Development and validation of a novel Middle childhood oral health impact scale (MCOHIS).

Purpose: The study was planned to develop and validate a novel middle childhood oral health impact scale (MCOHIS) for 6- to 9-year-old children in India. Methodology: A cross-sectional study design was employed to develop and validate MCOHIS in the sequential phases. A panel of ten pediatric dentists evaluated a pool of 36 items corresponding to the oral health-related quality of life (OHRQoL) of children. MCOHIS with 20 items under five domains was formulated and content validation was done. Cohen's kappa statistics was employed to measure the concordance between the child's self-report and the caregiver's proxy report. Concurrent validation was done among 130 participants from 13 districts of Tamil Nadu state, India. Discriminant validity was checked among another sample of 60 participants. Internal consistency and test-retest reliability of MCOHIS were assessed using Cronbach's alpha and Kappa statistics respectively. Results: MCOHIS had adequate content validation with Scale Level Content Validity Index / Average score of 0.94 for relevance. There was a statistically significant inter-rater reliability observed between the child's self-report and caregivers' proxy report in all items with a moderate to substantial agreement. Concurrent validation showed a statistically significant positive correlation with a Rho value of 0.712. There was a statistically significant difference noted in overall discriminant validity (P < 0.001). Acceptable internal consistency reliability was observed with Cronbach's alpha value of 0.75. Test-retest reliability showed a high stability coefficient of 0.98. Conclusions: MCOHIS was found to be a valid and reliable age-specific tool for assessing the OHRQoL of Indian children aged 6-9 years.

Ego defense mechanisms among pediatric dental postgraduate students in India: A descriptive cross-sectional study.

BACKGROUND: Ego defense mechanisms (EDMs) act as a major factor for overcoming stressful situations in life. AIMS: The study aimed to assess the various patterns and factors of EDMs employed by pediatric dental postgraduate students in India. SETTINGS AND DESIGN: Cross-sectional design, web-based questionnaire survey. METHODS: A cross-sectional questionnaire study on EDM was conducted among 246 pediatric dental postgraduates in India from July to October 2019. The modified form of the Defense Style Questionnaire-20 included 10 EDMs under three major patterns- Mature, Immature, and Neurotic. The questionnaire was sent to all pediatric dental postgraduates enrolled in the Indian Society of Pedodontics and Preventive Dentistry and reminders were sent every week for 6 weeks. RESULTS: Among the 1041 pediatric dental postgraduates who received the E-mail, two hundred and forty-six students responded to the same. The respondents included 89 males and 157 females. The mature pattern was found to be the most commonly employed EDM (males-47.20%; females-51.60%). Sublimation (72.76%), a mature type of defense was found to be the most common EDM factor employed by the majority of the students. The immature pattern was higher among males when compared to females (males-14.60%; females-5.70%). CONCLUSION: Most pediatric dental postgraduates exhibited a mature pattern, followed by a neurotic and immature pattern of EDM. The mature pattern of EDM was displayed more by the female students than the male students. Sublimation was found to be the maximum expressed factor followed by acting out.

Association between black stains and early childhood caries - A systematic review.

OBJECTIVE: To systematically review the association between black stains and early childhood caries. METHODS: Seven electronic databases and hand search were carried out using keywords on black stains and early childhood caries. Articles published in English from January 1947 to January 2020 were included. A total of 38,686 articles were retrieved, and 38,645 duplicate and irrelevant records were removed. Among the 41 articles obtained, 21 articles were excluded after screening the title and abstracts. Fifteen articles were excluded after analyzing the full text. Finally, five articles with cross-sectional study designs were included in this review. Quality analysis was carried out using a modified Newcastle-Ottawa scale. RESULTS: All the five articles included in this review had a low risk of bias. Two articles showed a significant negative association and one article showed a significant positive association between black stains and early childhood caries. CONCLUSION: Cross-sectional design and heterogeneity of the included articles provide an ambiguous opinion on the association between black stains and early childhood caries. More of longitudinal studies following rigid methodology is needed to establish the association between black stains and early childhood caries.

