Background: Enamel deproteinization using sodium hypochlorite entails the oxidation of organic components, resulting in the dissolution of proteinaceous components and subsequent cleansing of the enamel substrate. This oxidative treatment augments surface energy and promotes favorable interfacial interactions, thereby enhancing the adhesion and performance of dental materials, ultimately leading to better clinical outcomes. Aim: To evaluate the effectiveness of enamel deproteinization prior to etching on the retention of pit and fissure sealants (PFS) at different time intervals among 6–14-year-old children. Objective: The objective of this study was to evaluate the effect of 5.25% sodium hypochlorite on the clinical performance and retention of pit and fissure sealants in permanent molars. Materials and methods: A double-blind randomized controlled trial using a split-mouth design was conducted for a period of 1 year. The clinical trial registry was done CTRI/2023/06/053542. About 20 children aged 6–14 years, who required bilateral PFS for permanent molars, were included and divided into 20 units for each group. The contralateral side served as the control for the same patient. Randomization was performed using computer-generated numbers (Randomizer.com). Treatment was divided into two groups: group I: pit and fissure sealant with enamel deproteinization prior to etching, group II: pit and fissure sealant without enamel deproteinization. A blinded evaluator assessed the clinical outcome using modified Simonsen's criteria. Results: At the end of 12 months of follow-up, the results in the current study show that there is a statistical significance between groups I and II. In group I, only 10 teeth have experienced the event, while in group II, it is maximum, accounting for 33 teeth. It was found that the retention rate in group I is 88.1%, while in group II, it is 60.0%. Thus, we can conclude that the retention of pit and fissure sealant in group I is significantly better than in group II. Conclusion: The present trial yielded notable enhancements in the retention outcomes of PFS following the incorporation of an adjunctive procedure involving enamel deproteinization utilizing 5.25% sodium hypochlorite, combined with intermediate bonding, over a 12-month observation period. This approach holds promise as a strategic intervention for augmenting adhesion and optimizing the efficacy of PFS as a preventive measure.

Purpose: The mobile phone is arguably one of the fastest-spreading and adopted technologies in the world. In our pediatric clinic today, we are dealing with Generation Alpha, which is defined as those born in an era of rapid advanced technologies. Due to the high number of pediatric dental mobile apps available, it is difficult for users to find their desired applications. So, a genuine attempt was made to assess the mobile dental apps on both Google Play Store (GPS) and App Store (iOS) platforms using the prevalidated User Version of Mobile Application Rating Scale (uMARS). Materials and methods: A comprehensive app search was conducted on both platforms; searches were undertaken using keywords. A total of 226 pediatric dental apps were screened, and 126 apps were excluded. Of the remaining 100 apps, 24 dental apps were randomly selected by a computer software. The selected apps were evaluated and rated using uMARS. Results: After considering both subjective and objective scores, out of 24 apps, 13 apps scored acceptable (3–4), 9 scored poor (2–3), and 2 apps scored inadequate (1–2). The best five apps were: Dentist Surgery Hospital Game, Baby Panda Dental Care, Doctor Kids Dentist, Children Doctor Dentist, and I Am Dentist—Save My Teeth. Conclusion: None of the apps scored good or excellent as per uMARS criteria, and this situation needs immediate improvement. Based on the results of the study, various recommendations are proposed.

Background: Dental caries is a multifactorial disease and a dynamic process that can be prevented and reversed in its early stages. Risk assessment plays a crucial role in decision-making and treatment planning. Therefore, there is a need for a valid, reliable, economical, and chairside caries risk assessment tool for general and pediatric dentists. Aim: To correlate the Alban's test and smartphone Cariogram app for caries risk assessment in 4–13-year-old children. Design: A cross-sectional study was conducted in Faridabad. A total sample of 59 children, 4–13 years old, residing in Faridabad, were included. Salivary samples were collected and inoculated on BCG-Dextrose Agar. Caries activity was assessed using the Alban test. The caries risk profiles generated by the Cariogram software were compared with the Alban's test. Results: Data were analyzed for 59 children. The data were tabulated and subjected to suitable statistical analysis. Spearman correlation analysis demonstrated statistically significant negative correlations between Alban's test scores and Cariogram scores (p < 0.05). Conclusion: As the score of Alban's test increased (indicating more caries activity) at different points of time, the Cariogram result score, that is, the chance to avoid caries, decreased. Caries risk assessment tools play a very pivotal role in educating and motivating the parents and caretakers for preventive care of the children.

