Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study.

Introduction: Optimal pain management of symptomatic pulpitis in formative years goes a long way in developing a positive dental attitude. Efforts should be made to increase the success of anesthesia, thus diminishing negative dental experiences. The aim of the study was to assess the efficacy of preemptive analgesia on the success of pulpal anesthesia following inferior alveolar nerve block (IANB) in children with symptomatic irreversible pulpitis and on reducing postendodontic pain. Materials and methods: The research design was an in vivo, three-group, parallel, quadruple-blind study. A total of 75 patients were randomly allocated to one of the three groups-group I: ibuprofen, group II: combination of ibuprofen and paracetamol, and group III: multivitamin (placebo). Premedication was given 45 minutes before treatment, and patients received IANB in a standardized manner. Pain during pulpectomy was recorded using the face, legs, activity, cry, consolability (FLACC) scale and postoperatively using Wong-Baker's pain rating scale (WBPRS) at 4, 12, and 24 hours. Success was measured if the pain felt was of no or mild intensity. Results: Success of IANB was 64% for ibuprofen, 72% for the combination group, and 40% for the placebo group, with no statistically significant difference between all groups (p = 0.06) on the FLACC scale. At 4 hours postoperatively, a significant difference (p = 0.02) was found among groups with more children experiencing no or mild pain in groups I and II and the highest number of rescue medications taken by the placebo group. Conclusion: Ibuprofen and a combination of ibuprofen and acetaminophen as preemptive analgesics had no significant effect on the success rate of IANB, although it was effective in reducing pain at 4 hours postoperatively. How to cite this article: Gori NA, Patel MC, Bhatt RK, et al. Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study. Int J Clin Pediatr Dent 2024;17(1):72-78.

Iontophoresis-Infused Deep Topical Anesthesia and Injectable Local Anesthesia for Dental Procedures Among Pediatric Patients: Performances and Consequences.

INTRODUCTION: Exploring routes of needle-free anesthesia has drawn particular attention to the iontophoretic technique. Iontophoresis has a wide range of applications in dentistry, treating hypersensitivity, oral ulcers, non-invasive procedures of deep topical anesthesia, etc. Hence, this research was performed for a comparative assessment of topical anesthesia spray infused via iontophoresis and local anesthesia (LA) infiltration for dental procedures among 5-12-year-old patients. MATERIALS AND METHODS: A split-mouth, randomized clinical trial was undertaken over two years among study subjects aged 5 to 12 years. They were randomly assigned to one of two groups: the first (Group A - iontophoresis group) received topical anesthesia spray (Lidayn®; Pyrax Polymers, Roorkee, India) applied by iontophoresis, and the second (Group B - LA infiltration group) received local infiltration of 2% lignocaine solution (LignoTer®; Lusture Pharma, Ahmedabad, India), where primary teeth extraction or pulpectomy was performed. The Wong-Baker Facial Pain Rating Scale (WBFPRS) was used for a subjective assessment immediately following anesthesia. RESULTS: The mean value of current intensity for the extraction procedure was 9.43±0.95 mA, and the duration of application was 1.85±0.80 minutes. The mean value of current intensity for pulpectomy was 9.07±1.34 mA, and the time was 2.40±0.74 minutes. In inter-group comparison, WBFPRS scores were lower in Group A (1.96±1.64) compared to Group B (3.62±1.11), which was statistically significant with p=0.001. CONCLUSION: Compared to local infiltration, iontophoresis as a non-invasive approach for topical anesthesia was more well-received by pediatric patients.

A comparative assessment of efficacy and preference between needleless device INJEX and insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years: A split-mouth crossover randomized clinical study.

insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years. Materials and Methods: This randomized clinical study included 46 children aged 4-9 years. The patients were digitally allotted to receive 4% articaine for extractions of primary maxillary teeth, either using needleless device INJEX or insulin syringe on each side of the maxillary arch, in two different appointments after a 1-week washout period. Pain perception was measured by the subjective (Faces Pain Scale-Revised [FPS-R]) and objective pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC]) and hemodynamic parameters (heart rate and oxygen saturation) during LA administration and during extractions. After the second appointment, children were asked about their preference between needleless device INJEX and insulin syringe. Results: On evaluating subjective pain scores with FPS-R, intergroup differences between the INJEX and insulin syringe groups were found statistically insignificant, both during LA administration (P = 0.101) and extraction (P = 0.080). However, on assessing pain objectively during extraction using FLACC, the mean pain score was less with insulin syringe (2.78) as compared to INJEX (4.72) and the difference was statistically significant (P = 0.000). There was no significant difference in patient preference between the two methods. Conclusion: Pain perception was minimal during local anesthesia administration using needleless device INJEX; however, its clinical efficacy during extractions was reported to be lower than insulin syringe. Background: Managing pain in children is the most challenging task as it forms the foundation for instilling positive behavior toward dental treatment. Adequate local anesthesia (LA) is the cornerstone of pain management. However, the fear of needles, particularly in young children, can result in complete avoidance and refusal of treatment. Aim: This study aimed to evaluate and compare the efficacy and preference between needleless device INJEX and.

