Piagetian's principles on moral development and its influence on the oral hygiene practices of Indian children: An embedded mixed-method approach.

BACKGROUND: Moral principles in children can influence their oral hygiene practices and can be beneficial in providing better oral health care. AIM: To assess the consistency of Piaget's moral development principles in Indian children aged 7 to 11 years and evaluate its influence on their oral hygiene practices. DESIGN: The first phase of the embedded mixed-method approach included telephone interviews of 50 children on eight situations of moral development as suggested by Jean Piaget. Children were categorised into heteronomous and autonomous moralities based on the content analysis. The second phase of the study included a semi-structured qualitative interview on knowledge and practice behaviour of children on oral hygiene maintenance. RESULTS: There was no significant difference in the overall moral development of children aged 7 to 9 years and 9 to 11 years (p = .57). Only 4.8% of girls had heteronomous morality, and a significant difference was noted between boys and girls (p = .014). There was a significant difference in the oral hygiene practices observed between heteronomous morality and autonomous morality children. CONCLUSION: Children were autonomous in their morality at 7 to 9 years of age. Children with autonomous morality performed better oral hygiene practices than children with heteronomous morality.

Pre-eruptive intracoronal radiolucencies in permanent dentition of children in Tamil Nadu-A cross-sectional study.

BACKGROUND: Pre-eruptive intracoronal radiolucency (PEIR) poses a challenge to paediatric dentists as it cannot be clinically detected. AIM: To estimate the prevalence and coexisting factors of PEIR in permanent teeth of children and adolescents in western Tamil Nadu, India. DESIGN: This cross-sectional study assessed 5012 digital panoramic radiographs of children and adolescents below 14 years of age obtained from private digital imaging centers, dental clinics, and dental colleges located in five districts of western Tamil Nadu. The prevalence and PEIR and its coexisting factors were assessed by two independent calibrated investigators. Data were analyzed using the chi-square test. RESULTS: The subject prevalence and tooth prevalence of PEIR were estimated to be 3.2% and 0.4%, respectively. Maxillary canines and mandibular premolars were commonly involved. Majority of the lesions were limited to less than one-third of dentin thickness (74%) and distal aspect of the crown (45.1%). Ectopic positioning (9.3%) and dental caries in the preceding primary tooth (9.9%) were the most common coexisting factors. CONCLUSION: Pre-Eruptive Intracoronal Radiolucency defects were commonly seen in maxillary canines, mandibular premolars, and distal aspect of the crown involving less than one-third dentin thickness. Ectopic positioning and caries in primary teeth were commonly seen along with the PEIR defects.

Stress amongst paediatric dental postgraduate students in India: A mixed-method approach.

INTRODUCTION: Dental profession is one of the most stressful healthcare occupations. Paediatric dental postgraduates face multifaceted challenges in their everyday practice. This study aimed to determine the sources of stress amongst paediatric dental postgraduate students in India using a mixed-method approach. MATERIALS AND METHODS: A sequential mixed-methods approach was employed. In the quantitative phase, a cross-sectional web-based questionnaire survey was conducted amongst paediatric dental postgraduates in India using the "Google Forms application" link. Based on the Dental Environment Stress (DES) questionnaire, the stress PACT questionnaire which includes 35 items was framed and validated. This validated questionnaire was used in the survey. In the qualitative phase, one-on-one, semi-structured telephone interviews were conducted amongst 12 postgraduates. RESULTS: A total of 422 participants took part in the quantitative survey. Academic and specialty-related domains were found to be the significant causes of stress amongst the five domains (p < .001). The top three stressful factors were as follows: getting an ideal case for clinical exams (68.2%), financial resources for conferences, dissertation, short studies and publications (53.2%) and fear of unemployment after graduation (52.3%). Based on qualitative interviews, four themes were derived, namely choice of paediatric dentistry, postgraduate life experience, stress management and expected changes in postgraduate life. CONCLUSION: Psychological well-being of the student is an important factor that influences the overall performance of students. Identifying the stress factors and using appropriate coping strategies can help postgraduates achieve personal, academic and professional success.

