Ortho-Perio Interrelationship. Treatment Challenges.

It is an undisputed fact that sound periodontal health is a prerequisite for successful orthodontic therapy. Various complex dental problems necessitate a multidisciplinary approach; there cannot be a better example than an ortho-perio interaction. Certain periodontal treatment modalities need to be undertaken before commencing orthodontic treatment. And some periodontal procedures are required after active orthodontic treatment. The aim of this article is to familiarize clinicians in the field of both periodontics and orthodontics with the precautions and clinical techniques necessary to preserve the integrity of already compromised periodontium.

Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction.

Background: Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children. Materials and Methods: In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Results: Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Conclusion: Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Aneurysmal Subarachnoid Hemorrhage: Impact on Phenytoin Permeability across the Blood-Brain Barrier.

BACKGROUND: Phenytoin (PHT) is a routinely prescribed prophylactic antiepileptic following aneurysmal subarachnoid hemorrhage (aSAH). However, its prophylactic use in aSAH is controversial as emerging evidence suggests worsening of the neurological and functional outcomes. In addition, there is profound damage to the blood-brain barrier (BBB) in aSAH, posing uncertainty about the permeability of PHT across BBB in these patients. This pilot study was designed to evaluate the alteration in PHT permeability across BBB in aSAH patients. MATERIALS AND METHODS: For conducting the study, 20 patients (control n = 10; aSAH (grade 3 or 4) n = 10) were recruited from a tertiary care hospital. The patients undergoing cranial surgery for pathology with intracerebral mass lesions on MRI were chosen as control for aSAH group. Both groups were administered PHT loading dose (20 mg/kg), infused in 5% dextrose, at a rate not more than 50 mg/min, followed by a maintenance dose (5 mg/kg). Quantification of PHT concentration was performed in brain tissue, plasma, and cerebrospinal fluid (CSF) by LC-MS/MS. RESULTS: The median PHT concentration in brain was found to be significantly decreased (64.8%) in aSAH group (3.78 µg/g) as compared to control (10.73 µg/g), P = 0.010. Similarly, median PHT brain concentration as fraction of plasma was significantly decreased in aSAH group (36.72%) compared to that of control (89.55%), P = 0.003. There was no significant difference in PHT concentration in plasma, CSF, and CSF as a fraction of plasma between both the groups. CONCLUSION: There is a definite decrease in the penetration of PHT to the brain in patients with grade 3 and 4 aSAH.

Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients.

INTRODUCTION: Maintenance of good oral hygiene is important for patients undergoing fixed orthodontic treatment. AIM: The aim of this study was to evaluate the effectiveness of a manual orthodontic toothbrush, powered toothbrush with oscillating head and sonic toothbrush in controlling plaque, gingivitis and interdental bleeding in patients undergoing fixed orthodontic treatment, and to compare their relative efficacy. MATERIALS AND METHODS: Sixty subjects, who were to receive orthodontic treatment with both upper and lower fixed appliances, were randomly divided into three study groups, with 20 patients in each group. Groups I to III were given manual orthodontic, powered and sonic toothbrushes, respectively. Plaque index (PI), gingival index (GI) and interdental bleeding index were scored to assess the level of plaque accumulation, gingival health and interdental bleeding at baseline; 4 and 8 weeks recall visits after fixed appliance bonding. Paired t-tests and one-way analysis of variance (ANOVA) tests were used for intragroup and intergroup comparisons. The level of statistical significance was set at p < 0.05. RESULTS: This study showed that a significant reduction in all the three indices scores was found from baseline to 4 and 8 weeks in group III. On intergroup comparison, no statistically significant differences were detected between the three groups for any of the parameters assessed. CONCLUSION: On intragroup comparison, sonic brushes performed superiorly in reducing gingivitis, plaque and interdental bleeding as compared to the manual orthodontic and powered brushes. On intergroup comparison, the relative comparative effectiveness was found to be similar for all the three brushes. How to cite this article: Sharma R, Trehan M, Sharma S, Jharwal V, Rathore N. Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients. Int J Clin Pediatr Dent 2015;8(3):181-189.

Informed consent for braces.

The influence of law on the orthodontic profession has greatly increased in the last few decades. Dental law has emerged today as a full-fedged specialty dealing with a variety of areas, like professional negligence, doctor-patient contracts, consumer protection laws, ethics, general and special health legislations and practice regulatory mechanisms. This article highlights the concept of informed consent which is based on the premise that each individual has a right to make decisions concerning his health, disease and treatment. How to cite this article: Jharwal V, Trehan M, Rathore N, Rathee P, Agarwal D, Mathur N. Informed Consent for Braces. Int J Clin Pediatr Dent 2014;7(2):105-108.