Genetic variations in exon 10 of ENAM and their association with early childhood caries

OBJECTIVE

Enamelin is the largest enamel matrix protein encoded by the ENAM gene. The primary purpose of this study was to identify genetic variants in ENAM exon 10 that can alter susceptibility to early childhood caries (ECC).

METHODS

This case-control study included 248 children aged 3-6 years, with 124 children diagnosed with ECC in the case group and 124 children without caries in the control group. Questionnaires were used to record demographic data, socioeconomic status, hygienic practices, and feeding practices, and a 24-hour diet diary was kept. Seven polymorphisms (rs7671281, rs1738668322, rs3796703, rs3796704, rs759376039, rs775159311, and rs1738678483) in ENAM exon 10 were sequenced.

RESULTS

The heterozygous CT genotype of rs7671281 was significantly more common in the case group compared to the control group (odds ratio [OR], 6.1765; 95% confidence interval [CI], 2.05-18.58; P=0.0006). Under the dominant model, the TT genotype of rs7671281 was significantly more common in the control group (OR, 6.47; 95% CI, 2.15-19.39; P<0.001). The AG genotype of rs3796704 was significantly more common in the case group than in the control group (OR, 5.705; 95% CI, 1.60-20.25; P=0.006). Under the dominant model, the GG genotype of rs3796704 was significantly more common in children without caries than in children with caries (OR, 6.84; 95% CI, 1.96-23.90; P<0.001).

CONCLUSIONS

The C allele of rs7671281 and the A allele of rs3796704 can increase susceptibility to ECC.

A comparative evaluation of peppermint oil and lignocaine spray as topical anesthetic agents prior to local anesthesia in children: a randomized clinical trial

Background

In pediatric dentistry, fear and anxiety are common among children. Local anesthetics (LA) are widely used to control pain and reduce discomfort in children during dental treatment. Topical anesthetics play a vital role in reducing pain and the unpleasant sensation of a needle puncture in children. Peppermint oil has been extensively used for various diseases. However, its anesthetic properties remain unknown. Peppermint oil, used in mouthwashes, toothpastes, and other topical preparations has analgesic, anesthetic, and antiseptic properties. This study aimed to compare and evaluate pain perception following the topical application of peppermint oil versus lignocaine spray before an intraoral injection in children, aged 8-13 years.

Method

Fifty-two children, aged between 8-13 years, who required local anesthesia for dental treatment were divided into two groups of 26 each by simple random sampling (Group 1: 0.2% peppermint oil and Group 2: lignocaine spray). In both groups, physiological measurements (e.g., heart rate) were recorded using pulse oximetry before, during, and after the procedure. Objective pain measurement (Sound Eye Motor (SEM) scale) during administration and subjective measuremeant (Wong-Baker Faces Pain Rating Scale (WBFPRS)) after LA administration were recorded. This was followed by the required treatment of the child.Physiological parameters were compared between the two groups using an independent t-test for intergroup assessment and a paired t-test and repeated-measures ANOVA for intragroup comparisons. The Mann-Whitney U test was used to analyze the pain scores.

Results

Intragroup mean heart rates, before, during, and after treatment were statistically significantly different (P < 0.05). However, the intergroup mean pulse rates did not differ significantly between the two groups. The mean WBFPS score in the lignocaine spray group was 4.133 ± 2.06 was statistically different from that of the peppermint oil group (0.933 ± 1.03; P < 0.001*). The mean SEM score was significantly lower in the peppermint oil group than that in the lignocaine spray group (P = 0.006). No negative effects were observed in this study.

Conclusion

0.2% peppermint oil was effective in reducing pain perception.

AMELX gene association to early childhood caries in south-Indian children: a case-control study

PURPOSE

Genetic variants of AMELX gene can affect the protein content, organization of enamel prisms, microstructure and microhardness of the enamel, thus altering the caries susceptibility. The present study aims to assess the association between polymorphisms rs17878486, rs5934997, and rs5933871 of AMELX gene and Early Childhood Caries (ECC).

MATERIALS AND METHODS

This case-control study was conducted on 200 participants, aged 3-6 years, with 100 controls and 100 children with ECC. A questionnaire was used to collect demographic data, birth-weight, type of delivery, oral hygiene practices, feeding history and 24-h diet diary. DNA was isolated from blood and subjected to PCR followed by Sanger sequencing.

RESULTS

The CC genotype of rs17878486 showed an OR of 1.93 (0.34-10.81; P = 0.73). In a recessive model, the CC genotype of rs17878486 reported an OR of 2.04 (0.36-11.40; P = 0.68); rs5593871 reported an OR of 1.00 (0.31-3.21). Statistically significant differences (P ≤ 0.05) between genotype and allele frequencies of rs17878486, rs5934997, and rs5933871 were not observed between children with ECC and the controls.

CONCLUSION

Polymorphisms of AMELX gene did not show a significant association with ECC in this population. However, documentation of genetic data in a global context of ECC may be essential for the future.

Identification of the Ideal Reference Site and Pain Threshold Values for the Placement of Electric Pulp Testers in Permanent Upper and Lower Anterior Teeth: A Cross-Sectional Study

INTRODUCTION

Electric pulp testers (EPTs) are widely used diagnostic tools for diagnosing traumatized teeth. Several factors can affect the result of an electric pulp test. One such factor that will affect the diagnosis is the electrode tip placement. Hence, the current study aims to identify the most painful site and response time threshold in healthy anterior teeth.

METHODS

A total of 90 individuals, 48 male and 42 female, aged 19 to 25 years, were recruited. An EPT was placed on three different sites: the cervical, middle, and incisal third of the labial surface of both upper and lower anterior teeth (central incisor, lateral incisor, and canine) with an appropriate electrolyte as a conducting medium. Later, the threshold values were recorded, and pain assessment was done using the Memojis pain scale (MPS). Finally, the data was analyzed statistically using the Mann-Whitney U test.

