Comparison of clinical performance of obturating materials in pulpectomies: A randomized clinical trial.

BACKGROUND: Chemomechanical debridement is insufficient to disinfect all bacteria from the root canals of primary teeth, and obturation of canals with an appropriate material thus acquires excellent importance and remains a critical step in the ultimate success of pulpectomy. AIM: The aim of the study was to compare and evaluate Endoflas, Metapex, and a mixture of calcium hydroxide (CH) and zinc oxide (ZnO) as obturating materials (OMs) in primary mandibular second molars. MATERIALS AND METHODS: Seventy-five mandibular second primary molars requiring pulpectomies were identified in children aged 4-8 years. They were randomly allocated to the three treatment groups according to the type of OM received using the block randomization technique. After the completion of chemomechanical debridement, the canals were filled with Endoflas, Metapex, and CH-ZnO mixture, respectively. The intergroup clinical and radiographic comparison was made based on Coll and Sadrian criteria to decipher their clinical performance at 1, 3, and 6 months. RESULTS: No statistically significant differences between the groups were observed at any evaluation time interval (P > 0.05). At 6 months, the clinical success rates were 95.2% in Endoflas, 96% in Metapex, and 95.8% in the CH and ZnO mixture groups, respectively. The materials, however, behaved differently in different clinical situations. CONCLUSION: Based on the observations, all three OMs showed similar clinical success in maintaining tooth functioning, but their use can be restricted to indications. However, prospective studies with longer follow-ups with more stringent eligibility criteria are required to reach more definitive conclusions.

Central Odontogenic Fibroma of the Mandible in a 9-year-old Child: A Case Report with 24-month Follow-up.

Background: Central odontogenic fibroma (COF) is a rarely benign tumor with an incidence of only 0.1% among all odontogenic tumors, which commonly involve the mandible. Case description: A 9-year-old child reported with asymptomatic bony expansion of the mandible, showing an unilocular radiolucency on an orthopantomogram. The tumor was managed surgically by enucleation, and the surgical stent was placed, which was later modified as a removable functional space maintainer. The patient was followed up for 24 months with the complete healing of periapical radiolucency and the eruption of displaced permanent tooth to the proper position. Conclusion: This case report discusses the importance of the dentist in assessing and diagnosing COF, especially in the pediatric age group.

Firecracker Maxillofacial Injury in a 6-Year-Old Child- A Case Report.

The present case report highlights the management of a 6 years old female child who suffered oral and maxillofacial injury due to explosion of a fire cracker inside the mouth which was managed by primary closure after complete debridement and to prevent the post treatment microstomia, a modified microstomia prevention intraoral prosthetic appliance was given and followed up for 15 months.

Replantation of a Iatrogenically Avulsed Mandibular Premolar Undergoing Orthodontic Therapy: A 5 Year Follow-Up.

The succedaneous permanent teeth develop in close proximity to primary teeth. They can get accidentally luxated or avulsed during the extraction of primary teeth. The purpose of this paper was to describe a case of a 14-year-old boy with an "iatrogenic avulsion" of an immature mandibular second premolar during the extraction of a primary mandibular second molar. The case was managed successfully with replantation technique within 30 minutes of extra oral period and followed up for 5 years. The replanted tooth remained clinically asymptomatic, showed continued root development and eruption and remained vital. This paper had also discussed about the modifications in extraction technique to avoid the iatrogenic avulsion of permanent tooth bud during extraction of primary teeth.

Oral Health-related Quality of Life of Children with Early Childhood Caries before and after Receiving Complete Oral Rehabilitation under General Anesthesia.

