Angiogenesis Inhibitor Drug-induced Benign Migratory Glossitis in a Patient of Juvenile-onset Recurrent Respiratory Papillomatosis under Maintenance Therapy

Background

Benign migratory glossitis or geographic tongue is a chronic recurring inflammatory condition of the oral cavity. With its ephemeral characteristics, there has been reported literature showing its association with the administration of certain drugs including angiogenesis inhibitors. The antiangiogenic drugs act by selectively inhibiting the vascular endothelial growth factor (VEGF) signaling. It has been widely used as an adjunct and a maintenance agent for the treatment of various cancers.

Aims

This study aims to report probable characteristic oral mucosal changes in a patient with juvenile-onset recurrent respiratory papillomatosis (JORRP) under maintenance therapy with an antiangiogenesis drug.

Case description

The patient was presented with a burning sensation on having spicy food. This occurred after the completion of three cycles of bevacizumab infusion. It was associated with the appearance of migratory lesions over the tongue and evolved periods of remission and exacerbation. Clinical examination revealed lesions characteristic of the geographic tongue on the anterior two-thirds of the dorsal surface as well as the lateral surface of the tongue classified as type 2, according to Hume criteria. Oral examination revealed dental caries in relation to 52, 54, 62, 63, 74, and 85 teeth and grossly decayed 64. Topical lignocaine gel was instituted for symptomatic relief of the lesion. Full mouth rehabilitation with preventive and restorative therapeutic interventions was carried out.

Clinical significance and conclusion

The documented literature along with this report put forth a probable association of geographic tongue with the use of bevacizumab drugs which requires further detailed studies. These lesions generally require symptomatic treatment with assurance only. The etiology is poorly understood.

How to cite this article

Kalra N, Tyagi R, Khatri A, et al. Angiogenesis Inhibitor Drug-induced Benign Migratory Glossitis in a Patient of Juvenile-onset Recurrent Respiratory Papillomatosis under Maintenance Therapy. Int J Clin Pediatr Dent 2024;17(1):92-96.

A Rare Case of Shprintzen-Goldberg craniosynostosis syndrome with Hirschsprung disorder: Dental characteristics and its Clinical Management

Shprintzen-Goldberg syndrome (SGS) is an autosomal dominant syndrome caused by de novo gene mutations. It is characterized by a number of congenital defects such as craniofacial, skeletal, neurological, and connective tissue abnormalities. It is characterized by craniosynostosis and marfanoid features. To our knowledge, approximately 75 shprintzen-goldberg syndrome cases have been documented since it was first described in 1982. Rare cases of shprintzen-goldberg syndrome have been reported in which the mutated gene was inherited from an unaffected parent through their germline cells i.e., egg or sperm cells. This is a case report of a 6-year-old boy with clinically diagnosed Shprintzen-Goldberg Syndrome with Hirschsprung disease. Patient reported with multiple caries and malpositioned teeth. The treatment initiated with awareness about cariogenic foods, oral hygiene instructions and diet counselling. Subsequently, comprehensive rehabilitation was done. Key words:Dental management, Craniosynostosis, Hirschsprung disorder.

Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting

BACKGROUND

Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry.

METHODS

A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years.

RESULTS

Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge.

CONCLUSION

Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.

Three-dimensional Printing Technology: Patient-friendly and Time-saving Approach for Space Management in an Autistic Child in COVID-19 Times

Aim and objective

The present case report comprehensively illustrates the use of a novel digital three-dimensional (3D) printed band and loop space maintainer [computer-aided design and computer-aided manufacturing (CAD/CAM)] for the guidance of eruption with their distinctive attribute of reduced chairside time in a home-schooled autistic child.

Background

Three-dimensional (3D) printing is a promising and emerging technology in the arena of dentistry based on CAD/CAM. It has led to the production of customized 3D objects or patient-specific prostheses with accurate results achieved in a time-saving manner. 3D printing has been employed in several latitudes of dentistry; however, the applications are few in the field of pediatric dentistry.

Case description

The paper describes the space management of an autistic child for the missing mandibular left primary second molar through the novel technique of 3D printed band and loop space maintainer.

Clinical significance

The novel technique has definite advantages, including high precision, accuracy, fast production, and reduced patient exposure to dentists and vice versa, which has been the need of the hour since the advent of the coronavirus disease of 2019 (COVID-19) pandemic.

Conclusion

Three-dimensional (3D) printing minimizes dental aerosol-generated exposure by decreasing chairside procedural time and minimizing procedural sitting. The cost-benefit analysis, as applied to the Indian scenario, has also been computed, which makes it equally acceptable. Moreover, 3D printing reduces material waste production, offering a greener and environmentally friendly option in the coming years. The future of pediatric dentistry will evolve with signs of progress in the latest materials and technologies.

How to cite this article

Yangdol P, Kalra N, Tyagi R, et al. Three-dimensional Printing Technology: Patient-friendly and Time-saving Approach for Space Management in an Autistic Child in COVID-19 Times. Int J Clin Pediatr Dent 2023;16(S-3):S321-S326.

The association of screen time with intake of potentially cariogenic food and oral health of school children aged 8-14 years-a cross-sectional study

This study aimed to test the hypothesis that excessive screen time can affect the oral health of school children. In this observational cross-sectional study conducted in four schools in Delhi, National Capital Region (NCR), India, 497 school children aged 8-14 years were included. Convenience sampling was used to select schools. Data were extracted from a questionnaire pertaining to screen time and dietary habits, which was distributed to the school children during their first planned school visit. Seven days later, on their second school visit, the children were clinically examined by a calibrated examiner (κ = 0.9) for dental caries, plaque and gingival health using the following indices: Decayed, Missing, Filled teeth (DMFT)/decayed, extracted, filled teeth (deft), Silness-Loe plaque index (PI) and Loe-Silness gingival index (GI), respectively. Overall, 88.7% of the participants exhibited screen time of ≥2 h with maximum frequency for smartphones (93%), followed by television (84.7%). Significantly higher DMFT/deft values (3.20 ± 0.68 vs. 2.45 ± 0.35, p = 0.001), PI (1.04 ± 0.21 vs. 0.33 ± 0.10, p < 0.001) and GI (1.45 ± 0.34 vs. 0.12 ± 0.04, p < 0.001) were observed in those with screen time ≥2 h as compared to those with screen time <2 h. Data underwent statistical analysis with a significance threshold of p < 0.05. Excessive screen time can influence the eating patterns of children and contribute to higher DMFT, GI and PI.