Background: Presence of cariogenic trace elements alters crystal lattice and size of crystal, thereby increases the susceptibility of tooth to dental caries. So, the aim of the study is to estimate cariogenic trace elements such as lead, copper, selenium, and cadmium in sound and carious permanent teeth using acid etch biopsy technique and also to correlate the presence of trace elements and its cariogenicity of an individual. Materials and methods: A total of 805 children were screened, and 60 children were selected in the age-group of 12–14 years living in same locality and depending on caries status, 30 children in group I (caries-free group) and 30 children in group II [carious group with decayed, missing, and filled teeth (DMFT) score 2–3]. The 3 µL of 0.5 M perchloric acid was taken in Eppendorf pipette and applied over the isolated area for about 3 seconds and aspirated. Results: Unpaired t-test was used to compare between groups, and there was statistical difference in trace elements between carious group and caries-free group in both gender. Conclusion: The trace elements value was found to be more in carious group compared to caries-free group.

Background: Scientific research continues to make progress in identifying the best practices for treating and preventing dental caries. The quest to search for an ideal restorative material has been a challenge for researchers and academicians in the fraternity of restorative dentistry. Materials and methods: A total of 90 restorative specimens were prepared and divided into two groups comprising 45 samples each: gold label hybrid (group I) and antibiotic-modified glass ionomer cement (GIC) (group II). Each group was further subdivided into three groups of 15 samples each for the evaluation of compressive strength, setting time, and fluoride release, respectively. GC label hybrid was designated as group I, and an antibiotic mixture consisting of ciprofloxacin and metronidazole (1:1) was added at 1% concentration to conventional GIC (Fuji II), which served as group II. The compressive strength was evaluated using a universal testing machine with a crosshead speed of 1 mm/minute. The setting time was measured using Vicat's apparatus. Fluoride release was evaluated using an ion-selective electrode. The data were statistically analyzed. Results: The results showed a p-value of 0.001, signifying a statistically significant difference between the two groups in terms of compressive strength, setting time, and fluoride release after 24 hours and after 1 week. Conclusion: It can be concluded that antibiotic-modified GIC showed the best in vitro performance with improved characteristics, such as higher compressive strength, faster setting time, and enhanced fluoride release.

Purpose: This study aimed to evaluate the influence of silver diamine fluoride (SDF) on the microtensile bond strength (MBS) of glass ionomer cement (GIC) and composite restorations in carious primary dentin and to assess the modes of restoration failure. Methods: Seventy-two carious primary molars were categorized into four groups (n = 18). Samples were treated with 0.9% sodium chloride for 2 months, sectioned at the cementoenamel junction (CEJ), and stored in artificial saliva for 14 days. The SDF-treated groups were exposed to 38% SDF solution, while the control groups underwent restoration without prior SDF application. Specimens were tested for MBS using a universal testing machine, and failure modes were observed under a scanning electron microscope. Results: The highest MBS was observed in the GIC-SDF group (group II), followed by the composite restoration without SDF (group III), and the lowest in the composite-SDF group (group IV). Adhesive failure predominated in the GIC-SDF group, while the composite-SDF group exhibited mixed failure modes. Conclusion: The application of SDF did not adversely affect the bond strength of GIC but reduced the bond strength of composite resin. Adhesive failure was more common with GIC-SDF, while mixed failure characterized composite-SDF.

