Variation of OXIS contact areas in primary molars among 3-6-year-old children with intraoral digital scanning.

PURPOSE: To determine the variation of OXIS contact areas in primary molars using digital impressions generated from an intraoral scanner (IOS). METHODS: A cross-sectional study was carried out on 214 caries-free posterior quadrants of 80 children (38 males and 42 females) aged 3-6 years. Calibration of taking digital impressions with the IOS procedure was performed initially through scanning of ten quadrants of children to provide a learning environment to the examiner. The digital impressions were then exported, and the type of interproximal contact areas present between the distal surface of the primary first molar and the mesial surface of the primary second molar were identified according to the OXIS classification. The prevalence of the types of OXIS contact areas was expressed in the form of numbers and percentages. The chi-square test was applied to investigate the variability among the arches and to understand the association of OXIS contact areas across age, gender, and arches. RESULTS: The most common contact area type observed was I-type (59.8%), followed by S-type (15.4%), X-type (12.6%), and O-type (12.2%). The I-type contact area was most frequently seen in both males (51.6%) and females (65.5%), while the S-type contact area in males (14.7%) and X-type contact area in females (8.4% each) were the least frequent with no statistical significance between genders (p > 0.05). All three age groups studied showed the highest prevalence of the I-type contact area, which increased with an increase in age (p < 0.05). The inter-arch comparison showed a significant result in terms of the X-type contact area on the right side, and O-type, X-type, and I-type contact areas on the left side, while no statistical difference was seen in the intra-arch comparison for all contact types. CONCLUSION: I-type contact areas were the most prevalent across the arches, age groups and genders.

Reliability and validity of artificial intelligence-based innovative digital scale for the assessment of anxiety in children.

AIM: To assess the reliability and validity of an AI-based, innovative digital scale for the assessment of dental anxiety in children. BACKGROUND: Dental anxiety still persists as a potential problem in managing the child in the dental office. There is a need to develop a gold standard scale to measure anxiety in children incorporating newer technology. An innovative self-reported scale known as RMSDigital Anxiety Scale (RMS-DAS) incorporating artificial intelligence (AI) was developed. METHODS: Seventy-six children (aged 4-12 years) were included in the reliability group. The RMS-DAS test score was recorded on Day 1 where the child was asked to click on the expression produced by AI that matches his/her anxiety level the most at that moment. RMS-DAS retest score was recorded after 7 days. The validity group included 140 children. The anxiety scores were recorded using three scales; RMS-DAS, RMS-Pictorial Scale (RMS-PS) and Facial Image Scale (FIS) during the same visit where the child was asked to click on the expression that matches his/her anxiety level the most at that moment. Reliability was assessed by the internal consistency using Cronbach's alpha and the test-retest was assessed using paired t-test, scatterplot, and coefficient correlation. The validity of RMS-DAS was assessed by correlating it with RMS-PS and FIS using Spearman's correlation coefficient. CONCLUSION: RMS-DAS is a reliable and valid scale that can be used as a new digital tool to assess children's dental anxiety.

Evaluation of RURS elbow guard in the management of thumb-sucking habit in children with and without intellectual disability.

BACKGROUND: Digit sucking is a common oral habit among many children, which involves placing the thumb/finger into the mouth, which can cause malocclusion in mixed and permanent dentition. AIM: To evaluate the efficacy of the RURS elbow guard in the management of thumb-sucking habits in children with intellectual disabilities and those without in terms of the mean duration of appliance therapy. The secondary objective was to compare the RURS elbow guard with an intraoral crib in healthy children (without intellectual disabilities) to manage the habit of thumb-sucking. DESIGN: Children with intellectual disabilities and those without between the age of 4 and 16 years were included in the study and categorised into three groups, namely group I (50 normal children; intraoral crib appliance), group II (50 normal children; RURS elbow guard) and group III (50 children with intellectual disabilities; RURS elbow guard). RESULTS: The mean duration of appliance therapy for groups I, II and III were 200.20 ± 20.43 days, 204.34 ± 20.56 days, and 218.43 ± 15.66 days, respectively (p < 0.001). The differences in the mean duration between group I and group II were statistically non-significant, with statistically significant differences between group I and group III (p < 0.001) and between group II and group III (p < 0.05). CONCLUSION: The RURS elbow guard was found to be an efficient appliance in treating thumb-sucking among children who had mild to moderate intellectual disabilities. RURS elbow guard was equally efficient as an intraoral crib appliance in managing thumb-sucking habits in children without intellectual disabilities.