Mitochondrial Ca2+ overload due to altered proteostasis amplifies apoptosis in C2C12 myoblasts under hypoxia: Protective role of nanocurcumin formulation

Severe hypoxia triggers apoptosis leads to myofibers loss and is attributable to impaired intracellular calcium (iCa²⁺ ) homeostasis, resulting in reduced muscle activity. Hypoxia increases intracellular Ca²⁺ by activating the release of Ca²⁺ from iCa²⁺ stores, however, the effect of increased [iCa²⁺ ] on the mitochondria of muscle cells at high-altitude hypoxia is largely unexplored. This study examined mitochondrial Ca²⁺ overload due to altered expression of mitochondrial calcium uptake 1 (MICU1), that is, a gatekeeper of the mitochondrial Ca²⁺ uniporter, impaired mitochondrial membrane potential (ΔΨm). p53 stabilization and its translocation to the mitochondria were observed following disrupted mitochondrial membrane integrity in myoblasts under hypoxia. Furthermore, the downstream effects of p53 led to the upregulation of proapoptotic proteins (Bax, Caspase-3, and cytochrome C) in myoblasts under hypoxia. Nanocurcumin-pyrroloquinoline quinone formulation (NCF; Indian patent no. 302877), developed to address hypoxia-induced consequences, was found to be beneficial in maintaining mitochondrial Ca²⁺ homeostasis and limiting p53 translocation into mitochondria under hypoxia in muscle myoblasts. NCF treatment also modulates heat shock proteins and apoptosis-regulating protein expression in myoblasts. Conclusively, we proposed that mitochondrial Ca²⁺ overload due to altered MICU1 expression intensifies apoptosis and mitochondrial dysfunctionality. The study also reported that NCF could improve mitochondrial [Ca²⁺ ] homeostasis and antiapoptotic ability in C2C12 myoblasts under hypoxia.

Dietary administration of the glycolytic inhibitor 2-deoxy-D-glucose reduces endotoxemia-induced inflammation and oxidative stress: Implications in PAMP-associated acute and chronic pathology

Pathogen-associated molecular patterns (PAMPs) like bacterial cell wall components and viral nucleic acids are known ligands of innate inflammatory receptors that trigger multiple inflammatory pathways that may result in acute inflammation and oxidative stress-driven tissue and organ toxicity. When dysregulated, this inflammation may lead to acute toxicity and multiorgan failure. Inflammatory events are often driven by high energy demands and macromolecular biosynthesis. Therefore, we proposed that targeting the metabolism of lipopolysaccharide (LPS)-driven inflammatory events, using an energy restriction approach, can be an effective strategy to prevent the acute or chronic detrimental effects of accidental or seasonal bacterial and other pathogenic exposures. In the present study, we investigated the potential of energy restriction mimetic agent (ERMA) 2-deoxy-D-glucose (2-DG) in targeting the metabolism of inflammatory events during LPS-elicited acute inflammatory response. Mice fed with 2-DG as a dietary component in drinking water showed reduced LPS-driven inflammatory processes. Dietary 2-DG reduced LPS-induced lung endothelial damage and oxidative stress by strengthening the antioxidant defense system and limiting the activation and expression of inflammatory proteins, viz., P-Stat-3, NfκΒ, and MAP kinases. This was accompanied by decreased TNF, IL-1β, and IL-6 levels in peripheral blood and bronchoalveolar lavage fluid (BALF). 2-DG also reduced the infiltration of PMNCs (polymorphonuclear cells) in inflamed tissues. Altered glycolysis and improved mitochondrial activity in 2-DG-treated RAW 264.7 macrophage cells suggested possible impairment of macrophage metabolism and, therefore, activation in macrophages. Taken together, the present study suggests that inclusion of glycolytic inhibitor 2-DG as a part of the diet can be helpful in preventing the severity and poor prognosis associated with inflammatory events during bacterial and other pathogenic exposures.

A Rare Case of Autoimmune Polyendocrinopathy-candidiasis-ectodermal Dystrophy Syndrome: Dental Perspective on Diagnosis and Management

Aim

To report a unique case of Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) in a young boy and discuss the oral health impact and management of the disease.

Background

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autoimmune disorder with various clinical manifestations. Biallelic mutations in the autoimmune regulator (AIRE) gene lead to impairment of central immune tolerance and a targeted attack on various endocrine and non-endocrine organs. Patients classically suffer from a triad of disorders, including chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenocortical failure (Addison's disease).

Results

In recent times, it has been observed that oral manifestations of the disorder, such as enamel hypoplasia, appear early and frequently. Affected individuals require a comprehensive preventive and minimally invasive approach for oral health along with follow-up throughout their lifespan to manage potentially life-threatening disease manifestations.

Conclusion

Prompt recognition by a pediatric dentist can facilitate an earlier diagnosis and allow for screening, preventive and therapeutic services.

Clinical Significance

To deliver oral health care in an effective and comprehensive manner, clinicians should be able to recognize, diagnose and manage the signs and symptoms of the disease.

How to cite this article

Tyagi R, Kalra N, Khatri A, et al. A Rare Case of Autoimmune Polyendocrinopathy-candidiasis-ectodermal Dystrophy Syndrome: Dental Perspective on Diagnosis and Management. Int J Clin Pediatr Dent 2023;16(1):139-146.

