Morphological variations of the condylar head among children aged 4-15 years: A panoramic study.

BACKGROUND: Growth and development of dentocraniofacial complex occurs during various stage of development of dentition with TMJ as one of its centres of growth. The condition of temporomandibular joint can be visible from its condylar head form; therefore, it is crucial to recognize the normal morphology of condylar head during different stages of development of dentition. AIMS: The aim of the study is to view the morphological appearance of condylar head during primary dentition, mixed dentition and permenant dentition. SUBJECT AND METHODS: 400 panoramic images of 194 boys and 296 girls were collected and were divided into three groups bases on the stage of dentition. Shape of the condylar head were determined by tracing the print out of the panoramic image on an X ray viewer. RESULTS: The study showed that during primary dentition stage shape of the conylar head was dominated by round shape and as growth and development occurs the condylar head shape changes to convex. CONCLUSION: The study describes the normal morphology of mandibular condyles in a child population attending The dentition status as well as growth of craniofacial has a significant role in determining condylar morphology.

Relationship between chronological age, dental age, and body height using Demirjian method among children aged 4-14 years in Pune - A radiographic study.

CONTEXT: The assessment of dental age is useful in the planning of orthodontic treatment, in pediatric dentistry, pediatric endocrinology, and forensic medicine. It is essential for a pediatric dentist to formulate treatment plan and it is a source of complementary information for pediatrician. Changes in the body proportion and composition are the essential elements of growth, especially maturation. AIMS: The present study was aimed to correlate the chronological age, dental age, and body height in children from Pune region of Maharashtra, India. SUBJECTS AND METHODS: : Four hundred and thirty-one panoramic radiographs of 177 boys and 254 girls in the age group of 4-14 years were obtained. Chronological age was assessed by recording date of birth. Dental age assessment was done using orthopantamogram following the method described by Demirjian. Body height was recorded using a measuring tape. RESULTS: Chronological age and dental age showed significant positive correlation between male and female sample, i.e., r = 0.905 for males and r = 0.901 for females. Statistically significant correlation was observed between calculated dental age and body height. CONCLUSIONS: In the present study, it can be concluded that the Demirjian method of dental age assessment showed high accuracy when applied to pediatric population in Pune.

In vivo Comparative Evaluation of Mineral Trioxide Aggregate and Formocresol Pulpotomy in Primary Molars: A 60-month Follow-up Study.

INTRODUCTION: Pulpotomy is a regular procedure in the management of inflamed primary teeth. Diverse materials have been reviewed for the pulpotomy, some of them being formocresol, glutaraldehyde, ferric sulfate, and mineral trioxide aggregate (MTA). AIMS: The aim was to evaluate and compare clinically and radiographically the effects of MTA as a pulp dressing after coronal pulp amputation (pulpotomy) in primary molars. SETTINGS AND DESIGN: Sixty primary molars of thirty healthy children using split mouth design aged between 4 and 6 years were treated by pulpotomy technique. SUBJECTS AND METHODS: Sixty primary mandibular molars of thirty healthy children aged between 4 and 6 years were treated by pulpotomy technique. The teeth on the right side were assigned to MTA (Group A) and the left side for the formocresol (Group B). The children were then examined clinically and radiographically every 6 months. Statistical analysis used: Chi-square test using the SPSS version 19.0 was used to compare between the two groups. RESULTS: Results showed that both MTA and formocresol have the same outcome on the primary molars, with Chi-square value being 1.1483 (P ≥ 0.05). None of the teeth in any children in the study showed any clinical pathology. CONCLUSION: The principle conclusions of this study are that there are no significant differences in MTA and formocresol. The success rate of MTA and formocresol pulpotomy can be considered comparable till this therapy influences the development and growth of the permanent teeth.

Catalase and sodium fluoride mediated rehabilitation of enamel bleached with 37% hydrogen peroxide.

BACKGROUND: Bleaching agents bring about a range of unwanted changes in the physical structure of enamel which needs to be restored qualitatively and timely. Catalase being an antioxidant ensures the effective removal of free radicals and improvement in fluoride mediated remineralization from the enamel microstructure which if retained may harm the integrity and affect the hardness of enamel. MATERIALS AND METHODS: Thirty freshly extracted incisors were sectioned to 6 slabs which were divided into 5 groups: Group A, control; Group B, treatment with 37% hydrogen peroxide (HP); Group C, treatment with 37% HP and catalase, Group D, treatment with 37% HP and 5% sodium fluoride application, Group E, treatment with 37% HP followed by catalase and 5% sodium fluoride. Scanning electron microscope and microhardness analysis were done for all slabs. One-way ANOVA test was applied among different groups. RESULTS: Vicker's microhardness number (VHN) of Group B and C was significantly lower. No significant difference between VHN of Group B and C. VHN of Group D was significantly higher than Group A, B, and C; but significantly lower than Group E. VHN of Group E was significantly higher than any other experimental group. One-way ANOVA revealed a highly significant P value (P = 0.0001) and so Tukey's post-hoc Test for the group comparisons was employed. CONCLUSION: Subsequent treatment of bleached enamel with catalase and fluoride varnish separately results in repairing and significantly increasing the microhardness.