Attitude and Practices of Paediatric Dentists towards Parental Guidance on Dental Trauma. A cross-sectional survey.

AIM: There is a lack of sufficient information about the protocols followed by paediatric dentists in informing parents about traumatic dental injuries as a part of anticipatory guidance. Hence, the aim of this study was to assess paediatric dentists' attitudes and practices about parental guidance regarding these injuries. MATERIALS: This was a cross-sectional survey conducted using a validated questionnaire emailed through Google form to approximately 2500 paediatric dentists in various world regions. The sampling method used was a list-based sampling frame followed by simple random sampling. Participants were recruited through national member societies of the International Association of Paediatric Dentistry, personal contacts and social media groups. Only paediatric dentists with at least three years of experience after their post-graduation were only included in the study. Their attitudes and practices towards parental education on dental trauma during the child's first and recalled dental visits were assessed as per their age, gender, country of post-graduation qualification and years of experience in the profession. Chi-Square test was used to evaluate the association between the paediatric dentist response and the continent of practice. Kruskal-Wallis H test was used to assess the level of significance within each variable in relation to the continent of practice. A 95% confidence interval with a significance level of α = 0.05 was used. CONCLUSION: The overall attitude and practice of paediatric dentists toward parental education on traumatic dental injuries were not satisfactory. Many paediatric dentists do not impart education on emergency care and dental trauma prevention in primary teeth. Parents should be informed about oral hygiene instructions and prevention-oriented interventions during the first visit and about managing traumatic dental injuries.

Craniofacial and occlusal features of children with sickle cell disease compared to normal standards: a clinical and radiographic study of 50 paediatric patients.

PURPOSE: To evaluate craniofacial and occlusal features of children with sickle cell disease and compare them with the normal healthy children. METHODS: A total of 50 children diagnosed with sickle cell disease (Group I) and 50 normal healthy children (Group II) between age 10 and 18 years were included in the study. Dental casts were obtained, occlusal traits were recorded and DAI and DHC-IOTN were calculated. Cephalometric parameters were measured. Obtained data were compared between the two groups. RESULTS: In children with sickle cell disease, 24% had definite malocclusion according to DAI and only 4% of them had normal occlusion as per the DHC-IOTN index. Also, children with sickle cell had significant retruded mandible and vertical growth pattern when compared with normal children. CONCLUSIONS: Children with sickle cell disease showed delayed eruption of teeth, a tendency towards Class II molar relationship, with increased crowding in the lower anterior region, increased overjet and open bite when compared to the normal children. Children with sickle cell disease had severe and handicapping malocclusion as per DAI and DHC-IOTN indices and a tendency towards skeletal Class II with a vertical growth pattern.

Antimicrobial efficacy of photodynamic therapy, diode laser, and sodium hypochlorite and their combinations on endodontic pathogens.

