An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: An in-situ and in-vitro study

BACKGROUND

Molar incisor hypomineralization (MIH) affected teeth have enamel with altered mineral content like decreased calcium and phosphorus and increased carbon content leading to porous enamel and subsequent post-eruptive breakdown.

AIM

An in situ study was conducted to evaluate and compare the effects of a Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-based cream and fluoride varnish on the remineralization of MIH affected teeth.

METHODS

Enamel slabs were prepared from MIH affected teeth that had been extracted for various reasons and inserted in appliances of 30 participants who were undergoing interceptive orthodontic therapy. They were randomly divided into two groups using block randomization technique: Group A-daily single application of CPP-ACP cream (n = 15); Group B-professional application of fluoride varnishes every 3 months (n = 15). After 6 months of regular wear of the appliance, the enamel slabs were placed under Field Emission Scanning Microscope (FESEM) and Energy-Dispersive Spectroscopy (EDS) for evaluation of ultra structure and mineral content, respectively.

RESULTS

A significant increase in calcium and phosphorus content, and a decrease in carbon content was observed within the 6 months period, suggesting remineralization in both the groups. On comparing the Ca:P and Ca:C ratios, a significant increase in the Ca:C ratio was evident in the two groups. No significant difference was seen in the Ca:P ratio in the CPP-ACP group at six months. The inter-group comparison did not reveal any significant difference between the two groups either at baseline or at 6 months post-intervention.

CONCLUSION

Remineralization can be achieved in MIH affected teeth with the use of remineralizing agents.

Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial

BACKGROUND

Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations.

AIM

To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs).

METHODS

60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months.

RESULTS

After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups.

CONCLUSION

Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.

Label-free quantitative proteomics reveals molecular correlates of altered biomechanical properties in molar incisor hypomineralization (MIH): an in vitro study

PURPOSE

Molar-incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that affects first permanent molars with or without affecting permanent incisors. We aimed to carry out a quantitative proteomics-based study to compare and evaluate proteins in sound and MIH-affected enamel.

MATERIALS AND METHODS

Ten blocks each of the MIH-affected enamel and sound enamel were processed and prepared for LC-MS/MS analysis. Label-free quantitation was carried out to evaluate the differentially expressed proteins in the two groups of samples.

RESULTS

A significant increase in the number of proteins in MIH-affected enamel (50.3 ± 29.6) was observed compared to the sound enamel (21.4 ± 3.2). While proteins like collagens, α1-anti-trypsin, kallikrein-4 (KLK4), matrix metalloprotease-20 (MMP-20), alpha-2-macroglobulin, and alpha-2-HS-glycoprotein were upregulated in sound enamel, there was over-expression of albumin, calcium-binding proteins, anti-thrombin III, and dentin sialophosphoprotein (DSPP), along with proteins implicated in stress response and inflammatory processes in MIH.

CONCLUSION

We propose that altered biomechanical properties of the enamel in MIH samples arise due to (i) down-regulation of proteins contributing to collagen biosynthesis and fibril formation; (ii) an overall imbalance in required levels of proteases (KLK4 and MMP-20) and anti-proteases (anti-thrombin-III which inhibits KLK-4), essential for optimal mineralization; (iii) very low levels of alpha-2-macroglobulin with important consequences in enamel mineralization and amelogenesis; and (iv) increased albumin in MIH, preventing proper growth of hydroxyapatite crystals. Increased inflammatory component was also seen in MIH; however, whether inflammation is a cause or consequence of the poor mineralization process needs to be assessed.

Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre

To categorize and compare the dental emergencies along with status of health services received in the tertiary dental health care centre during the pre covid- 19 periods and period of the complete lockdown in COVID 19 pandemic. Methods: A retrospective cross-sectional observational survey was conducted. Four different groups period were studied on patients who visited for dental emergencies at tertiary care centre. April 14 to 13 May 2020 assigned and analyzed as a test period group or group IV. The control period group i.e. group III was 14 February 2020 to 17 March, pre lockdown COVID 19 month when there was no consideration of epidemic in India. Same as periods of group II and IV, group I and II from last year 2019 were also assigned and analyzed. The tertiary care centre provision of health services during this pandemic was also inquired and evaluated. The information was recorded regarding availability of health services like non-emergency dental treatments, emergency dental services, and online professional consultation. To compare four different time period of obtained data, Analysis of variance (ANOVA) and Chi square test were used. Results: The overall proportion and percentage of dental emergencies were raised. The reason for emergency visits to dental clinic were the main problem related with pulpal (46.0%) followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%) or trauma (0.3%). In lockdown most of the dental emergencies 228(2 6 5) were endodontic related (86.1%) which managed mostly through '3A" approach (advise, analgesics and antibiotics) (60.1%) and remaining (26.0%) through extraction.

Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia

BACKGROUND

Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC).

METHODS

A cohort of 43 patients, aged 3-12 years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports.

RESULTS

A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant.

CONCLUSION

Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.

Use of Fluoridated Dentifrices among Children: Are We in the Right Direction?

Introduction Use of topical fluorides in dentifrices has always been an important tool in prevention of dental caries in young children. Due to the easy availability of various low and high fluoride dentifrices, the parents have no clear understanding about their correct age-appropriate use in children. This study was undertaken to evaluate and understand the trend and current practices among the end user.

Materials and Methods A total of 173 children aged 4 to 6 years were enrolled in the study from schools located in two different geographical areas of the Chandigarh city; group 1 (n = 90) from a peri-urban slum cluster: (Govt. Primary School, Indira Colony, Mani Majra, n = 51); Govt. Middle School, Mani Majra (n = 39); group 2 (n = 83) from an urban private city school (Ankur, Punjab University, Sector 14) using cluster sampling method. Two examiners using type IV examination examined all the children aged 4 to 6 years present using a preinstructed close-ended questionnaire. Data were analyzed using SPSS Software Version 25 (SPSS Inc., Chicago, IL, United States).

Results The data regarding the knowledge of fluoride in pastes showed that 85% of the children were using high fluoride pastes, 10% were using nonfluoride pastes, and 5% were using low fluoride pastes. In group 1, none of the users were aware about the benefits/risk of using fluoride toothpastes and only 22% were aware in group 2. Only 27% of children in group 1 dispensed the correct amount of dentifrice for this age group i.e., a pea head size versus 67% in group 2; a half brush length was dispensed by 61.5% in group 1 and 28% in group 2, and just a smudge by 11.5% in group 1 and 5% in group 2. Forty one percent children in both the groups had a history of having intentionally consumed the toothpaste. The toothpaste was dispensed to the child by parent in 89% of cases in group 2 and only 50% in group 1 and 88% parents claimed to always supervise the child while tooth brushing versus only 53% in group 1. Majority of the respondents’, i.e., 97% in group 1 and 63% in group 2 had never been explained about the correct method of use of fluoride paste in children.

Conclusion Knowledge about fluoridated toothpastes is low among the population. The children in peri-urban slums areas are exposed to the high fluoride pastes from very early in life and there is no other toothpaste which is brought home except for those which are commonly used among the members. In the city schools; however, a small percentage of population uses low fluoride pastes in children, possibly due to a greater awareness and access to information, but has no clear idea about their limitations and benefits of age-appropriate use. Till appropriate guidelines are available for the country, a safe practice to follow is tailoring individual need based protocol. The children in peri-urban slums areas need to be educated more on the health practices and importance of use of fluoride dentifrices and the children in the city schools need to be guided more on the age appropriate use of high and low fluoride dentifrices.

Prevalence, defect characteristics and distribution of other phenotypes in 3- to 6-year-old children affected with Hypomineralised Second Primary Molars

PURPOSE

To assess the prevalence, severity and defect characteristics of hypomineralised second primary molars in schoolgoing children along with distribution of other phenotypes.

METHODS

A total of 3013, 3- to 6-year-old children were examined for the presence of hypomineralised second primary molars (HSPMs) using an adapted version of EAPD Criteria (2003). The molars were evaluated for the presence, location and colour of demarcated opacities along with associated post-eruptive breakdown (PEB) and atypical restorations. A thorough examination of the entire dentition was followed for evaluation of teeth other than primary second molars for the presence of similar hypomineralised defects. Data were analysed using Chi Square, Fisher exact's and Mann-Whitney U tests at α = 0.05.

RESULTS

A total of 3013 out of 3200 children were included having a mean age of 4.25 ± 0.5 years and deft of 2.1 ± 0.5. Using the adapted version of EAPD 2003 criteria for MIH, the children were evaluated for the presence of hypomineralised second primary molars, the prevalence of which was found to be 7.9%. Hypomineralisation defects were more commonly observed in the maxillary arch (53.4% vs. 42.8%, p = 0.04) with creamish white opacities involving the buccal and lingual surfaces being the most common defects (43.6%). The mean number of HSPMs per child was 1.9. Other phenotypes included demarcated opacities majorly on primary canines (6.6%) followed by primary first molars (4.6%).