First dental visit of children-A mixed-method approach.

BACKGROUND: First dental visit (FDV), the essence of preventive paediatric dentistry, has a significant impact on the child's oral health. Mixed-method research provides meaningful insight into the multiple facets of FDV. AIM: To evaluate the average age and most common reason for FDV of children in Namakkal district and to explore the individual perceptions of parent's view on their child's FDV. METHOD: Sequential mixed-method approach was employed. A cross-sectional questionnaire survey on FDV was conducted among 4543 parents of children <6 years. The second phase included a semi-structured face-to-face qualitative interview for 10 parents. RESULTS: Out of 4543 children, only 31.0% had FDV. Majority of children (49.0%) had FDV after 5 years of age. Dental caries was the most common reason for FDV (75.0%). Three themes were derived from the interviews, namely FDV experiences, barriers to child dental care, and solutions for an early dental visit. CONCLUSION: Children in Namakkal district had delayed FDV (>5 years). The most common reason for FDV was dental caries. Lack of knowledge, lack of interdisciplinary practices, and social and financial barriers seem to have influenced the FDV of lack of knowledge these children.

Effect of Custom-made Probiotic Chocolates on Streptococcus mutans, Plaque pH, Salivary pH and Buffering Capacity in Children - A Randomised Controlled Trial.

PURPOSE: To compare the effect of three custom-made probiotic chocolates and conventional chocolates on plaque pH, salivary pH and buffering capacity of saliva in children. The study also evaluated its antimicrobial efficacy against S. mutans. MATERIALS AND METHODS: A parallel randomised double-blinded trial was conducted in two phases. For the phase І trial, 90 children were randomly divided into 3 groups: milk (MC), white (WC) and dark chocolate (DC). Salivary pH, plaque pH and buffering capacity were assessed at baseline, 10 min, 30 min and 60 min after consumption of the chocolates. After a washout period of 20 days, the children were assigned to their respective probiotic chocolate groups and the assessments were repeated. In the phase ІІ trial, 60 children were divided into 3 groups (n = 20): probiotic milk (PMC), white (PWC) and dark chocolate (PDC). They were given probiotic chocolates for 5 consecutive days in a week. S. mutans colony count was measured at baseline, post intervention, 15 days and 30 days. RESULTS: All probiotic chocolates were less acidogenic than their counterparts. PWC was found to be the least acido-genic. DC was found to be the least acidogenic among plain chocolates. All probiotic chocolates were effective in reducing the S. mutans colony count. CONCLUSION: Chocolates can serve as a vehicle for delivering probiotics with the added advantage of making them tooth-friendly.

Comparison of Behavior and Dental Anxiety During Intranasal and Sublingual Midazolam Sedation - A Randomized Controlled Trial.

OBJECTIVES: The objective of the study was to assess the behavioral effects and the changes in the anxiety level of children after intranasal and sublingual midazolam sedation using Venham's clinical anxiety scale and salivary cortisol level. STUDY DESIGN: Twenty children aged 3 to 7 years were randomly assigned to Group A (n=10) intranasal or Group B (n=10) sublingual midazolam (0.2mg/kg) sedation. The anxiety levels at various time periods were assessed using Venham clinical anxiety scale and corresponding changes in salivary cortisol levels were assessed before and after the drug administration. The anxiety levels were assessed independently by two pediatric dentists from recorded videos. Wilcoxon signed rank test and Mann Whitney U test were used for statistical analysis using SPSS version 19.0. RESULTS: There was a significant decrease in anxiety level from baseline to 20 minutes after drug administration in group A (p=0.004) and group B (p=0.003). There was no significant change in salivary cortisol levels before and after the drug administration in group A (p=0.07) and group B (p=0.38). CONCLUSIONS: Both intranasal and sublingual administration of midazolam was equally effective in reducing the child's anxiety. However, there was no significant difference in the salivary cortisol levels in both groups.

