The management of pain and anxiety in dentistry encompasses a number of procedural issues, including the delivery of anesthetic solution. One of the most important ways to manage the behavior of children is pain control. Trypanophobia is very common among dental patients and the most important goal of guidelines on behavior guidance for pediatric dental patient is to ease fear and anxiety in dental procedures in children. For the stated reasons, the purpose of the present study was to record child's pain sensation both objectively and subjectively while receiving dental local anesthesia using conventional syringes and diabetic needles.

Twenty children of age group 6 to 12 years undergoing routine dental procedures participated in the study. Every child acted as one's own control, while receiving treatment on the opposite side of the same arch. Each patient was randomly assigned to receive the injection either with conventional syringe or diabetic needle for the first visit, while the injection with the other needle was administered during the second visit. Rating scales were used for objective and subjective evaluations.

Statistical analysis of the measurements were made using Wilcoxon signed U test and Mann—Whitney U test which showed the mean sound, eye, motor (SEM) score difference using insulin syringe. The outcome was statistically significant when compared using the mean ranks between male and female patients with that of control group.

It can be concluded that diabetic syringes exhibit clinical advantage and its use in pediatric dentistry for local anesthetics (LA) infiltration can prove beneficial.

Kour G, Masih U, Singh C, Srivastava M, Yadav P, Kushwah J. Insulin Syringe: A Gimmick in Pediatric Dentistry. Int J Clin Pediatr Dent 2017;10(4):319-323.

One of the most important factors for successful endodontic therapy is root canal cleaning. The difficulty involved in eliminating microorganisms, as well as their residual presence, warrants the use of root canal dressings after biomechanical preparation.

The aim of the study was to compare the diffusion ability between nonalcoholic calcium hydroxide—propolis paste, calcium hydroxide—saline paste, and calcium hydroxide—propylene glycol paste.

For this proposed study, single-rooted extracted permanent teeth were randomly divided into three groups to fill the canals: group I: Calcium hydroxide—propylene glycol paste, group II: Calcium hydroxide—saline paste, and group III: Calcium hydroxide—propolis paste. After complete filing of the root canal, the pH values of the solutions in the flasks are measured at an interval of 3, 24, 72, 168 hours.

After 168-hour interval, it was noticed that the mean pH obtained by calcium hydroxide—propolis paste was 10.54 (± 0.38), which was greater than calcium hydroxide—propylene glycol paste 9.70 (± 0.45) and calcium hydroxide—saline paste 9.16 (± 0.30) consecutively.

The nonalcoholic calcium hydroxide—propolis paste used during the study was able to diffuse through the dentinal tubules. Thus, it can be used as a vehicle for calcium hydroxide.

Baranwal R, Duggi V, Avinash A, Dubey A, Pagaria S, Munot H. Propolis: A Smart Supplement for an Intracanal Medicament. Int J Clin Pediatr Dent 2017;10(4):324-329.

The aim of this study was to assess the effectiveness of the 3-3 mandibular lingual stainless steel retainer to prevent a relapse of orthodontic treatment during the 12-year time span of the survey.

Fifty patients with canine-to-canine bonded retainers (placed at least 10 years earlier) were recalled. All patients had been followed up annually during this period. Patients were screened for stability of the retainer and for the condition of hard and soft oral tissues.

None of the patients reported a complete loss of the retainer; 14 patients reported single element partial losses and 13 reported multiple losses. Most partial failures were not perceived by patients, but noted by the orthodontist during the control visit. There was no notable variation of the gingival index occurring in these patients. In two cases patients had caries in the six teeth bonded with the retainer, but never on the lingual side; only in three teeth areas of decalcification in the proximity of bonded sites were reported. All patients showed good compliance with this kind of retention.

The composite adhesive technique allowed a reliable positioning system for directly bonded retainers and did not influence the occurrence of carious lesions or demineralized spots on fixed teeth. Full teeth fixation offered the possibility of stabilizing the irregularity index highlighted in various studies without increasing any side effects on gums and hard tissues.

