Minor physical anomalies including palatal rugae pattern and palatal dimensions in children with sickle cell disease: A cross-sectional analytical study

Background

Sickle cell disease (SCD) is the most common hereditary hemoglobinopathy, which delays growth leading to an altered skeleton and craniofacial pattern. Palatal rugae patterning has been considered the regulator of the development of the palate. The purpose of the research work was to study the morphology of the palate, rugae pattern, and its dimensions in SCD children and compare them with healthy normal children, and to evaluate its role as minor physical anomalies (MPAs).

Methods

A cross-sectional case-control study was designed as per STROBE guidelines. The sample comprised 50 children diagnosed with sickle cell disease (Group SCD) and 50 normal healthy children as control (Group C) belonging to the same age group (10-18 years). Dental impressions were made, followed by the pouring of dental casts. The length of the palatal rugae was measured and categorized into primary (>5 mm), secondary (3 mm-5 mm), and fragmentary rugae (<3 mm). The shape of each primary palatal rugae was identified and categorized as curved, wavy, straight, circular and non-specific. Linear and angular measurements of the palatal rugae patterns and palatal dimensions (width, height, area) were measured and recorded.

Results

The total number of palatal rugae and fragmentary rugae was lesser in Group SCD than in Group C (p < 0.05). The depth of the palate was significantly increased, whereas the area of the palate significantly decreased in Group SCD.

Conclusions

The children with SCD showed distinctive palatal rugae patterns and dimensions when compared with normal healthy children that can be attributed as potential MPAs for sickle cell disease. Children with SCD had an under-developed palatal rugae pattern with a deep, narrow and small palate when compared to healthy children.The dimensions of the palatal rugae pattern in SCD showed reduced distance between the incisive papilla and the first and last rugae, indicating a further decrease in the anteroposterior dimensions of the palate. These findings may aid in the early diagnosis and prevention of malocclusion in children with SCD by appropriate interceptive orthodontic treatment.

Comparative evaluation of three different regression-equation-based mixed dentition analysis of children for prediction of the mesiodistal width of permanent canine and premolars

BACKGROUND

Dental malocclusion is common all over the world, and it is caused by a difference in arch length and tooth size. This necessitates mixed dentition analysis for early intervention treatment planning such as eruption guiding, serial extraction, space maintainer, space regainer, and jaw extension. The aim of the study is to comparatively evaluate three different regression equation based mixed dentition analysis of children for prediction of the mesiodistal width of permanent canine and premolars in population of Vidarbha region.

METHODS

This study comprised of 300 patients aged 13 to 16 years old. The impressions of patients were poured, and the mesiodistal width of their teeth was measured and documented. Three independent analyses were performed using the Ling and Wong method (L&W), the Bernabe and Flores-Mir method (B&F), and the Tanaka and Johnston method (T&J), and the results were compared to the sum of permanent canine and premolar teeth (SPCP). ANOVA with post hoc analysis was used to compare the predicted mesiodistal diameter (MDD) by analysis to the SPCP observed on cast.

RESULTS

The mesiodistal width of SPCP of maxilla and mandibular teeth had statistically significant difference (P<0.001) with the predicted width by Ling and Wong method, Bernabe and Flores method and Tanaka and Johnston method for patients of Vidarbha region.

CONCLUSIONS

The study concluded that all the three analysis overestimated the mesiodistal width of the sum of permanent canine and premolar in the patients. Tananka and Johnston analysis method was better in predicting the SPCP of the children of Vidarbha region.

Management of Turner's Hypoplasia Using Resin Infiltration: A Case Report

The causes of enamel discoloration can vary, leading to aesthetic concerns for patients. Injuries to primary teeth can lead to developmental issues in permanent successors, with enamel hypoplasia, commonly referred to as Turner's tooth. Diverse methods are available for addressing tooth discoloration. A case of an 11-year-old pediatric patient with a brown patch on the upper left central incisor was reported to the Pediatric Dentistry Department. A well-demarcated, yellowish-brown lesion was present on the labial surface of 21 and was diagnosed as Turner's hypoplasia. Resin infiltration was done using the Icon Smooth Surface (DMG America Company, Englewood, NJ) resin infiltration kit. The resin infiltration technique provides an approach to meet aesthetic requirements. In this case, the resin infiltration technique was successfully utilized to address the discoloration of the left maxillary central incisor, which was affected by Turner's hypoplasia.

Comparative Evaluation of Electronic Acupuncture Pen and 2% Lignocaine Gel as an Intraoral Topical Anesthetic Agent in Children

Background The most exasperating aspect for pediatric patients in a dental setup is the fear and anxiety caused by injections, called "blenophobia". There are numerous local anesthetic agents available to reduce the needle prick pain. Taking into consideration the paradigm shift, there is always a possibility for alternate treatment options. This study aimed to evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) application through an electronic acupuncture pen (Meridian Energy Acupuncture Pen W-912 GENERIC) and 2% lignocaine gel as an intraoral topical anesthetic agent in children. Method Patients aged 6 to 12 years were eligible for inclusion. The topical anesthetic agents were administered to the patients in a bilateral split-mouth technique. In Group A, 2% topical anesthetic gel was administered on the first visit on one side of the mandible and topical anesthesia through the electronic acupuncture pen was administered on the next visit, on the opposite side of the mandible. The electronic acupuncture pen was applied on one side of the mandible on the first visit, and on the next appointment, 2% topical anesthetic gel on the other side was administered in Group B. Sound, eye, motor scale (SEM) and faces pain scale-Revised (FPS) were used as tools of evaluation after local anesthesia was administered.  Results  The comparison between electronic acupuncture pen and 2% lignocaine gel using the SEM scale shows a statistically insignificant difference (p-value = 0.082). Similarly, a comparison of FPS values between both groups indicates no significant difference (p-value = 0.582). However, results show a reduced pain perception in both groups. Conclusion Topical anesthetic agents are commonly used to reduce needle prick pain in children. TENS through the electronic acupuncture pen, a revisited aid in scientific research, has proved its efficacy as a topical pain reduction measure during dental treatment. This device overcomes the shortcomings of the anesthetic gels and also nullifies the chances of overdosage, hypersensitivity, and disagreeable taste. Thus, this tool can be used in dental practice for the management of pain in children.