Aim and background: This cross-sectional study investigates the correlation between nutritional status, as indicated by body mass index (BMI), and tooth count among schoolchildren aged 9–12 years. Materials and methods: A total of 400 students from government to private schools participated in the study, with anthropometric measurements and dental examinations conducted to assess BMI and tooth count, respectively. Results: The analysis reveals significant relationships between BMI and the number of primary and permanent teeth, with notable differences observed between boys and girls. Specifically, children with higher BMI tend to have fewer primary teeth but more permanent teeth, reflecting normal dental development and potentially indicating better nutritional status. Gender-specific correlation analyses further elucidate these relationships, highlighting variations in growth and development patterns. Conclusion: The findings underscore the importance of considering both nutritional status and dental health in pediatric health assessments and suggest that interventions aimed at improving children's nutrition could have beneficial effects on their oral health and vice versa. Clinical significance: Integrated strategies addressing both nutrition and oral health are crucial for promoting healthier growth and development in school-aged children. Further research, including longitudinal studies and investigations into specific nutrients’ impact on dental health, is warranted to better understand the causal mechanisms underlying these correlations and inform targeted interventions.

Aim and background: Glass ionomer cement (GIC) possess properties to fulfill the prerequisites of a restorative material for atraumatic restorative treatment (ART). Enhancing the antibacterial property of GIC remains the pressing priority to reduce the occurrence of secondary caries. Thus, this study aimed to evaluate and compare the setting time and antibacterial efficacy of cinnamic acid (CA)-incorporated GIC against Streptococcus mutans and Lactobacillus acidophilus. Materials and methods: CA powder was incorporated into the GIC powder in varying concentrations. For testing the setting time, the total samples of 15 disks were divided into five groups, namely—I: control—unmodified GIC, II: 2.5% CA + GIC, III: 5% CA + GIC, IV: 7.5% CA + GIC, and V: 10% CA + GIC. Setting time was evaluated after 30 seconds of mixing the powder and liquid by lowering a flat-end needle indentor. Similarly, for testing the antibacterial efficacy against S. mutans and L. acidophilus, the samples were divided, and 5 disks were allocated to each subgroup. The disks were placed in agar diffusion plates, which were inoculated with cultured test species separately. After 24 hours of incubation, the zone of inhibition (ZOI) was measured. Results: CA-modified GIC exhibited an increase in setting time and ZOI with the increase in concentration of CA, and this difference was found to be statistically significant between the groups. Conclusion: CA-incorporated GIC has greater antibacterial efficacy against the caries-causing bacteria with an acceptable change in setting time. Clinical significance: GIC with higher antibacterial potential can markedly decrease the occurrence of secondary caries and failure of restorations.

Aims and background: Glass ionomer cement (GIC) is an excellent example of dental materials that revolutionized the way we approach restorative dentistry. There have been several studies aimed at improving the properties of GIC while reducing its compressive strength, brittleness, etc. Over time, to combat this cumbersome problem, various agents have been added to GIC to increase its antimicrobial properties. The incorporation of fluoride, selenium, and other compounds has proven to reduce the rate of formation of cariogenic biofilm. However, the use of synthetic compounds such as fluoride can result in fluorosis. This calls for the need for a natural antimicrobial agent with minimal or no side effects and optimal effectiveness. Grape seed extract (GSE) and resveratrol (grape skin extract) are naturally occurring compounds having antibacterial, anti-inflammatory, and antioxidative properties. Materials and methods: GSE and resveratrol were incorporated into conventional restorative GIC. Conventional and experimental restorative GICs were manipulated according to manufacturer instructions and were then tested for their compressive strength, shear bond strength (SBS), and fluoride release. Results: Mean compressive strength was highest for GIC incorporated with GSE, followed by resveratrol incorporated GIC, with the least being in the control group. Mean SBS and fluoride release were highest in resveratrol incorporated GIC, followed by GSE incorporated GIC, with the least being in the control group. Conclusion: Positive results were observed, showing an increase in the properties of fluoride release, SBS, and compressive strength in GIC incorporated with plant-based extracts. Clinical significance: GIC is routinely used in pediatric dentistry, requiring constant evolution to improve its properties. The incorporation of plant-based extracts in GIC is a natural alternative to synthetic additives while also enhancing its physical properties. Further studies are required to assess the long-term effect of the experimental adhesives in clinical trials.