Association between Optimism, Psychosocial Well Being and Oral Health: A Cross-Sectional Study.

OBJECTIVE: The aim of the study was to assess the association of optimism and psychosocial well being of school going children on their oral health status. STUDY DESIGN: The study included 12- to 15-year-old school going children (N = 2014) from Tamilnadu, India. Optimism was measured using the revised version of the Life Orientation Test (LOT-R). A questionnaire was sent to the parents regarding their child's psychosocial behavior which included shyness, feeling inferiority, unhappiness and friendliness. Clinical examination for each child was done to assess the DMFT score and OHI-S score. The data obtained were statistically analyzed using Pearson Chi-Square test, Mann-Whitney test and Kruskal-Wallis test with the aid of SPSS software (version 17). Odds Ratio (OR) was calculated with 95% Confidence Interval (CI). The p value ≤ 0.05 was considered statistically significant. RESULTS: Boys with high optimism had significantly lesser DMFT score than the boys with low optimism (p=0.001). Girls with high optimism had significantly higher DMFT score (p=0.001). In psychosocial outcomes, inferiority (p=0.002) and friendliness (p=0.001) showed significant association with DMFT score. Among the boys, children who felt less inferior (p=0.001), less unhappy (p=0.029) and more friendly (p=0.001) had lesser DMFT score. CONCLUSION: Among the psychosocial outcomes assessed, inferiority and friendliness had significant association with oral health of the children and hence, can be used as a proxy measures oral health.

Effects of conventional vs game-based oral health education on children's oral health-related knowledge and oral hygiene status - a prospective study.

PURPOSE: To compare the effectiveness of conventional and game-based oral health education on the oral health-related knowledge and oral hygiene status among 5- to 10-year-old schoolchildren. MATERIALS AND METHODS: A total of 120 children aged 5 to 10 years were divided into 2 groups. Each group had 30 children aged 5 to 7 years and 30 children aged 8 to 10 years. A pretest evaluation of their knowledge regarding oral health and the estimation of Debris Index-Simplified (DI-S) was carried out. Children in group A were given oral health education through flash cards once daily for 7 days. Children in group B were educated through the play method (i.e. snakes and ladders game combined with flash cards). The evaluations regarding oral hygiene and DI-S were recorded on post-intervention day 1 and 3 months after the intervention. RESULTS: In group B, high knowledge scores of 14.6 and 14.47 were obtained by the 5- to 7-year-olds and 8- to 10-yearolds, respectively, on post-intervention day 1. The lowest mean percentage difference of 8.9 was seen in 5- to 7-yearold children of group A after 3 months. In group B (5-7 and 8-10) and group A (8-10) there was a significant increase in good oral hygiene scores and a significant decrease in fair and poor debris scores on post-intervention day 1 and at the 3-month follow-up. CONCLUSION: The knowledge scores of both the younger and older groups of children increased considerably when the game-based teaching intervention was used. Hence, it can be an effective aid for teaching basic oral health concepts to children.

Effectiveness of Plaque Removal Using Different Toothbrushes in Children - A Comparative Study.

BACKGROUND: Effective plaque control is essential for improved oral health. Advancements in mechanical plaque removal using toothbrushes still continue. One such sophisticated intervention is the app-based toothbrush, a new innovative technology that helps to track the child's brushing habits. AIM: The aim of this study is to evaluate the plaque removal efficacy of three different toothbrushes in children aged 6-8 years. METHODS: A randomized controlled clinical trial was conducted among primary school children with decayed missing filled teeth (dmft) score of ≤2. Baseline plaque score was collected using Turesky modification of the Quigley and Hein Index 1 week after oral prophylaxis. Children were randomly divided into three groups. Group I received conventional toothbrush (n = 25), group II received powered toothbrush (n = 25), and group III received app-based toothbrush (n = 25). Post-intervention plaque score, toothbrush wear and bite mark scores were done at the 15th, 30th, 45th and 90th day. Participant's opinion on their toothbrushes was evaluated using a questionnaire. RESULTS AND CONCLUSION: App-based toothbrush showed maximum plaque reduction followed by powered and conventional toothbrush. Significant reduction in plaque score was seen at 30th-, 45th- and 90th-day follow-up in group II (<0.001) and group III (<0.001). There was no appreciable difference in the toothbrush wear and bite mark score between the three groups. Children preferred app-based toothbrush in spite of the complex nature of using it.

