In Vitro Evaluation of Reliability and Validity of International Caries Detection and Assessment System II Coding for Occlusal Caries using Magnification.

Aim: To check the reliability and validity of International Caries Detection and Assessment System (ICDAS) II coding in occlusal caries detection under unaided visual and enhanced visual examination. Materials and methods: This study included 100 extracted premolars and molars. Two examiners independently scored occlusal caries using ICDAS II criteria without magnification and under 6x magnification in the dental operating microscope. The examination was repeated after one month to check the intraexaminer reliability. The examined samples were sectioned and the carious lesions were scored using Ekstrand-Ricketts-Kidd (ERK) histological criteria under 20x magnification in stereomicroscope. The ICDAS II scores given by the examiners were compared with the histological scores. Results: The κ values for interexaminer reproducibility of unaided and enhanced visual examinations were 0.695 and 0.626, respectively (substantial agreement), and 0.984 (almost perfect agreement) for histological examination. Intraexaminer reproducibility for unaided and enhanced visual examinations were 0.835 and 0.910, respectively (almost perfect agreement). Spearman's correlation coefficients of ICDAS II unaided visual and enhanced visual examinations to ERK histological scores were 0.724 and 0.689, respectively, which infers that there is a strong correlation between unaided visual and histological examination and a moderate correlation between enhanced visual and histological examination. For unaided visual examination, specificity is 100% and sensitivity is 92%, whereas for enhanced visual examination, specificity is 50%, and sensitivity is 100%. Conclusion: Unaided visual examination demonstrated good reliability and validity for ICDAS II coding, whereas enhanced visual examination exhibited good reliability but relatively lower validity. Clinical significance: This study reveals that magnification did not have any added benefits in occlusal caries diagnosis using ICDAS II coding compared to unaided visual examination. The use of magnification did not improve the validity and led to a drop in the specificity, which indicates higher chances of false positive results. How to cite this article: SasiRekha G, Chandrasekhar R, Vinay C, et al.In Vitro Evaluation of Reliability and Validity of International Caries Detection and Assessment System II Coding for Occlusal Caries using Magnification. Int J Clin Pediatr Dent 2023;16(S-2):S138-S141.

Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation.

Aim: To evaluate the effectiveness of laser-activated irrigation (LAI) and ultrasonic irrigation (UI) in the removal of calcium hydroxide [Ca(OH)2] and modified triple antibiotic paste (MTAP) from the root canals. Materials and methods: Root canals of freshly extracted human permanent maxillary incisors (n = 80) were prepared. The root canals of half sample (n = 40) were filled with Ca(OH)2 and the other half (n = 40) with MTAP, in which propylene glycol was used as a vehicle. After 14 days, roots were randomly assigned to four groups (n = 20) according to the irrigation technique used-group I [Ca(OH)2 with UI], group II (MTAP with UI), group III [Ca(OH)2 with LAI], group IV (MTAP with LAI). The roots were sectioned, and the intracanal medicament residues were evaluated at 25× magnification under stereomicroscope using 4-grade scoring system. Statistical analysis: One-way analysis of variance (ANOVA) and post hoc Tukey tests were performed. Results: Laser-activated irrigation (LAI) was found to be superior compared to UI. Ca(OH)2 was better removed compared to MTAP with either of the irrigation techniques. A statistically significant difference was found between the Ca(OH)2 with LAI and MTAP with UI groups in all the regions, that is, coronal, middle, and apical thirds. Conclusion: Laser-activated irrigation (LAI) was superior to UI in removing Ca(OH)2 and MTAP. Ca(OH)2 was better removed than MTAP, irrespective of the technique used. However, none of the irrigation techniques could completely remove the intracanal medicament from the root canals. How to cite this article: Swathi P, Uloopi KS, Vinay C, et al. Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation. Int J Clin Pediatr Dent 2023;16(S-1):S1-S5.

Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study.