CONCLUSIONS

Hypomineralised primary second molars are a fairly common condition affecting approximately 7.9% of the population thus warranting early recognition and management.

Validation of ICMR index for identification of dental fluorosis in epidemiological studies

Background & objectives:

The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the ‘ICMR Index for Dental Fluorosis’ in the field to check its reliability and reproducibility.

Methods:

A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability.

Results:

The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement.

Interpretation & conclusions:

The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

Delayed replantation of avulsed tooth with 15-hours extra-oral time: 3-year follow-up

BACKGROUND

Avulsion is one of the most serious injuries of the tooth which is most commonly seen in young children and occurs in the upper front teeth. Immediate transplantation of the avulsed tooth is recommended treatment and results in good prognosis although this may not be always possible.

CASE REPORT

The present case highlights the 3-year follow-up of delayed replantation (after 15h) of maxillary central incisor which was avulsed due to trauma. The complications seen in the present case were ankylosis and inflammatory resorption, but clinically the tooth was asymptomatic and maintains the esthetics of the individual signifying the importance of delayed replantation even after prolonged extra-oral time.

CLINICAL IMPLICATIONS AND CONCLUSION

Although complications like ankylosis or root resorption may be unavoidable, delayed replantation of avulsed tooth may be a good alternative to prosthesis (implant or fixed partial denture) till the growth is completed due to preservation of the alveolar bone and psychological benefit to the patient. Also efforts should be made to educate and update children, teachers and parents regarding management of avulsed tooth at accident site and also the dentists regarding its management in dental office.

Effect of oral-transmucosal midazolam sedation on anxiety levels of 3-4 years old children during a Class II restorative procedure

AIM

A double-blind randomized control trial was conducted to assess the effect of oral-transmucosal midazolam sedation on changes in anxiety levels of precooperative children during a Class II amalgam restorative procedure.

METHODOLOGY

A sample of 40 healthy, American Society of Anesthesiologists I, children aged 3-4 years having at least one carious primary mandibular molar requiring a Class II amalgam restoration with no previous dental history were randomly divided into experimental and control groups comprising of 20 children each. The children in the experimental group (Group I) received 0.5 mg/kg body weight of midazolam mixed in strawberry syrup and those in the control group (Group II) received the same syrup mixed in saline, 15 min prior to the restorative procedure. Routine nonpharmacological behavior management techniques were used in both groups. The anxiety levels were recorded using Venham's anxiety scale at the start and end of each procedural step.

RESULTS

There was a significant (P < 0.001) reduction in the anxiety levels of children in the experimental group on entry into the operatory compared with the control group. Introduction of each fear evoking stimuli showed a somewhat similar increase in anxiety levels in the two groups. In spite of a similar trend, the anxiety levels remained much lower in Group I than in Group II.

CONCLUSION

Midazolam in conjunction with behavior management is more helpful in relaxing the child initially than behavior management alone, thus increasing the chances of successful and easy accomplishment of further treatment steps.

Correlation between mutans Streptococci counts of parents and their children residing in Chandigarh, India

Objectives: To determine the prevalence of Mutans Streptococci (MS) in children and to evaluate the relationship between the salivary levels of MS in children and their parents. Material and Methods: 100 children aged 3-6 years along with their parents (100 mothers and fathers each) were included in the study. The children were segregated depending upon their age and level of caries experience. The children were examined clinically on an ordinary chair in natural daylight using the Møller’s index criteria. Assays for Mutans Streptococci (MS) were done for both the children and their parents using the Dentocult SM strip mutans test. Collected data was assessed using SPSS software. Results: The overall prevalence of MS in the children was 83%. A statistically significant correlation (p<0.05) was observed between salivary MS counts of children and their mothers. No significant correlation was seen with the fathers. Conclusions: The findings conclude that if primary caregivers harbour high levels of MS in their saliva, it is likely that their children will have the same.

Key words:Mutans streptococci, parents, children, dentocult SM kits.

Molar incisor hypomineralisation: prevalence and clinical presentation in school children of the northern region of India

There is rarity of prevalence data on molar incisor hypomineralisation (MIH) for the Indian population and the majority of data originated from European countries.

AIM

To report on prevalence and defect characteristics of MIH for school children of the northern Indian region.