Introduction: Early childhood caries (ECC) significantly affects the quality of life of children due to recurrent pain, infection, and other associated problems. Aim and objective: To assess the change in oral health-related quality of life of children aged <5 years undergoing complete oral rehabilitation under general anesthesia. Materials and methods: A total of 50 healthy children affected with ECC were enrolled for the present study. Oral health-related quality of life (OHRQoL) of every child was assessed by interviewing the mothers using a prevalidated Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire one day prior to the treatment appointment and comparing the scores with those at 1 and 3 months post-treatment to evaluate the changes in the OHRQoL, if any and assess the stability of the changes. Results: The results revealed a statistically significant reduction in Ouality of Life (QoL) scores of all the domains and total ECOHIS scores between baseline and 1 month, and baseline and 3 months. Conclusion: The oral health-related quality of life showed a significant improvement after complete oral rehabilitation under general anesthesia and the improvement persisted beyond the immediate post-treatment period. How to cite this article: Raghu R, Gauba K, Goyal A, et al. Oral Health-related Quality of Life of Children with Early Childhood Caries before and after Receiving Complete Oral Rehabilitation under General Anesthesia. Int J Clin Pediatr Dent 2021;14(S-2):S117-S123.

Safety and Efficacy of IV Dexmedetomidine as an Adjunct to Propofol to Sedate Anxious and Uncooperative Pediatric Dental Patients: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the safety and efficacy of dexmedetomidine (dex) as an adjunct to propofol sedation in pediatric dental patients. STUDY DESIGN: This RCT enrolled 30 anxious ASA-I 2-5 year olds. Allocated into 2 groups either receiving IV propofol (1 mg/kg)(Gp-P) or [IV dex (1ug/kg) with propofol(1 mg/kg)] (Gp-D) after oral midazolam premedication (0.5 mg/kg). Sedation maintained with propofol infusion at 50-75ug/kg/min. Additional bolus/es of propofol (1mg/kg) was/were administered in case of inadequate sedation. Primary outcome was to compare requirement of propofol in two groups. Secondary outcomes were to compare vital signs, depth of sedation, induction, treatment and recovery time, intra & post-operative complications and analgesic requirement post-operatively. RESULTS: Total propofol (in mgs) used and number of additional boluses were significantly higher in group P (p<0.05). Although within normal limits, heart rate was significantly lower in group D. Respiratory rate, oxygen saturation, NIBP were comparable. Depth of sedation achieved was comparable at all steps (p>0.05). Induction time (mins) was significantly lower in Group P (p<0.05), however treatment and recovery time were similar (p>0.05). Desaturation was observed in 3/15(group P) & 0/15(group D). Analgesic requirement post-operatively was significantly higher in group P (p<0.05). CONCLUSION: Dexmedetomidine is a safe and effective adjunct to propofol.

Effect of specially designed oral health preventive programme on oral health of visually impaired children: use of audio and tactile aids.

INTRODUCTION: Contemporary methods of teaching oral hygiene for the removal of dental plaque are not beneficial for visually impaired children, who depend on tactile sensations and hearing for learning. The present study was conducted to educate and motivate visually impaired children to maintain their oral health using specially designed methods that are easy for these children to understand. Additionally, the study evaluated the effectiveness of these methods over a 6-month period. METHODOLOGY: The investigation was done on 148 visually impaired children who were residents of two institutes for the visually impaired. The efficacy of a specially designed oral health education programme and two different motivational techniques utilising tactile (Group I: braille + plastic models) or auditory sensations (Group II: audio story + JAWS® , i.e. Job Access With Speech) was evaluated over 6 months based on the children's plaque and gingival scores. RESULTS: Significant improvement in mean plaque and gingival scores was evident in both the groups at the 6-month evaluation, validating the effectiveness of both the programmes. In Group I, the mean plaque score decreased from 1.34 ±â€…0.29 at baseline to 1.09 ±â€…0.26 at 3 months, with a further decrease to 1.04 ±â€…0.31 at 6 months post-implementation (P < 0.01). The mean plaque score in Group II decreased from 1.24 ±â€…0.47 at baseline to 1.15 ±â€…0.15 at 3 months (P = 0.12), and further to 1.10 ±â€…0.17 at 6 months (P < 0.01) post-implementation of the educational programme. At baseline, 87.8% of the children in Group I had moderate gingivitis, whereas 52.7% of the children in Group II belonged to the mild category. At the end of 6 months, 52.7% of the children in Group I were in the mild category, and 62.2% children in Group II were in the moderate category. CONCLUSION: Tactile and auditory measures were found to be effective in educating and motivating visually impaired children regarding maintenance of oral hygiene.

