Volumetric MRI Evaluation of Airway, Tongue, and Mandible in Different Skeletal Patterns: Does a Link to Obstructive Sleep Apnea Exist (OSA)?

Backgroun/Objectives: Craniofacial disharmony has been long debated as an important predisposing factor in the development and progression ofsleep-disordered breathing and OSA. The present study was aimed to determine and compare whether a direct correlation occurs between the airway volume, mandibular dimension, and tongue volume in different craniofacial growth patterns. The objectives were the 3D MR[ assessment and comparison ofairway volume, mandibular dimensions, and tongue volume in Class I normodivergent, Class II hyperdivergent, and OSA group. MATERIALS/METHODS: Study population included 45 patients (12-18 years). Soft tissue volume estimation for airway [oropharyngeal (OP), nasopharyngeal (NP)] and tongue was carried out using MRI and DICOM image processing software(Osirix@ v5.6).Mandibular dimensions were characterized on MR, and derivations were made using the Pythagoras theorem. Subsequently, 3D reconstructions were carried out. The mean and standard deviation were obtained. Kruskal-Wallis and Wilcoxon rank sum test were used. Multiple regression analysis was performed for OP and NP volumes using BMI, mandibular area, and tongue volume as predictors for the complete sample. RESULTS: It was found that in overall sample, mandibular length showed a positive correlation with OR NP and tongue volumes. For both OP and NP glossomandibular area, and tongue volume were found to be statistically significant predictors. CONCLUSIONS/IMPLICATIONS: A direct correlation was confirmed between the airway volume, mandibular dimensions, and tongue volume in different craniofacial growth patterns. The present knowledge can be utilized on patients for treatment of reduced airway space using the derived formula for mandibular dimensions, and the regression equations can be used as a diagnostic aid in determining the OP and NP volume for any individual using 2D radiofraphs in orthodontics.

A pediatric viewpoint on peripheral ossifying fibroma: a case report.

A peripheral ossifying fibroma (POF) is a type of reactive hyperplasia that is found exclusively on the gingiva. It is identified through histologic evidence of calcifications and ossifications that are seen in the context of a hypercellular fibroblastic stroma. This article presents the case of a POF in a 7-year-old girl, and examines the pediatric considerations for diagnosing and managing this lesion.

Orthodontic airway imaging: the cutting edge in treatment planning.

The upper airway has long been an area of interest in orthodontics. A normal airway is an important factor in the physiologic growth of craniofacial structures. The imaging of the upper airway is an indispensable tool in the field of orthodontics. Differing methods of measurement of nasal airway dimensions and function have been proposed and utilized; each technique has its strengths and limitations. Upper airway imaging has allowed us to begin to understand the biomechanical bases for obstructive sleep apnea syndrome and mouth breathing. Modern developments in imaging have produced many options and methodologies. This article reviews the contemporary status of approaches in airway imaging and discusses potential future needs and directions.

Assessment of safe zone in maxillary molar region for miniscrew placement in the mixed dentition period--a digital volumetric tomographic (DVT) study.

Assessment of bone thickness in maxillary frst molar region for miniscrew placement during the mixed dentition period with reference to the following variables a) mesio-distal bone width b) buccal cortical plate thickness c) palatal cortical plate thickness d) bucco-palatal bone depth. DVT images of fifteen healthy patients aged 8-10 years with early exfoliated maxillary second deciduous molar were obtained using the Kodak 9000 extra-oral imaging system. The scanned images were analyzed using Kodak dental imaging software [3DmoduleV2.2] and the bone thickness measurements were obtained at six mm and eight mm apical to the cemento-enamel junction. The mean and standard deviation for the measurements was calculated and data was statistically analysed using paired 't' test. The Method error calculations were performed using the Dahlberg formula. The mean values for the mesiodistal width, buccopalatal depth, buccal and palatal cortical bone thickness were found to be sufficient for miniscrew placement up to 1.2mm diameter and 10mm length. The bone thickness measurement and assessment of safe zone in maxillary posterior region from the present study showed potential for miniscrew placement in pediatric age group. Miniscrews can be considered as a promising aid in pediatric space management; so also, they can be used for molar distalization and space regaining in early mixed dentition period.