RESULTS

Mean and standard deviation values of reaction time were collected from 540 EPT readings (three sites from 180 teeth). Among the three sites tested, the difference between the upper and lower central incisors was statistically insignificant (p > 0.05). Similarly, when upper and lower lateral incisors and canines were compared, a statistically significant difference was observed among the three sites (p<0.05). There was a significant difference (p<0.05) in the pain scores only on the incisal and cervical thirds of the upper and lower central incisors. Only the incisal third showed a statistically significant difference (p<0.05) between the pain scores in the upper and lateral incisors. At the same time, a statistically significant difference in the pain scores was observed among the three tested sites between the upper and lower canines (p<0.05).  Conclusion: Lower threshold values were appreciated at the incisal third of all the upper and lower anterior teeth for placing the EPT. Most individuals have experienced a score of 2 (hurts little bit) for the perceived pain using EPTs for both the upper and lower anterior teeth.

Comparative Evaluation of Antimicrobial and Smear Layer Removal Efficacy of Mangifera indica Kernel Extract as Root Canal Irrigant in Primary Molar: An In Vitro Study

Background

Endodontic therapy aims to disinfect the entire root canal system. Extracts from the kernel of Mangifera indica has the potential to be a novel root canal irrigant that has yet to be studied. Hence, the present study evaluated the antimicrobial, and smear layer removal efficacy of the M. indica kernel extract as a root canal irrigant in primary molars.

Materials and Methods

Methanolic extract of M. indica was prepared using the standard method. The antimicrobial efficacy of M. indica kernel extract was determined by agar diffusion method with 3% sodium hypochlorite and distilled water as controls, and the smear layer removal efficacy was assessed under the SEM after processing the root samples with different concentrations of M. indica kernel extract with 17% EDTA and distilled water as positive and negative controls, respectively.

Results

A statistically significant antimicrobial efficacy was observed with the largest mean zone of inhibition recorded with 50 μl of M. indica kernel extract at 24 hr of incubation period, when compared to sodium hypochlorite as a root canal irrigant against Enterococcus faecalis using agar diffusion method at MIC value of 0.625 mg/ml. The smear layer removal efficacy of the M. indica kernel extract was not satisfactory, when compared with EDTA as a root canal irrigant in primary molars and observed under SEM. In contrast, a complete smear layer removal was observed with 17% EDTA solution.

Conclusion

M. indica kernel extract has an enhanced antimicrobial efficacy but poor smear layer removal efficacy when used as a root canal irrigant.

Evaluation of the effectiveness of tell-show-do and ask-tell-ask in the management of dental fear and anxiety: a double-blinded randomized control trial

Background

The objective of behavioral guidance is to establish effective communication that aligns with a child's requirements to manage disruptive behavior. This study aimed to evaluate the effectiveness of the Tell-Show-Do and Ask-Tell-Ask techniques in managing dental anxiety in children during their initial appointment.

Methods

The study included 50 children (28 boys and 22 girls) without any prior experience between the ages of 7 and 11 at their first dental visit. The children were randomly categorized into two groups: Group 1, Tell Shows Do, and Group 2, Ask-Tell-Ask. Subsequently, all children underwent noninvasive treatment procedures such as restorations, sealants, and oral prophylaxis. Furthermore, behavioral management techniques were employed based on the allocated group. Finally, anxiety levels for all children were assessed using the Raghavendra, Madhuri, and Sujata Pictorial Scale (RMS-PS) and heart rate at three different intervals (before, during, and after). The obtained data were entered into Microsoft Excel, and statistical analysis was performed using SPSS software. A paired t-test and Mann-Whitney U-test were used to compare the mean and median values of the two groups and determine their effectiveness.

Results

Children in the TSD group exhibited statistically significant heart rates and RMS-PS scores in intra-group comparisons. However, children in the ask-tell-ask group showed a significant reduction only in the RMS-PS scores (P < 0.001) but not in the measures used to assess heart rate (P < 0.001).

Conclusion

Tell-Show-Do was more effective than ask-tell-ask in alleviating dental anxiety in children. The simultaneous application of these two strategies can synergistically alleviate dental anxiety during a child's initial dentist appointment.

Visit to the Dentist for Oral Health Prevention at "Age One": A proposed policy report from the Indian perspective

Early childhood caries is a major public health issue in India. The primary reason for poor oral health in children is a lack of awareness about the role of primary teeth and the importance of an early dental visit for infants and toddlers. The primary objectives of an early dental visit are to analyze the child's risk level, provide guidance to parents regarding proper oral hygiene measures, review dietary and eating habits, provide information regarding the infectivity of dental caries, review the risks of traumatic injuries and discuss factors which affect the development of occlusion. Through this paper, we are proposing an "Age One" policy that recognizes dentists, physicians, allied health professionals, community health-care workers, and nongovernmental organizations to work toward a child's overall health as partners to achieve this goal. The expectation is that this policy will provide guidance to childcare centers, pediatric dentists, other health-care professionals, and legislators regarding oral health activities and the promotion of oral health in infants. The purpose of the policy is to lay the foundation for a lifetime of preventive education and dental care, to help ensure optimal oral health beginning in childhood and continuing through the life course.

Sucrose solution for alleviating needle pain during inferior alveolar nerve block in children aged 7-10 years: a randomized clinical trial

Background

Intraoral local anesthesia is essential for delivering dental care; however, injection of this local anesthetic is perceived as the most painful and distressing agent for children, parents, and healthcare providers. Reducing pain as much as possible is essential to ensure smooth subsequent treatment procedures, especially in pediatric dentistry. In clinical practice, oral sucrose administration has been reported to decrease the pain during heel lance and cold pressor tests in neonates and children. This study aimed to determine whether the prior administration of a 30% sucrose solution reduced the pain related to inferior alveolar nerve block in children.

Methods

A total of 42 healthy children aged 7-10 years requiring dental treatment of mandibular molars involving inferior alveolar nerve block were recruited. The participants' demographic details were recorded, height and weight were measured, and the anesthetic injection was delivered after receiving the respective intraoral sucrose solution and distilled water by the intervention (group 1) and control (group 2) group participants for 2 min. The subjective pain perceived during injection was measured using an animated emoji scale. The pain scores between the groups were compared using the Mann-Whitney U test.

Results

The median pain score and range for the intervention and control groups were 4 (2 - 6) and 6 (4 - 8), respectively, and statistically significant differences (P < 0.001) were observed in the intervention group. Age, sex, height, and weight did not influence the analgesic effect of the sucrose solution.

Conclusion

Oral administration of sucrose may relieve pain associated with inferior alveolar nerve block in children.

Arginine: A New Paradigm in Preventive Oral Care

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries.

