Clonidine versus Adrenaline as an Adjunct to Lignocaine on Haemodynamic Parameters during Nerve Block for Third Molar Surgical Removal - A Systematic Review and Meta-Analysis.

Background: Adrenaline or clonidine is used as adjuncts in conjunction with lignocaine to improve the depth of local anaesthesia in dental procedures. Objectives: This systematic review and meta-analysis intends to compare the haemodynamic parameters when clonidine or adrenaline is used in conjunction with lignocaine for third-molar surgical removal. Data Sources: Cochrane, PubMed and Ovid SP databases were searched using "MeSH" terms (((nerve block) OR (IANB)) AND ((clonidine) OR (adrenaline))) AND (lignocaine). Study Eligibility Criteria: Clinical studies where Clonidine + lignocaine and Adrenaline + lignocaine were compared directly during nerve block administration exclusively for third molar surgical removal were selected. Participants Study Appraisal: This current systematic review is registered in Prospero database CRD42021279446. Two independent reviewers were involved in collection, segregation and analysis of electronic data. The data were compiled in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search was conducted till June 2021. Synthesis Methods: Qualitative analysis of the selected articles was performed for systematic review. Meta-analysis is performed using RevMan 5 Software. Heterogeneity through the I2 statistics. Change in the haemodynamic parameters was the primary outcome evaluated, and secondary outcomes evaluated were onset and duration of anaesthesia in both the groups. Results: In all databases, 1141 records were screened, out of which a total of 21 articles were included for the evaluation for full-text analysis. Out of these, 16 articles were excluded and 5 articles were included for the final systematic review. Meta-analysis was performed only for 4 studies. Conclusion: Amongst the evaluated haemodynamic parameters, there was a significant reduction in the heart rate (baseline to intraoperative period) in clonidine and lignocaine groups than in adrenaline and lignocaine groups during nerve block administration for third molar surgical removal. There was no significant difference between other primary and secondary outcomes evaluated. Limitations: Blinding was not performed in all the studies, randomisation was performed in only three studies. The volume of local anaesthesia deposited varied in the studies (2 mL in three studies and 2.5 mL in two studies). Most of the studies (n = 4) were evaluated on normal adults and only one study evaluated mild hypertensive patients.

Assessing the risk factors for injuries to maxillary permanent incisors and soft tissues among school children - A cross-sectional study.

Aim: The present study aimed to determine the risk factors related to permanent maxillary incisors and soft tissue injuries along with providing information about the age distribution of trauma, overjet, lip competence and physical activity. Methods and Materials: The sample consisted of 2100 school children aged 8-14 years from 15 schools in the Nellore district. The sample was selected adopting a stratified random sampling method and screened applying WHO criteria for the oral examination. The screening was done in classrooms to obtain demographic data, including name, age, gender and children's experience to the maxillary incisor and soft tissue injuries. The injuries were categorized according to Andreasen classification. Overjet and lip competences were recorded, and physical activity was assessed using a questionnaire (PAQ-C). Results: Of the 2100 children, 228 (10.8%) had suffered traumatic injuries. Boys were 1.6 fold more prone to trauma than girls. Enamel fractures were a common type of trauma, and the commonly involved were maxillary central incisors. The relative risk for trauma is 1.215 times higher in increased overjet when compared to normal overjet. Incompetent lips showed 1.189 times greater risk of trauma. The high physical activity showed 1.692 times higher risk for trauma when compared to low physical activity. Conclusion: The prevalence of traumatic dental injuries among 8-14 year children was 10.8%. Boys were more commonly injured than girls. Increased overjet incompetent lips and high physical activities are risk factors for trauma. Enamel fracture was the most common type, and maxillary central incisors were the most common teeth having traumatic injuries.

Reframing in dentistry: revisited.

The successful practice of dentistry involves a good combination of technical skills and soft skills. Soft skills or communication skills are not taught extensively in dental schools and it can be challenging to learn and at times in treating dental patients. Guiding the child's behavior in the dental operatory is one of the preliminary steps to be taken by the pediatric dentist and one who can successfully modify the behavior can definitely pave the way for a life time comprehensive oral care. This article is an attempt to revisit a simple behavior guidance technique, reframing and explain the possible psychological perspectives behind it for better use in the clinical practice.

Unusual occurrence of accessory central cusp in the maxillary second primary molar.

Accessory cusp present on the occlusal surface may seldom pose problems. While its presence may not be a cause for alarm in most instances, it can sometimes lead to serious consequences if it is damaged. This case presents a rare finding of unilateral central accessory cusp seen on the occlusal surface of the maxillary left second primary molar and discusses the need for continuous dental surveillance and preventive measures.