Clinical Utility of Stepwise Bronchoalveolar Lavage Fluid Analysis in Diagnosing and Managing Lung Infiltrates in Leukemia/Lymphoma Patients With Febrile Neutropenia.

PURPOSE: Febrile neutropenia (FN) is a serious complication in hematologic malignancies, and lung infiltrates (LIs) remain a significant concern. An accurate microbiological diagnosis is crucial but difficult to establish. To address this, we analyzed the utility of a standardized method for performing bronchoalveolar lavage (BAL) along with a two-step strategy for the analysis of BAL fluid. PATIENTS AND METHODS: This prospective observational study was conducted at a tertiary cancer center from November 2018 to June 2020. Patients age 15 years and older with confirmed leukemia or lymphomas undergoing chemotherapy, with presence of FN, and LIs observed on imaging were enrolled. RESULTS: Among the 122 enrolled patients, successful BAL was performed in 83.6% of cases. The study used a two-step analysis of BAL fluid, resulting in a diagnostic yield of 74.5%. Furthermore, antimicrobial therapy was modified in 63.9% of patients on the basis of BAL reports, and this population demonstrated a higher response rate (63% v 45%; P = .063). CONCLUSION: Our study demonstrates that a two-step BAL fluid analysis is safe and clinically beneficial to establish an accurate microbiological diagnosis. Given the crucial impact of diagnostic delays on mortality in hematologic malignancy patients with FN, early BAL studies should be performed to enable prompt and specific diagnosis, allowing for appropriate treatment modifications.

Investigating stigma during the COVID-19 pandemic: Living conditions, social determinants and experiences of infection among employees at a tertiary referral cancer centre.

AIM: Healthcare workers (HCWs) have reported negative social experiences during the COVID-19 pandemic; however, this data is largely from medical personnel. We examined living conditions, social determinants, and experiences during the COVID-19 pandemic among all cadres of employees who had recovered from COVID-19 at a tertiary referral cancer hospital in India. METHODS: We conducted a mixed methods study combining a questionnaire-based survey followed by semi-structured interviews with open-ended questions, among hospital staff who recovered from COVID-19 between April and November 2020. We initially administered a 79-point survey to all participants; based on their responses, we used purposive sampling to identify 60 interview participants. The primary aim of the study was to examine the impact of socio-economic factors on experiences and potential stigma faced by staff during the COVID-19 pandemic. RESULTS: We surveyed 376 participants including doctors (10 %), nurses (20 %), support staff (29 %), administrators (18 %) and scientists/technicians (22 %). Of these, 126 (34 %) participants reported negative social experiences. Stigmatisation was lower among doctors compared to other professions, decreased in the second half of the study period, and was more among those living in less affluent surroundings. Interviews revealed 3 types of negative social experiences: neighbourhood tensions around restrictions of mobility, social distancing, and harassment. CONCLUSIONS: The first phase of the COVID-19 pandemic in India led to considerable negative social experiences among hospital employees, especially those lower in the socio-economic hierarchy, which was fuelled by restrictions imposed by the government and pressure on local neighbourhoods. POLICY SUMMARY: It is important to not just document and count stigma experiences during global pandemics, but also to examine sociologically the conditions under which and the processes through which stigma happens.

A Comparative Evaluation of Xylitol Chewing Gum and a Combination of IgY + Xylitol Chewable Tablet on Salivary Streptococcus mutans Count in Children: A Double-blind Randomized Controlled Trial.

Aim: The study was designed for evaluation and comparison of the efficacy of Xylitol chewing gum and a combination of IgY + Xylitol chewable tablet (Nodecay TM) against the "salivary Streptococcus mutans " count in children. Materials and methods: About 120 children belonging to 6-12 years age-group were enrolled into this "double-blind randomized control clinical trial" according to the selection criteria. They were randomly assigned to three groups of 40 each: Group I-Xylitol chewing gum, Group II-IgY + Xylitol Chewable tablet (Nodecay TM), and Group III-Control. Children in all the groups had to chew the gum/tablet twice daily for 5 minutes during the 15-day period. The salivary samples at baseline, 15 days, 1, 2, and 3 months were inoculated on mitis salivarius bacitracin agar with potassium tellurite medium and the number of colony-forming units (CFUs) of Streptococcus mutans were determined. The data obtained was subjected to statistical analysis. Result: There was a "significant" difference in the number of "S. mutans CFUs" amongst the three groups at 15 days, 1st month, 2nd month, 3rd month with highest levels of S. mutans CFUs in Group III-Control and least in Group II-IgY + Xylitol (NodecayTM). Conclusion: The combination of IgY + Xylitol (NodecayTM) when administered for 15 days had significant efficacy against "S. mutans" when compared to Xylitol and control group. Clinical significance: Passive immunization with immunoglobulin Y is known not only to decrease the S. mutans count but also confers extended immunity by preventing recolonization of the tooth surface by persistence of the antibodies in saliva. How to cite this article: Jain RL, Tandon S, Rai TS, et al. A Comparative Evaluation of Xylitol Chewing Gum and a Combination of IgY + Xylitol Chewable Tablet on Salivary Streptococcus mutans Count in Children: A Double-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-2):S212-S220.

