Background: Evaluation of bond strength and microleakage caused by polymerization shrinkage provides a screening mechanism and an indication of the potential for the clinical success of composite restorations. Aim: The aim of this study was to determine the effect on shear bond strength and microleakage of standard and expired composites. Materials and methods: Selected specimens were etched using 37% phosphoric acid for 15 seconds and were randomly divided into four groups. Group I: Standard composite and bonding agent; group II: Expired composite and bonding agents; group III: Standard composite and expired bonding agent; and group IV: Expired composite and standard bonding agent. Specimens were further subdivided into two subgroups. In subgroup A, specimens were sheared with a universal testing machine, and the results were calculated in MPa; in subgroup B, specimens was sectioned longitudinally and analyzed for leakage (dye penetration) using a stereomicroscope. Results: The results of the present study showed that acceptable values for bond strength and microleakage were obtained even if one of the components of the dental resin composite is expired. Conclusion: In Indian scenario, the expired composite material may provide some assistance in compromised clinical situations. It can be used as an interim restoration and compensate for the high material cost.

Aim: The aim of the present study was to identify the various background variables and its influence on behavior management problems (BMP) in children. Materials and methods: The study included 165 children aged 2 to 8 years. During the initial dental visit, an experienced operator obtained each child's background variables from accompanying guardians using a standardized questionnaire. Children's dental behavior was rated by Frankel behavior rating scale. The behavior was then analyzed in relation to the answers of the questionnaire, and a logistic regression model was used to determine the power of the variables, separately or combined, to predict BMP. Results: The logistic regression analysis considering differences in background variables between children with negative or positive behavior. Four variables turned out to be as predictors: Age, the guardian's expectation of the child's behavior at the dental examination, the child's anxiety when meeting unfamiliar people, and the presence and absence of toothache. Conclusion: The present study concluded that by means of simple questionnaire BMP in children may be expected if one of these attributes is found. Clinical significance: Information on the origin of dental fear and uncooperative behavior in a child patient prior to treatment process may help the pediatric dentist plan appropriate behavior management and treatment strategy.

Aim: The aim of this study is to evaluate the protective effect of the salivary proteins on the demineralization of enamel. Materials and methods: Twenty freshly extracted human molar teeth were used in this study. Enamel samples (2 mm thickness) were prepared from the buccal and lingual surfaces of the teeth selected. An acid-resistant nail varnish was used to cover every aspect of the sample, except an area of 5 × 5 mm limited by an adhesive tape. After drying, the adhesive tape was removed, exhibiting a rectangular area on the enamel surface. Samples were divided into two groups:   • Group I (10 samples): Each sample was coated by 100 μg of albumin for 2 hours at 37°C.   • Group II (10 samples): Each sample was exposed to 100 μL of deionized water. Samples were washed by dipping once in deionized water. They were then disposed into individual tubes containing demineralization solution for 1, 2, 3, and 4 minutes at 37°C with gentle agitation. The demineralization solution was utilized to determine the calcium loss from specimens at 1, 2, 3, 4 minutes using an ultraviolet-visible spectrophotometer. Results: Calcium loss was less from the albumin-coated samples than control group at all times and was statistically significant (p < 0.05). Also, calcium loss was maximum at the end of 1 minute, and it decreased as time interval increased and was statistically significant (p < 0.001). Conclusion: Albumin has provided a strong protection against enamel demineralization at all times compared to the one without it.

