Clinical evaluation of feasibility and effectiveness using a virtual reality device during local anesthesia and extractions in pediatric patients.

PURPOSE: Pediatric dentistry requires more than routine dental knowledge and skills in executing quality dental care. The quality of dental treatment is indirectly proportional to a child's anxiety and fear. The recent distraction technique, the use of virtual reality (VR) devices has intrigued many researcher's minds. Therefore, this study was conducted to assess the clinical feasibility and effectiveness of the VR device in reducing pain and anxiety in pediatric patients during mandibular primary molar extraction. METHODS: This research trial had 30 healthy children between the ages of 6 and 12 who required mandibular primary molar extraction. The subjects were divided into two groups using a simple randomization method. In the study group (n = 15), extraction was carried out using a VR device, whereas, in the control group (n = 15), extraction was carried out without the use of a VR device. Pre- and post-extraction anxiety levels were measured by Venham's picture test (VPT) and the heart rate. After the procedure, pain and behavior were evaluated by the Wong-Bakers Faces pain rating scale (WBS) and FLACC Scale respectively. RESULTS: The pre-extraction values of the VPT and heart rate showed no statistically significant difference. This indicates that participants of both groups had a similar level of anxiety at baseline. There was a statistically significant increase (p = 0.028) between pre- and post-heart rates in the control group, with no significant change in the study group. CONCLUSION: The use of a virtual reality device in children can reduce anxiety during primary molar extractions as evaluated by heart rate. Virtual reality devices might be an adjunct to high-quality dental care and to other behavior management methods. Definitive outcomes can be attained by encouraging studies overcoming the present limitations, and considering salivary biochemical indicators for the assessment of these devices.

Assessment of parental attitude toward different behavior management techniques used in pediatric dentistry.

BACKGROUND: The goal of any good dental treatment is to provide a quality dental care to the patient. This may not be possible if the patient is unwilling to cooperate or unable to do so due to their age or related factors. In such children, behavior management techniques are very helpful. With changing times, there have been changes in the law and the outlook of parents and society toward dental treatment. This influences the various behavior management methods used by pediatric dentists. OBJECTIVES: This study was conducted to assess the attitudes of parents of children of different pediatric age groups towards: Behavior management techniques used by pediatric dentists The effect of maternal anxiety on the child's behavior in clinic Pharmacological behavior management techniques The effect of parental presence in the operatory on the child's behavior. MATERIALS AND METHODS: Three hundred parents were evaluated and divided into three groups comprising 100 each on the basis of their children's age, Group A: 2-5 years, Group B: 6-9 years, and Group C: 10-13 years, which were further divided into two subgroups, on the basis of the child's gender, with each subgroup having parents of 50 male and 50 female children each. For example, Group A1: 50 parents of 2-5-year-old boys, Group A2: 50 parents of 2-5-year-old girls. RESULTS: ANOVA test showed different hierarchies of acceptance for the techniques in all the groups. In all the three groups, tell show do, positive reinforcement, and live modeling were the most accepted techniques. However, statistically significant difference between the groups was not observed for the three techniques. The least accepted techniques for all the groups were hand over mouth technique and voice control technique. CONCLUSION: Parents were more receptive of those techniques which were visually more acceptable involving a communicative management, such as tell show do, positive reinforcement, and live modeling.

Assessment of the changes in the stress-related salivary cortisol levels to the various dental procedures in children.

BACKGROUND: Fear and pain are the factors producing stress and there is evidence that dental fear acquired in childhood may persist to influence adult behavior. Dental treatment is often considered as anxiety producing and stressful. AIM: To assess the levels of stress displayed by the healthy children undergoing routine dental procedures like oral examination, restoration, and extraction by analyzing salivary levels of cortisol before, during, and after the procedures. MATERIALS AND METHODS: Twenty healthy children aged between 4 and 8 years having their first dental visit and requiring at least one restoration and one extraction were selected. In each patient, three procedures were carried out: (i) Routine dental examination, (ii) restoration, and (iii) extraction. Unstimulated salivary samples were collected 10 min before, during the procedure, and 30 min after each procedure at three different visits for comparison of cortisol production in response to anxiety and stress over time. Total 180 samples were collected to determine salivary cortisol levels using UBI-MAGIWEL TM kit and the readings were noted. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS) software with paired t-test, two independent sample t-tests, and analysis of variance (ANOVA) were used to analyze the findings. RESULTS: A correlation between salivary cortisol and stress in dental procedure was noticed. Cavity preparation is more stressful procedure in children, so alternative methods can be used in anxious children. Stress associated with extraction persists to a postoperative period. No correlation exists in between Corah's anxiety scale and salivary cortisol.