Comparative evaluation of three different recording criteria of dental fluorosis in a known endemic fluoride area of Haryana.

Background & objectives: Various indices are available to record different grade of severity of dental fluorosis. These indices have chances of inter- and intra- examiner variability. Therefore, study was conducted to compare three different indices for recording dental fluorosis to find out the best and most practical index of recording dental fluorosis for field studies in children living in a fluoride endemic area. Methods: The severity grades were recorded in 300 schoolchildren aged 12-15 yr having dental fluorosis of low, medium and high fluoride areas using three different indices, viz. Dean's fluorosis index (1942), tooth surface index for fluorosis (TSIF, 1984) and ICMR index (2013). Dean's index was used as gold standard. Results: The occurrence of moderate and severe cases was higher as per the Dean's index and of mild and severe cases was higher as per the TSIF and the ICMR index. The mean time required for recording dental fluorosis as per Dean's index and TSIF was similar and almost double (1.25±0.05 min) of that required for ICMR index (0.68±0.20 min). The intra-examiner variability was found to be least in the ICMR index compared to Dean's index and TSIF. Interpretation & conclusions: The ICMR index is a simple index with objective scores and takes less time in recording the dental fluorosis as compared to Dean's index and TSIF in field studies.

Management of prematurely erupted teeth in newborns.

The majority of natal and neonatal teeth are prematurely erupted primary teeth, whereas few are supernumerary in origin. They most commonly occur in mandibular central incisor region and often can lead to difficulty to the mother during breast feeding and tongue ulceration in newborn. Moreover, since majority of these have poorly developed roots and are mobile, there is always a fear of aspiration into respiratory passage. Extraction therefore is the most commonly rendered treatment for these teeth. This paper comprises cases of natal and neonatal teeth describing about their clinical characteristics and sequel. This paper has also highlighted the factor which needs to be considered during the management of natal/neonatal teeth and protocol followed at our centre.

Dentofacial characteristics in a child with Meier-Gorlin syndrome: A rare case report.

Meier-Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by the triad of microtia, absent or small patellae and short stature. The other associated clinical features may include developmental delay, congenital pulmonary emphysema, gastro-esophageal reflux, urogenital anomalies, such as cryptorchidism and feeding problems. The facial characteristics during childhood are typical, comprising of a small mouth with full lips and micrognathia/retrognathia. The condition is rare affecting about one to nine individuals per million. Mutation in the genes of pre-replication complex involved in DNA-replication is detected in the majority of patients. This impedes the cellular proliferation resulting in a reduction of total cell number and thereby retardation of overall growth. This case report describe the typical dentofacial characteristics in a 5 years old child affected with Meier-Gorlin syndrome along with other associated anomalies and a multidisciplinary approach for their management.

Clinical Performance of Indirect Composite Onlays as Esthetic Alternative to Stainless Steel Crowns for Rehabilitation of a Large Carious Primary Molar.

OBJECTIVE: The aim of the present study was to evaluate the clinical performance of indirect resin composite onlays (IRC onlay) compared to stainless steel crowns (SSCs), as an esthetic alternative for rehabilitation of extensively carious primary molars. STUDY DESIGN: Fifty pediatric patients each received either IRC onlay or SSC randomly on extensively carious endodontically treated primary molars. All the restorations were evaluated at baseline and then every 6 months till 36 months using 'modified FDI criteria' for retention, marginal integrity, occlusion, proximal contact, secondary caries and gingival health. The dental chair side treatment time and post-operative acceptability were also evaluated for both the groups. RESULTS: The cumulative survival rate of IRC onlays was 82.9% compared to 90.7% for SSCs over a time period of 36 months. The difference between the two study groups at various time intervals in terms of retention, marginal integrity, secondary caries, proximal contact, occlusion and gingival health was not statistically significant (p>0.05). The IRC onlays required significantly less mean chair side treatment time and were preferred the most by parents and children as per VAS scores compared to SSCs. CONCLUSION: IRC onlays are an acceptable esthetic alternative to SSCs and may be considered for use in aesthetically conscious children/parents as per their preference.