BACKGROUND: Sterilization of the root canal system is of prime importance for a successful root canal therapy. Lasers and photodynamic therapy (PDT) have become the latest choice to eradicate microorganisms in the root canal. OBJECTIVE(S): To evaluate and compare the antimicrobial activity of diode laser, photodynamic therapy, and sodium hypochlorite along with their combinations on endodontic pathogens: Enterococcus faecalis and Streptococcus mutans. METHODS: A total of 120 uniradicular teeth were stored in 5.2% NaOCl solution to remove organic residues and the crowns were sectioned at the cemento-enamel junction (CEJ) to obtain root canal length of 15 mm. Canals were shaped using step-back technique up to #40 K-file and were autoclaved. The selected teeth (specimen) were randomly divided into two equal groups with sixty teeth being inoculated with E. faecalis (Group E) and remaining sixty teeth with S. mutans (Group S). Further, the groups were subdivided according to the disinfection technique used. Ten teeth from each subgroup were disinfected with a diode laser, photo activated disinfection (PAD), sodium hypochlorite, a combination of sodium hypochlorite and diode laser, a combination of sodium hypochlorite and photo activated disinfection respectively. Ten teeth in each group served as control without any disinfection. The treated specimens were transferred to test tubes containing 5 ml sterile Luria Bertani broth, incubated and the bacterial count, optical density in each root specimen was calculated and compared. The pairwise comparison of colonies across the subgroups was done by the Kruskal-Wallis test and within the subgroups was carried out using the Mann-Whitney U test. The statistical implication was tested at 5% and the study was performed using SPSS 18.0 ver. (SPSS Inc.). RESULTS: A significant reduction (98%) in the E. faecalis count was observed when the NaOCl was used in combination with the diode laser or PAD. PAD along with 3% NaOCl presents the advantage of utilizing a lower wavelength laser beam. Hence, PAD in combination with NaOCl can be an alternative and better option for root canal disinfection for both the endodontic pathogens, E. faecalis and S. mutans.

Acquisition of Streptococcus mutans and dental caries experience in pediatric sickle cell anaemia patients under various prophylactic therapies.

OBJECTIVES: To determine the acquisition of Streptococcus mutans and dental caries experience in children with sickle cell anaemia (SCA) under various prophylactic therapies. METHODS: This study involved a total of 200 children who were divided into five groups comprising of 40 children each. Group SP included children who received prophylactic penicillin, Group SV who received pneumococcal vaccination, Group SPV who received both prophylactic penicillin and pneumococcal vaccination, Group SW who did not receive any prophylactic therapy and Group CC who were controls. Stimulated saliva samples from volunteers were collected and cultured in Mitis Salivarius Bacitracin (MSB) agar for estimation of Streptococcus mutans. Decayed, Missing, Filled (DMFT) index/decayed, exfoliated, and filled tooth (deft) index was used for assessment of dental caries. RESULTS: Group SP, Group SV, and Group SPV showed statistically significant difference in Streptococcus mutans count and dental caries experience in children when compared to Group SW and Group CC (p < 0.05) with the maximum reduction in Group SPV. No significant differences were observed in Group SW and Group CC. CONCLUSIONS: Reduction in the Streptococcus mutans acquisition and dental caries experience was seen in children with SCA who received prophylactic therapy with the least acquisition in combination therapy (Group SPV).

RMS Pictorial Scale (RMS-PS): an innovative scale for the assessment of child's dental anxiety.

BACKGROUND: Dental anxiety assessment for young children is as important as performing their treatment. Appropriate knowledge of patient's anxiety boosts confidence and will help us to review potential management options specific to every child. AIM: This study aimed to validate (RMS) Pictorial Scale (RMS-PS) and to compare it with Venham Picture Test (VPT) and Facial image scale (FIS) in measuring dental anxiety for young children during their first dental visit. MATERIALS AND METHODS: A total of 102 healthy children aged between 4 and 14 years during their first dental visit were randomly selected for the study. Childs anxiety level was measured using three different scales namely (i) RMS-PS (ii) VPT, and (iii) FIS. STATISTICAL ANALYSIS: Student t test was used to compare the scores obtained from all the three scales. Pearson correlation test was used to obtain correlation among the scales used in the study. RESULTS: A strong correlation (0·76) was found between the VPT and RMS-PS, and a moderate correlation (0.5) was found between RMS-PS and FIS, indicating good validity for the RMS-PS. CONCLUSIONS: The findings of this study suggest that the RMS-PS can be a newer and easiest means for the assessment of dental anxiety for young children in a clinical context.

RURS' elbow guard: an innovative treatment of the thumb-sucking habit in a child with Hurler's syndrome.