How to cite this article

Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial

Background

Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings.

Aim

To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment.

Methods

Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney U test (p value <0.05).

Results

Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (p = 0.14).

Conclusion

Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.

Erratum: Addendum: Comparative evaluation of efficacy of Physics Forceps versus conventional forceps in pediatric dental extractions: a prospective randomized study

[This corrects the article on p. 547 in vol. 21, PMID: 34909472.].

Memojis Pain Scale: A novel pain assessment tool

BACKGROUND

Dental pain exerts a considerable impact on the psychosocial well-being of children; reliable management of pain depends on the ability to assess pain intensity.

AIM

To validate and compare a new memojis pain assessment scale with the Faces Pain Scale-Revised (FPS-R) and Wong-Baker FACES Pain Rating Scale (WBFPS) in assessing dental pain experienced by children.

DESIGN

Two hundred and fifty healthy children aged 5-9 years without any past dental experience and requiring local anaesthesia (LA) administration were recruited. Three different scales [FPS-R, WBFPS and Memojis Pain Scale (MPS)] were applied to assess the children's pain during LA administration. The preferences of each child based on the ease of understanding the faces were recorded.

RESULTS

Pearson correlation test was performed to determine the correlation between MPS with WBFPS and MPS with FPS-R. A strong correlation was seen when comparing MPS with WBFPS (r = .966; p < .001) and MPS with FPS-R (r = .969; p < .001), and 81.6% of the children preferred MPS.

CONCLUSION

The Memojis Pain Scale was an effective pain assessment tool. It can be employed as an alternative scale for pain assessment in children.

Comparative evaluation of "Tell-Tell-Tell," "Ask-Tell-Ask," and "Teach back" communication techniques on oral health education among 12-13-year-old children - An educational intervention trial

Background

Effective communication with children can improve their understanding and aid in complying with oral hygiene instructions.

Aim

The aim is to compare the retentiveness of oral hygiene instructions in children educated using three communication techniques.

Methodology

One hundred and twenty children in the age range of 12-13 years were included in the study. Baseline awareness of oral hygiene maintenance was assessed using a questionnaire. Twenty children were randomly assigned to each group: Tell-Tell-Tell, Ask-Tell-Ask, Teach-back, and information provided. Knowledge was reassessed after a week; data were tabulated and assessed statistically.

Results

There were no statistically significant differences in the baseline data among the groups (P > 0.05). Regardless of the group, there was an improvement in knowledge regarding the frequency and timing of brushing as well as the cause of dental caries after the intervention. However, children in Ask-Tell-Ask and Teach back showed significant improvement over Tell-Tell-Tell (P ≤ 0.01).

Conclusion

Communication strategies, such as Ask-Tell-Ask and Teach back, which have a strategy to involve children, have been shown to be superior over Tell-Tell-Tell.

Single nucleotide polymorphisms of enamel formation genes and early childhood caries - systematic review, gene-based, gene cluster and meta-analysis

Introduction

Genetic polymorphisms of genes regulating amelogenesis can alter susceptibility to Early Childhood Caries (ECC). This systematic review aims to analyze associations between single-nucleotide polymorphisms of enamel formation genes and ECC.

Methods

Search was conducted across PUBMED, CINAHL, LILACS, SCOPUS, EMBASE, Web of Science, Genome-Wide Association Studies databases from January 2003 to September 2022. This was supplemented by hand search. Totally 7124 articles were identified and 21 articles that satisfied the inclusion criteria proceeded to data extraction. Quality assessment was done using the Q-Genie tool.

Results

Quantitative synthesis revealed that homozygous genotype AA of rs12640848 was significantly higher in children with ECC with an odds ratio of 2.36. Gene-based analysis revealed significant association between six variants of AMBN, four variants of KLK4, two variants of MMP20, and a single variant of each of MMP9 and MMP13 genes and ECC. The Bonferroni corrected-log10 P value of amelogenesis gene Cluster was 2.25 (0.05/88 = 5.6 × 10^-4). Search Tool for Retrieval of Interacting Genes and Proteins plot constructed to comprehend the protein-protein interaction revealed the presence of four functional clusters. Gene function prediction using Multiple Association Network Integration Algorithm revealed that physical interaction between these genes was 69.3%.

Conclusion

Polymorphisms of genes regulating amelogenesis can influence the susceptibility to ECC. AA genotype of rs12640848 may increase the susceptibility to ECC. Gene-based analysis revealed a significant association between multiple polymorphisms of genes regulating amelogenesis and ECC.

Addendum: Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

[This corrects the article on p. 345 in vol. 21, PMID: 34395902.].

Influence of information source regarding COVID-19 knowledge among the undergraduate dental students during the early lockdown: a multi-national study

OBJECTIVE

To assess the influence of information sources on the knowledge regarding COVID-19 among undergraduate dental students in India, Saudi Arabia, Malaysia, and Turkey.

SUBJECTS AND METHODS

An online questionnaire in a Google form link was circulated among the target population via various online platforms. It consisted of 14 close-ended questions assessing these students' knowledge and source of COVID-19-related information. SPSS software version 21.0 (IBM Corp., Armonk, NY, USA) was used to compute descriptive statistics, Chi-square test, independent t-test, and ANOVA tests for comparing various variables, and a p-value<0.05 was considered statistically significant.

RESULTS

The study yielded 809 responses from dental undergraduate students from India, Saudi Arabia, Malaysia, and Turkey. Dental students from Turkey reported a higher mean knowledge score of 7.91±1.34 and 7.88±0.58 for Malaysian dental students. In contrast, the lower scores were achieved by Saudi Arabia (7.36±1.22) and India (7.37±1.21) dental students, and the findings were statistically significant (p<0.05). The study population used various sources to attain information regarding COVID-19. Most respondents (63.1%) utilized information regarding COVID-19 from multiple sources rather than single sources (36.9%).

CONCLUSIONS

Reliable and validated information sources resulted in higher knowledge scores. Turkey and Malaysia dental students reported a higher mean knowledge score and the lowest for Saudi Arabia and India dental students. There is increased popularity of social media platforms as information sources.

Pulp oxygen saturation measurement as a diagnostic tool for assessing pulp status in primary teeth: A systematic review and meta-analysis

OBJECTIVES

This study aimed to determine the mean oxygen saturation values (SpO₂) in primary teeth using pulse oximetry.

