Influence of pretreatment exposure to pediatric dental care using the "Tiny dentist" game on 4-7 years old children's pain and anxiety: a parallel randomised clinical trial.

There have been no experiments on interactive modelling through computer games, although there have been a few on modelling a pre-exposure method for managing anxiety among preschoolers. The impact of partaking in a dental simulation game prior to the dental treatment on pain and anxiety in kids aged 4 to7 years during their first appointment was studied. A total of 156 kids who required unilateral pulp therapy and preformed crowns on their mandibular primary molars were enrolled in this double-blind, randomized clinical trial. They were then randomly assigned to intervention and control groups. The intervention group engaged in the game three times/day for 07 days prior to the anticipated appointment. The Wong-Baker Faces Rating Scale (WBFRS) was used to record their pre- and post-operative pain experienced during the dental procedure. Additionally, a finger pulse oximeter was used to record heart rate (HR) at each of the six treatment phases: baseline (the first session, two weeks prior to treatment) and stages 2-6. Playing video games considerably lowered the heart rate. Playing and the treatment period interacted in a major way. On comparing the groups at every time point, the intervention group displayed lower HR during injection, tooth preparation with an air-rotor and biomechanical preparation with endodontic rotary files.The results suggest that engaging in specific dental simulation games prior to the 1st dentist visit could help preschoolers feel less anxious during routine dental operations.

Biocompatibility, Bioactivity and Gene Expression Analysis of SHEDS Cultured in Various Calcium Silicate Based Cements: A Systematic Review and Meta-Analysis of in Vitro Studies.

AIM: To assess the biocompatibility, bioactivity and gene expression analysis of SHEDs incubated in various Calcium Silicate Based Cements. STUDY DESIGN: Following PRISMA statement, a search was carried out in the electronic databases-PubMed, Scopus, Embase, Google Scholar, JSTOR, and DOAJ from January 2000 to 31 May 2021. In vitro trials examining the response of SHEDs to the treatment with CSCs were eligible. RESULTS: 10 trials were included after the selection process. These trials involved the assessment of cell viability, cell migration, cell adhesion, mineralization potential and gene expression analysis of SHEDs cultured in MTA, Biodentine, EndoCem Zr, RetroMTA, TheraCal & iRoot BP plus. CONCLUSION: MTA, Biodentine, EndoCem Zr, RetroMTA and iRoot BP showed adequate biocompatibility, bioactivity and genetic expression towards SHEDs, to support their clinical use in vital pulp treatment of primary teeth.

Response of intra canal medicaments on viability and survival of SHEDs.

BACKGROUND: Regenerative endodontic procedures (REP) rely on the principles of tissue engineering and take advantage of the regenerative abilities of Stem Cells derived from human exfoliated deciduous teeth (SHEDs). Since REPs advise the minimal instrumentation of root canals, they are more dependent on intracanal medicaments with antimicrobial activity to provide a sterile environment for pulpal regeneration. Hence present trial was conducted to examine the influence of different intracanal medicaments on SHEDs proliferation and survival. STUDY DESIGN: SHEDs were cultured by using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde. SHEDs were subjected to the 3-(4,5- dimethylthiazol -2 -yl)-2,5-diphenyl-2H- tetrazolium bromide (MTT) assay, apoptosis using the Annexin V-binding assay and Alkaline Phosphatase (ALP) activity. RESULTS: All medicaments significantly reduced cell viability at different concentrations over different exposure times. Highest number of live cells and ALP activity was observed in SHEDs cultured in calcium hydroxide. CONCLUSION: Potassium iodide and glutaraldehyde were the significantly less likely of all the medications examined to adversely affect the viability and survival of SHEDs.

The 'new normal' in post-COVID-19 pediatric dental practice.

The COVID-19 pandemic has posed an extraordinary challenge to the world. Dental healthcare personnel are considered to be at high risk as they work in close proximity to the oral cavity of patients. New procedures of approach and management should be incorporated in different aspects of routine dental practice. In addition, pediatric dentists are posed with unique and extraordinary challenges of parental anxiety and behavioral guidance of pediatric patients and parents/guardians. The aim of this study was to highlight the changing perceptions of pediatric dental practice as the 'new normal' in the post-COVID era.

SHED's Response to Various Pulpotomy Materials: Cytotoxicity and Gene Expression Analysis.

