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Background Early childhood caries (ECC) is highly prevalent with significant long-term consequences. Parents are primarily responsible for the oral health practices of their children. Parents' health beliefs, attitudes, and cultural factors influence oral health practices. Aim To explore and understand the perceptions and challenges faced by the parents of the children with ECC in performing routine oral hygiene practices for their children. Design We conducted a qualitative description study with the parents of children with ECC. Data were collected through five focus groups using culturally appropriate, semi-structured, open-ended questions and probes. Focus groups were audiotaped, and field notes were taken, which were transcribed verbatim after each focus group session. Data were analyzed using content analyses. Results A vast majority of the participants were aware of the significance of oral hygiene. However, they faced challenges in implementing proper home hygiene practices at home and lacked knowledge about the type of toothpaste and toothbrush to be used for their children. Conclusion The parents of the children with ECC face a severe knowledge gap, which is interfering with the selection of proper oral hygiene aids for their children. They also face barriers in implementing oral hygiene routines for their children, in spite of awareness that tooth brushing is important.

Objectives: To evaluate the time taken and the mechanism through which the occlusion settles following the placement of a preformed metal crown (PMC) using the Hall technique. The secondary objective was to assess any temporo mandibular joint dysfunction (TMD) resulting from the Hall technique through a questionnaire. Study Design: 44 children fulfilling the inclusion criteria were evaluated for changes in overbite and occlusal vertical dimension (OVD) following the placement of preformed metal crowns (PMCs) using the Hall technique. The overbite and OVD measurements were taken before treatment, immediately post treatment, then at one, two, three and four weeks post treatment. After four weeks, a questionnaire recorded the occurrence of any signs or symptoms of TMD. Results: At the fourth week, the overbite measurement did not show a statistically significant difference (p value= 0.58) compared to baseline values indicating that the occlusion settled by the fourth week. By the third week the OVD values obtained did not show a significant difference compared to the baseline (p value= 0.42) indicating that the OVD had been restored. The questionnaire provided at the end of four weeks showed negative response for signs and symptoms of TMD in all the children. Conclusion: Any changes in occlusion following the placement of a Hall crown settles in four weeks. The OVD settles three weeks post placement implying that extrusion of teeth do not play a role in settling of the occlusion. The children do not develop any signs or symptoms of TMD post a Hall crown.

Dental fear and anxiety (DFA) serves as significant problem in child patient management as it leads to greater prevalence and increased severity of the disease associated with delayed dental visits. Therefore, it is necessary to effectively predict children dental behaviour and identify children at risk of Behaviour Management problems. Study of factors influencing DFA and its association with behaviour in children during first dental visit. The study included 209 children (5-14 years). DFA levels were assessed using 3 standardised questionnaires i.e. Facial Image Scale (FIS), Dental Anxiety Scale (DAS), Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS). The behaviour of the child was then assessed using Frankl’s Behaviour Rating Scale (FBRS). The data were analysed, and a correlation was established between DFA and behaviour using statistical analysis. Presence of DFA according to FIS is 13.4%, according to DAS is 15.2% and according to CFSS-DS is 17.7%. Maximum participants showed positive behaviour (81.8%) according to FBRS. Factors causing maximum Dental anxiety according to DAS was anticipation of treatment (26.30%) and factor which caused maximum dental fear according to CFSS-DS was injections (45.4%). There is association between DFA and behaviour in children during first dental visit. This study will help assess the factors which lead to dental fear and anxiety in children and also find a correlation between dental fear and anxiety and behaviour management problems which can help the Paedodontist to predict various behaviour management problems and to avoid the factors which lead to them before the initiation of the dental treatment. This can lead to a decrease in the fear and anxiety levels of children which will further lead to better treatment and in turn better case management.

