Effectiveness of Audiovisual Distraction in Reducing Children's Anxiety for Pain During Medical and Dental Treatments: A Systematic Review and Meta-analysis.

Background: Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. Objective: To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Methods: Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. Results: A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Conclusion: Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. Funding: None. Registration: PROSPERO (Ref no.: CRD42021245874).

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

BACKGROUND: Dental malocclusion is common all over the world, and it is caused by a difference in arch length and tooth size. This necessitates mixed dentition analysis for early intervention treatment planning such as eruption guiding, serial extraction, space maintainer, space regainer, and jaw extension. The aim of the study is to comparatively evaluate three different regression equation based mixed dentition analysis of children for prediction of the mesiodistal width of permanent canine and premolars in population of Vidarbha region. METHODS: This study comprised of 300 patients aged 13 to 16 years old. The impressions of patients were poured, and the mesiodistal width of their teeth was measured and documented. Three independent analyses were performed using the Ling and Wong method (L&W), the Bernabe and Flores-Mir method (B&F), and the Tanaka and Johnston method (T&J), and the results were compared to the sum of permanent canine and premolar teeth (SPCP). ANOVA with post hoc analysis was used to compare the predicted mesiodistal diameter (MDD) by analysis to the SPCP observed on cast. RESULTS: The mesiodistal width of SPCP of maxilla and mandibular teeth had statistically significant difference (P<0.001) with the predicted width by Ling and Wong method, Bernabe and Flores method and Tanaka and Johnston method for patients of Vidarbha region. CONCLUSIONS: The study concluded that all the three analysis overestimated the mesiodistal width of the sum of permanent canine and premolar in the patients. Tananka and Johnston analysis method was better in predicting the SPCP of the children of Vidarbha region.

Effectiveness of an Intravenous Insulin-Based Treatment Protocol for the Management of Hypertriglyceridemia-Associated Acute Pancreatitis.

Background: There is burgeoning interest in intravenous insulin for hypertriglyceridemia-induced acute pancreatitis (HTG-AP) as a less invasive alternative to plasmapheresis; however, there are few published descriptions of disease-specific insulin protocols. Objective: To compare the efficacy and safety of an insulin infusion-based protocol with nonstandardized medical therapy for HTG-AP. Methods: This is a retrospective analysis before and after creation of an HTG-AP-specific insulin infusion treatment protocol. Inclusion criteria were age ≥18 years, an initial triglyceride level >1000 mg/dL, and a diagnosis of AP. The primary outcome of the study was time to a triglyceride level ≤1000 mg/dL. Results: Sixty-seven patients were included in this study (26 pre-protocol and 41 in the HTG-AP insulin protocol group). Baseline characteristics between the groups were similar, with median initial triglyceride levels >3500 mg/dL. There was a trend toward patients treated with the HTG-AP-specific infusion reaching a triglyceride level ≤1000 mg/dL faster (43.3 [24.9-72.1] vs 26.9 [17.7-51.1] hours; P = 0.07). Those treated to ≤500 mg/dL achieved this faster with the disease-specific infusion (49.2 [29.4-67.8] vs 70.9 [36.3-107.2] hours, P = 0.04). Hypoglycemia was numerically lower in the HTG-AP-specific insulin infusion group despite higher insulin infusion rates (7.3% vs 19.2%). No patient in the HTG-AP-specific protocol group required plasmapheresis. Conclusions: The use of an HTG-AP-specific insulin infusion protocol, compared with antecedent nonstandardized care, resulted in prompter achievement of a triglyceride level ≤500 mg/dL and a strong trend toward faster achievement of ≤1000 mg/dL without an increased risk of hypoglycemia. While intravenous insulin may be considered the initial medical therapy for HTG-AP, further studies are needed to determine the optimal dosing.

A Unique Case of Recurrent Osteochondroma Enclosing Brachial Artery in a 13-Year-Old Female.

Introduction: Osteochondromas (OCEs) are benign chondrogenic lesions arising on the external surface of the bone with aberrant cartilage (exostosis) from the perichondral ring that may contain a marrow cavity also. In few cases, depending on the anatomical site affected, different degrees of edema, redness, paresthesia, or paresis can take place due to simple contact or friction. Furthermore, depending on their closeness to neurovascular structures, the procedure of excision becomes crucial to avoid recurrence. We report a unique case of recurrent OCE of the proximal humerus enclosing the brachial artery which makes for an important case and procedure to ensure that no relapse occurs. Case Report: We report a unique case of a 13-year-old female who had presented with a history of pain and recurrent swelling for 5 years. The swelling size was 4.4 cm × 3.7 cm × 4 cm with a previous history of swelling at the same site operated in 2018. Conclusion: This case report demonstrates that when presented with a case of recurrent OCE of the proximal humerus, doing proper excision of the tumor is crucial to prevent its relapse.

