Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

Effectiveness of Nitrous Oxide Sedation on Child's Anxiety and Parent Perception During Inferior Alveolar Nerve Block: A Randomized Controlled Trial.

Introduction Dental anxiety is a common phenomenon among children and can have significant implications for their overall oral health and well-being. Among the various dental procedures that induce anxiety in pediatric patients, the Inferior Alveolar Nerve Block (IANB) stands out as one of the most feared due to its perceived pain and discomfort. Dental anxiety not only affects the child's cooperation during the procedure but can also lead to long-lasting negative perceptions of dental care, resulting in the avoidance of necessary treatments in the future. Nitrous oxide (N2O) sedation is a well-established sedation technique in dentistry, widely used to manage anxiety and discomfort during dental procedures. However, its efficacy in reducing anxiety during the administration of IANB to pediatric patients remains the subject of ongoing research. The administration of N2O sedation during IANB may not only alleviate the child's anxiety but also influence the parent's perception of the procedure, which can have additional effects on the child's dental experience and future adherence to dental care. The aim of this study was to evaluate the effectiveness of N2O sedation on pain and anxiety in children before and after IANB administration and the parent's perceptions of sedation following the procedure. Methods The current study was a single-centered, double-blinded, randomized controlled trial. The participants were assigned randomly to two groups, with each group consisting of 20 participants. Group 1 (n = 20) was given only oxygen, and Group 2 (n = 20) was given N2O for sedation. Pain perception for local anesthesia was evaluated using the Face, Legs, Activity, Cry, Consolability scale. The anxiety of children was evaluated using the Facial Image scale. Parent satisfaction was analyzed using the Likert scale. Data were extracted before and after the procedure using the Mann-Whitney U test. Results Pain perception evaluated with the FLACC scale showed statistically low pain perception in Group 2 after the procedure with a p-value of 0.001, and anxiety levels assessed with FIS showed a significant difference in Group 2 after the procedure with a p-value of 0.003. Parent satisfaction was analyzed using the Likert scale, and Group 2 showed a statistically significant difference with a p-value of 0.001 after the procedure. Conclusion The administration of the N2O sedation results in a notable reduction in anxiety levels and pain perception, as well as better parental satisfaction. This method allows for a practically pain-free and anxiety-free environment.

Reasons for Crown Failures in Primary Teeth: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: There is a tendency nowadays to restore large defects in primary dentition with pediatric crowns instead of conventional restorations. Thus, understanding the factors contributing to the survival or failure of dental crowns in pediatric dentistry is essential for optimizing treatment outcomes. OBJECTIVE: The primary objective of this protocol is to outline the methodological approach for analyzing data from observational studies and randomized controlled trials to investigate reasons for the failure of dental crowns in primary teeth and to compute their survival and failure rates. METHODS: A comprehensive literature review will be performed in electronic databases, including PubMed (MEDLINE), Cochrane, Embase, and Web of Science. As per predefined inclusion criteria, we will include observational studies (prospective clinical studies) and randomized clinical trials that have an English abstract and involve children aged 1-10 years undergoing crown restorations. Two independent reviewers will independently screen all retrieved records and full-text articles and extract data. The study's methodological quality will be appraised using suitable tools. Assessments of publication bias will be performed using funnel plots. The findings will be described qualitatively for the systematic review. If possible, a meta-analysis will be performed to estimate failure rates by dividing the number of failures by the total exposure time. A Poisson regression model, assuming constant event rates, will be used to compute 3-year and 5-year survival proportions. The Pearson goodness-of-fit statistics will be used to assess the heterogeneity of the model. A P value <.05 will be considered significant. All analyses will be performed using R Statistical software (version 4.1.2; R Core Team). RESULTS: This systematic review and synthesis aim to assess the survival and failure rates of dental crowns in pediatric dentistry. By following this rigorous methodology, we seek to provide valuable insights into the factors contributing to the success or failure of these restorations. The results of our full review will have implications for pediatric dentists, researchers, and policy makers, helping to improve dental care for children. CONCLUSIONS: This systematic review protocol helps in establishing a thorough approach for reviewing failures in pediatric crowns. By following this methodology, standardization and transparency of the process as well as accountability for the stated methods and outcomes will be ensured. The findings of this review and analysis will provide useful data on the survival of crowns to pediatric dentists and researchers. TRIAL REGISTRATION: PROSPERO CRD42023442266; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=442266. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/51505.