Aim: The aim of the study is to evaluate the impact of parenting style on a child's behavior and caries experience in 3-6-year-old children. Materials and methods: This cross-sectional study included 1,216 parent-child pairs of 3-6-year-old preschool children. Parenting style was determined using Parenting Style and Dimensions Questionnaire (PSDQ). Child behavior was assessed using Frankl's behavior rating scale, and caries experience was recorded using the decayed, extracted and filled deciduous teeth surfaces index. Results: Out of the 1,216 parents, the authoritative parenting style is seen in 70%, authoritarian in 20%, and permissive parenting style in 9.5%. Children with a permissive type of parenting style have shown more negative behavior. Children of authoritative parents had 4.1 times higher odds of exhibiting definitely positive behavior, which is statistically significant (p = 0.004). Children of positive child behavior had 2.4 times higher odds of avoiding caries which is statistically significant (p = 0.0001). Children of authoritarian parents had 1.45 times higher odds of exhibiting caries than children of permissive parents; however, this difference is not statistically significant. Conclusion: Children of authoritative parents demonstrated low caries experience and desirable behavior in the dental office. On the contrary, children of permissive parents exhibited undesirable dental behavior, and children of authoritarian parents had high caries experience. Clinical significance: Twenty-first-century parents are less controlling and are more permissive leading to problematic child behavior in the dental office. Parenting styles have an impact on the effectiveness of behavior management as well as dental treatment. Pediatric dentists should identify different parenting styles and anticipate the child's behavior. This study emphasizes the effect of different parenting styles on a child's behavior and dental caries experience. How to cite this article: Shalini K, Uloopi KS, Vinay C, et al. Impact of Parenting Style on Child's Behavior and Caries Experience in 3-6-year-old Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):276-279.

Evaluation of Dentin Remineralization with Zinc Oxide and Calcium Fluoride Nanoparticles - An In vitro Study.

Background: Partially demineralized dentin is remineralizable when mineral ions are made available in the near vicinity. Nanoparticles (NPs) have wide applications in remineralization process. Zinc promotes remineralization and has a synergistic effect when combined with fluoride. Hence, zinc oxide and calcium fluoride NPs were considered for dentin remineralization. Aim: The aim of this study was to evaluate the remineralizing ability of zinc oxide and calcium fluoride NPs on demineralized dentin individually and in combined form. Settings and Design: This was an in vitro study. Materials and Methods: Forty-eight dentin disks were prepared from the crowns of 12 extracted human molars and were allocated into four groups of 12 each, i.e., Group I - nano zinc oxide (nZnO), Group II - nano calcium fluoride (nCaF2), Group III - combined group (nZnO + nCaF2), and Group IV - artificial saliva (AS, control group). The specimens were demineralized with 37% phosphoric acid and placed in the respective remineralizing solutions for 24 h and 1 month. Calcium (Ca) and phosphorous (P) uptake was measured using energy-dispersive X-ray spectrometry, and structural changes were analyzed using scanning electron microscopy (SEM). Statistical Analysis: One-way analysis of variance, Student's t-test, and post hoc Tukey's test were used for statistical analysis. Results: At 1-month interval, all the groups showed an increase in Ca/P ratio, with highest being the combined group (4.24), followed by nCaF2 (3.30), nZnO (1.71), and AS (1.31) groups, and these differences were statistically significant (P = 0.000). On SEM analysis of dentinal samples at 1 month, depositions were evident in intertubular regions, wherein the highest deposits were observed in the nZnO group, followed by nZnO + nCaF2 and nCaF2 groups. Conclusion: Dentin samples subjected to remineralization with aqueous solutions of nZnO and nCaF2 showed an increase in calcium and phosphorous uptake and also dense granular depositions were evident in intertubular regions of dentin.

A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children.

Aim: The study evaluated the effectiveness of nanosilver fluoride (NSF) in arresting dental caries in 4-8-year-old school children. Materials and methods: The two-arm, parallel-group randomized controlled trial included a total of 148 children aged 4-8 years with active carious lesions. Children were randomly divided into two groups: group I-NSF (n = 74); and group II-water (placebo and n = 74). Baseline data were recorded using the International Caries Detection and Assessment System (ICDAS) II criteria, and the teeth were treated with either of the solutions. Later, the teeth were evaluated by two blinded examiners for the lesion activity using ICDAS II criteria at 1, 3, and 6-month intervals. The obtained data were analyzed using the Chi-squared test for intergroup comparison and Cochran's Q test for intragroup comparison. Cohen's κ test was used to check the interexaminer and intraexaminer variability. Results: Carious teeth treated with NSF have shown 56.3, 59.2, and 62% arrested carious lesions, whereas the placebo group has shown 0, 2.9, and 4.4% arrested lesions at 1, 3, and 6-month intervals, respectively. NSF showed a high statistically significant difference (p < 0.001) in arresting dental caries compared to the control group at all the time intervals. Conclusion: Nanosilver fluoride (NSF) is found to be effective in arresting dental caries without staining carious lesions. Therefore, it can be used to reduce the bacterial load for caries stabilization in the initial phase of the comprehensive treatment protocol for the management of children with active caries lesions. Clinical significance: Most of the decayed teeth in the primary dentition remain untreated either because of inaccessible dental services or the uncooperativeness of children. Hence, there is an absolute need for a cariostatic agent which arrests the progression of caries in a simple and noninvasive manner. The results of this study evidence that NSF effectively arrests dental caries in primary teeth. Hence, this can be a very economical way of arresting caries in the population who don't have access to regular dental treatment. How to cite this article: Devi C, Chandrasekhar R, Vinay C, et al. A Randomized Controlled Trial Evaluating the Effectiveness of Nanosilver Fluoride in Arresting Dental Caries in School Children. Int J Clin Pediatr Dent 2023;16(5):667-670.

