Clinical Outcome of Direct Pulp Therapy in Primary Teeth: A Systematic Review and Meta-analysis.

Background: Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. Aim: To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Design: Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3-12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. Results: The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval -0.799-0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Conclusions: Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.

Comparative evaluation of antimicrobial efficacy of silver diamine fluoride, chlorhexidine varnish with conventional fluoride varnish as a caries arresting agent. An in vivo sodium dodecyl sulfate-polyacrylamide gel electrophoresis study.

INTRODUCTION: Silver diamine fluoride (SDF) is employed as an adjunct cariostatic agent in the management of dental caries in high-risk population. Other than fluorides, chlorhexidine (CHX) is the most potent antimicrobial and efficacious agent against Streptococcus mutans. AIM: The aim of this study is to evaluate and differentiate the efficacy of 38% silver diamine fluoride, CHX varnish, and fluoride varnish on carious primary teeth. MATERIALS AND METHODS: Ninety children having a count of ≥1 carious lesion were recruited. Thirty-eighty percent silver diamine fluoride or fluoride varnish and CHX varnish were topically applied on the lesion. The primary outcome measured was the arrest of carious lesion (lesion rendered inactive as per the Nyvad criteria) after a follow-up of 14-21 days. Dental biofilm sample was obtained from each child and subsequently assessed for microbial composition by colony-forming unit method before and after treatment followed by protein analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis method. RESULTS: Average proportion of arrested caries lesions in the SDF group was higher followed by CHX and fluoride varnish groups. Decreased total protein amount was found in SDF group. This proves that there is decrease in microbial load posttreatment in SDF group. CONCLUSION: Thirty-eight percent SDF is more effective than CHX varnish and fluoride varnish in arresting dentin carious lesions in young children.

Dental Anxiety Scales Used in Pediatric Dentistry: A Systematic Review and Meta-analysis.

AIM: To assess various dental anxiety scales used in children and to know the effectiveness of different projective dental anxiety scales used in pediatric dentistry. BACKGROUND: Dental anxiety poses a significant problem in child patient management and is considered to be the main barrier for successful completion of the dental treatment. REVIEW RESULTS: This systematic review and meta-analysis has been registered at the International prospective register of systematic reviews-PROSPERO-CRD42021247586. The systematic review was conducted in accordance with the Preferred Reporting Items in Systematic Review and Meta-Analysis (PRISMA) guidelines. Electronic databases [PubMed (MEDLINE), COCHRANE Library, EMBASE, EBSCO host, and Google Scholar database] were searched for corresponding references up to 2021. Observational cross-sectional studies comparing two different dental anxiety scales were selected for this systematic review. Search strategy generated 500 articles out of which 13 studies included in qualitative synthesis and only 7 studies were taken for quantitative synthesis. Among these seven studies, five studies compared FIS and VPT scales, two studies compared RMS, FIS, and VPT scales. Results of meta-analysis showed that an overall mean difference of dental anxiety between VPT and FIS scales was 0.11 (95% CI: 0.26-0.48), RMS and FIS scales was 0.05 (95% CI: 0.40-0.50), RMS and VPT was 0.27 (95% CI: 0.80-0.27) in the investigated population. CONCLUSION: No statistically significant difference was noted in all comparisons suggesting that all these scales are at par in assessing anxiety levels in pediatric population. CLINICAL SIGNIFICANCE: The projective scales Raghavendra, madhuriu, sujata pictorial scale (RMS), Facial image scale (FIS), and Venham's picture test (VPT) can be a pragmatic tool in assessing children's dental anxiety.

Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study.

BACKGROUND/INTRODUCTION: Cavity disinfection before restoration aids in reducing the number of residual bacteria, thus, decreasing the rate of secondary caries. Propolis, at low concentrations, inhibits the growth of cariogenic bacteria. Liquorice roots are known to have antimicrobial, anti-inflammatory, and antioxidant properties. AIM AND OBJECTIVES: Evaluation and comparison of antimicrobial efficacy of liquorice and propolis extract gels used as cavity cleaning agents against Streptococcus mutans in deciduous molars by confocal laser scanning microscopy (in vitro study). MATERIALS AND METHODS: Liquorice and propolis extracts were converted into gels after recording the minimum inhibition concentration. Class I cavity was prepared on 135 extracted deciduous molars and subjected to inoculation with S. mutans. Teeth were randomly divided into groups I, II, and III which were treated with gels of liquorice, propolis, and distilled water, respectively, for 60, 120, and 180 seconds each. Specimens were sectioned and stained with fluorescent dyes and observed under a confocal laser scanning microscopy (CLSM). The data obtained were statistically evaluated. RESULTS: The mean nonviable/viable bacterial count and the depth of penetration were found to be maximum in group I and minimum in group III. A statistically significant difference was found to be between groups I and II and groups I and III, while with groups II and III, it was nonsignificant at all 60, 120, and 180 seconds. The bacterial depth penetration between groups I and II at 180 seconds was nonsignificant. CONCLUSION AND CLINICAL SIGNIFICANCE: Though liquorice showed better antimicrobial potential as compared to propolis extract, both can be used efficiently as cavity disinfectants. HOW TO CITE THIS ARTICLE: Godbole E, Tyagi S, et al. Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(3):194-200.

