Root and Root Canal Anatomy of Primary Mandibular Central Incisor, Lateral Incisor, and Canine in Indian Children: A Cone Beam Computed Tomography Study.

Background: A thorough knowledge of root and root canal morphology in primary dentition is essential for success of endodontic therapy. This information also finds importance in anthropological research in reconstructing human population history. Lack of studies of root and root canal morphology in mandibular anterior teeth prompted us to the present study. Methods: A total of 109 extracted primary mandibular incisors and canines were collected, out of which 90 teeth were selected for this study and divided into 3 groups: CI, mandibular central incisor; LI, mandibular lateral incisor; C, mandibular canine. All the sample teeth were scanned using cone beam computed tomography (CBCT). Number of roots, number of root canals, length of root, mesiodistal (MD), and buccolingual (BL) width of canal, shape of canal, and presence of accessory canals were assessed. Collected data were statistically compared using one-way ANOVA and chi-square tests. Results: All teeth studied displayed single root with single root canal conforming to type I Vertucci's classification. Root length of CI was significantly shorter than both LI and C, with no significant difference between LI and C. Straight root canals were more common in CI and LI, whereas curved canals were more common in C. S-shaped canals were seen in a few CI and C. BL canal width was more than MD width in all teeth, C showing significantly larger dimensions than both CI and LI. Conclusion: This study presents root and root canal characteristics of primary mandibular central incisor, lateral incisor, and canine in children from Indian ethnicity.

A cone-beam computed tomographic study of root and root canal morphology of primary maxillary and mandibular second molars in Indian Children: An in vitro study.

Introduction: The root canal system in primary molars is considered to be complex. The aim of the present study was to assess the morphology of roots and root canals of primary maxillary and mandibular second molars using the cone-beam computed tomography (CBCT). Materials and Methods: From a total of 104 collected primary maxillary and mandibular molars (51 maxillary second molars and 53 mandibular second molars), 60 teeth (30 each of maxillary and mandibular second molars) were selected randomly and accordingly assigned into two groups: MAX2M (primary maxillary second molars) and MAN2M (primary mandibular second molars). CBCT was used to assess the number of roots and root canals, length of root, mesiodistal and buccolingual width of the canal, shape of the canal, and intercanal communications. Descriptive statistical analysis was performed using the SPSS software version 17.0. Results: The mandibular second molars showed the presence of two roots in 27 sample molars while the presence of three roots was observed in three MAN2M group. In these molars, all three roots exhibited Type I root canal configuration. The maxillary second molars exhibited three roots. A total of nine intercanal communications were seen in MAX2M group, whereas two communications were seen in MAN2M group. The palatal root in MAX2M group was more angulated (mean value: 127.21 ± 9.10) as compared to mesial (mean value: 95.39 ± 8.64) and distal roots (114 ± 11.24). Conclusion: The comprehensive knowledge of root and canal morphology of primary molars and anatomic variations is essential for successful endodontic therapy.

Prevalence of molar incisor hypomineralization in India: A systematic review and meta-analysis.

Research Question: To estimate the pooled prevalence of molar incisor hypomineralization (MIH) in children from India. Research Protocol: The PRISMA guidelines were followed. Literature Search: An electronic search of the databases was performed to find prevalence studies of MIH in children above age 6 years in India. Data Extraction: Two authors independently extracted the data from the 16 included studies. Quality Appraisal: The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale adapted for cross-sectional studies. Data Analysis: The pooled prevalence estimate of MIH was calculated using logit transformed data with inverse variance approach in a random-effects model with 95% confidence interval (CI). Heterogeneity was assessed with the I2 statistic. The subgroups were analyzed to assess the pooled prevalence of MIH according to sex, arch-wise proportion of MIH-affected teeth, and proportion of children with the MIH phenotypes. Results and Interpretation of Results: Sixteen studies included in the meta-analysis represented 7 states of India. A total of 25,273 children were included in the meta-analysis. The pooled prevalence of MIH in India was estimated to be 10.0% (95% CI: 0.07, 0.12) with significantly high heterogeneity between the included studies. The pooled prevalence did not vary according to sex. The pooled proportions of MIH-affected teeth were similar in the maxillary and mandibular arches. The pooled proportion of children with MH phenotype was higher (56%) than those with M + IH phenotype (44%). Further studies with standardized criteria for recording MIH are needed to ascertain the prevalence of MIH in India.