MATERIALS AND METHODS

This comprehensive literature search on pulse oximeter used for primary teeth in determining pulp vitality using MeSH terms in four electronic databases, including PubMed, Scopus, Cochrane Library, and Ovid^SP, from January 1990 to January 2022. Studies reported the sample size and the mean SpO₂ values (with standard deviations) for each tooth group were included. The quality assessment of all the included studies was done using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa Scale. The meta-analysis included studies reporting means and standard deviations of SpO₂ values. The I² statistics were used to determine the degree of heterogeneity among the studies.

RESULTS

A total of 90 studies were identified, of which five met the eligibility criteria that were qualified for the systematic review, and among them, three were included in the meta-analysis. All five included studies were of low quality due to the high risk of bias related to the patient selection, index test, and uncertainties about outcome valuation. In the meta-analysis, the mean fixed-effect measure of oxygen saturation in the pulp of primary teeth was 88.45% (confidence interval: 83.97%-92.93%).

CONCLUSION

Though most of the available studies were of poor quality, the SpO₂ in the healthy pulp can be established (minimum saturation, 83.48%) in primary teeth. Reference values established might help clinicians to assess changes in pulp status.

Association of Sleep-Time Feeding Practices with Early Childhood Caries: A Case-Control Study

Early childhood caries (ECC) remains a public health challenge globally, more so in developing countries. The association between sleep-time feeding practices and ECC remains obscure. The study evaluated this association using Feeding At Sleep Time (FeAST) scale. A case-control study was planned among 627 toddlers, were cases included children with ECC while controls were children without ECC. Three patterns of feeding associated with sleep were recorded: beginning of sleep, during the course of sleep, and early morning hours sleep. Dental caries was scored using International Caries Detection and Assessment System (ICDAS II). The study participants included 302 (48%) cases and 325 (52%) controls. Adjusted odds ratios (AORs) for breastfeeding at the beginning of sleep, during the course of sleep, and early morning hours sleep were 6.7, 6.5, and 3.7, respectively (p = 0.001), on comparing cases versus controls. Similarly, AORs for bottle-feeding at the beginning of sleep, course of sleep, and early morning hours sleep were 5.1, 8.3, and 3.7, respectively (p = 0.001). Addition of sweeteners yielded an AOR = 2.84, while the intake of solids during sleep yielded an AOR of 6.02(p = 0.001). Other feeding modes like sippers, tumblers, etc., had a statistically significant association (p = 0.001). Sleep-time feeding practices increase the risk for ECC in 12- to 36-month-old children.

Prevalence of gingival recession and associated etiological factors among the school children

OBJECTIVE

The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children.

METHODOLOGY

The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (<7 years), mixed dentition (7-12 years), and permanent dentition (>12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test.

RESULTS

The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P > 0.05). The GR was more in children in the 7-12 years age group (75%), followed by <7 years (21%) and >12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P < 0.05) compared to malocclusion and deleteriousness habits (P > 0.05).

CONCLUSION

The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7-12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.

Feeding At Sleep Time (FeAST) Scale: Assessing Risk for Developing Early Childhood Caries in South Indian Toddlers

PURPOSE

The Feeding At Sleep Time (FeAST) scale was developed and validated to assess sleep time feeding practices for children younger than three years. The purpose of this study was to describe the process of scoring and find an optimum clinical cutoff score for early childhood caries (ECC) using receiver operating characteristics (ROC) analysis, thereby enabling researchers and clinicians to assess risk for devel- oping ECC.

METHODS

The FeAST scale was administered to mothers of 527 toddlers, aged 12 to 36 months, attending four outpatient depart- ments. The score was calculated based on subconstructs of combined breast-feeding (CBR) and combined bottle-feeding (CBO), and suitable cutoff points were identified using ROC analysis.

RESULTS

The study established a cutoff score greater than 14 for the CBR construct and a cutoff score greater than 11 for the CBO construct of the FeAST scale to determine a child's risk for developing ECC. The area under the curve (AUC), which measures the overall performance of a scale, has yielded statistically significant values (P<0.001) with fair (0.707) and good (0.788) perform- ance for the CBR and CBO constructs, respectively.

CONCLUSION

The Feeding at Sleep Time scale, based on receiver operating characteristics analysis, can potentially be used by clinicians and researchers to screen toddlers at risk of developing early childhood caries.

Parents Attitude Towards Approaching the Paediatric Dentists During COVID-19 Pandemic: A Cross-sectional Study

Introduction: The infection potential of Coronavirus Disease 2019 (COVID-19) is remarkable due to its airborne transmission through droplets and aerosols. Paediatric dental needs were severely compromised during the COVID-19 lockdown period. Aim: To assess parents’ attitudes and concerns towards approaching paediatric dentists during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted in Department of Paediatric and Preventive Dentistry at Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India, from August 2021 to October 2021. The study included 200 parents to assess the attitudes and concerns towards approaching Paediatric dentists during the COVID-19 pandemic. A structured questionnaire was used through Google forms to collect from parents, information regarding precautions, mode of transmission of the virus and type of treatment option. The Chi-square test and Fischer-exact test were used to compare the parameters such as education and occupation with parents' attitude and knowledge. Results: Out of the 200 parents, 37 were males and 163 were females with mean age of the parents was 34.8 years. Out of total 200, 153 (76.5%) of the parents were worried to visit a paediatric dentist. Only 56 (28%) of the children suffered from toothache during the pandemic. About 28 (14%) of parents believed that the virus is transmitted through the air and 70% of the parents preferred teledentistry. A 152 (76%) of them were willing to pay extra costs and 123 (61.5%) of respondents expected to treat the emergency condition alone. A statistically significant difference was not observed between different occupation in the answers given about transmission paths of a virus (p-value=0.39), extra payment (p-value=0.77), and preference of approach (p-value=0.223). Conclusion: Majority parents were worried to visit a Paediatric dentist and preferred teledentistry. They were ready to pay extra costs for the sanitisation.

Knowledge and Perceptions Regarding Coronavirus (COVID-19) among Pediatric Dentists during Lockdown Period

AIM

To assess the knowledge and perceptions of COVID-19 among pediatric dentists based on their dependent source of information.

