Inferior alveolar nerve block anesthesia in children: The effect of ibuprofen and phentolamine mesylate on pain perception.

CONTEXT: For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. AIMS: Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. METHODS: The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. STATISTICAL ANALYSIS USED: A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. RESULTS: The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. CONCLUSION: It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Faculty perceptions on objective structured clinical exam in dental education / Percepción de los profesores sobre el examen clínico estructurado y su objetivo en la educación dental

Abstract Structured Clinical Exam (OSCE) uses standardized content and procedures to assess students across multiple domains of learning. The study is aimed to assess knowledge, attitudes, practices and observations of dental faculty on OSCE. The survey was distributed into dental faculty members in randomly selected government and private institutions in Saudi Arabia. The questionnaire was pre-tested and consisted of 4 categories including general characteristics of respondents, knowledge on utility of OSCE in curriculum and its reliability, attitudes regarding OSCE on a 5 point Likert scale, practices and observations on OSCE on Multiple choice questions (both single answer and multiple answer) and responses on a 5 point Likert scale. The sample size was determined to be 93 and the survey was sent electronically to 10 institutes. 101 complete responses from 7 institutions were considered from the 122 received. Faculty participation in OSCE was high within evaluators 94% (n=94) and administrators 61% (n=61). Majority of respondents (62%) believed that OSCE is most suited for competency based education, to assess cognitive skills (73%) and diagnostic interpretation (79%). Reliability of OSCE can be increased by standardization of evaluators (77%) with highest number believing that 6-8 stations (42%) are the minimum required in an OSCE. Institution guidelines (49%) coupled with workshops (47%) was the preferred method of preparation for OSCE. Majority felt that OSCE is most suitable for high stakes exams (mean=3.37) and it is an indispensable part of dental assessment (mean=3.78). Minimum number of stations for adequate reliability was reported to be lesser that in reported literature, specially so for high stakes assessments. Logistics required for arranging an OSCE and difficulty in standardized patients, may suggest that OSCE should be used in select situations.

Resumen El examen clínico estructurado (ECOE) utiliza contenido y procedimientos estandarizados para evaluar a los estudiantes en múltiples dominios de aprendizaje. Este estudio tiene como objetivo evaluar los conocimientos, las actitudes, las prácticas y las observaciones de los profesores de odontología sobre la ECOE. La encuesta se distribuyó a los miembros de la facultad de odontología en instituciones gubernamentales y privadas seleccionadas al azar en Arabia Saudita. El cuestionario se utilizó previamente y constaba de 4 categorías que incluían generalidades de los encuestados, conocimiento sobre la utilidad de la ECOE en el plan de estudios y su confiabilidad, actitudes con respecto a la ECOE en una escala Likert de 5 puntos, prácticas y observaciones sobre la ECOE en preguntas de opción múltiple (ambas respuesta y respuesta múltiple) y respuestas en una escala Likert de 5 puntos. Se determinó el tamaño de la muestra en 93 y la encuesta se envió electrónicamente a 10 institutos. Se consideraron 101 respuestas completas de 7 instituciones. La participación del profesorado en ECOE fue alta entre los evaluadores 94% (n=94) y los administradores 61% (n=61). La mayoría de los encuestados (62%) cree que la ECOE es más adecuada para la educación basada en competencias, para evaluar las habilidades cognitivas (73%) y la interpretación del diagnóstico (79%). La confiabilidad de la ECOE puede aumentarse mediante la estandarización de los evaluadores (77%) y el número más alto cree que 6-8 estaciones (42%) son el mínimo requerido en una ECOE. Las directrices de la institución (49%) junto con los talleres (47%) fue el método preferido de preparación para la ECOE. La mayoría consideró que la ECOE es más adecuada para exámenes de alto riesgo (media=3,37) y es una parte indispensable de la evaluación dental (media=3,78).Se informó que el número mínimo de estaciones para una confiabilidad adecuada es menor que en la literatura reportada, especialmente para evaluaciones de alto riesgo. La logística necesaria para organizar un ECOE y la dificultad en los pacientes estandarizados pueden sugerir que el ECOE se debe utilizar en situaciones seleccionadas.