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

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

Comparison of Remineralizing Agents in the Management of White Spot Lesions In Three- to Five-year-old Children: a Clinical Trial.

PURPOSE: The purpose of this study was to compare the effectiveness of P11-4 self-assembling peptide (CurodontTM Repair [CR]) and fluoride varnish with xylitol-coated calcium phosphate (Embrace TM Varnish [EV]) on enamel permeability and in the management of white spot lesions (WSLs) in primary teeth. METHODS: A clinical trial was conducted among 30 children aged three to five years with WSLs in 60 anterior teeth. They were randomly assigned to receive CR or EV. Preintervention and postintervention evaluation was done by International Caries Detection and Assessment System (ICDAS) and morphometric analysis. The secondary outcome was to assess the enamel permeability using scanning electron microscopy (SEM) of polyvinyl siloxane impressions. RESULTS: A statistically significant reduction in the ICDAS scores (P=0.05) and percentage area of WSLs in morphometric analysis (P=0.008) was seen in the CR group after six months. No statistically significant difference was observed in the EV group after six months. The SEM evaluation did not show a significant reduction in the percentage area of droplets in both the CR and EV groups (P=0.06 and P=0.21, respectively). No significant difference was seen between EV and CR in the three parameters assessed. CONCLUSION: Curodont TM Repair is effective at remineralizing white spot lesions in primary teeth and can be considered as a remineralizing agent.

Survival Function of Clinical and Radiographic Success of Three Obturating Materials in Primary Teeth at 3, 6 and 9 Months Periodic Intervals - A Randomized Controlled Clinical Trial.

The study aims to assess clinically and radiographically the success of zinc oxide eugenol, metapex, and endoflas as root canal obturating materials in primary teeth over 3, 6, and 9 months of time intervals. The randomized controlled trial was performed in 60 primary molars of 36 children aged between 4 and 9 years. Permanent restorations were given and stainless steel crowns were placed for the treated tooth. Comparing the survival proportion between the three groups was done using the Wilcoxon (Gehans) statistical test. The clinical survival variable showed 100% survival proportion for zinc oxide eugenol and endoflas, while for metapex it was 69% at the end of 9 months. The radiographical survival proportion was 100% for zinc oxide eugenol, followed by endoflas at 92% and 58% for metapex group.

Assessment of Personality Traits among Pediatric Dentists in India: A Cross-sectional Study.

Aim: To identify the most common personality traits among pediatric dentists in India. Materials and methods: A cross-sectional study was conducted using the Big Five personality test (BFPT). It included 50 questions based on five personality traits-extroversion, agreeableness, conscientiousness, emotional stability, and openness to experience. The questionnaire was e-mailed and also sent through WhatsApp messages as a Google Form to all the pediatric dentists in India. Scoring for each trait was done based on the specific formula provided. The data were subjected to statistical analysis using Mann-Whitney U test. Results: A total of 390 pediatric dentists responded and filled out the questionnaire. The agreeableness trait was the most commonly exhibited trait, followed by the conscientiousness trait. Emotional stability was the least exhibited trait. Emotional stability was statistically different between male and female pediatric dentists. Conclusion: Agreeableness and emotional stability were the most and least expressed traits, respectively, among the participants. This survey showed that pediatric dentists in India could have a high tolerance and competent behavior. Clinical significance: Dentists may possess unique personality traits that distinguish them from the general population. Within the dental profession, there could be variations in personality traits depending on the specialty they practice. How to cite this article: Asokan S, PR G, Dhanabalan O, et al. Assessment of Personality Traits Among Pediatric Dentists in India: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(3):489-493.