METHODS

A descriptive-analytical cross-sectional survey using a self-administered questionnaire with 23 questions was sent via Google forms to pediatric dentists. All participants were divided into three groups [postgraduate residents (PGs), private practitioners (PP), and faculty (F)]. The comparison of knowledge and perception scores was made based on occupation, source of information, and descriptive statistics used for the analysis using SPSS 21.0 (IBM, Armonk, NY, USA).

RESULTS

A total of 291 pediatric dentists completed the survey, and the majority of them were females (65%). Overall, good mean scores were obtained for knowledge (9.2 ± 1.07) and perceptions (5.6 ± 1.5). The majority of the participants used health authorities (45%) to obtain updates on COVID-19, while social media (35.1%) and both (19.6%) accounted for the next two. A statistically significant difference (p < 0.05) was found among different pediatric dentists groups for relying on the source of information.

CONCLUSION

Overall good pediatric dentists showed sufficient knowledge regarding COVID-19. The pediatric dentists' age, occupation, and source of information influenced knowledge regarding COVID-19, whereas perceptions were influenced by age and gender of the participants. Health authorities successfully educated pediatric dentists than the social media.

Comparative evaluation of efficacy of Physics Forceps versus conventional forceps in pediatric dental extractions: a prospective randomized study

BACKGROUND

This study aimed to determine the efficacy of Physics Forceps in pediatric dental extractions.

METHODS

This was a double-blind, randomized controlled trial with a parallel-arm design and identical allocation ratio (1:1). Children (n=104) were randomly divided into two groups for extraction of mandibular primary teeth (group I: Physics Forceps; group II: conventional forceps). The outcome variables assessed in the study were the time taken for extraction, pre- and postoperative anxiety (using RMS pictorial scale), incidence of fractured teeth, and postoperative pain on the first and third days (using the Wong-Baker faces pain scale).

RESULTS

A significant reduction (P < 0.001) in intraoperative time, anxiety, and incidence of tooth fracture was confined to group I. The pain significantly reduced from the first to the third postoperative day in both groups, but the mean reduction in RMS scores in the physics forceps group was far better than that in the conventional forceps group.

CONCLUSION

Physics Forceps aid in extraction of primary teeth with minimal trauma to supporting structures, as well as reducing anxiety in the pediatric population.

Preferences and their correlation between children and their parents' attitudes towards non-pharmacological behaviour guidance techniques - A cross-sectional study

Introduction

Dental treatment for children requires the use of behaviour guidance techniques (BGTs), which are used in the dental office to make children cope with dental treatment.

Aim

Evaluate how children and parents felt towards BGTs used in a dental office, by attitude meter and to correlate them.

Materials and Method

Children (200) from 7-17 years and their parents were selected randomly to participate in the study. Each child and parent was asked to watch four video scenes of live BGTs, which include Tell Show Do (TSD), Modeling, Reward system, and Hand holding. A questionnaire collected demographic data, and their expressive attitudes were assessed using Line of favour (LOF) scale and Kruskal-Wallis Test.

Results

Most preferred BGTs for Group I was modeling, Group II Reward, Group III Tell Show Do, and Group IV was Modeling, with a mean score of 5.95, 6.04, 5.57, and 5.78, respectively. Gender wise preferences, 32% of boys and 34% of girls preferred modeling in Group I, whereas, in Group II, 20% of boys and 21% of girls preferred reward, respectively. Chi-square test revealed that there is no significant difference between the groups and gender for the preference of BGTs in Group I (P=0.893) and Group II (P=0.592). There was no significant correlation between preferences of children and their parents.

Conclusion

Modeling was the most preferred BGT for primary school children and parents of High school children. A reward was the most preferred BGT for high school children. TSD was the most preferred BGT for parents of primary school children.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

Background

This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration.

Methods

This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4–11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05.

Results

Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group.

Conclusion

External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

Remote management of dental problems in children during and post the COVID-19 pandemic outbreak: A teledentistry approach

The recent pandemic outbreak of coronavirus disease 2019 (COVID-19) has created a helpless situation in healthcare systems worldwide. The disease can be transmitted in different ways, e.g., through contact, droplets, fomites, and aerosol-generating procedures. Subsequently, the World Health Organization (WHO) released recommendations regarding precautions to be taken by all healthcare workers, including dentists, in order to avoid the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 indeed has become a pandemic, and there is a need for an innovative method to continue providing dental care to children with a minimal risk of cross-infection. The objective of this short communication was to draw special attention to the teledentistry model in pediatric dentistry and to guide the management of children with dental problems during the COVID-19 pandemic. Teledentistry is a feasible method and its use can overcome challenges in the present situation. The teledentistry approach enables providing guidance, treatment plans and follow-up with remote-assistance dental care through the use of information technology instead of face-to-face contact with patients.

Etiological Factors of the Midline Diastema in Children: A Systematic Review

BACKGROUND

Midline diastema in children is a prevalent developmental entity, and this pathological condition may remain in many children due to various factors. Nonetheless, the evidence on etiological factors of the midline diastema in children is minimal.

PURPOSE

To evaluate the etiological factors of midline diastema causes in children below 12 years of age from the published data.

METHODS

A literature search was confined to the English language using MeSH terms conferring to PICO format in PubMed, Cochrane Library, and Ovidsp covering the period from January 1960 to December 2019. Search in Google Scholar, grey literature, and hand search on references were performed to find additional data. Suitable studies were selected based on the predefined inclusion and exclusion criteria. Quality analysis of the chosen studies conducted using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies.

RESULTS

Only eight studies were available for final analysis among those four studies from India, two studies from Korea, one study from Brazil, and another study from Canada. The most common etiology for midline diastema was supernumerary teeth followed by morphology labial frenum and nasal airflow condensation. The quality analysis of these studies based on NOS showed one study with unsatisfactory, four studies with satisfactory, and three with good quality.

CONCLUSION

Morphology of frenum, pre-maxillary supernumerary teeth, and nasal airflow condensation seem to be the most common causes of midline diastema in children below 12 years.

Dentistry for children during and post COVID-19 pandemic outbreak

BACKGROUND

During and post COVID-19 pandemic outbreak, it is essential for safeguarding this viral infection control and prevention in pediatric dental practices. The role of parents and pediatric dentist and their dental team requires specific guidance to deal with dental problems of children in the dental operatory during and post-pandemic outbreak of COVID-19 disease.