Effectiveness of Distraction with Virtual Reality Eyewear in Managing 6-11-year-old Children with Hearing Impairment during Dental Treatment: A Randomized Controlled Trial.

Aim: To assess the effectiveness of distraction with virtual reality (VR) eyewear along with modified tell-show-do (MTSD) on anxiety levels of 6-11-year-old children with hearing impairment (HI) during the noninvasive dental procedure. Materials and methods: The randomized controlled trial included 40 children with HI aged 6-11 years requiring oral prophylaxis. The children were randomly allocated into two groups. Oral prophylaxis was carried out in both groups, where in group I (VR + MTSD, n = 20), distraction with VR eyewear was performed along with MTSD, and in group II (MTSD, n = 20), MTSD alone was used. Pre and postoperative anxiety levels were assessed using facial image scale (FIS) (subjective) and pulse rate (PR) (objective) measures. Paired t-test and unpaired t-test were used to analyze the obtained data. Results: Postoperative (post-op) PR readings in the VR + MTSD group were reduced by 6.95, whereas it was increased in the MTSD group by 8.55, and the difference was statistically significant (p = 0.001). Post-op FIS scores were found to be reduced in the VR + MTSD group by 2.15, whereas it was increased in the MTSD group by 0.10, and the difference was statistically significant (p = 0.033). Conclusion: Distraction using VR eyewear along with MTSD is effective in reducing anxiety levels in 6-11-year-old children with HI during noninvasive dental procedures. Clinical significance: Hearing-impaired children are usually anxious about the unknown and have unmet oral health needs due to communication barriers. This study provides evidence that the distraction using VR eyewear along with MTSD is effective in reducing anxiety levels in children with HI. How to cite this article: Varshitha K, Uloopi KS, Vinay C, et al. Effectiveness of Distraction with Virtual Reality Eyewear in Managing 6-11-year-old Children with Hearing Impairment during Dental Treatment: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(6):820-823.

Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6-9-year-old Children: A Randomized Controlled Trial.

Aim: To evaluate the retention rate of self-adhering flowable composite as fissure sealant in comparison with the unfilled resin sealant on first permanent molars of 6-9-year-old children. Materials and methods: A 2-arm, split-mouth randomized controlled trial included 100 children of age 6-9 years with completely erupted mandibular first permanent molars. A total of 200 teeth were randomly divided into two groups, group I: self-adhering flowable composite; group II: unfilled resin sealant. Sealants were placed on the mandibular first permanent molars and the children were recalled at 6, 12, and 18 months intervals to evaluate the retention rate. Chi-square test was used to analyze the data. Results: Self-adhering flowable composite has shown a complete retention rate of 67%, 47%, and 46% at 6, 12, and 18-month intervals, respectively, whereas unfilled resin sealant has shown 41%, 8%, and 5% retention rate at 6, 12, and 18-month intervals, respectively. The difference in the complete sealant retention rates between the groups is found to be statistically highly significant at all the follow-up intervals (p = 0.0004, 0.0001, and 0.0001 at 6, 12, and 18-month intervals, respectively). In both groups, maximum sealant loss occurred between 6 and 12-month intervals. Retention rates were higher at 6 months intervals which were significantly reduced over 18 months intervals. Conclusion: Self-adhering flowable composite has shown a higher retention rate compared to unfilled resin sealant at all the time intervals. The retention rate of both materials decreased with time. However, the loss of sealant was more with unfilled resin sealant. Clinical significance: In pediatric dental practice, the elimination of a step in restorative dentistry protocol makes a big difference as time is a critical factor in obtaining children's cooperation. The use of self-adhering materials eliminates the step of bonding agent application, which simplifies the restorative protocol and makes the clinical practice effective. Therefore, these self-adhering flowable composite resin materials can be considered fissure sealants in routine clinical practice. How to cite this article: Bhuvaneswari P, Vinay C, Uloopi KS, et al. Clinical Evaluation of the Retention of Self-adhering Flowable Composite as Fissure Sealant in 6-9-year-old Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(3):322-326.

