Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study.

Aim: The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants-100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM). Materials and methods: A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups-group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al. Results: Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV. Conclusion: This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA. How to cite this article: Sudhakar S, Gupta N, Ghambir N, et al. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023;16(4):633-638.

Trends in surgery and survival for T1-T2 male breast cancer: A study from the National Cancer Database.

BACKGROUND: Despite evidence that early-stage male breast cancer (MBC) can be treated the same as in females, we hypothesized that men undergo more extensive surgery. METHODS: Patients with clinical T1-2 breast cancer were identified in the National Cancer Database 2004-2016. Trends in surgery type and overall survival were compared between sexes. RESULTS: Of 9,782 males and 1,078,105 females, most were cN0 with AJCC stage I/II disease. Unilateral mastectomy was most common in men (67.1% vs. 24.1%, p < 0.001) and partial mastectomy in women (64.7% vs. 26.4%, p < 0.001), with no significant change over time. Over 1/3 of men received ALND in 2016. While overall survival was superior in females (HR 0.83, 95% CI 0.73-0.94, p = 0.003), partial mastectomy was associated with a 42% reduction in mortality risk for males (HR 0.58, 95% CI 0.4-0.8, p = 0.003). CONCLUSIONS: De-escalation of surgery could be considered for MBC to improve survival and align with current standards of care.

Comparative Evaluation of Different Varnishes and Pit and Fissure Sealants on Streptococcus mutans Count in Saliva of Children.

Aim: This study aims to evaluate and compare the effect of different varnishes: 3M ESPE Clinpro and Voco Profluorid and fissure sealants- 3M ESPE ClinPro and Ivoclar Vivadent Helioseal-F on the S. mutans count in the saliva of children. Materials and methods: Eighty children of 6-12 years of age with no incidence of caries were selected and saliva samples were collected by drooling method after oral prophylaxis. The children were divided randomly into four groups and materials were applied accordingly. Saliva samples were obtained immediately after the procedure as well as 1-month, 3-months and 6-months posttreatment. Saliva samples were inoculated on Mitis salivarius agar and colony counts of S. mutans were obtained. Results: This study showed that both the varnishes and pit and fissure sealants were equally effective in reducing the salivary S. mutans count in children in a time period of 6-months however pit and fissure sealants were more effective in preventing caries. Conclusion: Both varnishes and pit and fissure sealants are equally effective in reducing S. mutans count in saliva. How to cite this article: Sharma R, Ghambir N, Gupta N, et al. Comparative Evaluation of Different Varnishes and Pit and Fissure Sealants on Streptococcus mutans Count in Saliva of Children. Int J Clin Pediatr Dent 2022;15(3):362-365.

The transcriptional response to oxidative stress is independent of stress-granule formation.

Cells respond to stress with translational arrest, robust transcriptional changes, and transcription-independent formation of mRNP assemblies termed stress granules (SGs). Despite considerable interest in the role of SGs in oxidative, unfolded protein and viral stress responses, whether and how SGs contribute to stress-induced transcription have not been rigorously examined. To address this, we characterized transcriptional changes in Drosophila S2 cells induced by acute oxidative-stress and assessed how these were altered under conditions that disrupted SG assembly. Oxidative stress for 3 h predominantly resulted in induction or up-regulation of stress-responsive mRNAs whose levels peaked during recovery after stress cessation. The stress transcriptome is enriched in mRNAs coding for chaperones including HSP70s, small heat shock proteins, glutathione transferases, and several noncoding RNAs. Oxidative stress also induced cytoplasmic SGs that disassembled 3 h after stress cessation. As expected, RNAi-mediated knockdown of the conserved G3BP1/Rasputin protein inhibited SG assembly. However, this disruption had no significant effect on the stress-induced transcriptional response or stress-induced translational arrest. Thus SG assembly and stress-induced gene expression alterations appear to be driven by distinctive signaling processes. We suggest that while SG assembly represents a fast, transient mechanism, the transcriptional response enables a slower, longer-lasting mechanism for adaptation to and recovery from cell stress.

Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique.

Aim: To compare freezed cone and 5% lignocaine as a numbing agent before intraoral injection and evaluate the effect of virtual reality distraction (VRD) as a distraction technique in reducing pain perception in children. Study design: Around 60 children of 6-11 years old undergoing treatment for the extraction or any pulp therapy of primary tooth were selected. Freezed cone and 5% lidocaine were used to decrease the pain during local anesthesia (LA). VRD was used as a distraction method and to analyze the pain perception, Wong-Baker Faces Pain Rating Scale was used. Materials and methods: Each child was randomly assigned to receive ice as a topical anesthetic or lignocaine 5% as a topical anesthetic agent. The pain perception was evaluated after the injection of 2% lignocaine hydrochloride (HCL). The primary researcher evaluated the pain during injection using the sound, eye, motor (SEM) scale. The pain experienced during injection was evaluated using Wong-Baker Faces Pain Rating Scale. Results: In the freezed cone group with the VRD technique, maximum responded to the less pain score. On the contrary, many responded to higher pain scores in the freezed cone group without the VRD technique. Conclusion: It was concluded that the VRD technique can be used for distraction and the frozen ice cone can be an alternative method to reduce the pain perception during LA. How to cite this article: Singh R, Gupta N, Gambhir N. Comparative Evaluation of Reduction in Pain Perception Using 5% Topical LA vs Freezed Cone as a Preparatory Agent for Intraoral Injection in Children and Effect of VRD as Distraction Technique. Int J Clin Pediatr Dent 2022;15(5):558-563.

Efficacy of Silver Diamine Fluoride on Streptococcus mutans Count Present in Saliva.

AIM AND OBJECTIVE: Evaluate the efficacy and longevity of silver diamine fluoride (SDF) to inhibit the dental caries initiator bacteria; Streptococcus mutans count in saliva. STUDY DESIGN: Twenty children having class I and II dental caries with no prior restorations were included in the study. Unstipulated saliva samples were collected before and immediately after application of SDF, 1, 3, and 6 months after application, and intergroup comparison was done. MATERIALS AND METHODS: Silver diamine fluoride was applied on the cavitated surfaces with microbrush tip under isolation, then wait for 4 minutes and washed away all surfaces with water spray. Saliva was collected in a sterile saliva collection tube and sent for microbiological culture assessment. CFU/mL of S. mutans count was done with the Digital colony counter. For statistical analysis, paired T-test was performed. RESULTS: Silver diamine fluoride showed a significant drop in CFU/mL of S. mutans count at 1 month then 3 and 6 months accordingly. CONCLUSION: Silver diamine fluoride can be used to prevent and arrest dental caries and the best result can be achieved by quarterly application. HOW TO CITE THIS ARTICLE: Chakraborty S, Gupta N, Gambhir N, et al. Efficacy of Silver Diamine Fluoride on Streptococcus mutans Count Present in Saliva. Int J Clin Pediatr Dent 2021;14(5):700-704.

Management of invasive ductal carcinoma in hypermobile Ehlers-Danlos syndrome: a case report.

Literature is sparse regarding the management and long-term outcomes of breast cancer in patients with Ehlers-Danlos syndrome (EDS). Of the EDS subtypes, hypermobile Ehlers-Danlos Syndrome (hEDS) is associated with cardiovascular dysautonomia which manifests as spontaneous episodes of tachycardia and hypotension. Given this clinical autonomic system impact, hEDS is known to have significant intraoperative risk and postoperative complications. However, outcomes of hEDS patients have not been specifically studied in the field of breast cancer surgery. Here we present a case of a 62-year-old female with hEDS and node-positive invasive ductal breast carcinoma. Given the patient's medical history of hEDS, close attention was given to the patient's intraoperative vital signs and predisposition for poor wound healing. The patient underwent left Goldilocks mastectomy with left axillary lymph node dissection. Due to cardiac comorbidities, she was not a candidate for neoadjuvant or adjuvant chemotherapy. The patient tolerated adjuvant radiation and endocrine therapy without side effects, and has remained free of local, regional, and distant cancer recurrence following treatment. This case report highlights a literature gap in the surgical and radiation therapy management of breast cancer in patients with hEDS. Although breast surgery and radiation therapy in patients with invasive breast cancer and hEDS can be a safe management option, we discuss how perioperative complications must be cautiously navigated and how treatment must be tailored to individuals' specific hEDS variant to ensure optimal patient safety and positive long-term outcomes.