Effectiveness of distraction techniques in the management of anxious children - A randomized controlled pilot trial.

AIM: The aim was to evaluate and compare the effectiveness of two distraction techniques, magic trick and mobile dental game with tell-show-do (TSD) in the management of anxious children. METHODOLOGY: Two hundred and thirty children aged 4-5 years were screened for their baseline anxiety using the Chotta Bheem-Chutki scale. A double-blinded randomized control trial was conducted among 60 children with high anxiety scores. They were randomly divided into three groups. Group 1 received a magic trick distraction technique. Group 2 received a mobile dental game distraction technique. Group 3, the control group received TSD. Readiness to accept the dental treatment and postoperative anxiety scores were recorded. RESULTS: Statistically significant reduction in the anxiety level was seen in children who received magic (P = 0.001), mobile dental game (P < 0.001), and TSD technique (P < 0.001). Based on the readiness to accept dental treatment, there was a statistically significant difference between the three groups (P = 0.025). The children in the mobile group were found to accept the treatment faster compared to the magic and TSD groups. CONCLUSION: All three techniques were equally effective in reducing the anxiety of children. The mobile dental game was superior to magic trick and TSD in terms of children's readiness to accept dental treatment.

Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review.

OBJECTIVE: To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6-12-year-old children. METHODS: Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors. RESULTS: Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced. CONCLUSION: School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.

School absenteeism, academic performance, and self-esteem as proxy measures of oral health status: A cross-sectional study.

PURPOSE: The purpose of the study was to assess the impact of school absenteeism, academic performances, and self-esteem of school-going children on their oral health status. Materials and. METHODS: The study sample included 2014 children aged 12-15 years from India. Rosenberg self-esteem scale was used to assess the self-esteem of the children. Data on school performance, homework completion, and absenteeism were obtained from the school authorities and parents. Clinical examination for each child was done to assess the Decayed, Missed, and Filled Teeth (DMFT) and Oral Hygiene Index-Simplified (OHI-S) scores. The data obtained were statistically analyzed using Pearson's Chi-square test, Mann-Whitney test, and Kruskal-Wallis test with the aid of SPSS software. Odds ratio was calculated with 95% confidence interval. P ≤0.05 was considered statistically significant. RESULTS: Oral health had a significant association with school absenteeism and homework completion. School absenteeism was significantly associated with dental caries (P = 0.007) and poor oral hygiene (P = 0.001), whereas homework completion was significantly associated with dental caries alone (P = 0.002). There was no significant association between variables like self-esteem, first language, mathematics, and DMFT/OHI-S score. CONCLUSION: School records such as absenteeism data and homework completion can be used as proxy measures of the oral health status in children.

Objective and subjective parameters of oral health in South Indian children: A cross-sectional study.

BACKGROUND: Oral health of schoolchildren is a strong predictor of their overall well-being. This study was planned to assess and compare the objective and subjective parameters of oral health of South Indian school children. METHODOLOGY: Three hundred and sixty school children participated in this cross-sectional study. Their oral hygiene status, dental caries status, and treatment needs were assessed. Two questionnaires were filled by these children, to assess their oral health-related quality of life (OHRQoL) and their knowledge on oral health. Their academic scores were collected from the schools. Statistical analysis was done using Kruskal-Wallis ANOVA test and Spearman correlation test appropriately. RESULTS: Children with no caries had better OHRQoL (P = 0.02). There was a negative correlation between dental caries status and OHRQoL score (P = 0.003) and dental caries treatment needs and OHRQoL score (P = 0.01). There was a positive correlation between knowledge on oral health and OHRQoL score (P = 0.02). CONCLUSION: Children with no caries had a better OHRQoL when compared to children with caries. Children with caries had more treatment needs, poor oral hygiene, low quality of life, and performed lesser in academics. However, they had adequate knowledge on oral health. Hence, both objective and subjective parameters of oral health should be given importance while treating children.