Background: Determining the postmortem interval (PMI) in forensic cases involving children is challenging owing to limited evidence. Deciduous teeth are valuable in forensic analysis because of their ability to preserve deoxyribonucleic acid (DNA) for longer than other tissues. Aim: This study investigated the effect of storage conditions (wet vs dry) on DNA degradation and microbial dynamics in deciduous teeth. Materials and methods: Forty-eight deciduous teeth from children aged 5–10 years were stored under wet or dry conditions. Each condition was evaluated at three time points: baseline (immediately postextraction), 1 month, and 6 months. DNA was extracted and quantified, and microbial profiles were analyzed using polymerase chain reaction (PCR) to detect common oral bacteria. Results: DNA quantification was highest immediately after extraction, with a significant decline over time. Under dry conditions, DNA levels remained higher than those under wet conditions. For dry storage, DNA quantification showed significant differences (p < 0.001), with baseline levels at 66.94 μg/mL, decreasing to 38.05 μg/mL at 1 month and 25.61 μg/mL at 6 months. Under wet conditions, DNA quantification also varied significantly (p < 0.001), with baseline levels at 73.30 μg/mL, reducing to 41.93 μg/mL at 1 month and 24.90 μg/mL at 6 months. Microbial analysis revealed that Fusobacterium nucleatum was significantly more prevalent at baseline (p = 0.022), whereas Streptococcus mutans increased after 6 months of dry storage (p = 0.027). Enterococcus faecalis and Lactobacillus displayed consistent prevalence across conditions (p > 0.05), indicating minimal variation. Conclusion: The environment in which deciduous teeth are stored significantly affects DNA preservation and microbial dynamics. These findings highlight the impact of environmental factors on DNA integrity and microbial profiles, emphasizing their importance in forensic analysis. Clinical significance: This study underscores the role of the environmental context in which teeth are found, affecting DNA and microbial data. This is crucial for accurate PMI estimation and forensic investigation of pediatric patients.

Background: Glass ionomer cement (GIC), or polyalkenoate cement, is popular for esthetic restorations due to its tooth-bonding ability but suffers from low mechanical strength, abrasion resistance, and moisture sensitivity, leading to the search for better alternatives. Aim: To evaluate the cytotoxicity, anti-inflammatory, antimicrobial, mechanical properties, and solubility of phyto-mediated nanocomposite-modified GIC. Materials and methods: Chitosan-titanium-zirconia-hydroxyapatite (Ch-Ti-Zr-HA) nanocomposites were synthesized using a single-step phyto-mediated process and added to GIC at 3, 5, and 10% concentrations (groups I, II, and III), with conventional GIC as the control (group IV). Characterization was done, and the effects on cytotoxicity, anti-inflammatory response, antimicrobial activity, compressive strength, flexural strength, microhardness, and solubility were assessed and analyzed using one-way analysis of variance (ANOVA) and the Tukey post hoc test. Results: Characterization confirmed all particles were within the nanoscale. A 10 wt% concentration of phyto-mediated Ch-Ti-Zr-HA nanocomposite enhanced antimicrobial activity against Streptococcus mutans and Lactobacillus. It also improved compressive strength (197.29 ± 0.253 MPa), flexural strength (34.71 ± 0.223 MPa), and microhardness (50.35 ± 0.232 MPa) compared to conventional GIC (p ≤ 0.05). Solubility was lowest at 10% (0.053 ± 0.005), followed by 5% (0.056 ± 0.005), 3% (0.086 ± 0.005), and conventional GIC (0.113 ± 0.005), with significance (p < 0.05). Toxicological analysis showed no significant toxicity, and anti-inflammatory properties were stable. The modified GIC with phyto-mediated nanocomposite shows potential as a dental restorative material, especially in regions of high stress. Conclusion: Our findings indicate that 10% phyto-mediated Ch-Ti-Zr-HA nanocomposite-modified GIC excels in antibacterial activity, compressive and flexural strength, microhardness, and solubility, outperforming conventional GIC and showing potential for enhanced dental applications.