Comparative Evaluation of Antifungal Efficacy of Five Root Canal Sealers against Clinical Isolates of Candida albicans: A Microbiological Study.

AIM AND OBJECTIVE: The aim of this study was to evaluate and compare the antifungal efficacy of MTA Fillapex, Metapex, zinc oxide eugenol cement, Endomethasone, and Endoflas against Candida albicans. MATERIALS AND METHODS: Root canal exudates of 30 patients were tested against MTA Fillapex (Angelus), Metapex (BioMed), zinc oxide eugenol (Deepak Enterprise), Endomethasone (Septodont), Endoflas FS (Sanlor Laboratories), MTA (Angelus) (positive control), and glycerine (negative control). Children with failed endodontic cases were included in the study. Tube dilution and agar diffusion methods were used to check the antifungal efficacy of the root canal sealers. In tube dilution method, 24-well culture plates containing freshly mixed material along with Candida albicans were used. Wells containing MTA (Angelus) along with Sabouraud dextrose agar and Candida albicans served as positive control while glycerine along with Sabouraud dextrose agar and Candida albicans served as negative control. All plates were incubated at 37°C for 24 hours. Growth of the fungi was monitored after 24 hours by the presence of the turbidity. The samples were recultured to test the experimental material using agar well diffusion method, and the Petri plates were incubated for 24 hours and 72 hours. Zone of inhibition was measured after respective time period. Paired t test was used for the data analysis. RESULTS: It was seen in tube dilution method Endomethasone showed least turbidity while maximum was shown by Metapex; similar results were seen in case of agar well diffusion method in which largest zone of inhibition was shown by Endomethasone while smallest was by Metapex. CONCLUSION: It was concluded that Endomethasone showed maximum efficacy against Candida albicans as compared to Metapex. HOW TO CITE THIS ARTICLE: Singh S, Srivastava B, Gupta K, et al. Comparative Evaluation of Antifungal Efficacy of Five Root Canal Sealers against Clinical Isolates of Candida albicans: A Microbiological Study. Int J Clin Pediatr Dent 2020;13(2):119-123.

Prevalence and Pattern of Hypomineralized Second Primary Molars in Children in Delhi-NCR.

BACKGROUND: Developmental defects of enamel especially enamel hypomineralization are prevalent among children. Hypomineralized second primary molars (HSPM) present a serious clinical dilemma for the current practitioners. It represents as a potential predictive factor for molar incisal hypomineralization (MIH). The reported prevalence of HSPMs in India however still remains uncertain. METHODOLOGY: A total of 649 children aged 6-10 years were randomly selected from various schools in Delhi NCR. The teeth were indexed for developmental defects of enamel using modified European Academy of Paediatric Dentistry judgment criteria given by Ghanim et al. RESULTS: A total of 83 HSPMs were observed in 33 of the 649 subjects examined, with a prevalence of 5%. Molars affected had prevalence of 62.88%, with two deciduous molars being most commonly affected. Of the defects present, creamy white opacities were most common followed by yellowish brown opacities. Posteruptive breakdowns (PEB) were more commonly associated with yellowish brown opacities. CONCLUSION: The prevalence of HSPMs in Delhi, NCR was 5%. Creamy white opacities were the most common lesion present. HOW TO CITE THIS ARTICLE: Singh R, Srivastava B, Gupta N. Prevalence and Pattern of Hypomineralized Second Primary Molars in Children in Delhi-NCR. Int J Clin Pediatr Dent 2020;13(5):501-503.