Maddalone M, Rota E, Mirabelli L, Venino PM, Porcaro G. Clinical Evaluation of Bond Failures and Survival of Mandibular Canine-to-canine Bonded Retainers during a 12-year Time Span. Int J Clin Pediatr Dent 2017;10(4):330-334.

This study was conducted to evaluate and compare the antimicrobial efficacy of magnetized water as a mouthwash on colony count of Streptococcus mutans in children.

Total sample size of 30 children were selected out of screened 290 children by simple random sampling between the age group of 7 and 12 years. The study was conducted over a period of 2 weeks. After selection of the children according to inclusion and exclusion criteria, children were allowed using 10 mL of 72 hours magnetized water for 3 minutes twice in a day for a period of 2 weeks, and further plaque and saliva samples were collected at 1- and 2-week intervals from baseline. Microbiological analysis of plaque and saliva samples was done by Dentocult SM strip kit (Orion Diagnostica, Finland), and the results were statistically analyzed and tabulated.

Statistically, there was highly significant reduction in S. mutans count in plaque as well as in saliva after 1- and 2-week intervals from baseline.

So, finally our study showed that magnetized water is as effective a mouthwash against S. mutans and has better action in plaque as compared with saliva. It can be used as an adjunct to commercially available mouthwashes.

Goyal AK, Rathore AS, Garg M, Mathur R, Sharma M, Khairwa A. Effect of Magnetized Water Mouthrinse on Streptococcus mutans in Plaque and Saliva in Children: An in vivo Study. Int J Clin Pediatr Dent 2017;10(4):335-339.

Oral health plays a pivotal role in the overall wellbeing of children. As children grow, there is a variation in their oral health status due to the changing trends and lifestyle.

To evaluate and compare the factors related to oral health status in two age groups of school going children.

A total of 582 children aged 8 to 11 years from 3 schools were included. Based on their school grade, they were grouped as younger (third grade) and older (fifth grade) children. Their dental caries status, caries treatment needs, oral hygiene status were assessed. A questionnaire was given to them to assess their knowledge on oral health.

Both third and fifth grade children had similar caries status. The caries treatment needs was significantly higher (p = 0.02) in fifth grade children of school III. The oral hygiene status was significantly better (p = 0.004) in fifth grade children of school I and third grade children (p < 0.001) of school III. Fifth grade children were found to have more knowledge on oral health and it was statistically significant in school II (p = 0.001). In school III, as caries status increased, the oral hygiene index score significantly increased (p = 0.001).

Age did not have any influence on the oral health status of children. The older children had better knowledge on oral health, but the oral hygiene practices were not followed effectively

Geethapriya PR, Asokan S, Kandaswamy D. Comparison of Oral Health Status and Knowledge on Oral Health in Two Age Groups of Schoolchildren: A Cross-sectional Study. Int J Clin Pediatr Dent 2017;10(4):340-345.

To determine and compare the relevance of Piaget's cognitive principles among 4- to 7-year-old parented and orphan children in Belagavi City, Karnataka, India.

This study was conducted on 240 children between the ages of 4 to 7 years who were equally divided into two groups of 120 parented and 120 orphan children. These were subdivided into four groups of 30 children each. Various characteristics like egocentrism, concept of cardinal numbers based on centration, lack of conservation, and reversibility were assessed, using experiments and comparison of their prevalence between two groups was carried out.

There is a statistically significant difference in the cognitive development among parented and orphan children age 4 to 7 years.

There is a significantly better cognitive development among parented children as compared with orphan children in Belagavi city.

A child is not a miniature adult but rather can think and perceive the world differently from an adult. Understanding a child's intellectual level can enable a pedodontist to deliver improved quality care to children. According to Jean Piaget, in the preoperational period, children think symbolically and their reasoning is based more on appearance rather than logic. It is often rightly said that a child's behavior is a reflection of his parents. However, Piaget did not consider the effect of social setting and culture on the cognitive development. This study was carried out as there is not much literature available to describe the cognitive development of children in the Indian scenario and the influence of parental presence on the same.

