Efficacy of a Modified Audio-Tactile Performance Technique with Braille (ATPb) on the Oral Hygiene Status of Visually-Impaired Children.

OBJECTIVE: We assessed the effectiveness of a modified audio-tactile performance (ATP) technique with braille (ATPb) on the oral health statuses of visually-impaired children. STUDY DESIGN: Ninety visually-impaired institutionalized children received oral hygiene instructions using audio (AM), ATP or ATPb techniques. Plaque scores were assessed at baseline and after reinforcement and non-reinforcement periods. RESULTS: In the totally visually-impaired, mean reductions in plaque scores in the ATPb, ATP and AM groups during the reinforcement period were 1.119 ± 0.260, 0.654 ± 0.239 and 0.237 ± 0.255, respectively (p <0.001), worsening to 0.107 ± 0.160, 0.083 ± 0.193 and -0.208 ± 0.267 during the non-reinforcement period (p <0.001), before culminating at 6 months at 1.227 ± 0.261, 0.737 ± 0.317 and 0.029 ± 0.108 (p <0.001). In partially visually-impaired children, reductions during the reinforcement period were 0.934 ± 0.279, 0.762 ± 0.270 and 0.118 ± 0.237, respectively, dropping to 0.176 ± 0.166, 0.083 ± 0.169 and -0.128 ± 0.114 without reinforcement and culminating at 1.109 ± 0.258, 0.845 ± 0.292 and -0.010 ± 0.226 (p <0.001). There were significant inter-group differences during the three periods (p <0.001), except in the ATP and ATPb groups during the non-reinforcement period for totally impaired (p = 0.157) and during reinforcement (p = 0.155) and non-reinforcement (p = 0.051) periods for partially impaired children. CONCLUSIONS: All three techniques were successful when reinforced periodically. However, only ATP and ATPb were successful during periods without reinforcement. The modified audio-tactile performance technique with braille (ATPb) was most effective, allowing visually-impaired children to retain oral hygiene information without intervention.

Characterization of Stem Cells from Human Exfoliated Deciduous Anterior Teeth with Varying Levels of Root Resorption.

BACKGROUND: Deciduous teeth undergo the physiologic process of resorption, during which the remnant pulp undergoes activation. However, the quality of stem cells obtained at various stages of root resorption has not been documented. OBJECTIVE: To isolate and characterize stem cells from deciduous teeth with varying levels of root resorption. STUDY DESIGN: Healthy primary anterior teeth were extracted according to the treatment needs of the patient. The teeth were categorized into SHED(1/3)- teeth with 0 to 1/3rd root resorption, SHED(2/3)- teeth with 1/3rd to 2/3rd root resorption, and SHED(COMP)- teeth with more than 2/3rd root resorption. SHED were characterized based on their morphology, viability, proliferation rate, population doubling time, expression of cell surface markers, and in vitro differentiation potential into osteocytes and adipocytes. RESULTS: SHED from all three groups demonstrated largely similar morphological and cellular characteristics. However, SHED(2/3) showed relatively better characteristics in terms of growth kinetics and phenotypic marker expression. Also, the differentiation ability for osteogenic and adipogenic cell lineages was slightly higher in SHED(1/3) and SHED(2/3) compared with SHED(COMP). CONCLUSION: Based on the cellular, phenotypic and biological characteristics, it is suggested that SHED (2/3) could be a useful source for tissue regeneration, and warrants further investigations.

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.

A spectroscopic and surface microhardness study of enamel exposed to beverages supplemented with ferrous fumarate and ferrous sulfate. A randomized in vitro trial.