Clinical performance of one shade universal composite resin and nanohybrid composite resin as full coronal esthetic restorations in primary maxillary incisors: A randomized controlled trial.

Background: Strip crowns are the first treatment of choice for restoring anterior teeth affected with early childhood caries. However, shade matching of resin composites is still an issue. The broad color matching ability of a recently introduced single shade composite, Omnichroma eliminates the need for shade-matching procedure, reduces composite inventory, and minimizes chair-side time. Aim: The aim is to evaluate the color match, color stability, and retention of one shade universal composite resin, Omnichroma and nanohybrid resin composite, Tetric-N-Ceram. Design: The study design involves split-mouth randomized controlled trial. Methods: The study was conducted on 25 children aged 3-5 years with multi-surface caries lesions in primary maxillary anterior teeth. Teeth were allocated to two groups randomly: Group 1 - One shade universal composite, Omnichroma (n = 25), Group 2 - Nanohybrid composite, Tetric-N-Ceram (n = 25). After caries excavation and tooth preparation, teeth were restored with corresponding materials using strip crowns. Color match at baseline, color stability, and retention after 6- and 12-month follow-up were evaluated using the Modified United States Public Health Services criteria. Analysis: The Mann-Whitney U test and Wilcoxon signed-rank test were used to analyze the data. Results: On comparison of Omnichroma and Tetric-N-Ceram groups, no statistically significant difference was observed in the color match at baseline (P = 0.716) as well as color stability (P = 0.575 at 6 months and 0.990 at 12 months) and retention (P = 0.153 at 6 months and 0.226 at 12 months) at both 6- and 12-month intervals. On intragroup comparison, the difference in the color stability at 6 and 12-month interval was statistically significant (P = 0.001) for both the groups, indicating that the color stability of restorations was better at 6-month interval compared to 12-month interval. In both Omnichroma and Tetric-N-Ceram groups, retention of restorations was better at 6-month interval compared to 12-month interval and this difference was statistically significant (P = 0.025 and 0.014, respectively). Conclusion: The clinical performance of Omnichroma in terms of color match, color stability, and retention was comparable to nanohybrid composite, Tetric-N-Ceram.

Treatment Outcomes of Pulpotomy with Propolis in Comparison with MTA in Human Primary Molars: A 24-month Follow-up Randomized Controlled Trial.

Aim and objective: To evaluate the clinical efficacy of propolis as pulpotomy medicament in human primary molars. Materials and methods: This randomized controlled trial is a two-arm, parallel group study with blinded outcome assessment. The study included a total of 60 primary molars that require pulpotomy treatment in 4- 8-year old children. Teeth were assigned to two groups randomly: Propolis (Test group); Mineral trioxide aggregate (MTA) (Control group). All the pulpotomized teeth were given stainless steel crowns and the teeth were evaluated clinically and radiographically at 6, 12, and 24 months to grade them as either success or failure. Chi-square test was employed to analyze the data. Results: Success rates of pulpotomy with propolis and MTA were 80% and 93.1% respectively at 24 months of follow-up interval. Propolis has shown success rates of 90% and 80% at 6- and 12-month follow-up, while MTA has shown a consistent success rate of 93.1% at all the follow-up intervals. The difference in success rate between the groups at all the time intervals is statistically nonsignificant. Conclusion: Propolis has demonstrated a clinically acceptable success rate comparable to MTA as pulpotomy medicament in primary teeth. Clinical significance: Biocompatible materials with regenerative potential have drawn the momentum in vital pulp therapy. In this regard, MTA has been emerged as most successful material, but its high cost has limited its use. Hence, there is an absolute need of cost-effective pulpotomy material with regenerative potential. This study provides an evidence that propolis has clinically acceptable success rate as pulpotomy medicament. Considering its low cost and ready availability, it can be recommended as a cost-effective alternative for primary teeth pulpotomy. How to cite this article: RojaRamya KS, Chandrasekhar R, Uloopi KS, et al. Treatment Outcomes of Pulpotomy with Propolis in Comparison with MTA in Human Primary Molars: A 24-month Follow-up Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-1):S3-S7.

Evaluation of caries arresting potential of silver diamine fluoride and sodium fluoride varnish in primary molars: A randomized controlled trial.