PURPOSE: To examine the cytotoxicity and genetic expression of SHEDs cultured in eluates of various calcium silicate based pulpotomy materials. STUDY DESIGN: MTT assay, flow cytometry, alizarin red staining and scratch assay was used to assess the cellular viability, apoptosis, calcium matrix deposits and cell migration respectively. The gene expression of ALP, OCN and BMP -2, were measured with rtPCR. One way ANNOVA and Bonferroni post test was used for statistical analysis. RESULTS: MTT assay analysis reported that all the test specimen had no cytotoxic effects. The highest number of live cells [ % ] was found in RetroMTA. The highest percentage of cell migration was observed in SHEDs cultured in EndoCem Zr. The mean absorbance for calcium matrix deposition was higher or similar in all test specimens, when compared to control groups. The expression of BMP -2 and OCN were significantly higher in cells exposed to RetroMTA and NeoMTA respectively after 24 hrs of incubation. After 72 hrs of incubation the mRNA expression of ALP was significantly higher in MTA. CONCLUSIONS: SHEDs cultured in eluates of various calcium silicate based cements exhibited cytocompatibility and maintained odontogenic like phenotype differentiation in SHEDs.

Awareness, Perception, Attitude Regarding CoViD -19 and Infection Control among Indian Pediatric Dentists: A Cross Sectional Study.

AIM: The rapid and extensive spread of CoViD -19 pandemic has become a major source of concern for healthcare system including pediatric dentists. The aim of the present study was to assess the awareness, perception and attitude regarding CoViD - 19 and infection control among Indian pediatric dentists. STUDY DESIGN: A total of 1009 Indian Pediatric dentists completed questionnaire based survey on the awareness, perception and attitude regarding CoViD - 19 infection and its control. Descriptive statistics have been used in the study to analyze the findings. Mean and standard deviation and proportion have been used to estimate the results of the study. RESULTS: 65.75% Indian pediatric dentists had answered questions regarding CoViD - 19 infection correctly. The present survey found a positive perception among Indian pediatric dentist regarding CoViD - 19 and infection control. However the attitude among Pediatric dentist regarding the same was not encouraging. CONCLUSION: As the global threat of CoViD-19 continues to emerge, it is critical to improve the awareness, perceptions and attitude of pediatric dentists. Educational interventions are urgently needed to reach pediatric dentists beyond borders, and further studies are warranted.

Reduction in Bacterial Loading using Papacarie and Carisolv as an Irrigant in Pulpectomized Primary Molars - A Preliminary Report.

Objective: The aim of the present study was to evaluate the reduction in bacterial loading using Papacarie and Carisolv as an irrigating solution in pulpectomized primary molars. Study design: A controlled, randomized clinical trial involving 120 necrotic canals from both genders between 3 and 7 years old children were included, 30 irrigated with Papacarie [ group I], Carisolv [ group II], 1% NaOCl gel [ group III] and 1% Na0Cl solution [group IV ] each; in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method. Results: The results were statistically analyzed by ANOVA. After analyzing samples before and after irrigation in all the groups, a strong significant decrease in bacterial load [ p = < 0.001 ] was found with Papacarie and Carisolv. Conclusion: Papacarie and Carisolv can be suggested as an alternative irrigant for pulpectomy of necrotic teeth.

Evaluation of cytotoxicity of 3.8 % SDF and BioAKT solutions on the viability of dental pulp stem cells.

Introduction: Nonsurgical endodontic therapies have evolved from classic endodontic therapies to regenerative endodontic treatments (RETs) in recent years. In context of the cytotoxic activity of the most commonly used endodontic irrigant, NaOCl, newer endodontic irrigating solutions should be tested for its effective use in RETs. The aim of this trial was to examine and assess the cytotoxic response of 3.8 % SDF and BioAKT irrigating solutions on the viability of DPSCs. Methods: The viability of DPSCs cultivated in 5.25 % NaOCl, 3.8 % SDF & BioAKT at dilutions of 1:100,1:20 &1:10 were evaluated through MTT assay after 10 min, 60 min and 24 h incubation, detection of apoptosis and ALP activity after 7,14 & 21-days incubation. A two-way analysis of variance (ANOVA) with post hoc Turkey HSD was performed to determine significant differences between the specimens tested. Results: When compared to the control at all time periods, all test specimens at varied dilutions (1:100, 1:20, and 1:10) caused no cytotoxic effects. The maximum number of live cells and ALP activity was observed with DPSCs cultivated in BioAKT followed by 3.8 % SDF and 5.25 % NaOCl at all time intervals. Conclusion: Different doses of 3.8 % SDF and BioAKT solution revealed encouraging outcomes when compared to 5.25 % NaOCl in terms of viability, proliferation and long-term ALP functioning potential when cultivated in DPSCs.