A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition.

Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and Methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.

A clinical trial on topical effect of probiotics on oral Streptococcus mutans counts in children.

BACKGROUND: Probiotics compete with the cariogenic oral bacteria like Streptococcus mutans (S. mutans) for carbohydrates resulting in substrate depletion and reduction in the number of S. mutans. AIM: The evaluation of topical effect of short-term application of Probiotic formulation on S. mutans counts in plaque of 7-12 years old children with decayed, missing, filled teeth (dmft/DMFT) score 2-5. MATERIALS AND METHODS: A registered randomized clinical trial (Clinical Trials Registry of India/ICMR - CTRI/2019/09/021205) was conducted on 7-12 years medium risk 10 children with dmft/DMFT score 2-5, where an innovative probiotic formulation (prepared from capsule) was applied for 6 consecutive days, on teeth and pre/post plaque samples were evaluated for S. mutans count on mitis salivarius agar. RESULTS: There was statistically significant and drastic reduction from 608,200 to 6600 (>90%) in the S. mutans count in plaque after the application of probiotic solution for a short period of time (6 days). CONCLUSION: Short-term application of probiotics can be used as an alternate topical preventive therapy to reduce the count of S. mutans effectively in oral cavity/plaque. Hence, probiotic can be used as topical caries preventive agent.

Osteochondroma Presenting Clinically with Carpal Tunnel Syndrome in a 12-Year-old Boy.

INTRODUCTION: An exostosis is a benign growth of bone, which when capped with cartilage is called osteochondroma, which can appear as solitary or multiple, mostly affecting the long bones, pelvis, and shoulder region. The prevalence of known solitary exostosis is 1-2% in the general population. They are slow growing lesions with rare malignant transformation. In patients with a solitary exostosis, the chance of developing a chondrosarcoma out of an exostosis is around 1%. CASE REPORT: A 12-year-old boy presented to our outpatient department with complaints of pain, and swelling at the right wrist since 1 year and tingling numbness on and around palmar aspect of index and middle finger since 6 months. The swelling was of size 3 cm × 2 cm, Tinel's sign was positive. His blood parameters were normal. X-ray showed exostoses. Magnetic resonance imaging was suggestive of osteochondroma. Nerve conduction study was normal. Excision biopsy confirmed the diagnosis and also relieved all symptoms. CONCLUSION: Our case report is unique in its own way as it reminds us that when presented with a case of osteochondroma of the distal radius in children, carpal tunnel syndrome can also occur.

Comparative evaluation of antimicrobial effectiveness of probiotic milk and fluoride mouthrinse on salivary Streptococcus mutans counts and plaque scores in children - An in vivo experimental study.

AIM: The aim of the study was to compare the effectiveness of probiotic milk and fluoride mouthwash on salivary Streptococcus mutans (SM) counts and plaque index (PI) scores in children. MATERIALS AND METHODS: Thirty children of 8-13 years with zero decayed, missing, and filled teeth (dmft)/DMFT were randomly divided into two equal groups of 15 each; baseline saliva samples were collected, and plaque scores were recorded. Group A received probiotic milk and Group B received fluoride mouthwash for 7 days, and then, saliva samples were collected for colony counting, and plaque scores were recorded on the 8th day. STUDY DESIGN: This was a double-blind experimental in vivo study and randomized sample selection. RESULTS: The results showed that there was statistically significant reduction in both salivary SM counts and plaque scores in both the groups after 7 days period. Intergroup comparison showed that there was no statistically significant difference between the two groups (i.e., both groups are equally effective in caries reduction). CONCLUSION: Probiotic milk was as effective as fluoride mouthwash in reducing SM counts and PI scores.

Infected Dentigerous Cyst and its Conservative Management: A Report of Two Cases.

