Comparison between the Radiographic and Clinical Rates of Success for TheraCal and MTA in Primary Tooth Pulpotomy within a 12-Month Follow-Up: A Split-Mouth Clinical Trial.

Background: The present study was conducted for contrasting the efficacy of TheraCal and MTA for primary molar pulpotomy. Methods: During the current split-mouth randomized clinical trial, 90 bilateral primary molars from 45 healthy 5- to 8-year-old children were pulpotomized using TheraCal in one bilateral tooth and MTA in the other, randomly. Glass ionomer (GI) was used to cover these materials. Then, the treated teeth were restored with stainless steel crowns (SSC) and followed up clinically and radiographically at months 6 and 12 after treatment for any pulpotomy failure indications. Finally, data were analyzed by chi-square test considering p value < 0.05 as statistically significant. Results: Among 82 teeth available at the final follow-up session, the total success rates were 98.1% and 99.3% for TheraCal and MTA, respectively, showing no significant difference between the two groups (p > 0.05). Conclusion: TheraCal can be used as an alternative material for pulpotomy of primary teeth instead of MTA.

Assessing the Different Levels of Virtual Reality That Influence Anxiety, Behavior, and Oral Health Status in Preschool Children: Randomized Controlled Clinical Trial.

BACKGROUND: Compared with a traditional behavior management strategy and oral health training, virtual reality (VR) integrated with multisensory feedback possesses potential advantages in dentistry. OBJECTIVE: This study aimed to assess the impact of different levels of VR on anxiety, behavior, and oral health status. METHODS: This study was carried out in the Department of Pediatric Dentistry at the Tabriz University of Medical Sciences from December 2020 to June 2021. We randomly assigned 60 healthy children aged 4 years to 6 years to 4 groups, each consisting of 15 children. The study consisted of 2 consecutive sessions. During the first visit, the plaque index was calculated, and oral health education was carried out in all groups using Immersive VR (group I), Semi-immersive VR (group II), Nonimmersive VR (group III), and tell-show-do (TSD; group IV). In the second session, an amalgam restoration was performed in all groups. Participants' anxiety and behavior were recorded using the face version of the Modified Child Dental Anxiety Scale (MCDAS[f]) and Frankl scale. The plaque index was recorded in 2 follow-up sessions. RESULTS: The greatest prevalence of positive behavior (P=.004) and the lowest anxiety (P<.001) were recorded in group I, followed by group II, group III, and group IV. The plaque index scores showed a reduced trend between the first session and follow-up sessions (P<.001), but the values did not differ significantly between the 4 groups during the 3 sessions (P=.28, P=.54, P=.18). CONCLUSIONS: The most positive behavior was observed in the Immersive VR group, followed by the Semi-immersive VR, Nonimmersive VR, and TSD groups. Moreover, oral health education using VR resources can improve oral health status in children. TRIAL REGISTRATION: Iranian Registry of Clinical Trials 20210103049926N1; https://www.irct.ir/trial/53475.

Oral health status and oral health-related quality of life in children with attention-deficit hyperactivity disorder and oppositional defiant disorder.

AIMS: Oral diseases can affect various aspects of life in patients with attention deficit hyperactivity disorder/oppositional defiant disorder (ADHD/ODD). This study aimed to assess the oral health status and oral health-related quality of life (OHRQOL) in ADHD/ODD children. METHODS: Forty ADHD/ODD and 80 control children aged 3-7 years old were included in the study. Gingival index (GI), dmft score, and the pediatric oral health-related quality of life (POQL) questionnaire were used to determine the oral health status and OHRQOL, respectively. RESULTS: The mean dmft and GI were significantly higher in the ADHD/ODD group than the control group (P = .002 and P = .001). In the ADHD/ODD children, the total score of OHRQOL and the mean scores of the emotional, physical, role, and social domains were lower than that in the control group (P = .0004, P = .027, P = .002, P = .014, and P = .043, respectively). Poisson's regression showed that there was a significant relationship between OHRQOL and dmft scores (P-value < .001). However, the association between GI and OHRQOL scores was not significant. CONCLUSION: Higher dmft and GI scores were found in children with ADHD/ODD than the control children. A lower POQL score was detected in ADHD/ODD patients, which translates to a better level of OHRQOL.

Primary tooth pulpectomy overfilling by different placement techniques: A systematic review and meta-analysis.