Oral Midazolam Sedation For Uncooperative Children In Outpatient Paedodontics: Time For Reappraisal.

Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'.

Effect of oral-transmucosal midazolam sedation on anxiety levels of 3-4 years old children during a Class II restorative procedure.

AIM: A double-blind randomized control trial was conducted to assess the effect of oral-transmucosal midazolam sedation on changes in anxiety levels of precooperative children during a Class II amalgam restorative procedure. METHODOLOGY: A sample of 40 healthy, American Society of Anesthesiologists I, children aged 3-4 years having at least one carious primary mandibular molar requiring a Class II amalgam restoration with no previous dental history were randomly divided into experimental and control groups comprising of 20 children each. The children in the experimental group (Group I) received 0.5 mg/kg body weight of midazolam mixed in strawberry syrup and those in the control group (Group II) received the same syrup mixed in saline, 15 min prior to the restorative procedure. Routine nonpharmacological behavior management techniques were used in both groups. The anxiety levels were recorded using Venham's anxiety scale at the start and end of each procedural step. RESULTS: There was a significant (P < 0.001) reduction in the anxiety levels of children in the experimental group on entry into the operatory compared with the control group. Introduction of each fear evoking stimuli showed a somewhat similar increase in anxiety levels in the two groups. In spite of a similar trend, the anxiety levels remained much lower in Group I than in Group II. CONCLUSION: Midazolam in conjunction with behavior management is more helpful in relaxing the child initially than behavior management alone, thus increasing the chances of successful and easy accomplishment of further treatment steps.

Habitual biting of oral mucosa: A conservative treatment approach.

Chronic biting of oral mucosa is an innocuous self inflicted injury, commonly seen in children suffering from developmental and psychological problems and has rarely been reported in normal unaffected individuals. The management strategies vary from counseling, prescription of sedatives to different prosthetic shields. The paper highlights the efficacy of a simple approach using soft mouth guard in the management of self inflicted lesions due to habitual biting of oral mucosa in two normal healthy children.

Orthodontic movement of a maxillary central incisor with a horizontal root fracture treated using an intra-radicular fibre splint.

This paper reports the case of a 15-year-old boy with a horizontal root fracture in the left maxillary central incisor along with class II division 1 malocclusion for whom a fixed orthodontic treatment was planned. The fracture was present at the junction of apical and middle-third as a result of trauma 2 years back. No splinting was carried out at that time and the tooth was found to be vital, asymptomatic and showed a type-1 repair pattern. An intentional root canal treatment was carried out for placement of an intra-radicular fiber splint, nearly 3 mm beyond the fracture line. Orthodontic treatment was initiated after a month; to which the fractured and splinted tooth responded successfully. This report highlights the successful use of an intra-radicular splint for horizontally fractured tooth requiring orthodontic treatment.

Congenital Rubella Syndrome: dental manifestations and management in a 5 year old child.

Congenital Rubella Syndrome is a rare disorder comprised of a constellation of physical abnormalities that develop in infants as a result of maternal infection and subsequent fetal infection with rubella virus. The congenital lesions involve vital organs such as heart, eye, ear, brain and endocrine system and less frequently, teeth. The severity of systemic involvement depends on the stage of gestation at which maternal rubella infection occurs. With the implementation of immunization programs worldwide, its incidence has been dramatically reduced during the past half century. This article provides an insight into the prolonged effect of the virus on ameloblasts by highlighting the presence of hypoplastic enamel in primary teeth and erupting permanent teeth in a female child diagnosed with congenital rubella syndrome.

An esthetic point of view in very young children.

Extensive carious breakdown of primary anterior teeth to the cervical level and their loss in very young children invariably leads to lack of confidence and self-esteem and may cause psychological problems. The present paper deals with the management of three such cases by means of biological restorations, anterior fixed space maintainer and over-dentures.