Aim: The purpose of the study is to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence (AI)-powered smartphone app, Sugar Smart, to be used by children's parents/caregivers for the maintenance of dietary records and oral hygiene habits of children in Maharashtra, India, through a single-arm parallel randomized control trial. Materials and methods: The app, developed based on validated research on local dietary habits, was utilized by 100 children. To evaluate the app, two validated questionnaires and a 7-day diet diary format were employed. The first questionnaire assessed ease of use and compliance using a Chi-squared test, while the second examined improvements in dietary awareness before and after app usage through a paired t-test. Results: The findings indicate that a significant majority of users positively perceived the mobile app. The first questionnaire showed high ease of use and positive feedback (87% found it easy to use, 99% reported it helped regulate sugar intake). The Chi-squared test confirmed the statistical significance (p < 0.05). The second questionnaire revealed significant improvements in oral health awareness and diet (correct brushing: 64–98%, reduced sugar usage: 28–91%). The paired t-test confirmed these improvements (p < 0.05), validating the app's effectiveness in enhancing dietary habits and oral health awareness. Conclusion: The study provides strong evidence for the effectiveness of the digital app in improving parental awareness and management of children's sugar intake. The significant improvements observed underscore the app's potential as a valuable tool in pediatric dentistry and public health. Clinical significance: This app demonstrates the potential to revolutionize dietary monitoring and behavior change in pediatric populations, promoting healthier dietary behaviors and thus being an effective digital tool in the reduction of caries burden.

Background: Dental caries remains a prevalent oral health concern among children worldwide, necessitating effective preventive measures. This study evaluates the efficacy of cranberry extract mouthwash and fluoride mouthwashes in reducing Streptococcus mutans counts among children aged 6–12 years with moderate to severe dental caries. Materials and methods: A randomized controlled trial was conducted involving children with three or more carious lesions [Caries Assessment Spectrum and Treatment (CAST) types 3–9]. Participants were assigned to receive either cranberry extract mouthwash or fluoride mouthwash, administered weekly for 6 months. S. mutans colony-forming units (CFUs) were assessed at baseline, 3 months, and 6 months to measure bacterial load reduction. Results: Both cranberry extract mouthwash and fluoride mouthwashes demonstrated statistically significant reductions in S. mutans CFUs at 3 months (p < 0.01) and 6 months (p < 0.01) compared to baseline. No significant difference was observed between the two mouthwashes, suggesting comparable efficacy in bacterial count reduction. Conclusion: This study supports the use of cranberry extract mouthwash as a natural alternative to fluoride mouthwash in managing dental caries among children. Both interventions effectively reduced S. mutans counts, highlighting their potential as adjuncts to conventional caries management strategies.