Background. This study was conducted to investigate root canal overfilling with different material placement techniques in primary teeth. Methods. A systematic search was undertaken by searching PubMed/MEDLINE and Scopus for English language peer-reviewed articles published until February 2018 that reported primary tooth pulpectomy overfilling. Two reviewers independently screened and identified studies in terms of the selection criteria and independently collected the data using a specially designed data extraction form. The overfilling rate was the primary summary measure. The weighted pooled overfilling rates were estimated by random-effects meta-analysis. Results. Twenty clinical and four in vitro studies met the eligibility criteria. In the clinical studies, the pooled overfilling rate for zinc oxide-eugenol (ZOE) was 23.3% with a lentulo spiral mounted on a handpiece, 22.7% with a hand-held lentulo spiral, and 17% with a plugger. The pooled overfilling rate for calcium hydroxide-based materials was 16.7% with a lentulo spiral mounted on a handpiece, 14.7% with a hand-held lentulo spiral, 19.6% with a syringe, and 25.7% with a plugger. In the in vitro studies, neither individual overfilling rates nor two-by-two comparisons were subjected to meta-analysis because of an inadequate number of studies. Conclusion. The lowest overfilling rate in the clinical studies was related to plugger and handheld lentulo spiral techniques for ZOE and calcium hydroxide-based materials, respectively.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial.

OBJECTIVE: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. STUDY DESIGN: 114 children aged 3-6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. RESULTS: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). CONCLUSION: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal.

The aim of this systematic review was to investigate the effect of treatment duration on children's behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children's behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children's dental anxiety or fear. There was a general tendency towards deterioration of children's behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.

The relationship between children's media habits and their anxiety and behaviour during dental treatment.

OBJECTIVE: The existing evidence suggests that media habits may have moderating role on children's psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children's media habits and their anxiety and behaviour management problems (BMP) during dental treatment. MATERIALS AND METHODS: A total of 289 children aged 3-6 years old were included. Dental anxiety (DA) and BMP were assessed using Clinical Anxiety Rating Scale and Frankl's Rating Scale during the dental treatment. The parents reported their own DA, educational level and economic status; and the children's and also their own daily hours of using media. The data were analysed with the Mann-Whitney U, Kruskal-Wallis, Chi-square or Fisher exact tests, Spearman's correlation coefficient and logistic regression. RESULTS: The children with DA had significantly higher amount of watching TV, playing e-games and surfing the Internet, and total amount of using electronic media than those without DA. The amount of watching TV and the total amount of using electronic media were significantly higher in the children with BMP than those without BMP. DA and BMP were significantly correlated with the children's hours of watching TV and total media time. CONCLUSIONS: There was a significant relationship between the amount of electronic media usage and DA and BMP in 3- to 6-year-old children.

Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth.

OBJECTIVES: This study was carried out to investigate whether the changes in hematologic characteristic and color of pulpal bleeding is associated with clinical and histologic status of the pulp in primary teeth. MATERIALS AND METHODS: A total of 211 primary molars in 103 patients, 3-6 years old, were treated. One hundred eight teeth had pulpectomy, 57 teeth had pulpotomy after pulp exposure during caries excavation, and 46 teeth had pulpotomy after accidental pulp exposure in sound dentin. After pulpal exposure, pulpal blood was collected in capillary tubes for blood color and hematologic assessment. Coronal and radicular pulp tissues were amputated for histologic assessment. RESULTS: Blood color was significantly darker in pulpectomy cases and samples with severe inflammation. The differences were clinically perceptible by the human eye. A significant negative correlation was detected between white blood cell (WBC) count and blood color. The counts of neutrophils and lymphocytes were significantly different between treatment groups. In addition, WBC, eosinophil, monocyte, neutrophil, and basophils counts were significantly different between degrees of inflammation in coronal pulp. Moreover, severe inflammation was higher in pulpectomy group versus pulpotomy groups. Pulp tissue calcification was also significantly higher in the pulpectomy cases. CONCLUSIONS: Considering the significant difference in pulpal blood color between the pulpectomy and pulpotomy cases, and between the different levels of pulpal inflammation; blood color can be a valid clinical diagnostic criterion of pulpal status and can be used for the selection of appropriate pulp treatment strategy. CLINICAL RELEVANCE: This study shows that pulp bleeding color can be used for selection of an appropriate pulp treatment method in primary teeth.

Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial.

PURPOSE: The aim of this study was to examine the effect of chlorhexidine disinfection, as a chemical method of oral hygiene practice, and subsequent use of probiotics on halitosis in children. The effects of mechanical and chemical oral hygiene practice methods on the severity of halitosis were also assessed. MATERIALS AND METHODS: 208 children with organoleptic test (OLT) scores of 2 or more were randomly assigned to four groups: A: conventional oral hygiene practices (COH) including toothbrushing and flossing; B: COH + tongue scraping (TS); C: COH + TS + chlorhexidine; D: COH + TS + chlorhexidine + probiotics. OLT was performed at 1-week and 3-month follow-ups. RESULTS: A significant and stable number of participants showed major and moderate levels of improvement in OLT scores in group D (p < 0.001). The improvement of OLT scores in group C was also significant (p < 0.001), but not stable over the follow-ups (p = 0.44). Neither significant nor stable improvements in the OLT scores were detected in groups A and B through follow-ups (p > 0.05). CONCLUSION: Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods.