PURPOSE: To compare the efficacy between supplementing ferrous fumarate and ferrous sulfate to carbonated beverages by recording the in vitro mineral loss and surface microhardness (SMH) changes in human enamel. METHODS: 120 enamel blocks each (from primary and permanent teeth) were uniformly prepared and the initial SMH was recorded. These enamel specimens were equally divided (n = 60) for their respective beverage treatment in Group 1 (2 mmol/L ferrous sulfate) and Group 2 (2 mmol/L ferrous fumarate). Each group was further divided into three subgroups as Coca-Cola, Sprite and mineral water (n= 10). The specimens were subjected to three repetitive cycles of respective treatment for a 5-minute incubation period, equally interspaced by 5-minute storage in artificial saliva. The calcium and phosphate released after each cycle were analyzed spectrophotometrically and the final SMH recorded. RESULTS: The results were tested using student's t-test, one-way ANOVA and Wilcoxon signed rank test (P < 0.05). The spectrophotometric assessment of calcium and phosphate withdrawal found more loss with the supplementation of 2 mmol/L ferrous sulfate than ferrous fumarate (P < 0.005). Similarly, the mean surface microhardness reduction was less with the supplementation of 2 mmol/L ferrous fumarate than with ferrous sulfate (P < 0.005). Statistical comparisons revealed the maximum surface microhardness and mineral loss with primary enamel and the maximum loss produced in all groups by Coca-Cola (P < 0.005).

Comparison of salivary calcium, phosphate and alkaline phosphatase levels in children with early childhood caries after administration of milk, cheese and GC tooth mousse: an in vivo study.

BACKGROUND AND OBJECTIVES: This study compares the Salivary Calcium, Phosphate and Alkaline Phosphataselevels in children with Early Childhood Caries after administration of Milk, Cheese and GC Tooth Mousse to a control group of caries resistant children. STUDY DESIGN: 90 kindergarten children both males and females aged 5 years, from the South Canara region were included in the study. Based on the dmfs score, children were divided into 3 groups: Control group, ECC group and S-ECC group. The Salivary Calcium, Phosphate and Alkaline Phosphatase levels in the sample were assessed before and after administration of Milk, Cheese and GC Tooth Mousse at three different intervals, i.e within 5 minutes, 30 minutes and 60 minutes by using Spectrophotometry. RESULTS: The mean Salivary Calcium levels were higher in caries free group whereas Phosphate and Alkaline Phosphatase were lower in the caries free group which was statistically highly significant (p < 0.001). The Tooth Mousse group showed higher bioavailability of calcium and phosphate which was statistically highly significant (p < 0.001). Salivary Calcium and Phosphate levels within 5 minutes after application of Milk, Cheese and Tooth Mousse were higher than at 30 and 60 minutes. Salivary Alkaline Phosphatase levels were lower than the baseline values at all the 3 intervals after administration of Milk, Cheese and Tooth Mousse and was statistically not significant (p > 0.05). CONCLUSION: Saliva should be saturated with Calcium and Phosphate to affect their bioavailability in amounts adequate for remineralizaton. Milk, Cheese and GC Tooth Mousse applicaton were equally beneficial in saturating the saliva with adequate amount of Calcium and Phosphate.

Total antioxidant concentrations of breastmilk--an eye-opener to the negligent.

The balance between free radical production and antioxidant defenses in the body has important systemic and oral health implications. There is convincing evidence that breastmilk containing antioxidants is important in the prevention of diseases in infancy. This study compared the total antioxidant concentration of human breastmilk expressed at different stages of lactation, stored at various temperatures and durations. Expressed breastmilk (EBM) samples of the third, seventh and 30th day were collected from women who had term and preterm deliveries (n = 20). Another cohort of women (n = 20) was also assessed; these women were more than five months postpartum and lactating. The total antioxidant capacity (TAC) of EBM was assessed at zero hours at room temperature, at 48 hours, one week post-refrigeration (4 degrees C), and freezing (-8 degrees C) respectively using the phosphomolybdenum method. The highest antioxidant levels were found in colostrum. The TAC of EBM reduced with time and at post-refrigeration and after freezing (p < 0.0005). No significant difference in the mean TAC was observed between the EBM samples obtained from women with either term or preterm deliveries. The progressive loss of antioxidant content of EBM emphasizes the need of awareness and curtailment of the practice of storing and later use of EBM.

Oral health of children with congenital heart disease following preventive treatment.