Background: Caries management in the modern era has shifted away from the traditional surgical method toward a medical paradigm, which often includes fluoride therapy. Fluoride used in various forms has been proven to be effective in dental caries prevention. Silver diamine fluoride (SDF) and sodium fluoride (NaF) varnish are effective in arresting caries in primary molars. Aim: This study aimed to evaluate the effectiveness of 38% SDF and 5% NaF varnish in arresting caries in primary molars. Settings and Design: This study was a split-mouth randomized controlled trial. Materials and Methods: The randomized controlled trial comprised 34 children aged 6-9 years with teeth having caries in both right and left primary molars without pulpal involvement. Teeth were randomly allocated into two groups. In Group 1 (n = 34), 38% SDF + potassium iodide was applied and in Group 2 (n = 34), 5% NaF varnish was applied. The second application was done after 6 months in both groups. Children were recalled at 6- and 12-month intervals and evaluated for caries arrest. Statistical Analysis: Chi-square test was used to analyze the data. Results: Caries arresting potential was found to be higher in the SDF group compared to the NaF varnish group at both 6-month (SDF - 82% and NaF varnish - 45%) and 12-month intervals (SDF - 77% and NaF varnish - 42%) and the difference was found to be statistically significant (P = 0.002 and 0.004, respectively). Conclusion: SDF was more effective in arresting dental caries in primary molars compared to 5% NaF varnish.

A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment.

Aim: To evaluate the effectiveness of oral irrigator and interdental floss as adjuncts to manual tooth brushing in 8-16 years old children with visual impairment. Materials and methods: A three-arm, parallel-group randomized controlled trial with blinded outcome assessment was carried out with the inclusion of 90 institutionalized children with visual impairment of age 8-16 years. They were equally allocated to three groups: group I: tooth brushing along with interdental flossing, group II: brushing along with a powered oral irrigator, and group III: brushing alone (control). Baseline oral hygiene index-simplified (OHI-S), gingival index (GI), and plaque index (PI) scores were recorded for all the samples and compared with post-intervention scores at 14 and 28 days intervals. Repeated measures of analysis of variance (ANOVA), one-way ANOVA, and post hoc Tukey tests were used for statistical analysis. Results: At 28 days interval, children in group II showed a highly statistically significant reduction in OHI-S (0.46; p = 0.0001), PI (0.16; p = 0.0001), and GI (0.24; p = 0.0001) scores compared to control group. They also showed a significant reduction in OHI-S (0.25; p = 0.018), PI (0.15; p = 0.011), and GI (0.15; p = 0.0001) scores compared to group I. There is no significant reduction in the scores of children of group I compared to control group except for the GI score (0.08; p = 0.02). Conclusion: Oral hygiene maintenance using oral irrigator along with brushing was found to be more effective in visually challenged children. Interdental flossing, along with brushing and brushing alone was found to be less effective. Clinical significance: This study underlines the fact that comprehensive oral hygiene care should include interdental cleaning aids for effective plaque control to prevent dental diseases in children with visual impairment. Since these children have less manual dexterity to perform good oral hygiene practices, electrically driven interdental cleaning aids like oral irrigator may help them to overcome the problem. How to cite this article: Deepika V, Chandrasekhar R, Uloopi KS, et al. A Randomized Controlled Trial for Evaluation of the Effectiveness of Oral Irrigator and Interdental Floss for Plaque Control in Children with Visual Impairment. Int J Clin Pediatr Dent 2022;15(4):389-393.

Awareness, Knowledge, Attitude and Empathy Levels of Dental Postgraduates Towards Their Patients During Practice and Research-A Questionnaire Based Survey.

Empathy is vital in ensuring the quality of the patient-clinician relationship. Empathy in the health care setting is the ability to understand a patient's experiences and feelings and communicate this understanding for better clinical outcomes in dental treatments. The study aimed to compare levels of empathy in post-graduate dental students across the different years of the master's degree course. Questionnaire forms distributed among post graduate students and awareness, knowledge, attitude, and empathy levels towards their patients were assessed. Responses of all the post-graduate students of all specialties in a dental institute were subjected to statistical analysis to know and compare their empathy towards the patients during their clinical practice and research throughout their three-year master's degree. The mean empathy score was 52.01 (maximum of 100), with a standard deviation of 6.69. The empathy scores decreased slightly from the first to the third year of the master's degree. The participant's age, marital status, place of residence, and specialties of dental post-graduation showed much significant difference in empathy levels. The study found slight significant gender differences in empathy among the participants. The empathy scores declined gradually very slightly as they were promoted to the next level in the course. The increase in empathy levels found in this study is more significant than those reported in similar studies due to the inclusion of educational and orientation programs at the time of admission into post-graduate studies.