Dietary Sugar Exposure and Oral Health Status in Children with Autism Spectrum Disorder: A Case-control Study.

This case-control study compared dietary sugar exposure and oral health status between children with and without Autism Spectrum Disorder (ASD), aged 5-12 years (n = 136, each). Data regarding socio-demographics, child's oral hygiene practices and behavior, diet-related behavior, oral habits and dental trauma were obtained. Child's diet on the previous day was recorded using 24-h recall method and sugar exposure was calculated using Dental Diet Diary (D3) mobile application. Oral Hygiene Index-Simplified (OHI-S), deft and DMFT were recorded. Results showed no significant differences in sugar exposure, deft and DMFT between the groups. Although oral hygiene practices were significantly better in children with ASD, their OHI-S was significantly worse. Significantly more children with ASD reported mouth-breathing, bruxism and self-injurious habits.

Paediatricians' views on dental and oral health and treatment needs in children.

PURPOSE: To assess paediatricians' knowledge, attitude and awareness towards dental and oral health and treatment needs of their patients. MATERIALS AND METHODS: Eighty-four paediatricians practicing in four cities of North Karnataka, India, were randomly selected for the study and were requested to fill out an objective questionnaire without providing any oral health information. RESULTS: The present study shows that paediatricians who were surveyed had poor knowledge regarding dental and oral health and treatment needs in children. CONCLUSION: Paediatricians need to update themselves on recent recommendations regarding dental and oral health so as to ensure that all their patients receive timely preventive and restorative dental care.

Constituents, properties and clinical applications of OrthoMTA & RetroMTA: A systematic review.

Aim: OrthoMTA and RetroMTA are newly developed mineral trioxide aggregates that were developed to achieve maximum benefits and clinical performance. This systematic review aimed at assessing and describing the constituents, properties and uses of OrthoMTA and RetroMTA. Methodology: Literature search was performed using the keywords, "OrthoMTA", "RetroMTA", "BioMTA", "constituents" and "properties" in the databases, PubMed, Cochrane, Semantic scholar and Europe PubMed Central. Original articles in English describing the properties, constituents, uses/indications, history and recent advances on OrthoMTA and RetroMTA were considered for the study. Results: A total of 35 articles were selected for the systematic review based on keywords selected. Among the 35 articles, 5 articles described the composition and properties of OrthoMTA and RetroMTA, 7 articles depicted the usage of OrthoMTA and RetroMTA and the remaining articles discussed on the various properties of both OrthoMTA and RetroMTA. Conclusion: The present review confirmed that RetroMTA exhibits an excellent property, namely, short setting time, less tooth discoloration, high compressive strength, higher shear bond strength with time, higher push-out bond strength, low solubility, low cytotoxicity, biocompatibility, antibacterial property, and can be used in reparative processes in case of blood contamination. However, even OrthoMTA showed less microleakage, is biocompatible and possesses antibacterial properties.

Does maternal tooth brushing-related sef-efficacy predict child's brushing adherence?