Effect of Catalase and Sodium Fluoride on Human Enamel bleached with 35% Carbamide Peroxide.

AIM: To evaluate the effects of postbleaching antioxidant application fluoridation treatment on the surface morphology and microhardness of human enamel. MATERIALS AND METHODS: Ten freshly extracted human maxillary central incisors were cut at cementoenamel junction. Crown portion was sectioned into six slabs which were divided into five groups: group A - untreated controls; group B - 35% carbamide peroxide (CP); group C - 35% CP and catalase; group D - treatment with 35% CP and 5% sodium fluoride; group E - 35% CP, catalase and 5% sodium fluoride. Thirty-five percent carbamide peroxide application included two applications of 30 minutes each at a 5-day interval. After treatment, the slabs were thoroughly washed with water for 10 seconds and stored in artificial saliva at 37°C until the next treatment. Two percent sodium fluoride included application for 5 minutes. Three catalase included application for 3 minutes. RESULTS: After 5 days, groups B and C showed significantly decreased enamel microhardness compared to control. Group D specimens showed relatively less reduction in enamel micro-hardness than group C specimens. There is a marked increase in enamel microhardness in group E specimens. CONCLUSIONS: Fluoride take up was comparatively enhanced after catalase application resulting in less demineralization and increased microhardness. How to cite this article: Thakur R, Shigli AL, Sharma DS, Thakur G. Effect of Catalase and Sodium Fluoride on Human Enamel bleached with 35% Carbamide Peroxide. Int J Clin Pediatr Dent 2015;8(1):12-17.

Juvenile obsessive compulsive disorder in a paediatric dentistry set-up.

Obsessive-compulsive disorder (OCD) is an anxiety disorder comprising uncontrollable thought processes and repetitive, ritualised behaviours that one feels compelled to perform. If an individual has OCD, he/she probably realises that his/her obsessive thoughts and compulsive behaviours are irrational but would still feel unable to resist them. Since a pedodontist's association with the child patient and parents is established at quite an early age, they should make good use of the opportunity to diagnose psychological disorders in child patients as well as adolescents. Prompt diagnosis in such cases would enable timely medical intervention and hence help in achieving a more cooperative dental patient to ensure instillation of a positive dental attitude. This endeavour highlights a case of a 10-year-old boy who had reported to a private dental set-up with dental problems and was concurrently diagnosed for OCD.

Assessment of the changes in the stress-related salivary cortisol levels to the various dental procedures in children.

BACKGROUND: Fear and pain are the factors producing stress and there is evidence that dental fear acquired in childhood may persist to influence adult behavior. Dental treatment is often considered as anxiety producing and stressful. AIM: To assess the levels of stress displayed by the healthy children undergoing routine dental procedures like oral examination, restoration, and extraction by analyzing salivary levels of cortisol before, during, and after the procedures. MATERIALS AND METHODS: Twenty healthy children aged between 4 and 8 years having their first dental visit and requiring at least one restoration and one extraction were selected. In each patient, three procedures were carried out: (i) Routine dental examination, (ii) restoration, and (iii) extraction. Unstimulated salivary samples were collected 10 min before, during the procedure, and 30 min after each procedure at three different visits for comparison of cortisol production in response to anxiety and stress over time. Total 180 samples were collected to determine salivary cortisol levels using UBI-MAGIWEL TM kit and the readings were noted. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS) software with paired t-test, two independent sample t-tests, and analysis of variance (ANOVA) were used to analyze the findings. RESULTS: A correlation between salivary cortisol and stress in dental procedure was noticed. Cavity preparation is more stressful procedure in children, so alternative methods can be used in anxious children. Stress associated with extraction persists to a postoperative period. No correlation exists in between Corah's anxiety scale and salivary cortisol.

Vacuum formed splints: Novel method for managing oro-facial trauma.

OBJECTIVE: Trauma to the oro-facial structures in children is different from trauma in adults. There are several points of differentiation between the two, the most important being growth. AIM: The purpose of this paper is to present the advantages of a vacuum-formed splint which was chosen as a practical and effective conservative treatment approach for the management of maxillofacial trauma. CASE REPORT: A 9-year old boy reported to the department of pediatric and preventive dentistry with right mandibular parasymphyseal fracture. The trauma presented with the unique challenge to save and support the unerupted and developing tooth buds. Therefore, a vacuum-formed splint was fabricated and cemented in place for the next 4 weeks. CONCLUSION: The splinting method used for stabilization of the injured teeth is an important issue in trauma therapy to support the periodontal healing. Pediatric maxillofacial traumas require different clinical treatment strategies compared with fractures of the adult population.

