Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy.

Context: Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. Aims: The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. Settings and Design: The study was a prospective clinical study with a 9-month follow-up period. Subjects and Methods: Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Statistical Analysis: Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Results: Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. Conclusion: The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.

Salivary Biomarker Levels in Children with Sleep Problems Before and After Twin Block Therapy.

BACKGROUND: Disturbances in sleep have a wide-ranging effect on a child's life profoundly impacting the standard of living. The aim of this study was to investigate levels of Salivary Tumor Necrosis Factor-Alpha (TNF-α) and Malondialdehyde (MDA) in a group of children with class II malocclusion and sleep problems before and after twin block appliance therapy. MATERIALS AND METHODS: Eleven children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study. All children were subjected to a recording of their sleep history and a clinical and radiographic examination. Pre-treatment levels of salivary TNF-α and MDA were recorded. A twin block appliance was custom made and delivered to every child. After a minimum follow-up period of 9 months, all children were recalled for a re-evaluation of salivary biomarker levels. RESULTS: Levels of salivary biomarkers TNF-α and MDA significantly decreased in children following myofunctional therapy using a twin block appliance. CONCLUSION: The measurement of TNF-α and MDA could be used as an alternative and noninvasive method to evaluate prognosis of twin block therapy for children with sleep-disordered breathing (SDB).

Salivary tumor necrosis factor-Alpha and malondialdehyde levels in children with class II malocclusion and sleep disorders: An evaluative study.

Context: Recently biomarkers for sleep disorders have provided an alternative and convenient means of diagnosis for children at risk. Aim: To evaluate salivary TNF-α and Malondialdehyde (MDA) levels in children with skeletal class II malocclusion and with a positive history of sleep disorders. Settings and Design: This prospective evaluative study was carried out from October 2020 to March 2021, in the Department of Pediatric and Preventive Dentistry. Material and Methods: 21 children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study (Group 1). 21 age and gender matched children with no skeletal malocclusion and no reported history of sleep disorders served as a comparison group (Group 2). All children were evaluated regarding their sleep history and clinically examined to determine craniofacial morphology. Unstimulated saliva was collected from all children. Salivary TNF-α was measured with a solid-phase sandwich ELISA. Salivary MDA was measured by using TBA reagent. Statistical Analysis: Intergroup comparison for age and normally distributed data was done using t-test. Comparison of frequencies of categories of variables was done using Chi-square test. Inter group comparison for TNF-α was done using Mann-Whitney U test. Results: There were significantly higher levels of salivary TNF-α and MDA, in children of Group 1 when compared to that of Group 2 children (p < 0.01). Conclusion: Salivary TNF-α and MDA may be a simple and non-invasive tool in the identification and screening of children at high risk for sleep disorders.

Effect of Twin-block Appliance on Pharyngeal Airway, Sleep Patterns, and Lung Volume in Children with Class II Malocclusion.

AIM: In this study, we sought to evaluate the effect of the twin-block appliance on pharyngeal airway dimensions, sleep patterns, and lung volumes in growing children with class II malocclusion with a retrognathic mandible. MATERIALS AND METHODS: Twenty children aged 9-12 years with class II malocclusion with a retrognathic mandible participated in the study. A validated sleep questionnaire assessed the sleep patterns and the sleep problems of the children. The pre-treatment cephalometric variables and the pharyngeal airway passage (PAP) dimensions were analyzed. Spirometry tests were performed to evaluate lung volumes. A custom-made twin-block appliance was fabricated, and children were instructed to wear it for a minimum of 10 months. All variables including sleep problems, cephalometric variables, and pharyngeal airway measurements were evaluated post-treatment. Spirometry tests were re-evaluated at the end of the twin-block treatment. All data were statistically analyzed. RESULTS: Post-twin-block appliance treatment, there was a definite decrease in snoring, noisy breathing, and sleeping with mouth open. The sella-nasion to B point angle (SNB), mandibular length, the depths of oropharynx, nasopharynx, and hypopharynx as well as the height of nasopharynx (HNP) were significantly increased post-treatment (p <0.001). The length and thickness of soft palate (SPI) increased significantly (p <0.001), while its inclination decreased significantly (p <0.001). We found improvements in forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1); however, the changes were statistically not significant (p = 0.88 and p = 0.78). CONCLUSION: Twin-block appliance significantly increased the pharyngeal airway dimensions and improved the length and thickness of the soft palate in children with class II malocclusion. Post-twin-block treatment showed a considerable reduction in the sleep problems of the children. The lung volume measurements showed improvement; however, it was not statistically significant. CLINICAL SIGNIFICANCE: Twin block may be used not only to correct the facial disharmony of children with a retrognathic mandible but also to improve the airway dimensions and lung volume as well as to reduce the sleep-disordered symptoms.