Mitigation of radiation injury to reproductive system of male mice by Trichostatin A

Trichostatin A (TSA), derived from the bacteria Streptomyces hygroscopicus, is a hydroxamic acid having various biological properties such as histone deacetylase inhibition, anticancer and radiomitigative action. However the mitigative activity of TSA against radiation-induced damages in the mouse reproductive system has not yet been elucidated. The present study unraveled the effects of 2 Gy whole body irradiation (⁶⁰Co γ- radiation) on C57BL/6 mice male reproductive system including structural damages to testes, increase in apoptosis and reduction in germ cell viability, reduced fertility as well as increased genomic instability in the next generation. Moreover, hematological study and micronuclei assay were used to record chances of radiation-induced hematologic cancer and disruption of genomic integrity in F₁ generation. Interestingly, TSA administration 1 and 24 h post-irradiation attenuated radiation-induced morphological damage and cellular apoptosis in testes. In male mice, TSA restored hematological parameters and micronuclei frequency to normal levels, restored sperm viability, and helped them overcome radiation-induced temporary sterility 5 weeks after the irradiation. Thus our results showed that TSA reduced the probability of radiation-induced hematologic cancers as well as genotoxicity and restored genomic integrity in the progenies of paternally exposed mice by reducing radiation-induced apoptosis in spermatogenic cells and restoring cell proliferation. This study suggested that TSA could be used as potential radiomitigator for male reproductive system.

Quercetin-3-Rutinoside alleviates radiation-induced lung inflammation and fibrosis via regulation of NF-κB/TGF-β1 signaling

BACKGROUND

Radiation exposure to lungs during nuclear catastrophes or radiotherapy poses long-term side effects and can induce pulmonary injury sufficient for causing death. The strategies for preventing or reversing radiation-induced lung injuries have not been yet developed. Quercetin-3-Rutinoside (Q-3-R), a polyphenolic bioflavonoid, has shown multifaceted pharmacological applications due to its high antioxidant and anti-inflammatory properties.

PURPOSE

In the current study, the potential of Q-3-R against radiation-induced lung pneumonitis/fibrosis and the possible underlying mechanism was investigated.

STUDY DESIGN

To evaluate the effect of Q-3-R against lung damage, C57Bl/6 mice were administered with Q-3-R (10 mg/kg b.wt.) and irradiated with a single dose of gamma radiation (12 Gy) at thoracic region.

METHODS

16 weeks after irradiation lung damage was seen by histopathological studies and staining for collagen deposition. Expression of Nuclear factor kappa-B (NF-κB), transforming growth factor-β1 (TGF-β1), Smad3, intercellular adhesion molecule 1 (ICAM-1), α-smooth muscle actin protein (α-SMA), Aquaporin 5 (AQP 5), Interleukins (IL-6, IL-18, IL-1β), tumor necrosis factor-α (TNF-α) and caspase-3 was evaluated by immunohistochemistry/western blot/Elisa. Reactive oxygen species (ROS)/ Nitric oxide (NO) scavenging potential of Q-3-R and inhibition of cell death in irradiated lungs were also assessed.

RESULTS

Mice showed signs of pneumonitis and fibrotic changes in lungs following radiation treatment. A dramatic increase in inflammatory cells and cytokines contributing to lung disease pathogenesis was observed. Furthermore, expression of NF-κB, TGF-β1, Smad3, ICAM-1, AQP5and α-SMA was found markedly up-regulated. However, pretreatment of Q-3-R significantly attenuated radiation-induced pneumonitis and fibrosis. Histological examination revealed less structural and fibrotic changes with down-regulation of AQP 5, ICAM-1, α-SMA and caspase-3 in Q-3-R pretreated irradiated groups. The formulation significantly relieved lung injury by suppressing inflammatory and pro-fibrotic cytokines such as IL-6, IL-18, IL-1β, TNF-α and TGF-β1 via inhibition of NF-κB. Q-3-R also curtailed radiation-induced ROS/NO generation and minimized DNA damage in the irradiated lungs.

CONCLUSION

The findings from the current study clearly demonstrate that Q-3-R provides radioprotection to the lungs by regulating NF-κB/TGF-β1 signaling, scavenging free radicals, preventing perivascular infiltration and prolonged inflammatory cascade which could otherwise lead to chronic radiation fibrosis. Q-3-R can be proved as a potential therapeutic agent for alleviating radiation-induced lung injury in case of planned or unplanned radiation exposure scenario.

Comparison of parental satisfaction with strip crowns and primary anterior zirconia crowns in 3-5 years old children over 1 year

BACKGROUND

During the past decade, parental involvement for the selection of full coronal restorations for the primary anterior teeth of their children has been increased. Two most common anterior aesthetic full coronal restorations, the strip crowns and the preformed zirconia crowns, are available options.

AIM

The aim of this study is to compare parental satisfaction with strip crowns and preformed primary anterior zirconia crowns over 1 year in 3-5 years old children.

MATERIALS AND METHODS

Forty maxillary primary incisors were restored by either strip crown or zirconia crown in 24 children. Permuted block randomization method was used for the allocation of participants. Twenty-four parents participated were recalled to fill the questionnaire over 1 year. One parent dropped out at the end of 1 year. Data were analyzed using the t-test and Chi-square test. P < 0.05 considered statistically significant.

RESULTS

Parents were satisfied with both types of restorations. Statistically significant relationship was found between overall satisfaction and durability (P = 0.004) with strip crowns and with the color (P = 0.043) in the zirconia crowns. The parents with the lower satisfaction levels with the durability of strip crowns and color of zirconia crowns rated high overall satisfaction.

CONCLUSION

Parental overall satisfaction was higher for preformed primary anterior zirconia crowns than strip crowns. Almost equal number of parents was satisfied with all other parameters except for durability, which was more for zirconia crowns.

Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4-8-year-old Children

Background

A pulpectomy is regarded as the choice modality of treatment for necrotic teeth. The use of hand files, though popular traditionally as a gold standard, may be challenging due to increased chairside time. Postoperative pain is one of the most common complications of pulpectomy and may be unpleasant for a child/pedodontist. Rotary files were found to reduce instrumentation time, reduce apical extrusion, and in turn reduce pain but there is a lack of studies in primary teeth particularly for pediatric and reciprocating file systems. The increased number of options available today makes it a dilemma for the operator to choose a suitable file system.

Aim and objective

The study aimed to evaluate and compare the instrumentation time, postoperative pain, and effect on child's behavior among three groups, i.e., hand K-flex files (group I), pediatric rotary files (group II), and reciprocating files (group III).

Materials and methods

A total of 75 primary molar teeth after meeting inclusion criteria were randomly allocated into three groups. During the procedure, step-wise instrumentation time was recorded using a stopwatch. The child's behavior pre- and postoperatively was assessed by an evaluator. The postoperative pain (up to 1 week) was assessed by a questionnaire.

Results

The mean age of children taken for the study was 6.03 ± 1.2 years with 46 males and 29 females. The mean biomechanical preparation time was observed to be significantly shorter in the pediatric rotary and reciprocating file groups vs hand K-flex files (p < 0.001**). The postoperative pain after 6 hours had a mean value of 0.88 + 0.9 for the hand K-flex file group which was significantly higher than both rotary file groups (p < 0.05*). The pre- and postoperative behavior revealed no significant difference.

Conclusion

The clinical performance of pediatric and reciprocating files was superior, but the choice of file system did not significantly alter behavior.

How to cite this article

Tyagi R, Khatri A, Kalra N, et al. Comparative Evaluation of Hand K-flex Files, Pediatric Rotary Files, and Reciprocating Files on Instrumentation Time, Postoperative Pain, and Child's Behavior in 4–8-year-old Children. Int J Clin Pediatr Dent 2021;14(2):201–206.

Mechanism of Action of Diallyl Sulphide in Ameliorating the Hematopoietic Radiation Injury

Diallyl sulphide (DAS), the pungent component of garlic, is known to have several medicinal properties and has recently been shown to have radiomitigative properties. The present study was performed to better understand its mode of action in rendering radiomitigation. Evaluation of the colonogenic ability of hematopoietic progenitor cells (HPCs) on methocult media, proliferation and differentiation of hematopoietic stem cells (HSCs), and transplantation of stem cells were performed. The supporting tissue of HSCs was also evaluated by examining the histology of bone marrow and in vitro colony-forming unit–fibroblast (CFU-F) count. Alterations in the levels of IL-5, IL-6 and COX-2 were studied as a function of radiation or DAS treatment. It was observed that an increase in proliferation and differentiation of hematopoietic stem and progenitor cells occurred by postirradiation DAS administration. It also resulted in increased circulating and bone marrow homing of transplanted stem cells. Enhancement in bone marrow cellularity, CFU-F count, and cytokine IL-5 level were also evident. All those actions of DAS that could possibly add to its radiomitigative potential and can be attributed to its HDAC inhibitory properties, as was observed by the reversal radiation induced increase in histone acetylation.

Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children

Background

This study assessed anticipatory dental anxiety levels among 8- to 12-year-old children based on subjective and physiological measures and their correlation. The variations in anxiety based on sex, age, temperament, and academic performance were evaluated.

Methods

An observational study was conducted in 60 children recruited from the waiting room over a 6-month period. The operator recorded subjective anxiety in the children using a novel visual facial anxiety scale. The operator also noted the demographic details and child's temperament using the nine dimensions of the Thomas and Chess criteria, and graded children as "easy," "slow to warm-up," and "difficult." The academic performance of the children was graded (parental ratings) on a five-point Likert scale. Physiological variables (heartrate [HR], oxygen saturation[SpO₂], and blood pressure [BP]) were recorded by another evaluator. The correlation between anxiety levels and physiological variables was also assessed. The effects of age, sex, temperament, and academic performance on anxiety were evaluated.

Results

The study included 60 children aged 8-12 years, including 36 boys and 24 girls. Seventy percent of children had mild to moderate levels of pre-extraction anxiety, while 30% of children demonstrated high anxiety. A significant positive correlation was noted between anxiety levels and HR (r_s = 0.477, P < 0.001^*) and systolic BP (r_s = 0.294, P < 0.05), while a significant but inverse correlation was observed with SpO₂ (r_s = -0.40, P < 0.05). Anxiety did not influence diastolic BP. Children with difficult temperament and poor academic performance had significantly higher anxiety.

Conclusion

A high percentage (70%) of children aged 8-12 years had mild to moderate anxiety prior to the extraction procedure. Increased HR, systolic BP, and reduced SpO₂ were significantly associated with high levels of anticipatory dental anxiety. Pre-extraction anxiety was significantly related to the temperament and scholastic performance.

Oral health status and microbial load of Streptococcus mutans in children with Cerebral palsy in a tertiary care hospital in Delhi

BACKGROUND

Cerebral palsy (CP) is a childhood debilitating condition which impairs the physical and mental ability of an individual to maintain oral health.

AIM

The objective of the present study was assessment of dental neglect and burden of treatment needs of children affected with CP as compared to normal children in a tertiary care hospital in Delhi.

SETTINGS AND DESIGN

A sample size of 104 children of age group of 6-14 years was selected, in which 52 children of CP (case group) and 52 normal school children (control group) were recruited.

MATERIALS AND METHODS

Children from both groups were examined, and calculation of drug master files (DMFS), defs, oral hygiene index (OHI), and gingival index was done. The presence of trauma and malocclusion was assessed. Present caries activity was assessed by the level of Streptococcus mutans present in saliva in both groups. Treatment needs were then assessed based on intraoral findings.

STATISTICAL ANALYSIS

Data were analyzed by SPSS 20.0 software. Student's t-test and nonparametric statistical tests such as Chi-square test and Mann-Whitney test were used as per the nature of variables studied for statistical analysis with the level of significance denoted at P < 0.05.