PURPOSE

To report dentistry for children during and post COVID-19 pandemic outbreak.

CONCLUSIONS

The present review highlights the clinical features, possible modes of transmission of COVID-19 in dental operatory, preventive strategies, emergencies that pose a significant challenge, and treatment strategies for dealing with children and parents during and post COVID-19 pandemic. Absolute measures for children during their visit to dental operatory, quality control for pediatric dental clinics, and additional preventive measures associated with examinations and management of dental problems in children have been covered in this insight.

Influence of Isolation Methods on Retention of Pit and Fissure Sealants in Young Permanent Teeth based on Simonsen’s Criteria: A Randomised Clinical Trial

Introduction: Pit and Fissure Sealants (PFS) are chemically-active liquid materials that are introduced into the occlusal surface of caries-susceptible teeth. These form a micro mechanically bonded, protective layer preventing access to caries-producing bacteria, from rest of the oral environment. Aim: To evaluate the retention of PFS placed on young permanent teeth using two isolation methods. Materials and Methods: This clinical study was carried out in the Department of Paediatric and Preventive Dentistry, at Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India. One hundred Permanent First Molars (PFM) from 25 healthy, cooperative children in the age group of 6-9 years were assigned by block randomisation into two groups (isolation type); each group containing the upper and lower PFMs of the right and left side receiving two different treatment modalities (split-mouth design). In Group I (n=50 teeth), the teeth received sealant with rubber dam isolation, and in Group II (n=50 teeth), with cotton roll isolation. The sealant was applied to all the PFMs as indicated. All the teeth were evaluated using Simonsen’s criteria at regular intervals of 3, 6, and 12 months. The data collected were subjected to statistical analysis using the SPSS statistical package (version 17) and statistical significance was set at 0.05. The difference in the retention of PFS with the two isolation methods was analysed using the Chi-square test. Results: After 12 months, the marginal integrity rate for sealants placed with a rubber dam and cotton roll isolation were 75% and 64%, respectively. The results were better in Group I than in Group II, although there were no statistically significant differences with respect to marginal integrity, discolouration, and anatomical failure. Conclusion: Retention of PFS in young permanent teeth was better with rubber dam than cotton rolls for isolation, though the results were not statistically significant.

Challenges and possible solutions in dental practice during and post COVID-19

The pandemic outbreak of coronavirus disease (COVID-19) created a significant impact on the oral healthcare profession, and dentists are reported to have a higher risk of transmission. Aerosols and droplets are considered as primary reasons for the transmission of this infectious disease. Quality dental treatment may not be possible without the interference of aerosols in daily dental practice. However, dental societies and healthcare communities around the globe developed various protocols and algorithms with standard infection control protocols. Nevertheless, many unanswerable questions strike in dentist minds to start the dental practice during or post COVID-19 pandemic. Hence, this review focuses on the common issues that raises in daily clinical practice and possible solutions.

The effect of pre-cooling versus topical anesthesia on pain perception during palatal injections in children aged 7-9 years: a randomized split-mouth crossover clinical trial

Background

To compare pain perception during palatal injection administration in children aged 7-9 years while using pre-cooling of the injection site versus application of topical anesthesia as a pre-injection anesthetic during the six months.

Methods

A prospective randomized split-mouth crossover trial was conducted among 30 children aged 7-9 years, who received topical application of either a pencil of ice (test group) or 5% lignocaine gel (control group) for 2 min before injection. The primary and secondary outcome measures were pain perception and child satisfaction, measured by the composite pain score and the faces rating scale, respectively. Unpaired t-test was performed to determine significant differences between groups.

Results

The test group had significantly lower pain scores for self-report and behavioral measures (P < 0.0001). The changes in physiological parameters at the baseline (P = 0.74) during (P = 0.37) and after (P = 0.88) the injection prick were not statistically significant. Children felt better by the pre-cooling method (P < 0.0001).

Conclusion

Ice application using a pencil of ice for 2 min reduced pain perception significantly compared to the use of a topical anesthetic. Moreover, ice application was preferred by children.

Retention and effectiveness of pit and fissure sealants placed with or without bonding agent in young permanent teeth: A randomized clinical trial with a year follow-up

Background and Aims

The aim of this study is to evaluate the clinical efficacy of pit and fissure sealants (PFS) placed on young permanent teeth with or without the application of the bonding agent.

Methods

A.

total of 100 permanent first molars from 25 children between 6-9 years of age were included and randomly allocated into 2 groups. In group A, the teeth received sealant with the bonding agent, and in group B, without a bonding agent. All the sealed teeth were evaluated for retention of the sealant at regular intervals of 3, 6, and 12 months. The difference in the retention rate with and without bonding was analyzed using Chi-square test.

Results

After 12 months, the clinically acceptable retention rates for PFS placed with and without bonding agent were 80% and 72%, respectively. No statistically significant difference was observed in relation to marginal integrity, marginal discoloration, and anatomic form among the PFS placed with and without bonding agent (Ps > 0.05).

Conclusions

Sealant application with bonding agent showed an increased retention rate than without the use of a bonding agent. However, an additional step of bonding may be excluded in children, as it did not show any statistically significant difference in clinical retention rate compared to PFS application without bonding.

Dermatoglyphics as a Novel Method for Assessing Intelligence Quotient in Children Aged 5&ndash;11 Years: A Cross-sectional Study

Aim

To measure the IQ and record dermatoglyphic patterns of children including intellectually disabled aged between 5 years and 11 years and to correlate them.

Materials and methods

The present study was a cross-sectional study conducted in two private schools in the city corporation limits. A total of 300 children aged between 5 years and 11 years were equally allocated into three groups based on IQ using covariate adaptive randomization. IQ of the children was measured using Raven's Coloured Progressive Matrices. Bilateral palmar and finger prints were obtained on A4-size papers by ink method using rolling technique. Prints thus obtained were analyzed for dermatoglyphic variables using magnification lens and are read based on Cummins and Midlo classification for fingertip patterns and Bali and Chaube classification for palmar flexion creases. The data were entered and statistically analyzed. For statistical significance, a two-tailed probability value of less than 0.05 was taken as significant.

Results

The current study suggests a relationship between different fingertip patterns of digits of I, II, III, and IV of left and right hand and also digit V of right hand with various levels of IQ.