BACKGROUND Dental caries is one of the most common multifactorial oral diseases and can be prevented using pit and fissure sealants. AIM To evaluate the effect of nano-hydroxyapatite (nanoHAP) incorporation on fluoride-releasing ability, penetration, and adaptation of a pit and fissure sealant. DESIGN This was an in vitro study with two groups: conventional sealant and nanoHAP-incorporated sealant. Sealant penetration and adaptation were assessed using stereomicroscope and scanning electron microscope (SEM) (15 and 10 samples per group, respectively). Fluoride release was analyzed using ion-selective electrode (15 samples per group). The chi-square test was used to compare penetration and adaptation between the 2 groups, and an independent Student t test was used to compare fluoride release. RESULTS The nanoHAP group showed significantly more samples with no bubbles (P = .001) and no debris (P

Introduction: Snacks and bakery foodstuffs like biscuits are the most preferred food items in the present decade. Thus it is important to know its cariogenicity. Aim: To study the effect of five commercially available biscuits on salivary pH, flow rate and oral clearance rate among children. Materials and methods: The study consisted of five groups of commercially available biscuits: oats, salt, glucose, cream, chocolate biscuits. Samples of saliva were collected, and pH was measured using an electrode, the flow rate directly from the calibrated test tube and the oral clearance time was estimated based on the time taken for the salivary pH to return back to the baseline values. After which, children were given one biscuit each and stimulated saliva samples were collected at different time intervals. Obtained values were subjected to the paired t-test, one-way analysis of variance (ANOVA) and post-hoc Tukey’s test. Results: Salivary pH had decreased compared to baseline for all the five commercially available biscuits with maximum drop seen for glucose, cream and chocolate biscuit group at 5 minutes. Oats group showed a maximum drop in mean salivary pH at 15 minutes and salt biscuits at 10 minutes. Increased salivary flow rate was seen for oats, salt, and cream biscuit group at 15 minutes and chocolate and glucose group had reduced when compared to its baseline value. The pH at 15 minutes had not returned back to the baseline values for all groups. Conclusion: The consumption of commercially available biscuits had an effect on salivary pH, flow rate and oral clearance rate in children.

Abstract: There are many common dental malocclusions seen in the mixed dentition, such as premature loss of, or retained, deciduous teeth, submerged molars, supernumerary teeth, midline diastema, crossbites, increased overjet, open bites, ectopic eruptions and crowding. In properly selected cases, like dental anterior crossbites or unerupted incisors, interceptive orthodontic treatment not only improves function and aesthetics, but also achieves a relatively stable outcome, even after the removal of the appliance. A removable appliance can be a mode of interceptive orthodontic treatment. The success of the interceptive treatment using a removable appliance, however, depends upon patient compliance. In this regard, use of a sectional fixed appliance is gaining in popularity. This paper discusses four case scenarios of malocclusion in the mixed dentition managed using sectional fixed therapy. CPD/Clinical Relevance: The sectional fixed appliance is versatile, easy to use and well tolerated by patients. When used correctly, it gives a more controlled approach to tooth movement in all three dimensions and a more predictable outcome.

Our aim was to compare the comfort of pediatric patients during the first stage of the conventional 2-stage inferior alveolar nerve block (IANB) versus the modified 2-stage IANB. This was a parallel group, single-blinded, randomized controlled trial. Pediatric patients meeting the inclusion criteria were randomly allocated to 1 of the 2 groups receiving IANB, group 1 (31 subjects) utilized a conventional 2-stage technique, and group 2 (33 subjects) utilized a modified 2-stage approach. Patient comfort was assessed indirectly by 2 observers using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during the first stage of the injections. FLACC score data between the 2 groups were analyzed using the chi-square test, and interobserver reliability was measured using kappa statistics. During the first stage of the injections, lower FLACC scores of 0 indicating a relaxed/comfortable patient experience were found in 57.6% of group 2 subjects compared with only 25.8% group 1 subjects, which was a statistically significant difference (p-value .013). Interobserver reliability assessed using kappa coefficients (κ = 0.812) indicated excellent agreement. FLACC scores for the pediatric patients during the first stage of the modified 2-stage IANB technique were significantly lower than during the first stage of the conventional 2-stage IANB technique.

Introduction: The two-stage technique of inferior alveolar nerve block (IANB) administration does not address the pain associated with “needle insertion” and “local anesthetic solution deposition” in the “first stage” of the injection. This study evaluated a “modified two stage technique” to the reaction of children during “needle insertion” and “local anesthetic solution deposition” during the “first stage” and compared it to the “first phase” of the IANB administered with the standard one-stage technique. Materials and Methods: This was a parallel, single-blinded comparative study. A total of 34 children (between 6 and 10 years of age) were randomly divided into two groups to receive an IANB either through the modified two-stage technique (MTST) (Group A; 15 children) or the standard one-stage technique (SOST) (Group B; 19 children). The evaluation was done using the Face Legs Activity Cry Consolability (FLACC; which is an objective scale based on the expressions of the child) scale. The obtained data was analyzed using Fishers Exact test with the P value set at

Supernumerary teeth appear as one of the most common and significant dental anomalies in the permanent dentition and are rare in primary dentition. Supernumerary teeth in primary dentition exhibit less variety in shapes and commonly occur as conical form. Early intervention is required when supernumeraries appear in primary dentition stage to achieve better occlusion form and function. This case report highlights unusual incidental finding and management of two supernumerary (bilateral, premolar like) teeth, present in the pre-maxilla region during the primary dentition stage of a male child.