RESULTS

The mean DMFS, gingival index, OHI, and treatment needs were observed to be higher in the CP group. Increased S. mutans levels were observed in saliva of CP patients. Defs score, trauma, and malocclusion were not statistically significantly higher in CP group as compared to the control group.

CONCLUSION

Cerebral palsy group had a poor oral and gingival health, a higher DMFT and burden of treatment needs and an increased risk of further caries progression due to high caries activity indicated by increased level of salivary Streptococcus mutans than the control group.

Hypnosis and progressive muscle relaxation for anxiolysis and pain control during extraction procedure in 8-12-year-old children: a randomized control trial

Introduction

Hypnosis (H) and Progressive Muscle Relaxation (PMR) have proven to be effective in a variety of medical settings; there is a paucity of their practical application in paediatric dentistry. The study aimed to comparatively evaluate the role of H and PMR on anxiety, heart rate (HR), oxygen saturation (SPO₂), blood pressure (BP), pain, and analgesic requirement during extraction in children.

Materials and methods

Sixty children aged 8–12 years undergoing primary molar extractions were randomly allocated to three groups—H, PMR, and control (C). The anxiety (proposed Visual Facial Anxiety scale), HR, and SPO₂ were measured pre/post-operatively with/without interventions (H, PMR, C) at 4 intervals. The BP and pain (Wong-Baker faces pain scale) were recorded pre- and post-operatively. Need for analgesic post-operatively was assessed.

Results

Statistically significant reduction in anxiety was noted post-extraction in H (0.30 ± 0.80), PMR (0.50 ± 0.69) (p < 0.001*). HR showed a statistically significant drop after H, PMR application. (p < 0.001*) No significant difference in SPO₂ was noted in the three groups (p > 0.05). Pain control was well achieved using H (85%), PMR (70%); BP was well-regulated in the H, PMR compared to C group (p < 0.001*). Need for analgesics was reduced in H (45%), PMR (50%) versus C (100%). Both techniques H, PMR were comparable in all measures.

Conclusion

Hypnosis and PMR are effective techniques for anxiolysis and pain control in paediatric dental patients.

Endovascular and percutaneous transabdominal embolisation of pseudoaneurysms in pancreatitis: an experience from a tertiary-care referral centre

AIM

To analyse the technical challenges, clinical success, and associated complications of endovascular and percutaneous embolisation of pancreatitis-related pseudoaneurysms.

MATERIALS AND METHODS

A retrospective study of patients referred for embolisation of pancreatitis-related pseudoaneurysms between January 2014 and March 2019 was conducted. Computed tomography angiography (CTA) was performed to assess the morphology of the aneurysms prior to any intervention. Percutaneous or endovascular embolisation was performed. Details of CTA and methods of embolisation were recorded. Technical success, clinical success, and complications were reported.

RESULTS

A total of 80 patients (mean age, 40.69 ± 13.41 years, 73 male) underwent embolisation during the study period. Pseudoaneurysms were related to chronic pancreatitis (CP) in 44 (55%) patients and acute pancreatitis (AP) in 36 (45%) patients. Pseudoaneurysms were detected in 65 (81.2%) patients on CTA. The most common site of pseudoaneurysms was gastroduodenal artery (GDA) followed by splenic artery. Seven patients were treated with percutaneous thrombin injection and five were treated with percutaneous glue injection under ultrasound/fluoroscopy guidance. The remaining patients (n=68) underwent catheter angiography with endovascular embolisation. Technical success was achieved in 4/7 (57%) percutaneous thrombin cases and in all the cases (5/5, 100%) with percutaneous glue or endovascular (68/68,100%) embolisation.

CONCLUSION

Endovascular or percutaneous embolisation of pseudoaneurysms has high technical success with an excellent safety profile.

Dental age assessment of North Indian origin children using Nolla’s method in mandibular second molar

Background

A cross-sectional study was done on 900 children of North Indian origin, (male = 458; female = 442) aged 10 to 16 years. Digital radiovisiography of permanent mandibular second molar was chosen over higher radiation extra oral projections used for whole arch-like orthopantogram. Each image was evaluated for mean dental age using Nolla’s method of age estimation and was compared to the mean chronological age of children in the study group. The study was conducted to evaluate the applicability of Nolla’s method of age estimation in the North Indian population.

Results

The mean dental age was found to be significantly underestimated by (1.8 ± 5.5) months in 900 children. The trend of underestimation was more in males ((2.5 ± 4.2) months) as compared to females ((1.1 ± 6.4) months). Both sexes showed underestimation of chronological age till 14 years. However, the dental age and chronological age became similar at 14 years, and overestimation of chronological age was observed afterwards (p value > 0.001).

Conclusion

Nolla’s method of age estimation using radiovisiograph for mandibular second molar is a reliable method in children of North Indian origin, although it underestimates the chronological age. After the average age of 14, dental age surpassed chronological age in the study group. In addition, permanent mandibular second molar was found to be a reliable tooth for dental age estimation.

Mild mitochondrial uncoupling protects from ionizing radiation induced cell death by attenuating oxidative stress and mitochondrial damage

Ionizing radiation (IR) induced mitochondrial dysfunction is associated with enhanced radiation stimulated metabolic oxidative stress that interacts randomly with intracellular bio-macromolecules causing lethal cellular injury and cell death. Since mild mitochondrial uncoupling emerged as a valuable therapeutic approach by regulating oxidative stress in most prevalent human diseases including ageing, ischemic reperfusion injury, and neurodegeneration with comparable features of IR inflicted mitochondrial damage. Therefore, we explored whether mitochondrial uncoupling could also protect from IR induced cytotoxic insult. Our results showed that DNP, BHT, FCCP, and BAM15 are safe to cells at different concentrations range depending on their respective mitochondrial uncoupling potential. Pre-incubation of murine fibroblast (NIH/3T3) cells with the safe concentration of these uncouplers followed by gamma (γ)-radiation showed significant cell growth recovery, reduced ROS generation, and apoptosis, compared to IR treatment alone. We observed that DNP pre-treatment increased the surviving fraction of IR exposed HEK-293, Raw 264.7 and NIH/3T3 cells. Additionally, DNP pre-treatment followed by IR leads to reduced total and mitochondrial oxidative stress (mos), regulated calcium (Ca²⁺) homeostasis, and mitochondrial bioenergetics in NIH/3T3 cells. It also significantly reduced macromolecular oxidation, correlated with the regulated ROS generation and antioxidant defence system. Moreover, DNP facilitated DNA repair kinetics evidenced by reducing the number of γ-H2AX foci formation and fragmented nuclei with time. DNP pre-incubation restrained the radiation induced pro-apoptotic factors and inhibits apoptosis. Our findings raise the possibility that mild mitochondrial uncoupling with DNP could be a potential therapeutic approach for radiation induced cytotoxic insult associated with an altered mitochondrial function.

