Comparison of clinical performance of obturating materials in pulpectomies: A randomized clinical trial

BACKGROUND

Chemomechanical debridement is insufficient to disinfect all bacteria from the root canals of primary teeth, and obturation of canals with an appropriate material thus acquires excellent importance and remains a critical step in the ultimate success of pulpectomy.

AIM

The aim of the study was to compare and evaluate Endoflas, Metapex, and a mixture of calcium hydroxide (CH) and zinc oxide (ZnO) as obturating materials (OMs) in primary mandibular second molars.

MATERIALS AND METHODS

Seventy-five mandibular second primary molars requiring pulpectomies were identified in children aged 4-8 years. They were randomly allocated to the three treatment groups according to the type of OM received using the block randomization technique. After the completion of chemomechanical debridement, the canals were filled with Endoflas, Metapex, and CH-ZnO mixture, respectively. The intergroup clinical and radiographic comparison was made based on Coll and Sadrian criteria to decipher their clinical performance at 1, 3, and 6 months.

RESULTS

No statistically significant differences between the groups were observed at any evaluation time interval (P > 0.05). At 6 months, the clinical success rates were 95.2% in Endoflas, 96% in Metapex, and 95.8% in the CH and ZnO mixture groups, respectively. The materials, however, behaved differently in different clinical situations.

CONCLUSION

Based on the observations, all three OMs showed similar clinical success in maintaining tooth functioning, but their use can be restricted to indications. However, prospective studies with longer follow-ups with more stringent eligibility criteria are required to reach more definitive conclusions.

Influence of periodontitis and diabetes on structure and cytokine content of platelet-rich fibrin

BACKGROUND

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate with multiple applications in wound healing and regeneration in both periodontitis and diabetes. However, the three dimensional (3-D) structure and cytokine content of PRF might be altered in patients suffering from either/both of the chronic inflammatory conditions, ultimately influencing the efficacy of PRF as a biomaterial for regenerative medicine.

AIM

The aim of the present study was hence to evaluate the effect of both these chronic inflammatory diseases on the 3-D structure of PRF membrane. An attempt was also made to compare the growth factor content between the plasma and RBC ends of the prepared PRF gel.

MATERIALS & METHODS

L-PRF was prepared for twenty participants, healthy (5), periodontitis (5), T2DM (5) and T2DM with periodontitis (5). Porosity and fiber diameter of PRF membranes was visualized under FE-SEM and measured using ImageJ Software. PDGF-BB and TGF-β1 levels in PRF gel were assessed by ELISA.

RESULTS

The average diameter of fibrin fibers under FE-SEM was 0.15 to 0.30 micrometers. Porosity was higher at the plasma end (p = 0.042). Red blood cell (RBC) end of the membrane had thinner fibers arranged in a comparatively more dense and compact structure with smaller porosities. Healthy subjects had the least porous PRF compared to subjects with either/both of the chronic conditions. PDGF-BB levels were similar along all the four groups. TGF-β1 levels were highest in healthy subjects.

DISCUSSION

3-D structure and growth factor content of PRF are influenced by a person's periodontal and/or diabetic status. The RBC end of the PRF membrane, as compared to the plasma end, has thinner fibers arranged in a comparatively more dense and compact structure with smaller porosities, and hence should be favored during periodontal regenerative procedures.

CONCLUSION

Both periodontitis and diabetes have a significant influence on the 3-D structure and growth factor content of PRF produced.

Validation of a noninvasive aMMP‐8 point‐of‐care diagnostic methodology in COVID‐19 patients with periodontal disease

Objectives

The aim of this study was to validate an active matrix metalloproteinase (MMP‐8) point‐of‐care diagnostic tool in COVID‐19 patients with periodontal disease.

Subjects, Materials, and Methods

Seventy‐two COVID‐19‐positive and 30 COVID‐19‐negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP‐8 (aMMP‐8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse‐based kit for general disease activity. In COVID‐19‐positive patients, the kits were run again once the patients turned COVID‐19 negative.

Results

The overall (n = 102) sensitivity/specificity of the mouthrinse‐based kits to detect periodontal disease was 79.41%/36.76% and that of site‐specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746–0.869 (p < .001) and 0.740–0.872 (p < .001) (the aMMP‐8 mouth rinse and site‐specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP‐8 mouth rinse test (p = .302) and aMMP‐8 site‐specific test (p = .189) once the subjects recovered from COVID‐19.

Conclusions

The findings of the present study support the aMMP‐8 point‐of‐care testing (PoCT) kits as screening tools for periodontitis in COVID‐19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user‐friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.