Badakar CM, Thakkar PJ, Hugar SM, Kukreja P, Assudani HG, Gokhale N. Evaluation of the Relevance of Piaget's Cognitive Principles among Parented and Orphan Children in Belagavi City, Karnataka, India: A Comparative Study. Int J Clin Pediatr Dent 2017;10(4):346-350.

To evaluate the fracture resistance of simulated immature teeth with an apical plug of biodentine followed by composite resin vs total obturation with biodentine tested immediately and after 3 months of aging and also to find out the chemical composition of dentin in contact with these materials.

Extracted human maxillary central incisors with simulated immature apex with radicular dentin thickness (RDT) of 1 to 1.5 mm selected and divided into three groups of 20 each. Group I (control)—4 mm biodentine apically and thermoplasticized gutta-percha. Group II—4 mm biodentine apically and composite resin. Group III—complete obturation with biodentine. About 10 samples from each group were tested immediately and remaining 10 stored in phosphate buffered solution (PBS) and tested after 3 months for fracture resistance and chemical analysis of dentin.

No significant difference in fracture resistance between the groups was observed when tested immediately. After 3 months of aging, only biodentine group showed a significant reduction in fracture resistance with increased Ca/P ratio of root dentine.

Biodentine group has shown drastic reduction in fracture resistance after 3 months of aging, and hence, cannot be recommended as a reinforcement material in immature teeth with thin dentin walls.

Zhabuawala MS, Nadig RR, Pai VS, Gowda Y, Aswathanarayana RM. Reinforcing Effects of Calcium Silicate-based Cement and Dual Cure Composite Resin in Simulated Immature Teeth with an Open Apex: An in vitro Study. Int J Clin Pediatr Dent 2017;10(4):351-357.

Interdental stripping is a common clinical procedure in orthodontic therapy, by reshaping the proximal contacts. Handheld abrasive strips have been criticized as time-consuming process. Metallic strip system, diamond disk, or segment disks have become increasingly popular. The aim of this study is to evaluate the morphological aspects of remodeled dental surfaces so as to conclude which of the different techniques (disk, bur, or strip) used to reduce the mesiodistal diameter is the best to reproduce the initial contour of the proximal surface of the tooth.

Seventy-nine pieces (“teeth”) were prepared from permanent healthy teeth (premolars and molars) extracted for orthodontic reasons. They were mounted on a stand resembling the position of the natural teeth in a mild crowded dentition. The “teeth” are divided into three groups as follows: group S (strip): 26 “teeth,” group D (disk): 25 “teeth,” group B (bur): 28 “teeth.” In order to study the changes, these prepared “teeth” are macro-photographed in groups of 5 before and after proximal grinding.

The “teeth” contours have been identified using piecewise cubic Hermit polynomials. The change in the contour has been traduced in terms of the change of curvature in the “teeth” contours. We used the z-test in order to find the confidence interval for the proportion of the class “+” for each of the techniques B, S, and D. With confidence level of 95%, we obtained the following confidence intervals:

B = (0.6943; 0.9057); S = (0.9093; 1.0138); D = (0.6184; 0.8616)

These results can be interpreted, as the technique S is significantly much better than the other two techniques if we aim at conserving the shape of the teeth before and after treatment.

We conclude that the use of a strip for remodeling the proximal surface of a tooth is an optimal technique to preserve the proximal shape of the tooth although it requires more time.

The use of abrasive strip preserves the best shape of the proximal side. Abrasive strip could be the last step of any proximal reshaping technique.

Nassif N, Gholmieh MN, Sfeir E, Mourad A. In vitro Macro-qualitative Comparison of Three Enamel Stripping Procedures: What is the Best Shape We can get? Int J Clin Pediatr Dent 2017;10(4):358-362

Hidrotic ectodermal dysplasia (ED) with the WNT10A mutation produces variable dentofacial symptoms. The aim of this study was to describe a new clinical symptom, i.e., specific to the WNT10A mutation in hidrotic ED. The study investigated the migratory trend of the lower second permanent molars to the ramus or coronoid process. To the best of authors' knowledge, no data in the literature describe this trend in cases of hidrotic ED.