Prevalence of sleep practices and sleep problems of schoolchildren in South Kanara.

BACKGROUND: Disturbances in sleep could affect normal growth as well as behavior of children. It could also impair their cognitive development. Sleep problems have been increasing over the past few years. However, there is a gap regarding information about sleep practices and sleep problems among Indian children. AIM: A sleep questionnaire was designed and validated to assess the frequency of sleep practices and sleep problems in 500 children. MATERIALS AND METHODS: The study was conducted in 5 local schools in South Kanara district by administering the questionnaire to the parents/caretakers under the guidance of a trained investigator. We also sought to examine the association of demographics, medical/behavior/academic performance, sleep patterns, and home environment to sleep problems in these children. STATISTICAL ANALYSIS: Descriptive statistics were recorded as mean and standard deviation for quantitative data and in frequency and percentage for qualitative data. RESULTS: We found a high prevalence of bedroom sharing (92.4%) and bed-sharing (91.2%). 46.4% of the children exhibited at least one sleep problem, the most prevalent being bed-wetting (17%). Sleep problems were considerably greater in older children and in children with behavioral problems. Practices such as watching TV and using computer after 8 pm/at bedtime were significantly associated with all sleep problems. CONCLUSION: Our study revealed definite and significant presence of sleep problems in the children of South Kanara. Strong associations were observed between certain sleep practices and problems.

Association of sleep disturbances and craniofacial characteristics in children with class ii malocclusion: An evaluative study.

BACKGROUND: Behaviour problems, poor academic performance and failure to thrive are some of the potential sequelae of sleep problems in children. Hence, there is a need to evaluate the prevalence of sleep problems and significant associations in children with skeletal class II malocclusion with mandibular retrognathism. AIMS: This study aimed to determine associations if any between sleep practices and problems and craniofacial characteristics in children with skeletal class II malocclusion with mandibular deficiency. SETTINGS AND DESIGN: A cross-sectional study was conducted among a group of children with skeletal class II malocclusion with mandibular retrognathism. MATERIALS AND METHODS: Fifty children aged 8-14 years with skeletal class II with mandibular retrognathism and who required myofunctional therapy were selected. A validated sleep questionnaire assessed the sleep practices and problems. A detailed clinical examination including tonsils and evaluation for mouth breathing was performed. A lateral cephalogram recorded specific linear, angular variables as well as upper and lower pharyngeal airway space. STATISTICAL ANALYSIS: Descriptive statistics, frequency, and percentages were calculated, and the Chi-square test was used. RESULTS: All children reported at least one sleep problem, with snoring reported by 76% of the children. Forty-two percent of the children showed a decreased upper airway, whereas 80% showed a decreased lower airway. Significant associations were seen between SN-MP and noisy breathing, upper airway, and snoring with a P value of 0.017. We also found significant associations between upper and lower airway and sleep positions with a P value of 0.021 and 0.005, respectively. CONCLUSION: All the children exhibited at least one sleep problem. There was a strong association of certain sleep practices and sleep problems with cephalometric variables.

Effect of Virtual Reality Distraction on Pain and Anxiety During Dental Treatment in 5 to 8 Year Old Children.