Oral Health-related Quality of Life of Children with Early Childhood Caries before and after Receiving Complete Oral Rehabilitation under General Anesthesia

Introduction

Early childhood caries (ECC) significantly affects the quality of life of children due to recurrent pain, infection, and other associated problems.

Aim and objective

To assess the change in oral health-related quality of life of children aged <5 years undergoing complete oral rehabilitation under general anesthesia.

Materials and methods

A total of 50 healthy children affected with ECC were enrolled for the present study. Oral health-related quality of life (OHRQoL) of every child was assessed by interviewing the mothers using a prevalidated Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire one day prior to the treatment appointment and comparing the scores with those at 1 and 3 months post-treatment to evaluate the changes in the OHRQoL, if any and assess the stability of the changes.

Results

The results revealed a statistically significant reduction in Ouality of Life (QoL) scores of all the domains and total ECOHIS scores between baseline and 1 month, and baseline and 3 months. Conclusion: The oral health-related quality of life showed a significant improvement after complete oral rehabilitation under general anesthesia and the improvement persisted beyond the immediate post-treatment period.

How to cite this article

Raghu R, Gauba K, Goyal A, et al. Oral Health-related Quality of Life of Children with Early Childhood Caries before and after Receiving Complete Oral Rehabilitation under General Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S117–S123.

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.

Systematic content analysis of online information on herbal smoking products

BACKGROUND

Herbal smoking products (HSPs) are marketed as a safer alternative to tobacco. These are easily available at affordable prices in the online retail websites. This study aimed to analyze the HSP-related informational content available in the most popular online platforms.

METHODS

Google, Yahoo, Bing and YouTube online platforms were searched for HSP related content using appropriate keywords. First 50 search results were retrieved and screened for potential eligibility. The included web-pages were categorized as video and still records. From each included record, information regarding source, primary theme, health benefits/hazards and tone was abstracted. Additionally, video production quality, like ratio and video power index was also computed for each video record. All included records were subjected to descriptive statistics and Chi-square test, as appropriate. Level of significance was set at <0.05.

RESULTS

174 still and 94 video records were included. 35.6% of the included still records were sourced by manufacturers/suppliers while that of scientific origin was 12.1%. 83% of the video-records were posted by general public. About 90% of the included records had not mentioned anything regarding age restrictions. 67.8% of the still records and 87.2% of the video records promoted the use of HSPs.

CONCLUSIONS

The informational content presented online is huge, mostly posted by the general public without any scientific rationale and exclusively favors the use of HSPs. There is no age restriction as to who can access the information, making this content easily accessible to people of all ages. Such spread of information may mislead the public in adopting the smoking of these herbal products. Since HSPs may act as a potential gateway to tobacco smoking, there is an urgent need to regulate the content available online.

Active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) in the COVID-19 pandemic

INTRODUCTION

Active matrix metalloproteinase (aMMP)-8 utilized in point-of-care testing (POCT) is regarded as a potential biomarker for periodontal and peri-implant diseases. Various host and microbial factors eventually influence the expression, degranulation, levels and activation of aMMP-8. The type of oral fluids (saliva, mouthrinse, gingival crevicular, and peri-implant sulcular fluids [GCF/PISF], respectively) affect the analysis.

AREAS COVERED

With this background, we aimed to review here the recent studies on practical, inexpensive, noninvasive and quantitative mouthrinse and GCF/PISF chair-side POCT lateral flow aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) and how they help to detect, predict, monitor the course, treatment and prevention of periodontitis and peri-implantitis. The correlations of aMMP-8 POCT to other independent and catalytic activity assays of MMP-8 are also addressed.

EXPERT OPINION

The mouthrinse aMMP-8 POCT can also detect prediabetes/diabetes and tissue destructive oral side-effects due to the head and neck cancers' radiotherapy. Chlorhexidine and doxycycline can inhibit collagenolytic human neutrophil and GCF aMMP-8. Furthermore, by a set of case-series we demonstrate the potential of mouthrinse aMMP-8 POCT to real-time/online detect periodontitis as a potential risk disease for coronavirus disease 2019 (COVID-19). The clinical interdisciplinary utilization of aMMP-8 POCT requires additional oral, medical, and interdisciplinary studies.

The clinical association between Periodontitis and COVID-19

OBJECTIVES

The study aimed to clinically assess the association between periodontitis and COVID-19-related outcomes.

MATERIAL AND METHODS

Data pertaining to patient demographics, medical history, blood parameters, periodontal clinical examination and aMMP-8 point-of-care diagnostics (both site-level and patient-level) was recorded for eighty-two COVID-19-positive patients. COVID-19-related outcomes such as COVID-19 pneumonia, death/survival, types of hospital admission and need of assisted ventilation were also assessed.