Introduction: The oral cavity provides the proper environment for the corrosive interaction between metals and saliva. Hazards of metals include hypersensitivity, dermatitis, etc. Stainless steel has been used routinely as a component of orthodontic appliances. In pediatric dentistry, stainless steel crowns have been used for a long time to restore mutilated primary teeth. Stainless steel crowns comprise base metal alloys that consist primarily of nickel (7–22%), chromium (11.5–27%), and carbon (0.25%). The increasing prevalence of early childhood caries and mutilated dentition compels the pedodontist to use multiple stainless steel crowns and space maintainers. The leaching of nickel and chromium, therefore, is a cause for concern from the crowns, bands, and wires. Aim: The aim of the study was to compare and evaluate the in vitro biodegradation of nickel and chromium from crowns to loop space maintainers made of crowns from three different companies in artificial saliva. Materials and methods: About 30 crown and loop space maintainers fabricated from Kids Crowns, 3M ESPE Crowns, and Hu-Friedy Pedo Crowns were used. The number of space maintainers in each group was 1, 2, 3, and 4, respectively. These were placed in separate glass beakers containing 100 mL of artificial saliva at 37°C for 4 weeks. Analysis for nickel and chromium ions was done on days 1, 7, 14, 21, and 28 using an inductively coupled plasma-optical emission spectrophotometer. Results: The total release of nickel and chromium from all crown and loop space maintainers ranged from 0.0 to 0.10 ppm and 0.0 to 0.019 ppm, respectively. Statistical analysis used: The data analysis was done using SPSS software, version 16. The comparison was done using a one-way ANOVA test. The post hoc Bonferroni test was used for multiple comparisons. Conclusion: The overall maximum release of nickel ions was seen from Hu-Friedy Pedo Crowns and was least for Kids Crowns. Chromium showed the maximum release from 3M ESPE Crowns, whereas Kids Crowns and Hu-Friedy Pedo Crowns showed the least. These values were well below the average dietary intake of these metals.

Background: Dental anxiety among pediatric patients needs to be tackled efficiently. Various nonpharmacological interventions, though proven effective, cannot be generalized for all. The use of complementary and alternative medicine has surged globally and is effective in reducing anxiety associated with dental procedures. Aim: This study aimed to compare the efficacy of acupressure, aromatherapy, and stress ball for reduction of dental anxiety in children during prophylactic and restorative procedures. Settings and design: Randomized controlled clinical trial. Materials and methods: The study comprised 160 children aged 8–12 years requiring scaling or restoration on the first visit. The children were randomly allocated to four groups: group I (n = 40)—control, group II (n = 40)—acupressure, group III (n = 40)—aromatherapy, and group IV (n = 40)—stress ball. For all the children, a self-report measure of anxiety [Modified Child Dental Anxiety Scale (MCDAS) and Chota Bheem–Chutki Scale (CBCS)], along with pulse rate, SpO₂, and respiratory rate, were recorded at three different time frames. The Frankl scale was used as the behavioral measure for all the children. Statistical analysis used: Student's t-test and ANOVA test were used to analyze the data. Results: Aromatherapy showed significant results in all the six parameters used. The MCDAS scores of groups II, III, and IV showed significant mean differences when compared to the control group (p = 0.000). In the Frankl behavior rating scale and SpO₂ readings, differences in the aromatherapy and acupressure groups were found statistically significant in comparison with other groups (p = 0.000 and 0.005). Aromatherapy was found statistically significant compared to other groups in parameters like the CBCS and pulse rate. All the three groups showed significant results in the respiratory rate interval. Conclusion: Aromatherapy was highly effective in reducing anxiety compared to the acupressure and stress ball groups during prophylactic and restorative procedures in children.

Purpose: To assess the perceived need for more esthetic options, the practicality of using newer technologies, and the barriers faced in implementing new technologies among pediatric dentists in the Southwest region of the US. Methods: A 23-question de-identified survey was sent to members of the Southwest Society of Pediatric Dentists in their quarterly newsletter (generated through a QR code) via RedCap. The survey included questions regarding the pediatric dentist's knowledge of available computer-aided design and computer-aided manufacturing (CAD/CAM) dental technology and areas of current application. Results: The survey revealed a moderate to significant need among dental practitioners for more esthetic and durable restorative options in pediatric dentistry, particularly for permanent teeth and special needs patients. There was a notable lack of current CAD/CAM technology usage, which is attributed to barriers such as cost and knowledge gaps. A high demand for esthetic solutions from parents was noted, although less importance was placed on custom restorations for primary teeth. The findings also indicated that demographic factors, such as age and years of experience, significantly influence the perceived necessity for new restorative options and the adoption of new technologies, with a trend toward greater interest in esthetics among female practitioners and those with longer practice experience. Conclusion: The results indicate an increasing demand for alternative esthetic and durable restorative options in pediatric dentistry, particularly for permanent teeth and special needs populations. However, the limited familiarity and knowledge concerning CAD/CAM technology among pediatric dentists suggest that further education and research are necessary to bridge this gap.