Comparative Evaluation of the Local Anesthetic Activity of Root Extract of Anacyclus pyrethrum and its Interaction at the Site of Injection in Guinea Pigs.

AIM: The aim of the study was to evaluate the local anesthetic activity of root extracts of the Anacyclus pyrethrum, and to check its effect of interaction at the site of injection in guinea pigs. MATERIALS AND METHODS: The study sample included thirty guinea pigs each weighing 450-500 g, maintained under standard conditions. The root extracts were prepared using three solvents, in 1% and 2% concentration and injected in guinea pigs. The animals were divided into five groups, six in each group based on the type of extract used along with a control and a standard drug. All the animals received 0.5 ml of intradermal injection of the prepared extract, with 1% concentration in the left and 2% in the right dorsal flank of the animal and were checked for local anesthetic activity by a pinprick test. After 72 h, biopsy was done from the injected site to check for drug interaction. RESULTS: The number of negative response obtained from 2% ethanol extract is more effective when compared to other extracts. Histological samples showed inflammatory changes in 1% aqueous extract in a single animal. CONCLUSION: Among the test compounds, 2% ethanol showed more significant effect; hence, it is suggested to synthesize more compounds in this series and evaluate their pharmacological actions.

Evaluation of sealing ability of Biodentine™ and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlled in vitro trial.

OBJECTIVE: The aim of this study was to compare the sealing ability of mineral trioxide aggregate (MTA) and Biodentine™ when used to repair the furcal perforations in primary molars using scanning electron microscope (SEM). STUDY DESIGN: The study sample comprised forty recently extracted primary molars. These teeth were placed in a 5.25% sodium hypochlorite solution for 24 h and washed with tap water. Access cavities were made using a round bur in high-speed handpiece. Perforations were made in the center of the floor of the pulpal chamber using a 0.5 mm round bur. The teeth were randomly assigned into two experimental groups based on the material used to seal the perforation: Group A - MTA and Group B - Biodentine™. The packed materials were allowed to set for 24 h. The samples were sectioned longitudinally and the extent of marginal adaptation was measured by SEM. Wilcoxon-signed rank test was used for statistical analysis using SPSS software. RESULTS: All teeth exhibited microleakage, but Biodentine™ showed significantly less leakage (0.149) compared to MTA (0.583). CONCLUSION: Based on the results of this study, Biodentine™ showed lesser microleakage compared to MTA and thus may be a good alternative to MTA.

Association between Optimism, Psychosocial Well Being and Oral Health: A Cross-Sectional Study.

OBJECTIVE: The aim of the study was to assess the association of optimism and psychosocial well being of school going children on their oral health status. STUDY DESIGN: The study included 12- to 15-year-old school going children (N = 2014) from Tamilnadu, India. Optimism was measured using the revised version of the Life Orientation Test (LOT-R). A questionnaire was sent to the parents regarding their child's psychosocial behavior which included shyness, feeling inferiority, unhappiness and friendliness. Clinical examination for each child was done to assess the DMFT score and OHI-S score. The data obtained were statistically analyzed using Pearson Chi-Square test, Mann-Whitney test and Kruskal-Wallis test with the aid of SPSS software (version 17). Odds Ratio (OR) was calculated with 95% Confidence Interval (CI). The p value ≤ 0.05 was considered statistically significant. RESULTS: Boys with high optimism had significantly lesser DMFT score than the boys with low optimism (p=0.001). Girls with high optimism had significantly higher DMFT score (p=0.001). In psychosocial outcomes, inferiority (p=0.002) and friendliness (p=0.001) showed significant association with DMFT score. Among the boys, children who felt less inferior (p=0.001), less unhappy (p=0.029) and more friendly (p=0.001) had lesser DMFT score. CONCLUSION: Among the psychosocial outcomes assessed, inferiority and friendliness had significant association with oral health of the children and hence, can be used as a proxy measures oral health.