The Influence of Parenting Style and Child Temperament on Child-Parent-Dentist Interactions.

PURPOSE: This study aimed to investigate the interaction between parenting style and child's temperament as modulators of anxiety and behavior in children during the dental procedure. METHODS: Healthy four- to six-year-olds (n equals 288), with carious primary molars scheduled to receive amalgam fillings were selected. The Primary Caregivers Practices Report was used to assess the parenting style, and the Children's Behavior Questionnaire-Very Short Form was used to evaluate child temperament. Children were managed using common behavior management strategies. Child behavior and anxiety during the procedure were assessed using the Frankl behavior rating scale and the verbal skill scale, respectively. Spearman's correlation coefficient was used to examine the correlation among variables. RESULTS: Authoritative parenting style was positively related to positive child's behavior (P<.05) and negatively related to child's anxiety (P<.05). A positive relationship existed between permissive subscale and negative behaviors (P<.05) and child's anxiety (P<.05). There was a significant direct effect of authoritative parenting style on the effortful control trait (P<.05) and permissive parent style on the child negative affectivity (P<.05). CONCLUSIONS: Parenting style appeared to mediate child temperament and anxiety, and was related to the child's behavior. Parenting style should be considered in the selection of behavior guidance techniques.

Linear reciprocal interaction between dental caries and salivary characteristics.

Carious tooth surfaces can alter saliva in various ways. We investigated whether salivary parameters were affected by elimination of existing active dental caries in 99 children (age 6-12 years) with more than five carious tooth surfaces. Unstimulated saliva samples were obtained from each child, and salivary characteristics were evaluated. One month after caries treatment that eliminated all existing dental caries, saliva sampling and analysis were repeated. Saliva viscosity significantly decreased (P = 0.04), while pH and saliva buffering capacity significantly increased (P < 0.001). There was no significant difference in unstimulated salivary production at the start of the study and 1 month after caries elimination (P > 0.05). The relationship between dental caries and salivary condition is reciprocal. Treatment of existing dental caries can prevent future caries by improving saliva quality.

Are referred inaccessible human primary molar teeth really inaccessible?

Despite a body of compelling evidence pertaining to the root canal accessibility of primary teeth, the number of referrals for inaccessibility of primary molars is considerable. The aim of the present study was to evaluate the prevalence of true and false primary molar inaccessibility among subjects who had been referred by general and pediatric dentists. We examined 199 primary molars in 156 patients (87 males, 69 females) aged 3-7 years who were referred by 215 general and 35 pediatric dentists. Problems related to inaccessibility were recorded for each tooth and any individual canal. One hundred seventy-five inaccessible teeth (87.9%) were successfully rehabilitated to accessible status (P < 0.001). The most frequent cause of inaccessibility was an inappropriate access cavity (42.3%), followed by difficult canals (32.6%) and orifice calcification (25.2%). The tooth most frequently reported as inaccessible was the maxillary first molar (40.2%), and that least frequently reported was the mandibular second molar (11.6%). The distobuccal canal of the maxillary first molar and the mesiolingual canal of the mandibular first molar were the most commonly inaccessible canals (P < 0.001). Only 1 out of 8 teeth referred as inaccessible was truly inaccessible. It seems that root canal inaccessibility is mostly attributable to lack of expertise among individual practitioners.

Design and preliminary validation of the verbal skill scale in the dental setting: an anxiety scale for children.

PURPOSE: The purpose of this study was to design and examine the validity of a scale that uses the verbal performance of children as an indicator of dental anxiety. METHODS: A total of 128 healthy 4- to 6-year-olds were included. The first sessions consisted of a dental examination; in the second session, identical dental treatment was provided to all subjects. In each session, a short communication was done for verbal assessment. During treatment, Frankl and clinical anxiety rating scales were utilized to assess the child's anxiety. Construct validity was assessed using Spearman's correlation coefficient; a factor analysis, concurrent validity, and inter-rater reliability were determined by kappa agreement statistics. Chi-square and Fisher's exact tests were used to assess the difference between sexes. RESULTS: The agreement between the raters was high and significant (k=0.71, P<.001). Intraclass correlation coefficient of 50 same children (28 boys and 22 girls) across a 2-week period showed a strong correlation (correlation=0.8, P<.001). Spearman's correlation coefficient revealed a high and significant correlation between the measures (P<.001). The kappa values ranged from 0.58 to 0.67, suggesting moderate to good agreement between measures. CONCLUSIONS: The verbal skill scale is a reliable and valid measure of assessing child dental anxiety in a clinical context.