RESULTS

Males were predominantly afflicted with COVID-19, with advanced age exhibiting a greater association with the presence of periodontitis. Higher severity of periodontitis led to 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of being deceased and 4.42 odds of COVID-19-related pneumonia. The aMMP-8 mouthrinse kit was slightly more sensitive but less specific than aMMP-8 site-specific tests.

CONCLUSIONS

Based on the findings of the present study, periodontitis seems to be related to poorer COVID-19-related outcomes. However, within the constraints of this work, a direct causality may not be established. Periodontitis, by means of skewing the systemic condition for a number of comorbidities, may eventually influence COVID-19 outcomes in an indirect manner.

CLINICAL RELEVANCE

The study is the first to clinically, and by means of a validated point-of-care diagnostic methodology, assess the association between periodontal health and COVID-19-related outcomes. Assessment of the periodontal status of individuals can aid in the identification of risk groups during the pandemic along with reinforcing the need to maintain oral hygiene and seeking periodontal care.

Modelling the impact of increase in sugar prices on dental caries in India

OBJECTIVES

This study aims to assess the impact of raising the price of sugar and/or sugar-sweetened beverages (SSBs) on caries incidence in the Indian population.

METHODS

A tooth-level decision-analytic model was developed to evaluate a change in caries increment after increasing the price of Sugar and SSBs. The transition of a tooth from a caries-free state to the state of tooth loss in both scenarios was modelled with the help of a Markov model for a time horizon of 63 years, ranging from 2021 to 2083 for the 12-year-old population cohort of India. A conceptual framework was designed to implicate the possible effects of an increase in sugar prices on the reduction of caries incidence. Health effects were estimated in terms of the number of carious lesions and tooth-loss in both the scenarios and modelled as a product of the dose-response relationship between sugar intake and caries incidence. The model was thus used to establish the number of caries lesions prevented, and tooth-loss avoided. Uncertainties in the parameters were assessed using probabilistic sensitivity analysis. The Monte Carlo method was used for simulating the results 999 times.

RESULTS

A 20% rise in the price of sugar is expected to result in the prevention of an average of 1.32 teeth in a lifetime of an individual and prevent 27.96 million tooth-loss incidents among the population cohort of India that will eventually lead to a saving of INR (₹) 3116.32 billion (US$ 42.69 billion) on account of dental caries treatment. Similarly, increasing-price of SSBs by 20% will lead to a 0.86% reduction in carious teeth incidence in an individual's lifetime.

CONCLUSION

Increasing the cost of sugar and/or SSBs will reduce the daily intake of sugar, which will reduce caries incidence and subsequent progression, thereby preventing caries-attributed tooth-loss and saving treatment costs.

Remineralization potential and caries preventive efficacy of CPP-ACP/Xylitol/Ozone/Bioactive glass and topical fluoride combined therapy versus fluoride mono-therapy - a systematic review and meta-analysis

OBJECTIVE

To compare the remineralization potential and caries preventive efficacy of CPP-ACP/bioactive glass/xylitol/ozone and topical fluoride (TF) combined therapy versus TF mono-therapy.

MATERIAL AND METHODS

Embase, PubMed, Scopus, Web of Science and Cochrane databases were searched. 4457 records were screened and 26 trials were included. Data from 16 trials was pooled using Review Manager 5.4. Level of significance was p < .05. The certainty of the evidence was evaluated using GRADE.

RESULTS

Pooled analysis of two trials for white spot lesions (WSLs) regression (SMD -0.6, 95% CI: [-1.07 to -0.14], p = .01) and three trials for post-intervention DIAGNOdent values (SMD -1.24, 95% CI: [-1.96 to -0.52], p = .0007) significantly favoured CPP-ACP-TF combined therapy over TF mono-therapy. The sub-group analysis for caries increment (SMD -0.14, 95% CI: [-0.21 to -0.07], p < .0001) and the post intervention S mutans count (SMD -0.42, 95% CI: [-0.62 to -0.23], p < .0001) significantly favours 'xylitol-TF' and 'CPP-ACP-TF' combined therapy respectively. The high/unclear risk of bias, imprecision and indirectness of the included trials presented a low certainty of evidence.

CONCLUSION

CPP-ACP-TF exhibits superiority over TF monotherapy in remineralizing existing lesions and demonstrates better antibacterial effect, whereas it is not more effective for preventing caries incidence. However, Xylitol exerts an added benefit over fluoride alone in preventing caries increment. The low-certainty evidence highlights the need for more good quality trials.