Comparative Evaluation of Antimicrobial Efficacy of Simvastatin Paste and Aloe Vera Paste as a Pulpotomy MedicamentAn In-vitro Study

Introduction: Pulpotomy is the complete removal of the coronal part of the dental pulp, followed by the application of an appropriate dressing or medicament to promote healing and maintain the viability of the teeth in the dental arch. Aloe vera has anti-inflammatory, anti-bacterial properties which can be used as a pulpotomy medicament. Simvastatin, a lipid-lowering medication has recently emerged as a potential medicament in regenerative dentistry. It has an anti-inflammatory and anti-oxidant properties. Hence, it can be used as a pulpotomy medicament. Aim: To evaluate and compare the antimicrobial efficacy of Aloe Vera paste and Simvastatin paste as pulpotomy medicament against Pseudomonas aeruginosa and E. faecalis. Materials and Methods: An in-vitro study will be conducted in Department of Paediatric and Preventive Dentistry at Sharad Pawar Dental College, Wardha, Maharashtra, India, in which Aloe Vera paste and Simvastatin paste will be prepared in an aseptic environment. The antimicrobial activity of simvastatin paste and Aloe Vera paste against E.faecalis and pseudomonas will be assessed using the agar diffusion method. It will be cultured overnight in brain heart infusion broth. On blood agar media, pseudomonas aeruginosa will be inoculated. 4 mm wells will be punched out on plates with a puncher and will be instantly loaded with freshly customised test materials. The agar plates shall then be incubated in an incubator at 37°C for 24 hours and 72 hours before being analysed. Statistical analysis will be done using Chi-square test, ANOVA test and multiple comparision 2k test. Expected Results: Aloe Vera and Simvastatin in the paste form shall be able to show its antimicrobial efficacy as a pulpotomy medicament. Conclusion: Aloe Vera paste and Simvastatin paste shall provide antimicrobial efficacy against E. faecalis and pseudomonas and prove to be a better pulpotomy medicament for primary teeth.

Evaluation of the Antimicrobial efficacy of a novel polyherbal extract against Streptococcus Mutans: An in-vitro study

Aim: The present study was done to assess the antibacterial efficacy of a polyherbal extract against Streptococcus mutans (S. mutans) in-vitro. Materials and methods: In the current study, the ethanolic extracts of Haritaki, Bhibitak, Amalaki, Yashtimadhu, Haridra and Vacha were subjected to microbiological assay. The microbial growth inhibitory potential of the polyherbal extract was determined by using the agar disc diffusion method. Results: Mean zone of inhibition of polyherbal extract mix against S. mutans at 48 hours was 24mm. Minimum Inhibitory Concentration and Minimum Bactericidal Concentration of polyherbal extract mix on S. mutans was 0.1gm/mL and 0.2gm mg/mL respectively. Conclusion: The polyherbal extract had antimicrobial efficacy against streptococcus mutans. This polyherbal extract could have potential clinical implications. Clinical significance: as many chemical agents used for prevention of dental caries might have long term adverse effects, use of plant based products could be an excellent treatment alternative. This polyherbal extract possesses antibacterial properties against streptococcus mutans and hence could be used for prevention of dental caries. The herbs used in the study are easily available, economically feasible and are being used since time immemorial. 

Assessment of a New Regression Equation for Mixed Dentition Space Analysis in Paediatric Population of Wardha, Maharashtra, India- A Research Protocol

Introduction: Prediction of the mesiodistal crown width of unerupted canines and premolars in mixed dentition analysis is crucial. When Tanaka-Johnston’s equations, the most popular approach, are applied to diverse ethnic groups, their accuracy is questioned. Aim: To derive a new regression equation of mixed dentition space analysis for predicting the size of unerupted canines and premolars teeth among paediatric population of Wardha, Maharashtra, India. Materials and Methods: The study will be conducted in two phases. The study design for First phase is observational and second phase is interventional. Dental study casts of 400 patients aged 11-18 years will be selected in the first phase. A Digital Vernier Caliper (DVC) will be used to measure the mesiodistal crown dimension of all erupted permanent teeth up to first molar. Between four mandibular incisors and the caninepremolar segments of both arches, correlation and linear regression equations will be created. In the second phase, 30 children aged 6-11 years will be randomly selected. Analysis of Tanaka-Johnston’s equations, Huckaba GW equation and the proposed equation will be compared and further statistical analysis will be carried out. Results: New derived regression equation will allow the closer prediction of the size of unerupted canines and premolars in the paediatric population of Wardha. Conclusion: This new equation will allow an accurate prediction of the width of unerupted canines and premolars at an earlier age in the said population.

Comparative Evaluation of Remineralization Potential of Acidulated Phosphate Fluoride and Hydroxyapatite Nanoparticles with and without Iontophoresis on the Incipient Carious Lesion in Permanent Teeth