Aim: To evaluate the antimicrobial efficacy of diode laser, triphala, and sodium hypochlorite (NaOCl) against Enterococc-cus faecalis contaminated primary root canals. Materials and methods: Forty-nine single-rooted human primary teeth were reduced up to cemento-enamel junction and biomechanically prepared. After sterilization, five teeth were selected as negative controls and remaining teeth were inoculated with E. faecalis. The teeth were then randomly divided into four groups. The first group was irradiated with diode laser, the second group was irrigated with sodium hypochlorite, and the third group with triphala solution. The fourth group served as the positive control. The antimicrobial efficacy was tested by collecting transfer fluid saline from the canals and counting the colony forming units (CFUs) of viable E. faecalis on agar plates. The Mann-Whitney test was used to analyze the results, using Statistical Package for the Social Sciences software version 19. Results: The results showed that mean bacterial CFU were 8.00 ± 7.87 for laser, 58.60 ± 16.63 for triphala, and 69.80 ± 19.57 for NaOCl. Laser group showed significant reduction in the colony count compared to the other groups. Triphala group showed better antibacterial activity than NaOCl, but the difference was not statistically significant. Conclusion: Laser was most effective against E. faecalis and triphala can be used as an alternative disinfectant to NaOCl in primary root canals.

Aims: Despite various advents in technology, the present era marks a shift to phytotherapeutics and alternative modalities to conventional endodontic treatments. Newer endodontic modalities have been developed inculcating the ancient system of medicine. The present study was done to compare and evaluate the clinical pulp response and radiographic signs after pulpotomy in four groups of primary molar teeth treated with formocresol (control), propolis extract, turmeric gel, and calcium hydroxide respectively. Materials and methods: Following ethical clearance, 90 primary molar teeth in 45 pediatric patients, aged between 4 and 9 years, were selected for pulpotomy. These were then randomly divided by split-mouth technique into two groups as experimental (propolis extract/turmeric gel/calcium hydroxide) and control (formocresol) groups. The patients were followed up for 6 months for clinical and radiographic signs and symptoms to evaluate the success of treatment. Results: A comparable clinical and radiographic success rate was seen with all experimental groups as compared to the control (formocresol) group. Conclusion: With concerns about the safety of formocresol appearing in the dental and medical literature for more than 20 years, the materials used in this study can be considered as promising alternatives for formocresol in pediatric endodontic treatment.

Aim: To develop a simple method to assess the level of anxiety by using children's drawings and correlating them with Frankl's behavior rating scale. Materials and methods: A total of 178 patients aged of 3 to 14 years were handed out two-page forms which contained three sections on coloring and drawing, along with general information, and Frankl's behavior rating scale for the visit. The three types of drawing exercises given to the patients were geometric copy drawings, coloring a nonthreatening figure, and an empty sheet for freehand drawing. Results: Out of 178 patients, 60 showed definitely positive behavior, 73 exhibited positive behavior, 37 showed negative behavior, and 8 were definitely negative on Frankl's behavior rating scale; 133 children had none or, 1 stress marker and 45 exhibited 2 or 3 stress markers in their drawings. Chisquare (ƒÔ2) analysis was done with a 2 ˜ 2 contingency table. Observed ƒÔ2 value was 46.166, which at 1 degree of freedom was much greater than that at 0.995 percentile. Therefore, the result was highly significant. Conclusion: Children requiring specialized behavioral techniques can be identified by the presence of stress markers in their drawings. This nonverbal activity by itself can have an overall positive effect on the behavior displayed in the dental clinic.

Introduction: Dental caries affects humans of all ages throughout the world and remains the major dental public health problem among children globally. Materials and methods: A cross-sectional study was conducted using the cluster sampling technique to obtain the required sample size of 400 children from urban slum population of Faridabad, Haryana, India. Data were collected using World Health Organization dentition status 1997 criteria and PUFA/pufa index. Type of study: Cross-sectional study. Results: Among 6- to 12-year-age group, 68.5% subjects had one or more decayed deciduous teeth, of which 65.3% subjects had one or more pufa score, and 26.4% subjects were having one or more decayed permanent teeth, of which 16.7% subjects were having one or more PUFA score. The overall caries prevalence was 79.64% and overall prevalence of one or more than one PUFA+pufa was reported in 69.2% subjects. Conclusion: The findings of the study showed the relevance of PUFA/pufa index to address the neglected problem of untreated caries and its consequences. The study also suggests the importance for implementation of the primary oral care programs for this deprived population.