Evaluation of marginal alveolar bone height for early detection of periodontal disease in pediatric population: clinical and radiographic study.

OBJECTIVES: To establish a normal range for the radiographic distance between cementoenamel junction and alveolar bone crest and the factors affecting distances for the early assessment of periodontal disease in Dravidian pediatric population. METHODS: Fifty children aged 6 to 8 years were selected based on inclusion and exclusion criteria. Clinical and radiographic examination was performed. All the surfaces were examined starting from the distal surface of primary canine to the mesial surface of first permanent molar. The various risk factors like plaque, calculus, proximal caries, restoration and bleeding on probing were recorded. A pair of bitewing radiographs was taken for each child. Bitewing radiographs were traced and analyzed. RESULTS: It showed that CEJ-ABC distance in primary teeth is about 1 ± 0.5 mm. In the permanent teeth, it was found to be 0.6 ± 0.5 mm in 6 to 8 years age group. CEJ-ABC distance was also affected by different variables like physiologic (eruption and exfoliation) and pathologic factors (plaque, calculus, dental caries, restorations, stainless steel crowns, bleeding on probing and probing depth). CONCLUSION: CEJ-ABC distances greater than 2.5 mm should be considered under recall and follow-up. Children and adolescents susceptible to periodontal disease should be identified by radiographic means as early as possible in order to prevent the advance of an otherwise possibly destructive disease. The concept of oral health examination and treatment must include examination of the periodontal status of the patient.

Missed canal...call from radix entomolaris.

A comprehensive understanding of root and root canal morphology of primary teeth is valuable for successful endodontic therapy. A supernumerary root is a developmental anomaly which can affect any tooth. An extra root placed lingually (radix entomolaris) or buccally (radix paramolaris) can be seen in mandibular molars nonetheless; bilateral association of an additional root in deciduous mandibular molars is rare. This report aimed to describe the diagnosis, significance and management of an extra root in deciduous mandibular molars bilaterally in perspective of modern clinical paediatric endodontics.

Repositioning a laterally luxated maxillary central incisor with a vacuum-formed splint: a case report.

Splinting is the standard care for stabilizing replanted or repositioned permanent teeth following trauma. Traditionally, semirigid splints are used to stabilize a repositioned tooth, with support provided by adjacent teeth. However, in cases when the adjacent teeth are wide and/or can only provide minimal anchorage and support, it is difficult to fix the luxated tooth to its original position. This case report describes how a clear vacuum-formed splint was used to reposition and stabilize an avulsed maxillary left central incisor. Due to the avulsion, an unerupted canine, and partially erupted premolars, it was difficult to fabricate a traditional splint, hence the creation of the vacuum-formed splint.

Prosthodontic management of patients with Christ-Siemens-Touraine syndrome.

Christ-Siemens-Touraine syndrome also known as anhidrotic ectodermal dysplasia. Ectodermal dysplasia is a hereditary disorder characterised by developmental dystrophies of ectodermal derivatives. It is characterised by triad of signs comprising sparse hair, abnormal or missing teeth and inability to sweat. Anodontia or hypodontia is the most striking dental manifestation. In severe hypodontia, there is lack of alveolar development with consequent protrusion and eversion of the lips. The case of three children with anhidrotic ectodermal dysplasia with partial anodontia is presented. Dental, oral and physical features were taken into consideration in diagnosis and different treatment modalities for this patient. Clinical management consisted of removable partial prosthesis in maxillary arch and complete denture prosthesis in mandibular arch. The main aim of the treatment was to improve psychological development and to promote better functioning of the stomatognathic system.

Comparative evaluation of formocresol and mineral trioxide aggregate in pulpotomized primary molars--2 year follow up.

AIM: The aim of the present study was to clinically and radiographically evaluate Mineral Trioxide Aggregate (MTA) as an agent for pulpotomy in primary teeth and to compare it with that of Formocresol (FC) pulpotomy. METHOD: Seventy first and second primary mandibular molars of children were chosen on patients who required minimum two pulpotomies in either arch or same arch. After the standardized technique of Pulpotomy with MTA and Formocresol, all molars were treated with a thick mix of Zinc oxide Eugenol cement into the coronal pulp chamber followed by preformed stainless steel crown. The children were followed up for clinical and radio graphical examination after 6, 12 and 24 month for Pain, Swelling, Sinus/fistula, Periapical changes, Furcation radiolucency and internal resorption. RESULTS: MTA represents 97% clinical success rate in comparison to Formocresol with 85% success. Radiographically also MTA showed more promising results with 88.6% success in comparison to Formocresol with 54.3%. CONCLUSIONS: Thus, MTA pulpotomy has emerged as an easier line of treatment to save the premature loss of primary teeth due to caries or trauma.

