-24months of age. I hypothesize that pathway 1 is caused by in utero insult/injury, pathway 2 by obstetric complications at birth, and pathway 3 by environmental triggers of ASD affecting infants 0-3years of age. Faster progress can be made in elucidating the underlying causes of neonatal and regressive forms of ASD if the diseases are investigated separately, instead of being part of the same disorder.

Worms on the spectrum - C. elegans models in autism research

The small non-parasitic nematode Caenorhabditis elegans is widely used in neuroscience thanks to its well-understood development and lineage of the nervous system. Furthermore, C. elegans has been used to model many human developmental and neurological conditions to better understand disease mechanisms and identify potential therapeutic strategies. Autism spectrum disorder (ASD) is the most prevalent of all neurodevelopmental disorders, and the C. elegans system may provide opportunities to learn more about this complex disorder. Since basic cell biology and biochemistry of the C. elegans nervous system is generally very similar to mammals, cellular or molecular phenotypes can be investigated, along with a repertoire of behaviours. For instance, worms have contributed greatly to the understanding of mechanisms underlying mutations in genes coding for synaptic proteins such as neuroligin and neurexin. Using worms to model neurodevelopmental disorders like ASD is an emerging topic that harbours great, untapped potential. This review summarizes the numerous contributions of C. elegans to the field of neurodevelopment and introduces the nematode system as a potential research tool to study essential roles of genes associated with ASD.

The Role of the Immune System in Autism Spectrum Disorder

Autism is a neurodevelopmental disorder characterized by deficits in communication and social skills as well as repetitive and stereotypical behaviors. While much effort has focused on the identification of genes associated with autism, research emerging within the past two decades suggests that immune dysfunction is a viable risk factor contributing to the neurodevelopmental deficits observed in autism spectrum disorders (ASD). Further, it is the heterogeneity within this disorder that has brought to light much of the current thinking regarding the subphenotypes within ASD and how the immune system is associated with these distinctions. This review will focus on the two main axes of immune involvement in ASD, namely dysfunction in the prenatal and postnatal periods. During gestation, prenatal insults including maternal infection and subsequent immunological activation may increase the risk of autism in the child. Similarly, the presence of maternally derived anti-brain autoantibodies found in ~20% of mothers whose children are at risk for developing autism has defined an additional subphenotype of ASD. The postnatal environment, on the other hand, is characterized by related but distinct profiles of immune dysregulation, inflammation, and endogenous autoantibodies that all persist within the affected individual. Further definition of the role of immune dysregulation in ASD thus necessitates a deeper understanding of the interaction between both maternal and child immune systems, and the role they have in diagnosis and treatment.

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.

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.

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.

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.

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.

The Interaction between the Immune System and Epigenetics in the Etiology of Autism Spectrum Disorders

Recent studies have firmly established that the etiology of autism includes both genetic and environmental components. However, we are only just beginning to elucidate the environmental factors that might be involved in the development of autism, as well as the molecular mechanisms through which they function. Mounting epidemiological and biological evidence suggest that prenatal factors that induce a more activated immune state in the mother are involved in the development of autism. In parallel, molecular studies have highlighted the role of epigenetics in brain development as a process susceptible to environmental influences and potentially causative of autism spectrum disorders (ASD). In this review, we will discuss converging evidence for a multidirectional interaction between immune system activation in the mother during pregnancy and epigenetic regulation in the brain of the fetus that may cooperate to produce an autistic phenotype. This interaction includes immune factor-induced changes in epigenetic signatures in the brain, dysregulation of epigenetic modifications specifically in genomic regions that encode immune functions, and aberrant epigenetic regulation of microglia. Overall, the interaction between immune system activation in the mother and the subsequent epigenetic dysregulation in the developing fetal brain may be a main consideration for the environmental factors that cause autism.

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.

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.

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.

Evaluation of the Microleakage of Chlorhexidine-Modified Glass Ionomer Cement: An in vivo Study

AIM

Recent advances including the incorporation of antibacterial substances, such as chlorhexidine, into restorative materials such as glass ionoer cement (GIC), might alter the physical properties of the material, which might affect the marginal seal of the restorations. Hence, the objective of this study was to compare the marginal sealing ability of GC Fuji IX modified with 1% chlorhexidine diacetate and conventional GC Fuji IX.

MATERIALS AND METHODS

Sixty healthy molars were selected from the oral cavities of 30 children. The teeth were divided into two groups: Group I, teeth restored with 1% chlorhexidine diacetate modified GC Fuji IX and group II, teeth restored with GC Fuji IX. The restored teeth were extracted following 4 weeks and immersed in 2% basic fuchsin solution for 24 hours. They were then sectioned and scored under a light microscope of 10 × 10 magnification for dye penetration.

RESULTS

On statistical analysis difference between Chlorhexidine-Modified GIC group and GIC group with regard to grade of microleakage was found to be statistically nonsignificant (p = 0.543).

CONCLUSION

Since, addition of 1% chlorhexidine diacetate to GC Fuji IX showed comparable results with regard to microleakage, it can be considered a valuable alternative especially in atraumatic restorative treatment and for general clinical utility in restorative dentistry. How to cite this article: Mathew SM, Thomas AM, Koshy G, Dua K. Evaluation of the Microleakage of Chlorhexidine-Modified Glass Ionomer Cement: An in vivo Study. Int J Clin Pediatr Dent 2013;6(1):7-11.