METHODS

A cross-sectional survey including 1,792, 6-9-year-old school children of Chandigarh, India was carried out using European Academy of Paediatric Dentistry (EAPD) 2003 criteria for diagnosis of MIH. In addition to descriptive analysis for distribution of various defects, comparative data analysis was carried out for inter-comparison of distribution and type of defect amongst two phenotypes, MH [first permanent molar (FPMs) involvement] and M + IH (simultaneous involvement of molars and incisors). Similar comparative analysis was performed for four subgroups on the basis of number of affected surfaces/subjects.

RESULTS

A prevalence of 6.31% was reported. FPMs (2.83 ± 0.874/subject) were more commonly affected than permanent incisors (1.19 ± 1.614/subjects). White/creamy opacity without post-eruptive breakdown (PEB) was the most common lesion, seen in 85% of subjects. MH phenotype was seen in 44% of subjects and 56% exhibited M + IH phenotype. A trend toward greater severity was seen in M + IH phenotype when compared to MH phenotype. A greater number of surfaces presented with white/creamy opacities without PEB (p < 0.05). With an increase in the number of surfaces involved the severity of MIH also increased with more frequent presence of brown defects with PEB.

CONCLUSION

With concomitant involvement of incisors, more severe presentation of MIH was seen. Also, with increase in number of affected surfaces a parallel increase in severity as well as extent of lesions was observed.

Firecracker explosion in the mouth of a 3-year-old child

Facial soft tissue injuries are commonly associated with majority of pediatric trauma cases. A rare case of soft tissue trauma caused due to explosion of a firecracker intraorally in a 3-year-old child is being presented.

Progressive changes in arch width from primary to early mixed dentition period: a longitudinal study

OBJECTIVE

The present study was conducted to evaluate, on a longitudinal basis, the changes in intercanine and intermolar widths form the primary to the early mixed dentition periods.

MATERIALS AND METHODS

A total of 38 children aged 4-5 years, with normal occlusion without any proximal caries or any dental anomalies, were selected. The impressions were recorded and casts were prepared. Intercanine and intermolar widths were measured on these dental casts with the help of a digital vernier calliper. After 3 years follow-up, the impressions were recorded again and dental casts were prepared. Intercanine and intermolar widths were measured again at this stage and were compared with the baseline data using the paired t-test and the chi square test.

RESULTS

There is a significant increase in the intercanine (3.93 + 1.70 mm) and intermolar width (1.49 + 1.77 mm) during the transition period from primary to early mixed dentition in both the arches and both the sexes. The gender-wise comparison showed a greater increase in males than in females, but this was not statistically significant.

CONCLUSION

A thorough knowledge of growth changes during various stages of the mixed dentition period are important for a pediatric dentist to make an accurate diagnosis and treatment planning during preventive and interceptive orthodontics.

In vivo remineralization of artificial enamel carious lesions using a mineral-enriched mouthrinse and a fluoride dentifrice: a polarized light microscopic comparative evaluation

BACKGROUND

Remineralization process is accelerated by the presence of fluoride ions in the oral environment, but this mechanism of caries reversal will be further enhanced if the concentration of calcium, phosphate and fluoride ions is supersaturated with respect to that of oral fluids.

AIM

This in vivo study was carried out to evaluate and compare the remineralizing efficacy of a urea-based mineral-enriched mouthrinse and a fluoridated dentifrice using an in vivo intraoral appliance model and polarized light microscopic evaluation technique.

MATERIALS AND METHODS

The specimens were prepared from sound teeth and artificial caries was produced using an artificial caries medium in vitro and enamel specimens were inserted in removable orthodontic appliances that were to be worn by 14 children of 10-15 years of age. They were divided into three groups - nonfluoridated dentifrice, fluoridated dentifrice and mineral-enriched mouthrinse groups. After the 6-month experimental period, during which the enamel specimens inserted in the intraoral appliance were subjected to one of the agents (either fluoride, nonfluoride dentifrice or mouthrinse) in vivo, the specimens were retrieved from the patients and were evaluated using the polarized light microscopic technique.

OBSERVATIONS AND RESULTS

On analysis, mineral gain occurred in all groups, viz. nonfluoride dentifrice group, fluoride dentifrice and mineral-enriched mouthrinse group. However, it was found to be complete in the mouthrinse group, i.e. both at the surface and at the subsurface (67%), while in the fluoridated dentifrice group, 43% of the samples showed mineral gain in both zones. In the nonfluoridated dentifrice group also, remineralization occurred but was limited either to the surface or the subsurface zone.

CONCLUSIONS

Urea-based mineral-enriched mouthrinse was shown to be more efficacious in the process of remineralization of artificial carious lesions.

Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal caries in primary molars using the histological gold standard: an in vivo study

AIM

This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth.

MATERIALS AND METHODS

Eighty-four primary molars in 52 children (aged 8-12 years), which were indicated for extraction, were selected and evaluated for dental caries using DIAGNOdent, visual and tactile examination and bitewing radiographs. Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for comparison of the above-mentioned methods.

RESULTS

When considering enamel caries, values obtained for sensitivity, specificity and accuracy were 48.15, 100 and 49.40% for visual examination, 48.15, 100.00 and 49.40% for tactile examination, 49.38, 50.00 and 49.40% for bitewing radiographs, 85.19, 50.00 and 84.34% for DIAGNOdent scores interpreted according to manufacturer's cut-off limits and 81.48, 100.00 and 81.93% for DIAGNOdent scores interpreted according to newly formulated cut-off limits, respectively. At dentin caries cut-off levels, the values of sensitivity, specificity and accuracy for visual examination were 52.78, 89.36 and 73.49%; 50.00, 91.49 and 73.49% for tactile examination; 30.56, 82.98 and 60.24% for bitewing radiographs; 72.22, 76.60 and 74.70% for DIAGNOdent scores when interpreted according to manufacturer's cut-off limits and 77.48, 74.47 and 75.90%, respectively, for the DIAGNOdent scores when interpreted according to the newly formulated cut-off limits.

CONCLUSIONS

DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional methods for detection of enamel caries, whereas for detection of dentinal caries, even though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other conventional caries diagnostic methods.

Dentigerous cyst in primary dentition: a case report

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown of an unerupted tooth. There is usually no pain or discomfort associated with the cyst unless there is acute inflammatory exacerbation. Management of dentigerous cyst in primary dentition needs special consideration regarding the preservation of the developing permanent tooth buds. Here, we report a case of dentigerous cyst in primary dentition in a 10-year-old male patient and its management.

Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth

Endodontic treatment was performed on 25 pulpally involved mandibular primary molars in 4 to 9-year-old children; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide, zinc oxide, and 10% sodium fluoride solution, using hand-operated lentulo-spirals. All cases were evaluated clinically every 3 months and also radiographically every 6 months to assess the success of the treatment; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material, if any, as the tooth resorbed with the passage of time. At 6 months, endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated; the remaining 22 teeth were without any signs or symptoms. At the end of 2 years, 14 teeth could be evaluated; out of these 12 had physiologically exfoliated. It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth. In three cases, where there was an overpush of the mixture, a gradual partial resorption was noted.

Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years

The prevalence of dental caries in 6, 9, 12 and 15-year-old school children of Chandigarh, selected on a randomized basis was evaluated using Moller's criteria (1966) and correlated with the various risk factors. The mean deft was found to be 4.0 +/- 3.6 in 6 year old and 4.61 +/- 3.14 in 9 year old, whereas the mean DMFT in 12 and 15 year old was found to be 3.03 +/- 2.52 and 3.82 +/- 2.85 respectively. The high prevalence of dental caries in these children was attributed to the lack of use of fluoride toothpaste (80% children), lack of knowledge about etiology of dental caries (98%) and frequency of sugar exposures up to more than five times per day (30%).

Jaw cyst-Basal cell nevus-Bifid rib syndrome: a case report

Jaw cyst-Basal cell nevus-Bifid rib syndrome or Gorlin-Goltz syndrome involves multiple organ system. The most common findings include multiple odontogenic keratocysts in the jaws and basal cell nevus on the skin that have an early age onset. These multiple odontogenic keratocysts warrant aggressive treatment at the earliest because of the damage and possible complications associated with them. Recurrence in these lesions is the most characteristic feature that has to be taken in consideration while explaining the prognosis to the patient. A case report of a child affected with Gorlin-Goltz syndrome diagnosed, treated and followed at this hospital is presented here.

Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide

PURPOSE

The purpose of this study was to compare mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2) for their efficacies and time taken for formation of apical biological calcific barriers and resolution of periapical radiolucencies, if present at baseline, in teeth with unformed apices.

METHODS

Twenty nonvital permanent maxillary incisors with unformed apices, stratified according to the size of periapical radiolucencies and stage of root development, were equally allocated to MTA and Ca(OH)2 groups. In group 1 (MTA group), after 7 days of disinfection with Ca(OH)2, MTA was packed into the apical one third of the root canals and obturation with gutta percha (GP) was performed in 90% (9/10) of cases within 15 to 30 days. In group 2 (Ca(OH)2 group), obturation was performed following clinical and radiographic depiction of the apical stop.