BACKGROUND: Dental plaque is a root cause of dental caries. Effective plaque control in young children can be achieved with twice-daily assisted tooth brushing. Self-efficacy relates to one's confidence in performing a task. Self-efficacy is shown to facilitate the behavior change in treatments for lifestyle diseases. The influence of maternal self-efficacy in children's oral health behaviors is less studied. AIM: The aim of this study is to evaluate an association between maternal tooth brushing-related self-efficacy (MTBSE) and child's brushing adherence. SETTINGS AND DESIGN: This cross-sectional study was conducted in schools and included 781 mother-child dyads with children between the age group of 2 and 6 years. METHODS: Selected mothers were asked to complete the questionnaires on sociodemographic data, mother's oral health knowledge (MOHK), tooth-brushing practices, and MTBSE. Brushing adherence was evaluated as complete adherence if the child followed twice daily assisted brushing using the toothbrush and toothpaste. STATISTICAL ANALYSIS: Nonparametric tests were used to compare the variables. Binary logistic regression was used to evaluate the predictors of brushing adherence. RESULTS: Complete brushing adherence (assisted brushing with toothbrush and toothpaste at least twice per day) was seen only in 26.9% children. More children with complete brushing adherence were single children (P < 0.001). Children with complete brushing adherence had mothers with significantly higher MTBSE (P < 0.001). The presence/absence of siblings, MOHK, and MTBSE were found to be strong and significant predictors of brushing adherence in children. CONCLUSIONS: MTBSE plays a significant role in complete adherence to toothbrushing in children aged 2-6 years.

Comparison of the effectiveness of Bach flower therapy and music therapy on dental anxiety in pediatric patients: A randomized controlled study.

BACKGROUND: Dental anxiety is a primary cause of missed dental appointments, delayed treatment, and untreated dental caries in children. Alternative techniques such as music therapy (MT) and Bach flower therapy (BFT) have potential to reduce anxiety. Lack of randomized controlled studies evaluating effectiveness of these methods in reducing dental anxiety led us to this study. AIM: To compare the effectiveness of BFT and MT on reduction of dental anxiety in pediatric patients. MATERIALS AND METHODS: A total of 120 children (aged 4-6 years) were selected and randomly allocated to three groups: BFT, MT, and control. All children received oral prophylaxis and fluoride treatment. Dental anxiety was evaluated using North Carolina Behavior Rating Scale, Facial Image Scale (FIS), and physiological parameters. RESULTS: Significantly better behavior was seen in children from the BFT group as compared to the control group (P = 0.014). FIS scores measured postoperatively did not show significant differences among the groups. Children from the BFT and MT groups showed a significant decrease in the pulse rates intraoperatively from the preoperative period. Intraoperative systolic blood pressure in children from the MT group was significantly lower than both the BFT and the control groups. Diastolic blood pressure significantly increased in the control group intraoperatively, whereas other groups showed a decrease. CONCLUSION: The results of this study demonstrate significant effects of both single dose of BFT and exposure to MT, on reduction of dental anxiety in children aged between 4 and 6 years.

Efficacy of Intraosseous Local Anesthesia for Restorative Procedures in Molar Incisor Hypomineralization-Affected Teeth in Children.

BACKGROUND: Treatment of teeth affected with molar incisor hypomineralization (MIH) in young patients is challenging due to chronic subclinical pulpal inflammation caused by porous enamel and exposed dentin. Hypersensitivity of the teeth and difficulty in achieving local anesthesia due to altered nerve potential affects the successful completion of the treatment. AIM: The aim of the study was to compare the anesthetic efficacy of the intraosseous (IO) anesthetic technique with conventional local infiltration technique in anesthetizing first permanent molars (FPMs) affected by MIH for restorative procedures in children. MATERIALS AND METHODS: This randomized controlled clinical trial recruited 54 MIH-affected mandibular or maxillary FPMs requiring restorations or stainless steel crowns. The teeth were randomly allocated to two equal groups to receive either IO injection or buccal infiltration (control), both using 4% articaine. Onset, time required, and pain experienced for administration, need for repeat, efficacy of anesthetic technique, heart rate, and postoperative complications were recorded in both the groups. Collected data were subjected to statistical analysis. RESULTS: Onset was significantly faster and pain experienced during administration was significantly lower with IO technique. Need for repeat of anesthesia was significantly more with infiltration (44.4% vs. 7.4% in IO, P = 0.004). Local infiltration failed to produce profound anesthesia in 74.1% MIH-affected teeth. IO anesthesia profoundly anesthetized 88.9% MIH-affected teeth. Anesthetic efficacy was significantly better with IO anesthesia (P < 0.001). Postoperative complications were significantly lower with IO anesthesia (P = 0.003). CONCLUSION: IO local anesthesia was found to be an effective and safe technique to achieve profound anesthesia in MIH-affected teeth in children in comparison to local infiltration.