Background: A non- invasive method used to improve the drug delivery with the help of electric arena is termed as Iontophoresis. The iontophoresis process may cause deeper penetration of ions using electric current. Remineralizing nanomaterial may be infused at higher concentrations in the deeper layer of incipient caries under the influence of iontophoresis. Hydroxyapatite crystals are the most stable form of calcium phosphate which is responsible for the mechanical strength of the dental tissues. Improvedre-mineralization occurs more with the apatite particle size of less than 4 µm. Due to the size of the nanocomplexes ofhydroxyapatite, there can be possibilities that they would enter the porosities and diffuse into the body of the subsurface lesion to enhance remineralization using iontophoresis technique. Objectives: 1) To evaluate the remineralization potential of APF gel with or without iontophoresis on the incipient carious lesion in permanent teeth. 2) To evaluate the remineralization potential of hydroxyapatite nanoparticles with or without iontophoresis on the incipient carious lesion of permanent teeth. 3) To compare the remineralization potential of APF gel and hydroxyapatite nanoparticles with or without iontophoresis on the incipient carious lesion in permanent teeth. Methodology: Forty extracted intact teeth will be taken and artificial caries will be induced.  These specimens will be randomly divided into five groups as per the treatment - 1) APF gel application 2) APF gel with iontophoresis 3) Hydroxyapatite nanoparticles solution application 4) Hydroxyapatite nanoparticles solution with iontophoresis 5) Distilled water (control group). Remineralization will be analysis by using Vickers hardness test.  The alterations in the carious lesion will be assessed by confocal laser scanning microscopy. Expected Results: APF gel and hydroxyapatite nanoparticles with iontophoresis will give superior remineralization effect as compared to the conventional method. Conclusion: The utilization of the iontophoresis with hydroxyapatite nanoparticle will provide improved mineralization of incipient caries and prove to be a better method for treatment.

Effect of Radiotherapy on Microhardness and Surface Morphology of Pretreated Primary Teeth with Silver Diamine Fluoride: An In vitro Study

Background: Radiation therapy has proven to be an effective modality in treating children suffering from cancer. High prevalence of dental caries is seen in children undergoing radiation therapy. This is primarily due to the direct effects of these harmful radiation on the enamel and not as a consequence to the reduced salivary flow. Mechanical properties of the enamel have been seen to be affected by radiation according to various studies conducted. Objectives: The objective of this study is to evaluate whether radiotherapy causes changes in the microhardness and surface morphology of enamel in primary teeth pretreated with silver diamine fluoride. Methodology: 22 primary teeth samples will be divided into two groups, 11 samples each-study group which will be pretreated with silver diamine fluoride (SDF) and control group. Both groups will be subjected to radiotherapy of 10 Gy radiation for a duration of 6 days. The samples will be tested for Vickers microhardness test and SEM analysis for surface morphological changes post radiotherapy. Statistical analysis will be done using “chi square test, paired and unpaired student t -test”. Surface microhardness and morphological changes of the study and control group compared. Expected Results: It is expected that SDF application will be effective modality in prevention of caries due to frequent radiation exposure in children suffering from cancer and undergoing radiotherapy. Conclusion: The study will conclude that SDF will cause a reduction in the microhardness of the surface and lesser morphological changes in the enamel of the primary teeth post radiation therapy in children suffering from cancer.

Evaluation of Antimicrobial Efficacy of Triphala Oral Spray in Patients Undergoing Orthodontic Treatment- A Randomized Clinical Trial

Background: Malocclusion is one of the most susceptible causes of the development of periodontal diseases and dental caries in young individuals undergoing fixed orthodontic treatment. It provides a surface area for the accumulation of food particles, which further leads to plaque formation. Various mechanical and chemical aids are used regularly to decrease the microbial load and accumulation of plaque. Chemical adjuncts such as chlorhexidine mouthwash are widely used as antimicrobial agents that have significant efficacy against oral Streptococci and Actinomyces species. Herbal agents have replaced conventional medications due to the development of antibiotic resistance. Among herbal medicaments, Triphala is the well-known drug formulation that can be used as an adjuvant for commercially available chemical aid. Chlorhexidine mouth wash requires the assistance of the caregivers. Therefore, there is a need for a newer modality to maintain oral hygiene in patients undertaking orthodontic corrections. Objectives: 1. To evaluate the antimicrobial efficacy of Triphala oral spray on Streptococcus mutants levels in children undergoing orthodontic treatment. 2. To evaluate the efficacy of Triphala oral spray in reducing dental plaque in children undergoing orthodontic treatment. 3. To evaluate the efficacy of Triphala oral spray reducing gingivitis in children undergoing orthodontic treatment. Methodology: A randomized control trial will be done among – participants with the age group of 10 to 15 years of age. A total of 25 children were included in the study. The participants will be told to use the spray two times a day for one week. After 7 days, plaque index and the gingival index will be re-recorded, and plaque samples will be collected for post-intervention microbial analysis. Results: Triphala-based oral spray will effectively reduce plaque score, reduce gingival inflammation, and show inhibitory effects on microbial count. Conclusion: Triphala oral spray can be used as an adjuvant by the orthodontic patients for reduction of the microbial load. It also provides better acceptability by the children as it does not require any assistance of the caregivers.

Clinical Evaluation and Comparison of Stainless Steel Crowns and Zirconia Crowns in Primary Molars- A Study Protocol

Aim: The present study will be undertaken to evaluate and compare the clinical success of stainless steel crowns and zirconia crowns in carious primary molars. Study Design: Randomized controlled trial. Place and Duration of the Study: Department of Pedodontics & Preventive Dentistry, Sharad Pawar Dental College & Hospital, Duration- One year Methodology: In this Split-mouth, 12 months study, set of primary molars in 4-9 years old children will be restored with stainless steel crown and zirconia crown. The primary objective is the assessment of clinical success by evaluating pain, swelling and pathologic mobility at baseline, 1, 3, 6 and 12 months interval. The secondary objectives are to assess the level of parental satisfaction by applying fivepoint likert scale and evaluate the gingival condition by recording Sillness and Loe Plaque index (PI) and Loe and Silness Gingival Index (GI) of study groups at periodic interval of 1, 3, 6 and 12 months. Results: The results of the present study will investigate the effectiveness of two types of pediatric full coverage restorations for management of extensive caries in primary molars. Conclusion: The findings of the present research would help the patient and practitioners to select appropriate therapeutic option.