RESULTS

The mean time taken for apical biological barrier formation was 3 +/- 2.9 months for group 1 and 7 +/- 2.5 months for group 2 (P=.008). The periapical radiolucencies were resolved in 4.6 +/- 1.5 months for group 1 and 4.4 +/- 1.3 months for group 2 (P=.83). The total treatment was completed in 0.75 +/- 0.4859 months and 7 +/- 2.5 months for groups 1 and 2, respectively.

CONCLUSION

The 2 materials were found to be equally efficacious in the management of nonvital teeth with unformed apices. Time taken to complete the treatment and the biological barrier formation in group 1 was significantly less than that for group 2. The healing time for periapical radiolucencies was almost identical.

Efficacy and acceptabilty of oral-transmucosal midazolam as a conscious sedation agent in pre-school children

The purpose of the present study was to test the efficacy of oral-transmucosal route of administration of midazolam in young potentially un-cooperative children. A sample of 40 children up to 4 years of age with ASA I status were randomly divided into experimental and control groups of 20 each. The children in experimental group received 0.5-mg/kg-body weight midazolam mixed in strawberry syrup via the oral-transmucosal route and those in control group were given the same syrup diluted with normal saline. A class II amalgam restoration was performed and routine behavior management techniques were employed in both groups. It was found that the number of procedures successfully completed and sedation produced 15 minutes after test solution administration was significantly greater in the experimental group compared to the control group. The total treatment time was also much lesser in the experimental group children. There was no significant difference in the acceptability of the test solutions in the children of the two groups.

Folic acid and phenytoin induced gingival overgrowth--is there a preventive effect

The role of folic acid (5mg/day) in combination with oral hygiene measures (group II) vis-a-vis oral hygiene measures alone (group I) in prevention of phenytoin-induced gingival overgrowth was investigated in a one-year follow-up study on sixty, 8-13-year-old epileptic children receiving phenytoin. The allocation of the children to the two groups was done alternately. In these children, at baseline, plaque (Silness & Löe), gingivitis (Löe & Silness) and probing depths of gingival sulcus were recorded. These parameters were re-evaluated at 3-monthly intervals when gingival overgrowth was also recorded (Modified Harris & Ewalt Index). It was seen that, after a period of one year, gingival overgrowth occurred in 60 and 50 percent children of groups I & II respectively and its development, too, was delayed in group II. More cases (93 percent) in group II exhibited minimal overgrowth as against 78 percent in group I. The study concluded that systemic folic acid prescribed along with phenytoin delays the onset and reduces the incidence and severity of gingival overgrowth induced by phenytoin.

Incidence of phenytoin induced gingival overgrowth in epileptic children: a six month evaluation

Thirty children aged 8-13 years with epileptic disorders and receiving mono-drug therapy with Phenytoin, were selected from the Departments of Pediatrics and Neurology of PGIMER, Chandigarh to evaluate the development of gingival overgrowth induced by phenytoin over a period of six months. These children were evaluated at baseline at three monthly intervals for a period of six months for plaque (Silness and Loe, 1964), gingivitis (Loe and Silness, 1963) and probing depth of the gingival sulcus. Gingival overgrowth was noted as and when it developed using modified version of Harris and Ewalt Index, 1942. No attempt was made to modify the childrens' prevailing oral habits. The results indicated that gingival overgrowth in 57% of the children was in the mesio-distal dimension of the gingival papillae and occurred within six months of initiation of therapy with Phenytoin.

Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation

The purpose of this study was to compare the clinical efficacy of resin modified GIC with amalgam as a restorative material, in Class-II cavities of primary molars. Restorations were evaluated at four, eight, and twelve months for their marginal integrity, anatomic form and development of recurrent caries. When each parameter was considered separately, there was no difference in the success rate between the two groups, except development of recurrent caries significantly less (p<0.05) in RMGIC group(4.7%) compared to amalgam group (12.5%) at twelve month follow up. However, the cumulative success rate at 12 month was found to be significantly higher (p<0.05) in RMGIC (Fuji II LC) group(83.1%) compared to amalgam(72%).