Background The growing interest on usage of probiotic lactobacilli in maintaining oral health has posed number of questions on its probable side effects. One such consideration could be an increased acid production in dental plaque, in turn leading to dental caries. Thus, the aim of this study was to comparatively evaluate the lactic acid producing ability of L. acidophilus and L. plantarum with and without dental plaque. Material and Methods The study consisted of five groups: 3 control groups (Supragingival plaque, L. acidophilus and L. plantarum) and 2 test groups (Supragingival plaque with L. acidophilus and Supragingival plaque with L. plantarum). 26 samples for each group were collected and their baseline spectrophotometric values were recorded. The acid production was initiated by adding 25?l fructose (10%) and stopped by centrifugation for 2 min. The concentration of the lactic acid produced was determined with the aid of COBAS INTEGRA 400 plus. Results On comparison of Lactic Acid estimation in mg/dl, the mean values of Plaque group was the highest followed by Plaque +L acidophilus, Plaque +L plantarum, L acidophilus and least in L plantarum. The posthoc analysis shows that the comparison of Group 1 (Plaque) and Group 2 (Plaque +L acidophilus) is statistically Significant results between all the groups except between the Plaque +L acidophilus and Plaque +L plantarum group. Conclusions The lactic acid producing ability of pure suspensions of L.acidophilus and L.plantarum and the lactic acid producing efficiency becomes more when they are added to the supragingival plaque. Key words:Probiotic, lactic Acid, plaque.

Dens invaginatus is a developmental dental anomaly which is clinically seen as a furrow on the palatal aspect of the tooth either limiting to the coronal pulp or extending to the radicular apex. It occurs most commonly in females affecting crowns of the maxillary lateral incisors. This case report presents two bilateral cases of Type II radicular dens invaginatus in mandibular first premolars. It was an incidental diagnosis on an intraoral periapical radiograph when a 12-year-old male patient and a 12-year-old female patient reported with their respective chief complaints. Conservative management in the form of strict follow up of the cases was planned.

Aim: To evaluate and compare the efficacy of customized toothbrushes in maintenance of oral hygiene and gingival health with that of conventional toothbrushes in children with cerebral palsy. Methods: Thirty patients with cerebral palsy in the age group of 6 to 18 years were randomly divided into two groups—group I (normal toothbrush) and group II (customized toothbrush). Common oral hygiene instructions were given to both the groups. Before beginning the study, plaque index (PI) and modified gingival index (MGI) were recorded, following which patients were made to practice their routine twice a day brushing with either normal toothbrush or custom-made toothbrush for 3 weeks. At the end of 3 weeks, PI and MGI were rerecorded. The subjects belonging to group II were also made to perform muscle exercises using the modified brush head. Results: Significantly high percentage drop between the pre- and post-PI as well as MGI (31.55% and 30.23%, respectively) was observed in the custom-made toothbrush group, while the percentage drop of only 8.34% (PI) and 14.51% (MGI) was seen in the normal toothbrush group. Conclusions: Custom-made tooth brushes increased the efficiency of maintaining oral hygiene and gingival health of individuals with cerebral palsy.

Cleft lip and palate (CLP) is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM) technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral) which underwent PNAM treatment and gave an excellent surgical prognosis.