Effect of Acupressure on Pain during Inferior Alveolar Nerve Block Injection in Children Aged 5-10 Years Old - An Experimental Study.

Background: Acupressure, which is related to acupuncture, is a noninvasive therapy suitable for use in children. However, data examining acupressure's effects on the pain of local anesthetic injection in children are sparse. Objectives: The purpose of this study was to evaluate acupressure's effects on the pain of local anesthetic injection in children. Methods: This randomized, double-blind, parallel-group clinical study included 37 5- to 10-year-olds who had an inferior alveolar nerve block (IANB) for a mandibular extraction and were randomized to one of two groups: acupressure (study group) or non-acupressure (control group). The Wong-Baker FACES Pain Rating Scale (WBFPS) and the Sound, Eye, Motor (SEM) scale were utilized for subjective and objective pain assessment during injection. Results: The objective and subjective assessment of pain during injection significantly differed between the groups, with the acupressure group displaying lower scores. Conclusion: Acupressure at the extra one point (EX-HN1) reduced pain during IANB injection in 5- to 10-year-olds and can be used as an adjunct to conventional measures like topical anesthesia to reduce pain.

Effect of audio distraction with thermomechanical stimulation on pain perception for inferior alveolar nerve block in children: a randomized clinical trial.

Background: Pain control is a crucial aspect of pediatric dentistry for patient management. Thermo-mechanical devices (Buzzy™ Pain Care Labs, USA) work on the concept of vibration and cooling and have shown promising results in pain control during local anesthesia in pediatric dentistry. On the other hand, audio distraction has also been used for pain management. The amount of pain endured is determined by the patient's perception and attentiveness. Thus, if audio function is added to the thermomechanical device it might increase its efficiency. Hence, the present study aimed to compare pain on injection using a thermo-mechanical device with and without audio during inferior alveolar nerve block (IANB) injection in children aged 5-10 years old. Methods: Twenty-eight children aged between 5 and 10 indicated for IANB were included in this randomized study. Children who were undergoing the dental procedure were divided into 2 groups, with 14 children in each group. The study group was the thermo-mechanical device with audio distraction; the control group was the thermo-mechanical device without audio distraction. IANB was administered. Subjective pain evaluation was performed using the Wong-Baker Faces Pain Rating Scale (WBFPR) and objective pain evaluation was done using the Faces, Leg, Activity, Consolability, Cry (FLACC) scale. Results: The outcome depicted a significant reduction in pain on injection for both objective and subjective evaluations in the thermo-mechanical device with an audio distraction group. Conclusions: Less pain on injection was observed, when a thermo-mechanical device was used with audio distraction for IANB procedures.

Non-syndromic Association of Natal Teeth in a Case of Septic Arthritis: Does Correlation Imply Causality?

Disturbances of dental development may result in anomalies, which may be apparent as soon as the child is born. This report aims to describe the occurrence of natal teeth in a non-syndromic case of neonatal septic arthritis of the knee joint. Various systemic conditions have been associated with the occurrence of natal teeth in the past. The present report highlights the importance of a proper referral system between the pediatrician and the pediatric dentist to provide a multidisciplinary approach in the first few months of life.

Buffered articaine infiltration for primary maxillary molar extractions: a randomized controlled study.