Anesthetic Effect of 2% Amitriptyline Versus 2% Lidocaine: A Comparative Evaluation.

Introduction A common dental problem is the fear of pain during needle prick for giving local anesthesia (LA). The needle prick pain during dental procedures often varies with sex and age. Perception of pain depends on various factors, which can be psychological and biological. This perception of pain may change the behavior of patients toward dental treatments. Traditionally, lidocaine gel formulation was utilized before the parenteral dosage form. The lidocaine gel formulation is considered the drug of choice for LA in dental surgery. Currently, amitriptyline has been utilized in dental practice because of its beneficial pharmacology. Hence, the present study has been undertaken to compare the anesthetic ability of amitriptyline as an intraoral topical anesthetic agent with lidocaine gel. Methods This study was a comparative clinical study between two medications' anesthetic properties. This study included 120 patients indicated for bilateral orthodontics (the subdivision of dentistry that emphasizes identifying necessary interventions for the malocclusion of teeth) procedures. All the subjects were divided into amitriptyline and lidocaine groups. Both anesthetic gels were applied at separate sites before the injection of LA. The time of the onset of anesthesia was noted and analyzed. Patients were selected on the basis of inclusion and exclusion criteria. Individuals aged 18 to 30 years who were systemically healthy and orthodontically indicated for bilateral premolar extraction were included in this study. Again, patients with a history of neurological disorders and allergies to amitriptyline and lidocaine were excluded from the current study. Results Significant differences emerged between groups at five and 10 minutes, with amitriptyline-induced partial numbness (36.7% and 6.7%). At 40 and 45 minutes, both groups showed varied partial and complete numbness, with amitriptyline leading to partial recovery (23.3% and 73.3% complete numbness, 23.3% partial recovery) and lidocaine resulting in partial recovery (81.7%). When comparing the visual analog scale (VAS) scores, both groups exhibited a similar simultaneous effect at 15 minutes. Nonetheless, amitriptyline displayed significantly lower scores at 25 and 35 minutes (p < 0.001) in comparison to lidocaine. Similar observations were made when controlling for pain intensity. Conclusion It was concluded that amitriptyline holds both anesthetic and analgesic properties. Nevertheless, this study was unable to generalize the study findings because of the small sample size and being a single-center study. However, the VAS scores of anesthetic and analgesic pharmacodynamics properties of amitriptyline were statistically significantly lower than lidocaine, particularly at 25 and 35 minutes. Additionally, amitriptyline-induced anesthetic and analgesic pharmacology, especially pharmacokinetics properties, depends on the location and pattern of pain.

A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial.

Background: Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years. Materials and Methods: In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4-6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05. Results: Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I - P ≤ 0.001, Group II - P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups. Conclusion: Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

Clinical and Radiographic Evaluation of Different Glass Ionomer Restorative Materials in Primary Molars: A Comparative Randomized Clinical Trial.

Aim: The study aimed to evaluate and compare the clinical and radiographic success rate of Ketac Universal (3M), GC 9 EXTRA (GC), and Cention N (Ivoclar) restorative materials in primary molars. Materials and methods: The study was conducted as randomized clinical trial in children aged 3-8 years old, out of which a total of 75 primary molars were selected in 43 patients who met the inclusion criteria. The sample size was further divided into three groups of restorative materials, which included group I-Ketac Universal (n = 25), group II-GC 9 EXTRA (n = 25), and group III-Cention N (n = 25). Class I restorations were placed randomly according to the computerized randomization in primary molars and evaluated at baseline (1 week), 6 months, and 12 months according to modified United States Public Health Service (USPHS) criteria and bitewing radiographs. Results: On intercomparison of three groups at 12 months, there was no significant difference found, while on pairwise comparison of Ketac Universal and Cention N, there was a significant difference in relation to surface texture (p = 0.04*) and anatomic contour (p = 0.04*) at 12 months. Conclusion: Newly introduced restorative material Cention N exhibited improved physical and mechanical properties and can be recommended as a cost-effective restorative and easy-to-use material in posterior load-bearing primary molars. Clinical significance: Restoration of primary teeth continues to be an important aspect of restorative dentistry. The longevity of restorations in primary teeth is significantly different for all materials compared to permanent dentition. This makes the assessment of these restorations as a separate group meaningful. How to cite this article: Kataria VG, Patel MC, Bhatt R, et al. Clinical and Radiographic Evaluation of Different Glass Ionomer Restorative Materials in Primary Molars: A Comparative Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(6):829-836.