Conclusion

Hence, dermatoglyphics can be considered as a preliminary noninvasive approach for the determination of IQ. Also, it plays an imperative role, especially in distinguishing genetic intellectual disabilities.

How to cite this article

Tharay N, Nirmala SVSG, Bavikati VN, et al. Dermatoglyphics as a Novel Method for Assessing Intelligence Quotient in Children Aged 5–11 Years: A Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(4):355–360.

Influence of parent-provided distraction and interactive distraction with a handheld video game on the child's responses during local anesthesia administration

BACKGROUND

To evaluate the influence of parent-provided distraction (PPD) and interactive distraction (ID) with a handheld video game (HVG) on the child's responses to local anesthesia (LA) administration during dental treatment.

METHODS

Children attending the department of pediatric dentistry were randomly selected and distributed to the two groups (PPD and an ID with HVG). Parents in the operatory and the principles of tell-show-do remained common in both the groups. Behavioral, physiological, and self-report measures of pain were estimated using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, pulse rate, as well as Iowa pain thermometer-revised (IPT-R) scale and compared for both groups correspondingly. The SPSS (standard statistical package) version 17.0 (SPSS Inc., Chicago, USA) was used for statistical analysis at the significance of P < 0.05.

RESULTS

A total of 30 children (15 in each group) aged 7-11 years participated in the study. There were no significant differences observed among boys and girls (P > 0.05). The independent t-test for the pulse rate showed no significant difference between the two groups (P > 0.05). Paired t-test for pulse rate in the PPD group showed a significant difference compared to ID with the HVG group (P < 0.05). The scores for FLACC and ID with HVG, showed a statistically significant decrease in scores recorded for ID with HVG, whereas the scores recorded for FLACC did not show any statistically significant difference.

CONCLUSION

Based on the study results, PPD would be the least distressful option, compared to the ID with HVG in children while administering LA.

Development and validation of a scale to assess Feeding at Sleep Time (FeAST) among infants and toddlers

BACKGROUND

Feeding practices adopted by parents play a critical role in the development of children's taste preferences, eating habits, nutrition and eventual weight status. Many scales have been developed to assess feeding practices among children of various age groups. This paper aimed to construct and validate a robust scale for the comprehensive assessment of sleep-time feeding practices for children aged 0-3 years and to establish the risk of developing Early Childhood Caries (ECC).

METHODS

There were multiple phases to the development of the scale: (a) formation of a conceptual framework, (b) systematic development of an item pool, (c) refinement of the item pool by focus group discussion, cognitive interviewing and pretesting, (d) validity testing and (e) reliability testing. The conceptual framework was built based on four broad constructs: breastfeeding, bottle-feeding, other feeding modes and 'tooth and diet' constructs. Reviews of existing scales in related areas were instrumental in scale development and helped to generate an initial pool of 45 items, which was finally refined to 28 items.

RESULTS

Cognitive interviews by the 'think-aloud protocol' helped to reduce ambiguity and maximize clarity of the questions. Pretesting the scale aided increased comprehension and specificity. Face and content validity were corroborated by 'subject matter experts' who endorsed the suitability and appropriateness of items. Reliability was assessed by test-retest, and a near-perfect agreement was obtained in 96% of the items.

CONCLUSIONS

This is the first validated scale currently available for recording sleep-time feeding practices of children less than three years of age. This 28-item scale can be applied as a potential clinical scale to record sleep-time feeding history and the risk of developing ECC as well as a research scale to investigate the association of sleep-time feeding practices with ECC.

Clinical Efficacy of Single-visit Pulpectomy over Multiple-visit Pulpectomy in Primary Teeth: A Systematic Review

Objective

The purpose of this systematic review was to compare the efficacy of single-visit pulpectomy (SVP) vs multiple-visit pulpectomy (MVP) in infected primary teeth.

Materials and methods

An extensive literature search in the English language was conducted in PICO format using MeSH terms using databases (PubMed, EBSCO, Ovid, and Cochrane) and pre-specified inclusion and exclusion criteria were applied to identify relevant studies comparing pulpectomy in single and multiple visits.

Results

Only 4 studies (3—in vivo clinical study; 1—in vivo microbial study) sustained the final analysis and were included for critical appraisal. Results of the systematic search revealed that there are only a few studies comparing the efficacy of single-visit pulpectomy vs multiple-visit pulpectomy in infected primary teeth.

Conclusion

On the basis of the available studies, evidence favors the SVP protocol over the MVP protocol. Whenever possible the single-visit protocol can be preferred over the multiple-visit protocol. The quality of evidence available is low.

How to cite this article

Tirupathi SP, Krishna N, Rajasekhar S, et al. Clinical Efficacy of Single-visit Pulpectomy over Multiple-visit Pulpectomy in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(5):453–459.

Efficacy of Licorice Lollipops in Reducing Dental Caries in a Paediatric Population: A Systematic Review

PURPOSE

To assess the efficacy of licorice lollipops in reducing dental caries in children.

MATERIALS AND METHODS

A literature search was confined to the English language using MeSH terms congruent with PICO format in 'PubMed', 'Cochrane Library' and 'Ovid', covering the period from April 1967 to December 2017. Searches in Google Scholar, grey literature and hand search of cross-references were performed to find additional data. Suitable studies were selected based on the predefined inclusion and exclusion criteria. Quality analysis and risk of bias of the selected studies were performed using the Cochrane Collaboration's tool for risk of bias.

RESULTS

Overall 519 articles were retrieved, 516 (electronic databases) and 3 (Google scholar). 516 publications were excluded due to non-availability of abstracts, or because they were unrelated studies, narrative reviews, and systematic reviews as well as letters to editors. Only three studies were included for final analysis. Quality analysis of these three studies showed that only one was of high quality, whereas the other two were rated as low.

CONCLUSION

Licorice lollipops showed a promising effect in reducing caries by decreasing Streptococcus mutans counts in the saliva. Further research using randomised controlled clinical trial (RCT) designs with large sample size are recommended.

Comparative evaluation of the effectiveness of a mobile app (Little Lovely Dentist) and the tell-show-do technique in the management of dental anxiety and fear: a randomized controlled trial

Background

Behavior guidance is a technique used to subdue inappropriate behavior by establishing communication that meets the needs of a child. This study aimed to measure the effectiveness of a mobile app (Little Lovely Dentist) compared to the tell-show-do (TSD) technique in managing anxious children during their first dental visit.