Thumb sucking is the process of sucking on the thumb for oral pleasure. Thumb and finger sucking habits, or nonnutritive sucking, are considered to be the most prevalent of oral habits. Some parents are concerned by thumb sucking and may even try to restrain the infant or child. In most cases, this is not necessary. Most children stop thumb sucking on their own. When older children continue to suck their thumbs, it could mean they are bored, anxious, or have emotional problems such as depression. This article presents a case report of a child with Hurler's syndrome along with thumb sucking/biting habit. Hurler's syndrome, also known as mucopolysaccharidosis I, is a rare condition inherited as an autosomal-recessive trait. It represents the classical prototype of mucopolysaccharide disorder. A unique appliance to prevent thumb sucking/biting was developed and termed as "RURS' elbow guard," which was successfully used to break thumb sucking of the child with Hurler syndrome. The present report also describes the steps in fabrication of this new habit-breaking appliance, which is also designed to protect the finger from the effects of the sucking habit.

Gestational trophoblastic disease metastatic to the brain.

PURPOSE: To evaluate clinical characteristics, treatment technique, and results in patients with gestational trophoblastic disease metastatic to the brain. MATERIALS AND METHODS: From 1962 to 1994, 26 (4.1%) of 631 patients who underwent treatment for trophoblastic disease had or developed evidence of brain metastases (patients were aged 14-43 years). All patients received multiagent systemic chemotherapy and whole-brain irradiation. Total doses of radiation were 2,386-4,000 cGy (200-300 cGy per fraction). No patient received intrathecal chemotherapy. Patients were divided into three groups: group A, symptomatic brain metastases at presentation; group B, asymptomatic or minimally symptomatic brain disease at presentation; and group C, development of brain metastases during systemic chemotherapy. RESULTS: The overall 5-year actuarial survival rate was 51%. Multivariate analysis findings indicated that age, preceding pregnancy event, human chorionic gonadotropin level, World Health Organization score, performance of craniotomy, and number of brain metastases did not influence survival. The difference in the 5-year overall survival rates between groups A (39%) and B (100%) was significant (P = .03). CONCLUSION: Gestational trophoblastic disease metastatic to the brain is curable with systemic chemotherapy and whole-brain irradiation. The authors suggest treatment with steroids, chemotherapy (etoposide, high-dose methotrexate [1 g/m2], dactinomycin, cyclophosphamide, and vincristine sulfate), and concurrent whole-brain irradiation (3,000 cGy in 200-cGy fractions).

Role of radiation therapy in the management of carcinoma in situ of the larynx.

Twenty-one patients with carcinoma in situ of the larynx were treated with definitive irradiation from 1959 to 1987. The in situ changes were limited to 1 vocal cord in 19 patients, and to both vocal cords in 1 patient. One patient demonstrated extensive in situ changes involving the vocal cords bilaterally, as well as the anterior commissure, with both supraglottic and infraglottic extension. The mean follow-up from completion of treatment was 6.2 years, with a median of 50 months. Definitive irradiation resulted in a local control rate of 95%. The patient with extraglottic spread of in situ changes experienced a local failure 7 months after completion of treatment and, despite surgical salvage, died of local recurrence. This patient represents the only recurrence in our series. Our data suggest that radiation therapy can provide excellent control in carcinoma in situ limited to the true vocal cord.

Results of radiation therapy in early glottic carcinoma: multivariate analysis of prognostic and radiation therapy variables.

A detailed retrospective analysis was performed with 103 patients who had T1 carcinoma of the glottic larynx and underwent radiation therapy between 1960 and 1987. Prognostic and radiation therapy variables were analyzed including sex; age; staging procedures; mucosal extent; histologic grading of tumor; field size; use of wedges; treatment of alternate fields versus both fields every day; nominal standard dose; time, dose, and fraction; dose per fraction; total radiation dose per fraction; total radiation doses; and the impact of cord stripping. Initial local control was 89%, and ultimate control after surgical salvage was 97%, with a 5- and 10-year adjusted survival of 98%. Univariate analysis indicated that larger field size (P = .04), histologic grade (P = .02), and treatment strategy (P = .08) were of some value in predicting recurrence. Multivariate analysis indicated that field size (P = .03) was the only significant variable in predicting local recurrence. These data confirm that radiation is highly effective in the treatment of early laryngeal cancer.

The role of adjuvant irradiation following primary prostatectomy, based on histopathologic extent of tumor.