Evaluation of the Cytocompatibility of Fluoride Varnish and Its Effect on Human Gingival Fibroblasts (hGFs): An In Vitro Study.

Introduction Untreated dental decay poses a significant oral health challenge, leading to pain, tooth loss, and infections. Fluoride varnishes are in prolonged contact with the tooth surface and this prevents dental decay. However, limited research has been conducted regarding the cytotoxicity and cytocompatibility of varnishes on oral cells. Recent studies have shed light on the cytotoxic effect of these varnishes on human fibroblast cells. Material and Methods The fibroblasts were isolated and cultured in 0.00001, 0.0001, 0.001, 0.01, 0.1, and 1 % fluoride concentration The cells were incubated for 72 hours at a temperature of 37°C and cell viability after the application of varnish was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide (MTT) assay. Results This study observed that fluoride varnish had a concentration dependant cytotoxic effect on human gingival fibroblasts (hGFs). As the concentration of fluoride increased, the cell viability decreased. At 1% concentration, there was maximum cell cytotoxicity. At the lowest concentration (0.00001), more than 78% of the cells were found to be viable. Conclusion Further research is necessary to develop safer and more biocompatible fluoride varnish formulations to ensure their efficacy in preventing dental caries without causing harm to oral tissues.

Assessment of Pain During Pediatric Dental Treatment Using Different Sedative Agents: A Crossover Trial.

Background Behavioral management techniques are employed for children who are fearful and uncooperative. Pharmacologic sedation and anesthesia are frequently utilized to manage pain and anxiety in pediatric dental patients. Aim  To evaluate the intraoperative and postoperative pain levels during dental treatment of children sedated with 1.5 µg/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide. Materials and methods In this crossover study, 24 children between the ages of five and seven years were randomly assigned to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhaled nitrous oxide during three different visits. At each visit, a single pulp therapy procedure was conducted after administering the respective sedative agent, and the pain levels were documented. There was a one-week interval between each visit to allow for a washout period. The data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp, Armonk, NY, United States) using the Wilcoxon signed-rank test and Kruskal-Wallis H test (p < 0.05). Results All three sedative agents were equally effective in controlling postoperative and intraoperative pain. Although there was no statistically significant difference among the groups, clinically, midazolam showed lower intraoperative pain levels (mean 1.78 ± 1.42). Conclusion  In pediatric dental patients, intranasal midazolam at a dosage of 0.3 mg/kg and intranasal dexmedetomidine at a dosage of 1.5 µg/kg demonstrate comparable effectiveness to nitrous oxide sedation in pain management. These options serve as effective alternatives for anxious children who may not tolerate nitrous oxide sedation.

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial.

Background: Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings. Aim: To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment. Methods: Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney U test (p value <0.05). Results: Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (p = 0.14). Conclusion: Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.

Reasons for Failure of CAD/CAM Restorations in Clinical Studies: A Systematic Review and Meta-analysis.

AIM: The systematic review presented herein was performed to descriptively analyze the causes for the failure of computer-aided design/computer-aided manufacture (CAD/CAM) restorations. The meta-analysis reported herein was performed to estimate long-term survival and success rates of CAD-CAM fabrications. MATERIALS AND METHODS: Using the PICOS paradigm, a systematic search was carried out in the PubMed and Cochrane databases to identify randomized controlled trials (RCTs) and prospective observational studies reporting survival data for CAD/CAM restorations. After selecting studies with a predefined set of selection criteria, data from included prospective clinical studies and RCTs were used for a systematic review aimed at a descriptive analysis of factors associated with failure of CAD-CAM restorations. Data from the included prospective clinical studies were used for meta-analysis, wherein 5-year and 10-year survival and success rates were estimated using Poisson regression models. RESULTS: The systematic review included data from 9 RCTs and 6 observational studies, which had a median follow-up of 36 months and 60 months, respectively. About 58 failures and 118 technical/ biological complications were noted in the included RCTs and 9 failures along with 58 technical/biological complications were noted in the prospective clinical studies. Poisson regression indicated an estimated 5-year and 10-year survival rates of 85.55-100 and 71-100, respectively. The estimated 5-year and 10-year success rates were 74.2-92.75 and 33.3-85.5, respectively. CONCLUSION: Several technical and biological complications contribute to failure of CAD/CAM restorations. However, CAD/CAM restorations with routine chairside materials might have clinically meaningful success rates in the long term. CLINICAL SIGNIFICANCE: The results presented herein indicate that optimal strategies for mitigation of biological and technical complications may augment the success of CAD/CAM fabrications in restorative dentistry. Studies aimed at identification of such strategies are needed to further enhance the long-term success rates of CAD/CAM restorations.