Response of stem cells derived from human exfoliated deciduous teeth to Bio-C Repair and Mineral Trioxide Aggregate Repair HP: Cytotoxicity and gene expression assessment.

Background: The aim of this study was to investigate and compare the cytotoxicity and gene expression of Bio-C Repair, Mineral Trioxide Aggregate (MTA) HP Repair, and Biodentine on stem cells derived from exfoliated deciduous teeth. Materials and Methods: In this in vitro study MTT assay was used to assess the cellular viability at three different dilutions. The gene expression of Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), osteocalcin [OCN], and dentin matrix protein-1 (DMP-1) was measured with real-time polymerase chain reaction after 7 days, 14 days, and 21 days of incubation. One-way analysis of variance and Bonferroni posttest were used for statistical analysis (p=o.o5). Results: After 72 h of incubation at dilution 1:4, stem cells derived from human exfoliated deciduous teeth (SHEDs) cultivated in Biodentine, followed by Bio-C Repair and MTA Repair HP reported with highest cellular viability. The highest mRNA expression of Runx2, ALP, OCN, and DMP-1 was reported in SHEDs cultured in Biodentine (after 21 days of incubation). Conclusion: Bio-C Repair and MTA HP Repair are biocompatible and capable of odontogenic differentiation similar to Biodentine when cultured in stem cells derived from exfoliated primary teeth.

Clinical and Epidemiological Interventions for Monkeypox Management in Children: A Systematic Review.

This review aims to compile the available literature on monkeypox, identify risk factors for developing the disease, and recommend effective preventative methods to reduce the number of reported cases and fatalities in children and pregnant women. In seeking out pertinent studies on monkeypox virus in children and pregnant women, we searched the literature using the databases Cochrane Library, Google Scholar, PubMed, EMBASE, Web of Science, and Scopus up to 1st February 2023. This study analyzed data from case studies of monkeypox in children and pregnant women. Clinical data and test findings of monkeypox patients less than 18 years old and pregnant women were analyzed. The Newcastle-Ottawa Scale was used to do the quality evaluation. Our record examination spanned the years 1985 to 2023 and found 17 children and five pregnant female patients treated with monkeypox in various hospitals/community centers. Zaire, Gabon, Chicago, Sierra Leone, Central African Republic, Northern DR Congo, Liberia, Cameroon, the Democratic Republic of the Congo, the United Kingdom, the Netherlands, and Florida all contributed to the 14 studies analyzed. There were no studies identified for meta-analysis of selected case studies of hospitalized children and pregnant women who were diagnosed with monkeypox. The incidence, prevalence, clinical characteristics, diagnosis, management, prevention, vaccinations, infant care, and care for expectant mothers are all discussed in this systematic review of monkeypox in children. Our research findings may provide a foundation for further focused research and the development of related recommendations or guidelines.

The COVID-19 pandemic in a paediatric population: A health care perspective.

SARS-CoV-2, a member of the coronaviridae family, has caused a deadly pandemic known as the Coronavirus disease 2019, (COVID-19). Paediatric patients get infected by direct exposures or airborne droplets, mostly from households with a cluster of infection or a history of exposure to outbreak areas. COVID-19 is contagious in children (those under the age of 18), with an average incubation time of around 6.5 days. Paediatric patients account for less than 5% of total COVID-19 patients worldwide, and hence studies involving such subjects are unlikely in the near future. As a result, there are inadequate data about COVID-19 infection in children. Therefore, we present this systematic review to understand the epidemiology, clinical features, diagnostic outcomes, and available options for the management of COVID-19 in paediatric populations in order to advise clinical and public health policy choices for safety of children worldwide.

Evaluation and comparison of silorane resin composite to glass ionomer in occluso-proximal restorations of primary molars: A randomized controlled trial.

Objective: In general, proximal restorations of primary molars fracture, so it is vital to study the new materials that could solve this problem. Hence, the present trial assessed the success of occluso-proximal atraumatic restorative treatment (ART) restorations using silorane and glass ionomer cement (GIC) in carious primary molars for a period of 2 years. Materials and Methods: One hundred and ninety-two children between the age group of 4 and 9 years were randomly allocated to GIC or silorane. In the clinical set up, they were treated by a pediatric dentist, and their restorations were evaluated at 3, 6, 12, 18, and 24 months. The primary outcome was the survival of restoration, which was analyzed using the Kaplan-Meier and superior Cox regression models. As a sensitivity analysis, intention-to-treat (ITT) was executed. Sex, age, molar, jaw, cavity volume, and caries incidence were the independent variables. Results: The restoration survival after 24 months for GIC and silorane was 82.75% and 88.88%, respectively, whereas ITT analysis showed a success of 84.37% and 89.58% for GIC and silorane, respectively. Conclusion: With regard to longevity, there was no statistically significant difference between silorane and GIC in primary molar occlusoproximal ART restorations.