A cone-beam computed tomographic study of root and root canal morphology of primary maxillary and mandibular second molars in Indian Children An in vitro study

Introduction: The root canal system in primary molars is considered to be complex. The aim of the present study was to assess the morphology of roots and root canals of primary maxillary and mandibular second molars using the cone-beam computed tomography (CBCT). Materials and Methods: From a total of 104 collected primary maxillary and mandibular molars (51 maxillary second molars and 53 mandibular second molars), 60 teeth (30 each of maxillary and mandibular second molars) were selected randomly and accordingly assigned into two groups: MAX2M (primary maxillary second molars) and MAN2M (primary mandibular second molars). CBCT was used to assess the number of roots and root canals, length of root, mesiodistal and buccolingual width of the canal, shape of the canal, and intercanal communications. Descriptive statistical analysis was performed using the SPSS software version 17.0. Results: The mandibular second molars showed the presence of two roots in 27 sample molars while the presence of three roots was observed in three MAN2M group. In these molars, all three roots exhibited Type I root canal configuration. The maxillary second molars exhibited three roots. A total of nine intercanal communications were seen in MAX2M group, whereas two communications were seen in MAN2M group. The palatal root in MAX2M group was more angulated (mean value: 127.21 ± 9.10) as compared to mesial (mean value: 95.39 ± 8.64) and distal roots (114 ± 11.24). Conclusion: The comprehensive knowledge of root and canal morphology of primary molars and anatomic variations is essential for successful endodontic therapy.

Does maternal tooth brushing-related sef-efficacy predict child's brushing adherence?

Background: Dental plaque is a root cause of dental caries. Effective plaque control in young children can be achieved with twice-daily assisted tooth brushing. Self-efficacy relates to one's confidence in performing a task. Self-efficacy is shown to facilitate the behavior change in treatments for lifestyle diseases. The influence of maternal self-efficacy in children's oral health behaviors is less studied. Aim: The aim of this study is to evaluate an association between maternal tooth brushing-related self-efficacy (MTBSE) and child's brushing adherence. Settings and Design: This cross-sectional study was conducted in schools and included 781 mother-child dyads with children between the age group of 2 and 6 years. Methods: Selected mothers were asked to complete the questionnaires on sociodemographic data, mother's oral health knowledge (MOHK), tooth-brushing practices, and MTBSE. Brushing adherence was evaluated as complete adherence if the child followed twice daily assisted brushing using the toothbrush and toothpaste. Statistical Analysis: Nonparametric tests were used to compare the variables. Binary logistic regression was used to evaluate the predictors of brushing adherence. Results: Complete brushing adherence (assisted brushing with toothbrush and toothpaste at least twice per day) was seen only in 26.9% children. More children with complete brushing adherence were single children (P < 0.001). Children with complete brushing adherence had mothers with significantly higher MTBSE (P < 0.001). The presence/absence of siblings, MOHK, and MTBSE were found to be strong and significant predictors of brushing adherence in children. Conclusions: MTBSE plays a significant role in complete adherence to toothbrushing in children aged 2–6 years.

Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India.