One hundred twenty-three patients who underwent primary prostatectomy at Northwestern Memorial Hospital during the-years 1976 to 1985 are reviewed. The patients were divided into three groups: Group 1 (50 patients) comprises patients with tumor well-contained within the prostate and without perineural, perivascular, or lymphatic (NVL) invasion; Group 2 (57 patients) comprises patients with more extensive tumor extending through or to the prostatic capsule, extending to or near the surgical margin, involving seminal vesicles, or having NVL invasion; Group 3 (16 patients) comprises those patients who received immediate postoperative irradiation. The actuarial 10-year local control rates of Group 1 (88%) and Group 3 (100%) were statistically superior to that of Group 2 (72%), p less than 0.05. The actuarial 10-year disease-free survival rate of Group 1 (72%) is statistically superior to that of Group 2 (56%), p less than 0.01; the difference in 10-year disease-free survival between Group 2 (56%) and Group 3 (64%) did not reach statistical significance. Ten-year actuarial survival statistics are 64%, 80%, and 76% for Groups 1, 2, and 3 respectively. There was no statistically significant difference in actuarial survival among any of the groups. Patients with tumor extending to or through the prostatic capsule, extending to or near the surgical margins, involving the seminal vesicles, or having NVL invasion all may benefit from adjuvant irradiation in the immediate perioperative period.

Adjuvant doxorubicin hydrochloride and radiation in stage D bladder cancer: a preliminary report.

The prognosis of patients with stage D bladder cancer is dismal. This report expands the results of our efforts to modify the clinical course of such patients by administration of doxorubicin hydrochloride sandwiched around pelvic radiation. Pathologic stage D bladder cancer was recognized in 19 patients by evaluation of tissue obtained by radical cystectomy and pelvic lymphadenectomy (8), pelvic lymph node dissection (5) or biopsies (3), ileal conduit and pelvic lymph node biopsy (1), or transurethral biopsy of the bladder and prostate (2). Treatment of these patients with doxorubicin hydrochloride before and after radiation was initiated 3 to 4 weeks postoperatively. The treatment regimen consisted of 1) 60 mg. per M.2 doxorubicin intravenously every 3 weeks for 3 cycles, 2) 5,000 rad external radiation to the entire pelvis in 5 to 6 weeks and 3) doxorubicin for 5 cycles. The observed survival rates were 37 per cent at 3 years and 28 per cent at 5 years. The median survival time was 16 months. Five patients had no evidence of disease 13 to 63 months postoperatively. One patient underwent salvage cystectomy for recurrent bladder carcinoma at 33 months and had no evidence of disease at 74 months. One patient was alive with recurrent disease at 13 months. Three patients who died did not complete the protocol owing to metastatic disease, 8 lived 6 to 52 months without recognized disease and died of metastases, and 1 died of a second primary. The extent of surgical excision was not associated significantly with survival. Of 8 patients treated with radical cystectomy 7 suffered a significant obstruction of the small bowel that required decompression or bypass surgery and all 7 recovered completely. These preliminary observations indicate encouraging results with a high but manageable morbidity for this regimen.

Treatment of stage D bladder cancer with adjuvant doxorubicin hydrochloride and radiation.

pathologic Stage D bladder cancer was recognized in 16 patients by evaluation tissue obtained by radical cystectomy and pelvic lymphadenectomy (7), pelvic lymph node dissection (3) or biopsies (3), ileal conduit and pelvic lymph node biopsy (1), or transurethral biopsy of the bladder and prostate (2). Treatment of these patients with radiation preceded and followed by doxorubicin hydrochloride (Adriamycin) was initiated three to four weeks postoperatively. The treatment regimen consisted of the following: (1) doxorubicin 60 mg/M2 intravenously every three weeks for three cycles; (2) 5,000 rad external radiation to the whole pelvis in five to six weeks; and (3) doxorubicin for five cycles. The mean survival was twenty-three months. The survival rate was as follows: one year, 10 of 15 patients at risk; two years, 6 of 11; three years, 5 of 9; four years, 1 of 4; and five years, 0 of 2. Ten patients died six to thirty-six months (mean 13.6) postoperatively. In 6 of the patients significant obstruction of small bowel developed. These preliminary observations indicate encouraging therapeutic results with an acceptable morbidity for this regimen.