Characteristics and Management of Children With Suspected COVID-19 Admitted to Hospitals in India: Implications for Future Care.

INTRODUCTION: There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials. OBJECTIVE: Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality. METHODOLOGY: A point prevalence study using specially developed report forms among 30 hospitals in India. RESULTS: The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery. CONCLUSION: It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs.

Evaluation of silver-modified atraumatic restorative technique versus conventional pulp therapy in asymptomatic deep carious lesion of primary molars - A comparative prospective clinical study.

Background: Lately, a paradigm shift from radical to conservative approach has popularized the selective caries removal over complete excavation in deep caries. Indirect pulp therapy over pulpotomy is being preferred due to risk of questionable pulp vitality in carious exposure of pulp. Silver diamine fluoride can be a useful tool for noninvasive caries management due to its antimicrobial and remineralization properties. Aim: The study aims to evaluate the success of minimum intervention approach using silver-modified atraumatic restorative technique (SMART) as indirect pulp treatment compared to conventional vital pulp therapy in symptomless deep carious lesions of primary molars. Materials and Methods: In this comparative, prospective, double-blinded, clinical interventional study, 60 asymptomatic primary molar teeth with international caries detection and assessment system score 4-6 were selected in children aged 4-8 years and were randomly allocated into SMART and conventional groups. The success of the treatment approach was assessed using clinical and radiographic criteria at baseline, 3, 6, and 12 months interval. Results: Data were analyzed using Pearson Chi-Square test at a significance level of 0.05. Conventional group showed 100% and SMART observed 96.15% clinical success at 12 months follow up (P > 0.05). One radiographic failure due to internal resorption at 6 months in SMART and one in the conventional group at 12 months was reported though the difference was insignificant (P > 0.05). Conclusion: Removal of all infected dentin in deep carious lesions is not required for successful caries treatment and SMART can be recommended as a potential biologic approach to manage asymptomatic deep dentinal lesions, based on optimal case selection.

Clinical Performance and Parental Satisfaction with Composite Strip Crown and Prefabricated Zirconia Crown for Primary Anterior Teeth: A Randomized Clinical Trial.

AIM: To compare clinical performance and parental satisfaction with composite strip crown and prefabricated zirconia crown for primary anterior teeth. MATERIALS AND METHODS: The study compares clinical evaluation and parental satisfaction of two different crowns for primary anterior teeth. A total of 102 teeth in each group selected between ages 3 and 6 years, who met the inclusion criteria, were randomly allocated into two groups for further evaluation. Group A for strip crowns (55 teeth) and group B for zirconia crowns (47 teeth). The crowns were evaluated clinically with various criteria like-color match, crown retention, gingival health, crown contour, opposing tooth wear, marginal integrity, and recurrent caries. The samples were also evaluated for parental satisfaction based on 5-point Likert scale and child liking was also recorded with Smiley face Likert scale at baseline, 3 and 9 months. Statistical analysis was done using Chi-square test (p <0.05). RESULTS: Zirconia crowns showed better color match, crown retention, crown contour, and gingival health. Strip crowns showed more discoloration and chipping of material over a period of time. None of the samples showed opposing tooth wear, open margins, and recurrent caries in strip and zirconia crown group. Parents and children both were highly satisfied with zirconia crowns. CONCLUSION: Clinically zirconia crowns showed higher success rate as compared to strip crowns and parental overall satisfaction was higher for zirconia crowns. CLINICAL SIGNIFICANCE: Zirconia crowns exhibited a higher clinical performance and parental satisfaction; hence, if affordability is out weighted, zirconia crown stands better with esthetics of the child.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future.

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications.

Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.

Evaluation of the Efficacy of Play Therapy among Children Undergoing Dental Procedure through Drawings Assessed by Graphological Method: A Clinical Study.