INTRODUCTION: An earlier epidemiological study by these authors revealed fluorosis at very low levels of fluoride concentrations in drinking water. AIM: The objective of present study was to investigate risk factors of dental fluorosis in permanent teeth in the villages of northern Karnataka, India. MATERIALS AND METHODS: The present survey was carried out in three villages of Hungund Taluk, Bagalkot District, Karnataka, India, with the fluoride concentration of 0.136, 0.381, and 1.36 ppm. Children aged between 9 and 15, with permanent teeth, were examined for dental fluorosis using Dean's index, as per WHO criteria. Required relevant information regarding risk factors was obtained through a questionnaire. STATISTICAL ANALYSIS: Data entry and analysis were performed using SPSS for Windows 16.0. Comparison of means of different indices by the three groups was performed using ANOVA and t-test (p < 0.05). Bivariate analysis was performed to identify significant risk factors that affected prevalence and severity of dental fluorosis. Those variables showing a statistically significant association (p < 0.05) on χ2 were entered into multiple logistic regressions to assess their independent effects. RESULTS: In this study, we analyzed risk factors for both prevalence and severity of fluorosis. From multiple logistic regression analysis, only fluoride concentration in drinking water was found significant with prevalence of fluorosis and only nutritional status showed significant association with severity of fluorosis. CONCLUSION: Presence or absence of dental fluorosis in permanent teeth was significantly associated with fluoride concentration in drinking water. Once present, its severity was determined by nutritional status of the children - malnourished children exhibiting severe form of fluorosis. HOW TO CITE THIS ARTICLE: Mahantesha T, Dixit UB, Nayakar RP, Ashwin D Ramagoni NK, Ellore VPK. Prevalence of Dental Fluorosis and associated Risk Factors in Bagalkot District, Karnataka, India. Int J Clin Pediatr Dent 2016;9(3):256-263.

Oral myiasis: a case report.

Myiasis is a condition caused by the invasion of tissues by larvae of Diptera flies. This phenomenon is well documented in the skin especially among animals and people in tropical and subtropical areas. The condition causes extensive tissue destruction as the larvae, at least for a certain period, feed on the host's dead or living tissue, liquid body substances, or ingested food. Mouth breathing during sleep, poor oral hygiene, alcoholism, senility, mental disability, cerebral palsy, and hemiplegia may facilitate the development of myiasis. We present a case report of oral myiasis in a 22-year-old male with cerebral palsy and severe mental retardation treated successfully by manual removal of the larvae by topical application of turpentine oil and oral systemic therapy with ivermectin.

Comparison of soft-tissue, dental, and skeletal characteristics in children with and without tongue thrusting habit.

BACKGROUND: Tongue thrusting habit is a condition in which the tongue makes contact with any teeth anterior to the molars during swallowing. Abnormal positioning of tongue may result in dental and skeletal abnormalities. OBJECTIVE: The aim of the present study was to study and compare soft-tissue, dental, and skeletal morphologic characteristics in children with and without tongue thrusting habit. MATERIALS AND METHODS: A total of 21 children with tongue thrusting habit and 21 children without any habit between age 10 and 14 years were selected for the study. Various soft-issue, dental and cephalometric parameters were measured and compared statistically. RESULTS: Significantly, higher number of children with tongue thrusting showed lip incompetency (86% vs. 14%), mouth-breathing habit (38% vs. none), hyperactive mentalis muscle activity (24% vs. none), Open-bite (52% vs. none) and lisping (86% vs. none) when compared to children without tongue thrust. Children with tongue thrust showed increased upper lip thickness and proclination of maxillary incisors No differences were found in angulation of mandibular incisors, inter-premolar or inter-molar widths and all the skeletal parameters studied. CONCLUSIONS: Tongue thrust seemed to affect some of the soft-tissue and dental characteristics causing lip incompetency, mouth-breathing habit, and hyperactive mentalis muscle activity, lisping, open-bite, and proclination of maxillary incisors; however, no significant skeletal changes were observed.

Study of occlusal characteristics of primary dentition and the prevalence of maloclusion in 4 to 6 years old children in India.