Knowledge and Attitude of Parents towards Avulsed Permanent Tooth of their Children and its Emergency Management in Bhopal City.

INTRODUCTION: Dental avulsion is a commonly reported traumatic injury causing pain, aesthetic, functional, psychological and mental impairment. Since parents are in the immediate vicinity of children in such situations, their knowledge regarding the same is of great importance. AIM: The aim of present study was to assess the level of parental knowledge and their attitude towards dental avulsion and its emergency management. MATERIALS AND METHODS: A 10-stemmed questionnaire was prepared for this study which was modified form of questionnaire used by Raphael and Gregory. The questionnaire consisted of two parts and was provided in both English and Hindi languages. Parents had to mark one option provided to them in multiple choice questions, which they found to be right. A written consent according to ethical guidelines was taken by all the participants before filling up the questionnaire. The survey consisted of 550 parents who accompanied their children aged between 6 to 13 years in the Department of Pedodontics and Preventive Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India. Chi- square test was applied to evaluate the associations in this study. RESULTS: Statistically it was observed that 34.5% of male participants exhibited more knowledge regarding the necessity of reimplantation of avulsed tooth in comparison to female participants. Also parents with higher educational background have showed positive response toward knowledge and attitude of emergency treatment of avulsed permanent tooth. About 25.6% of higher secondary level, 20.9% of undergraduate level, 10.9% of elementary school level and 0.4% of illiterate participants responded that reimplantation of avulsed permanent tooth is possible. CONCLUSION: It was concluded from the study that regardless of the age, education level or other factors, parental knowledge of tooth avulsion management was found to be very low in our society. Parents who participated in this study reported having insufficient knowledge about dental trauma and unskilled to provide emergency care to their child.

Erosive effects of pediatric liquid medicinal syrups on primary enamel: An in vitro comparative study.

CONTEXT: The use of liquid medicinal syrups in childhood is high owing to the reasons that children suffer from illness quite often. The acidic component in the formulations may cause erosion to the dental tissues. AIMS: The aim of this study is to evaluate the erosive potential of pediatric liquid medicinal syrups on the deciduous teeth. SUBJECTS AND METHODS: A total of sixty extracted/exfoliated noncarious deciduous molars were used. Four medical syrups were used (viz., 1 - artificial saliva [control], 2 - Ferium XT, 3 - Crocin syrup, 4 - Ambrolite-D) and the teeth were equally divided into the four groups (n = 15) for the immersion cycle, following which the teeth were examined for surface microhardness at 7, 14, 21, and 28 days. STATISTICAL ANALYSIS USED: ANOVA and post hoc analysis were applied. RESULTS: The time and immersion media interaction demonstrated that antitussives produced a significant and gradual loss of surface microhardness on all days (viz., 7, 14, 21, and 28 days), but a statistically significant difference was seen only between 7th and 28th day (P < 0.05). CONCLUSIONS: The knowledge of the erosive potential of commonly used syrups is mandatory as erosion in children teeth may be associated with dental hypersensitivity, loss of the occlusal vertical dimension, eating difficulties, poor esthetics, pulp exposure, and abscesses. Mouth rinsing with water after taking the medication; addition of calcium, fluoride, or phosphate to formulations; and consumption of the medication at meal times have been recommended to avoid tooth damage that is caused by the regular use of medication.

Assessment of nickel release from various dental appliances used routinely in pediatric dentistry.

CONTEXT: The use of nickel-containing alloys in dentistry has been questioned because of the biological liabilities of nickel and the release of nickel ions from dental appliances into the oral cavity. The potential health hazards of nickel and chromium and their compounds have been the focus of attention for more than 100 years. It has established that these metals could cause hypersensitivity. AIMS: To assess the nickel release from various dental appliances used in pediatric dentistry. SETTINGS AND DESIGN: It is a in vitro study. MATERIALS AND METHODS: The study was undertaken to analyze in vitro biodegradation of space maintainers and stainless steel crowns made out of stainless steel materials from different manufacturers. The leaching effect simulating the use of clinical practice was studied by keeping the respective number of Stainless Steel Crowns and space maintainers in the artificial saliva incubating at 37°C and analyzing for nickel release after 1,7,14,21 and 28 days using atomic absorption spectrophotometer. STATISTICAL ANALYSIS: The results were statistically analyzed by using One way ANOVA and repeated measures of ANOVA was applied at different time intervals i.e. 1,7,14,21,28 days. The critical value for statistical significance was set at P = 0.05. RESULTS: Results showed that there was measurable release of nickel which reached maximum level at the end of 7 days which was statistically significant (P < 0.05). CONCLUSIONS: The release of nickel and chromium very much below when compared with the average dietary intake of nickel (200-300 ppm/day) which were not capable of causing any toxic effects.

A rare case of gingival fibromatosis associated with hypertrichosis and a dysmorphic face.

Several forms of hypertrichosis have been described with and without gingival hyperplasia; some of them are recognized as genetic disorder and associated with syndromes. In all reported cases the most striking differences from other are the craniofacial features. We present a case of a 6-year-old boy with hypertrichosis associated with gingival hyperplasia and a characteristic, coarse face and we consider this case to be a distinctive entity.