Buccal swabs as non-invasive specimens for detection of severe acute respiratory syndrome coronavirus-2

Introduction

The current gold standard for detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA involves subjecting nasopharyngeal or oropharyngeal swabs to reverse transcription quantitative PCR (RT-qPCR). However, both sample types need to be collected by trained professionals. Using self-collected buccal swabs as an alternative could simplify and accelerate diagnosis of coronavirus disease 2019 (COVID-19).

Objective

To assess self-collected buccal swab samples as an alternative method for SARS-CoV-2 detection in patients with COVID-19.

Methods

Buccal swab samples were self-collected by 73 patients with COVID-19. Total RNA was extracted using Qiagen kits. RNA encoding the SARS-CoV-2 Env protein and human RNase P as an internal control was amplified using the TRUPCR^® SARS-CoV-2 RT-qPCR kit version 2.1 and a Bio-Rad CFX96 Real-Time Detection System.

Result

The sensitivity of RT-qPCR from buccal swabs was 58.9% (43/73; 95% confidence interval [CI] 46.77%–70.27%) and that of RT-qPCR from saliva was 62.90% (39/62; 95% CI 49.69%–74.84%) taking positive SARS-CoV-2 RT-qPCR from nasopharyngeal swabs as the gold standard.

Conclusion

Self-collected buccal swabs are promising alternatives to nasopharyngeal or oropharyngeal swabs for SARS CoV-2 detection.

Comparing the Effectiveness of Topical Fluoride and Povidone Iodine with Topical Fluoride Alone for the Prevention of Dental Caries among Children: A Systematic Review and Meta-analysis

Background

Combined use of povidone iodine (PI) along with topical fluorides (TF) has been suggested as a promising strategy to reduce dental caries incidence and cariogenic bacterial load. However, the available literature presents mixed evidence regarding its effectiveness as compared to TF application alone.

Aim and objective

'TF + PI' vs TF alone in the prevention of dental caries among 1-12-year-old children assessed through caries increment and mean S. mutans and Lactobacillus counts.

Materials and methods

Five databases (Cochrane Central Register of Controlled Trials, EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for relevant literature. Out of 72 studies that were screened, 7 eligible studies were included out of which 4 studies were subjected to meta-analysis. The generic inverse variance test was used to assess the primary outcome reported as mean ± SD/events occurred (caries incidence), whereas for mean post-intervention S. mutans colony count, inverse variance function was used. The Cochrane's Collaboration tool and Modified Downs and Black scoring criteria were used to evaluate the quality of the included articles. Heterogeneity across the studies was assessed using the I ² statistic. Statistical significance was set at p < 0.05.

Results

Overall, for primary and permanent dentition combined, the dental caries incidence was found to be significantly lower in the 'TF + PI' combined therapy group as compared to TF alone [SMD -0.4 (-0.78 to -0.03), p = 0.04]. The two groups showed no significant difference with respect to post-intervention S. mutans count [SMD -0.1 (-0.57 to +0.37), p = 0.69]. No study was found that compared post-intervention Lactobacillus count between the two groups.

Conclusion

Based on the pooled analysis from the limited literature available, there is a very low quality of evidence that 'TF + PI' combined therapy is more effective in the prevention of new caries lesions among 1-12-year-old children as compared to TF use alone. Future clinical trials with robust methodologies are recommended to generate conclusive evidence.

Clinical significance

PI application might exert an added benefit with TF in preventing the occurrence of new carious lesions among 1-12-year-old children.

How to cite this article

Gupta A, Nishant, Sharda S, et al. Comparing the Effectiveness of Topical Fluoride and Povidone Iodine with Topical Fluoride Alone for the Prevention of Dental Caries among Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2020;13(5):559-565.

Herbal smoking products: a systematic content analysis and mapping of the e-retail market

OBJECTIVE

To assess the online availability and e-marketing strategies of herbal smoking products (HSPs).

METHODOLOGY

Google, Yahoo and Bing were searched using relevant keywords related to HSPs. The first 50 records were retrieved and duplicates were removed. Two trained and calibrated authors screened the records according to the eligibility criteria and extracted data from each selected retail-webpage as per the pre-tested data extraction form.

RESULTS

Out of the initial 1044 records obtained, 73 retail webpages were finally included. Most of the webpages about HSPs hailed from India followed by the USA. The results showed 24 brands with about 189 flavour variants that are readily available online to all age groups including minors, with price per pack (20 sticks) of herbal cigarettes ranging from INR (₹) 51 to 1830 (median 588). There are no regulations regarding the sale and marketing of HSPs concerning age restrictions and display of health warnings.