Treatment Modalities for Rehabilitation of Mutilated Primary Anterior Teeth

Early childhood caries commonly affects the primary maxillary anterior teeth, in which extensive post- endodontic rehabilitation has always been a challenge. This is due to the small size of the crown, relatively large pulp chambers, and the age of the child. The remaining inadequate sound tooth structure renders restorations more prone to fractures. Among the available treatment modalities which include extraction of the grossly destructed tooth structure, use of semipermanent crowns and intracanal posts, the posts can be used effectively, to restore the lost function and anatomy. They also enhance the quality of the final coronal restoration by providing additional support for retention. The available methods for intracanal reinforcement for anterior teeth include the metal posts fabricated using orthodontic wires, short composite posts fabricated directed in the primary root canal, prefabricated glass fiber posts and posts utilising polyethylene fibers (Ribbond). Recently certain advanced techniques such as the biologic dentin and zirconia have also come into use. The various advantages and disadvantages for these have been summarised in this review along with the standardised clinical protocol for their placement in the primary root canals. Various in-vivo and in-vitro studies have concluded that the glass-fiber short intracanal posts provide the most suitable esthetics, strength, elastic modulus, and resilience. However, further qualitative research is required to certify it as a standard treatment modality.

Assessment of Knowledge, Attitude and Practice Behaviors of Parents towards Care of Primary Dentition – A Cross Sectional Study

Aims: The present study was undertaken to assess the knowledge, attitude and practice behaviors of parents towards care of the primary dentition of children in Wardha city, India. Study Design: Cross sectional study. Place and Duration of the Study: Department of Pedodontics & Preventive Dentistry, Sharad Pawar Dental College & Hospital, Duration- One year Methodology: A questionnaire based cross sectional study was conducted among parents of 3-7 year old children who visited the Department of Pedodontics & Preventive dentistry. The self-administered, close-ended questionnaire was adopted from oral health literature [Rwakatema et al 2009] and was modified based on researcher’s knowledge and experience of the issues under study. The first part of the questionnaire included the demographic details while the second part comprised of 25 items to test knowledge, attitude and practices of parents. Data was collected by a single investigator who distributed the questionnaire, allowed enough time to fill it and collected on the spot after they had completed. Results: Majority of parents (69%) had good knowledge about importance of milk teeth. 87% of parents were aware that oral health affects the overall general health of child. However, Bedtime bottle-feeding and sharing of spoons with the child was reported by 54% and 77% of the study participants respectively. Conclusions: The majority (57.9%) of the study population had good knowledge pertaining to oral health. However, their practices towards the oral health of children were not satisfactory. Therefore, there is a need to improve oral health care practices by conducting awareness programs for parents.

Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study

Aim and objective

Apical extrusion of debris and cleaning efficacy in primary root canal treatment has not been well elucidated by using specialized pediatric rotary endodontic files. The purpose of this study is to compare the amount of apically extruded debris and cleaning efficacy during the preparation of primary molar root canals using Pro AF Baby Gold and Kedo-S pediatric rotary files.

Materials and methods

Twenty extracted primary molar teeth were assigned randomly to two groups (n = 10 teeth for each group), injected with Indian Ink and instrumented using Kedo-S and Pro AF Baby Gold pediatric rotary files, respectively. The apically extruded debris was collected and dried in pre-weighed using Eppendorf tubes. The dry weight was calculated by subtracting the preoperative weight from the postoperative weight. The cleaning efficacy was evaluated after the diaphanization process. Statistics: Data were analyzed statistically using the independent sample t-test.

Results

The amount of apically extruded debris was significantly less for the Pro AF Baby rotary files group compared to the Kedo-S rotary files group (p < 0.05). Cleaning efficacy was significantly better with Pro AF Baby Gold when compared to Kedo-S rotary files in the apical region of the tooth.

Conclusion

All instruments caused apically extruded debris in primary teeth. Pro AF baby Gold files can be used with less apical extrusion of debris. Cleaning efficacy was shown to be better with the Pro AF Baby Gold pediatric rotary endodontic file.

How to cite this article

Rathi N, Jain SA, Thosar N, et al. Comparative Evaluation of Cleaning Efficiency and Apical Extrusion of Debris Using Two Pediatric Rotary Endodontic Files: An In Vitro Study. Int J Clin Pediatr Dent 2021;14(2):196–200.

Evaluation of antibacterial efficacy of Triphala toothwipes on oral Streptococcus mutans count in intellectually disabled children

AIM

To evaluate antibacterial efficacy of Triphala toothwipes on oral Streptococcus mutans counts in intellectually disabled (ID) children.

METHODS

Twenty-seven children with a mild ID were randomly divided into two groups: A - Triphala and B - placebo group. Toothwipes were given to caregivers of children belonging to the respective groups, and were instructed to use them 1 h after their meals, twice a day for 7 days. Simplified Plaque index was recorded and plaque samples were collected for microbiological examination at baseline, 48 h, and 7 days. The obtained data were tabulated and analyzed.

RESULTS

Triphala group showed a statistically significant reduction of S. mutans after 48 h and 7 days. Both Triphala and placebo groups showed a statistically significant reduction in dental plaque after 48 h and 7 days.

CONCLUSION

Triphala toothwipes are effective against the oral S. mutans compared with placebo toothwipes, while both the toothwipes are equally effective in reducing dental plaque. Thus, Triphala toothwipes can be used as an adjunct aid along with routine oral hygiene practices in individuals who lack psychomotor skills or are dependent on others to maintain oral hygiene, including infants, preschoolers, geriatric population, and children with special health care needs.