Comparative Evaluation of the Antimicrobial Activity of NeoPutty MTA and Modified NeoPutty MTA: An In Vitro Study.

Aim: Mineral trioxide aggregate (MTA) is a relatively new versatile dental material. MTA has many advantages as well as disadvantages. To reduce most of the drawbacks of MTA, a premixed bioceramic MTA, NeoPutty MTA, was introduced in 2020. In this study, we assessed the antimicrobial activity of the newer MTA, NeoPutty MTA. We modified NeoPutty MTA and compared both against Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Materials and Methods: Using the agar diffusion method, NeoPutty MTA was tested for antibacterial activity against the above-mentioned microorganisms. A base layer of Petri plates was done using Muller-Hinton agar for S. aureus, E. coli, and P. aeruginosa and brain heart infusion agar for E. faecalis. A total of 32 plates were employed; the plates were divided randomly into four test groups having eight plates each, so microorganisms were tested eight times. Three cavities were made in agar and filled with freshly mixed materials after 24 h. A pour plate seeded the microorganisms. The plates were pre-incubated for 2 h at room temperature and incubated at 37°C for 24 h. An independent observer measured the inhibition zone diameters. Results: NeoPutty MTA, when tested alone, did not show much antibacterial activity against E. faecalis, S. aureus, and E. coli but had significant antimicrobial activity against P. aeruginosa when used at different concentrations. Modified NeoPutty (NeoPutty with antibiotics added individually) showed significant antibacterial activity against these microorganisms, as seen by the zone of inhibition of these bacteria. Conclusion: Modified NeoPutty with antibiotics has a better antimicrobial effect than NeoPutty MTA.

Determination of the Ideal Tooth Surface and Pain Threshold to Improve the Efficacy of an Electric Pulp Tester in the Diagnosis of Pulp Sensitivity and Vitality in Premolar and Molar Teeth: A Cross-Sectional Study.

Introduction The electric pulp tester (EPT) is an extensively used diagnostic tool in endodontics. However, several factors, especially the location and thickness of the tooth structures, such as enamel and dentine, can affect the result of an electric pulp test. Further, these factors also alter the pain threshold, which may lead to an inaccurate diagnosis. Hence, it is crucial to ascertain the optimal tooth surface that requires minimal time to elicit a response and pain threshold to enhance the effectiveness of the electric pulp tester for diagnosing the status of the pulp. Methods Fifty volunteers (36 males and 14 females) aged 18 to 32 years without any prior experience with the EPT were recruited. The EPT was placed on the seven premolar sites, and molar teeth with an appropriate electrolyte as a conducting medium were tested. The pain threshold values were recorded using the stopwatch, whereas pain assessment was carried out using the Memojis pain scale. An independent sample t-test and descriptive statistics were used to analyze the data statistically. Results The buccal occlusal third in males (27.3±8.6 seconds) and the buccal middle third in females (28.5±8.2 seconds) showed lower response times than other sites in premolar teeth. The mesiobuccal cusp showed a lower response time for males (21.3±6.6 seconds) and females (21.5±6.2 seconds) in molar teeth. Of all the various sites tested, the majority of the individuals chose pain scores of 0 (36 in premolars, 84 in molars), two (138 in premolars, 180 in molars), and four (96 in premolars, 42 in molars) in both the premolars and molars. Conclusion The ideal sites for placing the EPT in premolars for males and females are the buccal occlusal third and the buccal middle third. At the same time, the mesiobuccal cusp is the ideal site for molars in both males and females, as it is responded to the quickest by the electric current. Most individuals have experienced a score of two (hurts a little bit) for the perceived pain using EPT for both the molars and premolars.