Emotional intelligence subscales: are they correlated with child anxiety and behavior in the dental setting?

OBJECTIVES: The present study aimed at evaluating the correlation between emotional intelligence subscales and childs anxiety and behavior in the dental setting. STUDY DESIGN: The study included 123 children aged 7-12 years, who were scheduled to attend two consecutive sessions. In the first session, the Bar-On Emotional Quotient Inventory: Youth Version (Bar-on EQ-I: YV) was administered to participants. The anxiety and behavior in children was evaluated during similar dental procedures in the second session using the Clinical Anxiety Rating Scale and the Frankl scale, respectively. RESULTS: 23 children were eliminated from the study, leaving 100 participants (47 boys and 53 girls) with a mean age of 9.32 +/- 1.59 years for study. There were statistically significant positive correlations between Frankl score and EQ total score (p < 0.001), interpersonal scale (p < 0.001), intrapersonal scale (p < 0.001), stress management (p = 0.03) and adaptability scale (p < 0.001). Significant negative correlations were found between anxiety score and, EQ total score (p < 0.001), interpersonal scale (p < 0.001), intrapersonal scale (p < 0.001), and adaptability scale (p < 0.001). Anxiety and stress management were not correlated (p = 0.16). Total EQ and EQ subscales can predict significance variance of Frankl score (p < 0.05) and anxiety score (p < 0.05) without confounding effect of age and sex (p > 0.05). CONCLUSIONS: The results provide evidence that children with higher total EQ as well as higher scores of intrapersonal, interpersonal, adaptability and stress management scales can generally be flexible and effective in coping in the dental setting. Higher score in stress management subscale seems to be related to better control over affective information including anxiety compared with other subscales in stressful situations. Overall, they behave and cooperate better than children with lower scores.

The impact of maternal emotional intelligence and parenting style on child anxiety and behavior in the dental setting

Objective. The present study investigated the correlations between maternal emotional intelligence (EQ), parenting style, child trait anxiety and child behavior in the dental setting. Study design. One-hundred seventeen children, aged 4-6 years old (mean 5.24 years), and their mothers participated in the study. The BarOn Emotional Quotient Inventory and Bumrind’s parenting style questionnaire were used to quantify maternal emotional intelligence and parenting style. Children’s anxiety and behavior was evaluated using the Spence Children’s Anxiety Scale (SCAS) and Frankl behavior scale. Results. Significant correlation was found between maternal EQ and child behavior (r=0.330; p<0.01); but not between parenting style and child behavior. There was no significant correlation between mother’s total EQ and child’s total anxiety; however, some subscales of EQ and anxiety showed significant correlations. There were significant correlations between authoritarian parenting style and separation anxiety (r=0.186; p<0.05) as well as authoritative parenting style and mother’s EQ (r=0.286; p<0.01). There was no significant correlation between child anxiety and behavior (r = -0.81). Regression analysis revealed maternal EQ is effective in predicting child behavior (β=0.340; p<0.01). Conclusion. This study provides preliminary evidence that the child’s behavior in the dental setting is correlated to mother’s emotional intelligence. Emotionally intelligent mothers were found to have predominantly authoritative parenting style (AU)

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The impact of maternal emotional intelligence and parenting style on child anxiety and behavior in the dental setting.

OBJECTIVE: The present study investigated the correlations between maternal emotional intelligence (EQ), parenting style, child trait anxiety and child behavior in the dental setting. STUDY DESIGN: One-hundred seventeen children, aged 4-6 years old (mean 5.24 years), and their mothers participated in the study. The BarOn Emotional Quotient Inventory and Bumrind's parenting style questionnaire were used to quantify maternal emotional intelligence and parenting style. Children's anxiety and behavior was evaluated using the Spence Children's Anxiety Scale (SCAS) and Frankl behavior scale. RESULTS: Significant correlation was found between maternal EQ and child behavior (r=0.330; p<0.01); but not between parenting style and child behavior. There was no significant correlation between mother's total EQ and child's total anxiety; however, some subscales of EQ and anxiety showed significant correlations. There were significant correlations between authoritarian parenting style and separation anxiety (r=0.186; p<0.05) as well as authoritative parenting style and mother's EQ (r=0.286; p<0.01). There was no significant correlation between child anxiety and behavior (r = -0.81). Regression analysis revealed maternal EQ is effective in predicting child behavior (ß=0.340; p<0.01). CONCLUSION: This study provides preliminary evidence that the child's behavior in the dental setting is correlated to mother's emotional intelligence. Emotionally intelligent mothers were found to have predominantly authoritative parenting style.