Association between sleep patterns and early childhood caries in 3-4-year-old children: A cross-sectional study.

Aim: The aim of this study was to assess the sleep practices of children and their association with early childhood caries (ECC) at three different age periods. Methodology: A cross-sectional study was conducted to assess the sleep practices, feeding practices, and oral hygiene practices of children during nighttime from 0 to 2 years of age. A survey among 550 mothers of children aged 3-4 years with ECC (n = 275) and without ECC (n = 275) was conducted using a pretested and validated questionnaire. The three practices (sleep practices, feeding practices, and oral hygiene practices) of children at 0-3 months, 4-11 months, and 1-2 years of age were recorded and analyzed. Results: Risk factors associated with ECC at 0-3 months of age were gender (odds ratio [OR]: 0.59, 0.36-0.98), no previous dental visit (OR: 2.30, 1.15-4.59), bedtime (OR: 3.54, 2.01-6.25), and intentional feeding practice at night (OR: 1.83, 1.0-3.35). At 4-11 months of age, no previous dental visit (OR: 3.28, 1.66-6.49), mother's education (OR: 0.42, 0.23-0.76), frequent night wakes (OR: 5.98, 1.89-19.21), and intentional feeding practice at night (OR: 111.09, 32.25-382.68) and, at 1-2 years of age, no previous dental visit (OR: 2.37, 1.45-3.88), intentional feeding practice at night (OR: 19.12, 9.09-40.21), and breastfeeding for more than 2 years (OR: 14.56, 7.17-29.56) were associated with ECC. Conclusion: Lack of previous dental visit and intentional feeding at night were the common risk factors associated with ECC in children.

Pediatrician's perception of oral health in children - A qualitative study.

Background It is important to assess pediatrician's perception on children's oral health as they tend to meet children early on a regular basis. Quantitative research has shown that pediatricians in India have inadequate knowledge and limited awareness about oral health care in children. Hence, it is important to assess pediatrician's opinion and perception on children's oral health using qualitative interview method. AIM: The aim of the study is to assess and explore the perception of pediatricians on children's oral health in Western Tamil Nadu, India. METHODS: A grounded theory approach was employed to conduct this qualitative study. Face-to-face interviews with the pediatricians were conducted using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Collected data were written as codes, from which categories and themes were derived. RESULTS: Four themes arrived: (1) dental health and disease, (2) anticipatory guidance, (3) barriers, and (4) remedial measures. The participants felt that they were underinformed about dental home, emergency care for dental trauma, and the interceptive role of dentists on oral deleterious habits. Insufficient dental information in their curriculum and the absence of common guidelines between pediatricians and pediatric dentists in India were considered the common causes for their lack of knowledge. CONCLUSION: Pediatricians were receptive to acquire knowledge and improvising their skills. They felt that periodic lectures and formal gatherings should be planned between pediatric dentists and pediatricians. Collaborations between pediatrics and pediatric dentistry societies are warranted to provide children with better oral health care.

Arginine: A New Paradigm in Preventive Oral Care.

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries. How to cite this article: Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.

Association between Intelligence Quotient Dental Anxiety and Oral Health-related Quality of Life in Children: A Cross-sectional Study.