A three-generation family pedigree was established for seven families after the diagnosis of hidrotic ED in a 10-year-old boy. Thereafter, a genetic and clinical study was conducted on three families with at least one individual affected by hidrotic ED (20 individuals). We selected the children with molar germs 37 and 47. The eruption axes of these germs were then traced on the panoramic images at the initial time (T₀) and 1 year later (T₀ + 1 year), and the deviations between these axes were measured.

A significant familial consanguinity was shown. Eight subjects presented with the hidrotic ED phenotype. Among them, three individuals carried germs 37 and 47. Over time, the measured deviations between the eruption axes of the latter displayed, in the majority of the cases, a distal inclination toward the ramus.

A larger sample size is mandatory to assess the frequencies and treatment modalities.

The presence of germs in the lower second permanent molars in patients with hidrotic ED is an important clinical symptom that should be monitored to detect and prevent ectopic migration of these teeth.

In hidrotic ED cases, the study of the presence of the second lower permanent germs must include clinical and radiological examinations. Establishing an interceptive treatment is necessary to prevent the migration of the molars in question.

Sfeir E, Aboujaoude S. Impacted Lower Second Permanent Molars at the Ramus and Coronoid Process: A New Clinical Symptom of the WNT10A Mutation in Ectodermal Dysplasia. Int J Clin Pediatr Dent 2017;10(4):363-368.

Pain control is one of the most important aspects of behavior management in children. The most common way to achieve pain control is by using local anesthetics (LA). Many studies describe that the buccal nerve innervates the buccal gingiva and mucosa of the mandible for a variable extent from the vicinity of the lower third molar to the lower canine. Regarding the importance of appropriate and complete LA in child-behavior control, in this study, we examined the frequency of buccal gingiva anesthesia of primary mandibular molars and canine after inferior alveolar nerve block injection in 4- to 6-year-old children.

In this descriptive cross-sectional study, 220 4- to 6-year-old children were randomly selected and entered into the study. Inferior alveolar nerve block was injected with the same method and standards for all children, and after ensuring the success of block injection, anesthesia of buccal mucosa of primary molars and canine was examined by stick test and reaction of child using sound, eye, motor (SEM) scale. The data from the study were analyzed using descriptive statistics and statistical software Statistical Package for the Social Sciences (SPSS) version 21.

The area that was the highest nonanesthetized was recorded as in the distobuccal of the second primary molars. The area of the lowest nonanesthesia was also reported in the gingiva of primary canine tooth.

According to this study, in 15 to 30% of cases, after inferior alveolar nerve block injection, the primary mandibular molars' buccal mucosa is not anesthetized.

Pourkazemi M, Erfanparast L, Sheykhgermchi S, Ghanizadeh M. Is Inferior Alveolar Nerve Block Sufficient for Routine Dental Treatment in 4- to 6-year-old Children? Int J Clin Pediatr Dent 2017;10(4):369-372.

To evaluate the occurrence of dental injuries in children, the level of knowledge of the participants about preventive measures, and management of dental trauma during sports, in New Delhi.

A cross-sectional study was carried out among 450 children aged 6 to 16 years. A structured interviewer-guided questionnaire was used to determine the prevalence of oral injuries sustained during sport activities, the use of mouthguard as well as the athlete's awareness regarding use of mouthguard. The respondents consisted of 313 males (69.6%) and 137 females (30.4%) with a mean age of 12.6 years.

Out of the total participants, 27 (6%) had chipping or fracture of teeth, 25 (5.6%) had soft-tissue laceration, 24 (5.4%) had avulsion of teeth, and 18 (4%) had suffered fracture of jaw/bones. Out of the total participants, 263 (58.4%) knew that it was possible to replant the teeth and 187 (41.6%) did not know that it was possible to replant the teeth. Out of the total participants, 203 (45.1%) did not know what is the best time to put the teeth back in the mouth and 247 (54.9 %) answered in affirmative with variable answer. Of the total participants, 223 (49.6%) answered that they would carry avulsed tooth in water, 94 (20.8%) wrapped in cloth, 57 (12.6%) in mouth/saliva, 9 (2%) in Hanks' balanced salt solution (HBSS), and 67 (14.8%) answered others. Of the total participants, 321 (71.3%) were aware that mouthguards prevent injury and 129 (28.7%) did not know about mouthguards. Out of the total participants, 94 (20.9%) used mouthguards and 356 (79.1%) had never used mouthguards.