Association of serum Vitamin D and salivary calcium and phosphorus levels in 3-11-year-old schoolchildren with dental caries.

BACKGROUND: Vitamin D plays an essential role in the formation of healthy teeth, protection against dental caries, and the appropriate secretion of salivary calcium. Salivary calcium and phosphate help in maintaining equilibrium between demineralization and remineralization of teeth. If we know the association between serum Vitamin D and salivary calcium and phosphorus, we may get a clue regarding serum Vitamin D levels which in turn is essential for good oral health. AIM: The aim of this study was to assess the association of serum Vitamin D levels and salivary calcium and phosphorus levels in children with dental caries. SETTINGS AND DESIGN: This was a comparative cross-sectional study. MATERIALS AND METHODS: One hundred children of age 6-11 years, 50 with Decayed, Missing, and Filled Teeth (DMFT) ≥5 (test group) and 50 with DMFT = 0 (control group), were included in the study. Oral examination was carried out and DMFT/deft scores were recorded. Serum 25-hydroxy Vitamin D levels and salivary calcium and phosphorous levels were measured. STATISTICAL ANALYSIS: Independent sample t-test, linear regression analysis, and Pearson correlation test were used for statistical analysis. RESULTS: Children with dental caries have shown lesser mean serum Vitamin D levels (15.37 ± 3.53) than caries-free children (17.26 ± 3.16). Children with decayed teeth have exhibited lower salivary calcium levels (3.92 ± 0.99) than those without caries (4.42 ± 1.37). Conversely, children with dental caries have shown higher mean salivary phosphate levels (6.27 ± 1.74) than caries-free children (5.18 ± 1.47). There is a significant decrease in salivary calcium (P = 0.018) and serum Vitamin D (P = 0.004) with a significant increase in number of decayed teeth. The greater the Vitamin D deficiency, the lesser are the salivary calcium levels observed (P = 0.001). CONCLUSIONS: Children with Vitamin D deficiency have lower salivary calcium levels. Vitamin D deficiency and lower salivary calcium levels can be the potential risk factors for the occurrence of dental caries.

Effectiveness of Pre-cooling the Injection Site, Laser Biostimulation, and Topical Local Anesthetic Gel in Reduction of Local Anesthesia Injection Pain in Children.

AIM AND OBJECTIVE: Evaluation of the effectiveness of laser biostimulation (LBS), ice, and local anesthetic (LA) gel in reducing the injection pain during administration of local anesthesia in children. MATERIALS AND METHODS: A 3-arm, crossover randomized controlled trial included 30 children of age 9-12 years requiring extraction of primary maxillary posterior teeth. Children were randomly allocated to 3 groups of 10 each. After proper isolation and drying of the buccal mucosa, one of the three techniques, i.e., either LBS or ice or LA gel was applied for 1 minute followed by administration of the LA solution. The pain response was assessed using Wong-Baker Faces Pain Rating Scale and the Sound Eyes Motor scale (SEM). Kruskal-Wallis ANOVA and Mann-Whitney U tests were performed for intragroup and intergroup comparisons, respectively. RESULTS: Lower pain score of zero suggesting no hurt was given by more children in the ice group, followed by LA gel and LBS groups in both the scales. The differences in pain scores recorded were found to be statistically significant. CONCLUSION: Ice is found to be equally effective as LA gel, whereas low-level laser therapy is less effective compared to the other two techniques in reducing the injection pain during administration of maxillary posterior buccal infiltration in children. CLINICAL SIGNIFICANCE: Pain management during LA injection is a critical step in gaining initial trust and during the subsequent treatment visits. The present study suggests that simple methods like pre-cooling the injection site with ice can be used as an effective non-pharmacological technique to reduce injection pain. HOW TO CITE THIS ARTICLE: AmruthaVarshini I, Vinay C, Uloopi KS, et al. Effectiveness of Pre-cooling the Injection Site, Laser Biostimulation, and Topical Local Anesthetic Gel in Reduction of Local Anesthesia Injection Pain in Children. Int J Clin Pediatr Dent 2021;14(1):81-83.

Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth.

BACKGROUND: Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. AIM: The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. SETTINGS AND DESIGN: This was an in vitro study. MATERIALS AND METHODS: Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. STATISTICAL ANALYSIS: Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. RESULTS: A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). CONCLUSION: Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.

In vivo evaluation of zinc oxide-propolis mixture as root canal filling material in the primary molars: A 24-month follow-up randomized controlled trial.