Prevalence of Early Childhood Caries among the 3-5-year-old Children in Jeddah, Saudi Arabia.

Introduction: Dental caries is a significant dental public health issue and it is the world's most common oral health condition among children. In the Kingdom, the prevalence and severity of early childhood caries has been rising. Aim: The aim of the study is to establish the prevalence of early childhood caries among children aged 3-5 years in Jeddah as well as the associated risk factor of visiting a dentist. Methodology: The research is based on a cross-sectional observational design. Children from both private and public schools were randomly selected from schools in all of Jeddah's regions until a sufficient sample size was attained. For the diagnosis of early childhood caries, the American Academy of Pediatric Dentistry criteria were used. Results: In Jeddah, the prevalence of early childhood caries is 57% among children aged 3-5 years. Conclusion: Caries in young children is a public health issue. There should be an increased emphasis to the parents that the child should visit the dentist by 12 months of age as recommended by many professional organizations. Regular dental appointments would then help to lessen the caries burden on children at an early age. The Four A's treatment regimen is recommended to aid in the prevention and early detection of early childhood caries. How to cite this article: Vanka S, Vanka A, Wali O, et al. Prevalence of Early Childhood Caries among the 3-5-year-old Children in Jeddah, Saudi Arabia. Int J Clin Pediatr Dent 2022;15(S-2):S197-S200.

Flipped classroom in dental education: A scoping review.

INTRODUCTION: There is a pressing need to explore strategies which adopt and incorporate contemporary teaching methods to keep abreast with technological advances. Flipped classroom is a type of blended learning approach that has received considerable attention as an alternative to traditional lectures. The purpose of this scoping review is to explore the characteristics of the flipped classroom model implemented in undergraduate dental education. MATERIALS AND METHODS: The scoping review has been reported under the PRISMA extension for scoping review guidelines. Systematic search of databases culminated in full-text papers that were evaluated for quality. RESULTS: A systematic search on flipped classroom in dental education identified a total of 30 papers for full-text evaluation. After further exclusion, 17 studies were selected for data charting. DISCUSSION: The student satisfaction, learning resources, pre-class and/or in-class activities, and academic scores are analysed and discussed. CONCLUSION: Flipped classroom improves student satisfaction in majority of the studies, whilst its effect on academic scores, particularly for skill development, needs more research.

Osteo/odontogenic Differentiation of Human Mesenchymal Stem Cells with Platelet-rich Plasma and Mineral Trioxide Aggregate.

AIM: Aim of the study was to investigate the effect of PRP and MTA individually and combined on in vitro human bone marrow mesenchymal stem cells' (MSCs) proliferation and osteo/odontogenic differentiation potential. MATERIALS AND METHODS: MSCs were cultured in vitro with MTA, 5% PRP, 10% PRP, MTA with 5%PRP, and MTA with 10% PRP. Fetal calf serum (FCS) was used as control. Cell viability and proliferative efficiency were tested with cell adhesion and MTT assay. Osteo/odontogenic differentiation was assessed and quantified with alizarin red staining. RESULTS: MTA alone, MTA with 5% PRP, and MTA with 10% PRP showed significantly high proliferation at day 7 and 14 when compared to the control group. Enhanced differentiation and the highest calcium deposition was observed in MTA with the 10% PRP group. CONCLUSION: Within limitations of the in vitro environment, results imply an increased proliferation and induction of MSCs into osteo/odontogenic differentiation by the combination rather than a mere sealing of PRP by MTA. CLINICAL SIGNIFICANCE: PRP and MTA have the potential for true regeneration of the pulp tissue. Moreover, the combination of PRP and MTA can be utilized to expand the MSCs to generate adequate numbers for clinical applications, without xenogenic contamination. How to cite this article: Vanka A, Vishwakarma SK, Bhat MK, et al. Osteo/odontogenic Differentiation of Human Mesenchymal Stem Cells with Platelet-rich Plasma and Mineral Trioxide Aggregate. J Contemp Dent Pract 2019;20(10):1171-1178.

Barriers of Restorative Care among Dental Patients in Jeddah: A Cross-sectional Analytical Survey.

