Case Report: Holistic dental care for a child with Hunter syndrome: Addressing dental ramifications, overcoming challenges, and enhancing quality of life.

Hunter syndrome (MPS II), an X-linked recessive lysosomal storage disorder, is a result of deficiency of the iduronate 2-sulfatase enzyme (IDS), leading to cognitive impairment, systemic organ involvement, and increased dental problems. This case report describes the management of a child with Hunter syndrome who was referred to the Department of Paediatric and Preventive Dentistry for pain in the upper front teeth. Intraoral examination revealed severe early childhood caries, prompting planning for full-mouth rehabilitation under general anaesthesia due to the child's uncooperative behaviour. In response to recommendations from the Department of Otolaryngology and the Department of Paediatric Surgery, a comprehensive treatment plan consolidated full-mouth rehabilitation in addition to adenoidectomy and inguinal and umbilical herniotomy procedures during a single session of general anaesthesia. Successful interventions were reflected in the uneventful one-month follow-up of the patient, highlighting the efficacy of the interdisciplinary approach. The key takeaway underscores the importance of collaborative interventions, emphasising singular intubation for patients requiring recurrent hospitalisations, providing both monetary relief and reducing post operative healing time. Designed to address global developmental delay in the child, a personalised home care plan was also implemented. Evaluation of plaque and gingival indices before and after the home care regimen demonstrated a notable improvement, indicating an enhanced oral quality of life.

Effect of audio and virtual reality distraction on the dental anxiety of children with mild intellectual disability.

BACKGROUND AND AIM: Intellectual disability, is a neurodevelopmental disorder that typically manifests early in childhood and consists of both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It can be categorized into mild, moderate, severe, and profound based on its severity. Cognitive impairment may be observed predominantly in children with intellectual disabilities. Marked deficits in areas of learning, planning, communication, social participation, and personal independence in children with mild intellectual disabilities make behavior guidance and communication a challenge during dental treatments. The aim was to evaluate and compare the use of two different distraction tools, audio, and virtual reality (VR) on the dental anxiety of children with mild intellectual disability during dental treatment. METHODS: Twenty children diagnosed with mild intellectual disability were equally divided into two groups. A cross-over study design consisting of two appointments 1 month apart was employed. In the first appointment, audio and VR distractions were provided to participants in Groups 1 and 2, respectively, and the distraction tools provided to the participants were interchanged in the second appointment. A trained observer recorded physiological parameters (pulse rate and oxygen saturation) and observational parameters (Venham's anxiety rating scale) during both appointments at three-time intervals. Statistical intra-group and inter-group comparison analyses were performed using Friedman's and Mann-Whitney U tests. RESULTS: A decrease in pulse, increase in oxygen saturation levels, and a decrease in Venham's Anxiety Rating Scores (statistically significant p < .05 / highly significant p < .01) was observed on introducing the distraction techniques in Groups 1 and 2 in both appointments. A statistically non-significant difference (p > .05) in physiological and observational parameters was observed between Groups 1 and 2 in both appointments. CONCLUSION: Audio and VR distraction techniques can be employed for behavior guidance in children with mild intellectual disability during restorative dental procedures.

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).

Repeated exposure of acidic beverages on esthetic restorative materials: An in-vitro surface microhardness study.

BACKGROUND: A manifold increase in the consumption of aerated beverages has witnessed a twin increase in tooth wear and raised demand for esthetic restorative materials. This study aimed to evaluate the surface microhardness changes of esthetic restorative materials following treatment with aerated beverages in an in-vitro situation. MATERIAL AND METHODS: The initial surface microhardness of the restorative materials GC Fuji II LC, GC Fuji IX, Nano Glass ionomer, Resin and Nano composite was recorded. These materials were studied under 3 groups that included those exposed to the acidic beverages daily, weekly once in a month and those that had no exposures at all. The final surface microhardness of the materials was recorded following experimentation and was subjected to statistical comparisons. RESULTS: The restorative materials were compared for their surface microhardness changes following respective treatments using the T-test and One-way ANOVA analysis. Inter-comparisons between the groups showed statistical significance (p<.05), when treated with both the beverages. The five restorative materials revealed surface microhardness loss; the maximum reduction noticed with the Nano glass ionomer cement tested (p<.0005). CONCLUSIONS: The surface microhardness of restorative materials markedly reduced upon repeated exposures with acidic beverages; the product with phosphoric acid producing the maximum surface microhardness loss. KEY WORDS: Restorative materials, acidic beverages, surface microhardness, resin composites, glass ionomers.

Use of different oral hygiene strategies in children with cerebral palsy: A comparative study.