A mixture of Ca(OH)2 paste and ZnO powder as a root canal filling material for primary teeth: a preliminary study

The present pilot study was conducted on five primary mandibular second molars requiring endodontic treatment to evaluate the clinical and radiographic success of root canal filling material which was a mixture of calcium hydroxide paste (1 cm), Zinc oxide powder (15 gms) and distilled water using hand operated lentulo spirals. All the five cases on clinical evaluation after 2,4,6,9, and 12 months were found to be asymptomatic with no history of pain, tenderness or abnormal mobility. Immediate post-operative radiographic evaluation revealed adequate root canal filling in all cases. The obturated material remained upto the apex of root canals till the beginning of physiologic root resorption. The roots of the primary teeth as well as the filling material mentioned above were seen to resorb at the same rate in one case.

Management of wide open apices in non-vital permanent teeth with Ca(OH)2 paste

A retrospective study on 15 non-vital immature incisor teeth was done using Ca(OH)2 Pulpdent paste. A success rate of 100 percent was achieved within one year. The variables influencing the time taken for apexification were also evaluated. The teeth were followed up to a period of 24 months. It was found that older children having narrow open apex had a shorter treatment time than the younger children (NS); teeth without periapical infection showed some amount of root growth and closing of apex that was faster than those with periapical infection (p < 0.001). The calcified bridge formed following apexification is a porous structure. This investigation provides information about the time taken and procedure required to achieve apical barrier formation in non-vital immature incisors.

Trend of dental caries in children of Chandigarh over the last sixteen years

The trend of dental caries in Chandigarh school children over a sixteen year period, studied by almost the same authors and using the same recording criteria of WHO reveals a continuous decline in 12 and 15 year children but a slight increase in the dental caries status of 5-6 year children. In 1977, the mean DMFT of 12 and 15 year children was 3.88 and 4.74 respectively. In 1985, it decreased to 1.38 in 15 year olds (12 year children not recorded) and in 1993 it marginally decreased to 1.12 +/- 1.35, much lower than the figure of 3.88 in 1977. In 5-6 year children, mean dmft/dmfs of 2.69 +/- 1.45 and 6.06 +/- 9.77 was found to be slightly higher as compared to the earlier caries prevalence figures (deft + DMFT-2.6 in 1977 and 2.26 in 1985).

Remineralizing efficacy of a mineral enriched mouth rinse and fluoridated dentifrice on artificial carious lesions: an in vivo scanning electron microscopic study

This comparative investigation was carried out to evaluate the remineralization potential on early artificial carious lesions under Scanning Electron Microscope (SEM) of a Mineral enriched mouthrinse and a fluoridated dentifrice using an in-vivo intra-oral removable appliance model. This findings revealed that the remineralization was found to have occurred in almost all the samples (in children) using non-fluoridated, fluoridated dentifrices as well as those using mineral enriched mouthrinse. However the qualitative analysis of the remineralization revealed that in case of non-fluoridated dentifrice group, the prismatic holes showed deposition of granular, variable sized particles with uneven distribution, while in fluoridated dentifrice group, deposits were found to have partially but more densely filled up the prism cores. In case of mineral enriched mouthrinse group these deposits were found to be in the form of amorphous globular precipitate.

Bioavailability of fluoride in humans from commonly consumed diets in India

There is a paucity of data on the amount of fluoride absorbed in humans from whole cooked food; especially a combination of different foods taken at regular meal times. The present study was thus aimed at estimating the amount of fluoride present and absorbed in humans from four regional representative meals viz. North Indian Vegetarian, North Indian Non-vegetarian, South Indian and East Indian. Twenty five healthy human volunteers aged 22-35 years participated in the study and each diet was tested on five volunteers. Each test diet was weighed into six equal parts, one part was kept for estimation of fluoride content and remaining five were given one each to the five test subjects in each of the four test diet groups. Eight hour plasma fluoride profiles were then studied after ingestion of weighed quantity of test diets and means calculated. The bioavailability of fluoride from these diets was evaluated in relation to that of sodium fluoride in solution form. The amount of fluoride estimated in different test diets varied between 1.53 - 10.0 mg. The bioavailability was found to be 1.6 per cent for north Indian vegetarian diet, 7.5 per cent for east Indian diet, 14.4 per cent for north Indian nonvegetarian diet and 31.7 per cent for south Indian diet, however, the amount of F(mg) absorbed in plasma from these diets was found to be low i.e. 0.06 mg, 0.75 mg, 0.72 mg and 0.48 mg respectively.