INTRODUCTION: The epidemiological data in the Kingdom of Saudi Arabia indicate that there has been increased prevalence of dental caries and increased treatment needs, with negligible rates of restorative care among the population. The restorative treatments done among the population are very limited. There are no published reports that systematically document the barriers of restorative care among the residents of Jeddah. AIM: This present paper is a humble attempt toward the study of barriers of restorative care and systematic documentation of the dental patients in a private dental school in Jeddah. MATERIALS AND METHODS: The methodology adopted by the study is the preparation of a questionnaire after validation and analyzing the responses from the sample of the universe of dental patients in Jeddah. The questionnaire broadly included (1) fear of consulting a dentist, (2) dental anxiety/fear to receive dental care, (3)cost of dental treatment, (4) fee for restoration, (5) pain, and (6) experience of a dentist (fear that a student may treat them). The completed questionnaire of 22 questions was proofread by a group of general dentists to check for clarity and meaning of the statements. After the changes, the questionnaire was distributed to 275 patients. The analysis of the data in the study was done by the SPSS version 23. Chi-square was calculated for the analyses of all the independent variables. RESULTS: 41.4% of people have fear to visit a dentist. Hence, this is one of the barriers of restoration. Nearly 50% have responded that restorative treatment is painful. In addition, the experience of the dentist has an impact on the respondents getting treatments in the dental clinic. 76% of the respondents have a fear when a student who has lesser experience will be treating them in the dental clinic. CONCLUSION: Dentists have to distinguish between perceived barriers and the real barriers to choosing restorative treatments.

Initial experiences with NAM-assisted primary repair of the BCLP deformity.

BACKGROUND: Primary surgical repair of the bilateral cleft lip and palate (BCLP) deformity is challenging. Infant Orthopedic (IO) procedures are often used to assist surgical reconstruction of normal anatomy. Nasoalveolar molding (NAM) is a presurgical infant orthopedic procedure that attempts to reduce the cleft nasal deformity, in addition to the lip and alveolus, leading to an esthetic primary surgical repair. OBJECTIVE: NAM provides the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus. METHOD: Infant nasal cartilages are amenable to correction with NAM in the first few weeks of infancy when they retain their plasticity. NAM-assisted surgical repair of a complete BCLP infant is discussed. Postoperatively nasal stents were used to retain results and minimize relapse. RESULTS: NAM helped correct premaxillary deviation and protrusion, reduce alveolar cleft width and improve the nasal morphology prior to surgery in the BCLP infant. CONCLUSIONS: NAM helped reduce the severity of the cleft deformity in the BCLP infant and facilitated an easier and esthetic single stage primary surgical repair.

A comparative evaluation of ProRoot mineral trioxide aggregate and Portland cement as a pulpotomy medicament.

INTRODUCTION: Recently, some studies have compared mineral trioxide aggregate (MTA) with portland cement (PC), concluding that the principle ingredients of PC are similar to those of MTA. The purpose of the present study was to evaluate the biocompatibility of PC as a pulpotomy medicament. MATERIALS AND METHODS: Thirty premolars that scheduled for extraction for therapeutic reasons were randomly assigned to two experimental groups: ProRoot MTA (PMTA) and PC. After isolation and pulp exposure, pulpotomy was carried out and pulps were dressed with PMTA and PC. After 6 months, the teeth were extracted and prepared for histological analysis based on Cox et al. criteria. The data were analyzed by Z-test of proportion with 1% of allowed error. RESULTS: No statistically significant difference was found between the two groups with respect to inflammatory response, soft tissue organization, and dentine bridge formation (P > 0.05). CONCLUSIONS: PC was associated with similar favorable biological response to pulpotomy treatment as PMTA. The findings of this study support the idea that PC can be considered a cheaper substitute to MTA.

Delayed replantation of an avulsed maxillary premolar with open apex: a 24 months follow-up case report.

Avulsion of permanent teeth is most serious of all dental injuries and accounts for 1-16% of all traumatic injuries, of which maxillary incisors are most commonly involved. However, in this report a rare case of isolated avulsed immature premolar has been described. The patient had reported more than 3 hours after the trauma with a tooth stored in dry condition and soil contamination. The prognosis depends on measures taken at the place of accident or the time immediately after avulsion. Replantation is the treatment of choice, but cannot always be performed immediately. An appropriate emergency management and treatment plan is important for good prognosis. In this report stepwise management of an avulsed immature maxillary premolar with extended period of dry storage has been described followed up for a period of 2 yrs.