AIM: To check the efficacy of decompression technique in children with dentigerous cysts. BACKGROUND: Most commonly occurring odontogenic cysts in the oral cavity are radicular cysts and dentigerous cysts.1 According to Kramer, a cyst is defined as a pathological cavity having fluid, semi-fluid, or gaseous contents, which is not created by the accumulation of pus. A cyst which is lined by epithelium is known as a true cyst and that which is not lined by epithelium known as a pseudocyst.2 The dictionary meaning of dentigerous is "structures resembling teeth".3 A dentigerous cyst is found enveloping the crown of an unerupted, embedded, or submerged tooth by the expansion of its follicle till the neck of the tooth.1 It is not unusual for a dentigerous cyst to mimic a radicular cyst, especially when the cyst is associated with a pulpectomized or carious primary tooth and its unerupted permanent successor. This article presents two cases of infected dentigerous cysts. The first case was of a female patient associated with tooth 45; and another case was of a male patient associated with tooth 35. The infected dentigerous cyst in both the cases was treated with the most conservative option available, i.e., decompression technique. CASE DESCRIPTION: In this article, two cases of infected dentigerous cysts are discussed, in which one case deals with the female patient associated with tooth 45 and the other case deals with the male patient associated with tooth 35. The infected dentigerous cysts in both the cases were treated conservatively, i.e., with the decompression technique. CONCLUSION: The present case report states that the decompression technique may be the most conservative method available for managing dentigerous cysts in children. HOW TO CITE THIS ARTICLE: Patil AS, Jathar PN, et al. Infected Dentigerous Cyst and its Conservative Management: A Report of Two Cases. Int J Clin Pediatr Dent 2019;12(1):68-72.

Comparative evaluation of two caries detection systems for detecting the prevalence of early childhood caries: A cross-sectional study.

BACKGROUND: The early diagnosis of dental caries is very crucial to prevent tooth loss, which leads to serious consequences in preschool children. The aim of this study is to compare the diagnostic outcome by the World Health Organization (WHO) and WHO and early carious lesions (ECLs) (i.e., WHO + ECL) criteria for assessing early childhood caries (ECC) in preschool children. MATERIALS AND METHODS: A cross-sectional, comparative study was conducted among 3-5 year old children (n = 358). Clinical examination was conducted using WHO and WHO + ECL criteria. The data were assessed using paired "t" test. P < 0.05 was considered as statistically significant. RESULTS: There was statistically significant difference between the mean decayed, missing, or filled teeth recorded by the WHO + ECL and WHO (P < 0.05) method. CONCLUSION: It was concluded that WHO + ECL criteria were significant and more precise in assessing the presence of ECL in preschool children.

Fibrolipoma on a Child's Lip: A Rare Clinical Finding.

Lipoma is very common benign tumor of adipose tissue, but its presence in the oral cavity is rare. Fibrolipoma is a histological variant of lipoma that affects the buccal mucosa and nasal septum in the orofacial region and causes functional and cosmetic issues. However, this lesion has not been reported on the upper lip and may be confused with other soft tissue lesions of children. Hence, accurate histopathological examination of lipomas is important for a correct treatment plan. The purpose of this report is to describe the case of an 11-year-old boy with fibrolipoma of the upper lip.

The Untold Story of Fluoridation: Revisiting the Changing Perspectives.

The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.

Childhood Occurrence of Pemphigus.

Pemphigus is a chronic mucocutaneous disease that initially manifests in the form of intraoral blisters which spread to other mucous membrane and skin. This study describes an unusual case of chronic generalized childhood pemphigus disease in an 11-year-old girl, who presented with multiple vesicles all over her body. Such a condition is seen more often in older people rather than children. It is crucial for dental professionals to be familiar with the diagnosis of bullous skin diseases in children and adolescents, especially in its initial stages in order to prevent the serious consequences and morbidity. The article highlights clinical presentation, histopathology, and successful management strategies useful for pediatric dental practice. HOW TO CITE THIS ARTICLE: Patil RU, Anegundi RT, Gujjar KR, Indushekar KR. Childhood Occurrence of Pemphigus. Int J Clin Pediatr Dent 2017;10(2):196-200.

The effectiveness of pendulum, K-loop, and distal jet distalization techniques in growing children and its effects on anchor unit: A comparative study.

BACKGROUND: A common strategy to correct Class II malocclusions using a nonextraction protocol in children is to move the maxillary molars distally using molar distalization appliances, which usually derive their anchorage from maxillary premolars, causing mesialization of premolars and protrusion of incisors. OBJECTIVES: To evaluate the skeletal, dental and soft tissue changes produced by three different distalizing appliances, namely, pendulum, K-loop, and distal jet appliances. MATERIALS AND METHODS: Sixty-six children of mean age 14.13 years requiring molar distalization were divided into three groups: Group I (pendulum appliance), Group II (K-loop), and Group III (distal jet). Lateral cephalometric films were taken before and after 5 months of molar distalization and following cephalometric parameters were used to assess the effects of maxillary molar distalization, namely, anteroposterior skeletal (SNA/SNB/ANB), vertical skeletal (face height ratio/Frankfort-mandibular plane [FMA]/angle formed between Maxillary plane & Mandibular plane (MM)), interdental (overjet/overbite), maxillary dentoalveolar, and soft tissue parameters. RESULTS: There was no significant age difference between the three groups. In overall treatment changes among the three groups, the Anteroposterior skeletal changes were not statistically significant, vertically FMA angle increased by 1.79° ± 2.25° and overbite reduced by 2.38 ± 1.83 mm. The maxillary first molars were distalized by an average of 4.70 ± 3.01 mm (Upper 6 [U6] to pterygoid vertical [PTV]). The maxillary central incisor labial tipping increased to an average of 1.61 ± 2.73 mm and cant of upper lip increased by 3.40° ± 5.88° are statistically significant (P < 0.05). CONCLUSION: All three distalization techniques in growing children produced significant effects on anchor unit. There was an increase in FMA angle, significant bite opening, proclination of the maxillary incisors and increase in the cant of the upper lip.