Health camps in schools and content analysis of the school textbooks: A cross-sectional study in Tamil Nadu.

BACKGROUND: School textbooks have been considered as an effective platform for promoting oral health. The information on oral health in the Indian school textbooks has not been evaluated. AIM: The aim of this study was to evaluate the contents of school textbooks on oral health and to quantitatively analyze the school health camps and guest lectures/demonstrations conducted in the schools of three districts in Tamil Nadu. METHODOLOGY: Twenty schools which participated in the study followed the Central Board of Secondary Education, matriculation, or the state board syllabus. A questionnaire was designed to collect information about the medical camps, dental camps, guest lectures, and demonstrations conducted in the last academic year from the schools. The questionnaires were distributed among the school teachers of grades I-V. They were asked to provide photocopies of the topics on oral health which were included in the syllabus. Content analysis of the information on oral health-related topics in the school textbooks was done. Descriptive statistics of the details of the camps and lectures was done using Pearson's Chi-square test (SPSS version 17) (SPSS Inc. Chicago, Illinois, USA). RESULTS: There was no significant difference in the number of medical camps (P = 0.445), dental camps (P = 0.055), and guest lectures (P = 0.069) organized among the three boards of schools. Basic information on the parts and type of teeth, tooth decay, and brushing were present in the textbooks of all three boards of schools. CONCLUSION: The school textbooks of all the three boards contained basic and adequate information on oral health. Periodic revisions of the content and quality of information in the school textbooks are essential. To make the information sticky for long-term, reinforcements in the form of school health education is needed.

Oral health-related quality of life of children seeking orthodontic treatment based on child oral health impact profile: A cross-sectional study.

AIMS: The aim of this study was to assess oral health-related quality of life (OHRQoL) using short form (SF) of child oral health impact profile (COHIP) in children aged 11-15 years who sought orthodontic treatment. A comparison was done between these children and age-matched peers who never had or sought orthodontic treatment. METHODOLOGY: This cross-sectional study included 227 children aged 11-15 years. A total of 110 participants had sought orthodontic treatment at KSR Institute of Dental Science and Research (orthodontic group) and 117 participants from a nearby school who had never undergone or sought orthodontic treatment (comparison group). OHRQoL was assessed with the SF of the COHIP, and malocclusion severity was assessed with the index of orthodontic treatment needs. Data presentation and statistical analysis were performed with the Statistical Package for the Social Sciences Software (Version 19, SPSS, Chicago, IL, USA). The Chi-square test and Fischer exact tests were used to analyze the qualitative data. RESULTS: Children with little to borderline treatment needs have a better quality of life when compared to children with definitive treatment needs (P = 0.049). No statistically significant difference in COHIP-SF scores was found between boys and girls (P > 1.000). In the orthodontic group, children with little to borderline treatment needs were 4.8 times (P = 0.037) more likely to report better OHRQoL when compared to children with definitive treatment needs. CONCLUSION: Children who sought orthodontic treatment had lower quality of life scores than those who never had or never sought treatment.

Behavioral response and pain perception to computer controlled local anesthetic delivery system and cartridge syringe.

AIM: The present study evaluated and compared the pain perception, behavioral response, physiological parameters, and the role of topical anesthetic administration during local anesthetic administration with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD). DESIGN: A randomized controlled crossover study was carried out with 120 children aged 7-11 years. They were randomly divided into Group A: Receiving injection with CCLAD during first visit; Group B: Receiving injection with cartridge syringe during first visit. They were further subdivided into three subgroups based on the topical application used: (a) 20% benzocaine; (b) pressure with cotton applicator; (c) no topical application. Pulse rate and blood pressure were recorded before and during injection procedure. Objective evaluation of disruptive behavior and subjective evaluation of pain were done using face legs activity cry consolability scale and modified facial image scale, respectively. The washout period between the two visits was 1-week. RESULTS: Injections with CCLAD produced significantly lesser pain response, disruptive behavior (P < 0.001), and pulse rate (P < 0.05) when compared to cartridge syringe injections. Application of benzocaine produced lesser pain response and disruptive behavior when compared to the other two subgroups, although the result was not significant. CONCLUSION: Usage of techniques which enhance behavioral response in children like injections with CCLAD can be considered as a possible step toward achieving a pain-free pediatric dental practice.