Association of pregnant women periodontal status to preterm and low-birth weight babies: A systematic and evidence-based review.

The mouth serves as a mirror to general health and also as a portal for disease to the rest of the body. Since the old wives' tale of "the loss of a tooth for every pregnancy", oral health during pregnancy has long been a focus of interest. In the past decade, there has been mounting scientific evidence suggesting that periodontal disease may play an important role as a risk factor for adverse pregnancy outcomes. Considering all the above stated factors this systematic review is aimed to focus on the association of periodontal diseases to preterm and low-birth weight (LBW) babies. In view of the large body of literature the review is limited to studies identified by computer searching. Hand searching of journals and gathering of unpublished reports and conference proceedings was outside the scope of the review. The PubMed database was searched using the search terms: periodontitis, preterm, LBW. The titles, authors, and abstracts from all studies identified by the electronic search were printed and reviewed independently on the basis of keywords, title and abstract, to determine whether these met the inclusion criteria. The electronic search identified 68 papers. After review of the study title, keywords and abstracts, 62 papers were identified potentially meeting inclusion criteria. Generally, all the studies reviewed in the paper suggest that periodontal disease may be a potential risk factor for preterm LBW babies.

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide.

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.

Tobacco cessation and counseling: a dentists' perspective in Bhopal city, Madhya Pradesh.

INTRODUCTION: Dental team has high potential to help smokers to better oral/general health but to achieve this; they need to be clear about their role. Considering the importance of tobacco cessation, the authors carried out this study aimed at assessing the role, knowledge, current practices, different barriers, and tools to overcome the same as perceived by dentists in Bhopal city. MATERIALS AND METHODS: A self-administered structured, coded questionnaire was distributed to 200 private practitioners and the teaching staff in all the dental colleges in Bhopal city. RESULTS: Out of 200 dentists to whom questionnaire was administered, 168 responded within a week's time resulting in a high response rate of 84%. A total of 97% of the dentists agreed that it is the duty of every dentist to advice patients about tobacco cessation. A total of 58% strongly agree that formal training will be an effective tool to provide the guidelines to dentists in tobacco cessation and counseling. CONCLUSION: Monitoring of effective planning and execution of these programs by appropriate authorities at regular intervals is vital for successful achievement of the goal of "Tobacco Free Society."

Compound odontoma associated with an unerupted rotated and dilacerated maxillary central incisor.

Odontomas are benign tumors containing various component tissues of teeth. They usually remain asymptomatic and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. A case of compound odontoma in association with an unerupted, rotated and dilacerated maxillary permanent right central incisor in a 12-year-old boy is reported. Such combination is rare, making it an interesting case for reporting. We have also discussed the clinical features, diagnosis and treatment of such a condition.

Analysis of Reporting Pattern in Children Aged 7 to 14 Years with Traumatic Injuries to Permanent Teeth.

AIM: To analyze the pattern of traumatic injuries to permanent anterior teeth reporting to the dental department with regards to age, gender, cause, proportion of different types of injury and time of reporting. MATERIALS AND METHODS: Children aged 7 to 14 years with trauma or related sequelae were included. The data was collected retrospectively on the basis of case history, clinical findings, radiographs and vitality tests. Ellis' classification was used to record injuries to anterior teeth. RESULTS: Boys had more injuries with the highest injuries at 12 years. Various causes of trauma included Falls, RTA, hits by object/person and bicycle related. The most common injury reported were cases of Ellis' class IV (50.7%) and the maxillary central incisors being the teeth most frequently involved (75%). The time lapsed after injury was more than 1 year in 42.8% cases and 62% cases reported with complications. CONCLUSION: Our findings suggest that a large number of cases reported in the age group 10 to 13 years with Class IV Ellis' fracture largely when symptoms appear. Reporting was delayed by more than a year in several cases, the barriers for which need to be analyzed, to develop strategies regarding prevention of traumatic injuries and their consequences.