Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction.

Background: Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children. Materials and Methods: In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Results: Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Conclusion: Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

An in vitro comparative evaluation of dentinal crack formation caused by three different nickel-titanium rotary file systems in primary anterior teeth.

Context: Cleaning and shaping of the canals damages the root dentin which becomes a gateway to dentinal cracks and thereby causes failure of the treatment. Aim: The aim of this study was to assess and compare dentinal crack formation caused by three different nickel-titanium (NiTi) rotary file systems in primary anterior teeth. Settings and Design: The present in vitro study is an experimental, comparative study. Materials and Methods: One hundred fifty extracted primary anterior teeth were included in this study. The teeth were randomly divided into five groups. Group 1: Pedoflex rotary file system, Group 2: Prime Pedo™ rotary file system, Group 3: Kedo-S2 rotary file system, Group 4: K-files, and Group 5: no instrumentation. Roots were sectioned and viewed under a stereomicroscope for the presence of any cracks. Statistical Analysis Used: The data were analyzed using the Chi-square test and Kruskal-Wallis test. Results: In the coronal, middle, and apical thirds, Group 2 showed a maximum number of crack formations in the middle third (57%), followed by Group 3 (43.3%) and Group 1 (36.7%). Groups 4 and 5 showed no crack formation in all the root sections. The middle third showed a maximum number of crack formations compared to the coronal and apical thirds. Conclusions: Rotary systems render various benefits with an acceptable success in comparison to conventional hand instrumentation. Within the limitation of this study, it was found that Pedoflex rotary file system was the best with the least number of crack formations.

An in vivo comparative clinical and radiographic evaluation of a mixture of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol as obturating materials in primary molars.

Background: To overcome some of the disadvantages of the current primary root canal obturating materials, there is a continued interest in search for chemical compounds with broader and more effective antibacterial action and less cytotoxicity. Aim: This study aimed to evaluate and compare in vivo the clinical and radiographic success of mixtures of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol (ZOE) as obturating materials in pulpectomy of primary molars. Settings and Design: This was an in vivo randomized controlled clinical trial. Materials and Methods: Ninety primary molars selected were randomly divided into three groups. Group A was obturated with zinc oxide-O. sanctum extract, Group B with zinc oxide-ozonated oil, and Group C with ZOE. All the groups were evaluated for success or failure based on clinical and radiographic criteria at the end of 1, 6, and 12 months. Statistical Analysis Used: The intra- and inter-examiner reliability of the first and the second co-investigators was calculated by Cohen's kappa statistic. The data were analyzed using Chi-square test, P ≤ 0.05 (indicates statistical significance). Results: By the end of 12 months, the overall clinical success rate was 88%, 95.7%, and 90.9% in Groups A, B, and C, respectively; whereas the radiographic success rate was found to be 80%, 91.3%, and 86.4% in Groups A, B, and C, respectively. Conclusion: On the basis of the overall success rates of all the three obturating materials, the following order of performance can be concluded: zinc oxide-ozonated oil > ZOE > zinc oxide-O. sanctum extract.

An in vitro comparative evaluation of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on remineralization of artificial caries lesion in primary enamel.

OBJECTIVES: To evaluate and compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate fluoride, tricalcium phosphate and grape seed extract on artificial caries lesions in primary enamel. STUDY DESIGN: A sample of 40 non-carious, primary molar teeth was collected and cut in longitudinal sections into three equal halves. Those 120 samples were divided into four equal groups. Group A: Sections treated with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), Group B: Sections treated with tricalcium phosphate, Group C: Sections treated with grape seed extract Group D: Sections treated with deionized water (control group). Samples were evaluated for change in surface characteristics, mineral content using Scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) and microhardness using Vicker's microhardness tester. Cavitated lesions were evaluated for Cone beam computer tomography to obtain baseline data post remineralization. RESULTS: The remineralization potential of grape seed extract was found to be greater compared to tricalcium phosphate followed by CPP-ACPF. CONCLUSION: All the three groups viz. CPP-ACPF, tricalcium phosphate and grape seed extract showed remineralization under the in vitro pH cycling model, while grape seed extract group showed significantly greater remineralization compared to the CPP-ACPF and tricalcium phosphate groups.

An in vivo, randomized, controlled comparative evaluation of efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years.