Background: Dental pain management is an important aspect of patient management in pediatric dentistry. Articaine is considered the most successful anesthetic agent for infiltration anesthesia. Buffered articaine has been observed to have faster onset and longer duration of action with less pain on injection. The aim of this study was to evaluate and compare pain on injection, onset of action, and pain during extraction using buffered (using Sodium bicarbonate (NaHCO3)) and non-buffered 4% articaine (with 1:100000 adrenaline) infiltrations for primary maxillary molar extractions in 4-10-year-old children. Methods: Seventy children who required extraction of maxillary primary molars were enrolled in this triple-blind randomized study. Children undergoing extraction were randomly divided into two groups, with 35 in each group. The study group was the buffered articaine group; the control group was the non-buffered articaine group. Buccal and palatal infiltrations were administered with either buffered or non-buffered articaine. Subjective evaluation was done for pain on injection, pain during extraction using Wong-Baker Faces Pain Rating Scale (WBFPR) and onset of anesthesia in seconds. Pain on injection, pain during extraction were objectively evaluated using Sound Eye Motor (SEM) scale and onset of anesthesia was also evaluated objectively by pricking with sharp dental probe. Results: The outcome was, significantly less pain on injection and significantly faster onset of anesthesia with significantly less pain during extraction for both subjective and objective evaluations in the buffered articaine group. Subgroup analysis was also performed and it showed variable results, with only significant difference for WBFPR scores in age subgroup 4-7 years for palatal infiltration. Conclusion: Less pain on injection, faster onset of anesthesia, and less pain during extraction were observed when buffered articaine was used for maxillary primary molar extraction.

Oral Healthcare Management of Children after COVID-19 Outbreak.

The emergence of the novel 2019 coronavirus disease (COVID-19) pandemic has led to a significant challenge to healthcare professionals. Among all the healthcare providers, dental clinical setup is exposed to the generation of potentially hazardous aerosols which could be a point of cross-contamination. Dentists catering to pediatric patients need to take special precautions, as they have milder symptoms or could be asymptomatic and hence potential vectors for the transfer of infection. One needs to change the perspective to manage the oral health of children as a child's oral health presents specific problems that could be time-bound and hence need to be treated accordingly. These problems can be managed on one hand by preventive methods, and on the other by implementing specific protocols relating to the conditions that represent an emergency, or those situations that fall into the category of elective dental procedures. This article highlights the routes of transmission in a dental practice and focuses on the categorization of treatment for children based on treatment needs. It proposes a restructuring of the treatment protocol and hence shifting to minimal invasive or non-aerosol-generating procedures (AGP). These techniques are also proposed to be used even after the end of the current emergency period to minimize the aerosol splatter. CLINICAL SIGNIFICANCE: The article highlights the protocol that needs to be followed after treatment categorization during and after COVID-19 pandemic. HOW TO CITE THIS ARTICLE: Lamba G, Nagpal DI, Chowdhari P, et al. Oral Healthcare Management of Children after COVID-19 Outbreak. Int J Clin Pediatr Dent 2021;14(2):293-297.

Effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12-15 years for plaque and gingivitis inhibition during 3 weeks of supervised use: A randomized control study.

BACKGROUND: Chlorhexidine mouth rinse, a 'Gold Standard'effective in reducing plaque and gingivitis, has some drawbacks like bitter taste, light brown staining of teeth etc. limiting its long-term use. Magnetized water is alkaline and inhibits the bonding process between plaque and teeth by "magnetohydrodynamic". Aim: To compare and evaluate effectiveness of magnetized water and 0.2% chlorhexidine as a mouth rinse in children aged 12-15 years for plaque and gingivitis inhibition during 3 weeks of supervised use. Settings and Design: This was a double blinded randomized control clinical study, carried out at a non-government high school. Methods:A total of 20 children aged 12-15 years were randomized into two groups, magnetized water and 0.2% chlorhexidine, each comprising of 10 children who were asked to rinse with the respective mouthwash. Plaque index (PI) scoresand gingival (GI) scoreswere evaluated at baseline, 2 weeks and at 3 weeksfor each child. Statistical analysis: Independent sample t test and paired sample t test were used to check the mean differences. Result: A statistically significant difference was found in reduction of mean PI and GI scores of magnetized water (p=0.0001) and Chlorhexidine groups(p=0.0001) both at 14 days (2 weeks) and at 21 days (3 weeks) with no adverse effects. Conclusion: Daily use of magnetized water as a mouth rinse was safe andeffective alternative to chlorhexidinein plaque and gingivitis reduction, which supplemented the benefits of daily toothbrushing in children.