Radio-pathological Correlation of 18F-FDG PET in Characterizing Gallbladder Wall Thickening

AIM

Thick-walled gallbladder is difficult to characterize on conventional imaging. 18F-FDG PET was used to differentiate benign and malignant wall thickness and compared with histopathology.

METHODS

Thirty patients with gallbladder (GB) wall thickening (focal > 4 mm and diffuse > 7 mm), underwents uspected on  ultrasound, or CT scan, and underwent 18F-FDG PET. Histopathology of the specimen was compared with imaging findings.

RESULTS

The mean age was 48.22 ± 31.33 years with a M:F 1:4 ratio. Twenty patients had diffuse and 10 had focal thickening. On 18F-FDG PET, lesion was benign in 12, malignant in 13, and indeterminate in 5. Histopathology was malignancy in 12; benign in 18-chronic cholecystitis in 11, xanthogranulomatous in 4, IgG4 related in 2, and polyp in 1. The mean GB wall thickness was 7.79 ± 3.59 mm (10.34 malignant and 6.10 in benign, p = 0.001). At a cutoff of 8.5 mm, the sensitivity and specificity of detecting malignancy was 94% and 67%. The mean SUV uptake was 7.46 (benign 4.51, malignant 14.26, p = 0.0102). At a cutoff of 5.95, the sensitivity and specificity of detecting malignancy was 92% and 79%. For 18F-FDG PET, overall sensitivity was 91%, specificity 79%, PPV 77%, NPV 92%, and diagnostic accuracy was 84%.

CONCLUSION

18F-FDG PET is a reliable method of differentiation between benign and malignant thickening of the gallbladder particularly when wall thickness and SUV value is taken into account.

A rare case of Dandy-Walker syndrome in the 12-year-old girl

Dandy-Walker syndrome (DWS) is a rare congenital cystic malformation of the posterior cranial fossa. Patients show signs and symptoms of complex clinical manifestations, ranging from cranial nerve and cerebellar dysfunctions to extracranial abnormalities, which may pose challenges in dental management. This article represents a rare case of a 12-year-old girl with DWS along with the involvement of the oral cavity.

Evaluation of oral health of 6 to 10-year-old asthmatic children receiving bronchodilator through inhaler

Aim

The aim of this study was to evaluate the oral health status in 6 to 10-year-old asthmatic children receiving bronchodilator (salbutamol, salmeterol, etc.) through inhaler and compare them with nonasthmatic healthy children.

Settings and Design

The present study was carried out at pediatric and pedodontic department and neighboring government school. It was an observational and case-control study.

Statistical Analysis

All data were analyzed using SPSS 20.0 software program and presented as mean ± standard error of mean. Chi-square test was used for the categorical data between groups. Numerical data were analyzed by Mann-Whitney U-test and t-test. Kruskal-Wallis test was performed for comparisons of median value of decayed, missing, filled surface and Decayed, Missing, Filled Surface (dmfs and DMFS) for different variables within asthmatic group. Mann-Whitney U-test for multiple comparisons and P value was adjusted according to Bonferroni correction. Negative binomial analysis was used to calculate adjusted dmfs and DMFS, and univariate analysis of variance was used for adjusted mean plaque and gingival index.

Materials and Methods

The study group composed of 70 asthmatic and 70 nonasthmatic children with the same age and social background aged between 6 and 10 years old. Oral health status was assessed using caries, plaque, and gingival index. Dental caries examination was done using the WHO criteria (1997), plaque index by Silness and Loe in 1964 and gingival health by Loe and Silness in 1963.

Results

The children in the asthmatic group had significantly higher caries prevalence, severity of dental plaque, and gingivitis compared with the nonasthmatic group. Plaque accumulation and gingivitis increased significantly as severity and duration of asthma increased.

Conclusions

Bronchial asthma had an overall deleterious effect on caries prevalence and severity, plaque, and gingivitis on primary and permanent teeth.

Pentalogy of Fallot: A case report and overview dental implications

Pentalogy of Fallot is a rare congenital cyanotic heart disease and a variant of tetralogy of Fallot, in which tetralogy of Fallot is associated additionally with an atrial septal defect. It is characterized by right to left intracardiac shunting of blood leading to decreased pulmonary blood flow resulting in the development of cyanotic episodes. The case report aims to present the dental management of an 8-year-old child with a repaired cardiac anomaly of pentalogy of Fallot. His medical condition was assessed and physician consent was sought for procedural intervention. All invasive procedures were planned under antibiotic prophylaxis to prevent bacteremia associated endocarditis. Elaborate chairside dental intervention was carried out beginning with preventive schedule, oral prophylaxis and topical fluoride application followed by interception of carious progression with multiple GIC restorations and extractions of retained and grossly decayed teeth. Patient was reviewed on follow-up visit and no pain, discomfort, or complications were reported. Based on the case report it can be concluded that the medical status in patients affected with Pentalogy of Fallot must be taken into consideration to plan dental treatment and precautions must be taken for prevention of stress induced cyanosis and bacterial endocarditis in such cases.