Context: The survival of atraumatic restorative treatment (ART) restorations would probably increase if near total elimination of cariogenic microorganisms could be done in the process of cavity cleaning before going ahead with the restoration. Thus, use of naturally occurring disinfecting agents for achieving this goal could herald a new beginning in the field of contemporary minimum intervention dentistry. Aims: To evaluate the efficacy of hand instruments in excavating dental caries and comparatively evaluate the roles of Aloe vera and propolis as potential cavity disinfecting agents after minimally invasive hand excavation of dental caries. Settings and Designs: Experimental, in vivo intergroup split mouth, randomized clinical trial. Subjects and Methods: The study included Group I (Control), Group II (A. vera) and Group III (propolis). Ten patients with three teeth each have occlusal/occlusoproximal lesions suitable for ART were selected. Dentinal samples were collected three times from each tooth viz., preexcavation, postexcavation and postdisinfection of the cavities. These dentinal samples were subjected to microbiological analyses for total viable count. Statistical Analysis Used: Repeated measures of analysis of variance (ANOVA) with Bonferroni post-hoc test and one-way ANOVA with Tukey post-hoc test. Results: In all the three groups, significant amount of bacteria were left behind after hand excavation. Group II and Group III, in which cavities were treated with A. vera and propolis extracts respectively, showed a significant reduction in the bacterial counts when compared to control the group. Conclusions: Hand excavation alone does not completely eliminate bacteria, which may predispose treated teeth to secondary caries. Both propolis and A. vera extracts can be used as potential natural disinfecting agents, thereby embracing the concept of phytotherapy in minimum intervention dentistry.

Context: Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care. Aim: This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit. Settings and Design: This cross-sectional study was conducted between the ages of 3–7 years. Materials and Methods: During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis. Results: The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively). Conclusions: The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.

Introduction: With increased trend among people to choose a healthy diet, there is an increased consumption of health drinks by children. Thus, it is important to know their cariogenicity. Aim: To evaluate the effect of consumption of health drinks viz., Horlicks, Boost and Complan on plaque pH in children. Materials and Methods: The study consisted of four groups: Group I (control)- 10% sucrose solution, Group II- Horlicks, Group III- Boost, Group IV- Complan. Samples of plaque from representative teeth were collected and pH was measured using an electrode outside the mouth. After baseline pH was recorded, children were given their respective drinks and were asked to consume slowly over a period of three to five minutes following swish with 20 ml of the test drink for one minute. The pH was then recorded after 10, 20, 30, 40 and 60 minutes of the post consumption period. Obtained values were subjected to one-way ANOVA test for multiple group comparison followed by Post-Hoc Tukey’s test for group wise comparison. Results: Twenty minutes after consumption of Complan and Boost, pH was decreased, but not to the critical pH value as in case of sucrose. The pH was found to be slightly increased, 20 minutes post Horlicks consumption. Post 60 minutes consumption of all the drinks including sucrose solution, the pH was increased in comparison to post 20 minutes. However, 60 minutes post consumption of Boost and Horlicks, pH increased above the baseline. Conclusion: Consumption of health drinks viz., Complan and Boost did not lower the plaque pH to the level of critical pH. Consumption of Horlicks increased the plaque pH.

Introduction: Managing an uncooperative child is the major issue in paediatric dentistry. In such cases general anaesthesia provides safe and effective dental treatment. Thus this study aims to elucidate the knowledge gaps and preconceived ideas that parent brings into a discussion with a paediatric dentist about GA through a questionnaire given to parents. Material and Method: A 17- question questionnaire, administered to parents of children presenting for care in paediatric dental practices, collected demographic information, media exposure, and parental knowledge/ opinions regarding GA procedures, and parental acceptance of treatment scenarios. Results: Maximum respondents were not aware (56.3%) and only few were aware (43.7%) that dental treatments for children is sometimes carried out under GA; 68% of respondents think that GA is safe and 32% think it’s not safe; 52.5% respondent said GA and conscious sedation are not same, 24.1% said yes and 23.4% said they don’t know. Cross tabulations and Pearson’s chi-square statistics were used to examine relationships between categorical variables. Conclusion: Previous GA experience in the family or child had improved parents knowledge on GA but education level of the parents had no influence. Father feels GA is safe. Parents are generally unaware of news coverage pertaining to GA use in Paediatric Dentistry

This is the case of a 12 year old, male child who reported with a 9mm midline diastema due to two mesiodens. The diastema was unusual as the central incisors were displaced unequally from the midline.

Dens evaginatus is a developmental anomaly in form of an accessory cusp. It arises during morpho differentiation stage due to abnormal proliferation of the inner enamel epithelium into the stellate reticulum of the enamel organ. Though mandibular premolars are most commonly affected teeth, there are case reports of dens evaginatus of maxillary molars. However, dens evaginatus of a mandibular molar has not been reported till date to best of our knowledge. Thus, this case report adds a rare form of presentation of dens evaginatus to the existing literature