Methods

Fifty children (30 boys and 20 girls) without any past dental experience, aged from 7 to 11 years, were randomly allocated into either the dental app group or the TSD group. The pre- and post-operative anxiety of children who underwent prophylactic cleaning was assessed both physiologically and subjectively using a heart rate measurement and the RMS pictorial scale, respectively.

Results

The intragroup comparison of heart rate and RMS scores for children allocated to the dental app group was statistically significant (P value ≤ 0.001). However, a significant reduction only occurred in the RMS scores, but not the heart rate measurements, in the TSD group. Conversely, there was an increase in heart rates in the TSD group.

Conclusion

Educating the child prior to a dental procedure using a smartphone application such as Little Lovely Dentist can significantly alleviate the anticipatory anxiety and engage children in dental treatment during their first visit.

Eye Movement Distraction: A New Distraction Technique for Management of Dental Anxiety during Intraoral Local Anesthesia Administration in Children

Background

To evaluate the efficacy of eye movement distraction (EMD) in reducing anxiety during intraoral local anesthetic administration in needle-phobic children.

Materials and methods

A total of 228 children aged 8–13 years were divided into two groups: group I (EMD) and group II (control), and subjective feelings of each child were recorded with a faces pain scale-revised (FPS-R) score. Both the groups (I and II) were compared using the Chi-square test.

Results

Children in the EMD group showed low FPS-R scores, which is statistically significant when compared to the control group (p < 0.0001).

Conclusion

Eye movement distraction can be used as an effective distraction modality to reduce anxiety during local anesthesia administration in needle-phobic children.

How to cite this article

Tirupathi S, Krishna N, Rajasekhar S, et al. Eye Movement Distraction: A New Distraction Technique for Management of Dental Anxiety during Intraoral Local Anesthesia Administration in Children. Int J Clin Pediatr Dent 2019;12(6):507–509.

Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children

Background

This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children.

Methods

A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7–11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates.

Results

Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores.

Conclusions

VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.

Impact of educational (sign language/video modeling) and therapeutic (Glycyrrhiza glabra--liquorice mouth wash) interventions on oral health pertaining to children with hearing impairment: A randomized clinical trial

PURPOSE

To compare the effect of educational (sign language and video modeling) and therapeutic intervention (liquorice) on oral hygiene status of children with hearing impairment (CHI).

METHODS

Ninety-three CHI, in the age range of 5-15 years, were recruited in to the study. Children were assigned to two educational intervention groups: sign language and video modeling. Each group was again randomly divided into two: with one subgroup receiving therapeutic intervention using liquorice as a mouth wash and the other group receiving no intervention. For all children, baseline oral hygiene, gingival, and plaque index scores were recorded and oral prophylaxis was performed. Based on the subgroup to which the child was assigned, oral hygiene instructions were given on a weekly basis, whereas therapeutic intervention was performed twice daily for 28 days. Reassessment was done after the completion of interventions and after 3 months, followed by statistical analysis.

RESULTS

There was a significant mean reduction in oral hygiene, gingival, and plaque scores in all the children. The educational intervention could not influence the scores recorded, but the therapeutic intervention with liquorice led to a reduction in all the oral health parameters during the follow-up periods.

CONCLUSION

Therapeutic intervention using liquorice as mouth wash along with educational intervention can be suggested in CHI.

Comparative evaluation of three obturation systems in primary molars - A randomized clinical trial

OBJECTIVES

The objective of this study is to evaluate and compare the radiographic efficacy of the quality of obturation and to assess the number of voids and the obturation time in primary teeth using Pastinject™, disposable needle, and capillary tips.

MATERIALS AND METHODS

A total of 34 teeth with 103 canals were randomly divided into three groups using chit method, based on used application: Group 1: Pastinject™ (Micro-Mega, Besancon, France); Group 2: Disposable needle (23G short needle BD Discardit™, Becton Dickinson India Pvt. Ltd.), and Group 3: Capillary tips (Meta Biomed^© Co. Ltd., China). All the groups were named based on obturation systems used. To compare the quality of obturation, the Chi-square test was used; to assess the number of voids, Kruskal-Wallis ANOVA test was used; and to evaluate the obturation time, post hoc Scheffe one-way ANOVA test was used. All P values having <0.05 were considered as statistical significant (P < 0.05). Kappa statistics were performed to check interexaminer reliability. Descriptive statistics were used for evaluation using SPSS (version. 21).

RESULTS

Capillary tips resulted in better optimal filled canals and less obturation time, compared to disposable needle and Pastinject (P < 0.001). There was no significant difference evident among three groups in relation to voids (P = 0.111).

CONCLUSION

Capillary tip technique proved to be the most effective, yielding a higher number of optimally filled canals and minimal voids, combined with easier placement of the material into the canals when compared to Pastinject and disposable needle obturation.

Comparative cariostatic efficacy of a novel Nano-silver fluoride varnish with 38% silver diamine fluoride varnish a double-blind randomized clinical trial

Background

To evaluate the clinical cariostatic efficacy of a concocted 5% Nano-silver incorporated Sodium fluoride (NSSF) dental varnish with 38% Silver diamine fluoride (SDF) in preventing the progression of dentinal caries of primary molars.

Material and Methods

A total of 159 active dentinal carious lesions in primary molars (from 50 children) were selected and randomly divided into two groups; NSSF and SDF. Varnish application was performed at the baseline visit and follow-up is carried out at 1, 3, 6 and 12 months. Parameters such as caries activity, depth, size, colour, and presence or absence of pain were noted at baseline and follow-up visits.

Results

The intergroup comparison of caries activity status did not reveal significant difference between the number of active and arrested caries lesions in NSSF and SDF groups at any visit (p >0.05) during the 12-month follow-up. There was no difference between overall failure and success rates between the two groups at any follow-up period (p-0.48).

Conclusions

Annual application of 5% NSSF is better than or equal to 38% SDF in preventing the progression of dentinal caries of primary molars. NSSF does not cause dark staining of dentinal tissue compared to the SDF and the use of NSSF can be recommended in children. Key words:Children, Nano-silver fluoride, Primary teeth, Silver diamine fluoride.