BACKGROUND: To assess the prevalence of malocclusion and to determine the different occlusal characteristics in primary dentition of 4 to 6 years old children in India. MATERIALS AND METHODS: The target population comprised 4 to 6 years old children attending different nursery, kindergarten and primary schools of Bagalkot city. Stratified cluster random sampling procedure was executed to collect the representative sample. Each subject was assessed for various occlusal characteristics. RESULTS: Occlusal characteristic found were flush terminal plane (52.5%), class I canine relationship (84%), maxillary developmental spaces (35.4%), primate spaces in maxilla (47.6%), mandibular crowding (4.6%), mandibular midline shift (5.6%), anterior multiple tooth crossbite (1.3%), scissors bite (0.6%), anterior open bite (1%), over bite of 0-2 mm (81.6%) and overjet of 0-2 mm (84.5%). The age wise difference for the occlusal characteristics was statistically significant. CONCLUSIONS: The data revealed that most of the children had malocclusion. This highlights the importance of identifying children who are in need of orthodontic treatment for dental health or aesthetic reasons.

Salivary cortisol response to psychological stress in children with early childhood caries.

AIMS AND OBJECTIVES: Early Childhood Caries (ECC) is a multi-factorial disease and has numerous biological, psychological, and behavioral risk factors. In this study, we have attempted to study psychological stress as a risk factor for early childhood caries by investigating and comparing the response of event-related stress on salivary cortisol level in children with ECC and those without ECC and also compared the adaptability to various dental procedures in children with early childhood caries and without early childhood caries. MATERIALS AND METHODS: One hundred children aged between four and five years were examined in the school and 16 pairs of children with caries and without caries were selected after cross-matching them on various risk factors for Early Childhood Caries. Oral prophylaxis and topical fluoride treatment procedures were used as stressors and salivary samples were collected at the time of arrival for the treatment, after Oral Prophylaxis and Fluoride treatment. The salivary samples were analyzed by radioimmunoassay for an unbound plasma cortisol level. RESULTS: Statistical analysis was performed using a paired t-test, on the collected data, to compare the mean values of the salivary cortisol across the group and within the groups to evaluate the cortisol response to stress. No significant differences were found between the salivary cortisol levels prior to treatment, post oral prophylaxis, or post fluoride treatment at the first and second appointments of both groups. At the first appointment, the fluoride treatment caused a significant increase in the salivary cortisol level over the pretreatment level, in both the groups, but it was not evident in either of the two groups studied at the second appointment. CONCLUSION: We have concluded that the stress produced by different dental procedures was similar in children from the two groups studied, and the coping ability of the children was also similar in both the groups. Small sample size may be one of the reasons why no significant differences were found between the groups. Similar study needs to be repeated with a larger sample size.

Salivary cortisol response to psychological stress in children with early childhood caries.

Aims and Objectives: Early Childhood Caries (ECC) is a multi-factorial disease and has numerous biological, psychological, and behavioral risk factors. In this study, we have attempted to study psychological stress as a risk factor for early childhood caries by investigating and comparing the response of event-related stress on salivary cortisol level in children with ECC and those without ECC and also compared the adaptability to various dental procedures in children with early childhood caries and without early childhood caries. Materials and Methods: One hundred children aged between four and five years were examined in the school and 16 pairs of children with caries and without caries were selected after cross-matching them on various risk factors for Early Childhood Caries. Oral prophylaxis and topical fluoride treatment procedures were used as stressors and salivary samples were collected at the time of arrival for the treatment, after Oral Prophylaxis and Fluoride treatment. The salivary samples were analyzed by radioimmunoassay for an unbound plasma cortisol level. Results: Statistical analysis was performed using a paired t-test, on the collected data, to compare the mean values of the salivary cortisol across the group and within the groups to evaluate the cortisol response to stress. No significant differences were found between the salivary cortisol levels prior to treatment, post oral prophylaxis, or post fluoride treatment at the first and second appointments of both groups. At the first appointment, the fluoride treatment caused a significant increase in the salivary cortisol level over the pretreatment level, in both the groups, but it was not evident in either of the two groups studied at the second appointment. Conclusion: We have concluded that the stress produced by different dental procedures was similar in children from the two groups studied, and the coping ability of the children was also similar in both the groups. Small sample size may be one of the reasons why no significant differences were found between the groups. Similar study needs to be repeated with a larger sample size.