Aims: The purpose of this study was to evaluate the accuracy of a new-generation electronic apex locator (iPex) to determine working length in primary teeth with or without root resorption as compared with the conventional radiographic method. Materials and methods: A sample of 30 primary posterior teeth which are indicated for pulpectomy were selected for the study. After obtaining the informed consent from the parents, local anesthesia was administered. Access cavity was prepared with no.10 round bur. Initial exploration of the canals was done with no.10 K-file. Pulp was extirpated with a barbed broach followed by thorough irrigation of the canals with 0.9% saline. Initially, working length was obtained with iPex (new-generation by Nakanishi International) apex locator using no. 10 K-file, which was then compared with conventional radiographic method (Ingle's method). Results: A total of 65 canals were available for the measurement. The data were analyzed using Statistical Analysis system and t-tests were carried out. There was no statistically significant difference found when using iPex apex locator for working length determination as compared with that of conventional radiographic method (p = 0.511). Conclusion: Working length determined by iPex apex locator is comparable with that of conventional radiographic method, hence, can be used as an alternative in determining the working length of primary teeth.

Many plants with biological and antimicrobiological properties have been studied since there has been a relevant increase in the incidence of antibiotic overuse and misuse. In dentistry, phytomedicines have been used as anti-inflammatory, antibiotic, analgesic, and sedative agents. Turmeric is used extensively in foods for its flavor and color, as well as having a long tradition of use in the Chinese and Ayurvedic systems of medicine, particularly as an anti-inflammatory and for the treatment of flatulence, jaundice, menstrual difficulties, hematuria, hemorrhage, and colic. This article studies ahead with a new idea of using powdered turmeric as a material of pulpotomy procedure in primary teeth.

Aim: The aim of this study was to evaluate the diffusion ability of ions through dentinal tubules of different nonalcoholic calcium hydroxide-containing herbal pastes and compare it with the calcium hydroxide paste prepared with saline. Materials and methods: A total of 36 single-rooted premolar teeth were used in this study. The tooth crowns were removed and the root canals were prepared. Depending on the vehicle to be used for preparing calcium hydroxide pastes, six groups were made: Group I: Ca(OH)2 saline paste (control group), group II: Ca(OH)2 papaya latex paste, group III: Ca(OH)2 coconut water paste, group IV: Ca(OH)2 Ashwagandha (Withania somnifera) paste, group V: Ca(OH)2 Tulsi (Ocimum tenuiflorum) paste, and group VI: Ca(OH)2 garlic (Allium sativum) paste. After biomechanical preparation, calcium hydroxide herbal paste dressings were applied and sealed with resin-based cement. The teeth were placed in containers with deionized water, and the pH of the water was measured at regular intervals over 3, 24, 72, and 168 hours. Results: We observed that all herbal pastes allowed the diffusion of ions, but pastes prepared with Ashwagandha and papaya latex showed more ion diffusion after 168 hours and marked increase in pH, depicting better support for calcium hydroxide action. Conclusion: We conclude that Ashwagandha and papaya latex allow better diffusion of calcium hydroxide through dentinal tubules, thus enhancing its action, and advise its use as a vehicle for placing intracanal medicament.

Background: Candida has been associated with cases of secondary and persistent root canal infections. The purpose of this study was to evaluate and compare the effectiveness of commonly used intracanal medicament against Candida biofilms found in root canals of human primary teeth with necrotic pulp. Materials and methods: Pulp canals of 45 single-rooted primary maxillary anterior teeth with pulp necrosis in 34 children were included in the study. They were divided into three groups of 15 samples each – group I: Ca(OH)2 (calcium hydroxide); group II: 1% chlorhexidine gel (CHX); and group III: 1% metronidazole gel. Bacterial count was obtained from each tooth at two different stages: (1) after instrumentation, and (2) after placement of the medication. Statistical analysis using the Statistical Package for the Social Sciences version 10.0 software program (Inc., Chicago, IL, USA) with Wilcoxon signed rank test after grouping the samples was performed. Results: Ca(OH)2, 1% CHX gel, and 1% metronidazole gel were ineffective in completely eliminating Candida biofilms from root canal of human primary teeth with necrotic pulp. Conclusion: None of the commonly used intracanal medicaments, i.e., Ca(OH)2, 1% CHX gel, and 1% metronidazole gel, was effective in completely eliminating Candida biofilm from root canal of human primary teeth with necrotic pulp. Ineffectiveness of these medicaments against Candida has opened new door of research regarding the use of suitable intracanal medicaments against single and multispecies biofilms.