Can birth order affect temperament, anxiety and behavior in 5 to 7-year-old children in the dental setting?

AIM: The aim of this study was to evaluate the relationships between birth order and child's temperament, anxiety and behavior in the dental setting. MATERIALS AND METHODS: A total of 200 healthy children aged 5 to 7 years, were included in this double-blind randomized controlled trial. The study consisted of two sessions. In the initial appointment, parents were provided with instructions and asked to complete children's behavior questionnaire (CBQ). In the second appointment, identical dental treatments were rendered to all subjects. During treatment, Frankl scale for child's behavior, facial Image scale (FIS) for situational anxiety, and clinical anxiety rating scale for clinical anxiety were utilized. Analysis of data was done using U Mann-Whitney and Kruskal-Wallis tests. RESULTS: Only children had higher clinical (p = 0.041) and situational (p < 0.001) anxiety, and more negative behavior (p = 0.013) compared to children with siblings. In children with siblings, first-born child was in increased risk of developing negative behavior (p = 0.008), clinical anxiety (p < 0.001) and situational anxiety (p = 0.006). With an exception (sadness, p < 0.001), no significant differences in temperament scale were observed among children with different birth orders. CONCLUSION: According to the results, only children and laterborns are at higher risk of developing worse outcomes in the dental setting. CLINICAL SIGNIFICANCE: The role of birth order has been ignored as a possible factor of behavior during routine dental treatment and these findings may shed light on our understanding of behavior management strategies in the dental setting. Considering the increasing pattern of family with an only child both in modern and developing countries, this is more likely that the dental team will face children with negative outcome during dental treatment.

The impact of emotional intelligence and intelligence quotient (IQ) on child anxiety and behavior in the dental setting.

OBJECTIVE: The aim of this study was to evaluate the impact of IQ and EQ on child's anxiety and behavior in the dental setting. MATERIALS AND METHODS: One hundred and seven children (age range 7-12 years) were selected. BarOn Emotional Quotient Inventory: Youth Version (Baron EQ-I: YV) and the Raven's Colored Progressive Matrices (RCPM) tests were administered on the first examination session. Children's anxiety and behavior were evaluated using the modified child dental anxiety scale (MCDAS) and the sound, eye and motor (SEM) scales, respectively, during the second session. RESULTS: The mean (SD) age of subjects was 8.48 (1.41) years old. The result revealed a significant negative correlation between children's behavior and total EQ score (p < 0.01) but there was no relationship found between children's behavior and IQ score. A significant positive correlation was found between anxiety scores on MCDAS and SEM (p < 0.01), but no relationship was found between EQ and MCDAS scores. Both anxiety (p < 0.01) and EQ score (p < 0.01) were effective variables in predicting the child's SEM score. CONCLUSION: The major finding of this research suggested that a high EQ may be more effective than a low EQ in moderating the level of cooperation during dental treatment of children. IQ scores, on the other hand, were related to the child's EQ score (r = 0.20) and age (r = - 0.29).

Impact of temperament on child behavior in the dental setting.

BACKGROUND AND AIMS: Temperament has been suggested to be a predictive factor for the child's reaction to dental treatment especially in young ages. The aim of this study was to assess the relationship between temperament and child behavior in relation to age in the dental setting. MATERIALS AND METHODS: In this descriptive-analytical study, 190 children, aged 1 to 7years, who visited dentist for the first time, were included. Early Childhood Behavior Questionnaire (ECBQ) for 18-36 month-olds and Child Behavioral Questionnaire (CBQ) for 3-7 year-old children were completed. Child behavior was rated during dental treatmentusing Frankl scale. Kolmogorov-Smirnov test was used to examine normal distribution of the population. The data were analyzed using descriptive statistics and ANOVA, Chi Square and Pearson's correlation coefficient. P< 0.05 was considered as sig-nificance level. RESULTS: 58 children (29.6%) had completely negative behavior and 27 children (13.8%) had completely positive behaviorduring the treatment. 65% of the children aged 1 to 3 years had completely negative behavior while this figure was 20% for the children aged 6 to 7 years. Temperament score for the children with completely positive behavior was 257.95 while it was 299.37 for children with completely negative behavior. As the temperament score increased, child behavior rank waslower. CONCLUSION: Age and temperament seem to act as predictors of child behavior in the dental setting.