Soil Fertility Levels in Bangladesh for Rice Cultivation

Determination of soil fertility with minimum data set for crop zoning and devising fertilizer recommendations as well as soil fertility evaluation method based on soil properties. The data were collected from existing literatures and scoring was done on 0–100 scale. The lowest score was assigned for the minimum value of tested attributes and then gradually higher scoring values. Arithmetic, weighted, geometric and most minimum of mean scores were calculated and their performances were compared with grain yield of dry season irrigated (Boro) rice. Soil fertility in 10-12 and 39-52% areas in Bangladesh are very low and low, respectively. Medium fertile and fertile soils are distributed in 17-41% and in about 8% areas of the country. About 55% soils scored 70–95 (medium to high SOC) and the rest belongs to inferior quality. In some areas P build up has taken place (25% areas), but widespread K mining. Sulphur and Zn status in about 40% areas are low to very low (scored <35 and <40). Soils of the major areas of the country are with low pH (5.0-6.0) and CEC in the range of 15-25 cmolc kg-1. Weighted mean score and most minimum of eight attributes score showed good relationships with dry season irrigated rice yields than other tested methods indicating that this technique can be used for soil fertility rating in tropical countries.

A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child

Infections, trauma, iatrogenic causes, congenital malformations, or complications of systemic diseases can result in perforation of the nasal septum. An intranasal stent is a removable prosthesis that can be inserted into the nasal cavity to support the form of nose. The stenting can be used for recanalization and nasal valve preservation. This case report presents a method for the fabrication of a customized nasal stent in a 14-year-old female patient with posttraumatic unilateral collapsed nasal vestibule.

Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures

Background

The purpose of this study was to compare the pain perception and anesthetic efficacy of 2% lignocaine with 1:200,000 epinephrine, buffered lignocaine, and 4% articaine with 1:200,000 epinephrine for the inferior alveolar nerve block.

Methods

This was a double-blind crossover study involving 48 children aged 5–10 years, who received three inferior alveolar nerve block injections in three appointments scheduled one week apart from the next. Pain on injection was assessed using the Wong-Baker Faces pain scale and the sound eye motor scale (SEM). Efficacy of anesthesia was assessed by subjective (tingling or numbness of the lip, tongue, and corner of mouth) and objective signs (pain on probing).

Results

Pain perception on injection assessed with Wong-Baker scale was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between buffered lignocaine and articaine (P = 0.041). The onset of anesthesia was lowest for buffered lignocaine, with a statistically significant difference between buffered lignocaine and lignocaine (P < 0.001). Moreover, the efficacy of local analgesia assessed using objective signs was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between lignocaine and articaine.

Conclusion

Buffered lignocaine was the least painful and the most efficacious anesthetic agent during the inferior alveolar nerve block injection in 5–10-year-old patients.

P101 The leeds paediatric brain arteriovenous malformation (BAVM) outcomes

Objectives

The commonest cause of stroke in a paediatric population is a ruptured brain ateriovenous malformation (bAVM). We aim to assess the functional outcomes of patients who have undergone operative intervention at our unit for ruptured and non-ruptured bAVMs.

Design

A single centre retrospective cohort analysis of paediatric bAVM patients.

Subjects

10 paediatric patients at time of surgery between January 2007 – December 2017 mean age at follow up 15.9 years, range 2–26 years, mean time to follow up 6.3 years, range 1.5–11.2 years.

Methods

Patients with bAVMs were identified via the paediatric neurovascular database. They were contacted via telephone and the Paediatric Quality of Life (PedsQL) questionnaire administered via parent proxy if the patient was under 18, and by the patient if above 18. Functional outcomes were assessed using the PedsQL questionnaire score and converted in to a health-related quality of life (HRQOL) score.

Results

10 patients underwent resection of their bAVMS, 9 survived and 7 were contactable. The mean HRQOL score 88.9 points, range 65.2–100. Only one patient had a HRQOL score below the mean of a child with chronic disease.

Conclusions

The mean HRQOL outcome score of operated paediatric bAVM was similar to that of healthy children. Patients having bAVM surgery within our unit have had a good functional outcome. Although there are small numbers in this series, there is a low incidence of operated paediatric bAVMs. Our findings suggests that such operations should be undertaken in units with expertise.

Double Lip-An Atypical Facial Anomaly: Two Case Reports

Double lip is a rare abnormality. It affects the lips, more often the upper lips and could be acquired or congenital. It may be associated with Ascher's syndrome or occur in isolation. In this deformity, there is an accessory fold of redundant mucous membrane inside the vermillion border. This cupid's bow-shaped accessory tissue is usually conspicuous during smiling but maybe occasionally visible even at rest. For the patient, this atypical facial deformity most importantly creates an aesthetic problem. Nonetheless, it may also interfere with their speech or function. Surgical excision is the treatment of choice and gives appropriate esthetic and functional results. In this article, we have presented two case reports of congenital maxillary double lip. The etiology, clinical presentation, histopathology and treatment of this infrequent anomaly have been discussed. How to cite this article: Kalra N, Tyagi R, Khatri A, Poswal A, Panwar G, Garg K. Double Lip-An Atypical Facial Anomaly: Two Case Reports. Int J Clin Pediatr Dent. 2018;11(5):451-455.

Neonatal molar in a child with Langerhan cell histiocytosis

Teeth which erupt in the 1^st month of postnatal life are known as "neonatal tooth." The incidence of these teeth ranges from 1:2000 to 1:3500 live births. Natal teeth are more common in mandibular central incisor region, followed by maxillary incisor region and mandibular canine region. The neonatal or natal teeth in the maxillary molar region are a rare occurrence. This article represents a rare case of the neonatal tooth with Langerhans cell histiocytosis.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Control of Anxiety in Pediatric Patients using "Tell Show Do" Method and Audiovisual Distraction

INTRODUCTION

Visiting a dentist can easily evoke strong fear reactions and acute anxiety in children. It is one of the most basic reasons for avoidance and neglect of dental care. It may obstruct delivery of dental care, as the child may be unwilling to accept the treatment being provided by the dentist.