OBJECTIVE: To compare and evaluate the efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. METHOD AND MATERIALS: 100 participants were randomly distributed to receive either 4% articaine using infiltration anesthesia or 2% lidocaine using inferior alveolar nerve block on each side of the mandibular arch, in two different appointments, after a 1-week interval. The pain perception was evaluated using visual analog scale (VAS) and Wong-Baker Faces pain rating scale (WBFPRS). In both the appointments, the efficacy and onset of anesthesia were evaluated using an electric pulp tester. Hemodynamic parameters, which included pulse rate and oxygen saturation levels, were evaluated using a pulse oximeter. Postoperative complications were evaluated at 24-hour follow-up. RESULTS: Pain score recorded with block was more painful compared to infiltration (P < .05). Anesthetic success was observed with both the local anesthetic agents, with no significant differences (P > .05). Shorter onset of action was observed with articaine (P < .05). Statistically significant differences between groups were noted with regard to heart rate (P < .05). Oxygen saturation levels did not show significant differences (P > .05). When postoperative complications were evaluated with either 4% articaine or 2% lidocaine, very few adverse effects were recorded (P > .05). CONCLUSION: Buccal infiltration using 4% articaine has the potential to replace 2% lidocaine using inferior alveolar nerve block in children.(Quintessence Int 2021;52:780-786; doi: 10.3290/j.qi.b1492247).

3D Printed Band and Loop Space Maintainer: A Digital Game Changer in Preventive Orthodontics.

Premature loss of primary molars often leads to loss of arch circumference in the primary and mixed dentition. It can lead to malpositioning and even impaction of permanent tooth, if not prevented. Space maintainers in preventive orthodontics, are imperative in maintaining arch integrity. Band and loop space maintainers are indicated whenever there is premature loss of primary molar. The conventional band and loop space maintainer is most routinely fabricated, but poses certain limitations. Three-dimensional (3D) printing in digital dentistry is one of the major developments in dentistry. It replicates the dental cast in the most accurate forms. This allows for supreme precision and minimal human errors. Besides decreasing the laboratory procedures, it has the least chance of failure or breakage. The current case report discusses 3D printing technology for the fabrication of band and loop space maintainer, which can revolutionize preventive orthodontics for children.

Determining caries risk susceptibility in children of Udaipur city with genetic taste sensitivity and hormonal fingerprint.

BACKGROUND: Propylthiouracil (PROP) (a medicated tool) and hormonal fingerprint (second to fourth digits [2D:4D]) ratio can be used for detection of caries which is most prevalent oral health disease. AIM: This study aims to determine the role of genetic taste sensitivity and hormonal fingerprint (2D:4D ratio) on caries risk susceptibility. MATERIALS AND METHODS: The present study was an observational and cross-sectional study. It was conducted on 570 children aged 6-12 years. PROP sensitivity test was done by PROP impregnated filter paper strips and subjects were divided accordingly into supertasters, medium-tasters, and nontasters. 2D:4D ratio was obtained by measuring length ratio of index to ring finger using Vernier caliper. Dietary preferences of the subjects were recorded. The evaluation of decayed, missing, and filled teeth/deft indices was done. STATISTICAL ANALYSIS: Intergroup comparisons were performed using One-way ANOVA test, independent t-test and Chi-square test at 5% significance level. RESULTS: Positive correlation between nontasters, low digit ratio, sweet likers, and high caries index was found with a high significant difference. CONCLUSION: Genetic taste sensitivity and hormonal fingerprint (biological marker) can be used for detection of caries as the present research confirmed impact of hormones on taste perception.

Impact of oral hygiene training to Anganwadi and Accredited Social Health Activist workers on oral health of young children in tribal regions of Rajasthan State, India.

CONTEXT: Early childhood caries is one of the most widespread diseases affecting children in urban and rural India. Community health workers can bring about a quantum of change in improving the oral health in children. AIMS: The aim of the study was to assess the impact of oral health training imparted to Anganwadi and accredited social health activist (ASHA) workers on improving the oral hygiene of 148 children aged 1-6 years. SETTINGS AND DESIGN: The preintervention followed by oral health training and postintervention assessment were done at three Anganwadi and ASHA centers of Rajasthan. METHODOLOGY: The preintervention data included Decayed, Missing, and Filled Teeth/decayed, extracted, and filled teeth, oral hygiene indices (Oral Hygiene Index-Simplified [OHI-S] and Oral Hygiene Index Simplified-Modified [OHIS-M]), plaque index, and caries activity using Oratest. The oral health training consisted of PowerPoint presentations, video presentations, live demonstrations on brushing technique, rinsing, plaque disclosure, and flossing technique. They were enlightened on deleterious oral habits, emergency protocol on trauma, etc. The postintervention data included outcome measures consisting of oral hygiene indices (OHI-S and OHIS-M), plaque index, and Oratest after 2 months to evaluate the impact of training. STATISTICAL ANALYSIS USED: The data were analyzed using Chi-square test, Fisher's exact test, independent t-test, paired t-test, and one-way analysis of variance test. RESULTS: There was a significant improvement in toothbrushing practices and rinsing (P < 0.05). There was a significant difference in debris index, calculus index, OHI-S/OHIS-M, plaque index, and Oratest after intervention (P < 0.05). CONCLUSION: Empowering Anganwadi and ASHA workers can be a feasible approach in India, where oral health is not a priority in primary health care as yet.