Background: Determining the intelligence quotient (IQ) grades of children help in managing dental anxiety (DA) and maintaining the good oral health-related quality of life (OHRQoL). Aim: To assess the association between IQ, DA, and OHRQoL in children aged 10-11 years. Design: This cross-sectional study was carried out among 202 children aged 10-11 years in the Southern part of Tamil Nadu, India. The IQ level, DA, and OHRQoL were measured using Raven's Coloured Progressive Matrices (RCPM), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and Child Oral Health Impact Profile Short Form (COHIP-SF) 19, respectively. Chi-squared test and Spearman rank order correlation test were used for analysis. Results: The results revealed a significant negative correlation (p < 0.05; r = -0.239) between IQ and OHRQoL. DA was negatively correlated with IQ (r = -0.093) and OHRQoL (r = -0.065), but it was not statistically significant. The gender-based comparison revealed no significant difference in the distribution of girls and boys within different grades of IQ levels (p = 0.74), DA (p = 0.29), and OHRQoL (p = 0.85). Conclusion: Children with higher IQ showed low OHRQoL scores. DA was negatively correlated with IQ and OHRQoL. How to cite this article: Asokan S, PR GP, Mathiazhagan T, et al. Association between Intelligence Quotient Dental Anxiety and Oral Health-related Quality of Life in Children: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(6):745-749.

Development and validation of a novel Middle childhood oral health impact scale (MCOHIS).

Purpose: The study was planned to develop and validate a novel middle childhood oral health impact scale (MCOHIS) for 6- to 9-year-old children in India. Methodology: A cross-sectional study design was employed to develop and validate MCOHIS in the sequential phases. A panel of ten pediatric dentists evaluated a pool of 36 items corresponding to the oral health-related quality of life (OHRQoL) of children. MCOHIS with 20 items under five domains was formulated and content validation was done. Cohen's kappa statistics was employed to measure the concordance between the child's self-report and the caregiver's proxy report. Concurrent validation was done among 130 participants from 13 districts of Tamil Nadu state, India. Discriminant validity was checked among another sample of 60 participants. Internal consistency and test-retest reliability of MCOHIS were assessed using Cronbach's alpha and Kappa statistics respectively. Results: MCOHIS had adequate content validation with Scale Level Content Validity Index / Average score of 0.94 for relevance. There was a statistically significant inter-rater reliability observed between the child's self-report and caregivers' proxy report in all items with a moderate to substantial agreement. Concurrent validation showed a statistically significant positive correlation with a Rho value of 0.712. There was a statistically significant difference noted in overall discriminant validity (P < 0.001). Acceptable internal consistency reliability was observed with Cronbach's alpha value of 0.75. Test-retest reliability showed a high stability coefficient of 0.98. Conclusions: MCOHIS was found to be a valid and reliable age-specific tool for assessing the OHRQoL of Indian children aged 6-9 years.

Art of Listening.

How to cite this article: Asokan S. Art of Listening. Int J Clin Pediatr Dent 2021;14(S-2):S105-S106.

Job satisfaction and stress among dental faculty members: A mixed-method approach.

OBJECTIVES: The study aimed to assess job satisfaction and stress among dental faculty members. It was also planned to explore their experiences and probable solutions through a mixed-method approach. METHODS: Sequential explanatory mixed-method approach was employed. In the quantitative phase, a cross-sectional web-based questionnaire survey was conducted among dental faculty members in Tamil Nadu, India using the "Google Forms application" link. Based on Dentist Satisfaction Survey, a questionnaire was framed, validated, and used. It included 25 items under four domains (PICS): personal, institutional, cofaculty, and students. Mann-Whitney test was used to compare the differences between two independent groups. Kruskal-Wallis test and Friedman test were used for multiple group comparisons. In the qualitative phase one-on-one, semistructured telephone interviews were conducted among 27 dental faculties from various sectors. RESULT: A total of 408 participants took part in the quantitative survey. The students-related domain was found to be the most dissatisfied or stressful domain (2.05±0.3) among dental faculties followed by the institutional domain (1.92±0.4) and cofaculty-related domain (1.81±0.6). Based on qualitative interviews, four themes were derived namely (1) academia as a profession, (2) potential stressors, (3) sequelae of stress, and (4) stress-free job. CONCLUSION: The present study provided deep insight into the stress among dental faculty members and emphasized the need for student-faculty mentor programs. It also stressed the importance of organized monetary structures or pay scales in private dental institutions in India.