Prosthetic rehabilitation of a preschooler with induced anodontia - A clinical report.

A case of prosthetic rehabilitation with complete dentures for a three year nine months old child is presented. Dental prosthesis are frequently used to avoid psychologic, speech, or swallowing problems in preschooler children. The case was followed up for a period of three years. These prosthesis were modified as the child grew and as the permanent teeth erupted into the oral cavity the dentures were trimmed from the areas of erupting teeth to facilitate their eruption.

Management of traumatic intrusive luxation of incisors in a patient with Down's syndrome.

Special needs individuals are children or adults who are prevented by a physical or mental condition from full participation in the normal range of activities of their age groups. They usually exhibit high treatment needs because of an increased prevalence and severity of trauma. This paper presents a case report and review of treatment strategy of repositioning, splinting of permanent incisors in a 13-year-old boy with Down's syndrome sustaining trauma led to intrusive luxation of maxillary incisors. The intruded incisors were immediately repositioned and splinted with composite within hours.

Happy Puppet syndrome.

Happy Puppet syndrome is characterised by a partial deficit of paired autosomal chromosome 15. It is a neuro-genetic disorder characterised by intellectual and developmental delay, sleep disturbance, seizures, jerky movements (especially hand-flapping), frequent laughter or smiling and usually a happy demeanour. It is also called as Angelman syndrome (AS). People with AS are sometimes known as 'angels', both because of the syndrome's name and because of their youthful, happy appearance. A 6.5-year-old girl is presented and clinical suspicion of AS was raised at the age of 4 years when she presented with mental retardation and epilepsy, absence of speech, inability to gait and unprovoked episodes of laughter. Fluorescent in situ hybridisation chromosomal analysis revealed micro deletion on the maternally derived allele of 15q chromosome.

Oral submucous fibrosis in a 9-year-old Indian girl.

Oral submucous fibrosis (OSMF) is a premalignant condition strongly associated with the practice of chewing areca nut, a habit common among South Asian population. It is characterised by inflammation, increased deposition of submucosal collagen and formation of fibrotic bands in the oral and paraoral tissues, which increasingly limit mouth opening. A case of OSMF occurring in a 9-year-old Indian girl is presented. This paper discusses the aetiology, clinical presentation and treatment modalities of oral submucous fibrosis.

Dental aesthetic index: applicability in Indian population: a retrospective study.

A variety of indices have been developed to assist professionals in categorizing malocclusion according to treatment needs. Dental aesthetic index (DAI) is one such index. DAI quantifies the normal variations usually seen and the dentofacial anomalies. A retrospective study on hundred available and treated cases was carried out on the casts. This survey was mainly carried out to determine the role of pedodontist in early identification of dental anomalies using DAI and sound referral of the patient to the orthodontist for better comprehensive care during the growth period in children. The materials used to collect data included periodontal probe with millimeter markings, ruler, calipers, pencil, and eraser. The results showed that when grouped according to various malocclusion severity levels by DAI, 3% had no or minor malocclusion indicating no or slight need of treatment, 15% had definite malocclusion and the treatment needed was elective, 27% had severe malocclusion and treatment was highly desirable, and remaining 55% of the casts had very severe or handicapping malocclusion and the treatment was mandatory. This study shows that DAI can be effectively used to evaluate and recognize the orthodontic needs of Indian children with permanent dentition and treated at an early stage so that the treatment is more effective.

Comparative evaluation of slot versus dovetail design in class III composite restorations in primary anterior teeth.

The esthetic restorations of primary anterior teeth have always occupied an important part of the pediatric dentist's armamentarium. Various materials have been tried for this purpose and ample materials have been researched in an attempt to fulfill the prerequisites for an ideal esthetic restorative material.Composite resins have been traditionally noted to have decreased bonding ability to primary teeth and the use of secondary retentive features has been advocated to increase bonding. Fifty pairs of anterior class III carious teeth were selected having mirror image lesions on their contralateral proximal surfaces. These teeth were prepared with either a slot or a modified dovetail type of cavity preparation. The patients were then kept on recall to check the clinical characteristics of the restorations at 3, 6, and 12 months. The criteria for evaluation included marginal adaptation, anatomic form, surface discoloration and secondary caries. It was concluded from the results that the both slot and dovetail types of cavity preparations were equally effacious when clinically reviewed for a period of 12 months. Hence the use of slot type of cavity preparation with reduced loss of the tooth structure is indicated for class III cavities in primary anterior teeth.