Congenital heart disease (CHD), abnormalities in the structural development of the heart, occurs in approximately 8:1000 live births. The causative microorganism for infective endocarditis in more than 60% of the patients with positive hemoculture of viridans streptococci (s.mutans, s.mitior) thus making it mandatory for these children to maintain their oral health. The present study assessed the oral health of children with congenital heart disease following preventive treatment. A total of 74 children with congenital heart disease were selected for the study with 30 healthy controls between the ages 5-16. The oral health was assessed by measuring the microbial counts, the OHI-S and the gingival indices. The data thus obtained were subjected to paired and unpaired t-test. Poor oral health was prevalent among these children of the study group as compared to the controls indicating a lack of sound knowledge of the maintenance of oral hygiene. Following preventive treatment the oral health improved considerably.

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.

Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report.

Tooth loss due to trauma often triggers residual alveolar resorption to a greater degree in the sagittal direction leading to atrophy. However, in a pediatric patient, if this defect is left untreated, it can cause further atrophy leading to collapse of the arch. In the maxillary anterior area, this is also of esthetic concern. Hence, it is viable to reconstruct the alveolar defects and restore the alveolar anatomy with superior quality of bone while the patient is still in growing phase to avoid any structural and dental malformation, as well as to provide a more novel treatment like dental implant at a later stage when growth ceases. Modes for successfully augmenting the bone are diverse. Among these, barrier membrane with guided bone regeneration, distraction osteogenesis, and bone block graft is ubiquitous. The current case report deals with the management of horizontal atrophic anterior maxillary region using autologous block bone graft harvested from mandibular symphysis, to augment the alveolar ridge and aid in esthetic and functional restoration of alveolar anatomy by restoring the defect with the bone of superior quality as well as preparing the site for receiving implant prosthesis in future when growth ceases. How to cite this article: Bhandary M, Hegde AM, Shetty R, et al. Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2021;14(2):311-314.

Knowledge of dental trauma among mothers in Mangalore.

AIM: The aim of this study was to assess the knowledge of Mangalore mothers regarding dental trauma. METHODS: A questionnaire inquiring about mother's knowledge on dental trauma was distributed to 500 working and non-working mothers via their children attending two primary schools in the Mangalore city. RESULTS: Around 68.5% of the mothers were aware of the management of dental trauma. Of the working mothers, 72% were aware of the management of dental trauma while 65% of the non-working mothers were aware. When asked about saving the avulsed tooth, 36% of mothers said that the avulsed tooth can be saved. Regarding mouth guards, 54.5% of the mothers said that they aware of the use of mouth guards to prevent traumatic injuries to the teeth. Of the working mothers 72% knew that mouth guards are useful in the prevention of dental trauma while 37% of the non-working mothers have this knowledge; 68% of the mothers would take the child to the dentist following tooth injury whereas 17% of the mothers would use an emergency kit. Chi-square test and logistic regression analysis indicated a significant difference between the responses of working and the non-working mothers with regard to mouth guard knowledge and recommendation (P-value 0.001). CONCLUSION: Most of the mothers were graduates and were aware of the emergency management of dental trauma. The working mothers had better knowledge and awareness regarding mouth guards (72%) when compared with non-working mothers (37%).

Sleep disordered breathing in children--a review and the role of a pediatric dentist.

Among the many factors important in children's development is sleep. Sleep disorders can impair children's sleep and lead to negative consequences. The most common sleep disordered breathing (SDB) in children is obstructive sleep apnea (OSA). One of the main causes of childhood SDB is enlargement of the tonsil tissues and, in most cases, their removal serves as an ultimate treatment of SDB. However, it remains unclear what proportion of children with enlarged tonsil tissue suffer from SDB. Dentists are becoming increasingly aware of the issue of SDB as they are sometimes involved in treatment of this condition using oral appliances. Moreover, as dentists often look into children's mouths, they can play an active role in identifying those with enlarged tonsils and referring them for sleep assessment. This review focuses on the diagnosis and treatment of SDB and also on the utility of oral appliances in the management of this disorder.

Finite element method--an effective research tool for dentistry.