Evaluation of Antibacterial Efficacy of Vitex negundo Linn. extract as Root Canal Irrigant against Enterococcus faecalis and its penetration into Root Dentin: An in-vitro study

Introduction: The aim of this study was to evaluate the antibacterial efficacy of Vitex negundo Linn. extract as root canal irrigant against Enterococcus faecalis and its penetration into root dentin. Methods and Materials: Forty single rooted premolars were randomly divided into 4 groups: 3% Sodium hypochlorite (NaOCl), 2% Chlorhexidine (CHX) , 100mg/ml Vitex negundo Linn. and saline as control all mixed with Rhodamine B dye. Test samples were analysed for bacterial count before and after irrigation using absorbent paper points and the colony forming units were recorded and measured. Sectioning of the samples was performed at three levels 3mm,6mm,9mm from apex and then these samples were analysed using confocal laser scanning microscopy for penetration depth of the irrigant within the dentinal tubules. Paired t-test and ANOVA test were used to perform statistical analysis with level of significance set at 0.05 Results: The mean CFU/ml count of Enterococcus facealis reduced significantly in all the groups post irrigation. All the irrigants showed maximum penetration depth at coronal third level compared to middle and apical third level respectively. The penetration depth of NaOCl group was better when compared to CHX group and Vitex negundo Linn. group but the difference was statistically not significant. Conclusion: Although 3% NaOCl was the most effective irrigant, all agents exerted acceptable antimicrobial activity against Enterococcus faecalis and penetration depth within tubules of dentin.

Comparative evaluation of a novel herbal anesthetic gel and 2% lignocaine gel as an intraoral topical anesthetic agent in children: Bilateral split-mouth, single-blind, crossover in vivo study

BACKGROUND

Topical anesthetics have an intrinsic part to reduce pricking pain sensation due to needle stick before injection in children.

AIM

The present study aimed to determine the effectiveness of a novel herbal anesthetic gel used as a topical anesthetic before an inferior alveolar nerve block.

SETTINGSANDDESIGN

This was a bilateral split-mouth, single blind, crossoverin vivo study.

METHODS

Atotal number of 30 children were selected for this study design. After the application of the topical anesthesia, a 26-gauge needle was inserted in the mucobuccal fold and local anesthetic solution was deposited. Assessment of pain perception was done before the procedure and at the time of needle penetration using hemodynamic parameters such as blood pressure and heart rate. The objective and subjective pain assessment was recoded through sound eye motor scale and Faces Pain Scale-Revised (FPS-R).

STATISTICALANALYSIS

As the data followed a normal distribution, parametric tests were used to analyze these data. The independent sample t-test and paired sample t-test were used to check the mean differences.

RESULTS

The data showed no statistically significant differences in the objective and subjective pain assessment values of the novel herbal anesthetic gel compared to the 2% lignocaine gel. However, the intragroup comparisons of the before and during treatment results showed statistically significant results (P < 0.05).

CONCLUSION

The novel herbal anesthetic gel was effective and safe in reducing the pain from needle insertion. Thus, setting up scientific evidence for the therapeutic usage of herbal products can, therefore, assist to develop a more efficient and alternative topical anesthetic.

Midazolam use in pediatric dentistry: a review

Behaviour management and dental procedures performed in very young, pre-cooperative, highly anxious, or medically disabled children are challenging tasks. Various drugs and methods have, however, been introduced to facilitate treatment for this patient population. Midazolam is a benzodiazepine used as an adjunct to behavior management techniques in the dental treatment of pediatric patients. Midazolam can be used as a safe and effective drug for conscious sedation, general anesthetic premedication, and treatment of seizures during dental procedures. Nevertheless, further research involving pediatric patients would be beneficial.

Comparison of impact of oral hygiene instructions given via sign language and validated customized oral health education skit video on oral hygiene status of children with hearing impairment

INTRODUCTION

Children with special health-care needs have limitations in oral hygiene performance due to their potential motor, sensory, and intellectual disabilities and so are more prone to have compromised oral health.

AIM

This study aimed to compare the impact of oral hygiene instructions given via sign language and a validated customized oral health education skit video on oral hygiene status of children with hearing impairment (CHI).

SETTINGS AND DESIGN

Ethical clearance was obtained from the institutional ethical committee for research activities. The study was carried out across CHI schools of Wardha district, Maharashtra, India.

METHODOLOGY

Sixty-eight CHI, within the age group of 6-13 years, were divided into two educational intervention groups: customized oral health educational video (Group A) and sign language (Group B). A structured questionnaire was designed to gather information about the routine oral hygiene practices via the Indian Sign Language. Baseline Gingival Index (GI)-S and Plaque Index-S indices were recorded. Based on the group assigned, oral hygiene instructions were given on a daily basis. Reassessment was done after 4 weeks.

STATISTICAL ANALYSIS

Unpaired t-tests were performed (P < 0.05) to determine if significant differences exist between the two groups.

RESULTS

Postintervention plaque scores between Group A and Group B were 0.12 ± 0.22 and 0.07 ± 0.22, respectively, and the difference between the two was statistically insignificant (P = 0.330). For GI, scores in Group A and Group B were 0.03 ± 0.12 and 0.04 ± 0.12, respectively, and the difference was statistically insignificant (P = 0.669).

CONCLUSION

Both sign language and the validated customized video modeling have been proved to be positively influencing the oral hygiene status of CHI equivalently.

Role of dexmedetomidine in pediatric dental sedation

Dexmedetomidine is a highly selective α2-adrenoceptor agonist with a vast array of properties, making it suitable for sedation in numerous clinical scenarios. Its use was previously restricted to the sedation of intensive care unit patients. However, its use in pediatric dental sedation has been gaining momentum, owing to its high suitability when compared with conventional pediatric sedatives. Its properties range from sedation to anxiolysis to analgesia, due to its sympatholytic properties and minimal respiratory depression ability. Because dexmedetomidine is an efficacious and safe drug, it is gaining importance in pediatric sedation. Thus, the aim of this review is to highlight the properties of dexmedetomidine, its administration routes, its advantages over the commonly used pediatric sedatives, and especially its role as an alternative pediatric sedative.

Comparative evaluation of Nano-Hydroxyapatite preparation and Calcium Sucrose Phosphate on microhardness of deciduous teeth after iron drop exposure - An in-vitro study

BACKGROUND

To evaluate and compare the microhardness of deciduous teeth treated with nano-hydroxyapatite and calcium sucrose phosphate after iron drop exposure.