Oral Health Status in Mentally Disabled Children, Dental Care Knowledge of Parents, and the Impact of Audiovisual Oral Health Education Program.

Aims and objectives: The aims and objectives of this study were to evaluate the oral health status in a group of mentally disabled children, to identify the oral health knowledge of parents and to assess the impact of audiovisual oral health education program. Materials and methods: The study sample comprised of 120 mentally disabled subjects aged 5-16 years and 40 parents attending a vocational institute in Jaipur, India. Caries status and oral hygiene status were assessed by DMFT Index and Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion, respectively. Twenty pre- and post-structured close-ended questions were designed and a 5-minute video on oral health education was prepared. Data was analyzed by using one way ANOVA test followed by Post hoc Tukeys HSD Test, Wilcoxon Signed Rank Test, and Chi-square test. Effectiveness index was calculated to find the impact of AV Teaching Program. Results: Oral hygiene status deteriorates as the severity of mental retardation increases but it was not found significantly associated with oral hygiene status. An effectiveness index of at least 0.5 indicates that the instructional media was satisfactorily effective. Conclusion: Maximum children with poor oral hygiene were in the category of severe mental retardation and mean OHI-S score decreases from severe-to-mild mental retardation. The newly designed audiovisual aid on complete oral health care was effective at some levels in improving the oral health knowledge of the parents/caregivers of mentally retarded children. How to cite this article: Shah RK, Choudhary S, Tandon S. Oral Health Status in Mentally Disabled Children, Dental Care Knowledge of Parents, and the Impact of Audiovisual Oral Health Education Program. Int J Clin Pediatr Dent 2022;15(2):143-148.

Hepatic tuberculosis masquerading as malignancy.

BACKGROUND AND AIMS: Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. METHODS AND MATERIAL: We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. RESULTS: The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan's giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. CONCLUSION: HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. TRIAL REGISTRATION: This is a retrospective and observational study hence clinical trial registration is not applicable.

Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer.

Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15-79 years) were identified. Of these 112 (93.3%; 95% CI 88.9-97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6-61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38-18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9-97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7-99.4%). Ascitic fluid Ziel-Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3-12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6-20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.

Improving accuracy of 18F-fluorodeoxyglucose PET computed tomography to diagnose nodal involvement in non-small cell lung cancer: utility of using various predictive models.

PURPOSE: To determine predictive models (PM) that could improve the accuracy for identifying metastatic regional nodes in non-small cell lung cancer based on both PET and CT findings seen on 18F-FDG PET CT. METHODS: Three hundred thirty-nine biopsy-proven NSCLC patients who underwent surgical resection and had a staging 18F-FDG PET CT were enrolled. PET parameters obtained were (1) presence of visual PET positive nodes, (2) SUVmax of nodes (NSUV), (3) ratio of node to aorta SUVmax (N/A ratio) and (4) ratio of node to primary tumour SUVmax (N/T ratio). CT parameters obtained were (1) short-axis diameter and (2) Hounsfield units (HU) of PET-positive nodes. PET and CT parameters were correlated with nodal histopathology to find out the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. Different PM combining these parameters were devised and the incremental improvement in accuracy was determined. RESULTS: Visual PET positivity showed sensitivity, specificity, PPV, NPV and accuracy of 72.4, 76.1, 30.1, 95.1 and 75.6, respectively. PM2 which combined visual PET positivity, NSUV and HU appears more clinically relevant and showed sensitivity, specificity, PPV, NPV and accuracy of 53.5, 96.5, 68.9, 93.6 and 91.2, respectively. PM6 which combined visual PET positivity, NSUV, N/A ratio and HU showed the maximum PPV (80.0%), specificity (98.3%) and accuracy of (91.9%). CONCLUSION: PM combining parameters like nodal SUVmax, N/A ratio, N/T ratio and HU values have shown to improve the PPV, specificity and overall accuracy of 18FDG PET CT in the preoperative diagnosis of nodal metastases.