Stress analysis of dental structures has been a topic of interest in recent years with the objective of determination of stresses in the tooth and it's supporting structures and improvement of the mechanical strength of these structures. The purpose of this article is to give an insight of the finite element analysis which has totally overtaken other experimental analysis due to its ability to model even the most complex of geometries with is immensely flexible and adaptable nature. Finite Element Analysis (FEA) is a computer-based numerical technique for calculating the strength and behavior of structures. It can be used to analyze either small or large-scale deflection under loading or applied displacement. However it is extremely expensive and can be used only with the help of an expert engineer who has mastered this technique. Still this methodology of stress analysis has become extremely popular in dentistry as various properties of dental tissues and materials can be just fed into it and with the ease and accuracy the analysis is done is just remarkable.

Total antioxidant capacity of saliva in children with HIV.

UNLABELLED: Several recent reports have indicated high levels of reactive oxygen species, causing oxidative stress, in the pathogenesis of HIV infection. Oxidative stress may lead to enhanced HIV replication in infected cells and may also aggravate the immunodeficiency by reduction of cellular immunity and possibly by increased programmed cell death of lymphocytes. Saliva can constitute a first line of defense against free radical mediated oxidative stress. The use of saliva as a diagnostic fluid has become somewhat of a translational research success story. Technologies are now available enabling saliva to be used to diagnose disease and predict disease progression. PURPOSE: The antioxidant capacity of saliva was investigated in 68 children who were divided into two groups. 34 children who were investigated were diagnosed as having HIV infection and the other group consisted of children who reported to the department and served as healthy controls. Total antioxidant capacity of saliva was evaluated by spectrophotometric assay. CONCLUSIONS: The results indicated that the total antioxidant capacity (TAC) of saliva decreased in children with HIV infection. TAC was seen to increase with the age of the children.

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.

Estimation of salivary cortisol in children with rampant caries.

Dental profession is largely challenged with rampant caries and probable predisposing factors for the same have been evaluated for ages. There is considerable evidence that emotional disturbances may be a causative factor in some cases of rampant caries. Thus the objective of the present study was to estimate the levels of salivary cortisol in children with active rampant caries before and after caries control using electrochemiluminescence assay. A total of 60 children between the age group of 5 to 10 years of both sexes were selected for the study. A questionnaire was also included to evaluate predisposing factors for caries. The results showed that there was an increase in salivary cortisol levels in children with rampant caries, the level decreased gradually when observed for a period of three months following dental treatment which was statistically significant.

Sex determination from the pulp tissue of deciduous teeth exposed to natural soil and wet clay - A PCR study.

CONTEXT: Dental tissue remains are the toughest, and chemically, the most stable tissue in the body. Its high resilience in the events of fire and bacterial decomposition makes them vital for DNA analysis by PCR method. AIMS: Determination of sex of children through molecular analysis of pulp tissue of exfoliated deciduous teeth stored in different media and analyzed after a different time period. SETTINGS AND DESIGN: Sixty samples of deciduous teeth were divided into three groups. Group IA and Group IIA were stored in natural soil and wet clay for 1 month, respectively. Group IB and Group IIB were stored in natural soil and wet clay for 6 months, respectively. Group III was analyzed immediately after extraction. METHODS AND MATERIAL: Sex determination was carried out in five steps: Pulp tissue removal, DNA isolation, DNA quantification, PCR amplification, Sex determination. X and Y specific chromosomes from each sample were amplified and compared. STATISTICAL ANALYSIS USED: Kruskal-Wallis test, Dunn's test, and Wilcoxon signed rank test. RESULTS: Group III revealed the highest amount of DNA quantified. Amount of DNA quantified after 6 months of storage in natural soil and wet clay decreased in both the groups with the samples stored in wet clay showing a maximum decrease. Results of the PCR analysis also showed 100% accuracy rate in the samples of Group III. CONCLUSIONS: Sex determination from pulp tissue depends a lot on the quality and quantity of DNA extracted. Sex could be effectively determined among the samples evaluated immediately after extraction. This ability decreases as the storage condition changes and the time period increases. Samples stored in wet clay were found to show the least sex identification ability than dry soil.