MATERIAL AND METHODS

Twenty healthy anterior deciduous teeth were collected and stored in 0.9% saline solution at room temperature. All the teeth were immersed in artificial saliva in an incubator shaker at 37° for an hour and then subjected to Vickers microhardness test at 100g load for 5 seconds. The teeth were then immersed in iron drop for 5 minutes, twice daily, rinsed with distilled water and kept in artificial saliva. This procedure was repeated for 7 days and teeth were subjected to microhardness testing. Further, the teeth were divided in two groups, each group containing 10 teeth. In group I, nanohydroxyapatite preparation and in group II, calcium sucrose phosphate were applied for 10 minutes, twice daily for 7 days and subjected again to microhardness testing again.

RESULTS

Vickers microhardness analysis revealed that iron drop exposure to teeth caused significant decrease in microhardness (p<0.05). Application of nanohydroxyapatite preparation in Group I showed significantly increased enamel microhardness (206.90) than that after iron drop exposure. Similarly, application of calcium sucrose phosphate in Group II showed significantly increased enamel microhardness (200.89) than that after iron drop exposure. Statistical difference was seen between the two groups, with nanohydroxyapatite preparation showing increased microhardness than calcium sucrose phosphate.

CONCLUSIONS

Nanohydroxyapatite preparation and calcium sucrose phosphate have remineralizing effect over teeth affected by acid challenge of iron drops, nanohydroxyapatite preparation showing better results than calcium sucrose phosphate. Key words:Iron drops, Nanohydroxyapaptite, calcium sucrose phosphate, anticay.

Determination of toral antioxidant capacity of saliva in sickle cell anemic patients - A cross-sectional study

BACKGROUND

Sickle cell anemia is a congenital hemoglobinopathy characterized by deformed red blood cells. Oxidative stress plays an important role in the pathophysiology of sickle cell anaemia as it destroys free radicals, and thereby depleting the protective mechanisms such as antioxidants in serum. These antioxidants are essential to protect against harmful oxidation-reduction reactions preventing oxidative damage to the cells.

AIM

To evaluate and compare the Total Antioxidant Capacity (TAC) of serum and saliva in sickle cell anemia patients.

MATERIALS AND METHODS

A total of 150 children aged 4-12 yrs were selected and divided into two equal groups: Children suffering from sickle cell anemia and healthy controls. Blood and saliva samples were collected aseptically from both groups and were subjected to phosphomolybdenum method. Absorbance was read spectrophotometrically at 695 nm. The concentration of total antioxidants was obtained by plotting absorbance of the test against the standard graph.

RESULTS

TAC levels in serum (0.29±0.19) and saliva (0.29±0.14) of sickle cell anaemic patients was reduced when compared with serum (0.32+ 0.18) and saliva (0.33+ 0.16) of the healthy children. The correlation between levels of TAC in saliva and serum was found to be statistically significant in sickle cell anaemic patients.

CONCLUSION

A significant correlation of the TAC was found in saliva and serum of the patients with SCA suggests that saliva could be used as a non invasive alternative for assessing the antioxidant status in patients with SCA.

Dental management of Rothmund-Thomson syndrome with partial anodontia

Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive trait disease. It is characterised by skin, eye and skeletal abnormalities. Abnormalities associated with teeth include abnormal crown and root formations, rudimentary or hypoplastic teeth, microdontia and multiple missing teeth. In the present case, there were multiple decayed primary teeth and multiple congenitally missing permanent teeth. Mandibular left primary first molar (tooth 74) was pulpally involved and obturated with mineral trioxide ggregate. Follow-up after 2 years revealed successful obturation.

Antimicrobial efficacy of five essential oils against oral pathogens: An in vitro study

Objectives:

This study was aimed to find out the minimum inhibitory concentration (MIC) of five essential oils against oral pathogens and to find out the minimum bactericidal concentration (MBC) and minimum fungicidal concentration (MFC) of five essential oils against oral pathogens.

Materials and Methods:

The antimicrobial activities by detecting MIC and MBC/MFC of five essential oils such as tea tree oil, lavender oil, thyme oil, peppermint oil and eugenol oil were evaluated against four common oral pathogens by broth dilution method. The strains used for the study were Staphylococcus aureus ATCC 25923, Enterococcus fecalis ATCC 29212, Escherichia coli ATCC 25922 and Candida albicans ATCC 90028.

Results:

Out of five essential oils, eugenol oil, peppermint oil, tea tree oil exhibited significant inhibitory effect with mean MIC of 0.62 ± 0.45, 9.00 ± 15.34, 17.12 ± 31.25 subsequently. Mean MBC/MFC for tea tree oil was 17.12 ± 31.25, for lavender oil 151.00 ± 241.82, for thyme oil 22.00 ± 12.00, for peppermint oil 9.75 ± 14.88 and for eugenol oil 0.62 ± 0.45. E. fecalis exhibited low degree of sensitivity compared with all essential oils.

Conclusion:

Peppermint, tea tree and thyme oil can act as an effective intracanal antiseptic solution against oral pathogens.

Comparative in vitro assessment of color stability of hybrid esthetic restorative materials against various children's beverages

Purpose:

The present study was aimed to evaluate and compare the color stability of two hybrid tooth-colored restorative materials, namely, resin-modified glass ionomer cement (GC Fuji II LC Capsules - GC Corporation, Tokyo, Japan) and giomer (Beautifil II - Shofu Inc, Kyoto, Japan) when subjected to immersion in various children's beverages.

Materials and Methods:

Standardized disc specimens were prepared using the test restorative materials. After preparation and rehydration of the specimens, baseline color evaluations were performed using spectrophotometer. The readings were recorded according to CIELAB color space. The experimental groups were further subdivided for immersion in orange juice, bournvita milk, and coke. Subsequent to immersion and pH cycling, new color evaluations were carried out after 1 week and 4 weeks for all the experimental groups. The mean color change values were calculated.