Validation of a novel behavior prediction scale: A two-center trial.

CONTEXT: Prediction of the child's behavior can adequately equip the dentist in rendering effective and efficient dental treatment. AIM: This study was planned to evaluate and validate a specially prepared questionnaire as a child behavior prediction scale. DESIGN: A two-center cross-sectional study was done to validate the new scale. MATERIALS AND METHODS: Children aged 3-12 years (n = 296), from two different centers participated in this study. The questionnaire used was a 10-point observational scale. Observations involved perceiving overt and subtle behavioral characteristics of a child, to assess the child's behavior in the dental office before treatment. An independent observer approached the children and their parents in the waiting room. The child's behavior was then evaluated by the dentist using Frankl behavior rating scale during and after treatment. The prediction of behavior compared to the Frankl scale was assessed and validated. STATISTICAL ANALYSIS: Sensitivity, specificity tests, and receiver operating curve analysis were used to validate the new scale and calculate the cut-off score for positive and negative behavior. All data were processed by SPSS software (16.0, SPSS Inc., Chicago, Ill, USA). RESULTS: The best cut-off score to predict a positive Frankl rating was ≥ 8.0 in both the centers. The sensitivity and specificity scores were 93.4% and 62.5% in center 1; 83.1% and 59.6% in center 2 respectively. CONCLUSION: This novel prediction scale can be of great importance in predicting children's behavior in the dental environment.

Comparison of behavioral response to caries removal methods: a randomised controlled cross over trial.

BACKGROUND: The issue of dental fear and anxiety still poses a significant problem in treating children. Various caries management protocols have been tried to make the dental visit more compatible to the child patients. AIM: The aim of the study was to evaluate and compare the behavioral and physiological responses to chemo-mechanical caries removal (CMCR) and conventional drilling method (CDM). MATERIALS AND METHODS: A total of 20 children with an age range of 7 to 11 years with bilateral frank carious lesions were included in this study. They were randomized into two groups: Group A--treated with CDM first followed by CMCR and Group B--treated with CMCR first followed by CDM. The physiological signs (pulse, blood pressure and oxygen saturation) were noted prior to treatment, during treatment, post treatment and 5 min after treatment. The behavioral responses were assessed by face, legs, activity, cry, and consolability scale and facial image scale. The participants were interviewed about pain, discomfort, taste, smell, preference and overall experience after every procedure. The pediatric dentist filled in details about patient behavior, time utilized and need for local anesthesia. The results were statistically analyzed using t-test and Chi-square test appropriately (SPSS version 11). RESULTS: There was no significant difference in any of the physiological parameters assessed between the two groups. Discomfort was significantly more (P < 0.025) in the CDM group than CMCR group. The time taken by the dentist was significantly lesser (P < 0.01) in the CDM group. CONCLUSION: Techniques which enhance the behavioral response in children should be considered for a better pediatric dental practice.

Turner's hypoplasia and non-vitality: a case report of sequelae in permanent tooth.

Hypoplasia is the result of disruption in the process of enamel matrix formation, which in turn causes defect in quality and thickness of enamel. Four cases of Turner's hypoplastic teeth with a previous history of trauma/infection in their primary predecessors at the age of 2-3 years have been reported. These hypoplastic teeth had turned non-vital without any carious insult, cavitation or further trauma. This article thereby stresses the importance of early detection of enamel hypoplasia and proper management at the earliest possible stage to enable an efficient prevention from clinically non-evident microbial invasion in the dentinal tubules and concomitant pulp pathosis.