CONCLUSION

HSPs are readily available online at affordable prices and attractive variants for customers of all ages. The flavour appeal and the health benefit appeal is being used to target minors and young women. There is an urgent need for some regulations on the sale and e-marketing of such products that have an enormous potential to be used as a gateway to tobacco smoking.

Endodontic Management of Complicated Vertical Crown-Root Fracture in Deciduous Molars: Report of Two Cases

Dental traumatic injuries most commonly occur in the primary and mixed dentition, but vertical complicated crown-root fractures are rarely seen in children. Clinical and radiographic examination of these injuries helps in accurate diagnosis and management. According to the International Association of Dental Traumatology guidelines, treatment usually involves extraction followed by placement of a space maintainer. Cases of complicated crown and root fracture in primary posterior teeth are often unnoticed by the clinician, at the time of injury. Two such patients are presented, who reported symptoms a few weeks after their accident. They were managed conservatively by initial stabilization with stainless steel crowns, followed by root canal therapy. This report highlights the need for referral to specialists and emphasizes the importance of conservative management of primary teeth to maintain functional demands.

Adherence to the tobacco-free educational institution guidelines at schools of Raipur Rani, Haryana

Tobacco-Free Educational Institution (ToFEI) guidelines are required to be followed by the schools. This cross-sectional study conducted in the year 2019 assessed the accordance with ToFEI guidelines among all the 84 schools of Raipur Rani educational block, Haryana. Investigators collected data from all the government (71) and private (13) schools during school working days. Tobacco sales within 100 yards of the school premises was covertly observed. None of the schools thoroughly complied with the tobacco-free school policy, though the compliance score for private schools (26.77 ± 19.15) was better than the government schools (13.65 ± 4.38). Only two private schools achieved the mandatory score of 50. All private schools and few government schools (42.3%) had successfully implemented the ban on tobacco sale within 100 yards of the school. None of the schools could achieve a ToFEI status in the present study. The policymakers and implementers should prioritize ToFEI agenda & support schools in achieving tobacco-free status.

Effect of an Oral Health Preventive Protocol on Salivary Parameters and Gingival Health of Children with Type 1 Diabetes

Context

Type 1 diabetic children exhibit poorer oral health than general population. However, no oral health preventive protocol exists for attending to the oral health needs of such children.

Aim

To evaluate the effect of an oral health preventive protocol on salivary parameters and gingival health of children with type 1 diabetes mellitus over a period of 6 months.

Materials and methods

Fifty diabetic children, aged 6–12 years were selected and divided into two groups. Children in group I received a comprehensive oral health preventive protocol. The parameters recorded were oral hygiene practices, salivary flow rate, pH, buffer capacity, viscosity, electrolytes, and plaque and gingival indices. These were compared at baseline, 3-, and 6-month intervals.

Statistical analysis

Statistical analysis was done using IBM SPSS STATISTICS (version 22.0). Tests were based on the type of data.

Results

The intervention group (group I) showed favorable improvements in the parameters assessed. A greater number of participants adopted the correct oral hygiene methods. Unstimulated salivary flow rate increased from 0.36 ± 0.21 to 0.82 ± 0.16 mL/minute in group I and from 0.32 ± 0.24 to 0.58 ± 0.16 mL/minute in group II after 6 months (p = 0.001). Salivary buffer capacity increased from 3.07 ± 2.64 to 10.40 ± 0.82 in group I while in group II, it improved from 3.20 ± 1.47 to 9.33 ± 1.44 (p = 0.02). Salivary viscosity decreased in group I from 1.97 ± 0.42 to 1.15 ± 0.06 and from 1.97 ± 0.35 to 1.23 ± 0.11 in group II after 6 months (p = 0.02). Gingival scores changed from 1.07 ± 0.35 to 0.20 ± 0.23 in group I and from 1.04 ± 0.28 to 0.85 ± 0.25 in group II (p = 0.001).

Conclusion

The preventive protocol used in the present study showed a significant (p < 0.05) improvement in the parameters assessed.

How to cite this article

Singh V, Gauba K, Goyal A, et al. Effect of an Oral Health Preventive Protocol on Salivary Parameters and Gingival Health of Children with Type 1 Diabetes. Int J Clin Pediatr Dent 2021;14(1):109–114.

Awareness among pediatricians regarding oral health care in children including those with special health care needs: A cross- sectional survey

Background:

Pediatricians are the custodians of the overall health of children and are the ideal healthcare personnel to impart information and instruction about oral health care. The aim of this survey was to evaluate awareness of pediatricians regarding oral health care and prevention of oral diseases in children.