Short- and long-term dental arch spatial changes following premature loss of primary molars: A systematic review.

Aim: The aim of this study was to evaluate the dental arch spatial changes in maxillary and mandibular arches after premature loss of primary molars. Introduction: Primary teeth must be maintained during the change from primary to mixed and then permanent dentition, to preserve and maintain the dental arch. When this normal process is disturbed, usually due to severe decay requiring extraction before normal exfoliation, it can result in migration of adjacent teeth toward the missing space resulting in decreased arch length and malocclusion in the permanent dentition. Materials and Methods: A comprehensive search was conducted using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, LILACS, and ScienceDirect. The title and abstract were screened to find relevant articles, which were then reviewed in full to see if they were worthy of inclusion. All longitudinal and observational studies that looked at space changes after the loss of primary first or second molars were included. Quality assessment of the studies was done based on the Newcastle-Ottawa scale as all the included studies were non-randomized studies. Results: Four thousand five hundred and seventy-eight articles were identified by screening electronic database and assessed for eligibility, 12 full-text articles were assessed, and 4 full-text articles were excluded as they did not match the inclusion criteria. Thus, eight articles were included in this systematic review. Short term and long term space changes and loss of maxillary and mandibular molars were studied individually. In the short term changes, the distal migration of the primary cuspid towards the missing space within 1 month was attributable to early space changes after premature loss of the mandibular first molar, and the greatest space loss was recorded in the first 3 months after premature loss. After the premature loss of the maxillary first molar, immediate space loss of 1mm was documented due to distal migration of the primary canine. Studies found that space loss was caused by the distal migration of primary canines in the case of mandibular primary first molar loss, and that space loss was larger in the mandibular arch after premature loss of second primary molars. Conclusion: The greatest repercussions occurred during the first 3 months after the deciduous molars were extracted, and a space maintainer was recommended in the majority of cases, mainly when there is premature loss of mandibular second primary molar as it leads to mesial displacement of the first permanent molar.

Pulp oxygen saturation measurement as a diagnostic tool for assessing pulp status in primary teeth: A systematic review and meta-analysis.

Objectives: This study aimed to determine the mean oxygen saturation values (SpO2) in primary teeth using pulse oximetry. Materials and Methods: This comprehensive literature search on pulse oximeter used for primary teeth in determining pulp vitality using MeSH terms in four electronic databases, including PubMed, Scopus, Cochrane Library, and OvidSP, from January 1990 to January 2022. Studies reported the sample size and the mean SpO2 values (with standard deviations) for each tooth group were included. The quality assessment of all the included studies was done using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa Scale. The meta-analysis included studies reporting means and standard deviations of SpO2 values. The I2 statistics were used to determine the degree of heterogeneity among the studies. Results: A total of 90 studies were identified, of which five met the eligibility criteria that were qualified for the systematic review, and among them, three were included in the meta-analysis. All five included studies were of low quality due to the high risk of bias related to the patient selection, index test, and uncertainties about outcome valuation. In the meta-analysis, the mean fixed-effect measure of oxygen saturation in the pulp of primary teeth was 88.45% (confidence interval: 83.97%-92.93%). Conclusion: Though most of the available studies were of poor quality, the SpO2 in the healthy pulp can be established (minimum saturation, 83.48%) in primary teeth. Reference values established might help clinicians to assess changes in pulp status.

Prevalence of Class V caries in maxillary and mandibular canines of 3-5-year-old children: A retrospective study.

Caries in primary teeth are a major health concern in socially disadvantaged populations and may alter the eruption pattern and function of their successor. The aim of the study is to find the prevalence of Class V caries in maxillary and mandibular canines in 3-5-year-old children. A single-centered retrospective study was conducted in a private dental institution, Chennai. The data were collected from the Dental Hospital Management System of Saveetha Dental College (DIAS). A test for significance was done with the help of the Chi-square test. The most prevalent caries in canines of children between the age group of 3 and 5 years were cervical caries or Class V caries. 5, 35,951 patient details that were available in DIAS, and 2,35,841 were details of pedodontic patients, 200 patients who fulfilled the inclusion criteria were analyzed. It was observed that the prevalence of caries on the right maxillary and mandibular canines (80.00%) was higher than the left counterpart (20.00%) of the same arch. Maxillary canines (70.00%) had more prevalence of caries as compared to mandibular canines (30.00%). Caries prevalence on the right maxillary and right mandibular primary canine was higher than their left counterparts. Maxillary primary canines had more prevalence of caries as compared to mandibular primary canines.