Space occupying lesion (paraganglioma) of the urinary bladder in a young male: A case report and brief review of the literature.

Urinary bladder paragangliomas are rare with a reported incidence of <1% of bladder tumors. In the absence of typical clinical features, histopathology helps in rendering definitive diagnosis. We describe a case of nonfunctional urinary bladder paraganglioma in a 28-year-old male who presented with the chief complaint of abdominal pain. The final diagnosis was made by histopathological and immunohistochemical analysis. It is important to distinguish paraganglioma from urothelial carcinoma as the treatment differs. This is an additional case of nonfunctional urinary bladder paraganglioma in a male patient with a brief review of the literature.

A simple HPLC method for quantitation of quercetin in herbal extracts.

A reversed-phase HPLC method with UV detection was developed for the determination of quercetin. The method produced linear response over a wide concentration range, with an average accuracy of 95% and average intra- and interday variation of 0.75 and 0.3, respectively. The exactness of the method was proven by determining the recovery rates from 50 to 150% of standard concentration, which were found within the acceptable range of 95 to 105%. The method was used for quantitation of quercetin in the extracts of Psidium guajava, Vitis vinifera, and extracts rich in quercetin and other flavonols in the flavonoid family.

Management of pediatric aphakia with silsoft contact lenses.

PURPOSE: To evaluate the performance of silicone elastomer lenses in pediatric eyes with aphakia. METHODS: We retrospectively studied pediatric aphakic eyes fit with Silsoft lenses (elastofilcon A, Bausch & Lomb) at the L.V. Prasad Eye Institute, India. RESULTS: Seventy-four children (106 eyes) with a median age of 9.0 months (range: 1 month to 12 years) were included in the study. Congenital cataract was the pre-existing pathology in 84 eyes. Lenses were fit between 1 week and 5 years following surgical intervention (median: 25 days). The most frequently used base curves were 7.5 mm (n=46 eyes) and 7.7 mm (n=39 eyes); lens diameter was 11.3 mm (n=103 eyes). Satisfactory fit was achieved in 86 eyes (81.1%). One-week extended wear was the most commonly recommended mode of wear (n=95 eyes). Lenses (n=118) were replaced for change of power, lens loss, and deposits or damage. Lenses were worn for > or =6 months in 68 eyes (64.2%). Twenty-three contact lens related adverse events occurred, all of which resolved uneventfully. On survival analysis, the probability of not having a lens related complication was 75.5% (95% CI; 61.5-89.5) at 24 months. CONCLUSIONS: In the management of pediatric aphakia, Silsoft lenses are safe, provide satisfactory optical correction, and are easy to handle. Limited availability and the financial costs associated with frequent lens replacement are limitations in our socioeconomic circumstances.

Heparin-surface-modified intraocular lenses in pediatric cataract surgery: prospective randomized study.

PURPOSE: To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediatric eyes after cataract surgery. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This prospective, randomized, double-masked, controlled clinical trial comprised 90 children aged 2 to 14 years with cataract. The patients were consecutively randomized to receive an HSM (Group 1) or an unmodified (Group 2) poly(methyl methacrylate) (PMMA) IOL. Extracapsular cataract extraction (ECCE) with IOL implantation was performed in children 8 years and older and ECCE with primary posterior capsulotomy, anterior vitrectomy, and IOL implantation in children younger than 8 years. Outcome parameters were inflammatory cell deposits on the IOL surface, posterior synechias, and anterior chamber reaction. RESULTS: Follow-up data were available for 73, 70, 60, and 68 patients at 1 week, 1 month, 3 months, and 6 months, respectively. Significantly fewer cell deposits were noted in Group 1 at 1, 3, and 6 months (P < .001). Synechia formation and anterior chamber reaction were comparable in the 2 groups. CONCLUSION: The lower incidence of inflammatory cell deposit formation in eyes with HSM PMMA IOLs indicates that these IOLs have greater bicompatibility than unmodified IOLs in pediatric cataract surgery.