Methodology:

The study participants consist of 102 young pediatricians working as Junior and Senior Residents. A questionnaire was formulated to evaluate their knowledge about oral diseases and their prevention. The questionnaire also tested the attitude and practices of pediatricians towards oral health of children with special health care needs.

Results:

Majority of the pediatricians had correct knowledge about dental caries (60%), bottle feeding (88.2%), tongue cleaning (83.3%) and medication causing gum enlargement (92.2%). Few had correct knowledge about recommended age to start tooth brushing (35.3%) and maximum recommended sugar exposures per day (35.3%). Although, majority (62.7%) had correct knowledge about fluoride and its role caries prevention, very few (2.9%) knew about recommended fluoride concentration in toothpaste for children.

Conclusion:

There was a lack of knowledge amongst pediatrician about oral health care, prevention, and appropriate referral. The study result necessitates the emphasis of improving oral health related knowledge among pediatrician.

A community-based pragmatic, controlled trial for preventing and reducing oral diseases among 1-6-year-old children visiting Anganwadi centers, under the Integrated Child Development Scheme, India

BACKGROUND

Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years.

METHODS

Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1-6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs.

DISCUSSION

ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1-3-year-old children for three consecutive years and cross-sectional follow up of all available 1-6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program.

TRIAL REGISTRATION

This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).

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.

Effect of oral health behavior and demographic variables on gingival health in 11-16-year-old school children in Chandigarh, India: A cross-sectional study

AIMS

The aims of the present study were to assess the prevalence and pattern of gingival bleeding on probing (BOP) and to evaluate the effect of oral health behavior and demographic determinants on gingival health in 11-16-year-old school children in Chandigarh, India.

METHODS

A cross-sectional study, using stratified random sampling, was conducted across two age groups, 11-13 years and 14-16 years, and two socioeconomic strata: upper and lower. The World Health Organization (WHO) Oral Health Questionnaire for Children was used to record the data, and the WHO Community Periodontal Index (modified) was used to assess gingival BOP.

RESULTS

Among all the 2294 children examined, an estimated 54.2% had gingival BOP. The odds of BOP were also higher in the younger age group (odds ratio [OR]: 1.261, 95% confidence interval [CI]: 1.068-1.487, P = 0.006), higher for boys (OR: 1.200, 95% CI: 1.017-1.416, P = 0.031), and lower in the upper strata (OR: 0.805, 95% CI: 0.682-0.951, P = 0.011). Gingival BOP was 58.5% in the mandibular and 41.5% in the maxillary arch (P < 0.0001); χ² -test found tooth cleaning frequency to be a significant contributing factor for gingival BOP (P = 0.014).

CONCLUSIONS

An inverse co-relation of gingival BOP with age, socioeconomic status, and a higher prevalence in boys was observed, necessitating periodic preventive dental education, particularly focusing on the target group. Additionally, early screening and prompt treatment to intercept the disease is advocated.

Rare case report of idiopathic gingival fibromatosis in childhood and its management

Idiopathic gingival fibromatosis (GF), also known as gingivomatosis, is a rare condition in childhood, with an unknown aetiology. The oral manifestations of the condition are varied and depend on the severity and age of involvement. This paper describe the case of a 5-year-old male child with extensive gingival enlargement covering almost all the maxillary and mandibular teeth resulted in difficulty with speech, mastication and poor aesthetics. Clinical and radiographic examination along with haematological investigations ruled out any systemic association. The case was managed with conventional scalpel blade surgery along with electrocautery under general anaesthesia yielding good results without any recurrence after a 12-month follow-up. The results revealed that the oral manifestations of GF depend on its severity and the age of onset. Timely intervention can help to prevent associated complications in a growing child.

Comparative evaluation of three different recording criteria of dental fluorosis in a known endemic fluoride area of Haryana

Background & objectives:

Various indices are available to record different grade of severity of dental fluorosis. These indices have chances of inter- and intra- examiner variability. Therefore, study was conducted to compare three different indices for recording dental fluorosis to find out the best and most practical index of recording dental fluorosis for field studies in children living in a fluoride endemic area.

Methods:

The severity grades were recorded in 300 schoolchildren aged 12-15 yr having dental fluorosis of low, medium and high fluoride areas using three different indices, viz. Dean's fluorosis index (1942), tooth surface index for fluorosis (TSIF, 1984) and ICMR index (2013). Dean's index was used as gold standard.