Comparison of Accuracy of Apex Locator with Tactile and Conventional Radiographic Method for Working Length Determination in Primary and Permanent Teeth.

BACKGROUND: Correct working length determination is one of the main factors leading to success in root canal treatment. The digital tactile sense technique and conventional radiography (CR) are common techniques for working length determination but both techniques have some limitations. A newer method of working length estimation involves use of the apex locator. The current study was carried out to compare the accuracy of the apex locator with a tactile and conventional radiographic method for working length determination in primary and permanent teeth. MATERIALS AND METHODS: The study was conducted on 60 children selected randomly from the outpatient department of the Department of Pediatric and Preventive Dentistry. The patients were divided into two groups: primary and permanent. An informed consent was obtained. After radiographic confirmation of the presence of more than two-third root length access, opening was done in all the teeth. The pulp was extirpated completely from the chamber and canals. Canals were dried completely using paper points. Working length was determined by all the three methods, i.e., digital tactile method, apex locator, and conventional intraoral periapical radiographic method in both primary and permanent teeth. RESULTS: The data were coded and entered into the Microsoft Excel spreadsheet. The analysis was done using the SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The variables were assessed for normality using the one-way ANOVA test. Within the limitations of this study, working lengths obtained by the tactile method, the apex locator, and the radiographic method were comparable. There was no statistically significant difference among the three methods except in mesiolingual and distobuccal canals of permanent teeth. CONCLUSION: The apex locator can serve as a useful guide to determine the working length in permanent as well as primary teeth. HOW TO CITE THIS ARTICLE: Rathore K, Tandon S, Sharma M, et al. Comparison of Accuracy of Apex Locator with Tactile and Conventional Radiographic Method for Working Length Determination in Primary and Permanent Teeth. Int J Clin Pediatr Dent 2020;13(3):235-239.

Recurrent Irritation Fibroma-"What Lies Beneath": A Multidisciplinary Treatment Approach.

Irritation fibroma is a benign, exophytic reactive oral lesion that develops secondary to injury. Its recurrence rate is rare but may happen in case of repeated trauma at the same site. This case report describes a recurrent fibroma in the anterior region of the hard palate in a 13-year-old male patient, which recurred in less than 1 year of surgical excision of the previous lesion. Through a detailed case history and clinical examination, the etiological factor of the same was found to be trauma from occlusion by the lower incisors. A multidisciplinary treatment approach was, therefore, undertaken, which included surgical excision of the lesion and correction of the underlying deep bite to prevent recurrence of the lesion. Thus, this article highlights the significance of a multidisciplinary approach for holistic dental treatment. HOW TO CITE THIS ARTICLE: Lalchandani CM, Tandon S, Rai TS, et al. Recurrent Irritation Fibroma-"What Lies Beneath": A Multidisciplinary Treatment Approach. Int J Clin Pediatr Dent 2020;13(3):306-309.

Primary tonsillar tuberculosis masquerading as carcinoma of the tonsil.

Primary tuberculosis (TB) of tonsil is a rare form of extra-pulmonary tuberculosis. Most tonsillar TB cases present with coexistent pulmonary tuberculosis. It can simulate tonsillar malignancy and poses a diagnostic challenge. Histopathological examination is often needed for confirmation. Herein, we report a case of primary tonsillar tuberculosis in a 55-year-old gentleman mimicking carcinoma of the tonsil.

Correction to: The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection.

The original article has been corrected.

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection.

Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra- and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