Pendulum Therapy of Molar Distalization in Mixed Dentition.

Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient's compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73.

A survey of the dentist attire and gender preferences in dentally anxious children.

BACKGROUND: Anxiety about doctors among children is very common. White coat phobia which is a classical conditioning phenomenon is said to be prevalent among children. OBJECTIVES: To analyze the association between anxious states of children about dentists and their preference of dentist attire and gender in the dental office. MATERIALS AND METHODS: The 9-12-year-old middle school children were selected for the study. Children were asked to fill a questionnaire containing children's fear survey schedule-dental subscale (CFSS-DS) and asked to prefer dental attire from four different pictures displaying the single anonymous dentist in four different attires in the same operator. The CFSS-DS gave the anxiety scale, and age, gender, and experience were also plotted against children preference in an apron, protective wear, and gender preference. Results were tabulated and statistically analyzed using Chi-square test. RESULTS: About 718 (62%) were scored as anxious children. Of all anxious children, 502 (69.9%) had preference of colored attires of the dentist, and 408 (66.8%) anxious children preferred dentist with protective wear. Female dentists were preferred by 452 (66%) anxious children. Same gender preference was also prevalent.

Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients.

INTRODUCTION: Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry. AIM: To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients. MATERIALS AND METHODS: A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study. RESULTS: Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001). CONCLUSION: Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved.

Permanent Maxillary Canine Agenesis: A Rare Case Report.

Congenitally missing teeth (CMT) are among one of the commonly known dental anomalies. The most frequently missing teeth in the permanent dentition, excluding the third molars, are mandibular second premolars and maxillary lateral incisors. Exclusive agenesis of both maxillary canines is an extremely rare occurrence and only a few cases have been reported. Previous studies showed that the prevalence of maxillary canine agenesis varies between 0.07 and 0.13%. In recent studies on Indian population, no cases of maxillary canine agenesis have been documented. This paper reports a case of non-syndromic bilateral agenesis of permanent maxillary canines, along with agenesis of both mandibular central incisors in a healthy 13-year-old Indian female patient; and a brief literature review on prevalence, etiology and treatment modalities of the condition. How to cite this article: Kambalimath HV, Jain S, Patil RU, Asokan A, Kambalimath D. Permanent Maxillary Canine Agenesis: A Rare Case Report. Int J Clin Pediatr Dent 2015; 8(3):242-246.

Autologous reattachment of complicated crown fractures using intra canal anchorage: report of two cases.

Crown fractures are most common form of dental trauma sustained by children and adolescents. Major portion of these crown fractures are uncomplicated. Complicated crown fractures though infrequent and account only 4-16%, is an enigma to any clinician. Autologus reattachment of the tooth fragment is a simple and conservative procedure in managing such crown fractures. The present article intends to report the successful clinical management of Autologus tooth fragment reattachment in two complicated crown fractures.

Evaluation of antidiabetic and related actions of some Indian medicinal plants in diabetic rats.

OBJECTIVE: To evaluate antidiabetic activity of chloroform extracts of Acacia arabica bark, Benincasa hispida fruit, Tinispora cordifolia stem, Ocimum sanctum areal parts and Jatropha curcus leaves. METHODS: The chloroform extracts of Acacia arabica bark, Benincasa hispida fruit, Tinospora cordifolia stem, aerial part of Ocimum sanctum and Jatropha curcus leaves were evaluated at different doses (250 and 500 mg/kg body weight.) for antidiabetic potentials in alloxan induced diabetic albino rats. The extracts were administered for two weeks in different groups whereas tolbutamide (80 mg/kg body weight) was used as reference standard throughout study. RESULTS: The result of present study showed test compounds significantly decreases elevated level of serum glucose and also caused to reverse the cholesterol, triglyceride, HDL and LDL values when compared to untreated diabetic rats. CONCLUSIONS: Our finding indicates that different test extracts were able to ameliorate the derangements in lipid metabolism caused by diabetes mellitus in alloxan induced diabetic rats towards normal level.