BACKGROUND: Cerebral palsy (CP) is described as a group of conditions usually occurring in childhood, where children have motor dysfunction and are unable to adequately master the necessary techniques of plaque control, which ultimately leads to dental caries and periodontal problems. AIMS: The objective of this study was to educate the parents/caretakers/institution staff and children with CP about the different preventive home care measures and to evaluate the oral hygiene and gingival health status of these children before and after the institution of different preventive home care measures. MATERIALS AND METHODS: A total of 64 individuals with CP, aged between 6 and 18 years, were examined for their oral hygiene and gingival health status, after which the parents/caretakers received a health education program. The children were then randomly divided into four groups. Each group was administered a specific preventive home care measure (mechanical and chemotherapeutic) to be followed for a period of 6 weeks, and the oral hygiene and the gingival health status were recorded at the end of 1 week, 2 weeks, and 6 weeks. The data were then subjected to statistical analysis. RESULTS: In the sample of 64 children diagnosed with CP, the mean OHI(S) score among the groups of children who were given different preventive home care measures was compared at baseline, 1 week, 2 weeks, and 6 weeks. Group 4 showed a marked reduction in the OHI(S) score measured from baseline to 6 weeks, when compared to the other three groups which wa statistically very highly significant (P < 0.001) The mean MGI score was compared at baseline, 1 week, 2 weeks, and 6 weeks home, Group 4 showed a marked reduction in the MGI score measured from baseline to 6 weeks, when compared to the other three groups. When the mean MGI score was compared from baseline to 6 weeks, there was a gradual decrease in the MGI score, which was statistically highly significant between baseline and 1 week (P < 0.05) and statistically very highly significant between 1 and 2 weeks (P < 0.001). However, this improvement was not statistically significant between 2 and 6 weeks (P > 0.05). CONCLUSION: A combined mechanical and chemotherapeutic measure is highly recommended to maintain the oral hygiene and gingival health of these special children because of their difficulties and their limited abilities to control dental plaque.

Clinical Management of Glanzmann's Thrombasthenia: A Case Report.

Glanzmann's thrombasthenia (GT) is a rare, genetically inherited platelet disorder in which the platelet glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either deficient or, dysfunctional. The incidence is about 1 in 1,000,000. This case report deals with a 4 year-old girl diagnosed with GT presenting with dental caries and periapical lesions in the primary mandibular first molars. To provide the best care, an interdisciplinary approach was followed by a team consisting of pediatric dentists, pediatricians and anesthesiologists. Complete oral rehabilitation was planned under general anesthesia which included extractions, multiple esthetic restorations and space maintainers with the utmost care to prevent unwarranted bleeding.

Knowledge of care providers regarding the oral health of visually impaired children.

OBJECTIVE: To assess the awareness of care providers of visually impaired children regarding their oral hygiene. METHOD: A simple pre-structured questionnaire was given to the care providers and the awareness regarding their oral health was assessed. RESULTS: There was a general lack of awareness among the care providers of these children regarding dental diseases and its prevention. Furthermore, the importance of oral hygiene was found to be very low. CONCLUSION: The results obtained showed that most of the caretakers were unaware of the difficulties faced by these children in the maintenance of their oral health.

Salivary antioxidants and oral health in children with autism.

UNLABELLED: Individuals with autism vary widely in abilities, intelligence, and behaviours. Autistic children have preferences for soft and sweetened food making them susceptible to caries. A wide spectrum of medical and behavioural symptoms is exhibited by children with autism, which makes routine dental care very difficult in them. Mental retardation is evident in approximately 70% of individuals with autism and most psychiatric disorders including autism are associated with increased oxidative stress. OBJECTIVES: To evaluate the oral health status of children with autism and to determine the salivary pH and total salivary antioxidant concentration (TAC). MATERIALS AND METHODS: 101 subjects with autism between age group of 6 and 12 year were part of the study and 50 normal healthy siblings of same age group were taken as control group. Oral health status was analysed using oral hygiene index-simplified and dentition status index. The salivary total anti-oxidant level was estimated using phosphomolybdic acid using spectrophotometric method and the salivary pH using the pH indicating paper. The results were statistically analyzed using Mann-Whitney U test. RESULTS: A statistically very highly significant difference was seen in the mean oral hygiene index scores (autistic group--1.2 and control group--1, P<0.001) and the mean salivary total antioxidant concentration (autistic group--5.7 µg/ml and control group--38 µg/ml, P<0.001). No statistical significant difference was observed in the dental caries status and the salivary pH of autistic group and the control group. CONCLUSIONS: Similar dental caries status was observed in children with autism and their healthy normal siblings. Oral hygiene was poor in children with autism whereas the Salivary TAC was significantly reduced in autistic children.