AIM

To evaluate and compare reduction in anxiety level in patients undergoing dental treatment at first dental visit.

TECHNIQUE

The study was conducted on 400 patients coming to the Department of Pedodontics and Preventive Dentistry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, for their first dental visit. Anxiety was recorded using facial image scale (FIS), Venham's picture test (VPT), blood pressure, pulse rate (PR), and oxygen saturation (SpO₂) at different stages of the visit. Patients coming for the first dental visit were subjected to restorative treatment under Tell show do (TSD) method and audiovisual distraction (AVD). The data collected were tabulated and subjected to statistical analysis.

CONCLUSION

The AVD was found to be more capable in reducing anxiety than TSD. Combination of TSD and AVD had an additive effect in reduction of anxiety level and it proved to be more beneficiary.

CLINICAL SIGNIFICANCE

If a child's behavior in the dental office cannot be managed, then it is difficult to hold out any dental treatment that is needed. Bringing positivity in the child's behavior would not only increase efficiency of work but would also make the experience for child undergoing treatment more pleasant.

Efficacy of generic oral directly acting agents in patients with hepatitis C virus infection

Novel direct-acting antivirals (DAAs) are now the standard of care for the management of hepatitis C virus (HCV) infection. Branded DAAs are associated with high sustained virological response at 12 weeks post-completion of therapy (SVR12), but are costly. We aimed to assess the efficacy of generic oral DAAs in a real-life clinical scenario. Consecutive patients with known HCV infection who were treated with generic-oral DAA regimens (May 2015 to January 2017) were included. Demographic details, prior therapy and SVR12 were documented. Four hundred and ninety patients (mean age: 38.9 ± 12.7 years) were treated with generic DAAs in the study time period. Their clinical presentations included chronic hepatitis (CHC) in 339 (69.2%) of cases, compensated cirrhosis in 120 (24.48%) cases and decompensated cirrhosis in 31 (6.32%) cases. Genotype 3 was most common (n = 372, 75.9%) followed by genotype 1 (n = 97, 19.8%). Treatment naïve and treatment-experienced (defined as having previous treatment with peginterferon and ribavirin) were 432 (88.2%) and 58 (11.8%), respectively. Generic DAA treatment regimens included sofosbuvir in combination with ribavirin (n = 175), daclatasvir alone (n = 149), ribavirin and peginterferon (n = 80), ledipasvir alone (n = 43), daclatasvir and ribavirin (n = 37), and ledipasvir and ribavirin (n = 6). Overall SVR12 was 95.9% (470/490) for all treatment regimens. SVR12 for treatment naïve and experienced patients was 97.0% (419/432) and 87.9% (51/58), respectively, P = .005. High SVR12 was observed with various regimens, irrespective of genotype and underlying liver disease status. There were no differences in SVR12 with 12 or 24 weeks therapy. No major adverse event occurred requiring treatment stoppage. Generic oral DAAs are associated with high SVR rates in patients with HCV infection in a real-life clinical scenario.

Clinical and radiographic comparison of platelet-rich fibrin and mineral trioxide aggregate as pulpotomy agents in primary molars

AIM

This study aimed to evaluate and compare the Platelet-rich fibrin (PRF) and Mineral trioxide aggregate (MTA) as a pulpotomy agent in primary molars.

MATERIAL AND METHODS

In this study, 50 primary molars from 50 healthy children aged 5-9 years requiring pulpotomy were randomly allocated into two groups. In PRF group, after coronal pulp removal and hemostasis, remaining pulp tissue was covered with PRF preparation. In the MTA group, the pulp stumps were covered with MTA (Pro Root MTA-Root Canal Repair Material, Dentsply International Inc.) paste obtained by mixing MTA powder with sterile water at a 3:1 powder to water ratio. All teeth were restored with reinforced zinc oxide eugenol base and glass - ionomer cement. Stainless steel crowns were given in both groups 24 h after treatment. Clinical evaluation was undertaken at 1, 3, and 6 months intervals whereas radiographic evaluation of the treated teeth was carried out at the interval of 6 months.

RESULTS

By the end of 6 months, the overall success rate was 90% in PRF group and 92% in MTA Group. A statistically significant difference was observed between the groups at 6 months of follow-up (P < 0.05). The results were statistically nonsignificant between the groups (P > 0.05).

CONCLUSION

Radiographic and clinical outcome in PRF group could suggest it as an acceptable alternative in pulpotomy of primary teeth. PRF holds a promising future in the area of primary tooth vital pulp therapy.

An Appraisal of the Prevalence and Attributes of Traumatic Dental Injuries in the Permanent Anterior Teeth among 7-14-Year-Old School Children of North East Delhi

Aims:

The aim of this study was to assess the prevalence, associated risk factors, characteristics, and pattern of traumatic dental injuries (TDIs) in the permanent anterior teeth among school children of North East Delhi area.

Settings and Design:

A cross-sectional study was done in 3000 school-going children aged 7–14 years.

Materials and Methods:

A detailed case history and clinical examination were performed on the entire sample population. TDIs were recorded according to Andreasen's epidemiological classification of TDIs including World Health Organization codes.

Statistical Analysis Used:

For finding the independent association of the significant variables with outcome, multivariable logistic regression analysis was used.

Results:

A prevalence of 10.7% was observed in the sample being studied. Dental trauma was significantly (P < 0.05) associated with male gender, and high statistical significance (P < 0.001) was noted with age, participation in sports, lip seal, and overjet. Fall of the child while playing by himself/herself was the most common cause; afternoon and schools were the most common time and place of occurrence of TDIs, respectively. Single tooth enamel fractures in the left maxillary central incisors were most commonly seen. Adhesive restorations were the most frequent form of treatment required.

Conclusions:

Organizing studies addressing the prevention and treatment needs of TDIs and educational programs aimed toward parents and school teachers are of paramount importance. Furthermore, recognizing the tremendous treatment negligence is extremely critical to adequately analyze indifference of the people toward dental trauma and its consequences.