Assessment of Bacterial Load Using 3.8% SDF as an Irrigant in Pulpectomized Primary Molars: A Randomized Controlled Trial.

Aim and objective: The aim of the present study was to evaluate the reduction in bacterial loading using 3.8% as an irrigating solution in pulpectomized primary molars. Study design: A randomized, controlled clinical trial was performed that included primary molars with pulp necrosis. Sixty necrotic canals were included, 30 irrigated with 3.8% SDF (experimental group) and 30 with 1% NaOCl solution (control group); in all cases, two microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method. Results: The results were statistically analyzed by student "t" test. After analyzing samples before and after irrigation in the control group (NaOCl), we found a strong significant decrease of bacterial load (p = < 0.001). The same occurred in the 3.8% SDF group samples (p = < 0.001). When both groups were compared post irrigation, a statistically significant difference was observed in favor of 3.8 % SDF. Conclusion: 3.8% SDF can be suggested as an alternative irrigant for pulpectomy of necrotic teeth. How to cite this article: Maru V, Padawe D, Naik S, et al. Assessment of Bacterial Load Using 3.8% SDF as an Irrigant in Pulpectomized Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-1):S47-S51.

Assessment of the Influence of Various Concentrations of Sodium Hypochlorite on Stem Cell Derived From Human Exfoliated Deciduous Teeth (SHED) Proliferation and Differentiation.

Objectives  Previous research has established that sodium hypochlorite (NaOCl) has a detrimental effect on dental stem cell viability and maturation. However, a review of the literature revealed no study evaluating the response of NaOCl to the survival of stem cells derived from human exfoliated deciduous teeth (SHEDs). Hence, the aim of the present trial was to assess the influence of various dilutions of NaOCl on SHED proliferation and differentiation. Materials and Methods The 5.25% NaOCl solutions at concentrations of 0.5, 0.1, 0.025, 0.0125, and 0.005 mg/ml were used to assess the response to SHED proliferation and differentiation through methyl tetrazolium (MTT) assay, alkaline phosphatase (ALP) assay, and reverse transcription polymerase chain reaction gene expression analysis at various time point intervals. Results  MTT assay showed that the viability of SHEDs decreased with an increase in the concentration of NaOCl and an increase in incubation time. The ALP activity decreased with an increase in the concentration of NaOCl up to 14 days of incubation. However, the ALP activity of all the test specimens further decreased after 14 days of incubation. The gene expression levels of osteocalcin, dentin sialophosphoprotein, and STRO-1 were statistically significant when compared to the control after one, three, and seven days of incubation. Conclusion  Different doses of NaOCl other than 0.5 mg/ml revealed encouraging outcomes in terms of proliferation, long-term ALP functioning, and odontogenic differentiation potential when cultivated in SHEDs.

Constituents, properties and clinical applications of OrthoMTA & RetroMTA: A systematic review.

Aim: OrthoMTA and RetroMTA are newly developed mineral trioxide aggregates that were developed to achieve maximum benefits and clinical performance. This systematic review aimed at assessing and describing the constituents, properties and uses of OrthoMTA and RetroMTA. Methodology: Literature search was performed using the keywords, "OrthoMTA", "RetroMTA", "BioMTA", "constituents" and "properties" in the databases, PubMed, Cochrane, Semantic scholar and Europe PubMed Central. Original articles in English describing the properties, constituents, uses/indications, history and recent advances on OrthoMTA and RetroMTA were considered for the study. Results: A total of 35 articles were selected for the systematic review based on keywords selected. Among the 35 articles, 5 articles described the composition and properties of OrthoMTA and RetroMTA, 7 articles depicted the usage of OrthoMTA and RetroMTA and the remaining articles discussed on the various properties of both OrthoMTA and RetroMTA. Conclusion: The present review confirmed that RetroMTA exhibits an excellent property, namely, short setting time, less tooth discoloration, high compressive strength, higher shear bond strength with time, higher push-out bond strength, low solubility, low cytotoxicity, biocompatibility, antibacterial property, and can be used in reparative processes in case of blood contamination. However, even OrthoMTA showed less microleakage, is biocompatible and possesses antibacterial properties.

Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review.