Aim: To evaluate and compare the sorption, solubility, and compressive strength of three different glass ionomer cements in artificial saliva – type IX glass ionomer cement, silverreinforced glass ionomer cement, and zirconia-reinforced glass ionomer cement, so as to determine the material of choice for stress-bearing areas. Materials and methods: A total of 90 cylindrical specimens (4 mm diameter and 6 mm height) were prepared for each material following the manufacturer's instructions. After subjecting the specimens to thermocycling, 45 specimens were immersed in artificial saliva for 24 hours for compressive strength testing under a universal testing machine, and the other 45 were evaluated for sorption and solubility, by first weighing them by a precision weighing scale (W1), then immersing them in artificial saliva for 28 days and weighing them (W2), and finally dehydrating in an oven for 24 hours and weighing them (W3). Results: Group III (zirconomer) shows the highest compressive strength followed by group II (Miracle Mix) and least compressive strength is seen in group I (glass ionomer cement type IX-Extra) with statistically significant differences between the groups. The sorption and solubility values in artificial saliva were highest for glass ionomer cement type IX – Extra-GC (group I) followed by zirconomer-Shofu (group III), and the least value was seen for Miracle Mix-GC (group II). Conclusion: Zirconia-reinforced glass ionomer cement is a promising dental material and can be used as a restoration in stress-bearing areas due to its high strength and low solubility and sorption rate. It may be a substitute for silver-reinforced glass ionomer cement due to the added advantage of esthetics. Clinical significance: This study provides vital information to pediatric dental surgeons on relatively new restorative materials as physical and mechanical properties of the new material are compared with conventional materials to determine the best suited material in terms of durability, strength and dimensional stability.   This study will boost confidence among dental surgeons in terms of handling characteristics, cost effectiveness and success rate.   This study will help clinically and scientifically; pediatric dental surgeons to use this material in stress-bearing areas in pediatric patients.

Aims: Severe oligodontia is one of the most important symptoms in children with hypohidrotic ectodermal dysplasia (HED). The growth of the maxilla is a key consideration in restoring their mouth. The aim of this study was to evaluate the transversal maxillary sutural growth, after passive masticatory stimulation, in HED children. We also thought to assess the efficiency and functional outcome of the proposed proprioceptive passive expansion (PPE) prosthetic device. Materials and methods: We studied 13 children (age 6–11 years) suffering from HED with severe oligodontia. Their maxilla was restored by a PPE device formed from two parts and joined by a passive slide system. Distance between the two parts was noted at the anterior and posterior regions at each control visit over an average of 23 months. We also conducted and filled a satisfaction questionnaire over the same period.   We tested the hypothesis that the posterior expansion is greater than the anterior expansion (one-tailed Student's t-test with p-value <0.05). Best-fit linear and quadratic models were used to explore the relationship between age, duration of observation, and the rate of growth. Results: The average opening of the device was 2.27 mm in the anterior region and 2.96 mm in the posterior region. The questionnaire response was positive for all children. There are no significant linear or quadratic relationships between the data at the 5% significance level. The posterior expansion is greater than the anterior expansion at the 5% significance level (p-value 0.000394). Limitations: Further studies are mandatory to assess the reliability of our particular intervention and treatment modalities for these cases. Conclusion: The PPE device, we propose, assures function and esthetics in the long- term. It enhances stimulation by a passive way that leads to physiological growth of the palatal suture. Clinical significance: Using this PPE device to restore the maxilla in children with HED promotes physiological growth. The passive nature of this prosthesis helps by eliminating the need for any changes or replacement over time.