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.

Knowledge and Oral Health Attitudes among Parents of Children with Congenital Heart Disease.

Congenital heart disease (CHD) is a devastating complex of diseases resulting from defects of development. It affects more than 1 of every 100 live births. Early preventive dental care should be adjusted to the special needs of these children in their first years of life. Knowledge of parental attitudes and experiences of dental care are therefore important. Aim : This study was done to assess the knowledge and attitudes among parents of children with congenital heart disease towards oral health and dental care. Materials and methods : Parents (n = 105) of children with congenital heart disease of an age ranging from 0 to 16 years were included in the study. A questionnaire was used to assess the knowledge and oral health attitudes. Results : The parents' knowledge was fair but the oral health attitudes were not very satisfactory. The parents in this study also recognized the importance of oral health for the well-being of rest of the body. Conclusion : The results of this study indicate that parents' and children's attitudes toward oral health and dental care need to be improved.

Crouzon's syndrome: A review of literature and case report.

Crouzon's syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon's syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Normally, the sutures in the human skull fuse after the complete growth of the brain, but if any of these sutures close early then it may interfere with the growth of the brain. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Case report of a 7 year old boy is presented with characteristic features of Crouzon's syndrome with mental retardation. The clinical, radiographic features along with the complete oral rehabilitation done under general anesthesia and preventive procedures done are described.

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.

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.

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.

Total antioxidant capacity of saliva and its relation with early childhood caries and rampant caries.

Dental caries is an infectious and communicable disease and multiple factors influence the initiation and progression of the disease. Recently it has been claimed that oxidative stress may play an important role in the onset and the development of several inflammatory oral pathologies and dental caries may also be included. Saliva could constitute a first line of defense against free radical- mediated oxidative stress. This is the reason why antioxidant capacity of saliva has led to increasing interest and hence the need for this study. The antioxidant capacity of saliva was investigated in 100 children who were divided into four groups. Two of which comprised the study and control groups of children with ECC (below 71 months of age) and the other two groups comprised of the study and control groups of the children with rampant caries [(RC) (6-12 yrs)]. Unstimulated saliva samples were collected from all the groups. Total antioxidant capacity of saliva was evaluated by spectrophotometric assay. The results indicated that the total antioxidant capacity (TAC) of saliva increased in children with caries. TAC also increased with the age of the children.

Transfersomes: self-optimizing carriers for bioactives.

The transdermal route of drug delivery has gained great interest of pharmaceutical research, as it circumvents number of problems associated with oral route of drug administration. The major barrier in transdermal delivery of drug is the skin intrinsic barrier, the stratum corneum, the outermost envelop of the skin that offers the principal hurdle for diffusion of hydrophilic ionizable bioactives. Recently, various strategies have been used to augment the transdermal delivery of bioactives. Mainly, they include iontophoresis, electrophoresis, sonophoresis, chemical permeation enhancers, microneedles, and vesicular system (liposomes, niosomes, elastic liposomes such as ethosomes and transfersomes). Among these strategies transferosomes appear promising. Transport of this vesicular system through skin and epithelial hurdle depends upon the flexibility of their membrane, which can be attained using appropriate ratio of surfactant. Transfersomes have shown immense potential in drug delivery across the skin. Recent success also demonstrates the potential of transfersome in vaccine, steroid, protein, and peptide delivery across the skin. It is also used for transporting genetic material and achieving transfection. This review highlights the various aspects of the transferosomes in the effective delivery of drug/bioactives across the skin.

Pediatric liquid medicaments--do they erode the teeth surface? An in vitro study: part I.

The present study was conducted to investigate the endogenous erosive potential of some of the most commonly used pediatric liquid medicaments in our day to day practice. Eight commonly used pediatric liquid medicaments were selected and their endogenous pH was measured using a pH electrode meter Twenty four exfoliated or extracted primary teeth without any carious lesion/restorations, maintained in selected pediatric liquid medicaments were observed under SEM after 1 min, 10 mins and 8 hours of time intervals. The pH ranged between 6.05 (Salbutamol) to 6.77 (Paracetamol) which were acidic, whereas Theophylline had a basic pH of 7.71. The irregular pattern of pit-like erosion area were seen in all specimens, varying from site to site and probably depending on the prismatic versus a prismatic nature and composition of the affected enamel. In conclusion, all the pediatric liquid medicaments used in this study showed an erosive effect on the primary enamel surface irrespective of their pH when viewed under SEM.