Choice of restorative materials by dentists in Class III dental caries in primary maxillary lateral incisors in 3-6-year-old children: A retrospective study.

Early childhood caries has an intricate etiology and it requires a helpless tooth surface, fermentable starches, and cariogenic microorganisms throughout some undefined time frame to start the carious cycle. Tooth-hued materials gained popularity in recent years for reestablishing primary and youthful blended dentitions. Hence, the main aim of this study was to investigate the choice of restorative materials in Class III dental caries in primary maxillary lateral incisors in 3-6-year-old children. Data collected from the records of the children 3-6 years of age for the choice of restorative materials of primary maxillary lateral incisors between September 2020 and February 2021 were included in the study. Retrospective study data were collected through the software DIAS and data analysis was carried out using Chi-square tests. Variation in the percentage of children who underwent restoration utilizing strip crowns was the highest within 3-4 years (38.26%) when compared to light composite restorations (LCR) (14.9%), whereas the least preferred restoration was glass-ionomer cement (5.37%) which was noted statistically significant. Considering the age group of 5-6 years preferred form of restoration was LCR (19.80%) when compared to strip crown (17.79%), whereas 4.70% of the treatment cases were utilized for glass-ionomer cement restorations. Strip crowns are a more predominantly used choice of restorative material in Class III dental caries in primary maxillary lateral incisors in between 3- and 6-year-old children.

Association of malocclusion and trauma in children: A retrospective study.

Malocclusion is considered one of the most prevalent oral issues and it is considered one of the major risk factors for dental trauma. Dental trauma is a distressing experience for children, and they can have long-term physical, esthetic, and psychological effects. Hence, the main aim of this retrospective study is to evaluate the association between dental trauma and malocclusion in children. Four hundred and fifty patients between the age of 8 and 17 years during March 1, 2020-February 31, 2021, with Ellis classes 1, 2, and 3 were included in the study. Association of type of fracture with gender and malocclusion was calculated using Chi-square test. In case of Ellis class 1 fracture, 9.1% of the patients had no malocclusion, 21.8% of them had crowding, 11% of them had spacing, and 21.8% of them had anterior protrusion. In case of Ellis class 2 fracture, 4.3% of them had no malocclusion, 6.4% of them had crowding, 2.8% of them had spacing, and 3.6% of them had anterior protrusion. In case of Ellis class 3 fracture, 2.7% of them had no malocclusion, 6.4% of them had crowding, 4.6% of them had spacing, and 4.6% had anterior protrusion. The results were not statistically significant. Children with anterior protrusion and anterior crowding are more prone to severe damage during traumatic dental injuries.

Prevalence of class I caries in the second mandibular primary molar in 3-6-year-old children.

Dental caries is the disease of the oral cavity with serious oral health concern. It affects 50% of the schoolchildren worldwide. The consequences affect quality of life and may lead to socioeconomic crisis. The study was undertaken with the aim to understand the prevalence of class I caries in the second mandibular primary molar in 3-6-year-old children. The data were collected from the institutional patient records between September 2020 and February 2021. Of 6828 children, 100 children with class I caries in the mandibular second molar were included in the study. Data analysis was performed to find the association. On analyzing the correlation between age and prevalence of class I caries, all the age groups (i.e., 3-6 years) have almost equal prevalence of class I caries in both left and right second mandibular primary molars. On analyzing the correlation between gender and prevalence of class I caries, male children constitute about 56% of overall prevalence. About 43% of female children constitute class I caries. From the present study, it shows that there is high prevalence of class I caries in the second mandibular primary molar in children of 3-6 years of age. Knowledge on caries pattern on individual teeth and risk factors will help control and reduce dental caries.

Prevalence of class I caries in the second maxillary primary molar in 3-6-year-old children: A retrospective study.