Results:

The occurrence of moderate and severe cases was higher as per the Dean's index and of mild and severe cases was higher as per the TSIF and the ICMR index. The mean time required for recording dental fluorosis as per Dean's index and TSIF was similar and almost double (1.25±0.05 min) of that required for ICMR index (0.68±0.20 min). The intra-examiner variability was found to be least in the ICMR index compared to Dean's index and TSIF.

Interpretation & conclusions:

The ICMR index is a simple index with objective scores and takes less time in recording the dental fluorosis as compared to Dean's index and TSIF in field studies.

Congenital granular cell tumor of the newborn - Spontaneous regression or early surgical intervention

Congenital granular cell tumor of the newborn is a benign, relatively innocuous hamartomatous lesion arising from the alveolar ridge. Large lesions often warrant prompt surgical removal owing to the associated difficulty in breastfeeding and respiration of the infant. However, for medium-sized lesions, another approach could be observed for spontaneous regression. The present case report highlights the use of a combination approach for management of tumor in a 2-day-old female child presenting with a large protruding mass from the mouth associated with difficulty in breastfeeding. A combination of observation for regression in size followed by electrosurgical removal of the tumor was done. The infant was followed up regularly over a long period of 3 years to assess any adverse effects of surgical intervention on the maxillary primary anterior dentition of which none were recorded.

Dentofacial characteristics in a child with Meier-Gorlin syndrome: A rare case report

Meier–Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by the triad of microtia, absent or small patellae and short stature. The other associated clinical features may include developmental delay, congenital pulmonary emphysema, gastro-esophageal reflux, urogenital anomalies, such as cryptorchidism and feeding problems. The facial characteristics during childhood are typical, comprising of a small mouth with full lips and micrognathia/retrognathia. The condition is rare affecting about one to nine individuals per million. Mutation in the genes of pre-replication complex involved in DNA-replication is detected in the majority of patients. This impedes the cellular proliferation resulting in a reduction of total cell number and thereby retardation of overall growth. This case report describe the typical dentofacial characteristics in a 5 years old child affected with Meier-Gorlin syndrome along with other associated anomalies and a multidisciplinary approach for their management.

Modified closed cap splint: Conservative method for minimally displaced pediatric mandibular fracture

Mandibular fracture in younger children is the most common facial fracture among all the facial fracture in the sequence of condyles followed by symphysis/parasymphysis and body of the mandible. Symphysis/Parasymphysis fracture of mandible can be minimally displaced or severely displaced depending upon the severity of the injury. This case report highlights the simple, reliable method of minimally displaced fracture i.e. modified closed cap splint for stability of the fracture segments in pediatric patients.

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.

Effect of health education on awareness about oral cancer and oral self-examination

CONTEXT

Oral cancer is preceded by visible changes in the oral mucosa. These lesions can be detected by oral self-examination, but awareness about oral cancer is still low in developing countries.

AIM

To evaluate the effect of health education on awareness about oral cancer and oral self-examination.

SETTINGS AND DESIGN

Quasi-experimental trial was conducted in an urban resettlement colony of Chandigarh, India.

MATERIALS AND METHODS

A brochure having information and pictorials on oral lesions was used for conducting health education sessions on a one-to-one basis in the household setting among 85 males in age group 15-59 years during 2013, and each participant was encouraged to perform an oral self-examination. Study participants were interviewed about their awareness on oral cancer and oral self-examination before- and after-health education using a pretested interview schedule.

STATISTICAL ANALYSIS

Awareness items were scored, and mean change in awareness score was computed. Paired t-test was used for testing statistical significance.

RESULTS

Thirty-three percent of the study participants were current smokers, 25% consumed alcohol, and 9.4% chewed tobacco. The awareness scores after health education increased significantly from 5.3 to 6.7 (P < 0.05), and 34% of the tobacco or alcohol users expressed their intention to quit these habits, and two persons actually quit tobacco chewing. Out of the 77 study participants who performed oral self-examination, nine were able to detect lesions, and one was found to have submucous fibrosis.

CONCLUSIONS

Health education intervention was able to initiate a favorable behavior change in the community. Hence, oral self-examination programs should be promoted.