Evaluation of the change in the knowledge of community regarding infant dental care subsequent to intervention strategies through existing health manpower in rural areas of Haryana (India)

The knowledge about infant dental care (as a part of primary preventive programme) was delivered by the existing health team of CHC viz. medical doctors, multipurpose workers, health workers, Anganwadi workers (ICDS scheme), after due training from the dental experts, in the rural community of Raipur Rani (Haryana). The knowledge of community regarding infant dental care subsequent to intervention strategies when evaluated and compared to baseline values three years after intervention revealed that 72 percent of the community had the correct knowledge of prolonged breast/bottle feeding causing nursing bottle caries. 94 per cent had correct knowledge about harmful effects of thumb/finger sucking on teeth and jaw bones and 77 percent about harmful effects of mouth breathing. 98 percent of expecting mothers knew when to clean the gum pads and 62 percent how to clean the gum pads in an infant. 100 percent of the expecting mothers had the correct knowledge that pacifiers should not be used in small children.

Role of trace elements Se and Li in drinking water on dental caries experience

An epidemiological survey of dental caries using modified Moller's index (1966) carried out in 483 children (aged 7-17 years) of rural areas--Talwandi Kalan, Dhanansu and Bhatian (District Ludhiana) of Punjab with almost similar F levels in their drinking water supply, similar socio-economic status, environmental factors/demographic parameters and dietary habits revealed wide variations in the prevalence and severity of dental caries. Further investigation extended to evaluate the concentrations of various trace elements Se, Li, Zn, Cu, Fe and Mn in drinking water to find out the disparity of dental caries status, revealed that the higher figures of prevalence and severity of dental caries observed in Dhanansu and Bhatian as compared to Talwandi Kalan could be attributed to the presence of Se in drinking water supply of these areas which was not detectable in the water supply of Talwandi Kalan. On the contrary, the concentration of Li in water supply of Talwandi Kalan with low caries was found to be higher compared to that of Dhanansu and Bhatian with higher dental caries in children population.

Placental transfer of fluoride in pregnant women consuming optimum fluoride in drinking water

The study was conducted on 25 healthy women residing in optimum fluoride areas, who were to deliver normally through vaginal route, to correlate the maternal and cord plasma fluoride levels and evaluate the placental transfer of fluoride. A wide variation was found in the maternal and cord plasma fluoride levels. In only 8 percent of the cases the fluoride levels in cord plasma were higher than maternal plasma. It was deduced that the placenta allows passive diffusion of fluoride from mother to foetus and does not act as a barrier.

Evaluation of KAP of oral hygiene measures following oral health education through existing health and educational infrastructure

This study is a part of a larger preventive oral health feasibility module embarked on a population of 120,000 of Raipurrani, district Ambala (Haryana). The KAP analysis of about 2000 individuals (including school children) on cross-sectional basis at baseline, one and two years after the implementation of knowledge about oral health measures to the community utilizing the existing health infrastructure at CHC, the Anganwadi workers (ICDS Scheme) and through school teachers in the schools revealed that at baseline datun was the most prevalent (63%) oral hygiene measure used in the community and students. After implementation, the practice of brushing thrice, twice and once daily increased but the most prevalent frequency remained once a day (39% out of 66 percent using brush in community and 37% out of 76 percent in students after 2 and 11/2 years of implementation respectively) followed by twice a day (23 & 31% respectively). A similar pattern of frequency was observed about datun users also, though the number using datun substantially declined from 62% to 33% in community and 63 to 23% in students after implementation.

Plaque pH modulations of children's favourite snacks

Cariogenic potential of a few children's favourite snacks, assessed by evaluation of pH modulations on their respective consumption after 2,5,10,20,30 and 40 minutes compared to 10 percent sucrose control using pooled plaque method, in 8-12 years old children revealed lollipop (hard sucking candy) to be the most cariogenic and samosa without chutney to be the least cariogenic. The cariogenic potential of ice creams were similar, however, low as compared to sucrose solution of 10 percent.

Evaluation of existing status of knowledge, practice and attitude towards oral health of rural communities of Haryana--India

The KAP survey on oral health practices of 3247 individuals, 6-60 years of age, of Sidhaura block of Haryana revealed that use of dattan was more prevalent (56% in adult community & 49% students) than tooth brush (35% adult community & 34% students). 37% of the total community had the knowledge of brush being the best oral hygiene measure. 25% of the community using brush were brushing only once/day. The knowledge of the community regarding the role of fluorides in prevention of dental caries was completely lacking: 1.8% of the community was using fluoride dentifrice. 35-45 percent of the community were practising sweet foods/drinks etc. four times a day. The snyder test showed a positive relation with frequency of sugar intake.