OBJECTIVE: This study was aimed at assessing the impact of Virtual Reality (VR) distraction technique on pain and anxiety in 5-8-year-old children, during short invasive dental procedures. STUDY DESIGN: 120 children, aged 5-8 years, scoring less than 25 on the SCARED questionnaire, scheduled to undergo short invasive dental procedures, were randomly divided into a control (without VR distraction) and study group (with VR distraction) of 60 each. State anxiety levels were assessed in the children from both groups using revised version of Modified Child Dental Anxiety Scale, before and after dental treatment. Pain perceived during treatment was assessed using Wong Baker Faces pain rating scale at the end of treatment. Salivary cortisol levels were also assessed before, during and after the dental procedure, in all children. RESULTS: We observed a significant reduction in pain perception and state anxiety in children, using VR distraction (p<0.001, p=0.002). The decrease in salivary cortisol levels was significantly greater in children using VR distraction (p<0.001). CONCLUSION: Virtual Reality distraction can be used as a successful behavior modification method in children undergoing short invasive dental treatments.

Effect of crude apple extract on the cariogenic factors of Streptococcus mutans: An in vitro study.

OBJECTIVE: The aim was to assess the effects of crude extract of whole apple on the cariogenic properties of Streptococcus mutans by evaluating (1) its growth, (2) its adherence property, and (3) changes caused by acid produced by S. mutans in the presence of sucrose (in vitro). STUDY DESIGN: Kashmiri Apples (sourced from the local market) were used for the study. Whole apple extracts including the skin were used to obtain undiluted crude apple extract. The growth of S. mutans in the presence of the crude apple extract was evaluated by agar diffusion test as well as direct contact inhibition test. The effects of the crude extract on the adherence of S. mutans was assessed by modified O'Toole method in which the viable cell counts of S. mutans which remained adherent on the microtitre plate were calculated. The effects of the test materials on pH changes caused by S. mutans in the presence of sucrose were assessed using pH meter. RESULTS: Crude extract of the whole apple showed no significant inhibitory effect on the growth of S. mutans while a significant inhibitory activity on the adherence of S. mutans was observed. Furthermore, the significant inhibitory effect on the pH drop was recorded, although pH remained below the critical value of 5.5 at all times. CONCLUSION: Crude whole apple extract has considerable anti-cariogenic effect on S. mutans and hence can be used as a natural alternative which can aid in the prevention of dental caries.

Breaking the sound barrier: oral health education for children with hearing impairment.

In our study, a visual oral health education (OHE) program was specially designed for children with hearing impairment. Its efficacy in improving their oral health status was evaluated after periods of reinforcement and nonreinforcement. One hundred and ten institutionalized children with moderate-to-severe hearing impairment aged 6-14 years were selected for the study. Oral health status was evaluated at the start of the study (pre-OHE level) using the Modified Gingival Index (MGI) and the Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index (MQPI). Salivary Streptococcus mutans levels of the children were also evaluated. Brushing skills were assessed using the Simmons index at the start of the study. Significant decreases were observed in the mean values of both the MGI and MQPI from the baseline up to the values obtained at the end of both periods of reinforcement and nonreinforcement. Significant reduction in S. mutans counts was observed, from Pre-OHE levels up to the levels at the end of the period of nonreinforcement. Brushing skills of children improved significantly at the end of study, notably in areas where brushing was previously deemed unsatisfactory. The OHE program specially formulated for the hearing impaired children was effective in improving their oral health status significantly.

PROP test: prediction of caries risk by genetic taste perception among the visually impaired children.

The study sample consisted of 100 children with visual impairment aged 6-14 years. 6-n-propylthiouracil (PROP) sensitivity test was carried out. The Caries experience was recorded, estimation of Streptococcus mutans done and their taste likes and dislikes assessed through a food preference questionnaire. The Caries experience and S. mutans levels were highest in the non-tasters, comparatively low in medium tasters and the least in the supertasters. Dietary preferences indicated tasters were sweet dislikers and non-tasters, sweet likers. PROP test can be a useful tool in determining genetic taste sensitivity levels amongst the visually impaired children and thus used as a screening tool in those children who are at a high risk of developing dental caries.

Knowledge of care providers regarding the oral health of visually impaired children.