Aim: To evaluate the effect of fluoride varnish on Streptococcus mutans count in saliva among 12-year-old school children. Materials and methods: A field experiment was conducted to evaluate the effects of fluoride varnish on S. mutans count in saliva among 12-year-old school children. A total of 42 school-going children attending schools in Vadodara district, Gujarat, India, were divided into two groups. Group I was treated with fluoride varnish and group II received no treatment. Assessment of S. mutans was carried out at baseline and 3 to 6 months postfluoride varnish application. Friedman analysis of variance test and post hoc test were applied to detect statistically significant differences between baseline, 3 to 6 months of fluoride varnish application, and also between groups I and II. Results: The mean number of salivary S. mutans value found in case group at baseline, 3 to 6 months was 31.23 ± 1.119, 9.27 ± 0.852, and 9.39 ± 0.908 × 104 colony-forming unit CFU/mL respectively. The difference in S. mutans count from baseline to 3 to 6 months was highly statistically significant (p = 0.000), but the difference from 3 to 6 months was not statistically significant (p = 0.142). In control group, the mean S. mutans value found at baseline, 3 to 6 months was 30.63 ± 1.436, 31.23 ± 1.351, and 31.40 ± 1.374 × 104 CFU/mL respectively. The differences between these values were not statistically significant (p = 0.11). Conclusion: Statistically significant reduction in S. mutans count in saliva was seen 3 to 6 months after fluoride varnish application.

Introduction: Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites. Materials and methods: Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given. Discussion: The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the “central target area.” The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury. Conclusion: Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc.

Informed consent in research, clinical trial, and practice is a process in which a patient/participant consents to participate or undergo the proposed procedures after being informed of its procedures, risks, and benefits. Ideally, the patient/participant is expected to give his consent only after fully comprehen-ding the information about the procedures, benefits, and risks involved in research/clinical trial/practice. Thus, many ethical issues are entwined in the process of obtaining a proper informed consent. Certain untoward events in the past led to propose guidelines to prevent exploitations and unhealthy practices in the field of life science. Eventually, the practice of obtaining informed consent was emphasized to make sure that a participant's rights were not in jeopardy. Yet, there are flaws in the practical application of obtaining consent due to lack of understanding, barriers in communication, culture, custom, and various other factors. The present article highlights the need for a complete and comprehensive format of recording informed consent without compromising the rights of an individual and the standards of research or practice on ethical and moral grounds.

Pediatricians have an important role in early identification and prevention of oral health, but they reported lack of knowledge in this field. Aim: the aim of the study is to evaluate the knowledge and attitudes of Lebanese pediatricians regarding children's oral health. Materials and methods: A cross sectional study including 100 Lebanese pediatricians was performed. They answered 21 questions. Three variables were taken into consideration: The number of years in practice, the place and type of practice. Results: 73.6% of pediatricians with more than 5 years in practice, 63.5% of pediatricians with an exclusive private practice and 74.7% of pediatricians working in cities/big villages believe that a child is able to brush properly his teeth before the age of 5 years. Only 27.6% of pediatricians with more than 5 years in practice, or working in cities/big villages and 12.7% of those having an exclusive private practice admit that white and black spots are signs of affected teeth. Discussion: Majority of our pediatricians reported that bottle feeding is associated with early childhood caries. They do not believe that the maternal milk can harm the baby's teeth. Concerning the transmission from mother to child of the bacteria responsible for dental caries, the reported percentages were not statistically different in relation to pediatricians' years of experience, type and place of practice. Pediatricians who are academically affiliated were more likely to report that fluoride is safe compared to those practicing in the private sector (P = 0,012). The majority believe that there is a relation between systematic manifestation such as fever and eruption of primary teeth. Conclusion: The Lebanese pediatricians have an acceptable level of knowledge in children's oral health, but should be better informed and motivated toward dental and oral issues.