Comparative evaluation of the compressive strength of two different post systems in primary anterior teeth restored with pediatric zirconia crowns.

BACKGROUND: In cases where there is an extensive loss of crown structure, these treatments require intracanal posts placement for retention as occlusal forces make the tooth structure weak and prone to fracture. Thus, restoration of primary anterior teeth, followed by post placement and cementation with pediatric zirconia crowns helps withstand masticatory forces to a greater extent. AIM: This in vitro study evaluates the compressive strength of two different post systems in the primary anterior teeth, restored with pediatric zirconia crowns. MATERIALS AND METHODS: The present study was an in vitro, experimental, comparative study, with a study sample selected using a convenience sampling method. Forty-five primary anterior teeth were obturated and restored with enhanced omega-shaped loop and reinforced glass-fiber posts were cemented with pediatric zirconia crowns. The compressive strength and the type of fracture were evaluated for each group. RESULTS: This study demonstrated that the glass-fiber posts had a higher compressive strength, although omega-shaped posts showed a higher presence of favorable fracture. CONCLUSION: Retentive omega-shaped loops and reinforced glass-fiber posts were both capable of withstanding high fracture loads. The addition of cemented pediatric zirconia crown on decayed primary anterior teeth restored with post systems helped withstand the load to a greater extent.

Value of surgery for infective endocarditis in dialysis patients.

OBJECTIVES: To determine the value of surgery for infective endocarditis (IE) in patients on hemodialysis by comparing the nature and invasiveness of endocarditis in hemodialysis and nonhemodialysis patients and their hospital and long-term outcomes, and identifying risk factors for time-related mortality after surgery. METHODS: From January 1997 to January 2013, 144 patients on chronic hemodialysis and 1233 nonhemodialysis patients underwent valve surgery for IE at our institution. Propensity matching identified 99 well-matched hemodialysis and nonhemodialysis patient pairs for comparison of outcomes. RESULTS: Staphylococcus aureus infection was more common in hemodialysis patients than in nonhemodialysis patients (42% vs 21%; P < .0001), but invasive disease was similar in the 2 groups (47%; P = .3). Hospital mortality was 13% and 5-year survival was 20% for hemodialysis patients, 20% below that expected in a general hemodialysis population but 15% above that of hemodialysis patients treated nonsurgically for IE. For matched patients, hospital mortality was 13% for hemodialysis patients versus 5.1% for nonhemodialysis patients (P = .05), and survival at 1 and 5 years was 56% versus 83% and 24% versus 59%, respectively (P < .004). Use of an arteriovenous graft for dialysis access (P = .01) and preoperative placement of a pacemaker (P < .0001) were risk factors for late mortality in hemodialysis patients. For matched patients, freedom from reoperation was similar in the hemodialysis and nonhemodialysis groups (P > .9). CONCLUSIONS: Intermediate-term survival after surgery for IE in hemodialysis patients is substantially worse than that in nonhemodialysis patients, but only slightly worse than that in the general hemodialysis population and substantially better than that in hemodialysis patients with IE treated nonsurgically, supporting continued surgical intervention for IE.

Truncus arteriosus and unbalanced complete atrioventricular septal defect: pulmonary protection in the neonate.

Surgical success for the combination of truncus arteriosus with unbalanced atrioventricular septal defect is limited. A low incidence and a poor understanding of these lesions, along with a dismal outcome, have made comfort care a common option. We report our experience with initial successful palliation of this combined lesion in two patients.

Characteristics of occlusion in primary dentition of preschool children of Udaipur, India.

OBJECTIVE: The present study aimed to study the occlusion characteristics of the primary dentition in a group of 3-5 year-old Indian children and the differences with age in the same group. METHODS: The study was a cross-sectional survey based on examination of the primary dentition of 200 preschool children aged 3-5 years who were selected from nursery schools in Udaipur, India, using a stratified random sampling technique. The study group was assessed for the several occlusal parameters, which included primary molar and canine relationship, degree of overjet and overbite, anterior and posterior crossbite, and the presence or absence of physiologic spaces and crowding. RESULTS: Flush terminal plane was more common at 3-4 years of age, mesial step at 4-5 years, and class I canine relationship in both age groups. The prevalence of overjet less than 1 mm and overjet exceeding 1 mm was almost comparable in both groups. Overbite with less than 30% overlap was most frequently observed in both age groups, with 30-60% overlap following closely behind. Physiologic and primate spacing were observed in less than half of the children examined, while a small percentage displayed the presence of either single-segment or two-segment crowding. CONCLUSION: The present study provided insight into the state of dentition, occlusal pattern, spacing, and crowding in the primary dentition of Indian children of Udaipur.