Stereotactic body radiation therapy for medically inoperable early-stage lung cancer: Tata Memorial Hospital perspective and practice recommendations.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is now considered the standard treatment for medically inoperable early-stage non-small lung cell cancer (ES-NSCLC). PURPOSE: There is a paucity of data related to outcomes with SBRT in ES-NSCLC from the developing countries. We report the early outcomes of ES-NSCLC patients treated with SBRT at our institute. MATERIALS AND METHODS: Between 2007 and 2015, 40 consecutive patients with histologically proven ES-NSCLC were treated with SBRT. Median age was 71 years (range: 46-88 years) and median Charlson comorbidity index (CCI) was 3. The majority had stage I (70%) and 45% of the tumors were centrally located. The median tumor diameter was 3.8 cm (range: 2-7.6 cm). The mean gross tumor volume was 41 cc (range: 4-139 cc) and the mean planning target volume (PTV) was 141 cc (range: 27-251 cc). Varying dose and fraction (fr) sizes were used depending on tumor location, tumor size, and treatment period. The median biologically effective dose (BED) was 77 Gy10 (range: 77-105 Gy10) for the initial cohort (2007-2012) and 105 Gy10 (range: 77-132 Gy10) for the subsequent cohort (2013-2015). RESULTS: After a median follow-up of 16 months (range: 3-99 months), the 2-year local control (LC), overall survival, and cancer-specific survival (CSS) rates were 94%, 41%, and 62%, respectively. The univariate and multivariate analysis determined CCI >3 and PTV >80.6 cc as significant predictors of worse OS and CSS (P< 0.01). The clinical stage, tumor location, BED, and treatment period (2007-2012 vs. 2013-2015) did not significantly predict any of the outcomes. The most common acute toxicities were skin erythema (10%), grade 1 esophagitis (8%), and exacerbation of previous chronic obstructive pulmonary disease (10%). Grade ≥2 late radiation pneumonitis was seen in 17.5%. One patient developed a rib fracture. No neurological or vascular complications were seen. CONCLUSIONS: SBRT results in excellent local control (LC) and acceptable survival in medically inoperable ES-NSCLC with minimal adverse effects. Charlson comorbidity index and target volume are important prognostic factors and may aid in patient selection.

Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study.

AIM AND OBJECTIVES: To evaluate clinical and radiographic efficacy of a mix of O. sanctum (tulsi extract) and calcium hydroxide as an obturating material in primary molars and to compare these findings with commercially available iodoform with calcium hydroxide paste (metapex). MATERIALS AND METHODS: The present study was conducted on sixty children age group 4-7 years requiring multiple visit pulpectomy for their primary molars. The teeth selected were randomly divided into two groups. One group received Metapex and other group received Tulsi extract with calcium hydroxide as an obturating material. Clinical and radiographic evaluation were done between both the groups. RESULTS: There was no significant difference in the clinical and radiographic success rate between both the groups. CONCLUSION: Tulsi extract with calcium hydroxide can be used as an obturating material in primary molars. HOW TO CITE THIS ARTICLE: Agarwal S, Gupta S, Tandon S, et al. Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(6):617-621.

Efficacy of Audiovisual Aid in Assessing Parental Attitude toward their Child's Oral Health.

OBJECTIVE: To evaluate the effectiveness of audiovisual (AV) aid in assessing the parental attitude for their child's oral health. MATERIALS AND METHODS: A study (cross-sectional) was conducted in 50 parents of the children between age group of 0 and 14 years. A PowerPoint presentation was given to parents in two batches, and its effectiveness was assessed by comparing results of questionnaire before and after presentation. Data were collected through a questionnaire. STATISTICAL ANALYSIS: All data were compiled using MS Office Excel Sheet, and analysis was performed using the Statistical Package for Social Sciences software for descriptive analysis, and the level of statistical significance used in this study was chosen at p value < 0.005. RESULTS: The results proved that selected sample had lack of knowledge regarding primary teeth and its importance, oral health care of the child from birth, ideal time of first dental visit, and preventive treatments before awareness program. But there was significant difference in attitude of parents regarding their child's oral health care after presentation. CONCLUSION: Within the limitation of the study, the high prevalence dental caries in children showed that change of parental behavior and attitude is much more important rather than focusing on increasing knowledge only. Hence, AV aids can be effective tools for increasing awareness. HOW TO CITE THIS ARTICLE: Kajal A, Tandon S, Rai TS, et al. Efficacy of Audiovisual Aid in Assessing Parental Attitude toward their Child's Oral Health. Int J Clin Pediatr Dent 2020;13(5):437-441.

Minimal Invasive Approach for Management of Lingual Swelling on Ventral Surface of Tongue.

Pediatric dentistry is a speciality of dentistry focusing mainly on oral health care of children. Early diagnosis and prompt treatment is key of a good treatment plan and effective results. Sometimes in infants, it is not possible to make a confirmatory diagnosis due to lack of cooperation, which is the biggest challenge of kids dentistry. In such cases, we need to take into consideration the psychological and physiologic aspect of child to find an alternative treatment plan, which is time saving and painless. Here, we present a unique case management of lingual swelling on the ventral surface of tongue in a 9-month-old girl child with a minimal invasive approach, thus avoiding a time-consuming and invasive surgical treatment plan. How to cite this article: Kajal A, Tandon S, Sharma M, et al. Minimal Invasive Approach for Management of Lingual Swelling on Ventral Surface of Tongue. Int J Clin Pediatr Dent 2020;13(S-1):S102-S105.