BACKGROUND: Pulpectomy is a routine practice in children with pulpal and periapical infections, the success of which depends on the elimination of bacteria from the root canals. Propolis, a natural product with proven antibacterial and anti-inflammatory properties when mixed with zinc oxide powder as root canal filling material, it could provide good success in endodontic therapy of primary teeth. AIM: The aim was to evaluate and compare the clinical effectiveness of zinc oxide-propolis mixture with zinc oxide eugenol (ZOE) as root canal filling material in nonvital primary molars. SETTINGS AND DESIGN: This was a 2-arm, parallel group randomized controlled trial with blinded outcome assessment. MATERIALS AND METHODS: Forty primary molars from children aged 4-8 years requiring pulpectomy treatment were randomly allocated into two groups according to the obturating material used: zinc oxide-propolis mixture (test group) and ZOE (control group). All the pulpectomy treated teeth were finally restored with stainless steel crowns, and the children were recalled at 6, 12, and 24 months for postoperative clinical and radiographic evaluation. STATISTICAL ANALYSIS: Chi-square test was used to analyze the data. RESULTS: The overall success rate of pulpectomy with zinc oxide-propolis mixture and ZOE was found to be 95% and 70%, respectively, and the difference was statistically significant (P = 0.037). Zinc oxide-propolis mixture has shown a success rate of 100% at 6 months and 95% at 12 and 24 months follow-up, whereas ZOE has shown 80% success rate at 6 and 12 months, and it declined to 70% at 24-month follow-up. CONCLUSION: Zinc oxide-propolis mixture demonstrated good clinical and radiographic success at the end of 24 months, and hence, it can be considered as an alternate root canal filling material in the primary teeth.

Impact of Calcium Glycerophosphate-supplemented Carbonated Beverages in Reducing Mineral Loss from the Enamel Surface.

AIM: The aim of this study was to evaluate the surface microhardness and mineral loss from enamel exposed to carbonated beverages supplemented with and without calcium glycerophosphate (CaGP). MATERIALS AND METHODS: Forty enamel blocks were prepared from 20 extracted premolars, and their initial surface microhardness was measured using the Knoop microhardness testing machine. The samples were divided into four groups based on the concentration of CaGP added to the beverage: group I: beverage without CaGP (control group), group II: beverage with 2 mM CaGP, group III: beverage with 5 mM CaGP, and group IV: beverage with 10 mM CaGP. The samples were subjected to four cycles of exposure to plain and CaGP-supplemented carbonated beverage with an intermittent buffering in artificial saliva, after which the final surface microhardness was measured. The mineral loss from enamel blocks was estimated spectrophotometrically. RESULTS: The obtained data were analyzed using paired t test and analysis of variance. A highly significant (p < 0.01) reduction in surface microhardness was observed in group I (beverage without CaGP). The reduction in surface microhardness in group III (beverage + 5 mM CaGP) and group IV (beverage + 10 mM CaGP) was not significantly different from that of sound enamel. A highly significant difference in calcium loss was observed between the groups (p = 0.00). Calcium loss reduced as the CaGP concentration increased in the groups. A similar trend was observed when phosphate loss was analyzed. CONCLUSION: Addition of CaGP to the carbonated beverages significantly prevented the reduction in surface microhardness of enamel and mineral loss. As the concentration of CaGP in carbonated beverages increased from 2 mM to 10 mM, the mineral loss is decreased. CLINICAL SIGNIFICANCE: Consumption of carbonated beverages has been increasing among the children and adolescents, leading to a higher incidence of dental erosion and caries. Hence, supplementation of these acidic beverages with buffering agents such as CaGP may help in preventing such dental problems among vulnerable populations. HOW TO CITE THIS ARTICLE: Manaswini YH, Uloopi KS, Vinay C, et al. Impact of Calcium Glycerophosphate-supplemented Carbonated Beverages in Reducing Mineral Loss from the Enamel Surface. Int J Clin Pediatr Dent 2020;13(1):1-5.

A Cross-sectional Study on Sense of Coherence and Its Relationship with Caries Experience and Socioeconomic Status in 11-16-year-old Schoolchildren.