Level of awareness and knowledge about sports-related orofacial injury is very poor among children in New Delhi. Education on prevention of orofacial trauma should be given to the coaches and children. Wearing of mouthguards during sport activities should be compulsory during practice and competition events.

Goswami M, Kumar P, Bhushan U. Evaluation of Knowledge, Awareness, and Occurrence of Dental Injuries in Participant Children during Sports in New Delhi: A Pilot Study. Int J Clin Pediatr Dent 2017;10(4):373-378.

The aim of the study is to evaluate the behavior of Lebanese pediatricians regarding children's oral health.

A cross sectional study including 100 Lebanese pediatricians was performed. They answered 11 questions. Three variables were taken into consideration: The number of years in practice, the place and the type of practice.

The answers were tabulated according to the latter three subdivisions. 97.7% of pediatricians who have been practicing for more than 5years reported inquiring about whether a child is taking a milk/juice bottle overnight as compared to 76.9% of pediatricians who have been practicing for less than five years. The majority of pediatricians working in cities/big villages (98.9%) and 76.9% in small villages do look for cavities during oral examination.

Independently of the years in practice, the majority of pediatricians look for cavities and check the mucosa/tongue during the oral examination. The results regarding dental examination revealed a significant difference between the pediatricians working in cities/big villages (98.9%) and those in small villages (76.9%). Regarding the frequent diagnosis of ECC, there is also a significant difference between pediatricians working in cities/ big villages (74.7%) and those working in small villages (46.2%).

The behavior of the Lebanese pediatricians regarding children's oral health is not satisfactory. In their daily practice, pediatricians need to have more interaction with pediatric dentists and should take into consideration the AAP and AAPD recommendations.

Noueiri B, Nassif N, Bacho R. Behavior of Lebanese Pediatricians regarding Children's Oral Health. Int J Clin Pediatr Dent 2017;10(4):379-383.

Individuals with cerebral palsy (CP) often present with oral alterations that impact oral health and require dental treatment.

This study aimed to evaluate the use of conscious sedation with nitrous oxide (N₂O) to control stress during dental treatment in individuals with CP using as parameters: Venham score (VS), heart rate (HR), and respiratory rate (RR).

A total of 77 CP patients >3 years of age with a mean age of 11.8 (± 6.4) years were evaluated in a rehabilitation center. Stress control was measured at the following time points: T1 (presedation), T2 (induction), T3 (sedated patient), and T4 (end). Student's t-test, the Chi-squared test, analysis of variance (ANOVA), and the McNemar test were used. The significance level was 5%.

Sedation ranged between 10 and 60% N₂O, with an average of 35.6% (± 10.4). The RR did not vary among the times (p = 0.12). The HR and VS varied significantly between times (p < 0.001), as significantly higher values of HR were observed at T1.

Conscious sedation with N₂O during dental care controls stress in CP patients, as verified by a decrease in HR, and does not promote respiratory depression. Higher concentrations of N₂O are recommended for CP patients with tachycardia.

Sedation modifies behavior during dental procedures, facilitating patient collaboration.

Baeder FM, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2017;10(4):384-390.

Shunmugavelu K, Subramaniam K. Management of Mandibular Angle Fracture in a 9-year-old with Miniplate and Monocortical Screws: A Clinical Challenge. Int J Clin Pediatr Dent 2017;10(4):391-393.

Syriac G, Joseph E, Rupesh S, Mathew J. Complete Overlay Denture for Pedodontic Patient with Severe Dentinogenesis Imperfecta. Int J Clin Pediatr Dent 2017;10(4):394-398.

Devasya A, Ramagoni NK, Taranath M, Prasad KEV, Sarpangala M. Acrylic Planas Direct Tracks for Anterior Crossbite Correction in Primary Dentition. Int J Clin Pediatr Dent 2017;10(4):399-403.