Phase Ib/II single-arm trial evaluating the combination of everolimus, lapatinib and capecitabine for the treatment of HER2-positive breast cancer with brain metastases (TRIO-US B-09).

BACKGROUND: Improving outcomes for patients with human epidermal growth factor 2-positive (HER2+) central nervous system (CNS) metastases remains an unmet clinical need. This trial evaluated a novel combination of everolimus, lapatinib and capecitabine for this disease. METHODS: Patients with trastuzumab-pretreated, HER2+ breast cancer brain metastasis without prior therapy with a mammalian target of rapamycin (mTOR) inhibitor were eligible. Patients received lapatinib and everolimus daily (continuously) and capecitabine twice daily (d1-14) in 21-d cycles. The primary endpoint was the 12-week CNS objective response rate (ORR). Secondary endpoints included safety, progression-free survival (PFS), overall survival (OS), best CNS ORR and extra-CNS ORR. RESULTS: A total of 19 participants were enrolled and treated with ⩾1 dose of the study drug. The median age was 58.5 years, the median number of therapies for metastatic breast cancer was 2.5 (0-11). Pretrial, 74% of participants had received prior lapatinib, capecitabine or both. A total of 63% had received previous CNS radiation or surgical resection and CNS radiation. The maximum tolerated doses were lapatinib at 1000 mg, everolimus at 10 mg, and capecitabine at 1000 mg/m2. Phase II proceeded with capecitabine at 750 mg/m2 due to better tolerability. The most common grade 3/4 adverse events were mucositis (16%), diarrhea, fatigue, and hypokalemia (11% each). Of 11 participants evaluable for 12-week CNS ORR, 3 (27%) had partial response and 7 (64%) had stable disease. The best CNS ORR in eligible participants was 28% (5/18). The median PFS and OS were 6.2 and 24.2 months, respectively. CONCLUSIONS: This novel triplet combination of lapatinib, everolimus, and capecitabine is well tolerated and yielded a 27% response rate in the CNS at 12 weeks in heavily pretreated participants. Larger studies are warranted to further evaluate this regimen. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01783756. Registered 05 February 2013, https://clinicaltrials.gov/ct2/show/NCT01783756.

Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis.

INTRODUCTION: The principal goal of dentistry is to maintain and improve the quality of life of the dental patients. As many of these objectives require the replacement or alterations of the existing tooth structure, the main challenge for centuries has been the development and selection of biocompatible materials that can withstand the unique conditions of the oral environment.Finite element analysis (FEA) is a modern technique of numerical stress analysis that has become a solution to the task of predicting failure due to unknown stresses by showing problem areas in a material and allowing designers to see all of theoretical stresses within. AIMS AND OBJECTIVES: To evaluate and compare the effect of various temperature changes on the stress distribution, in class II mesial-occlusal-distal (MOD) cavity when restored with different restorative materials, using the finite element method (FEM). MATERIALS AND METHODS: Using FEA, various thermal stresses generated in class II MOD lesion using different restorative materials were studied. RESULTS: The computer-generated models of intact tooth and teeth restored with the different restorative materials were designed, and thermal stress at different temperatures was observed when subjected to the thermal loads of 5°C, 20°C, 36°C, and 55°C. From the results of the study, it can be concluded that glass ionomer cement (GIC) performed best, followed by intact tooth, composite resin, silver amalgam, and zinc oxide eugenol cement. CONCLUSION: Restoration of class II MOD lesions with materials of lower modulus of elasticity and lower coefficient of thermal expansion will enable better stress distribution.How to cite this article: Srivastava B, Devi NN, Gupta N, Singh R. Comparative Evaluation of Various Temperature Changes on Stress Distribution in Class II Mesial-occlusal-distal Preparation restored with Different Restorative Materials: A Finite Element Analysis. Int J Clin Pediatr Dent 2018;11(3):167-170.