AIM: To know the association of sense of coherence (SOC), caries experience, and socioeconomic status (SES) in 11-16-year-old schoolchildren. MATERIALS AND METHODS: This cross-sectional study included a total of 595 schoolchildren aged 11-16 years, and informed consent was obtained. Demographic and socioeconomic data were collected through pro forma filled by the parents. Sense of coherence of children was recorded with SOC-13 item questionnaire given in both English and local language (Telugu). Caries experience was recorded with DMFT index by carrying out the intra-oral examination of children. RESULTS: In a total of 595 schoolchildren, 35% children have weak SOC, 34.9% have moderate SOC, and 29.9% have strong SOC. Caries experience was inversely associated with SOC (p value = 0.006) on analysis by ANOVA. On multivariate regression analysis, it was observed that for every one-unit increase in SOC, caries experience decreased by 0.11 unit. However, there was statistically no significant (p value = 0.09) relation between childhood SES and SOC. Age (p value = 0.08) and gender (p value = 0.19) are not associated with SOC. CONCLUSION: Sense of coherence influences the caries experience irrespective of socioeconomic status, age, and gender of the child. CLINICAL SIGNIFICANCE: Children having stronger SOC have increased likelihood to seek out preventive dental services, which helps in maintaining good oral health. SOC is structured mainly by the experiences during the early years of life. Therefore, SOC can be strengthened by interventions in the early life through school dental health programs. HOW TO CITE THIS ARTICLE: Mrudhula KJN, Vinay C, Uloopi KS, et al. A Cross-sectional Study on Sense of Coherence and Its Relationship with Caries Experience and Socioeconomic Status in 11-16-year-old Schoolchildren. Int J Clin Pediatr Dent 2020;13(5):493-496.

Influence of gratification behavior on early childhood caries and body mass index in preschool children.

BACKGROUND: Early childhood caries (ECC) and obesity are becoming major public health problems in children. Apart from biological and social risk factors, gratification response, a psychological behavior, may also have a large influence on body mass index (BMI) and occurrence of ECC in preschool children. AIM: The study aimed to ascertain the impact of delayed gratification as a behavioral risk factor for the occurrence of ECC and obesity in preschool children of age 5-6 years. SETTINGS AND DESIGN: Comparative cross-sectional study. MATERIALS AND METHODS: Fifty children with ECC (Group I) and 50 caries-free children (Group II) were included to participate in a task similar to the famous Stanford marshmallow experiment to assess their ability to delay gratification. BMI was calculated by obtaining the biometric measures of height and weight. Body weight status was determined using BMI for age percentile growth charts revised by the Indian Academy of Pediatrics, 2015. Children's caries experience and BMI status were associated with their gratification response. STATISTICAL ANALYSIS: Statistical analysis was performed using Fisher's exact test and Chi-square test. RESULTS: Higher percentage of children with ECC delayed their gratification (54%) than caries free (40%). Children who exhibited instant gratification (37%) had a higher BMI when compared to those who delayed their gratification (25%). CONCLUSION: Children with ECC were more self-controlled, and children with high BMI were more impulsive. Hence, delayed gratification for cariogenic reward is a behavioral risk factor for ECC, whereas instant gratification is an alarming risk factor for higher BMI in preschool children.

Preclinical Evaluation and Clinical Trial of Chlorhexidine Polymer Scaffold for Vital Pulp Therapy.

OBJECTIVE: To evaluate the preclinical effectiveness and clinical efficacy of chlorhexidine polymer scaffold for vital pulp therapy. STUDY DESIGN: Polymer scaffolds loaded with chlorhexidine were prepared by electrospinning. The scaffolds were evaluated using four different tests: i) The release of chlorhexidine from the polymer scaffold was evaluated by Fourier-transform infrared spectroscopy (FTIR); ii) Biocompatibility of chlorhexidine scaffold was tested by subcutaneous implantation in rabbits; iii) The scaffolds were implanted into human molars for further ex vivo histological evaluation; and iv) The clinical efficacy of the scaffold was evaluated as a pulp dressing following vital pulp therapy, in comparison with MTA (control) in a clinical trial of forty primary molar teeth in 34 children aged 6 to 8 years. RESULTS: The scaffold was antimicrobial to Streptococcus mutans, Lactobacilli and other facultative anaerobes. Fourier-transform infrared spectroscopy confirmed the presence of chlorhexidine and polyvinyl alcohol in the scaffold. The histological evaluation of the subcutaneous tissue of rabbits and ex vivo human molars provided an acceptable biocompatibility response to scaffold. The clinical trial showed that the efficacy of chlorhexidine loaded scaffold was 90% and comparable to MTA. CONCLUSION: The scaffold met acceptable standards in all the four tests that were performed, including the clinical trial. A larger clinical trial with chlorhexidine scaffold in adult teeth may be necessary to prove its efficacy. The preliminary clinical trial results demonstrated that the scaffold was beneficial in saving primary teeth that required pulpotomy as a vital pulp therapy.