Class I caries is located in the occlusal surface of molars and premolars. Dental care is an international public health challenge, mainly in young group children, as they are easily affected by caries with an increased addiction to sweets and chocolates. Caries begin early in life and progress rapidly and can affect a child in the long-term quality of life. The data were collected from the institutional patient records between June 2015 and February 2021. The details of 6831 pediatric patients were collected, of which 1500 patients fulfilled the inclusion criteria. The data were collected and analyzed using SPSS software (IBM Corp, IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY). P = 0.005 was set as level of significance. Highest prevalence of caries was seen in male children with P = 0.008 (<0.05), denoting that there is a significant association between gender and number of teeth affected with caries. When age group was considered, the caries prevalence was highest at the age of 4 years and the P value was statistically significant. The prevalence of class I caries in the second maxillary primary right molars was more than the second maxillary primary left molars and within the age group of 4 years.

Prevalence of Dental Trauma and Their Relationship to Risk Factors among 8-15-Year-Old School Children.

Background: Tooth injuries lead to functional, aesthetic, and psychological disorders, accompanied by the great concern of the child, the parents, and the dentist. Aim: (a) To assess the prevalence of traumatic dental injury (TDI) and its relationship to risk variables among 8-15-year-old school children in Mahbubnagar, India. (b) To collect baseline data as there are limited reports of TDI studies in South India to date. Methods: A cross-sectional study was conducted among 6643 children from 78 schools in Mahbubnagar using a multilevel random sampling method. The permanent incisors were examined according to the WHO classification using a standard oral mirror and probe. Individuals with clinical evidence of trauma were asked about the details of the injury event using a structured questionnaire. The chi-square test analyzed the distribution of all measurements in this study with a statistical significance of 0.05. Results: Among the 6643 children from the 78 schools surveyed, 9.3% experienced TDI. TDI occurred in 68% of boys, which was about twice as high in girls at 32%. The most commonly affected teeth were the maxillary central incisors. A higher number of children with an incisal overjet more significant than 3 mm had TDI than the children less than 3 mm, although this difference was not statistically significant. The lip closure incompetence was more common in children with TDI. The most frequent causes of TDI were falls, and the site of occurrence was school. Type I fractures were the most prevalent and most went untreated. Conclusion: The high level of dental trauma and the low percentage of children with trauma seeking treatment emphasize the need for greater awareness among the Mahbubnagar children.

Effectiveness of Pre-administered Natural Sweet-tasting Solution for Decreasing Pain Associated with Dental Injections in Children: A Split-mouth Randomized Controlled Trial.

AIM: This study aimed to discern if a prior intake of a natural sweet remedy (honey) impacted pain perception during intraoral injections. MATERIALS AND METHODS: One hundred healthy children who needed the same treatment bilaterally in either arch which required local anesthetic administration (infiltration in maxillary arch and inferior alveolar nerve block in mandibular arch) were recruited. The patients' demographic details were recorded. Local anesthesia was administered after taking 5 mL of honey solution on the test side and 5 mL of sterile water on the control side. Subjective pain perception during injection was measured using Wong-Baker Faces Pain Rating Scale and objective pain by sound, eye, body movement (SEM) rating scale. The parametric data were analyzed using a paired Student's t-test (p <0.05). Level of consensus between the two scales was assessed using Pearson's correlation. RESULTS: The test side yielded lower mean Wong-Baker Faces Pain Rating Scale (3.72 ± 1.80) and SEM (4.12 ± 1.04) scores than the control side (6.00 ± 2.06 and 5.00 ± 1.45 respectively). This was statistically significant. CONCLUSION: The administering of a natural sweet solution such as honey before dental injections in children tends to reduce the discomfort and pain associated with the procedure. CLINICAL SIGNIFICANCE: Pain management is of utmost importance in dentistry, especially among children. The consumption of natural foods such as honey helps in decreasing injection pain perception, making the child cooperative, and thereby allowing the dentist to provide the best dental care.

Oral health status for primary dentition - A pilot study.