BACKGROUND: Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth. MATERIALS AND METHODS: This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested. RESULTS: Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability. CONCLUSION: There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials. CLINICAL SIGNIFICANCE: The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength. HOW TO CITE THIS ARTICLE: Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30-39.

Caries Removal by Chemomechanical (Carisolv™) vs. Rotary Drill: A Systematic Review.

BACKGROUND: Chemomechanical caries removal is an effective alternative to the traditional rotary drilling method. The advantages of chemomechanical techniques in terms of the need for anesthesia, pain perception and patient preference are systematically reviewed and a meta-analysis of the time required for caries removal is reported. METHOD: Randomized controlled studies of comparison of chemomechanical techniques with conventional rotary drill were selected from a systematic search of standard biomedical databases, including the PubMed and Cochrane clinical trials. Non-repeated search results were screened for relevance and risk of bias assessment, followed by methodology assessment. Statistical models were applied to the outcome parameters - time required, pain perception, need of anesthesia and patient preference - extracted from the studies. RESULTS: Out of the 111 non-repeated search results, 26 studies receiving a low bias score were selected for the review, and 16 randomized clinical trials of rotary and Carisolv techniques were considered for meta-analysis. Meta-analysis by fixed effect as well as random effect models indicate that Carisolv takes more time (3.65 ± 0.05 and 4.09 ± 0.29 min) than rotary drill (8.65 ± 0.09 and 8.97 ± 0.66 min) method. Advantages of reduced pain (14.67 for Carisolv vs. 6.76 for rotary drill), need for anesthesia (1.59% vs. 10.52%) outweigh the longer time requirement and make it the preferred (18.68% vs. 4.69%) method. CONCLUSION: Chemomechanical techniques stand out as a minimally invasive and preferred method based on the meta-analyses. Evaluation of pain experienced using robust methods is needed to strengthen the evidence for their use.

Evaluation of Marginal Leakage and Shear Bond Strength of Bonded Restorations in Primary Teeth after Caries Removal by Conventional and Chemomechanical Techniques.

Background/Purpose. To evaluate and compare the marginal leakage and shear bond strength between conventional and Papacarie techniques of caries removal in primary molars. Materials and Methods. Sixty freshly extracted human carious primary molars were randomly divided into two groups: group I-caries removal by conventional method and group II-caries removal using Papacarie. After bonded restorations, both groups were further randomly subdivided into four subgroups for marginal leakage and shear bond strength evaluation. Results. Papacarie treated teeth (46.70%) showed less marginal leakage when compared to conventionally treated teeth (86.70%) for caries removal. The mean shear bond strength was found more in Papacarie treated teeth (12.91 MPa) than in those treated conventionally (9.64 MPa) for caries removal. Conclusion. Papacarie showed less marginal leakage and more shear bond strength when compared to those treated conventionally for caries removal.

Behavioral changes in preschoolers treated with/without rotary instruments.

BACKGROUND: Behavioral dentistry is an interdisciplinary science which needs to be learned, practiced, and reinforced in order to provide quality dental care in children. AIM: To assess the anxiety experienced during dental treatment in preschool children with/without rotary instruments using behavioral scale. STUDY AND DESIGN: Sixty pediatric patients of preschool age with bilateral occlusal carious lesions extending into dentin were selected for the study. Carious lesions were removed using conventional rotary instruments on one side and Papacarie - chemomechanical caries removal of approach on contra lateral side. Both cavities were restored with glass ionomer cement (Fuji IX). Anxiety scores were determined using 'Modified Child Dental Anxiety Scale' (Wong et al, 1998) during the various clinical stages of the treatment course. RESULTS: Children experienced relaxed behavior when subjected to Papacarie method of caries removal compared to conventional method using rotary instruments. CONCLUSION: This study helped us to provide behavioral measures and introduce children to dentistry in a nonthreatening setting.

Mongrelised genetics of H1N1 virus: a bird's eyeview.

H1N1 influenza, also known as "novel H1N1 virus" has led to a "global outcry." This virus is more virulent when compared with other seasonal flu viruses. Virulence may change as the adaptive mutation gene increases within the virus. A study at the US Centre for Disease Control and Prevention published in May 2009 found that children had no preexisting immunity to the new strain as they showed no cross-reactive antibody reaction when compared with adults aged 18-64 years, who showed a cross-reactive antibody reaction of 6-9% and older adults with 33% immunity. This review article depicts H1N1 virus, its virulence with genetic evolution potential and preventive protocol for the dental professionals. This would allow us to comprehend the changes in the disease process and contribute in its prevention as "prevention is better than cure."