Risk factors and prevalence of dental fluorosis and dental caries in school children of North India

The aim of the study was to assess the prevalence of dental fluorosis, dental caries, and associated risk factors in the school children of district Fatehgarh Sahib, Punjab, India, using a cross-sectional study design. Oral health status of children aged between 8 and 15 years was assessed using World Health Organization (WHO) 2013 criteria. Dental fluorosis was assessed using Dean's index, and dental caries were recorded using decayed, missing, filled/decayed, extracted, filled (DMF/def) indices. Four hundred school children were examined, of which 207 were in the 8-11-year-old group and 193 were in the 12-15-year-old group. The overall prevalence of dental fluorosis was 4.1%, which might be linked to a high concentration of fluoride in drinking water at certain locations of rural Punjab. The prevalence of dental caries was 36.5% with a mean DMF score of 0.3 and def score of 0.6. Risk factors for dental caries include oral hygiene behavior and sugar consumption patterns. The study highlights the need to increase awareness about the oral health and hygiene among the school children in India.

Unusual root development following surgical repositioning of horizontally developing central incisor

Dilaceration is one of the causes of maxillary central incisor eruption failure. If the dilacerated maxillary permanent central incisor is in a horizontal or vertical position and root formation is in early stages, surgical repositioning is frequently the treatment of choice. In this article, the case of a horizontally impacted and dilacerated maxillary central incisor is presented which was treated by surgical repositioning. The tooth developed an unusual form of the root with discontinuity at the middle third region with the coronal and apical parts growing separately. Radiographic and clinical monitoring of the case was regularly performed. The tooth completely erupted in 2 years after the repositioning and even after 6 years of surgery is currently successfully functional in the arch with the malformed root. This article highlights the ability of Hertwig's epithelial root sheath to withstand trauma and its ability to recover.

Comparison of risk indicators of dental caries in children with and without cleft lip and palate deformities

Objective:

To test the hypothesis that there are no differences in various risk factors of dental caries among children with cleft lip and palate when compared to non-cleft high caries risk and non-cleft caries free children.

Design:

Seventy-three children in the age range of 4–9 years comprised three groups; Group-I (n = 23, children with cleft lip and palate), Group-II (n = 25, non-cleft high caries risk children) and Group-III (n = 25, non-cleft caries free children). Various risk factors for dental caries like type of oral hygiene practice, sugar exposures/day, developmental defects of enamel, caries activity, salivary streptococci mutans levels and lactobacilli levels were evaluated and compared among the three groups of children.

Results:

The mean deft score among Group-II children was significantly more (P < 0.01) as compared to the Group-I children. The mean deft + DMFT score among Group-I and Group-II children was comparable (P = 0.149). Developmental enamel defects were more among Group-I children as compared to Group-II and Group-III children (P < 0.01). Hypoplasia of the maxillary anterior teeth was more common among Group-I children as compared to Group-II (P < 0.05) and Group-III children (P < 0.001). The association between hypoplastic teeth and dental caries was significant (P < 0.05). The salivary acidogenic potential as evaluated by Snyder test was comparable among Group-I and Group-II children. The salivary streptococcus mutans levels in Group-I and Group-II children were higher when compared to lactobacillus counts.

Conclusion:

The risk factors of dental caries among children with cleft lip and palate were more as compared to non-cleft high caries risk and non-cleft caries free children.

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.

Sinus histiocytosis with massive lymphadenopathy: a "massive" misnomer

Sinus histiocytosis with massive lymphadenopathy also known as Rosai-Dorfman disease is a rare, benign, histiocytic disorder of unknown origin characterized by lymphadenopathy. Since its original description by Rosai and Dorfman in 1969, small number of cases has been reported; hence no specific diagnostic criteria and treatment guidelines have been suggested. The purpose of this article is to present and discuss a case of Rosai Dorfman Syndrome in 4-year-old child diagnosed with the help of Fine Needle Aspiration Cytology. The swelling resolved over a period of 18 months without any recurrence in 2-year follow-up period. This case report highlights the role of Fine Needle Aspiration Cytology in the diagnosis of Rosai-Dorfman disease and the importance of regular follow ups using a careful wait and watch approach in its management. The report also briefly discusses the various dilemmas associated with its diagnosis and treatment.

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.

Brachman de Lange syndrome

Brachman de Lange syndrome or Cornelia de Lange syndrome (CdLS) is a genetic disorder which can lead to severe developmental anomalies. It affects both the physical and intellectual development of a child. It is characterized by skeletal, craniofacial deformities, gastrointestinal and cardiac malformations. This syndrome is of rare occurrence and affects between 1/10,000 and 1/60,000 neonates. Diagnosis is based on the characteristic phenotype, in particular, a striking facial appearance, prenatal and postnatal growth retardation, various skeletal abnormalities, hypertrichosis, and developmental delay. Here, we present the case of a 13-year-old patient, with micrognathia, delayed eruption, multiple carious teeth, missing teeth and periodontal problems together, which had never been reported before. The father was also found to have the same missing teeth as the girl child.

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.