Results:

The obtained data was subjected to statistical analysis. The results indicated that giomer specimens exhibited less color change as compared to RMGIC specimens indicating better color stability. The maximum color changes were found with the use of coke for a period of 4 weeks.

Conclusion:

Amongst the two materials, giomer showed less color changes as compared to RMGIC indicating a better color stability.

Assessment of safe zone in maxillary molar region for miniscrew placement in the mixed dentition period--a digital volumetric tomographic (DVT) study

Assessment of bone thickness in maxillary frst molar region for miniscrew placement during the mixed dentition period with reference to the following variables a) mesio-distal bone width b) buccal cortical plate thickness c) palatal cortical plate thickness d) bucco-palatal bone depth. DVT images of fifteen healthy patients aged 8-10 years with early exfoliated maxillary second deciduous molar were obtained using the Kodak 9000 extra-oral imaging system. The scanned images were analyzed using Kodak dental imaging software [3DmoduleV2.2] and the bone thickness measurements were obtained at six mm and eight mm apical to the cemento-enamel junction. The mean and standard deviation for the measurements was calculated and data was statistically analysed using paired 't' test. The Method error calculations were performed using the Dahlberg formula. The mean values for the mesiodistal width, buccopalatal depth, buccal and palatal cortical bone thickness were found to be sufficient for miniscrew placement up to 1.2mm diameter and 10mm length. The bone thickness measurement and assessment of safe zone in maxillary posterior region from the present study showed potential for miniscrew placement in pediatric age group. Miniscrews can be considered as a promising aid in pediatric space management; so also, they can be used for molar distalization and space regaining in early mixed dentition period.

Antibacterial effects of hybrid tooth colored restorative materials against Streptococcus mutans: An in vitro analysis

Objective:

The objective of this study was to evaluate the antibacterial effect of two hybrid restoratives, namely resin modified glass ionomer cement (GC Fuji II™ LC, GC Corporation, Tokyo, Japan) and giomer (Beautifil-II, Shofu Inc., Kyoto, Japan) against Streptococcus mutans [Microbial Type Culture Collection (MTCC), 890].

Materials and Methods:

The antibacterial effect was evaluated using an agar diffusion test. The prepared wells in petri dishes were completely filled with chlorhexidine (positive control group), resin modified glass ionomer cement and giomer respectively. Prepared bacterial suspension was poured over the petri dish and was spread evenly using the plate spreader. The culture plates were placed in the incubator for 24 h at 37°C. The antibacterial activity was evaluated after 24 h, 48 h, and 7 days for each group in triplicates.

Results and Conclusion:

The results of the antibacterial effect of the tested materials were collected, statistically analyzed using the ANOVA test to determine the difference between the mean diameters of the inhibition zone produced. The mean zone of bacterial inhibition was found to be more with the giomer specimens at all time periods. However, this inhibitory activity showed a gradual decrease over a period of 7 days and the maximum inhibition was evident after 24 h with both the test materials.

Orthodontic extrusion: diagnosis and treatment with CBCT in a pediatric patient

Traumatic injury to a primary tooth can affect the underlying permanent tooth germ, and may result in a malformed, hypoplastic crown or root. The degree and nature of malformation depends on the injury. Most trauma cases can be diagnosed using conventional 2-dimensional radiographs, but some cases may benefit from more advanced 3-dimensional imaging such as cone-beam computed tomography (CBCT). This report describes the use of CBCT in the diagnosis and treatment planning of a case in which a 10-year-old girl reported with an impacted, recessed central incisor. The tooth was deformed due to trauma at an early age. Conventional 2-dimensional occlusal and periapical radiographs seemed to indicate that the root had almost completely resorbed. This implied that the optimal treatment plan would be the extraction of the central incisor and, later, the placement of an implant with a crown or bridge. However, a 3-dimensional CBCT radiographic examination showed that the tooth root was long and had enough of a crown-to-root ratio to anchor the tooth. The CBCT examination compelled the treating dentists to maintain the central incisor by orthodontically extruding the tooth and then rebuilding it with a bonded composite restoration.

Occlusal traits of deciduous dentition of preschool children of Indian children

Objectives:

To assess the occlusal relationship, canine relationship, crowding, primate spaces, and anterior spacing in both maxillary and mandibular arches of primary dentition of Indian children of Wardha District and also to study the age-wise differences in occlusal characteristics.

Materials and Methods:

A total of 1053 (609 males and 444 females) children of 3-5 year age group with complete primary dentition were examined for occlusal relationship, canine relationship, crowding, primate spaces, and anterior spacing in both maxillary and mandibular arches.

Results:

The data after evaluation showed significant values for all parameters except mandibular anterior spacing, which was 47.6%. Mild crowding was prevalent at 5 year age group and moderate crowding was common at 3 year-age group.

Conclusion:

Evaluated parameters such as terminal molar relationship and canine relationship were predominantly progressing toward to normal but contacts and crowding status were contributing almost equal to physiologic anterior spacing. Five-year-age group showed higher values with respect to all the parameters.

Unusual Case of Calculus in Floor of Mouth: A Case Report

Calculus consists of mineralized bacterial plaque that forms on the surfaces of natural teeth. It is supragingival or subgingival depending upon its relation with gingival margin. The two most common locations for supragingival calculus are the buccal surfaces of maxillary molars and lingual surfaces of mandibular anterior teeth. It is very important to rule out the predisposing factor for calculus formation. In the present case of an 11-year- old female child, 1.2 × 1.5 cm large indurated mass suggestive of calculus in the left side of floor of mouth was observed. After surgical removal, along with indurated mass, an embedded root fragment was seen. Biochemical analysis of the specimen detected the calcium and phosphate ions approximately equals to the level in calculus. Thus, we diagnosed it as a calculus. Oral hygiene instructions and regular follow-up was advised.