OBJECTIVE: To assess the awareness of care providers of visually impaired children regarding their oral hygiene. METHOD: A simple pre-structured questionnaire was given to the care providers and the awareness regarding their oral health was assessed. RESULTS: There was a general lack of awareness among the care providers of these children regarding dental diseases and its prevention. Furthermore, the importance of oral hygiene was found to be very low. CONCLUSION: The results obtained showed that most of the caretakers were unaware of the difficulties faced by these children in the maintenance of their oral health.

Caries protective agents in human milk and bovine milk: an in vitro study.

OBJECTIVES: To estimate Calcium and Phosphorus withdrawal from hydroxyapatite in the presence of bovine milk and human milk from which the following protective fractions namely Casein, Whey protein, Lactose and Milk fat have been individually removed and to compare the above protective fractions in human and bovine milk. METHOD: Human milk obtained from lactating mothers in the labor ward of Kshema hospital was subjected to immediate analysis. Bovine milk was obtained from a local dairy. Equal quantities of human milk and bovine milk (1 ml) were separately subjected to the systematic removal of the four milk fractions. As each fraction was removed, the remaining milk samples were subjected to testing. Powdered hydroxyapatite from human dental enamel was subjected to demineralization with the addition of the milk sample under test for 20 minutes. This mixture was then centrifuged. Aliquots of the supernatant were taken for calcium and Phosphorus analysis using photospectrometry. Ten demineralization tests were similarly carried out for every milk fraction for both human and bovine milk separately. Equal samples of whole bovine milk and whole human milk were also subjected to similar testing. RESULTS: The calcium and phosphorus dissolution values were higher when the individual fractions were eliminated from both human milk/enamel samples and bovine milk/enamel samples as compared to the values obtained from whole human milk/whole bovine milk/enamel samples. Further higher calcium and phosphorus dissolution values were observed when the fractions were individually and separately removed from the whole human milk/enamel samples as compared to the corresponding values obtained when these fractions were removed from bovine milk/enamel samples. CONCLUSION: The evaluated milk fraction in bovine milk namely casein, whey protein, lactose and milk fat were individually more caries protective when compared to the corresponding fractions in human milk.

Oral health status of the visually impaired children--a south Indian study.

UNLABELLED: Oral health is an important aspect of health for all children, and is all the more important for children with special health needs. The oral health of children who are visually impaired can be disadvantaged, since they are often unable to adequately apply the techniques necessary to control plaque. PURPOSE: The purpose of the present study was to evaluate the oral health status of visually impaired children. METHOD: A modified WHO oral health assessment form was used to assess oral conditions, oral hygiene status, caries experience and gingival status. RESULTS AND CONCLUSION: The children exhibited suboptimal levels of oral health with majority of the children showing a high caries prevalence as well as moderate to severe gingivitis.

Propylthiouracil (PROP)--a tool to determine taster status in relation to caries experience, streptococcus mutans levels and dietary preferences in children.

PURPOSE: Dental caries remains the single most common disease of childhood that is neither self-limiting nor amenable to short term pharmacological management. Hence, there is a need to identify and institute preventive measures for those children who are at a greater risk for developing dental caries to determine the prevalence of tasters and non tasters among the group of school aged children. To compare and contrast the prevalence of dental caries, S. mutans levels and dietary preferences in children with different genetic sensitivity levels to the bitter taste of PROP. METHOD: A total no of 500 children belonging to the age group of 6-12 years of both sexes were recruited from A.B. Shetty Memorial Institute of Dental Sciences in Mangalore, India. PROP sensitivity test was carried out to determine the inherent genetic ability to taste a bitter or sweet substance. Estimation of Streptococcus mutans levels were done, a questionnaire was given to evaluate their dietary habits and the caries experience was recorded Collected data were tabulated and subjected for statistical analysis using Pearson Chi - square test of significance. RESULTS: The results suggested that there was increase in the caries experience and S. mutans levels among the group of non tasters as compared to tasters. Tasters tended to be sweet dislikers and non tasters tended to be sweet likers. On the whole tasters had a healthier dentition as compared to non tasters. CONCLUSION: The PROP test proved to be a useful tool in determining the genetic sensitivity levels of bitter taste. Knowledge of an individuals taste perception can help us in identifying the children who are at higher risk for dental caries.