Drooling of saliva in children with cerebral palsy-etiology, prevalence, and relationship to salivary flow rate in an Indian population.

The prevalence of drooling, the impact of various etiological factors on its severity, and its relationship to salivary flow rate were assessed in 113 individuals with cerebral palsy (CP). In this study, there were 74 males and 39 females with an age range of 6-18 years who were attending a special school in Chennai, India. The severity of drooling was assessed by visual examination; demographics and data regarding severity and control of drooling were collected via a questionnaire. Data regarding the type of CP and drugs taken by the children were obtained from the medical records maintained by the school. The unstimulated salivary flow rate of these children was determined through a passive method. The overall incidence of drooling was 48.7%, with 17.7% having severe drooling. Individuals with athetosis had the least severe amount of drooling. There was a significant relationship between ability to close the mouth and the severity of drooling. The severity of drooling was reduced with age. There was no significant difference in the mean salivary flow rate of those children who drooled and those who did not.

Relationship between body mass index, caries experience and dietary preferences in children.

UNLABELLED: Dental caries and childhood obesity epidemics are multifactorial complex disease and children's dietary pattern is a common underlying etiologic factor in their causation. MATERIALS: Five hundred children belonging to the age group of 8-12 years of both sexes were studied. In all of them BMI, dietary preferences to sweet and fatty food snacks and caries experience was determined. The results were subjected to statistical analysis using prevalence test, ANOVA test and chi-square test. RESULTS: We found that children with obesity and overweight had increased prevalence of dental caries in both primary and permanent dentition compared to normal weight children, which was statistically significant. In addition obese and overweight children had frequent preference to sweet and fatty food snacks compared to children with normal weight.

Study of stress distribution and displacement of the maxillary complex following application of forces using jackscrew and nitanium palatal expander 2--a finite element study.

UNLABELLED: The stress distribution patterns within the maxillary complex during the expansion by slow maxillary expansion plate and Nitanium palate expander 2 was analyzed. OBJECTIVE: This comparative study was done using a finite element model of a young maxillary bone. The model was generated using the data from computerized tomographic scans of a dried maxillary bone. The model was then strained to a dimensional pattern of displacement and stress distribution for the two appliances. RESULTS: This present study showed the maximum lateral displacement for jack screw by 0.170 mm at the region of cusp tips of posteriors indicating a tipping movement. Whereas NPE2, showed maximum displacement of 0.004 mm corresponding to maxillary molars. Concentration of stress distribution ranging from 343.42 N/mm2 to 412.60 N/mm2 for 0.5 mm of expansion was significantly depicted at the palatal bone beside the central incisors for jack screw, when compared to NPE2 which depicted low magnitude of stress ranging from 7.78 N/mm2 to 9.08 N/mm2 uniformly distributed along the midpalatal suture. CONCLUSIONS: The findings of this study suggests that NPE2 appliance basically an orthodontic appliance however is capable of producing mild to moderate orthopedic changes in maxilla.

Oral health status of children with congenital heart disease and the awareness, attitude and knowledge of their parents.

The oral health status of children with congenital heart diseases and the parental awareness on maintaining good oral health and attitude towards preventive dental health measures were evaluated. A total of 170 children between the age group of 1-16 yrs belonging to both genders, with the history of congenital heart disease from Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram and Narayana Hrudayalaya Institute of Medical Sciences, Bangalore were examined. Oral lesions and caries experience were recorded using modified WHO oral health assessment form. Oral hygiene of the children with congenital heart disease was found to be poor with tongue coating (50.6%), plaque (41.8%), calculus (35.3%), and caries (42.4%). Parental awareness on the importance of maintaining good oral hygiene, preventive dentistry, medicinal decay and its systemic effects has been found to be very poor. Dentistry should give priority to patients whose general health may be put at risk by poor dental health. Closer cooperation between Pediatrician, Pediatric Cardiologists and Pediatric Dentists could help improve dental care for these children.