Aim: The aim of this study was to assess the knowledge, attitudes, and practices of school teachers toward oral health. Settings and design: Descriptive study. Materials and methods: School teachers (n = 150) of Davangere city were recruited into this study. The subjects completed a questionnaire that aimed to evaluate teachers' knowledge, attitudes, and practices on oral health. Statistical analysis: The results were statistically analyzed and percentage was calculated. Results and conclusion: The participants' oral hygiene habits were found to be regular. The majority of teachers showed good knowledge on oral health. Most of the teachers in this study recognized the importance of oral health. The majority of teachers did incorporate the importance of oral health in teaching and educating children in the school. But, not all teachers are involved effectively. So, the teachers should be trained comprehensively regarding importance of oral health and creating awareness on oral health promotion for their students in combination with health care personnel.

Fibroma is one of the most common soft tissue benign tumors of the oral cavity. These masses represent hyperplasias instead of true neoplasm, which develop due to irritation to the mucosal tissue resulting in proliferation of the cells. Although so common in the oral cavity, its occurrence on the palate is rare, mainly due to fewer chances of trauma. Here, we report a case of palatal fibroma in a child diagnosed on the basis of clinical, radiological, and histological features. The case represents an extremely rare occurrence as unusual trauma due to thumb sucking seemed to be the only apparent traumatic factor in the palatal region.

Hidden caries is a dentinal lesion beneath the dentinoenamel junction, visible on radiographs. A single report described this lesion in primary dentition. This case report describes a case of hidden caries in a mandibular second primary molar, misdiagnosed as malignant swelling. A 3-year-old white girl was referred to the Department of Pediatric Dentistry with a chief complaint of pain and extraoral swelling on the right side of the mandible for the last 3 months. She was earlier referred to the surgical department for biopsy of the lesion. Radiographic and computed tomography scan examination showed a periapical lesion with buccal plate resorption and radiolucency beneath the enamel on the mesial part of tooth 85. The tooth was extracted, and follow-up of 2 years showed normal development of tooth 45. The main problem is early detection and treatment, since the outer surface of enamel may appear intact on tactile examination.

Gingival growths are one of the most frequently encountered lesions in the oral cavity. A plethora of lesions can be seen having similar clinical presentation, making diagnosis a dilemma. Peripheral odontogenic tumors are rare neoplasms to occur on gingiva, the most common among them being the peripheral odontogenic fibroma (POdF). The POdF is a benign, slow-growing, exophytic lesion. Although considered to have a recurrence potential after excision, the actual recurrence rate is not known due to paucity of reported cases. Presented here is a case of a rare neoplasm mimicking an inflammatory gingival lesion with review of the available literature.

The number of deaf children has dramatically increased in the past few decades. These children present to the pediatric dentist a unique set of challenges mostly pertaining to the establishment of communication with them. There have been very few attempts in the past to break down these challenges and formulate a strategy on how to manage them effectively. This is a case report of a child who was successfully managed using two different modes of communication. Finally, the advantages and disadvantages are mentioned, and a common strategy incorporating the positives of both the methods has been devised.

Pediatric dentists should always aim for esthetic and functional rehabilitation of decayed/traumatized primary teeth. The most common method for restoring such teeth involves the use of “strip crowns” with composites, while the recent trend is toward using other extracoronal restorations including preveneered stainless steel crowns and zirconia crowns. All these restorative options have shown good success rates, but also have some limitations. This case series depicts novel clinical technique of using a temporization material for full-coronal restoration(s) in primary anterior teeth. This included the chair-side custom fabrication of full-coronal restoration using temporization material, which has resulted in good immediate esthetics and might be a cost-effective alternative for restoring primary anterior teeth in future.