Queries of Parents Related to their Children's Oral Health in Rural and Urban Area of Jaipur: A Clinical Study.

BACKGROUND: There are a lot of questions in the mind of parents related to primary teeth. Various myths are also prevalent in the society about deciduous dentition. As a pediatric dentist, we come across various questions that are repeatedly asked, other than the chief complaint of the patient. No study has been conducted till date to address such queries. The current study highlights the major queries of parents related to their child's oral health. OBJECTIVES: The purpose of the study is to evaluate the most frequently asked questions by aediatric patient's parents in day-to-day practice apart from the chief complaint and to compare the queries of urban and rural population. METHOD: A sample size of 200 was taken for the study. Parents/attendants of the patients were given a questionnaire which consisted of queries of parents other than chief complain. The data were analyzed to find out what most of the parents want to know from a pediatric dentist about their child's dentition. RESULTS: Based on the survey, we were able to evaluate the most common questions about child's oral health and it was observed that there is a difference in the queries of parents among the rural and the urban population. CONCLUSION: The role of a pediatric dentist is of the utmost importance in creating awareness among patients and their parents about oral health and the importance of primary teeth. HOW TO CITE THIS ARTICLE: Rathore K, Tandon S, et al. Queries of Parents Related to their Children's Oral Health in Rural and Urban Area of Jaipur: A Clinical Study. Int J Clin Pediatr Dent 2019;12(2):88-91.

Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study.

INTRODUCTION: Usually discomfort and pain are associated with dental work, especially for young patients. Pain control can be achieved by using anesthesia. Sight of injection can terrify any patient and if the patient is a child it is really difficult to convince them for injections. Alternatives to injections have been explored. Pediatric dentists are using anesthesia in the form of jelly and patch. Recently, the concept of mucosal vibration has been put forward to enhance the effectiveness of local anesthesia. AIM: The aim of the present study was to compare and evaluate the effectiveness of lignocaine jelly and mucosal vibration in reducing pain during administration of local anesthesia in pediatric dental patients. MATERIALS AND METHODS: Thirty children in the age group 6 to 11 years who required bilateral anesthesia for dental treatment in mandible were selected for this study. Pain was compared using Wilcoxon signed-rank test at the time of injection using Sound, Eye, Motor (SEM) scale as objective criteria and facial pain rating (FPR) scale as subjective criteria after administration of injection by a trained assistant who was blinded to the procedure. RESULTS: Local anesthetic injection along with mucosal vibration resulted in significantly less pain (p = 0.001) in comparison with the injections without the use of mucosal vibration. CONCLUSION: The result shows that mucosal vibration can be used as an effective means to reduce the intensity of pain during local anesthetic injection in dentistry.How to cite this article: Tandon S, Kalia G, Sharma M, Mathur R, Rathore K, Gandhi M. Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study. Int J Clin Pediatr Dent 2018;11(4):261-265.

Speech evaluation in children with missing anterior teeth and after prosthetic rehabilitation with fixed functional space maintainer.

INTRODUCTION: Speech and language development in children is a dynamic process. Development of vocal sound into meaningful speech was one of the major discoveries which have made the human beings to reach the pinnacle of the animal kingdom. The ability to speak is determined by the flow of air into the mouth which affects pronunciation of various words and phrases. AIM: This study aimed to evaluate speech changes before and after prosthetic rehabilitation with fixed functional space maintainer in children with missing maxillary anterior teeth. MATERIALS AND METHODS: The study sample comprised of 25 children in the age range of 3-6 years having at least two maxillary anterior teeth indicated for extraction or had already got extracted. Speech therapist evaluated articulation of [v], [ph], [n], [d], [dh], [th], [t], [s.],[s], and [l] speech sounds of patients preoperatively (T0), postoperatively after the appliance insertion (T1), and postoperatively after 7 days (T2) using Weiss Comprehensive Articulation Test. The data obtained were analyzed using Chi-square and Mcnemar's test. RESULTS: There was statistically significant (P < 0.05) correction in [v], [ph], [d], [dh], [th], [t], [s.], and [s] speech sounds immediately after prosthetic rehabilitation (T1). While, the assessment of speech sounds after 7 days of appliance insertion (T2) showed statistically nonsignificant differences. CONCLUSIONS: The results suggested that treatment of a patient with missing anterior teeth should not be restricted to esthetic and functional oral rehabilitation, but also comprehend with the speech, as premature loss of the primary maxillary incisor appears to have long-term effect on the speech development.