INTRODUCTION: Behavior modification is defined as the attempt to alter human behavior and emotion in a beneficial way and accordance with the laws of learning. Play therapy is one such behavior modification technique. The study aimed to evaluate the efficacy of play therapy among children undergoing dental treatment by the graphological method. MATERIALS AND METHODS: Children were made to draw before treatment, after treatment of one class 1 lesion without application of any behavior modification technique and after treatment of the second lesion of class 1 caries with play therapy. Graphologist and scores assessed drawings were given by graphological method. RESULTS: Significant reductions in stress levels were observed in the drawings which were made after play therapy. CONCLUSION: Play therapy is an effective behavior modification technique in pediatric dentistry, which may be used in routine dental practice.How to cite this article: Kiran SDP, Vithalani A, Sharma DJ. Patel MC, Bhatt R, Srivastava M. Evaluation of the Efficacy of Play Therapy among Children Undergoing Dental Procedure through Drawings Assessed by Graphological Method: A Clinical Study. Int J Clin Pediatr Dent.,2018;11(5):412-416.

Comparison of Plaque Removal Efficacy of a Novel Flossing Agent with the Conventional Floss: A Clinical Study.

INTRODUCTION: The various methods for plaque control include mechanical plaque control methods which comprises use of toothbrushes, flosses, interdental brushes, and chemical plaque control which includes mouthwashes, dentrifices. The need for the study was to prove the efficacy of flossing in children using gumchucks. MATERIALS AND METHODS: A total sample size of 24 children age groups 6-12 years according to chronological age were selected. In 12 patients, flossing using gumchucks was done and in 12 patients flossing using unwaxed floss without handle was done. Proximal plaque index was taken at 0,2,4,6 weeks to assess the efficacy of both types of floss in removal of interproximal plaque. At the end of 6 weeks, patient's parents were asked to fill up the questionnaire. RESULTS: In the intragroup comparison for gumchucks, significant plaque reductions were found at 4 and 6 weeks. In the intragroup comparison for unwaxed floss, significant reduction for plaque marginal index were recorded from baseline to 2 and 4 weeks. In the intergroup comparison, significant reduction in plaque index was recorded at 4 and 6 weeks. CONCLUSION: Gumchucks have the high efficacy of plaque removal as well as easy in use for children routinely. Also when surveyed majority of the patents preferred gumchucks if available in the stores. HOW TO CITE THIS ARTICLE: Kiran SDP, Ghiya K, Makwani D, Bhatt R, Patel M, Srivastava M. Comparison of Plaque Removal Efficacy of a Novel Flossing Agent with the Conventional Floss: A Clinical Study. Int J Clin Pediatr Dent, 2018;11(6):474-478.

Impact of Dental Health Education on "Specific Learning Needs" Children.

INTRODUCTION: This article compares and evaluates the effect of dental health education through schoolteachers and dental health professionals to "specific learning needs" children attending special school. MATERIALS AND METHODS: A total of 71 "specific learning needs" children attending special school participated in the study. The baseline oral hygiene index-simplified (OHI-S) for all the participants was recorded. The training of schoolteachers was done using audiovisual and verbal methods on dental health facts and how to provide instructions on oral hygiene measures for reinforcing to the students. The students were randomly divided into three groups: Group 1 - No further dental health education by the schoolteachers or by the dental professionals was given to these students after the initial oral health education. Group 2 - In this group, the trained teachers taught students about the importance of oral health and demonstrated them brushing technique at intervals of 15 days, 1 month and 3 months. Group 3 - The dental professionals imparted dental health education and also demonstrated brushing techniques to these students at intervals of 15 days, 1 month and 3 months. Six months following the intervention a second examination was done to find out the OHI-S scores. Data analysis were done with Statistical Packages for the Social Sciences (SPSS) version 16 using one-way analysis of variance (ANOVA) statistical test. RESULTS: Group 2 demonstrated significant decline in OHI-S scores after intervention and all the three groups showed a statistically significant difference between the baseline OHI-S score and the scores after 6 months. CONCLUSION: Schoolteachers can be utilized for reinforcing dental health education among "specific learning needs" children effectively. How to cite this article: Relwani AH, Kiran S, Bhatt R, Patel M. Impact of Dental Health Education on "Specific Learning Needs" Children. Int J Clin Pediatr Dent 2016;9(1):31-34.

Adenomatoid odontogenic tumour in mandible in a 14-year-old boy.

A 14-year-old boy reported with a painless swelling over the right anterior mandible with missing right canine tooth. The lesion was diagnosed as 'central follicular adenomatoid odontogenic tumour' and excised surgically under general anaesthesia. The patient was on a year-long clinical and radiographical follow-up.