INTRODUCTION: Formulating an oral health status which will include oral hygiene index (OHI) exclusively for children, deft index, and the incidence of white spot lesions (WSL) will make it easier for the examiner to assess the current oral health status of a child and help in planning preventive strategies. This index will provide a comprehensive yet quick way to assess the oral health status of children as it includes past caries experience, present oral hygiene status, and future prediction of caries. MATERIALS AND METHODS: Two hundred children (100 male, 100 female) aged 3-5 years (primary dentition) were included in this study. OHI, recorded index tooth wise and segment wise, deft index, and the WSLs classification were recorded in all the children. Receiver operating characteristics (ROC) curve was used to evaluate the accuracy of recording OHI in children index tooth wise and segment wise. RESULTS: All the three indices were recorded for the 200 subjects, and based on the area under the curve of receiver operating characteristics, it was found that the OHI for primary dentition can be recorded tooth wise or segment wise. Index teeth chosen for primary dentition were labial surfaces of 54, 61, and 64, lingual surfaces of 82, 75, and 85. CONCLUSION: It includes the past caries experience, present hygiene status, and the future prediction of caries, making it a wholesome index. This cumulative index can be widely used in studies of epidemiology and ensure quicker evaluation during dental health programs in public school systems.

Estimation of salivary ferritin in children with childhood caries ­ a cross sectional study / Estimativa da ferritina salivar em crianças com cárie na infância - um estudo transversal

Objective: Early childhood caries is the presence of dental caries in a child upto seventy one months of age. Saliva plays a major role in maintaining good oral health. The composition of saliva acts as a marker for oral health and the salivary proteins help in modulating the oral microflora in the oral cavity. Some salivary biomarkers help in detecting caries risk and can also predict their prognosis. Ferritin is one of the major biomarkers present in the saliva which acts as an iron binding protein and also as a monitoring tool in children suffering from iron deficiency. The ferritin levels are in increased in serum as well as in saliva to balance the deficiency of iron in the body. Material and methods: Sixty children were selected for the study aged between three to six years. The saliva sample was collected using standard spit method in a sterile container and Ferritin was tested in the samples by Chemiluminescence microparticle immunoassay(CMIA). Results: Salivary ferritin was found to be higher in the saliva of children with early childhood caries(mean value= 5.867) than in children without early childhood caries(mean value= 3.412). Conclusion: A direct association is present between salivary ferritin levels and dental caries. Increased level of ferritin is observed in children with Early childhood caries. Clinical relevance: The level of salivary ferritin is found to be raised in the present study in children with Early childhood caries. The exact mechanism is although not known it can be assumed that the children with early childhood caries might have deficiency of iron which has led to the increased amount of salivary ferritin in the saliva. (AU)

Objetivo: A cárie precoce é definida como a presença de cárie dentária em uma criança de até setenta e um meses de idade. A saliva desempenha um papel importante na manutenção de uma boa saúde bucal. A composição da saliva atua como um marcador para a saúde bucal e as proteínas salivares auxiliam na modulação da microflora oral na cavidade oral. Alguns biomarcadores salivares ajudam a detectar o risco de cárie e também podem prever seu prognóstico. A ferritina é um dos principais biomarcadores presentes na saliva, que atua como uma proteína ligadora de ferro e também como uma ferramenta de monitoramento em crianças com deficiência de ferro. Os níveis de ferritina aumentam tanto no soro quanto na saliva para equilibrar a deficiência de ferro no corpo. Material e Métodos: foram selecionadas para o estudo 60 crianças com idades entre três e seis anos. A amostra de saliva foi coletada pelo método padrão de cuspir em um recipiente estéril e a ferritina foi testada nas amostras através de um imunoensaio de micropartículas por quimioluminescência (CMIA). Resultados: A ferritina salivar foi maior na saliva de crianças com cárie na primeira infância (valor médio = 5,867) do que em crianças sem cárie na primeira infância (valor médio = 3,412). Conclusão: Existe uma associação direta entre os níveis de ferritina salivar e a cárie dentária. Nível elevado de ferritina é observado em crianças com cárie na primeira infância. Relevância clínica: O nível de ferritina salivar está elevado no presente estudo em crianças com cárie na primeira infância. Embora o mecanismo exato seja desconhecido, pode-se presumir que crianças com cárie na primeira infância podem ter deficiência de ferro, o que levou a um aumento na quantidade de ferritina salivar na saliva. (AU)