How to cite this article: Bahadure RN, Thosar N, Jain ES. Unusual Case of Calculus in Floor of Mouth: A Case Report. Int J Clin Pediatr Dent 2012;5(3):223-225.

Evaluation of calcium ion, hydroxyl ion release and pH levels in various calcium hydroxide based intracanal medicaments: An in vitro study

AIMS

Evaluation of calcium ion and hydroxyl ion release and pH levels in various calcium hydroxide based intracanal medicaments.

OBJECTIVE

The purpose of this study was to evaluate calcium and hydroxyl ion release and pH levels of calcium hydroxide based products, namely, RC Cal, Metapex, calcium hydroxide with distilled water, along with the new gutta-percha points with calcium hydroxide.

MATERIALS AND METHODS

The materials were inserted in polyethylene tubes and immersed in deionized water. The pH variation, Ca(++) and OH(-) release were monitored periodically for 1 week.

STATISTICAL ANALYSIS USED

Statistical analysis was carried out using one-way analysis of variance and Tukey's post hoc tests with PASW Statistics version 18 software to compare the statistical difference.

RESULTS

After 1 week, calcium hydroxide with distilled water and RC Cal raised the pH to 12.7 and 11.8, respectively, while a small change was observed for Metapex, calcium hydroxide gutta-percha points. The calcium released after 1 week was 15.36 mg/dL from RC Cal, followed by 13.04, 1.296, 3.064 mg/dL from calcium hydroxide with sterile water, Metapex and calcium hydroxide gutta-percha points, respectively.

CONCLUSIONS

Calcium hydroxide with sterile water and RC Cal pastes liberate significantly more calcium and hydroxyl ions and raise the pH higher than Metapex and calcium hydroxidegutta-percha points.

Management of Talons Cusp associated with Primary Central Incisor: A Rare Case Report

The talon cusp is a relatively rare dental developmental anomaly characterized by cusp-like projections, usually observed on the lingual surface of the affected tooth. Normal enamel covers the cusp and fuses with the lingual aspect of the tooth. The cusp may or may not contain an extension of the pulp. The condition can occur in both the primary and permanent dentitions. However, the occurrence of anomalous cusp is rather infrequent in the primary dentition. Little data is available about the treatment of talon cusps in the primary dentition as compared with the permanent dentition. A case of talon cusp in the primary maxillary left central incisor is reported. This dental anomaly was not associated with any other somatic or dental abnormality. The tooth was carious. Pulpal extension into the cusp was detected radiographically. Pulpectomy of the tooth was carried out and restored with composite restoration.

How to cite this article: Bahadure RN, Thosar N, Jain ES. Management of Talons Cusp associated with Primary Central Incisor: A Rare Case Report. Int J Clin Pediatr Dent 2012;5(2): 142-144.

Conventional surgical treatment of oral mucocele: a series of 23 cases

AIM

Mucocele is a common lesion of the oral mucosa that results from alterations of the minor salivary glands due to mucous accumulation, causing swelling. Conventional surgical treatment was planned for these lesions in a group of children and the success rates of the therapy during the transitional period from mixed to permanent dentition were assessed with a series of follow-ups.

MATERIALS AND METHODS

A series of 23 cases of mucocele was observed in children under 10 years of age. Clinically the lesions consisted of a soft, bluish and transparent cystic swelling which normally resolved spontaneously and reappeared after rupture in few days. All cases were treated by conventional surgical procedure with excision of minor salivary glands and underwent a 3-year follow-up.

RESULTS

Out of the 23 cases, 19 (82.6%) were in the lower lip, 2 (8.6%) in the cheek, 1 (4.3%) in the retromolar area and 1 (4.3%) in the upper lip. Those in the lower lip, 15 (79%) were away from the midline and 4 (21%) at midline. One (4.3%) recurrence was seen at the 6-month follow-up. After 3 years, recurrence rate remained the same.

CONCLUSION

Conventional surgical excision with removal of affected minor salivary glands in paediatric patients is a definite treatment for mucocele.

Dental aspect of distal tubular renal acidosis with genu valgum secondary to rickets: a case report

Distal renal tubular acidosis is a disease that occurs when the kidneys do not remove acid properly into the urine, leaving the blood too acidic (called acidosis). Distal renal tubular acidosis (type I RTA) is caused by a defect in the kidney tubes that causes acid to build up in the bloodstream. It ultimately results rickets which include chronic skeletal pain, in skeletal deformities, skeletal fractures. Rickets is among the most frequent childhood diseases in many developing countries. Dental problems in rickets include delayed eruption of permanent teeth, premature fall of deciduous teeth, defects in structure of teeth, enamel defects in permanent teeth (hypoplastic), pulp defects, intraglobular dentine, and caries tooth. Herewith, reported a case of distal tubular renal acidosis with genu valgum secondary to rickets, with pain and extraoral swelling associated with right and left mandibular 1st permanent molars. Teeth were infected with pulp without being involved with caries. Radiographically cracks in enamel and dentin were observed. Pulp revascularization with 46 and root canal treatment was done for 36 with followup of 1 year.

Soft skill appraisal for dentistry: a tool for positive practice management

Soft skills adoption is a learning experience for every practitioner and every academician. Author has expressed his opinion for success through educational and real values of soft skill. Soft skills behavior of individual and institution help in achieving desirable goals in general and specialty practices. Author also focused on some realistic soft skill methods for improvisation of practices for all doctor.

CONCLUSION

These skills indulge positive energy in human relationship for working in symbiosis and explore infinite capabilities at institutional and doctoral level. Here, some optimistic suggestions are given for improving dental practices and academic fulfillments.

CLINICAL SIGNIFICANCE

These soft skills help to organize, plan and manage, and track changes during the course of the growing dental practices. However, understanding of the soft skills in practice management, its simplicity and complexity and also, its contributing factors, helps practitioners to understand the dynamic, social and complex contexts of practices. It is really helpful to all practitioners to grow their practices using soft skills.