Background: Lymphangiomas are generally regarded as hamartomas, which are developmental malformations of lymphatic vessels. Neonatal alveolar lymphangioma (NAL) is a rare benign condition most often reported in the oral cavity of neonates. Case description: The present case report describes NAL in a 2-day-old Indian neonate and follow-up until complete resolution. Conclusion: A unique type of lymphatic malformation is NAL. Accurate clinical recognition of NAL is essential because biopsy is not typically indicated for diagnosis. Because this is a clinical diagnosis, we recommend follow-up until the complete resolution of the lesion. In the case of residual or recurrent lesions, a biopsy would be clinically indicated.

Objectives: To employ three novel techniques and evaluate their results in the management of pediatric mandibular fractures. Case discussion: Three cases of pediatric mandible fracture were chosen. The use of impression compound as a cap splint, use of hooks for maxillomandibular fixation, and circummandibular wiring with stainless steel wire were evaluated for their results. Preoperative computed tomography (CT) scans and postoperative orthopantomograms were carried out to evaluate the results. Patients were evaluated for fracture site healing and their ability to perform functional movements easily. Results: The fracture healing was found out to be satisfactory, with patients being able to resume routine function within 6 weeks post-trauma. Conclusion: The management of pediatric fractures can be surgically challenging due to the involvement of permanent tooth buds and the need for patient compliance. Our techniques have simplified the process of overcoming both challenges, and we recommend the routine use of these techniques for the management of pediatric trauma cases. Clinical significance: Managing pediatric mandibular fractures is a challenging task due to the unique characteristics of children's jaw structure. Traditionally, these fractures are addressed using conventional closed reduction techniques. However, the authors have implemented three distinct techniques to address pediatric fractures that prioritize patient compliance, overcome financial constraints, and achieve shorter recovery times.

Case description: A 5-year-old boy presented with bleeding gums following a fall from the swing. Initial treatment at a private clinic involved clot removal and gauze application. Despite no prior history of abnormal bleeding, the child experienced delayed and continuous bleeding, prompting further evaluation. Blood tests revealed normal prothrombin time (PT) but abnormal activated partial thromboplastin time (APTT), indicating a coagulation disorder. Vitamin K was administered, but profuse bleeding recurred, leading to hospital admission. Further tests confirmed a diagnosis of mild hemophilia B with low factor IX levels. The patient received fresh frozen plasma (FFP) transfusion, which stopped the bleeding. Follow-up showed a clean injury site after intervention. Conclusion and clinical significance: This case underscores the need for high suspicion, thorough investigation, and prompt management in bleeding disorders, especially since patients may be unaware of their condition until a bleeding episode occurs.

The presence of an additional root in primary mandibular first molars, resulting in a three-rooted morphology, is a rare but significant anatomical variation. This article comprehensively explains three-rooted primary mandibular first molars, including the diagnostic methods, morphological variations, and clinical implications. Through an extensive examination, and careful clinical and radiographic observation, this study attempts to establish a relationship between the triangular morphology of the primary mandibular first molar and the presence of an additional root. Furthermore, a classification has been given explaining the five types of three-rooted primary mandibular first molar, based on the central groove pattern observed. This article aims to enhance awareness among dental practitioners and contribute to the advancement of knowledge in pediatric dental anatomy, along with its applications in various pediatric treatment protocols.